The Oxygen Advantage: The Simple, Scientifically Proven Breathing Techniques for a Healthier, Slimmer, Faster, and Fitter You

by Patrick McKeown

  It all started when Penny’s job became more demanding and she took on extra responsibilities and hours. Ireland has experienced an economic crisis for several years, leading to many cutbacks in our health service. As a result, the frontline staff of nurses has taken much of the brunt in the form of extra workloads. For Penny, the effect of these changes was increased anxiety, which she saw as the main cause of her arrhythmia.

  As an episode of arrhythmia began, Penny would feel a need for extra oxygen. To satisfy this air hunger, her anxiety and breathing would increase, making her heart race and further contributing to her complaint. It was a vicious circle, as her symptoms fed back into the condition.

  I met Penny at my clinic in Limerick and observed that she breathed through both her nose and mouth. Her breathing was noticeable, from the upper chest, and there was no natural pause on the exhalation. Her BOLT score was 8 seconds, leaving me in no doubt that she was chronically hyperventilating: the possible source of her cardiac problems.

  To begin retraining Penny’s breathing, I helped her to learn how to breathe using her diaphragm. I instructed her to place one hand on her chest and one hand just above her navel so that she could easily feel where her breathing was coming from, and begin to direct her breathing into her abdomen. Breathe in: abdomen out. Breathe out: abdomen in. Penny’s next step was to exert a small amount of pressure against her chest and abdomen with her hands so that she felt a slight resistance to her breathing. In blocks of 3 minutes, Penny practiced calming her breathing, gently slowing it down and taking less air into her body in order to create a slight shortage of air. I asked Penny to practice this exercise for 10 minutes, 5 times per day. The rest of her simple program consisted of breathing through her nose at all times and wearing paper tape across her mouth at night to make sure she didn’t breathe through her mouth during sleep.

  I met Penny several times over the following weeks, and by the third week her BOLT score had increased to 25 seconds. More important, her symptoms of arrhythmia had reduced significantly.

  The exercise I gave Penny is very similar to the Papworth method developed by Dr. Claude Lum. Dr. Lum was well known for his studies of overbreathing and was described as an “archetypal caring physician” who displayed the rare qualities of both sympathy and patience, particularly to those with psychosomatic disease. In 1959, at Papworth Hospital in Cambridgeshire, England, Dr. Lum formed part of a team developing cardiopulmonary bypass techniques, and during the following decades, his interest in habitual hyperventilation burgeoned. Together with his team of physiotherapists, he developed the Papworth method in order to address this common breathing disorder. Dr. Lum dedicated every effort to generate greater awareness of hyperventilation syndrome through his writings and lectures, many of which were published in reputable medical journals, including the Lancet, the Journal of the Royal Society of Medicine, and the Journal of Psychosomatic Research. He was one of those rare doctors with the drive and courage to devote much of his working life to unearthing the cause of so many common diseases of civilization that are, at best, only just managed with medication.

  Heart Attack: A Missing Link

  Myocardial infarction, otherwise known as a heart attack, occurs when blood flow to the heart is severely reduced or cut off altogether. This stoppage of blood results in oxygen starvation and damage or death to part of the heart muscle.

  Heart attacks often occur during or following physical exercise or emotional stress. Both activities increase breathing volume, and when breathing volume is greater than the body’s metabolic needs, carbon dioxide is removed from the lungs and blood, resulting in reduced blood flow and reduced oxygenation of the heart.

  Up to 10 percent of heart attack patients have symptoms attributable to hyperventilation. In one particular study, 3 to 6 percent of patients showed normal findings on coronary angiography soon after they experienced myocardial infarction, suggesting that the infarctions were not in fact due to any underlying heart disease but could have resulted from hyperventilation.

  Reduced blood flow to the heart muscle due to hyperventilation may then be partially or wholly responsible for myocardial infarction in some individuals. It follows, therefore, that the way we breathe, and the resultant levels of carbon dioxide in our blood, can have significant effects on the health and function of our hearts.

  In the following sections we will investigate whether patients with cardiac problems, including those who suffered a heart attack, breathe more heavily than normal and whether breathing exercises aimed at correcting breathing volume may reduce the risk of further cardiac problems, and whether hyperventilation during resuscitation can adversely affect outcomes.

  Heart Disease and Hyperventilation

  People with some types of heart disease tend to breathe more heavily and more intensely than healthier people, but many also experience a reduction of symptoms when their breathing volume is corrected toward normal. If these individuals had practiced light breathing in the first instance, would they have been less at risk of developing heart disease?

  A study of twenty patients with moderate to severe chronic cardiac failure showed that these individuals had a breathing volume of between 15.3 to 18.5 liters per minute. Given that normal breathing volume should be between 4 to 6 liters per minute, each of these patients was breathing a volume of air that was enough for two or three people. This research, along with other similar studies, show that patients with chronic heart failure breathe too intensely. Patients who exhibited heavy breathing were also found to have feelings of breathlessness during physical exercise. This comes as no surprise when you realize that how we breathe during rest determines how we breathe during physical exercise. Breathing noticeably from the upper chest during rest leads to increased breathlessness during physical exercise and the cycle of overbreathing is destined to continue.

  It is evident from this research that the way we breathe is a contributing factor in cardiac health, showing a positive correlation between increased breathing volume and the severity of chronic heart failure. Not only does overbreathing reduce the ability of the heart to pump blood around the body, an excessive breathing volume also reduces blood flow to part of the heart muscle, causing insufficient oxygenation. In a 2004 study published in the European Journal of Cardiovascular Prevention and Rehabilitation, fifty-five men were examined two months after suffering a heart attack. After following a program of breathing exercises, the patients’ breathing volume per minute significantly decreased by approximately 50 percent—from 18.5 to 9.8 liters. Remembering that normal breathing volume per minute is 4 to 6 liters, it is evident from this study that patients who suffered from a heart attack also tend to breathe far in excess of what is required, but that this volume can be reduced much closer to normal simply by implementing correctional breathing exercises.

  In addition, patients who practiced these breathing exercises showed an increase in the concentration of carbon dioxide in their arterial blood, from 33.2 mmHg to the highest point of the normal range of 44.2 mmHg. Based on improvements to breathing volume and respiratory function, the authors of the study recommended that breathing retraining could act as a valuable rehabilitation measure after heart attacks.

  Other studies confirm these benefits, showing how breathing exercises can have lasting effects on respiratory function and help to reduce symptoms of cardiac dysfunction.

  Hyperventilation During Cardiopulmonary Resuscitation (CPR)

  We have seen clearly how the effects of breathing light can improve blood flow and oxygenation, and may even be able to help prevent heart attacks in those who breathe excess volumes of air. Overbreathing can cause numerous health concerns, but there is a more disturbing risk associated with this condition that could literally make the difference between life and death.

  Cardiopulmonary resuscitation (CPR) is performed during cardiac arrest to help preserve normal brain function until further measures can be taken to restore blood circulation and breathing. We know that hyperv
entilation causes reduced blood flow and reduced oxygenation of the heart, but studies have also revealed that excessive ventilation during CPR is actually detrimental to survival.

  Researchers investigated instances where CPR resulted in death due to excessive ventilation applied by well-trained but overzealous rescue personnel. Despite adequate training, these professionals hyperventilated their patients while attempting resuscitation through higher than necessary breathing rates. It is thought that the high airway pressure resulting from administering more air into the patient than necessary had a detrimental—and ultimately fatal—effect on patients’ blood flow. One study concluded with the following warning: “Additional education of CPR providers is urgently needed to reduce these newly identified and deadly consequences of hyperventilation during CPR.”

  Reviewing the findings above, it is shocking to think that the very procedure designed to help save lives might in fact be having the opposite effect. It is even more shocking when we consider that the relationship between breathing volume and blood flow to the heart was first documented over a century ago. Thankfully, since 2007 there has been a monumental change in CPR procedures involving manual ventilation. Increasingly, the emphasis during CPR is now on chest compressions to maintain circulation, rather than manual ventilation.

  Over the years, I have witnessed many young athletes at all levels of fitness breathing too intensely for their given level of exercise. In this chapter, I have attempted to join the dots between excessive breathing volume, reduced oxygenation of the heart, and resultant ECG abnormalities, heart attacks, and chronic heart disease. It is only logical to surmise that a poorly oxygenated heart is less able to cope with the demands of intense physical exercise. Yet every month I see reports of children, teenagers, and young adults who were in the prime of life dying from undetected heart conditions. Upon hearing the news I often wonder: Could this tragedy have been avoided if the victim had been encouraged to breathe normally and through the nose? The breathing volume of athletes and nonathletes alike is crying out for attention, and greater awareness would be worth all of the effort, if even just one young life were saved.

  CHAPTER 12

  Eliminate Exercise-Induced Asthma

  In childhood, treatments for forty-three-year-old Julian’s asthma included cough medicine, trips to the coast for the benefits of sea air, and inhaling steam from a boiling kettle. On some nights, Julian remembers his wheezing being so bad that he stayed up most of the night with his head out the window in an effort to breathe. Any individual who experienced asthma as a child during the 1970s and 1980s can probably testify to the lengths that similarly worried parents took to try to help their children to breathe.

  By the late 1980s Julian had been prescribed various relievers and preventative medications, in addition to regular trips to the hospital for nebulizer treatment. This never-ending cycle of medication and hospitalizations continued for many years, and although Julian tried to keep fit, he often found he was unable to breathe, particularly during the small hours of the night.

  Fast-forward to 2006, and Julian was taking higher doses of asthma medication while his fitness level gradually reduced, a totally unproductive cycle that was beginning to seriously affect his health and well-being. Julian’s story is typical of any individual with moderate to severe asthma; although physical exercise can be very beneficial, many persons with asthma simply tend to avoid it for fear of having an attack.

  In early 2007, Julian attended one of my Dublin courses at which we focused on breathing through the nose, breathing light, and practicing breath holds while walking. Julian took his last dose of reliever medication the day after the course.

  Within six months, Julian’s asthma had drastically improved, and by Christmas 2007, he had his last dose of preventative medication. His fitness also improved and he was able to swim a mile per day, five times a week. In 2008, Julian’s GP agreed to reclassify his medical record as “asthma resolved.”

  Over the next three years, Julian’s exercise plan evolved to include eight hours of high-intensity indoor cycling, circuits, and stretching classes per week, as well as the techniques of nasal and reduced-volume breathing he learned from my course.

  These changes, along with adjustments to his eating habits, allowed Julian to improve his performance and enjoy more energy and stamina at a higher level of activity. At the age of forty in 2012, Julian ran five half-marathons and covered over 750 training miles. He achieved a personal best of 1:46 in his third half-marathon; two weeks later he completed the Berlin full marathon in 3:57. Following the Berlin Marathon, he ran the Dublin City Marathon in 4 hours. In six months, Julian had knocked over 8 minutes off his first half-marathon time.

  In six years, Julian progressed from a chance encounter with one of my books to attending my breathing course, improving his fitness, completely eliminating prescription medicine for his asthma, and running half and full marathons in very respectable times!

  The word asthma derives from Greek and means “to pant.” While asthma has been around for a very long time, it affects more people today than ever before. Exercise-induced asthma affects an estimated 4 to 20 percent of the general population and 11 to 50 percent of certain athlete populations. Interestingly, one study showed that while 55 percent of football athletes and 50 percent of basketball players displayed airway narrowing conducive to asthma, athletes from the sport of water polo showed significantly fewer asthma symptoms. Later on in this section we will investigate why this might be.

  So, what causes asthma? The most common theories include the hygiene hypothesis, which rests on the premise that too much cleanliness means children are not exposed to enough germs, resulting in diminished immune capabilities later on in life. A second commonly cited explanation is an increase in pollution, but while this may well be a trigger, it is not necessarily the cause. For instance, the west of Ireland, where I live, has a high asthma rate but very good air quality.

  Might there be another factor that plays a significant role in causing asthma—that of habitually breathing too much? If this were true, then surely reducing breathing volume could result in a reversal of the condition. By looking at the causes and symptoms of asthma, and the physiological changes resulting from the condition, we can begin to determine just how important breathing exercises can be in treating asthma.

  Since asthma is a condition characterized by difficulty in breathing, a logical approach would be to attempt to find the root cause by first addressing poor breathing habits. Tackling asthma from this angle is not new and was employed by the ancient Greek physician Galen and the sixteenth-century doctor Paracelsus, who recommended breath holding and breathing exercises for the treatment of coughing and narrowed airways.

  The prevalence of asthma increases relative to wealth. Increased wealth leads to a change in living standards: Food becomes more processed, competitive stress increases, houses become more airtight, we perform less physical exercise, and the majority of our jobs are sedentary. Fifty years ago, our living and working situations were quite different, and asthma rates were significantly lower. During that time, we ate more natural foods, had less competitive stress, our houses were drafty, and most occupations involved physical labor. Back then, our lifestyle was conducive to a more normal breathing volume, and, as a result, asthma was far less common.

  As we have seen, normal breathing volume for a healthy adult is generally agreed to be 4 to 6 liters of air per minute, but adults with asthma demonstrate a resting breathing volume of 10 to 15 liters per minute, two to three times more than required. Imagine the effect on the respiratory system when an individual breathes twice or three times too heavily all day, every day.

  Normal breathing during rest involves regular, silent, abdominal breaths drawn in and out through the nose. People with asthma, on the other hand, display habitual mouth breathing with regular sighing, sniffing, and visible movements from the upper chest. During an exacerbation of asthma, symptoms like wheezing and breathles
sness increase along with respiratory rate, relative to the severity of the condition. In other words, as asthma becomes more severe, there is also an increase in breathing volume.

  While it is well documented that people with asthma breathe too much, there is a need to determine whether the increase to breathing volume is a cause or effect of the condition. As the airways narrow a feeling of suffocation is generated, and a normal reaction is to take more air into the lungs to try to eliminate this sensation. Either way, it is a vicious cycle; narrowed airways lead to heavier breathing that causes an increase in breathing volume, resulting in the narrowing of the airways and on and on, worsening the condition and establishing bad breathing habits as a matter of necessity.

  The only way to determine whether breathing too much causes asthma is to investigate what happens when a group of individuals with asthma practice breathing exercises designed to bring their breathing volume toward normal.

  A study at the Mater Hospital in Brisbane found that when the breathing volume of adults with asthma decreased from 14 liters to 9.6 liters per minute, their symptoms reduced by 70 percent, the need for rescue medication decreased by 90 percent, and the need for preventer steroid medication decreased by 50 percent. The study found a direct relationship between the reduction of breathing volume and improvement to asthma. The closer breathing volume reduced toward normal, the greater was the reduction of asthma symptoms such as coughing, wheezing, chest tightness, and breathlessness. Furthermore, the trial’s control group—who were taught the hospital’s in-house asthma management program—made zero progress. The reason for this was solely due to the fact that there was no change to their breathing volume. Further studies reinforced these findings by showing that people with asthma who practiced reducing their breathing volume had far better asthma control with a significantly reduced need for preventive steroid and rescue medication within 3 to 6 months.