Photobiomodulation Shows Great Promise for Athletes, Chronic Pain Syndromes and More
- Published: Sunday, 12 November 2017 06:43
By Dr. Mercola
Light is perhaps one of the most underappreciated healing agents available. James Carroll, an expert in light as therapy, also known as photobiomodulation, has the ambitious goal of making photobiomodulation a first-line therapy for 100 diseases in 100 countries, by the time he's 100 years old - which is about 45 years from now.
Carroll has already spent the last 30 years of his life investigating the healing power of light - a passion that grew out of his involvement with the tissue repair research unit at Guy's Hospital in London in the 80s. At the time, he had a business raising government grant money, and Guy's Hospital was one of his clients.
He was able to see some of the work they were doing on cells and small rodents using lasers. “I thought, this is amazing; this is going to be in every corner of every department of every hospital in the whole world within the next five years,” Carroll says. While the technology didn't catch on as quickly as he'd imagined, his enthusiasm for it led to a change in careers as he went to work for the laser company supplying the technology for the research.
From Lasers to LEDs
In those earlier days, most light therapy made use of lasers, as light-emitting diodes (LEDs) were not readily available back then. Some of the first lasers Carroll used operated in the 15 milliwatts range. Over time, the lasers got increasingly stronger.
Today, 30-watts LED diodes are quite common. (An important point to be made is that the LEDs used for light therapy are not identical to LED lighting used in homes and offices. The LEDs used in photobiomodulation technologies typically have a very focused and narrow wavelength and cannot be used for lighting a room.)
That's not to say that more power is better. On the contrary, there's a Goldilock's Zone in which most of the therapeutic effects are found. According to Carroll, cells respond optimally to a range between 5 and 50 milliwatts per centimeter squared (mW/cm2).
“If you want to have successful in vitro studies, that's where you need to be. Similar doses seem to work in superficial wound healing and inflammation, and unless you're going for deeper targets, that's usually enough.” As for timing, as little as one minute will typically render results. An average treatment is typically in the 10 to 20-minute range.
Most modern light therapy products are in the 600 to 1000 nanometer (nm) range, with a gap around the 700s. A number of studies have suggested the 700-nm range has no beneficial health effects, although the issue has not been definitively settled as of yet. There's still a lot to learn, but great headway is being made.
According to Carroll, about 500 randomized controlled human clinical trials and some 4,000 laboratory studies have already been published on photobiomodulation, and each month approximately 30 new papers are added to this body of literature. Carroll has developed a database where he collects studies and so far, he has over 80,000 studies in this database on photobiomodulation.
NovoTHOR Improves Athletic Recovery
Carroll makes a photobiomodulation unit called the NovoTHOR, which has been shown to produce incredible health benefits but is not designed for individual use as it costs $120,000. I've used a less expensive version called Joovv that has red- and near-infrared frequencies to treat myself nearly every day before my far-infrared sauna.
Interestingly, Alberto Salazar, who was the U.S. Olympic track coach is a fan of photobiomodulation and purchased a NovoTHOR. Many Olympic athletes, including most of the American track team, began using the NovoTHOR prior to the Rio Olympics. It's currently being used in the Nike Oregon Project,1 the mission of which is to: “Develop the best distance runners in the world with our metric for success being Olympic and World Championship medals.”
“Alberto Salazar has always been trying to pioneer ways of getting people to train harder, longer, and recover faster. He says recovery, on a scale of 1 to 10, is a 10. It's as important as the training itself, he says. It's critical to their success as a team, and he feels that [photobiomodulation] is the best therapy he's ever used for recovery,” Carroll says.
Photobiomodulation has also been shown to increase muscle strength when used in conjunction with strength training. According to Carroll, weight lifters report exceeding their best competition scores even during normal training. “And where they've been stuck for years at a certain weight, they're going way beyond it,” he says.
Another area where photobiomodulation is showing great promise is in the treatment of burns. While there are few scientific studies to back up such claims, the anecdotal evidence consistently shows it can provide rapid and lasting pain relief. “It's not a temporary kind of pain relief,” Carroll says. “The scars heal much better and anybody who's got a low-level laser photobimodulation product, who's tried it on burns, will tell you the same. It's consistently amazing, so it is a disappointment that burn units are not using it.”
Light Therapy May Benefit Those With Kidney Failure, Including Pets
In a previous interview with Michael Hamblin, Ph.D., he mentioned that some people have successfully used light therapy to treat kidney failure. Some have been able to get off dialysis and no longer need a kidney transplant, which is a rather remarkable success.
Carroll adds further anecdotal support to this, saying he knows of a veterinarian who has been treating kidney disease in animals using photobiomodulation. In cats, by the time you get a diagnosis of kidney disease the disease is typically quite advanced and they only have a few months left to live. Using photobiomodulation, this veterinarian has been able to extend the life of many of these animals by several years.
An added boon is the lack of adverse side effects. Some conditions may feel worse before they get better, but most studies have found there are very few if any side effects. As noted by Carroll, “They report the same number of side effects in the placebo group as the treatment group, which basically tells you it's not a side effect at all.”
Some of the most exciting areas of use is in the treatment of central nervous system disorders, ranging from multiple sclerosis and traumatic brain injuries to Parkinson's disease and Alzheimer's. This was discussed at length in my previous interview with Dr. Lew Lim. Photobiomodulation can also be used in the treatment of dry, age-related macular degeneration (AMD), which is the No. 1 cause of blindness in the elderly.
“I'm a co-founder of Lumithera, which is another light therapy company, and it has developed a device specifically for treating diseases of the eye. Our first target has been dry AMD … Nothing has been proven to be effective for treating dry AMD … Our first study showed that in 129 patients there were up to three lines of improvement on the Snellen eye chart. Nothing else does that.
A more recent study (again without a control group) on 41 eyes, we did optical coherence tomography as well, and showed that the drusens, which are the deposits in the back of the eye that are the hallmark of this disease, are receding … We're optimistic that we're going to have the first randomized controlled clinical trial that will lead to [photobiomodulation] potentially being the first line of treatment for dry AMD, for which nothing else works,” Carroll says.
Many Pain Syndromes Can Be Safely Alleviated With Photobiomodulation
While the full-sized NovoTHOR unit is priced beyond what most people can afford, selling for about $120,000, they offer a less expensive desktop unit. It consists of a console with sockets you can plug various accessories into for different types of spot treatment. Accessories include intra-oral laser probes for analgesia, extra-oral probes that can be used for any area except the oral cavity and probes designed specifically for myofascial trigger points and superficial healing of injuries and wounds.
They also have a contract with the U.S. Veterans Administration to develop a helmet, which will be used for research on traumatic brain injuries and Alzheimer's. Dentists, it turns out, have shown great interest in PBM, as it can effectively alleviate oral pain. Carroll actually used the intra-oral device on himself in lieu of local anesthesia during the extraction of a molar.
“It did hurt, but it's tolerable pain. So, if you treat along the nerves and over the neck - over the cell bodies for the trigeminal ganglion, which are located in the neck - then yes, you can reduce dental pain,” he says. “I know dentists are excited about that. I'm more excited about [being able to treat] chronic pain, neuropathic pain, things like shingles and postherpetic neuralgia, trigeminal neuralgia, shingles around the orbit of the eye and in your hair, burning mouth syndrome …
You know, people commit suicide when they have diseases like these and therefore it's a priority for me to work with specialists in oral-facial pain and to develop these therapies. It feels like the most important place to be, in many ways … So, what I find more exciting is when we're actually solving peoples' chronic pain.”
How Does Light Therapy Work?
So, how is it that light, in certain frequencies, can have such profound clinical benefits? While there are a number of different mechanisms, the one that explains most of the effects seen clinically is the cytochrome c oxidase mechanism, which can be summarized as follows:
When you breathe, the oxygen in your lungs is taken up by hemoglobin, which in turn is carried around your body by red blood cells. The red blood cells deliver the oxygen to every single cell in your body. Similarly, when you eat, the food is broken down into glucose, fats and glycogen, and that glucose is delivered to every single cell in your body as well.
Once it has been transferred across the cell membrane, the glucose is then broken down through glycolysis into ATP and pyruvate. Mitochondria take the pyruvate and break it down further. The resulting byproducts - ATP, FADH and NADH - are then combined with oxygen in the electron transport chain, which creates hydrogen ions that drive ATP synthase.
Normally, the terminal ends on the electron transport chain - the cytochrome c oxidase - is taking up NADH combining it with oxygen and allowing two more electrons to be transferred from the electron transport chain. That pumps hydrogen ions through to drive ATP synthase to make ATP. This process works quite well when you're healthy. However, when you get sick, injured, stressed or old, the mitochondria begin to make excessive amounts of nitric oxide.
How Light Therapy Corrects Molecular Mechanisms Gone Awry
While nitric oxide has certain health benefits, when excessive nitric oxide is produced, excessive free radicals are also produced. Nitric oxide binds preferentially to cytochrome c oxidase and stops the consumption of oxygen, which means you then stop making the hydrogen ions that drive ATP synthase. But that isn't the biggest problem.
A more significant problem is that now you have a “constipated” electron transport chain because the last two electrons cannot be passed from cytochrome c to cytochrome oxidase, and this backlog of electrons in the electron transport chain lead to the production of super oxide and hydrogen peroxide. In other words, excess oxidation.
Some of the super oxide and hydrogen peroxide will leak out of the mitochondria into the cell, where it starts the processes of inflammation and cell death. Inside the mitochondria, super oxide and hydrogen peroxide will also damage the mitochondria, triggering mitochondrial dysfunction, which we now know is a foundational problem in most chronic disease.
“The wonderful thing is that light, in the kind of wavelengths we're using, at the kind of intensity we're using, seem to basically break the bond between nitric oxide and cytochrome c oxidase. The light is flushing out the nitric oxide from cytochrome c oxidase, so now you can start consuming oxygen again, combining with NADH and electrons now pulsing from cytochrome c to cytochrome oxidase again, and you start making ATP.
The cause of the constipated electron transport chain is gone and therefore you stop making too many of these reactive oxygen species that lead to inflammation and cell death,” Carroll says. “The shorter version of all of that is, basically, when we put light of the right wavelength and intensity into people for the right amount of time, the right intervals, we tip the balance … in favor of more ATP and less oxidative stress. And under those circumstances, people get better quicker.”
Why Some Studies Fail to Show Beneficial Results
When it comes to light therapy, even though you're “just” using light, the dosage does matter. It's actually quite easy, and common, to overtreat. Optimal results are obtained within a rather narrow range. Unfortunately, many researchers even fail to understand this. Many researchers also only talk about the total energy delivery, when in fact the rate of delivery is actually more important. Disturbingly, a number of studies have also failed to show a benefit for photobiomodulation simply due to mathematical errors.
“Yes, there are researchers who are overtreating and not getting the results they were hoping for. We got researchers who are not testing the lasers before they do studies, and those that do test the lasers don't actually measure the beam area correctly …
You need scientists and all the right kinds of engineers to know how to do this, but people who are not trained in physics unfortunately are doing tests on lasers and they're really not qualified and educated in the right way to actually, adequately, operate these things, and then they report negative findings.
Sometimes they're just reporting the total dose without explaining [the rate of delivery]. If they gave 4 joules per centimeter squared, was it a 4-watt laser for one second? That could have been, but of course that's not going to work, or was it something else? Doing these therapies have the same principles as cooking, in that you have to get the temperature right and then you put the food in the oven for the right amount of time.
Your favorite TV chef does not tell you to cook this chicken with 1 million joules per centimeter squared. That wouldn't tell you what the temperature of the oven is and how long you must cook it. You should not join those two numbers together in cooking, and you shouldn't do it in this therapy either.
But too many scientist are actually just giving you the one [measurement]. 'Here, use 4 joules per centimeter,' without appreciating that how fast you deliver it is necessary [to know] to get the dose right.”
Light Therapy Is an Excellent Adjunct to Other Mitochondrial Therapies
If you are even half as interested in PBM and using light as a healing tool then you would absolutely enjoy attending one of Carroll's one-day teaching events as he is one of the most knowledgeable people I have encountered in this area. I was able to really improve my understanding in this area thanks to his excellent teaching.
I believe light therapy can be a very powerful tool, and it aligns really well with the dietary aspect of oxidative stress that I discuss in my book, “Fat for Fuel,” which is that when you burn sugar as your primary fuel, you create about 30 percent more oxidative damage than when you're burning fat. Avoiding electromagnetic fields (EMFs) is another important aspect, as EMFs also cause harm by increasing oxidative stress.
In fact, EMFs cause more oxidative damage than ionizing radiation, even though the EMF typically doesn't have anywhere near the amount of energy that ionizing radiation has. The reason for this was explained in-depth in my interview with Martin Pall, Ph.D., who has identified and published research describing the likely molecular mechanisms of how EMFs from cellphones and wireless technologies damage plants, animals and humans.
When you combine EMF remediation efforts with photobiomodulation and optimal fuel intake (i.e., a diet high in healthy fats, low in carbs with moderate protein), you've got a triple win, and you can really optimize mitochondrial function, which is the end game.