You hear that a LeBron James is using it and you think, “Oh, so it must be a tool to help elite athletes with recovery”. Then you find out a Justin Bieber swears by it for depression and suddenly the window for its uses becomes much wider. But perhaps not as wide as when you discover that your next-door neighbor is also using it for their Crohn’s.
Such is the unique case of hyperbaric oxygen therapy (HBOT).
It waltzed onto the wellness scene a couple of decades ago and now everybody (who can afford it) seems to be using it for everything. But what exactly is HBOT? What is it approved for and what other information should you know if you’re considering it yourself?
Today, on the Rejuve.AI blog, we cover in-depth the 10 most asked questions about HBOT:
1- First Things First, Why Do We Need Oxygen?
While it’s basic knowledge that oxygen is necessary for survival, its exact role in our bodies is not as recognized by many. Scientists refer to it as the “forgotten nutrient” because, unlike other nutrients we consume through digestion, oxygen enters our bodies via the respiratory tract [1].
The oxygen delivery chain begins of course in the lungs, where it diffuses into the bloodstream. From there, it travels through blood vessels, carried by red blood cells, until it reaches its destination: the mitochondria inside the cells. In these cellular powerhouses, oxygen is essential for aerobic respiration, the process by which cells generate energy to sustain life [1].
All tissues in the body depend on a steady supply of oxygen, which must match each tissue’s ever-changing metabolic demands. A shortage of oxygen, known as hypoxia, can lead to serious health complications depending on its duration and underlying cause [1]. Fortunately, many of these conditions can benefit from HBOT, as we’ll learn next.
2- How Does HBOT Work?
You likely already have a mental picture of what an HBOT experience looks like. That large cylindrical tube where you lie down on a cushioned bed with pillows, breathing in. That’s the one-person hyperbaric chamber. There are also multi-person chambers, which resemble small spaceships, where a group enters together, each person wearing a mask through which they breathe.
Inside the chamber, you breathe pure oxygen — 100% oxygen compared to the 21% found in the atmosphere. But it’s not just the purity of the oxygen that makes HBOT effective. The therapy also involves high pressure, typically about twice the normal atmospheric pressure [2]. This is equivalent to being 33 feet underwater.
This combination of high oxygen concentration and increased pressure dramatically increases the amount of oxygen dissolved in your blood and other body fluids. With HBOT, oxygen levels in the blood can rise to 10 to 15 times the normal amount, delivering significantly more oxygen to your body’s cells [3].
This abundance of oxygen inside cells suffering from hypoxia turns on certain genes, activating innate healing processes [4]. These include creating new blood vessels to improve circulation, stimulating stem cells, enhancing the immune system, and triggering anti-inflammatory mechanisms [5].
3- What Are the Approved Uses of HBOT?
So far, the FDA has approved HBOT for 14 clinical uses, most of which are for conditions where hypoxia is the primary culprit [6]. These conditions are:
Air and gas bubbles in blood vessels
Severe anemia when blood transfusions cannot be used
Severe and large burns treated at a specialized burn center
Carbon monoxide poisoning
Crush injury
Decompression sickness associated with diving risk
Gas gangrene
Complete hearing loss that occurs suddenly and without any known cause
Severe infection of the skin and bone
Radiation injury
Skin graft flap at risk of tissue death
Vision loss when sudden and painless in one eye due to blockage of blood flow
Non-healing wounds, such as diabetic foot ulcers
Individuals who get their HBOT covered by insurance are most likely using it for any of the conditions above.
4- What Are Some Emerging Uses of HBOT?
Of course, a market valued at $3.73 billion isn’t just limited to the very specific critical conditions we mentioned above [7]. Indeed, HBOT is used as an experimental therapy for other more prevalent conditions in various centers worldwide. Let’s take a look at some of the most common emerging uses of HBOT and the evidence behind each:
HBOT and Autoimmune Diseases
HBOT has shown promise in some conditions where the immune system is altered, such as in autoimmune diseases. Studies of isolated cells were the first to support this view, as they suggest that HBOT can modulate certain cells that are commonly implicated in autoimmune diseases [8].
Fibromyalgia, an autoimmune disorder marked by chronic pain throughout the body, is a potential target of HBOT. Human studies show HBOT can improve the quality of life of affected patients [9].
Patients of inflammatory bowel disease, both Crohn’s disease and ulcerative colitis, may also benefit from HBOT as an adjunctive treatment. Clinical trials show that HBOT exerts its effect in that case by improving the immune response, controlling inflammation, and attenuating oxidative stress [10].
HBOT and Depression
HBOT has shown promising results for depression associated with other conditions, such as Parkinson’s [11], stroke [12], and spinal cord injury [13]. Few studies have looked at HBOT and depression which is not accompanied by other diseases. However, one human study has concluded that HBOT combined with an antidepressant led to higher efficacy in decreasing depressive symptoms compared to the antidepressant on its own [14]. More studies are needed to evaluate the potential of this treatment.
HBOT and Brain Injury
Traumatic brain injury results from a head impact, often due to accidents, causing significant cognitive and physical challenges. Dr. Ian Grover, Medical Director of Hyperbaric Medicine and Wound Care at UC San Diego Health, says, “In medicine, we’ve made a lot of progress treating cancer, sepsis, those kinds of things. But in the last 20–30 years, we haven’t made significant improvement in the treatment of traumatic brain injuries”.
That could soon change with the rise of HBOT. A literature review of nine clinical trials and one meta-analysis revealed evidence for recommending HBOT in acute moderate-to-severe traumatic brain injury, with patients showing improvement in cognitive function and decreased risk of mortality in studies that used it as an endpoint [15].
HBOT and Long COVID
After the pandemic, some individuals started reporting symptoms of chronic fatigue, brain fog, and sleep problems, even after seemingly recovering from the infection. This is now being recognized in medicine as long COVID syndrome.
Interventions tackling this new syndrome have been limited, with HBOT being one of the most promising. A clinical trial revealed that patients who received HBOT sessions reported positive changes in sleep quality, attention, and energy levels compared to the control group [16].
Interestingly, a follow-up of these same patients showed that the benefits of HBOT persisted even one year after the therapy was discontinued [17].
5- What’s the Evidence for Using HBOT as Anti-Aging Therapy?
In the previous question, we covered more common conditions which people tend to experiment with HBOT for. Now, we reach probably the most popular (yet off-label) HBOT condition: aging.
The evidence is certainly piling up, although not without its grain of salt.
One of the most influential HBOT anti-aging studies is a clinical trial focusing on telomere shortening and cellular senescence, both recognized as hallmarks of aging [18]. Telomeres are protective caps at the ends of chromosomes that serve to prevent DNA damage during cell division. With age and repeated rounds of cell division, telomeres shorten progressively. Cellular senescence, on the other hand, occurs when cells stop dividing but resist dying. And while they’re at it, they secrete harmful chemicals that can damage neighboring healthy cells.
In the clinical trial investigating HBOT and these hallmarks of aging, blood samples were collected from healthy adults aged 64 and older. Participants underwent 60 sessions over 3 months, each consisting of 90 minutes of breathing 100% oxygen at twice the normal atmospheric pressure, with 5-minute air breaks every 20 minutes. Analysis revealed longer telomeres and a reduction in senescent cells, suggesting potential signs of biological age reversal [19].
Another clinical trial by the same research group explored HBOT’s effect on VO2 max, an important physiological biomarker of aging. VO2 max refers to the maximum amount of oxygen the body can utilize during intense exercise and generally reflects cardiovascular fitness. In this trial, participants undergoing the same HBOT protocol mentioned above showed significant improvements in VO2 max compared to the control group. This finding suggests that HBOT may enhance physical performance in adults [20].
The same group conducted a clinical trial examining HBOT’s impact on skin aging. Results indicated higher collagen density and an increased number of blood vessels supplying nutrients to skin cells in the HBOT group compared to controls. These findings point to healthier, more youthful-looking skin [21].
Optimistic as these results are, some researchers have noted a key limitation in these trials: they were not double-blinded. Participants knew whether they were receiving HBOT or serving as controls, leaving the placebo effect unaccounted for. The placebo effect has historically been shown to influence physiological outcomes significantly.
Hopefully, the momentum from these trials will inspire even more rigorous studies to establish a definitive connection between HBOT and aging.
6- Will You Feel Any Pain during HBOT?
HBOT is a generally painless procedure. But, in the initial phase of the treatment, as the pressure is increased, you may experience a popping feeling in your ears similar to what you experience on a plane. This feeling may develop into ear pain and sinus discomfort. However, practitioners should be able to guide you with some techniques on how to avoid this discomfort.
7- Does HBOT Cause Any Side Effects?
Dr. Paul G. Harch, Director of Hyperbaric Medicine at LSU Health New Orleans School of Medicine once said about HBOT:
“This is one of the lowest risk procedures in all of medicine.”
Despite this reassurance, Dr. Harch insists on referring to HBOT as a “medical treatment” with its own set of potential side effects [22]. These include:
Claustrophobia:
Monoplace chambers are small and confined, which can trigger anxiety or panic attacks.
Middle Ear Injuries:
These may manifest as earaches, hemorrhage, fluid buildup, or eardrum rupture. Again, proper equalization techniques help minimize these risks.
Temporary Nearsightedness:
May be more common after 20 or more treatments, especially in patients with diabetes or aged 65+, who may temporarily lose the ability to see at a distance. Vision typically returns to normal.
Oxygen Poisoning:
Rare but severe, excessive oxygen intake may cause coughing, shortness of breath, or, in extreme cases, death.
Seizures:
Some patients experience convulsions, sensory disturbances, or fainting due to oxygen toxicity.
Most of these HBOT risks are avoidable if administered under medical supervision to ensure safety and efficacy.
8- What Should You Consider Before Choosing an HBOT Center?
Amidst the high levels of oxygen, a risk of fire isn’t to be made light of. Explosions and fires have occurred in HBOT chambers before, according to the FDA. That’s one of the main reasons to consider going to an accredited HBOT center. Accreditation bodies for HBOT include The Undersea and Hyperbaric Medical Society (UHMS).
9- Can You Take Your Phone with You in an HBOT Chamber?
Many HBOT practitioners say this is actually the most common question they get from patients. The answer is no, as electronics would constitute a major fire hazard with all the oxygen inside the chamber. However, essentially all HBOT centers are equipped with TVs (hung outside the HBOT chambers) and all the streaming services you need to pass the time, Alternatively, you may indulge in some meditation or just sleep the time away.
10- How much is HBOT?
An HBOT session may range from $150 to $650, which might sound more affordable than you thought. However, some HBOT protocols require up to 60 sessions. This is why more affluent individuals opt to buy their own chambers at home, which may cost upwards of $20,000.
Conclusion
Hyperbaric oxygen therapy is certainly one of the most exciting frontiers of regenerative medicine. However, there’s still plenty of work to be done when it comes to research and regulatory approvals.
In 2008, Dr. Robert Bartlett, former President of the American College of Hyperbaric Medicine, said:
“To ensure that this therapy becomes widely available, we must further define and demonstrate its benefits.”
Back then, there were 13 FDA-approved uses of HBOT — just one shy of the current number of 14. Here’s hoping we can turn the tide and accelerate the pace so more people can access this innovative therapy.
HBOT very likely holds promise not only for athletes and celebrities but for anyone seeking enhanced recovery and potentially even longevity benefits. As we look to the future, it’s crucial to balance enthusiasm with scientific rigor to ensure this therapy lives up to its transformative potential.
References:
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