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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS improvement and that clinical improvements may precede any measurable SPECT changes. They also note that the patient’s second series of 60 treatments not only re-instated the previous gains from one year prior, but yielded greater benefits than those initial 20 treatments. Gains were seen in gait velocity, working memory, language, and the processing speed of information. This supports other author’s suggestion that there is neural tissue around the area of damage that may be idle, yet viable, for several years after the initial neurological insult.(19) Similar results were also found by Golden et al. who studied both children and adults with chronic brain injury who had gone one year without clinical progress despite multimodal treatment. Patients who had previously decided to use HBOT were enrolled into HBO therapy programs, however the report did not indicate the specific HBOT protocols used. Outcome of HBO participants was measured with validated neuropsychological measures assessing a broad range of cognitive, social, and motor function (Vineland assessment). The results suggested that non-responders and responders existed within the treatment groups. Furthermore, the number of total treatments, not the treatment time period, was most suggestive of benefit. SPECT imaging was performed on these subjects as well. SPECT changes did not progress as quickly as cognitive changes progressed. The authors believed their results were ‚strongly supportive‛ for HBOT in the treatment of chronic brain injury and that SPECT changes may not be a reliable correlate of clinical improvement.(20) Even comatose patients may benefit from HBOT. Liu et al. found improvement in cerebral perfusion by SPECT and Glascow Coma Score in a prospective trial of comatose patients undergoing median nerve stimulation with or without (control group)HBOT. Control patients showed no measurable improvement while 6 of 12 patients in the HBOT group emerged from coma, none of the HBO group needed assisted ventilation, and only one still needed nasogastric tube feeding at one year.(21) 148 HBOT may have benefits from a neuropyschologic standpoint, as studies suggest beneficial effects on behavior and mood after HBOT. This could change the perspective on future HBOT research, allowing us to understand the role of HBOT in improving more subtle aspects of neurocognitive function. Improvements at this level are clinically measured in terms of enhanced mood and cognitive function. Most previous HBOT work has focused on the measurement of grossly observable changes (motor function,etc.), the measurement of metabolic changes that would validate improvement in ischemia, or objective measures of improved brain function (SPECT, EEG). These modalities of evaluation may not be accurate surrogates to determine an HBOT benefit as cognitive function may not be easily measured by physiologic or electrophysiologic changes. HBOT may provide clinical benefit in traumatic brain injury in the acute and chronic injury settings. It appears to offer neuroprotective benefits in acute TBI as well as long-term beneficial effects during recovery from a brain insult. The clinical benefits of HBOT in TBI is being actively explored in the literature. HBO therapy may work by improving oxygen delivery to metabolically inactive, yet viable tissue, reducing inflammation, aborting apoptosis, improving cerebral metabolism, and enhancing brain plasticity. HBOT likely has application to specific types of injury at specific times. More studies will be necessary to differentiate responder and non-responder types. HBOT has a very safe side effect profile and therefore, aside from cost, has little down side. Few good medical treatments exist for TBI; therefore, HBOT should continue to be researched to determine its full application and utility in the treatment of various forms of TBI. Summary Hyperbaric oxygen therapy is approved for the treatment of wounds and burns, decompression illness, and gas poisoning. Based largely on animal studies, its mechanism of action is likely based in its ability to reduce inflammation through its immune dampening effects. HBOT increases the 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS oxygen saturation of blood plasma and therefore is able to deliver oxygen to tissues independent of hemoglobin. Improving the delivery of oxygen to hypoxic tissues which have poor vascular supply may be one mechanism of action. Although not completely defined, the pathophysiology of multiple sclerosis, autism, and traumatic brain injury may be similar since all involve some degree of brain inflammation. The literature regarding the pathophysiology of autism suggests a variety of factors that can lead to brain inflammation: gut dysbiosis, intestinal hyperpermeability, mitochondrial disease, poor cerebral perfusion, oxidative stress and free radical damage. Studies on the pathophysiology of MS and TBI did not appear to evaluate these pathophysiological mechanisms, which may be a valuable area of research to explore, particularly with MS since it is an autoimmune disorder. Restoration of mitochondrial function may be a protective mechanism of HBO therapy for both autism and brain injury as suggested by animal studies.(22) This author suggests that the current multi-modal treatment strategies used for autism, although many of which are ‚off-label‛, could be used as a model for the treatment of MS and TBI since these disorders may share similar physiologic mechanisms of neurologic injury. For instance, the acute secondary injury following TBI is similar in many ways to the more chronic inflammatory issues of autism since both involve perfusion issues, inflammation, and metabolic derangements. Furthermore, multimodal therapy for brain injury, as is common to the treatment of autism, may be of great benefit for the treatment of MS and TBI. Outcomes from brain injury may be improved using nutrients, such as B-vitamins and folic acid, which alter homocysteine metabolism, omega 3 fatty acids and krill oil to balance inflammatory cytokines and reduce C-reactive protein, and bioavailable forms of choline to enhance brain recovery.(23) Clearly delineating the role of HBOT in the treatment of neurologic disorders will take careful 149 study with respect for the multiple factors that may impact treatment outcomes. Variables for HBO treatment include pressure, percentage of oxygen, length and frequency of treatment. Subpopulations of disease may also benefit differently from HBOT. The disorders discussed here have multiple pathways that lead to neurologic injury and dysfunction, and it is likely that individualized protocols will need to be developed based on the specific needs of the patient. HBO therapy appears to be a promising treatment modality for autism, multiple sclerosis, and traumatic brain injury and should be further explored. Jamie Wright is a Board Certified ‚reformed‛ Gynecologist who fully embraced integrative medicine as he helped his wife overcome autoimmune disease and chronic pain. He is pursuing a Master’s Degree from the University of South Florida Medical School with a focus on Metabolic and Nutritional Medicine. He is also board certified by the American Academy of Anti- Aging Medicine after completing Advanced Fellowship Training in Anti-Aging, Regenerative, and Functional Medicine. Dr. Wright knows that Wellness is the Natural State. He works with clients to help them achieve ‚LifeChange Through Wellness‛, a concept that leverages the power of health to create a vital life. Dr. Wright lectures and speaks to a variety of audiences. He delivers a motivational and educational message, centered around practical wellness principles. He enjoys challenging his audience to create a ‚Vicious Cycle of Wellness‛ in their lives, achieving greater satisfaction and performance in all aspects of life. Contact Jamie Wright at wrightjamie34@yahoo.com Website: www.CentersForBalancedLiving.com References: 2012
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