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Multi-step oxygen therapy

Multi-step oxygen therapy

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A lack of oxygen in the blood can have many causes. From disease of the respiratory tract to serious blood disorders, many disease scenarios are conceivable here. The consequences can also be very varied. One example is the bluish discoloration of the skin and mucous membranes (cyanosis). In the worst case, if there is an ongoing shortage of oxygen, tissue loss and organ failure can even occur. The oxygen multi-step therapy (short: SMT) is to compensate for an existing oxygen deficit by targeted oxygen administration. Find out below what this form of therapy is and how it works.

Oxygen multi-step therapy - brief overview

In our brief overview, we have summarized the most important information for you on the subject of "oxygen multi-step therapy":

  • Description: Oxygen multi-step therapy (short: SMT) is an alternative medical procedure that was developed in 1977 by physicist Prof. Manfred von Ardenne. It is used for the prevention and treatment of diseases and symptoms associated with a lack of oxygen in the blood.
  • Procedure: The therapy is usually carried out in three successive steps: firstly, the increase in oxygen uptake and utilizability by means of special vital substances, secondly, inhalation of an oxygen-enriched air mixture and thirdly, special exercise training to increase the blood flow.
  • Effect: The supporters of the SMT believe that the increased oxygen uptake and usability will result in a long-term improvement in the oxygen content in the arterial blood. This is supposed to stimulate healing processes, and at the same time a preventive effect is assumed due to the strengthened immune system.
  • Application areas: Circulatory disorders, migraines, respiratory diseases, strengthening the body's defenses, tinnitus, improving general well-being in the event of exhaustion and fatigue, accompanying cancer therapy, cancer prophylaxis and much more.
  • Side effects: If improperly carried out or overdosed, inhalation of high-proof oxygen can lead, among other things, to shortness of breath and impaired consciousness.
  • Contraindications: Among other things, the SMT must not be used for certain lung diseases (emphysema, open tuberculosis), bleeding tendency, hyperthyroidism, acute infections and fever of unknown cause.

Note: The "oxygen multi-step therapy according to Manfred von Ardenne" has proven itself over the years in practice for the treatment of oxygen deficiency conditions and diseases. In contrast to classic long-term oxygen therapy, however, SMT is an alternative medical procedure, the effectiveness of which has not been proven according to recognized scientific standards, according to the lung information service at Helmholtz Zentrum München.

The pulmonary information service also points out that multi-step oxygen therapy could be associated with risks. Accordingly, it has not yet been proven whether the inhalation of a relatively high-percentage oxygen mixture that is customary with this method can cause long-term health damage.

Our body's own oxygen supply

Human blood not only transports nutrients and immune cells, but is also an essential transport medium for the distribution of oxygen in the body. For this purpose, there is a very special dye in the red blood cells (erythrocytes), which is not only responsible for the red coloring of the blood, but also for its ability to bind oxygen molecules to itself. We are talking about the red blood pigment hemoglobin. It consists largely of iron, a chemical element known for its good oxygen binding.

After inhaling oxygen-rich air through the respiratory tract, the oxygen is absorbed through the blood vessels of the lungs and bound to the hemoglobin. The blood, enriched with oxygen, then flows through the arteries through the whole body, thus ensuring a regular supply of oxygen to all organs and tissue structures. When this is done, the remaining oxygen-poor blood flows back through the veins to the lungs, where the red blood cells are loaded with oxygen again before the blood circulation repeats.

The average blood oxygen level (CaO2) is usually around 18.6 percent by volume in the female and 20.4 percent by volume in the male body. There is a critical undersupply of the blood's own oxygen content if the standard values ​​fall below twelve percent by volume.

If there are any disturbances in the oxygen enrichment of red blood cells, this inevitably leads to the values ​​below the stated norms and there is a lack of oxygen in the arterial blood (hypoxemia). The red blood cells no longer take up enough oxygen through the respiratory system, which is why the oxygen content in the arteries drops drastically.

Hypoxemia and its consequences

Typical scenarios in which hypoxemia can occur are, for example, longer stays in oxygen-poor air, as is the case with mountain climbing at high altitudes. Even during longer dives, the regulated oxygen supply using breathing gas via an oxygen mask often reaches its limits.

In addition, hypoxemia is particularly dangerous in the context of pregnancy and birth complications, for example as a result of strangulation by the umbilical cord at birth or due to insufficient oxygen supply to the placenta in the course of prenatal developmental disorders in the area of ​​the blood vessels. Disease-related hypoxaemia, for example due to respiratory or blood disorders, is also conceivable.

In all of the cases shown, the first visible sign of a persistent lack of oxygen in the blood is usually the so-called blue addiction (cyanosis). It always appears when arterial blood increasingly suffers from a lack of oxygen, since this also causes a change in the color of the blood. Because the iron-containing hemoglobin compounds in the red blood cells change color sooner or later in the absence of oxygen from red to bluish violet to completely blue.

Since hypoxemia from the outside almost always first becomes noticeable in those parts of the body that are furthest away from the lungs as the central source of oxygen, cyanosis initially causes a blue discoloration on the outer extremities or acres, for example, on

  • Fingertips,
  • Hands,
  • Toes,
  • Feet,
  • Ears,
  • mouth
  • and / or nose.

Later, the cyanosis can also be felt in other parts of the body if the blood is insufficiently supplied with oxygen over a longer period of time. If this is the case, there is a risk of blood thickening (hemoconcentration), which in turn leads to disorders in the microcirculation of red blood cells.

In medicine, said circulatory disorders are better known as the sludge phenomenon, the English word sludge means something like "mud" or "semolina". It reproduces the viscous consistency of oxygen-poor blood, which increases the amount of slag and arterial semolina, which significantly reduces the flow rate of the blood and also severely impairs the passage of blood in smaller arterial capillaries. Such disturbances in blood circulation are noticeable among other things

  • Difficulty breathing,
  • Difficulty concentrating,
  • Drop in performance
  • and fatigue.

In the further course of the sludge phenomenon, even larger structural areas of body tissue are no longer adequately supplied with oxygen and there is inevitably an oxygen deficiency in the tissue (hypoxia). The consequences of such a deficiency can be very devastating and include symptoms such as

  • Shortness of breath,
  • low blood pressure (hypotension),
  • Tissue necrosis,
  • Circulatory problems,
  • Muscle weakness,
  • Loss of consciousness or fainting
  • or even organ failure

entail. It is therefore important to treat a budding lack of oxygen in the blood early in order to avoid life-threatening courses of hypoxemia.

What is multi-step oxygen therapy?

Oxygen multi-step therapy (short: SMT) describes an alternative medical procedure that is often used preventively or as an accompanying therapeutic measure to treat and - ideally - remedy diseases and symptoms associated with hypoxemia. In part, it also represents the main therapy. There are now over 20 different procedures for performing an SMT, with most of the variants having in common that they are carried out in three individual steps. The step-by-step procedure is therefore also due to the designation of oxygen multi-step therapy.

The three-step method of SMT serves a very specific purpose: In the first step, the patient to be treated is given a nutrient cocktail, the additives of which are intended to improve oxygen absorption in the blood and stimulate the metabolism. Vitamins and minerals such as vitamin C or magnesium are specifically administered here, which have been shown to increase the oxygen turnover of those affected, since this is important for the second step, the actual administration of oxygen.

Once the oxygen has been given, the patient is consciously instructed in the third and final step to move mentally and physically in order to achieve the best possible circulation of oxygen in the body. At SMT, the oxygen is administered in several sessions using an inhalation device. In part, it is inhalation therapy. Oxygen devices used here can be, for example, pressure-operated oxygen cylinders or electronically operated oxygen concentrators.

The latter suck the oxygen from the ambient air through a special filter system. The filter should prevent germs or dust from getting into the concentrator. There are both stationary and portable oxygen concentrators. Depending on which model is used by the therapist, it is at least theoretically possible to perform the oxygen multi-step therapy yourself.

Areas of application of oxygen multi-step therapy

Oxygen multi-step therapy was developed in the mid-1970s by physicist and inventor Manfred von Ardenne at his private research institute in Dresden. It originated from the long-term research on combating cancer - however, since numerous other diseases and complaints also go hand in hand with a deficient oxygen supply to the body, SMT can also offer very varied health support here.

Of course, the main causes of treatment are diseases that are usually also responsible for hypoxemia or hypoxia. Please refer to the overview below to find out which areas of application can be considered for therapy using SMT.

Respiratory diseases

Starting with the respiratory tract, diseases of the lungs must of course first be mentioned as possible causes of hypoxemia and thus also as possible reasons for multi-step oxygen therapy. These include, for example, chronic respiratory diseases such as bronchial asthma, in which bronchial spasms and temporary breathing disorders can lead to a temporary lack of oxygen in the blood. Also diseases of the lung tissue such as

  • chronic obstructive pulmonary disease (COPD),
  • Lung cancer,
  • Pulmonary emphysema
  • or pneumonia

impair the oxygen supply to the blood due to reduced lung performance. Chronic obstructive pulmonary disease ("smoker's lung") is accompanied by persistent complaints such as chronic bronchitis, which make breathing more difficult and also put a heavy burden on the immune system. Here, SMT can also reduce the risk of infection by stimulating the body's defenses.

Heart and vascular diseases

Hypoxemia does not always have to be associated with breathing problems. It very often happens that disorders in the heart function have a lasting effect on the oxygen transport in the blood. In this regard, oxygen multi-step therapy is used, among other things, for cardiac arrhythmias, which impede the conduction of the heart.

The heart's pumping process is severely disturbed, so that oxygen-rich blood can only be delayed in the surrounding vessels. Corresponding cardiac arrhythmias would be, for example

  • Stumbling,
  • Ventricular fibrillation or ventricular flutter,
  • Sinus node disorders (e.g. sick sinus syndrome),
  • slow heartbeat (bradycardia),
  • and atrial fibrillation (arrhythmia).

Likewise, a heart defect (vitium cordis) cannot be ruled out as the cause of the reduced pumping power of the heart. For example, wrong developments in the area of ​​the heart septum, the atrium or the sinus node, which is responsible for the excitation of the heart, are conceivable here. Corresponding malformations often result in heart failure (heart failure), in which the cardiac output and consequently also the oxygen turnover of the blood vessels turn out to be significantly lower than usual.

Speaking of vessels - vascular diseases can also be responsible for a reduced enrichment of the blood with oxygen. Arteriosclerosis (arteriosclerosis) should be familiar to most people here. It inevitably causes narrowing of the arteries through plaques in the vessel walls, which on the one hand favors the development of high blood pressure (hypertension). On the other hand, arteriosclerosis also makes it difficult for the blood to pass through the vessels and thus delays the transport of oxygen. This leads to massive circulatory disorders, which can sometimes even trigger a heart attack.

If arteriosclerosis is not treated in good time, it usually works its way towards the coronary arteries. Here, arterial calcification causes life-threatening coronary artery disease (CAD). In many cases, it requires a vascular transplant to avoid heart failure. In addition to symptoms such as angina pectoris known as chest tightness, coronary artery disease also threatens transport disorders in the body's oxygen balance.

Metabolic diseases and disorders

Diseases such as anemia are more likely to be located in the field of metabolic diseases as a possible reason for multi-step oxygen therapy. Hypoxemia results from a greatly reduced production of the blood pigment hemoglobin. Acute oxygen deficiency in the arterial blood is practically preprogrammed in this disease of the hematopoietic system. While some forms of anemia are genetically determined and thus congenital, previous illnesses such as renal insufficiency, deficiency diseases through improper nutrition or hormonal disorders can often be identified as the cause of acquired forms.

Since red blood cells consist of iron to a large extent, as mentioned at the beginning, this mineral is of course also essential for blood formation. Against this background, an iron deficiency (sideropenia) can contribute to anemia and thus to a lack of oxygen in the blood.

The triggers of iron deficiency once again show how diverse the health complaints for which an SMT can be carried out can be. A reason that is rather easy to remedy is nutritional errors, such as those caused by a lack of iron-containing foods (e.g. meat, cereals, legumes or nuts). Here the iron deficiency can be countered relatively easily by appropriate dietary changes.

On the other hand, underlying diseases in which sideropenia occurs as an accompanying symptom are significantly more serious. Which includes:

  • Malaria,
  • Inflammation of the bone marrow (osteomyelitis),
  • Tumor diseases
  • as well as tuberculosis.

Women of childbearing age represent a special risk group in the case of iron deficiency. Due to increased blood loss during their menstrual period, they require up to 15 milligrams more iron than men. If this increased iron requirement is not met in the long term, massive disturbances in the blood metabolism can occur. The need for iron is also significantly increased during pregnancy, here even by up to 100 percent. The reason for this is the fact that not only the pregnant woman, but also her unborn child must be supplied with blood via the mother's metabolism.

Important: If you donate blood regularly, you should be aware that an increased iron intake is also necessary here. Blood donors have to consume up to 250 milligrams more iron so that the blood loss can be compensated for. In such cases, SMT may also need to be considered in order to boost the metabolism and improve blood formation.

Other causes

Other reasons for an SMT can be complaints that are indirectly due to a lack of oxygen or can be alleviated by a targeted oxygen supply. These include in particular

  • general loss of physical performance,
  • Hearing problems (e.g. sudden hearing loss or tinnitus),
  • Lack of concentration,
  • A headache,
  • migraine
  • and chronic fatigue.

In the area of ​​wound healing, an improved oxygen supply can also stimulate the healing process. In the case of inflammation of the liver (hepatitis), blood formation is also greatly reduced, since the liver, as a blood-forming organ, can no longer perform this task in the event of illness or only to a limited extent. An additional oxygen supply can therefore also be useful in hepatitis to stimulate blood circulation.

Sequence of an oxygen multi-step therapy

By default, the SMT comprises around 15 separate sessions, which take place over a period of two to three weeks on selected consecutive days. Between the respective therapy intervals, one-day breaks are customary, which are usually put on the weekend in view of the patient's private life. A single session usually lasts two to three hours, whereby the three individual steps are as follows:

First step - nutrient administration

In order to increase the oxygen uptake in the blood as well as the performance and metabolic activity, those affected receive a nutrient cocktail in the first step of SMT. The exact components of this cocktail can vary depending on the SMT variant. Basically it is a mixture of vitamins and minerals that can achieve corresponding improvements in oxygen and power conversion. These nutrients include

  • Vitamin B1,
  • Vitamin C,
  • Vitamin E.
  • and magnesium.

Magnesium is mostly contained in the nutrient cocktail in the form of magnesium salt. The vitamins are dissolved in the cocktail as nutrient powder. In particular, vitamin E should be administered much earlier than the other nutrients (about an hour before oxygen is given) to ensure that the slow-acting vitamin is sufficiently developed in the body. All other nutrients are given half an hour before inhalation.

Second step: adding oxygen

Now the SMT is actually given oxygen. The patient inhales an oxygen-air mixture (O2) for about two hours through a nasogastric tube or breathing mask. The oxygen content of the mixture is about 40 percent, with about four to six liters of oxygen being added per minute during a session. For comparison: normal air contains only about 21 percent oxygen.

Slight deviations arise depending on the chosen dosage form and the equipment used. In total, however, approximately 7,500 liters of oxygen are administered in all cases over the 15 sessions. During the administration of oxygen, it is important that those affected relax, so that a harmonious blood flow is guaranteed.

Third step: physical activity

After oxygenation, the patient is instructed on physical and mental activity. This is supposed to stimulate blood circulation and ensure that the oxygen is distributed more quickly in the body. For example, brainteasers for mental and climbing stairs or gymnastic exercises for physical activity are beneficial.

After 20 minutes of exertion, light activity or even a break is held for two minutes in order not to lose the oxygen gain just achieved due to increased oxygen consumption due to physical exertion. Extreme sport as a measure of movement is therefore rather unsuitable.

Contraindications to multi-step oxygen therapy

The SMT must not be used for

  • acute infectious diseases,
  • Fever with an unknown cause,
  • acute ulcers in the gastrointestinal tract,
  • Hyperthyroidism,
  • Bleeding tendency,
  • Epilepsy,
  • active tuberculosis,
  • Emphysema,
  • acute heart muscle weakness,
  • acute allergic reactions
  • and respiratory global insufficiency.

It is important that the SMT is carried out exclusively by trained specialists, either a doctor or a trained alternative practitioner. Because even if the administration of oxygen is largely harmless to the intended extent, incorrect handling of the oxygen concentration can lead to considerable complications. In this context, an overdose of oxygen is particularly dangerous. In the worst case, this can lead to respiratory arrest, coma or seizures. If done correctly, no major side effects are known for SMT. (ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Ardenne, Manfred von: Where does oxygen multi-step therapy help? Urban & Fischer Verlag, 1999
  • Ardenne, Manfred from: Oxygen Multistep Therapy: Physiological and Technical Foundations, Thieme, 1990
  • Lung information service at the Helmholtz Zentrum München: Oxygen multi-step therapy (available on November 25, 2019), lung information service
  • German Society for Pneumology and Respiratory Medicine e.V .: An excessive supply of oxygen should also be avoided (available on November 25, 2019), pulmonologists online
  • Association of German Alternative Practitioners: Oxygen Therapies (available on November 25, 2019), Association of German Alternative Practitioners
  • Kleditzsch, Hannelore; Kleditzsch, Jürgen; Fuchs, Hildegard; Auschra, Ruth: Oxygen multi-step therapy in combination with other naturopathic treatments, in: empirical medicine, 52 (9), page 590-596, Karl F. Haug Verlag, 2003, Thieme

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