The Case for Mild HBOT for Chronic Inflammatory Response Syndrome

Written By Dr. Walker Porterfield

This article was originally written by a man who was diagnosed with CIRS on his personal blog “Biotoxin Journey” The original article may be found here. My comments can be found throughout using the * to distinguish them.

HBOT for Chronic Inflammatory Response Syndrome

Years back prior to being diagnosed with Chronic Inflammatory Response Syndrome (CIRS), the naturopath I was working with had diagnosed me with chronic Lyme disease. Given that I was having trouble tolerating some of the antibiotics, their very limited effect, and my reservations over their long term use, I researched alternative Lyme treatment protocols. It didn’t take long before my research led to Hyperbaric Oxygen Therapy (HBOT).

Even thought the price tag was steep, we ended up buying a used portable HBOT. If you’ve read some of my other articles, you know how how horrific those times were. To hell with the price tag; research showed HBOT could help.

Of course, later I discovered my real issue was CIRS. Regardless, the many benefits of HBOT apply to either condition. When it comes to CIRS, HBOT can work wonders healing the brain – not to mention stimulating blood vessel repair, reducing inflammation, and so on. I’ve now done probably close to two-hundred 1-hour long dives in our chamber. In this article, I’m going to cover what I’ve learned over the years in researching and using our HBOT.

Table of Contents

January 31, 2017

  • 1 HBOT Basics

  • 2 Portable mHBOT Chambers & Masks

    • 2.1 mHBOT Chamber

    • 2.2 Air Compressor

    • 2.3 Oxygen Concentrator

    • 2.4 Masks & Cannulas

  • 3 HBOT Physics

    • 3.1 HBOT Partial Pressures of Oxygen Table

  • 4 Hard Shell HBOT & mHBOT/HBOT Indications

    • 4.1 Undersea and Hyperbaric Medical Society (UHMS) Approved HBOT Conditions

    • 4.2 “Off-label” Studied Uses of HBOT

    • 4.3 More Benefiting Conditions

  • 5 False mHBOT Arguements

    • 5.1 HBOT Has Been Shown to Be No Better than Sham in Studies

    • 5.2 Studies Do Not Support the Use of mild HBOT Pressures

      • 5.2.1 HBOT General Benefits – Short List

      • 5.2.2 mHBOT Studies – A Smattering

    • 5.3 Soft Shell HBOT Can Not Saturate Tissue with Oxygen like Hard Shell HBOT

    • 5.4 Bacteria and Fungi May Grow Under Lower mild HBOT Conditions

  • 6 General Treatment Protocol

  • 7 My mHBOT Experiences

HBOT Basics


How a mild Hyperbaric Oxygen Therapy Chamber Works

What a Hyperbaric Oxygen Therapy Dive is Like

Essentially, Hyperbaric Oxygen Therapy (HBOT) consists of a person getting into a chamber that is then pressurized. While inside, the person breaths in higher concentrations of oxygen. The increase in both pressure and oxygen is considered Hyperbaric (meaning extra pressure) Oxygen Therapy and is very beneficial in many ways. However, before I get into a review of the benefits, its best if we first cover some HBOT basics.

The three factors that vary between the various types of HBOT sessions are pressure, oxygen concentration, and time. In general, as each of these is increased, the body’s tissues become more saturated with oxygen. To understand this, we need to look at what happens to our blood inside an HBOT chamber.

As pressure, oxygen concentration, or both increase, more oxygen is forced into the blood and subsequently the tissue. Normally, oxygen is carried by our red blood cells. However, given that the red blood cells are typically loaded up with oxygen in most people (above 95%), the red blood cells have very little extra oxygen carrying capacity. As a result, the extra HBOT oxygen is forced into the blood plasma – the liquid portion of the blood. This extra plasma oxygen courses through the body. With time, this extra oxygen seeps through the arteries and veins into the surrounding tissue producing all kinds of beneficial effects.

When it comes to the actual design of chambers, there are two basic types – “hard” and “soft” shelled chambers. Generally speaking, when you go to a clinic or hospital, the chambers have a “hard” shell. In the case of HBOT clinics, these hard chambers are usually a thick walled, clear acrylic tube with steel ends that is flooded with 100% oxygen. The tube is just big enough for one person to lie down inside. Hospital chambers can be much larger capable of accommodating many people in a seated position and may be flooded with 100% oxygen. Alternatively, participants may wear a clear hood that drapes over the head while the chamber is pressurized with regular room air.



In contrast, “soft” shell chambers consist of a sturdy, flexible bladder that is air tight once zipped closed. Often referred to as “Portable HBOT” chambers or “mHBOT” (mild HBOT), these “soft” chambers operate at significantly lower pressures compared to hard shell chambers and are always flooded with pressurized room air – never pure oxygen. While inside, users breathe in various levels of additional oxygen through either a nasal cannula or mask. Not surprisingly, for a given oxygen supply rate, the standard nose prongs on a tube (cannula) delivers the least amount of additional oxygen while specialized non-Rebreather masks, also called Exercise With Oxygen Therapy (EWOT) masks. deliver the highest levels.

Portable mHBOT Chambers & Masks

Before we get into the physics and HBOT studies, I thought I’d take a little time to describe my mHBOT chamber. Every mHBOT system consists of the chamber that the user climbs into, an air compressor that pumps up the chamber, and an oxygen concentrator to deliver extra oxygen via a cannula or mask. Let’s take a look at how these pieces work to create an mHBOT session – also called a “dive”.

Before climbing into the deflated chamber, the user turns on the oxygen concentrator and sets the flow rate. If they’re humidifying the pure oxygen that the machine is generating, they will also fill a small bottle with water that the oxygen is bubbled through.

*As a side note from Dr. Walker, Humidifiers are not recommended inside the chamber.

Once zipped inside, the occupant presses a remote control button that turns on an air compressor that delivers a fairly high volume of room air into the chamber. It’s the air compressor that pumps the chamber up to pressure. The sides of the chamber become drum tight.

*In my experience, you should avoid all technology inside the chamber, so turning the pump on before going in would be ideal, rather than using a remote.

The user controls the rate the chamber fills by turning a pressure control knob fitted at the head of the chamber. This knob has a shaft with a series of holes that are progressively opened and closed as the knob is turned one way or another. The knob is slowly closed to raise the pressure and opened to lower the pressure over a period of about 5-15 minutes.

*This individual is using a OxyHealth chamber. We recommended a more affordable option. Contact our team to see how affordable owning your own chamber can be!

When fully closed, the chamber eventually reaches its design pressure. In our chamber, this is 1.3 ATA or about 4.4psi on the pressure gauge. At that point, two pressure relief valves open at the foot of the chamber just enough to keep the chamber pressure from rising any further. Fresh air is continuously pumped in at the head the chamber for the duration of the dive while stale air exhausts out at the foot. When the dive is over, the compressor is turned off using the remote and the pressure is brought back down to ambient by slowly opening the pressure control knob.

As the pressure is being raised and lowered, you have to equalize your ears by moving your jaw in a chewing motion. It’s just like when you’re on a plane ride. Since you have control over how quickly the pressure changes, you can take your time. This is very important. By the time you feel any discomfort, damage has already been done.

As an aside, that’s one factor that I really didn’t like about the single hard shell HBOT session I did. Lying inside the thick-walled, clear acrylic tube, I had to communicate with the operator on how quickly to raise the pressure inside the chamber. I’ve learned since then that my ears are very sensitive to pressure changes. I chalk this up to all the tissue “remodeling” that’s been done over the years due to high TGF-beta1. In any case, I felt self-conscious having to ask the operator to first raise, then lower, then raise the pressure again too many times. Not only was it uncomfortable socially for me, but it was also damaging for my ears.

Setting aside that hard shell HBOT experience, once up to pressure, the soft shell mHBOT occupant dons a cannula or mask that delivers the higher concentration of oxygen. One important fact to understand is that people inside the chamber do not need the extra oxygen to breath. The chamber is being flooded with lots of room air by the compressor. There is absolutely no risk of suffocating. Even if the power goes out, a person simply slowly opens the pressure control valve to bring the chamber back down to normal and climbs out.

I’m not saying there’s zero risk but if a person makes sure to buy a quality chamber and regularly inspects it for failing seems, the risk is quite low. Take a look at the video below to get a sense for the features in a quality chamber. The seams should be well done, the ports reinforced, and the blow off valves should be at the foot of the chamber and the fresh air at the head.


In my estimation, the biggest catastrophic risk comes from unzipping the chamber before the pressure is completely normalized. I say this because once I foolishly rushed to open the chamber before it had completely stopped depressurizing. I could still hear a slight amount of air blowing through the open pressure relief valve. The moment the seal from the rubber flaps was broken, the remaining pressure dropped instantly and I got a very sharp pain in both my ears. I was OK, but it became very clear that the human ear can not tolerate even slight amounts of pressure change when done rapidly.

MHBOT CHAMBER

Chambers are made from a very strong material like nylon that is then impregnated with a rubber like material such as urethane to make them air-tight. Seams are typically stitched with Kevlar thread and the overlapping urethane seems are welded together. Semi-flexible polycarbonate windows allow the occupant to see out and communicate with others more easily. The user enters the chamber through a long double zippered closure with two heavy rubber flaps that seal the zippers air-tight when under pressure. A moon shaped cushion levels out the bottom of the chamber while providing comfort.

There are various ports at either end of the chamber. These ports are reinforced with an additional layer of fabric and most have a metal fitting with a threaded hole in the center. The 1” diameter compressed air line, a 1/4″ barbed fitting for the oxygen concentrator line, and the two pressure blow-off valves thread into these ports. Additionally, there is a pressure gauge on the outside, an air filter for the compressed air on the inside, and a pressure control valve fitted into custom ports.

On my chamber, there were two additional spare ports that I ran in power and CAT6 internet cable through. To do this, I removed the thread brass plug from each port and cut off the ends of the cord and internet cable. I then tightly wrapped just enough electrical tape around the cord and cable so that they were just thick enough to thread snuggly into the port holes. To finish, I re-attached an electric plug and internet cable end. In so doing, I can watch videos, check email, and do research for articles like these during my “dives”.

*I do NOT recommend taking any electronics in the chamber like this individual did. You run a risk, albeit small, of an electrical spark in a high oxygen environment.

AIR COMPRESSOR

On my system, the chamber is pumped up by an oil-less, double-head OxyHealth air compressor capable of delivering up to 4.5 cfm through as much as 50 feet of line. This room air passes through three separate air filters. The compressor plugs into a remotely controlled on/off devise that then plugs into the wall. As such, the compressor can be turned on and off from inside the chamber.

From Boyle’s Law, we know that when air is compressed, it warms up. In winter, this is a real bonus here in cold Wisconsin. In summer, wearing shorts and a tee-shirt sometimes isn’t enough. On those days, I’ll run a small fan inside the chamber to help keep cool. For those that need extra cooling, there are two basic approaches.

Using Boyle’s Law, the first air cooler blows off some of the pressurized air to help cool the air being delived to the chamber. Cool Hyperbarics makes this type of cooler that doesn’t use ice or Freon like other coolers. Alternatively, you can make your own cooler out a bucket that has roughly 15 feet of additional air line loosely coiled inside. Each time before firing up the compressor, the bucket is filled with ice. It’s pretty basic but I’m told it helps quite a bit.

OXYGEN CONCENTRATOR

Regular air is roughly 21% oxygen and 78% nitrogen. Oxygen Concentrators miraculously take the 21% oxygen found in room air and concentrate it so that nearly 100% oxygen flows out into the delivery line. They do this using Pressure Swing Adsorption (PSA) technology.

In short, PCA uses two metal canisters filled with tiny beads of a special material called a “molecular sieve” that are alternately and repeatedly compressed and decompressed with room air. It sounds like the machine is breathing. When the compressed room air comes into contact with all those special tiny beads, they absorb the 78% nitrogen in the air while allowing the remaining nearly pure oxygen to flow out to the recipient. On decompression, the sieve material relinquishes the trapped nitrogen that is then off-gassed into the room. It’s amazing to me.

Particularly at higher flow rates of 4L/min and above, pure oxygen can be drying for some. To address this, a plastic bubbler jar can be filled with water and the oxygen line hooked up to it. The dry incoming oxygen is delivered to the bottom of the water filled jar and bubbles up to the top. This humidified oxygen then continues on to the HBOT chamber.

The only adjustment comes in the form of an adjustable flow meter. Rotating a dial changes the rate in liters per minute that oxygen is delivered. Given that we wanted to be able to drive up oxygen levels in our bodies for some situations, we use a 10L/min concentrator.



Most of the time, oxygen concentrators are used by those with lung diseases. Consequently, they come with safety features. When first turned on, the machine sounds an alarm while going through safety checks. If everything is OK, the alarm goes off. If the power goes out or the unit begins to fail, the alarm sounds. Additional, a light on the front of the machine shines whenever the concentrator isn’t producing high levels of oxygen. Normally during startup, this light will stay lit for about 30 seconds.

The air compressor and oxygen concentrator make a fair amount of noise. To remedy this, I placed them in another room opposite to the room with the chamber. To make it easy to run the lines between them, I installed a 2″ PVC tube through the wall. Not only does it help greatly with noise, but it also keeps the room cooler.

MASKS & CANNULAS

Not knowing any better and thinking more oxygen was better, I began doing mHBOT sessions using a specialized non-Rebreather mask also called Exercise With Oxygen Therapy (EWOT) mask. This type of mask has a couple simple rubber flapper, one-way valves to control the air flow. While exhaling, stale air is directed out an exhaust port while the incoming oxygen is collected in a reservoir bag. During inhalation, the exhaust port is sealed and oxygen is inhaled from both the reservoir bag and the oxygen line. If the user takes in more oxygen than is available from the bag and line, a safety valve opens allowing room air to be drawn in.

Generally speaking, EWOT masks can deliver 70% oxygen or more. A regular mask delivers about 50% oxygen. Part of this has to do with the quality of the seal of the mask to the face. Another part has to do with the fact that during exhalation wearing a standard mask, the oxygen is not captured in a bag. It’s lost as it leaks out the mask into the surrounding air.

Over the years, I’ve customized my EWOT mask. Initially, I re-fitted the face portion. Not only do the cheap vinyl masks smell, but they don’t fit well to my face at all. They pinched my nose closed. Whenever I would start to fall asleep, I’d be woken up in a bit of a oxygen-deprived panic because I breath through my nose when I sleep. This was not good.

Incredulously, it was impossible to find a better quality non-rebreather/ EWOT mask. I ended up buying an Precise Flight’s Comfort Silicone Face Mask thinking it operated the same way as a non-rebreather mask. It didn’t.

Not one to give up, I sealed the valves in the mask with black duct tape and fitted my existing EWOT body to the silicone mask using a short length of 5/8” I.D. clear vinyl tubing. I heated the tubing in hot water to make it flexible enough to fit over the nearly same diameter ends of the mask and EWOT body. No oxygen flows through this short length of tubing; it simply connects the mask to the hard plastic EWOT body.

Additionally, I was never happy with the cheap vinyl reservoir bag. Not only because of the odor but also because it’s hard to sterilize and is too stiff. Over time, it became so stiff that a lot of oxygen was being lost because the bag didn’t fill out anymore. To remedy this, I found a non-latex, 1-liter reservoir bag. Happily, the plastic collar of the very flexible bag fit snugly over the tubing on the EWOT body with no modification.

I now have a very durable, well fitting and functioning EWOT mask. At the maximum flow rate of 10L/min, the oxygen concentrator can just keep up with my breathing during rest without triggering the safety valve. At these times, I’m receiving close to 100% of oxygen. If I move around too much, respiration increases and the bag doesn’t fill enough causing the safety valve to let in room air near the end of each inhalation.


body from and purchased through Longevity is no longer available. Longevity now sells a slimmed down version of the same mask. It looks like the valve body on their new mask could be similarly retrofitted to a better quality mask and reservoir bag. By the way, the “MaxO2” or “LiveO2” EWOT masks used during intensive training are completely different. They do not use a valve body connected to a small reservoir bag.

A nasal cannula consists of tubing with a loop at the end. Two nasal prongs are fitted into this loop and deliver oxygen to the nose. The cannula is put on by first placing the prongs into the nose and then draping the two ends of the loop over the ears. The ends of the loop then turn back to the front of the wearer where they collect into a single line in a Y-fitting at the front of the chest. The cannula is not worn like a headband. No tubing goes behind the head.

Unfortunately, inexpensive cannulas are made out of smelly vinyl. For a price, you can buy all silicone cannulas. Particularly if you’re humidifying the water, cannulas should be replaced often or boiled in hot water.

HBOT Physics

In order to understand the differences between hard and soft shell HBOT chambers along with make sense of various studies done on the therapeutic effects of HBOT, we need to talk a bit about pressure and oxygen concentration. In the United States, portable, soft shell, mHBOT chambers are not allowed to go above 1.3 ATA of pressure. It used to be 1.5 ATA like it is in Europe and elsewhere. In comparison, hospital and clinics typically work at 2.0 ATA and above.

So the question is, what does ATA mean and how does it relate to HBOT oxygen concentrations in the body. In terms of HBOT, Atmospheres Absolute (ATA) units indicate the amount the air pressure is increased. To get a sense of the significance of these values, you need to remember that air pressure increases the closer we are to the center of the earth and decreases the farther we are from the earth’s center – the higher up we are. This is because air consisting of about 78% nitrogen, 21% oxygen, along with a smattering of carbon dioxide and a handful of other gases, has weight. The closer a person is to center of the earth, the more air there is pressing down on the person – the greater the pressure.

Getting into some specifics, equipment like a soft shelled mHBOT operating at 1.3 ATA means the pressure inside the chamber is increased by a factor of 0.3 above what it is outside the chamber. If a person lives in Wisconsin like I do where we are close to sea level (800 feet above) the air pressure is very close to 14.7psi (pounds per square inch) or 760mmHg (millimeters of mercury). Given that the chamber is designed to operate at 1.3ATA, the total pressure works out to about 19.1psi. In other words, the HBOT pressure is 4.4psi greater than the atmospheric pressure.

On the other hand, someone that lives out West at let’s say an elevation of 5,500 feet above sea level is subject to close to half of the atmospheric pressure than those at sea level – 7.3psi. When these people climb inside their 1.3ATA mHBOT, the chamber is pressurized an additional (7.3X0.3)= 2.2psi and the total pressure is (7.3+2.2)= 9.5psi. That appears to be a significant difference in pressure.

Although I couldn’t find much material on this particular subject, and as you’ll see as we look over some of the HBOT studies, this is just one of many variables that haven’t been quantified well when it comes to HBOT therapy. This in no way means that HBOT isn’t helpful; it is. When it comes to variability in absolute pressures depending on elevation, I believe ATA is in fact the best possible unit of measure. In effect, what we’re really concerned with is how much the pressure is increased over ambient levels.

To understand this, it’s clear that as we go about our daily lives, the gases in the human body are naturally at equilibrium with the pressure exerted by the column of air pressing down on people from all sides. As such, it’s reasonable to assume that if we increase that pressure by a factor of 0.3, regardless of whether its 14.7psi, 7.3psi, or some other value, then the resulting increase in oxygen concentration in the blood plasma and other physiological effects will be about the same – regardless of the elevation. Said another way, you need more absolute pressure to force the same amount of extra oxygen into tissue when a body is subject to greater ambient pressure near sea level compared to a body at a higher elevation with less atmospheric pressure. This makes total sense.

OK, maybe you’re wishing I hadn’t dragged you through such a detailed discussion of relative pressures. For me, the question about different pressures at different elevations always bothered me so I thought maybe there might be others with this concern. The bottom line is you need not worry about elevation when using an HBOT.

So before we end this physics discussion, let’s take a look at some comparative numbers for various ATA pressures and oxygen concentrations. This will be useful as you do your own reading and in understanding why different pressures need to be used depending on the illness. As you’ll see later on, proponents of hard chambers like to twist the numbers in order to make soft chambers seem weak. The table below shines a light on this obfuscation by showing that mHBOT can produce oxygen pressures well over ambient.

In interpreting table values, what’s important to know is the relative HBOT oxygen concentration over breathing regular air at ambient pressure. This relative value changes with pressure and the concentration of oxygen being delivered. I have listed this increase in parenthesis as a multiple over the ambient room oxygen concentration. Take for example a person breathing 100% oxygen at 1.3 ATA. From the table, the multiple is (6.2). This means the person has roughly 6.2 times as much oxygen in their blood vessels as a person sitting outside the chamber breathing room air.

HBOT PARTIAL PRESSURES OF OXYGEN TABLE

HBOT partial pressures



  1. Room Air – table is based up 21% oxygen at sea level (760mmHg)

  2. Nasal Cannula – 24% oxygen delivery at 2L/min flow rate (at 4L/min oxygen delivery is 36%)

  3. Simple Mask – 50% oxygen delivery at 6L/min flow rate

  4. EWOT Mask – 70% oxygen delivery at 10L/min with Exercise With Oxygen Therapy mask (non-Rebreather mask)

  5. Pure Oxygen – 100% oxygen delivery sufficient to meet user’s needs

  6. HBOT is at sea level where 1.0 ATA is equivalent to 14.7 psi or 760 mmHg (millimeters of mercury)

  7. Arterial and venous oxygen concentrations are roughly 76% and 30% of listed oxygen pressures respectively

  8. Oxygen Pressure = Atmospheric Pressure (760mmHg) X ATA X Percent Delivered Oxygen

  9. Oxygen Multiple in Parenthesis = Oxygen Pressure/Oxygen Partial Pressure (160mmHg)

  10. The pressure at 1.3 ATA is equivalent to being 10 feet under water

  11. The pressure at 1.5 ATA is equivalent to being 18 feet under water

  12. The pressure at 1.75 ATA is equivalent to being 24 feet under water

  13. The pressure at 2.0 ATA is equivalent to being 33 feet under water

  14. The pressure at 2.4 ATA is equivalent to being 46 feet under water

  15. The pressure at 3.0 ATA is equivalent to being 66 feet under water

Hard Shell HBOT & mHBOT/HBOT Indications

One of the unfortunate aspects of HBOT is the conflicting studies. A person really has to spend a fair amount of time pouring over the various studies in order to determine under what conditions HBOT is helpful. On the one hand, hospitals and clinics with “hard” shell chambers that are typically operated at 2.0 ATA claim that HBOT should only be used for Undersea and Hyperbaric Medical Society (UHMS) recognized HBOT approved conditions. In addition, on U.S. Department of Veterans Affairs, articles like DOD, Va Research Again Finds Hyperbaric Oxygen Ineffective At Treating Concussion-Related Injuries suggest the use of HBOT for non-approved conditions is ineffective.

Furthermore, in articles like Hyperbaric Oxygen Therapy or “Mild” Hyperbaric Therapy, it is argued that portable mHBOT chambers don’t deliver a meaningful amount of oxygen, may promote bacterial and fungal growth, along with being illegal for naturopaths and chiropractors to use. Only physicians (M.D. or D.O.) or dental surgeons (D.D.S.) may prescribe or make chamber available that increases pressure regardless of the concentration of oxygen. These findings are apparently substantiated in Therapeutic HBOT v ‘Mild’ HBT Synopsis where data from Randomized Controlled Trials and Cochrane reviews of existing studies state that there is either no evidence, poor evidence, conflicting evidence, or no benefit to be had in the application of HBOT outside of UHMS approved conditions.

UNDERSEA AND HYPERBARIC MEDICAL SOCIETY (UHMS) APPROVED HBOT CONDITIONS

  • Air or Gas Embolism

  • Carbon Monoxide Poisoning

  • Carbon Monoxide Poisoning Complicated by Cyanide Poisoning

  • Decompression Sickness

  • Severe Anemia

  • Sensorineural Hearing Loss

  • Intracranial Abscess

  • Gas Gangrene

  • Crush Injury, Compartment Syndrome, and Other Acute Traumatic Ischemias

  • Central Retinal Artery Occlusion

  • Enhancement of Healing In Selected Problem Wounds

  • Necrotizing Soft Tissue Infections

  • Osteomyelitis

  • Delayed Radiation Injury

  • Compromised Grafts and Flaps

  • Acute Thermal Burn Injury

“OFF-LABEL” STUDIED USES OF HBOT

  • Cerebral Palsy

  • Amyotrophic Lateral Sclerosis

  • Complex Regional Pain Syndrome

  • Fetal Alcohol Syndrome

  • Ischemic Brain Injury

  • Traumatic Midbrain Syndrome

  • Closed Head Injury

  • Lupus

  • Stroke

  • Myocardial Infarction

MORE BENEFITING CONDITIONS

False mHBOT Arguements

At first flush, articles and studies like the ones just mentioned suggest that people that use HBOT for non-UHMS conditions are wasting their time, money, and may even be doing harm. Thankfully, pioneers like Dr. Paul Harch and many others have been diligently performing their own studies, digging into the research, and writing balanced evaluations that strongly suggest mild Hyperbaric Oxygen Therapy (mHBOT) is indeed helpful. Perhaps the best way to present the case for mHBOT is in juxtaposition to arguments against mHBOT made by “hard” chamber proponents.

HBOT HAS BEEN SHOWN TO BE NO BETTER THAN SHAM IN STUDIES

While reading over studies, it’s important to note the treatment protocol for the control group. In several studies, the control group was given a “sham” treatment that consisted of HBOT pressures around 1.3 ATA and varying concentrations of oxygen. As Dr. Harch describes in Hyperbaric Oxygen and Gene therapy HBOT 2014, very small amounts of pressure can produce dramatic positive effects. In one case, he shows markedly improved SPECT brain scans after a single treatment at 1.25 ATA and a total dive time of 30 minutes.

To give you an idea of how to properly interpret these types of studies, consider the Wolf study entitled The Effect Of Hyperbaric Oxygen On Symptoms After Mild Traumatic Brain Injury. As Dr. Harch points out in Hyperbaric Oxygen Therapy for Post-Concussion Syndrome: Contradictory Conclusions from a Study Mischaracterized as Sham-Controlled, the fact that there was no difference in outcomes between groups of brain injured veterans that received 2.4 ATA and 100% oxygen and groups that received 1.3 ATA and 21% oxygen does not mean that HBOT is ineffective treating mild Traumatic Brain Injury (mTBI) Post-Concussion Syndrome (PCS), and Post-Traumatic Stress Disorder (PTSD). In fact, given that both 2.4 and 1.3 ATA groups showed improvement, the correct conclusion is that HBOT at both of these pressures is helpful.

STUDIES SUPPORT THE USE OF MILD HBOT PRESSURES

In fact, there are lots of studies and supportive evidence that say that mild HBOT is helpful for a variety of conditions. In Hyperbaric Oxygen and Gene therapy HBOT 2014, Dr. Harch comments on research showing thousands of epigenetic switches in response to the application of lower pressures. Reviewing the series of videos on mHBOT by Dr. Harch, one comes away with the impression that mHBOT is indeed helpful. I’ve compiled the following short list of benefits and smattering of studies on mild HBOT.

HBOT General Benefits – Short List

  • Reduces Swelling & Inflammation

  • Up-Regulates Antioxidant Enzymes

  • Increase Mitochondria Function

  • Protects Cells From Dying

  • Up-Regulates Growth Factors

  • Stimulates Repair Of Blood Vessels (VEGF)

  • Up-Regulates Hypoxia-Inducible Factors (HIF)

  • Improves Gut Function

  • Activates Stem Cells

  • Promotes Wound Healing & Bone Knitting

mHBOT Studies – A Smattering

After pouring over studies and videos like the ones listed, my general take-away is that if a person is suffering from some sort of infected wound, diving bends, or carbon monoxide poisoning then high pressure and pure oxygen HBOT is advised. Although, as mentioned in Illusion of Higher Pressure HBOT More is Better, it’s important to realize that the risk of injury due to excessive oxygen (hyperoxia) is very real especially at higher pressures. Nonetheless, it makes sense that the higher oxygen concentrations are anti-bacterial. As such, high pressure HBOT serves to both kill off harmful bacteria along with reducing inflammation, up-regulating growth factors, and the like.

In contrast, lower pressures appear to be more beneficial for brain injuries and stimulating the positive physiological effects in general. In gist, driving too much oxygen into the body isn’t helpful unless there is a festering wound, diving injury, or carbon monoxide overdose. In fact, when it comes to brain injuries, autism, and others, it’s not uncommon for higher pressures to make matters worse.

That doesn’t mean lower mHBOT pressures are risk free. Just like with higher pressures, it is possible to cause injury due to excessive oxygen even at pressures as low as 1.5 ATA. In Hyperbaric Oxygen and Gene therapy HBOT 2014, Dr. Harch commented that a brain injured patient treated at 1.5 ATA and presumably 100% oxygen began suffering from hyperoxia after about seventy 90-minute sessions (dives). At 1.3 ATA and breathing from a cannula, the risk of hyperoxia injury seems to be very small.

SOFT SHELL HBOT CAN SATURATE TISSUE WITH OXYGEN LIKE HARD SHELL HBOT

As mentioned, articles like Hyperbaric Oxygen Therapy or “Mild” Hyperbaric Therapy attempt to show that mild HBOT can not deliver significant levels of oxygen to the body. Specifically, they state that arterial oxygen at 2.4 ATA and 100% oxygen is 1,824 mmHg. At 1.3 ATA and 24% oxygen (breathing from nasal prongs at a lower flow rate) is 230 mmHg. In comparison, they state that simply breathing 55% oxygen at room pressure (1.0 ATA) yields 418mmHg.

To begin, I’ll ignore the fact that the pressures they listed are oxygen partial pressures (pO2) and that arterial pressures are generally 75% of pO2 values. I’ll also “turn a blind eye” to the fact that studies have shown that even breathing room air at mild HBOT pressures can produce health benefits. Instead, I’ll just focus on the numbers. Looking at the table I developed, sure enough, their values are correct. However, the implication that mHBOT can not deliver significant oxygen levels is not. Reflecting on the table values shows this.

For example, I’ve made a specialized HBOT mask that comes close to delivering 100% oxygen. My chamber operates at 1.3 ATA. Using the table, the pO2 for my setup is 988mmHg – the oxygen concentration in my blood is roughly 6.2 times normal levels. Granted this falls short of the 11.4 factor for 2.4 ATA and pure oxygen. Nonetheless, the levels aren’t trifling.

At those levels, a person really needs to be very careful about causing brain or lung damage due to excessive oxygen (hyperoxia). Looked at another way, at 1.3 ATA, I’m two-thirds of the way to reaching the levels most often recommended for infected would healing (2.0 ATA and 100% oxygen) and way too far beyond the 237 or 274mmHg recommended for treating brain injuries of all sorts. The bottom line is mHBOT can deliver powerful amounts of oxygen.

Myth: BACTERIA AND FUNGI MAY GROW UNDER LOWER MILD HBOT CONDITIONS

Granted, if you crank up the pressure high enough and use 100% oxygen, you can stifle bacterial and fungal growth. For those that are treating infections, this is important. However, it’s not a sound argument against the use of lower mHBOT pressures and oxygen concentrations. Having said this, it is very important to replace oxygen delivery lines regularly especially if you’re bubbling the oxygen through water to humidify it.

General Treatment Protocol

Generally speaking, chronic injuries are treated with at least 40 “dives” at a rate of 5 days per week. In addition, Dr. Harch discusses evidence in Hyperbaric Oxygen and Gene therapy HBOT 2014 that the benefit from each dive is additive. In other words, twenty dives are more healing than ten; thirty dives are more healing than twenty, and so on. Between 30-40 dives is considered the minimum to ensure lasting benefit. Taking a short time off after the first 40 dives followed by an additional 40 dives is often recommended.

Normally, the time at full pressure is 60 minutes. Although, as Dr. Harch has shown using SPECT scans, as little as 15 minutes at full pressure can produce significant results treating brain injuries. Increasing the dive time beyond 60 minutes at full pressure is not necessary or helpful treating brain injury and various illnesses. In fact, as discussed, there is an increased risk of causing lung or brain injury due to excessive oxygen (hyperoxia) with longer dive times, increased pressure, and higher oxygen levels.

Having said this, for those suffering from Undersea and Hyperbaric Medical Society (UHMS) Approved HBOT Conditions, a hard shell chamber operated at pressures around 2.0 ATA is recommended. Once again, these higher pressures do not produce positive results in various other conditions especially brain injuries. Worse yet, they are more likely to lead to hyperoxia injury.

My mHBOT Experiences

For a long time, I was under the mistaken belief that when it came to mHBOT more oxygen was better. I used my custom EWOT mask and ran the oxygen concentrator full out. When I was really sick from CIRS (mold illness), I’d fall asleep for the first 30 minutes. However, by the end of the session I would frequently feel quite anxious.

I can think of three possible reasons for this anxiety. First, I was taking in serious amounts of oxygen – 6.2 times ambient. Given the infections in my jaw, MARCoNS, and gut dybiosis, I suspect I was killing off quite a few bugs at this intense level. The resulting toxins may have been too much. In hindsight, it might of helped if I’d taken charcoal prior to HBOT to mop up gut endotoxins.

Second, at one hour in The Human Detoxification System, Chris Shade talks about how mold blocks Nrf2 upregulation in response to oxidative stress. HBOT is definitely oxidative and normally triggers Nrf2 to turn up the glutathione system. When Nrf2 is blocked by mold toxins, oxidative stress just makes those with CIRS sicker due to the anti-oxidant repair system not working. As mentioned in Blocked Detox, Chris’s approach to clearing this Nrf2 block begins by using liposomal GABA with L-Theanine to calm down anxiety producing Glutamate activity in the brain followed by liposomal Diindolemethane (DIM) in high doses.

Third, I stayed in our moldy house for years while working to remediate it and trying to get better at the same time. It’s quite likely part of the limited benefit and extra anxiety from mHBOT during those times had to do with the oxygen concentrator and air compressor being contaminated with mold toxins – I tore them apart and cleaned them out since cleaning up the house. Anxiety is a common response to exposure to mold toxins. Staying in a moldy home was utter foolishness and no doubt hampered my health improvements regardless of the therapy.

Upon reflection, I would probably been better off had I waited until I was somewhat better from CIRS and used a lower flow rate of at most 4L/min. Studies show that this is enough to heal those with brain injuries, reduce inflammation, diminish pain, and so on. Given that CIRS causes portions of the brain to atrophy while others swell, CIRS definitely damages the brain. To give you a sense of this damage, take a look at Mold Toxins and Brain Damage where Dr. Ou has some SPECT brain scans taken at Dr. Amen’s clinic of a moldy brain.

So was HBOT helpful with CIRS? The answer is yes and no. Once those with CIRS are in better shape, I can definitely attest to the anti-inflammatory effect of mHBOT. Now that I’ve gotten past the really terrible anxiety, feelings of dread, and the like, I’m better able to notice the benefits of HBOT and my body is able to ramp up the glutathione system in response. After HBOT, I have notably less pain, my memory is definitely improved, I sleep considerably better with happy dreams, and I generally feel more energized. These positive benefits kick in after two of more sessions.

In addition, there are many other known healthful benefits of HBOT including improving VEGF, healing the brain, increasing growth factors, and so on. So yes, HBOT helps with CIRS and health in general. My wife and I plan on regularly using our portable mHBOT into the future.

Relatively speaking, I can tell you that I’m taking VIP now and I can’t say I notice a whole lot from it at four doses a day, living in a very clean house, avoiding mold exposure, watching my diet, and so on. This is unusual but does happen. At some point, I’m going to ramp up dosage to see if that helps. In contrast, I was really struck with how much mHBOT helped after climbing back in recently almost a year since my last dive. The benefits lasted for days. Now that I’m mostly recovered from CIRS, I plan on doing another series of 40 or more dives to see if I can’t get the benefits to stick.

On the other hand, even after 40 dives when I was really sick from CIRS, I can’t say that I got all that much symptom relief. I may have had some incremental reduction in pain and more energy but the intense anxiety, brain fog, depression, and the like remained. The benefits of HBOT got lost in the great number and severity of symptoms I was experiencing back then along with possible Nrf2 blockage.

The bottom line is mild Hyperbaric Oxygen Therapy (mHBOT) is a nice adjunct therapy for those that have started to heal from Chronic Inflammatory Response Syndrome (CIRS). Just like it helps brain injuries heal, I’m convinced it helps mold damaged brains too along with many other benefits. Note: Thankfully, when it comes to CIRS and those that don’t have access to a chamber, Vasoactive Intestinal Peptide (VIP) can help brains heal too.

If I had it to do all over again but with the insight I have now, I’m not sure if I’d buy a chamber or not. They’re really expensive. I know for sure the chamber helps but is that benefit enough to warrant the price tag? I suppose it depends on a person’s budget, the types of remaining symptoms after treating CIRS, and their severity.

Not surprisingly, the bottom line is that there are numerous factors to consider. With the information in this article, hopefully you’re in a better place to decide if mHBOT is right for you. Perhaps the best advice I can give to those with CIRS is to get through Shoemaker’s protocol the absolute best that you can and if you’re still not in as good of a place as you’d like to be upon completion, then mHBOT offers the potential for additional healing.

This article was very well written in my opinion. Completely unbiased, and using science to prove points. I think HBOT in a clinic would be a great option for those suffering from Chronic Inflammatory Response Syndrome. Chambers are much more affordable in 2024 than they were when this gentleman bought one. Contact our office to see if owning a chamber can be right for you!

Dr. Walker Porterfield
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