Health & Fitness

This article was previously published February 24, 2019, and has been updated with new information.

Dr.Jason Fung, is a nephrologist and author of three books, "The Obesity Code," "The Complete Guide to Fasting," and "The Longevity Solution," which is the topic of this interview. This book was also co-written with James DiNicolantonio, Pharm. D, who also happens to be the co-author of my book, "Superfuel."

The motivation for "The Longevity Solution" came from a discussion with DiNicolantonio. "He'd already talked about salt in his book, 'The Salt Fix,'" Fung says. "In 'Superfuel,' he talked about good fats, bad fats and super fuel. We thought it would be great to tie everything together in terms of the real dietary determinants of longevity." Fung added:

"I spend a good section of the book talking about protein — the different types of protein, animal versus plant protein, for example, and how much protein [you need]. These are really important questions because there's so much [information] out there, and you don't know who to believe."

From my review of the book, I think that is probably one of the most valuable pieces, because there's so much confusion about protein. There's good reason for this confusion, because it's a complex topic. An important part of the equation is the mammalian target of rapamycin (mTOR), also known as the mechanistic target of rapamycin, a very important pathway responsible for controlling autophagy.

If you inhibit mTOR — which you can do by restricting protein — you activate autophagy, which is a good thing. However, I've personally made the mistake of not eating enough. While excess protein can activate mTOR, your protein needs do increase with age, as you need to counteract progressive loss of muscle mass. So, your age really needs to be taken into account as well.

Understanding the Role of mTOR

As noted by Fung, mTOR is basically a nutrient sensor. While insulin primarily senses your intake of carbohydrates, mTOR primarily senses protein. Different proteins will stimulate mTOR more than others. Fung explains:

"The reason is that mTOR senses the availability of protein and increases these growth pathways. If you're trying to increase muscle, like bodybuilders will, for example, then this might be a very good thing. On the other hand, it impacts aging. One of the real interesting theories of aging is that there's a sort of trade-off between the growth program and the longevity program.

That is, if you grow, it's actually the same pathway as aging. Whether it's good or bad depends on your age. When you're young, you want to grow, so you activate all these growth pathways. But as you get older, if you keep revving that growth engine, it's just going to burn out.

Just like your car engine, revving it is great if you want to go fast. But if, on the other hand, you want to keep that car for a long time, you don't want to rev it that much. Things change as you go along.

During childhood and early adulthood, you want that growth program to go forward, but that growth program is intrinsically at odds with the longevity program. After a certain point, you may want to cut things back. That's the understanding of mTOR; mTOR drives all this growth. But then as you get older, you wind up with diseases of too much growth …

There are all these chronic metabolic diseases where increasing the growth pathway, which is the same as the longevity-aging pathway, is not good. At some point, you want to slow it down. But as you get older, your body actually becomes resistant to some of these growth pathways.

Therefore, you actually need to take a little bit more. If you're elderly and you're at risk of falls, for example, then taking more protein might be a good thing. This is one of the reasons that protein is so hard to understand because everybody's so different … You just have to look at your own situation."

What Are Your Real Protein Needs?

All of that said, there are some general guidelines you can use to estimate your protein needs. Children, for example, generally need higher amounts of protein since they're in growth mode.

Now, when calculating your protein needs, it's important to make the calculation based on grams per kilograms (kg) of lean mass, not total body weight. The reason for this is because you do not need protein to maintain your fat mass. You need it to maintain your lean muscle mass. The following amounts can be used as a general guideline:

Children — 2 grams of protein per kg of lean body mass

Young adults — 0.8 grams of protein per kg of lean body mass

Adults — 0.6 to 0.8 grams of protein per kg of lean body mass

Bodybuilders — 1 to 1.2 grams of protein per kg of lean body mass

Endurance athletes — 1 to 1.5 grams of protein per kg of lean body mass

Seniors — 0.8 grams of protein per kg of lean body mass; possibly more if muscle wasting is a problem

The Importance of Cycling High and Low Protein Intake

The challenge here is find the balance so that the whole system is optimized. Muscle loss is a more or less inevitable consequence of age. But with age you also have more damaged cells that need to be removed by autophagy. My solution has been to devise a program in which I combine protein restriction with fasting, followed by increased protein intake on strength training days.

"I think that makes a lot of sense," Fung says. "If you look at the literature on longevity, the only really well-established thing that makes people live longer is calorie restriction, but it's very hard to do. One of the things is to cycle it back and forth, so that … some days, you're taking very little; some days you're taking a lot. I think that's actually how people were actually meant to live …

I think it makes a lot of sense because it's this sort of growth-versus-longevity paradigm. If you're always eating the same thing, then you're not going to be able to get that balance right. Because [when] you're in a pro-growth [pathway], that's also a pro-aging pathway.

You really want to go in between the two. Some days, you're going to take a lot. That will stimulate your mTOR, as well as insulin, for example, and put you in this growth pattern. Then you'll have days where your mTOR is going to be driven down very low. Those are the days your body's going to go into more of a survival mode, if you will. That's going to activate autophagy.

When you eat protein, for example, mTOR, which is a nutrient sensor, goes up. It basically just shuts off autophagy. Autophagy is this sort of cellular recycling process. It's very important for aging because it's a rejuvenating cycle for your cells …

When mTOR is very low, then your body will start to break down some of the subcellular parts. Those that are going to be broken down first are those older damaged parts. You're going to get rid of them all. Everybody thinks breaking down protein is bad. But it's not, because that's the first step in renewing yourself. You've got to get rid of all the old stuff and you've got to rebuild the new things. That's why it's important to cycle it …

I think you should, one day, maybe take 100 [grams of protein], and the next day zero. I think that's much better [than eating a specific amount of protein each day], because on the day you're taking zero, you get rid of all your old cells. Then on the day you're taking 100 grams, you're going to rebuild."

In addition to protein, other nutrients can also activate or inhibit mTOR:

• Nutrients that activate mTOR include branched-chain amino acids, glutamine, methyl folate and vitamin B12
• Nutrients thatinhibit mTOR include polyphenols like curcumin, fisetin quercetin, resveratrol (found in wine) and epigallocatechin gallate (EGCG, found in green tea). Organic coffee and dark chocolate also contain high amounts of mTOR inhibiting polyphenols

The Importance of Fasting for Longevity

In his book "Circadian Code: Lose Weight, Supercharge Your Energy and Sleep Well Every Night," Satchidananda Panda, Ph.D., cites research showing that 90% of people eat across 12 hours a day or more, and compressing this eating window may in fact be one of the most important things you can do for your health.

Fung recently published a case series paper¹ detailing how fasting can be used as a therapeutic alternative for Type 2 diabetes. Three diabetic patients between the ages of 40 and 67 participated in a supervised fasting regimen to evaluate the effects on their insulin requirements. The patients had been diagnosed with Type 2 diabetes for 10, 20 and 25 years respectively, and were taking high doses of insulin daily.

Of the three patients, two did alternating-day 24-hour fasts, while one fasted for 24 hours three times a week over a period of several months. On fasting days, they were allowed to drink unlimited amounts of low-calorie fluids such as water, coffee, tea and bone broth, and to eat a low-calorie, low-carb dinner.

On nonfasting days, they were allowed both lunch and dinner, but all meals were low in sugar and refined carbohydrates throughout. (The complete manual of the fasting regimen used is described in Fung's book, "The Complete Guide to Fasting."²) Two of the patients were able to discontinue all of their diabetes medications while the third was able to discontinue three of his four drugs. All three also lost between 10 and 18% of their body weight.

"It was stunning because the time it took to get them off the insulin was between five and 18 days. The longest it took was 18 days … He had been told he'd be on it for the rest of his life … We got him off everything in 18 days," Fung says.

"We still follow those three … They're still off of all their medications. They manage it with their diet. The point is that if you have a disease that causes so much disability — Type 2 diabetes — you can allow your body to simply use up that excess sugar. It's like the body has too much sugar. That's the whole disease. Don't eat, and allow your body to burn it off. Now you have a completely free solution, a completely natural solution …

I don't know of anything that could be better for the treatment of Type 2 diabetes. It turns out there are all kinds of other benefits [as well] … Some of the research shows the average person is actually eating for 14 hours and 45 minutes per day. If you start eating breakfast at 8 a.m., you don't stop until 10:45 p.m. on average. This is the average American. That is unbelievable.

The point is [you need to] cycle. You have to put your body in a fed state. That is, you eat and your insulin goes up. Your mTOR goes up. But then you have to fast. There's a daily cycle that we're not respecting. There's a fed state. There's a fasted state … If you don't ever use that energy that you're putting into your body, you're just going to store it, and then it makes you sick."

Finding the Sweet Spot for Time-Restricted Feeding

Opinions about how long one should fast each day when intermittently fasting varies. Clearly, if your eating window is less than 12 hours, you're doing better than most. As a general rule, the recommended range is between 12 and 18 hours of fasting each day.

I'm of the opinion that 16 to 18 hours of fasting might be the sweet spot, as this allows your body to deplete the glycogen stores in your liver more and suppress mTOR and activate autophagy better. Fung agrees, saying:

"I think that somewhere around 12 to 14 hours is a sort of a baseline … The next step up is somewhere around 16 to 18 hours. That's so easy to do. Once you get used to it, it's so easy. You can build that right into your day without any problems at all. I think that's where you're exactly right. Your glycogen stores last about 24 hours.

But if you're following a lower carbohydrate diet, you're not going to build up those glycogen reserves. Therefore, in 16 to 18 hours, you're going to get down to that point.

Remember, when you've gotten rid of a lot of those glycogen reserves, then your body's going to go into this mode where you're going into gluconeogenesis, which is starting to break some of the proteins down, which everybody thinks is bad, but I actually think is a highly beneficial thing, because you will rebuild that.

Then you start to get into burning fat. That's really where you want to be on a daily basis, 16 to 18 [hours of fasting]. It allows you to just jump into the 20- to 24-hour [fasting] range without any difficulty if you're at that baseline already."

How Growth Hormone Is Affected by Fasting

Many hormonal shifts occur during fasting. Paradoxically, growth hormone, which would appear to stimulate mTOR, does increase when you fast — increasing two to three times its baseline level within 24 hours of fasting — yet mTOR is suppressed during fasting. Fung explains:

"The growth hormone question is really interesting, because it does seem paradoxical. Why would your body make all this growth hormone if you've got nothing to eat? It's because the growth hormone acts through the liver to produce insulin-like growth factor 1 (IGF-1) … which mediates all the effects of growth hormone. If you knock out IGF-1 and give growth hormone, it has no effect.

During fasting and calorie restriction as well, your liver downregulates the growth hormone receptor in the liver. So [while] the growth hormone level goes way up, your body's not that receptive to it. Therefore, there's not a lot of IGF-1 going on. That's very interesting.

Because then when you eat again, this is when that big surge of growth hormone can start to hit you, and then you can start to rebuild all your muscle and so on … That's, again, is [part of] this rejuvenation process and this antiaging process."

Since your growth hormone level will remain elevated for up to 48 hours, you can further optimize your fitness by doing strength training on the day you break your fast, as then you will enter your workout with a very high growth hormone level, allowing for maximum muscle growth.

"That's what people do [when] training in the fasted state. They fast for 18 to 24 hours, get the high growth hormone levels, train and then they eat. That's when you got the big growth hormone surge. What they found also was that when you exercise, your body becomes more responsive to this growth, of course, because it wants to rebuild. But it'll last for like48 hours," Fung says.

"You don't have to eat before you exercise. You can exercise, then anytime within the next 24 to 48 hours, if you eat a lot of protein or whatever, you're going to have that rebuilding, because the growth hormone is there. The body is in that state where it's trying to rebuild."

One slight caution here is that fasting, being a stressor just like exercise, will also increase the stress hormone cortisol. While for most people, exposure to this mild stress every day will make them stronger and healthier, for some it may be problematic, and may require you to tweak your fasting schedule. You may find your body responds better to a once-a-week 24-hour fast, for example, opposed to daily intermittent fasting.

More Information

Fung also discusses the benefits of tea, known for their longevity-boosting effects. Green tea is rich in catechins such as ECGC. Fung likes Pique Tea Crystals, which contain far higher amounts of catechins than regular green tea. Just remember, for tea to be beneficial, you need to drink it "straight," without sweeteners and milk.

Whole leaf teas will also typically be of higher quality than bagged teas. Black tea contains thioflavins, which also appear highly beneficial. "Tea, I think, is one of the underappreciated sorts of things. I think it's just a part of a healthy lifestyle," Fung says, adding:

"The book itself, I think, is fantastic. It goes through everything sort of in a shorter form. If you want to get more information on fasting, you can go to 'The Complete Guide to Fasting.' If you want to get more information on salt, you can go to James' book, 'The Salt Fix.' If you want to get more information about healthy fats, you can go to 'Superfuel' or 'Fat for Fuel' … ['The Longevity Solution'] is sort of a synthesis of all that.

Then what we do is we look at the blue zones, which is these long-lived populations, and … see how they stack up [against] these simple ideas that we put out there for healthy living.

We also looked at this very interesting study called the 'Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma' (REGARD), which looked at the Southern diet, which is of the southern United States.

Turns out that fad diet is highly, highly detrimental. Why? It's a lot of processed foods, a lot of processed meats, processed fats, high in salt but not good because it's all processed …"

If you're intrigued by what you've heard so far and want to learn more, be sure to pick up a copy of "The Longevity Solution." In addition, my book, "Ketofast" is also available.

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Dr. Jason Sonners, author of the book, “Oxygen Under Pressure: Using Hyperbaric Oxygen to Restore Health, Reduce Inflammation, Reverse Aging and Revolutionize Health Care,” started out as a chiropractor. His passion, however, is hyperbaric oxygen therapy (HBOT), which is the focus of his Ph.D. studies at the University of Miami.

While commonly used to speed up stubborn wounds and tissue infections, hyperbaric medicine can also be helpful in the treatment of infectious diseases such as COVID. It’s also enormously useful for stroke patients. I can't think of a more effective intervention than to get the stroke patient into a series of hyperbaric treatments as quickly as possible.

HBOT for General Health and Disease Reversal

Every cell in your body, with the exception of your red blood cells (which have no mitochondria that require oxygen), requires oxygen to create energy. Many chronic diseases of the modern world involve decreased mitochondrial function, increased systemic inflammation, and an inability of cells to generate the required amounts of energy for optimal function.

“We use hyperbaric oxygen, traditionally, for these terrible and severe conditions,” Sonners says. Unfortunately, it’s typically a last resort, literally right before an amputation surgery or as a life-saving mechanism for somebody with carbon monoxide poison or air gas embolism.

“So, we only think about it, traditionally, to help save the life or limb of somebody in a really severe condition, but the mechanisms that are working for those folks are very similar to the reasons that you and I might consider using hyperbaric oxygen:

For upregulating the oxygen levels inside your body, which will help reduce inflammation, increase mitochondrial function ... and thereby increasing the energy that those cells are able to generate ...” 

HBOT for Chronic Diseases

Sonners’ goal is to expand the use of HBOT from the acutely life-threatening issues like gangrene to more chronic conditions, such as autoimmune and neurodegenerative diseases.

“My thought process is that the mechanisms of action of hyperbaric are the same whether we're talking about gangrene, radiation burns and osteonecrosis, or TBI [traumatic brain injury], concussion, maybe MS [multiple sclerosis] and post-stroke.

If we really get a mastery of the mechanisms of action, we can start to apply those mechanisms across the board. Clinically, we've seen hyperbaric work for so many of these other chronic illnesses ...

So, if we could really home in on those mechanisms and understand them better, and then get a better feeling for what time and pressure settings we require in order to get those mechanisms to kick in, then we can really, with more confidence, apply this therapy to these other conditions and have more consistent results in doing so.

A lot of the work I'm proposing to do is tagging onto some of this work in regenerative medicine, where they were looking at the collagen, fibroblast and stem cell response to hyperbaric. A study came out in 2020 on telomeres, and looking at this potential, upwards of 20% increase in telomere length, especially in certain immune system cells.

I want to build on that knowledge base, so what I'm doing is I'm creating a study that's going to have a lower-pressure group and a higher-pressure group, and we're going to be looking at a whole cytokine panel, so we can understand the mechanisms of the anti-inflammatory side.

We're going to have a methylation panel so that we can start looking at the epigenetic effects of hyperbaric. We're going to have a telomere component, similar to the telomere study that was done a year and a half ago.

And we're going to start comparing all of those metrics across roughly a three- to six-month timeframe of treatment, and over two separate pressure settings, to better understand which pressures are getting which effects, and again, what period of time should we be expecting before we get the results that we're looking for?”

Research Underway

On the low end, Sonners will be using 1.3 atmospheres (4.2 PSI) at 100% oxygen, and on the high end, he’ll use 2.0 atmospheres (14.7 PSI) at 100% oxygen. All patients will use hard chambers at two different pressures. The lower pressure group will be at 4.2 psi, which is the same as soft chamber pressures. 

“There's nowhere near the amount of research in soft chambers as there are in hard chambers,” Sonners says. “The overwhelming majority of research is done at that 2-atmosphere range, which is why I'm choosing that as the upper end of the research that I'm doing in the soft chamber research.

There is definitely some [research] on sports recovery. There's actually some ongoing studies right now on hyperbaric for stem cell use that we're waiting for. In some cases, 1.3 [atmospheres] has been used as the sham group, opposed to a treatment arm in the research. Maybe the study team really thought that 1.3 wasn't going to have an effect and it's a legitimate sham ...

I'm not sure, but there are some great studies. There's a study that was done on cerebral palsy (CP) and 1.3 was used as the sham group ... In this particular study, with 1.3 being the sham group, there was also a ... control group that got no hyperbaric at all.

Within the sham group, there was significant improvement on the metrics they were measuring. Then they had a 1.5 [atmospheres at] 100% oxygen, which also had a good improvement and then, a 1.75 [atmospheres at] 100% oxygen, which had even a greater improvement.

The issue in the study was that while all three of those groups improved, there was no statistical difference or enough of a statistical difference between the 1.3, the 1.5 and the 1.75. So, the conclusion of the study was therefore that hyperbaric does not work for CP, although all three of those groups had significant improvement.

So, because the sham group was not considered a treatment, that was the conclusion of that study. Now, the natural consequence of that should have been redoing the study and creating a different level of what the sham and the treatment arms ought to be, but that was never redone.

So, as a result, there's this study with results that say hyperbaric does not work for CP. Meanwhile, clearly, what it means is we need more studies. It's just that studies are expensive. They’re very time consuming and you really have to have a large interest in trying to come up with the right answers to put forth the effort and time and money to get that kind of work done.”

Mechanisms of Action

If you breathe 100% oxygen under pressure, it’s intuitively obvious that you're going to deliver more oxygen to your tissues. That’s one clear mechanism, but it’s not the only or even primary reason for most of the benefits of hyperbaric therapy.

Evidence suggests part of the benefit might be related to the degeneration of a molecule called hypoxia-inducible factor alpha (HIF-1 alpha), which is generated when you lower the pressure. The pressure is high inside the chamber, and is lowered when you exit the chamber and enter the normal atmosphere. That means some of the benefit might actually be occurring when you get out of the chamber. Sonners explains:

“We don't have an exact number right now, but roughly half of the treatment is occurring while you're in the chamber, being exposed to the pressure, being exposed to the oxygen and literally accumulating a surplus of oxygen because of the therapy itself.

The other half of the therapy is when you get out of the chamber, as that oxygen can no longer stay in solution. It literally starts trying to bubble out of solution. As that happens, it's not inert, it's actually very active. So, as it's coming out of solution, it's interacting with all of our cells.

As a result, it's triggering a massive cascade of events, cellular communication that seems to stimulate multiple series of regeneration and anti-inflammatory [events], even within the reactive oxygen species themselves.

When we look at the first part, which is the dosage of oxygen a person is getting, and that's measurable, you could say, ‘Here's a person, they were in a chamber, they were at this pressure, breathing this percentage of oxygen for this amount of time,’ and you could literally calculate the theoretical dose of oxygen that person was exposed to and should have been able to absorb.

We've kind of just stayed in that mindset for all these years. [However], there was a great paper out of Israel called ‘The Hypoxia-Hyperoxia Paradox,’ and what they're saying is we know that there's amazing benefits of hypoxia actually.”

Benefits of Relative Hypoxia

Some of these benefits include the stimulation of HIF-1 alpha, stem cell responses, collagen responses and the angiogenic responses. For these reasons, Sonners views hyperbaric as an anabolic therapy — a therapy that stimulates vitally important growth and repair, as growth factors such as VEGF (vascular endothelial growth factor), and BDNF (brain derived neurotropic factor) are both stimulated.

Again, these growth factors are not stimulated by the hyper-oxygenation. They're a result from the hypoxic component, the process your body goes through as the oxygen is leaving your body.

“The important thing to note is that once you've accumulated all this extra oxygen, your hyper-oxygenation component, as that oxygen is leaving your body, you're never truly hypoxic,” Sonners says, “but the cell signaling factors that respond to traditional hypoxia are also seemingly responding to this relative hypoxia.

If you look at that paper [‘The Hypoxia-Hyperoxia Paradox’] ... it seemed to delineate this. With hypoxia alone, you will still get VEGF, which means you'll still get a lot of angiogenics, the rebuilding of the endothelial lining, the creation of a new micro-circulation bed, all this capillary regrowth will happen from hypoxia.

You'll get these stem cell releases, this potential for increase in the regenerative nature of cells. You'll get this increase in the HIF-1 alpha. But if you're chronically hypoxic, you're also going to get a downregulation of sirtuins [longevity proteins] and you're going to get a downregulation of mitochondrial function.

Sirtuins could play a great role in things like cell cycle life, getting cells out of cellular senescence — kicking them back into active life — or apoptosis, killing that cell so that we can replace it with a new stem cell, or even the genetic and epigenetic repair mechanisms. A lot of that has to do with sirtuins, so we don't want to downregulate those. We want to upregulate those.”

So, to clarify, with HBOT, you get the benefits of hypoxia with none of the downsides. Rather than inhibiting sirtuins, which are important for health and longevity, you actually get an upregulation of sirtuin activity. It also upregulates mitochondrial function and boosts mitochondrial replication, which the complete opposite to what happens in true hypoxia.

What About the Free Radical Component?

Without any doubt, HBOT is a type of oxidative stress, but it doesn’t have the adverse effects you’d expect. Sonners explains:

“There was a great paper done by Dominic D'Agostino and Angela Poff, back in 2017 or 2018, specifically looking at the reactive oxygen species or the free radical component of hyperbaric oxygen. What are the benefits or consequences as we upregulate, as we increase the amount of oxygen into the body?

As the cells and the mitochondria start to uptake that oxygen, producing more energy, there is a natural consequence where this byproduct of free radicals are released as a part of normal cellular respiration. Excess free radicals is obviously consequential to cell membranes, lipid peroxidation and protein degradation.

It could destroy cell membranes, mitochondrial membranes, nuclear membranes, genetic material ... At the same time, it's a normal response to cellular respiration and our bodies have their own intrinsic mechanisms for dealing with some of this excess free radical, things like the superoxide dismutase, catalase and glutathione pathways.

So, there seems to be a distinction that we should make. One is that some of the free radicals our bodies are exposed to come from the outside world in. Radiation, smoking, air pollution, the list goes on and on. So, we need to have a robust, intrinsic ability to tolerate these free radicals with our own antioxidant system.

But in excess, we could be getting too much free radicals and we could be depleting our own systems, in which case supplementation should certainly be considered and used. On the flip side, we look at hyperbaric oxygen as this tool that theoretically has all these great effects, but one of those consequences would also be this increase in free radical exposure.

There seems to be a very big delineation between a body that's exposed to free radicals from the outside world, versus a body that is exposed to free radicals that it's creating on its own.

One of those distinctions is that through the use of hyperbaric oxygen, even without supplementation, and the increase in free radical production from mitochondrial ATB production, the body itself — assuming it has the right raw materials — will actually increase its own superoxide dismutase, catalase and glutathione pathways.

This would No. 1, help make you more resilient to hyperbaric oxygen, but No. 2, would also help make you more resilient to all the other free radicals that you’re potentially exposed to in your environment.

So, I would say two things. One, especially with patients who are a little bit more fragile when it comes to oxidative stress, those people, I would tend to not over oxidize to begin with, so I might start at a gentler hyperbaric protocol with them, and I'm likely to want to start quickly upregulating their own system, getting the right supplementation for improving their intrinsic antioxidant systems ...

Then, as their system improves their tolerance for reactive oxygen species, we may not need as much of that, or if we're going to be using high dose hyperbaric oxygen for a period of time, we might use things like certain SOD precursors, or molecular hydrogen.

Through conversations with you, it has become one my favorite antioxidants that we use. Between 45 minutes to an hour before [hyperbaric treatment], we’ll start loading people with the molecular hydrogen as a mechanism to reduce the consequences. There are benefits, in other words. Reactive oxygen species on its own also helps stimulate hormone balance and helps stimulate cell repair by themselves. So, there has to be this balance.

We don't want to quelch all the free radicals because free radicals are a very important signaling molecule for so much cellular activity and at the same time, we want to be aware of the fact that hyperbaric does increase that, and we want to make sure that we're not over-exposing somebody.”

HBOT Functional Medicine Course Now Available

Sonners also reviews the curriculum he developed for the International Board of Undersea Medicine. The IBUM has been certifying people in hyperbaric medicine for 25 years, and the curriculum Sonners created has been taught as a functional medicine hyperbaric course for clinicians for the past year.

“A big push for me, and even for the research I'm doing, is to help create awareness that gets more doctors excited about [HBOT], that want to actually use it in their practice,” Sonners says. “So, this has been an attempt to really improve the education so that people aren't just going to hyperbaric courses to learn about wound care.

We needed courses to help practitioners like myself or other people interested in the regenerative side to be able to learn how to apply it that way. So, we now have a course that I teach a few times a year to get people on the same page.

The majority of this last year, other than getting through school and writing the thesis, has been developing and promoting that course. I think we've certified about 125 to 150 practitioners and technicians specifically on the functional medicine side of hyperbaric use ...

At this time, I still see a pretty big mix between soft chamber use and hard chamber use. A lot of those doctors are either Dos, MDs, chiropractors or naturopaths, getting into more of a functional medicine base, just looking for other natural approaches to the things they are treating.

Hyperbaric supplies the body with a fundamental ingredient and it's so necessary for cellular performance. It just seems to make sense to start implementing a tool and a modality like that into a setting where you're trying to reduce inflammation, you're trying to improve energy production cellularly.”

HBOT Has at Least 100 Indications for Use

While the list of potential uses for HBOT is extremely long, in the U.S., the Food and Drug Administration has approved and most insurance will pay for HBOT for the following 14 conditions:¹

Air or gas embolism	Carbon monoxide poisoning
Clostridial myositis and myonecrosis (gas gangrene)	Crush injuries, compartment syndrome and other acute traumatic ischemia
Decompression sickness	Arterial insufficiencies, such as central retinal artery occlusion
Severe anemia	Intracranial abscess
Necrotizing soft tissue infections	Osteomyelitis
Delayed radiation injury (soft tissue and bone necrosis)	Compromised grafts and flaps
Acute thermal burn injury	Idiopathic sudden sensorineural hearing loss

In terms of conditions that can benefit from HBOT, I would certainly add stroke, TBI, heart attack, anytime there's post ischemic reperfusion injury, and most neurodegenerative conditions. Internationally, there are about 100 recognized indications. While that might make it sound like a magical cure-all, it’s important to remember that it doesn’t cure anything directly.

What it does is provide your body with a foundational nutrient, oxygen, that virtually all cells require. HBOT supplies your body oxygen in a surplus, creating an excess reservoir of oxygen to improve that function. That’s why it can help improve such a wide variety of health conditions.

Even autoimmune diseases such as MS, lupus and rheumatoid arthritis, just to name a few, may benefit, Sonners says. A whole other category of potential use would be wellness, longevity and regenerative-type therapies.

“We're just applying the tools slightly differently to help match the intensity of the therapy to the severity of the condition. We can utilize the principles of gas exchange in various ways to help so many different types and various types of conditions,” Sonners says.

“One condition or subclass that we talked about it in the beginning is, from the immune system standpoint, upregulating your ability to fight infection by increasing white blood cell activation through the reactive oxygen species mechanisms. We use it for anaerobic infection, bacterial infections all the time.

One of the main reasons that hyperbaric works in those severe conditions is those bacteria are anaerobic. They don't live in high oxygen environments.

So, we know that putting a patient in a high oxygen environment massively decreases bacteria's ability to function, potentially helps to kill that infection, helps to block the toxicity of that infection and helps to break down the biofilms around that infection. So, hyperbaric becomes an amazing tool in the capacity of immune system balancing and/or ability to help fight infection.”

More Information

As a general guidance, Sonners recommends doing hyperbaric for about two hours a week on a regular basis. That’s his personal routine. In addition to that, three times a year he does a 30- to 40-hour protocol over the course of six to eight weeks. He explains why:

“We know that in general ... three or four sessions is not going to ever cut it. The main effect of hyperbaric is really achieved through the cumulative effect and the increasing and decreasing — the wave of hyper-oxygenation back to normal oxygen levels — creating that hyperoxia-hypoxia type paradox ...

When you do a protocol similar to like what I would do for a patient, let's say four to six hours a week for eight weeks, the frequency of those ... the space in between them, really shrinks and you get far more signaling to occur ...

If all we cared about was the physical dose, we would stay at 100% oxygen as long as we possibly could, at the highest pressure we could tolerate to get the most oxygen absorption. I don't think that that's where the majority of benefit exists.

Every time your pressure changes or your percentage of oxygen changes, you're stimulating HIF-1 alpha, the reactive oxygen species load, sirtuins, you're signaling a hormetic effect. I picture them as switches. You're flipping that switch on, off, on, off, on, off. I think it's the amount of times that you stimulate that switch that will create the benefits we're looking for, more than the physical dose of oxygen over time.”

To learn more about HBOT in general, be sure to pick up Sonners’ book, “Oxygen Under Pressure: Using Hyperbaric Oxygen to Restore Health, Reduce Inflammation, Reverse Aging and Revolutionize Health Care.”

In the interview, we also discuss how you can incorporate HBOT in your fitness routine, along with fasting, to augment and upregulate cellular performance, recovery and regeneration. So, if that’s of interest to you, be sure to listen to the interview in its entirety, or read through the transcript.

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