Another health paradox: with Oxygen, less is more
Published in the Nutritional Therapist Winter 2009
Teachings about breathing are central to ancient arts of Yoga, Qigong, Ayurveda and meditation. Coaches say that to find that sweet spot with your breath will improve your performance whether it be of rugby, swimming, football, singing or public speaking. Those of us who have come through the NTA training program have learned that, of the abundant nutrients around us, surprisingly, water is the single nutrient that people are most likely to be deficient in. This article looks at oxygen, another ubiquitous substance: can it too be crucially deficient?
While seeking to help a client with asthma recently, I borrowed a book about a therapeutic breathing technique developed in the 1930s by a Ukrainian doctor named Konstantin Buteyko. It was one of those moments where all roads lead to Rome. The same week my MD mentioned that asthma clients whom she had referred to a Buteyko practitioner had seen positive results. Not much later, a voice teacher mentioned a recent NY Times article about this same Buteyko technique while offering me a breathing exercise which was remarkably helpful for finding a comfortable singing voice. Thus began a new fascination. In this article I will look at breathing from the perspective of the Buteyko technique (as described in The Carbon dioxide Syndrome and in interviews with a Seattle practitioner, Pippa Kiraly); from the perspective of Donna Farhi, a yoga teacher who has made an extensive study of breath in her teachings and practice and shares it with us in her wonderful The Breathing Book, and puzzle briefly about the nutritional use of oxygen.
The stress of modern living, a stress without exertion, is getting us into trouble. The racing heart rate, the tense muscles, the release of sugar into the blood to provide energy, the suppression of the immune and digestive systems are a few of the processes of the stress response designed to focus energy for exertion. In days long gone that focus served us well. In the scenario of our modern, more sedentary stresses, these bodily responses can back fire for us. Breathing practitioners, not surprisingly, see the world through the lens of breathing. Rapid, shallow breathing is a symptom of stress, an indication that a person is in a sympathetic rather than parasympathetic state. This rapid breathing, which we adopt in stressful times, can become a longstanding habitual way of breathing which then triggers other, equally longstanding expressions of stress. Hyperventilation, a key concept in the Buteyko Method, is defined as any time that a person is breathing more than is metabolically necessary at a given time. Modern respiration rates are reported to be 12-20 breaths per minute in contrast to a breath rate of 6-8 breaths per minute in the 1890s. Signs of hyperventilation or over breathing include breathing at a pace faster than normal, using the upper chest muscles, mouth breathing, no pause at the end of the breath, the occasional yawn or sigh. While these troubled breath patterns can cause health issues, studying the breath and modifying breathing patterns appears to be a remarkably effective tool to reduce stress levels and improve health and performance.
Dr Buteyko developed his methodology while observing patients during his training in the 1940s and 50s. He noted that the severity of their illness correlated with their rate of breathing. He surmised that controlling the breathing might have a positive effect on health outcome. He had studied yogic breath restriction and applied some of these techniques to his own and his patient’s health. He found them to be effective and developed them over the years. It took several decades for his method to be adopted, but by the early 1980s the “Buteyko Method” had been approved by the Russian State Medical System for widespread use. It’s most prominent early use was for providing relief from asthma. In the late 1980s the Buteyko Method began to be taught in Australia. The first blinded trials of the Buteyko method were carried out in 1994. Since then, Buteyko has been spreading in various countries around the world and the number of people teaching the technique grows every year.
There is a surprising paradox at the core of Buteyko. When more air is breathed than is required, the cells are actually deprived of oxygen. With more rapid breathing, the partial pressure of oxygen does not significantly increase, but the levels of carbon dioxide become substantially lower. In 1903, Danish scientist Christian Bohr observed that the partial pressure of carbon dioxide in the blood affects the ability of hemoglobin to carry and release oxygen. A low partial pressure of carbon dioxide in the blood causes hemoglobin cells to hold more tightly to the oxygen they are carrying. A high pressure of carbon dioxide allows the hemoglobin to release the oxygen into the tissues of the body. This is, of course, the exact opposite of how a person who is short of breath feels. A person who is hyperventilating feels that they cannot get enough air. In reality they have about the same oxygenation in their arterial blood but too little carbon dioxide. This leads to Buteyko’s counterintuitive advice that to slow one’s breathing will actually improve oxygenation.
That it is easy to obtain sufficient oxygen is confirmed by the commonly known fact that it is possible to perform mouth to mouth resuscitation. We receive more than enough oxygen per breath. The pressure of oxygen in the body has to drop by over one third before breathing is stimulated to restore normal pressure. The body is, however, much more responsive to changes in carbon dioxide levels. Small changes from a healthy carbon dioxide level of 40 mm Hg pressure stimulate an increase or decrease in breathing. During exercise the cells require more oxygen and carbon dioxide is produced in large quantities. In the days where stress came wrapped up with physical exertion, quicker breathing would provide oxygen and the exertion created the appropriate balance of carbon dioxide.
A sustained low grade hyperventilation perpetuates a low level of stress. Some symptoms of hyperventilation are directly related to the stress response: panic attacks, an erratic or pounding heart rate, compromised digestion and immune response. Restriction in peripheral vasculature can cause numbness, cold or tingling in the extremities, headaches or unclear thinking . Muscles can become tense and sore. As carbon dioxide is lost the smooth muscles wrapped around the airways constrict. This response along with congestion and allergies are understood by the Buteyko practitioners as ways for the body to limit the loss of carbon dioxide. This is their explanation of the cause of asthma. The specific responses to long term hyperventilation can vary for each person, where their particular manifestation of ailments has to do with their genetically determined weak link be it cardiovascular, digestive, emotional or otherwise.
Buteyko method was first recognized and is best known for it’s success with treating asthma. Pippa Kiraly finds that the
Buteyko technique helps with many other ailments as well. Many of the clients who come to her for asthma find that they experience other positive results as they retrain their breathing. The list of other symptoms which can be helped is extensive and parallels the list of chronic symptoms of hyperventilation.
One function of healthy breathing is to maintain an acid balance in the blood. A low carbon dioxide level causes respiratory alkalosis where the body breaks down carbonic acid to make more CO2 and in so doing makes the blood more alkaline. Buteyko practitioners see insomnia as a symptom of over breathing. When relaxing before sleep, the pH decreases marginally, anesthetizing the nervous system and allowing sleep. High carbon dioxide pressure causes a sleepy relaxed feeling. Someone who is over breathing may not find it as easy to settle at night and might wake during the night with a dry mouth, rapid breath and the need to urinate. Incorrect breathing patterns interfere with the breath’s role of correcting the pH of the blood and the kidneys are called into play.
Pippa teaches her Buteyko in a course of five classes providing educational information about physiology and diet with daily exercises and homework. Specific exercises include slowing and extending the exhale, a mini pause at the end of the breath, observation of the breath and training in abdominal breathing.
In her book, The Breathing Book , Donna Farhi, a yoga instructor, is comfortable talking the language of science. She too describes the Bohr effect and the carbon dioxide syndrome. The symptoms of hyperventilation which she sites from a Journal of the American Medical Association article match those described in the Buteyko literature. The book provides a description of healthy breathing, various examples of unhealthy breathing, and offers breathing exercises and yoga poses to restore healthy breathing. The various forms of improper breathing, such as breathing with one’s chest muscles take much more effort and can lead to sore muscles in chest, neck and upper back. Farhi works with opening up and retraining both muscles and breath.
A simple exercise that Danna Farhi offers is “straw breathing” where one inhales normally and exhales through a straw for three minutes while concentrating on letting the next breath arise naturally. The inhalation comes as a natural result of a full exhalation. Upon counting their breaths per minute, before and after three minutes of straw breathing, Donna reports that her students typically reduce their breath rate by half after this exercise and notice continued relaxation well into the day.
Donna’s skills as a teacher shine through her soothing, poetic language in a style quite different from the more technical Carbon Dioxide Syndrome. She calls it not a how to book, but a how to un-do book and draws on poetry, drawings images and queries to teach: “Free breathing is a result of deep relaxation, not of effort.” While both books provide useful tools which could well compliment any health care approach, it takes concerted effort to change a breathing pattern. Buteyko’s in-depth breath training is helpful in providing the sustained focus needed for reversing a problematical breathing pattern. Donna’s use of physical poses and exploration of many different breath exercises offer the insight and the tools to take on the challenge of changing breathing patterns. _
Most of us have forgotten what it means to breathe deeply and peacefully. Could it be that we are indeed lacking something as ubiquitous as oxygen? Various westerners are discovering that studying the breathe offers not only a tool to calm stress, but also, as Eastern medicine has understood, a foundation for health and vitality.