By K Paul Stoller, MD, FACHM
What is hyperbaric medicine?
Hyperbaric medicine has been around a long time considering so few know anything about this therapy. It's simply providing oxygen (Hyperbaric Oxygen Therapy [HBOT]), or other mixed gases, under pressure for therapeutic benefit.
How does hyperbaric oxygen therapy (HBOT) work in the body for healing?
In the first decade of the 21st century the mechanisms of how HBOT works became better understood. While there are many mechanisms through HBOT activating DNA on a cellular level. The most important mechanism is through invigorating mitochondria. If you will remember high school biology, mitochondria are little organelles inside of every cell in the human body that help the cell create energy. Mitochondria have their own DNA, and HBOT signals that DNA to turn on, and therefore the mitochondria turn on, which is important especially if they have been damaged or turned off. HBOT also allows the cells in the body to make more mitochondria.
How does healthy mitochondria effect cancer cells through hyperbaric oxygen therapy?
Mitochondria are responsible for more than cellular respiration that converts oxygen and sugar into the energy that cells need to work. They are also responsible for something called apoptosis, which is a fancy word to describe cellular death. The mitochondria are in charge of the cell’s suicide program. The very important reason for cancer patients is that this function in the mitochondria of cancer cells does not work so cancer cells just seem to live on and on and on. But if hyperbaric oxygen therapy (HBOT) heals mitochondria, then healing the mitochondria in cancer cells can activate that cancer’s cell suicide program.
When was hyperbaric oxygen therapy first discovered and used against cancer? How is hyperbaric oxygen therapy now approved against cancer?
In the 1950s, the first research work was done showing that cancer exposed to hyperbaric oxygen and then radiotherapy (radiation) had greater involution then cancers not exposed to hyperbaric oxygen. This was not a mystery. The extra oxygen in the tissues exposed to ionizing radiation would cause greater free-radical production, which in turn would kill the cancer cells. However, this avenue of therapy to prep cancer patients prior to radiotherapy never became part of the standard of cancer care.
Today, HBOT is approved for treating cancer patients who have undergone radiation therapy but had healthy tissue compromised or burned. In other words, the capillaries feeding normal tissue are fried and can no longer supply blood to healthy tissues. This is the only currently approved use for HBOT in cancer therapy, and HBOT is the only therapy known to grow new capillaries into the previously healthy tissues that had been exposed to radiation.
HBOT should be offered after radiotherapy to help heal non-cancerous tissues burned after radiation, but very few patients are offered this crucial therapy to increase the quality of their lives. Unfortunately HBOT is not offered to patients due to an almost complete lack of knowledge of HBOT by oncologists and most other physicians.
What are some other conditions that hyperbaric oxygen therapy helps in cancer patients? What about chemo brain?
Because many of the mechanisms of how HBOT works are known, such as reviving mitochondrial function in injured cells, there is a wide array of conditions where HBOT could be very helpful if it were appropriately utilized. That includes chemo brain, but I'll start by explaining another condition. For example, HBOT has been approved for treating acute carbon monoxide poisoning (COP), a condition that interferes with the function of the mitochondria. But most carbon monoxide victims have subtle and prolonged exposures that over time affect brain function as well as some of the overt symptoms of headaches and nausea. Yet, they are not authorized to receive HBOT by most 3rd party payers. I have treated many chronic COP patients and they have all received great benefit as measured on neurocognitive tests from HBOT.
The symptoms of chronic COP have many similarities to those symptoms that some cancer patients get from receiving more chemotherapy drugs than their brains can handle. As a result, chemo brain develops in some cancer patients. After all, a poison is a poison with many side effects and research shows that includes chemo brain. Chemotherapy drugs impact mitochondrial function that ultimately affect the function of brain cells. To give potent poisons that are not targeted directly at cancer cells, but have their effect on all cells, will create collateral damage to healthy cells. With HBOT you have a benign, non-invasive therapy that has been demonstrated to revive cellular function in healthy cells. In the decade I have been treating patients, many of whom were cancer patients, I have witnessed impressive clinical events attributable to the ability of HBOT to revive the healthy activity of damaged cells, including to either eliminate or highly reduce chemo brain.
What are some research studies about hyperbaric oxygen therapy for cancer patients?
In 2007, researchers at the Department of Biomedicine, University of Bergen, Norway, published a paper (BMC Cancer. 2007 Jan 30;7:23) showing that HBOT caused significant reduction in tumor growth, and another study that year showed it increased apoptosis in leukemia cells (Leuk Res. 2007 Jun;31(6):805-15) In 2009 another study (Brain Nerve. 2009 Jun;61(6):677-81) showing HBOT to be useful in sensitizing brain tumor cells prior to radiation. In 2010 another study (Cancer Biol Ther. 2010 Aug;10(4):386-90) showed that HBOT inhibited ovarian tumor growth. And then, researchers at Washington State University reported in the journal Anticancer Research (Effect of Hyperbaric Oxygen on the Anticancer Effect of Artemisinin on Molt-4 Human Leukemia Cells: Anticancer Research 2010, 30(11), 4467-447) that HBOT combine with the compound artemisinin – isolated from Artemisia annua L, commonly known as wormwood –a natural remedy widely used to treat malaria increased this plant’s ability to kill leukemia cells by 50 percent. Other research indicates anti-cancer efficacy from HBOT. That includes a study published twenty years ago where a neurosurgeon was able to show that HBOT reduced the mortality from traumatic brain injury by as much as 60% (Journal of Neurosurgery 76:927-934, 1992).
Today, most oncologists still do not know about HBOT or its benefits. Information about HBOT is not taught in most medical schools. In our current reality, most oncologists and all physicians will have no exposure to hyperbaric medicine their entire careers.
After cancer research in the 1950s, what other research then occurred with hyperbaric oxygen therapy?
During the 1960s and 1970s, HBOT showed itself to be efficacious for a number of conditions from carbon monoxide poisoning to chronic bone infections. HBOT was shown to reduce the mortality of heart attacks and change the clinical course of Multiple Sclerosis (MS) patients. In fact in 1983, the New England Journal of Medicine (NEJM) published a placebo controlled double-blind randomized trial showing HBOT to be efficacious in treating MS patients. Despite his life saving scientific discovery, the tenured professor who wrote the study lost his job. Additional efforts by pharmaceutical companies occurred to not advance hyperbaric medicine in the United States. Today, few patients and providers in the United States know about using HBOT to treat Multiple Sclerosis. But across the pond in England, Dr. Fischer’s landmark study set off an eight-year longitudinal trial that showed great efficacy for MS patients. A patron then donated the funds to launch 6 HBOT charity centres that has now grown to over 60 charity centres, which is why HBOT is the primary method for treating MS patients in the UK by MS patients for MS patients. Even separate from the National Health Services, the charity centres provide their services to many Multiple Sclerosis patients.
How did hyperbaric oxygen therapy return to some national attention in the United States?
In 1987, HBOT received national attention after 18-month-old Jessica McClure (“Baby Jessica”) was treated with HBOT in Midland, Texas after being trapped in a well for two and a half days. HBOT saved her right foot and she only lost the tip of her 5th toe. However, reminiscent of the American Medical Association’s attack on Dr. Cunningham, an editorial letter printed in the Journal of the American Medical Association (JAMA) later said it was wrong to treat her with HBOT denying the effectiveness in wound healing. The authors of the editorial launched an animal experimentation to prove this opinion. But, results instead confirmed HBOT effectiveness in wound healing. The hyperbaric chamber that Jessica McClure was treated in at Midland Memorial Hospital was only there through a donation to the hospital by a private citizen. The donor had a daughter with Multiple Sclerosis and did not want her to travel to Dallas for HBOT treatments. Despite his donation, the donor was later refused treatment in the hyperbaric chamber at the hospital when he was diagnosed with ALS.
What is the original history of hyperbaric chambers? Why was hyperbaric medicine not advanced when it was seen as a therapy many years ago?
In pre-modern hyperbaric medicine spas in Europe had hyperbaric chambers as it was known to make people feel better, but it was not until 1890 that an infection was successfully treated. In the first quarter of the 20th century a lone anesthesiologist by the name of Orville Cunningham championed its use and saved many lives during the swine flu epidemic of 1918 (Spanish H1N1 flu) likely a result of the hyperbaric oxygen helping flu stricken patients fight off secondary bacterial infections. After saving the life a ball-bearing tycoon, Cunningham had the funds donated to build a hyperbaric hospital in Ohio at the same time as the Great Depression, so it quickly closed down and the steel was sold for scrap in World War II. Another factor was that Cunningham became the target of the American Medical Association that had a strong agenda to suppress or usurp any alternative medical treatments. But in 1937, the first scuba diver was treated for the bends and hyperbaric medicine found a home in military medicine. There were hyperbaric operating theatres in several major hospitals in the USA because before the heart-lung bypass machine came online it was in these pressurized rooms that open-heart surgery was performed.
What progress has occurred with health insurance coverage for hyperbaric oxygen therapy?
The International Hyperbaric Medical Association (IHMA) obtained permission from Medicare to have the first new approved indication for HBOT in three decades. In 2002, when Paul Harch, MD was president of the IHMA, we petitioned the Centers of Medicare & Medicaid Services for approval to treat diabetic foot ulcers. That was granted due to overwhelming evidence for preventing 75 percent of major amputations and saving the US Treasury vast sums of money. While that increased the number of hyperbaric chambers in the United States, today only one-sixth of hospitals have hyperbaric chambers.
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About the Author
 K Paul Stoller, MD, FACHM is an Adjunct Assistant Professor at the AT Still University School of Medicine, President of the International Hyperbaric Medical Association, a Fellow of the American College of Hyperbaric Medicine, and was Diplomat of the American Board of Pediatrics for over two decades. He is medical director of the San Francisco Institute for Hyperbaric Medicine and Hyperbaric Medical Center in New Mexico.
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