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Gladden longevity — Episode #57

Episode #57 —Dr. Paul Harch

Steve Reiter: Welcome to the Gladden Longevity Podcast with Dr. Jeffrey Gladden, MD, FACC, Founder and CEO of Gladden Longevity. On this show, we want to answer three questions for you: How good can we be? How do we make 100 the new 30? And how do we live well beyond 120? We want to help you optimize your longevity, health, and human performance with impactful and actionable information. Now, here's today's episode of the Gladden Longevity Podcast.


Dr. Jeffrey Gladden: Welcome, everybody, to this edition of the Gladden Longevity Podcast. I'm seated here with Dr. Paul Harch. Dr. Harch is a, probably, I don't know if you're considered the godfather or the grandfather or the father of hyperbaric therapy, but certainly, you have tentacles that go back in time, and you've been working with hyperbaric oxygen for a long time. There's a lot of buzz around hyperbaric oxygen, not only for its healing properties but also for its rejuvenation properties or purported rejuvenation properties. And it'll be interesting to have this conversation with you. So, welcome to the podcast, Paul.


Dr. Paul Harch: Thank you. Pleasure to be on.


Dr. Jeffrey Gladden: Yeah. Great. So, just to start to give the audience some sense of context here, maybe you can give us a little bit of your background. How did you get interested in hyperbaric oxygen and when was that, and what drew you into this?


Dr. Paul Harch: That's a great question. I was in a general surgery residency and had a very severe accident, an auto-pedestrian accident. I ended up taking a medical leave and, during that time, had accepted a job temporarily-


Dr. Jeffrey Gladden: Let me get this straight. You got hit by a car, is that what you're trying to say?


Dr. Paul Harch: Yes.


Dr. Jeffrey Gladden: Okay. So, you got hit by a car, and you got beat up pretty good. So, what got hurt? Your head?


Dr. Paul Harch: A lot of things.


Dr. Jeffrey Gladden: Including your head?


Dr. Paul Harch: A lot of orthopedic stuff, back, yes. Ended up with burns and some amputated toes, fractures.


Dr. Jeffrey Gladden: Okay.


Dr. Paul Harch: Yeah, I don't know. It probably should have killed me, but I managed to survive. Anyways, long story short, I ended up taking a temporary medical leave to have another operation, and in the process, I'd accepted a temporary job in New Orleans in emergency medicine. And I ended up in an emergency medicine group that was South Central United States and Gulf of Mexico referral for all diving accidents and had the option to learn diving medicine since, as you well know, none of us are taught that in medical school. And I went and got some training in it. And so, started this foray into diving, and an integral part of it was hyperbaric oxygen therapy. And what intrigued me-


Dr. Jeffrey Gladden: Let's just explain that to the audience. Why would hyperbarics be used in diving medicine and scuba divers? Maybe you can just walk them through that for a second.


Dr. Paul Harch: Well, anytime you go underwater, which is under increased pressure, our tissues take up and store the inner gas we're breathing. So, the nitrogen in our air is taken up in our-


Dr. Jeffrey Gladden: Yeah. About 80% of the air we're breathing is nitrogen, right?


Dr. Paul Harch: Right. And we take it up and store it. And when you then come up from your dive, scuba dive, or whatever, you have to release that, and you have to come up slowly. And even when you do come up slowly, about 5% of that gas is thought to separate out as bubbles into the bloodstream, into tissues, et cetera. And it turns out when you have too much of that and exceed your clinical threshold for symptoms, people get what's called decompression sickness, and the treatment-


Dr. Jeffrey Gladden: Yeah. The bends.


Dr. Paul Harch: Correct. The bends. And what people don't realize is that 80% of the bends is not the bends, the joints; it's spinal cord and brain involvement. And so, the treatment for it is to go back under pressure. And that's been the treatment since 1900. But in the 1930s, '40s, and '50s, US Navy decided and started introducing oxygen into the decompression, thinking that that might speed the resolution of the bubbles, and in fact, it did. And out of that, and some other roots used in the Netherlands for hypoxic conditions, carbon monoxide poisoning grew the subspecialty of hyperbaric oxygen therapy.


Dr. Jeffrey Gladden: So, why would this work for carbon monoxide poisoning? Explain that to your audience, how, I guess high pressure oxygen is going to push that carbon monoxide off the hemoglobin and put oxygen back in, is what we're thinking.


Dr. Paul Harch: That is one part of it, yes. So, the carbon monoxide binds to our hemoglobin, and displaces oxygen 250 times more avidly than oxygen does. So, you end up hypoxic, and when you give oxygen at pressure, the amount of it is able to displace that hemoglobin. But, in addition, it has a wide range of effects on the pathology that's caused by the carbon monoxide poisoning.


Dr. Jeffrey Gladden: Sure. It's actually probably directly pushing oxygen into the tissues, even irregardless of the hemoglobin. So, you're getting some oxidation that way.


Dr. Paul Harch: It is. And if you deliver it quickly enough, meaning within the first hour after pulling somebody out of the carbon monoxide environment, a large part of the injury from carbon monoxide is what's called reperfusion injury, which you well know, but our audience is... The inflammatory reaction of the body to reestablishment of circulation after a deprivation of oxygen or blood flow, and that, in fact, is more damaging. And if you can give a hyperbaric treatment almost immediately in that hour period, you can almost knock out 90% or more of the reperfusion injury.


Dr. Jeffrey Gladden: Yeah. This was the same thing in cardiology, of course, with heart attacks; if we could get the artery open fast enough, we could minimize the reperfusion injury. And there are strategies, and that's interesting for the audience to understand when a tissue doesn't have the oxygen that it needs, doesn't have the blood flow, which is bringing the oxygen, it starts to die. And if you reestablish blood flow or bring oxygen to that tissue, because the tissue's already been partially damaged, it has a hard time handling the oxygen that's coming in. And so, the oxygen being an oxidant actually can accelerate the damage that you're bringing oxygen back to try to alleviate. So, you get caught in this catch-22 of doing the right thing but still causing more damage in the process of doing it. And so, there have been many strategies around how to mitigate that reperfusion injury. One of the things that we have been thinking about is molecular hydrogen as a way to modulate reperfusion injury.


Dr. Paul Harch: Yes. Right.


Dr. Jeffrey Gladden: And I'd like to do a trial of that at the heart hospital, but I've got too many other things going on at the moment.


Dr. Paul Harch: Sure. But that's part of actually the paradox, or it's another hyperbaric oxygen paradox that you were talking about a little bit earlier. The idea of giving tons of oxygen with hyperbaric exposure in this immediate inflammatory period has always offended the medical profession, thinking you're doing more damage than good, meaning throwing gasoline on the fire. But, in fact, it quenches the reperfusion injury. And there's now extensive literature on this.


So, getting back to how I got into this, it was with looking at these divers and asking questions about what was going on in their brains and which the US Navy had pretty much ignored as part of the decompression sickness component. But, in fact, the bubbles go through the brain within minutes, and the reperfusion injury is what's dominating the reaction or the problem. And what we found, and what I discovered back in the literature buried, was that this acute treatment in the first hour that was curative for 90% of people with at least brain and body decompression sickness. In fact, we were treating reperfusion injury in the brain. We weren't treating bubbles. And that-


Dr. Jeffrey Gladden: Yeah, that's interesting. That's really interesting because now, when you think about reperfusion injury, basically, one of the things is the reactive oxygen species are triggering damage, but it's also triggering inflammation to occur, which actually generates more reactive oxygen species at the tissue level and perpetuates the damage. So, is the hyperbaric oxygen coming in and taming the inflammatory cytokines that are released, or is it actually doing something relative to the tissue in another way?


Dr. Paul Harch: Bingo. In fact, that acute hyperbaric treatment, what's been found is the primary target is polymorphonuclear neutrophils. So, the acute inflammatory cells that now come into the tissue damage express receptors on their surface, beta2-integrins, which attach to the inside lining of our smallest blood vessels. You know this, but I'm just saying it in terms of our audience.


Dr. Jeffrey Gladden: Sure, sure.


Dr. Paul Harch: And what happens is those white blood cells now stick to these inside lining of the tiny blood vessels, and they essentially clot them off. And so, what happens, and what's been shown, is if you can give that hyperbaric treatment in the first hour, it totally inhibits those attachment molecules on the white blood cells from expressing themselves. And the cells just roll right through. So you maintain circulation. And so, what it's doing is treating the white blood cell-mediated portion of the acute inflammatory reaction. And that-


Dr. Jeffrey Gladden: It's almost like you just turned off the fire alarm, right?


Dr. Paul Harch: Right-o.


Dr. Jeffrey Gladden: The white cells are rushing in to put out the fire and clean up the mess and all that, and then you basically dump in the oxygen. It's like, ‘oh, there's plenty of oxygen here. We can stop getting so excited.’ It's like stopping the firemen from breaking into the house.


Dr. Paul Harch: Yes, it quenches the reaction. It's almost like the CO2 fire extinguisher, but we're using oxygen and not CO2.


Dr. Jeffrey Gladden: Right. Okay. I get it. And so, that was interesting for you because now, all of a sudden, you're starting to see that. Obviously, their joints are important and critical, but their brain supersedes that, of course. And so, did you start to see better clinical outcomes in these people, or what was the story there?


Dr. Paul Harch: Not until the second component of this took place, and that was, I kept asking questions: ‘What's going on in their brains? Are there bubbles?’ Nobody knows the answer. ‘Well, okay, we just treated the guy, he's not all better. The US Navy says 90% of them are cured now. This guy's still got symptoms. Are the bubbles gone?’ Nobody knows. ‘Well, how many treatments do we have to give him?’ No one knows. You just keep treating.


The reality was all of the coastal facilities that treat divers do not get the same results the US Navy does. Often you have to give additional treatments, and nobody could answer this. And to me, I mean, I was just completely baffled, why are we not getting the same results? And the answer was we weren't treating the same thing. We're in New Orleans, we're 90 miles upstream from the Gulf of Mexico. By the time divers get in from the Gulf of Mexico, it's by sea, by land, maybe they can sleep it off, show up the next day, three days later, and now we're treating different pathology, we're treating the results of that reperfusion injury, tissue damage, ischemia, et cetera.


And what I found out was that if I dropped the traditional high dose of oxygen to a lower level, that the Germans in the '70s had shown acute severe traumatic brain injury and acute stroke was more sensitive to, these divers got better, and we had better neurological outcomes. And then it became: “What else could work? What other chronic or subacute injury?’ And we started looking at boxers, simultaneously, with this discovery.


Dr. Jeffrey Gladden: Let me interrupt you for just a second because this is interesting on the oxygen. Because when somebody comes in for hyperbaric therapy, acutely, in the room air that we're breathing, it's 21%, 20%, depending on your altitude, it can drop down to whatever is, I think it's 6%. But, of course, with hyperbarics and high oxygen, how much oxygen would be in there? Above 21%? Was it 50% or higher, or where were you going?


Dr. Paul Harch: Oh, no, it was 100%.


Dr. Jeffrey Gladden: 100%. Okay.


Dr. Paul Harch: So, the standard was 100% O2 by mask or entire chamber content at pressure. So, let's say you're at two and a half atmospheres, it's 250% O2.


Dr. Jeffrey Gladden: Okay. Exactly. Just so the audience understands, oxygen is... Everything is kind of in its own balance. So, water is good, but too much water is bad. Oxygen's good, not enough oxygen is bad. Too much oxygen is very toxic.


Dr. Paul Harch: Exactly.


Dr. Jeffrey Gladden: Just like too much water is very toxic. And so, when you're adding all this oxygen on top of the other injury, maybe you're turning off the fire alarm, but that much oxygen can actually perpetuate its own damage, so to speak. And so, that's-


Dr. Paul Harch: Correct.


Dr. Jeffrey Gladden: ... kind of what you're talking about here. So, then Paul was basically, Dr. Harch was turning down that concentration of oxygen to something lower, not to 21. Where did you turn it down to?


Dr. Paul Harch: Well, no, we turned actually the pressure down.


Dr. Jeffrey Gladden: Turning the pressure down.


Dr. Paul Harch: It was still using pure oxygen, and this is in the day before I had come across the information that probably the equal or greater benefit in this therapy was due to the pressure itself, not the oxygen.


Dr. Jeffrey Gladden: Got it.


Dr. Paul Harch: And so, what happened was we dropped the oxygen pressure down from standard 2.4, 2.5 atmospheres to roughly an atmosphere and a half, which is the equivalent of breathing pure oxygen going 16 and a half feet underwater on a scuba dive but with pure O2. And now it's a whole new world because of the realization that pressure is, in fact, a bigger component. And you may not even need the huge amount of oxygen depending on your condition.


Dr. Jeffrey Gladden: Right. Because if really what you're trying to do, well, you're trying to do two things. You're trying to push the nitrogen back into the tissue, so that requires pressure. And then you're trying to use oxygen to sort of quench the reperfusion elements and the inflammatory elements. So you're trying to balance two variables here to control two different sides of a problem, is what I'm hearing.


Dr. Paul Harch: Well, partly, but the other thing is the concept of barometric pressure, which has not been appreciated for the 362 years of this therapy. Barometric pressure is a totally separate entity from the oxygen, and it took the FDA for the first time looking at hyperbaric oxygen under the drug section in 2008 to suggest this. Nobody in my entire career in clinical hyperbaric medicine had ever suggested anything that pressure was bioactive. But it turns out it's in a category like a temperature. It's a thermodynamic intensity parameter and a completely separate entity. And so, it turns out it is the dose of pressure and the dose of oxygen, and the two are independent, overlapping, and interactive. And that's now been shown with gene expression. It's like a whole new world with hyperbaric oxygen.


Dr. Jeffrey Gladden: Yeah. That's beautiful. So then, have we gotten to the point where depending on the presentation of the person, the timing, the insult, et cetera, that you can dial in the right pressure and the right concentration of oxygen to treat that particular disorder?


Dr. Paul Harch: God, what a great question. That is where we are, where I am trying to take this field right now, is that the whole idea of dose and trying to personalize this has been completely beyond anybody's mentality for the history of this because no one understood how it worked. So, what happened is, and you'll appreciate this, it is the only specialty in medicine outside of experimental protocols where it is protocol-driven. ‘Oh, well, what worked for diabetic foot wounds?’ ‘Well, I treated it this way.’ ‘Okay, we'll try that.’ Pretty soon, you have a cluster of people that got better given a certain dose. So, diabetic foot wounds, what do you do? ‘Oh, that's the protocol.’ ‘Well, wait a minute. I'm an individual. I'm different from others, my diabetes may be-… my foot's different, my vasculature, my wound is different. I'm going to get the same exact dose, though.’ And now the appreciation is, ‘wait a minute’, and especially with the brain, this is going to be a matter of trying to find what your brain is responsive to. And that's what I'm doing with quantitative EEG right now.


Dr. Jeffrey Gladden: It should be possible to do this, I would think, in an experimental animal model where you dial up different things and start to measure gene expression, cytokine, all these different things and look at recovery times. And then from there, you start to postulate rather-


Dr. Paul Harch: Yes.


Dr. Jeffrey Gladden: ... that for this injury, we're going to do this with this percentage of oxygen and this level of pressure. I mean, it almost seems like if you had enough data, you could get an AI program to kind of spit that out for you.


Dr. Paul Harch: Eventually. Yes. And this is kind of what's been done, but sporadically over decades, even hundreds of years. So, 300 years of hyperbaric air therapy that predated all of this oxygen, hyperbaric oxygen, and that the idea of dosing, it's been sporadic in places, but no one has really finally put it together or even used it as a primary method of treatment.


Dr. Jeffrey Gladden: It seems to me one of the challenges there is actually being able to look at the gene expression. I mean, that's relatively esoteric testing, and we're doing it now in the aging process. We're looking at transcriptomics and proteomics of aging to see what are we actually accomplishing. Are we making somebody's DNA express itself in a younger fashion or not? But I can tell you, in the longevity space, it's taken me a while to get to that point where we could get this developed to the point where we could bring it forward. And I think it's got to be true in your field, too, that this is what you want to get done, but it's got to be difficult to do, right?


Dr. Paul Harch: Unquestionably. In fact, if you look at the 362-year history of this, the first concept of hyperbaric oxygen as a DNA signaling drug came about in '94. And it was out of a rat model, or excuse me, a rabbit wound-healing model a group of doctors in Minnesota and St. Louis were investigating, and over the subsequent, oh, 14 years, there were individual articles that targeted a single gene hyperbaric treatment to see if it upregulated or downregulated. Well, in 2008, Dr. Cassandra Godman, up in Massachusetts took chemo endothelial cells, single treatment mass gene array analysis, 8,101 of our 19,000 protein-coating genes. And now there's been a series of experiments on that.


Dr. Jeffrey Gladden: So, almost half, 45%, roughly, of the whole protein-coating genome, let's say, its regulation altered. Probably some up, some down, but it's altered, right?


Dr. Paul Harch: Yes, exactly.


Dr. Jeffrey Gladden: And so, it's fascinating to see just how when the body is stressed, what the magnitude of the response is. It's really such an intricate system.


Dr. Paul Harch: Unbelievable.


Dr. Jeffrey Gladden: It's really an intricate ecosystem. And when we go in, and we say: ‘Well, we're going to manipulate this gene, or we're going to use CRISPR, and we're going to pop this one out and pop that one in…’ I smile for several reasons. One: I'm so passionate about the intent of that. And then I smile for another reason, like: ‘Oh my gosh, we're so underestimating the ecosystem that we're working in.’ Right?


Dr. Paul Harch: We so do. This is actually a favorite topic of mine. It goes to our discussion about HIF-1-alpha earlier. You look at these 19,000 genes, a coating for all of these proteins-


Dr. Jeffrey Gladden: Let's define that for the audience. We were talking prior to the start here about the hypoxia-inducing factor, and it came up in a conversation because there was a paper written out of Israel that I read, and there are other papers that Dr. Harch knows about where they were talking about the paradoxical impact of oxygen in that it's hyperoxic, sort of external to the tissue, but at the tissue level, it was actually releasing hypoxia-inducing factor, which would be indicative of the fact that at the tissue level, it might be hypoxic or low oxygen, so high oxygen outside the cell and low oxygen inside the cell. And maybe that stress was related to the lengthening of telomeres that they saw, maybe, I don't know. There are lots of questions about that paper, and to me, it never really covered a lot of water.


Dr. Paul Harch: No, I agree.


Dr. Jeffrey Gladden: But we have much better ways to lengthen telomeres, quite honestly, than that, than sitting in a chamber five days a week for three hours. But anyway, back to this, you brought it up, the HIF. So, what were you going to talk about this hypoxia-inducing factor?


Dr. Paul Harch: Well, I was just trying to make the point of what you're making about the genome. If we put all of the human biochemistry on the wall and all these reactions, you could wallpaper a couple of rooms with it. And our approach in allopathic medicine is we're going to throw a dart at that one reaction there and think we're going to get a blocking agent or some drug, and it's going to ameliorate this lifestyle, chronic illness. To me, it's humorous. It gives a lot of people jobs and all of that, but it's not realistic.


Dr. Jeffrey Gladden: No, I agree. Yeah, I agree. It's completely unrealistic. So, I think one of the things that we have seen in the longevity space is kind of the utility and health giving benefits of what we call hormetic stresses, which are stresses that actually push the system. They don't break the system, but they allow the system to actually respond to that and get stronger. Do you feel like hyperbaric is also... I mean, I know the baric element of it, the pressure element of it is probably hormetic stress. We see genes activated to that. Do you think the whole thing is kind of a hormetic stress as well in terms of the regeneration that occurs?


Dr. Paul Harch: Unquestionably. In fact, you're familiar with- You're talking about essentially about hypoxic or ischemic preconditioning.


Dr. Jeffrey Gladden: Right.


Dr. Paul Harch: There is a whole literature now on hyperbaric oxygen therapy preconditioning where giving this up to 24 hours ahead of time, in fact, protects the organism against a subsequent ischemic and/or even traumatic insult, et cetera.


Dr. Jeffrey Gladden: Okay, let's just stop there for a second because the audience just got lost. What we're talking about here, let's say that you're in a lab and you have an animal and you have their heart, and you take one of their heart arteries, and you tie it off with a string, and all of a sudden there's no blood going to a section of their heart, that heart tissue starts to die very quickly. But if you precondition the animal, if you close the artery off for 30 seconds and open it, close it again for 30 seconds or a minute and open it, do that three or four times, and then seal it off completely, you've preconditioned the artery, now the heart attack is much, much smaller. The body has adapted to that and opens up collaterals and things like that. And you can precondition arteries by releasing nitric oxide, giving nitroglycerin, using things that will produce nitric oxide. And we're talking about hyperbarics here now as being a pre-conditioning stress that would mitigate what would happen if an artery were to be closed off, right?


Dr. Paul Harch: Exactly. And so, going to what we talked about earlier with the effect on white blood cells, which is a dominant part of any reperfusion injury, any tissue injury, and so on. What has been done with, for instance, carbon monoxide poisoning, is that if you give a hyperbaric treatment within 23 hours of a carbon monoxide exposure-


Dr. Jeffrey Gladden: Exposure.


Dr. Paul Harch: ... within the previous 23 hours in a rack, you can almost inhibit all the damage done by the carbon monoxide.


Dr. Jeffrey Gladden: Oh, wow.


Dr. Paul Harch: Yes.


Dr. Jeffrey Gladden: That's amazing. I've not heard that.


Dr. Paul Harch: Exactly. So now, hold on, I'm going to give you one more little one, a little tidbit here. We wanted to do this with coronary artery bypass surgery.


Dr. Jeffrey Gladden: Sure.


Dr. Paul Harch: Your area here. We used to call it ‘pump syndrome’ and such after bypass, and you go in the ICU and here are these people, they're no longer having their rest anginal pain, and yet they've got these long, drawn faces, they look like they've had decompression sickness, and we now all know it's the effect of bubbles and other stuff and many things going on during bypass.


Dr. Jeffrey Gladden: Sure.


Dr. Paul Harch: What's been shown is that if you give two hyperbaric treatments the night before cardiac surgery, you have a significant reduction in that cognitive insult that occurs with bypass.


Dr. Jeffrey Gladden: Beautiful.


Dr. Paul Harch: Published out of England, 1995.


Dr. Jeffrey Gladden: Beautiful.


Dr. Paul Harch: We had a study we wanted to... Yeah. Couldn't get it funded, though, in the late '80s or '90s.


Dr. Jeffrey Gladden: That's spectacular. And what were they using to do that? Is that 100% O2, or what was it?


Dr. Paul Harch: Yes. Yes. And I think it was 2.4 atmospheres or somewhere around there. It was 2005. I'm sorry, I think I said '95, but yeah, 2005.


Dr. Jeffrey Gladden: Cool. Well, that's fascinating. So, now you started a practice that utilizes hyperbarics, and you're located... Tell people where you're located.


Dr. Paul Harch: We're in New Orleans. And we're at this little remote clinic that grew up kind of because of the whole diving industry. And actually the end of this next month, in February, I'm moving across the river to another part of New Orleans, but we're in the New Orleans area.


Dr. Jeffrey Gladden: And so, out of that experience in the emergency room, when you got introduced to this whole field, then you basically made this your life's work is what I'm hearing. Is that correct?


Dr. Paul Harch: I did. And what happened was I saw my mentor, who really is the one who introduced me to this, Richard Neubauer, in South Florida. Brilliant man published a lot, but he never got any significant traction. In fact, he got a lot of criticism for a variety of reasons. But the main one also was he was doing it in a freestanding facility, no institutional support or attachment. And so, we realized that we needed some institutional coverage for credibility. So, we started a fellowship at LSU. And so, we've had an academic appointment there, and all of this work I've done has been done at this clinic, but the formal studies have been under LSU's IRB and so on. So, it's kind of been a two-track job, and the third was the teaching component of it.


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So, let me ask you this. At any of the LSU hospitals, are they doing hyperbaric prior to cardiac bypass surgery?


Dr. Paul Harch: No.


Dr. Jeffrey Gladden: No. Okay.


Dr. Paul Harch: No.


Dr. Jeffrey Gladden: Have you given a grand rounds on this?


Dr. Paul Harch: Oh my god, yes. I've talked about this. We've shown this years ago. The main problem-


Dr. Jeffrey Gladden: Isn't it fascinating?


Dr. Paul Harch: It is, but what's the nuts and bolts of it? It boils down to reimbursement. It is not reimbursed, so there is no way they're going to do it.


Dr. Jeffrey Gladden: If you don't think your doctor is handcuffed and your hospitals are handcuffed to the insurance payers, there it is right there.


Dr. Paul Harch: Oh my god.


Dr. Jeffrey Gladden: They are handcuffed. They are led by the nose by the insurance companies. It's a tragedy, quite honestly.


Dr. Paul Harch: Well, look at our training programs. What are we trained in and taught? We are taught reimbursable medicine.


Dr. Jeffrey Gladden: That's right. That's exactly right. Yeah, it's super sad. But anyway, so what are some of the innovative things you're doing in your clinic to help people? Give us some examples of that.


Dr. Paul Harch: Well, probably the most innovative is the way I'm trying to dose initial dosing to brain activity live. For the first, roughly 13, 14 years, we formally investigated and tied this therapy to brain blood flow imaging. And we used a provocative test that had been published once, brain blood flow scan next day in the chamber at a given dose of hyperbaric therapy. And then patient comes out, and we rescan. We did this for a good amount of time. Five and a half years, it was under a formal study, and it was very good. If you saw an improvement in brain blood flow on that second scan, I had 100% predictability guarantee, and it didn't matter what the neuropathology was or their disease, I could improve that patient, and I would tell them that. I'd promise it to them.


But the problem was that second scan was always three to four hours after they came out of the chamber. It was the delayed effect of what happened in the chamber. What I've now done is adapt quantitative EEG, so standard 19 lead EEG. And I do that before they go in the chamber, and then I put them in the chamber, and I take them through a dosing profile of five different doses of hyperbaric therapy, look at the brain live, record it, quantitate it, and then study it to find where I am best-impacting brain function. And that's where we start treatment.


Dr. Jeffrey Gladden: Okay. Well, I love the precision of that. I guess I have two questions about it. One is: it sounds like they're wearing an EEG cap while they're in the hyperbaric the whole time while you're adjusting the levels of pressure and oxygen.


Dr. Paul Harch: They are.


Dr. Jeffrey Gladden: So, you're getting real-time feedback.


Dr. Paul Harch: Yes.


Dr. Jeffrey Gladden: And then the second question, well, there are three questions. The second question is: What are you looking for? Are you looking for an increase in electrical signal? Or what are you actually looking for?


Dr. Paul Harch: If you look at QEEG, there is massive quantitation that is derived from that. And you look at the absolute power of the different bands of electrical currents. So, we have 40 different frequencies of electrical current in our brain all over the place. So, I'm looking to see absolute power, I'm looking for balance. I'm looking to see a global effect on the brain, which is what we saw with decompression sickness, with traumatic brain injury, what we saw in the SPECT brain imaging, and finally looking for connectivity. So, much of the brain diseases are caused by problems in the white matter, for our public, the connecting tracks that connect all the brain cells. And there is a way of looking at that connectivity with EEG, and you can quantitate it.


Dr. Jeffrey Gladden: Right. So, I like that a lot. So, then I guess the question is: if you do the EEG after they come out of the hyperbaric, let's say you did it two hours later or three hours later or the next day, would the effects be durable on some level? Or is it more of an acute event that stimulates healing, but what you see in the chamber actually dissipates over some period of time? How does that work?


Dr. Paul Harch: That's a great question. There is permanence and transience to that effect of every single treatment. And so, for the hyperbaric virgin who's never been in a chamber before that you're treating for the first time, the majority of it through that first block of treatment is permanent. And as time goes on and you do additional treatments, there's more of it that is transient. We're inducing a change that doesn't have as much permanence to it, but there's so many targets, and there's so much tissue pathology that it's impacting that you can't pinpoint exactly what's going on. I would just give you the gene expression argument part of it. And if we look at the SPECT brain imaging, the sweet spot for seeing that improvement in blood flow and brain function after they came out of the chamber was somewhere in the range of two to 10-12 hours later. But the effect is often there the next morning to some degree. And, yes, symptomatically, it will dissipate, but with the gene expression, what's been shown with a single treatment, you have gene expression going on for up to 48 hours. And that was just a limited experiment.


Dr. Jeffrey Gladden: Right. Interesting. So, I guess one question would be on the dosing or the timing of the dosing, would you wait 48 hours or not? And the other question that I had prior to that is whether- We do EEGs in our practice also, and what we see is that there are parts of the brain that are hypoactive and parts of the brain that are hyperactive. Does the hyperbaric, does it have a balancing effect that you see when you're doing this or [inaudible 00:35:33]?


Dr. Paul Harch: It does. It has a number of effects. If you look at what we saw with brain blood flow imaging, take the veteran study that I published, we saw a huge increase in brain blood flow in the group as a whole after one treatment, with that scan done about three to four hours afterward. But at the end of 40 treatments, all done in one month, so pretty much I compressed it, the overall average brain blood flow was unchanged, but the highs came down, the lows came up, and it had a more normalized-looking appearance to it. And so, the EEG, yes, we're changing things, but like wounding, you wound yourself right now, the timeline for healing that wound is at least a year. Look at plastic surgeons and when they'll want to remodel a wound or revise a scar. Most of the change is in the first six months, 85% of it, but it's in constant evolution. And so, depending on where you intervene, you're hitting a moving target, and the hyperbaric oxygen has its own timeline to it as well.


Dr. Jeffrey Gladden: Have you ever coupled this therapy with other regenerative technologies like exosomes or stem cells or peptides or anything like that?


Dr. Paul Harch: Indirectly, but not at my clinic. And the reason is, I've told people: ‘if you come here, we're going to have one variable and answer one question; is this therapy going to work for you or not?’ But ultimately, yes, synergy and multimodality therapy is the ultimate. And so, I have a lot of my patients who are also getting stem cells while they're here. They get them from another facility. In fact, there's a lecture I can point you to where I summed up all of this. There is now an accumulating literature on hyperbaric oxygen therapy effects on our own stem cells, from proliferation, migration, implantation, and every phase of it, to effects on administered stem cells.


So, from another source, or let's say you take them from yourself, now re-inject them IV, hyperbaric oxygen, if you couple it with it, has been shown to facilitate implantation. So yes, my patients get other therapies, but not generally here. They're coupled with it subsequently. And when I do long-term care, often it's... In fact, in Texas, a great example, I've got a patient who did EEG neurofeedback with continued hyperbaric oxygen, and the case report was just published last year.


Dr. Jeffrey Gladden: Well, that's fascinating because I've done some neurofeedback. And neurofeedback, it's interesting, but it doesn't seem to have quite as much stickiness as you would like. You can feel effects acutely, and you can feel effects kind of a little bit cumulatively, but it just doesn't seem to have the stickiness that I would like.

Mar 9, 2023

You can listen to this podcast by clicking the link below.

Episode #57

Episode #57 - Cont'd

Dr. Paul Harch: Right. Hyperbaric oxygen, in general, has more of that stickiness. And the reason is it's a trophic therapy. I mean, we are stimulating tissue repair.


Dr. Jeffrey Gladden: Well, let's define that word for the audience. ‘Trophic’ means that it causes growth. It causes rebuilding.


Dr. Paul Harch: Exactly. So, we're changing the tissue, anatomically, we're growing tissue. And if you look at hyperbaric medicine for these 362 years, where it's really found, it's a fact, is in wounds, all types of wounds and inflammatory conditions, internal wounds, external wounds, you name it.


Dr. Jeffrey Gladden: Yeah. So, what's on the horizon for you? What are you excited about now? You've been doing this for a week or two.


Dr. Paul Harch: The first thing is getting my move done, but simultaneously, I am republishing an article on oxygen toxicity and dosing of this and trying to bring people to the awareness that this is not a tree growing to the sky; stocks always go up, more is better. You have to be careful with dosing this, especially as with pure oxygen. The second thing is I'm involved in summarizing the 130, 140 drowned children that I have treated now over the past 34 years and trying to show and bring attention to the fact that this should be done immediately when they hit the ER. And as a prelude to helping to further introduce, and I've published book chapters on this, but the idea of acute treatment and then finally is trying to perfect this QEEG dosing.


Dr. Jeffrey Gladden: Okay. Yeah, that's very exciting. Are you working with anybody on the transcriptomics, proteomics of this or-


Dr. Paul Harch: I'd love to, and I've got some ideas on exactly what I want to look for, but I just haven't had the interface and the right people.


Dr. Jeffrey Gladden: Okay. We might be able to help you-


Dr. Paul Harch: I'm very interested.


Dr. Jeffrey Gladden: Yeah. We might be able to help you with that, quite honestly, which would be kind of interesting. Cool. What do you think about people with their home hyperbarics?


Steve Reiter: That was going to be my question.


Dr. Jeffrey Gladden: Okay, there you go. I'm reading your notes, Steve. You can go out and buy a hyperbaric; I guess it's a chamber. It's not like what you'd get-


Steve Reiter: A zipline bag.


Dr. Jeffrey Gladden: -at a medical facility. Right. Yeah, it's like a sleeping bag almost that's kind of propped up. The pressures that are in there are a little bit lower. I don't know what percentage of oxygen they're using exactly. But what do you think about that? People are using this on a regular basis. It's kind of like too much of a good thing is a bad thing. And how do you get the dose right? How do you know what you're doing? That's my question, but I wonder if you had an opinion on that.


Dr. Paul Harch: Well, this is at the heart of the hyperbaric medicine field right now, and it's extremely difficult for patients because there is so much misinformation and contradictory information. People have no idea. The reality is that we are all sensitive to changes in barometric pressure and oxygen. And what happened by pure accident, first of all, the Russians had looked at this lower dosing for years, but it's all tied up in the Russian language and scientific literature. And as you know, there are very few people that translate and disseminate that. And so, it really has not been known at all until an accident was made in a study design on cerebral palsy and hyperbaric oxygen in Montreal in 2001.


And I tried to warn them when they designed it that they were going to investigate a new dose of hyperbaric therapy that nobody had answers on, or at least I thought. And what they did was they took hyperbaric oxygen, right about the dose that we had shown was effective in cerebral palsy. That was the oxygen group. And then, they took a group of children; it was a randomized study, and the other children got hyperbaric air at 1.3 atmospheres. And lo and behold, the air group did as good as the pure oxygen group. And, of course, there was all this controversy, ‘it had to be a placebo here, hyperbaric oxygen, it's all placebo.’ It was called ‘the parent participation effect’ in an atmosphere of good cheer and conviviality, and all of this, they cheer lead these children to get better and show motor and cognitive gains. It was total fantasy that could explain it.


But the reality was nobody understood it. And it wasn't until my interaction with the FDA seven years later where, well, actually, the opinion came out in 2011 where they said, "It's the first time we've looked at hyperbaric treatment and, Doc, you're putting people in a chamber, and you're doing two things. You increase the pressure and increase the oxygen." And I said I thought these people were crazy. I went to the medical library, and what did I find? Fifty years of physiology showing barometric pressure was bioactive. So, what has come out, there is published information, and there is now a lot of science showing that there is a benefit in this lower pressure range. And so, you can get the benefit. What is not sorted out is: who, what dose exactly, what condition, and so on. But there is definitely bioactivity and benefit, especially for children.


But what's going on with the portable chamber world is it is unbridled selling of chambers to anybody, and it's a prescription medical device. It's just like a bottle of pills. And what they illegally do is couple oxygen concentrators with it. And the people then are just told to do whatever they can find on the internet. And so, you don't know what the results are, really. But in published experiences, there is a benefit. So, it's an amount of papa bear, mama bear, baby bear. It's trying to find the right dose for you and your condition, just like anything else in medicine, every drug that you prescribe, et cetera.


Dr. Jeffrey Gladden: That's right. It's ‘buyer-beware’ because you have to respect these technologies. I mean, these technologies can cause harm, right? It's like exercise. You have to respect exercise. I mean, running an Iron Man isn't actually the healthiest thing you can do. And so, you have to respect the dose. And I think the same is true here with hyperbarics.


Dr. Paul Harch: It's true. That's my oxygen toxicity article. I actually published this in a book chapter in 2001, but the book's out of print now. And it was a collection of cases of mothers who contacted me and said, "Look, we went out and got hyperbaric oxygen like you had published, and my kid's worse. What happened?" And I sat down, took notes, and it's a collection of all of these cases, actually far less than the number that are out there, obviously. But two of these children were killed in chambers in their homes by their parents. They put hard-shell chambers in, gave them too much oxygen. The kids started having seizures. They read that I had successfully treated seizure disorders, and you can with this therapy. And they over-treated them. The kids died in status epilepticus.


Dr. Jeffrey Gladden: Wow. Wow. That's bad.


Dr. Paul Harch: That's just two that I know of. There's a third; the mother didn't want to talk about it, gave me the medical records. But there are a lot with induced seizures with other problems. To give you an idea, and this is from the chamber of manufacturers, at the end of the first year after a portable chamber purchase, one-third of them appear on the used market. I would tell you that probably another third of them end up as a piece of furniture, meaning they didn't get the effect, or they had a bad outcome, or something happened, and they just stopped using it. And we get frequent phone calls about that. "I went and got this chamber, I'm not getting any benefit. What am I doing wrong?"


Dr. Jeffrey Gladden: No, it's a tricky business. I think what I like about your approach is the fact that you've really gone down the path of using the EEG to kind of guide your dosing. And I suspect that you're doing EEGs along the way. Let's say you're going to do 40 treatments. You're probably repeating an EEG at some point, if not every treatment. I don't know. But I think you'd have some sense of what progress looks like.


Dr. Paul Harch: Well, only in some. It's pretty tedious. And the other part of it is that the brain is changing all along, and I don't use that EEG then to make a decision. The decisions are made clinically. If they're not clinically improving, then, yes, it's time for dose change, it's time for reassessment, and so on. But if they're going good, I don't re-EEG them to see if, ‘well, wait a minute, is there a dose that we can get better?’ Because there are thresholds and there's an evolution to, let's say, a block of 40 treatments and what happens. So, I don't interfere with it if we're going in the right direction.


Dr. Jeffrey Gladden: Got it.


Dr. Paul Harch: I mean, I can change, but... It's a practice of medicine issue. It's no different than what you do and monitor your patient. We've done this with SPECT brain imaging where we've looked, let's say, at the midpoint, and at that point, actually, the brain is going through a transition. You get the brain imaging all over the place, and if you let that guide you, I would've been nowhere. In fact, it's in my studies where we talk about this transition point that patients go through, and it can be misleading, doing better, doing better, then they're a little bit off, it's like, "Wait a minute, I'm not getting better. This is not doing me any good." Whoa, what do we have here? A toxicity? No.


Dr. Jeffrey Gladden: Let me ask you a question. So, people that are interested in longevity or in brain optimization or performance optimization or things like that, what kind of advice do you have for them with regards to maybe their home unit or whether they should work with a professional if they're going to be having this done? And do you have any advice that you would give them on how to do this safely?


Dr. Paul Harch: Yes. And the advice is, what exactly are they looking for with it? That longevity and wellness, and so on, is a broad topic. And what some people think with longevity, it means they want to avoid heart disease, or ‘I want to stave off dementia’, or others, ‘I want to keep up my fitness.’ It depends on what they're looking for it to do.


Dr. Jeffrey Gladden: How about decrease inflammation or decrease neuroinflammation? Because as the aging process progresses, that becomes a major player in the whole phenomenon, right?


Dr. Paul Harch: Oh, aging and all of our chronic diseases, yes. Getting back to the gene expression thing, we know that hyperbaric oxygen has effects on our pro-inflammatory and anti-inflammatory genes. And the question then becomes: is dosing yourself to inhibit that? And the timeline of suppression is not well worked out. So, what I end up doing is I try to identify symptoms with patients. So, even people who are looking at longevity often have something that they've got some fatigue, or they've got some problem, dysfunction. They may not, but I try to identify symptoms, and the first step in it is trying to repair or address chronic cumulative pathology, which really is aging, if you will. And I recommend to them that you do a block of treatment.


And they will then get to a point of where they feel better, it's just a feeling of well-being. And as you then go on in time, you'll start to deviate from that. And what you do is you find out the periodicity and timeline of that for you and your condition, wellness, whatever. And as you start to drift off a little bit, it could be energy level, could be mood, could be joint pains, a variety of things, you reintroduce it. And what eventually this becomes is having the patient become their own doctor by having them tune into how they feel. It's what you and I and all doctors are doing with our treatment of patients. We're listening to them, listening to the symptoms, examining them, and trying to dose, treat, whatever to modulate that. And people often aren't as tuned into that, some are, but it's teaching them to do that and thereby dose themselves on a longer-term basis.


Dr. Jeffrey Gladden: It would be so helpful if there were some at-home testing that they could couple to this. Like they could track some simple inflammatory markers or maybe-


Dr. Paul Harch: Yes.


Dr. Jeffrey Gladden: ... something more complex than simple or something that would give them some feedback other than ‘how do you feel’.


Dr. Paul Harch: Yeah. But I would say, think of it, we don't have any surrogate biomarker for almost anything about how we feel or for even our medical conditions. Yeah, you can follow, let's say, tumor markers for tumor burden and so on, but how we're actually doing clinically, we don't have good surrogate markers for that.


Dr. Jeffrey Gladden: Yeah, I think that's where the transcriptomics and the proteomics start to come in. I mean, being able to make formations-


Dr. Paul Harch: It may.


Dr. Jeffrey Gladden: ... between gene expression and how you're feeling inflammatory markers and things like that. At least, that's the direction that we're exploring and going down right now is to make those correlations.


Dr. Paul Harch: If you can indulge me with just a little anecdote, and I hate that word, but a little vignette here. When I went to the NIH, and I went to the FDA, I went to them to propose and seek funding for studies and so on. We had multi-component studies, I should say multi-component outcomes, where I wanted to look at brain imaging, cognitive testing, symptom outcomes, mood scores, and all sorts of stuff. And both the NIH and the FDA said, "We're not interested in any of that. For you to prove this works, what we want to see is a broad-based symptom questionnaire that reflects how your patients are feeling and doing." I was absolutely floored.


Dr. Jeffrey Gladden: Man, that's-


Dr. Paul Harch: So, if you look at my randomized trial, the primary outcomes, I had two of them, one was working memory, the other was a broad-based TBI symptom questionnaire. The Department of Defense then did ten years of multiple studies on this work, and they looked at literally everything under the sun. And when they were done, they said, "We found no outcome that reflected the effect of hyperbaric oxygen on how these patients were doing," except the symptom questionnaire I used that the FDA recommended. And they said, "For a future study, that's all we're going to do is use that symptom questionnaire." So, this is what I do with my patients long term, it's symptoms and how they're doing.


Dr. Jeffrey Gladden: You have to know that it can't be right even though, in the current state of science, it's the best we can do. But you know that can't be right. You know that there has to be things that are changing that could be measured, that would be associated with these things.


Dr. Paul Harch: Sure. But I would suggest it's probably a cluster of things.


Dr. Jeffrey Gladden: Oh, for sure. For sure.


Dr. Paul Harch: That it's not going to be one thing.


Dr. Jeffrey Gladden: Oh, absolutely.


Dr. Paul Harch: That symptom questionnaire is a broad-symptom questionnaire, if you will, like TBI symptoms, 22 are on the questionnaire.


Dr. Jeffrey Gladden: No, the questionnaires are valuable. There's no doubt about it. I'm not negating their value in any sense. It's just that being able to get some other metrics to go along with it would seem to be-


Dr. Paul Harch: Ideal.


Dr. Jeffrey Gladden: Advisable. Yeah.


Dr. Paul Harch: Sure.


Dr. Jeffrey Gladden: And ideal. Sure, of course.


Dr. Paul Harch: That is a goal. Yes. I mean, that's what medicine and science are. It's trying to measure and get some precision to it.


Dr. Jeffrey Gladden: Exactly.


Dr. Paul Harch: But nature foils us often.


Dr. Jeffrey Gladden: So, let me ask you a question that we ask a number of our guests, which is: if you had three recommendations for the audience here about how to enhance their longevity from your perspective, looking through your lens and we know getting enough sleep, eating well, and getting some exercise on a daily basis, these are all important. But beyond that, from your special lens of the hyperbaric world, are there things that you would recommend to people?


Dr. Paul Harch: I would recommend this therapy. I mean, that's the number one thing. I'd even take you to 2001 Oprah Winfrey's interview of Dr. Oz, the special section on aging. And at the end of it all, all the things they talked about, he said: "And now I'm going to show you the number one anti-aging tool of the future." He rolled a hyperbaric chamber out on the stage and had this lady get in and give her a treatment. And so, I don't know. I came across this through the clinical experience of what I did with these really neurological throwaway cases. And it was so profound and powerful it totally changed my life and career. And then once I got in and found the science of it, I just don't know and have found any other therapy that has these broad-based effects that can impact people's health on a long-term basis, especially when coupled with lifestyle changes, balance, what you eat, exercise, relationships, love, work.


Dr. Jeffrey Gladden: But it sounds like what you're saying is that not only is the hyperbaric treating the acute issue, but it's also changing the natural history, if you will, of the disorder in the sense that it's mitigating its impact on both functionality and longevity. That's kind of what I'm hearing you say.


Dr. Paul Harch: Great comment. Because if you look, and I tell the story in my book, my mother's the best example of dying of dementia. We gave her six months to live. My younger brother's a general surgeon. My mom was just checking out. We did hyperbaric treatment on her, got her off all of her medicines except for thyroid. So, depression drugs, anti-inflammatories, pain medication, cognitive drugs, et cetera. She lived seven more years, and her quality of life was good, and she didn't die of her dementia at 90. And so, I've treated a lot of dementia patients, and what this is doing is prolonging their life. So, yes, it is altering the natural history, and that goes straight to your whole longevity theme.


Dr. Jeffrey Gladden: And how many treatments a week were you doing for these people?


Dr. Paul Harch: Well, for longevity purposes, I kind of used the multiple sclerosis model and, of course, another personal experience-driven thing. My wife has chronic progressive MS. And, as you well know: walking, cane, walker, wheelchair, bedridden, death. She's had it 24 years.


Dr. Jeffrey Gladden: Oh, wow.


Dr. Paul Harch: You would not know it. She does everything, physically. She has almost no symptoms, but we've done 500 and some treatments on her. And when you look at this, the English have studied this with a 14-year follow-up on 750 patients with MS, the ones who did the best did one hyperbaric treatment every two weeks roughly. And then, every six months, they did a little cluster of four or five. And what that does is suppress their immune system dysregulation and afford them a longer, healthier life.


Dr. Jeffrey Gladden: Any data on ALS patients with this?


Dr. Paul Harch: Yes. There have actually been Russian studies. There were two studies. The second one is a controlled one out of Miami. My experience, I've treated eight or nine of them. At most, by itself, you can get some limited temporary effect, but when coupled and other bio-oxidative therapies such as even... I would tell your patients go to the Kim Cherry website, and you'll see this guy's story, ALS unequivocally, but did hyperbaric oxygen at low dosing, ozone therapy, and a variety of herbal therapies, et cetera. And he has now, I want to say he's ten years into his ALS. So, by itself, hyperbaric oxygen has limited to no effect in ALS. Potentially coupled with some other therapies, yes, maybe, but not much evidence.


Dr. Jeffrey Gladden: So, his first name is Kim, and his last name is Cherry, like the fruit?


Dr. Paul Harch: C-H-E-R-R-Y. Yes.


Dr. Jeffrey Gladden: Okay, got it.


Dr. Paul Harch: I haven't talked to him recently, but as of a year ago, he was still alive.


Dr. Jeffrey Gladden: Excellent. Yeah, that's fantastic. Yeah. So, I think it falls into this category of hormetic stress, but here actually, what we're getting is this kind of probably upregulation of your body's ability to handle oxidative stress, which you also get with ozone, which you just mentioned, and then also this turning down inflammatory cytokines.


Dr. Paul Harch: Yes.


Dr. Jeffrey Gladden: You did bring up ozone. Ozone is something that we know quite a bit about and have had some good success with, also. Do you see them as being complimentary or in contrast to each other? How do you think about that?


Dr. Paul Harch: I do, but I don't have enough experience, and there's almost nothing published on it to really make a firm statement there. But I think they have some different effects, and of course, we know they do because there's no pressure component to the ozone, and that pressure effect is a very significant one.


Dr. Jeffrey Gladden: Right. Yeah. One of the nice things about ozone is that it does oxidize NADH back to NAD, and having high NAD levels, of course, is great for not only energy production but for sirtuin activation, DNA repair, and lots of cellular repair processes. So, there are some good things there. There is some data out of Cuba. There's been a lot of ozone work done in Cuba that I've gone through, and it can be quite powerful in its own right. So, even in head-to-head trials with hyperbaric, so it's interesting as well. 

  

Dr. Jeffrey Gladden: Well, this has been a wonderful conversation, Paul. I really appreciate you taking the time to chat with us here. It's been a real pleasure.


Dr. Paul Harch: My pleasure as well. Enjoyed it a lot.


Steve Reiter: Thank you for listening to this week's episode of the Gladden Longevity Podcast. If you would like more information on what we've discussed or other topics, please reference the show notes or go to gladdenlongevitypodcast.com. You can also find us on Instagram, Facebook, and Twitter by searching Gladden Longevity. If you've enjoyed this podcast, please subscribe to get future episodes delivered to you and share our podcast or this episode with someone in your life. They may find benefit. Thank you for listening. We'll be back next week with another exciting episode.


The Gladden Longevity Podcast is provided for informational purposes only. It does not constitute medical advice. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The use of any information and materials linked to this podcast is at the listener's own risk.

Episode #57
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