Diving into Healing: Exploring the Depths of Hyperbaric Oxygen Therapy (HBOT)

This article is written in conjunction with Dr. Scott Sherr as well as his recent podcast with Dr. Philip Ovadia on the Stay Off My Operating Table Podcast.

Most people first learn about hyperbaric oxygen therapy (HBOT) through various channels, personal anecdotes, medical advice, and information shared via social media or health-focused online platforms. Most healthcare providers learn about it in hospitals, treating diabetic wounds. Many share their HBOT experiences on social media platforms, especially about conditions like long Covid. Joseph Dituri spent three months in an underwater habitat and experienced health benefits attributed to HBOT-like conditions. Many athletes and celebrities use HBOT for wellness and recovery. Medical papers are being published on HBOT. In wound clinics or shock trauma centers, people get better quickly from things like flesh-eating bacteria, carbon monoxide poisoning, severe burns, and wounds.

From Caissons to Chambers: The Evolutionary Journey of Hyperbaric Oxygen Therapy

HBOT is a technology that’s been around for hundreds of years and has various forms. Hyperbaric (meaning “high pressure”) environments or HBOT were invented in the 1600s when a British physician and clergyman, Nathaniel Henshaw, was reportedly the first to use compressed air in a sealed metal chamber. He used an organ bellow to either blow air into the chamber, increasing the pressure (hyperbaric), or to suck air out of it, decreasing the pressure (hypobaric). The two following centuries saw reports of the benefits of using increased pressure for oxygenation. By 1877, hyperbaric chambers had been used for various conditions despite a general lack of scientific understanding or evidence about their mechanism of action or efficacy.

It wasn’t until 1917 that German inventors Bernhard and Heinrich Dräger successfully treated decompression illness from diving accidents using HBOT. This was the first indication approved for HBOT and remains one of the most widely used reasons for HBOT. The idea of using HBOT for decompression illness began during the bridge-building bonanza of the mid-to-late 19th century, especially the building of the Brooklyn Bridge in New York City. The “bends” were described in popular press during this bridge’s construction. Even the leading bridge architect, John Roebling, was paralyzed from the bends during construction.

The first hyperbaric chamber in the United States appeared in New York in 1861. Neurologist James Leonard Corning’s interest in HBOT therapy stemmed from witnessing severe decompression illness among the Hudson Tunnel site workers, who would often experience severe muscle pain and paralysis after working underwater all day. In 1921, the Kansas-based physician Orval J. Cunningham built a hyperbaric chamber in Kansas City after observing that morbidity and mortality rates from the “Spanish influenza” pandemic of 1918 were greater in higher elevations than in coastal areas, which he attributed to the barometric pressure. He opened the world’s largest HBOT chamber along the shores of Lake Erie in Cleveland, Ohio, in 1928. This million-dollar, 900-ton sphere measured 64 feet in diameter, was five stories tall, and had 12 bedrooms on each floor. The structure was known as the Cunningham Sanitarium and was considered the first attempt to build a hyperbaric hotel.

Interest in HBOT didn’t increase until 1956 when Dutch cardiac surgeon Ite Boerema reported using HBOT during cardiopulmonary surgery. Now, we have bypass machines, so we don’t use hyperbaric chambers. It’s arguable that we should probably use HBOT before CABG surgeries, and there is some evidence of that. It would potentially save both the heart and brain.

After that, more promising reports on the use of HBOT surfaced, including one by Boerema’s colleague, Willem Brummelkamp, who reported in 1961 that anaerobic (low oxygen) infections were inhibited by HBOT therapy.  Since then, HBOT has been used in the treatment of numerous medical conditions, including carbon monoxide poisoning, infections, wound healing, and trauma. Soft inflatable or low-pressure HBOT chambers were developed in the late 1990s and early 2000s to treat acute mountain sickness initially. Still, their indications are on the verge of exploding in the neurocognitive and exercise optimization spaces. Long story short, hyperbaric therapy has been around for a long time.

Oxygen — Just Breathe

Before we get into what actually happens in a hyperbaric chamber, let’s talk about oxygen. Mount Everest is the world’s highest peak, elevation 29,032 feet or 8,848.86 meters above sea level. Every year, climbers meet their death by ascending the mountain. Although in recent years, many deaths have been related to bottlenecks reaching the peak due to overcrowding, garbage strewn everywhere, accidents, or inexperience. Almost every climber that’s reached the peak has used supplemental oxygen. Of the 5,294 successful climbers ever (2019 statistic), only 163 have reached the top sans oxygen to help them along the way. Without extra oxygen, the chances of survival are much lower, except for the most experienced climbers.

Why?

At sea level, there is 21% oxygen in the air. The rest of the air is mostly nitrogen, and in cities, you get lovely toxins like carbon monoxide and MTBE (Methyl tert-butyl ether). Have you been to Beijing? At the top of Mt. Everest, this percentage of oxygen falls from 21% to 6.3%! Even at Everest base camp, at an altitude of around 17,000 feet, depending on whether you are North or South, the oxygen level in the air is effectively 11%.

You might wonder how anyone could survive on that little oxygen at Mt. Everest’s peak (let alone at base camp). As we will soon learn, the body has amazing ways of increasing oxygen-carrying capacity even in low-oxygen conditions called acclimation. But it takes time, and it’s certainly not easy. The Latin root of acclimate comes from "clima." meaning "slope, inclination," which was used to describe the slope of the Earth's surface, and by extension, regions with different weather patterns or climates. The prefix "ac-" in "acclimate" is often used to mean "to" or "toward."

If you don’t let your body acclimate, you’ll develop altitude sickness, which can kill you. Interestingly (and for reasons you’ll soon understand), this is the one insurance-approved/FDA-approved indication for mild pressure hyperbaric chambers.

Every time you fly in an airplane, you exist in deadly low oxygen (hypoxic conditions). Boeing’s Dreamliners are essentially hyperbaric chambers pressurized to simulate an altitude of 6,000 feet, which equates to an air oxygen concentration of about 16.6%. The jet lag you feel is partly due to this exposure to higher altitudes. You’re less hypoxic, so when you get to your destination, you’re also less jet-lagged and less prone to infection. More on all this later!

If you hike the Inca Trail in South America, the peaks are at14,000 feet. Spending a week acclimating between 8,000 and 10,000 feet before heading on the trail, makes the hike much easier because you are low-oxygen adapted. Even better, if you spend some of that time at the highest Irish bar in the world, which is at 10,000 above sea level in the town of Cuzco, Peru. A word to the wise: drinking at altitude is NOT a good idea. Alcohol dilates blood vessels, and the low oxygen levels don’t go well with this, as we’ll see.

The Dead Sea

If you had a chance to visit Israel and experience the lowest place on Earth, the Dead Sea. The Dead Sea has been a known healing place for thousands of years. It is 1,412 ft below sea level or 430.5 meters. At this depth, the amount of oxygen increases from 21% at sea level to about effectively 25%, depending on the season. Most websites emphasize the mud and the salt as being the main reason why the Dead Sea is a healing place, and there are indeed studies that show benefits to both. But the most intriguing and compelling data comes from studies in patients with [lung diseases like COPD and cystic fibrosis disease. These patients improve below sea level because there is more oxygen in the air even more, every cell in their body has more oxygen. And, as we’ll find out soon, whereas there’s less pressure the higher in altitude (known in common parlance as “thinner” air), there’s more pressure at the Dead Sea, which helps the oxygen diffuse into the the cells at higher levels.

Next time we’ll talk about why oxygen and mitochondria are important and what really happens inside a hyperbaric chamber.

Scott Sherr MD Website

Dr. Scott is a Board-Certified Internal Medicine Physician Certified to Practice Health Optimization Medicine (HOMe), a specialist in Hyperbaric Oxygen Therapy (HBOT), and COO of Troscriptions (a Smarter Not Harder company). His clinical telepractice includes HOMe as its foundation alongside an integrative approach to HBOT that includes cutting edge and dynamic HBOT protocols, comprehensive testing (using the HOMe framework), targeted supplementation, personal practices, synergistic technologies (new, ancient, psychedelic), and more. Together with the medical team at HMS, Dr. Scott works to develop personalized treatment plans for patients.