Altitude effect on diabetes

[Jhanananda]

My Case History:
I left my home town of Tucson, AZ, which has an altitude of 2600 ft (800m) and moved to Prescott, AZ, which has an altitude of 5500 ft (1700m) around 5 or 6 years ago.  Six months before I left Tucson I had a medical physical, which included standard blood tests. 

I was told, "Mr, Brooks your health is excellent and you have the cardiovascular system of an athlete."

Six months after arriving in Prescott, AZ I had another physical. 

I was told, "Mr, Brooks, you are full-on diabetic, you have high blood pressure, and you have high cholesterol."

I have often contemplated what could have happened in the space of a year that caused such a decline in my health.  The two factors that seemed to make sense all along were the change in elevation, and the return of the solar max.

I spent 5 years trying to master a low-carb diet to control my blood sugar.  All of my efforts seemed useless until I moved to Sedona, AZ, which is 4500 ft (1370m) of elevation, which is 1,000 ft (300m) lower in elevation than Prescott, AZ.  There I found I was successful at controlling my blood sugar on a low-carb diet.  Nine months ago I returned to Prescott, AZ. 

I maintained the low-carb diet and neglected to test my blood sugar until November 27, 2015. It was then that I found my blood sugar was regularly over 200.  I have since done everything I could to bring down my blood sugar, with no positive results.

On December 11, 2015 I drove to a site to explore for the winter retreat.  It is at an elevation of 2000 ft (600m).  I found my blood sugar had returned to normal within 9 hours time.  I remained there a week, before returning to Prescott, AZ to acquire resources.  Within 5 hours my blood sugar returned to over 200.

Jim's Case History:
While in town I happened to meet with a fellow type-2 diabetic, Jim, with whom I discuss our solutions to our blood sugar problems.

I asked Jim, "When did you move to Prescott from Phoenix?"

He said, "20 years ago."

I then asked him, "How long have you known you are type-2 diabetic.?"

He said, "I was diagnosed type-2 diabetic for the first time 20 years ago shortly after I moved here to Prescott."

Meredith's Case History:
Later that day I had a conversation with Meredith, a social worker who works for Catholic Social Services.  She happened to mention that she was "insulin intolerant."

I asked, "Was it before or after you arrived here in Prescott?"

She said, "I was diagnosed insulin intolerant after moving to Prescott, AZ.

Now, we could target Prescott, AZ as the problem.  After all this is an old mining town, and mining tends to dump toxic chemicals into the water supply; however, the water in Prescott, AZ is not know for being toxic.

So, my conclusion is the possible cause for my type-2 diabetes is altitude.  So, I plan to test this hypothesis rigorously, and I will report back.  If it turns out that altitude is the cause of my type-2 diabetes, then I will have to move to a lower elevation.  How low I do not know.

[bodhimind]

I found this article (although it is on type 1), which talks about how altitude has also affected her: http://asweetlife.org/catherine/blogs/type-1-blogs/high-altitude-diabetes-part-ii/11006/

I need to do more research on the causes behind altitude-induced insulin resistance, but from what I’ve read so far, it has something to do with the stress your body is under when you take away its oxygen. The process of acclimatization causes cortisol levels to rise, and as a result, your blood sugar digs in its heels and refuses to respond.

Might be useful.

[Jhanananda]

Thank-you, bodhimind, for posting this blog link. It does support my premise that there might be altitude-induced insulin resistance.  I searched for this subject, and found Acute altitude-induced hypoxia suppresses plasma glucose and leptin in healthy humans.  However, the article refers to extreme altitude in excess of 13,000ft (4,000m).  Whereas, it is looking more like moving to a higher elevation of a mere increase in 1-2,000ft (300-600m) might be enough to undermine long-term health of an individual, especially in mid to later life.

I then searched for: "altitude effect on health," and found the following:

The effect of high altitude and other risk factors on birthweight: independent or interactive effects?

OBJECTIVES: This study examined whether the decline in birth-weight with increasing altitude is due to an independent effect of altitude or an exacerbation of other risk factors. METHODS: Maternal, paternal, and infant characteristics were obtained from 3836 Colorado birth certificates from 1989 through 1991. Average altitude of residence for each county was determined. RESULTS: None of the characteristics related to birthweight (gestational age, maternal weight gain, parity, smoking, prenatal care visits, hypertension, previous small-for-gestational-age infant, female newborn) interacted with the effect of altitude. Birthweight declined an average of 102 g per 3300 ft (1000 m) elevation when the other characteristics were taken into account, increasing the percentage of low birthweight by 54% from the lowest to the highest elevations in Colorado. CONCLUSIONS: High altitude acts independently from other factors to reduce birthweight and accounts for Colorado's high rate of low birthweight.

Effect of Acetazolamide on Hypoxemia during Sleep at High Altitude

ACUTE exposure to high altitude results in respiratory alkalosis. With time ("acclimatization") blood pH tends to return to normal levels1; return is hastened by acetazolamide, a carbonic anhydrase inhibitor that slows the hydration of carbon dioxide and increases renal excretion of bicarbonate.2 Acetazolamide also lessens the symptoms of acute mountain sickness,3 4 5 6 in which insomnia and headache are frequently experienced. Insomnia is associated with increased wakings and periodic breathing or apnea,7 and headache is usually worst in the morning upon rising.8 Profound hypoxemia often occurs during sleep at high altitude.

International statistical classification of diseases and related health problems (book) World Health Organization.
From the above I found "Effect, adverse, high altitude, specific effect, NEC, T70.8."  I searched for this phrase and did not find the long term investigation that I would expect will result in meaningful data.

Effect of Aircraft-Cabin Altitude on Passenger Discomfort

Background
Acute mountain sickness occurs in some unacclimatized persons who travel to terrestrial altitudes at which barometric pressures are the same as those in commercial aircraft during flight. Whether the effects are similar in air travelers is unknown.

Methods
We conducted a prospective, single-blind, controlled hypobaric-chamber study of adult volunteers to determine the effect of barometric pressures equivalent to terrestrial altitudes of 650, 4000, 6000, 7000, and 8000 ft (198, 1219, 1829, 2134, and 2438 m, respectively) above sea level on arterial oxygen saturation and the occurrence of acute mountain sickness and discomfort as measured by responses to the Environmental Symptoms Questionnaire IV during a 20-hour simulated flight.

Results
Among the 502 study participants, the mean oxygen saturation decreased with increasing altitude, with a maximum decrease of 4.4 percentage points (95% confidence interval, 3.9 to 4.9) at 8000 ft. Overall, acute mountain sickness occurred in 7.4% of the participants, but its frequency did not vary significantly among the altitudes studied. The frequency of reported discomfort increased with increasing altitude and decreasing oxygen saturation and was greater at 7000 to 8000 ft than at all the lower altitudes combined. Differences became apparent after 3 to 9 hours of exposure. Persons older than 60 years of age were less likely than younger persons and men were less likely than women to report discomfort. Four serious adverse events, 1 of which may have been related to the study exposures, and 15 adverse events, 9 of which were related to study exposures, were reported.

Conclusions

Ascent from ground level to the conditions of 7000 to 8000 ft lowered oxygen saturation by approximately 4 percentage points. This level of hypoxemia was insufficient to affect the occurrence of acute mountain sickness but did contribute to the increased frequency of reports of discomfort in unacclimatized participants after 3 to 9 hours.

Observations upon the Effect of High Altitude on the Physiological Processes of the Human Body, Carried out in the Peruvian Andes, Chiefly at Cerro de Pasco

Vacation at Moderate and Low Altitude Improves Perceived Health in Individuals with Metabolic Syndrome

Background Recent data suggest that vacation may improve cardiovascular health, an effect possibly moderated by altitude. The aim of the present study was to study the effect of a 3-week vacation at moderate and low altitude on perceived health in individuals with increased cardiovascular risk.

Methods Seventy-two overweight males, both occupationally active and retired (mean age=56.6±7.2 years), with signs of metabolic syndrome were randomly assigned to identical sojourns at either moderate (1,700m) or low (300m) altitude and engaged in four 3- to 4-h heart-rate-controlled hiking tours per week. Perceived health was measured 2 weeks before vacation, at the beginning and end of vacation, and 7 weeks after vacation.

Results Fitness, recreational ability, positive and negative mood and social activities improved during vacation, independent of altitude and occupational status, although the day-to-day improvement in quality of sleep was delayed at moderate altitude. During the follow-up examinations, improvements in all reported aspects of health except for social activities were maintained. In comparison to retired individuals, active individuals showed a greater long-term improvement in social activities.

Conclusion Vacation positively affects perceived health independent of altitude or occupational status in generally inactive overweight males.

The possible effect of altitude on regional variation in suicide rates

Summary

In the United States, suicide rates consistently vary among geographic regions; the western states have significantly higher suicide rates than the eastern states. The reason for this variation is unknown but may be due to regional elevation differences. States’ suicide rates (1990–1994), when adjusted for potentially confounding demographic variables, are positively correlated with their peak and capital elevations. These findings indicate that decreased oxygen saturation at high altitude may exacerbate the bioenergetic dysfunction associated with affective illnesses. Should such a link exist, therapies traditionally used to treat the metabolic disturbances associated with altitude sickness may have a role in treating those at risk for suicide.

This article might provide us with further support for our basic premise.

Cancer and altitude. Does intracellular pH regulate cell division?

Abstract
Tissue culture growth rate is very sensitive to changes in pH of the external medium (H. Eagle), suggesting that the concentration in cells of +H or −OH might be the key factor controlling synthesis and eventual mitosis in normal and cancerous tissue. Since physiological acclimatization to higher altitudes produces changes in alkali-reserve in man and animals remaining at altitude, a possible correlation with statistics on cancer has been investigated.
Available data on registrations of cancer (International Committee Against Cancer) and of cancer deaths (World Health Organization) have been analyzed for possible correlation of age-specific rates with a population-weighted mean altitude for each region surveyed. There is no “altitude-effect” below 60 or 65 years, but a statistically significant negative correlation (r > 0·5. P < 0·05 in 8, < 0·01 in 7) was found for older ages in 15 of 16 sets of independent data. The drug acetazolamide has been used to produce “artificial acclimatization”, producing similar acid-base changes, and is reported (Evans) to have produced relief of intractable pain in terminal cancer patients. Some diseased states, such as achlorhydria and emphysema, in which there are chronic disturbances of acid-base relations, exhibit unexpected cancer rates.
Some other possible explanations of the apparent “altitude-effect”, particularly that it is related to inefficiency of collection of data at high altitudes, seem implausible.

Effect of High Altitude on Blood Glucose Meter Performance

ABSTRACT

Participation in high-altitude wilderness activities may expose persons to extreme environmental conditions, and for those with diabetes mellitus, euglycemia is important to ensure safe travel. We conducted a field assessment of the precision and accuracy of seven commonly used blood glucose meters while mountaineering on Mount Rainier, located in Washington State (elevation 14,410 ft). At various elevations each climber-subject used the randomly assigned device to measure the glucose level of capillary blood and three different concentrations of standardized control solutions, and a venous sample was also collected for later glucose analysis. Ordinary least squares regression was used to assess the effect of elevation and of other environmental potential covariates on the precision and accuracy of blood glucose meters. Elevation affects glucometer precision (p = 0.08), but becomes less significant (p = 0.21) when adjusted for temperature and relative humidity. The overall effect of elevation was to underestimate glucose levels by approximately 1-2% (unadjusted) for each 1,000 ft gain in elevation. Blood glucose meter accuracy was affected by elevation (p = 0.03), temperature (p < 0.01), and relative humidity (p = 0.04) after adjustment for the other variables. The interaction between elevation and relative humidity had a meaningful but not statistically significant effect on accuracy (p = 0.07). Thus, elevation, temperature, and relative humidity affect blood glucose meter performance, and elevated glucose levels are more greatly underestimated at higher elevations. Further research will help to identify which blood glucose meters are best suited for specific environments.

So, we can conclude that the meter is not at fault, because my blood sugar rises with altitude; whereas, if it were meter-effect, then the blood sugar should be artificially lower, not higher.

Systemic blood pressure in white men born at sea level: Changes after long residence at high altitudes

Abstract

A retrospective survey performed in 100 men born at sea level, residing at 12,398 feet of altitude for 2 to 15 years, has provided a basis for studying the systemic blood pressure changes possibly associated with prolonged residence in a hypoxic environment.

Comparison of the blood pressure at the initial and final examinations revealed: (1) decrements of 10 mm. Hg or more for systolic and diastolic pressures in the whole sample in 56 and 46 per cent of the subjects, respectively; (2) significant differences except for diastolic pressure in the subjects with the longest period of residence at high altitude; and (3) in lowlanders, a response of blood pressure to aging at this altitude differing from that at sea level. In general, the final blood pressure closely resembled that observed in healthy natives of the same altitude.

Since diet, physical activity on the job, and habits in these subjects were similar to those of their original countries and quite different from those of the Andean population, it seems probable that these findings are causally related to an environmental hypoxic stimulus. Functional or anatomic vascular changes decreasing peripheral vascular resistance to blood flow would be the principal determinant of the observed differences.

Conclusion:
There has not yet been meaningful research to cover the observed statistical rise of pancreatic dysfunction relative to residence at altitudes only a few thousand feet above home.

[Jhanananda]

Russ' Case History:
Today I spoke with Russ, is the chef at Open Door, a free-kitchen that serves the homeless.  He had told me at one time that he was type-2 diabetic. 

So, today I asked him, "When were you diagnosed type-2 diabetic?"

He said, "In 2003."

I asked him, "Where were you?"

He said, "I was in Chandler, AZ."

I know that Chandler, AZ is near Phoenix, and thus at about 1200 ft (365m) of elevation, which I figured would not be a problem.

I then asked him, "Did anything change about your condition over the years?"

He said, "Yes, after I moved here last July I saw a doctor, and he put me on insulin for the first time.  Before that I had been only using metformin."

conclusion:
The conclusion is his condition worsened immediately after his arrival in Prescott, AZ.

Bob's wife's case history:
Today I happened to run into Bob, a man who serves poor and homeless people at the local Salvation Army.  I had been made aware that his wife had some kind of serious medical condition.

So, in the source of a conversation with him I asked Bob, "When did your wife some down with hepatitis-c?"

He said, "We arrived here in Prescott, AZ in 2000.  Shortly after our arrival my wife was diagnosed with hepatitis-c.  Since my wife was not a user of injectable drugs, then to the best of our knowledge she must have acquired the infection in the 80s after a bad auto accident, when she received a transfusion.  However, her condition did not become active until after we arrived here."

Conclusion:

Perhaps altitude may effect other organ systems and thus manifest dysfunction in whatever organ is weakest.

A further conclusion may be had here: 

In just 2 days I have found 5 case histories that match the criteria of a condition either manifests or worsens upon arrival in Prescott, AZ.  It is either the town, its water, air, or soil, or it altitude that is causing this sudden medical condition.  It is my hypothesis it is the altitude.

[Sam Lim]

Russ' Case History:
Today I spoke with Russ, is the chef at Open Door, a free-kitchen that serves the homeless.  He had told me at one time that he was type-2 diabetic. 

So, today I asked him, "When were you diagnosed type-2 diabetic?"

He said, "In 2003."

I asked him, "Where were you?"

He said, "I was in Chandler, AZ."

I know that Chandler, AZ is near Phoenix, and thus at about 1200 ft (365m) of elevation, which I figured would not be a problem.

I then asked him, "Did anything change about your condition over the years?"

He said, "Yes, after I moved here last July I saw a doctor, and he put me on insulin for the first time.  Before that I had been only using metformin."

Metformin can worsen the condition of diabetes. There seems to be no evidence that altitude causes any problems. There are other conditions like diet and lifestyle which can contribute to diabetes. From type 2 to type 1 diabetes, it would take lots of abuse from foods, stress and enviromental conditions. If proper diet and medicinal herb is used it would not worsen. I don't live in high altitude though but I have diabetes. Through the use of herbs and oil , I have stabilised my condition. Also one have to take care of the liver and kidney. Perhaps the area that you are in are polluted or it emits some guide of gas that might cause one's condition to be worsen.

[Jhanananda]

Metformin can worsen the condition of diabetes.

So far the data suggests otherwise

There seems to be no evidence that altitude causes any problems.

While there is no medical research to support my findings, the fact that I came up with 5 case histories to support my premise that altitude may indeed have a profound effect upon the treatment of type-2 diabetes suggests otherwise.

There are other conditions like diet and lifestyle which can contribute to diabetes. From type 2 to type 1 diabetes, it would take lots of abuse from foods, stress and enviromental conditions. If proper diet and medicinal herb is used it would not worsen.

In my case it would be erroneous to conclude that my type-2 diabetes was due to "a lots of abuse," as I have led a disciplined, self-ware contemplative life for more than 40 years, and yet I contracted type-2 diabetes, suggesting more strongly an environmental cause.  The problem is the water and air here in Prescott, AZ is not known for being contaminated; whereas, the only significant factor is a change in altitude proximal to the arising of type-2 diabetes in myself and my other case histories.

I don't live in high altitude though but I have diabetes. Through the use of herbs and oil , I have stabilised my condition. Also one have to take care of the liver and kidney. Perhaps the area that you are in are polluted or it emits some guide of gas that might cause one's condition to be worsen.

The problem here in your assumption is I have done everything I can to control my type-2 diabetes and yet here in Prescott, AZ there has been no improvement; whereas, in Sedona, AZ, which is a 1,000ft (300m) lower in altitude, I had my blood sugar under control for 6 months.  And, upon returning to Prescott, AZ my blood sugar returned to out of control without a diet change.  And, I recently traveled down hill 3500 ft (1000m) and found my blood sugar normal in only 9 hours after it being out of control for the previous 9 months. Also, having simply stumbled upon 5 case histories that support altitude as a major factor in type-2 diabetes, in only 2 days; is good enough for me to pursue this course of study.

[Sam Lim]

https://www.youtube.com/watch?v=5I-Wr_s00aU

https://www.youtube.com/watch?v=WPgsgZ58jW4

[Sam Lim]

Trials being done on metformin.

https://www.youtube.com/watch?v=pUOC5d0Siws

[Sam Lim]

The data might not be accurate. I have a deep distrust with the Big Pharma.

The problem here in your assumption is I have done everything I can to control my type-2 diabetes and yet here in Prescott, AZ there has been no improvement; whereas, in Sedona, AZ, which is a 1,000ft (300m) lower in altitude, I had my blood sugar under control for 6 months.  And, upon returning to Prescott, AZ my blood sugar returned to out of control without a diet change.  And, I recently traveled down hill 3500 ft (1000m) and found my blood sugar normal in only 9 hours after it being out of control for the previous 9 months. Also, having simply stumbled upon 5 case histories that support altitude as a major factor in type-2 diabetes, in only 2 days; is good enough for me to pursue this course of study.

I don't assume anything. When one says one has done everything, is that really everything? Or is that everything correct. Perhaps elevation might have something to do about it but that would only be very slight as the condition still exist. Nobody really knows how one gets this disease and we can only speculate and test within one's own sickness. I have tried a lot of things, herbs, oils, exercises and fasting. Yet I did not say I've tried everything. There are still some other herbs I've not tried like fenugreek among others. I am doing resistant starch and it's good and working.

[Jhanananda]

Shocking Results to Metformin Study

Metformin should only be prescribed when diet and supplements have been tried... Metformin can cause a depletion of B-12

I am now eating dairy and eggs, so this should not be an issue.  However, if I observe any apparent side effects from taking it, then I will suspend taking it.

Metformin can cause low blood sugar.

That contradicts the wiki on Metformin. Since the above video is a promotional video for a supplement company, then it suggests this video is biased.

Is Metformin Worth The Risk?

This claim agrees with the above video; however, eating animal products, such as eggs, dairy and meat, should compensate for any depletion of B-12.

Metformin - The Case of Exaggerating Both Benefits and Harms

Lactic acid is not an issue... Based upon renal output he suggests not increasing the does over 1000mg

His use of humorous rock video content detracted from his otherwise very informative lecture on Metformin.  However, the thing to keep in mind is most of his lecture was on the risk of elevated blood glucose levels.  I believe this significance of his remaining talk, with respect to Metformin is the danger of tolerating elevated blood glucose levels believing that Metformin is treating the elevated blood glucose levels.

Thanks, Sam, for posting the links.

I am taking 500mg at present.  I will reevaluate its use over time.

[Jhanananda]

I have just collected 3 more case histories that support my premise that moving to Prescott, AZ causes some people to develop chronic inflammatory conditions, such as diabetes.

Yesterday a Baptist church bought me 100 more blood sugar test strips and a pulse and blood oxygen meter.  When I tested my blood O2 it was 92%, which is not good.  I left Prescott and drove 1,000 ft (300m) lower, and slept over night.  The next morning my blood O2 was 96%, which is an improvement. My blood sugar was normal again.  So, 4,500 ft (1370m) might be my upper limit for health and safety.

I have since returned to 2,000 ft of (600m) elevation.  I plan to test my pulse and blood oxygen every time I test my blood sugar.

[Jhanananda]

Hypoxia (medical)
Hypoxia (also known as hypoxiation or anoxemia) is a condition in which the body or a region of the body is deprived of adequate oxygen supply. Hypoxia may be classified as either generalized, affecting the whole body, or local, affecting a region of the body. Although hypoxia is often a pathological condition, variations in arterial oxygen concentrations can be part of the normal physiology, for example, during hypoventilation training[1] or strenuous physical exercise.

Hypoxia differs from hypoxemia in that hypoxia refers to a state in which oxygen supply is insufficient, whereas hypoxemia refers specifically to states that have low arterial oxygen supply.[2] Hypoxia in which there is complete deprivation of oxygen supply is referred to as "anoxia".

Generalized hypoxia occurs in healthy people when they ascend to high altitude, where it causes altitude sickness leading to potentially fatal complications: high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE).[3] Hypoxia also occurs in healthy individuals when breathing mixtures of gasses with a low oxygen content, e.g. while diving underwater especially when using closed-circuit rebreather systems that control the amount of oxygen in the supplied air. A mild and non-damaging intermittent hypoxia is used intentionally during altitude trainings to develop an athletic performance adaptation at both the systemic and cellular level.[4]

Hypoxia is also a serious consequence of preterm birth in the neonate. The main cause for this is that the lungs of the human fetus are among the last organs to develop during pregnancy. To assist the lungs to distribute oxygenated blood throughout the body, infants at risk of hypoxia are often placed inside an incubator capable of providing continuous positive airway pressure (also known as a humidicrib).

Signs and symptoms
Generalised hypoxia

The symptoms of generalized hypoxia depend on its severity and acceleration of onset.

In the case of altitude sickness, where hypoxia develops gradually, the symptoms include light-headedness / fatigue, numbness / tingling of extremities, nausea and anoxia.[5][6] In severe hypoxia, or hypoxia of very rapid onset, ataxia, confusion / disorientation / hallucinations / behavioral change, severe headaches / reduced level of consciousness, papilloedema, breathlessness,[7] pallor,[8] tachycardia and pulmonary hypertension eventually leading to the late signs cyanosis, slow heart rate / cor pulmonale and low blood pressure followed by death.[9][10]

Because hemoglobin is a darker red when it is not bound to oxygen (deoxyhemoglobin), as opposed to the rich red color that it has when bound to oxygen (oxyhemoglobin), when seen through the skin it has an increased tendency to reflect blue light back to the eye.[11] In cases where the oxygen is displaced by another molecule, such as carbon monoxide, the skin may appear 'cherry red' instead of cyanotic.[12]
Local hypoxia

If tissue is not being perfused properly, it may feel cold and appear pale; if severe, hypoxia can result in cyanosis, a blue discoloration of the skin. If hypoxia is very severe, a tissue may eventually become gangrenous.

Extreme pain may also be felt at or around the site.
Cause

Oxygen passively diffuses in the lung alveoli according to a pressure gradient. Oxygen diffuses from the breathed air, mixed with water vapour, to arterial blood, where its partial pressure is around 100 mmHg (13.3 kPa).[13] In the blood, oxygen is bound to hemoglobin, a protein in red blood cells. The binding capacity of hemoglobin is influenced by the partial pressure of oxygen in the environment, as described in the oxygen–hemoglobin dissociation curve. A smaller amount of oxygen is transported in solution in the blood.[citation needed]

In peripheral tissues, oxygen again diffuses down a pressure gradient into cells and their mitochondria, where it is used to produce energy in conjunction with the breakdown of glucose, fats and some amino acids.[citation needed]

Hypoxia can result from a failure at any stage in the delivery of oxygen to cells. This can include decreased partial pressures of oxygen, problems with diffusion of oxygen in the lungs, insufficient available hemoglobin, problems with blood flow to the end tissue, and problems with breathing rhythm.

Experimentally, oxygen diffusion becomes rate limiting (and lethal) when arterial oxygen partial pressure falls to 60 mmHg (5.3 kPa) or below.[citation needed]

Almost all the oxygen in the blood is bound to hemoglobin, so interfering with this carrier molecule limits oxygen delivery to the periphery. Hemoglobin increases the oxygen-carrying capacity of blood by about 40-fold,[14] with the ability of hemoglobin to carry oxygen influenced by the partial pressure of oxygen in the environment, a relationship described in the oxygen–hemoglobin dissociation curve. When the ability of hemoglobin to carry oxygen is interfered with, a hypoxic state can result.[15]:997–999
Ischemia
Main article: Ischemia

Ischemia, meaning insufficient blood flow to a tissue, can also result in hypoxia. This is called 'ischemic hypoxia'. This can include an embolic event, a heart attack that decreases overall blood flow, or trauma to a tissue that results in damage. An example of insufficient blood flow causing local hypoxia is gangrene that occurs in diabetes.[citation needed]

Diseases such as peripheral vascular disease can also result in local hypoxia. For this reason, symptoms are worse when a limb is used. Pain may also be felt as a result of increased hydrogen ions leading to a decrease in blood pH (acidity) created as a result of anaerobic metabolism.
Hypoxemic hypoxia
Main article: Hypoxemia

This refers specifically to hypoxic states where the arterial content of oxygen is insufficient.[16] This can be caused by alterations in respiratory drive, such as in respiratory alkalosis, physiological or pathological shunting of blood, diseases interfering in lung function resulting in a ventilation-perfusion mismatch, such as a pulmonary embolus, or alterations in the partial pressure of oxygen in the environment or lung alveoli, such as may occur at altitude or when diving.
Anemia
Main article: Anemia

Hemoglobin plays a substantial role in carrying oxygen throughout the body,[14] and when it is deficient, anemia can result, causing 'anaemic hypoxia' if tissue perfusion is decreased. Iron deficiency is the most common cause of anemia. As iron is used in the synthesis of hemoglobin, less hemoglobin will be synthesised when there is less iron, due to insufficient intake, or poor absorption.[15]:997–999

Anemia is typically a chronic process that is compensated over time by increased levels of red blood cells via upregulated erythropoetin. A chronic hypoxic state can result from a poorly compensated anaemia.[15]:997–999
Carbon monoxide poisoning
Main article: Carbon monoxide poisoning

Carbon monoxide competes with oxygen for binding sites on hemoglobin molecules. As carbon monoxide binds with hemoglobin hundreds of times tighter than oxygen, it can prevent the carriage of oxygen.[17] Carbon monoxide poisoning can occur acutely, as with smoke intoxication, or over a period of time, as with cigarette smoking. Due to physiological processes, carbon monoxide is maintained at a resting level of 4-6 ppm. This is increased in urban areas (7 - 13 ppm) and in smokers (20 - 40 ppm).[18] A carbon monoxide level of 40 ppm is equivalent to a reduction in hemoglobin levels of 10 g/L.[18][19]

CO has a second toxic effect, namely removing the allosteric shift of the oxygen dissociation curve and shifting the foot of the curve to the left. In so doing, the hemoglobin is less likely to release its oxygens at the peripheral tissues.[20] Certain abnormal hemoglobin variants also have higher than normal affinity for oxygen, and so are also poor at delivering oxygen to the periphery.
Hypoxic breathing gases
Main articles: Inert gas asphyxiation and Asphyxiant gases

The breathing gas in scuba diving may contain an insufficient partial pressure of oxygen, particularly in malfunction of rebreathers. Such situations may lead to unconsciousness without symptoms since carbon dioxide levels are normal and the human body senses pure hypoxia poorly.

A similar problem exists when inhaling certain odorless asphyxiant gases. These produce a hypoxic breathing gas which can produce unconsciousness and death without symptoms. This may cause inert gas asphyxiation. Such asphyxia may be deliberate with use of a suicide bag. Accidental death has occurred in cases where concentrations of nitrogen in controlled atmospheres, or methane in mines, has not been detected or appreciated.
Cyanide poisoning

Histotoxic hypoxia results when the quantity of oxygen reaching the cells is normal, but the cells are unable to use the oxygen effectively, due to disabled oxidative phosphorylation enzymes. This may occur in Cyanide poisoning.[citation needed]
Other

Hemoglobin's function can also be lost by chemically oxidizing its iron atom to its ferric form. This form of inactive hemoglobin is called methemoglobin and can be made by ingesting sodium nitrite[21] as well as certain drugs and other chemicals.[which?]
Physiological compensation
Acute

If oxygen delivery to cells is insufficient for the demand (hypoxia), hydrogen will be shifted to pyruvic acid converting it to lactic acid. This temporary measure (anaerobic metabolism) allows small amounts of energy to be released. Lactic acid build up (in tissues and blood) is a sign of inadequate mitochondrial oxygenation, which may be due to hypoxemia, poor blood flow (e.g., shock) or a combination of both.[22] If severe or prolonged it could lead to cell death.[citation needed]

In humans, hypoxia is detected by chemoreceptors in the carotid body. This response does not control ventilation rate at normal pO
2, but below normal the activity of neurons innervating these receptors increases dramatically, so much so to override the signals from central chemoreceptors in the hypothalamus, increasing pO
2 despite a falling pCO2

It is seen in a few humans (encountered with hypoxia), there is word loss in their speech due their state of confusion and cell damages in the brain.

In most tissues of the body, the response to hypoxia is vasodilation. By widening the blood vessels, the tissue allows greater perfusion.

By contrast, in the lungs, the response to hypoxia is vasoconstriction. This is known as "Hypoxic pulmonary vasoconstriction", or "HPV".[citation needed]

Chronic

When the pulmonary capillary pressure remains elevated chronically (for at least 2 weeks), the lungs become even more resistant to pulmonary edema because the lymph vessels expand greatly, increasing their capability of carrying fluid away from the interstitial spaces perhaps as much as 10-fold. Therefore, in patients with chronic mitral stenosis, pulmonary capillary pressures of 40 to 45 mm Hg have been measured without the development of lethal pulmonary edema.[Guytun and Hall physiology]

Hypoxia exists when there is a reduced amount of oxygen in the tissues of the body. Hypoxemia refers to a reduction in PO2 below the normal range, regardless of whether gas exchange is impaired in the lung, CaO2 is adequate, or tissue hypoxia exists. There are several potential physiologic mechanisms for hypoxemia, but in patients with COPD the predominant one is V/Q mismatching, with or without alveolar hypoventilation, as indicated by PaCO2. Hypoxemia caused by V/Q mismatching as seen in COPD is relatively easy to correct, so that only comparatively small amounts of supplemental oxygen (less than 3 L/min for the majority of patients) are required for LTOT. Although hypoxemia normally stimulates ventilation and produces dyspnea, these phenomena and the other symptoms and signs of hypoxia are sufficiently variable in patients with COPD as to be of limited value in patient assessment. Chronic alveolar hypoxia is the main factor leading to development of cor pulmonale--right ventricular hypertrophy with or without overt right ventricular failure--in patients with COPD. Pulmonary hypertension adversely affects survival in COPD, to an extent that parallels the degree to which resting mean pulmonary artery pressure is elevated. Although the severity of airflow obstruction as measured by FEV1 is the best correlate with overall prognosis in patients with COPD, chronic hypoxemia increases mortality and morbidity for any severity of disease. Large-scale studies of LTOT in patients with COPD have demonstrated a dose-response relationship between daily hours of oxygen use and survival. There is reason to believe that continuous, 24-hours-per-day oxygen use in appropriately selected patients would produce a survival benefit even greater than that shown in the NOTT and MRC studies.[1]

Treatment

To counter the effects of high-altitude diseases, the body must return arterial pO
2 toward normal. Acclimatization, the means by which the body adapts to higher altitudes, only partially restores pO
2 to standard levels. Hyperventilation, the body’s most common response to high-altitude conditions, increases alveolar pO
2 by raising the depth and rate of breathing. However, while pO
2 does improve with hyperventilation, it does not return to normal. Studies of miners and astronomers working at 3000 meters and above show improved alveolar pO
2 with full acclimatization, yet the pO
2 level remains equal to or even below the threshold for continuous oxygen therapy for patients with chronic obstructive pulmonary disease (COPD).[23] In addition, there are complications involved with acclimatization. Polycythemia, in which the body increases the number of red blood cells in circulation, thickens the blood, raising the danger that the heart can’t pump it.

In high-altitude conditions, only oxygen enrichment can counteract the effects of hypoxia. By increasing the concentration of oxygen in the air, the effects of lower barometric pressure are countered and the level of arterial pO
2 is restored toward normal capacity. A small amount of supplemental oxygen reduces the equivalent altitude in climate-controlled rooms. At 4000 m, raising the oxygen concentration level by 5 percent via an oxygen concentrator and an existing ventilation system provides an altitude equivalent of 3000 m, which is much more tolerable for the increasing number of low-landers who work in high altitude.[24] In a study of astronomers working in Chile at 5050 m, oxygen concentrators increased the level of oxygen concentration by almost 30 percent (that is, from 21 percent to 27 percent). This resulted in increased worker productivity, less fatigue, and improved sleep.[23]

Oxygen concentrators are uniquely suited for this purpose. They require little maintenance and electricity, provide a constant source of oxygen, and eliminate the expensive, and often dangerous, task of transporting oxygen cylinders to remote areas. Offices and housing already have climate-controlled rooms, in which temperature and humidity are kept at a constant level. Oxygen can be added to this system easily and relatively cheaply.[citation needed]

A prescription renewal for home oxygen following hospitalization requires an assessment of the patient for ongoing hypoxemia.

Pathophysiology and clinical effects of chronic hypoxia.

Abstract

Hypoxia exists when there is a reduced amount of oxygen in the tissues of the body. Hypoxemia refers to a reduction in PO2 below the normal range, regardless of whether gas exchange is impaired in the lung, CaO2 is adequate, or tissue hypoxia exists. There are several potential physiologic mechanisms for hypoxemia, but in patients with COPD the predominant one is V/Q mismatching, with or without alveolar hypoventilation, as indicated by PaCO2. Hypoxemia caused by V/Q mismatching as seen in COPD is relatively easy to correct, so that only comparatively small amounts of supplemental oxygen (less than 3 L/min for the majority of patients) are required for LTOT. Although hypoxemia normally stimulates ventilation and produces dyspnea, these phenomena and the other symptoms and signs of hypoxia are sufficiently variable in patients with COPD as to be of limited value in patient assessment. Chronic alveolar hypoxia is the main factor leading to development of cor pulmonale--right ventricular hypertrophy with or without overt right ventricular failure--in patients with COPD. Pulmonary hypertension adversely affects survival in COPD, to an extent that parallels the degree to which resting mean pulmonary artery pressure is elevated. Although the severity of airflow obstruction as measured by FEV1 is the best correlate with overall prognosis in patients with COPD, chronic hypoxemia increases mortality and morbidity for any severity of disease. Large-scale studies of LTOT in patients with COPD have demonstrated a dose-response relationship between daily hours of oxygen use and survival. There is reason to believe that continuous, 24-hours-per-day oxygen use in appropriately selected patients would produce a survival benefit even greater than that shown in the NOTT and MRC studies.

[Jhanananda]

sick building syndrome
Sick building syndrome (SBS) is used to describe situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified. A 1984 World Health Organization (WHO) report suggested up to 30% of new and remodeled buildings worldwide may be subject of complaints related to poor indoor air quality.[1]

Sick building causes are frequently pinned down to flaws in the heating, ventilation, and air conditioning (HVAC) systems. Other causes have been attributed to contaminants produced by outgassing of some types of building materials, volatile organic compounds (VOC), molds (see mold health issues), improper exhaust ventilation of ozone (byproduct of some office machinery), light industrial chemicals used within, or lack of adequate fresh-air intake/air filtration (see Minimum Efficiency Reporting Value).

Symptoms

Human exposure to bioaerosols has been documented to give rise to a variety of adverse health effects.[2] Building occupants complain of symptoms such as sensory irritation of the eyes, nose, throat; neurotoxic or general health problems; skin irritation; nonspecific hypersensitivity reactions; infectious diseases;[3] and odor and taste sensations.[4]

Extrinsic alergic alveolitis has been associated with the presence of fungi and bacteria in the moist air of residential houses and commercial offices.[5]

The WHO has classified the reported symptoms into broad categories, including: mucous membrane irritation (eye, nose, and throat irritation), neurotoxic effects (headaches, fatigue, and irritability), asthma and asthma-like symptoms (chest tightness and wheezing), skin dryness and irritation, gastrointestinal complaints and more.[6]

Several sick occupants may report individual symptoms which do not appear to be connected. The key to discovery is the increased incidence of illnesses in general with onset or exacerbation within a fairly close time frame—usually within a period of weeks. In most cases, SBS symptoms will be relieved soon after the occupants leave the particular room or zone.[7] However, there can be lingering effects of various neurotoxins, which may not clear up when the occupant leaves the building. In some cases—particularly in sensitive individuals—there can be long-term health effects.
Psychological factors

One study looked at commercial buildings and their employees, comparing some environmental factors suspected of inducing SBS to a self-reported survey of the occupants,[8] finding that the measured psycho-social circumstances appeared more influential than the tested environmental factors.[9] The list of environmental factors in the study can be found here.[10] Limitations of the study include that it only measured the indoor environment of commercial buildings, which have different building codes than residential buildings, and that the assessment of building environment was based on layman observation of a limited number of factors.

Greater effects were found with features of the psychosocial work environment including high job demands and low support. The report concluded that the physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.

Research has shown that SBS shares several symptoms common in other conditions thought to be at least partially caused by psychosomatic tendencies. The umbrella term 'autoimmune/inflammatory syndrome induced by adjuvants' has been suggested. Other members of the suggested group include Siliconosis, Macrophagic myofascitis, The Gulf War syndrome, Post-vaccination phenomena.[11]

Excessive work stress or dissatisfaction, poor interpersonal relationships and poor communication are often seen to be associated with SBS, recent studies show that a combination of environmental sensitivity and stress can greatly contribute to Sick Building Syndrome.
Causes

Sick building syndrome, it has been suggested, could be caused by inadequate ventilation, chemical contaminants from indoor or outdoor sources, and/or biological contaminants. Many volatile organic compounds, which are considered chemical contaminants, can cause acute effects on the occupants of a building. "Bacteria, molds, pollen, and viruses are types of biological contaminants" and can all cause SBS. The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) recently revised its ventilation standard, ASHRAE Standard 62.1-2013 Ventilation for Acceptable Indoor Air Quality (Tables 6.2.2.2.1) reduces previous minimum of 15 CFM of outdoor air per person (20 CFM/person in office spaces) to 10 CFM per classroom person and 5 CFM per office occupant. The five CFM per office person correlates with a predicted carbon dioxide 5.000 PPM occupancy level set by OSHA and adopted for federal workplaces and regulated energy policy during the late 1980s energy scarcity years. In addition, pollution from outdoors, such as motor vehicle exhaust, can contribute to SBS.[1] ASHRAE has recognized that polluted Urban Air, designated within the United States Environmental Protection Agency (EPA)´s Air Quality ratings as unacceptable requires the installation of gas phase filtration for which the HVAC practitioners generally apply carbon impreganated filters and their like. ASHRAE alleges that excessive energy is used to comply with its previous issues of the referenced IAQ Standard which coupled with improvements in furnishings, finishes and cleaning materials allow for these surprising reductions in fresh air ventilation rates.[12]

[Cal]

Hahaha so get out of the house and don't be so couped up.

[Jhanananda]

Hahaha so get out of the house and don't be so couped up.

It is not the house, it is the town, so there is no escaping the problem except leaving the town.

My blood sugar readings continue to go down the longer I am away from Prescott, AZ.  I checked the Air Quality for Prescott, AZ, and found there the levels of everything are consistently lower the normal, so I am still not sure what the problem is.