23 Powerful Ways to Support the Mitochondria in Your Brain

Picture of several mitochondria.

It’s becoming increasingly clear that chronic mitochondria dysfunction is one of the main underlying factors that contributes to poor brain function and mental illness. 

Mitochondria are unique structures within every cell of your body. You have trillions and trillions of them, making up approximately 10% of your total body weight.

Mitochondria are considered the “powerhouses of the cell,” generating most of the energy in your body by converting nutrition into adenosine-5’- triphosphate (ATP). ATP is your body’s main source of cellular fuel. You are constantly using it, and your brain needs enough of it to work properly (106-107). 

Along with your gut bacteria, your mitochondria are critically important and need to be supported to overcome depression and anxiety, and reach optimal brain and mental health.

Mitochondria are especially abundant in your brain cells and involved in many important biological processes in the brain, including the regulation of free radicals and neurotransmitters.

In fact, monoamine oxidase (MAO), the enzyme responsible for the metabolism of monoamine neurotransmitters, is localized within the outer mitochondrial membrane (91-93). 

So not surprisingly, numerous studies show that there is a correlation between impaired mitochondrial function in the brain and many psychiatric and neurodegenerative diseases, including:

In fact, some researchers are convinced that mitochondrial dysfunction is involved in almost every chronic disease (108-110). 

Mitochondria dysfunction decreases ATP energy production and increases oxidative stress, which are commonly found in the brains of people suffering from brain and mental health disorders.

Cognitive symptoms of mitochondrial dysfunction can also include impairments in attention, executive function and memory (105).

Unfortunately, a number of psychiatric drugs damage the mitochondria and worsen the dysfunction.

But luckily, there are ways to halt and reverse mitochondrial decay.

Below are a number of strategies I’ve used over the years to support my mitochondria.

Supplements and lifestyle changes can improve mitochondrial health by increasing the availability of proteins needed for ATP production.

They also act as antioxidants, assisting the mitochondria in reducing oxidative stress.

Some of the following lifestyle changes and supplements can also increase the number of mitochondria present within the cell.

And you can start using them today to regain optimal brain and mental health.

 

1. Eat Nutrient-Dense, Whole Foods

Dr. Terry Wahls standing in front of her wheelchair.

Eating lots of fresh, nutrient-dense whole foods is one of the most impactful actions you can take to power your mitochondria. 

In order to thrive, your mitochondria need phytonutrients, antioxidants, healthy fats and proteins.

Dr. Terry Wahls, MD, clinical professor of medicine at the University of Iowa, is a leading expert on the relationship between nutrition and mitochondrial health.

She was diagnosed with multiple sclerosis (MS) more than a decade ago but reversed the neurodegenerative brain disease by repairing her mitochondria with an intensive nutritional strategy.

She outlines how she recovered her health in her book The Wahls Protocol

Research on her protocol shows that patients witness a “significant improvement in fatigue” (67). 

She recommends eating six to nine cups of vegetables and fruits every day, including green veggies (kale, spinach), brightly colored vegetables (beets, carrots, peppers), and sulfur-rich veggies (broccoli, cauliflower).

My Free Grocery Shopping Guide for Optimal Brain Health contains a bunch of foods that you should be eating on a regular basis for optimal mitochondrial health. 

Dr. Wahls also has a fascinating TED talk that you can watch if you're interested in learning more. 

 

2. Avoid Certain Foods and Ingredients

Pizza, burgers and fries. Fast, processed food impairs mitochondria health.

Eating poor-quality foods can also wear down your mitochondria. 

Your mitochondria were not designed to deal with our current food environment and lifestyle habits. 

That’s why you should avoid refined sugars, processed flours, industrial oils and trans fats. They can damage your mitochondria and prevent them from properly producing energy.

Dr. Wahls also recommends you avoid all gluten, dairy and soy products for optimal mitochondrial health.

I personally feel much better avoiding them completely as well. 

 

3. Eat More Essential Fats

Healthy fats, including omega-3 fatty acids, help build and strengthen the membranes of your mitochondria. They’ve also been shown to improve mitochondrial function in the brain (5-7). 

That’s why Dr. Wahls recommends eating organic grass-fed beef or wild-caught fish, such as salmon, every day.

Avocados, nuts, seeds, coconut and olive oil are also rich in healthy fats. 

Supplementing with krill oil is another excellent option.

 

4. Exercise

Not surprisingly, exercise strengthens your mitochondria by increasing oxygen and blood flow and activating biochemical pathways that produce new mitochondria (8). 

Runners have more high-functioning mitochondria than non-runners, and strength training and high-intensity interval training also increase the number of mitochondria and improve the efficiency of your existing mitochondria (9, 10).

Many experts recommend exercise for brain health.

Exercise can also increase brain-derived neurotrophic factor (BDNF).

 

5. Low-Level Laser Therapy (LLLT)

Low-level laser therapy (LLLT) is a treatment that uses low-level (low-power) lasers or light-emitting diodes (LEDs) to stimulate brain cells, helping them heal and function better. 

There is strong evidence to suggest that LLLT supports the mitochondria. 

Research shows that LLLT reduces oxidative stress and increases the production of ATP energy in mitochondria (39, 40). 

These mitochondrial benefits have also been seen directly within the brain.

Studies show that LLLT increases mitochondrial activity within brain cells, and this leads to beneficial effects in behaviour (41). 

LLLT treatment has also been shown to increase the number of mitochondria, and mitochondrial oxygen usage, within the brain (42, 43).

I use these two LLLT devices myself at home to support my mitochondria and boost my brain function:

  • Platinum Therapy Lights Bio-450 (Combo Red/NIR) - This is a powerful all-one-device that shines 660 nm of red light and 850 nm of infrared light. I shine it on my forehead for 5-10 minutes every day or every other day. I also shine it on other parts of my head, and on my thyroid, thymus gland and gut. If you decide to get this device, you can use the coupon code OPTIMAL for a 5% discount.

  • Vielight 810 – This is an intranasal device with 810 nm of near infrared light that I use regularly. It penetrates deeper into brain tissue and is absorbed better by the central nervous system. If you decide to get this one, you can use the coupon code JORDANFALLIS for a 10% discount. Some research has shown a 20-fold higher efficiency of light delivery to the deep brain through the nose instead of transcranial application (125). Vielight also has two new devices - the Neuro Gamma and the Neuro Alpha. And they are apparently even more effective than the Vielight 810.

You can learn more about LLLT in this post

You should also limit your exposure to artificial blue light, as excessive blue light exposure can also wear down your mitochondria. You can learn more about the risks of too much blue light in this post

 

6. Resveratrol

Resveratrol is a beneficial antioxidant compound found in grapes and red wine. 

Not only does it increase BDNF levels, but it also activates the SIRT1 gene. This gene triggers a number of positive biochemical reactions that protect and improve the functioning of your mitochondria. Caloric restriction and intermittent fasting also trigger the SIRT1 gene (11-13).

In 2006, Harvard researchers found that resveratrol increases lifespan by protecting the mitochondria (14).

That’s why I take resveratrol every day and will continue to do so for the rest of my life.

Resveratrol is included in the Optimal Energy supplement.

 

7. Caloric Restriction and Intermittent Fasting

Restricting your calories is one the best actions you can take to improve mitochondrial function.

Studies show that eating less food reduces the demand and damage on your mitochondria. 

But reducing calories is tough to do and absolutely no fun. 

That’s why I fast intermittently instead. 

Fasting activates your mitochondria and triggers autophagy, which is an intracellular process that essentially allows your mitochondria to clean themselves by removing unwanted and damaged debris, proteins and reactive oxygen species (1, 2, 4).

This process has been shown to reduce the risk of cancer, Parkinson’s disease and Alzheimer’s disease (3). 

 

8. Nicotinamide Adenine Dinucleotide (NADH)

NADH is a naturally-occurring compound found in the cells of all living organisms.

It plays a key role in the production of energy within the cell and is highly concentrated within your mitochondria (45). 

Depletion of NADH has been linked to a number of diseases, including depression, chronic fatigue syndrome, Alzheimer’s and Parkinson’s.

But stabilized oral NADH has been shown to improve all of these conditions (46, 47, 48). 

Although I don’t take it anymore, I’ve witnessed a beneficial effect from supplementing with this NADH supplement.

LLLT is also known to increase NADH in your mitochondria. 

 

9. Ketogenic Dieting

A ketogenic diet is a very low-carb diet. 

When you restrict carbohydrate-rich foods, your body enters ketosis.

Ketosis is a metabolic state in which your body and brain run on fatty acids and “ketones” instead of glucose (36).

Ketones are an alternative source of energy for your brain cells and they support your mitochondria. 

When your mitochondria are dysfunctional, following a ketogenic diet can be an effective strategy to fuel the mitochondria. 

When mitochondria are fueled by ketones instead of glucose, their ability to produce ATP is enhanced and free-radical byproducts are reduced.
— Dr. Jong Rho, MD, Professor of Pediatrics and Clinical Neurology at the Alberta Children’s Hospital

Ketogenic diets may help treat many different brain and mental health diseases including Alzheimer’s, Parkinson’s, epilepsy and autism. 

Exogenous ketones can also help you get into ketosis and experience the mitochondrial-boosting effects of ketones very quickly.

I take Optimal Ketones, and it immediately increases my mental clarity (even when I'm eating carbohydrates). 

 

10. B Vitamins

B vitamins play an essential role in maintaining mitochondrial function.

In fact, your mitochondria will be compromised if you have a deficiency of any B vitamin (37). 

Deficiency is more likely if you take certain medications

Vitamin B1, B2, B3, B5, B6 and B12 are all included in the Optimal Energy supplement for this reason.

 

11. Ribose

Ribose is a five carbon sugar created naturally by your body.

Even though it’s a sugar, research suggests it does not raise blood sugar levels.

Instead, your body stores it in the mitochondria (49, 50). 

Ribose is used by the mitochondria to produce ATP and if you don’t have enough, you’ll experience low energy (51). 

Chronic stress can deplete ribose, and certain conditions have been linked to chronic ribose deficiency, including depression and chronic fatigue syndrome.

That’s why I recommend people supplement with ribose if they struggle with these disorders because it can help reduce mental and physical lethargy (52, 53).

Ribose is also included in Optimal Energy.

 

12. Coenzyme Q10 (CoQ10)

Coenzyme Q10 (CoQ10) is an antioxidant molecule found in every cell of your body.

It’s particularly concentrated in the mitochondria, playing a key role in the production of energy.

It also protects the mitochondria from oxidative damage. 

Without CoQ10, your body cannot synthesize ATP because CoQ10 is an essential component of the mitochondrial electron transport chain.

Many doctors are unaware that CoQ10 is an excellent treatment for many brain health issues, including depression, chronic fatigue syndrome, and Alzheimer’s disease

Low levels of CoQ10 can cause brain fog, mental fatigue, difficulty concentrating, memory lapses, depression and irritability (68-70). 

Researchers have found that CoQ10 levels are significantly lower in the depressed patients (71). 

Unfortunately, chronic oxidative stress and medications can further deplete CoQ10

But supplementing with CoQ10 can increase your mitochondrial energy production and reduce symptoms of depression and chronic fatigue (71). 

Food sources with high natural concentrations of CoQ10 include organic red palm oil and grass-fed beef heart (72, 73). 

But supplementing with it will give you a more significant mitochondrial boost.

 

13. Pyrroloquinoline quinone (PQQ)

Pyrroloquinoline quinone (PQQ) is a vitamin-like enzyme and potent antioxidant found in plant foods.

It has a wide range of brain health and mitochondrial benefits.

It’s been shown to preserve and enhance memory, attention, and cognition by protecting the mitochondria from oxidative damage.

It also promotes the growth of new mitochondria in the brain (56-59). 

Since it helps grow new mitochondria, it may help you if you suffer from depression, since fewer mitochondria have been found in people with depression (63). 

Reactive nitrogen species (RNS) and reactive oxygen species (ROS) cause severe stress on brain cells and mitochondria.

PQQ has also been shown to suppress RNS and ROS (60-62). 

Researchers have also found that supplemental PQQ can be neuroprotective by increasing mitochondrial activity levels (64-66). 

I personally never really noticed much of anything from PQQ. So I don’t take it anymore and didn’t include it in Optimal Energy.

You can get PQQ here if you want to try it though. 

 

14. Magnesium

Magnesium is a vital mineral within your body.

Mitochondria are considered magnesium “storage units” because they hold onto a lot of your body’s magnesium. 

Magnesium also protects the mitochondria and plays a role in the production and transfer of ATP within the mitochondria.

And research shows that if you have a deficiency in magnesium, your brain cells will have fewer mitochondria, and they will be less healthy (54, 55). 

This is just another reason to supplement with magnesium every day.

And it’s why I included magnesium in Optimal Energy.

 
Scientific representation of brain and brain blood flow.

Carnitine is an amino acid that improves mitochondrial activity and plays an important role in energy production.

It’s known to transport fatty acids directly into the mitochondria of your brain cells

It’s also required to produce ATP and deficiencies are associated with reduced mitochondrial function in the brain (74). 

Supplementing with carnitine makes it easier for fatty acids to cross your blood-brain barrier and nourish the mitochondria within your brain. This can improve your mood, memory and energy levels.

Several studies show that carnitine eases depressive symptoms and improves quality of life in patients with chronic depression (75-78). 

And individuals with autism often have reduced levels of carnitine within their brain (79). 

Carnitine is synergistic with Alpha Lipoic Acid (ALA), meaning that when you take them together, they are more effective at supporting the mitochondria in your brain.

ALA is a mitochondrial enzyme and antioxidant. It is fat soluble and can easily cross your blood-brain barrier.

It’s been shown to improve cognition by reducing oxidative stress in the brain.

It also protects existing mitochondria and creates new mitochondria in the brain (80, 101).

Both ALA and carnitine are included together in Optimal Energy.

 

16. Thiamine

Thiamine, also known as Vitamin B1, is an essential water-soluble nutrient that cannot be made by the body.

It’s used in nearly every cell in the body and it’s especially important for supporting energy levels and mitochondrial functioning in the brain.

It’s also required by nerve cells and other supporting cells in the nervous system.

Research shows that thiamine deficiency induces oxidative stress, resulting in mitochondrial abnormalities in the brain (21-22).

Healthy food sources of thiamine include green peas, beef liver, asparagus, pecans, spinach, sunflower seeds, macadamia nuts, oranges, cantaloupe and eggs. 

These foods are included in my Free Grocery Shopping Guide for Optimal Mental Health.

Thiamine is also included in Optimal Energy.

 

17. Creatine

Creatine is a molecule produced in the body and found in foods, particularly meat, eggs, and fish.  

Creatine is also available as a supplement.

Athletes, bodybuilders, wrestlers, sprinters often take extra creatine to gain more muscle mass.

It’s an incredibly well-researched supplement and safe to take regularly. 

Supplementing with creatine can also support the brain.

It's been shown to have neuroprotective effects. It rapidly produces energy to support brain cell function.

Researchers have also found that creatine supplementation improves function of mitochondria in the brain (25).

I used to take creatine powder before workouts, but I now just take the Creatine in Optimal Energy.

 

18. Curcumin

Curcumin is the most heavily researched compound within turmeric, the spice that gives curry its yellow colour.

It’s one of my favourite natural compounds for the brain.

One reason why is because it protects mitochondria and prevents mitochondrial dysfunction in the brain (111-113).

 

19. Malic Acid

Malic acid, also known as malate, is an intermediate of the Krebs cycle.

It’s a key step in the pathway of energy production by the mitochondria.

And it has a number of health benefits because it improves mitochondrial function.

Malate supplementation has been shown to increase the availability of NAD+, which is necessary for producing ATP.

Malate also increases NADPH levels, which is a fundamental antioxidant in the body that promotes mitochondrial function (114).

That’s why I’ve included malic acid in the Optimal Energy supplement.

 

20. Niacinamide

Niacinamide, also known as nicotinamide, is a vitamin found in foods.

It’s also often taken as a supplement.

Niacinamide is the precursor to NAD+ and therefore supplementation can increase levels of this molecule and improve mitochondrial function.

Researchers have found that niacinamide prevents energy depletion in the brain (115).

It also improves the mitochondrial quality of brain cells by inducing autophagy and causing dysfunctional mitochondria to fragment (116).

 

21. N-Acetyl-Cysteine

N-Acetyl-Cysteine (NAC) is a modified form of the amino acid cysteine.

It’s also the precursor to glutathione, your body’s master antioxidant.

Nowadays, we’re exposed to so many environmental toxins, which cause oxidative stress in the body and deplete our reserves of cysteine and glutathione.  

But supplementing with NAC can increase and normalize your cysteine and glutathione levels. 

This can combat and reduce oxidative stress in your brain, which can then help treat several mental illnesses.

NAC can also help support your mitochondria.

In one study, NAC treatment for 9 weeks reduced oxidative damage to the mitochondria (117).

And in multiple cell studies, NAC improved mitochondrial function by reducing oxidative stress (118-119).

 

22. Succinic acid

Succinic acid, also known as succinate, is an intermediate molecule of the Krebs cycle that plays a significant role in the electron transport chain.

It can be purchased as a supplement to boost energy production by the mitochondria.

Succinic acid has been shown to prevent structural and functional damage to the mitochondria caused by oxidative stress (120).

And in brain cells that have mitochondrial dysfunction, succinic acid supplementation improved mitochondrial functioning by increasing glucose and oxygen usage. This led to increased levels of ATP energy (121).

For this reason, succinic acid is in the Optimal Energy supplement.

 

23. EGCG

Epigallocatechin-3-Gallate (EGCG) is the main polyphenol found in green tea.

It’s been shown to have anti-inflammatory and neuroprotective effects.

EGCG accumulates within the mitochondria and activates a number of proteins related to mitochondrial function (122-124).

I personally drink organic green tea regularly, usually in place of coffee on days when I’m relaxing.

I also take a supplement that includes green tea extract and EGCG.

 

Conclusion

Picture of mitochondrion, the energy producer of brain cells.

Paying attention to your mitochondria is crucial for optimal brain and mental health.

Luckily there are a number of dietary and lifestyle habits that can protect and support mitochondrial function.

The following steps will ensure your body and brain have healthier and more abundant mitochondria: 

  • Take Optimal Energy. It’s an all-in-one mitochondrial supplement. It includes the 17 best natural compounds proven to boost mitochondrial functioning in the brain.

  • Eat nutrient-dense, whole foods, including plenty of fruits and vegetables. Download my free food guide for a shopping list of the best foods to eat.

  • Avoid refined sugars, processed flours, industrial oils, trans fats, gluten and processed dairy.

  • Eat organic grass-fed beef and wild-caught fish, or supplement with krill oil.

  • Exercise

  • Try LLLT

  • Restrict calories and/or fast intermittently

  • Follow a cyclic ketogenic diet and/or take Optimal Ketones

If you follow these strategies, there’s no doubt that you can improve your mitochondrial health and naturally restore your mood and energy levels.

Please share this post with one of your friends or family members who you think might benefit from protecting and supporting their mitochondria, because it really is an underappreciated and unknown aspect of optimal brain and mental health. 

 
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Live Optimally,

Jordan Fallis

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(107) http://www.umdf.org/site/c.8qKOJ0MvF7LUG/b.7934627/k.3711/What_is_Mitochondrial_Disease.htm

(108) http://www.ncbi.nlm.nih.gov/pubmed/17239370

(109) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566449/

(110) https://riordanclinic.org/wp-content/uploads/2015/01/mitochondria-and-cancer-1.pdf

(111) https://accelerating.org/articles/curcumin.html

(112) https://www.ncbi.nlm.nih.gov/pubmed/23422877

(113) https://www.ncbi.nlm.nih.gov/pubmed/26254982

(114) http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058345

(115) https://www.ncbi.nlm.nih.gov/pubmed/10566977

(116) https://www.ncbi.nlm.nih.gov/pubmed/19473119

(117) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312826/

(118) https://www.ncbi.nlm.nih.gov/pubmed/17917164

(119) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726696/

(120) https://www.ncbi.nlm.nih.gov/pubmed/3032929

(121) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430749/

(122) https://www.ncbi.nlm.nih.gov/pubmed/26731017

(123) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670924/

(124) https://www.ncbi.nlm.nih.gov/pubmed/16797120

Medically reviewed by Dr. Terry Wahls, MD

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How to Fight Alzheimer's Disease with Intranasal Insulin

A woman spraying insulin up her cose with an intranasal bottle.

Today I want to discuss "intranasal insulin", a cutting-edge therapy that could help a lot of people. 

Neurologists and psychiatrists tend to undervalue the impact of hormones originating outside the brain.

Until modern medicine treats the entire body as one unified system – like functional medicine practitioners do – people will continue to lose faith in conventional practitioners and look elsewhere for solutions to their chronic brain and mental health problems. 

As Dr. Suzanne Craft, Ph.D, Professor of Gerontology and Geriatric Medicine, explains:

People are now starting to understand the critical interaction between the brain and the body and that many of the peptides and hormones produced in the body have very substantial roles to play in the brain. I think we’re at the beginning of a very exciting era in which we’re going to be able to start putting together these systems to understand Alzheimer’s disease, which is clearly a disease of the entire organism, not just of the brain.

Insulin is one of the hormones that significantly affects brain function.

It's been shown to pass the blood-brain barrier and act on insulin receptors directly within the brain (3, 4). 

Not only does our body produce and release it, but it can also be taken as a medication, particularly for the treatment of diabetes (1, 2). 

Researchers have found that insulin has “neurotrophic, neuromodulatory, and neuroprotective effects” by:

  • Promoting neuronal growth;

  • Regulating the levels of certain neurotransmitters;

  • Increasing brain energy levels (ATP in your mitochondria);

  • Increasing blood flow in the brain;

  • Preventing dopaminergic neuron loss;

  • Reducing inflammation in the brain; and

  • Protecting against oxidative stress in the brain by restoring antioxidants and energy metabolism (5-13).

Insulin in the dictionary.
In the brain, insulin has a number of roles to play. It promotes glucose uptake in the neurons of the hippocampal formation and the frontal lobes, areas that are involved in memory. Insulin also strengthens the synaptic connections between brain cells, helping to form new memories. In addition, insulin regulates the neurotransmitter acetylcholine, which plays an important role in learning and memory.
— Dr. Suzanne Craft, Ph.D

So, it clearly does a lot in the brain, and research shows that it can be therapeutic for a number of mental health conditions, particularly Alzheimer’s disease

In a new therapeutic approach, commercially-available insulin (Novalin R) is prepared and added to nasal spray bottleslike this one – and sprayed and inhaled through the nose to support brain and mental health. 

Dr. William Banks, Professor of Internal Medicine and Geriatrics, says there are more than 100 different intranasal compounds that are being tested for the treatment of Alzheimer’s disease

“Intranasal insulin” is just one of them, and it’s one of the more promising ones, as it’s been reported to significantly enhance memory, increase mental energy, reduce brain fog, improve mood, and lower anxiety and stress levels

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The Link Between Alzheimer’s Disease, Insulin and Diabetes

Many of the brain health experts I’ve talked to are convinced that Alzheimer’s disease should actually be called "Type 3 diabetes".

This is because diabetes and insulin are closely linked to cognitive decline and dementia

Many studies show that diabetes is associated with an increased risk of cognitive dysfunction, and people with diabetes are 2 to 3 times more likely to be diagnosed with Alzheimer’s disease and mild cognitive impairment than non-diabetics (14-21). 

Researchers have also found that insulin declines in the brain as people age, and patients with Alzheimer’s disease often have insulin resistance and reduced levels of insulin in their brains (25-30)

But what if insulin deficiency is detected in the brain, and then insulin is supplied to the brain, could neurodegeneration and the development of dementia be prevented? And could the progression of existing Alzheimer’s disease be halted?

The answers to these questions appears to be yes:

  • Diabetic patients who take insulin have improved memory and reduced rates of Alzheimer’s disease;

  • Elderly diabetics who take insulin have less severe Alzheimer’s disease compared with non-diabetics;

  • Insulin improves cognition and memory in people with Alzheimer’s disease; and

  • Insulin prevents and reverses brain degeneration and cognitive impairment in diabetic animals (22-24).

Check out the below video to learn more from one of the leading researchers in the field: 

Cutting-Edge Research Shows That Intranasal Insulin Improves Cognition and Memory

The intranasal route of insulin administration provides direct access to the cerebrospinal fluid and brain.

This allows insulin to directly enter the brain from the nose, and bind to receptors within specific areas of the brain that are involved in memory and cognition (42). 

Insulin receptors in the brain are found in high densities in the hippocampus, a region that is fundamentally involved in the acquisition, consolidation, and recollection of new information.

An increasing amount of research has been published over the last ten years, demonstrating that intranasal insulin can significantly improve cognition, attention, memory and overall brain function in people with mild cognitive impairment and Alzheimer’s disease (31-33, 38-39, 43-45). 

In fact, there are over 30 randomized, double-blind, placebo-controlled trials showing that it’s effective at improving memory, learning and cognitive performance in humans (34-37). 

Illustration of how intranasal insulin works.

Yet most people aren’t aware of it, and doctors aren’t prescribing it, while millions of people suffer from dementia

One study found that it improved objective biomarkers of neurodegeneration, including amyloid deposits and tau pathology, in people with Alzheimer’s disease within a few months. In the group of patients that didn’t receive intranasal insulin, brain function continued to deteriorate (40). 

In another study, researchers gave intranasal insulin to 104 adults with mild cognitive impairment or Alzheimer’s disease. At the end of the 4-month study, the participants who received insulin had significantly better memory and cognitive function compared to the group who didn’t receive insulin (41). 

The researchers also found that the improvements in cognition were correlated with improvements in objective biomarkers, and concluded that “intranasal insulin therapy can help to stabilize, slow, or possibly even reverse the course of Alzheimer’s disease (41). 

Because of the promising research so far, the US government is currently funding a two-year long clinical trial to see if intranasal insulin will help 240 people with Alzheimer’s disease. Results from the Study of Nasal Insulin in the Fight Against Forgetfulness (SNIFF) are expected to be released in 2017. 

And intranasal insulin doesn’t just help elderly people with dementia. It’s also been shown to improve memory in younger, healthy individuals (46-51). 

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Intranasal Insulin and Other Brain and Mental Health Disorders

Alzheimer’s disease isn’t the only brain and mental health condition that can benefit from intranasal insulin. 

Here are some others:

  • ADHD and drug addiction – Insulin affects dopamine, which is a neurotransmitter linked to both these conditions (52).

  • Depression, anxiety and anger – In one study, 38 healthy people took intranasal insulin for 8 weeks and experienced enhanced mood, increased self-confidence and reduced anger. Another study found that it affected heart-rate variability (53, 59).

  • Stroke – Researchers point out that “intranasally administered insulin possesses many of the ideal properties for acute stroke neuroprotection” (54, 62).

  • Bipolar disorder – One study found that intranasal insulin significantly improved executive function in patients with bipolar disorder (55).

  • Neurodevelopmental disorder – Two studies have found that intranasal insulin improves cognition, autonomy, motor activity, nonverbal communication, social skills and developmental functioning of children and adults with a rare neurodevelopmental disorder (Phelan-McDermid syndrome) (57, 58).

  • Overall brain function – “Intranasal insulin appears to restore complex neural networking in the direction of normalization”. In other words, it seems to “reboot” the brain (56).

  • Parkinson’s disease and Down Syndrome – There is no evidence for this yet but there are ongoing trials looking into whether intranasal insulin could help people with these conditions (60, 61).

Safety of Intranasal Insulin and How to Try It Yourself

Numerous studies show that intranasal insulin is incredibly safe and does not cause any significant adverse side effects. The only minor side effects I came across were dizziness, nose bleeding and mild rhinitis, but these were rare (63-65). 

This is because unlike regular insulin administration, intranasal insulin only affects the nose and brain. It doesn’t enter the bloodstream, change insulin levels throughout the entire body, or cause low blood sugar (66-83). 

Overall, I believe the benefits outweigh the risks and it’s worth trying, especially if you’re struggling with mild cognitive impairment or early Alzheimer’s disease. It may be another decade or more until the research trickles down and reaches your doctor’s office. Research shows that it takes about 17 years for new scientific evidence to be implemented in clinical practice

However, I’m not a doctor and you should definitely talk to your doctor about this if you’re considering trying it. If you have an open-minded doctor, perhaps they will support you in trying it. Don’t be surprised if they dismiss the idea entirely though. 

With that said, you can easily and legally buy insulin yourself. It’s available over the counter without a prescription at any pharmacy (in the US and Canada). Pharmacists hold it behind the counter and you just have to walk up and ask for “Novolin R.” In Canada, it’s called “Novolin Toronto.”

It’s that simple. You don’t need to provide personal identification or sign anything. It costs about $30.

After that, you can get a nasal spray bottle - like this one or this one

Then, use pliers to carefully remove the rubber cap from the insulin vial, and pour the insulin into the spray bottle. 

At this point, you’re ready to use it. Make sure to keep it in the fridge when you're not using it. 

Again, I’m not a doctor. So talk to your doctor about this before trying it. But I feel this is worth sharing and writing about considering it has massive potential to help many people who are struggling day-to-day. 

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Dosage

Each spray from the nasal bottle is 0.1mL or 10IU of insulin. 

Dosages in human studies range from 10IU to 160IU (1 to 16 sprays) daily. 

In the longest lasting study, participants took either 20 IU (2 sprays) or 40IU (4 sprays) of insulin daily for four months (86). 

So, if you’re going to try it, I wouldn’t take more than 40IU (4 sprays) for longer than 4 months.

However, participants in the ongoing SNIFF trial have been taking intranasal insulin for more than one year, so once the results from that study are released in 2017, my recommendation may change. 

Overall, self-experimentation is necessary to find the correct dosage that works best for you. 

Conclusion

Intranasal insulin is a very impressive and exciting substance, and the lack of side effects is encouraging. 

If you’re looking to improve your memory and brain function and avoid Alzheimer’s disease, it’s definitely worth considering and talking to your doctor about it. 

An elderly man sprays intranasal insulin up his nose.

All that’s needed is:

I’m aware that this might be little bit “out there” for some people, but I think it has the potential to help a lot of people reach optimal brain and mental health. 

Please share with anyone who is struggling with cognitive impairment or the early signs of dementia because it isn't a very well known treatment. 

Enjoy This Article? You Might Also Like My FREE Food Guide for Optimal Brain and Mental Health!

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Live Optimally,

Jordan Fallis

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References:

(1) http://link.springer.com/article/10.1007/s00125-003-1153-1

(2) http://diabetes.diabetesjournals.org/content/31/11/957.short

(3) http://press.endocrine.org/doi/abs/10.1210/edrv-13-3-387

(4) http://www.ncbi.nlm.nih.gov/pubmed/26401706

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(9) https://www.ncbi.nlm.nih.gov/pubmed/18348871

(10) https://www.ncbi.nlm.nih.gov/pubmed/23907764

(11) https://www.ncbi.nlm.nih.gov/pubmed/26040423

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(13) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391678/

(14) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191295/

(15) https://www.ncbi.nlm.nih.gov/pubmed/22201977/

(16) http://diabetes.diabetesjournals.org/content/54/5/1264?ijkey=3186b318b004c253abda2b3f67535508da9fa50a&keytype2=tf_ipsecsha

(17) http://diabetes.diabetesjournals.org/content/63/7/2253?ijkey=5cc5fc39ea0a601c551a668d0829247222ae292e&keytype2=tf_ipsecsha

(18) http://care.diabetesjournals.org/content/20/3/438

(19) https://www.ncbi.nlm.nih.gov/pubmed/11678970

(20) https://www.ncbi.nlm.nih.gov/pubmed/10647755

(21) http://www.alzheimersanddementia.com/article/S1552-5260(13)02918-X/abstract

(22) https://www.ncbi.nlm.nih.gov/pubmed/15750215/

(23) https://www.ncbi.nlm.nih.gov/pubmed/23565496/

(24) https://www.ncbi.nlm.nih.gov/pubmed/22201977/

(25) https://www.ncbi.nlm.nih.gov/pubmed/17049785?dopt=Abstract

(26) https://www.ncbi.nlm.nih.gov/pubmed/17430239/

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(28) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743662/

(29) https://www.ncbi.nlm.nih.gov/pubmed/18549783

(30) https://www.ncbi.nlm.nih.gov/pubmed/15750215

(31) http://www.karger.com/Article/Abstract/106378

(32) http://link.springer.com/article/10.1007%2Fs40263-013-0076-8

(33) http://jamanetwork.com/journals/jamaneurology/fullarticle/1107947

(34) https://www.ncbi.nlm.nih.gov/pubmed/25008180/

(35) https://www.ncbi.nlm.nih.gov/pubmed/16266773

(36) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3260944/

(37) https://www.ncbi.nlm.nih.gov/pubmed/21883804

(38) https://www.ncbi.nlm.nih.gov/pubmed/22710630?dopt=Abstract

(39) https://www.ncbi.nlm.nih.gov/pubmed/21911655?dopt=Abstract

(40) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743662/

(41) https://www.ncbi.nlm.nih.gov/pubmed/219116/

(42) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443484/

(43) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804944/

(44) http://www.ncbi.nlm.nih.gov/pubmed/17942819/

(45) https://www.ncbi.nlm.nih.gov/pubmed/23507773

(46) https://www.ncbi.nlm.nih.gov/pubmed/20719831/

(47) http://www.psyneuen-journal.com/article/S0306-4530(04)00052-6/abstract

(48) https://www.ncbi.nlm.nih.gov/pubmed/15288712

(49) https://www.ncbi.nlm.nih.gov/pubmed/15288712?dopt=Abstract

(50) https://www.ncbi.nlm.nih.gov/pubmed/19091002?dopt=Abstract

(51) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391678/

(52) http://www.news-medical.net/news/2007/10/18/31385.aspx

(53) https://www.ncbi.nlm.nih.gov/pubmed/15288712

(54) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828994/

(55) https://www.ncbi.nlm.nih.gov/pubmed/23107220

(56) https://www.ncbi.nlm.nih.gov/pubmed/25249577

(57) http://www.nature.com/ejhg/journal/v24/n12/full/ejhg2016109a.html

(58) https://www.ncbi.nlm.nih.gov/pubmed/18948358

(59) http://diabetes.diabetesjournals.org/content/63/12/4083.long

(60) https://clinicaltrials.gov/ct2/show/NCT02064166

(61) https://clinicaltrials.gov/ct2/show/NCT02432716

(62) https://www.ncbi.nlm.nih.gov/pubmed/26040423

(63) http://www.ncbi.nlm.nih.gov/pubmed/25374101

(64) https://www.ncbi.nlm.nih.gov/pubmed/18948358

(65) http://www.ncbi.nlm.nih.gov/pubmed/25374101

(66) http://press.endocrine.org/doi/pdf/10.1210/jc.2007-2606

(67) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743662/

(68) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743662/

(69) https://www.ncbi.nlm.nih.gov/pubmed/23719722?dopt=Abstract

(70) https://www.ncbi.nlm.nih.gov/pubmed/15288712?dopt=Abstract

(71) https://www.ncbi.nlm.nih.gov/pubmed/19091002?dopt=Abstract

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Medically reviewed by Dr. Fred Hui, MD, CCFP, CAFC

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How to Improve Your Brain Function with An Oxygen Concentrator

Insufficient oxygen means insufficient biological energy that can result in anything from mild fatigue to life threatening disease. The link between insufficient oxygen and disease has now been firmly established.
— Dr. W. Spencer Way, Journal of the American Association of Physicians

Oxygen is absolutely essential for life, and your brain depends it more than any other part of your body.

Your brain weighs about 2% of your body weight.

But it consumes about 20% of the oxygen you breathe.

Your brain cells need to get enough oxygen to produce energy and function optimally.

If they don’t, they can start to deteriorate, leading to poor memory and concentration, low mood, lack of energy and drive. 

I personally use oxygen therapy with an oxygen concentrator to support and optimize my brain function. 

This post discusses oxygen therapy, the benefits, how I use it, and how it could help you. 

It’s a great way to boost cognitive function, memory and energy.

Read on to learn more. 

Types of Oxygen Therapy

Oxygen therapy is the use of supplemental oxygen to treat a variety of medical conditions.

Air is typically 21% oxygen by volume, but oxygen therapy increases the amount.

Hyperbaric oxygen therapy (HBOT) is the most well-known type of oxygen therapy, and it allows patients to inhale 100% pure oxygen in a total body chamber.

Tube plugged into oxygen tank

HBOT is often used by professional athletes for recovery and performance.

But it’s expensive and not available to most people. 

Luckily, it’s not the only option available to you. 

Normobaric oxygen therapy (NBOT) is much less expensive, and it’s easily accessible and non-invasive. I personally use NBOT at home. 

Similar to HBOT, NBOT brings a higher percentage of oxygen into the body and can bring major benefits to your brain and cognition.

Researchers have found that both normobaric and hyperbaric oxygen therapy increase the amount of oxygen that is delivered to the blood and brain (1-2). 

With normobaric therapy, oxygen can be delivered via an oxygen concentrator

An oxygen concentrator is a machine that separates oxygen from room air, and then delivers the concentrated oxygen through a nasal cannula or mask.

I use this oxygen concentrator. You can get it here or here.  

Make sure you read the “My Experience” section below where I discuss how to use it. .

Why You Might Need Oxygen Therapy and How It Works

Hypoxia is a condition in which the body or a region of the body is deprived of adequate oxygen supply.

If this happens to you, you can end up with mitochondria dysfunction and poor brain function. 

But how do you know?

You can use an oxygen saturation monitor to measure and monitor your blood oxygenation levels. I use this monitor. It’s the best and most accurate oxygen saturation monitor that is often used by medical professionals, and freely available to the public.

Your blood oxygen saturation levels (SpO2) should measure 99-100% if you want to feel optimal.  

An illustration of the benefits of oxygen therapy.

There are a number of reasons why your body and brain might not be getting enough oxygen:

  • Sedentary lifestyle and lack of exercise

  • Shallow breathing – Most people today don’t breathe well and are shallow breathers.

  • Chronic stressStress and anxiety can also affect your breathing. If you're stressed and anxious, you end up taking more shallow breaths. Your sympathetic “fight or flight” nervous system is chronically active, and this reduces the amount of oxygen that reaches your brain.

  • Abnormal blood pressure – Both high and low blood pressure can be problematic and may suggest that blood is not optimally flowing to your brain. If blood flow to your brain is poor, oxygen levels in your brain will also be suboptimal.

Normobaric oxygen therapy can help you if you’re struggling with any of these problems.

It can also help if you’re recovering from a concussion or brain injury or some sort of toxic exposure (e.g. mold). 

Neuroplasticity and neurogenesis require oxygen, and increasing the delivery of oxygen to the body and brain supports the healing process of damaged tissue.

Normobaric oxygen therapy has been shown to work by increasing brain blood flow, reducing permeability of the blood-brain barrier, and it may even have cholinergic properties (3-8). 

Researchers have concluded that the “neuroprotective role of normobaric oxygen therapy is extremely promising” (9). 

They have also found that it can lead to a number of positive cognitive outcomes, which I'll explore below. 

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1. Normobaric Oxygen Therapy Improves Memory and Recall

In their book Advances in Natural Medicines, Nutraceuticals, and Neurocognition, Dr. Andrew Scholey and Dr. Con Stough state that normobaric oxygen therapy is an effective memory enhancer

Research has shown that oxygen administration leads to improved long-term memory compared to a control group of normal air-breathing.

Several clinical studies also show that concentrated oxygen significantly enhances memory formation and recall in adults (10-11, 16-17). 

In one study, inhalation of oxygen immediately prior to learning a word list resulted in a significant increase in the average number of words recalled 10 minutes later (14). 

In other studies, subjects who received oxygen remembered shopping lists and faces better than subjects that didn’t receive oxygen (12-13, 18). 

Researchers have also found significant positive correlations between changes in oxygen saturation and memory performance (15). 

2. Normobaric Oxygen Therapy Improves Cognitive Performance

Research shows that concentrated oxygen significantly enhances cognitive performance (19-20, 29). 

And it doesn’t just improve cognitive function in the elderly; it also enhances cognitive processing in young adults (21-23). 

In one study, students that inhaled oxygen while playing a computer game performed much better compared to students who didn’t inhale any additional oxygen (26). 

In two other studies, researchers found that the inhalation of 30% oxygen improved cognitive functioning and performance by activating several brain areas (24-25). 

Oxygen administration appears to facilitate cognition most effectively for tasks with a higher cognitive load.
— Advances in Natural Medicines, Nutraceuticals, and Neurocognition

They concluded that breathing a higher concentration of oxygen increases blood oxygen levels in the brain, which then supports cognition (24-25). 

And other researchers have found significant correlations between blood oxygen levels and cognitive performance (27-28). 

3. Normobaric Oxygen Therapy Enhances Accuracy

Several studies have found that normobaric oxygen therapy can also increase your accuracy when doing tasks. 

Two studies found that 30% and 40% oxygen administration significantly enhanced accuracy rates compared to 21% oxygen (normal air). It did this by increasing oxygen levels in the blood, which then stimulated activity in the brain (31-32). 

As the difficulty of the task increased, the difference in the accuracy rate between 40% and 21% oxygen administration also increased (33-34). 

And researchers found a positive correlation between task performance and oxygen levels in the brain (33-34). 

Other research has found that 30% oxygen administration enhances accuracy rates during verbal tasks by activating specific areas of the brain (35-36). 

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4. Normobaric Oxygen Therapy Reduces Reaction Time

People who receive normobaric oxygen therapy also have faster reaction times (37-38). 

In one study, participants performed visual matching tasks under 43% oxygen or 21% oxygen (normal air).

Researchers reported a significant decrease in reaction time in the presence of 43% oxygen (39).

The researchers hypothesized that normobaric oxygen therapy increases oxygen levels in the blood, which then leads to more available oxygen in the brain (39). 

Another follow-up study confirmed that response time decreases during normobaric oxygen therapy due to the increase in blood oxygen levels (40). 

Normobaric oxygen therapy has even been shown to reduce reaction time in children with attention deficit hyperactivity disorder (ADHD) (41). 

5. Normobaric Oxygen Therapy Increases Energy

Despite comprising only 2 percent of the body’s weight, the brain gobbles up more than 20 percent of daily energy intake.

All cells within your body need oxygen, particularly your brain cells.

They require a lot of oxygen to produce energy. 

In fact, your energy levels depend on how much oxygen you have and how well your mitochondria utilize it.

If your brain doesn’t get enough oxygen, it simply won’t function properly, and you’ll end up feeling tired. 

But normobaric oxygen therapy can increase energy.

Research shows that it "decreases fatigue and reduces feelings of sleepiness" (51). 

6. Normobaric Oxygen Therapy Improves Neurological Function After Stroke

Researchers say that normobaric oxygen therapy is a promising therapy for stroke patients. 

It’s been shown to reduce brain swelling and blood-brain barrier permeability and increase brain blood flow after stroke (42-43). 

One study found that normobaric oxygen therapy significantly improved neurological functions in patients with acute ischemic stroke (44). 

Other researchers have found that normobaric oxygen therapy increases oxygen supply to damaged tissues and improves outcomes after stroke, in both animals and humans (45-46). 

As a non-pharmaceutical and non-invasive treatment, normobaric oxygen therapy is “worthy of notice” (47). 

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7. Oxygen Therapy May Help Reverse Brain Damage After Traumatic Brain Injury

Researchers found that a combination of normobaric and hyperbaric oxygen therapy reversed brain damage in 2-year-old girl who nearly drowned in a swimming pool.

She received normobaric oxygen treatment (twice daily for 45 minutes by nasal cannula), and doctors witnessed significant improvements in her neurological function (48-49). 

Normobaric oxygen therapy alone improved the girl’s neurological function before she started hyperbaric oxygen therapy (48-49). 

She eventually made a full recovery with both types of oxygen therapy. 

Researchers have also said that the “neuroprotective role of normobaric oxygen therapy is extremely promising” for traumatic brain injury (50). 

I’ve also seen multiple studies with rats and mice showing that normobaric oxygen therapy reduces brain swelling and brain damage.

8. Other Possible Benefits (with Less Research Behind Them)

  • Increases attention and vigilance – Oxygen administration significantly improved performance on several measures of attention and vigilance (52).

  • Reduces inflammation – Oxygen levels play a critical role in determining the severity of the inflammatory response and ultimately the effectiveness of anti-inflammatory drugs (53-54).

  • Improves hand-eye coordination (55).

  • Increases positive sense of wellbeing (56).

My Experience with Normobaric Oxygen Therapy

If you use oxygen for 20 minutes, muscles become loosened, headaches and stress seem to disappear, there is a renewed energy and a feeling of relaxation.
— Dr. Richard de Andrea

 

I was first introduced to oxygen therapy through an integrative doctor I know.

At the end of each appointment with him, I would use his oxygen concentrator for about 15-20 minutes. He used this oxygen concentrator

I eventually decided to buy my own oxygen concentrator and now regularly use it at home. 

There is a dial for adjusting the flow of oxygen and the port is located on the upper right of the machine.

There is a dial for adjusting the flow of oxygen and the port is located on the upper right of the machine.

I bought this oxygen concentrator. You can get it here or through Amazon. I'll discuss how it has helped me below.

The oxygen from the concentrator is supplied through an nasal canula. It’s completely non-invasive and painless, and it’s become one of my favourite tools for supporting my brain.

I use it for about 20 to 30 minutes, a few times each week. I often do this while exercising on this indoor stationary bike. Sometimes I use it without exercising on the bike. 

I also use it for about 3 to 5 minutes as needed, usually when doing work. 

During a session, I use this oxygen saturation monitor to measure my blood oxygenation levels. 

Your blood oxygen saturation levels (SpO2) should measure 99-100%. I see mine increase and max out while using the concentrator

My oxygen concentrator delivers up to 5 litres of oxygen per minute. I usually set mine somewhere between 3 and 5 litres per minute. 

But I would recommend starting lower and working your way up. 

Similar to low-level laser/light therapy, oxygen therapy is somewhat experimental. You need to find the right “dosage” for yourself.

Benefits and What I’ve Noticed

Jordan Fallis using oxygen concentrator.

I've had good results with concentrated oxygen therapy and it has surprisingly increased the quality of my life. 

One of the main things I notice is that it feels like it puts energy back into my body every time I use it.

One of my clients uses it whenever she gets brain fog, and it clears it up. Another client uses it when she gets a headache and the headache disappears within 10 minutes.

It also does an incredible job of getting rid of hangovers. They essentially go away if you use the concentrator the morning after drinking. You just immediately feel like a completely new person.

Here are some other benefits I’ve experienced:

Keep in mind that this is my personal experience (and the experiences of a couple of clients). There really is no guarantee that you’ll experience the same results, but it’s worth a try if you’re sick and other therapies aren’t improving your brain function. 

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Combining Oxygen Therapy with Other Therapies

I also combine oxygen therapy with other therapies and supplements for their synergistic effects. 

Researchers have found that combining normobaric oxygen therapy with the following therapies leads to better results (57-59):

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Live Optimally,

Jordan Fallis

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References:

(1) https://www.ncbi.nlm.nih.gov/pubmed/23317164

(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234199/

(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3023418/

(4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110143/

(5) https://www.ncbi.nlm.nih.gov/pubmed/28931617

(6) https://www.ncbi.nlm.nih.gov/pubmed/25804925

(7) https://www.ncbi.nlm.nih.gov/pubmed/27177548

(8) https://www.ncbi.nlm.nih.gov/pubmed/9600580/

(9) https://www.ncbi.nlm.nih.gov/pubmed/19922270

(10) https://www.ncbi.nlm.nih.gov/pubmed/9600580/

(11) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107523/

(12) https://www.ncbi.nlm.nih.gov/pubmed/10604851/

(13) https://www.ncbi.nlm.nih.gov/pubmed/9600580

(14) https://www.ncbi.nlm.nih.gov/pubmed/8740047

(15) https://www.ncbi.nlm.nih.gov/pubmed/18322865/

(16) https://www.ncbi.nlm.nih.gov/pubmed/9600580/

(17) https://www.ncbi.nlm.nih.gov/pubmed/9694523/

(18) https://www.ncbi.nlm.nih.gov/pubmed/9862412

(19) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107523/

(20) https://www.ncbi.nlm.nih.gov/pubmed/10604851/

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(23) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107523/

(24) https://www.ncbi.nlm.nih.gov/pubmed/15522765

(25) https://www.ncbi.nlm.nih.gov/pubmed/15684544

(26) https://goo.gl/h9o5Aj

(27) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107523/

(28) https://www.ncbi.nlm.nih.gov/pubmed/10604851/

(29) https://www.ncbi.nlm.nih.gov/pubmed/17662686/

(30) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107523/

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(32) https://www.ncbi.nlm.nih.gov/pubmed/17395994/

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(34) https://www.ncbi.nlm.nih.gov/pubmed/20080151

(35) https://www.ncbi.nlm.nih.gov/pubmed/16678926

(36) https://www.ncbi.nlm.nih.gov/pubmed/15929498

(37) https://www.ncbi.nlm.nih.gov/pubmed/15627418/

(38) https://www.ncbi.nlm.nih.gov/pubmed/10604851/

(39) https://www.ncbi.nlm.nih.gov/pubmed/19429029/

(40) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107523/

(41) https://www.ncbi.nlm.nih.gov/pubmed/22285726

(42) https://www.ncbi.nlm.nih.gov/pubmed/26416428

(43) https://www.ncbi.nlm.nih.gov/pubmed/25804925

(44) https://www.ncbi.nlm.nih.gov/pubmed/28931617

(45) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110139/

(46) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146175/

(47) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110139/

(48) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510296/

(49) https://goo.gl/m2CbrR

(50) https://www.ncbi.nlm.nih.gov/pubmed/19922270

(51) https://www.ncbi.nlm.nih.gov/pubmed/15627418/

(52) https://www.ncbi.nlm.nih.gov/pubmed/9694523/

(53) http://www.sciencedaily.com/releases/2013/12/131202121536.htm

(54) https://jlb.onlinelibrary.wiley.com/doi/abs/10.1189/jlb.0912462

(55) https://www.ncbi.nlm.nih.gov/pubmed/11258587

(56) https://www.ncbi.nlm.nih.gov/pubmed/11258587

(57) https://www.ncbi.nlm.nih.gov/pubmed/27458543

(58) https://www.ncbi.nlm.nih.gov/pubmed/27177548

(59) https://www.ncbi.nlm.nih.gov/pubmed/26416428

Medically reviewed by Dr. Fred Hui, MD, CCFP, CAFC

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