For many of you with some basic medical knowledge or exposure, this seven letter word ‘hypoxia’ may sound intimidating and somewhat threatening. The further thought process after reading this word might be associating it with sleep disorders and/or low oxygen levels, injury, suffering, and death. Undoubtingly, hypoxia has been under the radar of scientific discussion and clinical trials from the last couple of decades due to the detrimental effects it poses on human health. However, recent medical advancements are now showing some promising positive outcomes if the hypoxia is induced correctly in the right settings. Therefore, today we want to introduce you to this revolutionizing concept of intermittent hypoxia as a therapeutic measure. So today we’ll try to explain how this new therapeutic modality works and how you can add this into your routine to gain medical benefits.
What is intermittent hypoxia?
Hypoxia is a physiological state where a part or all of the body is deprived of adequate oxygenation at a tissue level. It is indeed an oxygen starvation event that poses multiple adverse signs and symptoms. However, if this hypoxia occurs in a controlled environment, episodically that is intermittently it can alleviate various pathological conditions.
Intermittent hypoxia is known to give birth to several adaptive responses. These adaptive responses prepare the body to better tolerate future hypoxic episodes and also provide some immunity against several other types of insults. Evidence shows that the nervous system increases the production of growth factors during the hypoxic episode to combat the injurious effect of hypoxia. Therefore, if channeled properly induced intermittent hypoxia can produce more beneficial results than any serious pathological effects.
What happens during intermittent hypoxia?
While the body is in the state of hypoxia the level of carbon dioxide rises in the bloodstreams along with the depletion of oxygen. if this state is to persist for too long, cell death and eventually tissue death occurs. However, if it occurs for a short duration it stimulates multiple changes as survival instincts in the body.
- The first and most important is the drive for oxygenation. The greater the carbon dioxide retention in the body, the stronger the brain urges the lungs to breathe and replenish oxygenation. A similar exchange occurs at tissue level; where increased carbon dioxide level causes the release of oxygen from its hemoglobin bound state and its migration into the oxygen-deprived tissues.
- High carbon dioxide levels in the blood also trigger a chemoreceptor called the Carotid body situated in the great vessel originating from the heart. The carotid body when activated promotes the production of serotonin, which then brings about changes known as plasticity. It acts on neuronal innervations, especially those connecting to the muscles and improving their functioning, such as respiration, etc.
- Other changes include; production of nitric oxide, migration of stem cells, production of erythropoietin, production of mitochondria, etc. these changes are individually discussed below.
These are the reasons why intermittent hypoxia is now being used to treat multiple degenerative diseases and for the enhancement of athletic and sports performances.
Beneficial effects of intermittent hypoxia therapy?
All the effects of hypoxia are generated by hypoxia-induced factor 1 (HG1) released during hypoxia that assists in survival at low oxygen levels. It induces some positive stress responses that are mentioned below.
- Increases hemoglobin:
Intermittent hypoxia increases the hemoglobin levels by stimulating erythropoietin production from the kidney. Erythropoietin is a hormone that plays a key role in the production of red blood cells.
- Enhances neuroplasticity:
HG1 is associated with enhancing neuroplasticity, which is increased neuronal connections to process and transfers more neuronal information. This results in improved cognitive and motor functions, and better responses to emotional and physical stress and trauma. Serotonin is said to play a major role in the stimulation of neuroplasticity.
- Boosts athletic performance:
Many athletes practice breathing exercises to induce intermittent hypoxia as it breaks down worn-out mitochondria to replace them with stronger ones. This positively impacts the athlete by increasing their resilience to physical activities and sports.
In ischemic tissues, intermittent hypoxia promotes the production of growth factors such as vascular endothelial growth factor (VEGF), responsible for the formation of new blood vessels (angiogenesis). For instance, during myocardial hypoxia, VEGF causes the formation of collateral coronary vessels that blunts down the damage and restores blood supply to the injured part of the heart.
- Cardioprotective action:
Intermittent hypoxia also has a significant role in nitric oxide production by inducing the enzyme Nitric Oxide Synthase (NOS). Nitric oxide is known for its action to decrease hypertension by dilating blood vessels and increasing the blood circulation when needed, such as in cases of myocardial infarction.
- Treats Erectile dysfunction:
Intermittent hypoxia is also effectively used to treat erectile dysfunction. It does by a similar mechanism of triggering nitric oxide production for quick vasodilatation required for the erection of the penis.
- Slows aging:
It is known to increase the resistance of tissue against various insults and injures such as radiation injuries and aging.
- Stem cell mobilization
In adults stem cells are restricted to specific regions of the body such as bone marrow. A few minutes of hypoxia daily is known to drive the migration of such stem cells from bone marrow to other parts of the body. In normal conditions the self-renewal property of stem cells is estimated to be 2%, this markedly raises up to 20% under hypoxic conditions. Mobilization of stem cells from the bone marrow are proposed to be therapeutic in several degenerative diseases, including type-2 diabetes mellitus and Idiopathic Parkinson’s disease and Osteoarthritis.
- Repairs DNA:
HG1 is also known to stimulate the TP53 gene that encodes for proteins that regulate the cell cycle. Whenever the body detects any DNA damage such as in cases of cancer, TP 53 is activated to repair the said damage. In cases where damage is beyond repair, TP53 initiates the process of cell death called apoptosis.
Diseases that can be treated or managed with intermittent hypoxia therapy:
With all the above mentioned beneficial effects intermittent hypoxia can be employed to manage or treat the following illnesses:
- Type-2 Diabetes mellitus,
- Coronary artery disease,
- Parkinson’s disease,
- Chronic renal failure,
- Erectile dysfunction,
- Chronic lung diseases,
- Asthma and chronic bronchitis,
- Liver and pancreatic diseases,
- Anxiety and depression,
- Iron-deficiency anemia,
- Lack of energy and fatigue.
Contraindications of intermittent hypoxia therapy?
Some of the conditions where intermittent hypoxia is contraindicated include:
- Patients with a history of a heart attack within the last three months, or acute ischemic stroke within the last six months,
- Patients with unstable angina,
- Current infectious disease,
- Patients on dialysis,
- Patients with severe uncontrolled hypertension,
- Patients with congenital malformations of the heart and great vessels,
- Patients with thromboembolic complaints,
- Patients intolerant to low oxygen levels,
- Patients with primary and secondary polycythemia,
- Patients with chronic obstructive pulmonary disease,
- Patients with chronic diseases with symptoms of decompensation or terminal illness,
- Cancer patients, unless IHT is prescribed by a doctor,
- People with epilepsy, pacemakers or heart arrhythmias, unless treatment.
Effects of long term uncontrolled hypoxia:
Certain populations such as deep-sea divers, professional swimmers and people living at high altitudes, etc, are able to tolerate hypoxic events better than others, where oxygen deprivation poses an imminent threat. This tolerance towards hypoxia can be increased with breathing exercises that promote intermittent hypoxia.
Some of the adverse symptoms produced by uncontrolled hypoxia are mentioned below. These can be avoided by practicing breathing exercises that cause intermittent hypoxia under the supervision of a professional trainer or alone only after proper training.
- initial confusion,
- dizziness, seizures or loss of consciousness,
- cyanosis of lips, tongue, and face,
- a tingling and numbing sensation in extremities,
- gasping for air or hyperventilation,
- injury to brain cells initiates within a minute or two of oxygen deprivation and within five minutes of hypoxia, the irreversible damage or death of brain cells ensues.
- mortality occurs in most patients within 10 minutes of hypoxia, even earlier in patients with comorbidities and poor general health status.
Inducing intermittent hypoxia through Mr Activated Breathing Methoda and Nisshesha rechaka pranayama
MR Activated Breathing Method
Practice Activated Breathing daily to create intermittent hypoxia. It involves different breathing patterns from slow and calming to rapid and stimulating. The exhalation is interrupted three times and at different levels of the body for a short period of pause. The pause at three different levels creates magic and intermittent hypoxia. The pause is a powerful technique to evoke a relaxation response and at different pauses, we are aware that the mind is in a very calm and balanced state that can rejuvenate and heal
Nisshesha rechaka pranayama is a yogic breathing technique that elicits an episode of intermittent hypoxia. It involves a stepwise breathing exercise where the breath is held after expiring all air out.
A study published in 2011 claimed Nisshesha rechaka to be the easiest way to produce brief, intermittent hypoxia. This clinical trial conducted at Antar Prakash center for yoga monitored peripheral capillary oxygen saturation in two different breath-holding maneuvers. They found Nisshesha rechaka technique was able to bring down the 0xygen saturation levels up to 80-88% within a few minutes, producing intermittent hypoxia.
The technique of nisshesha:
Nisshesha pranayama can be best carried out in two settings;
- In the first setting, the individual is made to sit comfortably and is asked to recite the word ‘om’ several times in a single breath (omkar japa). The concept behind this recitation is to allow the individual to take deep breaths or inhalation during the first phase that lasts for 15 minutes. As the person carries this out the duration of the inhalation is prolonged to up to 30seconds per breath. a 3 breath of deep exhalation and holding the breath at the end till possible is asked (nisshesha rechaka). It is seen that hypoxia of around 90% oxygen saturation is achieved very comfortably by this exercise.
- In the second setting the individual is asked to hyperventilate(Bhastrika) and then hold his/her breath in full expiration till possible (bhastrika followed by nisshesha rechaka). The concept behind this technique is to wash out as much carbon dioxide as possible with the help of hyperventilation. as carbon dioxide drives the main urge to respire, with low carbon dioxide level the individual is able to hold his/her breath more easily for a longer duration.
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