Ep. 475 Hyperbaric Oxygen: Benefits, Risks & Breakthroughs with Dr. Scott Sherr

I am delighted to reconnect with Dr. Scott Sherr today. He is a board-certified internal medicine physician, a certified practitioner of health optimization medicine, and the COO of Troscriptions, a range of physician-formulated, pharmaceutical-grade, precision-dose supplements containing innovative ingredients like methylene blue, with formulas to support energy, focus, sleep, stress, immune health, and more.

In our discussion, we delve into hyperbaric oxygen therapy (HBOT), examining what it is, how it works, and its effects on cellular senescence. We discuss what HBOT is, its impact on immune function, inflammation, stem cell activation, and oxygen, as well as its anti-infective properties and relative contraindications for HBOT treatment modalities. We also explore epigenetics and DNA expression, the effects of methylene blue, the specific indications and neurocognitive benefits of HBOT therapy, and its critical importance for recovery from infections, radiation injuries, tissue regeneration, sudden hearing loss, osteomyelitis, and other conditions.

This insightful conversation with Dr. Sherr is filled with vital information, so you will likely want to listen to it more than once.

IN THIS EPISODE, YOU WILL LEARN:

• How does HBOT work?

• Dr. Sherr describes the acute and long-term physical effects of HBOT.

• How HBOT increases stem cells, reduces inflammation, and boosts the immune system.

• How HBOT can decrease senescent cell populations, increase telomere length, improve cardiac function, and stimulate blood vessel regrowth

• Why clinicians must assess the acuity and chronicity of a condition before recommending HBOT therapy

• The importance of improving diet and lifestyle to optimize the body for HBOT therapy

• The benefits of low-dose methylene blue for mitochondrial support

• How carbohydrates support workout performance and recovery

• Dr. Sherr explains the different levels of hyperbaric therapy and their benefits.

• Why individualized HBOT protocols must be based on the goals and conditions of each patient

• How HBOT can regenerate tissue and prevent amputations due to radiation injuries from cancer treatments

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“Hyperbaric therapy can be transformative if you can get people into a chamber as soon as possible.”

-Dr. Scott Sherr

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Connect with Dr. Scott Sherr

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• One Base Health

Transcript:

Cynthia Thurlow: [00:00:01] Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. 

[00:00:29] Today, I had the honor of connecting with physician friend and colleague Dr. Scott Sherr. He's a Board-Certified Internal Medicine Physician Certified To Practice Health Optimization Medicine. He's also the COO of Troscriptions, a range of physician-formulated pharmaceutical grade precision dose supplements containing innovative ingredients like methylene blue with various formulas for energy focus, sleep, stress, immune support and more. 

[00:00:56] Today, we spoke about what hyperbaric oxygen therapy is and how it works, the impact on cellular senescence, the role of epigenetics and DNA expression, how specifically HBOT works and what this yields in terms of impact on immune function, inflammation, stem cell activation and oxygen as well as being anti-infective relative contraindications for HBOT, specific treatment modalities, the impact of methylene blue, the neurocognitive benefits of HBOT and lastly, specific indications for HBOT therapy and how it can be critically important for things like recovery from infections, radiation injuries, regeneration of tissues, sudden hearing loss, osteomyelitis and so much more. It's truly another invaluable conversation with Dr. Sherr, one that I'm sure you will listen to more than once.

[00:01:59] Well, welcome back Dr. Scott. Always a pleasure to connect with you. And I was telling you before we started recording that I have had no less than five people in the past week make the suggestion that I needed to interview. I said, “Oh, I've already interviewed him and he's coming back on next week.” So, this is very serendipitous. 

Dr. Scott Sherr: [00:02:14] Well, I'm glad I can be serendipitous and be back with you. Cynthia. It's good to see you. 

Cynthia Thurlow: [00:02:18] Absolutely. We were talking about our connection to Baltimore and how you became so interested in hyperbaric oxygen therapies. This is something that I think is on most functional integrative medicine providers radars now. But you've actually been using this technology for actually quite a long time. What got you initially interested in it as a therapy for your patients? 

Dr. Scott Sherr: [00:02:40] So, yeah, the Baltimore connection was an interesting one, because you know about this place called Shock Trauma in Baltimore. So, Baltimore is known for its shock and its trauma. [Cynthia laughs] And there was a show back on HBO when it was called HBO called The Wire,-

Cynthia Thurlow: [00:02:54] Fantastic show.

Dr. Scott Sherr: [00:02:55] -fantastic show, was filmed in Baltimore. And in fact, there was burnt out, decrepit old large building that was in the second season that I lived in after they refurbished it as part of this, reorienting or refurbishing project in the area called Fort McHenry in Baltimore, where I lived for about two and a half years at the end of my time there. But in medical school, lots of shock and trauma. We did a rotation at the Shock Trauma Center, which is basically an ER and a surgery center combined, is the best way to think about it. In the basement, there is a huge hyperbaric chamber. And they were using it for things like burns, but a lot of the burns went to Hopkins. But things like flesh-eating bacteria, which is also called necrotizing fasciitis, severe wounds, severe trauma, and I was very tired, Cynthia, [Cynthia laughs] we were on—The way Shock Trauma worked at the time for a medical student, like me was that you were on call, what was called Q3. So, every third night you were on call for 30 hours. 

[00:03:50] And so then you'd stay obviously the whole day and the night and the half of the next day. You'd sleep for about four hours. You'd get up and have dinner maybe, if you are awake enough, and then you go back to bed and then you wake up and you do it two days in a row, regular days, get there at 7, leave at 5 or something like that. And then that third day you'd again go for 30 hours and then you maybe get one day off a week. And it was for three weeks. So, I was dazed and confused a lot of the time that I was in Shock Trauma. But I just remember this one patient that came in with necrotizing fasciitis, flesh-eating bacteria. It's like really nasty. 

[00:04:21] There used to be these articles in the paper back in the 1990s and 2000s, just people their flesh getting eaten off and like it's nasty. But hyperbaric therapy has this amazing capacity to stop that infection in its tracks and reverse or mitigate a lot of the damage. And so, I saw somebody specifically that looked like they have to get all four limbs amputated, which is not uncommon with this particular infection. They didn't need to get two of their limbs amputated, they just needed to get two, but not two of the others. Both feet were amputated, but both arms were actually intact. And so, I was like, “Where did they go? What just happened?” 

[00:04:58] Because, basically for me as a student, I saw them come in the trauma bay, I saw them leave, [laughs] I saw them come back to the trauma bay, like a different human kind of thing. And so, I got really interested in what that was. And then when I had more time and I got a little bit more sleep, I looked into hyperbaric technology and I realized the power of this. And this is back in 2005, I think, when I first learned about it. And very interestingly, at the same time, or just about the same time, my father, who's a chiropractor on Long Island, Dr. Alan Sherr, who's been a chiropractor now for 45 years and counting, he was getting very interested in it from an alternative perspective, looking at it with kids with autistic on the spectrum, for example, and seeing really amazing benefits. 

[00:05:42] And so, my dad was my first mentor, and he is a chiropractor as I mentioned, still is. And so, we would talk all the time about my experiences in medical school. And there just felt there might be some connection here where I could bring this sort of chasm of alternative and conventional world together inside of the world of hyperbaric medicine. 

Cynthia Thurlow: [00:06:00] Yeah, it's so interesting because it is something that probably has been on my radar the last few years. But even though I was an ER trauma nurse in Inner City, Baltimore, I did not actually work at University of Maryland. So, although I did rotations at University of Maryland, I did not physically work there. For anyone that is in the Baltimore milieu, like Hopkins has the level one trauma center for peds. All the adults, generally speaking, go to Shock Trauma. It's a phenomenal place. I can't imagine being, that kind of rigor of being a student and then going two days, fairly normal days, and then 30 hours, you just were chronically sleep deprived in perpetuity. I can just imagine. 

Dr. Scott Sherr: [00:06:41] Yeah, in medical school, I'm not sure about in your professional schools, but in medical school, we had these shirts made that said “Sleep is for quitters.” [Cynthia laughs] And I think the absolute opposite now. Of course, we have much more tolerance when you're in your 20s to be able to be more resilient to these things. And that's why they can bludgeon us with these kinds of things. Although, as you know, Cynthia, the work hours and the amount of time overall that the medical students are spending in the hospital is much less compared to even when I was in medical school now almost a while ago, over 20 years ago now. And so, the things are getting better. We know that everybody works better when they're not sleep deprived. And so, it was a big piece of this whole puzzle. 

[00:07:19] But they'd always say, “Oh no, you have to stay up late because that's when you see all the crazy stuff that happens at 3 o'clock in the morning.” And they're not wrong, but you can just stay up since midnight, not since 7 o'clock in the morning [laughs] and you could still get that anyway, so things have changed. But definitely sleeplessness was the name of the game those years. And I feel very differently about sleep now, that's for sure. 

Cynthia Thurlow: [00:07:39] No, I think we both do. And I was on a rotation of days and nights and so I felt-- [crosstalk] 

Dr. Scott Sherr: [00:07:44] Oh that's terrible. 

Cynthia Thurlow: [00:07:45] I described to people that I felt I was never fully awake because I was so chronically, habitually sleep deprived. And now we know better. But my heart goes out to people that are still working those kinds of swing shifts because it's not easy to do. Let's talk about how does HBOT work and what you are using HBOT for now versus where you were 10 years ago? 

Dr. Scott Sherr: [00:08:08] So, yeah, my practice-- to take out the second one and give a little bit of tease of it before we get there to the definitions is that my practice is a truly integrative one, where I mostly focus on the things that are not covered by medical insurance. We will take about-- There is 14 indications that are currently covered in the United States. In some countries it could be as few as five and in other countries it can be as many as 70 or 80. So Japan, China and Russia have the most and some of the Queen's countries, UK countries, Canada, Australia have the fewest, interestingly enough. 

[00:08:40] And so my practice is an integrative one where I integrate lots of tools, technologies, practices, labs, ancient practices, new cutting-edge technologies, all things together inside of a hyperbaric ecosystem that includes hyperbaric therapy, but doesn't always actually include hyperbaric therapy. And you and I have had podcasts where we've talked about other things and that'll all integrate as we chat later. That being said, let's go back to your first question, which is what is hyperbaric oxygen therapy?

[00:09:07] So hyperbaric oxygen therapy, the definition is pretty simple. It's just the combination of increased inspired oxygen plus increased atmospheric pressure that is it. And so, let's go through those, because people need to understand what oxygen and pressure are. So, oxygen, it's pretty straightforward. Most of us know that we need to have oxygen to breathe or to make energy. 

[00:09:30] Why do we need oxygen? Because it's what's called the final electron acceptor in your mitochondria. So, you need oxygen to be in electron sink, basically, to take all these free electrons out of the electron transport chain and allow you to make ATP or our energy currency. So, fun fact, we make about 165 pounds of ATP, our energy currency, every single day. So that's a huge amount of energy that we need overall. And so, the mitochondria are the engine that do that. Okay. And so, in normal conditions and sea levels, most people that are listening will be. There's about 21% oxygen in the air that you're breathing. So, the rest of it's mostly nitrogen.

[00:10:09] If you live in a city or in a polluted location next to farms and industrial crops and things like that, you're going to have other pollutants and things like that. But that 21% of oxygen does a really good job at saturating a type of cell in our body called the red blood cell. Red blood cells are the cell in our body that carries all the oxygen from our lungs to the rest of our body to create that energy currency, okay? And so red blood cells have something on them called hemoglobin. Hemoglobin is a molecule that binds oxygen, and every hemoglobin molecule combine four oxygen molecules. And so, another fun fact, because I have a lot of these, there's 250 million hemoglobin molecules per red blood cell. So, every red blood cell is carrying just about 1 billion oxygen molecules. Pretty cool. 

Cynthia Thurlow: [00:10:54] Incredible. 

Dr. Scott Sherr: [00:10:55] Yeah. And so, it's amazing. This is happening. None of us were aware of this, of course. So, everybody's put on a pulse oximeter on their finger at this point in their life. Pulse oximeter is what they're measuring, is how many sites on those red blood cells are saturated with oxygen. So, if you have normal lungs, your oxygen saturation is typically going to be somewhere between 97% and a 100%. And that's the amount of sites on those red blood cells that are carrying oxygen. So, the question becomes, how can you get more oxygen into the system that's already being well infused with oxygen? Those red blood cells are already pretty well infused with oxygen, even at 21% oxygen in the air.

[00:11:32] So, you can do this a couple different ways, the most common ways is to increase the amount of red blood cells you have in circulation. The number of red blood cells goes up, the more of your oxygen carrying capacity is going to go up. And so how do you do that? You can come visit me here in Colorado, where I live. At Colorado, we have about 16% oxygen in the air at 5,500ft or so. And what we do living in Colorado is that you make more red blood cells. You secrete a hormone called Epogen or EPO for short. That Epogen hormone is increasing the number of red blood cells in circulation. So, this is why you always hear this adage from athletes train high and then compete low or something like that. 

[00:12:10] But training high that's why there's tons of athletes that live in Colorado and states like Utah and Wyoming, because they train at these altitudes and they come back to sea level and they have much more oxygen carrying capacity because they have a number of red blood cells that's higher compared to the average. Now, you can also take this hormone as an exogenous injection. And this is what doping is. Okay. So, there's another way to increase your oxygen carrying capacity. It's not relegated to your red blood cells, but actually to the plasma or the liquid of your bloodstream. So, liquid of your bloodstream is what carries everything else. It carries your red blood cells, it carries your nutrients, it carries white blood cells. It carries everything. It's like water, but more like a saline solution.

[00:12:48] And so, in a hyperbaric chamber, we can drive oxygen not only on those red blood cells, but actually into the liquid of your bloodstream. And we do that using pressure. So, this is the other aspect of it. So, pressure, so we increase the amount of atmospheric pressure you feel under a certain amount of seawater. So, if you're 15 or 20ft below the sea and you look up at all that water, you don't feel like that water's heavy. But if you picked up a bucket of water, that water would be extremely heavy. And that heaviness is what is pressure. And so, we simulate that heaviness in the chamber up to a certain degree. 

[00:13:21] It can be a mild amount of pressure, like 15 or 20ft, or it could be a deeper 33ft, 45ft, 66ft. We have a couple of these different metrics that are correlated to various types of things that we called ATA, or atmosphere is absolute. So, 1.5 ATA is about 20ft of seawater. 2 atmospheres of 2 ATA is 33ft of seawater and 3 atmospheres is 66ft of sea water. So, we simulate that pressure in a hyperbaric environment. You don't feel like you're underwater, but you do feel that pressurization sensation that you would feel. Now, the combination of that increased inspired oxygen with that increased atmospheric pressure drives a potentially huge amount of oxygen. Not only if there's any other sites on that red blood cell, but also into the liquid of the bloodstream itself, which could be up to 1200% more oxygen in the liquid of your bloodstream. 

[00:14:12] So, that's the power of hyperbaric therapy is that you have this acute infusion of a huge super physiologic level of oxygen. I'll stop for a moment and you can ask questions, but from there it's the power of all that oxygen, both acutely. So, immediately what happens when you're in the hyperbaric chamber and then long-term doing a hyperbaric protocol? What is the shift that happens in your expression of various genes and things related to what's called your epigenetics related to all that oxygen coming in? 

Cynthia Thurlow: [00:14:45] That is the best explanation I've ever heard of HBOT. And listeners for them to understand, this is why I wanted you to have this conversation with me. Talk to us about how HBOT can be utilized to potentiate longevity. I think there's a lot of discussions around longevity. 

Dr. Scott Sherr: [00:15:02] Sure. 

Cynthia Thurlow: [00:15:02] And cellular senescence. And how can this be beneficial specifically for that indication.

Dr. Scott Sherr: [00:15:10] Cool. And this is not the first rodeo of me explaining it. I've figured this out over many years, Cynthia. 

Cynthia Thurlow: [00:15:14] [laughs] You perfected it. 

Dr. Scott Sherr: [00:15:15] Yeah. I've gotten the structure of it over the years. But the next piece that I think is important to discuss longevity is to discuss what's actually happening when you're in the chamber, okay. And so, we talked about all this oxygen coming in. So, there's basically only three things that are happening when you get all that oxygen circulation. The first is that you're reversing low oxygen conditions. So, if you have an acute low oxygen state, let's call it a stroke, a heart attack, a traumatic brain injury, a spinal cord injury, a limb that's hanging off sideways. And you remember these kinds of things from trauma. But [Cynthia laughs] this is an event where some of the body is not getting enough oxygen.

[00:15:50] So, if you can get somebody inside of a hyperbaric chamber quickly, you can potentially mitigate the damage downstream of that lack of oxygen. So, we've seen studies in all the things that I just mentioned where hyperbaric therapy can be transformative if you can get them into a chamber as soon as possible with of course doing your other conventional indications. So that's the first thing that's happening with reversing low oxygen conditions. The second thing we're doing is we're creating what's called oxidative stress. And when you're creating oxidative stress, that means you're creating a stimulus in the body for things to change. And oxidative stress is not always a bad thing. People think of this as a bad thing because they hear it as a bad thing. But our body is always responding to stress. And the hope is that it's called eustress. This is good stress, but it can also be distress.

[00:16:37] And this is where it becomes really important long term. And I'll get there in a minute. The third thing that's really happening in a chamber is that there's pressure-induced changes. So, the pressure itself creates blood flow, it creates lymphatic flow. It probably creates more of something called easy water, which is a structured water around blood vessels as well. And that pressure itself is causing more energy to be produced. And so, as a result of those three things happening, the acute things that are happening once you get into a chamber, so you're reversing low oxygen conditions, you're making more energy, you're decreasing inflammation and swelling, you're increasing the number of stem cells that are being released from the bone marrow and other areas. 

[00:17:13] And stem cells are the baby cells in our body that help us regenerate tissue anywhere it might go. It's also anti-infective and that's why it worked in Shock Trauma with [unintelligible 00:17:22], for example. It's also an immune system booster. And it also increases blood flow and lymphatic flow that I mentioned. So that's all happening immediately. Okay, what happens long term is that those epigenetic changes are happening. Epigenetics is the study or the science of how our DNA shifts expression, genes turn on and off about 8,000 oxygen sensitive genes in a way that helps with growth, repair, decreasing inflammation. So, you get new blood vessels, for example, so angiogenesis, you get downregulation of inflammatory markers, things like interleukins and TNF alpha and things like that. 

[00:17:58] You get those stem cells that fully mature into the areas that they are going to help recover or regenerate, decrease inflammation, whatever it is. So, as I'm talking about all of these things you should be thinking about longevity in all of these ways. Because what is longevity? What is health span really as it is, is trying to optimize our lifespan and our health span at the same time. So, if our brains deteriorate as we get older and we regenerate them, that's longevity and health span too. If our cardiac muscle starts not working as well and regenerate cardiac function, that's longevity as well. So, there were some studies done in the early 2020-2021 on longevity, looking at how hyperbaric therapy decreases senescent cell populations. These are called zombie cells that accumulate as we get older.

[00:18:48] It increases telomere length, which is-- telomeres are the ends of your chromosomes that get shorter as we get older. And there's also signs of reversing, the deterioration of blood vessels in the heart, like regrowth-- regrowth in the heart, regrowth in the genital area, so better erections for men. This works in women too, by the way, at least clinically, I'll tell you that much. But also, it's just an overall strategy where you're decreasing inflammation, you're rebuilding blood vessels and you're optimizing physiology and healing wounds from the inside out, really what is aging, you know, wounds as it were and inflammation related to those as we get older. 

Cynthia Thurlow: [00:19:23] What are some clear-cut contraindications? If someone's listening and they're like, “I think this sounds awesome, I want to run out and do some therapies.” What are some clear-cut contraindications? People that should be whether it's temporarily or kind of long term, this would not be a treatment for them to utilize.

Dr. Scott Sherr: [00:19:41] Sure. So, there is what are called absolute and relative contraindications. Absolute are the things that you absolutely would not go into a chamber ever. And then there's relative, which is a much longer list actually. [Cynthia laughs] Of course, there's only one indication that's an absolute contraindication and that's called tension pneumothorax. And a tension pneumothorax is when the lungs are filled with air. Not the lung itself, but the cavity. And pressing your lung down, you can't breathe. And if you have one of those, you should be in a hospital, okay. But you are putting pressure on people's lungs to go into hyperbaric chamber because that's how the pressurization gets translated into the extra oxygen in circulation.

[00:20:20] So, there's a lot of what are called relatives contraindications. And I have a much longer list than the average, actually. But relative contraindications if you have any severe pulmonary disease, cardiac disease, if you have a seizure disorder, like a neurologic disorder that's not controlled because increased oxygen can cause seizures, it's very, very rare. But we have ways to mitigate that. If you're pregnant, you're not supposed to go into a chamber, but they do use it for carbon monoxide poisoning, and it's very, very effective for that. But it's not technically what you're supposed to do. If you have a fever, you're not supposed to go into in chamber. If you have really difficult time clearing your ears because it's a pressurization change. And there's others. But the main things, if you have severe or end-stage disease from like a primary organ, then you have to be thinking about it. 

[00:21:03] But for me, Cynthia, the biggest fork in the road is to understand is it acute or a chronic thing. So, if it's an acute like acute stress, acute trauma, acute inflammation, acute infection, there's a lot that hyperbaric therapy can do for almost anybody alongside conventional therapy, doing it in conjunction with other therapies and treatments. If it's a more of a chronic issue. So, something you've had for a longer period of time, say you've had chronic Lyme or you have mild cognitive impairment, chronic pain. It's very likely that hyperbaric therapy is not the first thing that you want to do. And fun story, I was disinvited to a hyperbaric conference because the title of my talk was going to be “Please do not put them in the chamber.”

[laughter]

[00:21:51] Not good for business. I worked as a medical director of a number of facilities before, when I was in California, before living in Colorado. This is difficult. I didn't own the facilities. I wasn't there running the facility and trying to make money from people going into the chambers. But there's always a balancing act here, right? I don't know if you remember this. Because I think you were training around the same time as me. There was a great YouTube at the time. YouTube had just maybe come out a couple years earlier than that. But it was on basically, if you have a heart and you go to a cardiologist, you're going to get an EKG and an echo. 

[00:22:24] If you have lungs and you go to a pulmonologist; you're going to get a chest x-ray and PFTs done. These are just standards. So, if you go to a Hyperbaric Clinic, they're going to try to put you in the chamber. It's the same deal. So, the key fork in there is acute issue or chronic issue. And then if it's a chronic issue, how can we create an integrative opportunity for you to truly leverage everything that could be helpful for you? Not just a hyperbaric chamber, but what are the dietary change, the lifestyle changes, what are the labs and supplementation that you can take? What are the other ways we could potentially downregulate your nervous system so that you can heal? And now we spoke about GABA a lot in another podcast just about this. 

[00:23:03] And so when it comes to contraindications, to go back to your question, most of them are relative. And what I find is that the ones that are not the more serious relative ones, but the ones that are more on the chronic condition side of things, if you can work with somebody, which I typically do for three to six months prior to them going into a hyperbaric chamber, you're not really wasting any time because they've had a chronic issue. It's not like this started a month ago. This started years often, and now it's about building them back up from the foundation.

[00:23:33] And the secret to all of this, Cynthia, is that if I do my job, hyperbaric therapy may not even be necessary, because you're able to get them to a place where, “Oh, I just changed my diet, I stopped drinking alcohol, and I downregulated my nervous system, and I feel 95% better.” And I'm like, “Well, you can still do hyperbaric therapy, but maybe we'll do another time,” [laughs] that kind of thing, as opposed to doing it now. And the adage that I always say here is it's not if hyperbaric therapy will be helpful, it's when. And I think the when is like, the most important part of the whole strategy that I use when I work with people. 

Cynthia Thurlow: [00:24:05] Well. And I think it’s that medical decision making that is so important, and that's really what you're speaking to. And I think for a lot of patients, HBOT is a really amazing tool. But ultimately, it's a tool. It's one of many tools and the lifestyle piece still has to be addressed. And you have brought this up in previous conversations. But when I'm looking at my patient population, women in perimenopause and menopause, how many of them are high-functioning workaholics? And when I say this, you don't have to be working outside the home to be a high-functioning workaholic. It's a trauma response. It's your perfectionism that's drawn inward. You're in this chronic sympathetic overload over activation. And so, when you're thinking about that particular population of patients, which you're shaking your head. So, I know you know what I'm talking about. 

Dr. Scott Sherr: [00:24:56] Of course, yes. 

Cynthia Thurlow: [00:24:57] How are you addressed. So, obviously, if it's an acute thing and they're appropriate for HBOT, that's great, but for a lot of these other patients, it might be lifestyle changes that could have just as much of an impact as going the route of HBOT.

Dr. Scott Sherr: [00:25:12] Yeah, 100%. I mean, the way I think about the acute side of things is I call it my educationally throwing shit at the wall strategy, where I have a framework that I use, and as long as they're safe to go into a chamber, for example, if they've had a concussion, they've been cleared and they're okay. Then I have a whole battery of tools, technologies, labs, supplementation, and things that I can do to help you downregulate their nervous system, increase nutritional optimization as best I can short term. But if it's somebody in the case that you're describing here, I have another good example. So, this is a fun one for me.

[00:25:43] When I gave myself a concussion maybe four or five years ago, it wasn't a very spectacular one. This is when I had young kids and I was in the bathroom and somebody yelled and I went like this to a sidewall and I nailed my head. And so good news, I have hyperbaric chambers at my disposal. So, this is more of an acute issue, but it's going to dovetail into, I promise in a minute what we're talking about. So I went to my local facility that I was a medical director in the Bay Area, and I went in the chamber and in some chambers, and in these particular chambers, you can watch movies. And so, this particular chamber had a TV screen outside of it, and you can listen to it. And I decided it would be a really good Idea to watch John Wick 2 in it. 

[00:26:19] And if anybody's listening and they know John Wick, John Wick is like a ridiculous, it's just really violent, lots of-- [crosstalk] 

Cynthia Thurlow: [00:26:27] Very violent 

Dr. Scott Sherr: [00:26:28] lots of death and destruction. And I was in there going like this and shaking. I'm like, [Cynthia laughs] “This is not going to help me heal.”

[laughter]

[00:26:38] And so, it dovetails to what you described there, which was, if we're really trying to prepare somebody, there are a lot of great ways that hyperbaric therapy can accelerate healing, recovery anything. So many different kinds of ideas and things that we can talk about here. What's coming to mind right now is like a surgery, right? Hyperbaric therapy is fantastic pre/post-surgery. This is more of an acute issue, of course, where you have like a surgical indication. 

[00:27:01] But if you're trying to prepare somebody for a hyperbaric program that could be very, very beneficial for them, it's going to be much more beneficial for them if you can work on downregulating their nervous system and trying to work on optimizing the machinery in their system to make energy. Hyperbaric therapy, as I mentioned earlier, is all predicated on getting all this oxygen in circulation, allowing you to make more energy as a result of that. And also, when you make all this reactive oxygen species, these oxidative molecules, that's what oxygen does to a significant degree. When you're bringing a whole lot in there. The body has to respond what's called an antioxidant neutrality, an antioxidant response. 

[00:27:40] And so if you're antioxidant deficient, if you don't have optimized levels of the machinery to help you make energy or the optimized levels of the machinery to help you to neutralize the waste products in “of making energy.” So, we make ATP, we also make carbon dioxide, water and these reactive oxygen species. And so, in my practice I figured this out very early on that when people were too sick and I tried to get them in the hyperbaric chamber, they would just get sicker. And sometimes like a little bit of that stress is fine. And we're used to that because the body recovers over about three to four days. And people that are relatively optimized or doing okay, but if they're not, like you could be down for a week or longer. 

[00:28:20] And I was trying to figure out what was going on and I went back to the physiology and I realized it was like, “Oh, it's what we call redox, it's all because we're bringing all this energy in to be made.” Can they make energy effectively? And they're bringing all this oxidative load in the system too. Can they detox or can they neutralize that? So, for me, when I'm talking to somebody, when they call me and they say, “Hey, Dr. Scott, I want hyperbaric therapy for fill in the blank.” Then I'm doing an assessment there of the acuity, number one. And the second is, well, is it the right time for them to go in or can we do some things and work on their physiology? 

[00:28:56] And sympathetic drive is a big one because that sympathetic dominance, that cortisol dominance is going to deplete your GABA levels, which we talked about in a previous podcast. GABA is your neurotransmitter that calms down the firing of your brain and it relaxes you. It's your off switch, basically. And so, if you don't have enough GABA around, you're going to be more anxious, you're going to be more stressed, you're not going to be able to sleep, you might be depressed and you might be thinking that's just your baseline and it could be, but it's a vicious cycle on some level where you're just depleting over time. And so, one of the goals I have is to work on downregulating the nervous system so that people can actually heal because you can't heal in a hyperbaric chamber. 

[00:29:34] I was shaking when I was trying to heal from my concussion. It's not going to work. If you can downregulate the nervous system, you're going to be able to heal better. But this is important too. It's not just about downregulating the nervous system oftentimes because as you know, people are trying to compensate for something. They're trying to compensate for mitochondrial dysfunction, for hormone dysregulation, for brain inflammation. And so, as a result of that, you can't just work on it like, “Oh, we just need to calm you down. That's all you need. Just calm you down.” That's not going to be enough because what's going to happen is that you calm them down and then they feel worse because their system needs a lot of support.

[00:30:12] So, for me, it's usually a multifaceted strategy where nervous system downregulation at the same time is energy and machinery for producing energy and detoxing being optimized and there's multiple levels of that. There's obviously the mitochondria itself we're talking about. There's also macronutrients. So, optimizing your ability to actually process those. There's your gut, there's your neurotransmitters, there's your hormones, there's your relationships, it goes on and on and on and there's your environment. So, there's all these other levels that we can go at. And I think for every person you have to start at a different angle there. But in essence what I'm trying to do is, mitochondria are the final or the most common denominator for all of those other levels.

Cynthia Thurlow: [00:30:57] Well, and I think it really speaks to the art and science of medicine that you could have 10 people with similar presentations and they might all need different strategies to start with and to end with. And that's why I sometimes get frustrated and I have to believe it's well-meaning individuals because I refuse to think about it any other way. But I'll sometimes see across social media like this one size fits all band-aid approach to middle-aged women and I'm like, if it were just about hormones, everyone would be fine. If it were just about hormones, if it was just slaps estrogen patch on every peri/postmenopausal woman, I wish it were that easy, but it really isn't. And it's really that bio-individual approach. So, let's think about this from the perspective of middle-aged woman. 

[00:31:45] Let's say she's working diligently on balancing her autonomic nervous system. She's still dealing with some anxiety, sleep issues and brain fog. And when you're looking at how best to support this woman from a very holistic perspective, very integrative approach. What are some of the low-level things, things that are relatively easy and accessible for everyone that you think are foundational to addressing brain health, neurocognitive health at this stage of life? 

Dr. Scott Sherr: [00:32:16] It's a great question and there's so many ways to think about it. [Cynthia laughs] There's like the dietary, there's lifestyle there. But let's assume here that people as you mentioned, are trying to dial in some of this already. They're already working with you or they already know your work and they're on that, let's call it the transformation. [Cynthia laughs] They're already working on that aspect of things. And so, what I would say is that the focus oftentimes needs to be on cellular medicine. The idea of working on the mitochondria itself. Now if you're already working on the diet, the lifestyle, the behaviors, that's great, and those for lack of a better term right now, trickle down to improving mitochondrial function. 

[00:32:57] So, if you really make it a point of getting to sleep every night at the same time and waking up every day that's going to really be a benefit to your mitochondria over time. So, there's kind of like a top down and bottom-up approach here, is what I would say. But my approach oftentimes, and people that are already starting to dial in a lot of the lifestyle things is the bottom-up approach, which is, “Well, how can we optimize your mitochondria to make everything else easier?” And so, there's a couple different things that I use as sort of really easy, low-hanging fruit levers at this point. One of them happens to be, and I think maybe we talked about another podcast, methylene blue, and methylene blue is a fantastic one because it's a compound, it's a synthetic ingredient.

[00:33:34] It's been around a long time and it is synthetic. So, people could get worried about that. But it's very safe if you find it from the right sources. And not everything synthetic is bad for you. Not everything natural is good for you. Cynthia and [Cynthia laughs] I have probably seen people so in Shock Trauma. Well, actually not in Shock Trauma, in the ICU at University of Maryland, I saw a couple people die of foraging for the wrong mushrooms. Probably seen a couple of those.

Cynthia Thurlow: [00:33:56] Very sad, very sad. 

Dr. Scott Sherr: [00:33:57] It's not a fun death at all. And so not everything natural is good for you, just to be clear about that. But methylene blue is a compound that's been around for a long time, it's got a lot of press over the last six months or so. But I've been using it much longer than that for the last five years or so in clinical practice. And what I find about it, which is super interesting, is that you can give very low doses of this, 4 mg, 8 mg, 16 mg, maybe a little higher, but maybe sometimes even a little lower. And that's going to do something very specific in the mitochondria, which is increased energy production and increased detoxification, energy and resilience is what I tell my patients. 

[00:34:31] But the problem is that most of us, 94% of US adults, are walking around with mitochondrial dysfunction. And our mitochondria are the ones that are part of our cells that make energy. And if we can't make energy, well, what does this manifest as. It depends on where the mitochondria are most affected. Most women maybe not know this, but we have the most mitochondria in our cell, if you're a woman, in the ovaries and the eggs themselves. And then in men it's in sperm. And then the next is your brain, your heart, your liver and your musculoskeletal tissue. So, brain fog, concentration problems, cardiac issues, detox issues, exercise-induced fatigue, infertility, these all at their root or at their bottom level is a mitochondrial issue. And so why are some people having these issues? 

[00:35:17] And Cynthia, you and I know the reasons, but number one reason actually is insulin resistance. And so, people that are diabetics, prediabetics, insulin resistant, medications that we're taking on a regular basis, things like PPIs and metformin, these destroy parts of the mitochondria itself or make them dysfunctional, toxins in our environment, which are everywhere, including toxic people. That's also-- [crosstalk] 

Cynthia Thurlow: [00:35:39] [laughs] Why boundaries are so important. 

Dr. Scott Sherr: [00:35:40] Yeah, exactly. Infections and then after infections, your postinfectious syndromes, like your long COVIDS, your fibromyalgias, your chronic EBV loads and things like that, these are all people that have chronic mitochondrial dysfunction. And so, what methylene blue can do-- and I use it a lot into my hyperbaric protocols actually, is I use a very low dose of it before they go into the chamber so that they have increased capacity to use that oxygen effectively to make energy and they have enough detoxification reserve so that extra oxygen coming in is not causing too much stress on the system. And so, low-hanging fruit for me is mitochondrial optimization in general or the bottom-up approach, I would say. And so, I use a lot of methylene blue and then at the same time I'm also working on their sympathetic nervous system from a mitochondrial perspective. 

[00:36:28] Because what happens there is that if your cortisol is elevated for too long, your blood sugar is going to be more elevated as well. Giving you this it can look like insulin resistance even in people that have normal insulin levels. And I was just talking to another menopause expert recently. She was telling me about, the type of perimenopausal women that has elevated A1c. But actually, it's not because they're prediabetic, it's because their cortisol is elevated all the time and their blood sugar's elevated, but you look at their insulin levels and they're normal. And so, I didn't know about this. It was very interesting to me. But I'm sure you talk about this all the time, but when that cortisol level is elevated all the time, it's putting a lot of stress on the mitochondria. 

[00:37:07] What I've been doing is working a lot on the GABAergic neurotransmitter system at the same time. So, and this has multifaceted aspects. We talked about this last podcast, I think, but like this is looking at their gut, for example, and how is their gut leaky or not looking at neurotransmitter levels. So, things like glutamate, which is an excitatory neurotransmitter, and looking at the balance between that and GABA, and then using supplementation to help work on the GABA system while they're doing the diet and lifestyle and things like that too. But I have multiple different angles there that I work. 

[00:37:36] But of course, hydration is a big one too. Most women and men are not hydrating well enough. And so, getting hydration is really important. Fun fact, it's better to sit throughout the day rather than to gulp and then not drink for long periods of time unless you're doing lots of exercise. I need to get fancy electrolyte solutions. I know there's a lot of them out there, which I use too for the convenience. But just a little bit of a pinch of salt in water can go a long way if you want to add a little bit of honey to it, you can do that if you're more active or even if you're not more active and need a little bit of, what's it called, a downregulation of your nervous system. 

[00:38:10] Because one thing that I know you're big into the fasting as well, but we have to be careful because fasting can also release more stress hormones in people too. And I'm sure you can probably add color to this part, but from a fasting perspective, carbohydrates can be good, and some women are not getting enough, and men are not getting enough carbohydrates to actually calm down their nervous system as well. So, I tend to have that conversation too. 

Cynthia Thurlow: [00:38:33] Yeah, no. So, there's so many insights that you just provided. So, number one, methylene blue, you definitely brought on my radar after our last conversation. I think there's a lot of, again, I have to believe it's well-meaning people that talk about methylene blue. But I see people not consuming small quantities, I see people consuming copious quantities. What are some of the untoward effects that can happen if-- it's all about this role of hormesis, beneficial stress, right amount, right time. But if people are overdoing it with methylene blue, what are some of the things that you look for or cause you concern as a clinician?

Dr. Scott Sherr: [00:39:10] So, the key to understand methylene blue is that at low levels, it should not cause a hormetic stress on the system. We're trying to just support the system. So, there are certain things that we want to be hormetic stresses and hyperbaric therapy is one of those, especially at deeper pressures. And I can delineate that a little bit because there's different pressures that we use, different types of chambers, things like that. But overall, low doses of methylene blue, we're not trying to cause a stress on the system. We're trying to compensate for dysfunction, usually or compensate for a lower oxygen environment. Because what methylene blue can do is it can act just like oxygen in the mitochondria to help you continue to make energy, even there's not as much oxygen around. 

[00:39:50] So, if you come visit me in Colorado, hopefully before you get on the plane, but definitely when you get off the plane, I'm giving you methylene blue while you're here, because it does seem to compensate for that low oxygen state. And then we're also working with endurance athletes, at least informally although I have a couple of things in the pipeline that I'm excited about where we've seen their endurance go up, their aerobic training capacity go up as a result of being on methylene blue while they're doing endurance work. The problem and this is what you were leading to, is that higher doses of methylene blue, especially over about a milligram per kilogram, which is going to be about 70 mg or so on average, can cause stress in the system as well. 

[00:40:27] Even lower doses can do it for some people. So, you have to be careful. But the higher the dose, the more stress the system's going to have. Some of that stress is related to something called, excuse me, the production of hydrogen peroxide. So, hydrogen peroxide is something that our cells make to help kill bugs and to biofilms, it kills biofilms too, and it recycles cells if you don't have need the cells anymore. So, hydrogen peroxide is a great anti-infective and so using higher doses of methylene blue around those doses can be very effective. However, if you're making more hydrogen peroxide in the system, the body has to compensate for that by creating more antioxidants to help neutralize that. And that's the primary one is glutathione in this case. And so, you have people that can't tolerate those higher doses because they don't have enough antioxidant capacity. 

[00:41:08] So, in the patients that I need to give higher doses that are sicker for whatever reason I'm giving them more antioxidant support, while they're on the higher doses. But once you get above about 2 or 3 mg/kg of methylene blue, which is about 150 to 300 mg of methylene blue, that's when you start getting into the realm of where you can be causing only stress on this system as opposed to having this energy and detoxification in combination. So, there's been lots of crazy influencer articles about blue brains and about things like that where-- these very, very high doses, 3 mg/kg IV, yes, they will cause a brain to be blue. 

[00:41:46] But these are in patients that are being-- they're in ICUs, they're in cardiopulmonary arrest, they're in septic shock and getting these very, very high doses to hopefully save these people's lives as kind of like a last-ditch effort. So, as with anything as you know, is like the dose is most important. So, it's like a dose response curve and how you should think about using methylene blue and that's how I think about it. Most of the time I'm using it at very, very low doses for mitochondrial support. 4 mg, 8 mg, 16 mg, 25 mg. But it's not usually much higher than that unless it's an infectious indication. And that's how I think about it, right? So, I know that there's been a lot of interest recently in the last six months or so-- a lot of information that's difficult to wade through. But in general, just remember these lower doses are very safe and they're very supportive. But as soon as you get to higher doses, around a milligram per kg or even a little bit less than that, if you've been sicker for longer, you might start seeing symptoms. And these symptoms could be like your Herx symptoms, like your detoxification, a little bit more brain fog, headaches, muscle pain, joint pain, GI distress. Those are common. But starting at lower doses mitigates the potential of those. If you start off a very high dose very quickly, you're going to get much more of the potential of having those kinds of things. 

Cynthia Thurlow: [00:43:02] No, thank you for that. You touched on exactly what I was hoping you would, just to provide some context about the benefits of low dose. And this is where low and slow really becomes the mantra. I do want touch on what you mentioned about fasting as a hormetic stressor. I always tell people that so much of it is dependent on the individual. If you are someone that is not sleeping, you are undereating, you're overexercising, your hormones are in the tank, you're going through a divorce, you lost your dog. The constellation of stressors like that is not the time to go overboard with intermittent fast. Maybe it's 12 hours of digestive rest. And also, the piece about carbohydrates. I think we have gotten so far off course about demonizing carbohydrates.

[00:43:48] I'm not talking about processed carbs, crackers and bread. I'm talking about, sweet potatoes and root vegetables and fruits, low-glycemic berries. I think we have demonized carbohydrates so much. If you are metabolically healthy, carbohydrates are absolutely part of your diet. And in fact, I would actually argue and I've shared this very transparently over the past 12 months in an effort to put muscle mass on, I've had to have a wider feeding window. I actually do better with a higher protein and carbohydrate diet than I do with a lot of fatty meats. And so, for me, the more carbohydrates, I probably don't have more than 75 or 100 g a day. 

[00:44:28] So let me be clear, it's not like I'm having 300 g of carbohydrate, but I found for a lot of my patients, as soon as we start liberalizing their carbohydrate intake with good quality carbs, they sleep better, they feel less agitated. They're able to work out harder, they just feel better. And so, I think in many ways, if someone is not metabolically healthy, insulin resistant, then yes, carbohydrate restriction may be really helpful with therapeutic intermittent fasting. But certainly, the message is don't eat and don't eat any carbohydrates. Because I think that can be problematic. 

Dr. Scott Sherr: [00:45:03] Yeah, 100%. And I'm on the same wavelength as you as well. Especially the more you're exercising, the more working out you're doing, the more carbohydrates you're likely going to need to see if you want to build muscle mass and strength. But I was actually reading a study recently, a colleague of mine-- we we're actually doing a talk coming up this weekend on parasympathetic activation for performance. And we were looking at carbohydrate intake and when it's most important, its most important either intra workout or post workout. So, you can use certain types of carbs intra workout. They're very easily going to be sucked up by your muscle tissue that needs them. You don't need insulin for that. And then post workout it's really important for glycogen stores and then also for building muscle.

[00:45:45] And so if you're thinking about carbohydrate intake, you don't need to use them before workouts to have the benefit. It's just during and after where there's actually most of the studies. And so, looking at that aspect of things has been interesting recently. On the performance side, of course, hyperbaric therapy is a fantastic tool for performance as well. But again, it comes in with this activation of parasympathetic mode where hyperbaric therapy, especially at milder pressures, so to talk about that just for a minute if we have time is like there's different levels of hyperbaric therapy. And I mentioned this a little bit earlier in the podcast for those that were listening, which was that there's different levels that we can give. I said like 15ft of seawater 33ft, etc. 

[00:46:22] So, the milder pressures there are not going to be as stressful as the deeper pressures. The deeper you go, the more oxidative load that you're going to have somebody under. Now, in somebody that's super sick, for example, that has a lot of oxidative stress, a lot of inflammation, they might get symptomatic at a very mild pressure of hyperbaric therapy because they're not used to any extra energy production. But if you're relatively well optimized, you might feel fantastic at a milder pressure that's just giving you a little bit of extra oxygen without a whole lot of stress. But you might not feel as good when you go deeper, for example. 

[00:46:51] And so it's important for me, as I'm thinking about, so what I've done in some cases, for example, is that if somebody is very sympathetically dominant, and then we're still working on that autonomic nervous system reset, working on their diet, their lifestyle, looking at supplementation and things, what I sometimes will do is have them go into mild hyperbaric chambers. A mild chamber can give them a little bit of extra energy. It can give them a little bit extra focus, a little bit of extra umph, without causing too much stress on the system. Because what happens as you go deeper is that oxidative stress is also going to cause a sympathetic response because the body has to respond to that. And so, you'll find, though, that over a hyperbaric protocol, that sympathetic response is not as dramatic. 

[00:47:31] But in the beginning it can be, because it's going from some amount of oxygen, your baseline, to a lot of oxygen in circulation. But if you stay at a lot of oxygen for a period of time, which a protocol can be 20 sessions, 30 sessions, 40, 5 days a week, sometimes we do hyperbaric therapy treatments daily, typically 5 days a week, for a cumulative exposure to that shift in DNA expression that we were talking about before. But as you're doing these hyperbaric protocols and you find that sympathetic dominance actually drops and actually HRV gets better. But in the beginning, what you can do and as you're starting to work with somebody, as I do, I can say, look, let's do a mild pressure protocol. Maybe come and go a couple times a week, and you'll feel better. You'll see your HRV is going to get better. Your recovery scores will get better. But not going too deep too quickly, right? 

[00:48:19] So, using it more of like a wellness tool, like a little bit of extra umph. I've seen that actually be very helpful helping with that autonomic reset. As long as we don't go too deep initially. But if the deeper pressures are technically more therapeutic for systemic kinds of things. This is like we're talking about two atmospheres or maybe a little bit less than that like a 1.8, that's about 28ft of sea water to about 33ft of sea water-Ish. And that range is great for systemic things. And we were talking about that longevity study in the beginning. That study was done at two atmospheres, for example. 

[00:48:51] But the brain also remember though-- the brain is more sensitive to oxygen and pressure. So, the neurocognitive indications tend to be more focused at the milder pressures like your 1.3 to 1.8. And the more systemic-related things are more focused between 1.8 to 2.4-ish as pressures. And then depending on the pressure, it will also depend on what kind of chamber design whether it be a soft chamber or be a hard-shell chamber or a single occupancy chamber or called a multiple occupancy or multi-level chamber where you could have multiple people in. And that's the type that I had when-- that I experienced initially when I was at Shock Trauma in Baltimore. 

Cynthia Thurlow: [00:49:29] Yeah, it's so interesting. So, inevitably the question will be, Dr. Scott there's a company, I won't name names because I don't want to call them out, but like they'll have HBOT in their wellness center, but it's not the HBOT that I'm familiar with. Do those smaller soft sided-- does that actually confer much in terms of benefit or do you really need to be in these what I refer to them, they look like an iron lung. I mean they're just massive.

Dr. Scott Sherr: [00:49:58] The medical grade.

Cynthia Thurlow: [00:49:59] Yes, medical grade. So, helping people understand if they're using at one of those local wellness centers that are franchised across the United States. Again, nameless. 

Dr. Scott Sherr: [00:50:07] There's multiple though. Yeah. 

Cynthia Thurlow: [00:50:08] Is there benefit to that? I'm assuming possibly. But I would imagine that if you're really looking for therapeutic benefit, what the studies are designed on are the medical grade option.

Dr. Scott Sherr: [00:50:20] So, you can get some significant medical benefit from the soft chambers. I will say that because if you have a neurocognitive condition, say concussions, stroke, mild cognitive impairment, even some brain fog as well, the mild chambers can be very beneficial. But the key is to understand what your goal is. Because if your goal is, “Oh, I just want to feel a little bit better this week,” then sure, go in the chamber at a mild pressure. If you feel better in it, keep doing it, fine. But if you have a goal, well, I have brain fog or I have chronic fatigue, or I have mild cognitive impairment or something more long standing or more indolent, let's call it, then it's usually a good idea to understand why you're going into the chamber. Because if you go to the one of these chain places, they're like, “Oh, go. Yeah, we have a hyperbaric chamber. You want to use it?” Sure, use the chamber. 

[00:51:03] And like, “Well, what kind of protocol should I do?” “I don't know, just go in when you feel like it.” [Cynthis laughs] And that drives me effing nuts. And that's one of the reasons I got so involved in education back, you know, it's been a while. It's like I just would get all these calls from people trying to use hyperbaric therapy and getting very poor direction or zero direction from the places that they were trying to go to even in medical grade facilities, to be honest, that's gotten better. I like to think that I've helped in that capacity because I know several facilities that show my videos to their patients. But when they're in the chambers, for example to learn about hyperbaric therapy. 

[00:51:36] So, the first 20 minutes of my podcast with you are common and you can find them in other podcasts. Although I think I did a pretty good job compared to other times this time around.

Cynthia Thurlow: [00:51:44] No, you did a great job. I was like “That’s explanation I've ever heard.” [laughs] 

Dr. Scott Sherr: [00:51:49] There's ways to think about it. But any respect, I think you can get benefit from the soft chambers. I have a soft chamber in my house. I use it periodically and I use it regularly depending on the situation. I have four kids. If somebody gets knocked around, they come into the chamber with me. I have a daughter that plays soccer, for example, and she's not the biggest defender, but she's strong, but she still gets beat up sometimes. She comes in the chamber with me. I think there's a lot of benefit though, when it comes to the medical grade chambers. Using them-- the deeper pressures are going to be more systemically beneficial. So, outside of the brain and the spinal cord, for example. 

[00:52:21] So, what I often say though is that if you have a longevity indication here, you can benefit even from the mild chambers, you can benefit neurologically and especially if you're combining it with other tools and technologies and practices. And again, my emphasis to all of your listeners is that I think it's a fantastic tool. I use it all the time. People call me from all over the world, I work with clinics all over the world that are integrating hyperbaric therapy within their environments, within their ecosystem, some medical, some non-medical. But it's not just about going into the chamber. And that's my ecosystem. That's what I've developed over the years. That's also what's gotten me into trouble in the hyperbaric community over the years because it's not always about going into the chamber right away. 

[00:52:59] So, if you're already-- if you're sick, if you have a long way to go, I can promise you that hyperbaric therapy is not the first thing you should be thinking about. A good example of this is that I've said this before on podcast, if you have chronic Lyme, and I do believe in chronic Lyme. I know some people don't. But I've seen people for years and years. If you need to be about 60 to 70% better to see a significant improvement long-term using hyperbaric therapy, if you're not already there, then it's not going to be a long-term option for you that you're going to see like benefit. In the beginning, when I first started working in hyperbaric medicine in 2012, I worked with a nurse named Gail who also had Lyme.

[00:53:38] And I saw her progress and I saw her lack thereof. I saw her get better, then she'd relapse and get worse and do more hyperbaric therapy. And then it became obvious to her over time that she needed to be at a certain level for her to be able to really benefit. And so that was my first experience with that kind of situation. But in the end, it's about creating an ecosystem in ourselves. The other word that, so we have a nonprofit one of our companies called Health Optimization Medicine and Practice and we train practitioners on how to optimize health. And we have a seven-module certification and all those things. But one of the main reframe we give for clinicians, you don't have to be a doctor to do this. You can just be somebody like that's seeing clients in any kind of capacity. It's called the holobiont. I don't know if you've heard this word before?

Cynthia Thurlow: [00:54:21] No.

Dr. Scott Sherr: [00:54:22] It's holo means whole and bion is your ecosystem. And so that we all know that we live in a population of individuals that live in a town, in a city in a state, all those kinds of things. But we are also our own ecosystem of human cells, of bacteria, fungus and virus, of the food that we eat, of the environment that we're in, of the water that we're drinking. So, this is called your holo organism and so or your holobiont. And so, we call ourselves holobiont hackers, not biohackers, but we’re biont hackers for sure. 

[00:54:49] And so the idea with my clinical practice is to bring somebody into that ecosystem, this holo, and then optimize their holobiont, their whole organism itself. So, this is that individualization you were talking about, Cynthia. It's not like you can just throw hormones on everybody through perimenopause. It's like you have to know what's going on. And then working on the data and then, cellular medicine then top-down approach, bottom-up approach and meeting somewhere in the middle and where hyperbaric therapy comes in is somewhere in that middle. It's somewhere like you can truly accelerate the progress of somebody if they have the right machinery to be able to do it. So, rebuild their brain so now they can think better, they have less brain fog. 

[00:55:24] You can use it for their mild cognitive impairment, even some dementia and Alzheimer's and Parkinson's and chronic pain and chronic infections. I think the list goes on and on, your autistic spectrum, your kids as well. But not without the other stuff. If it's an acute issue, sure, but without the other stuff long term, I just haven't seen the benefit without doing that whole organism approach.

Cynthia Thurlow: [00:55:45] Well and I think that's such an important distinction so that people understand. Again, it's one of many strategies used at the right time when you've made enough progress. And certainly, if someone has a chronic issue, it might be farther down the line, if it's something acute like a traumatic brain injury, someone's had a recent stroke, things like that, where it might be more beneficial to use it up front. To round out the conversation today I know that there are 14 approved indications for HBOT. We've touched on many of these do you feel that there's still pushback from a lot of insurers? I'm not even sure if you work with insurance, but for someone that's listening, we do have a lot of clinicians that listen to the podcast that are trying to help their patients. 

[00:56:28] Do you typically find that most insurers are willing to consider this option, or is it really the scant few insurers? Because I feel like even though I have good insurance, I mean, sometimes we get pushback. They want you to try 15 other things, make sure they've all failed. Then they're willing to entertain the possibility that one of these considered to be alternative therapy options might be viable. 

Dr. Scott Sherr: [00:56:51] So, there's 14 indications that are covered by insurance in the United States. There's very little way to back into these diagnoses. Because they're very specific. So, the first one is diabetic foot ulcers. So, if you have somebody that has, it's a Wagner grade IV ulcer. So, basically, just gangrene and close to amputation. Hyperbaric therapy is approved as an adjunctive treatment to help try to reverse and prevent an amputation. And I had stories when I was first starting out and doing a little bit of both, doing both the conventional hyperbaric work, which I don't do anymore, along with the more integrative and outside the insurance system. 

[00:57:28] I remember I had one lady, she was very sweet old Filipino lady, and she had already lost two of her toes. She came in, we saved her third toe, and she asked me afterwards, she's like, “Dr. Scott, why didn't they send me for the first two toes?” And so, it was heartbreaking on some level. But doctors actually they're underutilizing hyperbaric therapy. That's what it comes down to. It can be sometimes difficult to get it covered, like you said. But with the right criteria, it should be. The other one that's big is radiation injury from cancer treatment. So, radiation exposure, breast, bowel, prostate, brain, all these places that we get radiation for all these types of cancers, there can be radiation injury. And radiation injury can be significant. What hyperbaric therapy it does, it can regenerate the tissue in the radiated bed. So new blood vessels, new stem cells, new connective tissue. 

[00:58:14] And so when you see really great saves and it's the best treatment out there for radiation injury that's symptomatic after radiation exposure and so vastly underutilized for that particular indication, Radiation oncologists think that they're so good at what they don't think about these mild things sometimes or maybe more severe. And hyperbaric therapy becomes a last-ditch effort, sadly. But it does often work. I work with people that have a common one is a radiation cystitis. So, this is when you've got radiation to your bladder or around your bladder maybe for a prostate kind of thing. If you're a male and you get radiation cystitis, so your whole bladder gets friable and inflamed and bleeds. And so, you have chronic hematuria, chronic bleeding in your urine. 

[00:58:57] And what they go in is like, they'll do all these cauterizations and they'll go in with and try to burn it all. It doesn't often work and it recurs. But hyperbaric therapy can reverse all that. So, radiation injury is a big one. Diabetic foot ulcers I mentioned. We called flaps and grafts in plastic surgery. So, if you get a plastic surgeon, you get a graft at a certain location. Doesn't look like it's going to take. Hyperbaric therapy can be really beneficial there. Sudden hearing loss, sudden sensorineural hearing loss. So, this is a hearing loss that's neurologic in nature. You wake up one morning, you can't hear or half of your hearing's gone. It's very devastating in some people. Hyperbaric therapy can reverse that and chronic bone infections. Osteomyelitis is another one.

[00:59:33] The other indications are all maybe all really in acute care setting. So, carbon monoxide poisoning, burns, diving injury. So, the reason why hyperbaric therapy was developed was for decompression illness and diving. That's a whole another history lesson and for another time. But people can look that up. Scorpion bites actually. So, scorpion bites, is it scorpions or is it-- No, it's a certain type of spider bite that can cause gangrenous and loss of limbs that hyperbaric therapy is approved for. Those are the major ones overall in acute trauma, like acute compartment syndrome, where one of the limbs isn't doing very well or partial amputations and things like that. I saw it for some of those when I was at Shock Trauma. 

[01:00:12] But in essence, as I mentioned, before mentioning them specifically, is that you can't really back into those diagnoses. It's really like it is what it is. But if you can get it covered, like obviously that's great for your insurance, but if you have an off-label indication when these are ones that are not covered by insurance is going to be out of pocket for you. And that's why I'm so emphatic about making sure that it's the right time for you to use this technology rather than spending your money up front where it might have been better to use it in three or six months. 

[01:00:37] And, and that's where when I consult with people, that's often what, the conversation I'm having is like, is it right now that hyperbaric therapy is helpful or should you wait three or six months, get optimized, go skip a couple things, start some methylene blue or some GABA or whatever. But usually, it's more holistic than that. But sometimes, it's just like giving them some things that can help support them while they're on the path of trying to figure out more of a holistic plan as well.

Cynthia Thurlow: [01:01:00] Well, I always so love our conversations. Please let listeners know how to connect with you outside of the podcast, how to tune into your podcast, learn more about your supplements or even your certification program. 

Dr. Scott Sherr: [01:01:11] Yeah, so lots of things. So, easiest sort of central hub for me is my name, drscottsherr.com D-R-S-C-O-T-T-S-H-E-R-R, it's nothing fancy, but it gives you a sense of all the things that I do. I have a Hyperbaric Consulting Business where I consult with people all over the world on how to use hyperbaric therapy effectively. My secret's out that a lot of that has nothing to do with hyperbaric therapy. It's going to be about all the other things that might be able to help you. And so that's at integrativehbot.com but you can just go to my initial website and I also have my own what's called Health Optimization Medicine Practice where I work with people on the long term to optimize that holo organism that we’re talking about. 

[01:01:47] So, again you just go to my general website, you can find information on that part of my practice. There's the non-profit itself that trains practitioners. That's at health optimization. It's called Health Optimization Medicine and Practice. The website is homehope.org and what else? So, from my personal side of things you can find me on Instagram @drscottsherr D-R-S-C-O-T-T-S-H-E-R-R. We also have a company called Troscriptions which makes products and makes some methylene blue products. We've discussed also makes products in the GABAergic space. I use them a lot before Troscriptions was around and now I use a lot because we've developed them as well. 

[01:02:20] And so, we have some great things called Just Blue, for example, for methylene blue, we have Tro Calm for anxiety and stress relief and Tro Zzz for sleep and some other things that can be really, really helpful. So, you can check that out at Troscriptions also at troscriptions.com and what else am I forgetting?

[01:02:32] On the hyperbaric side, of course, I have a company called OneBase Health. And OneBase Health is an ecosystem that we're developing to help people integrate their technologies together in a home suite of things. But a lot of that's based on what I've been describing here today, is that when you're creating protocols, it's what tools, what technologies, what supplementation. So, the idea is to create that within a home ecosystem for everybody. And that's at onebasehealth.com and there's also chambers and other types of technologies available for people as well. 

Cynthia Thurlow: [01:03:01] Thank you so much. 

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