BREATH

Breath

James Nestor

There are a number of one-word titled books: Salt, Oak, Bourbon. These are all interesting and worthy reads. Breath is a qualitatively different book.

Breath examines a mix of hard science and alternative ways of thinking about the body. My personal experience with this approach pre-dates Medical School: I took a graduate course while an undergrad in neurobiology; the topic was, “How does acupuncture work?” It was a nine week exercise. It started with a canvasing of literature as it related to observed effects of acupuncture and we developed models with an allopathic point of view (vs the traditional Chinese point of view) to explain how the effects of acupuncture might be achieved. The Chinese model was a Feudal one; it was about balancing energy. With our approach, notions of the sympathetic and parasympathetic nervous system as well as the ability to manage these “autonomic” processes came to build the scaffolding for our model. This was a technical/anatomical detail that did not conflict with the Chinese model in that these portions of our nervous system are all about balance. I completed the nine week course firmly in the believe that acupuncture is not a placebo and by that simple standard, I stood (stand) apart from many a doctor.

Our review at Santa Cruz also brought forward fascinating experiences relayed in scientific journals: a yoga could slow and speed his heart rate up on demand; he could recount conversations in a room for the thirty minutes his brain waves suggested he was in deep sleep. He could change the temperatures as measured in his thumb and little finger, the difference being 15 degrees F without moving his hands.

The author of Breath, like me, started with observed findings that are unusual in our normal day-to-day experience. He is a journalist who has covered free diving. This is a competition where a person attempts to dive into the ocean as deeply as possible with one held breath. People actually survive this, sometimes being “down” for three minutes. World records have seen 100 meters depth and more. On one breath. Not dying.

How is that possible? He tells you: breath, properly. The book breaks down the process with physiological descriptions, history, and personal experience.

Air is followed anatomically into the body:

The Nose: if you have a dog of a pug or boxer breed, and they have surgery, you will hear about the care needed to keep these dogs alive after they are anesthetized; the shape of their nasal passages relative to their throats make them susceptible to choking and respiratory arrest. Humans have a similar anatomical problem but our lifestyles over the last few centuries have made this increasingly problematic. The narrative makes the case that examining skulls from antiquity will show constant traits that we (modern industrial age humans) as a group, lack. We have smaller jaws, shifted jaws, and crowding of teeth in a smaller oral cavity relative to hunter gatherers or even urban dwellers of antiquity and the middle ages. The sinuses occupy the mid face and changes here contribute to the anatomical changes he points out. He tries to make the case that our modern diets (cooked and soft foods) contribute to a few hundred years worth of changes not seen in the past or today’s third world settings. Active chewing in other primates and humans living in the wild provide the “exercise” needed to have jaws fitting properly, teeth that fit together, and a more open posterior pharynx/airway—the critical narrowing. Obstructive sleep apnea and mouth breathing are secondary problems. Well identified medical problems associated with them are reviewed. To entertain and educate us, he has a number of biometric measures taken; then, he and a collaborator have silicone plugs inserted up their noses, precluding nose-breathing for ten days. I love science and empiricism but I have my limits and this is one of them!*

His mouth breathing is pronounced, his sleep deteriorates, and sleep apnea becomes a dramatic night-time event. He is miserable and his health deteriorates. The plugs are removed and shortly thereafter, his health is restored. He then tapes his lips shut at night when sleeping—more improvements.

He ties these objective findings (his literature review and two experimental subjects) and relates them to ancient manuscripts offering up the need to breath nasally and with controlled breathing cycles. This theme is repeated and he makes the case that many modern researchers in breathing (he labels them Pulmonauts) resurrect what was known thousands of years ago only to have the newly found knowledge lost by western medicine and its outlook which carries its momentum in a different direction.

His ideas about consciously breathing through the nose, even when your habit or experience suggests you need to open your mouth leads us on.

The mouth and oral cavity: A further problem of breathing relates to the shape of our mouths and the fit for the tongue when the lips are closed. He describes “Mewing” and for this, I encourage a look at YouTube as this describes the techniques used to enlarge the space of the mouth with dental and breathing benefits. The Dentist, Dr. Mew, was largely considered a quack in his day but has newly found credibility.

The Diaphragm: I met a spaced-out mushroom major at Santa Cruz who proudly identified to me that he had learned to breath, “diaphragmatically.” This was a puzzle to to me having just studied mammalian physiology; we all breath that way……The characters in this section of Breath have much more credibility. Katharina Schroth is introduced: a German woman who had a dramatic childhood scoliosis that rendered her barely able to walk or breath normally. Her doctors had nothing to offer ( and today, a rather dramatic surgery would be contemplated with definite cons to consider before doing that) and given the ascendency of social darwinism of the time (ie the Nazi version) she was motivated to get better as if her life depended on it. She took to vigorous exercises moving her diaphragm more fully while in positions that helped open her rib cage up anatomically. With time, she improved her scoliosis, could breath better, and lived into her 90’s. She helped many people afflicted with her condition and was considered something of a kook—and yet, not being a doctor, she is now credited with having helped many people who otherwise would have been left in bed to whither up or in the late 1930’s in Germany, exterminated.

Carl Strough is identified; he treated COPD (chronic obstructive pulmonary disease or, emphysema) at a VA Hospital and later, his technique (like Katharina’s) was to develop disciplined patterns of slow, deep, regulated breathing. For the skeptical, he could demonstrate before and after excursions of the diaghragm on Xray that were clearly helpful to people with COPD. He helped train the track and field team for the USA which took place in Mexico City, a mile above sea level in 1968. His team was exceptional for not using supplemental oxygen and still took home many many medals; he was credited for having developed a new method for athletes.

This chapter took me back to exercise physiology as taught in medical school and this refresher reminded me of why some things that look silly in a gym suddenly make sense.

I see guys doing aerobic workouts with a mask that limits ventilation. That seems crazy. As I reviewed how oxygen is delivered to working tissues (muscles for example) the rational for this becomes more obvious: 3/4 of the oxygen you take in each breath is breathed out ie only 1/4 gets released to tissue. What drives the release is the acidity of the tissue that is working—the more work, the more acid, and this tips the release of oxygen to the tissue; the carbon dioxide which is chemically part of the acidity equation is taken by the hemoglobin back to the lungs where the acidity is normalized by the exchange of carbon dioxide back into the air in the lungs. So, rebreathing raises the carbon dioxide and hence, acidity in the system without impairing the amount of oxygen in the blood—but this acidity enhances the release of the oxygen into the tissues where it is needed the most.

This mechanism of oxygen exchange fits with his notion that we should jog breathing through our nostrils, and not our mouth. There is training involved—without thinking, we open our mouths and “hyperventilate” when we exercise. He makes the case that this is mal-adaptive and with training, learning to breath slower and deeper, our fitness and aerobic capacity for exercise will increase.

Tied to this is something we doctors are taught in physiology class but is not widely known: oxygen levels do not drive your brain’s signals to breath more or faster—it is the carbon dioxide level that does this. So the training in part, is to get your body and mind to accept that the subjective feeling of breathlessness can be suppressed with practice without danger of developing a lack of oxygen (this is in reference to healthy lungs, of course). Hence, deep divers who on one breath can dive a hundred meters, taking minutes to do it, and survive. The author practices breathing exercises that bring up carbon dioxide levels and he measures his performance on a biking exercise; as with the 1968 Olympians, he sees improvements within a month of 10%!

On an aside, he says something strange: carbon dioxide has carbon in it—when you add up how much you breath out in a day, he suggests this is a mechanism of weight reduction. OK…….. On a more telling point, he thinks most people, out of shape, tend to hyperventilate (breath more than physically needed) and with this, there is a constriction of blood vessels (accompanies low carbon dioxide levels in the blood) and subsequent lack of oxygen delivery to tissues. He labels this unhealthy; he then makes a point that in most religions across the globe, many prayers and mantras are spoken across many cultures with a typical cadence, one that will find you breathing in for 5.5 seconds and out 5.5 seconds for an average of 6 breaths a minute. He thinks this wisdom has a healthy physical benefit that is both calming psychologically and enhances blood flow throughout the body.

Hyperventilation with exercise can be quite detrimental and he cites among other problems, temporary brain dysfunctions such as with transient global amnesia or tia’s**

If interested, he goes into more detail describing the history and practices of Tumo and Holotropic breath work. These are intense and vigorous breathing exercises NOT for the faint of heart.

A very interesting experiment is found in the closing chapters. There is a rare condition that finds some people with no amygdala—a small area in the brain. If you don’t have an amygdala, you lose any sense of fear. He tells the story of a woman who did not feel fear—was sexually assaulted by a man who stopped when he feared discovery. As he was leaving to go to his car, she followed him and asked for a ride………this same woman was asked to describe what she felt when she breathed carbon dioxide gas (the intent of which was to determine the brain’s reaction to an extreme change in Carbon dioxide). She had never felt fear in her life but with just a few breaths of carbon dioxide, she reacted dramatically and would not try the experiment again—even months later. The brain has a very primitive mechanism for letting the body know that something is terribly wrong with breathing. While I love this anecdote, it only reinforces what I already knew from life: if you can’t breath, you will panic.

The book’s bottom line: The way we breath, no matter the breathing style, by and large will not cause any dramatic or immediate problems. For example, running with your mouth open or breathing a little fast when annoyed or stressed. If you try to hold your breath to commit suicide, you body will outsmart you and the breathing starts again, no matter how disciplined you are. The caveat is the way you breath can influence a wide number of discomforts and health problems of the “modern age,” which in turn, can shorten your life span: hypertension, headaches, chronic sinus infections, asthma, emphysema, and so on. He provides a number of breathing techniques to advance the cause of the pulmonauts and the wisdom of the ages.

The appendix has a number of techniques one of which I have adapted: it is the Navy Seal Boxed Breathing technique to calm the nerves. You inhale for four seconds, hold the breath for four seconds, exhale for four seconds, and hold for four seconds; begin again. You can modify it to breath in x 4 then hold x4, breath out for 6 and the hold for 2—begin again. This connects me to the Seals and helps me way more than watching those poor guys haul telephone poles across the sands of Coronado!

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* For you history buffs, James Hunter, the English surgeon who forever changed the status of surgeons from blue collar to white collar status, was famous for such experiments. He went to brothels on the docks of London and paid sailors to let him get some of the material from syphilitic sores and inoculated himself with them. That was dedication to science just as with the author of Breath with his nasal plugs! Thank you for your service……

** Read my experience with TGA (Total Global Amnesia) for a first-hand account of how it came on and what happened to me once it started.