Hyperbaric Remedy — A Vastly Underused Remedy Modality

Dr. Jason Sonners, creator of the e book, “Oxygen Below Stress: Utilizing Hyperbaric Oxygen to Restore Well being, Cut back Irritation, Reverse Growing older and Revolutionize Well being Care,” began out as a chiropractor. His ardour, nevertheless, 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 resembling COVID. It’s additionally enormously helpful for stroke sufferers. I am unable to consider a simpler intervention than to get the stroke affected person right into a collection of hyperbaric remedies as rapidly as potential.

HBOT for Common Well being and Illness Reversal

Each cell in your physique, apart from your purple blood cells (which haven’t any mitochondria that require oxygen), requires oxygen to create power. Many power ailments of the fashionable world contain decreased mitochondrial operate, elevated systemic irritation, and an lack of ability of cells to generate the required quantities of power for optimum operate.

“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 anyone with carbon monoxide poison or air gasoline embolism.

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

For upregulating the oxygen ranges inside your physique, which is able to assist cut back irritation, enhance mitochondrial operate … and thereby rising the power that these cells are capable of generate …” 

HBOT for Power Illnesses

Sonners’ aim is to increase the usage of HBOT from the acutely life-threatening points like gangrene to extra power situations, resembling 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, 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 power diseases …

So, if we may actually dwelling in on these mechanisms and perceive them higher, after which get a greater feeling for what time and strain settings we require with a purpose 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 have been wanting on the collagen, fibroblast and stem cell response to hyperbaric. A research got here out in 2020 on telomeres, and taking a look at this potential, upwards of 20% enhance 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 research that is going to have a lower-pressure group and a higher-pressure group, and we’ll be taking a look at 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, just like the telomere research that was executed a yr and a half in the past.

And we’ll begin evaluating all of these metrics throughout roughly a three- to six-month timeframe of therapy, and over two separate strain 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 shall 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 onerous chambers at two completely different pressures. The decrease strain group shall be at 4.2 psi, which is similar as mushy chamber pressures.

“There’s nowhere close to the quantity of analysis in mushy chambers as there are in onerous 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 mushy chamber analysis.

There’s undoubtedly some [research] on sports activities restoration. There’s truly 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 research group actually thought that 1.3 wasn’t going to have an impact and it is a authentic sham …

I am undecided, however there are some nice research. There is a research that was executed 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 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 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 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 research. Now, the pure consequence of that ought to have been redoing the research and creating a unique stage of what the sham and the therapy arms must be, however that was by no means redone.

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

Mechanisms of Motion

In the event you breathe 100% oxygen beneath strain, 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 a lot 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 if you decrease the strain. The strain is excessive contained in the chamber, and is lowered if you exit the chamber and enter the traditional ambiance. Which means a number of the profit may truly be occurring if you get out of the chamber. Sonners explains:

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

The opposite half of the remedy is if you get out of the chamber, as that oxygen can not keep in resolution. It actually begins making an attempt to bubble out of resolution. As that occurs, it isn’t inert, it is truly very lively. So, because it’s popping out of resolution, 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 collection of regeneration and anti inflammatory [events], even throughout the reactive oxygen species themselves.

Once we have a look at the primary half, which is the dosage of oxygen an individual is getting, and that is measurable, you could possibly say, ‘Here is an individual, they have been in a chamber, they have been at this strain, respiration this proportion of oxygen for this period of time,’ and you could possibly actually calculate the theoretical dose of oxygen that particular person was uncovered to and may have been capable of take in.

We have type 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 superb advantages of hypoxia truly.”

Advantages of Relative Hypoxia

A few of these advantages embody 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 development and restore, as development elements resembling VEGF (vascular endothelial development issue), and BDNF (mind derived neurotropic issue) are each stimulated.

Once more, these development elements are usually not stimulated by the hyper-oxygenation. They seem to be a end result 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’ve got amassed all this further oxygen, your hyper-oxygenation element, as that oxygen is leaving your physique, you are by no means really hypoxic,” Sonners says, “however the cell signaling elements that reply to conventional hypoxia are additionally seemingly responding to this relative hypoxia.

In the event 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 implies you may nonetheless get lots 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 will get these stem cell releases, this potential for enhance within the regenerative nature of cells. You will 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 operate.

Sirtuins may play an ideal 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 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 vital for well being and longevity, you truly get an upregulation of sirtuin exercise. It additionally upregulates mitochondrial operate and boosts mitochondrial replication, which the exact opposite to what occurs in true hypoxia.

What Concerning the Free Radical Part?

With none doubt, HBOT is a sort of oxidative stress, nevertheless it doesn’t have the hostile 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 enhance 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 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 number of the free radicals our our bodies are uncovered to return from the skin world in. Radiation, smoking, air air pollution, the record goes on and on. So, we have to have a strong, intrinsic potential to tolerate these free radicals with our personal antioxidant system.

However in extra, we might be getting an excessive amount of free radicals and we might be depleting our personal techniques, during which case supplementation ought to actually be thought-about and used. On the flip aspect, we have a look at hyperbaric oxygen as this instrument that theoretically has all these nice results, however a type of penalties would even be this enhance in free radical publicity.

There appears to be a really large 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 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 precise uncooked supplies — will truly enhance its personal superoxide dismutase, catalase and glutathione pathways.

This might 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 atmosphere.

So, I’d say two issues. One, particularly with sufferers who’re a little bit bit extra fragile relating to oxidative stress, these individuals, I’d are likely to not over oxidize to start with, so I would begin at a gentler hyperbaric protocol with them, and I am more likely to need to begin rapidly upregulating their very own system, getting the precise supplementation for bettering their intrinsic antioxidant techniques …

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

Via conversations with you, it has develop into one my favourite antioxidants that we use. Between 45 minutes to an hour earlier than [hyperbaric treatment], we’ll begin loading individuals with the molecular hydrogen as a mechanism to scale back the implications. 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 pay attention to the truth that hyperbaric does enhance that, and we need to guarantee that we’re not over-exposing anyone.”

HBOT Practical Medication Course Now Out there

Sonners additionally opinions the curriculum he developed for the Worldwide Board of Undersea Medication. The IBUM has been certifying individuals in hyperbaric drugs for 25 years, and the curriculum Sonners created has been taught as a purposeful 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 need to truly use it of their observe,” Sonners says. “So, this has been an try to essentially enhance the training so that individuals aren’t simply going to hyperbaric programs to study wound care.

We would have liked programs to assist practitioners like myself or different individuals within the regenerative aspect to have the ability to discover ways to apply it that approach. So, we now have a course that I educate a couple of instances a yr to get individuals on the identical web page.

The vast majority 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 purposeful drugs aspect of hyperbaric use …

Right now, I nonetheless see a reasonably large combine between mushy chamber use and onerous chamber use. Quite a lot of these docs are both Dos, MDs, chiropractors or naturopaths, entering into extra of a purposeful drugs base, simply on the lookout for 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 instrument and a modality like that right into a setting the place you are making an attempt to scale back irritation, you are making an attempt to enhance power manufacturing cellularly.”

HBOT Has at Least 100 Indications for Use

Whereas the record of potential makes use of for HBOT is extraordinarily lengthy, within the U.S., the Meals and Drug Administration has permitted 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, resembling central retinal artery occlusion

Extreme anemia

Intracranial abscess

Necrotizing mushy tissue infections


Delayed radiation harm (mushy tissue and bone necrosis)

Compromised grafts and flaps

Acute thermal burn harm

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 publish ischemic reperfusion harm, 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 keep in mind that it doesn’t remedy something immediately.

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

Even autoimmune ailments resembling MS, lupus and rheumatoid arthritis, simply to call a couple of, might profit, Sonners says. A complete different class of potential use could 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 alternate in numerous methods to assist so many differing kinds and numerous 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 potential to battle an infection by rising 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 important causes that hyperbaric works in these extreme situations is these micro organism are anaerobic. They do not reside in excessive oxygen environments.

So, we all know that placing a affected person in a excessive oxygen atmosphere massively decreases micro organism’s potential to operate, 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 instrument within the capability of immune system balancing and/or potential to assist battle an infection.”

Extra Info

As a basic steering, Sonners recommends doing hyperbaric for about two hours per week frequently. 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 basically … three or 4 classes will not be going to ever minimize it. The principle impact of hyperbaric is basically achieved by way of the cumulative impact and the rising and lowering — the wave of hyper-oxygenation again to regular oxygen ranges — creating that hyperoxia-hypoxia kind paradox …

Whenever you do a protocol just like like what I’d do for a affected person, for instance 4 to 6 hours per week for eight weeks, the frequency of these … the house in between them, actually shrinks and also you get way more signaling to happen …

If all we cared about was the bodily dose, we’d keep at 100% oxygen so long as we presumably may, on the highest strain we may tolerate to get probably the most oxygen absorption. I do not assume that that is the place nearly all of profit exists.

Each time your strain adjustments or your proportion of oxygen adjustments, 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 may create the advantages we’re on the lookout for, greater than the bodily dose of oxygen over time.”

To be taught extra about HBOT basically, be sure you choose up Sonners’ e book, “Oxygen Below Stress: Utilizing Hyperbaric Oxygen to Restore Well being, Cut back Irritation, Reverse Growing older 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, be sure you hearken to the interview in its entirety, or learn by way of the transcript.

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