Hyperbaric Remedy — A Vastly Underused Remedy Modality


Dr. Jason Sonners, creator of the guide, “Oxygen Below Strain: Utilizing Hyperbaric Oxygen to Restore Well being, Scale back Irritation, Reverse Ageing and Revolutionize Well being Care,” began out as a chiropractor. His ardour, nonetheless, is hyperbaric oxygen remedy (HBOT), which is the main focus of his Ph.D. research on the College of Miami.

Whereas generally used to hurry up cussed wounds and tissue infections, hyperbaric drugs can be useful within the therapy of infectious ailments similar to COVID. It’s additionally enormously helpful for stroke sufferers. I can not consider a simpler intervention than to get the stroke affected person right into a sequence of hyperbaric remedies as rapidly as attainable.

HBOT for Basic Well being and Illness Reversal

Each cell in your physique, excluding your purple blood cells (which don’t have any mitochondria that require oxygen), requires oxygen to create power. Many persistent ailments of the trendy world contain decreased mitochondrial perform, elevated systemic irritation, and an incapacity of cells to generate the required quantities of power 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 someone with carbon monoxide poison or air gasoline embolism.

“So, we solely give it some thought, historically, to assist save the life or limb of someone in a extremely extreme situation, however the mechanisms which are 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 cut back irritation, improve mitochondrial perform … and thereby rising the power that these cells are in a position to generate …” 

HBOT for Continual Ailments

Sonners’ objective is to develop the usage of HBOT from the acutely life-threatening points like gangrene to extra persistent situations, similar to autoimmune and neurodegenerative ailments.

“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, possibly 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 therefore many of those different persistent diseases …

So, if we might actually residence in on these mechanisms and perceive them higher, after which get a greater feeling for what time and stress settings we require in an effort 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 leads to doing so.

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

I need to construct on that data base, so what I am doing is I am making a examine 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 examine that was executed 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 raised perceive which pressures are getting which results, and once more, what time period ought to we expect earlier than we get the outcomes that we’re in search of?”

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 exhausting chambers at two completely different pressures. The decrease stress group will likely be at 4.2 psi, which is similar as tender chamber pressures. 

“There’s nowhere close to the quantity of analysis in tender chambers as there are in exhausting chambers,” Sonners says. “The overwhelming majority of analysis is completed 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 may be undoubtedly 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 circumstances, 1.3 [atmospheres] has been used because the sham group, against a therapy arm within the analysis. Perhaps the examine group 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 examine that was executed on cerebral palsy (CP) and 1.3 was used because the sham group … On this explicit examine, with 1.3 being the sham group, there was additionally a … management group that acquired no hyperbaric in any respect.

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

The problem within the examine 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 examine was due to this fact that hyperbaric doesn’t work for CP, though all three of these teams had important enchancment.

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

So, because of this, there’s this examine 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 must have a big curiosity in attempting to provide you with the appropriate solutions to place forth the time and effort and cash to get that form of work executed.”

Mechanisms of Motion

Should you breathe 100% oxygen below stress, it’s intuitively apparent that you will ship extra oxygen to your tissues. That’s one clear mechanism, but it surely’s not the one and even major motive for a lot of the advantages of hyperbaric remedy.

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

“We do not have a precise quantity proper now, however roughly half of the therapy is happening 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 whenever you get out of the chamber, as that oxygen can 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.

In consequence, 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 take a look at the primary half, which is the dosage of oxygen an individual is getting, and that is measurable, you can say, ‘This is an individual, they have been in a chamber, they have been at this stress, respiration this proportion of oxygen for this period of time,’ and you can actually calculate the theoretical dose of oxygen that particular person was uncovered to and will have been in a position to take up.

We have form of simply stayed in that mindset for all these years. [However], there was an ideal 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 essential progress and restore, as progress components similar to VEGF (vascular endothelial progress issue), and BDNF (mind derived neurotropic issue) are each stimulated.

Once more, these progress components usually are not stimulated by the hyper-oxygenation. They seem to be a end result from the hypoxic element, the method your physique goes via because the oxygen is leaving your physique.

“The essential factor to notice is that when 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 components that reply to conventional hypoxia are additionally seemingly responding to this relative hypoxia.

Should you take a look at that paper [‘The Hypoxia-Hyperoxia Paradox’] … it appeared to delineate this. With hypoxia alone, you’ll nonetheless get VEGF, which implies you will nonetheless get a number of 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 improve within the regenerative nature of cells. You may get this improve within the HIF-1 alpha. However in case 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 might play an ideal position 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 exchange it with a brand new stem cell, and even the genetic and epigenetic restore mechanisms. Numerous that has to do with sirtuins, so we do not need to downregulate these. We need to upregulate these.”

So, to make clear, with HBOT, you get the advantages of hypoxia with not one of the downsides. Slightly than inhibiting sirtuins, that are essential 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 Concerning the Free Radical Element?

With none doubt, HBOT is a kind of oxidative stress, but it surely doesn’t have the antagonistic results you’d count on. Sonners explains:

“There was an ideal paper executed 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 improve the quantity of oxygen into the physique?

Because the cells and the mitochondria begin to uptake that oxygen, producing extra power, 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 might 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 should 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 listing goes on and on. So, we have to have a strong, intrinsic capability 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 techniques, through which case supplementation ought to actually be thought-about and used. On the flip aspect, we take a look at hyperbaric oxygen as this device that theoretically has all these nice results, however a type of penalties would even be this improve in free radical publicity.

There appears to be a really massive 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 via the usage of hyperbaric oxygen, even with out supplementation, and the rise in free radical manufacturing from mitochondrial ATB manufacturing, the physique itself — assuming it has the appropriate uncooked supplies — will really improve 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 probably uncovered to in your setting.

So, I might say two issues. One, particularly with sufferers who’re just a little 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 need to begin rapidly upregulating their very own system, getting the appropriate supplementation for enhancing their intrinsic antioxidant techniques …

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

Via conversations with you, it has turn out to be 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 scale back the results. There are advantages, in different phrases. Reactive oxygen species by itself additionally helps stimulate hormone steadiness and helps stimulate cell restore by themselves. So, there needs to be this steadiness.

We do not need 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 would like to concentrate on the truth that hyperbaric does improve that, and we need to be sure that we’re not over-exposing someone.”

HBOT Useful Drugs Course Now Obtainable

Sonners additionally opinions 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.

“An enormous 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 need to really use it of their apply,” Sonners says. “So, this has been an try to actually enhance the training so that folks aren’t simply going to hyperbaric programs to find out about wound care.

We would have liked 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, aside from getting via college and writing the thesis, has been creating 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 exhausting chamber use. Numerous these docs are both Dos, MDs, chiropractors or naturopaths, moving into extra of a practical drugs base, simply in search of different pure approaches to the issues they’re treating.

Hyperbaric provides the physique with a basic ingredient and it is so vital 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 scale back irritation, you are attempting to enhance power manufacturing cellularly.”

HBOT Has at Least 100 Indications for Use

Whereas the listing 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 gasoline embolism

Carbon monoxide poisoning

Clostridial myositis and myonecrosis (gasoline gangrene)

Crush accidents, compartment syndrome and different acute traumatic ischemia

Decompression illness

Arterial insufficiencies, similar to central retinal artery occlusion

Extreme anemia

Intracranial abscess

Necrotizing tender tissue infections

Osteomyelitis

Delayed radiation damage (tender tissue and bone necrosis)

Compromised grafts and flaps

Acute thermal burn damage

Idiopathic sudden sensorineural listening to loss

By way of situations that may profit from HBOT, I would definitely add stroke, TBI, coronary heart assault, anytime there’s put up 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 essential to do not forget that it doesn’t remedy something straight.

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 will possibly assist enhance such all kinds of well being situations.

Even autoimmune ailments similar to MS, lupus and rheumatoid arthritis, simply to call a number of, could 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 rules of gasoline trade in varied methods to assist so many differing types and varied varieties of situations,” Sonners says.

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

One of many principal 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 capability to perform, probably 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 an incredible device within the capability of immune system balancing and/or capability to assist combat an infection.”

Extra Info

As a normal steering, Sonners recommends doing hyperbaric for about two hours per week frequently. That’s his private routine. Along with that, 3 times 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 usually … three or 4 classes shouldn’t be going to ever lower it. The principle impact of hyperbaric is admittedly achieved via the cumulative impact and the rising and reducing — the wave of hyper-oxygenation again to regular oxygen ranges — creating that hyperoxia-hypoxia sort paradox …

If you do a protocol much like like what I might do for a affected person, as an instance 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 presumably might, on the highest stress we might tolerate to get probably 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 change on, off, on, off, on, off. I believe it is the quantity of instances that you simply stimulate that change that may create the advantages we’re in search of, greater than the bodily dose of oxygen over time.”

To study extra about HBOT usually, make sure to choose up Sonners’ guide, “Oxygen Below Strain: Utilizing Hyperbaric Oxygen to Restore Well being, Scale back Irritation, Reverse Ageing 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, make sure to take heed to the interview in its entirety, or learn via the transcript.

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