79. Dr. Scott Sherr: Hyperbaric Therapy: This is How Pressure + Oxygen Unlock Healing

Low energy, brain fog, and poor recovery aren't just part of getting older—they're often signs that your cells are underperforming. And one major reason? They're starved for oxygen. In this episode of Extend, I talk with Dr. Scott Sherr, a hyperbaric medicine specialist who helps patients and doctors worldwide use oxygen therapy to restore cellular health. We get into what hyperbaric oxygen therapy (HBOT) actually does—not just more oxygen, but how it shifts gene expression, activates stem cells, and supports mitochondrial repair. We also discuss who shouldn't jump into HBOT too soon, and why testing antioxidant capacity and metabolic function is essential before starting. This isn't a quick fix—it's a targeted tool that works when your system is ready. If you're dealing with lingering symptoms or want to stay sharp and resilient long-term, this episode gives you a clear understanding of how HBOT fits into a true healthspan strategy. Dr. Scott Sherr is a board-certified internist and global expert in hyperbaric oxygen therapy, with over 20 years of clinical experience. He helps patients and physicians use HBOT to improve recovery, brain health, and long-term cellular function. We Also Discuss: The Real Goal: Longevity and Feeling Amazing Why Most Longevity Advice Misses the Mark Oxygen as Medicine? Inside Hyperbaric Therapy What Actually Happens in a Hyperbaric Chamber Can Oxygen Reverse Inflammation and Fatigue? Using Hyperbaric for Energy, Focus, and Recovery Thank You to Our Sponsor: IM8: Try IM8 today with a 30-day money back guarantee. You can get 20% off your first order with code DRSHAH at https://im8health.com/discount/DRSHAH. Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Scott Sherr: Website: https://www.hyperbaricmedicalsolutions.com https://www.hyperbaricmedicalsolutions.com/integrative-hbot/scott-sherr Instagram: https://www.instagram.com/drscottsherr/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:48Dr. Darshan Shah?

  Dr. Sherr, thank you for joining me today.

• 0:51Speaker 01

  Happy to be here, Darshan. Thanks for having me, man.

• 0:53Dr. Darshan Shah?

  Yeah, so you know, we met as part of the Longevity Doctor Group, which is a group of about 300 of us that are kind of a mind meld on longevity, which I love. And why I really wanted to have you on is you are the consultant to the longevity doctors often that we reach out to when we have questions and protocols that we need. So I was like, you're the expert's expert.

• 1:16Speaker 01

  Well, with very specific topics. You guys have a lot of expertise that I do not have. Let's be clear. And I also ask for advice all the time, too.

• 1:23Dr. Darshan Shah?

  No, you're so humble, but I love it that you're have done a deep dive in some therapies that we use here for longevity.

• 1:31Speaker 01

  Yeah.

• 1:32Dr. Darshan Shah?

  That actually, you know, I think it's so funny when we talk about longevity, right? Like, all these technologies just came out to add years to our lives. In reality, we've been using these for a long time, just in regular medicine.

• 1:44Speaker 01

  Sure, yeah. I mean, everything from methylene blue, which I know we'll talk about, to hyperbaric oxygen therapy, which are kind of the two areas I have an expertise in. The focus on longevity is also interesting, as you and I both know, because if you have a genie and you can ask for three wishes, if you ask for eternal life, make sure you also ask for eternal youth, right? Because who wants to live all these other years, but not have the health span associated? I know that's a big thing for you, too, so.

• 2:08Dr. Darshan Shah?

  Yeah, exactly. Isn't there a Greek fable about someone that asked for eternal life? And he ended up becoming like a completely shriveled up old? Human that lived forever. I mean, how miserable does that sound?

• 2:19Speaker 01

  Yeah, it is. It's a true Greek or true. It's a Greek fable for many, obviously, from that time. The deal still applies, right? Because now we are living longer overall, but as a result of living longer, we're not living healthier. And that's kind of our deal, right? The idea is how can we really truly optimize health span as opposed to just thinking about longevity as well?

• 2:37Dr. Darshan Shah?

  And that's my primary goal, right? Like, there needs to be some massive scientific breakthroughs that come out that's going to really add years to our life, right?

• 2:44Speaker 01

  Massive, yeah.

• 2:45Dr. Darshan Shah?

  They may or may not come. I mean, there's excitement around it, but really, the way you add years to your life, in my opinion, right now, is if I could live to be 100 years old and still be able to travel and meet my great grandchildren, like, those are massive opportunities that humans have not typically had.

• 3:03Speaker 01

  I know, and that's really what it's all about, right? So the way I think about practice, and I know you think about this the same way, is that how can we keep people healthy for as long as possible? And then that often means not just looking at markers that would be optimized for your age, but markers that would be optimized for somebody that would be at their prime of their life. And so I think you know that we have a nonprofit that I help run called Health Optimization Medicine and Practice.

• 3:24Dr. Darshan Shah?

  Right.

• 3:24Speaker 01

  And this is a nonprofit that's training practitioners how to optimize health rather than treat disease. And the focus is on keeping people healthy rather than looking at how you can look at the root causes of disease. I mean, and then there's a big reason for that, and we need that, too. That's much better. Functional medicine, for example, is great, much better than conventional medicine as far as preventative medicine and from a root cause perspective. But it's not looking at how you can keep people healthy, right? And so it's, let's focus on these other aspects of health, which is optimizing for when we were the most vital, usually between 21 and 30 years of age. And so when we're looking at nutrient networks, hormone networks, the gut, that's what we're looking to do. And that's kind of the goal of what, you know, my practice is and what I do personally as well with my patients.

• 4:02Dr. Darshan Shah?

  Yeah, no, that's fantastic. And, you know, for anyone out there that's in their 20s listening to this, one of the first thing that you should do is get a full set of biomarkers, right? Because this is when you're in your optimal.

• 4:12Speaker 01

  Become a blood boy, maybe?

• 4:15Speaker 01

  Just kidding.

• 4:16Dr. Darshan Shah?

  Maybe not a blood boy, but at least a few vials of blood. Get your hormone levels checked, your metabolism checked, et cetera. You know, first of all, people are getting chronic disease younger and younger.

• 4:26Speaker 01

  Much younger, that's true, yeah.

• 4:27Dr. Darshan Shah?

  If you're, even if you're feeling great in your twenties, it's so good to have those numbers. So you know where you're, where you want your numbers to stay for the rest of your life. That's kind of what you're talking about.

• 4:35Speaker 01

  Yeah, I mean, and also understanding that we know what those levels should be for our overall lifespan at this point, right? So like in the sense that if you're 20 to 30 now, fantastic. But if you're 60 or 70, like your marker shouldn't be normal for 60 or normal for 70. They should be optimized for when you were 21 to 30 or somewhere around that age. And that's, that's the marker range that we really look at, at, at health optimization medicine in practice. We call it home hope for short. And that's really where I think we need to be looking at for the future of medicine. The future of medicine is not just to focus on medical treatment, medical interventions, but to feel, but actually focusing on health and optimizing health. And because once you do that, you create a foundational framework, you optimize vitamins, minerals, nutrients and cofactors. You optimize the gut, lifestyle, diet, like whatever diseases or conditions you may have, they're likely going to get better on their own, or at least significantly improve,

• 5:19Speaker 01

  even if you don't directly address them with something. Sometimes you have to directly address it and that's totally okay. And we have a lot of really great docs in our group, especially that are doing things with chronic disease and long COVID and things like that, and that's really important. But it doesn't take away the fact that you need to think about what's happening underneath the hood and optimizing those kind of biomarkers that we're describing, so.

• 5:38Dr. Darshan Shah?

  Yeah, exactly. And that's the whole thesis around next health. My clinic practice is we want to not just reverse chronic disease, which is a great goal in and of itself, but we want people to feel incredible and have that vitality and that kind of spark and that mental clarity you have when you're in your twenties for the rest of your life. And that's what we're talking about here.

• 5:57Speaker 01

  Yeah, exactly. And that's what we're doing at, at Home Hope, our nonprofit, and trying to train practitioners that are interested in doing this in their own practice, but don't have a framework for it. And when I was looking as a hyperbaric physician for many years for that foundation, I was looking at functional medicine. I looked at other kinds of programs. I really didn't feel aligned until I met a colleague named Dr. Ted Archicoso, who started health optimization medicine in practice. And that was the focus shift that I needed, you know, because my, my clinical practice really started off as kind of focusing on. Hyperbaric medicine.

• 6:26Dr. Darshan Shah?

  Right.

• 6:26Speaker 01

  As the main thing that I did, but I realized very quickly that if you were just focused on hyperbaric therapy, you were missing the boat in a lot of cases, especially in chronic disease and and long term illness or long term goals. And so you needed a foundation, you need a framework to kind of have that sit under or sit over, I guess, that hyperbaric therapy being like, great, but if you didn't have that sort of foundational piece, I just found that if you had like somebody with a chronic issue, a long term goal, you're typically missing a significant amount of impact that you can make on their life, whether they got into a hyperbaric chamber or not.

• 6:55Dr. Darshan Shah?

  Exactly. So what type of, what type of training did you do in your medical career after medical school?

• 6:59Speaker 01

  So I was in medical school in Baltimore at the University of Maryland. I did my training at University of Maryland in internal medicine. So I did three years internal medicine and then I worked primarily as a hospitalist for many years and then I was doing hyperbaric therapy on the side, kind of deal as my family was growing. My wife was also a physician and she, she did a fellowship in allergy immunology at Stanford. And so we moved out to California from there. I became a medical director of a number of hyperbaric facilities in the, in the early 2000 or 2010s, 2000, what do we call them then? 2010, it was around 2012, 2013 that I became medical director of a hyperbaric facility. And then, that's really kind of where I started learning the ropes about being a hyperbaric physician and understanding the massive potential benefits,

• 7:38Speaker 01

  but also the potential, not downsides, but the, the potential pitfalls that, that could happen if you weren't thinking about some of these foundational things.

• 7:46Dr. Darshan Shah?

  Right.

• 7:46Speaker 01

  And so that's really what my training really was kind of on the ground as a hyperbaric physician. And then in 2017, I met this, my colleague, Dr. Ted, who had this training program called Health Optimization Medicine.

• 7:59Dr. Darshan Shah?

  Right.

• 7:59Speaker 01

  And practice and I trained in that and I started using that in clinical practice as well in 2019 or so. So not that long ago now. And then I kind of became more of a virtual consultant on the hyperbaric side. I was medical director for, as a few facilities, a few facilities, but then I decided I could help a lot more people if I was doing it more virtually. And so I consult with people all over the world that are interested in learning how to use hyperbaric therapy, either on its own or like in the context of an integrative perspective, which is I typically recommend and typically that's my focus. And so when people call me or talk to me about hyperbaric therapy, like 80% of what I say has nothing to do with hyperbaric therapy at all. And that sometimes can be frustrating for people. I'm like, We'll get there. Hyperbaric therapy, that's the easy part.

• 8:38Dr. Darshan Shah?

  Yeah.

• 8:38Speaker 01

  The more interesting and the more sustainable part is the part that's going to optimize your health and how we're going to look at that as a, as like your foundation so you can actually benefit the most from being in a chamber. And it's actually a funny story. I was actually disinvited from speaking at a hyperbaric conference in 2021, I think, and it was during the pandemic. Because the title of my talk was going to be, please do not put them in the chamber.

• 9:00Dr. Darshan Shah?

  Oh, my God.

• 9:01Speaker 01

  Because

• 9:02Dr. Darshan Shah?

  Was it disinvited?

• 9:02Speaker 01

  Yeah, I got disinvited. I mean, there's probably a couple of other reasons. That was the main one, though. I tend to, because I don't have, I wasn't, didn't have like allegiance with a certain chamber manufacturer. I really just wanted to help people as much as I could in a more holistic way. And if you have a hammer, everything looks like a nail, right? So, and so that if you have a hyperbaric facility, you think everybody should go into a hyperbaric chamber. If you, if you're a cardiologist, you think everybody needs an echo or an EKG. If, you know, if you're at whatever else you can just, you know, if you're a pulmonologist, you're like thinking of chest X-rays or whatever it might be. So what I found really, really impactful is if you could just wait in a lot of people, just wait and optimize them for three to six months before them actually getting into the chamber, they would do so much better long term. And this was just transformative to my clinical practice and how I kind of operate overall.

• 9:43Dr. Darshan Shah?

  Right.

• 9:43Speaker 01

  Yeah.

• 9:44Dr. Darshan Shah?

  So, you know, I think a lot of people listening to this podcast might not even know what hyperbaric medicine is. And so I love to dive in deep. You know, where I trained at the Mayo Clinic, we used hyperbaric medicine as well.

• 9:55Speaker 01

  Sure.

• 9:55Dr. Darshan Shah?

  We had people come to us with big, with large wounds mainly that would go into the hyperbaric chamber. So this is one of those technologies that's kind of been locked up in disease care world, I call it.

• 10:05Speaker 01

  Sure.

• 10:05Dr. Darshan Shah?

  And now we're seeing it brought out more into disease reversal, health optimization. But, you know, can you give people a quick primer on what is hyperbaric medicine?

• 10:15Speaker 01

  Sure. So hyperbaric therapy is a combination of increased atmospheric pressure and increased inspired oxygen. And so that's, we combine those things, those two things together to drive a huge amount of oxygen into the circulation. So here's a quick primer on oxygen, just to kind of go over that. So oxygen is typically carried on red blood cells. Red blood cells actually have 250 million sites where oxygen combined, they're called hemoglobin. And hemoglobin actually has four sites that each, that oxygen combines. So in total, every red blood cell has one billion oxygen molecules, just fun fact, everybody, right? But And so that's red blood cells are how we carry oxygen. And then why do we need oxygen? Of course, we need oxygen to be the final electronic receptor in our mitochondria so that we can make ATP our energy currency. Fun fact as well, we make about 165 pounds of ATP every day.

• 10:59Speaker 01

  So it's a huge amount of oxygen that we need to make all of that energy. So it's all being carried on red blood cells. So how can you increase your oxygen carrying capacity? Well, you can come to live in Colorado or go to Aspen as you do and hang out for about 90 days. And after you do, you're going to increase the number of red blood cells in circulation because you release a hormone called epigen or EPO for short. This is also the doping drug, as you know. Lance Armstrong and other cyclists were very famous for this. Because if you take EPO or you go to altitude where EPO is released, you're going to get a number of increased red blood cells in circulation. As a result of that, you're going to carry more oxygen because you have more red blood cells. The other way to do this, of course, is to inject yourself with EPO, which you can do, which people do, especially if you have kidney disease, because your kidneys make the epigen itself. And then you can also give yourself a transfusion of blood.

• 11:43Speaker 01

  This has also been done, and of course, not legal, for races and cycling and things like that and other sports, because it's going to increase your oxygen carrying capacity. Now, what we do in a hyperbaric chamber, though, is different. We increase the amount of oxygen in circulation by driving oxygen into the liquid of your bloodstream. Your red blood cells are already saturated. We can actually still get more oxygen in because we can saturate into the liquid. And this is because we're simulating the pressure you feel under a certain amount of seawater. So water is extremely heavy. And it's that heaviness that actually changes your physiology. It's a physics law called Henry's Law. That basically the more pressure you put on a gas, the more of that gas is going to go from a gaseous form to a liquid form. So as a result of putting pressure or simulating the pressure you feel under a certain amount of seawater, if you look above, you know, you're 30 feet below the sea,

• 12:27Speaker 01

  you're looking above, you don't feel that pressure, but it's a significant amount of pressure. Water is very heavy. If you carry a bucket of water, it's heavy, right? So that heaviness that we simulate allows you to drive 1,200% more oxygen or even more than that in circulation, depending on the circumstance. And then as a result of that, so you have all that oxygen in circulation, there are basically three things that are happening, okay? The first is that you're getting more oxygen delivery. That's pretty obvious. So if you've had an acute injury, stroke, heart attack, traumatic brain injury, spinal cord injury, one of your limbs is hanging off or something like that. Hyperbaric therapy used in the immediate setting can be very, very powerful and it's been shown in various studies to actually reverse or mitigate significant damage as a result of that. So getting oxygen circulation really important, right?

• 13:10Speaker 01

  Number two is that all that oxygen creates more energy. That's important, but also creates more stress on the system. It's called oxidative stress or hormetic stress in this case. And what that's going to do is going to shift your epigenetics, the way your genes are being transcribed on your DNA and how they're expressed as a result of that epigenetic shift and that oxidative load. That oxidative load is also going to release more stem cells. It's going to enhance your immune system function. It's also going to kill bugs, like bugs especially that do not like high oxygen environments. And the third thing that really happens is that there is the pressure itself in the chamber. The pressure itself causes a, kind of like a micro massage to your blood vessels and your lymphatics. So it improves flow, it improves lymphatic flow, improves detoxification, and it also

• 13:52Speaker 01

  has some energy production capacity just with the shearing or with the pressure sensation on the cells themselves because of the pressure. So as a result of all of that, you have reversing low oxygen, you have decreased inflammation, you have decreased swelling, you have immune system activation, you have killing bugs, you have lymphatic flow and you have detoxification and something else. I think that's most of them.

• 14:15Dr. Darshan Shah?

  Wow. Yeah. That's a great primer on it. So basically what we're doing is we're increasing the amount of oxygen that has been delivered to all of our tissues. We have more ATP production, more oxidative stress as well.

• 14:28Speaker 01

  Yes.

• 14:29Dr. Darshan Shah?

  And we're also having some mechanical effect also on our blood vessels and our lymphatics. And so those are the three primary mechanisms that this is exerting an effect in our body.

• 14:37Speaker 01

  Yep.

• 14:38Dr. Darshan Shah?

  But you know, you do that at a microcellular level to every cell in your body and whether it's a brain cell, a heart cell, a liver cell, a kidney cell, muscle cell, they're all functioning better because of this therapy.

• 14:50Speaker 01

  Hypothetically, right? And that's kind of what we're kind of alluding to all here, right? Because sure, getting more oxygen circulation sounds great unless you're creating a huge amount, huge amount of oxidative stress and that the person that you're giving the oxygen to cannot tolerate that oxidative stress because they're already inflamed, they're already antioxidant deficient. Because what happens is because you, all that oxidative stress Is causing all those positive changes, but if you don't have a neutralizing effect. What they've shown in various studies, it takes about three days for the average person to meet, to mount an antioxidant response. And that's appropriate because that's how what we want. Enough oxidative stress to cause those changes, but not so much that it's causing damage to the system, right?

• 15:28Dr. Darshan Shah?

  Right.

• 15:29Speaker 01

  So typically, as we think about hormetic stress, like exercise or sauna, like these are causing good stresses to the body, but not, it's not going to be a good stress for everybody. And so in some of the first people that I was treating in the chamber, they got terribly sick afterwards. And they were already very sick when they were going into the chamber. I'm like, well, what's, what's happening here, right? So trying to support them with antioxidants, trying to do things that would kind of mitigate some of that damage, but, or that potential damage, or kind of more distress on the system, I would say. It's usually not permanent damage. It's usually somebody will feel worse and then they can't go back into the chamber for a couple of days. And that's usually a sign that they need to have more optimization before they go in overall. So.

• 16:04Dr. Darshan Shah?

  Right.

• 16:04Speaker 01

  But to take a back step, it is those three mechanisms. And then acutely, all that's happening, immediately we get into the chamber, right? But then long-term, those epigenetic shifts, you have new blood vessels, so angiogenesis. You have down regulation of inflammatory markers. So your inflammatory meteors, like your interleukins, your TNF-alpha, the world. You also have a improvement in maturation of those stem cells into the types of stem cells or types of mature tissue that are needed in various areas. And they tend to hone to the areas where they need to go. So if you have a brain injury, you're more going to go there. If you have more of a knee injury, you're going to have more that go in there too.

• 16:38Dr. Darshan Shah?

  Yeah. Stem cells kind of find their way to where they're most needed and exert their effects at those areas.

• 16:44Speaker 01

  Exactly.

• 16:44Dr. Darshan Shah?

  And just by using hyperbaric oxygen therapy, what you're saying is you stimulate the stem cells to kind of just go out there and do their job.

• 16:51Speaker 01

  Yeah, exactly. I mean, there's an exponential release of stem cells from your bone marrow as a result of just going into the chamber. And that's that oxidative stress piece that we're talking about.

• 16:58Dr. Darshan Shah?

  Right.

• 16:59Speaker 01

  So again, that's, for me, the energy metabolism piece of things was just my foray into learning that I needed to have a foundational framework. Because you need to have the machinery to be able to make energy and to detox from the energy that you make if you're going to successfully accomplish a hyperbaric protocol. I mean, typically, protocols, if you have an acute issue, are going to be somewhere like maybe three, maybe even one session, but five, 10 sessions-ish. But if you have more of a chronic issue, a long-term goal, then you're looking at, so for example, if you have mild cognitive impairment or if you have a chronic infection, or if you're looking at like fertility or like optimization, longevity, like these things are more long-term. Shifts in that epigenetics that matter, right? So, and those protocols can be 20, 40, 60 sessions, sometimes more.

• 17:41Dr. Darshan Shah?

  Right.

• 17:41Speaker 01

  Five days a week to get the, get the effect that you want.

• 17:44Dr. Darshan Shah?

  Right.

• 17:45Speaker 01

  So if you want to optimize your time in the chamber, you're spending all that time anyway. Like oftentimes it's better to wait three or six months. Get yourself optimized or get yourself ready to go in the chamber is what I say.

• 17:54Dr. Darshan Shah?

  Yes.

• 17:54Speaker 01

  Like, and people that are super sick, super chronically sick, I usually have them say like, look, you need to be about 60 or 70% better before hyperbaric therapy, especially if the deeper pressure is, is going to be effective. So for me, it's all about, it all came down to energy metabolism. Understanding the machinery of production. So do you have the machinery that's able to allow you to make energy? And then do you have the machinery that's able to allow you to detox from the energy that you make? So that, you know, that you can really survive and thrive in a, in a vital way, you know, going through hyperbaric chambers.

• 18:24Dr. Darshan Shah?

  Right. The balance is so critical to this therapy, but yeah, just taking a step back, let's give people a kind of a visualization of what it's like to go through a hyperbaric protocol.

• 18:33Speaker 01

  Sure.

• 18:33Dr. Darshan Shah?

  You know, I think a lot of people, when they hear hyperbaric, they think about, you know, Michael Jackson sleeping in the chamber.

• 18:39Speaker 01

  Yeah.

• 18:39Dr. Darshan Shah?

  They think about maybe if they have a little bit of knowledge about it, they know that there's like these soft chambers you can have at your house. You, there's a harder chambers, you can find at facilities. And then there's facilities that have like these futuristic looking capsules, look like you're almost in cryostasis. I told you, I used to have the Beverly Hills hyperbaric facility here. And maybe kind of describing like, what does a protocol look like? How's the experience of being in a chamber? And what are all these different chambers?

• 19:07Speaker 01

  Sure. Well, Michael Jackson's a good story because he was filmed or photographed in the chamber, supposedly sleeping in it. But what he actually was using it for was he was burned in the Pepsi commercial back in the 1980s. And so he's using it to heal third degree burns that he had on his head as a result of that. When he was done with his chamber, he actually donated it to Cedars-Sinai here in LA. And so of course, you know, the tabloids will do what they do. And he was filmed, I have some photos of that, that I've found over the years of him, you know, quote unquote, sleeping in the chamber. But I think it was more just sleeping in the chamber for pictures, as far as I could tell.

• 19:37Dr. Darshan Shah?

  Yeah.

• 19:37Speaker 01

  But so, I mean, when it comes down to it is that there's multiple different types of chambers available, right? The, there are soft chambers that typical, typically go to milder. Pressures, these are usually made out of some sort of nylon or polyurethane kind of material. And they can be used in the home. Sometimes you'll find them in clinics as well. And you have medical grade chambers that go to a deeper chamber, deeper pressures. There are what are called monoplace chambers, which are single occupancy chambers. So it's a, one person goes in, they can be fully translucent, you can see all the way on the outside. Sometimes they look more like submarines, depending on the situation. And so then you have what are called multiplace chambers. And multiplace chambers where multiple people can get treated all at the same time. They look like submarines and these are where you'll find, you'll find them a lot of times in academic facilities. And you also find them at diving locations around the world.

• 20:22Speaker 01

  Because that's where hyperbaric therapy got its start is actually as a treatment for diving injury or the bends or decompression illness. So the experience is relatively the same depending, not really, doesn't really depend on the chamber in the sense that when you, when you go in there, you're going to feel like your ears are changing pressure. Just like if you're on a plane or a train, but it's usually not as significant, it's usually more significant, excuse me, than being on a plane because it's going to be more depending on how deep you're going to go, right? And so while you're, so you sort of, pretend you're starting at zero feet of seawater. You're diving, as we call it, diving down below the sea, simulating that up to a certain, or down to a certain pressure. So you're going to, let's say, thirty-three feet of seawater, okay? And so thirty-three feet of seawater is what we call two ATA in our parlance, in our nomenclature in hyperbaric medicine.

• 21:05Speaker 01

  And so as you're going down to pressure, your ears are going to be changing as well. And they're going to have to be popping, popping, popping. So if you have any issues with that, the pressure has to stop, you have to wait. And, and it, but ninety-five percent of people don't really have much of an issue. Of the five percent that do, oftentimes cleaning out your ears with some wax typically does the job. But, you know, in general, it's usually pretty well tolerated, but it takes a little bit of time to get used to. Then when you get down to pressure, you stay there for, depending on the, on the protocol, you can stay there for thirty minutes, forty-five, sixty, ninety, a hundred and twenty, depending on the situation. And then while you're there, your ears are no longer pressurizing. Now, sometimes what we do is when we're at that stable pressure, is that we do something called an air break. So what, and so that goes with the oxygen. So typically you're getting oxygen either via, depending, depending on the chamber,

• 21:47Speaker 01

  you can get it via nasal cannula, you can get it via face mask, you can get it via hood. You can also get it a hundred percent in the, in the chamber itself, depending on the situation. Most medical-grade facilities will use masks, although there are some that will use 100% oxygen in those single occupancy, monopole chambers, too. So what happens is you're breathing on oxygen, you have oxygen on while you're kind of diving down. While you get down to pressure, you're hanging out of pressure, but then every 20 minutes or so, what we'll typically do is we'll have you stop breathing the oxygen and just breathe air instead. And that's called an air break. Typically, we're using those more in pressures about 1.8 and below, but more people are using it at milder pressures, too. And the reason for the air break is that, number one, it decreases the risk of oxygen toxicity. So we were talking about that oxidative stress before.

• 22:31Speaker 01

  The deeper you go, the more risk you have. So at 3.0, at three atmospheres of pressure, you do have a risk of having a seizure at that pressure after about 15 or 20 minutes. And so, interestingly, if you take some ketones ahead of time, you actually extend that time significantly. This is where people like Dom DiAgostino got all his Office of Navy Research.

• 22:49Dr. Darshan Shah?

  I just talked to Dom yesterday.

• 22:50Speaker 01

  Oh, nice. Yeah. Good timing. And so that's how I first met Dom was through some of his work using ketogenic diets, actually for cancer and things, along with hyperbaric oxygen therapy. But he got his start at the Office of Navy Research because they were doing how far they could go without having a seizure, breathing 100% oxygen at three atmospheres. Yeah. So, in that respect, you're using this oxygen, which can cause stress in the system. So you have to be aware of that, like we were talking about. And so air breaks can be helpful, and we use it for the decreasing risk of oxygen toxicity. Seizures are very rare, I should say, in a hyperbaric chamber. I've only seen maybe two in my whole career, so very, very, very rare. But you mitigate them by this air break phenomenon. But also, there looks to be a positive potential with these air breaks, not only to have a

• 23:31Speaker 01

  mitigation of oxygen toxicity, but also it looks like these air breaks release certain factors that simulate the actually you being at altitude for those five minutes. And that's called the hyperoxic/hypoxic paradox.

• 23:43Dr. Darshan Shah?

  Yes, makes sense.

• 23:44Speaker 01

  And the idea is that because you're going from, let's say, 100% oxygen to 21% oxygen, that delta, that change, your body sees that as you going from, going to altitude, basically, going to a hypoxic state, even if you're going back to normal amounts of oxygen. Which, I should have also mentioned, there's 21% oxygen in the air at sea level. Okay, just to be clear. And then there's when I live where I live in Colorado, it's about 16%. So and in a chamber, we can go up to 100%, of course, right? So that delta causes this factor called hypoxic inducible factor to be released. And that increases blood vessel formulation, stem cell release, mitochondrial biogenesis.

• 24:20Dr. Darshan Shah?

  Right.

• 24:20Speaker 01

  As well. And that's been looked at as well in various studies.

• 24:22Dr. Darshan Shah?

  Yeah.

• 24:23Speaker 01

  So that's really the experience. And then at the end of the experience, you kind of come up. You depressurize, come back to the surface and you feel like your ears are popping again. Usually easier to come back up to the surface, back up from pressure rather than going down. My evolutionary reason for this is that when we were designed, we weren't designed to breathe underwater, obviously. And so if we were diving underneath the water, it should be harder for us to go down so that we didn't want to do it.

• 24:44Dr. Darshan Shah?

  Right.

• 24:45Speaker 01

  But if we were down there, we need to get up, we need to get the hell up as fast as possible. So without injuring our ears. So it's usually easier to go back up.

• 24:51Dr. Darshan Shah?

  That's right. So, you know, I think what's important about the hyperbaric treatment is that you're actually using multiple modalities. You're doing these air brakes, you're using oxygen at higher concentrations. The air brakes are giving you that effect where you're going hyperoxic, hypooxic, as you're saying. But then also you're using the pressure as well to increase the amount of oxygen in your bloodstream as well. So it's multiple

• 25:14Speaker 01

  Right.

• 25:15Dr. Darshan Shah?

  different mechanisms you're using simultaneously. And that's why it's so important to have someone such as yourself really design a protocol that fits what your particular physiology needs and what you're kind of going after, right?

• 25:26Speaker 01

  Yeah, it got me a little crazy in like in 2017, 2018 timeframe. When I started doing more of my independent consulting outside of being at a medical director. I would just find that there was so little education out there as to what people should do. And there was tons of companies and now there's even more that are making chambers that will give people a chamber and say, good luck.

• 25:46Dr. Darshan Shah?

  Yeah.

• 25:46Speaker 01

  And then I they find me six months or a year later, I'm like, what were you doing? Why did you? And then some of these companies are actually giving protocols to their these people and they're not, these are companies. They're not medical doctors and this it's become a whole thing. So for me, I that's why I really decided a number of years ago to start to start creating more of an ecosystem, talking more about it, obviously, and educating people. But, you know, I have my own company that makes hyperbaric technology. But really our goal is to try to find ways to how people, how people learn how to actually make. More individualized protocols, depending on their their markers, like their wearables, like their blood data eventually, and also being able to understand what's happening in their actual technologies, hyperbaric chambers being the first thing, but also looking at things like red lights and cold plunges and saunas. We actually have Bluetooth connectivity to all

• 26:30Speaker 01

  those different types of technologies. So you can use them all like on a phone app to like learn how to integrate all this stuff together. So like, that's really where I think I felt that my world was going. There's like, well, how do you work on all this stuff together, doc? Like, I have a hyperbaric chamber, where I want to use one, then I have lights, and I have sauna, and I have I have these laboratory markers, and I have these conditions, and like, how do you put it all together, right? So and so my consulting practice is a lot of that. That's what I do. I have that's what I do all the time, you know, every day, every week. But but also I wanted to find a way to kind of bring it out to more people as well. So we're working on that.

• 27:00Dr. Darshan Shah?

  I think I think what you're talking about, there's like really using the N of one kind of methodology where you're looking at your own data and seeing how these treatments are affecting you. Like, you have a aura ring on, I have one on, too. And it's just, you know, that constant tracking of your own data tells you how effective the therapy is, or if it's actually harming you, and if you need to do something different, right?

• 27:20Speaker 01

  Right, right. Yeah, we're actually having a coming out with something cool where you can monitor your health data real time while you're doing the technology. So like, while you're in a hyperbaric chamber, you can actually have your aura on and actually looking at what's happening like in our own dashboard. So that's all in the same location. So I just got really tired, as you have, like, everything's all kind of siloed out. So it's difficult. And and so integrating things together is kind of how I really operate. As I kind of alluded to, a hyperbaric therapy is kind of a smokescreen for me. Like, it's something that I absolutely love. I do a lot of, and I work with every day almost. But it's not the first thing that I'm usually recommending for people, unless it's more of an acute issue. If it's an acute issue, do not pass go, except for go to the hospital if you need to, of course, and then get stabilized.

• 28:02Speaker 01

  Like, although there are stories of these old hyperbaric Navy docs having strokes and just going downstairs in the chamber and reversing them.

• 28:08Dr. Darshan Shah?

  Are you serious?

• 28:09Speaker 01

  Yeah, I was actually, when I got trained back in 2012 or 2013, the doc got up and talked that story. And then his son also was involved, like, no, dad, you can't tell that story. You can't tell it anymore.

• 28:22Speaker 01

  It's gonna get us in trouble.

• 28:23Dr. Darshan Shah?

  Yeah.

• 28:23Speaker 01

  Because, you know, that's what these guys, they're all cowboys, right?

• 28:25Dr. Darshan Shah?

  Right.

• 28:26Speaker 01

  But in general, you want to get stabilized, right? And then hyperbaric therapy is a fantastic tool for acute injury. So that could be trauma, it could be ischemia, like we were talking about.

• 28:35Dr. Darshan Shah?

  Stroke.

• 28:36Speaker 01

  Stroke, but also could be like a surgery or like, or just a regular musculoskeletal injury.

• 28:39Dr. Darshan Shah?

  Right.

• 28:40Speaker 01

  If there's an inflammatory component, like you're gonna see massive amounts of improvement. But I'm sure you have something similar, but I call mine the, an integrative strategy. I call it like my educationally throwing shit at the wall strategy, right? So if you have, excuse the cursing.

• 28:52Dr. Darshan Shah?

  That's okay.

• 28:53Speaker 01

  But is it the first time anybody's cursed on this podcast? I'm hoping.

• 28:55Dr. Darshan Shah?

  I don't know, maybe, yeah, maybe it might be.

• 28:57Speaker 01

  Yeah, all right, well, you're welcome.

• 28:59Dr. Darshan Shah?

  Thank you.

• 29:01Speaker 01

  So when I'm thinking about that strategy, it's more of a holistic one, right? It's not just about putting them in the chamber. It's like, what is their diet gonna be? What's their, what are their supplements gonna be? What other, you know, practices that we want them to have to do?

• 29:12Dr. Darshan Shah?

  Absolutely.

• 29:13Speaker 01

  What other surveillance do we need so that we can kind of see and we can dial all that in?

• 29:16Dr. Darshan Shah?

  Right.

• 29:16Speaker 01

  But, you know, long-term, if you have more time, of course, then it's not educationally throwing shit at the wall. It's more like, let's have a intentional strategy based on your lab, it's based on your data, based on your lifestyle, your diet, you know, things that we need to kind of optimize.

• 29:29Dr. Darshan Shah?

  Right.

• 29:29Speaker 01

  If you're an endurance athlete, we have a protocol for that. If you're looking for longevity, we have protocols for that. But it's not just about, yes, I have hyperbaric protocols for that.

• 29:37Dr. Darshan Shah?

  Yeah.

• 29:38Speaker 01

  I can tell you that in three seconds.

• 29:39Dr. Darshan Shah?

  Right.

• 29:39Speaker 01

  But that's not necessarily what you need right now. And maybe it would be modified. A good example is that there was a study that got a lot of attention in 2022, I think it came out. It was the Israelis, they published a study on telomere length, senescent cells.

• 29:53Dr. Darshan Shah?

  Yep.

• 29:54Speaker 01

  They did 60 hyperbaric sessions, 6-0. They treated them at 2.0, Monday through Friday for three months.

• 29:59Dr. Darshan Shah?

  Right.

• 29:59Speaker 01

  And they saw-

• 30:00Dr. Darshan Shah?

  Forty-five minutes each?

• 30:01Speaker 01

  No, so it was-

• 30:02Dr. Darshan Shah?

  Ninety minutes?

• 30:02Speaker 01

  It was in total about two hours of pressure.

• 30:04Dr. Darshan Shah?

  Two hours of pressure.

• 30:05Speaker 01

  What they would do is they did 90 minutes of oxygen and they did, and they did air breaks as well.

• 30:09Dr. Darshan Shah?

  Got it.

• 30:09Speaker 01

  So in total, it's about 120 minutes.

• 30:11Dr. Darshan Shah?

  Yep.

• 30:11Speaker 01

  And so they saw a reversal of telomere attrition. So there's a 20% increase in telomere size, or telomere length, excuse me. And then there was a significant decline in senescent cell populations. Senescent cells are these zombie cells that I'm sure you've spoken about before. That increases as we get older. They don't divide, they don't die, they just kind of cause inflammation. They're associated with degeneration.

• 30:33Dr. Darshan Shah?

  These are all longevity markers.

• 30:34Speaker 01

  Longevity.

• 30:35Dr. Darshan Shah?

  Yeah, yeah, exactly. You want low senescent cells. Longer telomeres, basically.

• 30:39Speaker 01

  Hypothetically, yeah. I mean, especially with the senescent cells. There's some more controversy on the telomere side. And I'm not convinced that it matters as much as. But what really convinced me on the study was the senescent cell populations. Now, there's, of course, controversy, what types of cells are you looking at? And there's all these other things. But my sense is what's happening is that hyperbaric therapy is actually regenerating those cells. They could just be apoptosising and dying as well, which would be fine. But my sense is the way hyperbaric therapy works is that it can improve mitochondrial function. And then as a result of that, you're going to get these cells to kind of regenerate themselves and start working again.

• 31:11Dr. Darshan Shah?

  So it's actually healing the senescent cells and back into functional cells?

• 31:15Speaker 01

  That's my sense, yeah.

• 31:16Dr. Darshan Shah?

  Yeah, interesting.

• 31:17Speaker 01

  But I don't know for sure. What was interesting about that study, too, is that the most senescent cell downregulation or decrease in population was around treatment 30 or so.

• 31:24Dr. Darshan Shah?

  Right.

• 31:25Speaker 01

  So but they did 60, they did 60 hyperbaric sessions. So what was interesting for me is I look at this study. They didn't change anybody's diet. Of course, they can't because it's a study. They didn't change anybody's lifestyle. They didn't do anything except for putting them in a chamber. So in my experience, we can do a significant amount of benefit, if not the entire benefit, in 30 to 40 sessions in most people. If they're looking at optimizing their health and foundational markers and, you know, working with me or working with you or something where they're really looking at, you know, looking at this as a longevity health span piece and then adding hyperbaric therapy on top of that.

• 31:55Dr. Darshan Shah?

  Right. So going back to the chamber itself. I mean, you have different chambers, different types of chambers, hard, soft chambers. And they usually, the softer chambers don't get up to two atmospheres.

• 32:06Speaker 01

  Sure, yes.

• 32:07Dr. Darshan Shah?

  So can you talk a little about the number of atmospheres? And, you know, a lot of times I hear people in next cell talking to each other outside the chambers, like, oh, I got a three atmosphere chamber down here that I'm going to go to.

• 32:17Speaker 01

  No, no.

• 32:18Dr. Darshan Shah?

  And it's like, really? So talk a little bit about the, you know, you alluded to the number of atmospheres.

• 32:25Speaker 01

  Yeah.

• 32:25Dr. Darshan Shah?

  And how that, how you think about that and how people should think about that? And also the oxygen concentration that you're getting.

• 32:32Speaker 01

  Yeah, so as I was, we were talking about before, we talked about ATA. Right. Atmosphere is absolute. That's kind of our nomenclature. Right. It's equivalent to a certain amount of feet of seawater. Yes. So that's the other way to think about it. So if you're in a mild unit, typically, again, they're soft sided. They usually go to about 1.5 atmospheres at max, and that's going to be about 20 feet of seawater-ish. Then you have your monoplace, the hard shell chambers that go to about three atmospheres. Right. That's equivalent to about 66 feet of seawater. And then your multiplace chambers can go as deep as you need to. Because the multiplace need to go as deep as anybody was diving underneath the water. Exactly. And then I have, there's going to be saturation divers, people building tunnels and, and things like that that could go super, super deep. So they have to be able to go that deep. So in essence, that's the difference, differentials in pressure. When it comes to indications, which I think is important. That's one.

• 33:17Speaker 01

  The, the soft chambers or the mild sided units have been mostly studied for neurologic and neurocognitive optimization. In clinical practice, I see it also great for what I call day-to-day operations, you know, wellness, like jet lag and performance and recovery. It's really nice to have the mild chambers just for those things. Yeah. But if you're looking at the longevity studies, or at least the ones that we were alluding to, that really starts at about two atmospheres. And so in theory, it would be nice to have the option to go to both types of pressures. But in practice, it's hard because they're more expensive to go to deeper pressures. So a lot of people have the soft chambers at their house. More people are getting the hard chambers at their house now too, which is fine. But I think you can get a significant amount of benefit with the mild units, especially from neurocognitive perspective.

• 33:57Speaker 01

  But even from a physical systemic perspective too, if you're doing the other stuff, if you're optimizing vitamins, minerals, nutrients, your cofactors, your energy metabolism, taking some ethylene blue, other kinds of things, and then you're also adding other therapies like you have, like red light or sauna or. Absolutely. If you're, the way I think about it is that how can I enhance the capacity for the system to make more energy? Right. And then also, how can I enhance the, the flow of energy to, to where we want it to go? Like the flow of oxygen in this case, right? And so that means enhancing blood vessel dilation, right? So what also can happen in the chamber, in Icarus Baric Chamber, is the deeper you go, the more vasoconstriction you get too. Uh huh. So this is something you can mitigate by using various things ahead of going in the chamber. If vasoconstriction is not what you want, right? So if you've had like a brain injury and you have swelling, you need that vasoconstriction because that's going to stop the.

• 34:42Speaker 01

  Swelling and stop your brain from swelling, which is important. But in essence, from like a longevity, performance optimization, you don't need that as much.

• 34:49Dr. Darshan Shah?

  Right.

• 34:49Speaker 01

  And so you want to maybe mitigate some of that visa constriction. So, so in essence, the mild units are really for neurocognitive optimization, day to day wellness. I feel like, especially from a brain health perspective. But one thing that I always like to point out is that a lot of these soft chamber companies, what they'll say is that, oh, no, all you need to do is more hyperbaric sessions in a mild unit. And that's going to be the same as going to less sessions in a deeper unit. There's completely no basis for that in reality. They call that like an oxygen exposure, but what they forget to mention is that when you're getting oxygen in circulation, you're going to have a diffusion of that oxygen outside of a blood vessel to a certain amount.

• 35:24Dr. Darshan Shah?

  Right.

• 35:24Speaker 01

  Length, and that's not going to change at 1.3 or 1.5 compared to 2.0. It's going to be about double. So there's no real compare. I mean, you can make the comparison, but it's a false comparison.

• 35:34Dr. Darshan Shah?

  Right.

• 35:34Speaker 01

  If you're trying to make that comparison. So, so deeper pressures or milder pressures for longer does not equal deeper pressures for shorter. So I think that's important to mention as well.

• 35:43Dr. Darshan Shah?

  Yeah, for sure.

• 35:48Dr. Darshan Shah?

  Hi, Dr. Shaw here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30 year old people with cells that look like they're pushing retirement. And I've also seen 60 year olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells you see are like phones and they have limited cell phone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity.

• 36:32Dr. Darshan Shah?

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• 37:15Dr. Darshan Shah?

  Most people are aging twice as fast as they should, unfortunately. You don't have to be one of them. Try I am eight. I actually have a discount secured for you if you go to drshah.com/ima or go to imadehealth.com/discount/drsah and you can get 20% off with my discount code, Dr. Shah. You can also find the link below.

• 37:39Dr. Darshan Shah?

  Dr. Shah here, and I want to take a quick moment to talk to you about metabolism. So you've probably already heard, unfortunately, 88% of Americans are metabolically unhealthy. And it's not because of what they're eating. It's actually a lot about what's living in your gut. I'm talking about your microbiome. This is the community of bacteria that controls everything from how you process sugar to your energy levels, to your mood. There's actually one specific strain in your microbiome called Akkermansia muciniphila. That's absolutely critical for metabolic health. This is a bacteria that strengthens your gut lining. It helps you metabolize carbs more efficiently and it increases GLP-1 production naturally.

• 38:23Dr. Darshan Shah?

  The problem is almost everybody is completely deficient in it. And until recently, there was no way to get this. But that's why I'm really excited about joining Pendulum. They're the first company in the U.S. to bring live Akkermansia to the market. The company was founded by PhD scientists and doctors with the Mayo Clinic as their first investor. The metabolic daily formula that I take every single day doesn't just contain Akkermansia. It's formulated with multiple next generation strains. And these all work together to optimize your metabolism from the inside and out. So you can track every macro and calorie if you want. But if your gut microbiome is out of balance, you're going to be fighting an uphill battle. Pendulum is going to give you the tools that you need to fix your gut at its source.

• 39:08Dr. Darshan Shah?

  Try Pendulum today. Head to my link below and use the discount code. You're going to feel the difference a healthy gut microbiome can make.

• 39:21Dr. Darshan Shah?

  Some of these monoplaced chambers, like you said, you can be in there with 100% oxygen.

• 39:24Speaker 01

  Yeah.

• 39:25Dr. Darshan Shah?

  But that gets really dangerous, right? Because you, 100% oxygen environment is highly flammable as well. So, safety wise, what are your, what are your concerns? And how, let's talk about the oxygen concentrations as well.

• 39:38Speaker 01

  Yeah.

• 39:39Dr. Darshan Shah?

  And where you should be doing these types of therapies and how to keep it safe.

• 39:43Speaker 01

  Yeah, I talk with my hands. I'm keeping the microphone there.

• 39:45Dr. Darshan Shah?

  Yeah, me too. I talk with my hands.

• 39:46Speaker 01

  So, we're just kind of like, we're shaking here. So, when it comes to oxygen, there's a number of different ways for it to be administered. What you're talking about with 100% oxygen, usually it's only administered that way in the medical grade monoplaced chambers. And it actually can be really nice for certain types of patients. Patients that have a hard time putting something on their face. If they've had a stroke or if they've had other injuries or they've had plastic surgery on their face or something like that. So, there can be utility for it. But if you're going to go to a place that has 100% oxygen, you really have to make sure that they have really good safety protocols in place. So, I work with a number of facilities in New York and California and other places and Northern California as well, as well as Southern, that use 100% oxygen. Totally fine. But everybody's going in scrubs. You're going in with your mother, what your mom gave you otherwise, right?

• 40:28Speaker 01

  And you take off everything, jewelry, makeup, earrings, watches, everything.

• 40:32Dr. Darshan Shah?

  No electronics, you can't have your phone in there, none of that.

• 40:34Speaker 01

  So, it's definitely a higher risk from a flammability perspective. So, you know, most facilities will use, even with the monos that go to deeper pressure, they'll use a mask.

• 40:43Dr. Darshan Shah?

  Right.

• 40:44Speaker 01

  A mask. And so, that could be like, let's call it a non-rebreather. Or it could be, or you can use a hood as well, where they put a hood on top of you that gives you oxygen in your, like, in your, around your head, but not the rest of your body, which decreases the risk of flammability as well. In the soft sided units, you can get nasal cannula, you can get face mask, or you can get no oxygen at all as well. So, you know, fun fact, another fun fact here is that if you're at 1.3 atmospheres, which is about 15 to 20 feet of seawater, and you are just in a hyperbaric chamber without any extra oxygen, you're getting about 46% more oxygen in circulation.

• 41:16Dr. Darshan Shah?

  Oh, okay.

• 41:16Speaker 01

  And this becomes important because a lot of the studies that were looking, looking at hyperbaric therapy, they would compare somebody going to 1.3 without any oxygen to somebody that was going to more pressure, more oxygen. And they were calling this a sham controlled study, but it's not really because you were giving that patient that was getting the sham. You're getting them 46% more oxygen.

• 41:35Dr. Darshan Shah?

  Right.

• 41:36Speaker 01

  So that's not really a sham control. This became a problem in a lot of the traumatic brain injury work because the TBI patients do better usually at the milder pressures. So if you're comparing a 1.3 getting air, which is 46% more oxygen in circulation, to a 1.5 with 100% oxygen, they are getting more oxygen for sure at 1.5, but they're also getting oxygen at 1.3, right? So like, how do you make that? So it's, you know, there's still benefit at 1.3 without any extra oxygen, especially for brain and neurologic as well. So it's important. And so, you know, the oxygen's usually either given via like a oxygen concentrator. So there can be an oxygen concentrator outside of the chamber. It could be bottled oxygen, that's compressed oxygen. If it's at the deeper pressures, it also could be liquid O2 as well, depending on the situation. So, but yeah, oxygen, pressure, the combination.

• 42:21Speaker 01

  Like often you'll get the question, I get the question still, like, why can't I just breathe oxygen? Right? And it's because, no, you need the pressure to drive the oxygen circulation, right? And that's, that's key. So, and pressure is less appreciated in the hyperbaric field because everybody thinks, oh, it's oxygen, oxygen, oxygen. No, it's not just the oxygen. It's the oxygen because of the pressure.

• 42:39Dr. Darshan Shah?

  Right.

• 42:40Speaker 01

  And the pressure itself has having multiple different physiologic shifts as well, as we were discussing earlier, so.

• 42:45Dr. Darshan Shah?

  Right. Have you seen some of these newer chambers that have come out that actually put you into a hypopressure environment? And yeah, and then they bring you back and forth? Can you kind of contrast those newer chambers to the hyperbaric chambers? And what are the differences that you can use them for?

• 42:59Speaker 01

  So there's a couple of different companies that have these hypobaric chambers. And what they do is they start you at sea level and then they vary the pressure, the altitude, very, very quickly, very, very fast. And I think there is something to them overall. They are causing a hypoxic stress. And it's basically like the oxygen air brakes that we make in the hyperbaric chamber, but like constantly for 60 or 90 minutes.

• 43:20Dr. Darshan Shah?

  Right.

• 43:20Speaker 01

  And so what I've found is that if you're a performance athlete, it could be a huge performance boost to do that. But if you're already pretty sick or have like medical issues, you have to be careful because it could be too much stress on the system to have that much of a hypoxic stress overall.

• 43:33Dr. Darshan Shah?

  Right.

• 43:33Speaker 01

  But it is causing a lymphatic flow as well. So that the pressure altitude changes are increasing lymphatic flow. So there are some benefits, absolutely. And I have some friends that, you know, are very much into using it for performance, for athletic pursuits. And overall, I think that, you know, it's one of those things where my sense is that if you're relatively well optimized already, that I think hypoxic stress can be really good for you.

• 43:53Dr. Darshan Shah?

  Yeah.

• 43:53Speaker 01

  But I think my concern is people doing it too much, too often. But I think that it's definitely, there's definitely something there too.

• 43:58Dr. Darshan Shah?

  Yeah, it seems like it's utilizing, you know, we talked about the three mechanisms of why hyperbaric oxygen is working.

• 44:04Speaker 01

  Yeah.

• 44:04Dr. Darshan Shah?

  One of them being the kind of air brakes where we're, where we're changing pressures on people. So this new chamber is utilizing that air brake methodology to create that one effect. But you're not getting the oxygen driven into the cells. Which you're going to hyperbaric therapy.

• 44:18Speaker 01

  Yeah. So if you're getting real fancy, like some of my friends will, they'll start doing the hypoxic training and then they'll go and do hyperoxic training after that. But you have to be really careful with that because it could be a significant stress on the system if you're not used to it. But, but I think really where it comes down to is I think both are really helpful overall. And I think what's very similar about the two of them is that, is that you have these air brakes and hyperbaric chamber. And it's very similar to what's happening when you're in these kind of altitude chambers. But the altitude chambers are more constantly changing your pressure up and down, up and down, up and down. And so that's stressful to the system, more so than I think hyperbaric therapy is overall.

• 44:52Dr. Darshan Shah?

  Got it.

• 44:53Speaker 01

  I don't, that's not where I immediately go to with patients.

• 44:56Dr. Darshan Shah?

  Right.

• 44:56Speaker 01

  Or even my endurance athletes and performers, it's like, let's, let's do hyperbaric therapy. Let's work on that increased oxygenation piece first. Let's optimize your mitochondrial function that way. And then you bring more, the, the hypoxic stress is going to actually work better overall.

• 45:07Dr. Darshan Shah?

  Exactly. Right. And so I think there's an important distinction to be made because I think for people, like you mentioned traumatic brain injury. So, you know, we have a lot of football players that come into here after games sometimes and try to mitigate the effects of that. And they, and we also have some patients that have had maybe strokes that are trying to recover from their strokes, post-surgical patients.

• 45:26Speaker 01

  For sure.

• 45:26Dr. Darshan Shah?

  All of these are people that need hyperoxygenation to their brain and their tissues, right?

• 45:33Speaker 01

  Right. Exactly. Yeah.

• 45:34Dr. Darshan Shah?

  So really the, the hyperbaric chamber is going to be the best for that. Now, if you're looking at performance and utilizing some of the pressure shifts to create better performance.

• 45:43Speaker 01

  Yeah.

• 45:43Dr. Darshan Shah?

  Yes, the hypo baric chamber is definitely an option there as well.

• 45:47Speaker 01

  Well said. Well said. Yeah.

• 45:48Dr. Darshan Shah?

  Okay, let's talk about, I, I want to dive in a little bit because I think this gets confusing for people. This mechanism that occurs in our biology of hyperoxygenated stress and the recovery from that. And the utilization of antioxidants, you know, we were told for years that we need antioxidants. So why are we using hyperbaric therapy to create more oxidative stress? So let's talk about that balance that occurs at a cellular level a little bit.

• 46:13Speaker 01

  Yeah, I mean, so we know from various studies out there that just supplementing with antioxidants doesn't do the trick, especially if you're just using one antioxidant and not thinking about all the other antioxidants in the system. And then what happens with antioxidants is that you can cause oxidative stress because of those in too much over time. So, but in essence, what we think about with is a balance, as you mentioned. And so what hyperbaric therapy is doing is actually is shifting that into an imbalance for a short period of time. But the hope is that your system is optimized enough so that you have enough antioxidants in the system to be able to balance out the oxidative stress that just happened. The challenge, though, as we were alluding to earlier, though, is that most people, a lot of people do not have that capacity. They don't have the capacity to balance out that oxidative load. And so what is this manifest as?

• 46:57Speaker 01

  It manifests as fatigue, it manifests as muscle pain, joint aches, concentration problems, GI issues. These are kind of like your detox kinds of symptoms where your body's trying to do something about it, but it doesn't have the capacity to do it. So I'm always very cognizant when somebody's going into hyperbaric chamber, do they have the capacity to create an antioxidant response? And so we need an antioxidant response, but we also need oxidative responses too. So that our body responds to these oxidative loads by trying to optimize it itself, right? And so in a hyperbaric chamber, what's happening with all this oxidative load is that, excuse me, we're getting stem cells released. As a result of these stem cells release, we're getting, you know, these flood of new stem cells that we can heal different tissue, right? We're getting the immune system to activate, we're fighting infection, and that's really important.

• 47:41Speaker 01

  A similar kind of example would be exercise, of course. Like exercise, you're shearing your blood, your arms or your legs or whatever to break apart those muscle tissue and then you rebuild it and hypertrophy it as a result of that. So that's what the body does, the body responds to that oxidative stress. And so you want that capacity. And so I always dance around this because antioxidants around hyperbaric therapy is a good question in the sense that I don't often like to give antioxidants when somebody's using Hyperbaric therapy because we don't want to mitigate that hormetic response. But in some people, we need to give them because they're under such significant oxidative load already. And this is where something like, you know, methylene blue, for example, comes in, which is an energy enhancer and also as it works as an antioxidant as well.

• 48:23Speaker 01

  And so my, when I'm looking at somebody and working with them, I'm thinking, well, how can we optimize energy production? Of course, but how can we optimize their detoxification pathways and process at the same time so that they can benefit from the oxygen that's going in, creating that oxidative stress, increasing their energy capacity, and then all the fun things that happen with the epigenetic shifts that we discussed earlier. But at the same time, how are they going to be able to detox from the energy that they make? So it really becomes like a full-scale operation. And that's, you know, when you're thinking of things just in a silo, like one antioxidant, or without doing testing, for example, like, and that's a big part of what I do in my practice, is looking at what's called metabolomic testing. And metabolomic testing is like the study of how your cells are working, your vitamins, your minerals, your nutrients, everything in real time, what's happening in your cells. So I can look at that and I go, okay, look, not a good

• 49:07Speaker 01

  time to go into hyperbaric therapy. Like, or if you really need to go in, we need to really think about how we're going to support you so you can benefit, but you don't feel like you can't move for three days after you get out of the chamber.

• 49:16Dr. Darshan Shah?

  Right. No, it makes total sense. The analogy I use in my patients sometimes is, you know, you have a fireplace and then you have a flu in the fireplace. And if you have, what hyperbaric therapy is basically doing is it's giving you a ton more wood that you're putting into the fireplace and you get all this energy being made. But if your flu is not functioning well, then you're just going to accumulate a lot of smoke in the room and it's going to be very, it's going to make you sick, right? And so you have to have that flu functioning really, really well of the fireplace so that you can actually get rid of the runoff of the reactive oxygen species that you're creating. And I think people kind of understand that. So, you know, a lot of times, we do the same kind of testing as well to make sure the cellular function is good. And so people are ready for hyperbaric oxygen therapy. And a lot of times they're not, like, people are

• 50:00Dr. Darshan Shah?

  not ready for hyperbaric oxygen therapy. They don't have enough antioxidant production that they really should, like you said, optimize their system first before they go in the chamber.

• 50:08Speaker 01

  Yeah, it's, I mean, it's unfortunately a diagnostic indicator. If somebody goes into the chamber and feels like crap, because if they do, like, well, there's more we need to do before you're really going to benefit from this, right? Most people that will go in that are relatively optimized will actually feel better in the chamber. They'll feel they're more energy, they have more oxygenation, they'll feel a little bit brighter, they'll have several actually hours of where they feel like they can actually do more there. Interestingly, so when you're in the chamber, the oxygen stays in the circular Even when you get out for about thirty minutes or so. And so even so, within that thirty minutes, you should be able to do more work, exercise, aerobic capacity, et cetera. But even oxygen utilization goes up and stays up for about twenty four hours after being in the chamber. So if you're like an endurance athlete, you will see a benefit overall. But if you go too deep in the chamber and you're not well optimized, then you may not have that situation.

• 50:53Speaker 01

  And I've worked with tons of athletes over the years and we've found like the sweet spot is you really don't want to go. If they're like really hard training, if they're not recovering as well as they need to. If you go below about one point seven atmospheres, they don't do well because it's too much oxidative stress for their system overall.

• 51:06Dr. Darshan Shah?

  Got it.

• 51:07Speaker 01

  Unless they're being well optimized by somebody like yourself or otherwise and dialing in their antioxidants, dialing their dialing in their gut and all those kinds of things.

• 51:13Dr. Darshan Shah?

  Right.

• 51:14Speaker 01

  But in essence, you have to be really careful about oxidative stress and especially in elite athletes and people that are training all the time. Because they're just going to be more sensitive overall.

• 51:21Dr. Darshan Shah?

  Yep.

• 51:22Speaker 01

  And so it sort of correlates to people that are chronically sick as well.

• 51:25Dr. Darshan Shah?

  Yeah. So let's talk about that, a few of the indications of hyperbaric oxygen therapy. You know, we alluded to some of them and I'd love to know like how you kind of shift your thinking about the protocols. People that are using it for different indications. So, you know, I think if you're using it for post-stroke recovery, if you're using it for a large wound, you definitely want to go to like a medical center. That has someone like you on staff that can help you truly dial it in. But what if you're a person, let's say, let's go through a few different indications that we often see here.

• 51:54Speaker 01

  Sure.

• 51:55Dr. Darshan Shah?

  Sometimes a kid will be in a football game, high school kid, football game, had a concussion in the football game. How do you think about that patient?

• 52:02Speaker 01

  Yeah, so again, the educationally throwing S shit at the wall, I'm saying it again. But in the sense of the hyperbaric piece, obviously, the first step is to make sure that they're safe, that they've gotten checked out either by their team person. Or they've gone to the hospital, depending on the type of or how severe the concussion was. And then after that, the hyperbaric protocols can vary. The one that I like the most that's been pretty well studied is a gradation of pressure that starts off at one point five. And then goes to one point seven five, then goes to two point O, all in the same treatment. So it's twenty, twenty, ten, so twenty minutes at one point five, twenty minutes at one point seven five and ten minutes at two point O. This is, this was actually developed by a lady in outside of Chicago in North Dakota named Daphne Denham. And she had like four kids herself and she was treating her kids and having and all their. Kids, friends and teammates on all their teams and that kind of thing.

• 52:46Speaker 01

  So, and she published a case report on it, which is pretty interesting. And so I use that if it's available.

• 52:51Dr. Darshan Shah?

  Yep.

• 52:51Speaker 01

  If it's not, I mean, you can still get benefit even from going to a soft sided chamber. 1.3 or 1.5 and some depending on the severity, sometimes twice a day to start off with if they can. And thinking about their diet, of course, thinking about, you know, what else they're going to be doing. Certainly the, the recommendation of living in a dark room and not licking anything is not the way to go. And please don't do that, anybody. That's antiquated advice overall.

• 53:12Dr. Darshan Shah?

  It's actually creates the opposite response. It's, it's actually worse for your brain to do that.

• 53:16Speaker 01

  It's worse for your brain to do that. So, you know, we're trying to make sure they're not eating crappy food, you know, making sure that they're on the like the low carb keto side if possible. Thinking about adding ketones as well and also including that before hyperbaric therapy. Because ketones are obviously fat byproduct of, and we, we use ketones for energy. And what can happen is that it's a clean burning, more cleaning burning fuel. And it also protects the system from more oxidative stress. And so that could be really beneficial in something that just had a brain injury or stroke or another kind of injury as well. So.

• 53:45Dr. Darshan Shah?

  Do you have a favorite pre-treatment ketone product that you like?

• 53:47Speaker 01

  I use a number of them. I've, I've used the Ketone Aid for a while. I've also used the Ketone IQ. I just got this new one called Ketonics that one of the, one of our colleagues was talking about in our longevity chat, which I've been trying myself, but I haven't tried it on any patients yet. So do you have one?

• 54:01Dr. Darshan Shah?

  Um, I, I use Ketone IQ just because it's easy, just, you know, quick swig and it's done. But, uh, yeah. Okay, let's, okay, now we're, you know, we're in West Hollywood here.

• 54:08Speaker 01

  Sure.

• 54:08Dr. Darshan Shah?

  Very close to Beverly Hills.

• 54:09Speaker 01

  Sure.

• 54:10Dr. Darshan Shah?

  5,000 plus surgeons here.

• 54:12Speaker 01

  Is there 5,000 plus surgeons?

• 54:13Dr. Darshan Shah?

  I think it's close. I think it's one plastic surgeon for every two people that live here.

• 54:17Speaker 01

  That's crazy.

• 54:17Dr. Darshan Shah?

  So it's, uh, it's really nuts, but we have a lot of patients that come to us post-surgical. It doesn't have to be plastic surgery. It could be, you know, a knee replacement. It could be lots of different surgeries.

• 54:27Speaker 01

  Yeah.

• 54:27Dr. Darshan Shah?

  Post-surgically, how do you think about those types of protocols?

• 54:30Speaker 01

  Yeah. So ideally they get into the chamber before they get surgery.

• 54:33Dr. Darshan Shah?

  Oh.

• 54:34Speaker 01

  Uh, because that it helps. Kind of prepare the tissue for the actual surgery itself. And so then two to three, two to three sessions before, before the actual surgery. And then maybe three to five sessions afterwards is kind of the usual, but sometimes depending on the surgery, it could be more than that. Ideally, again, it's deeper pressures. The deeper the pressure in these cases, the more stem cells you release, the more inflammation that's going to go down. But you'll, you'll get benefit at 1.5 even so for sure, but the deeper the pressure, the better, at least to 2.4 is ideal. So I used to have, you know, when I had my clinic in, in San Francisco, we used to do 2.4 and like, I would see that like somebody's face go like from looking one way to be like looking significantly different or like you could see the swelling just go down very quickly after just one session. So then, I mean, then of course it's not just about going to the chamber, it's trying

• 55:17Speaker 01

  to also kind of impress upon them, you know, dietary strategies. I use a ton of, of methylene blue in the pre-post surgical perspective as well because it also can work on hypoxic tissue. So, and help keep some of that more vital if it was, look, especially if it looks like it's not looking so good. But again, it's more looking at the holistic strategy if we can, but it's not as important if it's an acute issue like a plastic surgery. Hypothetically, they were healthy enough to get surgery. So hypothetically, they're gonna, that's not always the case, as you know, but people sometimes will do surgery on anybody. But, but hypothetically, just hyperbaric therapy on its own is going to be very powerful in that setting.

• 55:51Dr. Darshan Shah?

  Yeah, for sure. And that, that's really great. And afterwards, you use it for like a week or two after the procedure?

• 55:56Speaker 01

  Yeah, three to five sessions or up to 10 sessions. I mean, it depends on the person, depends on the surgery. The more intense the surgery, the more protocol, the more hyperbaric, hyperbaric treatments they're probably going to benefit from. But sometimes it's hard for people to do that. So even if you can get two to three after a surgery, you're going to get, you're going to see significant benefit. From my perspective, what I've seen in the, over the years, and it's pretty good in the quoted literature, it's about, it's, it's a pretty wide range, 20 to 70% faster recovery if you're using hyperbaric therapy post-surgical.

• 56:25Dr. Darshan Shah?

  Which is massive.

• 56:26Speaker 01

  That's a, that's a, that's a big, it's a big range too, but it's still massive. On average is about 50%, 50% faster. And so of course, if you're an elite athlete and you get back on the field to make money, that's a big deal, right? But of course, if, if you're a plastic, if you got a plastic surgery, you don't want to look like you have raccoon eyes for three weeks. You want to look at it like you had two weeks of, and then that's, that's also nice too, right?

• 56:45Dr. Darshan Shah?

  Exactly.

• 56:46Speaker 01

  So I think it can benefit across the way. And it really comes down to the main thing that hyperbaric therapy is doing is it's healing wounds from the inside out, right? It's, it's doing all the things we described, you know, reversing low oxygen stays, decreasing inflammation, getting those stem cells to the area, preventing that tissue from scarring because it's getting more oxygen to that tissue, right?

• 57:02Dr. Darshan Shah?

  And that's what I was going to say. What I've found is it's not just faster healing, it's actually less chance of infection, less chance of losing some of the skin. If the skin incisions happen to be really tightly put together, there's also, like you said, less swelling, which leads to better results because swelling is sometimes mess up the results of surgery, for lack of a better term.

• 57:22Speaker 01

  Swelling is not what they want.

• 57:23Dr. Darshan Shah?

  Exactly. You want to, you want to minimize amount and the duration of swelling. And so hyperbaric is excellent for that.

• 57:29Speaker 01

  Yeah.

• 57:29Dr. Darshan Shah?

  Just moving on to patients with infections. So we have patients that come to see us that have either, you know, chronic mold exposure, they've had maybe Lyme disease. How do you think about those patients?

• 57:40Speaker 01

  So in a very multifaceted way. Typically with Lyme and mold, they need to be working with a provider that's also addressing the Lyme and mold together.

• 57:50Dr. Darshan Shah?

  Absolutely.

• 57:50Speaker 01

  Hyperbaric therapy on its own is not going to go very well.

• 57:53Dr. Darshan Shah?

  Absolutely.

• 57:54Speaker 01

  It can help maybe in the short term, but long term, they all go back to the way they were before. This is my experience. It's unfortunate. And this is why I mentioned that 60, 70% better before you come into a hyperbaric chamber, unless you're getting very directed mold therapy or directed Lyme, maybe earlier than that. But in general, I really try to wait until they're that better because if you go too early, they'll get a lot of pain related to going to hyperbaric chamber and they won't see a lot of the gain over the long term. Some people will, but in general, they tend to relapse over time. So, so I typically, if somebody's talking to me and they're saying, hey, doc, I have Lyme, I want to go in a hyperbaric chamber, like who's your Lyme literature physician? Or who are you working with that's working on the Lyme aspect of things? And then, because especially as we start, you know, killing organisms because of hyperbaric therapy. What we do, how is that all going to work?

• 58:37Speaker 01

  Are you, do you have the detox processes that are going to be able to be? Are they high enough? Are they revved up enough to be able to work with that? So I, I think about it in a multifaceted way.

• 58:45Dr. Darshan Shah?

  And usually these patients are not. Usually their detox pathways are very

• 58:49Speaker 01

  Yeah.

• 58:49Dr. Darshan Shah?

  Uh, slow and injured. And so they need to really get treated for that first, right?

• 58:53Speaker 01

  Yeah, and I, the, the nurse that I learned from was actually a Lyme patient.

• 58:56Dr. Darshan Shah?

  Oh, really?

• 58:57Speaker 01

  She was the, she was the head nurse at the facility that I was a medical director went in 2013 when I first started. And she, I saw her own experience. I saw her go into the chamber and get better, but then she would get worse again. I saw her get in the chamber and get worse again. And then she would tell me stories about the first time she went into the chamber where she'd have to like be wheeled in in a wheelchair. Like she couldn't even do it. And then she kept having all these relapses until she really started working with a provider that was really focused on the Lyme literate side of things and really working on her detox pathways and, and all the other aspects of Lyme treatment. And that's when I saw her really get better over time. And then that really, it really affected me significantly because I saw that not only with Lyme, I saw with mold, I saw with any chronic infection.

• 59:38Dr. Darshan Shah?

  So on firsthand.

• 59:38Speaker 01

  Yeah, and I saw it with chronic inflammatory disorders, autoimmune issues, all the same thing. Like if you went into the chamber, you didn't do all the other stuff beforehand? Like you just were not going to see the benefit that you wanted to see.

• 59:47Dr. Darshan Shah?

  Yeah.

• 59:48Speaker 01

  And so that's where I get in trouble, right? Because I don't always say, yeah, hyperbaric therapy, go ahead. Here's your protocol. Like, no, no, let's wait three, six months. Find a doctor that can help you. Maybe I am that person, maybe I am not that person, depending on the situation. And I'm happy to refer. I always, I always refer. I'm happy to do it.

• 1:00:02Dr. Darshan Shah?

  For sure.

• 1:00:03Speaker 01

  Yeah.

• 1:00:04Dr. Darshan Shah?

  And then maybe the last category of person that we'll talk about, we touched on this a little bit already, is long, the longevity enthusiast, the person seeking to maximize their health span and lifespan. And these are people that want to come in, you know, they, they want some sort of routine. I feel that it's hard for them to come in a daily basis because this is something they want to do for a long term.

• 1:00:23Speaker 01

  Of course.

• 1:00:23Dr. Darshan Shah?

  So what is the most manageable protocol for someone that's looking to optimize their longevity?

• 1:00:27Speaker 01

  Yeah, I mean, I think the first thing to say is that you should not be going to a hyperbaric chamber every day.

• 1:00:31Dr. Darshan Shah?

  Right.

• 1:00:31Speaker 01

  And I think that's another problem is that if you buy a chamber at the house

• 1:00:34Dr. Darshan Shah?

  Yeah.

• 1:00:35Speaker 01

  or from another company, whether it's a hard chamber or a soft chamber, you don't know. And then I've had people say, oh, I'll use it for six months every day. I'm like, oh, no, please no. No matter what type of chamber, that's not a good idea.

• 1:00:43Dr. Darshan Shah?

  Yeah.

• 1:00:44Speaker 01

  And so the key to understand And is that the way I think about sort of longevity and and long term use of hyperbaric therapy is that you're using it in protocols when you're going in five days a week for periods of time.

• 1:00:54Dr. Darshan Shah?

  Sure.

• 1:00:55Speaker 01

  Those periods of time get shorter as you've had the chamber for longer. And then but in between those periods, which may be every six months to a year, you're going in what I call in like kind of a maintenance type of mode.

• 1:01:04Dr. Darshan Shah?

  Yes.

• 1:01:04Speaker 01

  Where you're going in maybe two to three times a week and you're varying your pressure. Typically, you're not going to super deep pressures all the time because that's not really what the body needs all the time. And varying that pressure is like varying your exercise.

• 1:01:14Dr. Darshan Shah?

  Right.

• 1:01:14Speaker 01

  So you want to go like milder pressures of 1.3 to 1.5, maybe 1.7. But like you want to, you know, vary it around, right? And the key for me is that if you're doing a long term hyperbaric therapy, you can see massive benefit, but you also have to be looking at your biomarkers over time, too.

• 1:01:27Dr. Darshan Shah?

  Yes.

• 1:01:27Speaker 01

  Because you don't want to deplete all your antioxidants, like we talked about earlier. You don't want to deplete your your capacity, like your GI system and like all of a sudden having issues there, right?

• 1:01:35Dr. Darshan Shah?

  Hmm.

• 1:01:35Speaker 01

  Like it what especially if using deeper pressure for longer, deeper pressure hyperbaric therapy is going to kill anaerobic bugs. And that's good if you have.

• 1:01:42Dr. Darshan Shah?

  Infect your microbiome.

• 1:01:43Speaker 01

  It can. Yeah. We don't have a lot of data here, but in experience, we know that it likely directs it against anaerobic bugs.

• 1:01:49Dr. Darshan Shah?

  Right.

• 1:01:50Speaker 01

  These are the ones that cause issues in a lot of different conditions like inflammatory bowel disease, for example, right? So Crohn's and ulcerative colitis. But so yet my my concerns, and I work with people long term, they have their chambers at their house. I'm always looking at, look, if you're going to have a chamber like this, I don't care if it's a soft chamber or a hard chamber, but especially a hard chamber. You really got to be making a really good effort to follow your oxidative stress markers on a regular basis, your mitochondrial function on a basis on a regular basis. And then that's how you can maintain, you know, that you can really have a benefit without having any detrimental effect. And again, I use a lot of different tools and technologies aside from hyperbaric therapy. But but long term, it's either you're on a protocol, five days a week, or you're on maintenance.

• 1:02:26Dr. Darshan Shah?

  Right.

• 1:02:26Speaker 01

  But the protocols initially can be long, initially like maybe 20, 30, 40 sessions. But then over time, that might be 10 or 20, like six months or a year later. So it depends on the person overall, but.

• 1:02:35Dr. Darshan Shah?

  And so for the people that have a chamber, a hard chamber at home, for example.

• 1:02:38Speaker 01

  Yeah.

• 1:02:39Dr. Darshan Shah?

  Or a soft chamber, what are you recommending? Like once every three or four days, once every week? Or is it every other day?

• 1:02:45Speaker 01

  It just depends on what's going on, right? So I would I typically.

• 1:02:48Dr. Darshan Shah?

  For longevity, for example.

• 1:02:49Speaker 01

  Yeah. I mean, for like a longevity, it's, you know, it's one of those things where, what does that mean exactly, right? So but like for me, I would have them do. Doing a protocol where they went for their 40 sessions, typically at a deeper pressure if they could. Maybe once every three to five years, depending on the situation, maybe, maybe less, maybe more frequent than that. But in between that, you know, going in from like day to day operations. I like people to target their, their sessions to what they need. Like, is it targeting like for exercise recovery? Is it targeting because you just got off an airplane? So then maybe you want to do a couple of sessions in a row, right? You're targeting because you just got an injury. Are you targeting because you need to go in there with your daughter who just had a concussion? That happens to me, right, sometimes, right? Um, I bring my kids into my chamber at the house. But, so I like to think about it as maybe, maybe more on the health span side. Because it's not, it's more like, how are you optimizing your health today or tomorrow?

• 1:03:35Speaker 01

  I didn't really kind of figure that until just you asked me that question. It's a good one because like, it's not like a long, I think there's longevity potential.

• 1:03:41Dr. Darshan Shah?

  That's what I meant, yeah, more health span.

• 1:03:42Speaker 01

  But I think it's more like, how can you help on your day to day operations health? And that's what the, the like two to three times a week targeted to those health span metrics would be about, I think.

• 1:03:51Dr. Darshan Shah?

  Exactly. And I think it's also key for people that have their own, own home chambers is not to spend the night in the chamber.

• 1:03:57Speaker 01

  No, no, please don't do that. Yeah, no, no, no.

• 1:03:59Dr. Darshan Shah?

  You know, it's 45 to 90 minutes at most, but every few days is, and that's what I was kind of getting at. You know, we have a lot of people that, you know, once again, we're in Los Angeles. People are buying chambers for their home. A lot of people have their own biohacking facility in their home. And they really don't know how to manage it. They bought everything, but they have no idea how to use any of it. And people are trying to do everything in their home every day. Their LED light, their hyperbaric chamber, their cold plunge. And it's like way too much.

• 1:04:26Speaker 01

  Yeah, and this is actually why we created the education app that we've been working on. My company is called OneBase Health. And that company, that's exactly the reason. Because people are getting all this stuff at their house and they have no idea how to use it. And so the idea is like, well, let's show you how, let's, what are your, what are your goals? When do you not want to use these things? What are your wearable technologies showing you? And how is that all integrating together? And then how can you build your own protocols with your practitioners as well? And it kind of pushed that to the app as well.

• 1:04:50Dr. Darshan Shah?

  What's the name of your app?

• 1:04:51Speaker 01

  It's called OneBase Health.

• 1:04:52Dr. Darshan Shah?

  OneBase Health, I haven't seen this yet. I'm excited to check it out. Okay, great.

• 1:04:55Speaker 01

  Yeah, so just coming out with some features now. And the idea really is how you can integrate all these kinds of technologies together.

• 1:05:01Dr. Darshan Shah?

  I love this. I mean, you know, at Nexhealth, we have all these technologies. It'd be fantastic if we could work together with our patients to use your app. This is fantastic.

• 1:05:09Speaker 01

  Right now, they're all going to be built with our tech, so like our chambers and things. But, but over time, you know, there'll, there'll be more of a democratizing of that, I hope. That's my goal at least, over time, but yeah.

• 1:05:17Dr. Darshan Shah?

  Can I ask you a little bit about, you mentioned some biomarkers of oxidative stress, biomarkers, what are mitochondrial health? And these are biomarkers that most people don't normally get at the regular doctor's office visits. So can you talk about what are the biomarkers and how often are you checking these?

• 1:05:33Speaker 01

  Yeah, so I mean, there's different perspectives here. I know that, I'm interested in yours, actually, what your perspective is as well. What I typically use is, they're more advanced, but they're relatively basic. Because I think some of the advanced testing, I'm not convinced, really has a direct manifestation or a direct correlation yet. So I use typically organic acid testing. Pretty simple. It's a way to look at how those inputs are going in to your energy cycles and how you're doing on the detox pathways, right? So you can look at the intermediates in your citric acid cycle, which is part of your, in your mitochondria that helps us make energy from our food. And you can look at all of those, and you can look at signs of oxidative stress on the mitochondria itself, looking at various markers like lipid peroxidase and it hydroxy deoxyguanine,

• 1:06:16Speaker 01

  and looking at glutathione levels and CoQ10. I keep it relatively simple. You can look, I look at toxin detoxification markers on the organic acid panel, but those are the ones I typically will look at. And depending on what they, and sometimes blood markers too, some things like your CRP, your ESR, your fibrinogen, your ferritin levels and others that I'll use as well.

• 1:06:35Dr. Darshan Shah?

  Right. Yeah, that's kind of what I recommend people do is organic acid testing. There's some newer screens out there that, like you said, I'm not super convinced yet that they work, or they're even being done in CLIA certified labs and things like that. So I'm a little bit careful to have people waste their money on those. But I think organic acid testing has been pretty well documented and been used for a while now in these types of situations.

• 1:06:59Speaker 01

  Yeah, and that's one of the things that we teach, actually, at Health Optimization Medicine in Practice, is to how to interpret organic acid testing, metabolomic testing, which is metabolomic is the real time cellular processes, what's happening right now, what just happened. And that's what organic acid testing is really able to help you do. But we're focused on optimizing for the health of the system, not looking at disease markers or looking at it for disease state, per se. Now, it's a little bit of a different shift in perspective, but in essence, organic acid markers are fantastic because they give you a real sense. Of what's going on foundationally. So we teach how to interpret those markers. We teach you how to interpret them in the context of health, in the context of diet, lifestyle supplementation. It's the foundational module of the certification.

• 1:07:41Speaker 01

  And then there's six other modules, things like abigenetics and exposomics and gut health and bioenergetics. And exposomics is the study of toxins in the environment, by the way. And so, and a couple others as well, but in chronobiology and things. But the key really for my clinical practice is that's what I'm focused on. Yeah. I'm focused on really optimizing that foundation. And then, once that foundation is built, then it's much easier to do any other tool or technology that you wish to do, including hyperbaric therapy. But, you know, as you know, as well, Darshan, like so many people are just having such a hard time with mitochondrial function, right? Ninety-four percent of the US population at this point has some element of mitochondrial dysfunction. And it's really difficult, right? And there's been a lot of interest in methylene blue recently. I know, I know, we, you know, I've been chatting about this and I brought you some products as well.

• 1:08:26Speaker 01

  Thank you so much for these, yeah. Yeah, no problem. So I really got interested in methylene blue specifically. And that's, that's our, that's our product called Just Blue. Yes. When we realized that it had this amazing capacity to really support mitochondrial function, right, to really help with not only the capacity to make energy, but also the capacity to detox at the same time. There's very few things out there that do both. There's very few that will enhance energy production and also increase your capacity to have an additional antioxidant response. It can work directly as an antioxidant. At high, so at low doses, it does that. At high doses, it actually can induce the production of your own antioxidant supply as well. Interesting. Yeah. But the key with, with methylene blue that I found so fascinating is that it could compensate for any complex disorder in your electron transport chain.

• 1:09:11Speaker 01

  So you have these four complexes in your electron transport chain in your mitochondria that help you make energy. What methylene blue can do is that if any of those are disrupted, and many of them can be, it can compensate for that disruption. It can bypass it. It can recycle things like NAD. If NAD is not being used appropriately because complex one is not working very well. And so it has this capacity to go in there at these low doses and see remarkable changes in, not only in, in helping compensate for it, but then eventually helping with the Some of those issues as well with long term use, along of course with doing the other stuff, doing the vitamin, doing the optimizing lifestyle and diet supplementation. So it gives you and buys you time. And that's the hardest thing, I think, and you're in practice too, is like if people are

• 1:09:52Speaker 01

  so sick or they're just having such a hard time, even starting B vitamins can be difficult for some people. Like it's just the system can't tolerate it, right? But I found that like very low doses of methylene blue, you can start them at very low dose, four, eight, 16 milligrams, and you can slowly titrate up their dose and they start feeling better. And then all of a sudden they can start doing other things that you were hoping that they could do initially. They're more motivated because they have more energy. Their brain's starting working. I have a, I have a, I have a quiz question for you. Do you know where we have the most mitochondria per cell, Darshan?

• 1:10:22Dr. Darshan Shah?

  I would say it's your type two muscle fibers.

• 1:10:26Speaker 01

  That's if you were talking to Gabrielle Lyons, that's what you would say. But you have the most reserve in your muscle, but actually the most working at any one time is your ovaries or your sperm. Makes sense, right? Making a baby is a lot of energy, right? So you have your most mitochondria per cell in ovaries and sperm. And then second is your brain, then your heart, your liver, your, and your musculoskeletal tissue, right? So, so you have the most reserve.

• 1:10:49Dr. Darshan Shah?

  Got it.

• 1:10:50Speaker 01

  Awaiting the need in your musculoskeletal tissue, in case you need to run from a lion or something like that, right? But in essence, you know, that why are we seeing such issues of infertility, right? Because of mitochondrial dysfunction, brain issues, brain fog, concentration, fatigue, it's all related to mitochondrial dysfunction. So top causes, you know this, but you know, toxins in our environment, medications can do it. The most common medication actually that causes mitochondrial issues is metformin and PPIs are a big one too. Then you have infections that can do it. So COVID infection absolutely did it. Long COVID infection absolutely causing, you know, mitochondrial dysfunction. Then the big, the top one is actually insulin resistance. So if people are insulin resistant, like they're not utilizing sugar well, their mitochondria are

• 1:11:31Speaker 01

  not going to be happy. And so as a result of that, the got more flu, more smoke, as you said, I liked your analogy. And as a result, it's not going where it needs to go and get more, you know, more sludge in the system. So what can we do? Like, there's many things that we need to do, but sometimes just taking something is what all our patients can do initially. And methylene blue is a great way to start off with people.

• 1:11:51Dr. Darshan Shah?

  You know, methylene blue is such an incredible compound because, you know, I think my experience with methylene blue has been in surgery where we use methylene blue as a dye marker.

• 1:11:58Speaker 01

  As a marker, yep.

• 1:11:59Dr. Darshan Shah?

  Right? And then also, we use it as a marker for also tracing lymphatics because it'll Kind of travel along the lymphatics. So then when I heard about people using it for, you know, IV or orally, I was like, wait, what are they doing? And you often see people with like, you know, their mouth is blue, biohackers. I was wondering like, what is that all about? Like, I thought this was just dye. And it's really interesting to me, just at a, just a bioenergetics level, how something that manipulates light can actually affect your electron transport chain in your mitochondria. So what is, I mean, do you have any idea what the actual mechanism is?

• 1:12:34Speaker 01

  Yeah, we do. I mean, so the history of it is pretty interesting overall, right? So it was the first drug that was registered with the FDA back in 1897. And it was for malaria. And it got the name at that time of a magic bullet. And it got named magic bullet because you could give very high doses of methylene blue. It would kill pathogens, but it would not harm normal human cells. And so that's was kind of the, that's what they were looking for at the time. There was no chemotherapy. There was no drugs for anything like that. So methylene blue would work against infection and you could use it very high doses. And they were using huge doses actually for malaria. And it was like one of the first and the only antimicrobials available until the 1950s. And so it was used for urinary tract infections, for fungal infections.

• 1:13:16Speaker 01

  If you grew up in a developing country, you would get it as a lollipop for viral infections. Like you paint your mouth blue and everything like that because it's a fantastic antiviral as well. And it works at these higher doses, like above about a milligram per kilogram. So that's about 70 milligrams or above. It works as a increaser of something called hydrogen peroxide in the system. So what happens is that methane blue comes in, it competes with oxygen to bind in the electron transport chain, and it can actually make hydrogen peroxide instead. And then that hydrogen peroxide is a anti-infective. And hydrogen peroxide is how our body actually takes care of infection. And what's cool about that is that there's no resistance patterns that have ever been shown against methane blue to infection because it creates hydrogen peroxide as its main mechanism.

• 1:13:59Speaker 01

  And so until 1950s, it was the only thing around. But in the 1950s, penicillin, the magic drug. And of course, we know from there, antibiotics, antimicrobials of all different types. So methane blue became less used as a result of that. It also had these side effects, you know, these were minor side effects. But they were visual side effects. Blue urine, uh, blue secretions, otherwise, at very, very high doses, over three milligrams per kilogram, it actually can cause other secretions to be blue as well. And so it it got its new sort of, from the 1950s, it became, so the first, uh, first antipsychotics were actually derived from methylene blue.

• 1:14:33Dr. Darshan Shah?

  Really?

• 1:14:33Speaker 01

  Because methylene blue is also a monomine oxidase inhibitor. So it increases norepinephrine, serotonin, and dopamine. So it increases mood and improves mood, and actually has been shown in various studies to be pretty good for depression and bipolar as well. And so there are people that are weaning their patients off of things like SSRIs and using methylene blue instead, under clinical supervision, of course, because we know that depression is not a serotonin deficiency.

• 1:14:53Dr. Darshan Shah?

  Right.

• 1:14:53Speaker 01

  We know that depression is for a lot of different reasons, but it's not a serotonin deficiency. So, not that SSRIs can't be helpful in some people, but in essence, you know, methylene blue has that component. But the cool thing about it was that, I don't know if you did this, when I was in in college, I used methylene blue to stain our cells. And methylene blue is used in chemistry.

• 1:15:11Dr. Darshan Shah?

  Right.

• 1:15:11Speaker 01

  And what methylene blue does in chemistry class is actually concentrate or stain into or, you know, concentrate in your mitochondria.

• 1:15:17Dr. Darshan Shah?

  In the mitochondria, that's how you found the mitochondria, when you're looking under a microscope.

• 1:15:20Speaker 01

  Exactly, yeah, exactly, yeah. And so the mechanism there is that methylene blue is a redox cycler. Basically, it can donate or pick up electrons because of just how it's created. And so that if there is a need for it to donate electrons, it will do that. That's the electron transport chain. But if there's a need to pick up free electrons, which is your oxidative stress, it can do that as well. So it's this really cool capacity for it to do both, to can stain the system and recycle itself.

• 1:15:45Dr. Darshan Shah?

  Right.

• 1:15:45Speaker 01

  You know, cycle on, cycle off, like on and off, on and off. And so when it's in the oxidized form, which is when it's donating electrons, it can, it's it's blue. But if it's in its reduced form, which means it's picked up free electrons, it's actually colorless.

• 1:15:57Dr. Darshan Shah?

  Ah, interesting.

• 1:15:58Speaker 01

  Called leukomethylene blue.

• 1:16:00Dr. Darshan Shah?

  Got it.

• 1:16:00Speaker 01

  Yeah.

• 1:16:01Dr. Darshan Shah?

  And how, where does it come from? Where's it made from?

• 1:16:03Speaker 01

  It's a synthetic. Yeah, so it was made as a textile dye in the 1870s. And it was dyeing blue jeans blue. The first thing that died blue jeans blue was actually methane blue.

• 1:16:11Dr. Darshan Shah?

  So interesting.

• 1:16:12Speaker 01

  Yeah, you know, I don't know how they got from dying blue jeans to treating malaria. But I there was actually, but I kind of know, like, they were looking at this class of dyes that methane blue is part of and looking at what would kill malaria because they didn't have anything else that would really work against it. So that's really how it kind of came to pass that it got to be more of a medical therapy. But it really kind of fell by the wayside because, again, there was cooler, fancier drugs. And then now we know that it concentrates in mitochondria. There's been a lot of interest, at least in the research side, you know, using methane blue to improve mitochondrial function.

• 1:16:43Dr. Darshan Shah?

  Right.

• 1:16:43Speaker 01

  Of course, it's a drug that's way off patent. So nobody's.

• 1:16:47Dr. Darshan Shah?

  Making money off, no one's with studies on it, right?

• 1:16:49Speaker 01

  There's been a couple of different drug companies that have looked to look to find derivatives of it and then use that derivative in, you know, pharmaceutical. And there's a couple urinary tract infection over the counter.

• 1:16:59Dr. Darshan Shah?

  Yeah.

• 1:16:59Speaker 01

  That you can get methane blue in them with their. So, I mean, I'm using a lot of methane blue for urinary tract infections, both as prophylaxis and as treatment as well. But so the lower doses, four, eight, 16, 25 milligrams, these are really nice doses for mitochondrial optimization.

• 1:17:13Dr. Darshan Shah?

  Okay.

• 1:17:14Speaker 01

  They can support mitochondrial function. You titrate the dose until it starts working well. The higher doses over a milligram per kilogram, you know, 70 milligrams or higher, that's more for acute infection, acute stress. Like, I have all my patients with methane blue in their medicine cabinets at higher doses in case they get acute infection or they get acute trauma or, you know, God forbid, you know, a stroke or a heart attack, still go to the hospital, of course.

• 1:17:35Dr. Darshan Shah?

  Yes.

• 1:17:35Speaker 01

  But take your methane blue as well.

• 1:17:37Dr. Darshan Shah?

  Yeah.

• 1:17:37Speaker 01

  You know, about two milligrams per kilogram for something like.

• 1:17:39Dr. Darshan Shah?

  What about post-surgical?

• 1:17:40Speaker 01

  Yeah, post-surgical, same thing. Yeah, usually there's a huge amount of stress on the system, huge amount of inflammation. What's cool about methane blue is not only can it compensate for any aspect of the electron transport chain not working very well, it can also act just like oxygen. So it can be the final electron acceptor, just like oxygen would be.

• 1:17:56Dr. Darshan Shah?

  Yes, yes.

• 1:17:56Speaker 01

  So it works to increase your aerobic capacity. And they've done studies on stroke and traumatic brain injury, at least in animals, that have shown that they have more tissue that survives if you give them a higher dose of methane blue, a high dose of methane blue when they have the injury. So.

• 1:18:10Dr. Darshan Shah?

  Wow.

• 1:18:11Speaker 01

  Yeah, so, I mean, I don't think most people need high doses.

• 1:18:14Dr. Darshan Shah?

  Yeah.

• 1:18:14Speaker 01

  And I think, and in fact, I think that's been a big challenge over the last several years is that this. That just blew that that's 16 milligrams.

• 1:18:20Dr. Darshan Shah?

  16 milligrams. Okay, got it. And so this is a troche, which means you put under your tongue, a troche, you put in your tongue, onto your tongue.

• 1:18:26Speaker 01

  So the way we developed them at Troscriptions is the name of the company. So big story, a short story is that health optimization medicine we've been talking about is a nonprofit. We created a for-profit entity called Troscriptions in 2020 so that we can help people right now while they're on the longer path of health optimization, which, as you know, can take a while for some people. And the first products we came out with were the ones that were based on methylene blue.

• 1:18:48Dr. Darshan Shah?

  Got it.

• 1:18:48Speaker 01

  Because methylene blue, as we described, is a fantastic mitochondrial optimizer. And the dosing that we chose was much lower than what was thought to be the therapeutic dose. But there were some studies, especially, there's a really interesting, interesting study in Alzheimer's disease. They gave three doses of methylene blue. One was eight milligrams twice a day, 75 milligrams twice a day, and 150 milligrams twice a day. And the eight milligrams was your sham control, because everybody needed to have blue urine.

• 1:19:13Dr. Darshan Shah?

  Yes.

• 1:19:13Speaker 01

  If you have 16 milligrams of methylene blue, you're gonna have blue urine. The eight milligrams twice a day, the sham, did much better than the 75 or 150.

• 1:19:21Dr. Darshan Shah?

  Really? Interesting.

• 1:19:22Speaker 01

  And the reason for that is that these higher doses of methylene blue, they do cause stress on the system.

• 1:19:27Dr. Darshan Shah?

  Got it.

• 1:19:27Speaker 01

  They increase the amount of hydrogen peroxide produced, which is great as an anti-infective. But it also induces what's called your N R F 2 pathway, which hypothetically is gonna make you produce more glutathione.

• 1:19:38Dr. Darshan Shah?

  Right.

• 1:19:38Speaker 01

  If you can't do that, because your brain's already under duress because you have Alzheimer's or myocognitive impairment, that's gonna be a problem.

• 1:19:45Dr. Darshan Shah?

  Right.

• 1:19:45Speaker 01

  So one-time doses of these higher doses can be okay. Like, longer-term dosing at those kind of high doses can be detrimental, is what I found, especially for more of a chronic presentation like that.

• 1:19:55Dr. Darshan Shah?

  Makes sense. Okay.

• 1:19:57Speaker 01

  But if you're gonna be on higher doses for long periods of time, and some people do need these, like if you have Lyme, if you have, especially Bartonella, which has been shown to have, what methylene blue does at these higher doses actually breaks up biofilms. So it breaks up the biofilms that protect the organism from being treated with other types of things. And so it actually can break up the biofilm in your GI system. It can break up the biofilm in your urinary tract. And so we have a number of clinicians that are using it for a severe condition called interstitial cystitis.

• 1:20:22Dr. Darshan Shah?

  Sure.

• 1:20:23Speaker 01

  And using methylene blue at these higher doses, seeing massive benefit. You know, at the lower doses, we're seeing it as a prophylactic, right? As something that could potentially prevent infection, especially like women, menopausal, chronic urinary tract infections, using it regularly, at least anecdotally, we're seeing really benefit there. There hasn't been any studies on it, but I mean, at this point, you know, we're using our clinical judgment as we always have to in the world of what we do. But the trokey, just to mention that, so it's a dissolvable lozenge.

• 1:20:49Dr. Darshan Shah?

  Right.

• 1:20:50Speaker 01

  That can be dissolved between your upper cheek and gum.

• 1:20:51Dr. Darshan Shah?

  Uh huh.

• 1:20:52Speaker 01

  At Transcriptions, we developed the trokey because it's a fantastic delivery device up here. It works fast and it bypasses first pass metabolism in the liver.

• 1:21:00Dr. Darshan Shah?

  Yeah.

• 1:21:01Speaker 01

  Liver, digest things, degrade things, detoxify things, of course. However, with methylene blue, pure methylene blue, it's almost 100% bioavailable, whether you get it in the IV, obviously, or even as a trokey, or if you swallow it. So what's different about it, an oral version of it dissolving in here, is that how fast it's going to get into the system.

• 1:21:18Dr. Darshan Shah?

  Yeah.

• 1:21:18Speaker 01

  And a lot of my patients with chronic brain issues, concentration, fatigue, attention issues, they do better if they dissolve in the mouth.

• 1:21:26Dr. Darshan Shah?

  Right.

• 1:21:26Speaker 01

  However, that will mean that they will have a blue mouth.

• 1:21:28Dr. Darshan Shah?

  Yeah.

• 1:21:29Speaker 01

  And so the other, the better way to do it for most people is to have it on an empty stomach.

• 1:21:33Dr. Darshan Shah?

  Yeah.

• 1:21:33Speaker 01

  And then eat about 15 to 20 minutes later, in general. And that's, that's really a really nice way to take your methylene blue.

• 1:21:38Dr. Darshan Shah?

  So just swallow, swallow all of these and just eat later, right? Exactly.

• 1:21:42Speaker 01

  And the other thing about the trokeys is that they're scored. And so they have like, you can take a quarter, you can take a half, you can take a full. And so that's really a nice way for people to be able to titrate their dose over time.

• 1:21:51Dr. Darshan Shah?

  Got it.

• 1:21:52Speaker 01

  The titration is key, and you know this as well, right? At least in my clinical practices, like you don't always want to start off with the dose. You want to start off with, and this is with hyperbaric therapy too. We didn't talk about it, but like oftentimes with hyperbarics, like you don't start off at 2.4. Like you go 1.5, you go 1.7, and you kind of like, you know, you get them through. And like, that's what we do with the trokey, is it easy to kind of take a quarter, or half, or full? And so a lot of my patients, they're taking a quarter or half, you know, many times a week, especially when they're doing hyperbaric programs, if they're mitochondria, a lot of stress. And then we're titrating their dose to see what they need. But it's, it's a really fantastic tool.

• 1:22:25Dr. Darshan Shah?

  That's amazing. And so with hyperbaric therapy, like you're saying, you know, for most people, you don't want to have any antioxidants for maybe a day or two, let your body kind of develop the balance? Is that right?

• 1:22:35Speaker 01

  Yeah, I usually, it depends on the situation, like three to five hours at least.

• 1:22:39Dr. Darshan Shah?

  Three to five hours.

• 1:22:39Speaker 01

  Yeah, I mean, I, I think it depends on the person and kind of what they're going for, like, but in general, three to five hours is what my goal for most people.

• 1:22:46Dr. Darshan Shah?

  So if you're using methylene blue while you're on a hyperbaric protocol, how do you time it?

• 1:22:51Speaker 01

  So I usually, it depends on the person. It depends on what they're using hyperbaric therapy for. If they're super sick and we need to get them in the chamber, and I usually will give it before as a way to support their energy production system and as a way to help their detoxification system.

• 1:23:04Dr. Darshan Shah?

  Right.

• 1:23:05Speaker 01

  If they're relatively well optimized, then I usually give it about three to five hours afterwards.

• 1:23:09Dr. Darshan Shah?

  Right.

• 1:23:09Speaker 01

  Because that's going to help with their detoxification pathway and help them kind of clean things up. So it really just depends. But you know, oftentimes, it's usually very low doses before is when I'm using it because I'm trying to help support their antioxidant system, you know, while they're going through.

• 1:23:22Dr. Darshan Shah?

  That's great information to know. Yeah, absolutely. So I want to touch on one more thing in the few minutes that we have. You're, another one of your expertise is GABA.

• 1:23:30Speaker 01

  Yeah.

• 1:23:31Dr. Darshan Shah?

  And you also brought another product that you work on in this realm, right?

• 1:23:34Speaker 01

  Yeah.

• 1:23:35Dr. Darshan Shah?

  Can you tell me what this is?

• 1:23:36Speaker 01

  Yeah, that's called Trocom.

• 1:23:37Dr. Darshan Shah?

  Yeah, yeah. Tell me a little bit more about, is this a Trokey also?

• 1:23:40Speaker 01

  Yeah, there's Trokeys as well, yeah.

• 1:23:41Dr. Darshan Shah?

  Okay, great, great.

• 1:23:41Speaker 01

  That's a sample pack. But the, the kind of the big picture here, of course, right? So the nonprofit optimizing health, right? When you're optimizing health, a lot of roadblocks, a lot of bottlenecks. Energy is a huge one, right? But stress and anxiety is gigantic, right? So many of us these days are just on all the time. I have a really hard time shutting down and shutting off. And the system that's responsible for helping you shut off is the GABA system. So GABA is a neurotransmitter, GABA, amino butyric acid. It is our most prevalent, it's our largest, it's the one that causes the most inhibition of any other neurotransmitter. It's about 20% of the brain's neurotransmission is GABA. And GABA is always in a fine balance with something called glutamate. Glutamate is our primary excitatory neurotransmitter,

• 1:24:25Speaker 01

  and GABA is our primary inhibitory or relaxation. Think of GABA as like you're on and your GABA is you're off.

• 1:24:32Dr. Darshan Shah?

  Right.

• 1:24:33Speaker 01

  It's like the brakes of your brain. And what's interesting about that is that GABA actually gets converted in the brain from glutamate. So glutamate is your, it starts off as glutamate, and it gets converted into GABA in the brain. And so you don't have, it's very difficult to actually, you don't get GABA directly in the brain, you actually get converted from the glutamate. At least not very much. And so you always have this balance, right? So the common example, if you go to a Chinese restaurant.

• 1:24:56Dr. Darshan Shah?

  Sure.

• 1:24:57Speaker 01

  Was MSG in the food, monosodium glutamate. So all of a sudden, you get this huge amount of glutamate in the brain. And you get headaches, you feel irritable, you don't sleep very well because you can't, some people can't convert very fast over from that MSG from the glutamate to the, to, to GABA.

• 1:25:12Dr. Darshan Shah?

  GABA.

• 1:25:12Speaker 01

  You need some cofactors, like you need B6 and magnesium specifically to be able to do that. And so if you're deficient in those, for example, you're not going to have that good conversion. And the other challenge is that people are GABA deficient these days because they're hyper stressed all the time, that's going to deplete GABA, they're, they're toxic, they have leaky guts, and they're not, they don't have enough substrate, which means that like our main fuel that actually makes glutamate is something called glutamine, is an amino acid that also fuels our gut. And actually, it's the primary fuel for our small intestine. So if you have a leaky gut, all your glutamine is being used to try to heal that up.

• 1:25:42Dr. Darshan Shah?

  Yeah.

• 1:25:42Speaker 01

  And it's not getting enough glutamate, and you're not getting enough GABA. And so you can have vitamin, mineral, nutrient deficiencies that cause GABA deficiency. And then clinically, what do we see? We see people with anxiety, with insomnia and depression. And you know, GABA is really cool because it's, it's called an interneuron. So it's, it's basically like a waylay station between your superstar neurotransmitters, like your serotonin, your dopamine, norbinorphine. So it regulates the flow between all of that. So if GABA is not working well, you're not regulating flow well. And so it's interesting, like another good fun fact is that we have about 70,000 thoughts per day.

• 1:26:14Dr. Darshan Shah?

  Seventy thousand?

• 1:26:15Speaker 01

  Seventy thousand, yes. If you're anxious or you're depressed, it goes up to 120,000 on average.

• 1:26:20Dr. Darshan Shah?

  Wow.

• 1:26:21Speaker 01

  And so GABA is what's required to calm down that firing of your brain. So you can calm down all those thoughts to back to your baseline of 70,000 thoughts per day. Don't believe everything you think, right?

• 1:26:32Dr. Darshan Shah?

  Right.

• 1:26:32Speaker 01

  A lot of thoughts. And so what we did, and looking at it, is that, you know, there are people, and there's a lot of supplements out there that give you GABA, right?

• 1:26:40Dr. Darshan Shah?

  Yeah.

• 1:26:40Speaker 01

  The problem is though, that GABA is too big of a molecule to get across the blood brain barrier. So if you take GABA supplements and they work for you, it usually means that your blood brain barrier is not doing what it's supposed to do, otherwise known as having-

• 1:26:52Dr. Darshan Shah?

  Or it's a placebo effect.

• 1:26:53Speaker 01

  Or placebo effect, for sure. That's a good point. Or, or otherwise, I would say if the blood brain barrier is not working very well, we call that a leaky brain.

• 1:27:00Dr. Darshan Shah?

  Leaky brain, for sure.

• 1:27:01Speaker 01

  And that's a scary term for people, but usually that just means that you have to do some work on the, the gut itself, and a leaky gut is associated. So what we did at Transcriptions at the company was we created these compounds, one called TroCom, one called TroZ for sleep. That comprehensively enhance the GABA system in a holistic way. So they GABA, when it binds to the receptor, there's a site where GABA binds. And then there's also these other sites where other things can bind. Alcohol binds there, benzos bind there, a barbiturates bind there. And they massively increase the affinity for GABA to bind. But also, and that caused tolerance withdrawal and dependence because of that. There's also CAVA, CBD, CBG, hanakyle from magnolia bark. These bind to these other sites and enhance the affinity for GABA to bind. But the problem with just using those on their own is they will decrease GABA over time, too.

• 1:27:46Speaker 01

  So we combine what's called an allosteric or like a separate binding to the GABA site, along with something that binds to the GABA site where GABA would bind directly as well. And that's called an orthosteric ligand is the fancy term. So that could be GABA. So we, in our trocom, we have nicotinyl GABA, which is vitamin B3 attached to a GABA. And when it's attached, it can get across very easily across the brain barrier because B3 does have a transporter. So B3 kind of like takes GABA along for a ride. And then they break apart, you have B3 and GABA in the brain. GABA binds to where it would bind. And then you have CBD, CBG, and CAVA in that formula. They're all binding to separate sites on the GABA molecule, enhancing the affinity for GABA to bind.

• 1:28:24Dr. Darshan Shah?

  Got it.

• 1:28:25Speaker 01

  So what's cool about that B3 in there, too, is that it's mildly activating. So trocom is great because you don't feel tired, you just feel more relaxed. It's strange for patients because you're used to taking benzos and feeling dead. And so that's a little bit of an educational thing. But then we have our troz, which is our sleep formula. And that has hanakyle in it, which binds to a separate site on the GABA receptor. And something called agarin. Agarin is from a psychedelic mushroom called the amanita muscaria mushroom. It's the one that has a red cap with white dots. Santa Claus mushroom, Alice in Wonderland, Mario Brothers.

• 1:28:56Dr. Darshan Shah?

  Yeah, I've seen that mushroom. Where can people find you and hear more about you and some of your teachings?

• 1:29:03Speaker 01

  Yeah, so. So many places, right? So my hyperbaric consulting, I do that at integrativeHBOT.com. My hyperbaric company is called onebasehealth.com. And that's integrative app that's coming out. So you can figure out how to use all your technologies at the house and all going to be tied to a Bluetooth activation from one app, which is going to be fun. And then I have my own personal work, like on Instagram, at Dr. Scott Scherr, D R S C O T T S H E R R. So you can follow me there for tips and tricks. And then Troscriptions is the product development company with Methylene Blue, the Just Blue that you have over there. And Troscom, that's at Troscriptions and troscriptions.com. And then finally, if you're a practitioner, I already mentioned, homehope.org is where we have our training.

• 1:29:47Dr. Darshan Shah?

  Ryan, thank you so much for joining me today. I really appreciate you being here and can't wait to have you on again one of these days.

• 1:29:52Speaker 01

  My pleasure, man.

• 1:29:53Dr. Darshan Shah?

  We're going to talk a lot more stuff. Thank you so much.

• 1:29:55Speaker 01

  Enjoy the rest of your day.

• 1:29:56Dr. Darshan Shah?

  Thank you.

• 1:29:59Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.