Dr. Jason Sonners, chiropractor and clinical director of HBOT USA, shares his journey into hyperbaric oxygen therapy, or HBOT, and ongoing research into its role in treating infection, injury recovery, and athletic performance.
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Robert Rountree:
This is the Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Rountree, chief medical advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.
Hi, everyone, and welcome to the Thorne Podcast. Joining me this week is Dr. Jason Sonners, DC, the owner of Core Therapies Family Wellness Center in Florham Park, New Jersey. And he's the clinical director of HBOT USA, which is a service educating practitioners, patients, and athletes on the benefits of hyperbaric oxygen therapy, better known as HBOT. Jason, welcome to the show. What if you start by telling our listeners a little bit about who you are and how you got into this specialty of hyperbarics?
Jason Sonners:
Absolutely, and thanks for having me on. I'm happy to talk about hyperbaric oxygen. I think it's probably one of the most misunderstood and underutilized therapies out there and so powerful to have such great effects in many ways, which I'm sure we'll get into. So, I'm a chiropractor. Been a chiropractor for about 18 years, and a couple years into practice, I herniated a disc. That's not good for chiropractic business.
Robert Rountree: No.
Jason Sonners: And so, I was out of commission for a little bit. My wife's a chiropractor, so she was treating me. For the back pain issues, I had a pretty fast recovery. I was back to work in about two weeks or so, but I had drop foot in my right leg that continued to linger on, actually ended up lingering on for 18 months after that herniation.
And so, I was about 26 at the time, and I was training for a triathlon. And I could barely walk, let alone run or a bike. So, I kind of just started thinking my background was exercise physiology. I do a ton of nutrition. Between the chiropractic, the exercise, and nutrition, I was like, "I know how to help people with this problem." And I couldn't even fix my own situation. So, I happened to be at a conference, and they had chambers there. I had no idea what they were at the time, but they were doing demo sessions. So, I said, "Oh, that looks cool. I'll go in there."
So, I did about a 30-minute session. Climbed in. Climbed out. And I was walking around the vendor hall, and I had pins and needles in my foot. And it was the first time I had felt my foot in a year and a half. And so, all of a sudden, I was like, "Man, what? Is that happening?
Robert Rountree:
What just happened?
Jason Sonners:
Yeah. Is that from that thing I was just doing? I didn't even know what it was. So, I went back, and I spoke to the guy. And, of course, he said, "Oh, yeah, no. That's exactly what it does." And I'm like-
Robert Rountree:
What did you do to me?
Jason Sonners:
... "Yeah, right. You're just trying to sell me your chamber." And so, anyway, he agreed to ... I did about eight hours over four days, and I left that conference with about maybe 15, 20% improvement in my foot. And I was like, "I don't know what this thing is. I don't know what it does, but it's helping." I bought one. Brought it home and treated myself, and ended up having ... In a pretty short period of time, I had a full recovery of that drop foot.
And it really struck me because I said, "Listen, I didn't know. By no stretch do I know everything then nor now, but I felt like I had been through a lot. I spent a lot of time on education for myself and trying to do the right thing for patients. And at no point in time did hyperbaric ever come up. And here it is. I'm just stumbling on it by accident." And it was like the only thing that gave me my foot back.
And so, that struck a nerve, literally, and I jumped right into the research and tried to figure out as much as I could about it. We started implementing it in our practice shortly thereafter. So, it's been about 14 years that we've been offering it, and it's been quite the journey.
Robert Rountree:
That long, 14 years?
Jason Sonners:
Yeah, yeah. And it's been-
Robert Rountree:
So, you're really one of kind of the pioneers in doing this.
Jason Sonners:
I mean, there's quite a few well before me who've really ... We wouldn't be able to have this conversation should they had not been doing what they did in the research and getting themselves out there. But I guess I'd say we were early adopters. And since that's just brought us to a place now where we're still using it in clinic. We actually have a few clinics that we run, but now, I spend most of my time traveling around conferences teaching hyperbaric medicine to chiropractors, medical doctors, DOS, trying to really dispel the myths and misconceptions and hopefully, increase awareness to a point where more and more people are interested in implementing this because it is such a powerful tool. It is so safe, and it is able to do something that really nothing else can do.
Robert Rountree:
Maybe I can just throw in a little background and then get you to kind of explain what it is you're hearing from me, but I think when a lot of consumers hear about hyperbaric oxygen, they probably think of chambers, especially if they're certified divers. I was certified ... I don't know ... 35 years ago, and it was a big deal. You want to dive places that there are chambers. And what we were talking about are these big metal things that some of them big enough to walk into and sit up in, et cetera.
But your training includes understanding when to use these chambers, what they are. And then, at the same time, I remember in my residency program, we had a handful of people with chronic wounds, and they weren't healing any other way, a diabetic with an ulcer on their leg. And they were using the chambers for that purpose. What I remember from those days was that it was thousands of dollars an hour, very expensive. And you'll have to tell me, but I think it's what two atmospheres or more that they had in those chambers? So, it was pretty high pressure. And a lot of times, it was pure oxygen they were breathing.
So, that was kind of the early days of what I knew about it, and then, on top of that, here in Boulder, at the university, there's a guy named Igor Gamow. And Igor Gamow invented the Gamow bag, which is a portable soft chamber. You wouldn't really call it a chamber, a bag that you could pump up with your foot. And they would take these things up on the mountain. I think they pioneered them on Mount McKinley. So, if people got altitude sickness, they'd pump these things up and put people in there, not necessarily with oxygen. But if you added the oxygen, that helps.
So, now, we're talking about pressure. There's several different things involved here. Pressure that's greater than the pressure at sea level and oxygen, so hyperbaric oxygen. Can you tell us a little bit about how things have evolved from the early days where it was all about these big metal chambers to something you could buy and put in your office or people could buy and take home? So, can you tell us about the evolution of that?
Jason Sonners:
Yeah. So, what's funny is, in all these years, even the clinical chambers haven't changed that much. Typically, you'll see some clear acrylic tubes, but a lot of chambers are still large steel with a few porthole windows. The technology of the equipment has not evolved as much as you might think in all these years. The application of that tool has evolved a lot, but the technology of the equipment, not as much.
But, to your point, they were originally designed for the bends or decompression sickness, which is when you're breathing air, which is predominantly nitrogen. So, it's about 21% oxygen, 79% nitrogen. And you go to relatively deep depths, and you stay there for a period of time. You're accumulating oxygen, but your body's utilizing the oxygen. You're accumulating nitrogen, which is basically inert. There's really nowhere for that to go. And as you come up to the surface, all of those gases start bubbling out of your body. And because there's nowhere for nitrogen to go, if you come up to the surface too quickly, those nitrogen bubbles accumulate literally in your circulation.
Robert Rountree:
And your nervous system.
Jason Sonners:
And your nervous system. And so, it can create ischemic attacks, nerve blockages-
Robert Rountree:
Strokes.
Jason Sonners:
... arterial gas embolism, stroke, all of it. And so, that's called the bends, and there's a whole history with that, which we could do a whole show on. But, at the end of the day, what they figured out was if you get bent, which is a nitrogen gas issue, not an oxygen issue, if you get bent, you bring that person back to the depth where they were. You keep them there for a period of time, which is going to help dissolve all those bubbles back into the solution.
Robert Rountree:
So, 60 feet underwater or 90 feet underwater, yeah.
Jason Sonners:
Exactly, yeah. And then, you just bring them up real slow. And if you bring them up real slow, the bubbles still come out, but they don't accumulate in the body. And that gives the body a chance to off-gas. When you dive, if you have your three-minute safety stop at 15 feet, that's all about off-gassing nitrogen and just decreasing the chances of that stuff happening.
So, what we know about in general, just to go back to that, what we know about gas laws, if you will, is that at sea level, there's a pressure. There's an atmosphere. That atmosphere is what allows us to extract oxygen out of the air that you're breathing right now. And we call that at sea level, we call it one atmosphere. So, where I live, it's one atmosphere. It's the exact right amount of pressure to saturate my red blood cells 100%.
If you were to invite me to your house, and I was able to fly out there, there would be a huge difference in my body's ability to absorb oxygen. Not because there's less oxygen in Colorado, but because there's less pressure in Colorado because you're higher than sea level. So, as you leave sea level, and you go up in a mountain, or you live somewhere in altitude, there's less pressure. And because there's less pressure, the driving force, the gradient to drive oxygen into our body, is less. We perceive that as harder to breathe. And so, as a result, our body adapts. And so, if you live at altitude, your body will make more red blood cells than mine will at sea level, and that's because we can't fully saturate. We need more carrying capacity, so we increase our red blood cell count as a way to [inaudible 00:10:44].
Robert Rountree:
So, I tell you. Oximeter reading here in Boulder, which is a mile high, can be 96%. But when I go up to my cabin at 9,000 feet, it can drop to 88. And you go, "Whoa, am I dying?" It's just like you're saying. That's a normal adaption to what's going on.
Jason Sonners:
To the altitude, right. And then, if you came to me in New Jersey, you would have more red blood cells than I do, and you'd be able to saturate all of them. And that's really the performance aspect, where athletes train at altitude and then compete at sea level. It's about going to altitude, being exposed to lower pressures, increasing your red blood cell count, getting accustomed to that level of oxygen, then going back to sea level where the pressure's higher, saturating at a much higher red blood cell count, which gives you a huge advantage over me in terms of your oxygen-carrying capacity versus mine.
Robert Rountree:
Do they still say train high, sleep low? I remember that was a saying for a while.
Jason Sonners:
Yeah.
Robert Rountree:
Go do your running during the day, and then go back to lower altitude at night.
Jason Sonners:
Right. Yep, exactly.
Robert Rountree:
And some people would sleep in chambers to do that.
Jason Sonners:
And sleep in chambers and try to hyper-oxygenate or all those, yeah. And the science is mixed on that because, in order for the body to really build or let go of red blood cells, it has to be really convinced that that's important. So, 24 hours a day, seven days a week, definitely creates a lot of those adaptations. Eight hours a day, it may not quite cut it. But people still kind of tinker with a lot of those avenues.
Anyway, so just like you lose pressure when you go away from sea level, you gain pressure when you go below sea level. And so, hyperbaric is all about using it therapeutically to go below sea level pressures, increasing gradient. So, you increase the driving force of oxygen into the body. Now, you can certainly saturate your red blood cells. That's easy. But now, what you're actually doing is you're dissolving oxygen into the plasma-
Robert Rountree:
Into your tissue.
Jason Sonners:
... of the blood and the tissues in a way that normally is impossible at normal atmospheric pressures. And so, this is really the only tool that allows you to supersaturate with oxygen using hyperbaric, and then depending on what pressure you're exposed to, and what percentage of oxygen you're breathing, and how much time you spend in the chamber, that determines your overall absorption.
And now, just to your point with those other types of chambers, what we've realized is if you're treating something very serious, gangrene or wounds, really high pressure and 100% oxygen, it's required to have a meaningful effect on these people. If you're looking at this as just a general inflammation control, or just a less severe issue that you're trying to help somebody with, or performance, you don't need 2.5 atmospheres at 100% oxygen. So, we can start using lower pressure devices, lower percentages of oxygen but still have a very meaningful session.
And so, we've basically taken the Gamov bag that you described, which was for acute mountain sickness, which is a high altitude pulmonary edema and high altitude cerebral edema. And when somebody is experiencing that, and you put them back to close to sea level pressure ... So, they're still on the mountain, but because they're in the chamber, you're pressurizing the chamber and creating a temporary sea level-like environment ... the body will absorb a lot of that inflammation and those fluids, and you can really save a person's life in that moment.
Now-
Robert Rountree:
And you don't have to be in a big metal hard chamber to do that. That's your point is these soft chambers, where they-
Jason Sonners:
Now, people have these chambers. Now, if I'm at sea level ... I'm not at the top of Mount Everest. I'm just at sea level, and I use that same concept ... instead of being at 20,000 feet and trying to get somebody to 6,000 feet, I'm starting at, let's say, zero, and I'm going 10 feet below sea level. And, all of a sudden, I can get 30% more oxygen absorption than what my body's used to getting.
Robert Rountree:
Is that with additional oxygen? Would you say that?
Jason Sonners:
30% would just be air only.
Robert Rountree:
Air only.
Jason Sonners:
Because basically, what you're doing is you're increasing atmospheric pressure by about a third, and it's a direct correlation between pressure, and gradient, and oxygen drive. So, it's 29% increase in oxygen, air only, in a soft chamber from sea level. And then, if you added oxygen to that, you can go from about 30% up to about three, 3.5 times more oxygen in a simple setup, like a soft chamber with some 94% oxygen, give or take.
Robert Rountree:
So, when people come into your clinic, what would you typically do? How many atmospheres, and do you do oxygen or not? Let's say two different patients. One person's had traumatic brain injury. They've had a concussion, and they're having trouble recovering. So, that's one type. And then another one is an athlete that says I want to improve my endurance, or my speed, or something like that. Would you treat them differently?
Jason Sonners:
Yeah, yeah. So, I mean, that TBI, you're trying to bring down the inflammation. Ultimately, you'll get neurogenesis. So, you'll actually stimulate nerves, even central nervous system regrowth, central nervous system stem cells. The angiogenic effect of hyperbaric is pretty remarkable. So, if there's capillary damage, which typically there will be with some sort of trauma, especially brain trauma, so that angiogenic effect you're looking for. So, that person we're going to be pretty aggressive because ... not necessarily in pressure, but in frequency ... because if we can drive the stem cell effect and the angiogenic effect, we can get this person to heal and not need this going forward because we can literally regrow the blood vessels and have them self-oxygenate by the time we're finished.
So, that person, we might be doing 1.3, 1.5 atmospheres, typically 100% oxygen or 94% oxygen just to get that extra oxygen stimulating factor, and that'll help that person heal. But we'll be doing five or six hours a week for maybe-
Robert Rountree:
Oh, a lot. A lot.
Jason Sonners:
... [inaudible 00:16:41] months. So, the frequency really makes a huge difference from a healing standpoint.
For the athlete looking to recover, we could certainly do the lower pressures, so the 1.3-atmosphere range, and we could do with or without the oxygen. Some people feel like if a little is more, a lot has to be better. And so, people want the extra oxygen. Although I'd say 30% increase in a human who normally has no capacity to do that, it's a lot. That's very meaningful.
My whole story about the nerve and the disc and everything, that was 1.3 air only. I didn't even know about oxygen or higher pressure at the time. I had no idea what I was doing. I just bought this bag and zipped myself up. And I still was able to heal that nerve, so there's a lot of benefit in that air-only environment. But a lot of people still feel like they want that extra oxygen just to cover all their bases.
Robert Rountree:
And you usually use a mask or a nasal cannula.
Jason Sonners: Yeah, just use a mask for the oxygen, and then depending, that athlete could use it as performance, literally a few hours before an event. But a lot of athletes really benefit from it when they use it on some regular basis from a recovery from their training. In other words, I'd argue most elite athletes are overtrained and/or under recovered. And so, if we can do things to improve their recovery, by default, they're going to see an improvement in their performance. And so, if we use it behind the scenes ongoing, I think the improvement in recovery showing up in performance capacity is probably a bigger effect than the individual session, let's say, right before an event. [inaudible 00:18:19].
Robert Rountree:
Now, you told me earlier, before the show, that you were working with athletes in Hawaii. Can you tell us a little bit about that scenario?
Jason Sonners:
Yeah, so I mean, this is literally the same conversation almost in that concussions become a really big topic in the surf community. You know these guys. And it's not something I had really, just being honest, never really thought about much, but 20, 30-foot waves, 40, 60-foot waves, and these guys get tossed. And when you hit water going 30 miles an hour from a 60-foot wave, there's issues from that, or even if you got underwater, but then you hit some rock, or some reef, or the sand. So, TBI and concussions, it's a huge issue in the surf community.
So, there were some of those athletes were coming to us strictly, literally right before their heat, just to get kind of zoned-in because it's a really good time to just do some breathing, some meditation, some visualization. So, you're sort of alone in this chamber, really relaxing, really breathing. So, I think it's a good space to just get the mind ready for a competition, but it's also obviously, getting a huge amount of oxygen. So, they would come in pre-performance before their heat in order to get kind of boosted before that. But we had a lot of people coming on pretty significant protocols, trying to recover from their last, maybe, concussion or two from last year or this year. And so, we were doing even more with them, trying to have a healing effect outside of whatever the performance effect might be.
Robert Rountree:
Well, it sounds like you should have one of those portable chambers in the locker room at a football field, just have these guys getting in there preventatively because they're going to all get their heads knocked around.
Jason Sonners:
Definitely, yeah.
Robert Rountree:
Wow.
Jason Sonners:
And a lot of the football, some basketball players, but a lot of football players have these on their own in their home.
Robert Rountree:
Oh, they just own them.
Jason Sonners:
And they don't like to talk about it because they don't want people to know what they're doing that's getting better performance.
Robert Rountree:
It's their secret, yeah.
Jason Sonners:
Exactly. We've gotten a few teams to start incorporating it. It's harder to get the teams involved. Each athlete makes their own decision on their care, and a lot of them are seeing the benefit and the performance aspect. The teams are starting to come around, but yeah, I would put five or six of these in every locker room. And these guys could be using them ongoing from a concussion, brain. We'll see some CTE research coming out in the near future. It's very meaningful.
Robert Rountree:
So, actually doing studies on chronic traumatic encephalopathy and seeing what happens. So, here's kind of a million-dollar question, which is an issue that I've heard raised several times in the past. Hey, you're breathing all this oxygen at higher pressure. Doesn't that increase oxidative stress? Don't you get more free radicals in your body, and could that be bad for you? So, what's your response to that concern?
Jason Sonners:
Yeah, I've spent a lot of time on that one. Could be one, because I get that question a lot.
Robert Rountree:
A lot, yeah.
Jason Sonners:
And two, I'm in the middle of a ... So, because hyperbaric really requires more research on these topics that we just don't have, a couple years ago, I decided to go back. So, I'm in the middle of a Ph.D. In molecular biology and regenerative medicine and hyperbaric, and I'm doing some research on hyperbaric right now, trying to answer those questions because we need those answers as an industry. And I would break it down like this from what I can gather from the research that exists. Yes, oxidation is terrible. The lipid, peroxidation, the breakdown of our membranes, and our DNA, and our epigenome, there's a lot of consequences to being over oxidized. And so, I don't want to discount that at all.
At the same time, I do believe that there's a difference between becoming over oxidized from our external environment, which has a different effect than the oxidation that our body creates through normal respiration. So, in other words, extremes we'll use, but, let's just say, you sleep. Your wifi router is under your pillow. You smoke. You drink. Your food is all processed. All the [inaudible 00:22:32]-
Robert Rountree:
That's a typical American.
Jason Sonners:
Right, exactly. So, you're massively over-oxidized from your environment. That completely depletes your own intrinsic antioxidant systems. And if you're not doing something externally to support that through supplementation or other, you're going to be in a lot of trouble pretty quickly. And I think that's different than ...
So, yes, hyperbaric will increase oxygen to your mitochondria. A consequence or a byproduct of that oxygen to your mitochondria is an increase in superoxide, which is a free radical. There's no way around that. And at the same time, one of the effects that we see of using hyperbaric regularly is an increase in superoxide dismutase and an increase in glutathione. And so, what seems to be is because it's an intrinsic source of oxidation, it actually upregulates our body's own capacity to tolerate the oxidative effect.
I would take that one step further and say if you start somebody gently and build up their hyperbaric exposures, which allows them to build up their own intrinsic or endogenous antioxidant systems like the glutathiones and the SODs, not only will make them more resilient to the treatment, I believe it will make them more resilient to their environment. And so, I think that there's two pieces of that's critical, and I've seen that in patients over and over again just in clinical treatments.
Robert Rountree:
So, one of my take-home messages from what you're saying is that as a practitioner, it's important to know what you're doing.
Jason Sonners:
Totally.
Robert Rountree:
Because there are conceivably ways that you might cause more problems if you don't do this very precisely and correctly.
Jason Sonners:
I mean, everybody knows they've had those very fragile patients, and every supplement you try or dietaries, it's always you say, "Everyone takes five." They need to take half every other day just to ... And so, that's not the person I would just say, "Okay, let's go to 2.5 Atmospheres at 100% oxygen and keep our fingers crossed. We will certainly over-oxidize them. They are just too fragile. But if you can recognize that person and then build them up, and take them slowly through the process, then I think you can certainly see those benefits. And, in some cases, if it's critical, let's say with a certain Lyme patient or something, if I really want to go faster on the hyperbaric side, but I'm nervous that they're not going to tolerate it as well as I want them to, then I might actually load them up with some glutathione, some molecular hydrogen. I might do certain ingredients.
Robert Rountree:
NAC, perhaps.
Jason Sonners:
... to try to [inaudible 00:25:17]. Yeah, I'll just try to get a jump on it and protect them from the oxidative effect. I don't want to do a lot of that because I think the oxidative effect is actually a big part of the signaling benefit.
Robert Rountree:
It could be beneficial.
Jason Sonners:
So, I don't want to mute it completely, but I might want to just take the edge off so that I don't blast them out.
Robert Rountree:
Great. So, we're going to take a short break, and after that, we'll answer some questions from our listeners.
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And we're back. So, now, it's time to answer some questions that have come in from our community. Our first question this week comes from a listener who asks, "Should athletes use hyperbaric oxygen treatment?" And I assume what they're getting at is, is this something that all athletes will benefit from, certain kinds of athletes? And then, a part two of that question is if an athlete's going to do this to presumably improve performance, are there some dietary supplements that they would benefit from that are going to help them get the most out of this treatment?
Jason Sonners:
So, yeah, I mean, again, this will be, I guess, a personal opinion based on what I know in the research. I do think athletes should use hyperbaric oxygen. I think I alluded to earlier. I think most athletes are, whether you want to call it overtrained or under recovered. I think that taking steps, especially the typical athlete, even most of us in high school and college, it's we could do anything we wanted to our bodies without any consequences. And the more you realize, especially for them, that their paychecks are directly related to their performance, it's critical that they keep their bodies and minds sharp throughout the process. And so, helping their performance and really helping their recovery is probably the most important aspect to that.
I would take that one step further, and just to say, even if you're not an athlete and you just expect to have relatively decent performance in your life, and you're under a decent amount of stress, and you're under recovered and overperformed in your life, for myself, for sure, and a lot of my patients that aren't elite athletes, in a lot of ways, hyperbaric could be looked at as oxygen as a nutrient.
And I'll just go into this because it'll help me answer the next question. All vitamins have consequences of deficiency, optimum ranges, benefits for megadosing, and possible toxicity levels. So, if you don't get enough vitamin C, there's a name for that. It's called scurvy. There's consequences to that. Then, the RDA would tell you, "Well, here's enough vitamin C to not have scurvy," but it's not really enough to do all the things that you want it to do in your life. It's just enough to not have symptoms of a disease.
So, we might want to take a little bit more. Look at the optimum range of vitamin C that allows us to have enough vitamin C to do all the things that vitamin C does in our body. And even if we got that every day, periodically, we might want to megadose vitamin C for various reasons. There's a virus, a cold. People do vitamin C IV for cancers and treatments, different things. So, you might megadose it. And then, you could also take that too far and eventually get just too much vitamin C.
I look at oxygen the exact same way. If you don't get enough oxygen, there's consequences to that. It's called hypoxia. In order to get normal ranges or optimal ranges of oxygen, we need to be basically 100% saturated every minute of every day. There's no real storage of oxygen in our body. It's critical that we're constantly replenishing our oxygen load. And even if we're 100% saturated every minute of every day, that doesn't mean that periodically getting some more oxygen, megadosing that oxygen as a tool for healing, or a tool for recovery, or a tool for performance allows us to get a little bit more of that nutrient to have the outcome that we're trying to have. And just like anything else, you could overdo it.
And there is a thing called oxygen toxicity. I'm sure we'll talk about that later, but too much of a good thing is still not good. So, you know what? We want to avoid oxygen toxicity. So, if you look at it like a nutrient, you start to see that it's really something that most of us should do, if not on a regular basis, at least periodically.
That being said, what do you pair that with, especially for performance? When I look at performance, I look at mitochondrial function because, ultimately, we're talking about cellular energy. If your cells can make energy, then the tissues of those cells can perform better. Muscles have mitochondria to make energy. Your liver has mitochondria to detox your body. Your brain has mitochondria to make synapse connections and neurotransmitters. So, your whole body has to make energy in order to function properly, and the amount or the efficiency and the performance of each mitochondria could really make a difference in terms of how that tissue type is performing.
So, especially in sports, we're looking at muscle performance potentially. So, upregulating mitochondrial function, it would be critical for those people. So, if you look at all the rate-limiting steps to, let's say, ATP production, once you get through the first few steps of cellular respiration where the mitochondria is making energy, you can look at the electron transport chain. So, all the food you eat, really, you eat food so that you can break it down into this thing called NAD. And NAD gets to your electron transport chain to pass electrons through that process. So, the amount and the quality of NAD that makes it to the mitochondria, that's critical, and that comes from your food.
But now, we also know that we can get that through supplementation. So, we can get NR or NMN.
Robert Rountree:
Nicotinamide ribosides.
Jason Sonners:
So, these, basically, NAD precursors, and we can take that nutritionally as a way to fuel that first step of energy production.
Next, you have to be able to pass those electrons along. And one of the first rate-limiting steps is a thing called ubiquinol that happens to make CoQ10. So, CoQ10 is an electron transport carrier in the electron transport chain, and CoQ10 deficiency would limit your ability to make energy. So, making sure you have enough CoQ10 is a great next step in that process.
The next mobile carrier is a thing called cytochrome C. It happens to be that cytochrome C is very light-sensitive. And so, just like I talk about oxygen being a nutrient, I think light is a nutrient. And our body is very light-receptive, and certain wavelengths of red light and infrared light are very cytochrome C-stimulating. And so, again, these red light therapies that you start to see now popping up all over, infrared sauna or red light therapies, bulbs, and different ways that people use this therapy. That, to me, is a nutrient to stimulate that cytochrome C that does other things in our body too, but specifically with the mitochondria.
And then, the last step of energy production is ... Well, it's complicated, but ultimately, oxygen needs to be there to be the electronic acceptor to turn this free radical oxygen into water. And so, oxygen becomes a rate-limiting step, upregulating your oxygen. Just like in your car engine, you need fuel, and the quality of your fuel makes a difference, and you have to mix it with oxygen. And the amount of oxygen you mix in that mixture makes a difference. And in your engine, we call that combustion when the fuel and the oxygen mix to oxidize to make power, heat, and exhaust. We call that in our cell, metabolism. Fuel, NAD, mixes with oxygen, ultimately to create power, heat, and exhaust. And our exhaust is carbon dioxide and water. And upregulating all of the steps along that path could really make a difference in mitochondrial performance. And so, you can supplement a lot of those pieces along with oxygen to really get a boost in mitochondrial function.
Robert Rountree:
Cool, very cool. So, is there any downside to doing this? The next question says, "What are the potential complications or side effects of HBOT?" And then, part B to that question is, there are a lot of places popping up now that offer memberships where you can go in and get cryotherapy, IV, vitamin C, Myers cocktails. And we'll throw in a hyperbaric for $200 a month or something like that, but I don't think there's a lot of supervision in those centers. So, do you have any comments about A, is there a downside to doing this? And you've already kind of touched on that earlier, and then B, what about places where there really isn't anyone supervising you for side effects?
Jason Sonners:
Yeah. So, let's say absolute contraindications, there's very few. It's really if you can't equalize the pressure in your ears, you can't go in, just like scuba. So, as the pressure increases in the chamber, you need to do something to clear that pressure, just like when you're landing in an airplane. It's a very similar experience.
Robert Rountree:
Yeah, the baby's on the planes that start crying, right?
Jason Sonners:
Exactly. So, that's a thing. You have to be able to equalize the pressure. It's not hard to do, but that's just to say it out loud. And then, pneumothorax. So, if you have a hole in your lung, you can't go in the chamber because if you have an airspace that you can't equalize, that airspace will get pressurized and will cause lots of consequences. So-
Robert Rountree:
What if you knew you had a bleb, like you had a CT scan for some reason, and they said, "Oh, you got a bleb, but it's intact."
Jason Sonners: If it's intact, you're going to be okay. But if there's a definitive airspace, a loss of continuity between the lung and the chest wall, that'll be an issue. But if you had an expanded alveoli or something like that, but everything's intact, you're going to be all right.
So, those are the contraindications, but other side effects, higher pressure, especially, you might see some ... These are all temporary things, but some visual changes. There is a small possibility of increasing cataract maturation if you already have cataracts. It will lower your blood glucose, so, in general, in my world and in your world, that's a good thing. And we would-
Robert Rountree:
Yep, I like that.
Jason Sonners:
... use that to our advantage. It actually increases insulin sensitivity. But in traditional circles, that makes people nervous because if they have like a wildly out-of-control diabetic, and they go hypoglycemic in the chamber, that's going to cause a lot of problems. So, a lot of those people get a juice box before they go in. In my clinic, we work on glucose stabilization, and then we just use the hyperbaric to our advantage.
So, there's things like that, but applied properly and safely, hyperbaric is very, very low risk, and the possibilities for upside are enormous, which kind of brings us to that next question, which is my biggest nightmare. I spent a lot of time trying to get rid of the myths and misconceptions about hyperbaric. I spent a lot of time educating doctors about hyperbaric and certifying them in hyperbaric medicine. When I have a patient running around the streets saying I tried hyperbaric and it didn't work, that's my biggest nightmare. A lot of times, when that's happening, it's happening because it wasn't applied properly, or it was not appropriate in the first place, or we just never really gave it the chance that it needed.
And in a lot of cases, 10 sessions, 20 sessions, 40 sessions, these are not unreasonable numbers to expect, especially if we have an issue that we're really trying to heal like a TBI concussion, or autoimmune disease, or these kinds of things. So, if you have some significant health concern, and you do hyperbaric once or twice, and it didn't work-
Robert Rountree:
Once or twice.
Jason Sonners:
... it's not fair. It shouldn't have worked in that short period of time. And so, with these memberships, my problem, in general, is that hyperbaric chambers of any kind are still a medical device, and whether you're using it for wellness or using it to treat conditions, it's still an application of a medical device. And so, certain training should be there in order to operate that equipment. And then, an awareness of what to look for, what the safety concerns might be, and, most importantly, an awareness of what the protocols need to look like because if somebody comes into the place and they say, "Okay, well, I'll take two." To your point, "I'll take one vitamin C drip a week. I'll try your red light therapy twice a month. And I heard hyperbaric was cool, so I just want to do one of those," we're never going to get the results that we want, so really spending the time to educate people so that they understand.
A center like that, but it's doctor-driven or clinician-driven of some kind, where you can say, "Well, this is the reason we're doing this. This is how it works," and really, in order for you to get the results you're looking for, you would need two of these, six of these, seven of those, whatever it is, but to give people a better understanding of exactly the expectation so that they get the results that they want, then a situation like that would certainly function much better.
Robert Rountree:
Should a consumer look for a provider that's got a certain certification? Is there something that you see a certain kind of initials or an organization they're a member of that goes, "Yeah, this person knows what they're doing."?
Jason Sonners:
Yeah, I mean, there's a few. I would go so far as to say at least find somebody who did something. There are-
Robert Rountree:
They've had some training.
Jason Sonners:
Right. And there are a lot of people out there, maybe not the majority, but a lot of centers that have literally no training whatsoever. That being said, there's sort of two main organizations out there. There's the UA in traditional hyperbaric circles where we're treating the on-label conditions in a hospital or an outpatient clinic, the wound care, the diabetic neuropathy, the gangrene, carbon monoxide poisoning. There's an organization called UHMS, and they sort of govern clinics and guidelines around on-label usage. And then, there's an organization called the IHA, the International Hyperbaric Association, and they're sort of the folks who govern more of the less traditional pathway of hyperbarics. And so, being a member of the IHA, having a certification that the IHA approves, anything of that nature would certainly massively decrease any risks associated and certainly increase the effectiveness of the therapy because they got trained on protocol development and things like that.
Robert Rountree:
So, that's the International Hyperbaric Association, and I assume they have a website. So, if you want to find a doctor ...
Jason Sonners:
Yeah, ihausa.org is their website, yeah.
Robert Rountree:
And they would have a referral center if somebody says, "Hey, I love what you're saying today, and I want somebody who's had this."
Jason Sonners:
Absolutely, yeah.
Robert Rountree:
Yeah.
Jason Sonners:
Yeah.
Robert Rountree:
So, that kind of takes us to a question which is, "Well, are there studies? Are there empirical studies that show this stuff works or not?" What is it known to work for, and what does it probably work for?
Jason Sonners:
So, I'd still say we need more research, and that was really what prompted me to kind of go back to school to do research. But when I started 14 years ago, compared to today, there was a lot more today than there was then. There's a mountain of research typically on most of the 14 on-label conditions. And when I teach this, what I really teach people is that if you look at the 14 indications, which are basically life and limb-threatening, the mechanisms of action are all the same. They're on repeat; hyper-oxygenation, angiogenesis, stem cell release. It's a very anabolic and low-inflammatory type therapy. It stimulates growth like BDNF and VEGF. It stimulates all of these growth factors. It stimulates stem cells, and it reduces cytokines. And it helps the body fight infection. That's the main theme behind hyperbaric.
So, if you become a master of the mechanisms of action of hyperbaric, that allows you to then look at pathology and say, "Well, we know this really well. We have a ton of research on these mechanisms. Your pathology is X, Y, and Z. Is it appropriate to apply this therapy for this issue given those mechanisms?" Now, that being said, over the last, especially the last three years, there has been a great deal of effort into improving the research on all of these other off-label uses.
So, Crohn's and colitis, I mean, that should be an on-label. We get amazing results with those people, especially with the ulcers, and the fistulas, and the fissures healing, and stuff like that, not to mention just the whole immune system balancing because of the cytokine issues. But TBI and concussion, there's a mountain of research for that. If there was going to be another on-label use, it would probably be TBI and concussion, just more than enough research for that.
Robert Rountree:
What about infections like viral infections?
Jason Sonners:
Other infections because we use it for gangrene. We use it for necrotizing fasciitis. We use it for chronic osteomyelitis, so all these anaerobic infections. And we don't give it to them first, by the way. We give it to them last. So, after six months of nonresponse to increasing antibiotics up to IV antibiotic use and you still have these infections, then we try hyperbaric therapy, and it actually has an amazing effect. So, could we use it for H. Pylori, C. Diff, Lyme, mold? Those are the kinds of things that we teach in the course. We don't have an overwhelming amount of research for that yet, but applying the mechanisms would make sense that here's other anaerobic infections that should respond similarly to these other anaerobic infections that we already know that it helps with.
Robert Rountree:
I could have sworn I saw a paper on using it for COVID. Am I right about that?
Jason Sonners:
So, there was a huge push to use this for COVID because, especially acutely, COVID wasn't about the inability to breathe. These patients were breathing, but their sats were still dropping. Their oxygen saturations were dropping, even though they were able to breathe. It was a gas exchange issue, much more than it was a breathing issue. And so, we put them all on vents, and there was this huge push to use hyperbaric because hyperbaric will not force you to breathe the way the respirator will, but it will absolutely increase gas exchange. That's literally all that it does.
And so, I ended up on a handful of phone calls, even international, with Scotland, and Ireland, and England. Nobody was flying, right?
Robert Rountree:
Right.
Jason Sonners:
So, there was this big push to use big 747s as airplanes or hyperbaric chambers. So, if you're on the ground and you pressurize the cabin, you have these giant multi-place chambers, and they're all plumed for oxygen masks. So, it was a no-brainer, and there was this huge movement through like March, April, May of 2020. And then, it became something you weren't really allowed to talk about.
Robert Rountree:
Oops.
Jason Sonners:
And then you know all the other things that sort of went on.
So, it just sort of went out of fashion. That being said, right now, there's studies on COVID in Brazil, Israel, France. Actually, one out of, I think, New York and one out of Chicago. And so, they're still looking at it from a active infection standpoint, and they're looking at it from the long haul situation. These people are responding amazingly to hyperbaric therapy, so-
Robert Rountree:
So, stay tuned on that one.
Jason Sonners:
Yeah, this is something that clinically, we're seeing that, and everyone I know who does this who are seeing those people, everybody is seeing an amazing response to these long haul people, and pretty quickly.
Robert Rountree:
Well, one last question. What about using this for healthy aging? Does it help slow down aging, or is there any research showing that this blunts some of the known markers associated with aging?
Jason Sonners:
Yeah. So, aging, if you look at the pathology of aging, if that's the right way to explain that, and you look at the pathology of chronic illness, there's a lot of overlap in terms of increases in inflammation, increases in senescence cells, so cells that aren't going to die, but they don't replicate either. And they just sort of live on, but they end up secreting inflammatory chemicals and other chemicals that interfere with normal cell communication and then a decrease in overall cellular function and performance.
And so, theoretically, we've been using it that way forever, but we didn't have any proof for it. But I'd say again, in the last few years, there have been studies looking at cognitive decline or cognitive performance. And every one of those has shown amazing results. It's definitely something being used for things like dementia and Alzheimer's on a regular basis now that seems to be very, very favorable.
There are multiple studies, even the on-label studies, that show the decrease in cytokines, so the reduction in the overall inflammatory response. And then, there was a study a couple years, about a year and a half ago, that looked at hyperbaric and telomeres. So, telomeres are the ends of the DNA that protect the DNA from oxidation, and there's an idea that telomere length has something to do with aging. And shorter telomeres are associated with shorter, more inflammatory lifestyles, and longer telomeres are associated with youth.
And, for the most part, when we're looking at telomeres, we're trying to stop how quickly we degrade them. We have very few things that could actually grow telomeres. And this study that came out showed a 20% increase in telomere length after two months of treatment. And so, that was pretty amazing.
So, these were all studies that looked at individual aspects of this process. This study that I'm just starting, literally, we're enrolling people right now. It just started a couple weeks ago. We'll be doing this for the next six months, but we're combining all those pieces. So, we're actually looking at cognitive performance. We're looking at telomere length. We're looking at methylation panels that are exploring the epigenome. And then, we're looking at a 48-panel cytokine test to look at global inflammation, and then doing a similar two-month trial of treatment and seeing the pre and post on those folks.
Robert Rountree:
I have to say 48 cytokines is a lot of cytokines.
Jason Sonners:
A lot of cytokines.
Robert Rountree:
Yeah.
Jason Sonners:
And ultimately, it's because we don't ... I found a lab that did a great, large panel that wasn't that expensive, and we don't know all the effects that it actually has. And so, the broader the panel, the more information. I'm just trying to collect data so that ultimately, I'm hoping that this funds a larger study or helps to fund a larger study on this topic that we can narrow down once we see which effects we're having.
Robert Rountree:
Well, this is all incredibly exciting, and I really want to applaud you on the work you're doing. I mean, from starting in a place where there wasn't a lot of data to really seeing it explode, and it's being taken seriously by the mainstream. And so, I think there's a very, very bright future for this kind of therapy. So, I really want to thank you, Dr. Sonners, for coming on the podcast, and I'm sure our listeners are probably going to want to hear this episode more than once to get through all the details.
If people want to follow your work or get in the study, how would they find you?
Jason Sonners:
So, if they just want to see what we're doing and just globally sort of from a 30,000-foot view, HBOT USA, we have a ton of information. That's our main website. If they want to learn more about hyperbaric in general, we have a YouTube channel, HBOT USA. I have about 120 videos on there. Yeah, we're about to put 100 more on in the next six months, so it's just a place to learn and just understand the [inaudible 00:49:38] this whole time.
Robert Rountree:
Yeah.
Jason Sonners:
Support@hbotusa.com is our staff email. If people actually were interested in the study itself and/or participating, you can absolutely email support@hbotusa.com. We'll be recruiting at least for the next four to six weeks. And so, we're excited to get people rolling through this, and I know there's going to be a lot of benefit. I'm just excited to actually see it on paper and-
Robert Rountree:
Awesome. Well, thanks again for coming on the show, and thanks for all the amazing work you're doing. That was Dr. Jason Sonners, who's the clinical director of HBOT USA. And thank you all for listening, and we hope you tune in again. Bye now.
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