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Peppermint, bayberry, cranberry, wintergreen. Breath mints? Scented candles? No -- they're "flavors" of oxygen offered at your local oxygen bar. Since oxygen bars were introduced in the United States in the late 1990s, the trend has caught on, and customers are bellying up to bars around the country to sniff oxygen through a plastic hose (cannula) inserted into their nostrils. And many patrons opt for the "flavored" oxygen produced by pumping oxygen through an aroma en route to the nose.
The oxygen experience in a bar can last from a few minutes to about 20 minutes, depending on customers' preferences and the size of their wal-lets. The price of about a dollar a minute could leave you gasping for air, but frequent inhalers may get a dis-count.
Most oxygen bar proprietors are care-ful not to make medical claims for their product, and state that their oxygen is not a medical gas-it's made and of-fered strictly for recreational use. But under the Federal Food, Drug and Cos-metic Act, any type of oxygen used by people for breathing and administered by another person is a prescription drug. "It doesn't matter what they la-bel it," says Melvin Szymanski, a con-sumer safety officer in the Food and Drug Administration's Center for Drug Evaluation and Research (CDER). "At the other end of the hose is oxygen, and the individual that provides you with the nasal cannula and turns on the canister for your 20-minute supply is actually dispensing the prescription drug oxygen to you."
Although oxygen bars that dispense oxygen without a prescription violate FDA regulations, the agency applies regulatory discretion to permit the in-dividual state boards of licensing to en-force the requirements pertaining to the dispensing of oxygen, says Szymanski. Many states choose to allow oxygen bars; others discourage the businesses by requiring strict compliance with the law. However, serious health claims made for oxygen, such as curing can-cer or AIDS, or helping ease arthritis pain, would be investigated by the FDA, adds Szymanski.
Oxygen fans tout the benefits of oxygen as reducing stress, increasing energy and alertness, lessening the effects of hangovers, headaches, and sinus prob-lems, and generally relaxing the body. But there are no long-term, well-con-trolled scientific studies that support these claims for oxygen in healthy people. And people with healthy lungs don't need additional oxygen, says Mary Purucker, M.D., Ph.D., a pulmo-nary specialist in CDER. "We've evolved for millions of years in an atmosphere of about 21 percent oxygen."
The American Lung Association says that inhaling oxygen at oxygen bars is unlikely to have a beneficial physiologi-cal effect, but adds "there is no evidence that oxygen at the low flow levels used in bars can be dangerous to a normal person's health."
People with certain medical condi-tions are another matter. Some need supplemental oxygen, but should not go to oxygen bars, says Purucker. People with some types of heart disease, asthma, congestive heart failure, pul-monary hypertension, and chronic ob-structive pulmonary diseases, such as emphysema, need to have their medical oxygen regulated carefully to oxygen-ate their blood properly, says Purucker. "If they inhale too much oxygen, they can stop breathing."
People who have received bleomycin, a chemotherapy used to treat some types of cancer, are in danger if they are exposed to high levels of oxygen for too long adds Purucker. "People think oxygen is good, but more is not necessar-ily better."
One of the FDA's biggest concerns about oxygen bars is the use of "fla-vored" oxygen, says Purucker. The flavor is produced by bubbling oxygen through bottles containing aromatic solutions and then pumping the vapor-ized scent through the hose and into the nostrils. Some bars use oil-free, food-grade particles to produce the aroma, but others may use aroma oils. Inhaling oily substances can lead to a serious inflammation of the lungs, known as lipoid pneumonia. Even if an oil-free medium is used, the purity or sterility of the aerosol that is generated cannot be guaranteed. Susceptible cus-tomers run the risk of inhaling aller-gens or irritants that may cause them to wheeze. Inhalation of live contami-nants such as bacteria or other pathogens may lead to infection.
Although oxygen doesn't burn, it does fuel the combustion process. "Smoking anywhere near oxygen, even in the same room, can be extremely dangerous," says Duane Sylvia, a con-sumer safety officer in CDER. While some oxygen bars are located in health spas or other facilities that don't allow smoking, others are found in night-clubs or casinos where smoking is com-mon. Another fire hazard is the addition of substances, such as oils, in an oxygen-enriched environment.
Improper maintenance of oxygen equipment presents a potential danger. Some oxygen concentrators use clay fil-ters, which can start growing patho-genic microorganisms that can cause infection if they are not changed regularly.
And oxygen cylinders can be very hazardous if they are stored on their sides or not kept in a well-ventilated area, says Sylvia.
We've all seen it on TV-a football player runs off the field after a play and dons an oxygen mask. "They don't need it," says Conrad Earnest, Ph.D., director of exercise physiology at the Cooper Institute in Dallas. "It's one of the biggest placebo effects going," he adds. "It's a combative activity, so yes, the players are going to be out of breath, but it's because of massive exer-tion-not because of lack of oxygen." The exception, says Earnest, might be athletes who play at higher elevations than they are used to, and don't have time to acclimate. "If the New York Giants go to play the Wash-ington Redskins, the benefit of oxygen -- if any would be so small it wouldn't be measurable. But if they go to play the Denver Broncos -- going from sea level to a mile-high altitude -- they may be helped by oxygen while recovering from a play."
And products with added oxygen, such as oxygen-ated water, sports drinks, and skin sprays don't impress Earnest, who refers to their suppliers as putting "sales before science." "If you drink oxygenated water, either the water passes through the gut and has no effect, or the acid in the stomach reacts with it and the only ef-fect of the oxygen is that it will cause you to burp more," he says.
Atmospheric pressure decreases as altitude increases, making it more difficult to breathe. But people living at high altitudes do adapt to their environment with-out using additional oxygen, says Mary Purucker, M.D., Ph.D., a Food and Drug Administration pulmonary specialist. "The blood becomes more efficient at trans-porting oxygen to tissues."
Healthy people traveling from lower to higher eleva-tions don't usually need extra oxygen either, says Robert Mazzeo, Ph.D., an exercise physiologist at the Univer-sity of Colorado in Boulder. But if people who live at low elevations try to exercise at higher elevations, such as the mile-high city of Boulder, they should be aware that exercise will be more taxing. "Maximum capacity declines as altitude increases," says Mazzeo. "If you're used to running two miles a day, you can still run two miles, but not at the same speed."
Most oxygen bars use either "aviators breathing oxygen" or oxygen extracted out of the air in the bar. Aviators breath-ing oxygen (ABO) is a medical-grade oxygen, not less than 99.0 percent pure, intended for commercial or private air-craft use. ABO should not be used for recreational inhalation or medical therapeutic treatment of humans or animals.
Many oxygen bars use a concentra-tor, which filters out the nitrogen and other gases in the air circulating in the room, and then delivers the concen-trated oxygen, about 95 percent pure, through a hose at a continuous flow rate. But oxygen users inhale the sur-rounding air along with the oxygen pumped through the nose hose, which decreases the concentration. The con-centration is further decreased when oxygen is pumped through an aroma. According to one oxygen bar supplier, the customer gets less than 50 percent pure oxygen.
Although breathing these low levels of oxygen may not hurt a healthy person, "people have nothing to gain by frequenting oxygen bars, and subject themselves to unnecessary risk," says Purucker.
This article was reprinted from the November/December 2002 issue of FDA Consumer.