Carbon Dioxide for Cardiovascular Care

Knowledge and appreciation of the effects of CO2 on the heart are necessary for optimal clinical management in perioperative and critical care settings because CO2 impacts coronary blood flow and myocardial oxygen supply. Permissive hypercapnia improves outcomes in patients with respiratory failure, most likely because it reduces ventilator-induced lung injury. Because hypercapnia is a potent vasoactive stimulus, adequate tissue perfusion and oxygen delivery to dilated microvessels may be restored.[i]

The administration of carbon dioxide (CO₂) has been used for curative purposes for centuries. The first paper investigating the medicinal use of CO₂ was published by Brandi et al. in 1932, and yet over two hundred years ago, a book was written about its use to cure breast cancer. CO₂ passes freely through membranes and has a well-known vasodilatory effect. Both in vitro and in vivo studies have demonstrated a rightward shift of the oxygen–hemoglobin dissociation curve after the administration of CO₂. Sakai et al. described this as an “artificial Bohr effect.”

This is responsible for the decrease in pH and increase in partial pressure of oxygen in the tissues through facilitated O₂ release. CO₂ has been shown to increase blood flow and treat peripheral arterial and venous disorders, claudication, lower limb ulcers, hypertension, and heart failure. In short, CO2 treatment is a non-invasive, highly efficient, low-cost treatment capable of easing the symptoms of arterial and venous diseases, possibly due to vasodilatation and reduction of oxidative stress.

Carbon dioxide (CO₂) mist, which dissolves CO2 gas in H2O,
improves cardiac function after myocardial infarction (MI)
and increases the concentration of CO2 in the myocardium.[ii]

Carbon dioxide (CO2) balneotherapy is a remedy with a broad spectrum of applications that have been used since the Middle Ages. However, its potential use as an adjuvant therapeutic option in patients with cardiovascular disease has not been fully explored. Medical scientists who have performed a thorough review of the MEDLINE Database, EMBASE, ISI WEB of Knowledge, COCHRANE database, and sites funded by balneotherapy centers across Europe to recognize relevant studies and aggregate evidence supporting the use of CO2 baths in various cardiovascular diseases concluded that there are three main effects of CO2 hydrotherapy during whole body or partial immersion.

1. decline in core temperature.
2. an increase in cutaneous blood flow.
3. an elevation of the score on thermal sensation.

Dr. Irwin Stein and Irvine Weinstein assert that carbon dioxide baths have been employed for over a century to manage vascular disease. Because of its solubility in the skin’s watery and fatty constituents, the dissolved gas diffuses through the dermal layers, thus coming into intimate contact with the network of small blood vessels and causing them to dilate. The rationale for using carbon dioxide in cardiac and peripheral vascular diseases depends upon this specific vasodilating effect.

Evidence shows that the solubility of CO₂ emboli justifies
efforts to replace intracavital air with CO₂ in open-heart surgery.[iii]

Under clinical conditions, low oxygen and low carbon dioxide generally occur together. By inhalation carbon dioxide gas diluted in air, a therapeutic increase of carbon dioxide is often an effective means of improving the oxygenation of the blood and tissues.

Carbon dioxide is one of the most important gases for life. It is healthy and extremely necessary. Dr. Konstantin Buteyko said, “CO2 is the main source of nutrition for any living matter on Earth. Plants obtain CO2 from the air and provide the main source of nourishment for animals, while both plants and animals are nourishment for us. The great resource of CO2 in the air was formed in pre-historical times when the amount was about 10%.”

According to the Verigo-Bohr effect, we can state
that a CO2 deficit caused by deep breathing
leads to oxygen starvation in the cells of the body.

In 1904, Danish scientist Christian Bohr noticed that hemoglobin binds oxygen more tightly at high than low pH. This phenomenon is called the Bohr effect. CO2 and bicarbonate, carbon dioxide’s twin sister, are the vital players in the pH balance in cells, blood, and other bodily fluids, meaning CO2 holds the keys to oxygen delivery. If the level of carbon dioxide in the blood is lower than usual, then this leads to difficulties in releasing oxygen from hemoglobin.

Carbon dioxide is a harmless, colorless, non-toxic, natural gas that is the key link
in the carbon cycle of life. In the presence of a large amount of carbon dioxide, the
hemoglobin molecule changes its shape slightly in a way that favors the release of oxygen.

In 1940, Y. Henderson’s “Carbon Dioxide” paper in the Encyclopedia of Medicine said, “Before considering these matters, it will be best that the mind be cleared of certain deep-rooted misconceptions that have long opposed the truth and impeded its applications. It will be seen that carbon dioxide is truly the breath of life. Under clinical conditions, low oxygen and low carbon dioxide generally occur together. By inhalation this gas diluted in air, therapeutic increase of carbon dioxide is often an effective means of improving the oxygenation of the blood and tissues.”

Henderson showed that acapnia, a carbon dioxide deficiency in the blood and tissues, may induce acute heart disturbance and peripheral circulation failure. These conditions resemble the functional depression of shock in patients after prolonged anesthesia and significant operations. On the other hand, it was found that if the body’s carbon dioxide content was conserved, patients’ vitality, even under prolonged and extensive operations and trauma, was only slightly depressed.

Arterial hypocapnia (CO2 deficiency) causes Tissue Hypoxia

In patients with congestive heart failure (CHF), hypocapnia predisposes patients to ventilatory instability and leads to central apnoea during sleep. Hypocapnia contributes to the genesis of Cheyne-Stokes respiration and is associated with increased mortality. CHF patients with Cheyne-Stokes respiration and central sleep apnoea (CSR-CSA) have lower P_a,CO2 both awake and asleep. Hypocapnia (CO2 deficiency) in the lungs and, in most cases, arterial blood is a normal finding in chronic diseases due to the prevalence of chronic hyperventilation among the sick. Hypocapnia (Lower CO2) in the blood leads to reduced oxygenation.[iv]

Cell hypoxia is one of the leading causes of free radical generation and oxidative stress, leading to inflammation, especially in the capillaries. Capillaries are critical determinants of oxygen and nutrient delivery and utilization, so inflammation is telling. Hypocapnia constricts blood vessels and decreases oxygen perfusion of all vital organs. In emergencies, when these conditions are extreme, the organs and tissues of the body do not receive an adequate flow of blood.

Over the oxygen supply of the body carbon
dioxide spreads its protecting wings.
Friedrich Miescher
Swiss physiologist, 1885

Allopathic medicine hides the power of CO2, which is used quietly in hospitals to make oxygen safe. However, just as they hide magnesium that, when given via injection or intravenously, can prevent death from cardiac arrest, they hide the full power of what carbon dioxide can do for patients. CO2 is the most powerful way to release armies of oxygen into the cells. It is CO2 that liberates oxygen for healing.

Biologist Dr. Ray Peat tells us, “Breathing pure oxygen lowers the oxygen content of tissues; breathing rarefied air, or air with carbon dioxide, oxygenates and energizes the tissues; if this seems upside down, it’s because medical physiology has been taught upside down. And respiratory physiology holds the key to the special functions of all the organs, and too many of their basic pathological changes.”

Carbon dioxide is an essential component of life. The ability to produce and retain enough carbon dioxide is as crucial for longevity as the ability to conserve enough heat to allow chemical reactions to occur as needed.

In the past, many cases of pneumonia were treated with the inhalation of carbon dioxide in oxygen. Henderson and Haggard introduced a special tent for this treatment. Those who have used it believe that this treatment is decidedly superior to that with oxygen alone. A century ago, Henderson and his collaborators showed that the heart tends to develop partial tetanus or cramp under certain conditions. This condition may be overcome by employing carbon dioxide. They also showed that, owing to the loss of muscular tonus in animals under prolonged anesthesia and operation, the blood stagnates in the peripheral vessels, the venous return to the right heart decreases progressively, and the circulation finally reaches a standstill.

With these considerations as a physiological background, the influence of carbon dioxide inhalation was tried on several cases of angina pectoris, not as an emergency treatment but as a therapy for prolonged application. It was administered for 10 to 15 minutes, 2 or 3 times daily.

As we have seen, arterial hypocapnia (CO2 deficiency) causes tissue hypoxia, which triggers numerous pathological effects. Cell hypoxia is the leading cause of free radical generation and oxidative stress, and CO2 deficiency in the blood is one of the leading causes of hypoxia (low oxygen).

Having a normal level of CO2 in the lungs and arterial blood (40 mm Hg or about 5.3% at sea level) is imperative for everyday health. Do modern people have normal CO2 levels? When reading the table below, note that levels of CO2 in the lungs are inversely proportional to minute ventilation rates. In other words, the more air one breathes, the lower the level of alveolar CO2.

Dr. Lynne Eldridge and many others have noted most modern adults breathe much faster (about 15-20 breaths per minute) than what would be considered a healthy respiratory rate. Respiratory rates in cancer and other severely ill patients are usually higher, generally about 20 breaths/min or more. This means the general population is driving down oxygen available to cells, opening the door to increased incidences of cancer. Heavy metal and chemical toxification of the cells further impede oxygen, and nutritional deficiencies are the slam dunk that leads to cancer.

Oxygen availability to cells decreases glucose oxidation, whereas oxygen shortage consumes glucose faster in an attempt to produce ATP via the less efficient anaerobic glycolysis to lactate. This is much of the basis of oxygen therapy in cancer and a full range of other diseases because most chronically ill people if not all, have a hard time with both oxygen and its perfectly mated gas, carbon dioxide. In cancer treatment, this comes with the bonus of stimulating the immune system’s cancer-killer cells.

Carbogen

Carbogen, also called Meduna’s Mixture after its inventor, Ladislas Meduna, is a mixture of carbon dioxide and oxygen gas. A carbogen mixture of 95% oxygen and 5% carbon dioxide can be used as part of the early treatment of central retinal artery occlusion. On this same premise, it has also been proposed to manage sudden sensorineural hearing loss, which can increase the blood flow to the inner ear and possibly relieve the internal auditory artery spasm.

Inhaling CO₂ reduces blood viscosity and enhances cardiac output, cardiac efficiency, tissue perfusion, tissue oxygenation, and respiratory drive.

Helping Reverse Atherosclerosis with Carbogen

Advanced human plaques are hypoxic. Medical scientists have tested the hypothesis that reversing hypoxia in atherosclerotic plaques by breathing carbogen gas will prevent and possibly help reverse atherosclerosis. In many pathophysiological conditions, reduced oxygen tension (hypoxia) is a known stimulus of inflammation, angiogenesis, and apoptosis. Because the same processes drive the progression of atherosclerosis, they investigated whether hypoxia was present in atherosclerosis.

They found that Carbogen restored plaque oxygenation and prevented necrotic core expansion (a significant feature responsible for plaque disruption. After decades of sluggish progression, such plaques may suddenly cause life-threatening coronary thrombosis, presenting as an acute coronary syndrome. Most often, the culprit morphology is plaque rupture with exposure likely due to accelerated macrophage apoptosis and defective phagocytic clearance efferocytosis.

Carbogen enhances efferocytosis. Thus, plaque hypoxia is causally related to necrotic core expansion. In cell biology, efferocytosis is the process by which phagocytic cells remove apoptotic cells. It can be regarded as the ‘burying of dead cells.’ During efferocytosis, the cell membrane of phagocytic cells engulfs the apoptotic cell, forming a sizeable fluid-filled vesicle containing the dead cell. This ingested cyst is called an efferosome. Coronary atherosclerosis is the most frequent cause of ischemic heart disease, and plaque disruption with superimposed thrombosis is the leading cause of acute coronary syndromes of unstable angina, myocardial infarction, and sudden death.

Conclusion

The reduction of bicarbonates/CO2 in the blood is the cause of aging and diseases, not the result of aging. As long as we can replenish bicarbonates/CO2 in the blood, we don’t have to age so fast. Dr. Lynda Frassetto of the University of California, San Francisco, says, “Insufficient amounts of bicarbonates in our blood reduces our capabilities to manage (neutralize and dump) the acid our body produces. This is the cause of aging. The age of 45 is the average age when human beings start to show symptoms of diabetes, hypertension, osteoporosis, and many other adult degenerative diseases. And since we cannot manage the acid, we accumulate acidic wastes in our bodies. These wastes show up as cholesterol, fatty acid, uric acid, urate, sulfate, phosphate, kidney stones, etc.”

Bicarbonate and Carbon Dioxide
are two forms of the same thing.

Sodium bicarbonate is an emergency room intensive care medicine. Dr. Boris Veysman, a specialist in emergency medicine at the Robert Wood Johnson University Hospital in New Jersey, describes one emergency room experience:

“The emergency department is always noisy, but today the triage nurse is yelling “not breathing,” as she runs toward us pushing a wheelchair. A pale, thin woman is slumped over and looking gray. Without concrete proof of a “Do Not Resuscitate” order, there’s no hesitation. Click, klang, and the patient has a tube down her throat within seconds. I do the chest compressions. On the monitor, she is flat-lining — no heartbeat. I synchronize my words with the compressions and call out for an external pacemaker. Pumping … thinking: Cardiac standstill … after walking in … with cancer … on chemo. This resuscitation isn’t by the book. “Get two amps of bicarbonate,” I say to the intern. The jugular line takes seconds, and I flush it with sodium bicarbonate. This probably will correct the blood’s extreme acidity, which I suspect is driving up the potassium. The external pacemaker finally arrives. Potent electric shocks at 80 beats per minute begin to stimulate her heart. The vitals stabilize.

Baking soda (bicarbonate) is an essential medicine. It is probably one of the most valuable substances in the world—no wonder the pharmaceutical companies do not want doctors or anyone else to know much about it. Sodium Bicarbonate is an important medicine—one of the safest—and it is essential when treating cancer, diabetes, metabolic syndrome, kidney and cardiovascular diseases.

Carbon dioxide, like air, water, and oxygen, is essential for life and health, and specifically, it holds the key to resolving asthma, cancer, and many other chronic diseases. Carbon dioxide is a necessary constituent of tissue fluids and should be maintained at an optimum level in the blood. The gas, therefore, is needed to supplement various anesthetic and oxygenation mixtures for use under special conditions such as cardio-pulmonary bypass surgery and the management of renal dialysis.

Dr. Ray Peat says, “Breathing too much oxygen displaces too much carbon dioxide, provoking an increase in lactic acid; too much lactate displaces oxygen and carbon dioxide. Lactate itself tends to suppress respiration. Oxygen toxicity and hyperventilation create a systemic deficiency of carbon dioxide. This carbon dioxide deficiency makes breathing more difficult in pure oxygen, impairs the heart’s ability to work, and increases the resistance of blood vessels, impairing circulation and oxygen delivery to tissues. Circulation is improved in conditions that permit greater carbon dioxide retention, and the heart works more effectively. Carbon dioxide inhibits the production of lactic acid, and lactic acid lowers carbon dioxide’s concentration in various ways.”

Oxygen and its sister, CO2, operate at the heart of life. Nothing is more fundamental to life, so the command of carbon dioxide and oxygen gives us almost everything we need to fight disease, aging, and cancer. A study of 45 peer-reviewed articles published from January 1950 to August 2011 shows that exercisers are less likely to die of cancer than non-exercisers. In addition, observational studies strongly showed that exercise is associated with reduced death from breast and colon cancers.[v] Those who exercised were also less likely to die from diseases like heart attacks. Why? Because in exercise, both CO2 and oxygen levels are optimized.

Afternote: Sparkling water helps lower blood glucose and stimulates metabolism. A BMJ Nutrition, Prevention & Health report discussed how drinking sparkling water may contribute to weight loss. It suggests that the CO2 in the water leads to increased glucose breakdown and increased glucose uptake by red blood cells.

[i] Crit Care Med. 2007 Sep;35(9):2171-5. doi: 10.1097/01.ccm.0000281445.77223.31.
Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits.

[ii] Percutaneous Carbon Dioxide Gas Mist Treatment Improves Cardiac Function after Myocardial Infarction in Rats via Nitric Oxide Activity. Circulation Volume 126.

[iii] In open heart surgery, is there a role in using carbon dioxide field flooding techniques to reduce post-operative gaseous emboli? Interactive CardioVascular and Thoracic Surgery, Volume 3, Issue 4, December 2004, Pages 599–602, https://doi.org/10.1016/j.icvts.2004.07.004

[iv] Relationship of carbon dioxide tension in arterial blood to pulmonary wedge pressure in heart failure
European Respiratory Journal 2002 19(1): 37-40; DOI: https://doi.org/10.1183/09031936.02.00214502

[v] J Natl Cancer Inst, published online May 8, 2012