breathe slow

Wim Hof vs. Slow Breathing, Part 2: The Famous Endotoxin Challenge

 
 

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4 Thoughts


1. Slow Breathing = Deep Meditation?

“When researchers at Harvard, Yale, and the Massachusetts Institute of Technology scanned the brains of experienced meditators, they discovered increased thickness in regions of the brain's cortex, or grey matter, related to focus and attention…But what's intriguing about this study is that breathing rate was used to determine how deep in meditation the subjects were able to get. The slower the breathing rate, the deeper in meditation participants became. And, the more pronounced their increase in grey matter.” *

- Leah Lagos, Heart Breath Mind

That deserves a 🤯

If slower breathing rates are a byproduct (and measure) of deeper meditation, I wonder if we can reverse engineer it…

2. The Deep Breath Hypothesis

“The Deep Work Hypothesis: The ability to perform deep work is becoming increasingly rare at exactly the same time it is becoming increasingly valuable in our economy. As a consequence, the few who cultivate this skill, and then make it the core of their working life, will thrive.”

- Cal Newport, Deep Work

And similarly, this couldn’t be any truer:

The Deep Breath Hypothesis: The ability to perform deep breathing is becoming increasingly rare at precisely the same time it is becoming increasingly valuable to our physiology. Consequently, the few who cultivate this skill, and then make it the core of their waking life, will thrive.

3. Wim Hof vs. Slow Breathing, Part 2: The Famous Endotoxin Challenge

I’ve called Wim Hof’s endotoxin study the “4-minute mile” of breathing.

So, you can only imagine my excitement when I found a study basically doing the exact same thing, but with slow breathing (it was perhaps the most excited I’ve ever been reading a paper, lol).

I produced an in-depth comparison of the studies here.

But, here are some of the take-home messages:

  • The WHM reduced fever and all other flu-like symptoms.

  • Slow breathing reduced headaches and eye sensitivity to light, but did not reduce fever or other flu-like symptoms (e.g., nausea and chills).

  • Slow breathing improved autonomic functioning as measured by HRV, suggesting participants had greater resiliency. HRV was not measured during the WHM experiment.

  • The WHM significantly reduced inflammatory cytokines. Slow breathing did not.

  • The WHM significantly increased anti-inflammatory cytokines (by up to 194%). Slow breathing did not.

There are many (many) caveats and differences between the studies, so if you’re interested, see the full write-up for more details and additional thoughts.

But based on these results, the WHM was decidedly more effective than slow breathing at reducing acute inflammation and fighting off flu-like symptoms.

4. How to Change Our Species (hint: breathe)

“And I would argue that we humans are most human when we’re improving ourselves. We, unlike any other animal, can consciously change ourselves, to improve ourselves in ways we choose. This distinguishes us from every other species alive today and, as far as we know, from every other species that has ever lived.” *

- Anders Ericsson and Robert Pool, Peak

We are the only species that can consciously change ourselves to improve in ways we choose. We’re also the only ones that can consciously change our breathing in ways we choose.

Maybe that’s a coincidence. But then again, maybe it’s not…

 
 
 
 

1 QUOTE

“Happiness lies in your own heart. You only need to practice mindful breathing for a few seconds, and you'll be happy right away.” *

- Thich Nhat Hanh

 
 
 
 

1 ANSWER

Category: Breathing Rates

Answer: These aquatic mammals breathe around 1.5 - 2.5 breaths per minute at rest.

…

(Cue the Jeopardy! music.)

…

Question: What are bottlenose dolphins?

In good breath,

Nick Heath, T1D, PhD
“Breathing is the compound interest of health & wellness.”

P.S. haha anyways what’s up

 
 
 

* An asterisk by a quote indicates that I listened to this book on Audible. Therefore, the quotation might not be correct, but is my best attempt at reproducing the punctuation based on the narrator’s pace, tone, and pauses.

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Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

Wim Hof vs. Slow Breathing, and How to Start Something Meaningful

 
 

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4 Thoughts


1. How to Start Something Meaningful (hint: exhale)

“If you watch anyone on the verge of starting something that matters, you'll see them settle into the moment by taking a deep breath in and exhaling….It's the body rolling up its metaphorical sleeves and saying, ‘Okay.  It’s time. Let’s do this thing.’”*

- Michael Bungay Stanier, How to Begin

Starting something meaningful this year? Or just sending an important email or text? Roll up those metaphorical sleeves by taking a deep and relaxed breath in, and a relaxed and slightly longer breath out. “Let’s do this thing.”

2. Build Your Best Breathwork Practice

“You don’t have to build the habits everyone tells you to build. Choose the habit that best suits you, not the one that is most popular.”

- James Clear, Atomic Habits

Similarly:

You don’t have to use a breathing technique everyone tells you to use. Choose a method that best suits you, not the one that is most popular.

***

P.S. The next thought shows you why—two different methods, similar results.

3. Wim Hof “vs.” Slow Breathing, Part I: Indirect Comparison for Chronic Inflammation

A 2019 study looked at the full Wim Hof Method (breathing, cold, and meditation) in people with axial spondyloarthritis. They found that it reduced chronic inflammation, concluding:

“…our results are indicative that voluntary modulation of the immune response may not only be possible in acute inflammatory response due to microbial stimulation but also in chronic inflammation related to immune-mediated inflammatory diseases.”

A 2021 systematic review examined HRVB (aka slow breathing) in people with various chronic illnesses. They found evidence that there is an inverse relationship between inflammation and vagal nerve activity:

“…an increase in efferent vagal activity could suppress pro-inflammatory factors suggesting possible anti-inflammatory effects of HRVB.”

The point? Two wildly different approaches, two somewhat similar outcomes. It brings to mind the Chinese proverb, “There are many paths to the top of the mountain, but the view is always the same.” Choose which path is right for you.

***

P.S. I put quotations around “vs” because there’s no competition in breathing 😊Also, the word “indirect” in the title is critical. I’m being simplistic here and comparing apples to oranges, but I think the overall message is still helpful.

4. Operationalize Your Breathing Practice

“To make operational. To make ready for ‘live’ or ‘kinetic’ action.”

- Steven Pressfield

That’s Pressfield’s definition of “operationalize,” and it’s exactly what we need to do with our breathing. Make it ready for live action—for real life.

Of course, let’s use our practice as an escape into calmness, but let’s also remember to operationalize it so it’s useful in our everyday lives.

***

P.S. Everyday examples of how I operationalize breathing in my life:

  • Slow breathing while walking the dog.

  • Various slow and fast methods when I’m out surfing.

  • Slow, long exhales when my daughter throws a tantrum.

  • I’m not always successful with these, especially the last one : )

 
 
 
 

1 QUOTE

“Along the way of life, someone must have sense enough and morality enough to cut off the chain of hate. This can only be done by projecting the ethic of love to the center of our lives.”

- Dr. Martin Luther King, Jr.

 
 
 
 

1 ANSWER

Category: Nose and Smell

Answer: Cells responsible for scent regenerate this frequently.

…

(Cue the Jeopardy! music.)

…

Question: What is 30-60 days?

In good breath,

Nick Heath, T1D, PhD
“Breathing is the compound interest of health & wellness.”

P.S. when your only friend is busy

 
 
 

* An asterisk by a quote indicates that I listened to this book on Audible. Therefore, the quotation might not be correct, but is my best attempt at reproducing the punctuation based on the narrator’s pace, tone, and pauses.

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Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

Inner Resources, Better Blood Flow, and How to Focus on a Fuller Life

 
 

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4 Thoughts


1. Here is the Fastest Way to Achieve Well-Being

“So what is the fastest way to achieve well-being? It is so close to you that it can easily be overlooked. Your breath.  A rapid and reliable pathway into your nervous system, dedicated to helping you regain your optimal state.”

- Emma Seppälä, Ph.D., The Happiness Track

This is beautifully and perfectly said. Nothing to add here 🙏

2. On Sailboats, HRV, and Developing Your Inner Resources

“Developing inner resources is like deepening the keel of a sailboat so that you're more able to deal with the worldly winds—gain and loss, pleasure and pain, praise and blame, fame and slander—without getting tipped over into the reactive mode. Or at least you can recover more quickly.”

- Rick Hanson, Ph.D., Neurodharma

Although Dr. Hanson is talking about inner resources in general, this is an excellent analogy for why improving HRV via slow deep breathing is so helpful: it’s like deepening the keel of your physiological sailboat.

You will still be hit by life’s storms, but with higher HRV, you’ll remain steadier and recover quicker. We could say, then, that deep breathing = deep keel.

3. Slow Breathing for Better Blood Flow

“When [the small] blood vessels are relaxed, more blood can flow freely through them. When they become constricted, the same amount of blood flows through a narrower space, increasing your blood pressure.”

- Inna Khazan, Ph.D., Biofeedback and Mindfulness in Everyday Life

Slow breathing activates the calming parasympathetic nervous system, which relaxes the small blood vessels, lowers blood pressure, and improves blood flow.

This is a vital benefit of slow breathing because better blood flow is necessary for, well, just about everything (especially if you have diabetes).

So if you feel so inspired, give it a shot. Sit and breathe at 5-6 breaths/min for 2 min. Feel for yourself the rapid boost in blood flow to your hands and/or feet.

***

P.S. I’ve had cold hands & feet for as long as I can remember (thanks, diabetes). Although it’s improved considerably, one of my favorite things about slow breathing is the warmth I feel in them during and after my practice.

4. Control, and How to Focus on a Fuller Life

“Even if you don't have control over the outcome of the stressful situation, you may be able to exert some control over its impact…You can't always control what you feel or think, but you can control what you do. Focus on living a full life even though you don’t have [fill in your issue]…”

- Melanie Greenberg, Ph.D., The Stress-Proof Brain

When nothing seems to work, my blood sugars still go crazy, my insulin sensitivity is off, or I don’t sleep well, I always have the breath. I have something I can control, that gives me control.

It helps me focus on living a fuller life, and I hope it does for you too 🙏

 
 
 
 

1 QUOTE

“When you own your breath, nobody can steal your peace.”

- Unknown

P.S. Like a lot of what I share, this one is a reminder to myself : ) And it’s advice I haven’t been following that well lately (facepalm).

 
 
 
 

1 ANSWER

Category: Blood Flow

Answer: Although hemoglobin is best-known for releasing oxygen, it also releases this gas, which enhances blood flow and helps the oxygen actually get where it is needed most.

…

(Cue the Jeopardy! music.)

…

Question: What is nitric oxide?

In good breath,

Nick Heath, T1D, PhD
“Breathing is the compound interest of health & wellness.”

P.S. hoppity hop, hop hop hop

 
 
 

Sign Up For The Breathing 411

Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

22 One-Sentence Breathing Ideas for 2022

Let’s continue the tradition this year. Here are 22 one-sentence breathing ideas to kick off 2022. Enjoy!

***

Related: 21 One-Sentence Breathing Ideas for 2021

1. Demonstrations of breathing are small compared with the great thing that is hidden behind them. 

(Inspired by a Khalil Gibran Quote)

 

2. Breathing doesn’t heal you; it gives your body the environment it needs to heal itself.

 

3. We can be lost in breath, without knowing we have been breathing.

(Inspired by The Things You See Only When You Slow Down)

 

4. If you know only one breathing method, then you really know none; if you understand one breathing method, then you really know them all.

 

5. Breathing is the most direct path to practicing philosophy in our lives.

 

6. If breath is life, then optimal breathing is optimal living.

 

7. Science is timely; personal experience is timeless.

 

8. Every method works when used correctly, but no method works for everybody.

 

9. What one teacher says is essential, another will say is useless.

 

10. Breathing is a pair of leather shoes for life.

(Idea from The Tibetan Yoga of Breath)

 

11. The most practical tip for breathing is this: make it quiet and subtle. 

 

12. To breathe in a “quiet and subtle way” takes deliberate practice—effort leads to effortlessness.

 

13. Breathing may be my 70% solution but only your 20% solution.

 

14. Breathe less, sometimes more; breathe slow, sometimes fast.

 

15. We breathe through each nostril separately so they function better together as a whole.

 

16. Read about breathing but, most importantly, embody that education through practice.

 

17. Start by starting; one minute is always better than none-minutes.

 

18. A simple rule for getting started: 40% of your breath should be inhaling, 60% should be exhaling.

 

19. Holding implies tension and effort; pausing is natural and effortless.

 

20. Breath and mind are inseparable: This means you can use your breath, to change your mind, to change your breath for the better.

(A play on this line from Neurodharma: “Neurons that fire together, wire together. This means that you can use your mind, to change your brain, to change your mind for the better.”)

 

21. The goal of a breathing practice is better mindless breathing.

 

22. The joy of breathwork is breathing.

Light and Calm, Start by Starting, and the 60/40 Rule of Slow Breathing

 
 

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4 Thoughts


1. How to Get Started with Breathwork

“But this doesn’t have to be all at once.  Start by starting.  Add in what you can right now, and as these practices begin to improve your performance, they’ll end up saving you time.”

- Steven Kotler, The Art of Impossible

Kotler is discussing practices for peak performance, but the exact same goes for breathwork. Start by starting. One minute is always better than none-minutes.

So go easy and have fun with it : ) Your practice will grow naturally with time.

2. The 60/40 Rule of Slow Breathing

Speaking of getting started, here’s a simple rule you can begin with for slow breathing (and it’s one I use every day), inspired by Heart Breath Mind:

40% of your breath should be inhaling

60% of your breath should be exhaling

Here’s what it looks like:

  • 6.0 breaths/min: 4 sec inhale, 6 sec exhale

  • 5.5 breaths/min: 4.4 sec inhale, 6.6 sec exhale

  • 5.0 breaths/min: 4.8 sec inhale, 7.2 sec exhale

  • and so on…

Note that it’s hard to be this precise with most breathing apps, so just do what you can. For example, I simply use 5 in/7 out to breathe at 5 breaths/min.

3. Breathing and the Brain’s Default Mode Network

“The resting brain turns out not to be resting at all. Left to its own devices, the human mind holds imaginary conversations, replays past experiences, and reflects on the future.”

- Kelly McGonigal, PhD, The Joy of Movement

If you’ve ever tried to rest your brain, this passage probably isn’t surprising : ) It’s called the brain’s “default mode,” and it has a negative bias: Our natural tendency is to ruminate, criticize, and worry. Not so good.

Luckily, McGonigal says there’s an easy way to quiet it down. “In brain-imaging studies, focused breathing, mindfulness, and repeating a mantra have all been shown to deactivate hubs of the default mode network.”

Sounds good to me. So here’s to practicing some 60/40 slow breathing to deactivate our default mode, and activate more joy, today.

***

P.S. Don’t have time for mindfulness or breathing? Kelly has an even easier hack, which is to exercise in nature: “Green exercise appears to do something similar to the brain, but without the need for such dedicated mind-training.”

4. How Breathing (literally) Makes You Prosper

“Did you know the word ‘prosperity’ literally means ‘to go forward with hope’?”

- Brian Johnson, +1 on Spiritual Economics

I did not know that. But now that I do, I can confidently say that breathing makes us prosperous. When you walk away from a slow breathing session (or yoga, meditation, exercise, etc.), you always “go forward with hope.”

I wonder if it’s because we quiet our amygdalae and deactivate that pesky default network…🤔

 
 
 
 

1 QUOTE

“If our breathing is light and calm, a natural result of conscious breathing, our mind and body will slowly become light, calm, and clear, and our feelings also.”

- Thich Nhat Hahn

The Heart of the Buddha’s Teaching

 
 
 
 

1 ANSWER

Category: Breathing 101

Answer: The portion of each breath that does not participate in gas exchange is called this.

…

(Cue the Jeopardy! music.)

…

Question: What is dead space air?

In good breath,

Nick Heath, T1D, PhD
“Breathing is the compound interest of health & wellness.”

P.S. Good luck to her on this journey

 
 
 

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Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

Delightful Practice, Reverse Arambhashura, and The Buddha’s Take on Science

 
 

Listen Instead of Reading

 

Hello,

Here are four thoughts, one quote, and one answer for this week.

I hope you enjoy it!

 
 
 
 

4 Thoughts


1. What Science Has in Common with The Buddha

“Research in general tells us something about most people. Given that our concern is for what we, rather than what most people, should do, current medical practice alone cannot have a definitive answer…We need to learn how to integrate what the medical world knows to be generally true with what we know, or can find out, about ourselves.”

- Ellen Langer, Ph.D., Counterclockwise

Ellen Langer was the first woman to be tenured in Harvard’s Psychology Department. She’s a badass, and this book is insanely good. If you’re interested in applying scientific research in your own life, it’s a must-read.

The above passage is particularly critical for breathing. As we continue to learn new things about breathwork, the most important thing is to integrate that knowledge with our personal situation to find out what’s best for us.

And remember, just because it worked in a study doesn’t mean it will work for you.

As the Buddha supposedly said, “Believe nothing, no matter where you read it, or who said it, no matter if I have said it, unless it agrees with your own reason and your own common sense.” It seems like Dr. Langer would agree : )

How do we do this in our own lives? Let’s turn to another brilliant mind for more advice in Thought #2.

***

Related Quote: “I believe books are medicine. A library is a medicine cabinet. What can heal one person may not work at all for somebody else. You know when something is healing you, just as you know when something isn't.” - Sandra Cisneros (I know it’s about books, but still so good.)

2. Delight in Practice: How To Integrate Science Into Your Life

“So look for what feels good and meaningful in what you’re already doing, and perhaps find additional things that are naturally pleasurable for you…Practice is less effective if it’s heavy and somber most of the time. It’s ok to have fun with it.”

- Rick Hanson, Ph.D., Neurodharma

How’s that for a book title? There was no way I could not read that one : )

It’s packed with insight, but I thought this passage paired perfectly with Thought #1. To begin applying the new things you learn about breathing, start with what you already find meaningful, and add on from there.

For example, suppose you love the Oxygen Advantage. But, then you learn that taking big breaths every now and then is beneficial for lung capacity. In that case, you might try adding 5 big breaths before each breath hold you perform. If you like it, you keep it. If not, you don’t.

We also don’t want to take it too seriously (often guilty here). As Dr. Hanson also tells us, “It’s good to bring playfulness, even delight, to your practices.”

Here’s to applying rigorous science in our lives in a delightful way, today.

***

Related Quote: “As long as you derive inner help and comfort from anything, keep it.” - Gandhi

Related: Science Guides the Macro, Practice Guides the Micro (Thought #4)

3. Forbes: “How Breathing Calms Your Brain, And Other Science-Based Benefits Of Controlled Breathing”

“A brief review of the latest science on breathing and the brain, and overall health, serves as a reminder that breathing deserves much closer attention – there’s more going on with each breath than we realize.”

- David DiSalvo, Forbes Magazine

Here’s a quick summary of some of the science-backed benefits of breathing from Forbes. It was written 2017, but just as relevant today.

I liked the headline-paragraph-headline-paragraph style. Concise and informative. I hope you enjoy it too!

4. Slow Breathing as Reverse Arambhashura

There’s a Sanskrit word, arambhashura, which means something like “hero in the beginning.” We’ve all been there. You start a project all excitedly, but the excitement wanes. You hit some roadblocks. You decide it’s not worth it.

A slow breathing session is like reverse arambhashura. Because of the positive breathing-relaxation feedback loop, you gain motivation as you go. And when you’re done, you’re more focused, relaxed, and happy than when you began. You’re a hero at the end.

Here’s to practicing a little reverse arambhashura today.

 
 
 
 

1 Quote

“The kind of success I am most interested in is the sort available to every human being living, breathing, thinking, and doing things on this earth.”

– Tom Morris

 
 
 
 

1 Answer

Category: Body Oxygen Consumption

Answer: For the energy to perform their vital functions, the lungs themselves consume this percentage of the total body oxygen consumption.

…

(Cue the Jeopardy! music.)

…

Question: What is 5%?

In good breath,

Nick Heath, T1D, PhD
Diabetes is Tiny. You are Mighty.

P.S. I actually needed to hear this…

 
 
 

Sign Up For The Breathing 411

Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

A Danger of Breathwalking, and How I Almost Stepped on It

 
 

Listen to this post in 6 min 28 sec:

 

Welcome to another issue of The Breathing 411,

Here are four thoughts, one quote, and one answer to consider this week.

There’s also a fun bonus thought on the “Dangers of Breathwalking.”

I hope you enjoy it!

 
 
 
 

4 Thoughts

1. The Lungs Lead, Heart and Mind Follow

“This knowledge is spreading back to the West through disciplines such as yoga and mindfulness, but also through techniques aimed at improving endurance, and even intimacy. These practices demonstrate that the mind and the heart follow the lungs, not the other way around.”

- Michael J. Stephenson, MD from Breath Taking

Study after study has shown that breathing gives you access and control over your heart and mind, in ways such as increasing heart rate variability and synchronizing brain waves. That is, the lungs lead, the heart and mind follow.

But even with all this research, sometimes it takes an eloquent quote from a respected pulmonologist to make it seem so obvious.

Related: HBR: Why Breathing Is So Effective at Reducing Stress

Related Quote: “The obvious is that which is never seen until someone expresses it simply.” -Kahlil Gibran

2. Why Slow Nasal Breathing Could Be More Important in Type-2 Diabetes

Both type-1 and type-2 diabetes benefit from slow nasal breathing.

However, it could be more beneficial in type-2 diabetes since the primary issues there are reduced insulin production and reduced insulin sensitivity.

And it just so happens that slow breathing increases insulin production and improves insulin sensitivity. But maybe most importantly, nasal breathing helps you sleep better, which will indirectly boost insulin sensitivity.

Obviously, slow breathing isn’t going to cure you of type-2. But it’s safe, effective, and super practical. It seems like a no-brainer.

P.S. For T1Ds like me, all these things are still very helpful. We just won’t get the added benefit of increased insulin production…stupid pancreas…

3. How to Improve Concentration Using Your Breath

“by focusing on and regulating your breathing you can optimize your attention level and likewise, by focusing on your attention level, your breathing becomes more synchronized.”

- How to Improve Concentration Using Your Breath

In this great short article, you’ll learn that to improve your concentration, “It’s as simple as breathing through your nose.”

You’ll also get some excellent quotes from James Nestor and the director of the Yale Stress Center. Well worth the quick read. Enjoy!

Related: The nose knows: How breathing through your nose improves your health (This was linked in the Thrive article—it’s an excellent deep dive into the benefits of nose breathing, mainly from clinical doctors. I absolutely loved it. I just didn’t agree with the very last sentence.)

4. John Wayne’s Perfect Breathing Advice (almost)

“Talk low, talk slow, and don't talk too much.”

- John Wayne, Advice on acting

If we replace “talk” with “breathe,” we arrive at the perfect breathing advice:

Breathe low, breathe slow, and don’t breathe too much.

Extra Thought: The “Dangers” of Breathwalking

I’ve become somewhat obsessed with breathwalking. I use it in short 1-3 min intervals several times a day. It’s phenomenal. Thanks again, Louise!

Last Tuesday, I was walking around my backyard, completely focused on my breath. Then, I came about this close 🤏 to stepping on a snake. The snake had its head up, ready to bite. And here I am, Mr. Breathwalker, completely oblivious…lol.

Luckily, I managed to jump over it (maybe letting out a quick scream) and immediately starting laughing at the irony of the situation.

Focusing on your breath most certainly improves your concentration. But in the comfort of your backyard, that concentration might backfire!

Related: Thanks to M.C. for sharing this excellent 4.5 min video:

Breathwalking With Dr. Jim Nicolai | Andrew Weil, M.D.

 
 
 
 

1 Quote

“Few of these scientists set out to study breathing. But, somehow, in some way, breathing kept finding them.”

- James Nestor, Breath

 
 
 
 

1 Answer

Answer: In 2018, it was estimated that this percentage of the U.S. adult population had diabetes.

…

(Cue the Jeopardy! music.)

…

Question: What is 13%? (and 90-95% of those cases are type-2)

In good breath,

Nick Heath, T1D, PhD
Diabetes is Tiny. Breathing is Mighty.

P.S. Easter family get together

 
 

The Breathing 411 - Intermittent Fasting and Time-Restricted Breathing

 

Welcome to another week of The Breathing 4.1.1. Let’s get right to it.

 
 
 
 

4 THOUGHTS

1. Time-Restricted Breathing?

Every now and then, skipping a meal or two ("intermittent fasting") can be good for you. Studies have even found that just compressing your eating window (that is, "time-restricted eating") is beneficial for metabolism and weight loss.

You can do this on a much smaller scale with breathing. It’s called "intermittent breathing," or simply holding your breath. Maybe it’s only 30 seconds instead of 30 hours. Still, the idea is similar: Restrict your body from something it’s used to, and it elicits beneficial responses.

Similarly (although the analogy breaks down some), "time-restricted breathing" can also be done by setting aside time each day to breathe less. You might only do this for five minutes. But, like how time-restricted eating makes the meals you do eat more useful, time-restricted breathing improves your oxygen metabolism, making those other 20,000+ breaths you take each day more effective.

2. Slow Breathing as a Treatment for Insomnia

"Practicing the 0.1 Hz rate before sleep was shown to improve sleep onset latency and quality in insomniacs and enhance the stability of their sleep pattern (13). Thus, we suggest 0.1 Hz as the optimal frequency for a slow breathing technique." - Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia

Last week, I mentioned that slow breathing might be a way to help with insomnia, based purely on deductive reasoning. With insomnia on my radar, this article jumped off the page at me. I cannot recommend it enough. Choosing only one quote was nearly impossible.

Even if you do not care about insomnia, their sections on "Cardiorespiratory Synchronization" and "Slow Deep Breathing" are phenomenal. They will be the motivation of several future thoughts…

In the meantime, let us slow down our breathing before bed (to say, 6 breaths per minute, also known as 0.1 Hz) to help increase cardiorespiratory synchronization, increase parasympathetic tone, and have a restful night’s sleep.

3. Why You Need Efficient Breathing: 18x the Energy

"Anaerobic metabolism…is relatively inefficient compared with aerobic processes. Only two ATP molecules are produced…In contrast, the body reaps 36 molecules of ATP for each molecule of glucose metabolized aerobically."

- Respiratory Physiology: A Clinical Approach

That means that aerobic metabolism (with oxygen) is about 18x more efficient than anaerobic metabolism (without oxygen). Therefore, the more efficient you are at using oxygen, the more efficient you are at producing energy.

A practical way to improve your oxygen efficiency? Time-restricted breathing.

4. A Simple Way to Breathe Better Right Now

Make your breathing quiet. This might be the easiest, most practical thing you can do anytime, anyplace, to improve your breathing (after nose breathing, of course). Give it a try now, if you feel so inspired.

Make sure you cannot hear your breathing, even internally. You’ll naturally slow down your breathing and naturally breathe less. It’s fantastic, and it’s easy.

 
 
 
 

1 QUOTE

"Gandhi became absolutely motionless. His absorption was so profound that he scarcely seemed to breathe"

- Eknath Easwaran, Gandhi The Man

 
 
 
 

1 ANSWER

Answer: The average number of breaths in a lifetime.

…

(Cue the Jeopardy music.)

…

Question: What is over 600 million?

BONUS THOUGHT

"And if the traveler is fortunate—that is, if the path is complex and profound enough—the destination is two miles farther away for every mile he or she travels." - George Leonard

I am fortunate to be traveling with you. Thank you for reading.

In good breath,
Nick

P.S. You’re Wrong and College Has Failed You

 
 

The Breathing 411 - There Are No Quick Fixes, Except This One

 

Welcome to another version of The Breathing 4.1.1., where I curate the curators to bring you the best practical ideas I can find about breathing.

Below you’ll find 4 thoughts, 1 quote, and 1 answer (think "Jeopardy"). Enjoy!

 
 
 
 

4 THOUGHTS

1. There Are No Quick Fixes, Except This One

"You won’t find many quick fixes in this book, but there is one way to immediately boost willpower: Slow your breathing down to four to six breaths per minute [...] Slowing the breath down activates the prefrontal cortex and increases heart rate variability, which helps shift the brain and body from a state of stress to self-control mode. A few minutes of this technique will make you feel calm, in control, and capable of handling cravings or challenges."
-Kelly McGonigal, The Willpower Instinct

Beautifully said. Thank you, Kelly.

2. The #1 Breathing Fundamental

I’ve referred to it as the 1% rule (an idea I borrowed from James Clear and Dan Pink), but it is also the #1 fundamental: Breathe through your nose.

If you’re reading this, you’re probably aware of the importance of nose breathing. But, did you know that a 2018 study, which has been viewed over 93,000 times and cited 26 times, concluded that the benefits of breath control might be linked back to the nose?

"Taken together, these results confirm that nasal stimulation represents the fundamental link between slow breathing techniques, brain and autonomic activities and psychological/behavioral outputs." - Zaccaro et al. (2018)

That’s a powerful conclusion. So, to add on to what Kelly McGongical said above, breathe slowly and through your nose.

3. Breathing as Active Rest

"Active rest" has become a popular topic among athletes (and people who just enjoy exercising). It’s hard to take a day off when you love your workout, but it’s also necessary to give your body the rest it needs to recover. Enter: active rest.

There are several popular approaches. The sauna, an ice bath, or a long walk. But one of the most powerful is breathing…I’m not biased or anything : )

And the best part is that restful breathing doesn’t require any fancy equipment or money. It can be done anywhere, anytime.

In The Power of Rest, Dr. Matthew Edlund puts it this way:

“We want to learn to rest anywhere, anytime, in ways that restore us, calm us, relax us, and make us alert. That means we have to learn how to breathe.”

Agreed. See Kelly McGonigal’s advice above for the best way to "learn how to breathe."

4. Science Guides the Macro, Practice Guides the Micro

When studies show that something works, it doesn’t necessarily mean it’ll work for everyone.

We’re all different. We have different bodies, different environments, and different day-to-day stressors and stimuli that we’re exposed to. Although scientific studies try to be as general as possible, their results cannot be expected to work the same in everyone.

This gets to my thought: Science guides the macro, practice guides the micro.

For example, "get 8 hours of sleep" is a great macro statement. It sets a good target that will be beneficial for most people.

However, if you performed an in-depth sleep study on yourself, you might find that you need 7 h 37 min or 8 h 11 min to be fully rested. And that might vary from day-to-day, season-to-season.

The same goes for all of this "breathing" stuff. Guidance such as "breathe at 4-6 breaths per minute" is excellent general advice that will be beneficial for almost everyone. However, it is a macro statement. It will take personal practice to find what’s right for you.

 
 
 
 

1 QUOTE

"Breathing, like most forms of physical rest, improves as you practice. It takes a little time. But it’s a technique you’ll be able to do for the rest of your life, so it’s worthwhile getting good at it now."

- Matthew Edlund, The Power of Rest

 
 
 
 

1 ANSWER

Answer: This mammal, weighing in at only 2 g, has the smallest lungs.

…

(Cue the Jeopardy music.)

…

Question: What is the bumblebee bat?

If you enjoy my work, check out a guest blog post I recently did for BreathWrk:

Pilot Your Breathing: The Unexpected Goal of a Breathing Practice

In good breath,
Nick

P.S. The Ultimate COVID-19 Sport.

 
 

The Breathing 4.1.1. - Slow or Control? (+ Seneca on Walking & Breathing)

 

Happy Monday to you! Welcome to a new edition of The Breathing 4.1.1.

Below you’ll find 4 thoughts, 1 quote, and 1 answer (think "Jeopardy"). Enjoy!

 
 
 
 

4 THOUGHTS

1. Breath Rate or Breath Control: Which is More Important?

Last week, we talked about a powerful evolutionary advantage: Rather than evolving to breathe slowly, we evolved the ability to control our breathing.

We know slow, controlled breathing is beneficial, but what about just the controlled aspect itself?

A study published in 2017 examined this by having participants perform controlled breathing at 12 breaths per minute. This rate is on the low end of average for spontaneous breathing.

They found that this practice reduced sympathetic activity. There was something about the act of consciously controlling the breath that helped promote autonomic balance, despite the rather ordinary rate.

Slow breathing provides a host of additional benefits. But let us not forget the power of simply controlling your body’s most important function: breathing.

2. While We’re on the Subject: Slow Breathing Restores Balance in COPD

People with COPD have similar complications to diabetics, such as increased sympathetic tone and reduced baroreflex sensitivity (BRS).

A study published in 2008 found that slow breathing at 6 breaths per minute for 4 minutes significantly reduced sympathetic activity and increased BRS in COPD patients. That is, it helped restore cardio-autonomic balance. 

Their words are always better than mine:

“In summary, patients with chronic obstructive pulmonary disease showed sympathetic excitation and depression of the baroreflex. Slow breathing counteracted these changes.” - Raupach et al.

3. Another Non-Breathing Tip: I Take This Every Morning

To build off of my #1 non-breathing tip (2-4 hours between dinner and bedtime), here’s another one I use every day: baking soda.

Baking soda has been shown to improve performance and even help with autoimmune conditions. From a breathing perspective, it has also been shown to increase breath-hold time (something I have anecdotally experienced).

Here’s how I take it every morning:

  • 2 tablespoons of apple cider vinegar

  • 1/2 teaspoon of baking soda

  • Mix and "enjoy"

It sounds disgusting, but it’s actually not too bad. Apple cider vinegar might also help control blood sugars, so that’s an added bonus for us diabetics.

4. A Race for the Future

"Looking at the evidence, it’s hard not to conclude that our entire physiology was engineered to reward us for moving." - Kelly McGonigal, The Joy of Movement

I love Physiology First, its mission, and the people behind it. On August 15, they are holding a run/walk to collectively cover 1,000 miles. You can join virtually anywhere (my wife and I will be joining from here on the Space Coast of Florida).

It’s been a while since my 100-mile ruck, so this is a great reason to get out and move for a good cause. Every mile helps, and there is no minimum. I hope to "e-see" you there!

More Details:

A RACE FOR THE FUTURE
(We’re signing up for the "1000 Miler")

 
 
 
 

1 QUOTE

Speaking of walking and breathing:

“We should take wandering outdoor walks, so that the mind might be nourished and refreshed by the open air and deep breathing.” —Seneca, On Tranquility of Mind

(I found this quote in Ryan Holiday’s Newsletter.)

 
 
 
 

1 ANSWER

Answer: The number of oxygen molecules in each red blood cell.

…

(Cue the Jeopardy music.)

…

Question: What is 1 billion?

In good breath,
Nick

P.S. Keeping Cool During COVID.

 
 

The Breathing 4.1.1. - Can This Acid Help You Digest Oxygen Better?

 

I hope this edition of "The Breathing 4.1.1" helps start your week off right.

Below you’ll find 4 thoughts, 1 quote, and 1 answer (think "Jeopardy"). Enjoy!

 
 
 
 

4 THOUGHTS

1. My #1 Non-Breathing Tip to Improve Your Breathing

There are non-breathing ways to improve your breathing. Here’s the easiest and most helpful one I’ve found: Add 2-4 hours between dinner and bedtime.

For example, I now eat dinner around 5:30 p.m. and go to bed around 7:45 - 8:00 p.m. (I used to eat closer to 7:00 p.m. with the same bedtime).

After one or two nights of the earlier dinner, my CO2 tolerance increased by about 20 seconds. And it’s remained that way ever since. If you’re not already, give it a shot and see how you feel after a couple of nights.

(As a side note, I also lost about 5 lbs after 1-2 weeks of doing this. So, when I saw this article on ScienceDaily, it jumped off the page at me: People who eat a late dinner may gain weight.)

2. Can This Acid Help You Digest Oxygen Better?

"Oxygen is what we breathe in. CO2 is what we internally produce in order to allow us to use that oxygen most efficiently." - David Bidler, Breathe to Perform

I love that interpretation. Rather than thinking of CO2 as a waste product, why don’t we instead view it as something our body produces to use the oxygen we breathe in.

While reading this passage, I also thought of a new analogy. It’s not technically correct, but I think it helps get the point across:

Your body produces stomach acids to digest food. It produces blood acids to digest oxygen.

3. Why Don’t We Breathe Slowly, 24/7?

I talk about the benefits of slow breathing a lot (maybe too much). With all of those benefits, it begs the question: Why didn’t we evolve to breathe slowly all the time? (Thanks, Ben!)

Rather than breathing slowly all the time, I believe we evolved something even more powerful: The ability to control our breathing.

We have been given access to our autonomic nervous system. We can choose to ramp it up or choose to slow it down. We can respond to our outer environment while being in control of our inner one.

With great power comes great responsibility. It’s up to us if we use it or not.

4. How Your Body Remembers High Altitude (1-Minute Podcast)

This episode of 60-Second Science from Scientific American explains how our red blood cells "remember" exposure to high altitude:

Red Blood Cells Remember Your Mountain Vacation

Although breath holds and high altitude exposure are not the same thing, we can elicit similar drops in blood oxygen saturation, presumably leading to similar effects. But, they’re not permanent:

"So the longer you stay at sea level before you re-climb to high altitude, then such memory will gradually disappear." - Yang Xia, UT Health Science Center

That’s why I’m also a fan of consistency over intensity to hep keep the benefits around.

 
 
 
 

1 QUOTE

"However, there is a bridge between our conscious mind and the subconscious action of the autonomic nervous system – breathing."

- Stephen Elliot with Dee Edmonson, The New Science of Breath

 
 
 
 

1 ANSWER

Answer: In 1978, two mountain climbers achieved this monumental feat for the first time.

…

(Cue the Jeopardy music.)

…

Question: What is climbing Everest without supplemental oxygen?

In good breath,
Nick

P.S. When You Finish Your To-Do List.

 
 

Breathe The Change You Want to See (In Your Body)

 

"To say…that a man is made up of certain chemical elements is a satisfactory description only for those who intend to use him as a fertilizer." - Herbert J. Muller

 
 
Breathe_the_Change_1_New.png
 
 

When I first started a “breathing” practice, it seemed a bit silly. But then I started seeing dramatic improvements in my sleep, energy, and blood sugars. How could something as simple as breathing do so many things? The more I thought about it, the more I realized it wasn’t silly or crazy at all.  

Close your mouth and pinch your nose.  

In a few seconds, you’ll begin feeling a desire to breathe so strong it’s almost uncontrollable. This simple act of holding the breath helps us appreciate just how important it is.

Why would an urge like this exist? One that can be felt by people who, quite literally, have no fear.  

It’s because there is more to breathing than just breathing. It’s biomechanics and biochemistry. It’s psychology and physiology. It’s in your brain, and it’s in your core. Breathing provides the link between your mind and your cardiovascular and autonomic nervous systems.  

How to Breathe the Change You Want to See

Breathing is also very unique. It’s automatic, yet it is also under our conscious control. It’s up to us whether we want to take advantage of this.

For example, there is a cluster of neurons in your brain that monitors your breathing. If you breathe slowly and calmly, that message is sent to important regions of your brain. If you breathe fast and anxiously, that message is relayed as well.

Want to be anxious? Breathe anxiously.

Want to be calm? Breathe calmly.

Thus, we can consciously choose the messages we send with our breath. And this goes not just for the brain, but the cardiovascular and autonomic nervous systems as well. We can literally breathe the change we want to see in our bodies.

The First Place to Start

One of the most effective ways to “breathe the change” is with slow breathing. Slow breathing improves oxygenation, restores cardio-autonomic balance, increases heart rate variability, and so much more.

Give it a shot today. Breathe between 3 to 6 breaths per minute, for 5 minutes. Try it out for five days straight and see how you feel.

There’s no pill. There’s no money to be made. It’s just simple physiology.  

In good breath,

Nick  

P.S. “Sorry, but you’re going to need a pre-authorization.”

 

Can Overbreathing Cause Osteoporosis?

 

“Life-transforming ideas have always come to me through books.” - Bell Hooks

 
 
 
Overbreathing_Osteoporosis_1_New.png
 
 
 

This week, I want to look at a few fascinating passages on overbreathing from “Breath: The New Science of A Lost Art.”

Let’s start with James Nestor’s insight into tissue hypoxia (my bold for emphasis):

“In this, chronic overbreathing will not create ‘hypoxia’ in tissues; this is a fact that many Buteyko adherents consistently get wrong.  The real damage from overbreathing comes from the constant energy the body has to expend to run more cells anaerobically and to constantly buffer for carbon dioxide deficiencies.”

So James is saying that tissue hypoxia itself is not the problem with overbreathing. The damage occurs because of the body’s response to prevent tissue hypoxia from happening.

Overbreathing and Cell Metabolism

Aerobic = “With Oxygen”

Anaerobic = “Without Oxygen”

This damage occurs partially because of sustained anaerobic metabolism. We have all probably heard of aerobic and anaerobic exercise. Slow and steady is typically aerobic, fast and intense is usually anaerobic. We don’t have to think about it. When we push ourselves, our oxygen supply can’t keep up, and our body naturally switches to anaerobic metabolism.

This anaerobic switch creates a more acidic local environment, which will help release oxygen from the hemoglobin and help restore aerobic energy production.

But, with chronic overbreathing, this aerobic balance cannot be achieved.  So your cells are running as if you’re always doing high-intensity training…not the most efficient way to spend your day.

But that’s not even the worst part of overbreathing.

Restoring pH Balance Causes the Real Damage

The body is always trying to find balance, and this is especially true for pH. Blood pH is kept in a tight range (around 7.4) to allow the body to function correctly.

When we chronically overbreathe, we offload too much carbon dioxide, which increases pH. The body compensates through a process called “buffering,” where the kidneys begin releasing bicarbonate into the urine to restore pH balance. The real damage comes from what bicarbonate takes with it:

“This occurs because as bicarbonate leaves the body, it takes magnesium, phosphorus, potassium, and more with it. Without healthy stores of these minerals, nothing works right: nerves malfunction, smooth muscles spasm, and cells can’t efficiently create energy.” - James Nestor

Overbreathing Weakens Our Bones

All of which leads us to how overbreathing can contribute osteoporosis:

“Constant buffering also weakens the bones, which try to compensate by dissolving their mineral stores back into the bloodstream. (Yes, it’s possible to overbreathe yourself into osteoporosis and increased risk of bone fractures.)” - James Nestor

Alright, let’s break these steps down to see how this happens:

  1. Overbreathing offloads too much carbon dioxide, preventing adequate oxygen delivery to the cells.

  2. The cells compensate with chronic anaerobic metabolism.

  3. The kidneys compensate by excreting bicarbonate into the urine to balance pH.

  4. The excretion of bicarbonate “steals” important minerals from the blood.

  5. The bones then compensate by dissolving minerals back into the blood, which weakens them.

It is simultaneously amazing and scary what our bodies are capable of.  

There is Always Good News

Although this negative feedback loop is alarming, there is a way to prevent or reverse it: Stop overbreathing.

And the best way to do that? Breathe through your nose, breathe slowly, and breathe slightly less than you think you need.

In good breath,
Nick

P.S. Just Along for the Ride.

 
 

Two Regulatory Effects of Breathing (+ James Nestor Breathing Q&A)

 
 

“Waste no more time arguing what a good man should be. Be one.” - Marcus Aurelius

 
 
 

You probably hate Zoom meetings by now. In fact, if you work in an office setting, you’re probably just tired of meetings in general. But every now and then, you have a truly important meeting. You prepare, rehearse, read, dress nice, and do everything you can to show up ready. 

Physiologically, we step into one of these “truly important meetings” approximately 25,000 times per day…no big deal, I know :) And we can choose how well we prepare for each one. We can send messages of calm, focus, and relaxation, or messages of anxiety, stress, and arousal.  

Whichever we choose, the messages we send with our breathing regulate many aspects of our health and well-being.  

How? Well, the answer to that is complex because breathing interacts with many systems of the body simultaneously (as we learned last week). But, the paper I am sharing this week goes through two significant regulatory effects of breathing.

 
 
 
 

Modulatory Effects of Respiration

Published in Autonomic Neuroscience: Basic and Clinical (2001)

Click Here to Read the Full Summary

 
 
 
 

The two main takeaways from this study are:

(1) Breathing modulates the cardiovascular system through respiratory sinus arrhythmia  

(2) Specific breathing patterns can reduce our chemosensitivity to carbon dioxide and hypoxia


1. Breathing and the Cardiovascular System

Respiratory sinus arrhythmia (RSA) measures how breathing, heart rate, and blood pressure all interact. Put simply, RSA is the increase in your heart rate as you inhale and the decrease in your heart rate as you exhale. RSA is thought to be an index of vagal activity and direct measurement of heart rate variability.  

When we breathe so that the length of our inhale matches our heart rate increase and our exhale matches our heart rate decrease, we maximize RSA. Typically, this occurs when breathing at around 6 breaths per minute. This coherence among breathing and heart rate maximizes heart rate variability and improves cardiovascular efficiency.

 

2. Breathing and Chemoreflexes

They reviewed a study conducted with yoga trainees and non-yoga trained participants. This study assessed how different breathing protocols affect sensitivity to high carbon dioxide (hypercapnia) and low oxygen (hypoxia). These sensitivities are known as chemoreflexes.

As we might expect, the chemoreflexes of the yoga practitioners at baseline were much lower than the non-trained participants. This means their breathing did not increase as much when exposed to hypercapnia or hypoxia.

Interestingly, when breathing at 6 breaths per minute, the controls' chemoreflexes decreased to levels similar to the yogis.  Therefore, the simple act of slow breathing reduced chemosensitivity to carbon dioxide and hypoxia, regardless of previous training.

Being able to tolerate changes to carbon dioxide and oxygen easily is a sign of respiratory and physical resiliency. And merely slowing down your breathing can improve this resiliency almost immediately.

 

How Will Your Next Meeting Go?

Breathing is fascinating because it’s both autonomic and under our control. Obviously, we can’t control every breath we take, and I think that would be an awful way to live.  But, we can deliberately set aside time to harness what we’ve learned from this study.  

Just a few minutes of slow breathing at around 6 breaths per minute can improve chemosensitivity and align your cardiovascular and respiratory systems.  This will help make the other 25,000 odd breaths you take that much more effective.

Here’s to being the regulator of our health and well-being.

In good breath,
Nick

P.S. I would be the first one captured.

 

James Nestor Q&A

James Nestor is holding a “Breathing Q&A,” where he is rounding up questions related to all aspects of breathing to sending them to be answered by experts in the field of respiratory science. I have a few to submit…you should too!

Learn More Here.

Yoga & Breathing Virtual Workshop

My wife is teaching a masterclass on breathing and yoga as part of a larger Virtual Yoga Festival. She’s mixing in slow breathing, CO2 tolerance, Oxygen Advantage, and The Art of Breath. I don’t “advertise” in my newsletter, but the studio hosting the event is donating all of the profits to No Kid Hungry. So if you’re into yoga and/or breathing, you can learn and support a good cause at the same time.

Learn More Here.



 

Breathing Restores Autonomic Control in Type-2 Diabetics with Complications

 

“Quit worrying about your health. It’ll go away.” - Robert Orben

 
 

As people with diabetes (type 1 or 2), we know our bodies are under extra stress. This is due to things like fluctuating blood sugars and chronic inflammation. These factors can gradually accumulate into nerve damage and a variety of other long-term complications.  

However, we have recently learned that some “long-term complications” are functional and reversible (at least in their early stages). One way to reverse them is slow breathing.

Slow breathing treats the root cause of many complications, tissue hypoxia, which then restores autonomic functioning. This has been proven in several studies involving people with type-1 diabetes. However, most participants had not yet developed severe complications.

Putting Slow Breathing to the Test

It seems reasonable to assume that slow breathing would have the same effects in type 2s. But, what if these people with type-2 diabetes have chronic kidney disease? With a severe complication such as this, could slow breathing still have the same benefits?

 
 
 
 

Trained breathing-induced oxygenation acutely reverses cardiovascular autonomic dysfunction in patients with type 2 diabetes and renal disease

Published in Acta Diabetologica, 2016

Click Here to Read the Full Summary

 
 
 
 

The Study Group and Breathing Protocol

This study had 26 type-2 diabetic patients, 12 of which had diabetic kidney disease, and 24 non-diabetic controls. The protocol was simple: They had the participants lay down and breathe normally for five minutes, followed by two minutes of slow breathing at 6 breaths per minute.

The primary outcome was a change in baroreflex sensitivity (BRS). BRS measures your body’s ability to quickly adjust blood pressure to meet the current demands of your situation. It is thought to be an overall measurement of autonomic and cardiovascular control. In general, diabetics have lower BRS scores than non-diabetics.


Slow Breathing Improves Autonomic Function in Diabetics With Kidney Disease

At baseline, the type-2 diabetics had a lower resting oxygen saturation and lower BRS. When they switched to breathing at 6 breaths per minute, their oxygen saturation and BRS both increased significantly. Their blood pressure also reduced.

Perhaps most importantly, these same changes were observed in the diabetics with kidney disease. Both sets of diabetics (kidney disease and no complications) showed similar increases in BRS and oxygen saturation.  This indicates that, even in diabetics with severe complications, slow breathing can acutely reverse autonomic dysfunction.


Getting Back to Tissue Hypoxia

The authors suggest that these improvements in autonomic function were due to increases in tissue oxygenation. Similar to the study we featured on type-1 diabetes, they indicate that by increasing tissue oxygen levels, sympathetic activity is reduced, and autonomic balance is restored.


A New Model of Diabetic Complications

These results again indicate that autonomic dysfunction is not an expression of nerve damage. Instead, it is a reversible phenomenon that might actually be the precursor to nerve damage.  This paradigm-shifting view opens the door to new opportunities for treating autonomic dysfunction in diabetics.


In good breath,

Nick

P.S. A Zoom Meeting I would Look Forward To.

P.P.S. James Nestor’s new book, Breath: The New Science of a Lost Art, comes out tomorrow. I don’t know James, but from the podcast interviews I’ve heard so far, this sounds like a must-read if you’re into all this “breathing” stuff :)

And if you really want to geek out, James and Patrick McKeown got together for an hour long conversation on all things breathing. Watch/Listen Here.

 
 

Lack of Oxygen Might be the Root Cause of Diabetic Complications

 
 

Since we cannot know all that there is to be known about anything, we ought to know a little about everything.” - Blaise Pascal

 
 
 
 

People with diabetes are at an increased risk of cardiovascular and autonomic problems. Diabetics also display altered respiratory control, for example, showing depressed (or enhanced) chemoreflexes.

However, previous studies have never examined these two aspects in an integrated fashion.

Integration Over Isolation

The problem with separately studying these systems is that the results might not be independent. For example, if a study shows that diabetics have decreased respiratory control, it might conclude that this is from diabetic nerve damage.

Likewise, if a study shows that cardiovascular function is depressed, it might also conclude that this is due to diabetic nerve damage.

However, if we study them together, we might find that there is a reciprocal relationship. Maybe the respiratory problems are causing cardiovascular issues? Perhaps it’s the other way around?

This study takes that approach and has some pretty remarkable conclusions.

Integrated cardiovascular/respiratory control in type 1 diabetes evidences functional imbalance: Possible role of hypoxia

(Click Here to Read Full Summary — I don’t say this often, but please read this one if you have diabetes)

Published in the International Journal of Cardiology, 2017.

In forty-six type-1 diabetics and 103 age-matched controls, they measured baroreflex sensitivity (BRS) as a marker of cardiovascular function and chemoreflexes as a marker of respiratory control.

Chemoreflexes estimate how sensitive you are to increasing CO2 (hypercapnic chemoreflex) and decreasing O2 (hypoxic chemoreflex).

The Hypothesis: If BRS and chemoreflexes are reduced, this would suggest diabetic nerve damage. However, if some are reduced while others are elevated, this reciprocal relationship might be showing autonomic dysfunction instead of diabetic nerve damage.

This is such an important distinction. “Damage” implies that the damage is done. “Dysfunction” implies that we could make it functional again.

Diabetics Have Worsened Cardiovascular and Respiratory Control

The results showed that subjects with diabetes had a lower BRS than the controls. They also had a suppressed hypoxic chemoreflex. However, they had an elevated hypercapnic chemoreflex. (Remember their hypothesis: if it was nerve damage, both of these chemoreflexes would be reduced.)

Interestingly, the diabetics also showed a lower oxygen saturation. And, they also had relatively high HbA1c’s (an average of 8.19%). A high HbA1c will decrease oxygen delivery to the tissues and cells.

Tissue Hypoxia is at the Root of Diabetic Complications

The reduced oxygen saturation and high HbA1c suggest a resting state of tissue hypoxia in diabetes. Over time, we become “numb” to this, which explains the decreased hypoxic chemoreflex.

The body compensates with an up-regulated hypercapnic chemoreflex, which leads to chronic activation of the sympathetic nervous system (fight or flight).  Chronic sympathetic activation then suppresses our cardiovascular control.

It’s a vicious cycle with negative long-term implications:


 
 
Root_of_Complications_Cycle.png
 
 

Dysfunction, not Damage: A Silver Lining

“We show in the present study that what is normally called ‘autonomic neuropathy’ could be in many cases a functional condition of sympathetic activation, driven by many factors, one of which seems to be resting hypoxia.”


This is all actually good news.  Their results suggest that diabetic autonomic imbalance is mainly functional and not related to nerve damage.  In fact, the authors suggest that this imbalance likely leads to nerve damage, rather than being the result of it. Therefore, therapies targeting cardio-respiratory control could help reverse/prevent diabetic complications if caught early enough.

Break Out Your Slow Breathing Hammer

What are these therapies? One is slow breathing. Slow breathing will immediately improve cardiovascular and respiratory reflexes. It will also enhance oxygenation (when breathing through the nose).

I hate sounding like all I have is a “slow breathing hammer,” but it is just too important not to stress over and over again.

Here’s to taking the first step toward protecting our long-term health as diabetics.

In good breath,
Nick

P.S. A great podcast was recently released with James Nestor, author of the soon-to-be-released book: “Breath - The New Science of a Lost Art”. (The book looks terrific, so I pre-ordered my copy about a week ago.)

You can basically learn everything you’ll ever need to know about breathing in this quick 35-minute interview. I loved it.

Listen to the podcast here.

 
 

The Best Way to Begin Slow Breathing

 
 

“The secret of making progress is to get started. The secret to starting is to divide your complex, overwhelming task into small, manageable tasks, and then start the first.” - Mark Twain

 
 
 

Slow breathing has many benefits. For example, it improves cardiovascular and autonomic functioning. However, as we mentioned last week, you can quickly get “lost in the crabgrass of details” if you’re not careful, which is basically what I do every day :)

For instance, there are several ways to breathe slowly. You can use equal inhales and exhales, extended exhales for more relaxation, or you can include ujjayi breathing if you’re a trained yogi.

The study I’m sharing this week examined some of these nuances to determine which is best for beginners.

Cardiovascular and Respiratory Effect of Yogic Slow Breathing in the Yoga Beginner: What Is the Best Approach?

(Click Here to Read Full Summary)

Evidence-Based Complementary and Alternative Medicine, 2013

The study had seventeen non-yoga practitioners perform several different breathing protocols:

  • Spontaneous breathing

  • Controlled breathing at 15 breaths/min

  • Slow breathing at 6 breaths/min, 5 sec inhale, 5 sec exhale (equal)

  • Slow breathing at 6 breaths/min, 3 sec inhale, 7 sec exhale (extended)

  • The above two slow breathing protocols, but with ujjayi

Measurements of baroreflex sensitivity (BRS), blood pressure, and several respiratory variables were taken during the experiment.

Most Improvements from Slow Breathing without Ujjayi

They found that slow breathing without ujjayi was the most effective at improving cardiovascular and autonomic function (as measured by BRS) and at reducing blood pressure.

However, keep in mind that these were not trained yogis. Therefore, the added effort of ujjayi likely dampened the parasympathetic response. The results would likely be different in a trained ujjayi practitioner.

Getting Started: Breathe at a Ratio That Is Comfortable For You

All of their results revealed that slow breathing with an equal inhale-to-exhale ratio performed best. However, the differences between the balanced and extended exhale techniques were small. Therefore, they concluded that “practitioners can engage in a ratio that is personally comfortable and achieve the same BRS benefit.”

For us, the take-home message is that slow breathing at a rate of 6 breaths/min improves cardiovascular and autonomic function. The best way to begin is to choose a ratio that is comfortable for you.

I suggest that you start with a 4 second inhale and a 6 second exhale and see how it feels. Begin with a five-minute session first thing in the morning and build up from there to reach three 5-minute sessions a day.

In good breath,
Nick

P.S. Me. Also me.

 

Are Long-Term Diabetic Complications Reversible?

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As a person with type-1 diabetes, long-term complications are like the boogeyman. I hide under the covers, turn off the lights, and they can’t get me. I am healthy, after all. Right?

But the truth is, diabetic complications are more common than I would like to admit. There are, however, two pieces of good news.  

There is Always Good News

First, a popular study showed that for every 1% reduction in HbA1c, there was a significant reduction in the risk of many diabetic complications.  

For example, in type-2 diabetics, a 1% drop in HbA1c was associated with a 14% drop in heart attacks. Because we know that slow breathing can help reduce HbA1c, this is more motivation to be consistent with our breathing practice (and exercising, eating healthy, and sleeping more).

Second, the study I’m sharing this week found that some diabetic complications are reversible by slow deep breathing:


Deep breathing improves blunted baroreflex sensitivity even after 30 years of type 1 diabetes

(Click Here to Read Full Summary)

Journal: Diabetologia, Volume 54, Article number: 1862 (2011)

Baroreflex sensitivity (BRS) measures your heart’s ability to adjust your blood pressure in response to changing conditions. It’s also an early indicator of autonomic dysfunction. People with diabetes typically have reduced BRS, even before other complications show up.

This study found that slow breathing at six breaths/min restored BRS to normal levels, even in long-duration type-1 diabetics (>30 years). These results indicate that reduced BRS in diabetics is partially functional and hence partially reversible.

How did slow breathing do this? The authors showed that it increased heart rate variability and parasympathetic tone, leading to improved cardiovascular and autonomic functioning.


More Benefits of Slow Breathing for Diabetics

While getting this post ready, I was considering all of the research showing the benefits of slow breathing for diabetes. This inspired me to create this little graphic, which I think sums it up succinctly.

 
 
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The earlier we address the adverse effects of diabetes, the better our chances are of avoiding complications.

In good breath,
Nick

P.S. That is trust.

P.P.S. My stats for this week:

Average BOLT Score: 30 sec (Min: 26 sec, Max: 36 sec)
Average CO2 Tolerance: 64 sec (Min: 54 sec, Max: 82 sec)
Average Blood Sugar: 102 mg/dL (Min: 47 mg/dL, Max: 230 mg/dL)

 

Only Breathing Principles Endure

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The first time I heard that quote, I thought of Wim Hof. Although Wim’s charisma is what sets his method apart from others, the principles he teaches are timeless.

For example, in the classic book Science of Breath, the following advice is given to avoid catching a cold:

When chilled, breathe vigorously for a few minutes, and you will feel a glow all over your body. [1]

How about the Oxygen Advantage? Well, that originated with the Buteyko Method. And long before Buteyko, yogis were training themselves to “bottle up” as much CO2 as possible (my bold).

He had learned much about the basics of the transparent gas in medical school and quickly realized that yogic rituals worked to bottle it [CO2] up inside the body. The main technique of manipulation was pranayama… [2]

It is often said that history repeats itself. Breathing techniques are no exception. People relearn the same principles and add their own unique take on it. But the the principles remain.

That’s why for health and wellness, I focus on principles, not techniques. And from thousands of years of practice, and hundreds of years of research, the key principles are:

  1. Breathe Through Your Nose (24/7) - Unless you’re an elite athlete, you should be breathing through your nose all the time. This is especially true during sleep.

  2. Breathe Slowly - Almost every technique (and scientific study) has focused on breathing slowly, usually in the range of 4-6 breaths/min. Use any method you’d like to achieve this rate (equal inhale/exhale, extended exhale, box breathing, etc.).

  3. Hold Your Breath - Breath holds have amazing benefits, doing everything from improving immune function to increasing blood flow to the brain.

I’ve jumped on almost every breathing bandwagon there is. And every time, I discover that there is no “cure all.” There are only principles. And when they are practiced with patience, persistence, and diligence, the true magic begins.

In good breath,
Nick

[1] Science of Breath

[2] The Science of Yoga