How Hyperbaric Oxygen Therapy Improves Cognition with Dr. Shai Efrati

By Longevity by Design, September 18, 2023

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Hyperbaric oxygen therapy (HBOT) is a medical treatment in which patients breathe pure oxygen at higher than normal atmospheric pressure. This increases the amount of oxygen dissolved in body tissues, enabling tissue rejuvenation and accelerated recovery. Historically, HBOT has been used for chronic wounds like diabetic foot ulcers, radiation injuries, and non-healing surgical wounds. 

However, the research on HBOT is evolving and has recently suggested its use can have regenerative effects on the brain. At the forefront of this research is the Sagol Center in Israel, where scientists have shown that HBOT can also induce brain tissue regeneration and neuroplasticity, even years after brain injuries. These findings are expanding HBOT’s potential therapeutic uses for conditions like cognitive decline, traumatic brain injuries, stroke recovery, chronic pain, and other medical conditions. 

This episode of Longevity by Design features an exclusive interview with the founder and director of the Sagol Center, Dr. Shai Efrati. Dr. Efrati explains the science behind HBOT and how this treatment improves cognition. He details how oxygen fluctuations trigger the body's regenerative processes within the brain. He also underscores the importance of precision and exactness in using medical-grade equipment for this treatment, cautioning against the use of at-home hyperbaric oxygen therapies.


Episode timestamps

  • Dr. Shai’s background (00:00-16:30)
  • How exercise promotes angiogenesis (16:30-19:30)
  • Commercialization of Hyperbaric oxygen therapy (HBOT) (19:30–25:30) 
  • Health benefits of HBOT (25:30–33:00)
  • Optimal HBOT protocol for improved cognition (33:00–39:10)
  • Is HBOT beneficial for younger populations? (39:10–48:00)
  • Can HBOT benefit individuals with impaired brain function? (48:00–52:20)
  • Alzheimer's disease: Phenotypes and treatment (52:20–59:30)
  • Top tip for brain health (59:30–end)

Top 5 biomarkers for longevity- small, use this lead capture-1-min

About Dr. Shai Eftati

Dr. Shai Efrati is Chair of Aviv Clinic's Medical Advisory Board and Founder and Director of the world-leading Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center. He also serves as Director of Research and Development and Head of Nephrology. Dr. Efrati’s research focuses on novel aspects of hyperbaric medicine and brain rehabilitation. He is a professor at the Sackler School of Medicine and the Sagol School of Neuroscience at Tel Aviv University. Since 2008, he has served as Chairman of the Israeli Society for Diving and Hyperbaric Medicine.

What is Hyperbaric Oxygen Therapy?

Hyperbaric medicine, commonly known as hyperbaric oxygen therapy (HBOT), boosts oxygen delivery to body tissues by elevating atmospheric pressure, increasing the number of oxygen molecules in each unit of air. 

To compare, the air we breathe is made up of, on average, 21% oxygen. HBOT delivers 100% oxygenated air under elevated ambient pressure. This level of oxygenation translates to up to 20 times more oxygen delivery through the bloodstream to injured organs and tissues than regular air alone. This increased oxygen intake can facilitate healing processes throughout the body, including essential regenerative elements like stem cell proliferation and the generation of new blood vessels. [1,2]  

The hyperoxic-hypoxic paradox in hyperbaric oxygen therapy  

Dr. Efrati's lab has taken a unique approach to HBOT, harnessing its regenerative potential in a new way. He argues that the most powerful trigger we have in our body to induce regeneration is hypoxia—the lack of adequate oxygen in our tissues. By fluctuating the amount of oxygen his patients are exposed to during their HBOT treatment, he is able to mimic hypoxia-like conditions without putting his patients in danger of reaching low blood oxygen. Although the body perceives this as hypoxia, the patients are actually in a hyperoxic state, as they are breathing pure oxygen and saturating the body with an abundance of oxygen. He calls this the hyperoxic-hypoxic paradox. 

Under the hyperoxic-hypoxic paradox method, patients are seated in a hyperbaric oxygen chamber, wearing a mask that allows them to breathe pure oxygen at 2.0 atmospheres of pressure. The mask will deliver oxygen until the patient’s blood oxygen levels rise from 100 mercuries of oxygen to 1500 mercuries of oxygen. Once this level is reached, patients remove their masks, causing a rapid decline in blood oxygen levels back to normal. The body interprets this rapid decline in oxygen levels as hypoxia—therefore inducing the regenerative mechanisms that happen during hypoxia but in hyperoxygenated conditions.

What repair processes does the hyperoxic-hypoxic paradox induce? 

Dr. Efrati explains that exposure to these dramatic fluctuations in oxygen can lead to:

  • Mitochondria proliferation: Leading to more energy to support the body's regenerative efforts and aiding in tissue repair
  • Angiogenesis (the generation of new blood vessels): Supplying oxygen and nutrients to tissues, especially those undergoing repair, and contributes to improved tissue healing and regeneration 
  • Angiogenesis in the brain: New blood vessels in the brain enhances blood flow and nutrient supply to brain tissues, supporting cognitive functions and overall neurological well-being
  • Stem cell proliferation: More cells with the ability to transform into various cell types and facilitate tissue repair
  • Neuronal stem cell proliferation and neurogenesis (formation of new neurons): Essential for brain repair and function. Both contribute to brain plasticity, memory, and cognitive improvements, playing a vital role in healthy aging and recovery from brain-related conditions.

How many sessions of HBOT are needed to best improve cognition?

To improve cognition, Dr. Efrati recommends 60 two-hour HBOT sessions. He recommends that patients come in five days per week. During each session, oxygen fluctuations are generated, leading to regenerative processes in the brain.  

How does the hyperoxic-hypoxic paradox differ from commercially available HBOT?

Dr. Efrati points out three main ways that his paradoxical protocol differs from commercialized HBOT. 

  1. The absolute pressure reached: For best results, at least 2.0 atmospheres of pressure with 100% oxygen must be reached. This is the amount of pressure needed to increase blood oxygenation from 100 mercuries of oxygen to 1500 mercuries of oxygen. For context, commercialized HBOT treatments typically only reach 1.2-1.5 atmospheres of pressure.
  2. The fluctuations in blood oxygen: Fluctuations in blood oxygen need to be generated in order to mimic hypoxia conditions in the brain. The fluctuation of going between 1500 mercuries of oxygen back to around 100 mercuries of oxygen is how the best regenerative capacity is attained.
  3. Air quality regulation: Dr. Eftati explains that commercialized hyperbaric medicine has a different quality assurance compared to medical grade chambers. For example, medical-grade hyperbaric chambers ensure the appropriate pressure is reached and that the air is well-controlled and ventilated.

Key takeaways

Dr. Efrati and his team at the Sagol center are at the forefront of groundbreaking research for enhancing cognition with HBOT. This episode discusses Dr. Efrati’s unique approach to HBOT and how to leverage this therapy to improve brain health. 

  • Hyperbaric Oxygen Therapy (HBOT) involves breathing pure oxygen at higher pressures, enabling tissue rejuvenation and accelerated recovery in conditions like chronic wounds, radiation injuries, and non-healing surgical wounds.
  • Recent research suggests HBOT has regenerative potential on the brain, promoting brain tissue regeneration and neuroplasticity, even years after brain injuries.
  • Dr. Efrati’s team has discovered the hyperoxic-hypoxic paradox: manipulating HBOT to mimic hypoxia-like conditions without compromising patient safety. 
  • Hyperbaric chambers in the paradoxical protocol fluctuate oxygen levels, leading to various repair processes like mitochondria proliferation, angiogenesis, and stem cell proliferation.
  • The hyperoxic-hypoxic paradox method differs from commercial HBOT in terms of pressure levels reached, fluctuations in blood oxygen, and air quality regulation, optimizing the regenerative capacity for improved results.







Longevity by Design

Longevity by Design is a podcast for individuals looking to experience longer, healthier lives. In each episode, Dr. Gil Blander and Ashley Reaver join an industry expert to explore a personalized health journey. The show helps you access science-backed information, unpack complicated concepts, learn what’s on the cutting edge of longevity research and the scientists behind them. Tune into Longevity by Design and see how to add years to your life, and life to your years.

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