# Bohr effect

Category: Metabolism

Carbon dioxide (or acidity) displaces oxygen from hemoglobin.

9 passages · 3 authors · 2006–2021 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/bohr-effect

## Synthesis

The **Bohr effect** describes the phenomenon whereby **carbon dioxide** (or acidity) displaces oxygen from hemoglobin, facilitating its delivery to tissues. [Source 9] Peat argued that this principle, first elucidated by Christian Bohr in 1903, is not limited to hemoglobin but is a *general effect applying to proteins throughout the body*. [Source 3, 5] When carbon dioxide binds to amino groups on proteins, it changes their conformation and isoelectric point, making them less accessible to oxygen and thereby protecting against oxidative damage. [Source 3] This stands in contrast to the conventional medical view that treats carbon dioxide merely as a waste product; Peat considered it a fundamental stabilizer of cellular structure and function. [Source 7]

The Bohr effect is intrinsically linked to the **Haldane effect**, which states that high oxygen pressure displaces carbon dioxide from hemoglobin. [Source 9] Peat emphasized that these two effects describe a reciprocal destabilization of binding, meaning that breathing pure oxygen or hyperventilating causes a rapid loss of carbon dioxide, paradoxically leading to tissue hypoxia despite high blood oxygen saturation. [Source 4, 6] Dinkov has elaborated on this clinical misinterpretation, noting that a recently deceased person can have 100% oxygen saturation precisely because the oxygen is no longer being released to tissues in the absence of carbon dioxide. [Source 6] This reciprocal relationship explains why *lactic acid* production increases when carbon dioxide is deficient; the resulting alkalosis from carbon dioxide loss provokes a compensatory shift toward lactate, which itself suppresses respiration and increases capillary leakiness. [Source 4, 8]

Peat extended the significance of the Bohr effect to explain the health benefits observed at high altitude. At altitude, lower atmospheric oxygen pressure allows the body to retain more carbon dioxide, which through the Bohr effect ensures efficient oxygen delivery to tissues and suppresses the formation of lactic acid, a phenomenon known as the **lactate paradox**. [Source 5, 9] This retention of carbon dioxide makes cellular respiration more efficient and is credited with the lower incidence of degenerative conditions such as cancer, heart disease, and cataracts seen in high-altitude populations. [Source 1, 4] Peat noted that wounds heal faster at altitude and that studies involving tens of thousands of patients showed a negative correlation between altitude and cataract incidence, an effect powerful enough to override the increased ultraviolet radiation exposure. [Source 1, 2]

At the cellular level, Peat situated the Bohr effect within a broader critique of membrane physiology, arguing that the whole substance of the cell, particularly its structural proteins, is involved in life processes. [Source 1, 2] The loss of carbon dioxide and a shift toward lactic acid production increases the electrical charge on structural proteins, causing them to separate and absorb water in a *swelling pathology* that characterizes conditions from cataracts to heart failure. [Source 2, 9] Roddy has summarized this bioenergetic view by noting that carbon dioxide, produced by properly respiring cells, essentially "breathes oxygen into us," and that its stabilizing role dampens the activation of stress systems. [Source 5, 7] Peat maintained that stress, shock, inflammation, and organ failure are, in important ways, respiratory problems rooted in the disruption of the carbon dioxide equilibrium described by the Bohr effect. [Source 4, 9]

## People also ask

### How does the Bohr effect protect proteins from oxidative damage?

Peat argued that when carbon dioxide binds to amino groups on proteins, it changes their conformation and isoelectric point, making them less accessible to oxygen and thereby protecting against oxidative damage.

### Why can breathing pure oxygen paradoxically cause tissue hypoxia?

Peat emphasized that high oxygen pressure displaces carbon dioxide from hemoglobin via the Haldane effect, and the resulting loss of carbon dioxide prevents oxygen from being released to tissues despite high blood oxygen saturation.

### What role does the Bohr effect play in the health benefits of high altitude?

Peat explained that lower atmospheric oxygen at altitude allows the body to retain more carbon dioxide, which through the Bohr effect ensures efficient oxygen delivery to tissues and suppresses lactic acid formation, correlating with lower rates of degenerative conditions.

## Related concepts

- [Haldane effect](https://bioenergeticoracle.com/md/concepts/haldane-effect/index.md)
- [Lactate paradox](https://bioenergeticoracle.com/md/concepts/lactate-paradox/index.md)
- [Cori Cycle](https://bioenergeticoracle.com/md/concepts/cori-cycle/index.md)
- [Acidosis](https://bioenergeticoracle.com/md/concepts/acidosis/index.md)
- [Benign Prostatic Hyperplasia (BPH)](https://bioenergeticoracle.com/md/concepts/benign-prostatic-hyperplasia-bph/index.md)
- [Cataracts](https://bioenergeticoracle.com/md/concepts/cataracts/index.md)

## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — The Transparency of Life

Ray Peat · Newsletter · 2006

> When cells metabolize, they create gradients. In the cell, electrical, chemical, osmotic, and thermal gradients, for example, are constantly being produced or maintained. The whole substance of the cell is involved in its life processes. Because of prejudices introduced 200 years ago, the life of the cell has been relegated to its “membrane” (where hypothetical “membrane pumps” reside) and its nucleus. When the term “cell” (hollow space) came into use instead of “corpuscle” (little body), a mind-set came into existence that discounted the importance of most of the living material, and claimed that it was a mere “random solution.” Random solutions don't do much. The wonderful “membrane,” under the direction of the nucleus (and its set of instructions), took care of everything.
>
> Whenever assimilation or excretion took place, it was explained by inventing a property possessed by the cell “membranes.” Therefore, we have physiology textbooks that have an unfounded explanation for everything. Before Copernicus, planetary movements were described as arbitrary “epicycles.” They didn't make sense, but people studied them and felt that they were important. “Membrane physiology” is the modern equivalent of the Ptolemaic epicycles.
>
> We know that glucose can be metabolized into pyruvic acid, which, in the presence of oxygen, can be metabolized into carbon dioxide. Without oxygen, pyruvic acid can be converted into lactic acid. The production of lactic acid tends to increase the pH inside the cell, and its excretion can lower the pH outside the cell.
>
> The decrease of carbon dioxide that generally accompanies increased lactic acid, corresponds to increased intracellular pH. Carbon dioxide binds to many types of protein, for example by forming carbamino groups, changing the protein conformation, as well as its electrical properties, such as its isoelectric point. With increased pH, cell proteins become more strongly ionized, tending to separate, allowing water to enter the spaces, in the same way a gel swells in an alkaline solution.
>
> The Bohr-Haldane effect describes the fact that hemoglobin releases oxygen in the presence of carbon dioxide, and releases carbon dioxide in the presence of oxygen. When oxygen is too abundant, it makes breathing more difficult, and one of its effects is to cause carbon dioxide to be lost rapidly.

### Source 2 — The Transparency of Life

Ray Peat · Newsletter · 2006

> The Bohr-Haldane effect describes the fact that hemoglobin releases oxygen in the presence of carbon dioxide, and releases carbon dioxide in the presence of oxygen. When oxygen is too abundant, it makes breathing more difficult, and one of its effects is to cause carbon dioxide to be lost rapidly. At high altitude, more carbon dioxide is retained, and this makes cellular respiration more efficient.
>
> The importance of carbon dioxide to cell control process, and to the structure of the cell and the structure of proteins in general suggested that degenerative diseases would be less common at high altitude. Wounds and broken bones heal faster at high altitude, but the available statistics are especially impressive in two of the major degenerative conditions, cancer and cataracts.
>
> The two biggest studies of altitude and cataracts (involving 12,217 patients in one study, and 30,565 lifelong residents in a national survey in Nepal) showed a negative correlation between altitude and the incidence of cataract. At high altitude, cataracts appeared at a later age. In Nepal, an increase of a few thousand feet in elevation decreased the incidence of cataracts by 2.7 times. At the same time, it was found that exposure to sunlight increased the incidence of cataracts, and since the intensity of ultraviolet radiation is increased with altitude, this makes the decreased incidence of cataracts even more important.
>
> All of the typical causes of cataracts, aging, poisons, and radiation, decrease the formation of carbon dioxide, and tend to increase the formation of lactic acid. Lactic acid excess is typically found in eyes with cataracts.
>
> The electrical charge on the structural proteins will tend to increase in the presence of lactic acid or the deficiency of carbon dioxide, and the increase of charge will tend to increase the absorption of water.
>
> The lens can survive for a considerable length of time *in vitro* (since it has its own circulatory system), so it has been possible to demonstrate that changes in the composition of the fluid can cause opacities to form, or to disappear.
>
> Oxidants, including hydrogen peroxide which occurs naturally in the aqueous humor, can cause opacities to form quickly, but they will also disappear quickly in a solution that restores metabolic energy. The lens regulates itself powerfully; for example, it will swell when put into a hypotonic solution, but will quickly adapt, returning to approximately its normal size.

### Source 3 — Ask the Herb Doctor: Altitude (July 2013)

Ray Peat · Interview · 2013

> **Ray Peat:** But a few people who have tested other proteins find that That's a general effect. The Haldane-Bohr effect applies to proteins in general. When there's a lot of carbon dioxide, it basically changes the pH or the isoelectric point of the protein, making it less accessible to oxygen. And that in itself is a protection against the attack of oxygen against proteins. But more than that, the particular group that carbon dioxide sticks to on a protein, such as hemoglobin, is an amino group.

### Source 4 — Altitude and Mortality

Ray Peat · Article · 2006 · https://raypeat.com/articles/aging/altitude-mortality.shtml

> People who live at very high altitudes live significantly longer; they have a lower incidence of cancer (Weinberg, et al., 1987) and heart disease (Mortimer, et al., 1977), and other degenerative conditions, than people who live near sea level. As I have written earlier, I think the lower energy transfer from cosmic radiation is likely to be a factor in their longevity, but several kinds of evidence indicate that it is the lower oxygen pressure itself that makes the biggest contribution to their longevity.
>
> “Mountain sickness” is a potentially deadly condition that develops in some people when they ascend too rapidly to a high altitude. Edema of the lungs and brain can develop rapidly, leading to convulsions and death. The standard drug for preventing it is acetazolamide, which inhibits carbonic anhydrase and causes carbon dioxide to be retained, creating a slight tendency toward acidosis. This treatment probably mimics the retention of carbon dioxide that occurs naturally in altitude adapted people.
>
> The reasons for mountain sickness, and the reasons for the low incidence of heart disease, cancer, cataracts, etc., at high altitude, offer clues to the prevention of death and deterioration from many other causes.
>
> When the weather in a particular place is cool, sunny and dry (which in itself is very good for the health) the atmospheric pressure usually is higher than average. Although sunny dry weather is healthful, periods of higher pressure correspond to an increased incidence of death from heart disease and strokes.
>
> The Haldane-Bohr effect describes the fact that oxygen and carbon dioxide destabilize each other’s binding to hemoglobin. When oxygen pressure is high, the blood releases its carbon dioxide more easily. In stormy weather, or at high altitude, the lower oxygen pressure allows the body to retain more carbon dioxide. Carbon dioxide, produced in the cells, releases oxygen into the tissues, relaxes blood vessels, prevents edema, eliminates ammonia, and increases the efficiency of oxidative metabolism.
>
> Hyperventilation, breathing excessively and causing too much carbon dioxide to be lost, is similar to being in the presence of too much oxygen; it’s similar to being at low altitude with high atmospheric pressure, only worse. Therefore, the physiological events produced by hyperventilation can give us an insight into what happens when the atmospheric pressure is low, by looking at the events in reverse.

### Source 5 — Hair Like a Fox: A Bioenergetic View of Pattern Hair Loss

Danny Roddy · Book · 2013

> This process occurs in two phases: the anaerobic phase and the aerobic phase. In the anaerobic phase (without oxygen), glucose (6 carbon atoms) is broken down into two pyruvate molecules (2 carbon atoms each) in the cell’s cytoplasm. In the aerobic phase (with oxygen), the two pyruvate molecules generated in the anaerobic phase are decarboxylated (carbon dioxide removed) and have lipoic acid molecules attached to them yielding two molecules of acetyl-CoA. The acetyl-CoA molecules then enter the Krebs cycle in the mitochondria, producing small amounts of energy before realizing the complete oxidation of glucose in the electron transport chain, where almost all the energy that could possibly be derived from glucose is derived. Cells without oxygen convert pyruvate to lactate, rather than acetyl-CoA, generating small amounts of energy in the process and allowing glycolysis to continue to ‘run’ in the absence of oxygen. This inefficient process, called glycolysis (or fermentation), not only generates many times less energy than oxidative metabolism does, but is also inflammatory. Lactate activates many mediators of inflammation, which are also incidentally involved in the genesis of baldness; in stark contrast, lactate does not accumulate during mitochondrial respiration but is instead removed from the blood.1 Mitochondrial respiration is approximately 93 percent more efficient than fermentation2 as far as energy is concerned; however, the advantage of the former process hinges largely on the “waste product” carbon dioxide. Carbon dioxide allows cells, tissues, and organs to better absorb oxygen, essentially “breathing oxygen into us.” The Danish physician Christian Bohr is credited for elucidating the details of this finding, showing in 1903 that carbon dioxide, produced by properly respiring cells, caused hemoglobin molecules (the proteins on which red blood cells bind and transport molecular oxygen) to release their oxygen atoms, increasing the availability of oxygen to cells (i.e., the Bohr effect). In this respect, carbon dioxide and lactate share an inverse relationship, evidenced by the fact that lactate levels are no higher during bouts of exertion as a person acclimates to a higher altitude, where oxygen levels are lower than they are at sea level. This phenomenon is called the lactate paradox.

### Source 6 — Episode 7: Georgi Dinkov (Haidut) on Carbon Dioxide (CO2) and Testosterone

Georgi Dinkov · Interview · Jun 12, 2020 · https://www.youtube.com/watch?v=ztzIGcwMu3M

> **Georgi Dinkov:** First, how fast your pulse is, and second, what is the saturation of hemoglobin with oxygen. Medicine says, the lower the oxygen saturation in the blood is, they take that as a sign that you are in a state of hypoxia, that is, you lack oxygen. And immediately they give you a mask and begin to make you breathe pure oxygen. But in the vast majority of cases, the condition of these patients who are given medical oxygen does not improve. Why? Because in medicine, and every doctor studies this in medical university before even becoming a doctor, there is the so-called Bohr effect, named after a Danish physician who was the brother of the famous physicist Bohr. And the Bohr effect says that the affinity of hemoglobin for oxygen decreases in the presence of carbon dioxide. That is, what does this mean? When you breathe air that contains oxygen, this oxygen, passing through the lungs and alveoli, binds to the hemoglobin in the blood and begins to circulate around the body. But the bond between oxygen and hemoglobin is quite strong. And this well-oxygenated blood, circulating around the body, this is not enough for the oxygen to be given to the tissues, because the tissues need the oxygen, not the blood itself. Blood is simply a transport mechanism. And now, if you do not produce enough carbon dioxide in your tissues, this means that the bond between hemoglobin and oxygen will remain strong, and this blood will continue to circulate in your body and will not be able to deliver oxygen to the tissues; it will remain bound to hemoglobin. And on paper, or with this little device, you may have 100% oxygen saturation, and the doctors will applaud and say, wow, great, this is getting fixed and so on, while in fact you are in a state of extremely bad hypoxia. The extreme example that is given for this is, if you measure the oxygen affinity, the oxygen saturation of the blood of a recently dead person, it will be 100%.

### Source 7 — Ep. 99 Interview Danny Roddy: The Wisdom of Ray Peat, and How Elevation Will Help You Live Longer

Danny Roddy · Interview · Nov 24, 2021 · https://www.youtube.com/watch?v=W7F-rIgoHd8

> **Danny Roddy:** Yeah, so I think that ties back to thyroid hormone. Thyroid is the hormone of respiration that's stimulating the consumption of oxygen and glucose to make carbon dioxide, water, and ATP. And then the carbon dioxide is often thought of as a waste product. But I think in Ray's whole point of view, and then also what Christian Bohr pointed out, via the Bohr effect, that the carbon dioxide dissociates oxygen from hemoglobin, better allowing cells, tissues, and organs to absorb it. and i think that's happening after adaptation uh when you get to high altitude so your body can is has more carbon dioxide and it stimulates cellular respiration and the consumption of oxygen and it just makes the system run a lot smoother and i think that whole process dampens the need for the activation of the stress systems And it gets to, have you ever heard Ray talk about carb amino groups on proteins and stuff? It gets really granular, an area I think only maybe Ray or Georgi could get into, talking about how it reinforces the proteins and the adsorb water on cells and things like that. It's like a basic stabilizing factor like progesterone or thyroid. And I guess the more of it you're exposed to during your lifetime, the healthier you'll be or the more resistant to stress you'll be. and to be honest with you living here for a few years like i couldn't tell you oh it does x y and z to me but i i think there i do have a lot of good days in mexico whereas when i would travel to japan or go to thailand or go to malaysia or go wherever i think there were some like kind of like down days and i just like barely ever feel like that here and so maybe the carbon dioxide is just um i don't know making me slightly more resistant to stress or depression or whatever.

### Source 8 — This Novel Flu Season

Ray Peat · Newsletter · 2020

> The causes of relative hyperventilation continue to be disputed.
>
> The basic principles of respiration, the Bohr and Haldane effects, describe the physical equilibria of oxygen and CO2 in people who have adapted to living at different altitudes. The Haldane effect describes the fact that increased oxygen pressure decreases the amount of carbon dioxide retained by hemoglobin, and decreased oxygen pressure increases the amount of CO2 retained. A steady increase of retained CO2 with increasing altitude occurs in those who adapt. People who fail to adapt experience a loss of CO2, with an increase of lactate. It has become increasingly common to treat altitude sickness with carbon dioxide. A few people have argued for a long time that mechanical ventilation would be less harmful if a mixture of CO2 and O2 were used (Laffey and Kavanagh, 1999; Kregenow and Swenson, 2002), analogously to the therapeutic effect of CO2 in high altitude sickness (Harvey, et al., 1988).
>
> In a state of chronic stress, oxidative energy production is low, and mediators of inflammation are likely to be chronically increased; there is typically a chronically increased production of lactate, and/or decreased oxidation of it. In this state, the increased ventilation caused by high altitude will cause an increased loss of carbon dioxide, increasing the pH of the blood, which increases the formation of lactic acid. The lactate increases the leakiness of capillaries and loss of fluid, and decreases the ability of oxygen to diffuse from the alveolus to the erythrocyte. Since carbon dioxide diffuses many times more rapidly than oxygen, this diffusion barrier results in low blood CO2 at the same time as hypoxia. Even at sea level, an increase of lactate immediately increases the lungs’ diffusion barrier.
>
> Thinking of the infection as the disease, and therefore considering the “receptor,” “entry,” and replication of the virus to be sufficient to explain damage to infected cells, tissues, and organs, and defining the disease as an inflammation of the respiratory tree and lung, the hospital system went into action. Failing to think of the intestine (which is infected as easily as the nose and lungs), the meaning of events throughout the organism, including the lungs, is misunderstood.

### Source 9 — Altitude and Mortality

Ray Peat · Article · 2006 · https://raypeat.com/articles/aging/altitude-mortality.shtml

> # Altitude and Mortality
>
> Breathing pure oxygen lowers the oxygen content of tissues; breathing rarefied air, or air with carbon dioxide, oxygenates and energizes the tissues; if this seems upside down, it's because medical physiology has been taught upside down. And respiratory physiology holds the key to the special functions of all the organs, and to many of their basic pathological changes.
>
> Stress, shock, inflammation, aging, and organ failure are, in important ways, respiratory problems.
>
> ## Definitions
>
> - **Haldane effect**: Oxygen displaces carbon dioxide from hemoglobin, in proportion to its partial (specific) pressure.
> - **Bohr effect**: Carbon dioxide (or acidity) displaces oxygen from hemoglobin.
> - **Lactic acidemia**: The presence of lactic acid in the blood.
> - **Alkalosis**: A pH of the blood above 7.4.
> - **Acidosis**: A blood pH below 7.4.
> - **Lactate paradox**: The reduced production of lactic acid at a given work rate at high altitude. Muscle work efficiency may be 50% greater at high altitude. ATP wastage is decreased.
>
> There are some popular medical ideas that obstruct clear thinking about respiration. One is that high altitude deprives you of oxygen, and is likely to be bad for people with heart disease and cancer. Another is that breathing pure oxygen helps sick people to oxygenate their tissues while exerting less effort in breathing. These are both exactly wrong, and the errors have been explored in quite a few publications, but the ideas persist in the culture to such a degree that our perceptions and intuitions have been misled, making closely related things seem to be unrelated.
>
> In this culture, it is hard to see that heart disease, cancer, and cataracts all involve a crucial respiratory defect, with the production of too much lactic acid and too little carbon dioxide, which leads to a “swelling pathology”: A pathological retention of water. The swollen heart beats poorly, the swollen lens turns milky, other cells divide rapidly as a result of swelling.
>
> People who live at very high altitudes live significantly longer; they have a lower incidence of cancer (Weinberg, et al., 1987) and heart disease (Mortimer, et al., 1977), and other degenerative conditions, than people who live near sea level.

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