Photobiomodulation Lecture 2015 (Low Level Light Therapy)
Life for me when before he started the treatment was very very stressful. It was unbelievable he used to wander. He would go through cupboards. He would have temper tantrums and it was very very very difficult, it was very stressful. Yeah. It's better now, right? Yes, yes, yeah. Much better, eh? Much better. I'm going to tear up now because it was so awful before.
Yeah, I guess. It seems with dementia, you don't see everything right.. I guess you see everything right but you don't feel everything right. This study that we're involved in is a feasibility study so it's relatively small but it is a randomized, controlled study. With the treatment, I feel a lot brighter. Nothing's dull anymore, I look around and nothing's dull. It was a complete change, he became calm. He stopped wondering, he was able to sleep at night and he stopped searching for everything.
Essentially, what we're doing is evalulating the patients at three points. Baseline, where they were before they start treatment. Halfway through treatment at six weeks and at completion of treatment at 12 weeks - and then she told me that I had to give it up. Hello everyone, my name is Lew Lim. I am truly looking forward to taking you on this journey of understanding, healing with light. At the end of this journey, you will take away three things. An understanding of the healing power of light, how it works and how you can use its power to heal yourself and others. As an example, I will show you its potential to address Alzheimers disease.
Now let's get into this lecture. Today this healing process with light is called "photobiomodulation". "Photo" means light, "bio" means the biological system and "modulation" is associated with change and alterations. It is progressively replacing the longstanding label of low-level light therapy and is part of this exciting field of photomedicine. In this lecture, I will often mention red and near-infrared light which are parts of the light spectrum, that are most relevant to photobiomodulation. It's because it is this range that has been found to cause cells to go into a healing process.
Photobiomodulation helps your body to use its own ability to heal more effectively. Have you noticed your body can heal on its own? It can overcome the common cold and repair wounds. We will show you the way to enhance this capability with light but first up, let's look briefly at how photobiomodulation began. Actually, it was an accidental finding that Andre Mester discovered that applying red photons or red light to wounds that were not healing well, would make them heal better and he was actually trying to cause skin cancer. He had two groups of rats and he shaved all the hair off the backs of each group of rats and he was going to have an experimental group, where he was going to shine these read these red lights, red laser and he's going to see if he could cause skin cancer and then he has the control group and he's not gonna do anything to them. Well, surprise surprise! All the hair grew back twice as fast on the back that had received the red laser light and he said "Oh, my goodness" this is a beneficial effect, it's never going to cause skin cancer, it's going to heal wounds and so that was the beginning of an accidental finding and from then on people were off studying why is the red light effective to help the cells. Many important experiments in photomedicine are now carried out in respected research institutions in North America - including Harvard Medical School, Boston University, Stanford, MIT, Texas and the University of Toronto. As well as top institutions around the world - including in Russia and China, where a lot of discoveries are being made.
Today you'll find light therapy devices in chiropractic clinics for pain reduction. In dental offices, in hospitals for cancer treatments, in veterinarian hospitals for many applications, and in homes where they are used for treating winter depression and other conditions. The power of wearable photobiomodulation therapy lies in what it can offer you. Effectiveness, no major side effects, affordability, ease of use and most of all light energy that is natural. In this lecture, I will be explaining the ability of your body to seek out where healing is needed within its biosystem, when light energy is properly introduced. Additionally, I'll show you a new and promising solution for delivering light energy to key areas within the brain to improve recovery from neurological disease and cognitive performance. Light powers life, it is that fundamental. Understanding how our bodies react to light enables us to utilize that knowledge for healing.
Evolutionary biology tells us that life on earth began nearly four billion years - as a few connecting molecules responded to light from the Sun. This response included the production of nucleic acids, the precursors of the DNA that carries genetic code for every form of life. Over billions of years, these molecules continue to harness photos (or quanta of light energy) to proliferate into cells and form bigger and more complex organisms. Studies explain the signaling that takes place when the photons are delivered to the cells, resulting in a healing process.
More on this later Now at this point, you might be asking yourself, "Why have you not heard of this form of therapy?" If it has such promise. Good question, there are no big marketing dollars for photomedicine because simply, there is no company the size of the pharmaceutical giants. However, interest grows because the science is plausible, the evidence is growing and most of all people who have benefited are spreading the word. One of those people is Dr. Michael Hamblin of Harvard Medical School. Dr. Hamblin is one of the most esteemed thought leaders in the world of photomedicine and probably, has more published books and peer reviewed articles with his name, than anyone else in the world in this field. I can easily tell you what excited my interest initially in photobiomodulation.
I was doing a lot of research in photodynamic therapy, so they use light plus photosensitive dyes to kill bacteria, you want to kill undesirable tissue and when you do these experiments you have to have a "light alone" control. So it's usually red light because that excites the photosensitizers, so you put red light alone and you find that's doing exactly the opposite oh photodynamic therapy (PDT). So it's not killing things, it's actually stimulating things. So, once you do these control experiments few times, you sort of can't ignore it. A lot of people in the PDT field assume that light alone does nothing. Right? It's like negative control, but it actually does do something and then once you see that, you can study it. So that's how I got into it. Once you see that shining low levels of red and near-infrared light onto tissue has a positive effect, which is not what intuitively you would expect.
You would expect it had no effect. It's just light. Once you see it does have a positive effect then scientifically, it becomes very intriguing to see what's going on. Let's now delve deeper into the mechanism of photobiomodulation, to understand how and why it works - from the cellular level right up to the systemic levels. Let's begin with the mitochondria. Mitochondria are the energy factories that exist within almost every cell.
They are the key to photomodulation. Mitochondria have a substance called the "cytochrome oxidase", that can absorb red and near-infrared light and convert the energy into a form of biological energy called adenosine triphosphate( or ATP). What is ATP? Essentially it acts as a signaling molecule that leads to healing and tissue repair. The process also generates a mild level oxidant, Reactive Oxygen Species (abbreviated as "ROS"), which is another signaling molecule to start the action of transcribing genetic factors that lead to tissue repair. Some people identify this as a "redox signaling molecule".
This is where physical healing can be accelerated when you introduce red and near-infrared light. There is another important molecule in the picture, nitric oxide. Nitric oxide can be a major factor that contributes to cellular dysfunction. If it sits in the cell, it clogs the respiratory chain. So what is the respiratory chain? The respiratory chain is the process that leads to generating ATP. It is the core of the mitochondria. Low-level red and near infrared light actually frees the nitric oxide back into the body and restores the function of the respiratory chain. Then it takes on an important wide-ranging role of improving blood circulation by relaxing the blood vessel walls.
The cellular mechanisms are complex but we can summarize the key players during photobiomodulation. One : cytochrome oxidase, the substance that absorbs light. Two : ATP for cellular energy and signaling. Three : ROF mild oxidant that signals for cellular repair. Four : nitric oxide which when released by the photons, improve cellular function and has a healthy impact on the central nervous system. It will also help to relax the blood vessels and improve blood circulation. Cells respond to the photons when they are functioning below below par are not in homeostasis, or not in a balanced state. Therefore, light energy is only selectively used when needed There is a built-in check-and-balance to ensure that there is no overstimulation.
That is - provided that the light energy is kept low. That is why for many years, the process is called low level light therapy. When the cells respond collectively, the effect becomes systemic. The body goes through a negative feedback loop, which means that wherever it gets a negative feedback in the system (like something is not working properly), it responds by correcting it to meet its set point of optimum health. This loop continues until the problem is corrected as far as possible. With this going on, photomodulation has been experimentally and practically shown to make a healing difference in the immune system, the vascular system, endocrine system, where the hormones are controlled and of course, the brain. When we speak of internal systemic healing of the body - intranasal light therapy - which I'm very familiar with, is one of the most promising.
It is the foundation of what I do as co-inventor. But how did it evolve? During the 1980s, Russian scientists developed a technique that involved injecting low-level laser light into the blood circulatory system through the vein. It was successful as a holistic treatment to help with metabolic activity, blood circulation, systemic pain, inflammation, immune system and several other indications. It became very popular and centers were set up throughout Russia and various parts of the world to offer this modality. Patients still travel to these centers for treatment.
The challenge with this technology, is that using a needle to inject the light is invasive and only specifically trained technicians are qualified to do the procedure. But could there a way to achieve this with a non-invasive solution? The answer is actually on our face. Since the objective is to irradiate the blood with low intensity red laser, we can achieve the same effect by irradiating the system through the nasal passage (or "intranasal"), where there is a rich supply of capillaries near the membrane. There are more blood capillaries per square centimeter just underneath nasal membrane, than almost anywhere in the body. As an added bonus, when you place the light source inside the nasal cavity, there is little barrier between it and the brain. Not only does this remove the need to use a needle, this allows the technology to be downsized into something portable. Allowing the user to use it anywhere and at anytime. These discoveries make it a potentially wearable technology for general wellness.
Given all of this, how impactful is it when you introduce light energy into the circulatory system this way? Have a look at these clips. We found that 92% of cases respond this way. Persistent stickiness of the blood is found to be associated with elevated risk for a cardiovascular event, like a heart attack, as well as diabetes. But what happens in the brain? Brain cells or neurons are another form of cells.
We now have the basis to make the statement, about the potential of photobiomodulation of the brain. Let's now take a look at a difficult condition, like Alzheimer's disease. In Alzheimer's disease, we lost cognitive function because the disease signficantly shrinks the brain over time.
This we know. There is no consensus on how Alzheimer's disease is developed. The most widely followed is the "amyloid hypothesis", which proposes that beta amyloid is the primary causative agent for Alzheimer's disease. These plans are toxic to brain tissues. Many critics believe it is merely a biomarker that is created by the disease. Other hypotheses include those that relate to the deficiency of the neurotransmitter acetylcholine, the tau protein abnormalities which lead to the formation of neurofibrillary tangles oxidative stress in the mitochondria, intake of metals such as aluminum and copper, herpes simplex virus, environmental pollution, myelin sheath breakdown and a few more. For someone who has already developed the disease the best that existing pharmaceuticals can offer is to temporarily restore cognitive function.
Usually for about six months to a year. This is not a reversal. There is still nothing on the horizon for the estimated 40 million people around the world, who have been diagnosed as having Alzheimer's disease or alternative forms of dementia. Now what if we just forget about being fixated with trying to attack the biomarkers, the symptoms and just trust the body's intelligent response, When we help it by directing near infrared light to the neurons. So let's actually look at the science related to photobiomodulation. Specifically, relating to the brain and Alzheimer's disease.
I have already explained that cells are able to harness light energy for survival and propagation. Neurons are just another form of cells, complete with the necessary structures that enable them to do the same. Impaired neurons respond positively to near-infrared light. There are several published studies that demonstrate that damaged neurons restore their structures after irradiation with red and near-infrared light. Not just on cells in experiments, but also on laboratory rats with Alzheimer's disease.
Neurons damaged by oxidative stress, which is the basis of one of the hypothesized causes of Alzheimer's disease, has also been found to recover in a similar fashion, after irradiation with near-infrared light. Now if you subscribe to the amyloid hypothesis, this therapy does indeed reduce the amyloid beta protein as well as the precursors. It mitigates the damage of the disease and improves cognitive functions. There has been a range of studies carried out with the directing light to the brain, in the form of transcranial photobiomodulation. Researchers at the University of California San Francisco just discovered that stem cells become neurons in the presence of persistent light energy. This is the basis to hypothesize that if stem cells are present in the brain, the regular presence of light energy in the brain could result in new neurons. At the forefront of research on photobiomodulation on human brains is Dr. Margaret Naeser I'm a research professor of neurology at Boston University School of Medicine and I'm located here at the Boston VA Medical Center where I conduct research with light-emitting diodes applied to the head and into the nose to treat the brain to improve cognition and thinking and veterans who have suffered traumatic brain injury or have PTSD or a special group of veterans who served in Kuwait in 1990, 91 and they have developed what is known as Gulf War illness.
I actually got into photobiomodulation work, through my studies in acupuncture. I worked with stroke patients who have language problems probably for 43 years now and I have noticed that my stroke patients would have paralysis and it would be rather level in their recovery and I had read papers and sort of learned about this in San Francisco, I used to live in California - that you could apply acupuncture to treat paralysis in stroke patients. In 1984, a doctor from Shanghai, China, came to MIT here in Boston area and gave a three day class on laser acupuncture. Laser acupuncture, what could that be? well it meant shining a red laser light on acupuncture points. No needles just shining laser light on the acupuncture points. So in 1985, I went to Shanghai, China, I studied for two months at the Huashan EUON, the Shanghai number one medical college and I learned how to do laser acupuncture. It's very simple you just put the red beam laser light, it's painless, you don't burn the skin its non-invasive, painless completely and you just put on the acupuncture points and you eventually, after maybe four weeks you see change in their paralysis and it's very helpful.
It helps about 66% of stroke patients. I brought that information back to the Boston VA Medical Center here and started treating stroke patients with paralysis. I did learn about light-emitting diodes applied to the head. I learned about that from Anita Saltmarche in Toronto, Canada. I also learned a lot about it from Michael R Hamblin, PhD, cell biologist, at Massachusetts General Hospital. What is the treatment protocol with the light-emitting diodes for a traumatic brain injury patient or PTSD patient is going to be very different from that for a stroke patient who had a stroke just on one side of the head and if it's on the left it's going to cause language problems. You really just want to put those LEDs where the brain damage is.
Now with traumatic brain injury, that is often caused by accelerated twisting. The head goes forward and is twisted, so you get damage on both sides of the brain. So that's fine to treat both sides of the brain with traumatic brain injury and then often those patients who have PTSD also, so that's why you want to treat both sides of the head with those patients and we get very good results. Let's now continue with our quest to improve neurological outcomes. We have seen that near infrared light can heal impaired neurons and this usually takes some time, depending on the subjects conditioning and the nature of this disease. Do we know for sure that near-infrared light can get the neurons of the human brain to immediately start responding? The answer is "yes". I was surprised at how active the brain is in trying to restore normative brain condition in just once session. Stay with me for awhile here.
This QEEG reading is one of a healthy 22-year old in the pre-treatment recording. You'll notice some fairly mild abnormalities in different brain waves. Simply, abnormalities are seen as represented in any color other than pure green in the top two rows. After a 25 minute illumination of the brain with near-infrared light, there are heavy restorative activities throughout the brain network, as represented in red and blue connectivity lines in the bottom three rows.
As a result, we see more normative brain waves represented by more areas restored to green after the treatment. It appears that restoration continues beyond the treatment. Experiments of healing the brain with light are not that old. That technique traditionally involves directing light to the brain through the skull, called transcranial light therapy. Published studies go back to about 10 years, and they reported successful experiments in lab mice with stroke. Since then, studies have covered human subjects with traumatic brain injury and stroke. Some of them documented by Dr. Margaret Naeser and the research collaborators using transcranial clusters of red and near infrared LEDs.
The first patient, big car hit her from behind in her smaller car, the driver of that car was going about 55 miles an hour and was focused on a green light a block away but failed to see the red light where she was stopped. This woman was highly educated she taught at university in New York, had basically a whiplash traumatic brain injury. She had been a professor teaching web design. She had to resign all her professional work for six years.
The longest she could work on a computer was twenty minutes. She had been through all sorts of cognitive rehabilitation therapy programs, so she had her first treatment. When we treat traumatic brain injury, we apply the light emitting diode cluster heads and we place them all over the head. We do 6 at a time, about 10 minutes per placement and there's two sets of placements in order to cover the whole head. We treat every 48 hours during the week, so outpatient treatments.
They come in - it's Monday, Wednesday, Friday and we do that for 6 weeks and then we test. She went to her computer and she could work on computer for 40 minutes. Now that was twice what she could have done for the preceding six years. Then she kept going back once a week and after eight weeks, that would be two months, she could work on her computer for two hours. So, she was so happy because she's basically described this as "I got my brain back". Another traumatic brain injury case who we've been able to help quite a bit was a gentleman, who through a work-related accident was actually pulled into a blast furnace. He got a lot of facial trauma and broken bones in the face and then for two years this accident he had a lot of problems thinking, problems with cognition, problems with memory, so we treated him with our treatment program.
Transcranial treatment program, and he was treated Monday, Wednesday, Friday for six weeks and then we tested him at the sixth week and there was again significant improvement and executive function and in verbal memory but the most striking finding for him was he was so grateful that after three weeks of the LED treatments to his head, he no longer had recurring nightmares of the accident where he had been pulled into the blast furnace and that had been going on for two years. Taking this further, I wanted to see how we can deal with the great challenge of Alzheimer's disease. If we can successfully deal with this, this will go a long way to support the efficacy of photobiomodulation for tough neurological conditions in general. Perhaps we can help all those people who have developed Alzheimer's disease. We approach this challenge with some experience on our side. A growing number of people are reporting significant improvements with the existing near-infrared intranasal device. But it has not been as consistent as we would like.
How can we improve the outcomes? We combined intranasal with transcranial. We wanted to make this available to many people, we were faced with two challenges. The first was to get light through the skull in an efficient manner. The second was to provide an effective affordable solution that people with Alzheimer's disease could use on a daily basis. Our first challenge is that of getting light into the brain.
We knew from past published research that certain near infrared wavelengths are particularly good. Not only because they travel deeper into the tissues, they're not lost by being absorbed by blood and water before they reach the brain. This was later confirmed by the work of Dr. Juanita Anders, of the Uniformed Services University and her research collaborators. Furthermore, they found that certain range of near-infrared light was also effective with nerve tissues. The wavelength was identified as around 810 nanometer.
The same wavelength we had been using successfully with our intranasal device. We now know that this is the wavelength that we should use for the transcranial portion. What else can we do to propose an efficient design? Brain imaging work has revealed that Alzheime'rs disease lesions are closely related to the hubs of the Default Mode Network in the brain. Default Mode Network kicks in when we're resting or not performing a task. Your brain never actually rests. Many neurologic conditions are associated with the dysfunctional Default Mode Network. So, it could be very important that our Default Mode Network is healthy.
Alzheimer's disease is just one of these conditions. The others include Parkinson's disease, multiple sclerosis (MS), autism, schizophrenia, depression, chronic pain and others. So how do we achieve a healthy Default Mode Network? We know that the network is interconnected with the hubs, which are like busy railway junctions. In fact, the lesions associated with Alzheimer's disease are also found in these hubs. The other information we know is that our brain cells heal when near infrared light is directed into them. Hence the rational solution is to direct near infrared light energy to the hubs of the Default Mode Network. We are now putting this intranasal-transcranial combination product to the test, in a properly designed controlled study. The independent clinician is Anita Saltmarche, one of our early research collaborators with Dr.
Naeser, who you heard from earlier. This study we're involved in is a feasibility study. So it's relatively small but it is a randomized controlled study. Life for me when before he started treatment was very very stressful. It was unbelievable.. So what happened is, in 2001 my husband had a serious head-on car crash and they thought he was dead and so the ambulance took their time to get there.
He started to lose his memory then. About five years ago he got diagnosed with dementia or Alzheimer's. It seems with dementia, you don't.. See everything right. I guess you see everything right but you don't feel everything right. I think you have to live it, to know what we go through.
You really have to. You have to be there, you have to see it, because nobody understands. Patients who come in are randomized. I don't select who goes into treatment and who gets a sham or control, which means no treatment.
Actually, I volunteer for anything.. Anything.. To see if we can come up with something to solve this. When I saw in the paper there was an opportunity, I'm in. I knew this would work from day one - because my friend, who had told me, "Whatever you do, get him in there and get him to take the light therapy".
Patients are treated for 12 weeks then we stop treatment and they have a month with no treatment and then they come back and are re-evaluated. Essentially what we're doing is evaluating the patients at three points. Baseline, where are they before they start treatment. Halfway through treatment at six weeks and that at completion of treatment at 12 weeks. It was a complete change, he became calm.
He stopped wandering, he was able to sleep at night and he stopped searching for everything. So a lot of the things stayed in the same place, so it was very very oh - it was miraculous to me. With the treatment I feel a lot brighter, things aren't dull. Nothing's dull anymore. I can look around and nothing's dull. After the treatment, he stopped wandering, he was able to sleep at night and he stopped searching for everything and so a lot of the things stayed in the same place. So it was very very - oh, miraculous to me. That happened just right after he started treatment and it and it was like wonderful little things that we noticed, like oh my god I can actually sleep at night.
So it was wonderful for me. Then we give them a month where we actually take away their product. I nodded and I thought to myself, I'm going to do it anyway and then she told cause I'm not going without this and then she told me that I had to give it up. My husband started to wander, right away right after he stopped. He started to wander, he started picking garbage up from the side of the road. I had to go and pick him up It was awful. He started immediately, he forgot things so where I saw this accomplishment it was like "Oh my god" I'm right back to hell, and it started like almost like a week later.
They have a month of no treatment, and then they come back. They're tested again using standardized tools that are well accepted and used in a clinical research community. Then after that, we teach them how to use the equipment and they take it home and they'll continue. I would say the vast majority of the patients will be more than happy to be followed even further but the study ends at that point. Umm.
It's becoming human again. The pilot study is a good first step in validating the efficacy of photobiomodulation for Alzheimer's disease, especially that it is blinded and placebo-controlled. We are now planning to raise the level of evidence by doing bigger trials. I hope you're taking away a better understanding of photobiomodulation and with it, a greater appreciation of its potential. We're looking forward to using light, to brighten your life! The end.
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