Pangaea Clinic of Naturopathic Medicine
interventional natural medicine for rapid, lasting health
Pangaea Clinic of Naturopathic Medicine
#120 - 12011 Second Ave
Richmond, BC
V7E 3L6
(604) 275 - 0163
(604) 677 - 5910 (fax)
drchan@pannaturopathic.com
drward@pannaturopathic.com
The information presented within this web site is solely for education. It is copyrighted and protected as intellectual property. As all physicians have their unique opinions, this information is not to be taken as the opinion of any association or regulatory body.  This website is not a substitute for personalized care by Dr Eric Chan or Dr Tawnya Ward; liability is excluded for misuse.
Articles for your browsing. These are past newsletters emailed to our patients and also responses for requests for information. If you have a specific topic you'd like a comment on, please email us.


The Oxygen and Oxidative Therapies: broad utility in treating chronic degenerative disease and in anti-aging. (Ozone, ultraviolet blood irradiation, hydrogen peroxide IV)

Lately, a few patients have noticed that others in the IV room are getting an interesting treatment whereby their own blood is being re-infused after treatment with ozone gas.  Inevitably, the interest of seeing a patient’s own blood, instead of the B-vitamin rich yellow fluids most people see, sparks conversation.  The patient getting the ozone treatment, called major autohemotherapy, then proceeds to explain how after the first treatment, energy and mood started to improve noticeably, and then further into the course of 6-10 treatments the chief complaint (usually of recurrent infections, fatigue, muscle/joint pain, or allergies) improves.   Inevitably though, the mechanisms of the treatment aren’t always explained by the patient because they don’t understand it themselves completely. 

Therefore, this newsletter will give an abbreviated description of the mechanism in the manner that I describe to patients.  With the mechanism, the diseases and complaints treated then become easily apparent.  If you want more detail, the second part of this newsletter is a translation from the German (this therapy is widely used in Germany) of a patient pamphlet on ozone therapy.  For the detail-minded, the third section, written by a vet, goes into the reactions and substrates that ozone stimulates in the body.

In medicine, the paradigm has always been extremely linear.  The doctor makes a diagnosis based on symptoms and history, and then for each individual diagnosis there is an individual drug.  In naturopathic medicine, this linear method is important but it must be supported with non-linear thinking and treatments.  Basically, the non-linear components are cellular nutrition and cellular detoxification. If a cell has all the resources it needs, and is not impeded by toxins, healing can be greatly expedited.  Advanced, aggressive, interventional naturopathic treatments such as ozone treatments of the blood (cellular nutrition and detoxification) combined with chelation therapy (cellular detoxification) make an amazing treatment for chronic diseases; and when combined with diet and exercise, there is no better anti-aging program.

The reason why the oxygen/oxidative therapies (ozone) and chelation have always been so controversial (even more controversial than the fact that vitamins and minerals might be useful in treating non-deficiency related diseases!) is that they don’t fit into the linear paradigm.  In other words, while they are the crown-jewels of healing for many doctors, they are just too good and their use is too broad to be received by conventional medicine.  Even chelation therapy is subject to the same limitations, as the $30 million dollar study by the National Institutes of Health is limited to a subset of cardiovascular patients, those who have already had heart attacks, even though its’ use is so much more broad.  Ozone falls into the same category, but more so.  Instead of just detoxifying cells, as chelation does, ozone also provides the most important nutritional component to cells, energy: ozone stimulates and restores cellular energy production. 

In fact, almost all chronic diseases have the common factor of decreased mitochondrial energy production.  Even the aging process itself has been shown to have this single problem at the cellular level.  When a patient receives a chelation treatment, they detoxify heavy metals that block energy production pathways.  When a patient receives an ozone treatment, they stimulate the energy producing pathways of the cells.  The combination has a remarkable healing process on many diseases; however the most clinically remarkable effect involve two groups of diseases: 1) diseases improved by better delivery and utilization of oxygen: hypoglycemia, diabetes, fatigue and 2) diseases with an aberrant immune system component: chronic fatigue syndrome/fibromyalgia, allergies, auto-immune disease/arthritis, supportive care in cancer, and recurrent infections.  The most likely reason for these two improvements involve the types of cells that we treat when we give ozone to the blood and then reinfuse the blood.

Our blood is made of two types of cells which include the red blood cells and the white blood cells.  The first group of diseases always improves when we improve our metabolism and the efficiency with which we combine our food substrates with oxygen to make energy.  For example, when we metabolize sugar, if we run at 100% efficiency each molecule of sugar will generate 38 units of energy.  This occurs when that molecule of sugar goes through a series of reactions and then ultimately reacts with oxygen.  If that molecule of sugar does not react with oxygen but instead inefficiently ferments, then we get 2 units of energy only.  The initial result is that the cells must burn much more sugar in order to get the same out put of energy – the result is hypoglycemia and/or fatigue.  When this energy production becomes even more inefficient then the result is diabetes.  Thus when we give ozone treatments (through the mechanisms described below) this energy production is restored to a better efficiency and hypoglycemic attacks disappear, fatigue is replaced with energy.

The second group of diseases improves from ozone’s effects on the white blood cells.  The white blood cells in the blood make up an important part of the immune system.  A researcher out of Italy, Dr Bocci, has shown that ozone treatments of the blood in the form of major autohemotherapy increase remarkably two chemicals called interferon gamma and tumor necrosis factor alpha.  These chemicals are called cytokines and are specifically responsible for a rebalancing and stimulation of the immune system.  This effect is most remarkable in pain and fatigue associated with a deranged immune system; the effect is even more amazing in cases of auto-immune type arthritis.  In cancer, it is a useful adjunctive therapy to keep the patient strong during chemotherapy and radiation and also to help the immune system to fight the cancer. 

With these effects on these two types of cells alone, ozone treatments would definitely fall into the realm of the most important medical treatments available.  When combined with an aggressive detoxification program (chelation), the anti-aging effects are incredible.  It is unfortunate that the linear paradigm of having one diagnosis, and then one drug for that single diagnosis is so unyielding that therapies with multiple utilities immediately are discounted. Nonetheless, as a treatment for my patients, it works remarkably well.

Below, once again, is first a FAQ from the Ozone Society in Germany, followed by more detailed scientific explanations of ozone’s mechanism with diagrams.   If you have more questions, or am curious as to whether or not ozone treatments may be for you, please don’t hesitate to call the office or email Dr Eric Chan at drchan@pannaturopathic.com or  Dr Tawnya Ward at drward@pannaturopathic.com .

Eric Chan, ND

INFORMATION FOR PATIENTS

The Medical Society for Ozone Application in Prevention and Therapy has published informaiton brochures for patients in both English and German, which can be ordered at any time.

OZONE THERAPY

What a patient must know*

*printed with the friendly permission of U. Gutzen and R. Viebahn-Hänsler.

Medical society for Ozone Application in Prevention and Therapy
[Ärztliche Gessellschaft für Ozon-Anwendung in Prävention und Therapie]


CONTENTS

1.WHAT IS OZONE?

2.WHAT IS OZONE THERAPY?

3.IN WHAT DISEASES IS OZONE THERAPY USEFULLY APPLIED?

4.WHAT SHOULD THE PATIENT KNOW?

5.OZONE FINGERPRINT

6.OZONE THERAPY – A QUICK SURVEY

7.WHERE CAN A PATIENT OBTAIN INFORMATION?

1.WHAT IS OZONE (O3)?

Basic information

Ozone is a chemical compound consisting of three oxygen atoms O3 (ie triatomic oxygen), a highly energetic form of normal (diatomic) atmospheric oxygen (O2).  Thus, the molecules of these two forms are different in structure, ie:

Oxygen Formula: O2        O----O

Ozone Formula: O3            + O –
                                            /    \
                                         O      O

At room temperature, O3 is a colourless gas with a characteristic odour (eg after thunderstorms, at high altitudes or near the sea etc).  Its name is from the Greek ozein meaning “to smell”, and it was discovered in 1840 by the German chemist Christian Friedrich Schönbein (1799-1868).  Closer to ground level it can occur in the form of smog at concentrations of 1 part O3 per 10 million parts air (=0.1 ppm = 200 μg/m3); at a height of 2,000 metres (or 6,561.6 feet), however, it is much less, as a rule only 0.03 – 0.04 ppm.
Due to its being an extremely powerful oxidizing agent and a highly effective disinfectant, it is used throughout the world to destroy germs in water treatment installations supplying drinking water.

2.WHAT IS OZONE THERAPY?

Ozone as a therapeutic

Medical ozone is always a mixture of purest ozone and purest oxygen (see under Medical ozone in Section 5 below).
According to its application, the ozone concentration can vary between 1 and 100 μg/ml (0.05 – 5% O3).  The ozone therapist, a trained physician, determines the complete dosage according to the medical indicaiton and the patient’s condition.


Properties and effect

Medical ozone has highly pronounced bactericidal, fungicidal and virostatic properties, and is thus widely used in disinfecting infected wounds, as well as in bacterially and virally produced diseases.
Its ability to stimulate the circulation is used in the treatment of circulatory disorders and makes it valuable in revitalizing organic functions.
When administered at low concentrations, the organism’s own resistance is mobilized, ie ozone (re)activates the immune system.
As a response to this activation through ozone, the body’s immune cells produce special messengers called cytokins (including important mediators such as interferones or interleukins).  These inform other immune cells, setting off a cascade of positive changes throughout the immune system, which is stimulated to resist diseases



for example.  This means that the application of medical ozone is extremely useful for immune activation in patients with a low immune status and/or immune deficit.
Small quantities of ozone applied to what is called “major autohemotherapy” (external treatment of the patient’s blood before reinfusion) consequently activate the body’s own antioxidants and radical scavengers.
It is thus possible to understand why ozone is used in diseases which involve chronic inflammation.


Indications

Thanks to its selective properties, medical ozone is used in three principal fields of indication:

1.The treatment of circulatory disorders, also in the field of geriatrics, and
2.The treatment of diseases produced by viruses such as liver diseases (hepatitis) and herpes
3.The treatment of infected, badly healing wounds and inflammatory processes, such as for example
Open ulcers on the legs (ulcus cruris)
Inflammatory intestinal conditions (colitis, proctitis)
Burns, scalds and infected wounds, fungus infections and others

As an additive or complementary therapy in various types of cancer, ozone is applied for general immunoactivation at low


dosages in the form of “major autohemotherapy” (reinfusion) or “minor autohemotherapy” (reinjection) via the intramuscular route.


Forms of application

NOTE: In any form of ozone therapy, the breathing in of ozone gas is forbidden.

Many decades of experience and a number of recent clinical studies have shown that the following five application methods are valid for ozone:

1.Major autohemotherapy (treamtnent of a patient’s blood outside the body before reinfusion) in geriatics (age-related conditions?), for revitalization, in the treatment of circulatory disorders and virus-produced diseases, and for general immunoactivation.
By this method, 50 to 100 ml of the patient’s own blood is withdrawn in the normal manner, enriched externally with an exactly defined quantity of ozone (with disposable sterile material and containers!).  The ozone reacts completely 0 ie at a rate of 100% - with specific substances making up the red and white blood cells and thereby activates their vital activities = metabolism.  It is this activated blood (not ozone or oxygen!) that

is immediately reintroduced into the patient’s system using a normal drip unit.
2.using the same principle, minor autohemotherapy is an application, via the intramuscular route, of O3 treated blood for unspecific immunoactivation or revitalization: it can be used in allergic diseases or in a general way to improve the body’s inehrent resistance.
3.External treatment is primarily achieved through a closed system using O3 gas fed into special plastic “boots” (for the legs and feet) or bags, foils etc fitting various parts of the body.  These are of course made of ozone-resistant materials.  The parts of the body treated have previously been moistened with water, as ozone cannot act on dry areas.  This method is highly effective in treating ulcers, sores, open wounds, postoperative lesions, shingles (herpes) and infected areas etc.  other forms are ozonized pure water (eg in dental treatments) and ozonized pure medical olive oil (for skin eruptions such as eczemas and conditions involving molds, funguses and licens etc).
4.O3 gas application via the rectal route is not as inconvenient or unpleasant as it sounds (medically, it is called insufflation).  In fact, the patient feels absolutely nothing, as the

O3 gas is directly absorbed by the sensitive intestinal membranes; in addition, the specially designed disposable tube is lubricated, which makes the method totally hygienic – and practical, as a patient can apply it himself/herself.  This method is primarily indicated for inflammatory conditions of the intestinal tract, but is finding increasing use for general revitalization processes.
5.Injection of ozone into the joints (ie via the intraarticular route); as the term implies, ozone is carefully injected – by a trained specialist – in the treatment of inflammed and painful joints (arthritis, recurrent arthrosis, general pathalogical stiffness).

3.IN WHAT DISEASE IS OZONE
THERAPY USEFULLY
APPLIED?

A whole number of pathalogical conditions exist which can be influenced positively or even healed by ozone.  This is a fact which has been confirmed by a wide series of scientific investigations and medical publications.  As a rule, medical ozone is applied in addition to other therapeutic methods ie it belongs to the field of complementary medicine.
For all patients, men and women, to know about the latest developments in ozone therapy – and as quickly as possible – a large number of therapists (in Europe) got together and founded the (legally registered)

Medical Society for Ozone Application in Prevention and Therapy*, formerly called the Medical Society for Ozone Therapy**, with the aim of providing basic information to doctors/therapists and patients alike.  This important information exchange function has increased over the years.  As to how far your physician is able to inform and help you depends on the country you are in and the current status of medical ozone.  All should know, however, that medical ozone, when properly and responsibly handled (and the correct indication has been established), is safe, practical, effective and – as a preventative at least – low in cost.  Naturally, in spite of this, as with all other forms of medical treatment, no 100% guarantee can be given that ozone therapy will alleviate the condition it has been applied for.  Success will vary according to the patient’s state of health, the frequency of ozone treatment, the doses and concentrations applied, and a number of other factors.


Circulatory disorders

In this therpauetical category, ozone shows its greatest efficacy in arterial circulatory disorders characterized by a sensation of heaviness and coldness and/or pains in the legs, especially when walking.  In fact, patients affected are only able to cover relatively short distances (well known as smoker’s leg or intermittent claudication) – a signal of alarm.  In fact, this form of treatment has avoided amputations in a large number of clinically recorded cases.


Infected wounds

“Open leg” ulcers (ulcus cruris), bed sores (decubitus) and burns are successfully treated by ozone in practically all cases.  Clinical studies have shown that even very severe cases (eg gangrene, local necrosis) can obtain restoration.


Geriatric (age-related) conditions

Thanks to its general revitalizing capacity (including nerve and brain functions), ozone can be used successfully for poor concentration, forgetfulness, general reductions in mental and physical performance, insecurity in walking (balancing problems) and clinical dizziness or vertigo.  Elderly persons in particular experience an improvement in wellbeing and life quality.


Macular degeneration

O3 is also used to exert a positive influence on weak sight (decreasing visual acuity) due to age-related retinal detachment.


Intestinal conditions

Inflammatory conditions of the large (eg colitis) and small intestines, fistulas, and proctitis (inflammation of the rectum).  A local application of ozone gas introduced via insufflation provides rapid relief to many


such unpleasant and inconvenient conditions.


Virus-produced diseases

A series of clinical trials and pharmacological studies are able to demonstrate the good success rate of ozone treatment in painful, virus-produced conditions such as hepatitis and herpes.  The term of the disease is greatly shortened, healing is more efficient, and the patient is rapidly restored to his/her original wellbeing.


Rheumatism/arthritis


In the whole complex of “rheumatic/arthritic” conditions, all of which attak the skeletal and locomotory systems to a varying degree, ozone successfully causes pain and inflammation to subside.  Repeated treatment can even produce permanent restoration.


Cancer

In this context, it must be emphasized that ozone is not a curative, it is only a complementary measure applied in addition to standard methods.  Having said this, however, case histories have shown (over the last decades) that ozone can produce impressive results due to its function as an immunoactive agent.


4.WHAT SHOULD I KNOW AS A
PATIENT?

Before undergoing any form of ozone therapy, you should inform your doctor about any medical or special dietary measures you are taking or have been taking recently.  You should only discontinue a regimen of this kind if your doctor advises you to do so.  He or she should also know about allergies, inherited diseases or other complaints, and how they have been treated.
In many countries, especially outside Europe, ozone therapy is not always covered by health insurance policies or employers’ medical benefit schemes.  You should also try to find out where ozone units exist in your country, what trained specialists are available, and how much treatment costs.  Most ozone applications are in a series of up to 10 sessions, and a second or even third series may be necessary in some indications.  Nevertheless, you should always remember that a little prevention can save a much more expensive full-scale treatment later on.
Ozone therapy is low risk and usually applied as a complementary, additive or restorative method, ie in accompaniment of standard medical treatments.


5.OZONE FINGERPRINT

ozone is one of the most important gases in the stratosphere surrounding our planet (at a height of 10 – 50 kilometres/6-30 miles).  At a height of 20-30 kilometres (12-18 miles), its maximum concentration is 1 part O3 per 100,000 parts air (10 ppm) and thus


much greater than at ground level (0.03 – 0.04 ppm).


The ozonosphere

This protective layer of ozone acts as a filter against the otherwise highly destructive hard radiation in the form of ultraviolet (UV) energy coming from the sun, thus helping to maintain the biological balance on our planet Earth.


The ozone gap

Due to a complicated process caused by industrial gases (containing FCKW’s and other halogens), the O3 in our protective ozonosphere is cuased to break down.  As there is then not enough ozone to act as a filter, this cuases an increasing large gap through which UV rays (which are capable of causing skin cancer and influencing genetic processes) can penetrate without hindrance.


Smog alarm

However, much closer to the ground, as in large cities, ozone can be produced via waste or exhaust gases (eg from automobiles and factories) and the interaction of nitrogen oxid and sulfur oxides, and from oxygen through ultraviolet radiation.
As we are able to measure O3 very accurately, it is therefore used and quoted as an indicator for environmental pollution, though it does not cause it.

Maximum worksite concentration (MWC)

The maximum permissible worksite concentration (MWC) for ozone is 200 μg/m3 or 0.1 ppm, and must not be exceeded during an 8 hours’ working day and 40 hours per week, as ozone is capable of causing damage to the respiratory tract and mucous membranes.  Values vary from one country to another and are not always obligatory (in Germany for example, this was reversed as a legal regulation in 1995 and is now a recommendation).


Technical ozone

Technical ozone (TechO3) is a mixture of ozone and air prepared from atmospheric air which is used all over the world, principally for sterilizing water (city installations) and in chemical bleaching processes etc.


Medical ozone

Contrary to technical ozone, the medical form is prepared from pure medical oxygen (MedO2) via silent electrical discharge for use as an ozone/oxygen mixture at an exact concentration and dosage.
Its concentration ranges from 1 to 100 micrograms per millilitre (μg/ml), corresponding to an ozone/oxygen mixture at ratios between 0.05% O3 and 5% O3.  As the ozone molecule is not stable, its medical form is always freshly prepared on site (in a special generator) for immediate use ie administration.  (this is because, after about 1 hour, only half the original ozone is still present, the rest having decomposed to become oxygen again).


6.OZONE THERAPY – QUICK
SURVEY

EFFECTMEDICAL USES
Activation of red blood cell metabolism => improved oxygen supply
* arterial circulatory disorders (peripheral and cerbral in particular); revitalization
Activation of immune cells
=> the body releases its own vital cytokins, such as interferones and interleukins
* add./complementary therapy in various kinds of cancer; Revitalization; General immune weakness
Increase and activation of the body’s own antioxidants and radical scavengers* Inflammatory processes, eg arthritis, reactivated arthrosis, vascular conditions; age-related processes


7.WHERE CAN I OBTAIN
INFORMATION?

Depending on what country you are in, your physician and/or pharmacist may know about medical ozone and its uses in therapy.  However, basic information in all fields can be obtained from the:

Medical Society for Ozone Application in Prevention and Therapy.

SECRETARIAT EUROPE:
Nording 8
D-76473 Iffezheim
Germany
Telephone 0049-7229 30 46 17
Fax 0049-7229 30 46 30
E-mail: info@ozone-association.com
Website: www.ozone-association.com
E-mail: ozonosan@aol.com
http://www.ozonosan.de

Published by the Medical Society for Ozone Application in Prevention and Therapy
[Ärztliche Gessellschaft für Ozon-Anwendung in Prävention und Therapie]


Translation of the 8th revised [German] edition


© Dr. med. Ulrich Gutzen, Krefeld (Germany) &
Dr. rer. Nat. Renate Viebahn-Hänsler, Baden-Baden (Germany)

Ozone and the Production of Energy  
The feature characteristic to all chronically ill patients is that they produce insufficient energy. This is seen as a lowered core body temperature, decreased ATP production, and lowered basal metabolic rate. Assuming that there is normal cardiopulmonary function and no anemia, possible causes of deficient energy metabolism are 1) increased fibrin accumulation in capillaries due to abnormal clotting from immune causes 2) decreased cellular uptake of substrates of fat and glucose, due to chronic insulin excess secondary to insulin resistance. (This is always a problem in diabetics and persons over 50 years of age.)  3) Mitochondrial dysfunction, where glucose metabolism takes place.
 
             Mitochondrion

 
 

 





















Energy in the body is derived from fats, carbohydrates (glucose), and proteins, but no matter the source, products of their metabolism ultimately end up in the citric acid cycle.
 
 
The amount of energy released from one mole (180 grams) of glucose is 686,000 calories. Of these, 230,000 calories are used for heat and 456,000 calories can be stored in the form of ATP, adenosine triphosphate, the primary energy currency of the body. ATP is present everywhere in the cytoplasm and nucleoplasm of cells.  Essentially all physiological mechanisms that require energy obtain it from ATP and another high energy phosphate, guanosine triphosphate. There are two high energy phosphate bonds per ATP molecule, and the energy released from one of these high energy phosphate bonds under normal body conditions is 12,000 calories.
There are four phases of glucose metabolism in the production of energy in the form of ATP.
 
 
      Two Forms of the Glucose Molecule







 
 



The first stage is glycolysis, which yields  pyruvic acid and 2 molecules of ATP from each molecule of glucose and  releases four hydrogen atoms.
The next stage is the formation of acetylcoenzyme A, accomplished  by combining the pyruvic acid with coenzyme A, a derivative of pantothenic acid. This reaction forms no ATP but releases four hydrogen atoms, which later are used to create more ATP in the citric acid cycle and electron transport chain.  
 
                     Citric Acid Cycle







































 
Acetylcoenzyme A initiates the citric acid cycle. The citric acid cycle releases sixteen hydrogen atoms. These hydrogen atoms must be transferred through the eight steps of the citric acid cycle. This is carried out by nicotinic adenine dinucleotide (NAD+). Each NAD+ is converted to NADH in three steps of the citric acid cycle. FAD is converted to FADH2 in step six of the cycle similar to the production of NADH. Buildup of pyruvic acid (caused by inadequate oxygen) and NADH stop the glycolytic process. For each molecule of glucose the citric acid cycle occurs twice, giving the net production of two more molecules of ATP. 

Electron Transport System
 






















FAD and NAD are supplied by oxidative phosphorylation, the major source of energy production in the body. This catalyzes the reduction of hydrogen and formation of water, releasing ATP. NADH and FADH2 are supplied by the citric acid cycle, and thus oxidative phosphorylation and the citric acid cycle are mutually dependent. When one system slows down, so must the other. In chronically ill patients it is found that there is a lowered NAD/NADH ratio signifying a blockage, so to speak, at the level of oxidative phosphorylation. By using ozone to oxidize NADH to NAD and FADH to FAD increased levels of coenzyme A are available to fuel the citric acid cycle and oxidative phosphorylation. Some studies have shown a total increase of 40% in ATP production after ozone therapy and an increase in lowered NAD/NADH ratios found in all ill persons.
It should be noted that the best source of acetyl CoA is from fat metabolism. Acetyl CoA only lasts 2 hours in the system. As we grow older, fat metabolism becomes more inefficient and we burn glucose instead to form acetyl CoA. Glucose is more easily exhausted and thus so is the older patient who complains of brain fatigue.  Also, the brain can only generate acetyl CoA from glucose, not from fat.
Decreased mitochondrial function may be caused by insufficient coenzyme A production from glucose resulting in the accumulation of excess lactic acid responsible for the tiredness and acidosis of the chronically ill. There may also be decreased coenzyme A production via fat metabolism. Insufficient coenzyme A leads to the suppression of the citric acid cycle. Also, a decrease in oxidative phosphorylation can be initiated by viruses, heavy metals, pesticide and petrochemical sensitivity, and autoantibodies. By oxidizing NADH and FADH2 to NAD and FAD, medical ozone can correct all these mitochondrial lesions. This process is best carried out by Major AutoHemoTherapy (MAHT).
During glucose breakdown from glycolysis through citric acid cycle, 24 hydrogen molecules are released. Twenty of these hydrogen molecules are converted to ATP by oxidative phosphorylation in the chemiosmotic process of the electron transfer system. During this process, up to 3 ATP molecules per each 2 hydrogen molecules are released, generating an additional 30 ATP molecules.
The remaining four hydrogen molecules are also released into the chemiosmotic system to generate 4 more ATP molecules. In total, from glycolysis, acetylcoenzyme A production, the citric acid cycle and the electron transfer sysytem, 38 molecules of ATP are formed from each molecule of glucose being processed by this four step process. The citric acid cycle also is oxygen dependent. Without oxygen the citric acid cycle cannot be completed.  More importantly, without oxygen, the initial step of acetylcoemzyme A production from pyruvate cannot happen. In the absence of sufficient oxygen, pyruvate is turned into lactic acid instead of forming acetylconezyme A, a process which to generates only 6 molecules of ATP and does not allow the utilization of glucose to proceed through the citric acid cycle and the electron transport process.   (Robert Wendell, DVM)