HBOT- Rejuvenation & Healthspan Optimisation using Hyperbaric Oxygen Therapy?
HBOT- rejuvenation & Healthspan Optimisation using Hyperbaric Oxygen Therapy? Is it the only current rejuvenation therapy that actually works?
31 August 2021
Is Hyperbaric Oxygen Therapy (“HBOT”) the only therapy existing today where you can partially rejuvenate yourself at almost any age using a specific protocol of HBOT? (beyond rejuvenation or slowing of aging occurring from notably boosting or improving your exercise, sleep, diet, and emotional balance?)
HBOT can be used primarily for one or more of three reasons:
- Wound healing (eg from a stroke, or diabetic ulcers etc)
- Function improvement (eg brain function improvement)
- Energy (to boost energy)
Headline key effects for many after months of almost continuous treatment can be:
- 10 to 15 times increase in oxygen in your plasma during treatment repeatedly provides deeper oxygenation of many parts of your body
- increase in stem cells by 3 to 8 times, so possible repair of underperforming tissues or organs
- new blood vessels grown- ie angiogenesis
that underpins the 3 reasons for undertaking a program of HBOT.
Note that this is not medical advice and anyone seeking treatment for something needs to consult with their licenced medical professional.
This note reviews HBOT, what it can do for you, rejuvenation, various players, potential risks and the potential etc in the following sections:
1) What is HBOT?
2) How does HBOT work?
3) What is rejuvenation and how can it be measured?
4) What can HBOT do for you - does it really work?
5) Where can you get it done, and what protocol?
6) What is the difference between different HBOT centers, (and why can it matter which center you use)?
7) What are the risks versus the rewards?
1) What is HBOT?
First, we should ask three questions before doing anything medical ie HBOT, (effectively a drug) in this case:
1) If one does HBOT, how high is the probability of harm? (and how bad..?)
2) If you do HBOT, what is the probability of benefit? (and how good?)
3) What is the opportunity cost of doing HBOT?
So I will seek to answer these questions in this note. But first some headline stuff:
Air we breathe at sea level is generally about 21% oxygen, and circa 78% nitrogen, at a pressure of 14.7 pounds per square inch, or 1 ATA (Atmosphere Absolute). As you go to higher altitudes the pressure decreases, (12.2 psi at 5,000 feet, 10.1 psi at 10,000 feet, 4.36 psi at close to the height of Mount Everest). If you scuba dive the pressure increases. Each atmosphere when diving is equivalent to 33 feet / c. 10 metres deep underwater. If you are scuba diving, at Two atmospheres (1 ATM of air and 1 ATM of water), 33 feet / c. 10 metres deep underwater, your lungs shrink to 1/2 of their size at sea level, and air pressure is 29.4 PSIA (A= absolute). At 66 feet deep, 20 metres, 3 atmospheres, 44 PSIA, lungs shrink to 1/3 of their size. (That’s why ascending rapidly to the surface when scuba diving without expelling air can be extremely dangerous.)
HBOT simulates you diving to these depths, but instead of breathing 21% oxygen you hop in to a HBOT chamber and are breathing 100% oxygen, -ideally through a mask, for safety reasons - and the air is pressurised, likely to some 2 ATA. You then stay at this depth for maybe 1 to 2 hours, and probably cycle through 100% oxygen and 2 ATA down to 21% oxygen and 2 ATA, with these “air-breaks” for, in some protocols, for perhaps 5 minutes or so, every 20 minutes or so. Some HBOT chambers can go up to 3 ATA, but the higher the level above 2ATA the higher the risk of some negative effects.
2) How does HBOT work?
HBOT hugely boosts oxygen within the whole body. The process increases oxygen levels in the body to 10 to 15 times higher than normal. This oxygen then penetrates deeper in to tissues and organs than would otherwise happen, repeatedly - from a series of treatments- providjng parts of the body with much more oxygen
Assuming you do not have health issues, then your sea level oxygen saturation in your blood is likely to be 95% to 100%. As you breathe air then the oxygen is placed on a protein called haemoglobin in the red blood cells which then carries the oxygen around your body, and from the blood circulation is sent to the tissues of the body, where it is utilized mainly within the mitochondria- the energy powerhouses of cells (explains the energy boosting effect for many). Under normal conditions in human circulation, each milliliter of blood carries about 0.2 ml of oxygen. In arterial blood, about 98% of this oxygen is reversibly bound to this hemoglobin protein, and the remaining oxygen is in a free form, dissolved in both blood plasma and in the hemoglobin solution inside the red blood cells. The blood plasma makes up over half of the blood volume, and HBOT can take the oxygen in the plasma to approaching 100%.
As the usual oxygen transport mechanism- your blood cells carries almost maximum oxygen, then HBOT saturates the plasma with oxygen, also carrying it around the body. The extra oxygen reaches all around the body.
When you take an air-break for maybe 5 minutes after 20 minutes at 100% oxygen i.e. 100% oxygen plunges to 21%, (but still pressurized) your body senses a rapid change (it appears to measure change / fluctuation, as opposed to absolute values), and thinks it has a big problem and hypoxic ie lacking in oxygen (even though you are now just at normal oxygen levels) and races to send out the emergency and repair crew, such as stem cells. Certain levels of exercise may have a similar effect, and perhaps can be called “hormesis”, where the body realises it has to improve something and sends out the body’s repair and construction teams to fix things and build them up stronger for the next time the same “ issue” occurs. Eg building muscle, you stress it, the body builds it back bigger and stronger…
Hence, HBOT produces rejuvenation, building and repair. The necessary dosages are discussed below.
As people age, they will tell you and you can observe that issues / wounds take a lot longer to heal. This is mainly because you use up your stem cells bank and they become more tired, less effective, and slow down with age. The body does not distribute the stem cells as readily for two reasons
1) the density of capillaries (blood vessels)- the home of Mesenchymal Stem Cells (MSCs) throughout the body diminishes and
2) the division rate of the stem cells slows considerably. Simply going from a stem cell doubling time of 24 hours to 72 hours can make a 90 day difference in the amount of time required to reach the critical mass of cells required to heal a wound.
Stem cells replication rate: As an example, MSCs from a new born will divide approximately every 24 hours; from a 35 year old every 48 hours, and from a 65 year old, every 60 hours. So one stem cell would be 1 billion cells at 30 days for the new born, 32,000 for the 35 year old, and 200 for the 65 year old. If you body needed 10,000 stem cells to heal something, you would be in trouble if you only produced 200 cells…
Time, lifestyle and genetics effect the overall number of stem cells in the body. Some people are born – good genes? - with a lot of stem cells and manufacture a lot, others not nearly as much. So the same lifestyle and environment for different people may have very different health outcomes. With research and advances being made in using other peoples stem cells (“Allogenic”) hopefully in the not too distant future one will be able to buy “top ups” to your stem cell bank to repair various injuries, and rejuvenate oneself.
HBOT boosts stem cells by 3 to 8 times… so notably increases repairs and rejuvenates the body.
Also, in normal conditions, the oxygen level in our arteries is 100mm Hg. Increasing the pressure at 2 ATA, the oxygen level in our arteries becomes 1400 mm Hg, an increase of 14 times than normal conditions. Some view this as anti-inflammatory.
For more info see some videos:
3) What is rejuvenation and how can it be measured?
Rejuvenation can be defined as an action or process of giving new energy or vigour to something, or restoring younger appearance to something, so physical and / or cosmetic. It may not only delay aging but actually revert it, leading to a younger cell, tissue, or body. Rejuvenation could erase age-accumulated damage and aging hallmarks collected during one's life. Some organs can be replaced eg heart transplant for a younger and better working heart, but these are of such a dramatic nature, that other processes are impacted, so I currently consider that HBOT is a more natural and less invasive approach to rejuvenation.
So if HBOT can give new energy to people, make them look younger or even better, make certain cells actually become younger, then it can be said to be rejuvenating. It appears that under some current measures of aging (and aging being synonymous with decline in function) then HBOT is demonstrating a rejuvenating effect, the extent of which varies by individual, and can vary by organ. I set out some initial evidence, often based on studies on people, in this note.
We all age, some of us much faster or slower than others, and different parts of our body can age at different speeds from other parts of our body. If one drinks a bottle of vodka a day, then rapidly the liver becomes damaged, and then the brain and other organs, but your muscles might be ok, so the liver and brain will be aging much faster and likely have an older biological age than your chronological age, and you will likely die much younger than others, not to mention the wide range of health problems you will encounter.
Aside from subjective views where people feel they have a lot more energy, feel a lot better or sharper mentally, or people say they look younger, there are many “biological age” clocks available, and emerging, and databases being built up to compare you to others and to state that you are a biologically younger, or older, person than your chronological age. There are over one dozen such clocks, all taking different approaches and with their strengths and weaknesses, and some cameras with programs that measure skin age etc. However some of them have such a wide spread of “variance” eg your age, plus or minus 5 years, that one can doubt their current reliability or usefulness. However this area is constantly improving, and accurate clocks are sorely needed to check if rejuvenation therapeutics are actually working, as one cannot try a therapeutic and wait 50 years to see if it works!
You can have your telomeres read and check your “biological age eg How TeloYears Genetic Age Testing Works | TeloYears™ Many now question the utility of such a measure, but many believe that activities that increase the length of your telomeres will lengthen your life and healthspan.
It is interesting to note that studies and scientific papers from Aviv Scientific / Aviv Clinics scientists showing that HBOT can notably extend telomere length. Some telomeres increased by more than 20% in length, while senescent cells decreased in number by as much as 37 percent. Whilst the science is still ongoing here, the current view is that a reduction of senescent cells of this magnitude could only be very beneficial for overall health, and therefore extension of healthspan.
Or you can use another clock to measure biological age, such as the Levine and Horvath clocks (DNA methylation / epigenetic age) , or Glycanage, Grimage, Immunoage, or look at the proteome. They are pretty good predictors of future health.
If you believe that such clocks provide meaningful insights in to your health, then it would seem worthwhile for some to undertake activities and measure your “progress” due to lifestyle changes ie are you becoming younger and rejuvenating due to the protocol you are following?
But one of the key repair mechanisms in the body are stem cells- they go to where there is a problem and help fix it, and HBOT boost stem cells by 3 to 8 times… so repairs and rejuvenates the body. (See the prior section for more comment on stem cells). If you have a damaged organ then that will likely shorten your life, and healthspan, so fixing it, by definition, extends your healthspan.
4) What can HBOT do for you - in addition to the approved 14 medical indications - does it really work?
Would you like to:
- Have more energy during the day, and be able to exercise more
- sleep better with the right kind and amount of sleep
- be stronger
- think more clearly and be mentally sharper with better focus and concentration
- look younger
- defer general aging conditions, like cardiovascular disease, neurodegeneration etc
If you answer yes to any of the above, then HBOT may be for you. But the effect on each person can be different.
The science behind this is referenced in the appendices, or see Science of aging (aviv-clinics.com).
It really works, for some ailments. There are 14 FDA approved indications (health issues) in the USA that HBOT can be used for, and many other ailments use HBOT “off-label” ie not officially approved by the FDA. 73 indications are approved in Russia, and some 60 in China.
The 14 FDA approved indications include areas such Decompression sickness- where divers that stayed too deep for too long so ascended too quickly, and got “the bends” are treated (the original reason for HBOT chambers)(the “bends” was because they bent down in agony- due to excess nitrogen in the body); carbon monoxide poisoning , gas gangrene, radiation poisoning, burns, enhancement of healing of diabetic wounds, and a number of other wound healing applications. See Wikipedia for the more detailed longer list.
There are many “off label” indications that are suggested or claimed for that HBOT can treat. Many centers also suggest that HBOT can be used for:
· Stroke- post stroke recovery / restoration of function
· Cognitive improvement; Stimulation of axonal regeneration (brain)
· Remove the sensation of brain fog and jet lag
· Age-related cognitive and functional decline / restore cognitive function / dementia
· Treat cancer patients suffering from chemotherapy side effects- it can decrease the effects of radiation and chemotherapy (some take it before radiation therapy)
· Stimulation of collagen synthesis (good for cosmetic enhancement / beauty..?)
· Reactivate skin cells and improve blood circulation
· Angiogenesis- (making new blood vessels)
· Stem cell stimulation
· Post Traumatic Stress Disorder (PTSD)
· Stimulate the natural healing process and immunity
· Boost vitality, heighten concentration and memory
· Reduce fatigue and improve energy levels, stamina and endurance
· Improve cell rejuvenation
· Multiple sclerosis
· Rheumatoid Arthritis
· Poor eyesight
Robust scientific evidence still needs to be built for this, but for some people that engage in a series of HBOT sessions, they report positive results in the above. Others do not recognise an effect. It will all depend on the individual, their ailment / objectives, and the HBOT and other protocols they follow.
5) Where can you get it done and who and what program should you choose; what dosage, frequency and timing is best?
There are numerous HBOT chambers / centers around the world, or you can buy your own chamber (low ATA ie under 1.4 ATA) for use at home (you might get one for <$10k, then pay for oxygen and electricity). Google will direct you to available centers.
The program you choose will depend on what you are trying to achieve. A number of decisions need to be made- how deep- 1.3 or 1.5 or 2.0, 2.5 or 3 ATA; how long- 30, 60, 90, 120 minutes; how often- once or twice a day, 5 or 7 days a week, for how many weeks or sessions- 4 weeks, 8 or 12 weeks, 10, 20, 30, 40, 60 sessions, and so on.
In London, UK, it can cost £150 per 75 minute session at 2 ATA. Eg see How Much Does Oxygen Therapy Cost? | HBOT Pricing & Package (myoxygenclinic.com)
Some believe that after 25 to 40 treatments, the body’s tissues can be permanently changed.
Others believe that 60 sessions are needed. It will likely depend on your objectives and your condition.
6) What is the difference between different centers, (and why it can matter which center you use)?
The chambers ie pressurized rooms / tubes, that you can have HBOT in include single place or multi place, or “soft shelled” (up to c. 1.4 ATA); or hard shelled (up to 3 ATA) and multi-place- perhaps up to 30 seats. If you have above 1.4 ATA you will need a full time operator, ideally for safety reasons, especially if there are problems eg epiletic fit, power failure etc. And making sure you comply with safety protocols eg nothing that can cause a spark, as high oxygen levels can rapidly drive a highly flammable situation to develop.
- Single chamber versus multiplace chambers…
If you are doing many HBOT sessions then undertaking them in a multi-place chamber could be a much more pleasant and enjoyable experience, as when there are the 5 minute air-breaks every 20 minutes or so, when you take your pure oxygen mask off for the 5 minutes you can talk with other participants in the chamber, or stretch etc, making the whole experience somewhat of a social event and allowing the passing of the time much more quickly and pleasantly. Some multi-place chambers also have computer screens to allow focus on ipad type activities, brain training etc. And sitting in a multiplace will likely be less claustrophobic than laying in the single place chamber.
There are many single person chambers in cities all over the world, LA, San Francisco, New York, London etc. EG: NUMA - Hyperbaric Oxygen Therapy Centre in London (numaoxygen.com)
However one needs to check that
1) they are supplying 100% medical grade oxygen via a mask (otherwise dangerous or possible less effective), and
2) the operator is skilled, to ensure complete safety, and
3) they have done the proper medical checks to ensure that you are not one of the small number of high at risk patients if you do HBOT; and
4) their protocol of sessions and air-breaks and session length is properly matched to your objectives or condition.
Home use chambers- eg soft walled one, or hard ones, generally are under 1.4 ATA, and some only use oxygen concentrators, so not medical grade oxygen at 100%. Some use a mask with which to breathe through, others saturate the chamber with 100% oxygen- which has a fire risk- if there is a spark in 100% oxygen filled chamber, one can burn to death as oxygen boosts the flammability of an environment. And the higher the pressure and if you get the air-breaks wrong, then health issues can occur, such as an epileptic fit. Hence operators always in attendance and trained to deal with issues is important for safety. Ideally the operator will be in the chamber with you, so large multi seat chambers are needed. It is not clear how therapeutcis a 1.4 ATA chamber will be.
- Different countries
Different countries approve different treatments, where the USA is different to Russia and different to China, two large users of HBOT as a therapeutic.
The primary differences are what you are looking to achieve and what is approved in the country you are seeking HBOT. For simplicity comments made herein are primarily focussed on the USA. Many hospitals have centers, and their websites will tell you what they offer and treat, eg Mayo Clinic, John Hopkins etc. The largest center in the world, doing scientific research, is the Sagol center in Tel Aviv. The Sagol Center for Hyperbaric Medicine and Research (shamir.org), where much research is being undertaken.
In Russia, there are over 1,200 HBOT providers and organisations, - The Moscow hyperbaric Center has about 80 oxygen chambers- and 73 approved indications. See Medical Equipment Manufacturer : Khrunichev Medical Plant (zavodmt.ru) They state that they know that HBOT allows restoring of self-regulatory systems balance inside the human body. In Moscow HBOT is used for treatment of inflammation, virus diseases, rehabilitation after brain strokes, and vascular diseases.
In China, there are 12 emergency indications approved, and 48 non emergency indications approved by the CMA (Chinese Medical Association), including strokes, heart attacks, benign brain tumour surgery, periodontal diseases; viral encephalitis; spinal cord injury, ulcerative colitis; frostbite; plastic surgery; multiple sclerosis; bronchial asthma; and acute respiratory distress syndrome. However, contraindications are relatively limited.
If you want to hear /read the experiences of a renowned and hugely accomplished neurosurgeon, 81 years old, Dr Joe Maroon, that still competes in triathlons, and is very cognitively sharp, see his website where he recounted his 60 HBOT sessions at the Aviv Clinics under their specific protocol. He is a fan.
7) What are the risks versus rewards?
So how high is the probability of harm?
Based on what is currently known, the risks seem minimal, so quite a low probability of harm, where there are few side effects and contraindications, and most are minor, however some people might experience inner ear trauma / barotrauma, etc, and if you do not use an appropriate HBOT protocol or if the medical personnel checking you before allowing HBOT sessions do not do adequate checks then the risks may increase. For further details on safety see: Safety of Hyperbaric Oxygen Treatment (aviv-clinics.com).
Air-breaks are needed -probably every 20 minutes or so minutes, depending on the pressure level eg 2ATA or 2.5 ATA, to avoid oxygen toxicity or pulmonary effects from longer term use.
However there does not appear to be long term studies- say 10 to 20 years later- available for extended HBOT sessions eg >60 sessions at 2.0ATA or higher, although initial safety reviews point to no apparent risks at this time. Some people have done over 700 “dives” and exhibit no signs of adverse effects even over 20 years later. So anecdotally it appears low or without risk, but I am not aware of any formal studies to confirm this.
If procedures are correctly followed, fire risks are almost non existent.
A big question , at least for the author, is are you bringing forward anything that your body might need later in life and thereby shortening your quality of life, or lifespan? So, for example, if you trigger the use of many stem cells now with HBOT sessions, will you have less stem cells to address future problems… But as stem cells degrade with age, it seems that fixing any ailment now might require less stem cells, that will be more efficacious, so probably on balance a good idea.
Cancer risk?: On cancer, given that HBOT is said to create/ require angiogenesis ie the growth of new blood vessels to feed the tumour, there was concern that HBOT could help a tumour grow. A 2012 report disputed this view, “Hyperbaric Oxygen therapy and Cancer”, Moen, 2012, and offers deeper reasons why there is no evidence of increased cancer risks, in the paper.
Angiogenesis is today proposed to be a key factor for cancer growth and metastasis. However cancer cells are often hypoxic, and HBOT makes the cells hyperoxic; see the above paper for more detail.
Should there a problem, some chambers take circa 8 minutes for slow depressurisation from 1.5 ATA. Depressurisation with the emergency stop can be 40 seconds in some chambers. Soft chambers (under 1.5 ATA) can risk Co2 poisoning if there is a power failure. More faqs from a chamber supplier can be seen on FAQ's - OxyHelp.
Dr Willam Maxfield, co-founder of the American Board of Hyperbaric Medicine states that if you overdo HBOT treatments, you can plateau and start to revert back to where you were in the beginning.
So what is the probability of benefit?
For many, especially those with a certain pathology eg stroke, or non healing wounds, there is a high probability of large benefits.
The rewards are fixing many health problems.. and probably lengthening your healthspan.
For example, in brain injury, and stroke; many blood capillaries around the area of cell death become torn. The blood plasma then leaks out causing swelling in the surrounding brain tissue, squeezing it like a sponge and so reducing blood flow and therefore nutritional supply. Without this essential nutrition, the brain's electrical activity becomes diminished and signals can not be effectively rerouted. Unfortunately the tiny tubules leading to the capillaries also become so constricted that the red blood cells can not get through to heal the torn capillary walls; HBOT alleviates this.
What is the opportunity cost of HBOT?
Ie what else could we be doing instead of HBOT? A 60 session protocol takes some 3 months, and can cost in the tens of thousands of dollars, so the time and cost commitment is non negligible. However if you are seeking to remedy a pathology / health issue it may be easily justifiable to do HBOT versus other techniques that do not work. For general health and rejuvenation the commitment may well be worth it, but that is a very individual decision. For some, lacking the ability or desire to boost exercise, sleep, or change their diet or lifestyle, HBOT may be a good approach.
On balance it seems that for a large number of people, a longer group of correctly administered HBOT sessions- perhaps 60 in 3 months, could have substantial rejuvenation benefits, with little current known downside for most people. A key consideration however is to ensure that you are properly reviewed by qualified medical professionals before you begin HBOT treatment just in case you are in the small group of people that risk having negative consequences of your treatment. However there is increasing evidence that HBOT could be rejuvenating for many and treat an ever increasing list of ailments one accumulates as one ages. However more correctly run science based research is needed to soundly establish the benefits and longer term risks of different HBOT treatment regimes.
So, for effective possible rejuvenation (or treatment)
- Choose the right center and protocol- could be a multi-place chamber (see Aviv clinics)
- Stick to the full protocol (the right dose, frequency and timing is important)
- Consider taking baselines -before, then during and after, to check effect (Objective measures)
- Have top-ups every few months to extend effects for you
And for the avoidance of doubt, as previously stated, this is not medical advice and anyone seeking treatment for something needs to consult with their licenced medical professional.
1. NOAA- The Physics of Diving (National Oceanic and Atmospheric Administration, USA)
2. The theory of oxygen transportation to the cells. 1989. Papers author: Popel, John Hopkins University.
3. Modelling of oxygen diffusion from blood vessels to intracellular organelles. Popel, 2003
4. The Oxygen Cure, William Maxfield, MD, 2017
5. The Oxygen Revolution, Paul Harch, 2016
6. The anti-inflammatory Oxygen Therapy, Dr Mark Sircus, 2015
7. The Oxygen Advantage, Patrick McKeown, 2015
8. Stem Cell therapy, a rising tide. Neil Riordan, 2017
9. Endless websites-HBOT clinics at Hospitals etc, and Aviv-Clinics and Sagol Center, and internet articles