What is Ozone Therapy & Treatment?

HBOT & Performance

Jay Campbell

Oxygen:

Overlooked and underutilized, Oxygen is the most important nutrient!

We can live for weeks, even months without food, days without water yet only minutes without oxygen. While we all know this fact, the use and importance of oxygen as a nutrient seems to have slipped our consciousness. Maybe because we breath about 23,000x per day we simply take this notion for granted. Well if you are reading this article It is very likely I know a few things about you. I know that health optimization and biohacking must be one of your priorities. I know that you are at least as interested in pushing your bodies level of performance as you are in pushing the boundaries of longevity and I believe if this assumption is correct, you will be amazed at what role oxygen plays in these processes.

Health and adaptation

We have all heard of the concept: Survival of the fittest. When people first hear this concept, many associate fittest with strongest. Fight or flight…. He who can get away fastest or fight the hardest wins. Well it is not that simple. What was actually meant by the term fittest was most able to adapt. The person who can adapt to an ever-changing environment around them is most likely to survive. This means that our health, our performance and ultimately our quality of life is directly related to our ability to teach our body how to adapt to our world. The term hormesis has been used in our circles to describe this phenomenon. Continuous exposure to some degree of stress, enough to create a healing response from the body, ultimately leading us toward improved recovery ad performance but not so much to break us down and hinder those abilities. Almost all our health optimization strategies are based on this premise.

Deficiency and Toxicity

While this is an absolute oversimplification of how our bodies work, I think it helps to understand that the root of virtually all disease and dysfunction can be reduced to toxicity and deficiency. Even more so, that any degree of toxicity or deficiency will limit our ability to adapt. This does not only include foods and vitamins. We can be toxic and deficient in our chemistry ( the things we put in our body i.e. food, vitamins, alcohol, medications etc), but we can also be toxic and deficient with regard to our physical bodies ( what we do with our bodies i.e. exercise, postures, positions, etc) and emotionally as well (what we think about i.e. jealousy, fear, anger etc.) A goal of purity and sufficiency in what we put in our bodies, what we do to our bodies and even in our daily thoughts will all lead to improved health. We are designed to have optimal health and performance in our life. If we are expressing anything less than optimal health we are either toxic (we have too much of something our body needs to get rid of) or we are deficient (we are missing something our body requires to perform optimally) If we view each of our health journeys through this lens, deviations from optimal health become very obvious and a plan we each need to work toward peak performance starts to lay itself out. As you begin to understand the role oxygen plays in our body, we can begin to appreciate its role in helping our body detoxify as well as the massive consequences that arise when we become even mildly let alone moderately oxygen deficient.

Oxygen as a nutrient

A nutrient is: a substance that provides nourishment essential for growth and the maintenance of life. Oxygen absolutely falls into that category! Like all nutrients in our body there are 3 ranges of dosage. The RDA or the minimum amount required before we express obvious disease or dysfunction of deficiency. The optimal range, or the amount required to make sure we are sufficient enough in that ingredient to ensure we have enough for all the complex interactions our body goes through in a given day. Lastly the megadose, Even when we are optimally sufficient there may be period in our life where a much higher dose is recommended or required for helping our body transition though a health challenge. Oxygen can be viewed through this lens. An oxygen deficiency is called hypoxia. Hypoxia can be systemic due to some cardiovascular or respiratory (heart, circulatory or lung) condition where we cannot efficiently absorb or deliver oxygen to our cells. Hypoxia can also be local. Meaning we absorb oxygen well, we can pump and circulate oxygen throughout our entire body but there is a problem delivering oxygen to a certain area, tissue type or organ. This is more common than many people realize. Perhaps a recent or even old injury where the microcirculation (capillary beds) were damaged, maybe an area of chronic inflammation, or a location of scar tissue and fibrosis not allowing normal circulation and therefore proper oxygenation of tissue. In some of these cases the tissue can be hypoxic because very little is getting through. The tissue is alive but functioning poorly. (common in TBI/Concussion as an example) Perhaps some oxygen is getting through enough to function under minimal daily routines but as soon as we increase demand (intense focus and concentration or increased physical demand) we cannot efficient increase oxygen supply and therefore our performance suffers. Like getting the RDA of oxygen but not really getting the optimal range. In other cases we can consistently supply the body with optimal ranges of oxygen and yet we still want to expose ourselves to mega doses periodically. Maybe this is to overcome an injury, or trauma. Maybe this is to help alleviate pain or chronic inflammation from a condition we have and sometimes this is to simply improve our performance capacity and quality of life. It turns out oxygen is a rate limiting step to many of our cells ability to make energy. As we step up our oxygen exposure, we are able to step up our mental and physical capacities for performing tasks. This may all sound great in theory. Increase your oxygen absorption = increase capacity to heal, detoxify, produce energy and perform however there is one major challenge. Based on our physiology and ability to carry oxygen, it is not an easy task to increase oxygen absorption. Generally speaking, without any cardiovascular or respiratory condition, we are all carrying almost all the oxygen we are capable of carrying. Our “optimal” dose of oxygen is 97-100% red blood cell oxygen saturation. Under normal conditions we rely on our red blood cells to carry oxygen to our tissues and cells and as we stand here right now they are almost already completely saturated with oxygen only able to carry 1-3% more at any time. So if we had a mask and a tank of oxygen we can increase our absorption by only a few percent and that is really not enough to make a difference in our health the way we would all want to.

Oxygenation:

There are many tools and techniques which can help us become more oxygen efficient. We can breathe on an oxygen tank for a while, this will help some. We can certainly learn how to breathe more effectively and deeply. We can use breathing techniques like Wim Hof and holotrophic breathing as examples and absolutely improve our tissue’s oxygenation on the cellular level. We can also use tools like EWOT which help to shift the supply and demand equation within our body helping to drive increased oxygen into our tissues. These are all great strategies however, by far, hyperbaric oxygen therapy (HBOT) is the most powerful way to deliver oxygen and change our physiology with regard to oxygenation of our tissues and cells. Pressure and Oxygen The reason we absorb any oxygen at all is due to pressure. Our atmosphere exerts a pressure on our body. We don’t feel it, but at sea level there is a constant 14.7 psi exerted on our bodies all the time. This pressure creates a gradient allowing oxygen to flow from high concentration (our atmosphere) to lower concentration (our lungs). At sea level we expect this pressure to be sufficient enough to oxygenate all of our tissues. At altitude, say 5000 ft above sea level, the pressure of our atmosphere is less and this allows less oxygen absorption than at sea level. Our body “feels” this difference and the result is an increase in red blood cell production. If we have more red blood cells, we can improve our efficiency of carrying oxygen required due to the decrease in pressure. I use the word “Feel” because as it turns out, we have oxygen sensors in our body that can not only detect changes in oxygen concentration but also changes oxygen pressure. There is 21% oxygen in our air no matter what the altitude we are at. The pressure of the atmosphere is what changes. At sea level, the pressure of air is 760mmHg and our oxygen pressure is 159 mmHg. At 8000 ft above sea level the pressure of air is 564 mmHg and the pressure of oxygen is 118 mmHg. That difference in pressure is  what makes the air “thinner” at altitude. It is the same but opposite phenomenon below sea level. As we descend below sea level the pressure increases and therefore the ability to absorb air and oxygen also increases. The deeper you go, the more pressure, the more we can absorb. In a hyperbaric environment, we can control the amount of pressure we exert on a person and the amount of time they are in this pressurized environment and therefore predictably control the amount of increased oxygen absorption they can take into their cells. Once absorbed this “extra” oxygen can be used for making ATP and energy, increasing the capacity for working tissues to perform or increase the capacity of healing and recovery.

Oxygen In Lungs

Oxygen in lungs and tissues are in equilibrium

Oxygen In Lungs

Increased pressure of oxygen in the lungs drive increased diffusion into tissues

Oxygen In Lungs

That Increased diffusion continues until equilibrium is reached again.

Nobel prize in medicine 2019

Three scientists were awarded the Nobel prize in medicine for their discovery of these oxygen sensors. They are called Hypoxic induction factors (HIF’s). These HIF’s are responsible for many of the changes our body goes through as oxygen percentages change as well as oxygen pressures change. It is well documented at this point that over 8100 different epigenetic factors are tied to and influenced by these changing pressures and changing oxygen levels. The moral of the story here is that if we really want to influence our body to improve healing, recovery, performance and quality of life we not only need to manipulate absolute oxygen levels, we need to also manipulate pressures as well, which is where hyperbaric oxygen really fits in. 10 well established benefits of Hyperbaric Oxygen

1. Increased oxygen perfusion- (Immediate increase in free floating oxygen available for tissue use)

2. Neovascularization- Angiogenesis (new blood vessel growth)

3. Increased white blood cell function (improved neutrophil and macrophage activity)

4. Nerve healing factors (increases in VegF, BDNF, HIF1)

5. Wound healing Increased capacity for healing (PDGF, VegF, collagen production circulatory
healing)

6. Stem cell release (up to 8-fold increase in mesenchymal and CNS stem cells)

7. Vasoconstriction (decrease edema and swelling from damaged tissues)

8. Mitochondrial healing (increase in size, shape and number of mitochondria)

9. Anti-inflammatory (reduction of inflammatory cytokines, increase in anti-inflammatory
cytokines)

10. Anti-microbial/microbiome balancing (reduction in anaerobic pathogens and increase in aerobic
probiotics)

O-P-M (Oxygen-Pressure-Minutes)

How many sessions do I need to do? Can I use a soft chamber or do I need a hard chamber? What is the best protocol for health optimization? I get questions like this all the time and there is unfortunately no single or simple answer to any of them. We have 3 variable we can manipulate, oxygen levels we are exposed to, pressure levels we are exposed to and minutes we are under pressure. We can use all three of these variables to create protocols. In some cases where higher pressure would have been great to have, we use higher oxygen levels and more sessions to make up for the loss in pressure. Time is our biggest input here. While there are certain conditions (gangrene, open wounds, osteomyelitis, radiation burns) that require absolute high pressure and high oxygen levels most of us are not using these chamber for those issues. Therefore we can use mild pressures and lower oxygen levels and use longer sessions and more frequent sessions to get the results we are all looking for, especially if we use a soft chamber in our home. Typically we offer people who buy home chambers a consultation to decide what their issues are, what their goals are and therefore what protocol they should use in order to get the most out of their equipment. It is important to us that people who choose this equipment learn how to use it properly, are safe and of course effective in implanting strategies that get them the results they need!

References:
Palzur E, Zaaroor M, Vlodavsky E, et al. Neuroprotective effect of hyperbaric oxygen therapy in brain injury is mediated by preservation of mitochondrial membrane properties. Brain Res., 1221 (2008), pp. 126-133

K.R. Dave, R. Prado, R. Busto, A.P. Raval, W.G. Bradley, D. Torbati, M.A. Pérez-pinzón, Hyperbaric oxygen therapy protects against mitochondrial dysfunction and delays onset of motor neuron disease in wobbler mice, Neuroscience, Volume 120, Issue 1, 2003, Pages 113-120

Gonzales-Portillo B, et al Hyperbaric oxygen therapy: A new look on treating stroke and traumatic brain injury. Brain Circ. 2019 Sep 30;5(3):101-105. doi: 10.4103/bc.bc_31_19

Vadas D, Kalichman L, Hadanny A, et al. Hyperbaric oxygen environment can enhance brain activity and multitasking performance. Front Integr Neurosci. 2017;11:25. Published 2017 Sep 27. doi:10.3389/fnint.2017.00025

Hadanny A, Maliar A, Fishlev G, et al. Reversibility of retinal ischemia due to central retinal artery occlusion by hyperbaric oxygen. Clin Ophthalmol. 2016;11:115–125. Published 2016 Dec 29. doi:10.2147/OPTH.S121307

Tal S, Hadanny A, Sasson E, et al. Hyperbaric oxygen therapy can induce angiogenesis and regeneration of nerve fibers in traumatic brain injury patients. Front Hum Neurosci. 2017;11:508. Published 2017 Oct 19. doi:10.3389/fnhum.2017.00508

Gil-Ortega M, Garidou L, Barreau C, et al. Native adipose stromal cells egress from adipose tissue in vivo: evidence during lymph node activation. Stem Cells. 2013;31:1309–1320

Milovanova TN, Bhopale VM, Sorokina EM, et al. Hyperbaric oxygen stimulates vasculogenic stem cell growth and differentiation in vivo. Journal of Applied Physiology. 2009;106:711–728

Tepper OM, Capla JM, Galiano RD, et al. Adult vasculogenesis occurs through in situ recruitment, proliferation, and tubulization of circulating bone marrow-derived cells. Blood. 2005;105:1068–1077.

Gallagher KA, Liu ZJ, Xiao M, et al. Diabetic impairments in NO-mediated endothelial progenitor cell mobilization and homing are reversed by hyperoxia and SDF-1 alpha. J Clin Invest. 2007;117:1249–1259

Gu GJ, Li YP, Peng ZY, et al. Mechanism of ischemic tolerance induced by hyperbaric oxygen preconditioning involves upregulation of hypoxia-inducible factor-1alpha and erythropoietin in rats. J Appl Physiol. 2008;104:1185–1191

Thom SR, Bhopale VM, Velazquez OC, et al. Stem cell mobilization by hyperbaric oxygen. Am J Physiol Heart Circ Physiol. 2006;290:H1378–H1386.

Xu, Y., Wang, Q., Qu, Z., Yang, J., Zhang, X., & Zhao, Y. (2019). Protective Effect of Hyperbaric Oxygen Therapy on Cognitive Function in Patients with Vascular Dementia. Cell Transplantation, 096368971985354. doi:10.1177/0963689719853540

Dinar S, Agir H, Sen C, et al. Effects of hyperbaric oxygen therapy on fibrovascular ingrowth in porous polyethylene blocks implanted under burn scar tissue: an experimental study. Burns. 2008;34:467–473

Schmidt TM, Kao JY. A little O2 may go a long way in structuring the GI microbiome. Gastroenterology. 2014;147(5):956–959. doi:10.1053/j.gastro.2014.09.025

Thompson CD, Uhelski ML, Wilson JR, et al. Hyperbaric oxygen treatment decreases pain in two nerve injury models. Neurosci. Res., 66 (3) (2010), pp. 279-283

Oyaizu T, Enomoto M, Yamamoto N, et al. Hyperbaric oxygen reduces inflammation, oxygenates injured muscle, and regenerates skeletal muscle via macrophage and satellite cell activation. Sci Rep. 2018;8(1):1288. Published 2018 Jan 22. doi:10.1038/s41598-018-19670-x

Oxygen

The Rate Limiting Compound?

Although our brain makes up less than 2% of our body’s mass it consumes 20-25% of our body’s oxygen intake. Unlike other organs, the brain has no storage capacity for energy, therefore it requires a constant and consistent blood flow for delivery of oxygen, glucose and fatty acids for metabolism.

20-25% is an incredibly high number for 1 organ and this means that our brain is massively energy dependent for proper function!

The next logical question would be, “Is that the correct percentage of oxygen our brain requires for optimal function, or is that just the maximum amount of oxygen the body has to spare and share with and feed the brain.”

In other words, if the brain had access to higher concentrations oxygen, could it function at a higher level? With greater nourishment to the brain, we could potentially heal faster from injury, perform at higher levels and generate greater capacity for neuroplasticity.

Research is now being conducted to try and answer this very question!

Background Information:

Under “normal” healthy circumstances, we are already about 97-99% saturated with oxygen. This means that we are already carrying almost all the oxygen we are capable of carrying.

In fact, we really need to be almost fully saturated with oxygen every minute of every day just to maintain “normal” healthy functions. Testing the question, can the brain increase performance if it had access to higher levels of oxygen?, has been generally overlooked since it is not easy to find ways of getting the body to absorb more than 100% oxygen saturation. One of the only ways to do this is through Hyperbaric Oxygen Therapy (HBOT). In a hyperbaric environment, we are able to absorb more oxygen because we can bypass the normal red blood cell carrying capacity all together. This lets us to absorb oxygen directly into the plasma of our blood and into our tissues, allowing us to access extraordinary amounts of “extra” oxygen. Depending on the amounts of pressure and oxygen being used along with manipulating the frequency and duration of treatments we are able to increase oxygen absorption well beyond the 100% carrying capacity of the red blood cells. It is possible to see anywhere from 15%-60% more absorption of oxygen in a hyperbaric environment.

By performing pre and post testing of multitasking and dual tasking activities, the research has proven beyond any shadow of a doubt that if our brains had access to higher levels of oxygen, they would be capable of higher and more complex processing of information and performance.

As a result of exposure to higher levels of oxygen following the HBOT treatments the subjects all demonstrated increases in their performance and capacity scores. This has obvious implications in improving performance as well as improving neuroplasticity healing and growth.

Dor Vadas1*, Leonid Kalichman2, Amir Hadanny3,4,5 and Shai Efrati3,4,6 (2017) Hyperbaric Oxygen Environment Can Enhance Brain Activity and Multitasking Performance Front. Integr. Neurosci., 27 September 2017 | https://doi.org/10.3389/fnint.2017.00025

Choi, M. H., Kim, J. H., Kim, H. J., Choi, J. S., Yi Jeong, H., and Chung, S. C. (2013). Correlation between cognitive ability measured by response time of 1 back task and changes of SpO 2  by supplying three different levels of oxygen in the elderly. Gerontology 13, 384–387. doi: 10.1111/j.1447-
0594.2012.00911.x

Boussi-Gross, R., Golan, H., Volkov, O., Bechor, Y., Hooflen, D., Schnaider Beeri, M., et al. (2015). Improvement of memory impairments in poststroke patients by hyperbaric oxygen therapy. Am. Psychol. Assoc. 29, 610–621. doi: 10.1037/neu0000149

Incorporating Hyperbaric Oxygen Therapy into a Functional Medicine Practice

by Drs. Jason and Melissa Sonners

Background:

Humans have very few absolute requirements for life; food, water, and oxygen. Well, especially in this group of people, we understand that we can go weeks (even months) without food, but we can only live a few days without water ultimately only a few minutes without oxygen. Proper oxygen levels is something our body literally needs every minute of everyday just to perform “normal” functions. If we look at oxygen through this lens, we begin to understand the role of oxygen not only as a gas, but as an essential nutrient. Like any other nutrient our body needs, there are times we may become deficient and this deficiency has consequences. Likewise, there may be times we want or need to get more the typical daily amount of oxygen required in order to help our body heal. The same way we might take “extra” vitamin C if we were getting a cold, there are time we would want “extra” oxygen to improve our ability to heal.

“Normal Oxygenation” 

Under normal circumstances, oxygen is transported throughout the body only by red blood cells. Assuming no cardiovascular or respiratory diseases, we are already carrying just about all the oxygen we are capable of carrying. Most of us are already between 96-99% saturated with oxygen. That said, learning how to maximize the remaining 1-4% of oxygen saturation can be very meaningful for optimizing function. Beyond that developing tools, techniques or other method of improving the rate and efficiency we oxygenate can have a powerful impact on our over health. Training at altitude (a legal strategy) and blood doping (not legal) are two techniques athletes have used to improve their oxygenation because they understand the massive benefits on performance, recovery and healing when we have access to increased oxygen!

Methods for Improving Oxygenation

Breathing techniques

We are designed to take in long, slow belly breaths using our diaphragm. If you ever watched a newborn breath, you’ll know what I’m talking about. Many of us however, live over-stressed lives. As a result, and without realizing it, many of us take very shallow chest breaths all day long.

This does 2 things:

1. Limits the amount of air and oxygen we are able to get into our lungs
2. Perpetuates the fight or flight bio-chemistry of the stress response.

Learning powerful breathing techniques (Fulford Breathing, Wim Hof Technique, even simple belly breathing techniques) will help to reduce the stress response so many of us deal everyday and equally important will maximize your lung capacity and oxygen absorption with each breath you take.

Pros: decreased stress response, improved relaxation, improved lung capacity, improved oxygenation

Cons: NONE

Exercise With Oxygen Therapy (EWOT)

The concept here is to improve oxygenation through increasing both oxygen demand and oxygen supply.

Demand

In this technique we are increasing demand through exercise. As we exercise our heart rate and breathing rate will both increase. The main reason for this change in rate is to increase the quantity of oxygen delivery to the working muscles supplying them with the fuel they need to keep moving.

Supply

As far as supply goes, we are using oxygen concentrators rather than ambient air as the oxygen source. Air is 21% oxygen which typically does supply us with enough oxygen for daily life but breathing through an oxygen concentrator we can breath 97% oxygen thereby increasing supply. The overall process here is that we create an increased oxygen demand through heavy exercise, usually through a bike, and then we massively increase the oxygen supply by breathing much higher levels of oxygen throughout the duration of that exercise session. This increases the saturation, the rate and amount of oxygen that our red blood cells can deliver to the working tissue helping to create an oxygen surplus.

Pros: Increased oxygen turn over, increased oxygen delivery, increased oxygen saturation.

Cons: Need to be able to exercise at a level meaningful to create the demand which depends on your health and ability or that of your patients. Also still relies on red blood cell carrying capacity Oxygen Deprivation Tents/Masks The theory here is similar to training at altitude. When we are exposed to low oxygen environments (like altitude) our body senses suboptimal oxygen levels and mild hypoxia. The response to that is an increase in red blood cell production. More red blood cells equal more oxygen carriers.

Pros: Increased red blood cell quantity which will increase the amount of oxygen able to be carried.

Cons: In order for this system to work the body needs to be in this low oxygen environment very consistently and for many hours each day. Also the amount of increased red blood cells is dependent on the amount of time spent in the oxygen deprived environment.

Hyperbaric Oxygen Therapy (HBOT)?

HBOT is a treatment which enhances the body’s natural healing process by inhalation of oxygen in a pressurized environment. Breathing in a pressurized environment allows our body to absorb more oxygen than any other tool on the market. Hyperbaric oxygen therapy (HBOT) is rapidly growing in popularity as a natural treatment used to help a large variety of conditions, usually as a part of a functional medicine care plan.

Pros: Very high increase in oxygen absorption, well beyond red blood cell carrying capacity. Passive therapy, almost anyone can receive this therapy

Cons: Sessions can be long, 30-90 minutes depending on patient needs.

How Does HBOT work?

With HBOT, oxygen is dissolved into all of the body’s fluids, the plasma, the central nervous system fluids, the lymph, and the bone and can be carried to areas where circulation is diminished or blocked. Breathing oxygen under pressure (depending on the amount of pressure and duration of the treatment) we can absorb not the 1-3% as mentioned above but actually between 20-60% more oxygen. In this way, extra oxygen can reach all of the damaged tissues and the body can support its own healing process.

The increased oxygen greatly enhances the ability of white blood cells to kill bacteria, reduces swelling and inflammation, allows new blood vessels to grow more rapidly into the affected areas, improves oxygenation of poor blood flow areas like joints, ligaments and spinal discs, stimulates neuroplasticity, improves cognition, aids detoxification, increases mitochondrial efficiency and density making more ATP production possible, and so much more.  It is a simple, non-invasive and painless treatment with incredible results. It has long been known that proper healing of the body cannot take place without appropriate oxygen levels in the tissue.  Most illnesses and injuries occur, and often linger, at the cellular or tissue level due to the microcirculation damage associated with the damage.  Even in traditional medicine HBOT is used to help heal in really tough cases of anaerobic infections like Gangrene and osteomyelitis, non-healing wounds and radiation burns, diabetic neuropathy osteonecrosis. In all of these cases, circulatory damage, chronic inflammation and infection are preventing the body’s ability to heal because adequate oxygen cannot reach the damaged area.  Even in these very difficult to treat, often life-threatening cases hyperbaric oxygen therapy provides these patients with the extra oxygen they need to heal naturally and with minimal, often no side effects.

What are we using HBOT for in our offices?

For the same way HBOT helps with these acute, complex and difficult cases, it helps the exact same way with less intense but more chronic conditions. The mechanisms of inflammation, circulatory damage and often immune dysregulation exist in most of our chronic diseases as well. We have been successfully treating patients with hyperbaric oxygen therapy for more than a decade, focusing primarily on conditions such as:

Autism
Cerebral palsy
Chronic fatigue
Fibromyalgia
Crohn’s/Colitis
Dementia/Alzheimer’s
Lyme Disease
Multiple Sclerosis/ALS
Post-surgical care and healing
Post-stroke
TBI/concussion

And many more…

For More on HBOT…Check out this video!

Our company, HBOT USA, works to bring hyperbaric oxygen therapy to the widest possible audience. We are committed to education and implementation strategies for clinics wanting to utilize hyperbaric therapy as well as improving access for patients in need of this modality. We rent and sell chambers to patients for in-home use and to providers for use in their clinics. In addition, we offer programs to help providers build and run HBOT facilities. We’re happy to answer any questions about hyperbaric oxygen therapy in general as well as the specifics of how to run a successful HBOT practice.

Drs. Jason and Melissa Sonners are co-owners of HBOT USA.