Positive Health Online

The importance of Breathing in Health and Disease

Breathing is one of our most important functions and plays a large part in the patterns of disease and health. Most doctors and health care practitioners know little about how people in optimal health breathe in comparison to those suffering from some illness. However breathing can be implicated in 50-70% of diseases as a causative or contributing factor according to Dr Charles Stroebel, Professor of Psychiatry, University of Connecticut Medical School.1 Dr Konstantin Buteyko, former head of the Laboratory of Functional Diagnostics in the Siberian Soviet Academy of Sciences identifies 150 diseases as being associated with breathing.2

Amazingly some of the most effective breathing techniques which enhance heath and control symptoms of disease involve reducing the amount of ventilation or breathing air with reduced oxygen pressure.

The Buteyko method, Intermittent Hypoxic Breathing Training and Eucapnic Breathing all use intermittent hypoventilation and have been used to successfully treat conditions as varied as Asthma, Chronic Fatigue, Sleep Apnea, Infertility, Immune Dysfunction and Allergy, Obesity, Angina and Hypertension.

Breathing – Physiological Tool for Transformation?

When we look closely at the way breathing affects our physiology we see why such a broad range of effects come about from working with breathing.

We are all aware that without oxygen we quickly die. Of major importance is the fact that it is not how much oxygen we breathe that matters as much as how much is effectively utilised by the cells of our body. A deeper understanding of the role that breathing can play as a healing tool also comes from understanding the pivotal role that carbon dioxide and pH plays in numerous homeostatic processes in the body, including regulation of tissue oxygen levels and the functioning of numerous biochemical processes.

Hyperventilation – "When less is more and more is less"

Most people equate good breathing with deep diaphragmatic breathing. Most breathing techniques used to enhance health have encouraged people to take large lung fulls of air. The aims being to thus fill the body with life giving oxygen. In Russia over the last 30 years profound healing effects have been seen when people are taught to breathe less for certain specified periods of time. The aim of intermittently reducing the volume of breathing is to train the body to adapt itself to higher levels of carbon dioxide and to have an increased tolerance to hypoxia. The end result of this is that the person develops an improved capacity to utilise oxygen and maintain homeostasis.

The most common dysfunction that occurs in breathing in people who don't suffer from the more serious forms of organic lung disease and including conditions such as asthma is actually Hyperventilation. Medical textbooks tend to focus on lack of oxygen and accumulation of carbon dioxide as the only important factors in disease; however, in the case of breathing often "less is more". Recent authors who discuss Hyperventilation in popular books written in English are Dr Robert Fried The Breath Connection3 and Dinah Bradley Hyperventilation Syndrome.4

The pathophysiology of Hyperventilation and the subsequent depletion of carbon dioxide and alkaline reserve has been described in the medical literature since soon after the turn of the century and the recognition of Hyperventilation symptom patterns has existed since the time of Hippocrates. Some of the early important writers include JS Haldane in 1922 and Henderson in 1925. It is considered that at least 1 in 10 of healthy people Hyperventilate,7 the percentage would be expected to be much higher in those with symptoms or chronic illness. Yet Hyperventilation goes mostly undetected and inadequately treated.

The breathing techniques discussed in this article all correct chronic Hyperventilation by retraining the breathing control centre in the brain.

Hyperventilation and Asthma

Asthma is one condition which responds with dramatic results when the Hyperventilation which accompanies this condition is controlled. The Buteyko method of breathing states that asthma is largely a response to Hyperventilation and teaches asthmatics how to reduce ventilation levels and raise CO2 to initially control symptoms and later to change the underlying immune system and inflammatory condition in asthma. A recent research trial in Australia on the Buteyko method showed that asthmatics were able to reduce their bronchodilator intake by 90% and steroids by 30% with no deterioration in symptom score and improved quality of life scores when using the Buteyko breathing method.19

Buteyko ideas run contrary to currently held medical views about asthma; however the recognition of Hyperventilation as a factor in asthma is not new. Herxheimer, author of numerous papers on bronchial asthma including one in the Lancet linked Hyperventilation and asthma as far back as 1946.8 Investigators such as McFadden,9 Sterling10 and van den Elshout,11 Clark12and others in recent times have shown the links between Hyperventilation, carbon dioxide depletion and asthma.

The Link Between Breathing and other Diseases

People can develop a large number of symptoms with Hyperventilation. These can affect all the major systems of the body including the nervous, circulatory, digestive and respiratory systems.13 Many medical conditions have been linked with breathing. In Dr Fried's excellent and well referenced book on the Hyperventilation Syndrome3 he gives details of the way that hyperventilation is linked with conditions such as epilepsy, migraine, angina, hypertension, heart rhythm irregularity, brain hypoxia and mental disorders.

Basic physiology tells us that if we increase ventilation or breathing above the body's needs we lose too much CO2. Because CO2 and bicarbonate are the most important controllers of pH this becomes disturbed. Initially there is a condition known as respiratory alkalosis but over time a compensatory metabolic acidosis can develop because of secondary loss of bicarbonate. The respiratory alkalosis is accompanied by a state of tissue hypoxia. This is due to something called the Bohr effect which basically means that as pH becomes more alkaline due to a drop in CO2, oxygen binds more strongly to oxygen and is not easily released to tissues. The alkalosis also means that nervous tissue becomes more irritable and smooth muscles constrict. Oxygen levels also drop as small blood vessels (containing smooth muscle) constrict in response to this alkalosis. The effects of this tissue hypoxia are of particular importance in organs like the brain where Hyperventilation can result in a 30% decrease in oxygen. It is known that depletion of oxygen to the brain is associated with changes in brain wave patterns and this can play a part in conditions such as epilepsy, panic attacks and cognitive dysfunction.

The heart muscle shows similar susceptibility. Angina and heart irregularity can also in some people be explained by the fact that depletion of carbon dioxide results in constriction of the smooth muscle of the blood vessels feeding the heart. Circulation and blood flow to the heart are reduced substantially. The heart muscle itself becomes more irritable and prone to irregularity. Hypertension in some cases is helped with learning breathing control because as pH normalises constriction in the smooth muscles of the arteries is relieved. Also in some people depletion of minerals like magnesium, potassium and calcium come about from the secondary compensatory mechanisms that come into play in alkalosis. Depletion of these minerals are know to contribute to Hypertension.

Hyperventilation can also be a perpetuating factor in Chronic Fatigue Syndrome, being associated with a decreased anaerobic threshold, impaired energy production in the mitochondria and lactate accumulation in muscle. British cardiologist Dr PGF Nixon has drawn parallels between CFS and the condition previously known as Effort Syndrome that afflicted soldiers suffering from battle fatigue.14,15 Many athletes with over-training syndrome actually suffer from a type of Hyperventilation syndrome with depletion of bicarbonate buffers and glutamine showing a disfunction of pH.

It is considered by many psychologists familiar with the condition of Hyperventilation that all of the physical symptoms of anxiety are related to Hyperventilation.1 Hyperventilation is frequently provoked and sustained by anxiety and chronic unresolved stress.16 Working with breathing can modify the stress response. This gives one the tools and ability to modify their own anxiety response increasing the sense of control which is so important in decreasing the health damaging effects of stress.

The Buteyko Method

Russian physician Dr K.P. Buteyko developed the theory that chronic Hyperventilation and subsequent depletion of carbon dioxide lead to the development of defensive reactions of the body. The defence mechanisms which develop are attempts by the organism to limit the further exhalation and loss of CO2. He also states that disease may occur either:
1. as a change in body function due to deficiency of CO2or
2. as the defensive reaction of the organism to the removal of CO2

The Buteyko method assesses the degree of depletion of CO2 by measuring the length of breath holding time.

Another of Dr Buteyko's unique contributions is the use of restrained under breathing to the point of experiencing a sensation of light lack of air for prolonged periods of time. The Buteyko method also utilises systemic breath holding. The rationale given is that it allows the rapid accumulation of CO2 levels. This allows homeostatic mechanisms that have adapted to habitual low levels of CO2 due to chronic hyperventilation to normalise.

Hypoventilation/Hypoxic Breathing: A Russian Contribution

The possibility exists that the success of underbreathing and breathholding in modifying many disease processes also has to do with the fact that the body is being trained to tolerate hypoxia, making it ultimately able to better utilise oxygen. Athletes know that training at altitude can enhance performance at sea levels. I personally remember feeling better than I have ever felt after returning to low altitude after adaptation to high altitude in the Himalayas.

The use of intermittent hypoxic breathing training was developed by other Russian doctors such Professor Assya Kolchinskaja and Professor R.S. Vinitskaja of the Commission for Advanced Medical Technologies of the Ministry of Health Care of the Russian Federation. Dr Kolchinskaja writes, "My personal research, the studies of my colleagues and the work of other medical researchers standing for Hypoxic therapy share the belief that disease can be treated or prevented by activation of compensatory mechanisms (pulmonary ventilation, blood circulation, haemoglobin production), responsible for oxygen supply to the tissues and cells." She continues, "The cell of the person after being given hypoxic training will utilise even more oxygen than in the case of being given Hyperoxia."17

Hypoxic Breathing in Infertility

Hypoxic training was applied in over 3000 patients for diseases like neurotic disturbance, pulmonary diseases, allergic conditions, angina, female gynaecological disease and skin disease. One research trial was conducted where 49 infertile women suffering from a range of gynaecological conditions where given hypoxic training (involving breathing an air mixture low in oxygen for a period of time daily), 48 of the 49 women became pregnant and delivered healthy children. Cancer patients using this treatment were found to have an increased resistance to radiation treatment. A device called a hypoxicator delivers low oxygen metered pressure. Overall treatment sessions last for about ½ hour daily. The person inhales the low oxygen mixture for short periods of time, the doses are repeated frequently throughout the session and normal air is breathed in between.17

Eucapnic Breathing an Holistic Approach

Our levels of health, state of physical fitness, stress levels and nutritional status will impact significantly on breathing. Often it is impossible to change breathing long term unless these other issues are addressed. A highly stressed and unfit individual will be constantly reinforcing the pattern that led to the Hyperventilation pattern of breathing initially. The highly allergic individual with mineral deficiency will also be driven to hyperventilate because of the condition of the intra-cellular environment and the level of inflammation in their systems. A number of practitioners working with breathing who work with this holistic approach describe themselves as Eucapnic-Buteyko practitioners. The term Eucapnic breathing denotes the use of breathing techniques that aim to normalise carbon dioxide. The concepts of Eucapnic breathing are developed from the Buteyko method but the approach of practitioners is broader and more eclectic. There is greater flexibility in breathing techniques used with the emphasis on Hypoventilation techniques which encourage adaptive, homeostatic change in the body. The importance of general health measures such as nutrition, exercise and stress reduction are emphasised.

Short Glossary of Terms

Apnea – lack of oxygen
Eucapnia – normal levels of Carbon Dioxide in the body.
Hypocapnia – low levels of Carbon Dioxide in the body
Hypercapnia – high levels of Carbon Dioxide in the body

Try this exercise to test your degree of overbreathing. Sit comfortably. Take a gentle breath in, then a gentle breath out. Stop breathing and hold your breath until you feel the clear and distinct desire to breathe. While holding your breath count the seconds until you feel this desire to breathe. Dr Buteyko believes that 60 seconds is the ideal time it should take before you should feel the desire to breathe. If you can go for 60 seconds you are a superb specimen of perfect breathing, with optimal levels of oxygen utilisation and carbon dioxide. Few without training have this perfect breathing. Many with training never achieve it. However, most people will improve substantially in both breath holding time and health with practice of the breathing techniques he developed.

Case History

Sean had been an elite athlete and had won a scholarship to study in an American University. He was highly competitive and trained many hours per day. He suddenly started finding that he was getting over one viral infection, only to come down with another a week or so later. He also found that he was developing increasing breathlessness some- times even at rest. What had previously been an easy run had him huffing and puffing within 5 minutes. His pulse rate normally in the 50s now was often in the 80s at rest. He was constantly tired. Due to his inability to compete and train satisfactorily he became depressed. He consulted many doctors who suspected but were unable to confirm asthma. He began a course of breathing retraining that taught him to reduce the intensity of his exercise while also controlling his breathing. He completely overcame his breathlessness and high pulse rate in 3 weeks and over the course of a couple of months regained his energy. Over the next year he resumed competition and had only 1 cold during the entire winter .

Case History

Irene was a woman in her 30s who was suffering from Panic Attacks. These were always worse pre-menstrually. She was terrified of air travel because of her over- whelming panic attacks. She was advised to learn Buteyko-Eucapnic breathing and eventually did so when her family was planning an overseas holiday and she didn't want to be left behind. As she worked steadily with her breathing over 2 months she started to have fewer and fewer panic attacks. An added bonus was that her pre-menstrual syndrome symptoms of sore and swollen breasts, headaches and fluid retention also disappeared. She made the trip.

References

1. Fried R., The Hyperventilation Syndrome, Research and Clinical Treatment, John Hopkins University Press, Baltimore and London, 1987.
2. Buteyko K.P., Buteyko Method; Experience of Application in Medical Practice. Patriot, Moscow, 1990.
3. Fried R, The Breath Connection, Plenum Press, New York and London, 1990.
4. Bradley D. Hyperventilation Syndrome, Tandem Press, New Zealand, 1992.
5. Haldane J. S., Respiration, Yale University Press, 1922.
6. Henderson Y., Physiological Regulation of the Acid-Base Balance of the blood and some Related Functions, Physical Review 5: 131 (April) 1925.
7. Huey and Secherest, 1981, quoted by Robert Fried, The Hyperventilation Syndrome, John Hopkins University Press, 1987.
8. Herxheimer, Hyperventilation Asthma, Lancet, 6386: 83-87 1946.
9. Mc Fadden et al, Arterial Blood Gas Tension in Asthma, New England Journal of Medicine, 278:19, 1027-1032 1968.
10. Sterling, The Mechanism of Bronchoconstriction due to Hypocapnia in Man, Clinical Science, 34: 277-285 1968.
11. van den Elshout, Effects of Hypercapnia and Hypocapnia on Respiratory Resistance in Normal and Asthmatic Subjects; Thorax, 46: 28-32 1991.
12. P.S. Clark, Asthma, hyperventilation and emotion, Australian Family Physician, 9, 715-719 1980.
13. L.C Lum, The syndrome of chronic habitual Hyperventilation In: Hill OW, ed. Modern Trends in Psychosomatic Medicine, 3, London , Butterworth, 196-230 1976.
14. Nixon PGF, Effort Syndrome, hyperventilation and reduction of anaerobic threshold. Biofeedback and Self Regulation 19: 155-69 1994.
15. Nixon PGF. Hyperventilation and chronic fatigue syndrome. QJ Med 88: 73-4 1995.
16. Timmons B. A Brief History of the Annual International Symposium on Respiratory Psychophysiology and Summary of the 1993 Workshop, Biofeedback and Self-Regulation, Vol. 19, No.2, 1994.
17. Popov V., Hypoxia as Essential Healing Factor in Clinical Medicine in Russia, Townsend Letter for Doctors and Patients, August/September; 87-91 1996.
18. Ivanov, S.D., Nunn, J.F., Influence of duration of hyperventilation on rise time of PCO2 after step reduction in ventilation. Resp. Physiol. 4, 243 1968.
19. Bowler S., Green A, Mitchell C, Buteyko Breathing Techniques in Asthma, a blinded randomised controlled trial; MJA, Vol. 169, p575-578 1998.