A Physician Spills His Insider Secrets On How To Use HBOT Properly To Accelerate & Optimize Healing, Performance, and Recovery.
What is Hyperbaric Oxygen Therapy (HBOT)?
HBOT is simply the combination of increased inspired oxygen and increased atmospheric pressure, typically in some kind of chamber (often a “hard-shell” or “soft-shell” chamber).
Let’s talk about oxygen first.
If you are at sea level, there is 21% oxygen in the air. The rest of the air is mostly nitrogen, and in cities, there are also pollutant gasses including carbon monoxide. Oxygen is kind of a big deal. Without it, you would not be able to make ATP, your cellular energy currency. ATP is made in the mitochondria when oxygen accepts an electron from the electron transport chain, forming water in the process. Without oxygen, ATP stores drop quickly. Degeneration and death are not far behind.
Red blood cells (RBC) are the cells that carry oxygen throughout the body. Each RBC has four hemoglobin molecules which can bind one oxygen (02) each from the air we breathe. In people with normal lungs, 97-100% of these hemoglobin sites are easily bound as RBCs pass through the lungs. Have you ever used a pulse oximeter to check your oxygen levels? The measurement you receive is the percentage of hemoglobin sites bound with oxygen in arterial blood. As you will learn in a minute, a pulse oximeter is not at all a good indicator of the power or effectiveness of HBOT.
The ability of your body to carry oxygen where it’s needed is called oxygen-carrying capacity. Most of us know about this in terms of endurance and strength training—but even more essential, if oxygen-carrying capacity is compromised, you can’t make enough energy and this can lead to fatigue, brain fog, cold extremities, chronic infections, more severe acute infections, and a host of other issues.
There are two ways to increase oxygen-carrying capacity:
1. Increase the number of RBCs in circulation. The more RBCs, the more hemoglobin sites to bind oxygen. The legal way to do this is by altitude training or simulating altitude in a HYPObaric environment, putting the body under hypoxic conditions that stimulate the natural hormone erythropoietin to be released to make more RBCs. The illegal way to improve oxygen-carrying capacity is via blood autotransfusion or exogenous erythropoietin administration. Remember Lance Armstrong? Blood doping = Exogenous erythropoietin!
2. Diffuse more oxygen into the plasma or the liquid of the blood as unbound liquid 02. This is how HBOT works, but you need pressure to do it.
So let’s dive into pressure.
Sea level pressure is defined as 1 ATA (atmosphere absolute). The deeper you dive beneath the surface of the sea, the more pressure that is created because water is very heavy. You can simulate this heaviness in a hyperbaric chamber and take advantage of Henry’s Law, a physics law that states that the more pressure that is exerted on a gas, the more that gas will go from gaseous to liquid form.
In a hyperbaric chamber, as inspired oxygen concentration is increased and combined with increased atmospheric pressure, 1200% or more oxygen can be driven into circulation. If there are any unbound hemoglobin sites on RBCs, these will be bound first but far and away, the power of HBOT is its ability to infuse massive amounts of unbound liquid oxygen directly into the plasma or liquid of your blood. The plasma has very little oxygen in it at sea level but it has massive oxygen-carrying potential. The only way to infuse it with oxygen is by increasing atmospheric pressure.
Remember that pulse oximeter I mentioned earlier? It measures hemoglobin oxygen saturation, which in a chamber will rise to 100%, but it has no way of quantifying how much unbound liquid oxygen is in circulation. As a result, a pulse oximeter is a very poor measure of HBOT power/potential. There are currently some invasive ways of measuring full arterial oxygen saturation, but noninvasive tech is coming soon!
Here’s a cool example to illustrate the power of HBOT: At 3 ATA, the equivalent of 66 feet of seawater, and 100% inspired oxygen, so much oxygen can be infused into the plasma that RBCs are no longer needed to maintain physiologic function. This is used therapeutically for patients with severe anemia (blood loss) and is also used for those of the Jehovah’s Witness religion who decline blood transfusion for religious reasons.
The HBOT Chamber Experience :
Imagine that you are diving underneath the sea, except you aren’t diving and there is no sea. This is how it feels to be in an HBOT chamber.
As you descend to your prescribed depth, you’ll feel an ear-popping sensation just like you would experience on a plane or a train. Of course, if you’ve ever been scuba diving, it’ll feel like that too.
Depending on your comfort with pressure changes, you’ll get to prescribed depth in 5 to 15 minutes. Once you’re there, no further ear equalization is required.
In most hard chambers, nothing is allowed inside the chamber with you except, as we like to say, “what your mama gave you” due to the potential flammability of oxygen at deeper pressures. There are some exceptions to this, especially if the chambers are pressurized with air as opposed to oxygen. At the clinics I work with directly, all patients change into cotton scrubs prior to treatment. We typically make the following exceptions to the “what your mamma gave you” rule as well:
* You can bring in your glasses or wear your contacts (as long as they are soft contacts).
* You can wear your undergarments as long as they are 100% cotton and don’t contain wire frames or other metals. I’m talking to you, Ben!
* If you’re circumcised, we let you in too. We know this wasn’t your choice! And no, at least at my facilities, we won’t ask!
Once you’re inside, you can go to sleep, watch a movie, meditate, do serial seven brain exercises, etc. If you’re in a soft chamber, you can also get fancy with the biohacking tech I’ll describe below.
HBOT General Principles & Protocols
The times you can’t use HBOT are just as important as the times you can use it.
So before you get started with an HBOT protocol, here are some general principles to keep in mind:
* The more acute the condition, the less HBOT is needed to accelerate and optimize healing. The longer the condition has been ongoing, the more you’ll need.
* If your goal is to optimize health over the long term (reverse aging, cognitive optimization, endurance, sexual health optimization, and others) protocols are also longer.
* More pressure is not always better! Optimal pressures for neurologic indications are most often between 1.3 ATA and 2.0 ATA. For conditions/goals outside of the central nervous system, we usually use pressures of 2.0 to 2.8 ATA.
* Most HBOT protocols have you at pressure for 60 to 120 minutes but some of my newer ones are as short as 30 minutes.
* HBOT treatments are often done in succession. This is most important for the long term benefits of a protocol but there are some exceptions.
* HBOT is safer than taking a Motrin or Ibuprofen and is as powerful as taking a steroid for inflammation, but there are risks. Every person getting into a chamber is required to have a prescription and be screened for these risks, no matter the type of chamber.
* Consider ways to mitigate vasoconstriction, maximize energy production, and enhance detoxification while getting HBOT. This is the fun biohacking stuff which I’ll detail below.
* Consider assessing your ability to harness the power of HBOT most effectively (i.e. are you toxic? Do you have optimal levels of vitamins, minerals, nutrients, antioxidants?). In my practice, I test metabolomics using a framework called Health Optimization Medicine, pioneered by the father of holobiont hacking, Dr. Ted Achacoso, a former podcast guest of Ben’s.
HBOT Indications :
In the US, soft chambers pressurize to 1.3 ATA, and the only insurance approved indication is acute mountain sickness. See here for the full list of both insurance-approved and investigational indications.
In my experience, however, there are several situations/conditions where HBOT can also be helpful. The research hasn’t quite caught up yet, but it’s coming.
Some of these additional indications for mHBOT at 1.3 ATA include:
* A quick energy boost: Short mHBOT sessions, usually around 30 minutes can really do this for many people, but not all. You’ll have to try it out for yourself and see how you feel.
* Cognitive Optimization: Short, medium, and long term improvements are possible.
* Cognitive Injuries (concussion, stroke, anoxic brain injury, etc) and Dementias (Vascular, Alzheimer’s, Parkinson’s, Lewy Body, and others): I often recommend hard chamber HBOT if possible (at least for acute injuries) and most studies for these conditions have been at 1.5 ATA but I have seen amazing recoveries with mHBOT.
* Cardiac Optimization: Consider getting into the chamber immediately prior to endurance or exercise that requires maximum oxygen-carrying capacity. The oxygen infused will remain in circulation for about 30 to 45 minutes.
* Work out recovery: Get blood where it needs to go and compress those lymphatics at the same time for good detox.
* Immune system boost: Since the 1980s, we’ve known that HBOT can boost immune system function. Now in the 21st century, there are many ways to stack HBOT even with mHBOT that will likely confer benefit as well.
* Jet lag: When you fly, you’re pressurized to 8,000 feet elevation (or 6,000 feet on the Dreamliner) so there’s less oxygen in the air. This hypoxia (low oxygen) is responsible for increasing your risk for illness, your fatigue, and more. Get in a chamber to reverse this as soon as possible!
* Sensory Deprivation: You can bring electronics into a soft chamber but you don’t have to, either. Use it as a time to meditate and disconnect with the world on occasion.