How I Trained for Altitude and Why We All Benefit from Breath Training

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Listen Instead of Reading

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Autonomic Neuroscience says slow breathing is for diabetes & hypertension.

Harvard Medical School says yogic breathing is for stress.

And Tibetan Yoga says breath training is for everyone.

Let’s see how…

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4 Thoughts

1. How I Trained for High Altitude (it’s not what you might think)

I thought, “I’m The Breathing Diabetic. I better be able to handle some altitude.”

But I didn’t train how you might think. Of course, I initially started with more breath holds. But I realized that the issue at altitude is lower air pressure.

- How I Trained for High Altitude Blog Post

This one was slightly too long to fit in as a “Thought,” so I made it a really short blog post.

Give it a read to learn my somewhat odd training method for my recent hike up to 13,200 feet…and to see if it actually worked (pictures included).

Please respond to this email if you have any thoughts on my reasoning…it was my first time at altitude, so I’d appreciate any feedback or thoughts you have.

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Related: How To Breathe To Live Longer

2. Slow Breathing for Diabetes and High Blood Pressure

“Even in already well controlled diabetic patients, guided breathing had beneficial influences on cardiovascular autonomic control and a measurable impact on BP control.  It enriches available options for non-pharmacological blood pressure…reduction.”

- Effects Of Guided Breathing On Blood Pressure And Heart Rate Variability In Hypertensive Diabetic Patients

According to Johns Hopkins, approximately two-thirds of adult diabetics have high blood pressure or take medication for it. And people with diabetes and hypertension are 4x more likely to develop heart disease.

Fortunately, this study found that just 12 minutes a day of slow breathing (with no changes to medication) led to significantly lower blood pressure, increased heart rate variability, and a reduced spontaneous breathing rate (indicating reduced sympathetic arousal).

All of which led to this remarkable final statement: “If consistently used, guided breathing enhances restoration of physiological autonomic balance in patients with diabetes and hypertension.” Amen 🙏

Here’s to controlling our breath to control of our blood pressure, today.

3. Harvard Medical School: “Yogic Breathing Improved University Students' Response to Stress”

“When we anticipate a stressful situation, our breathing and heart rates naturally go up…but the yogic breathing group seemed to show protection against that type of stress. Their heart rate increased only slightly when they knew a stressful situation was coming.”

- Yogic breathing improved university students' response to stress

Enjoy this excellent and quick write-up showing that yogic SKY breathing can significantly reduce the stress response. It’s from the Beth Israel Deaconess Medical Center, a world-class teaching hospital of Harvard Medical School.

The next thought builds off of this idea of “protection against stress”…

4. What Turbulence Can Teach Us About Breathing

When you’re flying and hit turbulence, you’re told to put on your seatbelt.

It’s reactive.

It’s similar to when turbulence hits in our lives. We react. We start eating healthy or meditating or exercising more.

But a regular breathing practice is proactive.

It helps you avoid turbulence altogether.

Or, if you can’t avoid the turbulence, it’s like your seatbelt. You’re already fastened in. You don’t need to rush back to your seat. You’re ready.

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1 Quote

“Because the breath is such an excellent and abundant support for life and vitality for every being on the planet, everyone can benefit from training in the breath.”

– The Tibetan Yoga of Breath

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1 Answer

Category: Hypoxia and Red Blood Cells

Answer: During hypoxia, this organ releases additional red blood cells to increase your oxygen carrying capacity.

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(Cue the Jeopardy! music.)

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Question: What is the spleen?

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In good breath,

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

P.S. “sorry, it’s my first day!”

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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.

How Modern Science Supports Ancient Yoga, plus Comfort in Breathwalking

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Listen Instead of Reading

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The way you breathe might affect your insulin sensitivity. And the way you walk definitely affects your ability to withstand discomfort.

Let’s find out how…

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4 Thoughts

1. Longer Exhalations are Naturally Relaxing

“It's helpful to extend your exhalations because the ‘rest and digest’ parasympathetic nervous system handles exhaling while also slowing your heart rate. So, longer exhalations are naturally relaxing.”

- Rick Hanson, Ph.D., Neurodharma

Just a friendly reminder that extending the exhalation is one of the fastest ways to naturally relax. That is all : )

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Related: Longer Exhalations Are an Easy Way to Hack Your Vagus Nerve

Related: BBC: Why slowing your breathing helps you relax

2. How Breathing Might Help with Insulin Sensitivity

“These observations demonstrate that hypoxia rapidly regulated the inhibition of the insulin signaling pathway […] During reoxygenation, the ability of insulin to stimulate phosphorylation of insulin receptor and signaling proteins was restored after 45 min.”

– Hypoxia Decreases Insulin Signaling Pathways in Adipocytes

Insulin resistance is a critical factor in diabetes and overall metabolic health. In this paper, we learn that low tissue oxygen (hypoxia) can trigger insulin resistance. Encouragingly, however, reoxygenation restored it.

This is one reason why optimal breathing is so essential for metabolic health, especially for people with diabetes. By practicing slow nasal breathing, we increase our blood and tissue oxygenation. This could potentially maintain, or even restore, insulin sensitivity.

Of course, there is no research showing that slow nasal breathing does this—no one is going to fund that study : ) But, given what we know about slow breathing, tissue oxygenation, and blood flow, it seems reasonable to hypothesize that it would help. I know have certainly noticed a difference.

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Related: The Lesser-Known Benefits of Nasal Breathing, Designed for Diabetes

3. “Role of respiration in mind-body practices: concepts from contemporary science and traditional yoga texts”

“Traditional yoga texts also suggest a solution for the imbalance in prana, through slow, deep breathing. … The beneficial effects of deep breathing are supported by contemporary science.”

- Telles et al. (2014), Frontiers in Psychiatry

I’ve shared a quote from this paper before, but if you haven’t read the full thing, it’s well worth it. It describes how modern science supports ancient yogic breathing, for example, how “Conventional physiology has found benefits of deep breathing supporting the importance given to regulating the breath in yoga.”

Another interesting idea they mention is that breathing “acts as both a top-down and bottom-up mind-body practice.” It makes perfect sense, but I hadn’t thought about it that way.

Ancient Yogic Wisdom + Modern Science = A Fantastic Read

Enjoy!

4. Finding Comfort in Breathwalking

“To take my mind off the discomfort, I settle into a respiratory rhythm. I take one step as I breathe in, then two steps as I breathe out. One step breathing in, two steps breathing out. Over and over, focusing only on the breath.”

- Michael Easter, The Comfort Crisis

Easter spent more than a month in a remote region of Alaska. And this book that came out of it is incredible—a perfect blend of science and storytelling.

Of course, this part stood out to me : )

Easter is making a ridiculous walk back to camp with a ton of weight. He naturally settles into his breath, and this gives him comfort and endurance.

As he puts it, “There's science behind this. Brazilian researchers found that people who are able to detach from their emotions during exercise, for example, not thinking about or putting a negative valence on their burning legs and lungs, almost always perform better.”

So aside from the mechanics and oxygenation, here’s another way in which breathwalking can be beneficial. It helps you detach from your emotions. As Easter tells us, you’ll “almost always perform better.” Sounds good to me.

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Related: Breathwalking with Gandhi

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1 Quote

“He let me see that, because the breath is so unassuming, I had been undervaluing it. I was looking for a complicated path to enlightenment, when this simple one was right before me.”

- Larry Rosenberg, Breath by Breath

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1 Answer

Category: Hypoxia

Answer: A blood oxygen saturation below approximately this value is considered hypoxic.

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(Cue the Jeopardy! music.)

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Question: What is 90%?

P.S. Different places give slightly different numbers…sometimes it’s 94%, sometimes 92%.

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In good breath,

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

P.S. What if?

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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.

The Breathing 4.1.1.

I am trying a new format this week. I’m calling it “The Breathing 4.1.1.”

Below, I share 4 thoughts, 1 quote, and 1 answer (think “Jeopardy”). Enjoy!

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4 THOUGHTS

1. Expert Q&A on Sleep Tape

James Nestor’s first "expert Q&A" episode has been released. It’s on sleep tape with Dr. Mark Burhenne. I especially appreciated Dr. Burhenne’s confidence in recommending that people wear mouth tape. Watch Interview Here.

2. An Easy Hack for Dropping SpO2 during Breath Holds

I’m always playing around with my breath holds. Lately, I’ve been performing a full exhale before each hold.

Normal Breath In —> Fast and Complete Exhale Out —> Hold

I’ve seen additional SpO2 drops of 5-10% (!). My breath holds are not as long, but I’m getting into intermittent hypoxia easier. I really try to empty my lungs as much as possible to get more significant drops in SpO2.

3. Is Tissue Hypoxia Really the Problem?

“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.” - James Nestor, Breath

I talk about tissue hypoxia a lot. Here, James says that it’s not necessarily tissue hypoxia that’s the problem, but the body’s response to prevent it from happening that causes the damage. In any case, the underlying issue is the same: We need to get an adequate supply of oxygen for our cells to function correctly.

4. A Simple Way the Breathe Light

Teaching people to breathe "light" is often tricky. However, in Restoring Prana, Robin Rothenberg provides one of the most practical ways I’ve heard: Imagine taking up less space with each breath. I imagine less air being pulled into my nose with each inhale, and each exhale disturbing less air around me. Give it a shot.

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1 QUOTE

“He who tastes a grain of mustard seed knows more of its flavor than he who sees an elephant load of it.” - Yogi Mamacharaka, Science of Breath

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1 ANSWER

Answer: The amount of water used to humidify the air we breathe each day.

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(Cue the Jeopardy music.)

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Question: What is 1 pint? [1]

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In good breath,
Nick

P.S. Coming to you live from…

[1] Essentials of Pathophysiology (3rd Edition), Carol Mattson Porth

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.

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Modulatory Effects of Respiration

Published in Autonomic Neuroscience: Basic and Clinical (2001)

Click Here to Read the Full Summary

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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.

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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.

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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.

Exercise and Hypoxia Increase Insulin Sensitivity (& 100 Mile Ruck Website)

There are many paradoxes in breathing. For example, breathing less air delivers more oxygen to your cells.

Here is another one. Many diabetic complications (for example, insulin resistance) are rooted in tissue hypoxia. Yet, the deliberate practice of intermittent hypoxia (IH) can improve insulin sensitivity, as shown by the study I’m sharing this week.

Acute hypoxia and exercise improve insulin sensitivity (Si2*) in individuals with type 2 diabetes

(Read the Full Summary)

This research examined four different protocols:

1. Rest at normal O2 levels for 60 min

2. Rest in hypoxia for 60 min

3. Exercise with normal O2 for 60 min

4. Exercise in hypoxia for 60 min

All participants were type 2 diabetics. Oxygen levels for the hypoxic group were maintained at ~14.6%, and the results showed that the participants’ SpO2 never fell below 88% (well within the therapeutic range).

Here were the main findings:

• Hypoxic rest increased insulin sensitivity more than rest at normal O2 levels

• Hypoxic exercise improved insulin sensitivity greater than exercise in normal O2 levels

Together, these results imply that exercise and hypoxia can be added together to improve insulin sensitivity.

However, before jumping in, we must remember that hypoxia does induce stress, and stress hormones increase the body’s production of glucose. Thus, the increased insulin sensitivity could just be the body’s preemptive response to the stress: It knows more sugar is coming, so it primes itself to use it.

We should keep this in mind as we practice intermittent hypoxia: It’s important to find our Goldilocks zone, where we’re experiencing hypoxia, but not inducing too much stress. I recommend starting slowly with walking breath holds. You get the benefits of exercise and hypoxia in a safe, easy-to-perform way.

Try adding 3-5 walking breath holds to your morning routine. They don’t have to be intense, just enough to feel it. And, make sure you can recover normal breathing within 3 breaths after the hold…this ensures you do not push too hard.

Give it a shot, and remember, consistency over intensity.

In good breath,
Nick

P.S. Here is the link to the 100 Mile Ruck fundraiser page:

https://www.hhp-foundation.org/donate

Please share the link with friends and family. And consider walking a mile or two with me virtually. Or, if you can, come out to Gleason Park in Indian Harbor Beach, FL between 8 AM - 10 PM on Feb. 29th to walk in person!

Our Breathing is Shallow and Irregular for 1/3 of Our Lives

Two weeks ago, we discussed some surprising aspects of breathing during sleep.
Quick recap:

• Breathing volume is significantly reduced (by 8-16%)

• O2 drops and CO2 increases significantly

• Breathing rate remains the same, or even increases

I often work backwards, reading one paper, then getting super excited and reading the papers it referenced. The study I’m sharing this is part of my trip down the rabbit hole of breathing during sleep.

Respiration During Sleep in Normal Man

(Click Here to Read the Full Summary)

Healthy participants were studied during sleep between the hours of 10 PM and 7 AM. None of the subjects reported sleep problems or sleep-disordered breathing (not that they would know, I guess).

They found that during non-REM sleep, breathing volume reduced between 6% and 8% from awake values. During REM sleep, breathing volume decreased by as much as 16%. Interestingly, most of these subjects had a faster breathing rate during sleep. This suggests that their breathing was shallower and lighter during sleep than while awake.

Their breathing patterns were also irregular, especially during REM sleep. (Some participants had somewhat regular breathing during non-REM sleep, but they all had unstable breathing during REM). This reduced and irregular breathing led to an estimated 39% decrease in gas exchange in the lungs, which then led to relative hypoxia (low O2) and hypercapnia (high CO2).

And the most interesting part? These findings are considered normal. These somewhat counterintuitive breathing patterns are what our bodies are meant to do during sleep.

Personally, I find it fascinating that during our body’s most restorative process (and when we have no control), our breathing is significantly reduced. If we naturally breathe less and increase CO2 during sleep, there is clearly something to it.

I’m not quite sure what to make of our shallow breathing during sleep. It might be that, because we’re lying down, we don’t need to bring air as deep into our lungs to match blood flow. In any case, it appears to be related to breathing less.

If we breathe less during sleep, and sleep is so important for health, maybe we should try it during the day sometimes too?

In good breath,
Nick

Increase brain blood flow by 20%

Hi everyone,

Over the last month, we’ve learned several important aspects of intermittent hypoxia (IH). For example, IH increases immune function and the production and storage of nitric oxide.

Although we’ve only scratched the surface on IH, I want to wrap up the discussion (for now) with one of my favorites benefits: Increased brain blood flow.

Intermittent hypoxia increases brain blood flow by 20%

(Published in 2017 in Hypoxia. To read the full summary, Click Here)

The participants in this study inhaled air with 10% oxygen for 6 min to induce hypoxia. Then, they breathed normal room air for 4 min. This cycle was repeated 5 times.

Measurements were recorded during the first and fifth bouts of hypoxia:

They found that intermittent hypoxia increased brain blood flow by 20%(!)

Fractional oxygen extraction in the brain also increased significantly. Pretty remarkable.

How to use these findings in your life

Statistical analysis revealed that major increases in brain blood flow occurred when blood oxygen saturation dropped to ~86%.  We can achieve this (with practice) using breath holds. 

I recommend performing 3-5 breath holds, with a 1-min recovery between each one, approximately 10-30 minutes before a workout, competition, or presentation. The increased brain blood flow will help focus your mind and prepare you for what’s ahead.

In good breath,
Nick

P.S. Breath holds can be dangerous. Take a look at Principle 3 before getting started.

P.P.S. The ~86% finding won’t be universal. Sometimes I barely drop my O2 below 95% and still feel major enhancements in my focus and concentration. In my experience, simply performing a few cycles of mild-to-moderate breath holds is all that is needed to feel the benefits.

The protective effects of intermittent hypoxia

Hi everyone,

Happy (almost) Fall!

A few weeks ago, we learned that intermittent hypoxia increases nitric oxide (NO) production and storage.

The paper I’m sharing this week examines NO’s protective effects during hypoxia.

The protective role of nitric oxide during adaptation to hypoxia

(Read on website)

The experiment gradually adapted mice to a simulated altitude of ~5000 m (>16K ft).

After the acclimation, the mice nearly doubled their NO metabolites. Their NO storage significantly increased as well.

Hypoxia protects against NO-overproduction

They also gave a subset of mice a condition causing excessive NO, which dropped their blood pressure about 36 mm Hg. However, when the mice were acclimated to hypoxia, they only showed a 19 mm Hg drop.

Hypoxia protects against NO-deficiency

Mice given a condition of NO-deficiency (which increases blood pressure) also saw protective effects from hypoxia. Without hypoxia, their blood pressure increased ~80 mm Hg. With adaptation, it only increased ~20 mm Hg.

Overall, these results indicate that adaptation to hypoxia protects against both over- and under-production of NO.

The final sentence from their abstract sums up the benefits nicely:

“The data suggest that NO stores induced by adaptation to hypoxia can either bind excessive NO to protect the organism against NO overproduction or provide a NO reserve to be used in NO deficiency.”

In good breath,
Nick

Nitric Oxide, Hypoxia, and Batman

Hi all,

Greetings from Lakeland, FL! We live near the east coast of FL, so we evacuated inland. My thoughts are with any of you affected by Dorian. Stay safe!

We learned last week that nitric oxide (NO) is a critical in areas of tissue hypoxia (see review here). With that in mind, what happens when we purposefully induce hypoxia via intermittent hypoxic (IH) training (Principle 3)?

Intermittent hypoxia increases production and storage of nitric oxide

(Read on website)

In this study, mice were gradually adapted to an altitude of ~5000 m over a 40-day period.

After acclimation, their NO metabolites (nitrite and nitrate) increased significantly.

• This indicated that either (1) more NO was being generated or (2) NO was being released from storage.

However, the mice also increased their NO storage considerably.

• The increase in NO storage correlated significantly with the increase in NO metabolites.

All together, these results indicate that adaptation to intermittent hypoxia increases NO production and storage.

The storage rate was higher than the production rate, which was likely a protective mechanism to ensure that blood pressure did not drop too low.  However, the large storage also ensured that NO could be readily released if needed, highlighting yet another benefit of adaptation to hypoxia and intermittent hypoxia training.

In good breath,
Nick

P.S. Speaking of IH training, here’s a shot of me wearing the Oxygen Advantage® Sports Mask at the teacher training last week. Yes, I look like Bane, but it adds a lot of resistance to each breath, which helps improve CO2 tolerance, increases breathing muscle strength, and allows me to drop into hypoxia easier.