Hyperbaric Oxygen Therapy (HBOT) for Lyme Disease- Interview w/ Dr. Alexander Alvarez

Hyperbaric oxygen therapy (HBOT) is a decades-old protocol that involves breathing pure oxygen in a pressurized environment. Alexander Alvarez, MD is an Aviv Clinics Physician with over 35 years of experience in internal medicine, and surgery, and is certified in hyperbaric medicine. He spoke with Project Lyme about how Aviv is using HBOT to treat Lyme disease. To learn more about the patient experience of HBOT visit this blog.

Project Lyme does not endorse, recommend, or certify any medical practice or physician and does not guarantee the quality of medical advice or care given. The information shared in this article is purely for educational purposes.


Dr. Alexander Alvarez sat down with Project Lyme to discuss the use of HBOT for treating Lyme disease. This non-traditional treatment method is meant to help chronic Lyme patients who have not had success with antibiotics or other traditional methods. 

It is common knowledge that Lyme persists. For years patients have received multitudes of antibiotics which have been proven to not fully eradicate infection. This occurs because the spirochete can change its environment and hide from treatment. You can learn more about this phenomenon on our Lyme Persists page.

So, what makes HBOT effective? 

HBOT can be used to treat Lyme disease and is most specifically effective against neurological Lyme. The reason it is so effective was discovered in a 1998 study by William Fife at Texas A&M who found that by exposing spirochetes to oxygen they are weakened and can die off. After further research it was found that exposing it to above normal levels of oxygen, Borrelia bacteria are unable to survive. By doing “dives” of two atmospheres (33 ft) below sea level for 2-3 hours, 5 days a week for 12 weeks, the oxygen levels inside your body are risen by 10-15 above normal levels. The pressurized oxygen penetrates Borrelia bacteria, even those that have developed biofilms and antibiotic resistance, reducing inflammation in the brain and stimulating new stem cells that strengthen the immune system. Dependent on how advanced the Borrelia bacteria it may require slightly deeper “dives”, but this is determined through advanced monitoring. 

The main side effects of HBOT are barometric problems that can cause ear pain, but Dr. Alvarez stated that if you can handle going up in an airplane then it shouldn’t be an issue. Another side effect that may be irritating in the short term but is a sign that treatment is working is a Jarisch Herxheimer reaction. According to the study by Dr. Fife, all but one of the patients treated had this reaction. Dr. Alvarez agrees that herxing is a critical step on the road to recovery.