A Breathing 4-Minute Mile, plus Inhaled Nitric Oxide

TGIM. Here are 4 thoughts, 1 quote, and 1 answer for this week. Enjoy!

---

4 THOUGHTS

1. The Breathing 4-Minute Mile

The Wim Hof endotoxin study is breathing’s equivalent to a "4-minute mile."

People have been using breathing to modulate their autonomic nervous and immune systems for thousands of years. But Wim brought it to the world.

He proved it was possible, scientifically. And similar to how people now run 4-minute miles without using Roger Bannister’s exact training, I believe science will show that many breathing techniques work in similar ways.

But what matters most is that it’s possible. And it’s possible through breathing.

2. Inhaled Nitric Oxide has Whole-Body Effects

To date, I believe this might be one of the most important findings in breathing.

We typically believe the benefits of inhaled nitric oxide (NO) end in the lungs. However, a paper I recently reviewed showed it has whole-body effects.

Here are the take-home points from the study:

• Their measurements were consistent with systemic transport and delivery of bioactive inhaled NO.

• Inhaled NO can improve blood flow in distant regions where endothelial NO is suppressed—it works "where needed."

• These effects on blood flow might be most relevant in diseases that disrupt endothelial-derived NO, like diabetes & many others.

If you’re interested, see the full summary for more details. I will be expanding on this topic with more recently-published research in the coming weeks.

3.   Why We Sigh - A Vice Article

"Breathing isn’t only the automatic exchange of oxygen and carbon dioxide, afterall. The way we breathe is influenced by our emotions and environment, and vice versa."

- Shayla Love, Why We Sigh

This was a fantastic read; I couldn’t recommend it more. I especially enjoyed the short passage about sighing and breathing variability.

I hope you all like it as much as I did.

4. Three Steps to Breathe Better Right Now

1. Breathe through your nose.

2. Slow down your breathing.

3. Make each breath inaudible.

---

1 QUOTE

"How do you identify someone who needs encouragement. That person is breathing."

- Truett Cathy

---

1 ANSWER

Answer: In the atmosphere, nitric oxide is generated from this energetic process.

…

(Cue the Jeopardy! music.)

…

Question: What is lightning?

---

In good breath,
Nick

P.S. Doesn’t seem like a fair fight.

---

The Breathing 411 Newsletter

Each Monday I share 4 thoughts, 1 quote, and 1 answer like the ones you just read. If you enjoyed it, please sign up below.

Exciting News: A New Breathing Gas Discovered

Happy Monday. There was a breakthrough in breathing research over the past few weeks: A new breathing gas has been discovered. I hope the extra hour of sleep you got this weekend will help this exciting news sink in even deeper.

OK, let’s get to it. Here are 4 thoughts, 1 quote, and 1 answer for you to think about as we begin November.

---

4 THOUGHTS

1. A New Breathing Gas Discovered

"Thus, H2S [hydrogen sulfide] produced by CBS surely has a crucial role in maintaining eupneic-pattern respiration."

- Nature, Communications Biology

Hydrogen sulfide. It’s toxic, and it’s what gives rotten eggs their rotten smell. It also helps maintain our breathing.

A study published in Nature: Communications Biology on October 16, 2020, found that a small amount of hydrogen sulfide is critical to maintaining normal breathing. It does this through modification of the neural connections in the region of the brain that controls breathing.

When hydrogen sulfide production was stopped in rats, normal breathing turned to gasping, implying that it is vital to maintaining rhythmic breathing.

From a practical perspective, I’m not sure what this means yet. At a minimum, breathing now appears to be a four-gas system: oxygen, carbon dioxide, nitric oxide, and hydrogen sulfide.

We’ve found ways to breathe to optimize the first three. However, it’s not yet clear if the way we breathe (or do anything else, for that matter) can influence hydrogen sulfide.

In any case, as a fellow breathing nerd, I hope you find this as fascinating and humbling as I did. Here’s to the joy of never-ending learning.

P.S. Here’s a short summary of these findings from ScienceDaily.

2. The Single Most Important Part of the Breath

"Interestingly, Törnberg et al. recently showed that more NO is released from the nasal passages during nasal inhalation compared with exhalation." - Lundberg et al. (2008)

Here is yet another reason why inhaling through your nose might be the single most important part of breathing: nitric oxide (NO) production is much greater during inhalation than exhalation.

Here’s the finding from the paper mentioned above: "There was a marked flow dependency of nasal NO output, with the highest levels observed during inhalation at flows similar to those seen during normal breathing." - Törnberg et al. (2002)

In hindsight, this makes complete sense. NO helps protect our lungs from inhaled pathogens and it redistributes blood flow in the lungs. So, of course our bodies would maximize it on the inhale. But it wasn’t until I read these two papers that it made sense to me.

"The obvious is that which is never seen until someone expresses it simply.” - Kahlil Gibran

3. What Focusing on the Breath Does to Your Brain

"Conversely, it may be possible to reduce fear and anxiety by slowing down our breath." - Greater Good, UC Berkeley

Here is a quick-reading article, packed full of excellent information, from The Greater Good Science Center at UC Berkeley. Anytime you see a headline like "Managing stress: Is it all in the breath?" you know it’s going to be a good read. Enjoy!

4. Sleep Scientists Call for the Elimination of Daylight Saving Time

"It is, therefore, the position of the American Academy of Sleep Medicine that these seasonal time changes should be abolished in favor of a fixed, national, year-round standard time."

- Journal of Clinical Sleep Medicine

I hope you all enjoyed the extra hour of sleep you got this weekend. The world’s leading sleep scientists say your body will function better, and they suggest we keep it this way (Standard Time) forever.

The above article is pretty short. But if you’re interested, here’s an even more concise summary, along with a rather impressive list of organizations that support the permanent change to Standard Time.

Because nasal breathing at night changed my life, I am endlessly fascinated with sleep. So I hope we all enjoy the next few months of better sleep and better optimization of our body's wake-light cycles.

---

1 QUOTE

“A mind that is stretched by a new experience can never go back to its old dimensions.”

- Oliver Wendell Holmes

---

1 ANSWER

Answer: Average walking speed (~2-4 mph) is also around the average speed of this physiological function.

…

(Cue the Jeopardy music.)

…

Question: What is blood flow?

---

In good breath,
Nick

P.S. New life in a new city.

Is This Stuff Really in Textbooks? And A New Nose-Opening Method

Hello, and happy Monday. Here are 4 thoughts, 1 quote, and 1 answer for you to consider as we wrap up October.

---

4 THOUGHTS

1. Is this Stuff Really in Textbooks?

Carbon dioxide (CO2) and the Bohr effect have motivated almost all the interest in breathing for health and performance.

CO2 is said to loosen the bond between oxygen and hemoglobin, allowing more efficient release into the tissues (the Bohr effect). Thus, counterintuitively, by breathing less (retaining more CO2), we actually get more oxygen.

It is often stated that this is just basic (but underappreciated) physiology that is in all the medical textbooks. Luckily, I find joy in reading medical books I don’t fully understand : ) Here’s what I have found:

- “Hemoglobin’s affinity for oxygen is also influenced by pH, carbon dioxide concentration, and body temperature…it releases it more readily under conditions of…increased carbon dioxide concentration." - Essentials of Pathophysiology, pg. 534

- “The shift of the curve to the right may be seen as a compensation that results in greater release of oxygen to the tissues…Temperature affects the relationship (increases in body temperature shift the curve to the right), as do carbon dioxide." - Respiratory Physiology, A Clinical Approach, pg. 110

- “Most of the effect of PCO2, which is known as the Bohr effect, can be attributed to its action on H+ concentration. A rightward shift means more unloading of O2 at a given PO2 in a tissue capillary." - Respiratory Physiology, The Essentials, pg. 91

So yes, this is basic physiology. It’s nothing new. But knowledge is only potential energy. What we’re doing is applying this knowledge in a simple way. Breathe less, get more.

2. A New Nose-Unblocking Exercise

Patrick McKeown’s nose unblocking exercise is phenomenal. It’s simple, and you feel it immediately. However, no one knows precisely how it works. My hypothesis is that it’s primarily due to nasal nitric oxide (but have no way of testing this, except on myself).

It just so happens that last week we discovered a way of breathing that increases nasal nitric oxide (nose in - mouth out). It also just so happens that I got a terribly stuffy nose during that same time.

So, here was my N=1 test. If the unblocking exercise works due to NO, it would stand that performing nasal-in, mouth-out breathing would help clear my nose.

So here’s what I did. I inhaled through my nose, pinched my nose, slowly exhaled through my mouth as long as I could comfortably, and repeated. And, lo and behold, it helped.

However, it took much longer than Patrick’s method (about 2 minutes for me). And, it wasn’t nearly as dramatic. Each breath only opened it slightly more. Conversely, in Patrick’s version, you go from blocked to open almost instantly.

What does this mean? Well, nothing, really. There are many factors to consider. But it *might* be suggesting that NO is, in fact, the “unblocking” mechanism.

So, here’s my request: If you get a stuffy nose this cold season, give it a try and let me know if it does anything for you. N=1 means nothing statistically, but it’s better than nothing practically.

3. For the Practice or For the Results? Why Not Both?

"How do you best move toward mastery? To put it simply, you practice diligently, but you practice primarily for the sake of the practice itself." - Robert Greene, Mastery

Why do you practice breathing? For the practice itself, or for the outcome?

What I love about breathing is that it can be both. In fact, you automatically take care of both, regardless of which one you are focusing on. It’s health and mastery, wrapped in our body’s most important function.

4. Woo-Woo or Wu-Wei?

"It refers to the dynamic, effortless, and unselfconscious state of mind of a person who is optimally active and effective."

- Edward Slingerland, Trying Not to Try

Wu-Wei literally means "effortless action." If it didn’t sound so much like "woo-woo," it might be the perfect definition of ideal breathing.

We train our breathing so that we don’t have to think about it. We train our breathing to achieve this state of effortless yet highly effective action.

---

1 QUOTE

“It’s not enough to understand; you’ve got to do something.”

- Sandra Day O’Connor

---

1 ANSWER

Answer: On one breath, the world record for this movement is 81.6 meters.

…

(Cue the Jeopardy music.)

…

Question: What is underwater walking?

(P.S. The video is pretty amazing. Watch out Laird.)

---

In good breath,
Nick

P.S. Very Scary.

Could nasal nitric oxide help to mitigate the severity of COVID-19?

“We have too many high sounding words, and too few actions
that correspond with them.” - Abigail Adams

When the pandemic began, many people in the “breathing community” immediately started talking about nasal nitric oxide because of its antiviral and antimicrobial effects. Nose breathing seemed like washing your hands: Of course, no scientific studies were showing it worked for this specific virus yet, but it made it common sense to practice it anyways.

Now that we’re getting back to normal (despite the record number of cases in some parts of the world), nose breathing is more important than ever. And it looks like many in the scientific community agree.

Last month, a Commentary was published in Microbes and Infection titled “Could nasal nitric oxide help mitigate the severity of COVID-19?” [1]. (I saw this article through the Oxygen Advantage newsletter…thanks, Patrick!) It’s a short and easy read that I highly recommend. 

Click here to read the full commentary

Here’s one of my favorite quotes from it:

“Mouth breathing during sleep may therefore worsen the symptoms of COVID-19, consistent with the observation that symptoms of respiratory infections are usually worse in the morning.”

---

LA Times Article on Inhaled Nitric Oxide for COVID-19

About two months ago, a good friend, and reader of this newsletter, shared this article from the LA Times with me. I think it pairs nicely with the commentary above:

How a discovery that brought us Viagra could help those battling the coronavirus

Click Here to Read the Article

Here’s my favorite quote from that one:

“In 2004, researchers at the University of Leuven in Belgium discovered yet another property of nitric oxide: It killed coronaviruses.

More specifically, it killed the coronavirus that leapt from bats to humans and sparked the 2003 epidemic of severe acute respiratory syndrome, the disease better known as SARS.”

---

Here’s to putting science into action by simply breathing through your nose while you’re out and about.

In good breath,
Nick

P.S. How to Enunciate Correctly in 4 Steps.

[1] Martel, J., Ko, Y. F., Young, J. D., & Ojcius, D. M. (2020). Could nasal nitric oxide help to mitigate the severity of COVID-19?. Microbes and infection, 22(4), 168–171. Advance online publication. https://doi.org/10.1016/j.micinf.2020.05.002

Unlock Your Breathing "Combination Lock"

For each scientific paper I read, I ask myself,

“What practical takeaways can my readers and I apply in our lives today based on these results?”

I usually get similar answers: (1) Breathe slowly, (2) breathe through your nose, or (3) hold your breath. (This is how I discovered the three breathing principles.)

Feeling Like Bill Murray in Groundhog’s Day

These common answers can be frustrating because I often feel like a broken record. Each paper I read is full of awesome, nerdy information. But, from a practical perspective, it’s all really simple stuff.  

For example, the paper I’m sharing this week reviews the latest science on nasal nitric oxide (including two new things I hadn’t read anywhere before). But, the take-home message is simple: Breathe through your nose.

Let’s look at this excellent paper, and then I’ll explain how Jim Rohn helped me work out my frustration.

---

Recent Advances on Nitric Oxide in the Upper Airways

(Click Here For Full Summary)

Journal: Current Medicinal Chemistry, Volume 23, Issue 24, 2016

Since we’ve reviewed the beneficial effects of nasal nitric oxide several times, let’s focus on the two new things from this paper:

1. Nitric Oxide Plays a Role in Warming Incoming Air

A study showed that increased nasal NO release was associated with increased temperature in the nasal airways. There precise mechanism for this was unclear, but interesting nonetheless.

(If this interests you, please send me an email and I’ll share some of my speculation as to what is happening.)

2. Nasal NO Enhances Cilia Functioning

Cilia are tiny little hairs in your upper and lower airways. They move back and forth to push inhaled particles out of your airways and back out through your nose. They are your lungs' main line of defense against inhaled pathogens.

Nasal nitric oxide enhances the functioning of these cilia, and low levels of NO have been associated with weakened cilia movement. Here is yet another way that NO defends us against airborne pathogens.

---

Jim Rohn and His Combination Lock

Again, the take-home message from this paper is: breathe through your nose to harness the benefits of nasal nitric oxide. Which brings me to Jim Rohn’s wisdom:

“Ideas can change your life. And sometimes all you need is just one more good idea in a series of good ideas. It’s like dialing the numbers of a combination lock. After you’ve dialed five or six numbers, the lock may not come open. But you probably don’t need five or six more numbers. Maybe you need just one more number, one more idea.”

Although I feel like a broken record, this passage reminded me that broken records are necessary for learning.  

I hope the (repetitive) ideas shared here help you breathe through your nose more today.

In good breath,
Nick

P.S. Can’t wait for grandchildren.

Nasal Nitric Oxide is My New Favorite Gas

The nose warms and humidifies incoming air. We’ve heard that a lot.

However, when you dig into the scientific literature, you learn that nitric oxide (NO) might outweigh all other aspects of nasal breathing. It’s actually hard to overstate the benefits of nasal NO.

Which brings us to this week’s paper:

Nasal Nitric Oxide in Man

- Published in Thorax in 1999 (Read Full Summary Here)

This was a great overview of the many functions of nasal NO. Here are a few of my favorites. Check out the full summary for more.

The general consensus is that NO is continuously released in the paranasal sinuses. Because of this continuous release, a lower flow rate will result in higher concentrations. This could be yet another benefit of slow breathing: Increased nitric oxide delivery to the lungs.

Another amazing benefit of nasal NO is that it increases arterial oxygenation. For example, one study showed that nasal breathing increased tissue oxygenation 10% more than mouth breathing.

Finally, and this was my favorite part, a study showed that breathing humidified air through the mouth did not increase oxygenation; however, breathing supplemental NO through the mouth increased oxygenation similar to what is seen in nose breathing.

Although the warming and moistening effects are important, this suggests that nitric oxide might explain many of the benefits of nasal breathing.

I am continually amazed by everything nitric oxide does in the body.  I think it’s my new favorite gas (never thought I’d have one of those!).

In good breath,
Nick

P.S. Who Needs Gas?.

Nasal Nitric Oxide: Our Body's Answer to Gravity?

Gravity is pretty awesome. After all, it keeps us here on Earth. And when our bodies are not subject to gravity (say, if you’re an astronaut), some crazy things happen. For example,

• Astronauts lose 25% of their aerobic capacity in 7-14 days (it usually takes 10 years to lose 10% here on Earth)

• Bone density can decrease as fast as 5% a month (it’s usually about 1% a year on Earth)

Thus, our bodies are clearly meant to be under the influence of gravity. However, as we became upright mammals walking on two feet, gravity could have posed an issue.

Blood flow in our lungs is influenced by several factors, but one of the largest is gravity. Gravity acts to focus blood toward the base of the lungs.

Interestingly, in humans and other primates, the nasal airways produce a considerable amount of nitric oxide (NO). As we’ve learned before, NO is a potent vasodilator that is critical for whole-body oxygenation.

Maybe the NO produced in the nasal airways is an adaptation to walking upright and helps counter gravity’s effects on blood flow? That was the hypothesis of the study I’m sharing this week.

Nasal Nitric Oxide: Nature’s Answer to Gravity?

(Read Full Summary Here)

This research found that when participants breathed through their noses, blood flow in the lungs became more uniform and gas exchange was increased. Breathing through the mouth did not have these effects.

However, if subjects breathed through their mouths but were given supplemental NO, the blood flow in their lungs looked similar to nasal breathing.

This suggests that NO is responsible for making blood flow more uniform in the lungs.

The authors hypothesize that nasal NO might be an evolutionary adaptation to counter the effects of gravity on lung blood flow, allowing greater and more efficient gas exchange to occur.

We often praise nasal breathing for its warming and humidifying effects. But the more I learn, the more convinced I am that nitric oxide is the real hero.

In good breath,
Nick

P.S. Happy New Years Dance!