root cause

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 SummaryI 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.