"By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest." - Confucius
I hope my experience with this game and these tips help at least some of you fellow achievement-hunters obtain this tough achievement.
1. Get a kapala. The kapala is extremely useful for staying alive. With the kapala, the blood of your defeated foes can be transferred to imbue you with life-points. To get the kapala, you need to make enough sacrifices to the god Kali. The appearance of Kali's altar is randomized. The easiest way to appease Kali, is to sacrifice a damsel each time you come across a Kali altar, it only takes two damsel sacrifices to be granted the kapala, and they are most definitely worth it.
2. Get a jet-pack (or at least a cloak). These upgrades make the ice caves a breeze, and overall just make platforming easier. The jet-pack also removes any reliance on ropes (for the most part).
3. Don't anger the shopkeepers. Unless you are an expert at the game, angry shopkeepers are possibly the biggest danger in the regular zones. Even if you find a stocked jet-pack that you can't afford, the added challenge of the shopkeepers is usually not worth the risk.
4. Get a shotgun, and hold onto it. Having a shotgun is the difference between a Mario with no mushrooms and a Mario with two. It overall just makes the game easier. In the jungle zone, during the random undead event, there is a guaranteed shotgun. While most of the tombstones will spell "R.I.P", one will spell "ASH". A shotgun is buried under this tombstone, ready to be plundered. This secret is likely a reference to the cult Evil Dead movies, starring Bruce Campbell as Ash.
5. Get a compass. They are cheap, and prove extremely useful in the Ice Caves and the dreaded dark levels.
6. Stock up on bombs for the Olmec (final) battle, encountered in zone 4-4. I would suggest having at least 15 bombs ready for the fight. The object of the battle is to force Olmec to plunge himself into the lava pits at the bottom of the level. The best thing to do in this final battle, is to bomb out a sizable portion of the floor all the way to the lava pits, before Olmec notices you. Then you just need to get the attention of Olmec, and lead him straight down into the pit. The exit to the level is on the far right-side of where you spawn, so make sure you have a way back up.
7. Always carry something. If you don't have a shotgun, you can still use rocks, pots, animals and even the lovely damsels to set off traps, be your pincushion, or be thrown at enemies. A carried rock is infinitely more useful than carrying nothing at all.
8. Possibly most important to succeeding at this game, is the virtue of patience. You can hold up or down to get a better look at your surroundings, and avoid any nasty surprises. It is vital to know what you are getting yourself into, don't just jump down into a steep pit. If you get frustrated and/or rush through a level, you generally aren't going to last very long. Take your time, be wary of your surroundings and always learn from your mistakes.
Good luck, and watch out for the teleporting lizard guy.