Breath: The New Science of a Lost Art

The decline of human breathing has been well documented in recent decades, not by medicine, but by anthropology. Twelve thousand years ago, humans in Southwest Asia and the Fertile Crescent in the Eastern Mediterranean stopped gathering wild roots and vegetables and hunting game, as they had for hundreds of thousands of years. They started growing their own food. Ancient humans and modern tribal populations developed full jaws and airways, perfect teeth, rarely got sick, and chronic health problems appeared nonexistent. The secret was nasal breathing, body movement, and food from nature. Farming introduced processed food options. While eating raw food from nature required intense chewing for hours a day that stimulated proper jaw development, processed foods became soft and required less chewing which contributed to underdeveloped jaws. As civilization progressed, farming practices expanded and food processing became common place. About 300 years ago, food became more and more refined. Advances in milling removed the germ and bran from rice, leaving only the starchy white seed. Roller mills (and later steam mills) ripped the germ and bran from wheat, leaving only a soft, white flour. Meats, fruits, and vegetables were canned and bottled. All these methods extended the shelf life of foods and made them more accessible to the public, but also made food soft and mushy. Sugar, which was once a prized commodity of the wealthy, became increasingly common and cheap, and widely adopted. This new, processed diet lacked fiber and the full spectrum of minerals, vitamins, amino acids, and other nutrients, and was highly inflammatory. As a result, people’s faces and mouths grew smaller and smaller, compromising their airways. Furthermore, the inflammatory nature of food congested their nasal airways resulting in chronic mouth breathing, and introduced a host of chronic diseases.

Ancient skulls have huge sinus cavities, full strong jaws, and straight teeth. Almost all humans born before 300 years ago shared these traits because they chewed a lot and food was less inflammatory. As humans evolved and had access to consistent food, brains grew larger, which meant faces grew smaller as the brain expanded forward, and sinuses, mouths and airways shrank. Overtime, the more we cooked, and the more soft, inflammatory food we consumed, the larger our brains grew and the smaller our airways became. Small mouths meant not enough space for the teeth, so teeth became crowded and crooked. Mouth breathing and the introduction of sugar increased the incidence of cavities, periodontal disease, and bad breath. Not just the poor suffered, the upper class was also affected. “The better the school, the worse the teeth” a Victorian dentist observed noting sugar as the culprit. Breathing problems skyrocketed.

In colder climates, our noses would grow narrower and longer to more efficiently heat up air before it entered our lungs. In sunny and warm environments, we adapted wider and flatter noses, which were more efficient at inhaling hot and humid air. Along the way, the larynx descended in the throat to accommodate vocal communication. The larynx works as a valve to shuttle food into the stomach, and protect us from inhaling it and other objects. As humans developed speech, the larynx sank further, opening up space in the back of the throat and allowing a wider range of vocalizations and volumes. Smaller lips were easier to manipulate for speech, and ours evolved to be thinner and less bulbous. More nimble and flexible tongues made it easier to control the nuance of sounds, so the tongue slipped farther down the throat.

Proper breathing starts at birth. Studies show that mothers in modern tribes around the world follow the same practices: carefully closing their baby’s lips with their fingers after feeding and while sleeping. Native Americans explain that breath inhaled through the mouth saps the body of strength, deforms the face, and causes stress and disease. On the other hand, breath inhaled through the nose keeps the body strong, makes the face beautiful, and prevents disease. This is ancient knowledge that somehow got lost along the way in Western society. Of the 5,400 different species of mammals on the planet, humans are now the only ones to routinely have misaligned jaws, overbites, underbites, and crooked teeth (called malocclusion). With mouth breathing, the tongue rests low in the mouth. When this happens during facial development, the tongue is not pressed against the palate to stimulate proper jaw growth. The result is narrow dental arches. The upper jaw is the base of the nose, so if the upper jaw is narrow, so is the inside of the nose. Without proper stimulation during growth, the palate forms a high arch, often in a V-shape, which decreases the space inside the nose for nasal breathing and limits tongue space. The limited space inside the nose is further compromised by inflammation, such as from processed food, allergens, pollutants, and stress, which constricts an already narrow airway. The narrower the airway, the more resistance to airflow. This can result in increased mouth breathing and therefore more low tongue posture, which not only compromises jaw development but overall body posture.

In the 1930’s, dentist Dr. Westin Price felt that vitamin deficiencies played a role in deficient facial development, crooked teeth, and airway issues. He set out to prove his theory and find a cure. Dr. Price compared the teeth, airways, and general health of populations around the world. He examined indigenous communities whose members were still eating traditional foods, and compared them to other members in the same community, sometimes the same family, who had adopted a modern industrialized diet. He compiled more than 15,000 print photographs, 4,000 slides, thousands of dental records, saliva and food samples, films, and a library of detailed notes. He found that societies that replaced their traditional diet with modern, processed foods suffered up to ten times more cavities, severely crooked teeth, obstructed airways, and poorer overall health. While the traditional diets varied, they all contained high amounts of vitamins and minerals: from one and half to 50 times that of modern diets. He postulated that vitamin and mineral deficiencies contributed to poor dental and airway development. He was only partially right. Airways develop based on tongue posture, nasal breathing, food, and chewing. Without adequate chewing, not breathing through our nose, not posturing our tongue on the palate, eating food deprived of appropriate nutrients, and eating food that is inflammatory, our airways cannot develop properly. Aside from mouth breathing, one of the reasons why the tongue does not rest naturally on the palate is tongue-tie. This is a common problem that often goes undiagnosed. The tight fascia under the tongue does not allow full extension to the palate, thus does not allow proper palatal stimulation for jaw development. This tight fascia under the tongue has further consequences for breathing, speech, swallowing, and overall body posture. The tongue must rest properly on the palate in order to create a seal in the mouth to allow for proper nasal breathing, and to allow for the neck to be in proper position. If the tongue is low in the mouth, the neck compensates by posturing forward to create more space at the back of the throat for the airway. If the neck is cantilevered forward, it adds extra weight to the head, which puts pressure on the cervical spine and the muscles of the head, neck, and back. This has consequences for spinal, pelvis, and overall body alignment, and is a common cause of chronic pain. Resolving tongue-tie is a simple process that involves orofacial myofunctional therapy and often a frenectomy (tongue-tie release).

James Nestor recognized many of these issues in himself and was on a mission to discover what was going on in modern society. He had anxiety, small jaws, crooked teeth, a history of retractive orthodontics, nasal issues, sleep issues, and dysfunctional breathing. He worked with a number of experts in medicine, dentistry, anthropology, and the science of breathing. He also explored ancient wisdom to understand the difference between Western and Eastern philosophies and practices.

James did an experiment with a colleague, Anders Olsson, an expert in breathing and author of the book Conscious Breathing. The experiment consisted of two phases: plugging their nose to force mouth breathing and living their normal lives; then switching to nasal breathing only, while living their normal lives and practicing nasal breathing techniques. Before the experiment, they saw an ear, nose, and throat specialist (ENT) at Stanford University, who scanned their head, endoscoped their noses, and did a series of tests: bacterial sample, blood gases, inflammatory markers, hormone levels, smell, rhinometry, pulmonary function, and others. For 10 days, they plugged their noses with silicone covered with surgical tape to prevent nasal breathing. They tracked their vitals and sleep throughout, as well as electrocardiogram, nitric oxide, carbon dioxide, and more. By forcing themselves to breathe through their mouth, they watched their blood pressure spike, heart rate variability decrease, heart rate increase, body temperature decrease, mental clarity decrease, overall well-being decrease, need to urinate at night increase, dry mouth increase, snoring increase, and sleep apnea events increase; all suggesting that their bodies were in a state of distress. Every day these physiological biomarkers seemed to be getting worse. After 10 days, they saw the ENT again and repeated the tests. Then they spent the next 10 days focusing on nasal breathing. They taped their mouth shut at night and watched as their snoring and sleep apnea disappeared, insomnia resolve, and the need to pee at night resolve. Their vital signs normalized. James had a bacterial infection in his nose beforehand that cleared up quickly without treatment due to nasal breathing at night. James learned from the ENT that he had a deviated septum and boney obstructions called concha bullosa that constricted his nasal airway causing nasal airway resistance and thus contributing to mouth breathing. When the nasal cavity gets congested, airflow decreases and bacteria flourish. These bacteria replicate and can lead to infections, colds and more nasal congestion, which leads to more mouth breathing. After the experiment, working with Olsson, he explored techniques to expand the lungs, develop the diaphragm, flood the body with oxygen, hack the autonomic nervous system, stimulate the immune response, and reset chemoreceptors in the brain. By slowing breathing to one third of the normal rate, Olsson demonstrated that he could raise his carbon dioxide levels by 25 percent while keeping his oxygen levels the same, and decreasing his blood pressure and heart rate.

Ninety percent of children have acquired some degree of deformity in their mouths and noses. 45 percent of adults snore occasionally, and a quarter snore constantly. A quarter have obstructive sleep apnea with an estimated 80 percent of moderate to severe cases undiagnosed. The majority of the population suffers from some form of breathing difficulty or resistance, and are largely unaware. Contrary to what most of us might think, no amount of snoring is normal, and no amount of sleep apnea comes without serious health risks. The effects of unmanaged breathing disorders include bed-wetting, attention deficit hyperactivity disorder (ADHD), diabetes, cancer, insomnia, mental health and mood disorders, hypertension, hypotension, learning disabilities, headaches, erectile dysfunction, acid reflux, heart disease, neurological disorders, autoimmune disorders, and many more. Mouth breathing is considered acceptable in our Western society, despite the nose being the ancillary organ for breathing. Forty percent of today’s population suffers from chronic nasal obstruction and around half are habitual mouth breathers, with females and children suffering the most. The causes are many: dry air, pollution, stress, inflammation, allergies, processed foods, pharmaceuticals, tongue-tie, and others. Common breathing issues can involve nasal congestion, nasal and sinus infections and polyps, runny nose, sinusitis, snoring, sleep apnea, allergies, and asthma. Symptoms of breathing issues include fatigue, daytime sleepiness, insomnia, mouth breathing, dry mouth, difficulty concentrating, chapped lips, sore throat, anxiety, depression, unmanaged stress, irritability, mood issues, decreased libido, dark circles under the eyes, jaw joint issues, forward head posture, headaches, bruxism (teeth clenching or grinding), small jaws, gasping or choking during sleep, snoring, frequent waking at night, tossing and turning, waking up to pee, asthma, and allergies.

Mouth breathing in unfiltered, unmoistened, and unheated air dries out the mouth, throat, and lungs, and is prone to infection. The nose is crucial because it cleans, heats, and moistens air for easier absorption. Inside the nose are curly bones called turbinates (nasal concha). The lower turbinates at the opening of the nostrils are covered in erectile tissue, itself covered in mucus membrane that moistens and warms the air to your body temperature while filtering out particles and pollutants. All these invaders could cause infection and irritation if they got into the lungs, depending on the person’s immune system. The mucus is the body’s “first line of defense”. It collects inhaled debris in the nose, then, with the wave-like action of hair-like cilia, moves the debris down the throat and into the stomach, where it’s sterilized by stomach acid, delivered to the intestines, and removed. Working together, the different areas of the turbinates will heat, clean, slow, and pressurize air so that the lungs can extract more oxygen with each breath. This is why nasal breathing is far more healthy and efficient than mouth breathing. Furthermore, the paranasal sinuses release a gas called nitric oxide, which is a vasodilator and has anti-microbial activity. As a vasodilator, the nitric oxide mixes with air inhaled through the nose and increases the diameter of the blood vessels in the lungs for optimal oxygen and carbon dioxide exchange. The anti-microbial activity of nitric oxide allows for air inhaled through the nose to be purified from microorganisms. Nitric oxide has been shown to have benefits that include immune function, weight management, circulation, mood, and sexual function. When we breathe through our mouth, we do not mix our inhaled air with nitric oxide, and thus miss out on these benefits. Nasal breathing alone can boost nitric oxide sixfold, which is one of the reasons we can absorb 18 percent more oxygen than by just breathing through the mouth.

Our noses have erectile tissue lining each nostril. As the erectile tissue in one nostril engorges with blood and closes, the other opens. This is called the nasal cycle and occurs about every 30 minutes to 4 hours, often shifting due to sexual urges and stress. This happens because the nose is more intimately connected to the genitals than any other organ; when one gets aroused, the other responds. The mere thought of sex for some people causes such severe bouts of nasal erections that they’ll have trouble breathing and will start to sneeze spontaneously. The right nostril is intimately connected to the sympathetic nervous system (fight or flight), while the left nostril is intimately connected to the parasympathetic nervous system (rest and digest). Both of these nervous systems are part of the autonomic nervous system, and balance in this system is influenced by the nasal cycle.

Our bodies are essentially a collection of tubes. There are wide tubes, like the throat and sinuses, and very thin tubes like capillaries. The tubes that make up the tissues of the lungs are very small and we have more than 1,500 miles of them. Each breath you take must first travel down the throat, past a crossroads called the tracheal carina, which splits into the right and left lungs. As the breath keeps going, it gets pushed into smaller tubes, called the bronchioles, until it ends at 500 million little bulbs called alveoli. Each alveolus is surrounded by tiny capillaries filled with blood and therefore red blood cells. Under pressure oxygen molecules slip across the membranes of the alveoli into the blood attaching to the hemoglobin on red blood cells to be delivered to cells elsewhere in the body. At the same time, carbon dioxide releases from hemoglobin and moves into the alveoli for release through the exhaled breath. Inside each of our 25 trillion red blood cells are 270 million hemoglobin, each with room for 4 oxygen molecules. That’s around a billion molecules of oxygen within each red blood cell.

Regular and consistent blood flow is essential to delivering fresh oxygenated blood to cells and removing waste. What influences much of the speed and strength of this circulation is the thoracic pump, the name for the pressure that builds up inside the chest when we breathe. As we inhale, negative pressure draws blood into the heart; as we exhale, blood shoots back out into the body and lungs, where it recirculates. Part of what powers the thoracic pump is the diaphragm, the muscle that sits beneath the lungs in the shape of an umbrella. The diaphragm lifts during exhalations, which shrinks the lungs, then it drops back down to expand the lungs during inhalations. This up-and-down movement of the diaphragm occurs within us some 50,000 times a day, around 25,000 breaths per day. A typical adult engages as little as 10 percent of the range of the diaphragm when breathing, which overburdens the heart, elevates blood pressure, and causes circulatory issues. Extending the breaths to 50 – 70 percent of the diaphragm’s capacity will ease cardiovascular stress and allow the body to work more efficiently. The diaphragm beats to its own rhythm and affects the rate and strength of the heartbeat. Over time, shallow breathing will limit the range of our diaphragms and lung capacity, and can lead to common postural compensations and anxiety. Fixing this type of breathing and posture is relatively easy. The point is to get the diaphragm accustomed to wider ranges so that diaphragmatic breathing becomes unconscious. It involves breathing coordination, when the respiratory and circulatory systems enter a state of equilibrium – when the amount of air that enters us equals the amount that leaves, and our bodies are able to perform all their essential functions with the least exertion. Just a few minutes of daily stretching and nasal breathing with our diaphragm properly engaged can expand lung capacity. The smaller and less efficient lungs become, the quicker we get sick and die. Our ability to breathe full breaths is, according to researchers, literally a measure of living capacity. The key to breathing, lung expansion, and the long life that comes with it is the transformative power of exhalation. With proper exhalation, singers can sing more clearly, robustly, and with added nuance, and people with breathing complications can transform their lives.

Emphysema is a gradual deterioration of lung tissue marked by chronic bronchitis and coughing. The lungs become so damaged that people with the disease can no longer absorb oxygen effectively. They’re forced to take short breaths very fast, often breathing in far more air than they need, but still feel out of breath. Emphysema has no known cure. Patients suffer not because they can’t get fresh air into their lungs, but because they can’t get enough stale air out. Their diaphragms are broken down and functioning only at a fraction of the capacity of a healthy patient. Training emphysemics to expand their lungs with diaphragmatic breathing exercises allows them to access parts of their lungs that are still functional and improve their quality of life. These same diaphragmatic breathing exercises have proved useful in improving asthma, bronchitis, pneumonia, and the general health of everyone.

There is a gap in our science of breathing and its role in our bodies. Olsson discovered that we’ve done a good job of examining what causes breathing problems but have done little to explore how they first develop and how we might prevent them. Doctors have been complaining about this for years. The field of respiratory physiology is expanding in all directions, yet so preoccupied have most physiologists been with lung volumes, ventilation, circulation, gas exchange, the mechanics of breathing, the metabolic cost of breathing, and the control of breathing, that few have paid much attention to the muscles that actually do the breathing or proven breathwork techniques.

According to dated science, aging was supposed to go like this: starting around 30, we should expect to lose a little more memory, mobility, and muscle with every passing year. We would also lose the ability to breathe properly. Bones in the chest would become thinner and change shape, causing rib cages to collapse inward. Muscle fibres surrounding the lungs would weaken and prevent air from entering and exiting. All these things reduce lung capacity. The lungs themselves would lose about 12 precent of capacity from the age 30 to 50, and would continue declining even faster as we get older, with women faring worse than men. If we make it to 80, we’d take in 30 percent less air than we did in our 20’s. We’d be forced to breathe faster and harder. This breathing habit leads to chronic problems like hypertension, immune disorders, and anxiety. What the Tibetans have long known and what Western science is now discovering is that aging doesn’t have to be a one-way path of decline. The internal organs are malleable, and we can change them at nearly any time. Freedivers know this better than anyone. James learned it from freedivers years ago, when he met several people who had increased their lung capacity by an astounding 30 – 40 percent. They’d taught themselves how to breathe in ways that dramatically changed the internal organs of their bodies. Fortunately, diving down hundreds of feet is not required. Any regular practice that stretches the lungs and keeps them flexible can retain or even increase lung capacity. Moderate exercise like walking or cycling has also been shown to boost lung capacity by up to 15 percent. Modern science has shown that orthopedic breathing, breathing predominately into one lung at a time, can even correct scoliosis. The best way to prevent many chronic health problems, improve athletic performance, and extend longevity is to focus on how we breathe, specifically to balance oxygen and carbon dioxide levels in the body. To do this, we need to learn how to inhale and exhale slowly through our nose and engage our diaphragm properly.

We have 100 times more carbon dioxide in our bodies than oxygen, and most of us need even more than that. Humans can increase carbon dioxide in our bodies and sharpen our minds, burn fat, and heal disease. Carbon dioxide is a metabolic waste product. Long-term effects of chronically breathing too heavy, quickly, and deeply, can be detrimental because it depletes our body of carbon dioxide. Carbon dioxide in every exhale has weight, and we exhale more weight than we inhale. We, in part, lose weight through exhaled breath. For every ten pounds of fat lost in our bodies, eight and half pounds of it comes out through the lungs as mostly carbon dioxide mixed with water vapour. The rest is sweated or urinated out. As such, the lungs are a weight-regulating system in the body. Certain muscles used during exercise receive more oxygen than lesser-used muscles because they are producing more carbon dioxide as waste, which attracts more oxygen. It is supply on demand, at a molecular level. Carbon dioxide also has a profound dilating effect on blood vessels, opening these pathways so they can carry more oxygen-rich blood to demanding cells. Breathing less allows more energy to be produced more efficiently, while heavy and panicked breathing purges carbon dioxide. Just a few minutes of heavy breathing above metabolic needs can cause reduced blood flow to muscles, tissues, and organs. We can feel light-headed, cramped up, get headaches, or even black out. If these tissues are denied adequate blood flow for long enough, they can break down.

For a healthy body, overbreathing or inhaling pure oxygen has no benefit, no positive effect on oxygen delivery to our tissues and organs, and could actually create a state of oxygen deficiency leading to relative suffocation. In other words, the pure oxygen an athlete might breathe between plays, or a jet-lagged traveler might pay for at an oxygen bar in an airport are of no benefit. Inhaling the gas might increase blood oxygen one or two percent, but that oxygen never makes it to the cells, it is simply breathed back out. Olsson spent months recording how carbon dioxide levels changed inside his body with new breathing techniques, how it affected his blood pressure, and his energy and stress levels.

The body makes energy from food through aerobic respiration and anaerobic respiration. Anaerobic energy is generated only with glucose (a simple sugar), and it’s quicker and easier for our bodies to access. It’s a kind of backup system and turbo boost when the body doesn’t have enough oxygen. But anaerobic energy is inefficient and can be toxic, creating an excess of lactic acid. The nausea, muscle cramps, muscle weakness, and sweating you experience after you’ve pushed it too hard at the gym is the feeling of anaerobic overload. This process explains why the first few minutes of an intense workout are often so miserable. Our lungs and respiratory system haven’t caught up to supply the oxygen our bodies need, and so the body has to use anaerobic respiration. This also explains why, after we’re warmed up, exercise feels easier. The body has switched from anaerobic to aerobic respiration. When we run our cells aerobically with oxygen, we gain some 16 times more energy efficiency over anaerobic respiration. The key for exercise is to stay in the energy-efficient aerobic zone for the vast majority of the time and all times during rest. Olsson’s research showed that mouth breathing during intense exercise puts the body in a state of stress that can make us more quickly fatigued and decrease athletic performance. With mouth breathing during exercise, breathing rate increases; with nasal breathing during exercise, breathing rate decreases, which reduces exertion and increases endurance. Slow paced nasal breathing relaxes the body and calms the mind, even during exercise.

What’s considered medically normal today is 12 – 20 breaths per minute with an average intake of about half a liter per breath. However, we are a culture of overbreathers. The fix is easy: breathe less. We’ve become conditioned to breathe too much, just as we’ve been conditioned to eat too much. With some effort and training, however, breathing less can become an unconscious habit. Indian yogis train themselves to decrease the amount of air they take in at rest, not increase it. Tibetan Buddhists prescribe instructions to reduce and calm breathing for aspiring monks. Chinese doctors two thousand years ago advised 13,500 breaths per day, which is about 9.5 breaths per minute. In Japan, legend has it that samurai would test a soldier’s readiness by placing a feather beneath his nostrils while he inhaled and exhaled. If the feather moved, the soldier would be dismissed. Ancient mantras, regardless of origin, when spoken are often done in around 6 breaths per minute. In some studies, whenever subjects followed this slow breathing pattern, blood flow to the brain increased and the systems in the body entered a state of coherence as the functions of heart, circulation, and nervous system coordinate to peak efficiency. The moment the subjects returned to spontaneous breathing or normal talking, their hearts would beat a little more erratically, and the integration of these systems would slowly fall apart. A few more slow and relaxed breaths, and it would return to coherence again. To be clear, breathing less is not the same as breathing slowly. Average adult lungs can hold about 4 – 6 liters of air. Which means that, even if we practice slow breathing at 6 breaths per minute, we could still be easily taking in twice the air we need. The key to optimum breathing, and all the health, endurance, and longevity benefits that come with it, is to practice fewer inhales and exhales through the nose in a smaller volume while engaging the diaphragm. Resonant Breathing (Coherent Breathing), a technique that involves taking slow breaths, about 6 per minute, has been shown to offer similar benefits as meditation for people who didn’t want to meditate. Ordinarily, we should breathe as closely in line with our needs as we can. But occasionally willing the body to breathe way less has some potent benefits just as fasting does, and sometimes it can even lead to euphoria.

Dr. Konstantin Pavlovich Buteyko went to the most prestigious medical school in the Soviet Union where, during his residency, he noticed that patients in the worst health all seemed to breathe far too much, while healthier patients breathed far less. The more they breathed, the worse off they were, especially those with hypertension. Dr. Buteyko himself suffered from severe high blood pressure, along with the debilitating headaches, and the stomach and heart pain that often accompanies that condition. He’d been on prescription drugs to no effect. Doctors gave him a year to live at age 29. He knew he was a heavy breather and a mouth breather, so he tried an experiment: he started breathing less, to relax his chest and stomach, and sip air through his nose. A few minutes later, the throbbing pain in his head, stomach, and heart disappeared. Dr. Buteyko returned to the heavy mouth breathing he’d been doing minutes earlier and within five breaths, the pain returned. He wondered if overbreathing was the cause of many diseases not just a symptom. He developed techniques with the common purpose of training patients to always breathe as closely in line with their metabolic needs, which almost always meant taking in less air. Within a few sessions of hypoventilation training, patients reported tingling and heat in their hands and toes, their heart rates slowed, and the hypertension and migraines that had debilitated them began to disappear. Those he trained who were already in good health felt even better and athletes performed better. By the end of his career, and the end of his life in 2003 at the age of 80, Dr. Buteyko became a mystic. He barely slept and claimed that his techniques could not only heal illnesses but also promote intuition and other forms of extrasensory perception.

James visited with several Buteyko teachers and they all told the same story of how they’d been plagued by some chronic respiratory illness that no drug, surgery or therapy could fix, and how they’d all cured themselves with nothing more than breathing less. The techniques they used varied, but all circled around the same premise: to extend the length of time between inhalations and exhalations. The less one breathes, the more respiratory efficiency experienced, and the further a body can go.

Nearly 8 percent of Americans suffer from asthma, a fourfold increase since 1980. Asthma is the leading cause of emergency room visits, hospitalizations, and missed school days for children. It is considered a controllable, but incurable disease. Asthma is an immune system sensitivity that provokes constriction and spasms in the airways. Asthma attacks can be caused by pollutants, dust, viral infections, cold air, overbreathing, and physical exertion. Exercise-induced asthma affects around 15 percent of the population and up to 40 percent of athletes. At rest or during exercise, asthmatics tend to breathe more than the general population. The worldwide annual market for asthma therapies is $20 billion and drugs often work so well that they can feel like a virtual cure. But drugs, in particular oral steroids, can have horrendous side effects after several years, including deteriorating lung function, worsened asthma symptoms, blindness, and increased risk of death. Millions of asthma sufferers already know this, and are experiencing these problems for themselves. Many of them have trained themselves to breathe less and have reported dramatic improvement.

The optimum amount of air we should take in at rest per minute is 5.5 liters, optimum breathing rate is 5.5 breaths per minute, which is 5.5 second inhales and 5.5 second exhales. This is the perfect breath. Asthmatics, emphysemics, Olympians, and almost anyone, can benefit from breathing this way, even for just a few minutes a day. To inhale and exhale this way feeds our bodies just the right amount of air, at just the right time, for us to perform at peak capacity. To take the perfect breath, we must breathe through our nose and engage our diaphragm properly. Research shows that mouth taping helps children overcome ADHD, improves snoring and obstructive sleep apnea, and improves nasal congestion. When the nose is denied regular use it becomes inflamed and congested. Keeping the nose constantly in use, trains the tissues inside the nose and throat to flex and stay open. Many people heal themselves by simply breathing through their nose, all day and all night. Sprays, rinses, and allergy medications can sometimes help temporarily clear up minor congestion, but more serious chronic nasal and sinus issues may require surgery. Nostrils that are too small or that collapse too easily during inhalation, called a nasal valve collapse, can inhibit the free flow of air and contribute to breathing issues. This condition can be tested by the simple Cottle’s maneuver, and relieved with a minor surgery or managed by nasal dilators, such as Breathe Right Strips or Mute.

About three quarter of modern humans have a deviated septum, which means the bone and cartilage that separate the right and left airways of the nose are off center. Along with that 50 percent have chronically inflamed or overgrown turbinates, which creates resistance for nasal breathing. Both problems can lead to chronic breathing issues and increased risk of nasal and sinus infections. Surgery is highly effective in straightening or reducing these structures, but needs to be done carefully and conservatively by an ear, nose, and throat specialist (ENT). The nose is a wonderous, ornate organ whose structures work as a tightly controlled system. Surgery can create more space for nasal breathing, which relieves congestion, headaches, anxiety, and mouth breathing. However, if surgeons aggressively drill out too much bone, especially the turbinates, the nose can no longer effectively filter, humidify, clean, or even sense inhaled air. Each breath comes in too quickly because they lose their natural resistance that slows down the inhaled air. This condition is called empty nose syndrome. These patients experience sleepless nights, panic attacks, anxiety, loss of appetite, and chronic depression. The more they breathe, the more out of breath they feel. For those who have severe jaw deficiencies that contribute to breathing issues, oral and maxillofacial surgery may be an effective option for advancing the jaws and relieving symptoms of obstructive sleep apnea. Many patients have nasal obstructions and deficient jaws, so surgical options can be permanent solutions for their breathing conditions.

Inflamed or infected tonsils and adenoids can be both the cause and symptom of breathing issues in children and occasionally adults. 50 percent of kids with ADHD were shown to no longer have symptoms after having their enlarged tonsils and/or adenoids removed that were obstructing their airway. Children with bedwetting, as well as nocturnal bruxism (teeth grinding), have also experienced relief from having their tonsils and/or adenoids removed. However, they may develop breathing problems later in life if their jaws were already too small at the time of surgery because the damage had already been done before diagnosis and treatment. 90 percent of the obstruction of the oropharyngeal airway occurs around the tongue, soft palate, and soft tissues in the throat and back of the mouth. The smaller the mouth, the more the tongue, soft palate and related soft tissues can collapse and obstruct the airway. After talking with airway dentists, James discovered that the deeper the uvula appears to hang in the throat, the higher the risk of obstructive sleep apnea. The uvula may not be visible at all, indicating very high risk. If the tongue overlaps the lower molars or has scalloping (indentations) on the sides, the jaws are too small for the tongue, and the tongue is more likely to fall back in the throat during sleep, causing obstructive sleep apnea, as well as adversely impacting swallowing and speech. Thicker necks crowd oropharyngeal airways. Men with neck circumferences of more than 17 inches, and women with necks larger than 16 inches, have a significantly increased risk of obstructive sleep apnea. The more weight you gain, the higher your risk of suffering from snoring, upper airway resistance syndrome, and obstructive sleep apnea. Weightlifters can also struggle with obstructive sleep apnea and chronic breathing problems; but instead of fat, they have muscles crowding the oropharyngeal airway.

While the majority of the population suffers from a breathing disorder, their primary care doctors routinely misdiagnose them and prescribe them anti-anxiety, anti-depressant, and/or sleeping medications, however, the drugs don’t work because they are ignoring the root cause of the problem: breathing. Some obstructive sleep apnea cases may be diagnosed and patients may choose to try continuous positive airway pressure (CPAP), which is a machine that forces air past the obstructed and collapsing airways into the lungs. CPAP can be a lifesaver for those suffering from moderate to severe obstructive sleep apnea, and the devices have helped millions of people finally get a good night’s sleep. However, many people suffering with a breathing disorder that seek help do not have medically diagnosed sleep apnea based on their sleep study. They do, however, still have numerous symptoms, which may indicate the often undiagnosed condition of upper airway resistance syndrome. An oral sleep appliance that postures the lower jaw forward to open the oropharyngeal airway can be effective in treating snoring, upper airway resistance syndrome, and obstructive sleep apnea.

Preventative medicine is the best medicine. The most important thing we can do to manage the pandemic of breathing issues is to screen our children and address the root causes: tongue-tie, inflammatory foods, nasal obstructions, pollutants, and obesity. Early orthodontic devices weren’t intended to straighten teeth, but to widen the mouth and open airways. However, by the 1940s, to correct crowded teeth in an already too small mouth, it became standard practice for dentists to extract teeth then use that extra space to pull back the remaining teeth with headgear, braces, and other orthodontic devices, creating an even smaller mouth and more crowded airway. By the 1950s, tooth extractions – two, four, six at a time – and retractive orthodontics were routine. A few months, or years, after their mouths were compressed with retractive orthodontics, some patients would complain about breathing difficulties like snoring, sleep apnea, and asthma, as well as jaw joint pain and clicking, that they’d never had before. Some began to look different, their faces growing longer, flatter, and less defined, expressing concern about aesthetic issues.

A British orofacial surgeon, Dr. John Mew, who James interviewed, began measuring the faces and mouths of young patients who’d received teeth extractions and retractive orthodontics, and compared them with patients who’d received jaw expansion treatment. The ones who had received retractive orthodontics, as they grew up, their bodies and heads grew, but their mouth were forced to stay the same size, especially if they were wearing their retainer. This mismatch created a problem at the center of the face: eyes would droop, lower faces would collapse, and chins would recess. Furthermore, their jaw joints were pushed back and up in the sockets creating temporomandibular joint (TMJ) disorders. The more teeth these patients had extracted, and the longer they wore braces and other retractive orthodontic devices, the more obstruction they developed in their airways and the more TMJ issues they developed. He found that the devices invented to fix crooked teeth caused by too-small mouths were making mouths smaller, breathing worse, and creating new problems. Several other dentists had come to the same conclusion, publishing scientific papers on the subject. They advocated for a change, but nobody did anything, nobody cared. Conventional orthodontists were happy making lots of money doing business as usual. Dr. Mews was sued repeatedly to stop practicing expansion orthodontics and eventually lost his dental license. But something curious has happened in the last few years: hundreds of leading orthodontists and dentists have come out in support of Dr. Mew’s position, saying that, yes, traditional orthodontics are making breathing worse in half their patients. Fifty years ago, Dr. Mews said “In ten years, nobody will be using traditional orthodontics. We’ll look back at what we’ve done and be horrified.” Dr. John Mews’ son, orthodontist Dr. Mike Mews, recommends a series of tongue-thrusting exercises, called “mewing” that applies pressure to roof of the mouth to help expand the palate and open the airways. After a few months, people using the “mewing” technique have experienced expanded palates, jaws more defined, reduced sleep apnea symptoms, and easier breathing.

Dr. Theodore Belfor, a dentist in New York City, understood that we can grow bone at nearly any age using functional orthodontic appliances that stimulate stem cells epigenetically. These stem cells are activated by chewing as well as signals from these orthodontic appliances, which increases bone density and growth, causing us to look younger and breathe better. He treated James with the Homeoblock, a functional orthodontic expansion device, he invented in the 1990s. The purpose was to expand his mouth and make breathing easier by opening the nasal and oropharyngeal airways. The device also stimulates chewing by using a bite block placed on one side that addresses cranial strains, reduces TMJ symptoms, and improves facial aesthetics. Dr. Belfor, now deceased, had decades worth of patient records showing extraordinary results in bone growth and healing using that appliance, but was universally ignored until recently. The reason being is that dentists were, and still are, taught that we can not grow bone past age 30. This is in stark contrast to decades worth of scientific evidence. With Dr. Belfor’s appliance, which only requires nighttime wear, James was able to grow bone in his cheeks, right eye socket, nose, and upper jaw. His jaw became better aligned and balanced. His airways widened and became more toned, and he was able to breathe easier. Inflammation in his sinuses completely resolved. Dr. Belfor demonstrated the bone growth to James by superimposing before and after CT scans of his head. Dr. Belfor would say “Nature seeks homeostasis and balance”. This is the objective of Homeoblock and other functional orthodontic devices aimed at improving airway, alignment, and aesthetics.

The problems and solutions start at infancy. The chewing and sucking stress required for breastfeeding exercises the tongue, the masster muscle, and other facial muscles, and stimulates stem cell growth, stronger bones, and more pronounced airways. Until a few hundred years ago, mothers breastfeed their babies up to two to four years of age, and sometimes to adolescence. The more time babies spend sucking and later chewing, the more developed their faces and airways become, and the better they breathe later in life. Research has shown lower incidences of crooked teeth, snoring and sleep apnea in people who were breastfed longer over those who were bottle-fed. Research published more than a century ago advised that “an early soft diet prevents the development of the muscle fibres of the tongue resulting in a weaker tongue which cannot drive the primary dentition out into a spaced relationship with fully developed arches which will lead to more crowding of permanent teeth.” This research exposed that the human jaw is gradually becoming smaller, which is a fact that is now becoming universally recognized, but somehow this early research was ignored for a hundred years. Now we have reached pandemic proportions of malocclusion where getting orthodontics is seen a rite of passage for children and adolescents in affluent societies. This is a consequence of ignoring the evidence on jaw development, orthodontics, and breathing, and choosing profit over patients for many professions.

Tummo, the Tibetan word for “inner fire”, is a breathing technique, which was adopted and revised by Wim Hof for Westerners, that can help regulate the autonomic nervous system through brief conscious hyperventilations followed by breath holds. Breathing is an autonomic function that we can consciously control. These breathing techniques can keep a body warm in freezing temperatures, improve immune function, and heal diseases – all proven by numerous controlled scientific experiments over several decades. Many people using these techniques have got off medications that they have been on for years, which were prescribed by doctors who aimed to just cover up symptoms, and who ignored the root causes and ignored the evidence for effective holistic approaches. The Wim Hof technique allows for control of heart rate, temperature, and immune response by stimulating the sympathetic nervous system. This practice of heavy breathing along with regular cold exposure releases the stress hormones adrenaline, cortisol, and norepinephrine. The burst of adrenaline temporarily increases some immune responses programmed to heal wounds, and fight off pathogens and infection, however, if continued for longer periods of time, suppresses the immune system. The spike in cortisol temporarily helps downgrade short-term inflammatory immune responses, however, in the long-term suppresses the immune system and increases chronic inflammation. A squirt of norepinephrine redirects blood flow from the skin, stomach, and reproductive organs to muscles, the brain, and other organs essential in stressful situations, and has an anti-inflammatory effect. This breathing technique also floods the brain and body with endogenous opioids, dopamine, and serotonin, with numerous feel good effects.

Dr. Stephen Porges, a scientist and professor of psychiatry, has studied the human nervous system and its response to stress for 30 years from which he created the Polyvagal Theory. This theory proposes that the vagus nerve plays a key role in regulating social interaction, emotional regulation, and fear responses through its influence on the autonomic nervous system. The vagus nerve connects to all the major internal organs, turning them off and on in response to stress, as part of the autonomic nervous system. Our tendency to faint is controlled by the vagus nerve, specifically how sensitive we are to perceived danger. Some people are so anxious and oversensitive that their vagus nerve will cause them to faint at the smallest things, like seeing a spider, hearing bad news, or seeing blood, because their stress response system becomes overwhelmed. Consciously breathe slowly opens up communication along the vagus nerve and relaxes us into the parasympathetic state. Breathing really fast and heavy on purpose, flips the vagus nerve response the other way, moving us into a stressed state through the sympathetic nervous system. Consciously breathing heavy for a short period of time teaches us to consciously access the autonomic nervous system and control it: to turn on heavy stress specifically so that we can turn it off and spend the rest of our day relaxing and restoring our body and mind. This was previously thought to be biologically impossible as the autonomic nervous system was thought to be automatic, as in beyond our control. In parts of medicine, this is still believed to be true by those who refuse to acknowledge the new science and accept ancient wisdom.

Holotropic Breathwork, an evidence-based, guided breathing technique created by psychiatrist Dr. Stanislav Grof, aims to induce non-ordinary states of consciousness through hyperventilation, music, and bodywork, followed by integration exercises, with the objective of releasing trauma by accessing unconscious thoughts and emotions, rewiring the mind through neuroplasticity, and moving towards wholeness. Mystical visions, spiritual awakenings, connections to oneness, psychological breakthroughs, overcoming fears, out-of-body experiences, life-death-rebirth experiences, and sustained addiction recovery are common. Why is every doctor not recommending this?

During rest, about 750 milliliters of blood flows through the brain every minute. Blood flow in the brain can increase a little during exercise, just as in other parts of the body, but usually stays relatively consistent. That changes when we breathe quickly and heavily. Whenever the body is forced to take in more air than it needs, we’ll exhale too much carbon dioxide, which will narrow the blood vessels and decrease circulation, especially in the brain. With just a few minutes of intense hyperventilation, such as in Holotropic Breathwork, brain blood flow can decrease by 40 percent. The areas most affected by this are the brain’s hippocampus and frontal, occipital, and parieto-occipital cortices, which, together, govern brain functions such as visual processing, body sensory information, memory, the experience of time, and the sense of self. Disturbances in these areas can elicit powerful temporary hallucinations, which include out-of-body experiences and waking dreams. If we keep breathing a little faster and deeper, more blood will drain from the brain, and the visual and auditory hallucinations will become more profound.

When we’re breathing too slowly for our oxygen demand and carbon dioxide levels rise, the central chemoreceptors in the brain stem monitor these changes in carbon dioxide and send alarm signals to the brain, telling our lungs to breathe faster and more deeply. When we’re breathing too quickly, these chemoreceptors direct the body to breathe more slowly to increase carbon dioxide levels. This is how our bodies unconsciously determine how fast and often we breathe, not by the amount of oxygen, but by the amount of carbon dioxide. Chemoreceptor flexibility is part of what distinguishes good athletes from great ones. It’s why some elite mountain climbers can summit Everest without supplemental oxygen, and why some freedivers can hold their breath underwater for 10 minutes. All these people have trained their chemoreceptors to withstand extreme fluctuations in carbon dioxide without panic. Our mental health relies on chemoreceptors as well. For the past hundred years psychologists may have been treating chronic fears, and all the anxieties that come with them, in the wrong way. Fears aren’t just mental problems, and they typically can’t be treated by simply getting patients to think differently. Fears and anxiety have a physiological component as well. They can be generated from outside of the amygdala, from within a more ancient part of the reptilian brain – the chemoreceptors in the brain stem. Eighteen percent of Americans suffer from some form of anxiety or panic, with these numbers rising every year. Perhaps the best step in treating them, and hundreds of millions of others around the world, is by first conditioning the central chemoreceptors and the rest of the brain to become more flexible to carbon dioxide. By teaching anxious people the art of holding their breath.

As far back as the first century BCE, inhabitants of what is now India described a system of conscious breathholding, which they claimed restored health and ensured long life. The Bhagavad Gita, a Hindu spiritual text written around 2,000 years ago, translated a breathing practice of pranayama to mean “trance induced by stopping all breathing”. A few centuries after that, Chinese scholars wrote several volumes detailing the art of breathholding. Today, breathholding is mostly associated with disease. Denying our bodies a consistent flow of oxygen is bad, or so we’ve been told. Up to 80 percent of office workers suffer from continuous partial attention. In this state of perpetual distraction, breathing becomes shallow and erratic. Sometimes we won’t breathe at all for half a minute or longer, which can contribute to some of the same issues as sleep apnea. The breathholding that occurs in sleep apnea and continuous partial attention is unconscious – it’s something that happens to our bodies, something that’s out of our conscious control. The breathholding practiced by ancients and revivalists is conscious. These are practices we do to ourselves, and when we do them properly, can work wonders.

Anxiety and depression are the most common mental illnesses in the United States, and about half of the population will suffer from one or the other in their lifetime. To help cope, 13 percent of people over the age of 12 will use anti-depressants, often selective serotonin reuptake inhibitors (SSRIs). These drugs have been helpful for millions, especially those with severe depression. But only less than half the patients who take them get any benefits and they have serious long-term side effects. A wealth of scientific research shows that meditation and breathwork can change the structure and function of critical areas of the brain, help relieve anxiety and depression, and boost focus and compassion. It can work wonders, but few of us will ever reap these rewards, because the vast majority who try meditation and breathwork will give up and move on. Exposure therapy, a technique that exposes patients repeatedly to their fears so that they become more accepting of them, is highly effective but takes a while, usually involving many long sessions over weeks or months. Research shows that those with the worst anxieties consistently suffer from the worst breathing habits. People with anxiety, panic, anorexia, or obsessive-compulsive disorders consistently have low carbon dioxide levels and a much greater fear of holding their breath. To avoid an attack, they breathe far too much and eventually become hypersensitized to carbon dioxide and they panic if they sense a rise in this gas. They are anxious because they’re overbreathing and overbreathing because they’re anxious. Research has shown that patients have been able to reduce their panic and asthma attacks, dizziness, shortness of breath, and feelings of suffocation by slowing their breathing to increase their carbon dioxide.

With each breath we inhale prana (life force, energy). Breathing techniques were so fundamental, such that prana, ch’i, and other ancient terms for energy are synonymous with breathing. When we breathe, we expand our life force. The Chinese called their system of conscious breathing qigong (meaning “breathwork”). Pranayama is a yogic practice focused on breath control that expands prana (life force, energy). Everything is energy and consciousness. The physical universe is composed of molecules, which are composed of atoms, which are composed of subatomic particles called protons, neutrons, and electrons, which are essentially just light energy (photons) and “empty space” filled with consciousness (called the quantum field in quantum physics). In every culture and medical tradition before ours, healing was accomplished by moving energy through the body. Ancient yogis spent thousands of years honing pranayama techniques, specifically to control this energy through the conscious breath and distribute it throughout the body. This process takes several months to years to master. Breathing techniques give us the means to expand our lungs and straighten our bodies, boost blood flow, balance our minds and moods, and excite our energy. Breathing techniques allow us to sleep better, run faster, swim deeper, live longer, and evolve further. They offer a mystery and magic of life that unfolds a little more with every new breath we take.

The human body has evolved to be able to breathe through two channels for a reason. It increases our chances of survival. Should the nose get obstructed, the mouth becomes a backup ventilation system. The body is not designed for chronically mouth breathing unfiltered air for hours at a time, day or night. There is nothing normal about it. Most of us engage only a small fraction of our total lung capacity and diaphragm with each breath, requiring us to do more and get less. One of the first steps in healthy breathing is to breathe through our nose not our mouth, to extend these breaths to a slower pace, to move the diaphragm up and down a bit more, breathe into our belly not our chest, and to get as much air out of us as possible before taking a new breath. To breathe properly, we need our tongue on the roof of our mouth, our teeth slightly apart with our jaw relaxed, and our lips together.

Before we know it, diaphragmatic breathing slow, less, and through the nose with a longer exhale will be big business, like so much else. But be aware that the stripped-down approach is as good as any. It costs nothing, takes little time and effort, and you can do it wherever you are, whenever you need. It’s a technology that our species has been perfecting with only our lips, tongues, noses, and lungs for hundreds of thousands of years. All we need to do is understand the basics and commit ourselves to daily practice until it becomes our new normal.

In my experience, breathing and sleeping has been a lifelong struggle. I grew up with an undiagnosed tongue-tie, deviated septum and concha bullosa, soft inflammatory food, chronic sleep issues, and allergies. I had retractive orthodontics in my early 20s by a dentist who did not diagnose the underlying causes of my small jaws and nasal obstruction. My teeth were straightened, but my breathing and sleeping issues became increasingly worse and I developed clicking jaw joints. I somehow made it through dental school without a single dentist mentioning that my jaws were too small, and without the physicians who prescribed me sleeping pills investigating the root cause of my insomnia and repeated awakenings. With much self-inquiry, connecting with an airway dentist at conference who suggested I get a sleep study, and reading the Breath book, I eventually discovered that I had severe obstructive sleep apnea. I immediately contacted Dr. Theodore Belfor for one-on-one training on the Homeoblock to see what I can do about it. After extensive studying in craniofacial pain and sleep breathing disorders, I’ve effectively managed my symptoms that no previous dentist or physician could figure out. I no longer take medications. I consistently use meditation and breathwork to manage stress and anxiety, and improve my sleep and breathing. I recommend Holotropic Breathwork for anyone interested in exploring their true self and releasing trauma, and who are willing to surrender to the process. It is a very powerful tool for transformation and should be recommended by more doctors.