Red Light Therapy (Can Heal Thyroid & More) Part II

Plus a deep dive on mechanism with Ari Whitten.

Dr. Michael Ruscio: Hey, everyone. Today was part two on photobiomodulation, or red light therapy, with Ari Whitten. This was just fantastic.

We make a few great parallels. The one that I want to paint for you is that you can think of red light therapy, kind of like a funky-looking light panel that you can buy and use in your home, can be thought of as a way of replacing the long-term exposure we should be having to natural sunlight. Not like a tanning bed where you’re getting a ton of light in a short period of time.

Even when we were hunter-gatherers outside in the shade, we were getting this long-term exposure to natural light. And that actually has a hormetic effect on our mitochondria, making them better able to produce antioxidants. This might be one of the key mechanisms which explains the litany of benefits in using a red light therapy device. We go into some of that as well as some of the research.

Red Light therapy expert @ariwhitton discusses the far reaching benefits of red light therapy and why it works. Click To Tweet

Some of the research behind thyroid is absolutely staggering, and he goes into some of the details there. We also talk about how to best use these devices and give you a simple protocol, and a more detailed protocol, as best we can, because there are so many ways to use it. But we can also boil that down to a distillation of a few simple concepts.

I really hope that you will listen to this episode. Also, if you’re enjoying the podcast, please, please, please go over to iTunes and give us a quick review. It’s vitally important to help the show and messages like this reach more people. And with that, we will now get on with the show with Ari Whitten, number two of his appearances on the podcast about red light therapy, aka, photobiomodulation.

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Episode Intro

Dr. Michael Ruscio: Hi, everyone. Welcome back to another episode of Dr. Ruscio Radio. This is Dr. Ruscio. Today, I am here with Ari Whitten, and we are doing part Deux of red light therapy, which is something that people had a lot of questions about.

One of the things I love about Ari and his approach, quite like the way I like to look at things, is he doesn’t look for the most complicated way to advise on how to use red light therapy, but the most pragmatic, practical, and simple protocol that we can put together.

So that is what I want to tease you with here. We will work our way to it in the episode as we elaborate further on how to use red light therapy. We will cover:

  • mitochondria health
  • thyroid health
  • skin health
  • joint health
  • and more

Today we will go over what we should use it for, what we shouldn’t use it for, and how to use it. Ari, I’m laying out some pretty big shoes for you to fill for the show.

Dr. Ari Whitten: Yeah. Thank you very much. We have a lot to cover and a very short amount of time to try and cover a lot of material, so I’m excited to get into it.

DrMR: Awesome. For those who want to know Ari’s background, just look up the last time he was on the episode. We’ll skip that part for now, because I want to give as much of your knowledge here as we can to our audience.

One of the things that we didn’t have a chance to really go into last time we spoke was the mechanism. And I know mitochondria are involved. I don’t know the details, and there are likely a few mechanisms. So, why don’t you define what red light is for people, in case they’re new to the conversation. And then, let’s go into the mechanisms from there.


What is the Electromagnetic Spectrum?

DrAW: So, I would definitely say listen to part one where I cover what it is in-depth. Here is the quick summary. There is something called the electromagnetic spectrum, and it might be a good idea to do a Google image search of what that is so you can visualize this. On one end of the spectrum, we have things like X-rays and gamma rays. On the other end of the spectrum, we have things like microwaves and radio waves, like AM/FM radio waves that you pick up on your radio. These are all part of this thing called the electromagnetic spectrum.

It goes through lots of different kinds of energies, electromagnetic energies, and part of the spectrum is light. It’s visible light that humans see with our eyes, so the colors of the rainbow that we all learned as a kid, ROYGBIV: red, orange, yellow, green, blue, indigo, violet. The violet, that’s ultraviolet rays. That’s what we know as UV light from the sun.

Then we have blue light. So, for example, if you look at a blue sky, those are blue wavelengths of light entering your eyes. Side note, there’s a whole bunch of physiology that’s massively affected by those blue light wavelengths entering your eyes through the circadian rhythm, which regulates all kinds of systems of our body, all kinds of aspects of physiological and metabolic function — widespread regulation. It’s a whole other topic we could talk about for three hours.

Then we have green light, yellow light, and then red light, which is literally visible red light that we can see with our eyes. So, if you’re looking at a fire, for example, or candlelight, it is emitting a large portion of its light in the red spectrum.

As you move out of the visible part of the spectrum, then we get into invisible parts of the spectrum, parts of the spectrum that humans cannot see with our eyes. As an example, we can’t see radio waves with our eyes. We can’t see X-rays with our eyes. So, there are parts of this electromagnetic spectrum that we can’t see, but have biological effects nonetheless.

So, even though you can’t see X-rays, if you get a bunch of X-rays poured into your system, you’re going to cause a bunch of DNA damage. There are all kinds of bioactive wavelengths that are visible and invisible that are affecting the way our bodies function, unbeknownst to most people. Most people are not used to thinking of how light is affecting their body.

The Infrared Spectrum

So, we move out of the red spectrum, and we get into the infrared spectrum. It starts in what’s called near-infrared, and then it gets into mid-infrared and far-infrared. Now, if you’ve heard of an infrared sauna, that is far-infrared energy. That is mostly felt by your body in the form of heat. So, it basically heats up your tissues.

Then, there’s near-infrared, which is right next to red light on the electromagnetic spectrum. Red and near-infrared light, for all intents and purposes, are the same. There are only really two notable differences. One is, they’re invisible. It’s sort of a pragmatic difference between the two that our human biology — our optical systems and brain, we can see the red part of the spectrum. We cannot see the near-infrared part of the spectrum.  

But in terms of how it affects us, the mechanisms of how it works, basically identical. The only real difference is near-infrared light penetrates into our body a little bit deeper than red light does. But the mechanisms they engage, which we’re about to get into, are identical.

DrMR: That’s perfect.

DrAW: Did you follow everything I said there, or do you want me to clarify anything?

DrMR: No, I think that allows the audience to understand what it is. To tie that to a consumer product, there are various products in the market. We have talked in the past about Platinum LED. You may have heard of the Joovv light. There are a litany of different red lights or photobiomodulation devices that people are using, and they’re using them for a host of different applications. We’ll get into those applications in a minute. But before we do, let’s cover the mechanisms of how shining a light on you could improve your skin, or reduce joint pain, or maybe even help with thyroid inflammation.


How Light Regulates the Body

DrAW: So, I want to just present the big picture here. Most people are not used to thinking of light as bioactive, light as affecting the way their cells, and their hormones, and their biology, functions. So, we’re used to going into a room, flipping on a light switch, and light is there to help us see. But we’re not used to thinking of rays of light, or photons of light, penetrating beneath our skin and doing things inside of our cells. So, that’s first just a frame of mind shift to wrap your head around what’s going on here.

Let me also just present for context, I already mentioned circadian rhythm. That blue light enters our eyeballs, feeds back through nerves into this circadian clock in our brain, which has all kinds of effects on neurotransmitter levels and hormones that regulate our sleep and wake cycles. This 24-hour rhythm of when you fall asleep, and when you wake up, and your mood, and cognitive function, and energy levels during the day, as well as how tired you are and how well you sleep at night, among many, many, many different innumerable hormonal and neurotransmitter effects that affect all kinds of systems in your body and relate massively to your disease risk of cancer, cardiovascular disease, neurological disease, many, many diseases.

Let me also present UV light, ultraviolet light, for context. People know you’re supposed to go out in the sun because sunlight interacts with your skin in a way that creates vitamin D synthesis. Specifically, the ultraviolet wavelengths of light that are interacting with our skin to create this vitamin D. So, just for context, we have those two layers of how light is bioactive, and light is regulating our physiology.

Now, red and near-infrared light work through an entirely different set of mechanisms. One significant difference between this and, say, blue light or UV light is, red and near-infrared light have a unique ability to penetrate beneath our skin.

Blue light and UV light really stop at the skin surface. They don’t really penetrate very deeply into our skin. But red and near-infrared light actually penetrate up to inches into our body. They’re going way beneath the skin, getting almost up to about three inches into your body.

You can test this if you shine a flashlight up to your hands, which you probably did as a little kid when you were playing with a flashlight. You can notice that the light that comes through your fingernails on the other side is red-tinted, and that’s specifically because it’s only those wavelengths of light that really can penetrate deeply into human tissues.

They don’t just penetrate into our body and do nothing. Turns out, they penetrate into our bodies and do a whole bunch of things. Just really fascinating. One layer of the story is, they interact with our mitochondria in a way that basically stimulates energy production. So, our mitochondria are the cellular energy generators that produce virtually all of the energy in virtually all of the trillions of cells in our bodies.

Turns out, they have a little photoreceptor right on them called cytochrome c oxidase that basically catches photos of light. And that light, very much like how food is used by mitochondria to produce energy, can be captured in a way that helps stimulate energy production by the mitochondria. So, wrap your head around that. It’s an interesting thing to think about.

We’re used to thinking about plants using light through photosynthesis in this kind of way, but we’re not used to thinking of how our cells capture photons of light to help produce energy. So, that’s one layer of the story. Basically, cells work better when they have more energy supplied to them when the mitochondria are working better. So, red and near-infrared light help your mitochondria work better to produce more energy. That’s one layer of the story. 


Misconceptions About Oxidants

Then, the next layer is something called hormesis, which is basically transient metabolic stress. So, if you think of exercise as an example, most people are used to thinking of the story of antioxidants and oxidants as like, oxidants are bad, free radicals are bad, they cause damage inside of our cells, and antioxidants are good, we need antioxidants to get rid of the oxidants or the free radicals so that those free radicals don’t cause damage to our bodies.

Well, the story is actually way more complex than this. It turns out, we have an actual, what’s called a redox balance in our cells and in our mitochondria where these free radicals, or reactive oxygen species, or oxidants, actually are intentionally produced by our cells and serve vital signaling roles. They are molecules that communicate inside of the cell and between cells to stimulate certain pathways that are actually needed for normal, healthy cell function.

So, the real goal is never to just take massive amounts of antioxidants to get rid of all the oxidants, the free radicals. It is to optimize the balance of free radicals, or reactive oxygen species, to antioxidants. And it turns out that our cells actually come equipped with their own internal antioxidant defense system where it produces powerful antioxidants, things like glutathione, and superoxide dismutase, and catalase. And that system is designed to regulate this proper balance between reactive oxygen species and antioxidants.

Building Up Your Internal Antioxidant Defense System

Now, it turns out that one of the best ways that you can actually build up your internal antioxidant defense system, which is the really critical thing when it comes to resilience to stress, resistance to stress, and resistance to the cell damage that comes from stressors and the aging and disease associated with that, one of the most important things you can do is build up your internal antioxidant defense system. One of the best ways to do that, actually, by far the best way to do that, is through, very counterintuitively, stress. It’s through creating bursts of reactive oxygen species of those free radicals. That actually stimulates the internal antioxidant system to grow stronger.

So, much like when you lift a weight and do bicep curls, you are stimulating your bicep to grow stronger. The same exact thing is going on inside your cells at the cellular level. You’re stimulating that internal antioxidant system to grow stronger through the stressors that create bursts of reactive oxygen species, or free radicals.

DrMR: Right. And there’s a great parallel here. Just one thing I want to chime in on to hopefully make a connection for the audience. We’ve talked in the past, even with Lenore Skenazy, about how this happens in more of the psychological realm, and how Jonathan Haidt made this great parallel to this concept known as antifragility, where the immune system, the skeletal system, are systems that require stress in order to operate effectively.

So, same concept here. Maybe a little harder to picture. Like we picture a bone, we can’t really picture mitochondria as much. But the same concept, we need that oxidative stress to help our body be more able to function, and that leads to tissue benefit. But just want to make that tie-in for our audience that this is a common theme in biology, that stress, the right amount, can lead to improved function.


Benefits of Oxidative Stress for Tissue Repair and Regeneration

Key Takeaways

[Back to Top]

Mechanisms

  • Stimulate mitochondria – Mitochondria have light receptors and red light can be used by mitochondria to create energy
  • Hormesis – Healthy stress that helps the body better produce antioxidants, builds up your internal antioxidant defense system. (Antifragility concept).
  • Retrograde signaling – Mitochondria impact gene expression through retrograde signaling

DrAW: Exactly. And I think it was Taleb’s book, Antifragile. I don’t know if Jonathan Haidt’s written about that as well, but Nassim Taleb wrote that book, Antifragile. But, yeah, hormesis is actually one of my favorite topics. I could talk about this for three hours. And I don’t want to take too much time on this subject, but it really is massively important and underappreciated, and little known.

I found that a lot of people actually don’t understand this, that even health professionals don’t understand this deeply. Basically, it was thought for a long time, like Harman’s free-radical theory of aging, it was thought for decades that oxidants are bad, we just need to take lots of antioxidants to neutralize them, and then we can prevent cellular damage.

Basically, all the research that’s tested that has shown that it doesn’t work that way. And counterintuitively, things that promote bursts of increased reactive oxygen species, or free radicals, extend lifespan. So, all these longevity studies in animals show that when you subject animals to physical stressors, when you subject them to heat stress, cold stress, to hypoxia, to various kinds of stressors, it actually extends their lifespan.

And the reason why is because you’re stimulating this internal antioxidant defense system, and you’re also stimulating the mitochondria to grow bigger and stronger. And actually, you’re stimulating something called mitochondrial biogenesis, the creation of new mitochondria from scratch.

So, this layer of the story of hormesis is really important, and red and near-infrared light, much like exercise, much like sauna exposure, and many other types of hormetic stress, they are a hormetic stressor that created bursts of free radicals. Again, it sounds like a bad thing to be a “stressor” or to create a spike of free radicals. But, actually, we know that that is profoundly beneficial and health-promoting by stimulating these adaptations.

The other key mechanism that I want to mention is something called retrograde signaling. So, it used to be thought for a long time that our DNA was the big boss, and we have our DNA in the nucleus of the cell, and that gives commands of what to do to all the different parts of your cell, and you’re ultimately you. And it turns out that it doesn’t really work that way, that environmental input into that system is really important. So, epigenetics, and the mitochondria, in particular, are a critical environmental sensor that picks up on the signals from the environment and relays that back to the nucleus, and then regulates which genes get expressed, or which genes get turned off.

And one of the things that red and near-infrared light do, maybe even the most important thing, is they’re switching on and off genes. So, by exposing your cells to red and near-infrared light, you’re literally regulating the expression of your genes in the nucleus of your cells, your DNA. In particular, it is turning off genes related to chronic inflammatory responses. It’s turning on genes related to this internal antioxidant defense system and growing mitochondria and mitochondrial biogenesis. Importantly, it’s ramping up the expression of genes related to growth factors in those specific tissues. And this is in a tissue-specific way.

We have different chemicals in different parts of our body. For example, in the brain, we have things like nerve growth factor and brain-derived neurotrophic factor. In our muscles, we have different growth factors that are involved in increasing strength and muscle protein synthesis to grow bigger muscles. In our tendons and our skin cells, we have collagen fibroblasts that are responsible for synthesizing collagen.

Basically, all of these different tissues have their own versions of their particular growth factors that are involved in cell regeneration and healing. Basically, red and near-infrared light work to stimulate the expression of genes involved in cell healing and cell regeneration.

So, it’s literally modulating the expression of chemicals in that environment in a lasting way that lasts for several hours, or even days, that creates healing and regeneration of those tissues.

DrMR: It’s phenomenal, the impact that it can have, outside of what I had already heard about. The mitochondrial, the hormetic piece is fascinating to think about. It makes complete sense. But also, this potential to regulate phenotypic expression is also fascinating. I’m glad we took the time to go over the mechanisms. The audience probably is used to me tut-tutting mechanisms, but I do think there is a time and a place for going into the mechanisms because they can be important. This is a great example of how insightful it can be to understand the mechanism behind the theory.

DrAW: I actually totally agree with you, by the way, about mechanisms. It is a giant pet peeve of mine. There are a lot of people who use mechanisms to build a theory and basically say, “Oh, so-and-so engages this mechanism and, therefore, will have this and this benefit,” in the absence of actual data showing that it has those benefits. So, I start with the big picture, “Does this actually work?” first. “Do we have good data showing it works?” If we have that, then it’s insightful, interesting, and fascinating to explore the mechanisms of how it works.

DrMR: Couldn’t have said it better myself. So, now, we’ve got this great Data Dump on the mechanism. Which, if I’m being honest, it makes me want to get in front of my red light right now. I’m going to probably do that first thing once we end the recording here. It makes me even more excited.

But I want to go back to the light. Let’s go over the best conditions this can be helpful for, and what, if any, if you feel are being marketed on the internet that are claims that aren’t really fully supported.

DrAW: So, there’s so much there.

DrMR: Yeah, I know. An easy question, right?


Studies on Red Light Therapy

DrAW: Yeah. So, I’m going to try and cover this very fast. There are over 5,000 studies on red and near-infrared, what’s called photobiomodulation. Photo means light. Bio is your biology. And modulation is change or regulation. So, using light to change your biology. There are 5,000 studies for all kinds of different things from skin anti-aging, to wound-healing, to repairs of diabetic ulcers in people with diabetes, to fat loss, to hair regrowth, to combatting cellulite, to tendonitis, to arthritis, to using it as a therapy for people undergoing chemotherapy who have side effects from chemotherapy.

One of the most well-known side effects is something called oral mucositis, which is inflammation of the oral mucosa, the lining of your mouth. And red and near-infrared light therapy, there are hundreds of studies showing that it’s one of the best, if not the single best therapy, for people experiencing that chemotherapy side effect to heal the lining of their mouth.

Hypothyroidism is another big one. Bone healing, immune function, brain function. So, enhancing cognitive performance, combatting depression. There are studies on Parkinson’s, on Alzheimer’s. There are studies on fertility in women, as well as in men, enhancing sperm motility and increasing amounts of sperm. Chronic pain and joint health. Sleep. I could go on here.

Let me mention maybe just one more. It pairs extremely well with exercise too, for a number of different outcomes. There are studies that look at actual performance, so strength and endurance performance, and how red and near-infrared light therapy can enhance that. But it also may be more relevant to people who are not really interested in competing or performing necessarily that well, but people who want practical benefits, like more fat loss, or more muscle gain, more strength gain, more of the benefits from exercise.

There are a number of studies that show that this pairs extremely well with exercise to basically amplify all of the benefits that you would normally get from exercise. So, improvements in insulin sensitivity, fat loss, muscle gain, improved recovery simultaneous to improved performance. There’s a whole bunch of fascinating research around that. So, I would say skin anti-aging, fat loss, muscle gain, improved recovery, healing of injuries, those are some of the big ones that people use it for, as well as, relevant to your audience, improving thyroid function, if you have hypothyroidism.

Skepticism Around Red Light Therapy

DrMR: Now, for the skeptics in the audience, if you’re saying, “Well, how can it do all these things?” Remember, if we’re stimulating a mechanism that’s foundational to cellular function and cellular health, then that is how we can see one therapy have a wide array of benefits.

There’s also the question of effect size, which I’m sure is probably varied from study to study. And that’s something to keep in mind, that if you’re 100 pounds overweight and you’re expecting to lose 50 pounds from the red light, I’m assuming that effect size has not been shown. So, it’s probably important to bear in mind effect size also. I know it’s hard to do this on a per condition basis, Ari, but any thoughts on effect size, and what people should be cognizant of in that regard?

DrAW: I agree with everything you just said there. I want to comment on the first thing you said, which is the skepticism around, “How could this affect so many different things?” And I totally understand the skepticism. I get that when you hear this long list of things that it could help with, you’re like, “Aw, this sounds like snake oil to claim it’s such a panacea.” First of all, it’s not a panacea. I could give you a long list of things it doesn’t work for, [laughs] if you wanted. I’m sure there are several hundred things that it doesn’t work for. But what I listed off there are the things that it does work for.

I would also ask, and this is a good way of thinking about it, how do you think exercise, physical exercise, works to not only strengthen muscles but works to prevent cardiovascular disease mortality, works on all these systems of the body that aren’t even directly related to your muscles?

So, it works to boost your mood and combat depression. It works to combat neurological disease. It works to combat dozens of different diseases beyond just some effect of increasing your endurance or strength.

Hormones

I would also add nutrition. Good nutrition does the same. It doesn’t just locally affect the gut tissue. All of the cells in your body depend on adequate nutrition, getting enough of the right stuff, and not a lot of the bad stuff. And light is actually very much the same principle. Light, like food, like physical movement, is a necessary nutrient for your cells to function normally. That is a critical thing that needs to be understood here.

This is not some random miracle therapy that someone came out with that just shocks your body or does something weird or random that has all these magical effects for random reasons. It is because your biology has been programmed by millions of years of evolution to require the nutrient of light. Specifically, and especially, it requires UV light for vitamin D. It also requires blue light for circadian rhythm, and it also requires red and near-infrared light for all of these different cellular effects that I just mentioned. We humans are meant to spend time in the outdoors getting sunlight every single day, so this is a necessary nutrient that is required by your body to function normally.

DrMR: I’m so glad you made that point.


Red Light Therapy for Sunlight Deficiency

DrAW: What we’re doing with this, with this red and near-infrared light therapy, is largely replacing the sun, because most of us have shifted to indoor lifestyles where we don’t get enough natural light from the sun.

DrMR: I’m so glad you made that point. And it was a thought that I had to ask you before, and then we got wrapped up in a few other things. And the thought was, is this akin to replacing some of the deficiency we have with exposure to light, because most of us now are working indoors most of the time, whereas we evolved being outdoors most of the time. Though not necessarily always in direct sunlight, we were outside. Oftentimes, you could argue, somewhat scantily clothed. Certainly not with any UV-blocking lotions on our skin.

So, it seems fairly plausible from an ancestral perspective that we are way deficient in light exposure, current day. And I was going to ask you, and you just answered, does photobiomodulation, red light, does that give you a way of supplementing with what we’re all a bit now deficient in?

DrAW: Yeah, 100%. And it’s important to understand, just to connect the dots here for people, that the sun has a big chunk of its spectrum in the red and near-infrared light spectrum. So, evolutionarily speaking, we are wired to get exposed to red and near-infrared light for several hours each day on our whole body, if we’re in some equatorial region, we’re hunter-gatherers spending hours every day out and about hunting food or gathering food. And so, it is to be expected by our biology that we’re getting lots and lots of red and near-infrared light every day.

And it is very possible, to be honest with you, that in people who already have adequate sun exposure, there may be very little potential to get much benefit from red and near-infrared light therapy devices.

It’s sort of like, imagine if you had a machine that exercised you and exercised your muscles, and you could just sit at home and use this machine that exercised you. Well, if you were already going to the gym for an hour every day and doing hard workouts, there would probably be very little to gain from using this machine at home that exercises you.

But if you’re not already going to the gym every day and doing hard workouts, then this hypothetical machine would obviously be massively beneficial. And that’s really what I think is going on with red and near-infrared light therapy is, we’re absolutely replacing a deficiency that most people have in the modern world because we’re just not spending enough time outdoors in sunlight.

DrMR: It’s a fantastic connection to make. I think it helps fill in the rationale behind this, especially for those who tend to be a bit more naturalistic in their philosophy, that this isn’t like you said, some weird outer space light thing, who knows how it works or what it’s doing.

DrAW: Yeah. But we can come back to the effect size thing. I wanted to make sure that I made that point for people.

DrMR: Oh, yeah. We touched on that briefly.

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DrMR: So, let’s go on to the effect size, briefly. What are your thoughts there?

Who Can Benefit from Red Light Therapy Devices?

Key Takeaways

[Back to Top]

Best Uses

  • Skin
  • Joint and Injury
    • Cut healing time in almost half
  • Body Fat
    • Study showed a 6% decrease in body fat in group that just did exercise vs 11% decrease in group that used red light + exercise
  • Insulin Resistance
    • The training group improved their insulin sensitivity by 22%, and the training plus red light therapy group improved by 40%
  • Thyroid
    • 2010 study found
      • 38% of Hashimoto’s patients reduced thyroid medication dose
      • 17% were able to come of medication entirely
    • Another study in 1997 lead to halving of thyroid medication
    • Another study in 2013 showed 47% of patients came off medication

Other important uses:

  • Sperm motility
  • Sleep
  • Energy
  • Cognitive function
  • Exercise

DrAW: Okay. So, what you said is absolutely true, and this varies depending on the specific thing that you’re looking at, the effect you’re analyzing for. It’s also important to point out that there’s a massive diversity in the types of devices used by researchers who are studying red and near-infrared light therapy. Some people are using laser devices, some people are using LED devices, and they’re using different devices at different parameters, at different dosing, and different protocols for dosing.

And so, there’s so much diversity there that you absolutely have a case where even within the same particular condition or symptom that we’re looking at, let’s say as an example, arthritis. So, there’s at least dozens, if not hundreds, of studies on red and near-infrared light therapy in the context of arthritis, “Does it help people with osteoarthritis?” Some of those studies show no significant effect. Maybe it was a three percent difference between the placebo group and the light group. And so, they said, “Oh, this study had no significant effect. We couldn’t detect any benefit from the use of light.” And maybe there are 10 studies like that.

But then there’s 40 other studies that use different devices and different parameters that show big benefits, right? So, even within the same condition, you can find that sort of divergence in the studies. Among different conditions, it’s certainly true that red light is more effective for some things than it is for other things. Let me give you a few examples, to make this practical, of effect sizes that the research has shown for various things.

There’s a 2015 study, and people can find the links to all of these on my website. I have a big, “Ultimate Guide to Red Light Therapy” post. There’s also, obviously, my book on Amazon. All these studies are in there, if anybody’s interested in the references. But it was a 2015 study where they looked at 30 healthy males who were randomized into three groups.

One was the control group. They just remained sedentary. Another one did weightlifting only. And then another group was weightlifting plus light therapy before each training session.

So, as an example, they looked at strength gains and muscle size gains. The training group improved their strength by an average of 14% over this eight-week span. And the one that did the weightlifting plus light therapy before each session improved by nearly 25%. So, it’s almost double, the strength improvement. If it was 28%, it would be double. But it’s a very significant improvement. The muscle size improved by about 10% in the normal training group. The group that included light therapy almost doubled that improvement, again.

To give you another example, when it comes to weight loss, there was a study that used light therapy with exercise and looked at exercise alone versus exercise plus red light therapy. And what they found is, when they looked at fat mass, there was a reduction in fat mass of about six percent in the group just doing the exercise, versus 11%. So, again, almost double the decrease in fat mass.

And when they looked at insulin-sensitivity, they measured it in two different ways. They measured insulin levels, and they measured insulin resistance, something called HOMA-IR. And what they found is, on the measure of insulin resistance, the training group improved their insulin sensitivity by 22%, and the training plus red light therapy group improved by 40%. So, again, almost double.

I’ll give you a couple more examples. And this is not the case that everything is going to be double the benefit. Again, there is a divergence, some things have minor effects, some things have really big effects. But there’s also some really impressive studies on Hashimoto’s hypothyroidism. One 2010 study[1] showed 38% of study participants, these are people with Hashimoto’s who were using red light therapy, were able to reduce their thyroid medication dose, and 17% were able to stop taking the medication altogether and still have normal thyroid levels.

There’s a 1997 study that showed that, again, in Hashimoto’s patients, they found that a large majority of the study subjects improved their thyroid hormone levels enough that they required, on average, about half as much thyroid hormone medication. And there was a 2013 randomized placebo-controlled study,[2] again in people with Hashimoto’s, that showed that 47% of patients were able to stop taking the medication completely, and they showed massive reductions in TPO antibodies, which is, as you know, a measure of how active the immune system is going after the thyroid gland. And there a few other studies I could mention there.

DrMR: That’s pretty remarkable. I didn’t realize the extent of the literature and the findings in hypothyroidism.

DrAW: Yes. So, to give you some examples, there are also studies on college athletes, and there are some cool studies where they look at how many days after a particular injury does it take people to return to the playing field, normally, and then how long does it take to return to the playing field if they’re doing red and near-infrared light therapy.

And they show that it, I think it was something like, if it normally requires 18 days, in the case of using light therapy, it only required about nine or 10 days. So, really, pretty massive effects. I could obviously give you lots of other specific examples here.

Now, there are cases where for a particular thing, maybe it only enhances in a smaller way. Let’s say healing of a particular diabetic ulcer, it only creates a 20% increase in the healing rate compared to normal. I’m just making something up. That’s something that would be genuinely beneficial, but would be a small enough effect size that probably the person wouldn’t really even notice it, especially because they don’t have the ability to compare. Unless they had one on each foot, one where they didn’t do the light therapy, and the other one where they did do the light therapy.

But outside of that, it’s going to be a small enough effect that the person probably wouldn’t even notice something happened that benefitted them. Because it’s not like you just shine it on the diabetic ulcer, and then you wake up the next morning, and boom, it’s healed. It’s not that fast of an effect. It’s more accelerating the rate of tissue healing.

DrMR: And certainly, the studies that you’re citing, there’s at least a clinically significant effect size. It’s not some obscure statistically significant but clinically meaningless effect. Certainly, these percentages are something that one would notice.

DrAW: Most definitely. And I would also just point out, again, there are 5,000 studies on this subject, and there are researchers, hundreds if not thousands of researchers, all over the world who are devoting their careers to studying this subject. And those 5,000 studies have been accumulated over several decades. So, on a common-sense level, obviously, you would not expect thousands of scientists to be dedicating themselves to studying something that only has minor, mostly insignificant effects. No, it has very big effects on a lot of things.

DrMR: Now, what’s the best way to apply this? And one of the things that I know you do a really good job with, and I appreciate about you, is you’re not looking to give people the most complicated answer. And you don’t fall in love with superfluous details just because you find them interesting.

You look for, what is the commonality in the applications, and how can we get people a simplified set of rules for their application. Things like how long of a session, how far do you need to be away from the device, do effects at one site have a distal benefit. Meaning, there’s not maybe one spot in particular where you have to shine the light. So, that’s one example of a distal effect. Take us through how someone sets this up and uses it to try to get all these benefits.


How to Use Red Light Therapy

Key Takeaways

[Back to Top]

How to Dose

  • Dosing is somewhat device dependent: Use a good quality unit with high output (18-20 inch light)
  • Gradually increase your dose over time, just like a new exercise plan
  • Basic protocol
    • Once everyday or every other day
    • Distance – 3 inches – 36 inches depending on what you are looking to treat
    • Time – 2 min to 25 min per session depending on what you are looking to treat
  • Detailed protocol
    • Closer to light = deeper penetration. Requires longer treatment times
    • Skin/anti-aging – about a foot away, or more, for shorter time
  • Eyes – controversy regarding if eye exposure is beneficial

DrAW: Well, there’s lots of good questions in there. I’m going to address things in the simplest way first before we delve into details. The very, very simple answer is, you get one of these devices, you put it on a table next to you, or on the wall, or on the ground next to you, if you want to lay down on the ground. You flip it on, and you sit next to it, and allow that light to shine on your body. So, that’s the first layer of answer on the simplest level.

The dosing time will be somewhere between about two minutes to maybe 25 minutes, on the high end. These are broad guidelines I’m painting now.

Now, one really important detail here that I need to mention that’s sort of a make or break is, you’ve got to understand that there are very, very, very different, radically different devices on the market. Some are really powerful, and some are not powerful at all. Some are really big, and some are really tiny.

That’s a critical detail, because it’s sort of like saying, “How many minutes of exercise should I do?” And one person who’s asking that question is doing like a little pinky finger-lift where they’re lifting a quarter-pound weight with their pinky, and that’s all they’re doing. They’re doing little pinky curls. And the other person is going to the gym, and they’re doing a CrossFit workout where they’re going all-out intensity, squats, deadlifts, sprints, power cleans, pullups, and all kinds of crazy stuff for half an hour.

There are radically different demands on the body in each of those cases. You can do five minutes of each of those two kinds of exercise, or let’s say you could do 20 minutes of each of those two kinds of exercise. But they’re totally different things, right? The pinky curls are not analogous to the CrossFit workout, right? So, the same thing is true of these devices.

This is a hard thing for people to understand. If you go on Amazon and just buy any random device, you could get something that’s like 15 watts, whereas you can go and get a real device that’s 600 watts or 1000 watts. Those are not comparable. So, just keep in mind that when I’m giving these guidelines here about how long to do it, and the details I’m about to give you, I’m starting from the assumption that you’re using a quality, powerful device, not some cheapy, crappy device that you just found online and you bought it because it was $50.00.

DrMR: Right. So, maybe a range there . . . I like the Platinum LED that I have, and they seem to have pretty good power behind their unit. I have a unit that’s about three or three-and-a-half feet tall. I know they have ones that are maybe as small as a tissue box. Is that a general range between those two device sizes that, a proximal target we can paint for people?

Small Versus Large Red Light Therapy Devices

DrAW: So, there’s some complexity here with the small devices versus the much larger devices. There are devices that are full-body units, six feet tall, head to toe. And it’s important to understand, there are two layers here that need to be understood. One is a local effect on specific tissues of your body. So, if you’re shining a light specifically on your face for anti-aging skin effects on your face, and maybe you’re using a small device that’s just a face-size unit. It’s 10 inches tall, and you just want it on your face. So, there’s a time that’s optimal for treating those specific tissues.

Simultaneous to that, there’s also a total energy or total amount of light delivered to the entire body. Those are two things that we need to consider. And this is why I started with the simplest variation. But, again, these two things to consider are, there is an optimal dose for treating any specific area of your body, or specific tissue. So, let’s say you did a leg workout at the gym, and you want to use the light on your quadriceps. On specifically that part of your body, there’s an optimal dose of light delivered to those quadricep muscles to amplify the benefits of that exercise, speed up recovery, increase strength, muscle mass, fat loss, etc.

At the same time, we also need to consider, especially as we get into these much larger devices that are blasting our whole body all at once, that the total amount of light delivered to our entire body can be orders of magnitude greater.

It can be 10 times greater with a larger light than with a smaller light. That is something to consider because, again, this is a hormetic stressor. So, going back to the CrossFit versus the pinky curls, you need to consider the total demand being placed on the body, especially when you’re getting into these much larger lights, that you want to be much more mindful of not doing a long session.

Now, if you have a small, weak device, you could literally use that on your body for hours every day, and never get to a point where you would experience any sort of side effects. But if you’re using a super large, really powerful device, especially from a close distance to your body, you probably don’t want to go beyond about 20 minutes or so. And if you do, there’s a significant portion of people, we don’t have good data on it, but my estimates are somewhere between five to maybe 15% of people who will, and it’s usually people who are sicker, who will have negative side effects. So, they’ll feel fatigued from that treatment.

In some rare cases, like people with severe chronic fatigue syndrome, they might even feel wiped out for two days from it. Like a super intense exercise session would do to them.

DrMR: Quick question there. And it’s a great point. I’m glad you made it. Is it fair to say that people will develop a tolerance over time? Is it just like exercise, you may not want to start someone with a 45-minute intense workout like CrossFit, but they would be able to recover from that if they build up to it slowly?

DrAW: Exactly.


Red Light Therapy Tolerance

Key Takeaways

[Back to Top]

  • Most people will tolerate well
  • Hyper-responders may experience mild symptoms of fatigue, small subset of the population
  • Non-responders – will see no benefit, small subset of the population
  • Gradually increase your dose over time, just like a new exercise plan

DrMR: kay. So, someone will be able to gradually tolerate more without a negative impact over time, most likely?

DrAW: 100%. So, it’s a principle that applies to exercise. It applies to, for example, sauna exposure. People who have very poor heat tolerance who might only be able to tolerate three minutes in a sauna, initially, if they do it slowly and systematically over time, and as they improve their health, they might, within a few months, be able to tolerate 45 minutes in that same sauna without any negative side effects.

So, the same exact principle is at play with red light therapy. Just as you wouldn’t take a sedentary person and say, “Hey, go run a marathon,” or, “Go bench press 300 pounds,” doing that from being sedentary to jumping straight into that is a really horrible idea. But if you build up to that slowly over time, then you absolutely can eventually do it, yes. By building up slowly over time, you’re getting benefits along the way. Same principle with red light therapy.

DrMR: I just want to second that. When I first started doing this, I had three, full-body Joovv lights going, and I was doing that for 20 minutes every day. After a week or two, I crashed. I think I was doing way too much. I was also probably burning the candle at both ends, at that point, so my hormetic stress load was probably more than my body could recover from. So, again, just reminding people that more doesn’t always equal better.

I see the same thing in the clinic with fasting. It does seem that people can tolerate longer fasts if they work up to it. But just like you couldn’t go right into running 10 miles if you’ve never ran, we want to work our way up on these things. So, for the audience, I know you’re excited, potentially, to use a red light, but go small and steady so that you don’t have the crash that, idiotically, I did because I was so excited.

I went right to the deep end of the pool, and then I felt really tired for about a week before I got back.

DrAW: Yes, 100%. So, anybody who’s sick, especially who is in poor health currently, better to start with like two or three minutes as your initial dose. Then, if you have no negative effects from that, then you build up. But I’ve seen everything from people who, in the most severe, rare of cases, people who do a minute and report feeling fatigued or having headaches, or something like that afterward, to people who can literally do it for hours. I don’t recommend doing that, but I’ve seen people do it for hours every day without experiencing any negative side effects. So, there’s a big range here.

Three Categories of Responders to Red Light Therapy

I talked about this in my interview with one of the world’s top researchers on this subject, Dr. Michael Hamblin, and he talks about three categories of people. There are non-responders, there are hyper-responders, and then there’s people in the middle who are responders. A small subset of people, probably one or two percent of people, seem to not respond to red light therapy at all. There’s no detectable effect.

There’s also hyper-responders, people who are hypersensitive to this, that require much lower treatment times and are much more susceptible to negative side effects. And then there’s the vast majority of people, probably well over 80% of people, that are not going to be prone to any negative side effects, that are going to get the benefits.

There’s a real big margin for error. It’s not something that is easy to overdo. Much less so than exercise. Exercise is much easier to overdo and get into negative side effects than red light therapy is.

DrMR: Right. Really good cautions for people. So, is it fair to say that there’s, globally speaking here, maybe big picture and painting with a broad brush, there are maybe two ways people can apply this? They can go closer to and more targeted for a specific tissue effect, let’s say thyroid, so you’re going to have it close to your throat. And then if people are looking for more of a total-body mitochondrial impact, they’re perhaps a little bit farther away. And because they’re farther away, they can have a little bit longer treatment time. Is that a general guide we can put out there for people? Would you modify that?


Treating Deeper Tissues with Red Light Therapy

DrAW: I would mostly agree with that. I would say a better way of thinking about it would be if you want to treat deeper tissues, so if you want to treat muscles, fat tissue, tendons, bones, internal organs, things like that, brain tissue maybe more so than anything, because the light has to penetrate through the skull, and that’s probably the hardest thing for light to do, is to penetrate through bone, and then get through that to deliver light to the brain. But any sort of deeper tissue, you want the light to be closer to you. That amplifies the amount of light being delivered.

To be clear, the intensity of the light and the total amount of light actually penetrating into your body is much greater the closer the light is to you. And you want to do longer treatment times because a lot of the light is being absorbed in the surface layers. And so, if you’re trying to treat the deeper tissues, you need close proximity to the light, and you need deeper penetration and longer treatment times to deliver enough of a dose of light to those deep tissues.

Whereas, if you’re using it for skin anti-aging purposes, especially if you’re using a powerful light, you might want to go further away from that light, something like a foot away to 24, even 36 inches away, if you have a real big, powerful light.

And you can do skin anti-aging treatments across the entire front or the entire back of your body all at once from that further distance away. And it might be only a five-minute session, whereas if you’re treating the deeper tissues, you might do something like a 15 or 20-minute session.

DrMR: I had one question on that one. This is something a patient recently asked me, and I didn’t actually have a good answer. They said, “Well, I don’t care as much about my skin, but I’m trying to boost collagen underneath my skin.” And I was assuming you’d go just a touch closer. But is there that much of a delineation between skin effect and collagen effect?

DrAW: No. I would just say that person’s confused. So, to positively affect your skin is to boost collagen synthesis. They’re basically one and the same. There is no skin anti-aging effect without the boosting of collagen synthesis.

DrMR: That makes sense, for sure.

DrAW: That’s really where the skin anti-aging effect comes from. So, they’re the same thing. But I guess it’s possible if someone saying, “I don’t care about my skin, but I want to boost the deeper layers of collagen,” as we have collagen throughout our body. I guess if they’re saying that….

DrMR: Well, my presumption was, it’s the collagen production that will reduce the wrinkles that’s going to give the anti-aging effect.

DrAW: Exactly.

DrMR: I wasn’t sure. And unless I know for sure, I try not to stick my neck too far out there.

DrAW: You’re absolutely correct.


Is Red Light Therapy Safe for Eyes?

DrMR: What about eye exposure? Do we need to wear eyewear? Is some exposure to the eyes beneficial?

DrAW: It’s actually a controversial subject.

DrMR: I was assuming it was.

DrAW: Yeah, because there’s such variation in the dosing parameters. We have everything from studies showing extremely beneficial effects of red and near-infrared light therapy on eye health, to people selling red and near-infrared light therapy devices with protective goggles, like you’re supposed to cover up your eyes to prevent the light from getting in there because it could be damaging. Just that whole spectrum is pretty confusing, right? So, one hand, we got research showing it’s beneficial. And the other, people are warning you not to get any in your eyes because they’re saying it could be damaging.

Here’s what it amounts to. The eyes are a fragile, sensitive tissue, and the optimal range for the proper dose is probably a much narrower range for eyes as it is compared to, let’s say, if you’re just shining it on your back, or your muscles, or something like that. So, in other words, it’s probably easier to exceed the optimal dose of what would benefit your eyes, and then get into something that’s harmful. Just as if you over-exercise, you can get tissue damage. You can get overtraining, or you can drop dead from a heart attack while running a marathon. There are consequences to overdoing the dose of anything, and the same is true of red light therapy.

In general, the possibility of doing that is much lower than with something like exercise or using a sauna. Meaning, you’re much less likely to experience side effects. But in certain fragile tissues, maybe that’s a possibility. And I’ll tell you what I do. So, in the absence of very clear data saying, “Hey, here’s the exact research saying how long to use this exact device on your eyes for benefits without getting any harm,” in the absence of that data, here’s my reading of the literature and what I do.

My opinion is, it’s beneficial for eye health. As long as you don’t do a crazy high dose of super-powerful lights blaring into your eyes for half an hour or 45 minutes, nonstop, from a close distance, you’re almost certainly going to experience benefits without harm.

So, I have my eyes open. I don’t mind five, 10, or 15 minutes of the light getting into my eyes at all. And, if anything, my eyesight has improved in the last several years. In other words, I’m not afraid of any negative effects on that front, and I believe that it’s only benefitting my eye health.

DrMR: Got you. I had a sense, just because looking at the sun on the horizon, I think it’s called sun gazing, is controversial, I had a feeling that same controversy would exist here.

DrAW: Yeah. There’s one more nuance to that that I want to mention, which is, there is actually literature on, for example, welders who are using welding equipment and then creating this super high-intensity light and infrared source. And it’s not just pure near-infrared. It’s not really analogous to these red and near-infrared light therapy devices. But there’s a lot of far-infrared, and it’s at an intensity that is extremely high. If you do that for hours a day, there absolutely is evidence that harms eye health. So, just as with anything, the context, the specific dosing parameters, and the details of the wavelengths, all of that stuff matters. And just as it’s possible to cause harm from over-exercise, it’s also possible to cause harm from too much infrared light at too high of intensity for too many hours every day.

DrMR: Makes sense. Makes sense. And then, one of the final questions I want to ask here is, how long should someone be looking to reevaluate if this is helping them? I’m assuming it’s not a highly expeditious response, like a day or two. I’m assuming it’s probably at least a few weeks to know the initial response. But what would you tell people in terms of, what’s the patient window that you have to wait through before reevaluating?


Duration of Red Light Therapy

Key Takeaways

[Back to Top]

How long to notice impact

  • Can take a few days (pain, recovery) to several weeks (hair, skin, fat loss)

DrAW: Good question. It actually depends on what specific outcome you’re looking at. So, some things, you can actually have an almost immediate effect, or within a day or two. I’ll give you an example. Pain relief is one context in which you can have an almost immediate effect. So, if you have knee pain and you use it on your knee, after about half an hour you can get pain relief for many, many hours, or maybe even up to a day. And it’s very noticeable, pretty much immediately.

If you’re using it for something like, let’s say, hair regrowth, like you’re trying to regrow your hairline or something like that, that’s obviously a process that occurs over months, and it’s not something you can notice from one day to the next. So, basically, my point is, there are some outcomes which it’s possible to notice a fairly immediate effect. Other outcomes are physiological processes that take place over weeks and months.

One other example I can give is recovery from exercise. So, if you normally do a certain workout and you get a certain degree of soreness, and it takes you 48-hours or 72-hours before all that muscle soreness goes away, you might do a 20-minute red light session after your workout and notice that your soreness went away in 24-hours, or the amount of soreness that you experienced was cut in half of what it normally would be. So, those are typical things that someone might notice.

DrMR: Okay. That’s good to know. I think we picked that pretty clean.


Episode Wrap-Up

Key Takeaways

DrAW: Yeah. Well, I feel like we’ve delved so much into the nuances of dosing parameters and the details that it might leave people confused. So, I just want to quickly summarize some of the key takeaways for dosing to simplify this and make it less intimidating for people. So, get one of these devices. If you get one of the recommended devices, Platinum, Red Therapy Co, Joovv, they all make good devices that are similar power outputs. There’s some difference in pricing between the different companies. But outside of price, honestly, they’re mostly using the same wavelengths. They have similar light outputs. There are small differences between them.

If you get one of those lights, the basic principle of what you should do is, once every day, or every other day, sit in front of the light, or stand in front of the light, or lay next to the light, flip it on in the areas you want to treat. So, if you want to heal some tissues on your body, if you have tendonitis, or joint pain, or arthritis, if you want to do anti-aging on your face, you want to amplify the benefits of exercise and use it on the muscles that you just worked out in the gym, any one of those 15 other benefits that I listed off, you want to use it on that certain part of your body, just flip the light on, stand next to it, or sit next to it, or lay next to it, and keep that light somewhere between six to 24 inches away. If you’re trying to treat deeper tissues, you want it closer. If you’re trying to do skin anti-aging, you want it further away.

Then, basically, all you need to do is just have that light shining on that area of your body for somewhere between about five to 25 minutes. So, that’s the big picture, how simple this can be. Yes, there are a lot of nuances. We could talk for an hour about all the details and nuances of treating this versus that, and big light versus small light, and all the optimal dosing parameters. But the basic idea is, just set the light up, turn it on, sit next to it for five to 25 minutes.

DrMR: Love it. Love it. And then people can work up from there. If you go too aggressive, you may notice a little bit of a negative effect. But generally speaking, pretty safe. Just go slow and steady. Don’t overcomplicate it. Look to your body’s biofeedback. Don’t read too much on the internet and spin yourself into a tizzy with every detail. Try to set up this experiment in such a way that you can read the signal from your body. And listen to your own body. I would imagine people could very easily get thrown off with what they read.

And, obviously, do your research and look into some of the background here beyond this, if you desire to. But be careful not to let what everyone else is saying throw you off of listening to your body’s own biofeedback. Because that’s, in my experience, been one of the best things. As in this case. I was reading about all the great stuff, I overdid it, and then I got slapped by my body because I didn’t follow the very simple adage of go slow and steady.

So, listen to your body. Some phenomenal advice from you here, Ari, and really just an overall fantastic conversation. Do you want to point people anywhere? I know we were just talking offline you released a new mitochondrial supplement, which I’m actually looking forward to trying. Tell people a little bit about that, and anything else you want to point them to regarding your website, or other resources that you want to point out.

DrAW: Thank you for asking. So, my website is called The Energy Blueprint. It’s all about helping people overcome fatigue and massively increase their physical energy levels. And there’s a lot of things we offer. We have The Full Energy Blueprint Program. I have a sleep and Circadian Rhythm Optimization Program. That’s a key aspect to optimize for people looking to improve both their sleep and their energy levels.

I’m super excited about this new custom supplement that I’ve just come out with that’s been in the works for a year-and-a-half now. It’s called Energenesis, and it’s a mitochondrial optimization formula.

This is really an energy supplement that is different from all the typical “energy supplements” on the market. Most energy supplements are really just stimulants, and caffeine, and sugar, oftentimes. And they’re meant to give you a quick, instant jolt of energy for a few hours.

But the problem is, stimulants and caffeine, while they give you that quick jolt, they’re not doing anything to benefit your long-term energy. And, if anything, they’re actually worsening your long-term energy. So, this is a different kind of energy supplement altogether. It’s not meant to give you an instant jolt from stimulants. It’s meant to give you a subtle benefit in terms of your energy immediately.

More importantly, it’s really meant to build long-term energy levels to build a high-energy body at the cellular level by boosting and building your mitochondria. So, it’s something that builds your energy over time, over the weeks and months that you take it, rather than, “Hey, here’s a quick hit of caffeine and stimulants.” And the feedback on it has been amazing so far. We sold out of our first batch several months ago, and I just have testimonials rolling in for this stuff every day. People are just loving it, so I’m super excited about that. Again, that’s called Energenesis.

DrMR: Sweet. Well, I’ll be looking forward to trying mine. Ari, thank you again for demystifying this topic. It’s really something I’m encouraging people to experiment with, because I do feel that this has been something that’s really helped me. There’s a little bit of a learning curve like I said. But I’m not outside as much as I’d like to be, and this seems to be, as we discussed, a way of supplementing that exposure to light that we’re not getting. So, I encourage you, if you haven’t tried it out yet, to cautiously give a trial to red light therapy and see what kind of benefits it may hold in store for you. Ari, thank you so much for being here today. It was a really fantastic conversation.

DrAW: Thank you so much for having me. It’s really always a pleasure to talk with you.

References
  1.  2010 Aug;42(6):589-96. doi: 10.1002/lsm.20941.
  2. https://link.springer.com/article/10.1007/s10103-012-1129-9
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