May 12, 2020
I've been really geeking out on hyperbaric oxygen therapy (HBOT) lately—so much so that in the past couple of months I…
- Set up my own softshell HBOT unit for my home (I went with the HBOT USA Vitaeris 320 model – the same one I discuss in the podcast link below), and I've been climbing into it just about every day for reading and napping…
- Took a deep dive into all things HBOT on the podcast “A New Treatment For Blasting Tissues With Oxygen, Growing New Blood Vessels, Recovering Faster, Killing Bacteria, Building Stem Cells & Much More!“…
- Published the article “My Latest Biohacking Infatuation: The Effects Of Hyperbaric Oxygen Therapy (HBOT) On Performance And Recovery (Plus 10 Proven Benefits Of High-Pressure Oxygen)“…
…because, although spendy, HBOT has become a big game-changer in my personal recovery and health protocol. It's been allowing my body to get a burst of pressurized, concentrated oxygen on a near-daily basis, which is actually quite important, because much of the stem cell and inflammatory pathway benefits of HBOT truly begin to kick in after you've done about 40 consecutive sessions. In the past several months, I've logged over 60 forty to sixty-minute sessions in my own chamber!
So when a true expert in the field of hyperbaric oxygen, Dr. Scott Sherr, offered to write a guest post on HBOT for my blog, I couldn't wait to hear what he had to say. Dr. Sherr is a board-certified internal medicine physician specializing in HBOT. He runs a worldwide virtual HBOT consultation, education, and advocacy practice and posts all of the latest news and scientific studies regularly to his Instagram account.
Dr. Sherr's clients include high-level athletes, Silicon Valley entrepreneurs, weekend warriors, coders, tons of biohackers, gamers, and many others. He is also one of the masterminds and formulators behind the tiny little methylene blue nootropic troche (save 5% with code BEN) I've discussed in other podcasts and articles.
Today's article by Dr. Sherr is a deep dive (yes, pun intended!) into HBOT’s potential to accelerate and optimize healing, performance, and recovery. Starting with basic hyperbaric physiology, he'll proceed with an overview of the types of chambers available, conditions treated, general guidelines to optimizing therapy, HBOT protocols + biohacking stacks, and then finish up with safety.
Note: There will also be a postscript on HBOT and viruses at the end of this article, given some recent promising data coming out of China and new studies underway here in the US on the use of HBOT for viral infections.
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:
- 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!
- 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.
Different Types of Hyperbaric Chambers
There are three main types of hyperbaric chambers available: soft chambers, monoplace chambers, and multiplace chambers.
Soft chambers are built out of an elastic plastic called thermoplastic polyurethane (TPU). Monoplace chambers are single-person chambers that are built out of composite metal, steel, and/or fiberglass. Multiplace chambers are steel chambers that can go to very deep depths and can treat many patients at the same time.
The same TPU used in soft chambers is also used in many common goods, including inflatable rafts and conveyor belts. Soft chambers inflate with air to a certain set of dimensions and internal chamber pressure. In the US, soft chambers pressurize to the mild HBOT (mHBOT) pressure limit of 1.3 ATA or 10 feet of seawater equivalent. They are approved for home use and are insurance approved for acute mountain (altitude) sickness. There is also a growing list of investigational indications with the research most promising in neurocognitive recovery (traumatic brain injuries, anoxic brain injury, dementias, etc) and cognitive optimization. In addition, there are many ways to stack additional technologies and therapies before, during, and after soft chamber HBOT. This is why I call them the “Neurohacker Special.” Keep reading and see below for details on that. Ben personally uses a softshell chamber by HBOTUSA – the Vitaeris 320.
Monoplace chambers can reach internal pressures of 2 or 3 ATA (33ft to 66ft of seawater equivalent) and are the most common type of chamber used to treat insurance-approved indications for HBOT in the US and many of the investigational indications as well.
The most famous occupant of a monoplace chamber was Michael Jackson in the 1980s who used it (initially at least) to recover from third-degree burns he sustained while filming a Pepsi commercial. He then donated the chamber to a burn unit in Los Angeles. He was also reportedly sleeping in the chamber as well, which except for short naps, is something I never recommend due to risks of oxygen toxicity which I will discuss below as well.
Multiplace chambers are often found in trauma centers, tertiary care hospitals, and popular diving destinations because they are able to treat very sick patients who are on ventilators, IV drips, or otherwise requiring more intensive care. Multiplace chambers can treat all HBOT indications but are most famous for their use in treating decompression illness or “the bends” (decompression sickness). This was the first indication for HBOT in the early 1920s. The largest multiplace facility in the world is in Tel Aviv, Israel at the Sagol Center for Hyperbaric Medicine. It is run by my colleague, Dr. Shai Efrati. The Sagol Center has a waiting list of over 10,000 people for their reverse aging program.
Ultimately, if you're looking into simple HBOT for home use, a softshell chamber is what you'll likely end up using.
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.
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.
For HBOT indications at >1.3 ATA (mostly at 2.0 ATA or greater), I’m going to focus on those most pertinent to those reading this article, but feel free to comment below if you have questions about these or other conditions.
- Endurance/Cardiac Optimization: Longer HBOT protocols can optimize blood flow in the coronary arteries by increasing vascular density, which has been shown in some small studies to improve Vo2 max.
- Regenerative Medicine Synergy: We are combining HBOT with PRP to accelerate recovery. Here is a study in rugby players. We are also combining exogenous stem cells, exosomes, and other regenerative products with HBOT for a synergistic effect. Because HBOT stimulates a massive release of your body’s own endogenous stem cells, HBOT pretreatment prior to stem cell harvesting procedures is also becoming more popular, whether this harvest is for cancer treatment or full body stem cell makeovers.
- Infections: At deeper pressures, HBOT’s oxidative effects can be a very powerful killer of bugs that don’t like high oxygen environments. This includes anaerobic bugs (Claustrida, Bacteroides) and facultative anaerobes like MRSA and Lyme. HBOT also has fungicidal and virucidal effects as well.
- Pre/post-surgery optimization: Hyperoxygenation prior to HBOT and then after surgery can cut recovery times in half.
- Workout Recovery: As with mHBOT, single HBOT treatments can help for their oxygen delivery and detox enhancing potential. At deep pressures, recovery potential is even greater vs. mHBOT but too much can also cause too much oxidative stress in some athletes.
- Injury Recovery (outside the central nervous system): HBOT delivers more oxygen to tissue, decreases inflammation, decreases swelling, releases massive amounts of stem cells, and kills bugs. Almost any injury is going to benefit from this!
- Reverse Aging: This is the program in Israel with a 10,000 person waiting list. It is leveraging the benefits of HBOT with diagnostics before and after to show the benefit. This includes brain scans (such as functional MRI) that show blood vessels and brain tissue regenerating; heart scans that show the increase in vascular density; and in some patients, genital MRIs (the penis, specifically) that show penile blood flow improvements. They also perform Vo2 max testing before and after as well. There are a few clinics in the US that are working towards a similar model. This one is the closest so far.
- Infertility: HBOT increases the thickness of the uterine lining which facilitates embryo implantation after fertilization. HBOT also improves sexual function so babies are more likely as a result of that too!
- Cancer Synergy: HBOT is insurance approved to treat complications of radiation therapy for cancer treatment. It also shows promise in combination with chemotherapy, radiation, the ketogenic diet, and other oxidative strategies (like IV Vitamin C).
- Inflammatory Bowel Disease (UC and Crohn's Colitis): There are several good case series and a few randomized controlled trials showing that HBOT has the potential of putting some of the most challenging cases into remission.
- Chronic Fatigue: This is very much a multifactorial condition, but I have seen HBOT work wonders for these patients, if used in an integrative context.
- Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome): This is a chronic debilitating pain syndrome that is highly responsive to HBOT.
- Dementias (Vascular, Alzheimer’s, Parkinson’s, Lewy Body, other): HBOT at 1.5 ATA to 2.0 has been most studied but benefit at 1.3 ATA is possible as mentioned above.
- Traumatic Brain Injury/Concussion: My colleagues are working on some amazing acute concussion protocols, and for those with chronic symptoms, I have seen great benefit both at 1.5 ATA and 1.3 ATA as well, although 1.5 ATA tends to work faster and most studies are at 1.5 ATA.
It’s also important to note that treatment at 1.3 ATA is not optimal for everyone. These are the people that should very likely not be treated at 1.3 (with very few exceptions):
- Any of the insurance-approved indications except for acute mountain sickness. For all approved conditions, the studies performed used pressures of 2.0 ATA or greater.
- Open Wounds: These wounds require deeper oxygen tensions in vascular beds than mHBOT can provide.
- Ongoing infections of any type, especially aerobic (oxygen-liking) bugs. In patients with facultative anaerobic infections (Lyme, MRSA), I have also seen worsening with mHBOT.
- If you have chemical sensitivities: Soft chambers are made out of TPU which can off-gas. For most people, this isn’t an issue, but for those that are sensitive, it can be.
- If you have an autoimmune condition: I’ve found that these need to be addressed or at least stabilized first prior to treatment.
- If you have a moderate to severe acute condition: A hard chamber treatment is ideal, but there are ways to benefit in a soft chamber as long as you are medically cleared. Please do not get into a chamber without being medically cleared!
The Many Benefits of HBOT
Many of the immediate effects of HBOT are secondary to oxidative stress. If you are reading Ben’s blog, I doubt oxidative stress scares you, but just in case let’s break it down.
In short, think of HBOT as a hormetic stress that revs up energy metabolism.
When you flood the body with oxygen, more energy is made at the cellular level, and also, as a consequence, more reactive oxygen species (ROS) are produced. It is via ROS that HBOT stimulates the release of exponential numbers of stem cells, upregulates the immune system, kills bugs (especially those that do not like high oxygen environments), and shifts the expression of DNA via epigenetics.
Some real-world examples of the ROS benefit in HBOT include using HBOT to increase stem cell yield, combining it with the ketogenic diet in cancer treatment, and treating infections like Lyme's disease or MRSA. There might be some benefit in viruses as well, especially for severe cases. This is currently being studied in China and in the US, my colleagues and I are working hard to make this happen. See the postscript below for more info.
An additional benefit of HBOT-induced ROS is vasoconstriction.
In an acute trauma, constricting blood vessels will prevent leakage from injured vessels, decreasing swelling and inflammation in the surrounding tissue. If, for example, one of these damaged blood vessels is in your brain, decreasing the swelling can save your life. A few years ago, there was a phase II study on patients who had suffered severe traumatic brain injuries. They had just three HBOT sessions within the first 72 hours of presentation. The authors were able to show that HBOT acutely decreased intracranial pressure and, as a result, significantly decreased mortality. There was also a decrease in morbidity/disability over the long term as well. A phase III study is underway now.
For high-level athletes and others without acute injuries, the good news is that there are many ways to mitigate vasoconstriction and I will describe them in detail below. It’s also important to remember that despite vasoconstriction, the blood plasma is still supersaturated with oxygen so the net delivery of oxygen is much higher despite any vasoconstriction that occurs.
One more word on ROS: Research by Dr. Dom D’Agostino (a previous podcast guest of Ben's on a couple of episodes worth checking out here and here) and others has shown that after about three HBOT treatments, the body produces a reactive antioxidant surge that balances out the ROS. This occurs through the upregulation of superoxide dismutase, NRF2, and other antioxidant pathways. Of course, your ability to produce this antioxidant surge depends on your antioxidant reserves and energy production capacity. As mentioned above, in my practice, I assess this whenever possible using a framework called Health Optimization Medicine founded by one of Ben’s former guests, Dr. Ted Achacoso. I talk more about this below and highly recommend you check it out!
HBOT also very likely creates more exclusion zone (EZ) Water.
EZ Water, which is essentially synonymous with structured water, was discovered by Dr. Gerald Pollack. If you’d like to learn more about it, read this article, and check out Ben’s interview with Dr. Pollack here and also Ben's interview with Gary Greenfield here. Dr. Pollack has shown in his lab that increased atmospheric pressure and increased oxygen both increase EZ Water. This creates a host of benefits including enhanced flow of blood to tissue and enhanced lymphatic flow that facilitates detoxification. More EZ Water also improves mitochondrial function, which may be another reason HBOT works so well to preserve and optimize energy production.
Now let’s focus on the long-term benefits of HBOT oxygen infusion protocols.
These protocols can be as few as 20 treatments or as many as 120 (and sometimes more) and treatments are often done on 5 successive days with weekends off. Why so much and so often?
It all comes down to epigenetics. HBOT modulates at least 8,000 genes via ROS, suppressing genes that are responsible for inflammation and apoptosis (programmed cell death) and facilitating the expression of genes that are responsible for growth, repair, and decreasing inflammation. This epigenetic shift actually starts happening immediately with your first treatment, but successive-day HBOT exposure amplifies and solidifies these catalytic shifts.
I like to think of HBOT as the great scaffold (re)builder. With an HBOT protocol, you can grow new blood vessels, new connective tissue, new bone, new cartilage, new neurons, new supporting cells in the brain, down-regulate inflammatory cytokines (IL1,6,8,12, TNF alpha), rid your body of senescent cells, and more.
The end result: Sustainable health benefits long after finishing your HBOT protocol. Whereas the acute infusion of oxygen accelerates healing and recovery, an oxygen infusion protocol heals you from the inside out and reverses your biological age in the process. The latter point is slightly hyperbolic (another pun!) at the moment, but recent studies (and a few soon-to-be-published) show that HBOT regenerates blood vessels in the brain, around the heart, and even in our sexual organs. HBOT for better erections? Yup, it’s natural Viagra.
Harnessing the power of a massive oxygen infusion to save tissue in acute trauma.
The increased oxygen made available in circulation from HBOT creates a massive oxygen diffusion gradient from the blood vessels to surrounding tissue, driving oxygen about 4x further into tissue at deeper pressures. At the micron level, this is a huge amount of tissue that can potentially be saved when there is acute trauma (blood flow is damaged) or acute ischemia (lack of blood flow).
This at-risk tissue can still make ATP (and not die) because oxygen continues to diffuse into the cells under hyperbaric conditions. If oxygen continues to flow to at-risk tissue despite surrounding damage, it may also prevent reperfusion injury, which occurs when damaged tissue regains blood flow but inflammatory cytokines, hormones, and cellular debris have already been released secondary to hypoxia. Reperfusion injuries compound the original injury and can at times dwarf it in scope/scale.
HBOT is used routinely in acute trauma and is emerging as a treatment of acute coronary syndrome and stroke (both after revascularization), acute traumatic brain injury, and more.
I, of course, encourage all patients with these conditions to go to the hospital first before seeking out HBOT therapy. Then, when stable, I encourage them to strongly consider HBOT as soon as possible.
Investigational HBOT Indications & Costs
There are currently 14 insurance-covered indications in the US. In China, Japan, and Russia, there are over 80. Follow this link to learn about the ones we most commonly treat at my practice.
My integrative HBOT practice is focused primarily on dynamic and personalized protocols for investigational (non-insurance approved) conditions.
For investigational conditions, it’s cash money to get into the chamber. Out-of-pocket costs depend on the chamber type and where you live. Depending on your location, soft chamber prices per treatment average $100 to $200, and hard chambers prices per treatment average $150 to $400. The coasts and big cities are more expensive.
If you’re interested in a home chamber, prices range from around 11K to 22K. My new favorite chamber is the Henshaw out of the UK but there are many out there to choose from. Ben personally uses the HBOT USA Vitaeris 320 model, which he has waxed positive on many a time, and that one also is becoming quite popular.
How To Biohack Your HBOT Experience
OK, here's the part many of you have been waiting for. HBOT by itself is a powerful healing and optimizing technology.
But over the years, I’ve discovered that it can be vastly more effective when combined with targeted biohacking strategies.
The first biohack focuses on mitigating vasoconstriction. As I explained earlier in this post, the acute infusion of oxygen generates Reactive Oxygen Species (ROS). This ROS induces vasoconstriction. You can mitigate vasoconstriction in several ways, but in essence, consider strategies that will dilate blood vessels prior to getting into the chamber so that you can improve oxygen delivery, very similar to how you would a pre-workout blood-boosting formula or a pre-sex nitric oxide-releasing supplement or medication.
Some of my favorite supplements to consider using prior to HBOT are L-Arginine, CoQ10, NO (Nitric Oxide) boosting supplements such as the Biotropic labs formulas (code BEN for 20% off + free shippiing), and niacin. Ketones and MCT oil increase blood flow and protect the body from oxidative stress as well.
A few dosage approximations to use 10-30 minutes prior to your HBOT experience are:
- L-Arginine: 500mg to 2000mg
- CoQ10: 100 to 300mg
- NO: Dosing depends on your specific NO supplement.
- Niacin: Use the dose that makes you flush. This is usually between 500mg to 1500mg
- Ketones & MCT: Titrate to nutritional ketosis (>0.5mmol on finger stick testing)
Biohacking technologies that dilate blood vessels include low-level light therapy, infrared sauna, PEMF, and cryotherapy. At first glance, cryotherapy may seem paradoxical but after vasoconstriction in the cold, there is a reflexive (and massive) vasodilation which can then be harnessed in a chamber to deliver oxygen further into tissue. The ideal time to use any of these would be prior to using HBOT.
Finally, certain breathing patterns such as Wim Hof or SOMA breathwork may dilate blood vessels as well. If you are considering breathwork, I strongly suggest that you don’t hold your breath in the chamber. This is never advised and can be dangerous, especially on descent to pressure and ascent back up.
Next, you should focus on optimizing energy production during HBOT.
If there’s time (i.e. this is not an acute condition such as a concussion), I use the HOMe framework to detect and correct imbalances at the level of the metabolome with my clients. This way, I’m sure they have all the vitamins, minerals, antioxidants, and nutrients needed to make energy efficiently and harness the full power of HBOT. The HOMe framework is exactly what Ben and Dr. Ted Achacoso discuss in this podcast.
HOMe or not, I often recommend mineral supplementation before, during, and/or after with a good mineral supplement. I like Totum Sport, and Ben is a big fan of Quinton hypertonic minerals. If it is more of an acute situation, IV nutrient supplementation to supply the cofactors required for energy production is also helpful, but that obviously will require some medical assistance, unless you're using something like Dr. Craig Koniver's Push IVs. Lately, I’ve been exploring IV NAD as well and this looks promising. One could also use oral NMN or NR.
If you are in an mHBOT chamber (the soft version of an HBOT), there is also the potential to biohack while fully oxygenated!
Examples include using portal LLLT or red light therapy devices such as a JOOVV Go inside the chamber to target specific areas, neurofeedback protocols, breathing practices such as Wim Hof or SOMA breathwork (again, do NOT hold your breath!), and more. Another perk of HBOT is that your multitasking performance is increased. So in an mHBOT chamber, you can take your calls and meetings. Or, you bring in your computer and do your writing and creative work!
(Note from Ben: I personally discourage any use of an EMF generating device inside the HBOT, and personally just use books, magazines, or a journal).
Finally, you can maximize detoxification in the chamber.
When you make more cellular energy, you also make more waste products including ROS and others. HBOT will pressurize the lymphatic vessels and facilitate the waste removal process. The faster you get “rid” of this waste, the faster you’ll feel better. As you can imagine, this is very important from a recovery standpoint.
Supplements to consider for detoxification include antioxidants such as quercetin phytosome, minerals such as Quinton (save 10% with code GREENFIELD10), additional IV nutrition such as Dr. Craig Koniver's Push IVs, rectal ozone or ozonated water, and hydration in general with mineral or spring water—or better yet, hydrogen water (save 10% with code GREENFIELD). Technologies and practices to consider for enhancing detoxification include infrared sauna, compression technologies, manual therapies, massage, yoga, and many others.
HBOT is safer than taking a Motrin or Advil—with much better anti-inflammatory effects and none of the side effects.
Although HBOT is an extremely safe technology, at all HBOT pressures (and especially pressures >1.5 ATA), there are very rare (but very real) risks of toxicity to your heart, lungs, and brain if you are not screened appropriately.
Conditions like congestive heart failure, unstable heart disease, COPD, or uncontrolled seizures are just a few examples where HBOT may pose risk. There are also several drugs that can increase risk of toxicity, especially chemotherapeutic drugs. This is why I highly recommend that you speak to a knowledgeable practitioner and get a prescription for HBOT before starting, even if it is in an mHBOT chamber.
The most common potential side effect of treatment is ear pain. While descending to (and ascending from) treatment pressure, you’ll have to equalize or “pop” your ears just as you do when traveling on a plane or train. The vast majority of people have no issues at all. The worst-case scenario is that you damage your eardrum or rupture it. Both are thankfully rare and very simple to prevent: If you can’t equalize your ears, stop the pressurization until you can.
Other concerns with HBOT at deeper pressures include:
- Increased insulin sensitivity and decreased blood sugar levels. This is something we have to be especially careful about in diabetics, but if you are following a ketogenic diet (or you are fasting), the good news is that your ketone levels will rise.
- Possible changes to your vision, secondary to convexity changes of the lens in your eye. This will return to normal after the treatment course is completed.
- Fire safety is important at every pressure, but especially at deeper pressures because oxygen is flammable.
At a hard chamber facility, there should always be a technician watching and in communication with you. If not, this is an unsafe environment, and you should find another place to get treated!
HBOT is a powerful healing, optimizing, and recovery technology. I may be slightly biased in saying this (okay, as a physician who implements HBOT as a core part of my practice, very biased), but I strongly feel that it is among the best biohacking and health technologies on the planet. The beauty is in its simplicity: it’s just oxygen and pressure, that’s it.
Combine these two naturally occurring elements and infuse 1,200% or more oxygen into circulation, reverse hypoxia, decrease inflammation, release an exponential number of stem cells, kill bugs, improve immune system function, and so much more.
There is practically no disease or condition on the planet that won’t benefit from these fundamental physiologic shifts. The question truly is not if HBOT is right for you, but when it is.
Let me be very clear, however: I do not recommend HBOT right away or to everyone, and for some, the ROI would be better spent elsewhere. It has also become abundantly clear to me that my patients with optimized levels of vitamins, minerals, antioxidant capacity, and cofactors prior to treatment are able to harness the power of HBOT more effectively and efficiently.
In my Health Optimization Medicine (HOMe) practice, this is exactly what I do using the sciences of metabolomics, gut microbiota, epigenetics, bioenergetics, exposomics, evolutionary medicine, and chronobiology. In total, these make up what is known as the Holobiont, a term used for the collective “you,” which is made up of human cells, bacterial cells, viruses, fungus, toxic metabolites from the environment, electromagnetic frequencies, and much more. Again, Dr. Ted Achacoso and Ben discuss this approach quite thoroughly in this podcast episode.
Of course, there isn’t always time to optimize. For an acute situation, this is when I, as a clinician (and you as a biohacker) have to proverbially “throw the bus” at the situation. Even still, I am methodical about this in my practice, using targeted supplements, dietary strategies, ancient and cutting edge tech, allied practitioner referral, and HBOT (but not always!).
Finally, here are a few easy questions to ask yourself if you’re considering HBOT:
- Do you have hypoxic tissues (tissue with low oxygen levels)?
- Do you have inflammation?
- Do you have a need for stem cells?
- Do you have an infection?
If so, then HBOT may be right for you, but do yourself a favor and optimize your foundational health first if there’s time!
Here are some additional resources:
- Optimized HBOT with Dr. Scott Sherr (Facebook Group)
- One Hit Away foundation (for sports-related concussion)
- HOMe/HOPe (Nonprofit)
- Hyperbaric Oxygen Therapy with Dr. Jason Sonners of HBOT USA
- My Latest Biohacking Infatuation: The Effects Of Hyperbaric Oxygen Therapy (HBOT) On Performance And Recovery (Plus 10 Proven Benefits Of High-Pressure Oxygen)
And finally, if you're ready to invest in your own at-home HBOT unit, then I'd suggest Ben's recommendation of HBOT USA (again, he uses the Vitaeris 320).
Please leave your thoughts, comments, or questions below, and I'll be happy to answer!
Quick Postscript on Viruses:
I have posted on Instagram several articles looking at the use of HBOT for viruses.
The quick reason why HBOT may work? It may be able to overcome the hypoxia (low oxygen levels) that many of these patients have secondary to fluid in their lungs and the massive inflammatory response that occurs secondary to viral replication and cytokine storm.
Preliminary research in China looks promising, and the world is getting creative: A hospital in Chicago is using a pressurized oxygen hood that mimics mild HBOT pressures to stave off intubation. There is even a company looking to retrofit airplanes as hyperbaric chambers to treat large numbers of people if this is needed. Airplanes are usually HYPO baric environments, not HYPERbaric, but there is evidently a way to make them massive makeshift HBOT chambers!
Some of you may be asking yourself a very reasonable question: Would HBOT prevent viral infections or be a treatment for mild to moderate infection? Right now, we just don’t know. There is some conjecture that at very deep pressures it might actually kill the virus, but this has not been substantiated as yet. For now, I’m personally using it for all the physiological benefits—along with my personalized HOMe protocol and around 20 additional biohacking strategies daily—but hopefully, we’ll know soon if this a viable strategy for the masses!