Far Infrared and NIR Infrared Heat Lamp/LED Therapy is NOT Red Light therapy!
Far infrared saunas that use carbon and ceramic heating elements AND NIR infrared saunas that use near and middle infrared heat lamps are both therapeutic thermal healing modalities that are good for circulation, detox, muscle stiffness and more. A common confusion is that red light therapy should also have some thermal effect or that combining heat and red light together is somehow advantageous like in red / nir heat lamps OR combining far infrared saunas with red light therapy panels. This appendix will dispell that myth and show - along with information in chapter 11 - that red and near infrared light therapy which is LED photobiomodulation therapy (from 600-1100nm), is non-thermal and non-heating. In fact you DO NOT want to combine heat and red light therapy for many reasons we outline in chapter 11. Sauna or heat therapy is great but it is not the same as red light or photobiomodulation therapy (also called LLLT = low level light therapy).
Should you feel heat during red light therapy?
People tend to think they should feel something while doing red light therapy. The irony is if you feel warmth or heat that is actually NOT a good thing (again for many reasons we outlined in chapter 11). Typically the benefits of red light therapy happen AFTER a session like decreased pain, improved energy, better sleep; and over time things like better skin, weight loss and more.
Most photobiomodulation studies report that the patients typically doesn't feel anything at all with a properly designed clinical PBM study using low power lasers or LEDs. Since the definitions of Red Light therapy, LLLT and PBM are clearly non-thermal according to every authority in the field, then typically barely any warmth should be expected. Feeling rapid heating is a sign the device is too powerful and hasn't been clinically studied for LLLT/PBM!
One article tells us the official medical definitions for LLLT and PBM:
"Low-level light therapy (LLLT) is defined as “Treatment using irradiation with light of low power intensity so that the effects are a response to the light and not due to heat. A variety of light sources, especially low-power lasers are used.” in the Medical Subject Headings (MeSH) Descriptor Data 2017.
Photobiomodulation (PBM) therapy is “A form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical (i.e., linear and nonlinear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and pro-motion of wound healing and tissue regeneration.” as a defined in Anders et al. [1]. Keywords here in these official definitions are "not due to heat" and "it is a nonthermal process"
Based on these broad definitions, you can use a wide range of wavelengths and light sources to do LLLT/PBM. It is very easy to meet this criteria, the only thing you can't do - is heating. Many high intensity devices causing radiant heat are no longer considered true LLLT/PBM.
Heat Therapy like far and near infrared saunas and heat lamps/LEDs is hopefully now clearly different from Red Light Therapy. It has different mechanisms, different dosing, and different safety considerations. If Red Light Therapy was meant to be a form of heat therapy, it would be called something like Red Heat Therapy. The near infrared heat lamps used in some saunas is a form of infrared heat therapy, but note that they aren't called NIR Light Lamps because their main mechanism is heating so we call them NIR heat lamps. See the difference?
People tend to think they should feel something while doing red light therapy. The irony is if you feel warmth or heat that is actually NOT a good thing (again for many reasons we outlined in chapter 11). Typically the benefits of red light therapy happen AFTER a session like decreased pain, improved energy, better sleep; and over time things like better skin, weight loss and more.
Most photobiomodulation studies report that the patients typically doesn't feel anything at all with a properly designed clinical PBM study using low power lasers or LEDs. Since the definitions of Red Light therapy, LLLT and PBM are clearly non-thermal according to every authority in the field, then typically barely any warmth should be expected. Feeling rapid heating is a sign the device is too powerful and hasn't been clinically studied for LLLT/PBM!
One article tells us the official medical definitions for LLLT and PBM:
"Low-level light therapy (LLLT) is defined as “Treatment using irradiation with light of low power intensity so that the effects are a response to the light and not due to heat. A variety of light sources, especially low-power lasers are used.” in the Medical Subject Headings (MeSH) Descriptor Data 2017.
Photobiomodulation (PBM) therapy is “A form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical (i.e., linear and nonlinear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and pro-motion of wound healing and tissue regeneration.” as a defined in Anders et al. [1]. Keywords here in these official definitions are "not due to heat" and "it is a nonthermal process"
Based on these broad definitions, you can use a wide range of wavelengths and light sources to do LLLT/PBM. It is very easy to meet this criteria, the only thing you can't do - is heating. Many high intensity devices causing radiant heat are no longer considered true LLLT/PBM.
Heat Therapy like far and near infrared saunas and heat lamps/LEDs is hopefully now clearly different from Red Light Therapy. It has different mechanisms, different dosing, and different safety considerations. If Red Light Therapy was meant to be a form of heat therapy, it would be called something like Red Heat Therapy. The near infrared heat lamps used in some saunas is a form of infrared heat therapy, but note that they aren't called NIR Light Lamps because their main mechanism is heating so we call them NIR heat lamps. See the difference?
Expert Michael Hamblin on PBM is nonthermal and non-heating
Dr. Hamblin also writes in one article:
"PBM generally uses red (620–700 nm) and/or near-infrared (780–1270 nm) wavelengths of light at an intensity that causes no tissue heating, and its activity is based on well-established biological and cellular mechanisms." [2]
And Then in Another:
"By now everybody will accept that PBMT using red or NIR radiation (or indeed blue and green wavelengths) can produce biological effects by a photochemical mechanism as opposed to a photothermal mechanism." [4]
These definitions shows the core of the problem with many LED bed and LED panel companies with their marketing especially. The intensity of the red and near infrared light must be low enough to not cause tissue heating (photochemical NOT photothermal) to meet the criteria of being PBM therapy according leading researcher Dr. Hamblin. Dr. Hamblin and many other published studies have noted that using low intensities/irradiances that don't cause tissue heating is a main point of doing proper PBM therapy which of course includes red and near infrared light therapy.
In an article by Dr. Barolet, Dr. Christians, and Dr. Hamblin, they note the following criteria to help avoid excessive heating (and thus meeting the definition for PBM):
"Lower irradiance (<50mW/cm2) is less likely to induce skin hyperthermia leading to potential deleterious effects." [3] This quote tells us that high intensity will lead to the photons being converted into heat. Thus, not contributing to the Joules/cm^2 for proper dosing of red light therapy. The energy (Joules) calculation only works for Photochemical reactions and not for Photothermal reactions.
Dr. Hamblin also writes in one article:
"PBM generally uses red (620–700 nm) and/or near-infrared (780–1270 nm) wavelengths of light at an intensity that causes no tissue heating, and its activity is based on well-established biological and cellular mechanisms." [2]
And Then in Another:
"By now everybody will accept that PBMT using red or NIR radiation (or indeed blue and green wavelengths) can produce biological effects by a photochemical mechanism as opposed to a photothermal mechanism." [4]
These definitions shows the core of the problem with many LED bed and LED panel companies with their marketing especially. The intensity of the red and near infrared light must be low enough to not cause tissue heating (photochemical NOT photothermal) to meet the criteria of being PBM therapy according leading researcher Dr. Hamblin. Dr. Hamblin and many other published studies have noted that using low intensities/irradiances that don't cause tissue heating is a main point of doing proper PBM therapy which of course includes red and near infrared light therapy.
In an article by Dr. Barolet, Dr. Christians, and Dr. Hamblin, they note the following criteria to help avoid excessive heating (and thus meeting the definition for PBM):
"Lower irradiance (<50mW/cm2) is less likely to induce skin hyperthermia leading to potential deleterious effects." [3] This quote tells us that high intensity will lead to the photons being converted into heat. Thus, not contributing to the Joules/cm^2 for proper dosing of red light therapy. The energy (Joules) calculation only works for Photochemical reactions and not for Photothermal reactions.
NASA - NO HEAT
Lets now take a look at a couple of quotes describing the NASA LED therapy in published peer-reviewed literature.
"NASA developed LEDs to offer an effective alternative to lasers. These diodes can be configured to produce multiple wavelengths, can be arranged in large, flat arrays (allowing treatment of large wounds), and produce no heat. It is also of importance to note that LED light therapy has been deemed a nonsignificant risk by the FDA; thus, FDA approval for the use of LEDs in humans for light therapy has been obtained." [5]
The NASA LED therapy is described as producing no heat. As well we can see that non-heating LEDs are non-significant risk by the FDA.
Lets now take a look at a couple of quotes describing the NASA LED therapy in published peer-reviewed literature.
"NASA developed LEDs to offer an effective alternative to lasers. These diodes can be configured to produce multiple wavelengths, can be arranged in large, flat arrays (allowing treatment of large wounds), and produce no heat. It is also of importance to note that LED light therapy has been deemed a nonsignificant risk by the FDA; thus, FDA approval for the use of LEDs in humans for light therapy has been obtained." [5]
The NASA LED therapy is described as producing no heat. As well we can see that non-heating LEDs are non-significant risk by the FDA.
FDA - No Heat
The FDA recently issued guidelines for their definition of LLLT/PBM and criteria for device applications and approvals (see link below):
https://www.fda.gov/regulatory-information/search-fda-guidance-documents/photobiomodulation-pbm-devices-premarket-notification-510k-submissions
In both the Introduction and Background section the FDA clearly notes that LLLT/PBM is non-thermal.
Introduction:
"The device is designed to deliver a non-heating dose of light energy into the body to provide clinical benefit to the patient."
(pg 5, FDA draft guidance for PBM, Jan 12, 2023)
Background:
"For the purpose of this guidance, the term “photobiomodulation” is defined as the application of light at an irradiance that does not induce heating with the goal of altering biological activity."
(pg 6, FDA draft guidance for PBM, Jan 12, 2023).
So this is just further proof that having low power, low intensity, or low irradiance (aka low power density, mW/cm^2) is the primary factor to make sure there is no heating for true LLLT/PBM. But to be clear you do need ENOUGH power to be therapeutic (remember our sweet spot of 27-35 mW/cm^2 based on Nature and clinical research.
High intensity devices that create too much heat are the enemy of true medical grade LLLT/PBM, despite the paradoxical marketing that everyone needs the "highest intensity" device to be effective.
The FDA recently issued guidelines for their definition of LLLT/PBM and criteria for device applications and approvals (see link below):
https://www.fda.gov/regulatory-information/search-fda-guidance-documents/photobiomodulation-pbm-devices-premarket-notification-510k-submissions
In both the Introduction and Background section the FDA clearly notes that LLLT/PBM is non-thermal.
Introduction:
"The device is designed to deliver a non-heating dose of light energy into the body to provide clinical benefit to the patient."
(pg 5, FDA draft guidance for PBM, Jan 12, 2023)
Background:
"For the purpose of this guidance, the term “photobiomodulation” is defined as the application of light at an irradiance that does not induce heating with the goal of altering biological activity."
(pg 6, FDA draft guidance for PBM, Jan 12, 2023).
So this is just further proof that having low power, low intensity, or low irradiance (aka low power density, mW/cm^2) is the primary factor to make sure there is no heating for true LLLT/PBM. But to be clear you do need ENOUGH power to be therapeutic (remember our sweet spot of 27-35 mW/cm^2 based on Nature and clinical research.
High intensity devices that create too much heat are the enemy of true medical grade LLLT/PBM, despite the paradoxical marketing that everyone needs the "highest intensity" device to be effective.
Conclusion
The purpose of this brief appendix is 2-fold. First to show that Red light therapy is Phototherapy or Light therapy not Heat therapy or Sauna therapy. And secondly that using heat in conjunction with red light therapy OR using too much power as to create heat is detrimental to the benefits that red light therapy provides. Our advice: if you want heat therapy get a good sauna, but if you want true research back red light therapy get a full body red light panel with irradiances around 27-35 mW/cm^2. Anything more than that and you end up with counterproductive and even inhibitory heating effects!
The purpose of this brief appendix is 2-fold. First to show that Red light therapy is Phototherapy or Light therapy not Heat therapy or Sauna therapy. And secondly that using heat in conjunction with red light therapy OR using too much power as to create heat is detrimental to the benefits that red light therapy provides. Our advice: if you want heat therapy get a good sauna, but if you want true research back red light therapy get a full body red light panel with irradiances around 27-35 mW/cm^2. Anything more than that and you end up with counterproductive and even inhibitory heating effects!
[1] Amaroli, Andrea et al. “Improving Consistency of Photobiomodulation Therapy: A Novel Flat-Top Beam Hand-Piece versus Standard Gaussian Probes on Mitochondrial Activity.” International journal of molecular sciences vol. 22,15 7788. 21 Jul. 2021, doi:10.3390/ijms22157788
[2] Hamblin MR. Transcranial photobiomodulation for the brain: a wide range of clinical applications. Neural Regen Res. 2024 Mar;19(3):483-484. doi: 10.4103/1673-5374.380891. PMID: 37721264; PMCID: PMC10581558.
[3] Barolet, Daniel et al. “Infrared and skin: Friend or foe.” Journal of photochemistry and photobiology. B, Biology vol. 155 (2016): 78-85. doi:10.1016/j.jphotobiol.2015.12.014
[4] Hamblin MR. Molecular and Cellular Mechanisms of Water-Filtered IR. 2022 May 6. In: Vaupel P, editor. Water-filtered Infrared A (wIRA) Irradiation: From Research to Clinical Settings [Internet]. Cham (CH): Springer; 2022. Chapter 23. Available from: https://www.ncbi.nlm.nih.gov/books/NBK593483/ doi: 10.1007/978-3-030-92880-3_23
[5] Whelan HT, Smits RL Jr, Buchman EV, Whelan NT, Turner SG, Margolis DA, Cevenini V, Stinson H, Ignatius R, Martin T, Cwiklinski J, Philippi AF, Graf WR, Hodgson B, Gould L, Kane M, Chen G, Caviness J. Effect of NASA light-emitting diode irradiation on wound healing. J Clin Laser Med Surg. 2001 Dec;19(6):305-14. doi: 10.1089/104454701753342758. PMID: 11776448.
[2] Hamblin MR. Transcranial photobiomodulation for the brain: a wide range of clinical applications. Neural Regen Res. 2024 Mar;19(3):483-484. doi: 10.4103/1673-5374.380891. PMID: 37721264; PMCID: PMC10581558.
[3] Barolet, Daniel et al. “Infrared and skin: Friend or foe.” Journal of photochemistry and photobiology. B, Biology vol. 155 (2016): 78-85. doi:10.1016/j.jphotobiol.2015.12.014
[4] Hamblin MR. Molecular and Cellular Mechanisms of Water-Filtered IR. 2022 May 6. In: Vaupel P, editor. Water-filtered Infrared A (wIRA) Irradiation: From Research to Clinical Settings [Internet]. Cham (CH): Springer; 2022. Chapter 23. Available from: https://www.ncbi.nlm.nih.gov/books/NBK593483/ doi: 10.1007/978-3-030-92880-3_23
[5] Whelan HT, Smits RL Jr, Buchman EV, Whelan NT, Turner SG, Margolis DA, Cevenini V, Stinson H, Ignatius R, Martin T, Cwiklinski J, Philippi AF, Graf WR, Hodgson B, Gould L, Kane M, Chen G, Caviness J. Effect of NASA light-emitting diode irradiation on wound healing. J Clin Laser Med Surg. 2001 Dec;19(6):305-14. doi: 10.1089/104454701753342758. PMID: 11776448.
Photobiomodulation (which replaced LLLT in 2015)
(which is a photochemical NOT photothermal therapy).
Most people nowadays are familiar with laser therapy and even low level laser therapy LLLT, but probably have not heard of photobiomodulation (PBM). The name was changed back in 2015. First, it turns out you don't need a laser, as there is nothing really magical about laser beams. Since the vast proliferation of LEDs, researchers realized that there is nothing special about a laser, and LEDs - especially full body LED panels or beds - work just as good or BETTER because of the ability to use higher total power over a larger area of the body.
The other issue with the name LLLT is "low level", which is not well defined and it is a relative term. And finally because some of the applications do NOT involve stimulation, they involve inhibition, like inhibiting pain signals for example. So "modulation" is a much more apropos term which we'll explore in detail through this book. But in PBM, research still uses low level lasers, LEDs are fast surpassing lasers as the device of choice in research studies, mainly because of their affordability, and ability to cover a much larger area for healing then lasers which are frankly too focused and localized for many conditions. Though they will always have a place for lasers for spot treatments of all sorts and laser acupuncture.
As we'll see, because near infrared and red light therapy work with the body's innate biological wisdom to create balance and homeostasis, photobiomodulation (PBM) is a perfectly chosen word. The reason I use the term "red light therapy" throughout this book is that it has become the more common and popular moniker, but know when I use the term red light therapy I interchange it with photobiomodulation providing it is understood it is photobiomodulation from 600-1100 nm.
Because research is shifting to PBM in this appendix we'll use this terminology to emphasize that PBM/ red light therapy is a non-thermal photochemical effect on the cells to create ATP, NO and a whole host of benefits that improve our healthy and biology. It is more akin to photosynthesis in plants which is also a nonthermal interaction of light to create energy in plants in the form of ATP.
(which is a photochemical NOT photothermal therapy).
Most people nowadays are familiar with laser therapy and even low level laser therapy LLLT, but probably have not heard of photobiomodulation (PBM). The name was changed back in 2015. First, it turns out you don't need a laser, as there is nothing really magical about laser beams. Since the vast proliferation of LEDs, researchers realized that there is nothing special about a laser, and LEDs - especially full body LED panels or beds - work just as good or BETTER because of the ability to use higher total power over a larger area of the body.
The other issue with the name LLLT is "low level", which is not well defined and it is a relative term. And finally because some of the applications do NOT involve stimulation, they involve inhibition, like inhibiting pain signals for example. So "modulation" is a much more apropos term which we'll explore in detail through this book. But in PBM, research still uses low level lasers, LEDs are fast surpassing lasers as the device of choice in research studies, mainly because of their affordability, and ability to cover a much larger area for healing then lasers which are frankly too focused and localized for many conditions. Though they will always have a place for lasers for spot treatments of all sorts and laser acupuncture.
As we'll see, because near infrared and red light therapy work with the body's innate biological wisdom to create balance and homeostasis, photobiomodulation (PBM) is a perfectly chosen word. The reason I use the term "red light therapy" throughout this book is that it has become the more common and popular moniker, but know when I use the term red light therapy I interchange it with photobiomodulation providing it is understood it is photobiomodulation from 600-1100 nm.
Because research is shifting to PBM in this appendix we'll use this terminology to emphasize that PBM/ red light therapy is a non-thermal photochemical effect on the cells to create ATP, NO and a whole host of benefits that improve our healthy and biology. It is more akin to photosynthesis in plants which is also a nonthermal interaction of light to create energy in plants in the form of ATP.
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