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The Primacy of Oxygen Issues Over Carbon

Majid Ali, M.D.

Oxygen deficit is the primary threat to life on the planet Earth. Carbon excess is a secondary threat to planetary life. I expect these words to surprise most, if not nearly all, readers. Succinctly stated, carbon creates a mess and oxygen cleans up that mess. This statement is also likely to raise many eyebrows, because it might be seen as too broad and sweeping to be considered seriously.

Scientists diligently document global warming caused by carbon emissions from fossil fuel, incremental global chemicalization, devastation of human habitat, mass mortalities of aquatic life, and extinction of species. They tell us about melting of polar ice caps, and cooling of oceanic conveyer belts. Environmentalists vigorously debate issues of greenhouse gases and climatic changes. Policy makers heatedly argue about the significance of these changes. Politicians brazenly distort scientific facts to promote themselves. People all over the world now recognize these looming threats and want to know what they can do to counter those threats. These subjects have been presented at length in several recent volumes, most notably in Blatt's America's Environmental Score-Card (2004),1 Gelnspan's Boiling Point (2004),2 Flannery's The Weather Makers (2005),3 Gore's An Inconvenient Truth (2006),4 Kerry's This Moment on Earth (2007),5 and Frumhoff's Confronting Climate Change in the U.S. Northeast (2007).6 Notably absent in all those deliberations and efforts are any considerations of the primacy of oxygen-related problems (the "oxygen concerns" over the carbon-related issues [the "carbon concerns"]).

For decades, some scientists, environmentalists, and policy makers have sought to protect human habitat by focusing on carbon emission and global warming. These efforts are commendable. However, their focus on carbon—in my view—misses the essential point: Oxygen deficit is a much more immediate and dangerous threat to planetary life than carbon excess. In past publications, I have systematically related derangements of oxygen signaling and oxygen-driven cellular energetics to the pathogenesis of aging,7 obesity,8 inflammation,9 diabetes,10-12 cardiovascular disorders,13-17 asthma and atopy,18-20 renal failure,21 pseudomenopause and related menstrual disorders,22-24 arrested growth in children,25 liver disorders,26 fibromyalgia.27 pain,28osteoporosis,29 parasitic infestation,30 war-related chronic illness,31 malignant disorders,32-36 Here, I address issues of climatic chaos, global warming, and earth chemicalization issues that adversely affect global oxygen homeotasis—crucial issues that have not been considered in the context of human disease.

What poisons plants also poisons animals and that which poisons animals also poisons people. This is the basic chemistry of oneness that binds humans with animal and plant kingdoms. The putative differences among species in their responses to toxins are significant only on a small time scale. In the larger global context, our shared vulnerability to a poisoned environment is far more important. Anthropogenic influences are disrupting the elemental cycles of the planet Earth—the cycles of economies of oxygen, carbon, nitrogen, sulfur, iron, and essential elements—to increasing degrees. Among those disruptions, the most important involve the oxygen cycle.

In 1998, I introduced the term dysoxygenosis (dysox, for short) to refer to a state of dysfunctional oxygen homeostasis characterized by deranged oxygen signaling and impaired oxygen-driven energetics.37-39 In subsequent publications, I presented a large body of clinical, microscopic, and biochemical data to show that all symptom-complexes of chronic disorders are caused, amplified, and perpetuated by oxygen-related factors.9-36

I support my view of primacy of the oxygen concerns over the carbon concerns by reviewing a large body of observations of natural phenomena under the following headings:

1. Oxygen issues and carbon issues;

2. Oxygen deficit is the primary threat to planetary life;

3. Carbon creates a mess and oxygen cleans up that mess;

4. Oxygen: an orphan element;

5. Oxygen and nitrogen economies;

6. Eutrophication;

7. Scorched lands and big thaws;

8. Hypoxic and anoxic waters;

9. Smog and oxygen deficit;

10. Clean energy, dirty energy;

11. Primacy of oxygen issues over carbon issues for aquatic species;

12. Primacy of oxygen issues over carbon issues for land animals;

13. Primacy of oxygen issues over carbon issues for plants;

14. Primacy of oxygen issues over carbon issues for humans;

15. The age of mystery maladies;

16. Oxygen and the edges of human life span;

17. Humans are not the apex predators; and

18. What next? A world order of ethics?


The emphasis on the carbon concerns is based on sound scientific data. After years of spirited media discourse and bitter political debate, there is emerging agreement on the threat posed by carbon excess—and resulting global acidification, climatic warming, and consequent threats to life. However, it has not been recognized that all adverse biologic effects of carbon excess are mediated by oxygen deficit—quantitatively, slowing metabolic pathways, as well as qualititatively, disrupting oxygen signaling. The crucial point here is: Victory in the struggle with carbon issues will prove hollow unless all relevent oxygen issues are effectively addressed. Below, I summarize my main points:

*  Human and animal cells produce energy by oxygen-driven processes;

*  Human and animal cells are injured when their oxygen-driven processes are impaired;

* Human and animal cells are clogged by excess carbon;

*  Clogged human and animal cells are unclogged by oxygen;

*  All forms of chronic cellular injury involve functional oxygen deficit (dysox);

Most forms of cellular injury do not involve carbon excess;

*  Cellular injury caused by carbon factors is mediated by oxygen factors;

*  Cellular injury caused by oxygen factors generally does not involve carbon factors;

*  Carbon factors generally injure cells by covering them with grease—denatured lipids embedded in cellular waste—impeding cellular respiration, figuratively and literally;

Oxygen and oxyradicals remove that grease to restore cellular respiration; and

*  The fundamental energetics of aerobic life—humans and animals inspire oxygen and expire carbon—are identical. So, it follows that what injures humans also injures animals, and vice versa.


Oxygen is the organizing principle of all aerobic life on the planet Earth. This statement may be considered strident—even a leap of imagination, unsupported by scientific facts. Students in all fields of biology learn about fundamental oxygen-driven cellular energetics. Then their interest in the subject wanes. Deranged oxygen signaling and impaired Krebs cycle chemistry are at the roots of all chronic disorders. Zoologists and botanists consider the problems of oxygen homeostasis only in a perfunctory manner—therapeutic interventions for oxygen issues are not in vogue in their respective disciplines. The case of human sickness is different and compelling. There is a profound irony here. Physicians in clinical practice seldom, if ever, show any curiosity about the Krebs cycle derangements as the basis of clinical symptom-complexes they encounter in their patients. They simply prescribe drugs to suppress symptoms. Marine biologists consider oxygen issues but also fail to recognize the primacy of the oxygen issues over the carbon issues.

Historically, we physicians have had little, if any, interest in understanding the issues of biology and ecology of animal and plant kingdoms. Now the large and looming threats of global warming, incremental global chemicalization, and climatic changes require that we seek a broader and integrated view of oxygen homeostasis on the planet. All life on the planet is in jeopardy. The oxygen issues of humans can no longer be separated from those facing animals and plants. I began Oxygen and Aging (2000)40 with the following words:

Cellular oxygen dysfunction, in my view, is the single most important threat to human health. Cellular oxygen metabolism is put in jeopardy by a growing number of nutritional deficiencies, metabolic roller coasters, synthetic chemicals, and lifestyle stressors.

Human canaries [individuals with chronic disabling energy deficit syndromes] tell all of us something about the shape of things to come. No one is immune to what poisons them. It is merely a matter of time. As poisons accumulate to paralyze oxygen metabolism, everyone can be expected to become a canary. This is not a doomsday prophecy. In my travels from Beijing to Bankok, from Moscow to Nairobi, from Oslo to the Honduras, I have seen human canaries of all colors, of all shapes, and of all ages. Everywhere I went, I saw human canaries in increasing numbers. This book in that sense is a wake-up call about the pandemic of dysfunctional oxygen metabolism.

In the past, we physicians have not been ecologic thinkers. We must be now. My main point in Oxygen and Aging was to underscore the importance of keeping oxygen homeostasis at center stage in making all clinical management decisions. The rate of predicted climatic changes is expected to increase, worsening the degrees of dysox in chronic environmental, nutritional, infectious, and stress-related disorders. For these reasons, and to foster a deeper understanding of the energetic basis of clinical disease, we physicians must closely examine the the issues of dysox and climatic chaos as intricately connected twin global threats to all life on the planet. It is essential to develop a broad integrative perspective on issues of anoxic waters, massive kills of the aquine species, and mass mortalities of land species (disappearing frogs, missing amphibians, collapsing colony disorder of bees, and decimation of the world's butterflies).


My essential argument here is: Carbon covers cells with grease while oxygen and oxygen-derived radicals serve as molecular detergents, penetrate that grease, remove it, and permit cells to breathe again—figuratively and literally. I do not take poetic license with facts of biology. In the process of living, cellular grease—debris embedded in rancid fats and disfigured proteins— accumulates on the cell membranes, matrix, and mitochondria. In health, oxygen oxidizes and breaks up the grease, allowing cells to "breathe" again—literally and figuratively—restoring the gating functions of cell membranes, matrix-based regulatory signaling, and mitochondrial ATP generation. This basic order of biology prevails in all human, animal, and plant cell populations.

For human biology, nature subordinated the "carbon chemistry" to the "oxygen chemistry." It established the same heirarchy concerning the chemistries of nitrogen, sulfur, iron, and other elements. I presented these subjects at length in Darwin, Oxygen Homeostasis, and Oxystatic Therapies, the tenth volume of The Principles and Practice of Integrative Medicine.41 Carbon is used to build chemical bond energy. Oxygen both regulates that process and breaks down these bonds to release energy. Carbon toxicity poisons the environment—by acidification with carbon dioxide, for instance—and threatens human and animal life by the same final pathways of tissue injury: disruption of oxygen signaling and oxygen-driven cellular energetics. However, oxygen homeostasis is a vast ever-changing kaleidoscopic mosaic with elaborate adaptive and self-correcting mechanisms that protect it from threats posed by a carbon chemistry run amuck—global warming, acid rains, incremental burden of industrial pollutants, pesticides, radiation, and lifestyle stressors. Chronic environmental and nutritional illnesses essentially begin when the oxygen-driven detoxification pathways of the body are overwhelmed.

I cite the case of water stratification to elaborate my point that oxygen, not carbon, completes the story of disease and death. In a large lake, the surface water is aerated and oxygenated. On the lake floor, water becomes nutrient-rich as plankton and algae release minerals from the lake bed and build nutrients, using chemical bond energy generated by photosynthesis. If such water strata were to be left undisturbed, the aquatic life in oxygen-rich surface water would sicken and die because of malnutrition, and species in the deep nutrient-rich, oxygen-depleted water would die of suffocation. Nature regularly and vigorously mixes surface and deep waters—by, let's say, monsoon storms—to prevent mass extinction of species in that lake. Nature is also cyclical. During some periods, water stratification persists due to absence of sufficient storm activity, and mass mortalities do occur in aquatic species. However, such disruptive natural weather cycles are generally followed by others with strong restorative influences. The problem now is that those natural cycles are being disrupted with increasing frequency by anthropogenic influences.


In human spheres, oxygen has no guardian angel. No one makes money from discussing it in the media. Politicians are blissfully ignorant about oxygen—no surprise, their ignorance is painful only for others. Drug makers have not yet discovered how to earn billions by deceiving the public with an "oxygen pill." There are some who push liquid oxygen, however, their deceptions are puny. As for doctors, their silence in this area is deafening—a sad state of affairs since diseases are fundamentally caused by clogged oxygen-driven energetics and by deranged oxygen signaling. What is surprising here is the absence of scientists in oxygen issues of our time. Oxygen continues to be an elemental orphan.

Why did the larger threat of oxygen deficit escape the notice of biologists, physicians, and the public? There are many reasons. Carbon pollutants were more visible—black smoke from industrial chimneys is hard to miss, soot in diesel exhaust is not easy to escape—and their adverse effects on planetary life were very visible. So, concerns about carbon excess were raised early by scientists and recognized by many in the general public soon after. The story of oxygen deficit has been quite different. First, absence of invisible substances is not likely to be noticed as readily as the presence of dirty and smelly carbon substances. Second, carbon pollutants were easily traced to industries. By contrast, the corporations that contributed to oxygen deficit were hard to pin down. Third, the professionals who should have been the first to recognize the direct and dire consequences of oxygen deficit were least prepared to do so—the doctors. The chemistry of the Krebs cycle—the primary cycle of energy generation in cells—appears in the first year curriculum of medical students, and then disappears forever. Except for a handful of integrative physicians, doctors never investigate and address issues of impaired or blocked cellular energetics. Fourth, even when unequivocal evidence for chronic and unrelenting illness caused by oxygen deficiency is forthcoming, it does not fit into the prevailing model of treating and "preventing" diseases with synthetic chemicals. There are simply no drugs to treat clinical problems created by oxygen deficit.


Carbon has been the darling of environmentalists and earth scientists. It has drowned all voices about nitrogen issues. Oxygen has not had anyone to champion its cause so far. The "oxygen economy"—production matched by consumption—of the planet Earth evolved over a period of more than three billion years. Oxygen is mass-produced by phytoplankton and macroalgae in aquatic environments, primarily by splitting water molecules. The development of this reaction by harnessing solar energy was the defining event in the history of biology on the planet. Oxygen is utlized by bacteria and all other organisms (zooplankton, algae, fish) that consume oxygen by respiration. Ecologic balance between oxygen production and consumption in different regions of the world is defined and preserved by the prevailing geologic, ecologic, climatic, and predator-prey dynamics of extant species.

Animal and plant species crawled from water to find their habitat on dry lands. (Could this be the origin of human fascination with bodies of water around them?) The move from the water to the land called for myriad adaptations, which evolutionary pressures provided with stunning diversity. It is a most remarkable fact of biology that the enormous range of speciation observed today was energetically sustained by essentially two modes: oxygen-driven high-efficiency human mitochondrial ATP generation and low-efficiency, largely oxygen-independent fermentative ATP production. This is a crucial subject. In previous publications,37-39,42 I demonstrated that the respiratory-to-fermentative shift in ATP generation and deranged oxygen signaling are the fundamental molecular lesions that produce myriad clinical symptom-complexes.

Another important consideration is that of the fundamental oxygen economy of large bodies of water and landmass that did not significantly change over the past millions of years—until modern times. Then began the era of dysox and climatic chaos. A diligent study of the records of the oxygen conditions at the micro levels—mitochondrial energy generation and related phenomena—as well as at macro global levels clearly reveals an inexorable shift to the primordial, low-efficiency, fermentative mode of metabolism (described at length in Darwin, Dysox, and Disease, the eleventh volume of The Principles and Practice of Integrative Medicine.43 Of course, the current shifts in carbon economy of the planet Earth are compounding the problems of the oxygen economy.

In high school, I was taught that nitrogen is an inert element. That is not true. Nitrogen is leached into groundwater and so enters drinking water, often reaching concentrations that are deleterious to human health. Nitrogen is converted into nitrite, which has recognized toxic effects. For example, nitrite reacts with hemoglobin to form methemoglobin, a form that cannot carry oxygen. Under some clinical conditions, accumulation of methemoglobin can reach a point when it literally suffocates the individual. Nitrite also is converted into nitrates by the bowel microbiota. Nitrates have well-established toxic effects, including carcinogenicity.

Human-related nitrogen shifts largely involve its movement from land to water, both surface or ground water. Nitrogen travels with agricultural efflux, storm drains, sewage pipes, and other types of surface runoff. Agribusinesses apply large quantities of nitrogen to the soil for maximizing production, with strong short-term and devastating long-term results. Such application generally far exceeds the nutrient required by crops. Regrettably, regulators who are expected to minimize nitrogen build-up are themselves regulated—paid off, to be blunt—by the polluters.

The combustion of fossil fuels is major source of anthropogenic contributions to atmospheric nitrogen pollution. Acid rains add to atmospheric deposition of nitrogen on lands and water. This problem used to be attributed to highly industrialized regions of the world. This view, in my opinion is not tenable anymore considering the rapid globalization of environmental pollution. Nitrogen is released into the air because of ammonia volatilization and nitrous oxide production further adding to Earth's nitrogen load.

As for the nitrogen economy of the planet, it is a foundational component of living organisms.44,45 However, in many Earth systems, it is in short supply in readily assimilated forms for plants in both aquatic and land ecosystems. As a consequence, it serves as a rate-limiting factor in restraining primary production in the biosphere, and, therefore, a limiting factor for growing crops for human use. Humans are significantly and negatively affecting the nitrogen cycle. In some ways, the nitrogen cycle is intricately involved with the carbon cycle of the planet, each feeding the other. The production and industrial use of artificial nitrogen fertilizers worldwide have greatly increased food production, but it has also caused serious environmental problems, including eutrophication of terrestrial and aquatic systems (discussed below), global acidification, and chemicalization.

In the 1990s, the anthropogenic nitrogen addition to the environment amounted to more than 352 billion pounds (160 teragrams, Tg = 1012 gm) of nitrogen per year. Globally, this amount is more than that supplied by natural biological nitrogen fixation on land (110 Tg of nitrogen per year) or in the ocean (140 Tg of nitrogen per year). Undoubtedly, such nitrogen burden will continue to grow due to predicted increases in the world population, energy demands of people, and consequent anthropogenic nitrogen fluxes. Indeed, it has been predicted that humans will double the turnover rates of the terrestrial nitrogen cycle.

The manifold consequences of anthropogenic influences over the planetary nitrogen cycle have been investigated by many regional and international research groups. However, few efforts have been made to examine the interactions of nitrogen with other major biological and geochemical cycles, especially the effects on the carbon economy. Remarkably, there have been no studies of the interactions of the nitrogen cycle on the oxygen cycle (economy) of the earth system.


Eutrophication is the phenomenon of increased growth of vegetaion due to nutrient build-up in ecosystems, both aquatic and land-based.46-49 In most instances, it involves the accumulation of compounds containing nitrogen and phosphorus. Excess of nutrients generally sets the stage for increased primary productivity— excessive growth and decay of vegetation—of the ecosystem. Diverse consequences of eutrophication include a lack of oxygen and diminished quality of water. Not unexpectedly, eutrophication often severely affects the populations of fish and other species.

During eutrophication, the patterns of growth of aquatic vegetation (plankton and algae) are often markedly altered by an influx of large quantities of nitrogen, phosphorus, and other nutrients, causing disruptions of the regional ecologic conditions and increasing the supply of normally growth-limiting nutrients. These changes cause major shifts in the species composition of ecosystems by influencing the competitive struggle for resources among extant species. For example, an increase in nitrogen availability can allow species newly arriving in an ecosystem to invade, rival, and out-compete original inhabitant species. This has been documented in many regions of the world. In discussions of eutrophication, oxygen is seldom, if ever, duly considered because marine biologists generally do not view oxygen as a crucial nutrient.

Eutrophication has many documented adverse ecological effects: amplified biomass of toxic phytoplankton, increased blooms of gelatinous zooplankton, decreased biomass of certain algae (benthic, epiphytic, and others), altered populations of some species, reduced water transparency (increased turbidity) with consequential changes in water characteristics, and increased incidences of fish kills. All of these factors decrease, directly or indirectly, the amount of dissolved oxygen in water, increasing the degree of Eutrophication. Among the three most consequential changes of overstimulated growth of some species at the expense of others are: (1) diminished biodiversity; (2) altered changes in species composition and dominance; and (3) toxic effects.

In the basic oxygen order in aquatic ecosystems, oxygen is released during daylight hours by photosynthesizing plants and algae. Oxygen is utilized by all respiring plants and marine species.

Under eutrophic conditions, the amounts of oxygen dissolved in water increase substantially during the day, and decrease substantially after dark as it is picked up by the respiring algae and microorganisms that feed on the increasing mass of dead algae. When the eutrophic balance is disturbed and dissolved oxygen levels decline to hypoxic levels, fish and other marine animals sicken and die of suffocation. All species are affected, albeit to varying degrees, most prominently the immobile bottom dwellers. In extreme instances, hypoxia progresses to anoxia—anaerobic conditions that foster growth of anaerobes, such as Clostridium botulinum, which produces deadly toxins that kill birds and animals. Zones affected by such extremes are designated as dead zones.

When an ecosystem accumulates excess nutrient load, the primary producers of that system reap the benefits first. In marine systems, algae are commonly the first species to overgrow, a phenomenon called an algal bloom. Such blooms can reach proportions enough to significantly limit the sunlight available to the bottom-dwelling organisms, causing wide fluctuations in the amounts of dissolved oxygen in the region.

In stable ecosystems, some nutrients serve as rate-limiting factors for some but not all species. So, differential availability of various nutrients influence the competitive struggle for resource allocation. Eutrophication alters such competitive balance, favoring some aquatic species with an excess of choice nutrients. This results in shifts in the species composition. For example, an increase in nitrogen allows newly introduced species in an ecosystem to invade, out-compete, and overwhelm native species. This has been documented in certain New England salt marshes.

Food for some is poison for others. This observation concerning humans and their foods made by some physicians of antiquity is applicable also to various ecosystems of the planet. Some algae produce specific compounds which, when in excess during algal blooms, become toxic not only to aquatic species but also to humans, animals, and plants.50,51 Colloquial terms used for such algal blooms include nuisance algae and harmful algal blooms. Not unexpectedly, such toxic substances travel up the food chain, causing disease and death among other species. For example, freshwater algal blooms are known to have killed livestock. Notable among such toxins for humans are neurotoxins and hepatotoxins. Such biotoxins produced in excess during algal blooms are consumed by shellfish (mussels, oysters, and others), resulting in human food poisoning, such as paralytic, neurotoxic, and diarrhoetic shellfish poisoning. Other aquatic vectors for such toxins— ciguatera, for example—are ingested by predator fish that accumulate the toxin and later poison humans when the poisoned fish is consumed.


Planetary oxygen homeostasis is put in jeopardy when some of the planet's lands are scorched and when others are thawed. Scorching kills vegetation and so stops the release of oxygen from plants. Thawing of frozen lands (permafrost) initially makes more oxygen available through availibility of water. However, the long-term consequences of the loss of permafrost result in markedly diminished availibility of oxygen by diverse mechanisms, as I explain below.

An increasing number of regions in the world face an ever-growing problem of spreading deserts, called desertization (defined as increasing desert-like conditions in arid and semi-arid lands).52-54 Desertification, sandification, and desiccation are other terms sometimes used for the process. There are many causes of this phenomenon but few, if any, solutions. The Sahara desert of northern Africa is the largest desert in the world, and it is expanding at the rate of 1km/yr. Some sense of the enormity of this problem may be gained by one estimate that a 15-mile wide and 1370 miles long forest wall is needed to prevent southern spread of the desert. Global warming unquestionably will deepen the problem in African and many other regions in the world. Climatic changes, humans, and livestock are considered as the main culprits.

As for big thaws, consider the following quotes from a 2008 report concerning climatic changes in Mongolia published in Science55:

Global warming is not a uniform process. Mongolia, particularly at the high altitudes around Lake Hovsgol, has been warming more than twice as fast as the global average. Unique ecosystems are feeling the heat...Winter temperatures in Mongolia have increased a staggering 3.6°C on average during the past 60 years. The mountains are losing their snowcaps, and the glaciers on the northern shore are shrinking.

Higher average temperatures in summer are thawing the layer of permanently frozen soil, or permafrost, and disturbing the soil structure around the shallow tree roots...

Here at the transition between steppe grassland and taiga, plants and animals are confronted with a changing environment--and the outlook is not good for the herders who are crowding up from the south...If land-use patterns were the only change, Mongolia's predicament would not be so dire. But now the land itself is changing.

Increased a staggering 3.6 oC on average! Disturbing the soil structure around the shallow tree roots! Nature perfected its balancing act over millions of years. Now it is being disrupted within decades. Life simply cannot evolve fast enough to survive such sweeping changes. Now consider another quote from that report:

As permafrost retreats deeper or disappears, the ground becomes a giant sponge that wicks water away from plant roots. That sets big changes in motion topside. Taiga and permafrost always go together...You can't have one without the other. Hovsgol's taiga forest is growing patchier. And without the insulating tree cover soil warming accelerates.

The ground becomes a giant sponge! Two points need to be recognized here. First, stagnation in the massive sponge suffocates life in the sponge. Second, eventually all wet sponges dry up when the supply of fluids that saturates them dries up.


Hypoxia is oxygen deficit. Hypoxic waters are bodies of water with deficiency of oxygen. Anoxia is absence of oxygen. Anoxic waters are bodies of water with an absence of oxygen. Hypoxia develops in aquatic environments as the amount of dissolved oxygen (molecular oxygen dissolved in the water) falls to a level that is detrimental to fishes and other forms of oxygen-breathing aquatic species.56-59 The temperature and salt content (salinity) of bodies of water determine the amount of oxygen dissolved in the water. So, the value of dissolved oxygen is expressed as a percentage of the amount of oxygen that would dissolve in the water at the prevailing temperature and salinity. An aquatic ecosystem without dissolved oxygen (0% saturation) is designated as an anoxic aquatic system. Dissolved oxygen is measured in standard solution units of millimoles O2 per liter (mmol/L), milligrams O2. At 20 °C under sea level atmospheric pressure, the value of dissolved oxygen in freshwater is 9.1 mg/L, a value that is designated as 100% saturation. The U.S. Geological Service (USGS) offers at its web site solubility tables showing the values, in milliliters per liter [ml/L], based upon temperature and corrected for different salinities and pressures.

It is noteworthy that most species of fish cannot survive in waters with dissolved oxygen saturation of less than 30%. For optimal sustenance of oxygen-utilizing life forms, an aquatic ecosystem must not develop oxygen deficits that allow the dissolved oxygen levels to fall below 80%.

Are natural bodies of water sometimes supersaturated? Can excess dissolved oxygen in water can sometimes be harmful for fish, aquatic animal species, and aquatic vegetaion? Not much has been documented in this area. However, it is known that oxygen supersaturation does develop under certain conditions and causes decompression damage to aquatic life.

Algae and related aquatic vegetation called phytoplankton in the water mass release oxygen by spliting water into hydrogen and oxygen in the process called photosynthesis. On the other side of the equation, oxygen is picked up and metabolized by bacteria, fish, and organisms included in the category. This is the essential "oxygen balance," not only in aquatic ecosystems, but on land masses as well. In oceans, seas, and large lakes, the equilibrium between the two mechanisms for the release and consumption of oxygen determine the amount of oxygen dissolved in the water which, in turn, determines the aquatic biomass (the total mass of living species, vegetative as well as animal species). I might add here that the difference between the amount of oxygen in the water (theoretical concentration if there were no living organisms) and the actual amount (concentration) of oxygen is designated as the biological demand of oxygen.

The climatic changes documented so far are deepening the "oxygen crisis" in most bodies of water in the world. If the current trends hold, the predicted climatic chaos will dangerously enlarge the bodies of anoxic waters with dire consequences for life within them. There are several mechanisms by which global warming, incremental carbonization of oceans and land masses, and chemicalization of the planet decreases the amount of dissolved oxygen saturation in water. Specifically, such mechanisms include the following.60-62

*  Warm water holds less oxygen;

*  Eutrophication (increased growth of plankton and algae due to addition of nitrogen, phosphorus, and potassium in water) reduces the amount of oxygen dissolved in water;

*  Persistence of stratification in large bodies of water, as described earlier, disrupts oxygenation of deep waters;

*  Higher air temperature intensifies the density stratification of water making it less dense and relatively anoxic;

*  Solar warming of the surface water reduces water density and causes anoxia;

*  Saltier water increases the density of water;

*  Change of direction of the wind can cause significant local upwelling of the anoxic bottom water (wind can actually drag the surface water away from shore, replacing it with deeper water);

*  Increasing anthropogenic nitrogen input;

*  Stratification;

Energetic tidal circulation; and

The pycnocline effect (a rapid change in water density with depth).

In the large bodies of fresh water, the density change is essentially caused by changes in the temperature, while in the oceanic waters the density change is caused by changes in water temperature and/or salinity. For further information on the above subjects and specific data concerning the extent and duration of harmful algal blooms (Microcystis aeruginosa) in the Potomac River, the reader is referred to

Anoxia develops in sea waters under natural conditions. Anoxic sea water is generally found in regions of restricted water exchange. In general, oxygen does not reach the depths of the sea area due to a physical barrier, such as silt and extended periods of density stratification. Such conditions allow bacteria to increase their rates of the oxidation of organic matter, thus increasing oxygen utilization beyond the supply. For example, the occurrence of markedly anoxic conditions have been documented in the geological history of the Baltic Sea. Recent evidence shows that increasing degrees of eutrophication have increased the degrees of the anoxic regions in the Baltic Sea and the Gulf of Mexico.

Anoxic states are created by water stagnation, density stratification, influx of organic matter, thermoclines, and bacterial metabolism of sulfide. Sulfur compounds settle in the sediments and later rise into the surface waters. Recent reports of anoxic waters are disturbing both for the degrees of oxygen deficit and for the frequency with which such deficits are encountered, especially the findings of fatal anoxia in the bodies of water in which anoxia was not previously present. For example, in February 2008, severe anoxia was detected for the first time in the northern California current system, an enormous ecosystem with no previous record of extreme oxygen deficits.63 The severity of anoxia raises the specter of rapid and discontinuous ecosystem changes in highly productive coastal systems that sustain the world's fisheries.

In 1888, Lajos Winkler, a Romanian chemist, developed a method of determining the level of dissolved oxygen in water samples.64 The test is designated as the Winkler test. It is interesting to note that the subject of the oxygen content of large bodies of water (and its effects on life in them) preoccupied a Romanian student as far back as the end of the nineteenth century. Yet, it holds little, if any, interest for doctors today, notwithstanding the central importance of oxygen factors in the pathogenesis of all chronic disorders.


The story of smog has many interesting faces: clinical, historical, biochemical, environmental, and political. The clinical problems associated with poor quality air, first and foremost, should have been related to problems of oxygen homeostasis in health and disease. What could be simpler than that? Why do we breathe except to bring oxygen in and expel the produced waste. It both amused and saddened me when I read a large number of articles about smog posted by governmental, public, environmental, and academic groups. For three hours, I read and read without finding a single reference to smog disrupting oxygen signaling and oxygen-driven cellular energetics. Inexplicably, the literature of smog evolved into a literature of ozone in ambient air.

For public education, the United States Environmental Protection Agency (EPA) developed an Air Quality index to explain the degrees of air pollution. For reasons that escape me, it built its entire case around the eight-hour average concentration of ozone in the air, as if the sulfur and nitrogen pollutants do not matter. The EPA promulgated the following standards:

85 to 104 ppbv (parts per billion by volume): Unhealthy for Sensitive Groups

105 ppbv to 124: Unhealthy

125 ppbv to 404 ppbv: Very unhealthy

Smog, in reality, is much more than just the concentration of ozone in the air. It is the sum total of all noxious and toxic elements that exist in the ambient air at any given time. Did the folly of fixating on ozone levels lead to the disastrous proclamation on September 15, 2001 of Christie Whittman, the then EPA chief when she declared that air in New York was safe to breathe, following the inferno of collapsed World Trade Centers (WTC). That comment stirred me to action and culminated in the publication in early 2002 of my book September Eleven,2005 (2002),65a volume of predictions written in a fictionalized past tense. I had three primary reasons for writing that book:

1. To predict that more than 250,000 people exposed to the poisons released from the WTC inferno would become chronically ill due to 9/11-related causes in September 2005;

2. To assert that at the levels of oxygen signaling and oxygen-driven cellular energetics, terror turns into toxicity, and toxicity into terror;

3. All patterns of chronic illness triggered by 9/11-related events would be fundamentally caused by disruptions of the oxygen signaling and oxygen-driven cellular energetics;

4. Much of 9/11-related illness could be prevented by robust integrative treatment plans that restore deranged oxygen signaling and oxygen-driven cellular energetics; and

5. Regrettably, the fundamental oxygen issues of the 9/11 tragedy would be ignored by the prevailing one-disease-one-cause-one-drug model of thinking.

In 2008, anyone who reads September Eleven, 2005 will recognize the utter logic and predictability of events that I foresaw. In September 2001, I knew that the EPA and the mainstream medicine would stubbornly refuse what Londoners of the Roman times knew: Pollutants in the air sicken the people who breathe it. Indeed, The New England Journal of Medicine considered the 9/11 events "not necessarily medical significant"66 and advised its readers not to "medicalize"67 them (see September Eleven, 2005 for full details).

The English claim the origin of the term "smog"and attribute it to Dr. Henry Antoine Des Voeux in his 1905 paper entitled "Fog and Smoke" presented at a meeting of the Public Health Congress.68 On July 27, 1905, the London newspaper Daily Graphic celebrated the paper, writing that Des Voeux had done a public service in coining a new word for the London fog. Californians challenge that claim, citing the use of the word "smog" by Los Angeles Times on January 19, 1893. The English need not feel up-ended since the Times attributed it to "a witty English writer." The Londoners have sound reasons for amusing themsleves with the assertions of Angelos. Since the Roman times, they have recognized this distinction. In 1306, King Edward I briefly banned coal fires in the city. In 1661, John Evelyn's Fumifugium blamed burning coal for what people considered to be London cough. In 1952, The Great Smog darkened the city sreets and killed approximately 4,000 people in four days, claiming another 8,000 during the days and weeks that followed it. Some readers might find the following text I found in Transcultural Psychiatry69 interesting in the current context:

Reports of occupational mass psychogenic illness (OMPI) in the scientific literature were examined to describe underlying presentation patterns and explain their sporadic appearance in the literature. Three distinct patterns were identified: (i) mass anxiety hysteria is precipitated by the sudden appearance of an anxiety generating stimulus following the redefinition of an innocuous or imaginary odour or agent that is perceived as an immediate threat; (ii) mass motor hysteria is characterized by internalized conflict which fosters dissociation, histrionics and psychomotor agitation. Episodes are typified by an atmosphere of pre existing tension and employee dissatisfaction with restrictive management practices coupled with inhibited negotiation channels; (iii) a third presentation pattern involves the relabelling of endemic symptoms and the occasional appearance of conversion reactions, which are reinforced by a hypervigilant medical community and exacerbating factors. Social factors may explain the irregular appearance of reports.

Notice, the author does not recognize any oxygen-related issues in his discourse on what he designates occupational mass psychogenic illness. Simple tests done to measure the urinary excretion of the metabolites of Krebs cycle and glycolytic pathways, mycotoxins, and hippuric acid in the subjects of his study would have shed much light on what was observable and documentable in the chemistry of those afflicted by the putative occupational mass psychogenic illness.


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2. Gelnspan R. Boiling Point. 2004. New York. Basic Books.

3. Flannery T. The Weather Makers. 2005. New York. Grove Press.

4. Gore A. An Inconvenient Truth. 2006. New York. Rodale.

5. Kerry J, Kerry T. This Moment on Earth. 2007. New York. Public Affairs.

6. Frumhoff PC, McCarthy JJ, Melillo JM. Confronting Climate Change in the U.S. Northeast (2007) . Union of Concerned Scientists: Cambridge, MA, UCS Publications.

7. Ali M. The dysox model of aging. Townsend Letter for Doctors and Patients.2005;269:130-134.

8. Ali M. Obesity is cellular oxygen deficiency state. Aging Healthfully. 2004;5:2-19.

9. Ali M. Oxygen governs the inflammatory response and adjudicates the man-microbe conflicts. Townsend Letter for Doctors and Patients. 2005;262:98-103.

10. Ali M. Beyond insulin resistance and syndrome X: The oxidative-dysoxygenative insulin dysfunction (ODID) model. J Capital University of Integrative Medicine. 2001;1:101-141.

11. Ali M.The Dysox Model of Diabetes and De-Diabetization Potential. Townsend Letter-The examiner of Alternative Medicine. 2007; 286:137-145.

12. Ali M. Darwin's Drones, Dysox, and Diabetes. 2008. New York, Canary 21 Press.

13. Ali M, Ali O: AA oxidopathy: the core pathogenic mechanism of ischemic heart disease. J Integrative Medicine 1997;1:6-112.

14. Ali M, Ali O, Fayemi A, et al: Efficacy of an integrative program including intravenous and intramuscular nutrient therapies for arrested growth. J Integrative Medicine 1998; 2:56-69.

15. Ali M. Fischer S, Juco J, et al. The dyso model of coronay artery disease. Townsend Letter for Doctors and Patients. 2006;270/71:110-112.

16. Ali M. Beyond the cholesterol and inflammatory theories of coronary artery disease: The oxidative-dysoxygenative coronary disease (ODCAD) model. J Integrative Medicine. 2002; 7:1-19.

17. Ali M, Ali O, Fayemi A, et al: Guidelines for intravenous therapies in integrative medicine. J Integrative Medicine 1998; 2:82-95.

18. Ali Recent advances in integrative allergy care. Current Opinion in Otolaryngology & Head and Neck Surgery 2000;8:260-266.

19. Ali M. Oxidative coagulopathy in environmental illness. Environmental Management and Health. 2000;11:175-191.

20. Ali M. Juco J, Fayemi, A, et al. The dysox model of asthma and clinical outcome with integrated management plan. Townsend Letter-The examiner of Alternative Medicine. 2006;274:58-61. (May 2006)

21. Ali M. The dysox model of renal insufficieny and improved renal function with oxystatic therapies. Townsend Letter for Doctors and Patients.2005;267:101-108.

22. Ali M: Amenorrhea, oligomenorrhea, and polymenorrhea in CFS and fibromyalgia are caused by oxidative menstrual dysfunction (OMD-I) J Integrative Medicine 1998; 2:101-124.

23. Ali M: Oxidative menopausal dysfunction (OMD-II):hormone replacement therapy (HRT) or receptor restoration therapy (RRT)? J Integrative Medicine 1998;2:125-139.

24. Ali M. The unifying dysox model of hormone disorders and receptor restoration therapy. Townsend Letter-The examiner of Alternative Medicine. 2007; 291;145-151.

25. Ali M, Ali O, Fayemi A, et al: Efficacy of an integrative program including intravenous and intramuscular nutrient therapies for arrested growth. J Integrative Medicine 1998; 2:56-69.

26. Ali M. Restoration of lipid signaling in fibromyalgia and chronic fatigue syndrome. Townsend Letter-The examiner of Alternative Medicine. 2008; 295/6. 131-7.

27. Ali M: Fibromyalgia: an oxidative-dysoxygenative disorder (ODD). J Integrative Medicine 1999; 3:17-37.

28. Ali M The Oxygen View of Pain: Every chronic pain represents cells' cries for oxygen. Townsend Letter for Doctors and Patients. 2005;258:46-48-102.

29. Ali M. Bone homeostasis is but one face of oxygen homeostasis. Townsend Letter for Doctors and Patients. 2005;261:86-93.

30. Ali M. The dysox state and chronic parasitic infestations. Townsend Letter-The examiner of Alternative Medicine. 2006;276:82-84. (July 2006)

31. Ali M. Prevention of the Iraq War-associated sickness (I-WAS): A prediction and a challenge to the Department of Defense- Townsend Letter for Doctors and Patients. 2005;259/260:134-138.

32. Ali M. Carcinogenesis: The Oxidative-Dysoxygenative Model. J Integrative Medicine 2001;5:9-32

33. Ali M. Cancer, Oxygen, and pantotropha — Part I. Townsend Letter for Doctors and Patients. 2004;256:98-102.

34. Ali M. The Cancerization/De-Cancerization Dynamics of the Dysox Model of cancer. Cancer, Oxygen, and pantotropha — Part II Townsend Letter for Doctors and Patients. 2005;264:122-131.

35. Ali M. The Crab, Oxygen and Cancer. Volume I: The Dysox Model of Cancer. 2007. New York, Canary 21 Press.

36. Ali M. The Crab, Oxygen and Cancer. Volume II: The Oxygen Protocol for Cancer. 2007. New York, Canary 21 Press.

37. Ali M: Darwin, oxidosis, dysoxygenosis, and integration. J Integrative Medicine 1999;3:11-16.

38. Ali M. Respiratory-to-Fermentative (RTF) Shift in ATP Production in Chronic Energy Deficit States. Townsend Letter for Doctors and Patients. 2004. August/Sept. issue. 64-65.

39. Ali M. Hurt human habitat and energy deficitHealing Through Restoration of Krebs cycle chemistry. Townsend Letter-The examiner of Alternative Medicine. 2006; 279:112-115.

40. Ali M. Oxygen and Aging. (Ist ed.) New York, Canary 21 Press. Aging Healthfully Book 2000.

41. Ali M. The Principles and Practice of Integrative Medicine Volume III: Darwin, Oxygen Homeostasis, and Oxystatic Therapies. 3 rd. Edi. New York. Insitute of Integrative Medicine Press.

42. Ali M. What is health? The South African of Natural Medicine. 2004;14:14-17.

43. Ali M. The Principles and Practice of Integrative Medicine Volume XI: Darwin, Dysox, and Disease. 2000. 3rd. Edi. 2008. New York. Insitute of Integrative Medicine Press.

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