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INTERMITTENT
HYPOXIC
TRAINING
Rejuvenation, healing and
enhanced athletic
performance are just a few of
the benefits
by Rosalba Courtney
Only a few times in my adult life can I remember feeling the
unbounded exuberant energy of childhood and experiencing it
continuously for days at a time – a feeling of my body being
light and movement effortless, drawing energy from a
seemingly bottomless well. One of those times was when I was
trekking in the Himalayas, descending from an altitude of 5000
metres. Walking up had been a fairly gruelling experience, but
on the way down I felt like I could walk all day and never tire.
High altitude for health
Athletes have known for many years of the benefits of altitude
adaptation in enhancing performance. Using the principle of
'train high and live low', they have been able to perform better
at sea level when their bodies compensate for oxygen levels
lower than those found at altitude by becoming more efficient
at utilising oxygen. What's more, altitude adaptation has
implications well beyond giving elite athletes that extra edge.
Russian medical researchers and others are finding increasingly
that adaptation to altitude has tremendous potential for
enhancing the health of the average person and modifying the
course of many chronic illnesses. Are people who are
acclimatised and live at altitude healthier than those living at
sea level'? The answer seems to be a clear
International Wellbeing
Issue 83, Feb-Mar 2001

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INTERMITTENT HYPOXIC TRAINING
diseases found commonly at lower altitudes occur less at
high altitude. The Indian Army recorded the incidence of
18 different diseases in 130,700 soldiers stationed at
altitudes from 3692 to 5538 metres over a period of seven
years. When the rates of disease were compared to those
found in soldiers on the plains, almost all diseases had a
lower incidence at altitude. The occurrence of bacterial,
viral or protozoan infections was significantly lower
(except for amoebic hepatitis and lobar pneumonia).
Diabetes, hypertension, ischemic heart disease, asthma,
rheumatoid arthritis, several types of gastric disorders, skin
diseases, psychiatric ailments (including neurosis and
psychosis) and anaemia all occurred with much lower
frequency when the soldiers were living at altitude.
Living continuously at altitude for a period of months or
years is not an option for most people. Russian doctors, in
trying to find a solution to acclimatising pilots, athletes,
mountaineers and cosmonauts to low-oxygen environments,
discovered that adaptation to low-oxygen environments
could occur rapidly in a clinical setting and without the side
effects of altitude sickness. The oxygen levels found at
altitude were administered in a controlled manner and given
in measured intermittent doses. The technique became
know as Intermittent Hypoxic Training (IHT), whereby
oxygen levels of between 10 and 15 per cent (equivalent to
an altitude range of 2500-6000 metres) are administered by
a machine known as a Hypoxicator, which separates air
through a semi-permeable membrane. The person is asked
to breathe the high-altitude air for just a few minutes at a
time while their blood oxygen levels are continuously
monitored. They then breathe ambient or normal air for a
few minutes, giving their body time to adjust back to
normal conditions. The time spent alternating between low-
oxygen air and normal air is 60 to 90 minutes at a time. The
procedure is generally carried out once or twice a day for a
total of 16 to 30 sessions. Researchers found that this
technique allowed adaptation to altitude to occur with less
stress to the body than continuous exposure to low oxygen.
Because the dose and the blood oxygen levels are totally
controlled, there is no danger of altitude sickness. The
intermittent nature of the hypoxic exposure means the
adaptation to lowland is not lost, as is the case in normal
acclimatisation to altitude. Adaptation to intermittent
hypoxia has the unique attribute of activating the body's
own internal production of antioxidants in the brain, liver
and heart as a result of the frequently repeated re-
oxygenation that occurs on breathing room air. This differs
from continuous hypoxia, which actually reduces
Since the beginning of time, living things, from simple
viruses and bacteria to humans, have shown the seemingly
miraculous ability to adapt to changes in their environment.
In humans the process of adaptation is more efficient and
more fascinating than in any other species. Our genetic
characteristics and potentials are not fully expressed until
something challenges us to adapt. In this way, challenges
and stresses help us to develop strengths and abilities we
might not otherwise have developed. As we adapt to one
level of any environmental or even emotional stress, we
become capable of handling even larger doses in the future.
This ability is what enables, for example,
weightlifters to lift unimaginable loads well beyond their
own bodyweights. This is why our species (and all other
currently living species) has survived and even thrived
despite environment changes and times of extreme difficulty
and social upheaval. IHT forms an important branch of an
emerging new discipline called Adaptive Medicine. The
Russian Academy of Medical Sciences has a Department of
Adaptive Medicine, one of its aims being to look at the
therapeutic potential of IHT. An International Academy of
Adaptive Medicine was formed in 1990 by an
interdisciplinary group of scientists and clinicians from
many countries including Japan, Australia, Germany and the
USA. Its aim is to develop further understanding and share
information about the ways in which the adaptive process
enables the body to respond to different stress stimuli, with a
view to treating and preventing different diseases. The
scientific definition of stress as given by Dr Hans Selye, one
of the first researchers to really study stress in the laboratory,
is: "A stressor is anything that challenges an organism to
adapt." In this context, heat, cold, physical exercise,
electrical stress, lack of food, hypoxia of altitude and even
emotional or psychological turmoil are stress factors that can
be used to strengthen us if we experience them in amounts
we can tolerate and to which we scan adapt. Almost all of
these factors have been used as means to help people restore
health. On the other hand, too much of any of these stress
factors, carried on for too long without sufficient recovery
time, can exhaust the adaptive mechanism and contribute to
disease rather than health. If you fast, use saunas or cold
baths, begin an exercise program to get fit or undertake IHT,
you are engaging the principles of adaptation for the
restoration of health. One of the amazing things about
adaptation is what's known as 'cross adaptation'. Adaptation
to one type of stress or load will, to some extent, increase
the body's ability to cope with
stresses of another type. It is well know that a regular
exercise program is associated with an increased tolerance to
stress. Stress-related diseases such as hypertension, heart
disease, ulceration of the stomach or duodenum, diabetes,
dermatological diseases and disordered immunity have all
been shown to have improved outcome with both exercise
and IHT. Protection comes because the body becomes more
tolerant and resistant to stress. Dr F Z Meerson, one of the
most prolific writers and researchers in the field of Adaptive
Medicine, describes in his book Essentials of Adaptive
- Fade away of the stress reaction
- Increased activity of the central and peripheral stress
limiting systems
Desensitisation of target organs
-
Oxygen deficiency is associated with many diseases. It has
been postulated to play a role in many metabolic diseases,
including
Intermittent Hypoxic Training (IHT)
Adaptive Medicine and IHT
Using oxygen more efficiently
Like a finely tuned motor vehicle, if
you are adapted to altitude with IHT
you can run on less fuel with less
wear and tear to your ‘motor’.

Page 3
cancer, fatigue, epilepsy and poor neurological functioning.
For this reason it might seem difficult to accept that hypoxia,
or lack of oxygen, might actually be a more powerful
healing factor than therapies that promote giving oxygen.
IHT increases the efficiency with which the body takes up,
transports and utilises oxygen. The heart and lungs are
stimulated to increase their functions and even over the long
term to increase in size. Blood vessels dilate and new
capillaries are formed in the heart, brain and skeletal
muscles. In the blood, levels of erythropoietin (EPO),
haemoglobin and myoglobin increase. All these factors
make the blood capable of carrying more oxygen. On a
cellular level there is a growth of the cellular structures
needed for the metabolism of oxygen. If you undergo IHT,
the net effect is a decrease in the need for oxygen by about
20 per cent and an increase in the ability to use oxygen, as
measured by VO2 max. Like a finely tuned motor vehicle, if
you are adapted to altitude with IHT you can run on less fuel
with less wear and tear to your 'motor'. And when you need
to run in high gear you can do so and use all the fuel or
oxygen you need to achieve maximum performance. Once
the body has built the structures such as new capillaries, new
blood components, new cells for the heart and lungs, new
mitochondria and enzymes for using oxygen, it has increased
its functional reserve and can extract more oxygen from
normal lowland atmospheric air. The body now has an
increased functional reserve that can offset fatigue and
enhance areas of functioning in the body that require
oxygen. If you were to rely on administered oxygen, like
hydrogen peroxide or oxygen administered in a hyperbaric
chamber, the effects might be available to the body for only
the short length of time the oxygen is in your system,
the asthmatic will continue to hyperventilate. The improved
oxygen capacity observed after adaptation to hypoxia results in
the oxygen required by the body being supplied with less
volume of air needing to be taken in and less hyperventilation
taking place. Recent experiences with patients on artificial
ventilation indicate that the stress of breathing itself might
adversely affect susceptible airways. Lower ventilation levels
are associated with a 30 per cent lower mortality rate in
patients with severe lung disease.
The effects of altitude on the functioning of the brain and
neuroendocrine system are very interesting. The Eastern
tradition of spiritual aspirants going to the mountains to
purify the mind and elevate the spirit might have a
physiological basis. The neurotransmitters dopamine and
seratonin, associated with positive mood and calmness,
showed quite a significant increase in people who
underwent a three-week course of intermittent hypoxic
acclimatisation. Norepinephrine, the neurotransmitter
associated with increased activity of the sympathetic
nervous system and the so-called 'fight or flight' response,
was decreased.
In general, IHT contributes to improved immunological
status. The occurrence of allergies and inflammatory diseases
decreases. This has been observed in continuous exposure to
altitude, as well as with IHT. Studies have been able to show
improvements to conditions of an inflammatory nature, such
as arthritis, asthma, allergic rhinitis, auto-immune thyroiditis
and inflammatory skin diseases. Even the difficult-to-treat
and disabling disease rheumatoid arthritis showed a positive
response, with seven out of 10 patients receiving IHT
showing less inflamed joints, reduced pain and morning
stiffness and reduced need for medication. All patients
reported improved mood, sleep and appetite and increased .
physical activity. Asthma has received particular attention,
with several studies showing significant improvement.
Observations made in the Netherlands have shown that
asthmatics treated in climatic chambers that simulated
altitudes of 1500 to 2550 metres improved rapidly, and with
60 to 100 treatments were 'cured'. This certainly fits with the
common observation that asthmatics, despite their obvious
fears about altitude, usually have less asthma and do much
better at altitude. I have taught the Buteyko method for the
past nine years. This highly successful method (also
originating in Russia) teaches that hyperventilation and loss
of carbon dioxide (which is anti- inflammatory and broncho-
dilating) worsen the asthmatic condition. Inflammation in the
lungs is one reason asthmatics hyperventilate. Another
perpetuating factor to hyperventilation could be inefficient
oxygen metabolism. Until this is improved,
Neurotransmitter
Norepinephrine
Dopamine
Seratonin
(n = 5)
186
132
108
(n = 10)
150
167
238
p
<0.05
<0.05
<0.01
In Russia, IHT has been used and investigated for more than
20 years. The process of full acceptance and endorsement by
the Russian Ministry of Health has been slow and arduous.
Proponents of the technique had to prove in numerous
clinical trials the efficacy of the technique for the
enhancement of general health. Clinical trials on more than
300,000 people suffering such varied conditions as neurotic
and psychiatric disturbance, heart disease, female
gynecological disease, paediatric diseases and many other
conditions were conducted over this time and showed
positive results. One of the turning points in convincing
authorities of the dramatic effects possible with this therapy
came with a trial involving 49 women with various
gynaecological conditions who had been unable to conceite
or carry through a full-term pregnancy. Amazingly, 48 of the
49 women became pregnant and delivered healthy children.
The children and mothers were then followed for two years
and were found to be exceptionally healthy.
At present in the western world, knowledge of IHT has been
mainly among elite athletes. In the Sydney 2000 Olympics,
the Australian swimming team and various competing
individual athletes had access to a Hypoxicator. Canadian
Simon Whitfield, while he was not considered a contender,
surprised many by coming forward to win the men's
triathlon.
reported that he "...ran the last 150
metres as though he'd done nothing more strenuous that
morning than taken a shower". Based on findings among
other athletes using IHT, it could be speculated that
incorporating IHT into his training during the 12 months
before the Olympics might have helped Simon give this
outstanding performance.
7ime Magazine
IHT for inflammatory conditions
Improved athletic performance
Results from Russia
Effects on the brain

Page 4
Athletes in New Zealand have had access to IHT for the
past 'Ovo years. A study by Dr John Hellemans, sports-
medicine doctor from Christchurch and a world triathlon
champion himself, showed that after 15 to 20 daily or twice-
daily sessions of IHT lasting 60 to 90 minutes, athletes'
performance improved by 2.9 per cent. Blood tests also
showed that IHT stimulated red blood cell and haemoglobin
levels and that this correlated with improvements in
performance. Dr Hellemans suggests, 'The method of IHT
can be strongly acommended for any serious athlete as part
of their training and preparation." Dr Hellemans found that
the results of using IHT were particularly successful for
athletes suffering from fatigue and overtraining in
recovering full functional capacity. One dramatic case study
of an elite triathlete incorporating IHT in his normal
training routine over a 14-day period showed a 7.25-second-
per-kilometre improvement in performance time. In
addition, his resting heart rate dropped from 35 to 28, his
weight dropped from 68.7 to 67.9 kilos and his red blood
cell .count increased from 44 to 51 per cent.
Most of us are not elite athletes, therefore being a few
seconds faster has no real significance whatsoever. What we
do want, however, is to be able to carry out our day-to-day
living without fatigue and with ease and enjoyment. Elite
athletes balancing precariously on the pinnacle of human
achievement consider themselves lucky to increase
performance by three per cent. The good news is that
untrained people show an even more dramatic improvement
in fitness, energy and endurance when given a course of
IHT. In one study with healthy but untrained men,
adaptation increased the total amount of work performed on
an ergometer by 27 per cent; the maximal output of their
heart increased by 15 per cent; their lung capacity increased
by up to 40 per cent.
In my practice, the main consistent benefit of using a
Hypoxicator is improved energy levels. Judith (not her real
name) was one of the first people to complete the course of
IHT at the clinic. She was generally healthy but suffered
from high blood pressure (which tended to always be a little
high even with medication), some asthma, fatigue and
insomnia. Although she exercised regularly at the gym three
to four times a week and played golf at least twice a week,
she often felt extremely tired, after, even moderate exercise.
After golf she always felt really exhausted and wondered if
it was a symptom of menopause. Seeing octogenarians skip
up the steps to the clubhouse, she wondered why she felt so
tired when she looked so healthy. Her gym sessions left her
feeling really tired for about two hours. After completing 16
sessions of IHT, Judith finds she can do her exercise at a
more intense level than she could previously, and without
any subsequent fatigue. She says: "My energy and
performance levels have increased to a marked degree. Even
after extreme effort I am not as tired. I recently spent a few
days cross-country skiing at a high altitude. Previously, it
would have taken a couple of days for me to acclimatise.
After having IHT I found I did not experience the usual
headaches or tiredness. I also slept better than I did at
altitude." Also, throughout the period of having IHT, Judith
monitored her blood pressure. Previously it was difficult to
stabilise and 'tended to be 145/95 or sometimes up to
155/100. Now it is
consistently lower, at around 125/80 to 135/85, with fewer
fluctuations.
My own experience with IHT has been fantastic. In my late
40s I have achieved a level of fitness I did not enjoy even in
my younger days. There are days when I just feel
effervescent with energy and can work all day without total
fatigue waiting to meet me afterwards.
After a stressful year of drama and tragedy, I found myself a
year ago experiencing palpitations on just walking up a
small hill. I felt grief at my lost health and resolved to do
what I could to regain it. I began a slow and careful exercise
program and was gradually building up a program of
running and walking, combined with more time spent in
relaxation. Even though I was starting to become fitter and
the palpitations had gone, I still didn't have much endurance.
However, a few weeks after starting IHT I noticed the same
feeling I had experienced after trekking in the Himalayas: a
combination of bliss and bouncy, resilient energy. I found
for the first time in my life I could run for 30 minutes
without stopping and without breathlessness or gasping. I
now go out and do this almost every day – because I want
to. I feel more confident that I will be able to remain fully
functional and vibrant as I get older.
IHT might prove to be of tremendous help for sufferers of
chronic fatigue syndrome (CFS). People with CFS
frequently suffer from breathlessness, poor aerobic
metabolism, lactic acid accumulation after exertion and
other indicators of poor oxygen efficiency. Studies have
been conducted showing that improving fitness though
exercise therapy helps CFS suffers have more energy and
general improved functioning. The problem is that exercise,
if overdone, can also easily lead to incapacitation. IHT
might prove to be a stepping stone for increasing fitness and
functional capacity for people with CFS. The CFS sufferers
at our clinic who have completed their acclimatisation to 11
per cent oxygen have all shown marked and even
exceptional improvement in their condition over a few
months.
Rosalba Courtney is an osteopath, naturopath and
acupuncturist with a special interest in breathing therapies.
She practises at Mona Vale, Sydney. Ph: (02) 9979 9444. For
more information about IHT go to: www.go2altitude.com
Increased energy and endurance
Hope for chronic fatigue sufferers
Getting fit for non-athletes