Ep. 23 - Inhaled Xenon Gas for Altitude Adaptation

Exploring Xenon Gas for Altitude Acclimatization and Sport Performance
In this episode of Wilderness Medicine Updates, host Patrick Fink delves into the use of inhaled xenon gas for sports performance enhancement and altitude acclimatization. The discussion is prompted by a recent claim from a UK climbing team that xenon helped them achieve a rapid ascent of Mount Everest. Xenon, a noble gas traditionally used as an anesthetic, has been shown to trigger hypoxia response pathways and boost EPO levels in animal studies. However, human trials have yet to demonstrate significant performance benefits or lasting changes in blood composition. The episode also examines the safety concerns and potential risks associated with unsupervised xenon use. While xenon shows some promise, current evidence suggests it may be more of a placebo effect rather than a reliable tool for enhancing athletic performance or altitude adaptation.

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Chapters
00:00 Introduction to Wilderness Medicine Updates
00:19 Xenon Gas in Sports and Altitude Acclimatization
02:26 The Science Behind Xenon Gas
06:13 Human Studies on Xenon Gas
12:19 Risks and Side Effects of Xenon Gas
15:50 Conclusion and Final Thoughts
18:04 Social Media Announcement

Sources
Dias, K.A. et al. (2019). Effect of acute and chronic xenon inhalation on erythropoietin, hematological parameters, and athletic performance. Journal of Applied Physiology, 127(6), 1503-1510

Lawley, J.S. et al. (2019). Safety, hemodynamic effects, and detection of acute xenon inhalation: rationale for banning xenon from sport. Journal of Applied Physiology, 127(6), 1511-1518

Ma, D. et al. (2009). Xenon preconditioning protects against renal ischemic-reperfusion injury via HIF-1α activation. Journal of the American Society of Nephrology, 20(4), 713-720

Pappas, S. (2023). “Did Inhaling Xenon Gas Really Help Mount Everest Climbers Reach the Summit in Record Time?” Scientific American

Hackett, P. (2025). “Xenon Gas and High-Altitude Performance: What We Know and What We Don’t.” Uphill Athlete

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Transcript

Patrick: 0:13

Hello and welcome back to Wilderness Medicine Updates the show for providers at the edges. I'm your host, Patrick Fink. Today we're gonna talk about inhaled xenon gas for sport performance, for altitude acclimatization, and the risks associated with its use. You might have heard about this recently as a team of climbers from the UK recently ascended Mount Everest and claimed that exposure to xenon gas helped them make one of the fastest ascents ever seen, essentially at a round trip in a week from the uk. Let's dive right in. In recent years, inhaling Xenon gas has been proposed as a shortcut for athletes to boost endurance and speed up altitude. Acclimatization the idea got attention after reports that Russian athletes use Xenon before the 2014 Sochi Olympics, which prompted the world Anti-Doping Agency or WADA to ban xenon and argon as prohibited performance enhancers. More recently, this commercial expedition claimed that climbers summited mount Everest in a week by using xenon inhalation as an acclimatization aid. These headlines have sparked interest in the science Behind Xenon. Essentially, can a Noble Gas really enhance performance or altitude adaptation? So what did the expedition do? This group, which included four former Special Forces members under the direction of Mountain Guide Lucas TBA conducted a typical physical training regimen of conditioning leading up to the expedition. Though the details of their training hasn't been shared, beginning around. Beginning around 10 weeks before the expedition, they used hypoxic tents at home to begin the acclimatization process. And then two weeks before the expedition, they traveled to Germany to be treated with xenon exposure by an anesthesiologist. Then after arriving at Everest Base Camp, the group climbed to the summit in less than three days using supplemental oxygen, and they claim that xenon exposure was critical to their fast ascent and short stay at Everest. So how might Xenon work? Xenon is a colorless, odorless, noble gas, traditionally known for its use as an anesthetic. It's still in use as an anesthetic occasionally in places like Russia. Um, what is a Noble gas in brief? I'm not a chemist or a physicist, but essentially it's a gas that has its full outer shell of electrons full. So you probably are most familiar with helium. Um, and then xenon argon, those noble gases go right down the right side of the periodic table. And what that means, because their outer shell of electrons is full, is that they don't like to play with others. They're replete with electrons. They're not interested in forming bonds, and so they tend to be very inert, meaning that they don't engage in chemical processes very easily. Now xenon when inhaled produces anesthesia. It's thought to do that by blocking NMDA receptors in the brain dampening neural activity. This NMDA receptor blockade is also associated with neuroprotective effects. It's been shown to reduce brain cell damage in models of stroke and trauma. And these protective properties in low oxygen conditions have suggested that Xenon could help the body cope with altitude stress. Some animal studies. Found that Xenon can activate the body's hypoxia response pathways. It induces what's called hypoxia inducible factor alpha, which is a genetic transcription factor that triggers genes that help the body cope with low oxygen environments. So by activating HIF. One alpha xenon increases production of epo, which is the kidney hormone that stimulates red blood cell formation to carry more oxygen. Best known for its use as a blood doping agent that has been used previously in professional cycling. this EPO boosting effect is the main reason Xenon drew interest as a performance enhancer. More red blood cells means higher oxygen carrying capacity akin to the benefit of altitude training or that blood topping. In fact, early preclinical experiments showed dramatic effects using xenon. For example, in a mouse study, a two hour exposure to 70% xenon gas activated hf, one alpha in the kidneys, and significantly upregulated EPO and vascular endothelial growth factor which helps you form new blood vessels and capillaries. And that happened all within 24 hours of the exposure. Mice pretreated with xenon were also protected from kidney injury in a low oxygen experiment, an effect that disappeared if HI one alpha was intentionally blocked, which implies that specifically xenon tricks the body into mounting an oxygen starvation response mediated by HF one alpha, and that potentially improves red cell count and protects organs from hypoxic damage. Sounds fantastic. From a sports perspective, these mechanisms sound promising. Athletes have long used altitude training or simulated hypoxia like hypoxic tents to naturally increase EPO and red blood cells. A substance that could rapidly induce EPO without actual high altitude exposure would be an attractive shortcut to training. However, by 2014, evidence was mostly from cells and animals. No human data had yet shown that xenon inhalation actually raised blood EPO levels or improved exercise capacity. Nevertheless, out of caution and due to reports of use by athletes, WADA added Xenon to the band list in 2014, classifying it as a prohibited method of artificially boosting epo. That's set the stage for scientists to start investigating. Does xenon inhalation truly enhance red blood cells or performance in people, or is it just another thing that works in mice and doesn't bear out in humans? So what about humans? To date, no published human studies have demonstrated any improvement in athletic performance from Xenon. The primary evidence on Xenon in athletes comes from a 2019 clinical trial funded in part by anti-doping authorities. In that randomized study, 12 endurance athletes underwent a regimen of daily xenon inhalation versus a placebo over several weeks. The Xenon group inhaled a sub anesthetic dose, which was 70% xenon, mixed with oxygen for two minutes each day over four weeks. Researchers then tracked the cascade of effects that came from that EPO levels, blood volume and hemoglobin mass VO O2 max, as well as a three kilometer run performance test before and after the intervention. So what did they find? They found that EPO spikes acutely after exposure to even a single xenon inhalation. Within hours of breathing that xenon mix EPO levels were slightly elevated relative to baseline, which confirmed that acute hypoxia inducible factor and EPO response is that we saw in animals, also occurs in humans. However, there were no lasting changes. To blood composition. Despite the e PPO bump, there was no significant increase in hemoglobin mass or total red blood cell volume After four weeks of daily xenon use. The initial EPO stimulation wasn't enough to substantially ramp up red cell production in these athletes over time. One transient effect that was noted was a short term expansion of plasma volume after a week of xenon dosing. Essentially the watery part of the blood, but this didn't translate into improved oxygen carrying capacity. It is worth noting though that plasma volume expansion is one of the adaptations that we see in people who are undergoing acclimatization. Last and most importantly, they found no improvement in fitness or performance. The Xenon group saw no gains in their VO O2 max, or in their running time trial performance compared to the placebo group. In the three K run tests, there are times and physiological responses like heart rate and breathing seem to be unchanged by xenon inhalation. So in short, breathing, xenon for a month intermittently did not make the athletes any faster or fitter. These results align with other evidence that simply raising E PPO a bit may not confer a performance edge unless it leads to a real increase in red blood cell count. Even direct epo, doping with injections hasn't consistently improved exercise performance at high altitude in controlled studies. So how did this team go up Everest so quickly? The central promise of Xenon for mountaineers is that it could accelerate acclimatization meaning help the body adjust to high altitude more quickly by increasing red blood cells or protecting against low oxygen damage. For this Everest expedition, the four climbers inhaled xenon before their rapid ascent, but they also underwent extensive conventional preparation with hypoxic tents for six to eight weeks to pre acclimatize, and they used supplemental oxygen during the climb. Hypoxic training is a proven method to boost red blood cell count and ventilatory adaptation. With those factors in play, any help that they got from Xenon may be difficult to discern. Indeed, Dr. Peter Hackett, a leading high altitude medicine specialist, wrote an excellent article on uphill athlete.com that is linked in the show notes that says that Xons theoretical benefit of more red cells may be of marginal benefit at extreme elevations because above about 5,000 meters. Performance is limited more by how well your lungs can oxygenate blood than by the absolute number of red cells. Essentially, it's a problem of gas exchange rather than oxygen carrying capacity. You can have all the capacity in the world, but if you can't fill it with oxygen because the partial pressure of oxygen at that altitude is a third of what it is at sea level, then it just doesn't matter how many box cars you have, you don't have cargo. The body's most critical adaptation to altitude. Is an increase in breathing and other physiologic changes that improve oxygen uptake, not just a higher hemoglobin count. So even if Xenon could slightly elevate EPO or hemoglobin, that might not translate to better function in the death zone of Everest. And there's no published human trials showing that XENON prevents acute mountain sickness or high altitude pulmonary or cerebral edema. Hackett points out that the only quote data on Xenon for mountaineering so far are these anecdotal reports from guides like Lucas Kurtenbach, who claim success using Xenon with some clients previously. And while these stories are intriguing, it's not controlled science until proper studies are done. We can't confirm Xenon as a reliable shortcut to acclimatization. Still, we can't deny that the expedition was successful and very quick what could play into that? First, these are former special forces guys. They tend to be tough, and I'm guessing that they were diligent and thorough with their physical preparation. It was probably top-notch fitness going into this trip. Second, they use hypoxic tents. And hypoxic tents do appear to have some benefit to acclimatization, which could speed their ability to ascend quickly. Third, they use supplemental oxygen, which is essentially a norm now on Everest. And that helps to address the primary issue of climbing the Everest Summit, where again, available oxygen is about a third that of sea level. And finally, Kurtenbach said that the primary benefit of Xenon administration is that it helps you, quote, feel better with some kind of direct effect on breathing, such that respiration during exercise feels deeper and easier after being treated with xenon. Since Respiration and Gas Exchange are the primary limiters of performance in death zone mountaineering, it remains possible that Xenon exposure induces an adaptation in the lungs that is of actual benefit at altitude. The best way to investigate this would be a blinded study of climbers who are treated with quote unquote gas exposure prior to the ascent, but only some of whom are actually exposed to xenon. So is there a downside to xenon use? While xenon appears safe when administered by a medical anesthetic professional, its use as a do it yourself performance enhancer would raise serious concerns. Okay, first, it's an anesthetic so xenon can cause profound sedation and cognitive impairment. at high concentrations. Xenon induces anesthesia within seconds. Causing rapid loss of consciousness, even at sub anesthetic doses used for athletic performance, it can cause notable impairment. So in one study, subjects inhaling 70% Xenon became so sedated they could not reliably perform a simple task. After about 60 to 90 seconds, some participants experienced restlessness or disorientation alongside that sedation. So Xenon can significantly degrade. Mental and motor function while it's in your system, that makes it dangerous to use without supervision. Obviously folks aren't using this up on the mountain. That would be a terrible idea. There are no reports of long-term cognitive damage from occasional xenon use, but we simply don't have data on frequent exposure in athletes. The main risk here is the risk of overdose and asphyxiation if used without an anesthesiologist, the margin between an effective xenon dose and an anesthetic overdose is narrow. It requires mixing it with enough oxygen, maybe 70% xenon, 30% oxygen. So if someone were to accidentally inhale xenon from a tank without sufficient oxygen, this would be a lot like inhaling nitrous oxide from a tank that hasn't been sufficiently mixed. If you get anoxic mixture, you can quickly suffocate or suffer brain damage. So even with oxygen, sedation can cause a user to pass out while still attached to the gas delivery, and that would be dangerous even. At a normal mixture in practical terms, an athlete in their garage trying to breathe Xenon could lose consciousness with a mask on Leading to an unprotected airway or continued inhalation without breathing support and fatal accident would be a real risk if this was done improperly. Third Xenon does have cardiovascular effects. Acute xenon inhalation does have measurable effects on hearts, heart, and blood vessels. So initially it causes a drop in peripheral vascular resistance or vasodilation, which can lower blood pressure, accompanied by a reflex increase in heart rate. By the end of a several minute inhalation, studies have shown a swing to mild hypertension or elevated blood pressure. And increase cerebral blood flow velocity. These changes aren't likely to be concerning in healthy subjects, but they do indicate that Xenon isn't completely benign and has direct effects on the circulatory system. Finally, what other side effects are there? So, so far no specific organ toxicity or allergic reactions have been linked to xenon. It's chemically inert and it's exhaled unchanged. Unlike other inhalants, Xenon doesn't linger in the body or metabolize into harmful compounds. The main issues are the immediate anesthetic effects. There's no evidence of xenon causing addiction or dependency. It's not a euphoric recreational drug the way nitrous oxide can be, and the biggest quote, unquote side effect might actually be the financial cost. A xenon is extremely rare and expensive to procure in large quantities. This means that any athlete attempting to use it regularly would have significant expense associated with it, and the high cost has naturally limited how many people have experimented with it. So the bottom line inhaled xenon gas raises a fascinating intersection of high altitude physiology and sports doping. But the science so far indicates more hype than tangible benefit. Xenon can indeed activate the body's low oxygen response by triggering PPO release, and it has shown organ protective effects in lab studies, but human trials have not found improvements in aerobic performance or altitude tolerance from Xenon. The current evidence suggests that while Xenon might give a small, short-lived bump in ppo, it doesn't translate into more red blood cells or enhanced fitness in practice. It remains possible that xenon exposure could induce helpful changes in the lungs, but it's more likely that it's a potent placebo for athletes or climbers. Considering xenon, the risks appear to outweigh any unproven benefits, particularly if it was to be used outside of medical supervision. It's sedative power makes its unsupervised use, extremely dangerous, and a mix up in dosage or a few extra minutes. Inhaling could knock someone out cold. Essentially using Xenon for acclimatization is akin to using an anesthetic as a training tool, which should give you pause. That's it for this episode of Wilderness Medicine Updates. I hope you enjoyed that dive into the science that we have around xenon exposure. Don't go try this at home. Not even with nitrous oxide. It's not a safe option. I look forward to seeing more research on this as I'm sure that this news has stimulated a lot of research interest in the topic that probably, um, wouldn't have occurred otherwise. And do check out the sources and news articles down in the show notes if you wanna learn more. I particularly like, uh, Dr. Hackett's article, Xenon Gas and High Altitude Performance. What we Know and What We Don't. I'm Uphill Athlete. And Uphill Athlete is just a great resource for information about training for trips to altitude as well. If you wanna learn more about hypoxic training on there, they link within that article and you can really take a deep dive. Also, sort of pains me to say this, but you asked for it and here it is. Wilderness Medicine updates, has some social media accounts now. Big thanks to listener James who reached out and offered to take this on. So we're gonna be pushing out some content through a few different wilderness medicine social accounts, which are linked down in the show notes. We're on X, we're on blue sky, we're on Instagram. So you can get show announcements, you can get other tidbits, news articles, um, throwbacks clips. So if you want to connect with us or you want to pass along some feedback. Get in touch with wilderness medicine updates, check out the links down in the show notes and reach out to us on social, like, follow, subscribe, do all that stuff. until next time, if you like this show, give us a five star review on iTunes. I hear people who are listening on Audible get out there on Spotify. Those reviews and those stars help us reach more people, and this has been accelerating and it's great to see. I love hearing from all of you who reach out to us at. Wilderness medicine updates@gmail.com. I read all of that information and I eventually reply to all of it. And until next time, share the show with someone who you think might appreciate it. Another climber, another nurse, doctor, medical student, SAR member ski patroller, or just recreationalists who likes a little dorky science. I'm your host, Patrick Fink. Until next time, stay fit, stay focused, and have fun.