Ozone Therapy

What Is Ozone?

The ozone molecule is composed of three oxygen atoms bound together (O=O=O) and is written in short form as O3. The “oxygen” which we breathe and require for cellular functioning is actually two oxygen atoms bound together (O=O), written as O2. Ozone is a less stable form of oxygen than the O2 form of oxygen which we breathe on a daily basis and as a result, degrades fairly quickly. The medical applications of ozone are due to this instability and the reactions which take place when it breaks down.

History of Medical Ozone

Ozone began being used medically in the early 1900s. In 1915, German physician Dr. Albert Wolf described the topical use of ozone for wounds, decubitus ulcers and osteomyelitis1. During the First World War ozone was also used to disinfect wounds2. In 1958 Dr. Joachim Hänsler released the first commercial medical ozone generator and his company, Ozonosan, lives on in Germany today. Water ozonation has been deemed acceptable for water treatment and disinfection by Health Canada3 and locally it has been employed in Halifax harbour clean-up efforts.

How Does Ozone Therapy Work?

Ozone therapy, red blood cells & bacteria

Oxygen Utilization
The ability of ozone gas to increase oxygen saturation4, oxygen utilization and tissue oxygen delivery4,5 are several of the actions which are attributed with its therapeutic effect. Ozone therapy has a 2-fold effect in that it increases the oxygen saturation of the blood and also increases oxygen utilization. Red blood cells exposed to ozone during an autohemotherapy treatment have an increased production of 2,3-DPG and ATP, two essential components in the metabolic energy production pathway6,7.

Anti-infection
Ozone gas is an unstable molecule and breaks down readily, exposing nearby simple pathogenic organisms such as bacteria, viruses, fungi and parasites to oxidation and oxidation by-products (peroxides). Three atoms of oxygen bound together are unstable and want to break down into two conjoined atoms of oxygen and one single oxygen atom. The single oxygen atom is quite unstable on its own and wants to interact with another molecule through oxidation. Oxidation is the mechanism responsible for the anti-microbial effect of ozone.

Conditions Treated By Ozone

Medical ozone can be used to treat a broad spectrum of health conditions.

Musculoskeletal Conditions (Pain and Injuries)

Ozone, prolozone knee
Many musculoskeletal conditions have shown excellent results when treated with ozone. Clinical research with ozone in the treatment of herniated discs8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 has yielded overwhelmingly positive results in reduction of associated pain and improved healing. Fracture and displacement of the lumbar vertebrae (spondylolysis and spondylolisthesis) have also responded well to treatment with ozone, with a significant reduction of pain19. Patients with temporomandibular joint (TMJ) dysfunction20 and osteoarthritis (arthritis)21, 22, 23 have shown positive results with ozone treatment in clinical trials. Low back pain in general has responded well to treatment with ozone therapy24, 25. Fibromyalgia, a classically difficult condition to treat, also showed improvement in associated pain and depression26.

Adding on to the above, I have seen very encouraging results in patients with painful conditions, especially osteoarthritis. In treating an osteoarthritic joint, ozone gas is injected directly into the affected joint space. I have found this treatment to be quite effective for treating the pain associated with osteoarthritis and promoting healing. The injection itself ranges from not painful at all to mildly uncomfortable.

Cardiovascular conditions

By increasing oxygen utilization and oxygen saturation, treatment with ozone therapy has significantly improved several cardiovascular conditions including peripheral artery disease4, 27, 28, critical limb ischemia29 (very poor circulation to a limb) and Raynaud’s syndrome30. Each of these conditions involves cardiovascular degradation and slowing of the blood flow through arteries.

Hepatitis

Ozone acts by inactivating the viruses which cause hepatitis (inflammation of the liver) as well as by stimulating the immune system, helping patients with hepatitis to fight off the infection. Hepatitis B31 and Hepatitis C32, which are classically very serious and difficult conditions to treat, have responded well in clinical trials to treatment with ozone.

Dental Conditions

There has been a large volume of clinical research performed on the use of ozone in a dental setting for treating infections of the teeth and gums. It is clear that ozone is helpful it treating dental caries (cavities)33, 34, 35, 36, 37, 38, 39, periodontitis (gum infection)40, 41 and is also helpful in improving dental surgery healing rate. The main mechanism by which it achieves these changes is through an anti-bacterial effect42.

Skin & Nail Conditions

Ozone’s anti-microbial effects have also been found to be quite effective for treating infections of the skin and nails in clinical research. Fungal infections of the nails (onymycosis)43, 44 have responded better to ozone treatment than standard medical treatment. Diabetic foot ulcers have similarly shown significant improvement45, 46.

Other Infectious Conditions

Ozone has also been researched in the treatment of several other infection-associated health conditions. Treatment of pneumonia47, chlamydia48, fistulas49 and gastric ulcers50 have all shown excellent results. Ozone has also been effective in preventing infection when given as a pre-treatment for men undergoing prostate surgery51.

Other Conditions

Ozone therapy has also shown promise in treatment of a variety of other conditions in clinical trials including pancreatitis52, vestibulocochlear syndrome53 (a condition characterized by vertigo, nystagmus, tinnitus and hearing loss), sudden sensory-neural hearing loss54, macular degeneration55, emphysema56 and osteonecrosis57.

How Is Ozone Used?

Ozonated olive oil
There are several ways which ozone therapy is applied:

  • Ozone (Prolozone) Injections: During a prolozone treatment ozone gas is injected intra-articularly (into the joint) or subcutaneously (under the skin) in order to treat painful conditions of the joint and/or joint instability. Osteoarthritis is a commonly treated and well-responding condition to intra-articular prolozone injections.
  • Intravenous major autohemotherapy: During a autohemotherapy treatment a sample of blood is collected and ozone gas is bubbled through the blood sample. The ozone gas quickly breaks down, exerting a gentle oxidative effect on the blood. Finally the blood sample is returned into the vein from which it was collected. The oxidative effect is believed to be the cause of the increased energy production, oxygen saturation and oxygen utilization which occurs after treatment.
  • Ozonated olive oil: When bubbled through olive oil, ozone quickly degrades and reacts with the olive oil being used. The remaining olive oil has undergone significant peroxidation, which essentially means that it has taken on some of the unstable properties of the gas which it has reacted with. This olive oil doesn’t contain ozone gas but has inherited it’s anti-microbial (anti-bacterial, anti-viral, anti-fungal and anti-parasitic) properties.
  • Ozonated water: Water is a good medium for carrying ozone gas. When ozone is bubbled through water, a significant amount of the gas becomes dissolved in the water. This “ozonated water” has a potent anti-microbial effect 58, 59, 60, 61 and is used by some dentists as an antiseptic.
  • Limb-bagging: Limb-bagging introduces topical ozone gas directly to an affected area of the skin. A limb, such as an arm or leg, is covered with a plastic bag which is filled with ozone gas through a small opening in the bag. This application is helpful in the treatment of many types of topical infections including diabetic ulcers, onychomycosis (fungal nail infection), athlete’s foot and tinea versicolor (a pale discoloration of the skin brought on by a fungal infection).
  • Rectal insufflation: Ozone gas can also be introduced into the body through the digestive tract. Rectal insufflation involves inserting a small catheter into the rectum and introducing ozone gas to tolerance level. This avenue is ideal for people with certain conditions affecting the blood and people who are adverse to needles.

Is Ozone Safe?

While a high concentration of ozone gas inhaled over long periods of time is irritating to lung tissue, this is due to the fragility of the lung tissue and it’s susceptibility to oxidation. Ozone gas is non-toxic when used in physiologic doses in the medical applications discussed in this article. A properly trained practitioner applies ozone in a safe and controlled manner with a high quality generator and medical grade oxygen.

Education & Training

I have been trained in the use of ozone therapy with Dr. Frank Shallenberger MD of Reno, Nevada. Dr. Shallenberger is recognized as the foremost educator on the use of ozone therapy in North America. Dr. Shallenberger’s training includes clinical indications, safety and methods of application of ozone therapy, as well as practical applications on volunteers.

Ozone Therapy in Halifax, Nova Scotia

If you are interested in receiving ozone therapy treatments and are located in the Halifax area, please contact MacLeod Naturopathic to book an initial naturopathic visit to discuss your options.

References

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  2. Stoker G(1916). “The Surgical Uses of Ozone”. Lancet II: 712.
  3. “Water Treatment Devices for Disinfection of Drinking Water”. Health Canada 2008. Web 22 August 2014. http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/disinfect-desinfection-eng.php
  4. Giunta R, Coppola A, Luongo C, Sammartino A, Guastafierro S, Grassia A, Giunta L, Mascolo L, Tirelli A, Coppola L. Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease. Ann Hematol. 2001 Dec;80(12):745-8.
  5. Bocci V, Zanardi I, TravagliJ V Transl Med. Ozone acting on human blood yields a hormetic dose-response relationship. 2011; 9:66
  6. Sagai M and Bocci V. Mechanisms of Action Involved in Ozone Therapy: Is healing induced via a mild oxidative stress? Med Gas Res. 2011, 1:29
  7. Viebahn-Haensler R. 2007. The Use of Ozone in Medicine. ODREI Publishers. Iffezheim
  8. Melchionda D, Milillo P, Manente G, Stoppino L, Macarini L. Treatment of radiculopathies: a study of efficacy and tollerability of paravertebral oxygen-ozone injections compared with pharmacological anti-inflammatory treatment. J Biol Regul Homeost Agents. 2012 Jul-Sep;26(3):467-74.
  9. Yu Z, Luo W, Wang B. Targeted injection of ozone through the posterior approach via the spinal canal and dural sac for treating lumbar disc herniation. Nan Fang Yi Ke Da Xue Xue Bao. 2012 Feb;32(2):243-6.
  10. Paoloni M, Di Sante L, Cacchio A, Apuzzo D, Marotta S, Razzano M, Franzini M, Santilli V. Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection. Spine. 2009 Jun 1;34(13):1337-44.
  11. Wu Z, Wei LX, Li J, Wang Y, Ni D, Yang P, Zhang Y. Percutaneous treatment of non-contained lumbar disc herniation by injection of oxygen-ozone combined with collagenase. Eur J Radiol. 2009 Dec;72(3):499-504.
  12. Bonetti M, Fontana A, Cotticelli B, Volta GD, Guindani M, Leonardi M. Intraforaminal O(2)-O(3) versus periradicular steroidal infiltrations in lower back pain: randomized controlled study. AJNR Am J Neuroradiol. 2005 May;26(5):996-1000.
  13. Paradiso R, Alexandre A. The different outcomes of patients with disc herniation treated either by microdiscectomy, or by intradiscal ozone injection. Acta Neurochir Suppl. 2005;92:139-42.
  14. Buric J, Molino Lova R. Ozone chemonucleolysis in non-contained lumbar disc herniations: a pilot study with 12 months follow-up. Acta Neurochir Suppl. 2005;92:93-7.
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  16. Wei CJ, Li YH, Chen Y, Wang JY, Zeng QL, Zhao JB, Mei QL. Percutaneous intradiscal oxygen-ozone injection for lumbar disc herniation: no need of perioperative antibiotic prophylaxis. Nan Fang Yi Ke Da Xue Xue Bao. 2007 Mar;27(3):384-6.
  17. Gallucci M, Limbucci N, Zugaro L, Barile A, Stavroulis E, Ricci A, Galzio R, Masciocchi C. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology. 2007 Mar;242(3):907-13.
  18. Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR Am J Neuroradiol. 2003 May;24(5):996-1000.
  19. Bonetti M, Fontana A, Albertini F. CT-guided oxygen-ozone treatment for first degree spondylolisthesis and spondylolysis. Acta Neurochir Suppl. 2005;92:87-92.
  20. Daif ET. Role of intra-articular ozone gas injection in the management of internal derangement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jun;113(6):e10-4.
  21. Li JH, Zhou LX, Li GY, Cheng B. Treatment of middle-aged and aged patients with knee osteoarthritis of yang-deficiency induced cold-damp syndrome by ozone combined Chinese materia medica: a clinical research. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013 Apr;33(4):471-5.
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  23. Benvenuti P. Oxygen-Ozone Treatment of the Knee, Shoulder and Hip. A Personal Experience. Rivista Italiana di Ossigeno-Ozonoterapia 5: 135-144, 2006
  24. Bonetti M, Fontana A, Cotticelli B, Volta GD, Guindani M, Leonardi M. Intraforaminal O(2)-O(3) versus periradicular steroidal infiltrations in lower back pain: randomized controlled study. AJNR Am J Neuroradiol. 2005 May;26(5):996-1000.
  25. de Nêuton F, Magalhães O, Soares SC, Torres JM, Ungaretti A, Cacciacarro MF, Teixeira MJ, Fonoff ET. Effects of ozone applied by spinal endoscopy in patients with chronic pain related to failed back surgery syndrome: a pilot study. Neuropsychiatr Dis Treat. 2013;9:1759-66.
  26. Hidalgo-Tallón J, Menéndez-Cepero S, Vilchez JS, Rodríguez-López CM, Calandre EP. Ozone therapy as add-on treatment in fibromyalgia management by rectal insufflation: an open-label pilot study. J Altern Complement Med. 2013 Mar;19(3):238-42.
  27. Di Paolo N, Bocci V, Salvo DP, Palasciano G, Biagioli M, Meini S, Galli F, Ciari I, Maccari F, Cappelletti F, Di Paolo M, Gaggiotti E. Extracorporeal blood oxygenation and ozonation (EBOO): a controlled trial in patients with peripheral artery disease. Int J Artif Organs. 2005 Oct;28(10):1039-50.
  28. Biedunkiewicz B, Tylicki L, Nieweglowski T, Burakowski S, Rutkowski B. Clinical efficacy of ozonated autohemotherapy in hemodialyzed patients with intermittent claudication: an oxygen-controlled study. Int J Artif Organs. 2004 Jan;27(1):29-34.
  29. Marfella R, Luongo C, Coppola A, Luongo M, Capodanno P, Ruggiero R, Mascolo L, Ambrosino I, Sardu C, Boccardi V, Lettieri B, Paolisso G. Use of a non-specific immunomodulation therapy as a therapeutic vasculogenesis strategy in no-option critical limb ischemia patients. Atherosclerosis. 2010 Feb;208(2):473-9.
  30. Cooke ED, Pockley AG, Tucker AT, Kirby JD, Bolton AE. Treatment of severe Raynaud’s syndrome by injection of autologous blood pretreated by heating, ozonation and exposure to ultraviolet light (H-O-U) therapy. Int Angiol. 1997 Dec;16(4):250-4.
  31. Jiao XJ, Peng X. Clinilal study of medical ozone therapy in chronic hepatitis B of 20 patients. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2008 Dec;22(6):484-5.
  32. Zaky S, Kamel SE, Hassan MS, Sallam NA, Shahata MA, Helal SR, Mahmoud H. Preliminary results of ozone therapy as a possible treatment for patients with chronic hepatitis C. J Altern Complement Med. 2011 Mar;17(3):259-63.
  33. Case PD, Bird PS, Kahler WA, George R, Walsh LJ. Treatment of root canal biofilms of Enterococcus faecalis with ozone gas and passive ultrasound activation. J Endod. 2012 Apr;38(4):523-6.
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  35. Baysan A, Lynch E. Effect of ozone on the oral microbiota and clinical severity of primary root caries. Am J Dent. 2004 Feb;17(1):56-60.
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  38. Dähnhardt JE, Jaeggi T, Lussi A. Treating open carious lesions in anxious children with ozone. A prospective controlled clinical study. Am J Dent. 2006 Oct;19(5):267-70.
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  40. Kshitish D, Laxman VK. The use of ozonated water and 0.2% chlorhexidine in the treatment of periodontitis patients: a clinical and microbiologic study. Indian J Dent Res. 2010 Jul-Sep;21(3):341-8.
  41. Hayakumo S, Arakawa S, Mano Y, Izumi Y. Clinical and microbiological effects of ozone nano-bubble water irrigation as an adjunct to mechanical subgingival debridement in periodontitis patients in a randomized controlled trial. Clin Oral Investig. 2013 Mar;17(2):379-88.
  42. Sadatullah S, Mohamed NH, Razak FA. The antimicrobial effect of 0.1 ppm ozonated water on 24-hour plaque microorganisms in situ. Braz Oral Res. 2012 Mar-Apr;26(2):126-31.
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  44. Menéndez S, Falcón L, Simón DR, Landa N. Efficacy of ozonized sunflower oil in the treatment of tinea pedis. Mycoses. 2002 Oct;45(8):329-32.
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  46. Wainstein J, Feldbrin Z, Boaz M, Harman-Boehm I. Efficacy of ozone-oxygen therapy for the treatment of diabetic foot ulcers. Diabetes Technol Ther. 2011 Dec;13(12):1255-60.
  47. Belianin II, Shmelev EI. Ozone therapy for protracted pneumonias. Probl Tuberk Bolezn Legk. 2009;(3):28-33.
  48. Neĭmark AI, Kondrat’eva IuS. Combined treatment of complicated chlamydial infection in males with ozone therapy. Urologiia. 2008 May-Jun;(3):31-6.
  49. Clavo B, Santana-Rodriguez N, Gutierrez D, Apodaca B, Lopez L, Febles G, Cruz F, Llontop P. Ozone therapy in the management of enterocutaneous fistulas resulting from postsurgery abdominal/pelvic mesh placement. J Pain Symptom Manage. 2012 Apr;43(4):e1-4.
  50. Lelianov AD, Budrin VA, Novikov AS, Guseva ED, Nesterov AA, Kirsov PP. Optimization of the treatment of stomach ulcer in patients subjected to perforated gastroduodenal ulcer closure. Eksp Klin Gastroenterol. 2007;(5):81-5, 165.
  51. Mustafaev EM, Martov AG, Naumov AG, Siniukhin VN, Shakir F, Merinov DS, Amelin AV, Al’bitskaia AIu. The role of ozone therapy in prevention of pyoinflammatory complications after transurethral resection of prostatic adenoma. Urologiia. 2007 Jan-Feb;(1):18-23, 27.
  52. Kopchak VM, Khomiak IV, Duvalko AV, Stasenko AA, Dieiev VA. Application of ozone therapy in complex treatment of patients with acute necrotizing pancreatitis. Klin Khir. 2008 Oct;(10):28-31.
  53. Menéndez S, Del Cerro A, Alvarez T, Hernández F. Application of ozone therapy in the vestibulocochlear syndrome. Rev Recent Clin Trials. 2012 Nov;7(4):321-8.
  54. Ragab A, Shreef E, Behiry E, Zalat S, Noaman M. Randomised, double-blinded, placebo-controlled, clinical trial of ozone therapy as treatment of sudden sensorineural hearing loss. J Laryngol Otol. 2009 Jan;123(1):54-60.
  55. Borrelli E, Diadori A, Zalaffi A, Bocci V. Effects of major ozonated autohemotherapy in the treatment of dry age related macular degeneration: a randomized controlled clinical study. Int J Ophthalmol. 2012;5(6):708-13.
  56. Calunga JL, Paz Y, Menéndez S, Martínez A, Hernández A. Rev Med Chil. 2011 Apr;139(4):439-47. Rectal ozone therapy for patients with pulmonary emphysema.
  57. Ripamonti CI, Cislaghi E, Mariani L, Maniezzo M. Efficacy and safety of medical ozone (O(3)) delivered in oil suspension applications for the treatment of osteonecrosis of the jaw in patients with bone metastases treated with bisphosphonates: Preliminary results of a phase I-II study. Oral Oncol. 2011 Mar;47(3):185-90.
  58. Sadatullah S, Mohamed NH, Razak FA. The antimicrobial effect of 0.1 ppm ozonated water on 24-hour plaque microorganisms in situ. Braz Oral Res. 2012 Mar-Apr;26(2):126-31.
  59. Dhingra K, Vandana KL. Management of gingival inflammation in orthodontic patients with ozonated water irrigation–a pilot study. Int J Dent Hyg. 2011 Nov;9(4):296-302.
  60. Kshitish D1, Laxman VK. The use of ozonated water and 0.2% chlorhexidine in the treatment of periodontitis patients: a clinical and microbiologic study. Indian J Dent Res. 2010 Jul-Sep;21(3):341-8.
  61. Baysan A, Whiley RA, Lynch E. Antimicrobial effect of a novel ozone- generating device on micro-organisms associated with primary root carious lesions in vitro. Caries Res. 2000 Nov-Dec;34(6):498-501.
Dr. Colin MacLeod ND

Dr. Colin MacLeod ND

Naturopathic Doctor at MacLeod Naturopathic
Dr. Colin is a naturopathic doctor practicing in Upper Tantallon in the Halifax Area. He was born and raised in rural Cape Breton, Nova Scotia and always knew he would return to Nova Scotia after finishing his naturopathic education in Toronto. His clinical focuses include pain, athletic performance and digestive issues. He utilizes platelet-rich plasma, neural prolotherapy, prolozone and acupuncture to help alleviate his patients' pain.
Dr. Colin MacLeod ND

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