The Melanie Avalon Biohacking Podcast Episode #125 - Joe Dituri

TRANSCRIPT

Melanie Avalon: Hi, Friends, welcome back to the show. I am so incredibly excited about the conversation that I'm about to have. It is a long time coming and I do have a little bit of a backstory behind it. So, on the show, I talk about a lot of the biohacking things, and one of the biohacking things that has been around for actually, a long time, and probably wasn't even originally a biohacking thing, is hyperbaric oxygen therapy. I keep seeing it everywhere. People talk about on different podcasts, on different shows, I've been very fascinated by it. The problem with all of this is that, I actually-- I have a very strange phobia. I have claustrophobia and then I actually get very distressed by the concept of pressure on things. I don't know if this is like a thing, but I get really stressed about the concept of pressure if I think about it.  

So, hyperbaric oxygen therapy requires getting at a small-ish device with pressure on you. I've been actively avoiding it for a while. But then it just got thrown in my face because I had on the show multiple times. Dr. Kirk Parsley, who you guys have loved the episodes with him. He's a sleep expert. So, we'll put links in the show notes to those interviews. But he was doing research on hyperbaric oxygen therapy with his friend Dr. or I should say, Commander, Joseph Dituri and just forced it in my face, and was like, "Do you want to do an episode on hyperbaric oxygen therapy?" And I was like, "I guess, I really need to." [giggles] So, we got connected, and I met Joe, and talked to him, and was just blown away by his knowledge and his insight, and it made me really interested in learning more, and actually, since then, this is what I was going to tell you, Joe, I actually did some hyperbarics myself. 

Joseph Dituri: You did not. 

Melanie Avalon: I did. I did. [laughs] You inspired me. 

Joseph Dituri: I'm proud of you.  

Melanie Avalon: Yeah. It was really, really wonderful. So, I'm really excited to dive deep into the science. So, listeners, I'll tell listeners a little bit about your ridiculously extensive resume. It's very overwhelming. So, Commander Joseph Dituri, he is a retired naval officer. He has a BS in computer science, a master's degree in Astronautical Engineering, what was the third one?  

Joseph Dituri: PhD. 

Melanie Avalon: The PhD. And what's the PhD in?  

Joseph Dituri: Biomedical Engineering. 

Melanie Avalon: Biomedical Engineering with a focus on life support equipment design, high carbon dioxide environments, and hyperbaric and hypobaric medicine. Maybe, we can discuss the differences there. He has an array of awards from the Navy. It's just overwhelming. I'll put a link in the show notes to his full bio, so you can check them out. He is also the director of the Undersea Oxygen Clinic. He's the course director for a UHMS approved 40-hour introductory hyperbaric course, He's an associate professor at the University of South Florida, and he is the co-author. We were just talking about this before we started recording. He has a book called Exploration and Mixed Gas Diving Encyclopedia. 

Friends, this book, if you want to know anything about diving or hyperbarics, it's intense. [giggles] It's amazing. There's a lot in there. And then, he also has a children's book that he wrote with his daughter called My Daddy Wears a Different Kind of Suit to Work, and it's adorable and I love it. So, we'll put a link in the show notes to all of that. But [gasps] all that said, Dr. Dituri, thank you so much for being here. 

Joseph Dituri: If you don't call me doctor, come on. Please don't. Can we just go with Joe? That'd be great. 

Joseph Dituri: I can go with Joe. Yes. 

Joseph Dituri: Thank you. Okay. I feel uncomfortable. I want to look around for my dad or something. I'm like, "Okay." 

Melanie Avalon: Well, Joe, thank you so much for being here. I've really been looking forward to this. And yes, so I did hyperbarics. How many sessions did I do? I probably-- we can talk about-- I mean, there's so much to talk about. We can talk about what I probably did not do the protocol the way I should have done it, but I did multiple sessions over a month because I had a membership somewhere that had free sessions for a month. Yeah, which was really nice, then they get you, though, because then after the month you have to pay for it, but so much to tackle. To start things off, I just said a lot about you, but would you like to tell listeners a little bit about your own story. I'm really, really curious to know about your experience in the Navy, and what made you so interested in hyperbaric medicine, and what you're doing now with diving, and just all of the stuff? I'm fascinated by it. So, what happened? 

Joseph Dituri: Sure. I'd love to. So, I spent 28 years in the navy as a-- First, I was a special operations diver, and then I became an engineering duty diver, and I work with Dr. Parsley as a matter of fact he was my doc at Deep Submergence Unit when I was in charge of the diving detachment there. He was my doc, and we'd go off together, and we became really, probably, one of my best friends in the world. I love it. But all of my life in the military was all about life support systems. So, my master's degree you mentioned is in astronautical engineering but that is with a life support system's bent. And then, biomedical engineering. Well, that's with a life support system's bent. And then, when I finished over at Deep Submergence Unit, I came to us Special Operations Command, and I help build-- well I was the guy who they called in to build and design dry combat submersible, which is nothing more than a life support system. It's a submersible, goes underwater, but it's pressurized. So, it's just like a hyperbaric chamber.  

I had to learn all the rules, I had to go through all those systems certification authority, and I was the guy like literally, Admiral, Bill McRaven calls me into his office, he says aquanaut, "Go build me dry combat submersible." I'm like, "But sir, I need money." He said, "Commander, which part of 'go build me dry combat submersible', don't you understand?" "Yes sir." "No problem, $22 million. Okay. I'll make it work." So, that was it. Now it's I think, a $1.4 billion program or record and we have like three dry combat submersibles and we're pumping them off the line, and we're in the process of producing these things. But it was great because literally this idea started in a bar with a couple of Navy Seals, and an engineer, and a napkin. I'm not joking that I wish I had kept that napkin [laughs] So, my life centers around and if you think about like, I look at my vision board all the time and it says, "What do I want to do when I grow up?" It's performed studies to make aquanauts, astronauts, and undersea structures including submersibles safer. That's what I want to be when I grew up and that's what I've wanted to be since the beginning. So, it's all life support systems. It's all that same bent. 

So, I did all that time in the Navy, I retired. When I retired, Admiral McRaven offered me a great job at SOCOM doing almost the same thing I was doing when I was in only just being the guy. I said, "Look, I want to do something not this. I want to start helping people." So, I want to start living that dream, I want to start living that goal. Went back to school, got a PhD in Biomedical Engineering, and then, now, it's like, "Okay, now, I can start writing papers." The impetus for the PhD, I didn't really want a PhD, but I started to try and write papers, and they said, "Oh, sorry, you don't have a PhD." I'm like, "It's hard?" They're like, "Oh, it's very difficult." I'm like, "Oh, do me a favor? Hold my beer. I will be right back." Five years later, I come back and they're like, "Damn it. Now, we have to listen to him. He has a PhD." [laughs] So, yeah, that's a little bit about me if that helps and hopefully the journey if that gives you any insight. 

Melanie Avalon: No, that already got me thinking about things I have never thought about in my entire life. I don't think I've ever actively contemplated life support systems. So, is there life support systems like diving underwater compared to-- you talked about like astronauts? Are they all just completely different, are there overlaps there? I've just never thought about this before. 

Joseph Dituri: 100% the same thing. Do you know that astronauts have to decompress to get into the US spacesuit? 

Melanie Avalon: No.  

Joseph Dituri: Yeah. We worked out all that decompression math. When I say, we, it really wasn't me, but it was a guy who was my teacher at one point, Mike Gernhardt, and he was an astronaut, and he worked out all that math, and divers will make the best astronauts I'm telling you. I'm here to say it, I had a lifelong goal of becoming an astronaut. I still have that dream I'm holding on, but I don't have $28 million. If you have $28 million, I'll take a seat of the next show going up. 

Melanie Avalon: Like what is the pressure on a diver compared to an astronaut? 

Joseph Dituri: Yeah. So, it's pressure in the opposite direction. When we go underwater, we increase in pressure. For every 33 feet, we add another 14.7, 15 pounds. As you increase that pressure, what Haldane said-- old dead guy who made a rule, what Haldane said was, "You can cut the atmosphere in half and not do any decompression." So, I can go from two atmospheres to one atmosphere and require no decompression. That seems to hold true in the whole mathematical process with-- When you modeled the compression, it's a third order partial differential equation. So, it's a lot of math. And you're modeling 16 individual compartments and their uptake, and they're off gassing each time, and all the bubble nucleonics and the math behind the pressure-volume-temperature relationship.  

As you model that, you find that, yeah, Haldane was actually correct. You can double the atmosphere or half the atmosphere and not worry about it. So, when we go down, we double the atmosphere and then we decompress and come up back to one atmosphere. So, we're living at one atmosphere right now.  

If you weighed all the molecules from here to the top of the stratosphere in one square inch, it would be about 14.7 pounds. So, that pressure is pressing on us right now as you speak. It's like, this is the pressure that you have surrounding you, it's air pressure. Every 33 feet, you go underwater for one inch a square. That's another 14.7. Well as you go up, so, here we are in the International Space Station, which is also at 14.7 pounds per square inch. Well, it also turns out that our spacesuit is at 4.3 psi or pounds per square inch. So, that is way less than half the atmosphere. When we get in that spacesuit, we have to be using pure oxygen in that spacesuit, we have to be scrubbing out the carbon dioxide, the natural byproduct of oxygen metabolism, and then we have to decompress to get into it because it's less than one half the atmosphere, which is what Haldane said way back in those days, and it turns out to be true. So, it's kind of a decompression theory program problem and everybody goes, "Why don't we just make our space suit 7 or 8 psi?" Because so that we can get into it really easily without doing any "decompression." 

The Russian spacesuit is at 9 psi, so you can get in that without any decompression. That's pretty easy and straightforward. The Orlan spacesuit is one of the things that we use when we are in the International Space Station, but it doesn't have near the dexterity that ours does. So, if you want to do a small minute task or something that involves finger wiggling, you could imagine that 9 pounds per square inch on your fingers because what's the atmosphere like outside of the spacesuit? Well, you're in 0. So, you're in grab-- that whole vacuum of space. So, here you are in this vacuum of space, you're at 0 psi, the difference between 9 pounds per square inch on the tips of your fingers and 4.5 pounds per square inch. Well, that's what we want is, we want less pounds so that there's less of a change in pressure, so you can have more dexterity and be able to do stuff. 

Melanie Avalon: So, if you don't go through these decompression protocols or don't do it safely, what would happen on both extremes like on the bottom of the ocean and then up in the sky? [laughs]  

Joseph Dituri: Yeah. So, what you do is you get bent. The ideology of the bends or decompression sickness comes from when we're working on the Brooklyn Bridge back in the day, the divers that weren't divers, they were called sandhogs at the time, they would go down to the bottom, and they dig out-- We put the case on, we put a big case on, we put it in the water, and then we'd fill it with air, and then we push it all the way down to the bottom of the seabed there, which was 30 feet or so, and we pressurize it, and then the guys would climb in there, and they dig and dig and dig and dig and dig, and that worked out great until they hit bedrock, and then they fill it with cement, and that becomes the entire bridge abutment. Basically, that's what you build the entire bridge upon. There're two spans in the Brooklyn Bridge, no problem.  

One span hit what we call the bottom or the seabed floor, it hit that bottom and there was no problem, piece cake. But then the second one, on the Manhattan side was much deeper. So, they tried to push the case on all the way down and when they started going all the way down before they hit bedrock, they got to 50 or 60 feet before they actually hit bedrock. The people would come out of there with the bends, they would literally bend over in half and go, "Oh," and then they'd fall on the floor and maybe they die or maybe they just be paralyzed. But we didn't know what was wrong with them. We're talking in 1873, Andrew Smith was the first person that coined the term caisson's disease. He had 110 cases of decompression sickness as a physician in charge on the Brooklyn Bridge. So, it's like "Holy mackerel, that's when we started using hyperbaric oxygen." Honestly, even before that, when you think about it, this guy named Henshaw in 1664, he used compressed air as what's called the domicilium or basically a room that improved digestion and respiration because all he did was like, you could imagine this boiler that they had in the 1600s riveted together, and they just pressurized it, and it made people feel better. So, you think about it. This has been around almost 400 years. [laughs]  

Melanie Avalon: And the reverse, if you're an astronaut, would you like explode outwards? 

Joseph Dituri: You wouldn't explode outward, but you would just be bent. You would just be bent, you would basically bend over at the waist. It's the same exact thing because the inner gas bubbles that are absorbed in your tissues tend to come out. They come out of solution and they cause this. You probably heard a lot of this during COVID, a cytokine storm or a systemic inflammatory disease if you will. That's the kind of thing that happens during a decompression sickness hit. The phagocytes and the leukocytes all get activated and they call the macrophage out, the point being that you have this over ridiculous response. It's like a histamine response to a bee sting. When you get this bee sting, what happens? It swells up. That's the same thing that's happening inside your whole body. It's a systemic inflammatory response and your body is in overload.  

So, you're just hurting, and this is why when you come out of the water, you bend over at the waist or when you're up in that spacesuit, and you start working, and you start increasing your circulation, i.e., perfusion, now, you're increasing your perfusion. So, you bend over at the waist and you feel like you're in pain. Like intense girdle pain, real visceral pain that comes from DCS or that can come. Pilots get bent all the time. So, the SR-71 Blackbird, when we used to fly it, used to fly very high and when we flew it, we had to have a bend's team on the ground, on standby waiting for them to come down because when they came down quite often, a large percentage of time they'd be bent. 

Melanie Avalon: This is literally my worst nightmare talking about the pressure. [laughs]  

Joseph Dituri: Don't be scared. I got you.  

Melanie Avalon: Yeah, just pressure on things really stresses me out. 

Joseph Dituri: You know a guy, it's okay. 

Melanie Avalon: I know-- I know. So, clarification about the suits because you're talking about the different levels of pressure. So, these different suits, they make your body feel like the normal pressure that we're at in everyday life and some are a different pressure than everyday life? Because you were talking about different numbers. 

Joseph Dituri: Right. So, the International Space Station is at 14.7 pounds per square inches is what we're at right now. So, it's pressurized to make you feel like you're at home. Only you're weightless because you're constantly falling. That's the only difference with that. When you get into the Russian spacesuit, that is pressurized to 9 psi, which is you know, 9 psi is like 5 psi less than 14.7 give or take, right? So, you're looking at 5 psi less, and then our suit is 4.3 psi, which is like 10 psi less. So, you have to decompress to get into our suit, but not until the Russian suit. 

Melanie Avalon: And you said the benefits of that are that you can move more? 

Joseph Dituri: Yeah, it's trade space. If you put your hand out in front of you and you try to move it, you'd realize there's no pressure on your hand. Well, now, put on the end of your fingertip, hold your palm straight up on the end of your fingertip, now, try and curl, when you have a 10-pound weight on the tip of your finger, and try and do a curl. Well, you can't. Why? Because-- or you may be able to do it, but you're not able to do it a hundred times, which you know when you're working, so, they went up and they repaired the Hubble Space telescope. And what they did was they chose a whole bunch of tall, lanky people with long fingers who were very dexterous, who were able to do the stuff. They picked a bunch of surgeons to do all the repair on the Hubble Space telescope. Why? They have great dexterity, they have great manipulation of their fingers, and they can work things, and they have strength in their fingers because they do it all the time. So, yeah, you need to be as close to the pressure that you're working in, which in this case was the vacuum of space or zero pounds per square inch, and then each movement you make is only with 4.3 pounds per square inch, and that's the difference in the pressure inside the suit and outside the suit. Does that make sense? 

Melanie Avalon: The thing I'm confused about is, so if you're experiencing the pressure within the suit, why does it matter what the pressure is outside of the suit? 

Joseph Dituri: Well, because it's all about the change in pressure. In the International Space Station, it's 14.7 pounds per square inch. Some of the International Space Station is little more than a blow-up doll. It's basically a plastic section that you just inflate with air and then you can live in that. But it becomes really rigid on the outside, why? Because there's 0 pounds per square inch on the outside, and there's 14 pounds per square inch on the inside. So, it's like blown up and now it's rigid. So, in order for us to crush that, we'd have to be able to push 14.7 pounds per square inch on the inside and we can't. It's one of those physical human things that's hard. 

Melanie Avalon: And the interesting thing and this is why I didn't realize before I tried the hyperbarics myself is that, once you reach a different pressure, you don't really perceive it as a different pressure. Is it like a thing with boiling a frog? Could you get up to a certain pressure that would kill you and you wouldn't feel it if you went slow enough? 

Joseph Dituri: I've never boiled the frog. I just want to say that for the record. [laughs] Your listeners will be like, "Who is this clown and why is he boiling frogs?" [laughs]  

Melanie Avalon: Let me clarify, just for listeners who aren't familiar, if you boil a frog like slowly enough, they won't realize that. If you slowly increase the temperature of the water that they won't perceive the temperature, would that happen with pressure? 

Joseph Dituri: So, no, mammalian tolerance or human tolerance as the cases is 2,265-- 2,265 feet. You can't go any deeper than that. We've tried. I think the French just set that record recently. Maybe it's a little deeper than that but 2,000 feet, in excess to 2,000 feet to do that kind of a dive, but really the problem is from a life support systems perspective, there's lots of gas laws that are affecting you and you're absorbing inert gas, and you're really-- you're lethargic. So, realistically, humans can't really work at depths deeper than about 1000 feet. So, you can't work at a depth deeper than 1000 feet. You can go to that depth but that's about it. So, what would happen if you went deeper, I guess, is the question? You'd pass out. And that's basically it. Your system would be so repressed, so suppressed, you wouldn't really be functioning well. It doesn't mean that you can't do it but you just wouldn't function. 

Melanie Avalon: Okay. Well, I will not do that. 

Joseph Dituri: Well, I mean, 2,000 feet of sea water is deep.  

Melanie Avalon: Oh, yeah, I can't even imagine. Okay, so, back to the actual hyperbarics. So, it sounds like-- the original intention was to mitigate the damage that these divers were experiencing with the pressure, how does hyperbaric oxygen therapy work and what are the benefits when you're not tackling something like undoing the effects of the bends and pressure that you've experienced? 

Joseph Dituri: Sure. The thing with hyperbaric oxygen therapy is like I said the first and only approved indication was diving. So, you're trying to fix people that dive and then you're like, "Well, how else can we use this?" Like I said, in 1664, Henshaw used it, and he saw all these great things happening, and it's like, "What else could we use it for, what else can we start thinking through?" and that's where all the science started to come in. So, we have found different mechanisms of action and these mechanisms of actions are very, very simple. We know that hyperoxygenation, hyper being too much oxygen-- or more-- hyper, more; oxygenation, oxygen. So, hyper oxygen, when you're in a hyperbaric chamber and you're at least two if not three partial pressures of oxygen, so, three times 100% oxygen on the surface. You can transport a significant amount of oxygen through your plasma, sufficient enough.  

Normally, hemoglobin transports oxygen and hemoglobin in the grand scheme of things is big and plasma in the grand scheme of things is small. So, if I can carry enough oxygen in my plasma to support cellular respiration, well, then I can fix things that are poorly perfused areas. So, with that, that's the first mechanism of action and that's why it works to help heal decompression sickness. Then, after that we go into lots of other stuff. We reduce the bubble size by increasing the pressure. That just makes sense. If you have a bubble, you can push on the outside of it, I increase the pressure and you can reduce that size. 

You could reduce lipid peroxidation, it stems vasoconstriction, which also reduces the inflammation in your body, it's got a toxin inhibition that comes with it, there's some antibiotic synergy that comes with it, this process is known as angiogenesis, fibroblast proliferation including collagen synthesis. Collagen is the building block of everything in our body. So, everybody thinks, "Oh, I want to go to a store and I want to get a collagen injection. I want to go whatever, I want to take collagen, and then I can have a prettier face." It's not just that. Everything in your body is built on collagen. So, when you cut yourself open before surgery, you get hyperbarics, you heal 40% faster with a 30% reduction in infection rate.  

The other thing that it does is, it boosts stem cell production. CD34+ progenitor stem cells are increased by 800 times in 20 oxygen treatments. And those are the wildcard of all stem cells. Everybody wants stem cells but most of them that you get from like a PRP, platelet spin down, all those are like-- they don't get uptake into the body because your body looks at it and goes, "Oh, my God, intruder alert. I want to get rid of most of that." So, it tries to get rid of half of it. Well, when your body makes it, it doesn't try and get rid of it. So, you can use all that CD34+ which are the wildcard of all stem cells. They're like the gold card. They're the-- whatever they're the best thing to have in your body for healing so. 

Melanie Avalon: So, are the benefits coming from the pressure or from the pressure increasing the oxygen concentration in the blood? 

Joseph Dituri: So, all the benefits come from the pressure and Henry's law and having to do with absorption, and you're pushing this oxygen into solution. Because the hemoglobin while they can carry a little bit more, they're not going to carry a substantial amount. In 1950s, there was a paper written called Life without Blood and what they did was they pressurized a whole bunch of pigs down to 3 atmospheres, which is three times the pressure that we're at right now. So, 3 atmospheres absolute gave them a 100% pure oxygen, removed all of their red blood cells and reinfused a circulatory system with a plasma of sorts and that plasma was sufficient enough to transport oxygen for them to be alive. Then, we started doing open heart surgery at pressure. This is what was happening in the 50s. We exsanguinate all these pigs and then we see, "Oh, gosh, oxygen can be great," and then we bring them back to the surface, re-infuse them with their own blood, and they live happily ever after, and we're going, "Wait, this stuff really works. Holy mackerel." 

Melanie Avalon: So, the pigs basically weren't breathing any oxygen, but they were still being oxygenated from the pressure? 

Joseph Dituri: No, they were breathing oxygen. So basically, they were breathing in and out and their fluid in their circulatory system was replaced. Instead of having hemoglobin, it had just plasma. 

Melanie Avalon: Oh, okay. They didn't have any hemoglobin. Okay.  

Joseph Dituri: No hemoglobin. They exsanguinated them basically and when they did so, you had to see the picture is pretty gruesome. You could look it up, [laughs] but it's-- they're very pale and ashen. You look at them and you go, "Oh, my God, that pig's dead." Sure enough, they re-infused it and it was okay. 

Melanie Avalon: Wow. Okay. So, if a person had anemia? 

Joseph Dituri: Oh, yeah, absolutely. So, anemia can be fixed. This is where I kind of go into it. Look, we can fix anemia, but what caused the anemia? If you're anemic because you have a shortage of ability to produce hemoglobin, I can fix you short term, but I can't fix your long term. 

Melanie Avalon: You have to walk around in a pressure suit. 

Joseph Dituri: Exactly, walk around in a pressure suit. But what this does is, it fixes something called oxygen debt and the oxygen debt that most people run around with, people in poor health, smokers, those emphysema patients, they walk around in this, oh, the post-COVID people, they walk around in oxygen debt. Your body has great compensatory mechanisms. Your listeners probably know all this because they beat themselves up on a daily basis and then they repair themselves. They beat themselves up, then they repair themselves. It's what our body does. It's that whole, I want to break the muscle down, I want to build the muscle up. Same general principle. When you are looking to hyper oxygenate something, you're looking to find the real reason for it. Like I said that anemia is the underlying problem with the oxygen debt gives you a-- it basically gives you like this, you're walking around in a debt for days and this is why people will have-- they have lethargy, they have brain fog, they're nauseous, they have inability to take a full breath, dyspnea, and we're helping this oxygen debt by paying back that oxygen debt. Your body can run for a little while even when it's in an oxygen debt, but you got to pay it off at some point and that is what we can help do. 

Melanie Avalon: When you're in the chamber, you breathe 100% oxygen? 

Joseph Dituri: There's two types of chambers. Well, there's three types of chambers. But there are mild hyperbaric oxygen therapy chambers, which are basically flexible, and they would be on the floor and maybe somebody's office. They're not hard-shelled chambers. Then, there are hard-shell chambers. There are other kinds, veterinary chambers and so forth and so on, I don't want to go into those because I don't think your audience is there. But with respect to these, there are two separate kinds. You are looking for a hard chamber. Why? Because all the math, all the science, all the papers that were written were all written on the science that happens inside the hard chambers. When I say hard chambers, these are all at two times the pressure or three times the pressure that we're at right now.  

The soft chambers, they can only go to like 1.1 or 1.2 times the pressure we're at right now. So, what I continually go after them at is I said, "Listen, where's the science behind what you're doing in the soft chamber? Because it can only go to like one point--" You're basically breathing effectively 117% oxygen. So, why are we doing that? What's the real benefit there? So that's where I'm looking for the science. And look, science wins over BS every time that's at least what I say. I don't throw at the laws of physics because they always apply. Will it carry a little more oxygen in the plasma when you're at 117% oxygen as opposed to when you're at almost 300% Oxygen? Yeah. But how much more? 

Melanie Avalon: The one I did was a soft chamber, sad face. I need to clarify. [laughs] 

Joseph Dituri: No. No, no. no. Here's the good news. If you can get in a soft chamber, you can get into my chamber and come down here and do a podcast from inside my chamber. It is clear acrylic, you'll look through it, and I'm telling you people will sit up halfway through the treatment, like, they're talking to me and forget that there's something over their head because you really can't see through it. You can seek completely through it, you really can. You can't see that it's there because there's nothing there. They hit the head on chamber like, "Wait, don't, don't--" bonk. [laughs] Okay. And then they go, "Damn it. I totally forgot that was there." [laughs]  

Melanie Avalon: It's doable. Since it does go to the higher pressure, does it feel any different?  

Joseph Dituri: Nope.  

Melanie Avalon: Yeah, that just kind of blew my mind the fact that you don't realize it. You don't feel it. For the hard chamber, how long does it take to pressurize, to bring you up to that pressure? 

Joseph Dituri: I take it nice and slow. When I take my patients down, I'll take them in a curvilinear descent or very, very slow at first and then faster as you get deeper. It prevents any problem with middle ear barotrauma which by the way is the most common problem in pressurizing in chambers. So, I try and prevent middle ear barotrauma. It takes me 10 minutes to get to depth. I go real slow. 

Melanie Avalon: Okay, 10 minutes, okay. Are airplanes pressurized too what we normally experience or they pressured different? 

Joseph Dituri: Interestingly enough airplanes, the Boeing 767 Dreamliner, which is the only one that I have the numbers off the top of my head at, the Boeing 767 Dreamliner is pressurized to 11.06 pounds per square inch. So, about 11 pounds per square inch, right?  

Melanie Avalon: And we're at 14 something, right?  

Joseph Dituri: And we're at 14.7. So, that's why your ears kind of pop as you go up. Then when you come down, you have to put your finger-- This is why babies cry on airplanes. Because their ears are all jacked up, and they don't know what's going on. So, if their mom gives him a bottle on the way down, they can sort of work that out. They stretch the eustachian tube, they clear a little bit, they get rid of that inner ear problem or the middle ear problem as the case may be. But you notice that it's only pressurized to about 8,000 feet, which is about 11 psi. But they fly at 35,000 feet. So, technically, a plane is a hyperbaric chamber because at 35,000 feet, it would be less than a half an atmosphere. When you pressurize it or can pressurize it to 8,000 feet, which is about 11 psi, so you go from about 7 psi if you're at 35,000 feet all the way to 11 psi, a plane is a hyperbaric chamber. 

Melanie Avalon: It's a hyperbaric chamber, but less pressure compared to hyperbaric therapy where it's more pressure. 

Joseph Dituri: Exactly, exactly. But it's less pressure than it's at because it's flying at 35,000 feet. Yeah, it's pressurized to feel like it's flying at 8,000 feet. See, I'm saying so, they increase the pressure inside the plane. 

Melanie Avalon: So, it's more pressure than the outside. Okay, I understand.  

Joseph Dituri: That's exactly right.  

Melanie Avalon: More pressure than the outside, it's less pressure than when we're at sea level. So, when the plane is going up, is that when the pressurizing is happening and is it slowly happening? 

Joseph Dituri: Yep. So, it's slowly happening the entire time as you ascend. You go over 8,000 feet, it continues to pressurize, pressurize, pressurize. Actually, truly, it starts before that because it takes time for that to build up. And you know, airplanes are kind of leaky. They're held together with pop rivets and stuff like that. But they're not made to be completely pressure proof. They leak a little bit. So, the turbine engine devotes a small amount of that air to compress that air so that it goes in and pressurizes and then it also goes into the engine so that it can efficiently combust while it's in the engine. Otherwise, when you're at 35,000 feet not a lot of combustion happens at 35,000 feet, but we need the airplane to fly. So, we have to pressurize that air so that it can be combustible. 

Melanie Avalon: Is our baseline pressure related to what we experience every single day. Let me clarify-- Like what I mean by that is, so, when we're up in that plane and we're at a pressure that is higher than the pressure outside, but lower than the pressure when we're down below, is our body experiencing more or less pressure? Like where's the baseline? Is it comparing it to outside the plane? 

Joseph Dituri: No. So, your body is at less pressure and it feels like-- Your body only feels the pressure that it's at right now. Here I am flying in a plane and I'm at 35,000 feet, that cabin is pressurized, it feels like I'm at 8,000 feet above sea level which is about 11 psi or pounds per square inch, which is only about 3 psi less than we're at right now-- 3 or 4 psi less than we're at right now. 

Melanie Avalon: So, it compares to the psi, the baseline that you came from which was on the ground. 

Joseph Dituri: Exactly. Interesting, when you're in Colorado, you're at 5,000 feet when you start [laughs] you knew you were going there, weren't you? [laughs] I love it. I love it. 

Melanie Avalon: How long would it take for your body to have a new baseline?  

Joseph Dituri: Yeah. So, this is exactly why your athletes that listen into this show probably train in a hypoxic environment. Because after a period of a couple of days, you can acclimate to an altitude. And this is your body's compensatory mechanism. Your body makes more hemoglobin to transport the basically, less pressurized oxygen when you're at 5,000 feet. This is why we got those climbers that are climbing Mount Everest. They go to basecamp which is arguably 14,000, 15,000 feet of basecamp, and here they are acclimating for weeks trying to get your body to build up more red blood cells so that you can increase the oxygen carrying capacity throughout the entire body. But that's the compensatory mechanism. This is why we can live at 8,000, 10,000, 12,000 feet and get away with it because our body compensates for it. 

Melanie Avalon: Oh, so the reason that you build more oxygen capacity at higher altitudes is because you have to because you don't have the pressure that's like when you're at lower altitude. 

Joseph Dituri: Exactly. Because there's effectively less oxygen. This is why athletes go and train so that they get that extra--. This is blood doping. I'm dumbing it down but yeah, this is blood doping. No joke. [laughs]  

Melanie Avalon: If you were in a pressurized chamber not breathing pure oxygen, would you still get oxygenated from the pressure alone? 

Joseph Dituri: A little bit, yes, but because there's-- effectively, if you're at 2 atmospheres, which is in this case 33 feet of seawater or double the pressure that we're at right now, you could pressurize to 2 atmospheres, you would effectively be carrying 21% oxygen on the surface. That's what's in air, basically, 20.8 but 21. You'd be carrying 42% oxygen because it doubles the amount of oxygen. 

Melanie Avalon: With the chambers themselves, so, the one I did the soft shell, you wore a mask to breathe in the oxygen? What's the difference between that and the chambers that are pressurized with actual oxygen? 

Joseph Dituri: Pressurizing with oxygen and breathing oxygen, it makes no difference. So, if you beath-- so oxygen is classified as a drug by the USP. It's dosed in liters per minute but it has to be inspired. You can't just pull oxygen around your body, and try and breathe it in through your body. There's a little bit of absorption that comes through your body, but not enough to support cellular respiration. So, when you breathe in oxygen and I'm talking breathing in 100% oxygen, not a mixture of compressed air that is oxygen, and that's the problem with the soft chambers. They only get you about 80% or 90% pure O2 coming in those. So, it's not even as effective as 100% oxygen would be with that pressure, too. So, it's kind of a problem there but yeah, if you're breathing 100% oxygen the effect is the effect. Now, that makes sense?  

Joseph Dituri: Yeah. Yes, it does. I was suspicious of that when I was in the soft chamber. 

Joseph Dituri: Yeah, because that mask probably didn't seal very well.  

Melanie Avalon: She told me it didn't matter if it wasn't completely sealed. I was like, "This just doesn't make sense to me." 

Joseph Dituri: No, that matters 100%. It matters. [laughs] It's physics, it has to work. This is what I love. It's like, "Oh, it's just physics." [laughs] 

Melanie Avalon: It's fine. [laughs] Really random question. You were talking about the planes being leaky. Why do balloons pop? 

Joseph Dituri: Ah, great question. So, it's the general gas law, right? Pressure times volume divided by temperature equals pressure times volume divided by temperature, right? As you ascend, as you get up in the air, basically, that gas because pressure-- if we fix temperature, pressure and volume are inversely proportional. One goes up, the other has to go down. One goes down, the other has to go up. So, what we have is a balloon, there's less pressure on the balloon the more you go up. So, if I'm here at the surface, I'm holding my hands around the balloon and I basically have a balloon that's the size of your head. So, I'm holding my hands on a balloon that's the size of your head. If I go to half an atmosphere, that is half the pressure, that balloon will be twice the size. Because pressure and volume are inversely proportional given a fixed temperature. You have to fix temperature. You have to fix something in these laws. So, what happens is we have the expansion of things. So, the expansion of things will cause that balloon to wind up bursting at a certain-- You have structural integrity of a balloon at some altitude or whatever but that's exactly it.  

Melanie Avalon: Man, now, I wish, I want to go back to college. I want to study this.  

Joseph Dituri: Don’t do it, don't do it. I did it when I was 48. That was like I hated it.  

Melanie Avalon: I wish, I understood. This is a very esoteric question but the gas laws, and volume and pressure and temperature, is this something that only exists within our reality like quantum physics and stuff? Could it be different? 

Joseph Dituri: I love it. Let me brag on my middle daughter for just a half a second. She's a physics major at Caltech on a full ride. So, she freaking brilliant. She'd probably be able to answer that question on quantum physics better than I, given the current laws that we understand at this moment in time. I say that all the time because we are learning stuff that blows my mind. When I talk about quantum singularity or start thinking about quantum singularity, which sadly is what I do at 4 o'clock in the morning when I'm wide awake looking at the ceiling. I'm like, "I wonder if there's a universal constant that --" [laughs]  

Melanie Avalon: I'm an insomniac. You can text me next time. We can talk about it at 4 AM. [laughs]  

Joseph Dituri: This is why Kirk's trying to get me to sleep. He's like, "You need to sleep, idiot." [laughs] Given what we know right now, these laws are what-- This is like the guiding principles of our universe are the laws. These are the laws of physics. So, we can't break those laws. Right now, it's what we know. Now, are there ways around it? Sure. We were smart enough to think of ways around it, but maybe not me. Maybe there's somebody else smarter.  

Melanie Avalon: Well, this is a Star Trek episode here. Okay, so, back to the hyperbaric oxygen treatment, who should do it? Should you do it more likely if you're addressing certain conditions or can anybody benefit from it, and then, yeah, so, who should do it? 

Joseph Dituri: Great question. So, there are 14 approved indications by the approving authority. Basically, that's arterial gas embolism, anemia, arterial insufficiencies, carbon monoxide poisoning, blah, blah, blah, blah, blah, all these boring things, intracranial abscesses, thermal burns, all of those are pretty lockstep and most providers think, "Yeah, this is good juju. We want to make sure that we give people hyperbarics because this is something that we know." It's very tried and true if you know what I mean, right? Then, there's a whole host of what we call off label indications. I want to talk about the difference between off label and on label. So, off label indications are things that something is not approved for which means that CMS or the Center for Medicare or Medicaid services will not pay for them. But that doesn't mean that they don't work. So, there are plenty of people who are-- Look, for instance, Viagra. Viagra was designed as a cardiac drug. All of a sudden, we found out it's a smooth muscle mediator, and oh, my gosh, people were maintaining erections for long periods of time. Wow, this could be used off label for erectile dysfunction. Holy mackerel. 

We use drugs off label all the time. Like I said, USP is classified this oxygen as a drug, which by the way kills me because it's like a naturally occurring element. How do we classify it as a drug? It makes me insane. But I mean, off label indications, autism, multiple sclerosis, cerebral palsy, stroke, migraines, traumatic brain injury, Lyme disease, drowning, fibromyalgia, I could go on and on and on. There's like 30 or 40 indications. Now, some of them, it makes sense. Some of them, people are just looking for a cure. People are looking for a cure for their child who has multiple sclerosis. Does it work doc? I'm like, "Uh-huh. I don't know is the answer." The jury's half out, it's really hard because cerebral palsy, multiple sclerosis, even autism, they're really hard to get objective quality evidence behind them, because what mom says, "Well, I think he talks more." Well, I think and talks are, I need something objective. I need a cerebral blood flow brain scan so that I could prove beyond the shadow of a doubt that we increase CBF to the point where this person now had these outcomes that I can measure. 

Melanie Avalon: Speaking of oxygen as a drug, is there the potential for oxygen toxicity? 

Joseph Dituri: Absolutely. There is definitely a potential-- You can't get something good without having some possibility of something bad. So. yes, central nervous system, oxygen toxicity, there are two types of oxygen toxicity. Central nervous system, which has the manifestation of convulsions, visual disturbances, hearing disturbances, nausea, euphoria, twitching, tingling, irritability, and dizziness. Now, most of those are pretty innocuous. Who cares if you're a little dizzy, who cares if you're a little nauseous? It's not a big deal. Tingling, twitching, no big. But a convulsion, a full-on convulsion, that's some serious stuff. So, we want to try and avoid that. Generally speaking, human tolerance goes up to 3.0 pO2 or the effect of breathing 300% oxygen. We like to keep treatments a little lower, we like to keep them on the 2.0 side unless there's something really, really wrong with you. For instance, if you have carbon monoxide poisoning, the byproduct of burning any petroleum product if you will, that carbon monoxide buildup, it bonds more readily to your hemoglobin and you could die. It has a six-and-a-half-hour life in air. It has a 23-minute half-life in 100% oxygen at 3 atmospheres. So, this is a life saving measure in that case. So, we go all the way up to 3.0 or the effect of breathing 300% oxygen.  

Now, let me talk to you about this statistical probability of central nervous system oxygen toxicity. With all the other comorbidities involved, and I'm talking the poorly perfused, the diabetic ulcer, the emphysema with CO2 retention, all these things that are involved in selecting patients if you will, the worst of the worst. The statistical probability is one in 10,000. It's a 0.02% chance of getting it. [laughs] So, I'm laughing, but let me just give you a for instance. With none of the other comorbidities like if you're a basically what we call a walkie talkie, like you're a person that can walk around and talk pretty readily and you generally speaking are in good health, you have a one in 50,000 chance of getting central nervous system oxygen toxicity. So, one in 36,000 is the chance of you getting four white balls with no power ball. [laughs] And people don't even get that. Like, I've never got that many. Like I might get one number on the lot-- [laughs] Think about that the next time you're worried about central nervous system oxygen toxicity.  

But the other one is pulmonary oxygen toxicity, and that is, it builds up over time. When you're getting treatments over a long period of time, you could have reduced vital capacity, substernal irritation, pain on inspiration, and a dry, scratchy cough. That is common but realistically it's a 4% reduction in vital capacity. So, if you take a couple of days off, which is why we only treat Monday to Friday, we generally speaking don't treat on the weekends, unless it's an emergency. 

Melanie Avalon: I never tested for it. So, I can't confirm that I had it. But I'm pretty sure I had carbon monoxide poisoning. I was in an apartment and I was using the oven every night and I felt so sick in that apartment, and then finally I had the gas company come, they had to shut it off. They're like, "This has been leaking," and that apartment had black mold. Fun times. 

Joseph Dituri: Oh, let me tell you what, by the way, #moldtoxicity is something we treat in here because there's an anti-toxin effect of the oxygen that I'm telling you, the physician that I have is sold on, this is the cure for the mold toxicity thing.  

Melanie Avalon: Does it do that by increasing reactive oxygen species temporarily? 

Joseph Dituri: Yeah. We do increase reactive oxygen species, but it's a necessary evil. But yeah, so, you wind up working through the toxicity, like I said, there's an anti-toxin sort of effect. Same thing with carbon monoxide poisoning and mold toxicity. It's the same apparent mechanism of action. Now, mind you, there are only a couple of peer reviewed papers on mold toxicity, but it's pretty well good. The results are good. Even if you only help 50% of the people, is that good enough? I don't know. You know, look, the Center for Medicare-Medicaid Services, the problem with them is they can't approve every indication, even if the science supports it. If they do, there's just no money behind it. So, they go, "Oh, well, there's no money. So, therefore, we're not going to be able to do that." 

Melanie Avalon: That's really encouraging though, because I feel like mold toxicity is such an insidious thing that is really hard for people to find treatments for that work. 

Joseph Dituri: Yeah, I mean Crohn's ulcerative colitis, vascular dementia.  

Melanie Avalon: Is there anything that you recommend stacking like supplement wise while doing it? What would happen if you took aspirin, which is a blood thinner, how would that affect things? 

Joseph Dituri: So, with respect to that, aspirin would probably increase the perfusion because it's going to make it thinner. You decrease the viscosity or increase the perfusion, that make sense to me. This is actually what I teach at the university. So, I teach blood flow in the human body. When I teach this stuff, this is where the physicians go, "Wait, hold on a second. That's not the way it works." I'm like, "Actually, that's exactly the way it works." [laughs] So, as you're looking at this, I would say, remember, I'm a PhD, not an MD. So, I don't have a medical opinion. I just have an opinion. I would say, the first thing you need to do is prep the mitochondria. Because the mitochondria has adenosine triphosphate, adenosine diphosphate up, down, up, down. We need the mitochondria to be healthy. Once the mitochondria healthy, we can do this whole oxygen uptake thing. We can do this whole cellular respiration thing more efficiently. Short of that, I worked with a whole bunch of physiologists in the very beginning of my navy days, and when I'm working with these guys, they're like, "Listen, don't waste your time on changing small variables like whether or not I'm going to get antioxidants in my body. Don't worry about that. You're going to do an inch of change for going down the road two miles." It's like, so, you go two miles and one inch. Okay, I got you. You know what I'm saying? So, go with the thing that's the prime mover. Go with the thing that helps you the most.  

Melanie Avalon: Would that be like diet and lifestyle compared to supplements? 

Joseph Dituri: That would be where I would go is diet and lifestyle changes as opposed to supplements. Look, people are like, "Do you eat chocolate?" Well, yeah, I eat chocolate. Of course, I eat a chocolate. "Would you rather have dark chocolate or light chocolate?" I don’t know. Whichever chocolate you have is probably the chocolate I'll take. But I like I said, I don't put too much stock in the fact that yes, I believe that dark chocolate is probably better for you, and releases antioxidants, and blueberries, too. But yeah, I do the lifestyle change first that'll probably help you. Good healthy habits are Joe's opinion, you know. 

Melanie Avalon: Do you have thoughts on daily low dose aspirin for health? 

Joseph Dituri: Yeah. So, depending on where you're at, I suggest that all my divers, any of my divers, and I'm not a doctor, but I'm not an MD. So, I suggest that all my divers have that baby aspirin that whatever, it's 81 milligrams, I think. 81 milligram aspirin because it increases or it thins your blood basically. So, yeah, it's a good thing when you're in this situation. So, should you continually moderate that? No. Should you be on a small dose of aspirin all the time? No. I don't do a lot of-- I had to teach my kids some sort of religion if you will, and what I wound up teaching them was this whole thing about balance, I'm like, "Listen, my opinion is that everything should be in balance. Then, there's family, consideration of others, all that kind of stuff." But all that has to be in balance, right?  

So, even a baby aspirin every day? No, I don't do anything every day. So, balance, if you always take it, then your blood will go back to the level that it was before because it'll increase viscosity in some other way. You know what I'm saying? So, everything has to be in balance. If you stop that production ability for your body to decrease the viscosity, then your body will no longer be able to do that. So, second, third order consequences, you'll pull yourself in a direction where possibly you would not like where you want to be. 

Melanie Avalon: Okay. I'm haunted by this question.  

Joseph Dituri: Oh, gosh, really?  

Melanie Avalon: Yes. I just don't know if I should I be taking daily low-dose aspirin or not. I ask everybody who I think might have some knowledge about this question and you really would have knowledge because of your expertise so.  

Joseph Dituri: Well. [laughs] I hope that I'm helping. Most of the time, the questions really don't have an answer. It's like, "I don't know," is the answer, oh goodness. [laughs]  

Melanie Avalon: Story of my life. But another question about the gases. Have you read Breath? 

Joseph Dituri:  Wim Hof?  

Melanie Avalon: James Nestor. 

Joseph Dituri: No, I have not read.  

Melanie Avalon: I love Wim Hof.  

Joseph Dituri: Yeah. Me, too. Me, too. 

Melanie Avalon: Did I tell you I had him on the show?  

Joseph Dituri: No. Oh, my gosh. Oh, that would have been freaking epic to meet him. [laughs]  

Melanie Avalon: Honestly, I mean this. Out of all the conversations I've had in my entire life, it was the most inspiring conversation I've ever had. 

Joseph Dituri: That guy is incredible.  

Melanie Avalon: He's insane and his book is amazing. Do you do this Wim Hof Method? 

Joseph Dituri: I do. I do. I do and I love it.  

Melanie Avalon: Yeah, daily? 

Joseph Dituri: Daily. I don't do anything daily, unfortunately, but [laughs] I believe there's significant benefit in that and I have-- This whole mind control, body control thing, there's a lot to that. I believe that there is a ton to that and we're just cracking the code on this now. 

Melanie Avalon: Yeah. The studies on his work are really, really incredible. I love it. For listeners, I'll put a link in the show notes to that episode. I've started doing cryotherapy as well. Do you do that? 

Joseph Dituri: I don't do cryo. I'm an ice bath kind of guy.  

Melanie Avalon: Okay. Yeah. I haven't done an ice bath, actually. 

Joseph Dituri: Oh, my God. Me, 40 pounds of ice and 22 minutes. Oh, wow. Oh, yeah. You have to build up to 22 minutes, but Dr. Kirk Parsley will do-- he'll do 30 to 40 minutes. He's like, "Yeah, no problem." I'm like, "You're insane, man." [laughs] But when you think about it, it is all about perfusion? So, what happens when you ice things you decrease the blood flow to them? Then when you get out, you get right in the hot water, what do you do? You increase the blood flow. So, you're changing the perfusion, and you're rapidly infusing, and then you're rapidly reversing it, and then you're rapidly infusing it, and then you're rapidly reversing it. So, all that healing power that comes from that inrush of oxygenated blood is like, "Ah." It gets through the poorly perfused spots. So, it is an epic form of doing things. Now, I don't know. I've heard people that stand in those cold things and it doesn't do any good for them. I've never done it, so I couldn't even tell you whether it's good or not. 

Melanie Avalon: I will just say I am so addicted now. It makes me feel so good. Like, so good. And I do three minutes at -220 and I walk out, I just feel like amazing.  

Joseph Dituri: Really? Yeah, look, as far as I'm concerned, if it's a placebo and it works, my goodness, it works. [laughs] I don't care. Or if it does something, then great. I'm all for things that help you whether it's just, "Hey, I took a sugar pill and I feel better in my head." [laughs]  

Melanie Avalon: With ice bath do you alternate, do you go to like a sauna and the ice bath? 

Joseph Dituri: So, I'll do it twice. I'll do it rapid cold, sit in it for 22 minutes, get up, go take a hot shower, and then wait till my body back, gets to be the point where it's hot again. And then, I will dump right back in which is really freaking hard to go right back in. As a matter of fact, I use Wim Hof when I'm in the ice bath because I'm like, [fast breathing] I'm like, "Where's that stuff, heat me up now, Wim?" [laughs]  

Melanie Avalon: Oh, my gosh. He's amazing. I remember the first time I ever tried his method, I was just shocked by how long I could hold my breath. I was like, "What is happening?" I was watching the clock and I was like, "This is so easy." I'm so confused. 

Joseph Dituri: Why is this so hard for people? Yeah, no good stuff. 

Melanie Avalon: James Nestor, it's all about breathing, and I had him on the show as well but he talks a lot about oxygen versus carbon dioxide, and he talks a lot about the benefits of carbon dioxide. Do you have thoughts on oxygen deprivation or excess carbon dioxide for health? 

Joseph Dituri: Carbon dioxide, so, I'm trying to think through the physiology. A carbon dioxide is a vasodilator, oxygen is a vasoconstrictor. So, they have an opposite effect. Oxygen, it would increase vasoconstriction, which will increase blood pressure and reduce the amount of oxygen delivered to your tissues. This is why you have to balance that thing. But carbon dioxide is a vasodilator, which will increase the amount of oxygen to the tissues. But once again, this is like you're trying to needle this thing down and you're going to get an inch ahead when you're actually moving a mile. So, I would say that, is there benefit in doing hypoxic training? That means less oxygen than 21%. So, yeah, if you're doing hypoxic training, what does your body's compensatory mechanism do? It makes more red blood cells, which then increases your oxygen carrying capacity for your overall body, that makes sense. To me, carbon dioxide base training doesn't make a whole lot of sense. But that doesn't mean that it's not right. Just because I haven't heard of it, it doesn't make it-- I'm not the end all, be all I'm at. Trust me. 

Melanie Avalon: Well, I think the most fascinating thing I learned from his book is, have you heard about the studies they've done on phobias with carbon dioxide treatment?  

Joseph Dituri: No. 

Melanie Avalon: Oh, my goodness, it blew my mind. So, they can treat phobias with carbon dioxide and he talks about how he did it in the book. They just give you excess carbon dioxide and you still have normal oxygen, but for some reason, you feel like you can't breathe with the carbon dioxide. They use it to treat phobias because I guess, he talks about the science of it. The acute exposure to that just complete panic does something to the body. I'll put a link in the show notes. It sounds really terrifying. So, I took a quiz on my claustrophobia. The fun fact. There're two types of claustrophobia. Did you know this?  

Joseph Dituri: No.  

Melanie Avalon: So, if you take a claustrophobia quiz to figure out what type you have. I have the form that's actually fear of suffocation. It's not what you think of with claustrophobia, it's fear of suffocation. So, literally, that carbon dioxide treatment sounds like the worst thing I could ever experience because you just feel like you're suffocating.  

Joseph Dituri: That seems daunting to me but look, man, like I said, there's a whole bunch in this life that I do not understand.  

Melanie Avalon: It's fascinating. Okay, one more question about the hyperbarics. So, actually, doing the treatment because you talked about doing it Monday through Friday and how you don't do it on the weekends. So, if somebody is doing it for health or to treat something, what is the typical treatment protocol like, is there a dose, like a high dosing period in the beginning where you're doing it more or--? 

Joseph Dituri: No, it's not a high dosing period. Because like I said, oxygen is a vasoconstrictor. So, the more oxygen you apply, the more your body's going to vasoconstrict, and the more it's going to reduce the blood flow to the area. So, it's-- the life lesson is balanced. Everything has to be in balance. So, wait, let me back up. The data doesn't support that seven-day-a-week habit. Now, the reason why some of these protocols are written and you asked me what the common protocol is and I'll just tell you. Commonly, people and things are treated between 2.0 and 2.4 partial pressure of oxygen or about 200% to 240% oxygen if you will. So, that's basically effectively being at 33 to 45 feet of seawater, give or take, pressurized if you will. But you're in a dry chamber, so you can do that for between 60 and 90 minutes, and generally speaking, that cures most of the things that we have.  

Now, traumatic brain injury, PTSD, those are being treated at far less 1.6, 1.7 pO2 or 160, 170 partial pressure of oxygen. But generally speaking, everybody's treated around 2.0. We don't dose load, we don't do like a five, four, three, two, one or anything like that. Unless, there's something really acute wrong with you, carbon monoxide poisoning, we may treat you three times a day, then two times a day, then one time a day, but that's only to reduce the half-life of carbon monoxide. So, generally speaking that's the dosing and that's the dosage that we will be looking for in the general time. 

Melanie Avalon: And how long did those sessions last? 

Joseph Dituri: Oh, between 60 and 90 minutes. 

Melanie Avalon: Okay. Is it something that you can continue for life or how long do you do it for? 

Joseph Dituri: So, everybody had that picture of Michael Jackson in the hyperbaric chamber and they said, he sleeps in the hyperbaric chamber. So, first of all, that never actually happened. What happened was, you're not old enough to remember him getting his hair caught on fire during the Pepsi commercial. He got his hair caught on fire, and then he got burned while he was in Miami doing that shoot. So, they sent them over to the Miami Burn Center, and they did such a good job with him being burned victim, he decided to donate a ton of money, they opened up the Michael Jackson wing, which put hyperbaric oxygen therapy in the burn unit, and he did a photo op of him laying in the chamber, and everybody's like, "Oh, he's sleeping in the chamber. This is why he looks like he's a child." No, that's not how it worked. [laughs] So, now, did he do some different things? Yeah, he did. But that wasn't the cause of all that problem.  

Can you stay in there forever? Sure. You can do anything but what's Joe's first life lesson, balance? So, if you all of a sudden have all the oxygen that you need, you don't need any extra hemoglobin. What's that going to do? It's going to reduce the amount of hemoglobin production that you do. So, your bone marrow is not going to need that. Your bone marrow is not going to be able to produce that. And then when you come back into an air environment, you're going to be in a slightly hypoxic state. Why? Because you live in a state that's 100% oxygen at 2.0 pO2, you can have big problems long term, like I said, the pulmonary oxygen toxicity, reduced vital capacity, substernal irritation, pain on inspiration, and dry, scratchy cough, those things will come after about five days' worth of treatment, and you'll be hearing the patient, you're treating the patient, and they're kind of wheezing a little bit like [wheezing noises] You know, that happens.  

But all of these protocols that we have designed a researcher, I just want to keep-- your listeners to keep this in mind. The researcher sat in a room, came up with this protocol without any input. And I'll give you a perfect for instance. There was for instance of a colonel who was doing this because the Air Force did a whole bunch of treatment protocol stuff. Colonel that was doing these treatments and a four-star General that was one of his patients that was going to do a study in how he got cured and got better using hyperbaric oxygen therapy. So, the colonel came up with the protocol and said, "Listen, it's going to be two hours long, you're going to be in the chamber, it'll take you 10 minutes to get down, six minutes to get up, so, that's two hours and 16 minutes. I want to treat you seven days a week." The General-- the four-star general looks at him and goes, "Mm, no." So, here's the way it's going to happen, colonel. I'm only going to do this five days a week, Monday through Friday, because I'm not coming in on Saturday and Sunday. And then, oh, by the way, you're going to reduce that time down to about an hour and a half so that I can get out and catch the bus. The bus comes every two hours to come to this facility and I am not going to wait around here for extra hours sitting here doing nothing when I have just missed the bus. Do you understand me, colonel?" And the colonel went, "Yes, General," because that's what colonels say when Generals tell them something. But that's how the protocol was made and it turned out that it worked. Now, would it have worked if they did the seven-day week protocol, two hours? Probably, but who knows. That protocol came completely, you know-- So, yes, it's written in science, but it's not exact science.  

Melanie Avalon: And to clarify, you've said, five days a person might start experiencing these symptoms. Is that if the person is having issues and experiencing this-- will every person after five days experience that or just if they are having issues with it? 

Joseph Dituri: No. So, you may or may not experience those things. It depends and individual susceptibilities vary on individual days. So, you go back to the mechanism of action for the seizure, the convulsion-- the hyperbaric oxygen convulsion. We still don't know what the true mechanism of action is. We think it's increased cerebral blood flow, and then, we think it's something, well, we know it's something going on in the central nervous system because we have EEGs to prove it. So, we see it's in the central nervous system, we see that it's happening. But all we know is that it seems to occur with a high amount of oxygen and longer duration than shorter duration. So, it's like, we think we know the etiology sort of, but really, it's not pinpointed. So, this is one of those like could happen on a Tuesday, it might happen on a Wednesday, it might happen to you tomorrow, but will not happen to you today. I ate an onion last night, maybe that's got something to do with it. I have no idea. So, I think like, if you start --  

This is why I recommend that people don't start changing around their physiology. Because for instance, if you break down the things that have to do with hyperbaric oxygen, and you being able to stave off central nervous system oxygen toxicity, you find that vitamin E is one of those things that makes you, it's prophylactic the central nervous system oxygen toxicity, but if you don't have enough of it, it makes you more likely to have oxygen toxicity. So, it's like, "Wait a minute, wait a minute, you're messing with your vitamin E, I would not mess with my vitamin E levels like oh, boy, in and out." 

Melanie Avalon: I get really nervous with concentrated supplements like that or vitamins because I just don't feel like my conscious brain has more knowledge about what I need in my actual body, like taking things naturally from food compared to giving it in concentrated form. I feel like my body could probably figure it out better. 

Joseph Dituri: Yeah, exactly. That's why it's like, listen, just do whatever you do. People like, "Should I be in ketosis because I heard that starvation releases ketones and that seems like it's catabolic instead of anabolic." So, maybe, yeah, okay that might work. I'm like, "No, don't mess with anything." If you're in ketosis, be in ketosis and that's just fine. But if you're not, don't do it just for this decompression chamber treatment. 

Melanie Avalon: I interviewed Dave Asprey on this show and he suggested getting your own at-home unit. How do you feel about that?  

Joseph Dituri: The at-home units?  

Melanie Avalon: He said like, order your own unit, and have at your house, and just do it yourself, and it'd be cheaper. Is that okay, is that dangerous? 

Joseph Dituri: It's a ton cheaper. Is it okay? There's no science that says that it's okay. So, basically, what it is, is the soft chambers or these home chambers, or things like that, they wind up giving you about-- Ballpark, if you do the math, it winds up being about 120% or 117% oxygen. This is my problem with the soft chambers. I'm like, A, where's your research behind that? B, you're going to say that 117% oxygen is statistically significantly better than 100% oxygen. Show me the paper. Show me one paper. Show me something that's scientific peer reviewed, that's published literature that gives you--" I'm not saying that physics doesn't apply. I'm sure there's more oxygen carrying capacity in 117% oxygen than there is in 100% oxygen, but how much more? Two-fifths or five-eighths of whatever? [laughs] No. Realistically, they're about $30,000 apiece. So, if you had $30,000, and you want to go get hyperbaric treatments, I'm going to ballpark it here and I'm going to say that most treatment places for hard shell chambers are between $200 and $350 for a treatment. Let's just put it right, you know, $250.  

Even if you get $250 treatments, you can get hundred [laughs] You know, what are we talking about here? So, I don't know. Here's my theory, when we treat people here at the clinic. I would like to treat you for x number of times, and then you go away, and the only time I see you is when you bump into me at the mall and you go, "Oh, my God, doc, you guys did so great. I was perfect from that point on. Thank you very much." If some kind of thing that you're doing requires you to keep coming back for more, probably not doing what you think it's going to do. Because we're trying to help you or what my MD says is, "Address the bottom line." You can fix anemia but if you're still anemic and you have a problem with hemoglobin production, you're going to be anemic and you haven't fixed the problem. You fixed your oxygen depth, but you haven't fixed the problem. So, you know the drill. 

Melanie Avalon: So, it sounds like for listeners, they want to seek out a hard unit at a clinic, perfect. Is there anything that we didn't really touch on that you think is really important for listeners to know about all of this? 

Joseph Dituri: Oh, my gosh, like 8 billion other things, I mean-- So, for instance, post-COVID long haulers were trying to get funding, finish up the funding for a study. University gave me a little bit of funding for a study in post-COVID. What I found is that, when you have post-COVID, you have the lethargy, you have the nausea, you have the brain fog, and you have the reduced vital capacity. You can get in hyperbaric chamber and about 10 treatments later, if you're at the right partial pressure of oxygen and everything, you can be treated, and you can pay back that oxygen debt that COVID gave you. You can pay back that oxygen debt, reduce the brain fog, and from--  

Now, brain fog, something that I can't really quantify. But I can quantify vital capacity. So, I can use a measure called FEV1, forced expiratory volume. I can say that I increased your FEV1 from 60 something percent to 90 something percent. Wow, we did something with that. That's what hyperbaric oxygen therapy does. We treated the flu of 1918 in hyperbaric chambers. We treat viral infections in hyperbaric chambers all the time. But it is not something that's common. So, all these doctors are going, "It's not standard of care." I'm like, "Really? What's the standard of care for COVID?" So, just understand what the physics and physiology does and like I said, don't throw the baby out with the bathwater. Maybe, it'll work. 

Melanie Avalon: Do you think this is something that will be more and more available to people? Do you think it's on the rise? 

Joseph Dituri: I opine that people are looking for a different answer. I don't know what your problem is but it's not a pill that's going to fix you. So, you got to give your body the opportunity to fix itself. How do you do that? You can do something naturopathic, natural. So, I'm getting lots of calls, anti-aging calls, anemia calls, wellness calls, mold toxicity calls, addiction calls, ulcerative colitis and Crohn's. I'm like, "Look, I'll do a study on it. We'll see if it'll work." It kind of makes sense whatever but yeah, I think, it is on the rise, and as we make this break from Western medicine, and a pill as your cure, and pharmacist industry trying to lead us to something that is a little more help based, that type thing, I think that we're going to be a lot better off. So, that's my opinion. I think that it's on the rise, it's on the uptake. 

Melanie Avalon: I have a super random question for you. I was just wondering if especially, after reading your kids book, I'm just wondering what's like the craziest thing you've seen in your diving adventures in the ocean? Have you seen any sea monsters or sunken ships or--? 

Joseph Dituri: Yeah. So, one of the coolest dives I've ever done was on the Arizona. As a military officer, you get to re-enlist a person. I did a really cool dive on the Arizona Memorial where we kneeled down, lots of solemn, lots of prayer, that kind of thing, and it was you know-- This is basically a grave site, and you're on this thing, and hands down it was a great experience because you felt like you're bonded with these sailors that were down there. You did the reenlistment for the guy. That was a great thing. But now, I haven't seen a whole lot of stuff. I did a bunch of time, doing deep dives, and you see interesting fish, but yeah, fish don't throw me, my ichthyologist friends, yes, they do, but not me. [laughs]  

Melanie Avalon: I just thought it was so cool how in the book you said, "I've never thought about this that the colors disappear in the order of the rainbow." 

Joseph Dituri: Yeah. Oh, so red, orange, yellow, green, blue, indigo, violet. So, by the time you get to like 70, 80 feet, everything basically looks the same. So, it's like it's all purplish, bluish. That's why they call it the Twilight zone. So, you go down there and it all looks like it's Twilight. It's darker, it's hard to see, it's tough. So, you want to do some cool diving, go in the shallows and you will see lots of pretty colors and lots of pretty fishes. 

Melanie Avalon: Perfect. Oh, my goodness. Well, this has been absolutely amazing and wonderful. I learned so much. My mind is blown. I have so many things I want to think about now. 

Joseph Dituri: Well, pick up the phone, call me or I'll come back if you need me or want me, or whatever. I'd love to continue the education because this is what I do. I teach this course at the University of South Florida-- I teach a course in hyperbaric medicine at the University of South Florida Medical School as well as the Biomedical Engineering Department. So, we try and get this word out to the people so that we understand it.  

Melanie Avalon: That's amazing. I feel like you'd be a really amazing professor. You're like the cool professor. [laughs]  

Joseph Dituri: I don't know about that.  

Melanie Avalon: Oh, my goodness. Well, so the last question I actually ask every single guest on this show and it's just because I realized more and more each day how important mindset is surrounding everything. So, what is something that you're grateful for?  

Joseph Dituri: Oh, my goodness. I absolutely lead a blessed life. I really do. I stopped about eight, 10 years ago, and I started making a list of all the people that were positive influences in my life. I'm talking like mentors and for instance, Kirk Parsley, he's one of them. I started making a list of all these people and I have so many people that were positive influences in my life. I'm just a kid from New York who grew up in New York. I couldn't even make it into college. They looked at my SAT score and laughed. I'm not even joking. I got a nine, 10 on the SAT, and they were like, "What? Are you broken? What's wrong with you?" Now, I have a PhD. It's like, it doesn't matter, right? But why? Because somebody saw something in me, and put their hand out, and then I had the guts to reach up and take their hand, and then they pulled me up.  

So, I have all these people in my life that have blessed me, that have pulled me up, that have helped me continually, I mean, Dr. Parsley is one of them, and he helps me on a daily basis. Every time I think about something that he does, it's like, "Oh, yeah, that's what I do." Then it's a great symbiotic relationship because we bounce off of one another. But people like that in my life, that's the thing that I'm most grateful for just being lifted up by others. So, I'm blessed man. 

Melanie Avalon: I love that. Like I said, I ask every guest that question. Nobody's said anything like that before. That's like such a wonderful answer. I agree. [laughs] So, one last question for you. How can listeners best follow your work? 

Joseph Dituri: I have all these handles. So, Dr. Deep Sea seems to be the main one. So, it's D-R-D-E-E-P-S-E-A. And you can look on Instagram and Twitter and all that and check out www.drdeepsea.com. Please don't laugh at the handle. It's kind of a marketing thing. 

Melanie Avalon: No, I love it. I love it. So, for listeners, we'll put links to all of that in the show notes. The show notes again will be at melanieavalon.com/hyperbarics. And then, also for listeners, the show notes will have a complete transcript. So, I know we went deep, no pun intended into a lot of things. Yeah, you can check out that transcript. I'm so grateful to have met you. This has been amazing. 

Joseph Dituri: Listen, I'm going to put down the gauntlet. Here's the challenge. Tampa is not that far of a drive. Come down here, I will slowly work you into the chambers, we will get you in the chamber, and you do a podcast from inside the chamber. Show your people, who will just go crazy. It'd be great. Talk about setting a goal, and achieving a goal, and having the proper mindset. Let's get you. 

Melanie Avalon: Goals. I was scared to even get in one. So, baby steps. Although, now, I feel like I'm not scared.  

Joseph Dituri: Right. Now, you're a rockstar. Let's do it.  

Melanie Avalon: Okay, okay. In the books, we'll put it in the books. [laughs]  

Joseph Dituri: Well, you know a guy. 

Melanie Avalon: I do.  

Joseph Dituri: Have a blessed day. Thank you so much. 

Melanie Avalon: You, too. You, too. Bye. 

Joseph Dituri: Bye.