Hyperbaric Remedy — A Vastly Underused Remedy Modality

Dr. Jason Sonners, writer of the guide, “Oxygen Beneath Stress: Utilizing Hyperbaric Oxygen to Restore Well being, Cut back Irritation, Reverse Growing old and Revolutionize Well being Care,” began out as a chiropractor. His ardour, nonetheless, is hyperbaric oxygen remedy (HBOT), which is the main target of his Ph.D. research on the College of Miami.

Whereas generally used to hurry up cussed wounds and tissue infections, hyperbaric drugs will also be useful within the therapy of infectious illnesses akin to COVID. It’s additionally enormously helpful for stroke sufferers. I am unable to consider a more practical intervention than to get the stroke affected person right into a sequence of hyperbaric remedies as rapidly as attainable.

HBOT for Normal Well being and Illness Reversal

Each cell in your physique, aside from your pink blood cells (which don’t have any mitochondria that require oxygen), requires oxygen to create vitality. Many persistent illnesses of the trendy world contain decreased mitochondrial perform, elevated systemic irritation, and an incapability of cells to generate the required quantities of vitality for optimum perform.

“We use hyperbaric oxygen, historically, for these horrible and extreme situations,” Sonners says. Sadly, it’s usually a final resort, actually proper earlier than an amputation surgical procedure or as a life-saving mechanism for any person with carbon monoxide poison or air fuel embolism.

“So, we solely give it some thought, historically, to assist save the life or limb of any person in a extremely extreme situation, however the mechanisms which can be working for these of us are similar to the explanations that you simply and I’d think about using hyperbaric oxygen:

For upregulating the oxygen ranges inside your physique, which can assist scale back irritation, enhance mitochondrial perform … and thereby growing the vitality that these cells are in a position to generate …” 

HBOT for Power Illnesses

Sonners’ aim is to develop using HBOT from the acutely life-threatening points like gangrene to extra persistent situations, akin to autoimmune and neurodegenerative illnesses.

“My thought course of is that the mechanisms of motion of hyperbaric are the identical whether or not we’re speaking about gangrene, radiation burns and osteonecrosis, or TBI [traumatic brain injury], concussion, perhaps MS [multiple sclerosis] and post-stroke.

If we actually get a mastery of the mechanisms of motion, we will begin to apply these mechanisms throughout the board. Clinically, we have seen hyperbaric work for thus many of those different persistent sicknesses …

So, if we may actually residence in on these mechanisms and perceive them higher, after which get a greater feeling for what time and stress settings we require as a way to get these mechanisms to kick in, then we will actually, with extra confidence, apply this remedy to those different situations and have extra constant ends in doing so.

Quite a lot of the work I am proposing to do is tagging onto a few of this work in regenerative drugs, the place they had been wanting on the collagen, fibroblast and stem cell response to hyperbaric. A research got here out in 2020 on telomeres, and this potential, upwards of 20% enhance in telomere size, particularly in sure immune system cells.

I wish to construct on that information base, so what I am doing is I am making a research that is going to have a lower-pressure group and a higher-pressure group, and we will be a complete cytokine panel, so we will perceive the mechanisms of the anti-inflammatory aspect.

We will have a methylation panel in order that we will begin wanting on the epigenetic results of hyperbaric. We will have a telomere element, much like the telomere research that was accomplished a yr and a half in the past.

And we will begin evaluating all of these metrics throughout roughly a three- to six-month timeframe of therapy, and over two separate stress settings, to higher perceive which pressures are getting which results, and once more, what time frame ought to we expect earlier than we get the outcomes that we’re on the lookout for?”

Analysis Underway

On the low finish, Sonners will likely be utilizing 1.3 atmospheres (4.2 PSI) at 100% oxygen, and on the excessive finish, he’ll use 2.0 atmospheres (14.7 PSI) at 100% oxygen. All sufferers will use arduous chambers at two totally different pressures. The decrease stress group will likely be at 4.2 psi, which is identical as tender chamber pressures.

“There’s nowhere close to the quantity of analysis in tender chambers as there are in arduous chambers,” Sonners says. “The overwhelming majority of analysis is finished at that 2-atmosphere vary, which is why I am selecting that because the higher finish of the analysis that I am doing within the tender chamber analysis.

There’s positively some [research] on sports activities restoration. There’s really some ongoing research proper now on hyperbaric for stem cell use that we’re ready for. In some instances, 1.3 [atmospheres] has been used because the sham group, against a therapy arm within the analysis. Perhaps the research crew actually thought that 1.3 wasn’t going to have an impact and it is a respectable sham …

I am undecided, however there are some nice research. There is a research that was accomplished on cerebral palsy (CP) and 1.3 was used because the sham group … On this specific research, with 1.3 being the sham group, there was additionally a … management group that obtained no hyperbaric in any respect.

Throughout the sham group, there was vital enchancment on the metrics they had been measuring. Then they’d a 1.5 [atmospheres at] 100% oxygen, which additionally had a very good enchancment after which, a 1.75 [atmospheres at] 100% oxygen, which had even a better enchancment.

The difficulty within the research was that whereas all three of these teams improved, there was no statistical distinction or sufficient of a statistical distinction between the 1.3, the 1.5 and the 1.75. So, the conclusion of the research was subsequently that hyperbaric doesn’t work for CP, though all three of these teams had vital enchancment.

So, as a result of the sham group was not thought-about a therapy, that was the conclusion of that research. Now, the pure consequence of that ought to have been redoing the research and creating a distinct stage of what the sham and the therapy arms should be, however that was by no means redone.

So, because of this, there’s this research with outcomes that say hyperbaric doesn’t work for CP. In the meantime, clearly, what it means is we want extra research. It is simply that research are costly. They’re very time consuming and you actually need to have a big curiosity in attempting to give you the suitable solutions to place forth the time and effort and cash to get that type of work accomplished.”

Mechanisms of Motion

When you breathe 100% oxygen beneath stress, it’s intuitively apparent that you will ship extra oxygen to your tissues. That’s one clear mechanism, nevertheless it’s not the one and even major motive for many of the advantages of hyperbaric remedy.

Proof suggests a part of the profit is likely to be associated to the degeneration of a molecule known as hypoxia-inducible issue alpha (HIF-1 alpha), which is generated while you decrease the stress. The stress is excessive contained in the chamber, and is lowered while you exit the chamber and enter the traditional ambiance. Which means a few of the profit would possibly really be occurring while you get out of the chamber. Sonners explains:

“We do not have a precise quantity proper now, however roughly half of the therapy is going on whilst you’re within the chamber, being uncovered to the stress, being uncovered to the oxygen and actually accumulating a surplus of oxygen due to the remedy itself.

The opposite half of the remedy is while you get out of the chamber, as that oxygen can now not keep in answer. It actually begins attempting to bubble out of answer. As that occurs, it isn’t inert, it is really very lively. So, because it’s popping out of answer, it is interacting with all of our cells.

Consequently, it is triggering an enormous cascade of occasions, mobile communication that appears to stimulate a number of sequence of regeneration and anti inflammatory [events], even throughout the reactive oxygen species themselves.

After we have a look at the primary half, which is the dosage of oxygen an individual is getting, and that is measurable, you may say, ‘Here is an individual, they had been in a chamber, they had been at this stress, respiratory this proportion of oxygen for this period of time,’ and you may actually calculate the theoretical dose of oxygen that individual was uncovered to and will have been in a position to take up.

We have type of simply stayed in that mindset for all these years. [However], there was an awesome paper out of Israel known as ‘The Hypoxia-Hyperoxia Paradox,’ and what they’re saying is we all know that there is wonderful advantages of hypoxia really.”

Advantages of Relative Hypoxia

A few of these advantages embrace the stimulation of HIF-1 alpha, stem cell responses, collagen responses and the angiogenic responses. For these causes, Sonners views hyperbaric as an anabolic remedy — a remedy that stimulates vitally vital progress and restore, as progress elements akin to VEGF (vascular endothelial progress issue), and BDNF (mind derived neurotropic issue) are each stimulated.

Once more, these progress elements should not stimulated by the hyper-oxygenation. They are a outcome from the hypoxic element, the method your physique goes by way of because the oxygen is leaving your physique.

“The vital factor to notice is that after you have amassed all this further oxygen, your hyper-oxygenation element, as that oxygen is leaving your physique, you are by no means actually hypoxic,” Sonners says, “however the cell signaling elements that reply to conventional hypoxia are additionally seemingly responding to this relative hypoxia.

When you have a look at that paper [‘The Hypoxia-Hyperoxia Paradox’] … it appeared to delineate this. With hypoxia alone, you’ll nonetheless get VEGF, which suggests you will nonetheless get numerous angiogenics, the rebuilding of the endothelial lining, the creation of a brand new micro-circulation mattress, all this capillary regrowth will occur from hypoxia.

You may get these stem cell releases, this potential for enhance within the regenerative nature of cells. You may get this enhance within the HIF-1 alpha. However when you’re chronically hypoxic, you are additionally going to get a downregulation of sirtuins [longevity proteins] and you are going to get a downregulation of mitochondrial perform.

Sirtuins may play an awesome function in issues like cell cycle life, getting cells out of mobile senescence — kicking them again into lively life — or apoptosis, killing that cell in order that we will substitute it with a brand new stem cell, and even the genetic and epigenetic restore mechanisms. Quite a lot of that has to do with sirtuins, so we do not wish to downregulate these. We wish to upregulate these.”

So, to make clear, with HBOT, you get the advantages of hypoxia with not one of the downsides. Reasonably than inhibiting sirtuins, that are vital for well being and longevity, you really get an upregulation of sirtuin exercise. It additionally upregulates mitochondrial perform and boosts mitochondrial replication, which the exact opposite to what occurs in true hypoxia.

What In regards to the Free Radical Part?

With none doubt, HBOT is a kind of oxidative stress, nevertheless it doesn’t have the adversarial results you’d anticipate. Sonners explains:

“There was an awesome paper accomplished by Dominic D’Agostino and Angela Poff, again in 2017 or 2018, particularly wanting on the reactive oxygen species or the free radical element of hyperbaric oxygen. What are the advantages or penalties as we upregulate, as we enhance the quantity of oxygen into the physique?

Because the cells and the mitochondria begin to uptake that oxygen, producing extra vitality, there’s a pure consequence the place this byproduct of free radicals are launched as part of regular mobile respiration. Extra free radicals is clearly consequential to cell membranes, lipid peroxidation and protein degradation.

It may destroy cell membranes, mitochondrial membranes, nuclear membranes, genetic materials … On the identical time, it is a regular response to mobile respiration and our our bodies have their very own intrinsic mechanisms for coping with a few of this extra free radical, issues just like the superoxide dismutase, catalase and glutathione pathways.

So, there appears to be a distinction that we must always make. One is that a few of the free radicals our our bodies are uncovered to return from the skin world in. Radiation, smoking, air air pollution, the checklist goes on and on. So, we have to have a strong, intrinsic capacity to tolerate these free radicals with our personal antioxidant system.

However in extra, we may very well be getting an excessive amount of free radicals and we may very well be depleting our personal programs, wherein case supplementation ought to definitely be thought-about and used. On the flip aspect, we have a look at hyperbaric oxygen as this device that theoretically has all these nice results, however a kind of penalties would even be this enhance in free radical publicity.

There appears to be a really huge delineation between a physique that is uncovered to free radicals from the skin world, versus a physique that’s uncovered to free radicals that it is creating by itself.

A kind of distinctions is that by way of using hyperbaric oxygen, even with out supplementation, and the rise in free radical manufacturing from mitochondrial ATB manufacturing, the physique itself — assuming it has the suitable uncooked supplies — will really enhance its personal superoxide dismutase, catalase and glutathione pathways.

This could No. 1, assist make you extra resilient to hyperbaric oxygen, however No. 2, would additionally assist make you extra resilient to all the opposite free radicals that you simply’re doubtlessly uncovered to in your setting.

So, I might say two issues. One, particularly with sufferers who’re slightly bit extra fragile in terms of oxidative stress, these folks, I might are inclined to not over oxidize to start with, so I’d begin at a gentler hyperbaric protocol with them, and I am prone to wish to begin rapidly upregulating their very own system, getting the suitable supplementation for bettering their intrinsic antioxidant programs …

Then, as their system improves their tolerance for reactive oxygen species, we might not want as a lot of that, or if we will be utilizing excessive dose hyperbaric oxygen for a time frame, we would use issues like sure SOD precursors, or molecular hydrogen.

By means of conversations with you, it has change into one my favourite antioxidants that we use. Between 45 minutes to an hour earlier than [hyperbaric treatment], we’ll begin loading folks with the molecular hydrogen as a mechanism to cut back the implications. There are advantages, in different phrases. Reactive oxygen species by itself additionally helps stimulate hormone stability and helps stimulate cell restore by themselves. So, there needs to be this stability.

We do not wish to quelch all of the free radicals as a result of free radicals are an important signaling molecule for a lot mobile exercise and on the identical time, we wish to pay attention to the truth that hyperbaric does enhance that, and we wish to make it possible for we’re not over-exposing any person.”

HBOT Useful Drugs Course Now Out there

Sonners additionally evaluations the curriculum he developed for the Worldwide Board of Undersea Drugs. The IBUM has been certifying folks in hyperbaric drugs for 25 years, and the curriculum Sonners created has been taught as a practical drugs hyperbaric course for clinicians for the previous yr.

“A giant push for me, and even for the analysis I am doing, is to assist create consciousness that will get extra docs enthusiastic about [HBOT], that wish to really use it of their apply,” Sonners says. “So, this has been an try to actually enhance the schooling so that folks aren’t simply going to hyperbaric programs to study wound care.

We wanted programs to assist practitioners like myself or different folks within the regenerative aspect to have the ability to learn to apply it that method. So, we now have a course that I train a number of instances a yr to get folks on the identical web page.

Nearly all of this final yr, apart from getting by way of faculty and writing the thesis, has been growing and selling that course. I believe we have licensed about 125 to 150 practitioners and technicians particularly on the practical drugs aspect of hyperbaric use …

Right now, I nonetheless see a reasonably large combine between tender chamber use and arduous chamber use. Quite a lot of these docs are both Dos, MDs, chiropractors or naturopaths, entering into extra of a practical drugs base, simply on the lookout for different pure approaches to the issues they’re treating.

Hyperbaric provides the physique with a elementary ingredient and it is so mandatory for mobile efficiency. It simply appears to make sense to start out implementing a device and a modality like that right into a setting the place you are attempting to cut back irritation, you are attempting to enhance vitality manufacturing cellularly.”

HBOT Has at Least 100 Indications for Use

Whereas the checklist of potential makes use of for HBOT is extraordinarily lengthy, within the U.S., the Meals and Drug Administration has authorised and most insurance coverage pays for HBOT for the next 14 situations:1

Air or fuel embolism

Carbon monoxide poisoning

Clostridial myositis and myonecrosis (fuel gangrene)

Crush accidents, compartment syndrome and different acute traumatic ischemia

Decompression illness

Arterial insufficiencies, akin to central retinal artery occlusion

Extreme anemia

Intracranial abscess

Necrotizing tender tissue infections


Delayed radiation damage (tender tissue and bone necrosis)

Compromised grafts and flaps

Acute thermal burn damage

Idiopathic sudden sensorineural listening to loss

When it comes to situations that may profit from HBOT, I will surely add stroke, TBI, coronary heart assault, anytime there’s publish ischemic reperfusion damage, and most neurodegenerative situations. Internationally, there are about 100 acknowledged indications. Whereas which may make it sound like a magical cure-all, it’s vital to do not forget that it doesn’t treatment something immediately.

What it does is present your physique with a foundational nutrient, oxygen, that just about all cells require. HBOT provides your physique oxygen in a surplus, creating an extra reservoir of oxygen to enhance that perform. That’s why it may assist enhance such all kinds of well being situations.

Even autoimmune illnesses akin to MS, lupus and rheumatoid arthritis, simply to call a number of, might profit, Sonners says. A complete different class of potential use can be wellness, longevity and regenerative-type therapies.

“We’re simply making use of the instruments barely otherwise to assist match the depth of the remedy to the severity of the situation. We are able to make the most of the ideas of fuel alternate in numerous methods to assist so many differing types and numerous forms of situations,” Sonners says.

“One situation or subclass that we talked about it to start with is, from the immune system standpoint, upregulating your capacity to battle an infection by growing white blood cell activation by way of the reactive oxygen species mechanisms. We use it for anaerobic an infection, bacterial infections on a regular basis.

One of many major causes that hyperbaric works in these extreme situations is these micro organism are anaerobic. They do not dwell in excessive oxygen environments.

So, we all know that placing a affected person in a excessive oxygen setting massively decreases micro organism’s capacity to perform, doubtlessly helps to kill that an infection, helps to dam the toxicity of that an infection and helps to interrupt down the biofilms round that an infection. So, hyperbaric turns into a tremendous device within the capability of immune system balancing and/or capacity to assist battle an infection.”

Extra Info

As a normal steering, Sonners recommends doing hyperbaric for about two hours per week regularly. That’s his private routine. Along with that, thrice a yr he does a 30- to 40-hour protocol over the course of six to eight weeks. He explains why:

“We all know that normally … three or 4 periods isn’t going to ever lower it. The principle impact of hyperbaric is actually achieved by way of the cumulative impact and the growing and lowering — the wave of hyper-oxygenation again to regular oxygen ranges — creating that hyperoxia-hypoxia kind paradox …

Once you do a protocol much like like what I might do for a affected person, for example 4 to 6 hours per week for eight weeks, the frequency of these … the area in between them, actually shrinks and also you get way more signaling to happen …

If all we cared about was the bodily dose, we might keep at 100% oxygen so long as we probably may, on the highest stress we may tolerate to get essentially the most oxygen absorption. I do not suppose that that is the place the vast majority of profit exists.

Each time your stress modifications or your proportion of oxygen modifications, you are stimulating HIF-1 alpha, the reactive oxygen species load, sirtuins, you are signaling a hormetic impact. I image them as switches. You are flipping that swap on, off, on, off, on, off. I believe it is the quantity of instances that you simply stimulate that swap that can create the advantages we’re on the lookout for, greater than the bodily dose of oxygen over time.”

To be taught extra about HBOT normally, you should definitely choose up Sonners’ guide, “Oxygen Beneath Stress: Utilizing Hyperbaric Oxygen to Restore Well being, Cut back Irritation, Reverse Growing old and Revolutionize Well being Care.”

Within the interview, we additionally talk about how one can incorporate HBOT in your health routine, together with fasting, to enhance and upregulate mobile efficiency, restoration and regeneration. So, if that’s of curiosity to you, you should definitely take heed to the interview in its entirety, or learn by way of the transcript.

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