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Bohr Effect: Healthy vs. Sick People

Bohr effect (medical or scientific explanation is below)

“All chronic pain, suffering and diseases are caused
from a lack of oxygen at the cell level."

Prof. A.C. Guyton, MD, The Textbook of Medical Physiology*

* World’s most widely used medical textbook of any kind
* World's best-selling physiology book

The Bohr effect explains cells oxygen release or why red blood cells unload oxygen in tissues, while carbon dioxide (CO2) is the key player in O2 transport due to vasodilation and the Bohr effect (or Bohr law).  The Bohr effect was first described in 1904 by the Danish physiologist Christian Bohr (father of famous physicist Niels Bohr).

What is Bohr effect in simple terms?

Bohr effect in healthy people

The Bohr effect is a normal process in healthy people since healthy people have normal breathing at rest and normal arterial CO2 levels. How does the Bohr effect work? As we know, oxygen is transported in blood by hemoglobin cells. How do these red blood cells know where to release more oxygen and where less? Or why do they unload more oxygen at all? Why is O2 released in tissues? The hemoglobin cells sense higher concentrations of CO2 in tissues and release oxygen in such places.

 Bohr effect explained: How CO2 helps to release O2

Bohr effect summary. More oxygen is released in those tissues that have higher absolute and/or relative CO2 values. Note that this is true for healthy people who have normal breathing pattern.

Suppressed Bohr effect in people with chronic diseases

Can people with chronic diseases enjoy the normal Bohr effect and normal oxygen delivery to the brain, heart and all other vital organs? Consider these medical studies.

Minute ventilation rates (chronic diseases)

Condition Minute
Number of
All references or
click below for abstracts
Normal breathing 6 L/min - Medical textbooks
Healthy Subjects 6-7 L/min >400 Results of 14 studies
Heart disease 15 (±4) L/min 22 Dimopoulou et al, 2001
Heart disease 16 (±2) L/min 11 Johnson et al, 2000
Heart disease 12 (±3) L/min 132 Fanfulla et al, 1998
Heart disease 15 (±4) L/min 55 Clark et al, 1997
Heart disease 13 (±4) L/min 15 Banning et al, 1995
Heart disease 15 (±4) L/min 88 Clark et al, 1995
Heart disease  14 (±2) L/min 30 Buller et al, 1990
Heart disease 16 (±6) L/min 20 Elborn et al, 1990
Pulm hypertension 12 (±2) L/min 11 D'Alonzo et al, 1987
Cancer 12 (±2) L/min 40 Travers et al, 2008
Diabetes 12-17 L/min 26 Bottini et al, 2003
Diabetes 15 (±2) L/min 45 Tantucci et al, 2001
Diabetes 12 (±2) L/min 8 Mancini et al, 1999
Diabetes 10-20 L/min 28 Tantucci et al, 1997
Diabetes 13 (±2) L/min 20 Tantucci et al, 1996
Asthma 13 (±2) L/min 16 Chalupa et al, 2004
Asthma 15 L/min 8 Johnson et al, 1995
Asthma 14 (±6) L/min 39 Bowler et al, 1998
Asthma 13 (±4) L/min 17 Kassabian et al, 1982
Asthma 12 L/min 101 McFadden, Lyons, 1968
Sleep apnea 15 (±3) L/min 20 Radwan et al, 2001
Liver cirrhosis 11-18 L/min 24 Epstein et al, 1998
Hyperthyroidism 15 (±1) L/min 42 Kahaly, 1998
Cystic fibrosis 15 L/min 15 Fauroux et al, 2006
Cystic fibrosis 10 L/min 11 Browning et al, 1990
Cystic fibrosis* 10 L/min 10 Ward et al, 1999
CF and diabetes* 10 L/min 7 Ward et al, 1999
Cystic fibrosis 16 L/min 7 Dodd et al, 2006
Cystic fibrosis 18 L/min 9 McKone et al, 2005
Cystic fibrosis* 13 (±2) L/min 10 Bell et al, 1996
Cystic fibrosis 11-14 L/min 6 Tepper et al, 1983
Epilepsy 13 L/min 12 Esquivel et al, 1991
CHV 13 (±2) L/min 134 Han et al, 1997
Panic disorder 12 (±5) L/min 12 Pain et al, 1991
Bipolar disorder 11 (±2) L/min 16 MacKinnon et al, 2007
Dystrophia myotonica 16 (±4) L/min 12 Clague et al, 1994

Note that advanced stages of some conditions (e.g., asthma and CF) can lead to lung destruction,
ventilation-perfusion mismatch and arterial hypercapnia causing further reduction in body oxygen levels.

Overbreathing or hyperventilation in the sick causes hypocapnia or reduced CO2 tension in the lungs and arterial blood (since ventilation-perfusion mismatch is not a common finding in the sick). This leads to hampered oxygen release and reduced cells oxygen tension due to the suppressed Bohr effect (Aarnoudse et al, 1981; Monday & Tétreault, 1980; Gottstein et al, 1976).

Suppressed Bohr effect in the sick due to low CO2Hence, for the suppressed Bohr effect, the absolute CO2 concentration is low (see the picture of the right side), and O2 molecules are stuck with red blood cells. (Scientists call this effect “increased oxygen affinity to hemoglobin”). Hence, CO2 deficiency (hypocapnia) leads to hypoxia or decreased cell-oxygen levels (the suppressed Bohr effect). The more we breathe at rest, the less the amount of available oxygen in the cells of vital organs, like the brain, heart, liver, kidneys, etc.

Many people believe that breathing more air increases oxygen content in cells. This is not true. Generally, breathing more even reduces oxygen content even in the arterial blood. Indeed, hemoglobin cells in normal blood for very small normal breathing are about 98% saturated with O2. When we hyperventilate this number is about the same (in real life it gets less since most people make a transition to automatic costal or chest breathing that reduces arterial blood O2 levels), but without CO2 and the Bohr effect, this oxygen is tightly bound with red blood cells and cannot get into the tissues in required amounts. Hence, now we know one of the causes why heavy breathing reduces the cell-oxygen level of all vital organs.

The Bohr effect is crucial for our survival. Why? During each moment of our lives, some organs and tissues work harder and produce more CO2. These additional CO2 concentrations are sensed by the hemoglobin cells and cause them to release more O2 in those places where it is most required. This is a smart self-regulating mechanism for efficient cells oxygen transport.

Bohr effect (medical or scientific explanation)

Bohr effect curvesChristian Bohr stated that at lower pH (more acidic environment, e.g., in tissues), hemoglobin would bind to oxygen with less affinity. Since carbon dioxide is in direct equilibrium with the concentration of protons in the blood, increasing blood carbon dioxide content, according to the Bohr effect, causes a decrease in pH, which leads to a decrease in affinity for oxygen by hemoglobin (and easier oxygen release in capillaries or tissues).

The description of the Bohr effect, which is a physiological law, can be found in nearly all physiological textbooks. Modern studies related to the Bohr effect are devoted to more advanced topics (see the titles of studies for modern research below). It is the central proposition of the Bohr effect that oxygen affinity to hemoglobin depends on absolute CO2 concentrations and reduced CO2 values decrease oxygen delivery to body cells.

Bohr effect and physical exercise

Bohr effect during exerciseFor example, without the Bohr effect, we could not walk or run for even 3-5 minutes. Why? In normal conditions, due to the Bohr effect, more O2 is released in those muscles, which generate more CO2. Hence, these muscles can continue to work with the same high rate.

However, sick people have reduced CO2 blood values. Hence, they are likely to experience symptoms of chronic fatigue, and poor results for physical fitness tests due to tissue hypoxia (low cell-oxygen levels).

Professor Henderson about Bohr effect

This is what Professor Henderson from the Yale University wrote about the Bohr effect,

"But even as early as 1885, Miescher (Swiss physiologist) inspired by the insight of genius wrote: "Over the O2 supply of the body, CO2 spreads its protecting wings" Yandell Henderson (1873-1944), in Henderson Y, Carbon dioxide, in Cyclopedia of Medicine, ed. by H.H. Young, Philadelphia, FA Davis, 1940.

Here is YouTube video that considers the Bohr effect and explains the mechanism why overbreathing decreases cell-oxygen level.

Get flash player to play to this file

Another web page related to oxygen transport and cell oxygenation: Vasodilation (expansion of arteries and arterioles due to higher CO2 values) or why breathing less improves perfusion or blood flow to all vital organs.

You can read medical research abstract devoted to the Bohr effect and role of CO2 in cells O2 delivery.

Click here for references used on this page.

Back to Effects of carbon dioxide on human health
* Illustrations by Victor Lunn-Rockliffe

Reference pages: Breathing norms and the DIY body oxygen test:
- Breathing norms: Parameters, graph, and description of the normal breathing pattern
- Body-oxygen test (CP test) : How to measure your own breathing and body oxygenation (two in one) using a simple DIY test

References: pages about CO2 effect:
- Vasodilation: CO2 expands arteries and arterioles facilitating perfusion (or blood supply) to all vital organs
- The Bohr effect: How and why oxygen is released by red blood cells in body tissues
- Nerve stabilization: Carbon dioxide has powerful calmative and sedative effects on brain neurons and nerve cells

Or go back to Diseases

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