List of articles in order:

1. Hyperbaric oxygen therapy at 1.3 atm at room temperature is just as effective as 100% oxygen at 2.4 atm as evidenced by research.

2. How hyperbaric oxygen therapy works so well

3. Treatment of traumatic Brain Injury with hyperbaric oxygen therapy

4. Hyperbaric Oxygen therapy – a vastly underused treatment modality

Hyperbaric oxygen therapy at 1.3 atm at room temperature is just as effective as 100% oxygen at 2.4 Atm as evidenced by research

https://portchiro.com/blog/article/2020/5/18/hyperbaric-oxygen-therapy-1-3-atm-room-temperature-just-effective-100-oxygen-2-4-atm-evidenced-research/

May 18, 2020

Breathing regular air under hyperbaric oxygen conditions of 1.3 Atm leads to more than 50% elevation in tissue oxygenation. There are many case reports illustrating significant effects due to small increases in air pressure, including effects on the brain (2,3,4,5). Moreover, even a slight increase in partial pressure, such as to 1.05 Atm at altitude 402 m below sea level (the Dead Sea) can lead to noticeable physiological effects (6-10). Since 50% elevation in tissue oxygen can have significant physiological effects, treatment with room air at 1.3Atm is not an “ineffectual treatment”..(1)

A recent randomized, controlled trial on mTBI patients by Wolf et al (11), used room air at 1.3 Atm as sham control for treatment with 100% oxygen at 2.4 Atm. Both groups revealed significant improvements in cognitive symptoms and in the measure of post traumatic stress disorder (PTSD). WE find these results very important: they actually demonstrate that the significantly less expensive and logistically simpler treatment of mTBI patients with mild HBNO2 (mild hyperbaric pressure of 1.3Atm and regular air) can lead to meaningful improvements. Interpretation is based on previous studies demonstrating that mild HBNO2 conditions can be effectual treatments (1).

For the first time, convincing results based on a crossover study, demonstrating that HBOT can induce neuroplasticity and significant brain function improvements in mild TBI patients with prolonged Post-Concussion-Syndrome at late chronic stage, years after injury. HBOT can be effective in treating other brain impairments, like easing PTSD symptoms or repairing radiation damage. It is also reasonable to expect that HBOT can help slow down or even reverse metabolic disorders associated with neurodegenerative diseases (1).

Breathing 100% oxygen at 2.4 ATA generate very high oxygen levels in tissues, which can cause an inhibitory effect or even focal toxicity, it is conceivable that HBOT using 2.4 ATA can be less effective than 1.3 ATA or other lower levels of pressure (5).

(1) Hyperbaric Oxygen Therapy Can Improve Post Concussion Syndrome Years after Mild Traumatic Brain Injury – Randomized Prospective Trial. Rahav Boussi-Gross. November 2013, Volume 9, Issue 11

(2) James PB (2001) Hyperbaric oxygenation for cerebral palsy. Lancet 357: 2052–2053. [PubMed][Google Scholar]

(3) Golding FC, Griffiths P, Hempleman HV, Paton WD, Walder DN (1960) Decompression sickness during construction of the Dartford Tunnel. British journal of industrial medicine 17: 167–180. [PMC free article] [PubMed] [Google Scholar]

(4) Austin D (1998) Gammow bag for acute mountain sickness. Lancet 351: 1815. [PubMed][Google Scholar]

(5) Mychaskiw G, 2nd, Stephens PL (2013) Hyperbaric Oxygen, Mild Traumatic Brain Injury and Study Design: An Elusive Target. Journal of neurotrauma. [PubMed]

(6) Goldbart AD, Cohen AD, Weitzman D, Tal A (2007) Effects of rehabilitation winter camps at the Dead Sea on European cystic fibrosis patients. The Israel Medical Association journal: IMAJ 9: 806– 809. [PubMed] [Google Scholar]

(7) Kramer MR, Springer C, Berkman N, Glazer M, Bublil M, et al. (1998) Rehabilitation of hypoxemic patients with COPD at low altitude at the Dead Sea, the lowest place on earth. Chest 113: 571–575. [PubMed] [Google Scholar]

(8) Falk B, Nini A, Zigel L, Yahav Y, Aviram M, et al. (2006) Effect of low altitude at the Dead Sea on exercise capacity and cardiopulmonary response to exercise in cystic fibrosis patients with moderate to severe lung disease. Pediatric pulmonology 41: 234–241. [PubMed] [Google Scholar]

(9) Abinader EG, Sharif D, Rauchfleich S, Pinzur S, Tanchilevitz A (1999) Effect of low altitude (Dead Sea location) on exercise performance and wall motion in patients with coronary artery disease. The American journal of cardiology 83: : 250–251, A255. [PubMed] [Google Scholar]

(10) Gabizon I, Shiyovich A, Novack V, Khalameizer V, Yosefy C, et al. (2011) Impact of descent and stay at a Dead Sea resort (low altitude) on patients with systolic congestive heart failure and an implantable cardioverter defibrillator. The Israel Medical Association journal: IMAJ 13: 402–407.[PubMed] [Google Scholar]

(11) Wolf G, Cifu D, Baugh L, Carne W, Profenna L (2012) The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury. Journal of neurotrauma 29: 2606–2612. [PubMed][Google Scholar]

How Hyperbaric Oxygen Therapy Works So Well

by Dylan Silliphant retrieved from https://www.hyperbariccentral.com/hyperbaric-will-accomplish-health-needs/

Hyperbaric oxygen therapy is typically defined as the inhalation of 100% oxygen at greater than 1 atmosphere absolute (ATA) in a pressurized chamber. This definition is now popularly defined as the inhalation of varying degrees of oxygen at greater than 1 atmosphere absolute (ATA) in a pressurized chamber. You will hear many terms used interchangeably by lay people and professionals alike: hyperbaric oxygen therapy (HBOT), mild hyperbaric oxygen therapy (mHBOT), hyperbaric therapy (HBT), hyperbaric oxygen (HBO), hyperbaric air therapy (HBAT), hyperbaric enriched air therapy (HBEAT), etc. However, the most common way the term is used to just say “HBOT”. Then most patients will state what they are doing, e.g. “we’re using 1.5, 1.75, or 2.0 atmospheres in a hard chamber with 100% oxygen, or we’re using a soft chamber (also referred to as a mild chamber) at 1.3 atmospheres ‘with or without a mask’ to which ‘concentrated oxygen’ is be supplied at concentrations varying from 24% to 70%.” Conventional wisdom states that unless one receives HBOT in a hard chamber with 100% oxygen at atmospheric pressures greater than 1.5 ATA, little or no benefit will be seen.

However, as history has shown repeatedly throughout the years, convention is only convention until challenged, proven wrong, and then changed. Such is the case with HBOT and chronic health conditions/neurologic disorders. Based on published studies by Dr. Rossignol, the early work of Dr. Buckley and Dr. Kartzinel, and the tremendous number of children that have been treated for autism by physicians such as Dr. Bradstreet, Dr. Feingold, Dr. Freedenfeld, Dr. Stoller, and a growing number of other physicians who are now using HBOT routinely in their offices, there remains no doubt that HBOT works and that it works well for children with autism and a gambit of other challenging health conditions.

There is also no doubt that it works well at low pressures with varying degrees of oxygen concentrations as well as at varying degrees of high pressures with 100% oxygen, which is why it is being implemented by a growing number of hyperbaric oxygen treatment centers .

The reason hyperbaric oxygen treatment centers recommend HBOT for their patients is because there is scientific evidence that pressure, independent of the concentration of oxygen, decreases inflammation and that any concentration of oxygen under any increased amount of pressure will allow more oxygen to dissolve into the extracellular fluids of the body: plasma, lymph, cerebrospinal fluid, and interstitial fluid.

Because dissolved oxygen is not confined to a hemoglobin molecule, it can go wherever “body water goes” and therefore reach ‘deeper tissues’ more easily and more consistently than ever before. Fortunately, evidence exists and continues to accumulate of the great success stories experienced by patients worldwide.

A few of the multiple mechanisms demonstrating how HBOT may work include:

Angioneogenesis from the addition of oxygen:
The growth of new blood vessels has been shown to occur from soft chambers as well as from hard, and is a process that may continue to increase subsequent to discontinuing therapy for a period of time after oxygen loading. Though it has been stated often on the internet boards that angioneogenesis does not occur unless pressures are 1.5 ATA or greater, the South American physician Efrain Olszewer has pre- and post-angiograms documenting collateral circulation beginning as early as ten to twenty hours after initiating hyperbaric therapy for cerebral vascular disease and peripheral arteriosclerosis at pressures lower than 1.3 ATA. For example, one of the problems children with autism have is decreased blood flow to the brain (cerebral hypoperfusion). And many conditions which typically entail chronic inflammation, also include the reduction of blood flow to the vital body regions.
Therefore is has been speculated that angioneogenesis is the way that HBOT helps relieve and improve health conditions.
However, though angioneogenesis increases oxygen delivery, helping patients through HBOT, angioneogenesis is not the only mechanism by which HBOT works. The extra amount of increased oxygen needed by the cells to improve their function does not necessarily require new blood vessel formation to accomplish health improvement. Therefore, cells work more efficiently while receiving an increased oxygen delivery from increased blood vessel formation that delivers a greater oxygen load because it carries more hemoglobin.
Increases in blood flow independent of new blood vessel formation, not only due to the competing mechanisms of vasodilation and vasoconstriction, but also due to decreasing the inflammation that constricts blood vessels. Because inflammation is accompanied by swelling, tissue expansion or compression will occur. Therefore, whenever inflammation brings more fluid to a region of the body that is comprised of solid tissue and hollow blood vessels, the first thing to happen is that the hollow blood vessel walls will be compressed and deliver fewer red cells carrying oxygen to the area. Once inflammation is reduced the vascular narrowing is improved allowing increasing amounts of red blood cells carrying oxygen to reach the hypoxic (damaged and sick) areas.
Decreasing levels of inflammatory biochemicals: Recent studies have demonstrated that chronically ill people frequently have neuro-inflammatory and gastrointestinal inflammatory conditions occurring. Multiple studies demonstrate the beneficial effect of hyperbaric oxygen therapy in inflammatory conditions. C-reactive protein and high levels of cytokines have been shown to decrease with HBOT. One study demonstrates that the anti-inflammatory effect from HBOT is probably due to pressure effects and not necessarily increased oxygen tension.
Up-regulation of key antioxidant enzymes and decreasing oxidative stress: Patients have been shown to have increased oxidative stress and active glutathione, one of the body’s most important antioxidants. HBOT, especially when using pressures less than 2.0 atmospheres, can up-regulate these antioxidant enzymes and afford antioxidant protection against oxidative stress.
Increased oxygenation to functioning mitochondria: Mitochondria are the energy producing organelles of the body. A growing number of studies are focusing on the mitochondria and its relationship to many disorders The possibility exists that some chronic symptoms may occur because these organelles are dysfunctional and fewer in number than the number found in normal people. HBOT may have the potential to activate dysfunctional mitochondria and/or to activate “dormant/idling cells” thereby allowing more “mitochondrial product” to be appreciated by the body.
Increased production of new mitochondria from HBOT.
Bypassing functionally impaired hemoglobin molecules, the result of abnormal porphyrin production, which thereby allows the increased delivery of oxygen directly to cells: A recent study documented impaired production and abnormal ratios of porphyrins in children with autism. Because porphyrin is involved in the production of functional heme/hemoglobin, and because this appears to be disordered in autism, the impaired delivery of oxygen to cells will be improved when HBOT bypasses hemoglobin-dependent oxygenation.
Improvement in immune and autoimmune system disorders: HBOT has been shown to benefit the immune system and multiple studies have shown that many neurological and chronic conditions are frequently associated with various types of immune and autoimmune system biomarkers.
Decreases in the bacterial/yeast load found systemically and in the gut: Many ill patients with have increased amounts of abnormal bacteria and yeast in their gastrointestinal tracts. These same patients have shown clinical improvements when this overgrowth phenomenon is treated with hyperbaric oxygen therapy. HBOT has been shown to decrease abnormal bacteria/yeast in the gut.
Decreases in the viral load found systemically and possibly decreases in a viral presence that may exist in the intestinal mucosa: Patients with developmental & neurological disorders and chronic conditions typically have difficulty handling viral infections, most likely due to immune dysfunction. It has been postulated many times these people generally have a chronic low grade viral gastroenteritis and viral encephalitits. HBOT has been shown to decrease HIV viral loads. I speculate that one of the primary reasons HBOT works so well for so many patients whose abnormal stools improve once they start HBOT, is because the chronic, low-grade, smoldering live viral load harbored in the intestinal mucosa (Wakefield/Krigsman hypothesis) does poorly when surrounded by higher oxygen concentrations.
The literature states that in order to kill viruses 100% oxygen at 2.7 ATA or above is required. However, there is no reason to believe that even mildly increased oxygen tensions may inhibit viral activity and/or make the host less hospitable to chronic viral inhabitation. This explanation is in keeping with the clinical results that so many hyperbaric oxygen treatment centers are seeing. It’s noted that improved bowel function is in the top 20 most commonly seen benefits. To get cockroaches out of the kitchen, you can either kill them with your shoe or turn on the light. Interestingly it only takes a little bit of light for them to leave the room.
Likewise it only takes a little bit of increased oxygen tension for viruses to leave.
Increases in the production of stem cells in the bone marrow with transfer to the CNS: Studies have shown that HBOT increases the production of stem cells in the bone marrow and that transfer of stem cells to the central nervous system is possible.
(Theoretical only) Direct production of stem cells by certain areas in the brain.
Increased production and utilization of serotonin: Studies have shown abnormities in the autistic brain whereby it does not produce and subsequently does not use serotonin properly. Newer studies have shown that HBOT can work like an anti-depressant by increasing brain serotonin levels.
(Theoretical only) The possibility that oxidation may help rid the body of petrochemicals.
(Theoretical only) The possibility that oxidation may help rid the body of mercury and heavy metals.

Treatment of Traumatic Brain Injury With Hyperbaric Oxygen Therapy

May 27, 2019

Bruce I. Goderez, MD

Psychiatric Times, Psychiatric Times Vol 36, Issue 5, Volume 36, Issue 5

https://www.psychiatrictimes.com/view/treatment-traumatic-brain-injury-hyperbaric-oxygen-therapy

Hyperbaric oxygen therapy (HBOT) is defined as the use of oxygen at higher than atmospheric pressure for the treatment of underlying disease processes and the diseases they produce. Modern HBOT in which 100% O2 is breathed in a pressurized chamber dates back to the 1930s, when it was first used for treatment of decompression illness in divers. There are currently 13 FDA-approved uses for HBOT, including decompression illness, gas gangrene, air embolism, osteomyelitis, radiation necrosis, and the most recent addition-diabetic ulcers.

Just as practicing physicians routinely identify off-label uses for medications, over the years HBOT physicians have identified many other conditions that respond to HBOT. A number of chronic neurological conditions including traumatic brain injury (TBI) have been shown to respond particularly well. There is published literature supporting HBOT’s efficacy for TBI, including human trials and animal research, but due to the impossibility of arranging sham pressure there are no rigorous double-blind placebo-controlled trials.¹ As a result, HBOT is not FDA-approved for TBI, and insurance will generally not pay for it.

HBOT can dramatically and permanently improve symptoms of chronic TBI months or even many years after the original head injury. This assertion is generally met with skepticism within the medical establishment because we have been taught for generations that any post-concussion symptoms persisting more than 6 months or so after a head injury are due to permanent brain damage that cannot be repaired. Therefore, treatment has been limited to symptom management and rehabilitative services, and any claim suggesting that fundamental healing is possible is suspect. The combination of entrenched skepticism and lack of insurance coverage has made it very difficult for patients to access treatment.

Another source of skepticism has been the large number of disparate conditions that are claimed to be helped by HBOT. A brief review of the mechanisms through which HBOT triggers healing responses, with particular reference to the modern understanding of the pathophysiology of TBI, provides a theoretical framework to explain these claims.

Physiological effects of HBOT

About 97% of the total oxygen in blood is tightly bound to hemoglobin when breathing room air (21% O2) at sea level (1 atmosphere, or 1 ATM; 3% of the oxygen is dissolved in blood serum. This amounts to about 0.3 mL of oxygen dissolved in 100 mL of serum. By the time oxygen diffuses out of the circulatory system and ultimately reaches the mitochondria, there is just a trace amount present. HBOT’s primary mechanism is to temporarily hyper-oxygenate body tissues. HBOT delivered at 1.3 ATM increases dissolved oxygen in serum by a factor of 7. HBOT delivered in hard chambers at 2.5 to 3.0 ATM increases dissolved oxygen by a factor of 15 or more. Oxygen levels in body tissues outside the circulatory system will be increased commensurately.

If a hyper-oxygenated state is maintained for long periods it will cause significant oxidative damage, but when it is “pulsed” for an hour it triggers a variety of healing processes without overwhelming the body’s anti-oxidant system. The currently known mechanisms include a powerful anti-inflammatory effect, reduction of edema, increased blood perfusion, angiogenesis, stimulation of the immune system, stimulation of endogenous antioxidant systems, mobilization of stem cells from bone marrow, axonal regrowth, and modulation of the expression of thousands of genes involved in the inflammatory response and various healing responses.^2,3

Pathophysiology of TBI

At each site of impact a contusion can develop-essentially a bruise that may involve local bleeding and neuronal death. Over hours to days an area of inflammation will develop around the contusion, just as inflammation will occur around an injury anywhere in the body. Since the brain is encased in the skull swelling is strictly limited, resulting in increased pressure in the affected area. The increased pressure results in reduced blood flow, damaging a much larger area of cortex than was initially injured. Within this penumbra, neurons may be injured and unable to carry out their prime function of transmitting neuronal impulses, yet they can survive in this stunned or “idling” state indefinitely.⁴

This understanding of the pathophysiology of TBI explains the typical evolution of symptoms after a concussion. The patient may lose consciousness or may just feel stunned for some time. There may be an initial headache and some degree of confusion, which often improve over the next few hours. However, as the inflammatory process evolves more severe symptoms develop, usually peaking within 1 to 2 weeks. These include headache, “brain fog,” nausea, photophobia, hyperacusis, difficulty with focus and multitasking, impaired memory, difficulty with visual processing with prominent difficulty looking at screens, and profound fatigue. The symptoms eventually stabilize, then begin a slow recovery over several months.

This type of injury is referred to as “mild” TBI, since there is no gross destruction of brain matter. The absence of gross damage is reflected in the typical finding of unremarkable CT and MRI scans even in the presence of disabling symptoms. However, in many cases a brain perfusion (SPECT) scan can image macroscopic areas of reduced perfusion of the cortex.

Treatment protocol for TBI

HBOT is regulated by the FDA as a drug, and like a drug, the appropriate dose can vary with the condition being treated. Dose is determined by the pressure in the chamber and the total hours of treatment. HBOT for FDA-approved indications is most commonly delivered in hospital settings, usually in large multi-place chambers at a pressure of 2.0 ATM or higher. High pressure treatment is superior for infections and for other acute severe problems.

It took several decades to determine that, due to excessive oxidative stress, high pressure HBOT carries a significant risk of further damage in chronic diffuse neurological conditions. Treatment at lower pressures in conjunction with limits on the number of sessions has been shown to be safer and more effective for these conditions, including TBI.

The recommended protocol for TBI is currently one or more blocks of 40, 1-hour HBOT sessions delivered at 1.3 to 1.5 ATM. Treatment can be conveniently delivered in “mild” hyperbaric chambers, soft vinyl chambers limited to 1.3 ATM that are inflated by a small compressor using room air (eliminating the risk of fire). Oxygen is extracted from ambient air by a portable oxygen concentrator, removing the need for oxygen tanks. Oxygen is fed into the chamber through a tube and delivered to the patient via an ordinary hospital oxygen mask.

These chambers are affordable, simple to assemble, simple to operate, and can be used in the outpatient setting. They are considered class II medical devices similar to a continuous positive airway pressure machine, requiring a doctor’s prescription but usable at home without direct medical supervision.

CASE VIGNETTE

RP is a 55-year-old man who originally entered treatment with a 20-year history of bipolar disorder. His life had been chaotic because of lack of treatment adherence. He was stabilized on a modest dose of lithium and has been in a stable relationship and successfully self-employed for the past 10 years.

When it occurred to me to ask him about concussions, it emerged that there were several significant sports-related concussions during adolescence and at least a half-dozen serious concussions in early adulthood, possibly related to recklessness during manic episodes. His last concussion occurred 30 years before this history was obtained. He was unable to describe any specific post-concussion symptoms, possibly because he had so many concussions starting in adolescence, and could not remember what his functioning was like prior to his concussions. A brain-perfusion SPECT scan showed extensive perfusion defects consistent with TBI, which is a strong predictor of clinical benefit with HBOT. Accordingly, he was offered treatment even in the absence of a clear history of acquired symptoms.

The patient rented a mild-HBOT chamber and did the treatment at home. He completed two blocks of 40 one-hour sessions of mild HBOT (1.3 ATM, 100% O2) over the course of 4 months. A post-treatment SPECT scan was obtained about 56 months after he completed the treatment protocol.

Following is the summary section of the radiologist report for each scan. Note that a normal SPECT scan should show homogeneous perfusion, whereas areas of reduced perfusion or heterogeneous (spotty) perfusion indicate cortical areas of reduced blood flow.

Pre-treatment SPECT scan,
Aug. 29, 2016

“Findings: Decreased tracer perfusion is seen in the right temporal lobe and also there is heterogeneous perfusion in the bilateral parietal and posterior frontal lobes. The cerebellar hemispheres are symmetrically perfused in the correct clinical settings, this may reflect sequelae of traumatic brain injury.”

Post-treatment SPECT scan,
Dec. 27, 2017

“Findings: Brain SPECT images demonstrate homogeneous perfusion of the cerebral hemispheres. There are no asymmetric perfusion defects, with interval resolution of previously seen asymmetrically decreased radiotracer uptake in the right temporal lobe. Similarly, previously seen decreased perfusion in bilateral parietal and posterior frontal lobes has resolved. Impression: Normal brain perfusion SPECT with interval resolution of previously seen areas of decreased perfusion.”

After completing treatment he reported improvement in focus, improved ability to multitask, and generally more stable emotional functioning. He noted that he was using vocabulary that he had not used since he was a teenager, which was readily observable on interview. He found that he was communicating with people in a much more direct way, in contrast to his usual tendency to be tangential with difficulty getting to the point. He stopped using an appointment book for his business, finding that he could keep track of appointments with his clients for several weeks ahead by memory.

Discussion

This case is not ideal as a teaching vehicle because of the lack of clear documentation of changes in post-concussion symptoms or neuropsychological testing results. However, the normalization of a grossly abnormal SPECT scan is clear indication that HBOT can repair neurological damage even decades after an injury, bringing macroscopic areas of cortex back “on-line.” The changes in the patient’s functioning and demeanor were striking, and clinically there was no doubt about the magnitude of the response. A controlled trial in a series of similar patients including pre- and post-neuropsychological testing, rating scales, and serial SPECT scans was published in 2012.¹

Cerebral palsy (CP) can be considered to be perinatal TBI and patients with CP have been shown to respond significantly to HBOT.⁵ Benefits brought about by HBOT in TBI and CP are generally permanent, although patients may be more vulnerable to reinjury. Clinical experience and compelling case reports suggests that Alzheimer disease and multiple sclerosis can be improved to some extent by HBOT. Benefits in patients with progressive illnesses such as multiple sclerosis will tend to deteriorate over time. A maintenance schedule of perhaps a few sessions per week can slow down and, in some cases, appears to prevent progression.^6,7

Conclusion

HBOT can bring about dramatic improvement in many neurological conditions for which we have had very little to offer other than palliative care. Considering the high incidence of many of these neurological conditions, the safety of treatment, and the simplicity and relatively low cost of mild-HBOT, it is unfortunate that it is not more widely available.

Disclosures:

Dr Goderez is a psychopharmacologist and integrative medicine practitioner in private practice. He offers hyperbaric oxygen therapy for traumatic brain injury and other neuropsychiatric conditions including dementia and radiation necrosis.

References:

Harch PG, Andrews SR, Fogarty EF, et.al. A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. J Neurotrauma. 2012;29:168-185.
Efrati S, Ben-Jacob E. How and why hyperbaric oxygen therapy can bring new hope for children suffering from cerebral palsy: an editorial perspective. Undersea Hyperbaric Med. 2014;41:71-74.
Harch, P. Hyperbaric oxygen in chronic traumatic brain injury: oxygen, pressure, and gene therapy. Med Gas Res. 2015;5:9.
Harch P, Mccullough V. The Oxygen Revolution. Hobart, NY: Hatherleigh Press; 2010.
Mukherjee A, Raison M, Sahni T, et.al. Intensive rehabilitation combined with HBO2 therapy in children with cerebral palsy: a controlled longitudinal study. Undersea Hyperbaric Med. 2014;41:77-85.
Harch PG, Fogarty EF. Hyperbaric oxygen therapy for Alzheimer’s dementia with positron emission tomography imaging: a case report. Med Gas Res. 2018:8:181-184.
Jain KK. Textbook of Hyperbaric Medicine. New York, NY: Springer International Publishing AG; 2017: 345-348.

Hyperbaric Therapy — A Vastly Underused Treatment Modality

Dr. Joseph Mercola April 24, 2022

STORY AT-A-GLANCE

Hyperbaric oxygen therapy (HBOT) is indicated for at least 100 different conditions, but only 14 are approved indications by the U.S. Food and Drug Administration, which most insurance companies use for reimbursement.

HBOT boosts mitochondrial function, decreases systemic inflammation and helps cells generate the required amounts of energy for optimal function. It also stimulates stem cell responses, growth factors, collagen responses and angiogenic [growth of blood vessels] responses.

The main benefits of HBOT are achieved through the cumulative effect and the increasing and decreasing — the wave of hyper-oxygenation back to normal oxygen levels, creating a hyperoxia-hypoxia type paradox.

Conditions that can benefit from HBOT include tissue wounds, stroke, TBI, heart attack, post ischemic reperfusion injury, neurodegenerative conditions and autoimmune diseases.

Hyperbaric can also rebalance the immune system and help fight infection, and can be added to longevity and regeneration therapies.

______

Dr. Jason Sonners, author of the book, “Oxygen Under Pressure: Using Hyperbaric Oxygen to Restore Health, Reduce Inflammation, Reverse Aging and Revolutionize Health Care,” started out as a chiropractor. His passion, however, is hyperbaric oxygen therapy (HBOT), which is the focus of his Ph.D. studies at the University of Miami.

While commonly used to speed up stubborn wounds and tissue infections, hyperbaric medicine can also be helpful in the treatment of infectious diseases such as COVID. It’s also enormously useful for stroke patients. I can’t think of a more effective intervention than to get the stroke patient into a series of hyperbaric treatments as quickly as possible.

HBOT for General Health and Disease Reversal

Every cell in your body, with the exception of your red blood cells (which have no mitochondria that require oxygen), requires oxygen to create energy. Many chronic diseases of the modern world involve decreased mitochondrial function, increased systemic inflammation, and an inability of cells to generate the required amounts of energy for optimal function.

“We use hyperbaric oxygen, traditionally, for these terrible and severe conditions,” Sonners says. Unfortunately, it’s typically a last resort, literally right before an amputation surgery or as a life-saving mechanism for somebody with carbon monoxide poison or air gas embolism.

“So, we only think about it, traditionally, to help save the life or limb of somebody in a really severe condition, but the mechanisms that are working for those folks are very similar to the reasons that you and I might consider using hyperbaric oxygen: For upregulating the oxygen levels inside your body, which will help reduce inflammation, increase mitochondrial function … and thereby increasing the energy that those cells are able to generate …”

HBOT for Chronic Diseases

Sonners’ goal is to expand the use of HBOT from the acutely life-threatening issues like gangrene to more chronic conditions, such as autoimmune and neurodegenerative diseases.

“My thought process is that the mechanisms of action of hyperbaric are the same whether we’re talking about gangrene, radiation burns and osteonecrosis, or TBI [traumatic brain injury], concussion, maybe MS [multiple sclerosis] and post-stroke.

If we really get a mastery of the mechanisms of action, we can start to apply those mechanisms across the board. Clinically, we’ve seen hyperbaric work for so many of these other chronic illnesses …

So, if we could really home in on those mechanisms and understand them better, and then get a better feeling for what time and pressure settings we require in order to get those mechanisms to kick in, then we can really, with more confidence, apply this therapy to these other conditions and have more consistent results in doing so.

A lot of the work I’m proposing to do is tagging onto some of this work in regenerative medicine, where they were looking at the collagen, fibroblast and stem cell response to hyperbaric. A study came out in 2020 on telomeres, and looking at this potential, upwards of 20% increase in telomere length, especially in certain immune system cells.

I want to build on that knowledge base, so what I’m doing is I’m creating a study that’s going to have a lower-pressure group and a higher-pressure group, and we’re going to be looking at a whole cytokine panel, so we can understand the mechanisms of the anti-inflammatory side.

We’re going to have a methylation panel so that we can start looking at the epigenetic effects of hyperbaric. We’re going to have a telomere component, similar to the telomere study that was done a year and a half ago.

And we’re going to start comparing all of those metrics across roughly a three to six month timeframe of treatment, and over two separate pressure settings, to better understand which pressures are getting which effects, and again, what period of time should we be expecting before we get the results that we’re looking for?”

Research Underway

On the low end, Sonners will be using 1.3 atmospheres (4.2 PSI) at 100% oxygen, and on the high end, he’ll use 2.0 atmospheres (14.7 PSI) at 100% oxygen. All patients will use hard chambers at two different pressures. The lower pressure group will be at 4.2 psi, which is the same as soft chamber pressures.

“There’s nowhere near the amount of research in soft chambers as there are in hard chambers,” Sonners says. “The overwhelming majority of research is done at that 2-atmosphere range, which is why I’m choosing that as the upper end of the research that I’m doing in the soft chamber research.

There is definitely some [research] on sports recovery. There’s actually some ongoing studies right now on hyperbaric for stem cell use that we’re waiting for. In some cases, 1.3 [atmospheres] has been used as the sham group, opposed to a treatment arm in the research. Maybe the study team really thought that 1.3 wasn’t going to have an effect and it’s a legitimate sham …

I’m not sure, but there are some great studies. There’s a study that was done on cerebral palsy (CP) and 1.3 was used as the sham group … In this particular study, with 1.3 being the sham group, there was also a … control group that got no hyperbaric at all.

Within the sham group, there was significant improvement on the metrics they were measuring. Then they had a 1.5 [atmospheres at] 100% oxygen, which also had a good improvement and then, a 1.75 [atmospheres at] 100% oxygen, which had even a greater improvement.

The issue in the study was that while all three of those groups improved, there was no statistical difference or enough of a statistical difference between the 1.3, the 1.5 and the 1.75. So, the conclusion of the study was therefore that hyperbaric does not work for CP, although all three of those groups had significant improvement.

So, because the sham group was not considered a treatment, that was the conclusion of that study. Now, the natural consequence of that should have been redoing the study and creating a different level of what the sham and the treatment arms ought to be, but that was never redone.

So, as a result, there’s this study with results that say hyperbaric does not work for CP. Meanwhile, clearly, what it means is we need more studies. It’s just that studies are expensive. They’re very time consuming and you really have to have a large interest in trying to come up with the right answers to put forth the effort and time and money to get that kind of work done.”

Mechanisms of Action

If you breathe 100% oxygen under pressure, it’s intuitively obvious that you’re going to deliver more oxygen to your tissues. That’s one clear mechanism, but it’s not the only or even primary reason for most of the benefits of hyperbaric therapy.

Evidence suggests part of the benefit might be related to the degeneration of a molecule called hypoxia-inducible factor alpha (HIF-1 alpha), which is generated when you lower the pressure. The pressure is high inside the chamber, and is lowered when you exit the chamber and enter the normal atmosphere. That means some of the benefit might actually be occurring when you get out of the chamber. Sonners explains:

“We don’t have an exact number right now, but roughly half of the treatment is occurring while you’re in the chamber, being exposed to the pressure, being exposed to the oxygen and literally accumulating a surplus of oxygen because of the therapy itself.

The other half of the therapy is when you get out of the chamber, as that oxygen can no longer stay in solution. It literally starts trying to bubble out of solution. As that happens, it’s not inert, it’s actually very active. So, as it’s coming out of solution, it’s interacting with all of our cells.

As a result, it’s triggering a massive cascade of events, cellular communication that seems to stimulate multiple series of regeneration and anti-inflammatory [events], even within the reactive oxygen species themselves.

When we look at the first part, which is the dosage of oxygen a person is getting, and that’s measurable, you could say, ‘Here’s a person, they were in a chamber, they were at this pressure, breathing this percentage of oxygen for this amount of time,’ and you could literally calculate the theoretical dose of oxygen that person was exposed to and should have been able to absorb.

We’ve kind of just stayed in that mindset for all these years. [However], there was a great paper out of Israel called ‘The Hypoxia-Hyperoxia Paradox,’ and what they’re saying is we know that there’s amazing benefits of hypoxia actually.”

Benefits of Relative Hypoxia

Some of these benefits include the stimulation of HIF-1 alpha, stem cell responses, collagen responses and the angiogenic responses. For these reasons, Sonners views hyperbaric as an anabolic therapy — a therapy that stimulates vitally important growth and repair, as growth factors such as VEGF (vascular endothelial growth factor), and BDNF (brain derived neurotropic factor) are both stimulated.

Again, these growth factors are not stimulated by the hyper-oxygenation. They’re a result from the hypoxic component, the process your body goes through as the oxygen is leaving your body.

“The important thing to note is that once you’ve accumulated all this extra oxygen, your hyper-oxygenation component, as that oxygen is leaving your body, you’re never truly hypoxic,” Sonners says, “but the cell signaling factors that respond to traditional hypoxia are also seemingly responding to this relative hypoxia.

If you look at that paper [‘The Hypoxia-Hyperoxia Paradox’] … it seemed to delineate this. With hypoxia alone, you will still get VEGF, which means you’ll still get a lot of angiogenics, the rebuilding of the endothelial [blood vessel] lining, the creation of a new micro-circulation bed, all this capillary regrowth will happen from hypoxia.

You’ll get these stem cell releases, this potential for increase in the regenerative nature of cells. You’ll get this increase in the HIF-1 alpha. But if you’re chronically hypoxic, you’re also going to get a down-regulation of sirtuins [longevity proteins] and you’re going to get a down-regulation of mitochondrial function.

Sirtuins could play a great role in things like cell cycle life, getting cells out of cellular senescence — kicking them back into active life — or apoptosis, killing that cell so that we can replace it with a new stem cell, or even the genetic and epigenetic repair mechanisms. A lot of that has to do with sirtuins, so we don’t want to downregulate those. We want to upregulate those.”

So, to clarify, with HBOT, you get the benefits of hypoxia with none of the downsides. Rather than inhibiting sirtuins, which are important for health and longevity, you actually get an up-regulation of sirtuin activity. It also up-regulates mitochondrial function and boosts mitochondrial replication, which the complete opposite to what happens in true hypoxia.

What About the Free Radical Component?

Without any doubt, HBOT is a type of oxidative stress, but it doesn’t have the adverse effects you’d expect. Sonners explains:

“There was a great paper done by Dominic D’Agostino and Angela Poff, back in 2017 or 2018, specifically looking at the reactive oxygen species or the free radical component of hyperbaric oxygen. What are the benefits or consequences as we up-regulate, as we increase the amount of oxygen into the body?

As the cells and the mitochondria start to uptake that oxygen, producing more energy, there is a natural consequence where this byproduct of free radicals are released as a part of normal cellular respiration. Excess free radicals is obviously consequential to cell membranes, lipid peroxidation and protein degradation.

It could destroy cell membranes, mitochondrial membranes, nuclear membranes, genetic material … At the same time, it’s a normal response to cellular respiration and our bodies have their own intrinsic mechanisms for dealing with some of this excess free radical, things like the superoxide dismutase, catalase and glutathione pathways.

So, there seems to be a distinction that we should make. One is that some of the free radicals our bodies are exposed to come from the outside world in. Radiation, smoking, air pollution, the list goes on and on. So, we need to have a robust, intrinsic ability to tolerate these free radicals with our own antioxidant system.

But in excess, we could be getting too much free radicals and we could be depleting our own systems, in which case supplementation should certainly be considered and used. On the flip side, we look at hyperbaric oxygen as this tool that theoretically has all these great effects, but one of those consequences would also be this increase in free radical exposure.

There seems to be a very big delineation between a body that’s exposed to free radicals from the outside world, versus a body that is exposed to free radicals that it’s creating on its own.

One of those distinctions is that through the use of hyperbaric oxygen, even without supplementation, and the increase in free radical production from mitochondrial ATB production, the body itself — assuming it has the right raw materials — will actually increase its own superoxide dismutase, catalase and glutathione pathways.

This would No. 1, help make you more resilient to hyperbaric oxygen, but No. 2, would also help make you more resilient to all the other free radicals that you’re potentially exposed to in your environment.

So, I would say two things. One, especially with patients who are a little bit more fragile when it comes to oxidative stress, those people, I would tend to not over oxidize to begin with, so I might start at a gentler hyperbaric protocol with them, and I’m likely to want to start quickly upregulating their own system, getting the right supplementation for improving their intrinsic antioxidant systems …

Then, as their system improves their tolerance for reactive oxygen species, we may not need as much of that, or if we’re going to be using high dose hyperbaric oxygen for a period of time, we might use things like certain SOD precursors, or molecular hydrogen.

Through conversations with you, it has become one my favorite antioxidants that we use. Between 45 minutes to an hour before [hyperbaric treatment], we’ll start loading people with the molecular hydrogen as a mechanism to reduce the consequences. There are benefits, in other words. Reactive oxygen species on its own also helps stimulate hormone balance and helps stimulate cell repair by themselves. So, there has to be this balance.

We don’t want to quelch all the free radicals because free radicals are a very important signaling molecule for so much cellular activity and at the same time, we want to be aware of the fact that hyperbaric does increase that, and we want to make sure that we’re not over-exposing somebody.”

HBOT Functional Medicine Course Now Available

Sonners also reviews the curriculum he developed for the International Board of Undersea Medicine. The IBUM has been certifying people in hyperbaric medicine for 25 years, and the curriculum Sonners created has been taught as a functional medicine hyperbaric course for clinicians for the past year

“A big push for me, and even for the research I’m doing, is to help create awareness that gets more doctors excited about [HBOT], that want to actually use it in their practice,” Sonners says. “So, this has been an attempt to really improve the education so that people aren’t just going to hyperbaric courses to learn about wound care.

We needed courses to help practitioners like myself or other people interested in the regenerative side to be able to learn how to apply it that way. So, we now have a course that I teach a few times a year to get people on the same page.

The majority of this last year, other than getting through school and writing the thesis, has been developing and promoting that course. I think we’ve certified about 125 to 150 practitioners and technicians specifically on the functional medicine side of hyperbaric use …

At this time, I still see a pretty big mix between soft chamber use and hard chamber use. A lot of those doctors are either DOs, MDs, chiropractors or naturopaths, getting into more of a functional medicine base, just looking for other natural approaches to the things they are treating.

Hyperbaric supplies the body with a fundamental ingredient and it’s so necessary for cellular performance. It just seems to make sense to start implementing a tool and a modality like that into a setting where you’re trying to reduce inflammation, you’re trying to improve energy production cellularly.”

HBOT Has at Least 100 Indications for Use

In terms of conditions that can benefit from HBOT, I would certainly add stroke, TBI, heart attack, anytime there’s post ischemic reperfusion injury, and most neurodegenerative conditions. Internationally, there are about 100 recognized indications. While that might make it sound like a magical cure-all, it’s important to remember that it doesn’t cure anything directly.

“The main effect of hyperbaric is really achieved through the cumulative effect and the increasing and decreasing — the wave of hyper-oxygenation back to normal oxygen levels — creating that hyperoxia-hypoxia type paradox. ~ Jason Sonners”

What it does is provide your body with a foundational nutrient, oxygen, that virtually all cells require. HBOT supplies your body oxygen in a surplus, creating an excess reservoir of oxygen to improve that function. That’s why it can help improve such a wide variety of health conditions.

Even autoimmune diseases such as MS, lupus and rheumatoid arthritis, just to name a few, may benefit, Sonners says. A whole other category of potential use would be wellness, longevity and regenerative-type therapies.

“We’re just applying the tools slightly differently to help match the intensity of the therapy to the severity of the condition. We can utilize the principles of gas exchange in various ways to help so many different types and various types of conditions,” Sonners says.

“One condition or subclass that we talked about it in the beginning is, from the immune system standpoint, upregulating your ability to fight infection by increasing white blood cell activation through the reactive oxygen species mechanisms. We use it for anaerobic infection, bacterial infections all the time.

One of the main reasons that hyperbaric works in those severe conditions is those bacteria are anaerobic. They don’t live in high oxygen environments.

So, we know that putting a patient in a high oxygen environment massively decreases bacteria’s ability to function, potentially helps to kill that infection, helps to block the toxicity of that infection and helps to break down the biofilms around that infection. So, hyperbaric becomes an amazing tool in the capacity of immune system balancing and/or ability to help fight infection.”

More Information

As a general guidance, Sonners recommends doing hyperbaric for about two hours a week on a regular basis. That’s his personal routine. In addition to that, three times a year he does a 30- to 40-hour protocol over the course of six to eight weeks. He explains why:

“We know that in general … three or four sessions is not going to ever cut it. The main effect of hyperbaric is really achieved through the cumulative effect and the increasing and decreasing — the wave of hyper-oxygenation back to normal oxygen levels — creating that hyperoxia-hypoxia type paradox …

When you do a protocol similar to like what I would do for a patient, let’s say four to six hours a week for eight weeks, the frequency of those … the space in between them, really shrinks and you get far more signaling to occur …

If all we cared about was the physical dose, we would stay at 100% oxygen as long as we possibly could, at the highest pressure we could tolerate to get the most oxygen absorption. I don’t think that that’s where the majority of benefit exists.

Every time your pressure changes or your percentage of oxygen changes, you’re stimulating HIF-1 alpha, the reactive oxygen species load, sirtuins, you’re signaling a hormetic effect. I picture them as switches. You’re flipping that switch on, off, on, off, on, off. I think it’s the amount of times that you stimulate that switch that will create the benefits we’re looking for, more than the physical dose of oxygen over time.”

To learn more about HBOT in general, be sure to pick up Sonners’ book, “Oxygen Under Pressure: Using Hyperbaric Oxygen to Restore Health, Reduce Inflammation, Reverse Aging and Revolutionize Health Care.”

Sources and References:

National Hyperbaric