At A Glance:
Aging is not a single event but a wide variety of biological processes such as accumulation of cellular damage, reduced regenerative capacity, or overall physical declines [1].
At its core, aging reflects the diminished ability of tissues to maintain homeostasis in the face of oxidative stress, persistent low-grade inflammation, and metabolic inefficiencies. These hallmarks of aging drive many of the chronic age-related conditions that emerge in later life, including:
Most conventional treatments focus on modifying symptoms, rather than addressing the root causes or the biological aging processes. However, recent research has explored various interventions that might slow or counteract these age-associated processes, including ozone therapy.
In this article, we cover the molecular mechanisms and other aspects of aging supported by ozone therapy. This explains why many biohackers who seek to improve their healthspan and prevent age-related diseases are already using ozone therapy. Then, we’ll also share specific clinical studies that demonstrate the safety and effectiveness of ozone therapy for age-related diseases.
A key driver of modern aging could arise from the lack of hormeses—the exposure to small stressors that make you stronger [2]. Nowadays, we have an abundance of food and comfort, and we’re exposed to less sun or physical discomfort. There’s much less need to physically move. To a large extent, the age-related diseases are tied to overconsumption of calories and physical inactivity, for example. In the long run, overabundance, comfort, and lack of hormetic stress worsen your body’s ability to manage oxidative stress, inflammation, and metabolism.
Some of these hormeses, like ozone therapy and other biooxidative therapies, work partly through creating a small amount of oxidative stress that initiates various physiologic processes in your body [3]. These physiologic processes may include:
What is aging? After decades of research, aging researchers summarized it into 12 key hallmarks. To learn more about these, check out Lopez-Otin et al (2023) [9].
Excess oxidative stress itself is not a hallmark of aging, but it contributes to most of the hallmarks. Also, the older you get, the worse your body tends to become at neutralizing oxidative stress.
Remember that oxidants are not all bad—you need them for vital processes in your body. For example, your immune cells communicate with each other via oxidants [10]. Wounds and injuries need oxidizing chemical reactions and oxygen to heal [11]. Even living and breathing involve oxidation-reduction reactions. It’s only when your oxidative stress exceeds your ability to rebalance them that it becomes a problem.
Unmanaged oxidants can damage DNA, proteins, and cell membranes [12]. This damage can accelerate cellular senescence, age-related decline, and chronic inflammation. Both the oxidative stress and inflammation inhibit mitochondrial function, which explains why people feel less energized and more physical discomfort as they age.
Ozone therapy stimulates Nrf2, a transcription factor that manages the readouts from antioxidant and cell protection genes [13]. Once activated, Nrf2 turns on genes that encode antioxidant enzymes. These enzymes can neutralize the oxidants, helping your body restore balance [14]. Naturally, Nrf2 goes down with age.
Nrf2 is not a gene that you want turned on all the time because occasionally, you do need some oxidants in your body. You only want to activate Nrf2 sometimes to reap the benefits without the downsides.
At the same time as Nrf2 is stimulated, oxygen and various ozonated byproducts help ensure that biological processes that require oxidative reactions happen. This explains why ozone therapy and ozone oils can stimulate wound healing and tissue regeneration and relieve pain [15], [16]. Ozone therapy doesn’t just neutralize the oxidative stress—it ensures your body has the antioxidants and oxidants where they’re needed.
Your mitochondria are your cell’s main energy production factory. They make energy as ATP from carbohydrates, fats, and parts of amino acids. In the final step, they use oxygen to receive the high energy electron.
Aside from producing energy, your mitochondria also detect danger or cellular damage. If a cell is too damaged, its mitochondria can cause apoptosis (cell death) or senescence, so the cell doesn’t grow or cause more problems.
Mitochondrial dysfunction is another defining hallmark of aging [17].
Your mitochondria produces energy by moving high-energy electrons. The dysfunction can arise when the mitochondria produce less energy and leak oxidative molecules [18]. You may experience this as fatigue and reduced regenerative capacity as you age.
On the other hand, accumulated oxidative stress from other sources or cellular damage can cause mitochondrial dysfunction. Lack of oxygen, whether from poor circulation, low iron, or other causes, can also increase oxidative stress.
Ozone therapy, when done at the right doses, help the mitochondria by:
Systemic ozone therapy also improves circulation through increasing nitric oxide, which can improve oxygen delivery to cells and indirectly helps with mitochondrial function [23]. Some people experience it as improved stamina and wellbeing.
In 2023, prominent aging researchers suggested that dysbiosis (imbalanced gut flora) is a key hallmark of aging.
Your gut is home to trillions of microbes that help digest food, absorb nutrients, and turn them into important vitamins and smaller bits for absorption. These bacteria also “talk” to your brain and other organs to help keep the body balanced and healthy.
These microbes are like your adaptable backpocket of genes. You have about 20,000 genes, but collectively, your gut microbes have about 3.3–5 million genes. Your relationship with these microbes is two-way. Your diet, environment, mindset, stress levels, and even relationships can significantly change your gut flora in as fast as 2–3 days [24]. Conversely, they play a massive role in your aging processes, cardiovascular risks, weight, mental health, cognition, digestion, skin, and much more. It’s an active area of research where microbiome researchers are discovering new connections every day.
Now, we’re certain that dysbiosis is bad—it can contribute to obesity, diabetes, heart disease, and digestive issues. However, dysbiosis is not a deficiency of probiotic supplements. If you have an unhealthy flora, it’s got a lot to do with you and whether your colon makes a good home for the friendly microbes.
One of the key determinants of this is oxygen and mitochondrial function.
Your colon is typically responsible for absorbing water and moving electrolytes through its walls. The cells that line the inside of the colon walls rely on the mitochondria to make the ATP that fuel the absorption. In the process, they use up the oxygen, leaving none for your gut microbes.
Most beneficial gut microbes, like Lactobacilli, Bifidobacteria, and Akkermansia, generally dislike oxygen. Akkermansia and several other beneficial bacteria find oxygen toxic and die when it exceeds certain levels. These good bacteria reinforce epithelial health and help maintain microbial balance [25].
When the gut becomes inflamed or metabolically stressed, the mitochondria of your colon lining cells don’t work as well. So, you start having too much oxygen around for bad bacteria, like Proteobacteria and E. coli to take advantage of and proliferate. When overgrown, the bad bacteria continue to create inflammation and make the health of the gut worse [26].
This is not a situation easily fixed by probiotics, and that is where ozone can come in to jumpstart the right systems.
Ozone delivered via rectal insufflation can stimulate mitochondrial function in colonocytes [27], [28]. It can also rebalance the oxidative stress and inflammation in these cells.
Initially, the ozone may kill a few bacteria cells. However, by jumpstarting mitochondrial function, ozone therapy can help restore the gut condition that favors a healthy flora.
Chronic low-grade inflammation is a key hallmark of aging, referred to as “inflamm-aging.” [29]
Unlike acute inflammation, which serves a protective and time-limited role, inflamm-aging reflects a persistent, systemic imbalance. This imbalance results in tissue damage, immune dysfunction, and eventually the development of age-related diseases.
One theory behind inflamm-aging is reduced autophagy, the process by which cells clear out damaged proteins, cellular debris, and cell parts like the mitochondria [30]. Researchers suspect that with less clean up, these damaged cell parts build up and stimulate the immune system.
This background “smoldering” inflammation not only accelerates biological aging but also undermines cellular resilience.
Ozone therapy has dual potential in this context.
Controlled oxidative stress from ozone exposure reduces pro-inflammatory cytokines and restoration of redox balance, both of which may counteract the chronic inflammatory load associated with aging [31], [32].
A cell-based study suggests that oxidative preconditioning can stimulate autophagy, which promotes the clearance of damaged mitochondria and protein aggregates [5].
By promoting autophagy and tempering chronic inflammation, ozone may contribute to cellular housekeeping processes that are essential for longevity and functional health. These housekeeping processes “upkeep” cell health through breaking down waste, repairing damage, and recycling old components.
Nitric oxide (NO) is a simple gas molecule that the body makes to help blood vessels relax and improve circulation. NO is crucial for cardiovascular health, exercise performance, tissue repair, sexual health, and much more. In your blood vessel wall, the gas also enhances blood flow and regulates platelet activity [33].
Naturally, you can get nitric oxide from plants like leafy greens, beets, and citrus fruits. However, around 90% of people nowadays are not eating enough plants [34].
As you age, blood vessels stiffen and lose flexibility, blood flow to tissues becomes less efficient, compromising nutrient and oxygen delivery, and waste removal [35]. As a result, you may experience [36]:
With age, NO bioavailability tends to decline due to oxidative stress and chronic inflammation, leading to endothelial dysfunction and restricted circulation.
Systemic ozone therapy increases nitric oxide production, supporting endothelial function and improving vascular reactivity. By lowering leukocyte adhesion and enhancing redox equilibrium, ozone stabilizes small blood vessels and improves blood flow to tissues [37].
In animal models, improved tissue oxygenation and blood metabolics profiles have been observed following ozone administration [38].
In the context of aging, ozone may counteract one of the fundamental drivers of functional decline by influencing NO signaling and optimizing microcirculation. It’s also one of the ways that ozone delivers cardiovascular benefits.
Cardiovascular and metabolic disorders remain the leading contributors to morbidity and mortality in aging populations. These are linked to the dysfunctions in the cells that line your blood vessel walls, chronic low-grade inflammation, and mitochondrial dysfunction.
Ozone therapy influences cardiovascular health by modulating redox balance, inflammation, and nitric oxide pathways.
In animal models of ischemic injury, ozone therapy increased oxygen delivery, reduced lipid peroxidation, and stabilized the functions of cells that lined the blood vessels [39]. These are aspects of cardiovascular health that tend to become compromised with aging.
Metabolic dysfunction, such as metabolic syndrome and type 2 diabetes, are age-related conditions for which ozone therapy may help [40]. Key pathologies of these conditions include unmanaged oxidative stress, mitochondrial dysfunction, and poor circulation.
Ozone therapy improves oxidative balance, glucose utilization, and inflammation [41] that tend to worsen blood sugar control. While these outcomes are exploratory, they show that ozone preconditioning and mitochondrial support may help restore metabolic homeostasis.
Taken together, ozone therapy could address two of the most pressing disease clusters of aging through mechanisms that target their root drivers.
Ozone therapy can also help with diabetic wounds and ulcers, which are common complications.
To learn more, check out our article on ozone therapy for diabetes.
A randomized clinical study of 119 elderly patients (aged between 65–83 years old) with coronary heart disease or bronchial asthma were treated with ozonated saline administered parenterally to investigate whether ozone could influence oxidative stress, lipid metabolism, endothelial function, and vasoactive substances [42].
Participants were sorted into the following groups:
Participants went through six sessions of intravenous infusions with 200 mL ozonated saline at low concentrations (≤1.8–2.0 mg/L), administered every other day.
Results showed that:
Although larger trials may be needed to further validate these findings, ozone seems to alleviate oxidative stress, vascular function, and platelet activity. This may be highly relevant for research into age-related cardiovascular and metabolic diseases.
Neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, and other forms of age-related cognitive decline are closely tied to the hallmarks of aging.
As neurons are highly energy-dependent and sensitive to redox imbalance, even small disruptions in oxidative homeostasis or mitochondrial efficiency can lead to neurodegeneration [43].
There is very limited clinical evidence for ozone therapy. However, the mechanisms and preclinical evidence are convincing enough that the Italian Ministry of Health funded a randomized controlled trial of 75 elderly participants. This ongoing study aims to evaluate the effects of a 5-week ozone rectal insufflation on cognitive frailty [44].
Participants were assigned to one of three groups: active ozone rectal insufflation (150 cc, 30 µg/mL O₃ for 5 weeks), compared to oxygen alone, or placebo (air).
Preliminary findings suggest that ozone therapy may help support cognitive function and reduce biological markers of stress or damage in this population [44].
An animal study investigated the effects of ozone therapy in a rotenone-induced rat model of Parkinson’s disease (PD). Forty-eight Sprague–Dawley rats were divided into four groups [45]:
Ozone treatment in the D/R/O group produced significant improvements in key biomarkers compared to the rotenone-only group.
Specifically, tissue levels of α-synuclein, a protein found in Parkinson neurons, were normalized, and TH+, nNOS+, and glial cell counts increased. These results indicate better protection of dopaminergic neurons and reduced neurodegeneration.
In conclusion, ozone therapy may have neuroprotective effects, even in experimental models of Parkinson’s disease.
The skin is one of the most visible markers of aging, reflecting both internal biological changes and external environmental exposures.
Signs of aging skin include [46]:
These changes lead to thinner, less elastic skin, slower wound healing, along with wrinkles, pigmentation, and skin sagging [46].
Because the skin is also a barrier organ, its decline with age not only alters appearance but also affects systemic resilience.
Ozone therapy, ozone injections, and topical ozone oil and glycerin may help with skin aging by [47], [48], [49]:
A randomized, prospective clinical study of female volunteers from 40-60 years old evaluated the safety and efficacy of platelet-rich plasma (PRP) alone versus PRP combined with ozone therapy (PRPOT) in the treatment of facial aging [50].
Volunteers received intradermal injections at 42 pre-defined facial points. Each volunteer underwent four sessions, with 15-day intervals between sessions.
Treatment showed:
This pilot study supports the safety and feasibility of PRP and PRP combined with ozone therapy for facial rejuvenation.
Both interventions showed improvements in wrinkle severity, self-esteem, and patient satisfaction, suggesting they may represent effective and minimally invasive options for managing signs of facial aging.
The combination of PRP with ozone (PRPOT) appeared to enhance outcomes, though larger, controlled trials are necessary to confirm the added benefit of ozone.
A combined test tube and prospective clinical follow-up study investigated whether ozone treatment increased concentrations of key growth factors (GFs) in platelet-rich plasma (PRP), and evaluated the safety, efficacy, and patient satisfaction of ozone-enriched PRP (oxygen-rich PRP) injections for facial and neck rejuvenation over six months [51].
In vitro, PRP samples were treated with varying ozone doses.
Clinically, patients received PRP or ozonized PRP injections and were followed up for 6 months. Intradermal injections of 10–12 mL ozonized PRP were administered into the face and neck at multiple pre-determined points for four sessions, spaced 15 days apart.
Results showed:
These findings suggest that oxygen-rich PRP may be a promising approach for facial rejuvenation, although larger, controlled clinical studies are needed to optimize protocols.
Other types of ozone skin treatments may also improve overall skin aging. To learn more, check out our ozone treatment for skin article.
Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by [52]:
Although not exclusive to older adults, its prevalence and severity often increase with age, leading to disability and reduced quality of life in aging populations.
RA is also deeply linked to hallmarks of aging such as chronic inflammation, oxidative stress, mitochondrial dysfunction, and impaired cell regeneration. [53].
Ozone therapy suppressing pro-inflammatory cytokines such as TNF-α and IL-1β, alongside enhancing activity of antioxidant enzymes has the combined effect of tempering the exaggerated immune response that drives joint destruction [54].
A randomized clinical trial enrolled 45 elderly patients with rheumatoid arthritis and other inflammatory disorders. The trial evaluated whether ozone rectal insufflation could modulate oxidative stress markers and inflammation in elderly patients with age-related diseases [55].
Treatment was divided into:
Results showed:
This study demonstrated that ozone rectal insufflation could significantly mitigate oxidative damages and disease progression in elderly patients with rheumatoid arthritis, diabetes, and hypertension. The treatment also modulated vasoactive mediators in bronchial asthma patients. The rectal insufflation treatment may also deliver these benefits by improving the gut flora.
Learn more about ozone therapy for RA in our autoimmune disease and pain articles.
Clinical research into ozone therapy has explored a variety of administration routes, each designed to engage systemic redox and metabolic pathways while maintaining safety.
The protocols used in various trials vary depending on disease context, but certain methods are most consistently applied.
MAH is one of the most widely studied approaches. In this method, a patient’s blood is withdrawn, exposed to a carefully calibrated ozone oxygen mixture, and then reinfused.
Although dosage protocols vary, standard use can entail an O3-MAHTs mixture of 50 μg/mL in 200 mL of autologous blood, given biweekly across at least 5 weeks. MAH can be supplemented with weekly topical, IV, or rectal insufflation doses as well [56].
This technique has been used in studies on:
These trials found clinically significant improvements in redox balance, blood lipids, and vascular parameters.
When autohemotherapy is well tolerated and the patient may experience more benefits at higher doses of ozone, other IV treatment options may be considered.
Rectal insufflation is another common route in clinical studies pertaining to age-related conditions.
Although dosage protocols can vary across treatment types, they follow a similar structure that consist of 2–3 sessions per week across 6-8 weeks, with an ozone concentration of 20–40 μg/ml and a total gas volume of between 100–400 mL per session [60].
Parenteral ozonated saline infusions have been studied across several conditions, including infections and coronary heart disease [61], [42], [62].
Protocols typically involve low concentrations of ozone-infused saline, administered intravenously in multiple sessions (e.g., six infusions every other day, over 12 days).
Typical outcomes that are studied with IV infusions include:
In dermatological and aesthetic applications, ozone has also been combined with platelet-rich plasma (PRP) or applied as ozonized PRP injections to the face and neck.
These protocols often involved intradermal injections at multiple standardized points across the skin, with sessions repeated every 15 days over several months.
Although protocols vary, a unifying theme is the use of repeated, 10mL ozone exposures designed to produce hormetic oxidative preconditioning.
Ozone therapy can help with many aspects and hallmarks of aging. The clinical evidence for age-related diseases and aging mechanisms is limited, but growing. Given its track record of safety and effectiveness, ozone therapy may be a great modality to explore if you’re interested in improving your healthspan.
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