An Approach for Increasing Brain Blood Flow and Oxygen Delivery Question and Answer Session.
Featured speakers Alex Stenzler, 12th Man Technologies, and Dr. Megan Fitzgerald, Brain Inflammation Collaborative, answered audience questions during a recent educational webinar. Watch the webinar recording by clicking here.
Check out additional resources and information on this emerging technology at 12thmantec.com/long-covid-research.
Alex Stenzler answers audience questions about brain blood flow and the sequential rebreather.
For the reduction of brain blood flow in Long Covid, do we know what cell types are driving it and where they reside in healthy versus symptomatic people?
Alex: The alteration is in the smooth muscle and endothelial cells. If these cells are targeted by the virus and get inflamed, you would have a reduction in blood flow. And the definition of “healthy” may not be as clear as we would like. A large
percentage of people who had COVID-19 and “completely recovered” still have reductions in cognitive function. This cognitive function decline has been reported as an equivalent decrease in IQ of 3 to 9 points.
What are the safest and most effective ways to attenuate microglia?
Alex: CO2 has been demonstrated to modulate the microglia, but I don’t have direct evidence of our own to demonstrate that. There is a reference on our webpage that discusses that. 12thmantec.com/long-covid-research/.
Would Viagra or similar ED vasodilators help blood flow get oxygen to the brain?
Alex: Viagra is PDE inhibitor and most of them are specific for targeted vascular beds. While Viagra and Sildenafil have been also used for pulmonary vascular relaxation, I am unaware, without doing some research, if they would affect the cerebral vascular bed.
What types of surgical and non-surgical interventions are available to help improve blood & therefore glymph flow?
Alex: There are several techniques researchers have used to increase cerebral blood flow, including electrical stimulation, counter-pulsation, etc. I don’t know anyone performing surgical procedures to increase cerebral blood flow.
What should patients do to increase blood flow?
Alex: I think that patients should speak with physicians that specialize in Long COVID to hear what they recommend. My only experience for directly changing cerebral blood flow has been with CO2.
Increasing CO2 in the blood will support the delivery of O2 to the tissue. To high O2 might deteriorate the breathing impulse. Is this at risk? - How is the mechanism to increase cerebral blood flow by increasing CO2 level in blood?
Alex: Low oxygen levels don’t drive breathing until they get extremely low and therefore high oxygen levels don’t suppress breathing either. CO2 is the primary driver of breathing. 100% oxygen over longer periods can cause fibrotic changes in the lung tissue. Remember that many critically ill patients on mechanical ventilators may be on 100% oxygen for many days and still fully recover.
Please explain the detailed mechanisms through which higher or lower levels of CO2 in the blood impact the feeling of shortness of breath.
Alex: A high level of CO2 will definitely stimulate a sense of shortness of breath. A low level of CO2 won’t generate a sense of breathlessness (assuming oxygen levels are not very low). However, a low CO2 might reduce cerebral blood flow and cause lightheadedness, producing a sense of anxiety, which might be interpreted as shortness of breath.
Can you explain the risks or benefits for people with mitochondrial dysfunction?
Alex: The benefits are that the increase in blood flow might quiet or reset the mitochondria (unclear for certain), which would be a significant benefit. The risk is that the increased work of breathing might increase the anoxia in the muscle cells and trigger a PEM crash. One of the reasons that we are considering people with a propensity for a PEM crash to start with shorter treatment periods is to limit the level of anerobic metabolism. We have not tested this theory as yet.
Why is the rebreather treatment a one-time thing? Is there a permanent change it brings about that negates the need for follow-up treatments?
Alex: Very much depends on each individual. Some people find that one 28 day session (56 treatments) brings them back to where they were before. As I said during the presentation, 20-25% of the people who used the rebreather, gained no benefit. A few also slide backwards. And some have maintained the benefit with continued use.
Can high CO2 like 1000ppmv or high O2 like 100%, or trace H2 <2% help brain fog/SpO2/reduce inflammation/help ME/cfs/Long Covid?
Alex: Both of your propositions require an external gas tank. I have no experience with hydrogen. The benefits we see as related to cerebral vascular inflammation would be appropriate in these other cases, assuming there is a reduction in cerebral blood flow.
Is ABG measured at all? How do you know that the level of CO2 isn’t too high?
Alex: We did not measure arterial blood gas values in these patients. In the Canada study, we did look at end-tidal CO2 to judge the increase in CO2. For most patients, since we are shipping technology directly to them, we are unable to dial in the O2 flow specific to their needs. However, we have had good results at the 2 LPM. If patients contact me with difficulties, I can usually have them adjust the O2 flow over the phone to solve their problems. If the CO2 climbs too high, patients would not find the treatment tolerable, and they would just take the mask off their face.
"Brain fog" isn't just a symptom of Long COVID. Plenty of conditions (and some treatments) have it as a symptom, including ME/CFS, MS, diabetes, stress, depression, hormonal imbalances, sleep deprivation. Have the treatments in the presentation been tested in populations with these conditions?
Alex: This treatment might be of value in many other conditions, including vascular dementia, Alzheimer’s and other conditions related to reduced cerebral blood flow. We’ve used it in a few patients with both of these conditions with subjectively reported benefits. However, these are anecdotally reported cases, and I would not state a firm benefit.
Could reduced breathing techniques designed to increase CO2, like Buteyko, have a similar effect without needing the added equipment of the oxygen concentrator and mask?
Alex: It’s possible that controlled breathing like Buteyko would be beneficial. However, the increase in CO2 with this technique will not increase the CO2 to the levels to get the blood flow to where you may need it.
I have clients who practice Wim Hoff's methods and they are reluctant to add anything to that. How is this different?
Alex: Wim Hoff’s method would appear to be contraindicated for Long COVID. If I understand it correctly, it is a method of hyperventilation to reduce CO2, which would have the undesired effects of lowering cerebral blood flow.
Can you explain the risks for asphyxiation?
Alex: In the US and Canada, where both the Hi-Ox and Rebreathing circuits are cleared for sale, a physician only needs to write a prescription for “Oxygen concentrator at 2 LPM with a Hi-Ox sequential rebreathing mask for 30 minutes, twice a day for 28 days. If asked, you direct them to our webpage and the references. You can also print out the first two references and give them
to the doctor for a clearer explanation of what it is. Internationally, it’s a little different. In some countries, having FDA clearance is sufficient for use. We did have CE mark years ago, but the increased cost of certification exceeded the revenue from sales. Therefore, in the EU, the only way to prescribe it is as a custom device for a specific patient. A little more paperwork, but
possible to do.
Are there any ways to replicate what the rebreather does, for those without access to the device?
Alex: It may be possible to somewhat approach the rebreathing with an oxygen cannula and a paper bag. However, there is no way to sequentially rebreathe, so I don’t recommend it.
Has the device been studied in pediatric patients?
Alex: The Hi-OxSR has been used in children with neurodevelopmental problems. However, we were
not involved in those studies, and I don’t have data. We did have a pediatric mask at one point and the Hi-Ox without the rebreathing tube has been used in many children.
The information provided here is general in nature, and is intended for use as an educational resource only. You should seek the opinion and consultation of a licensed healthcare professional for all diagnostic and treatment related to any diagnosed or possible medical condition. You should consult a licensed healthcare professional before deciding on any treatment, course of treatment, medications, etc.
Written By
Taylor McGowen
Director of Development, Brain Inflammation Collaborative
