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Normal breathing: the key to vital health Disclaimers and warnings While the author has used reasonable efforts to include accurate and up-to-date information in this book, there are no warranties or representations as to the accuracy of such information and no guarantee or promise about effects and treatment of any health conditions is given. The information provided in this book and its pages is for guidance only and should be used under the supervision of a qualified medical physician, or a family doctor, or a Buteyko practitioner. The user of this book should not alter any medication without professional medical advice. Before undertaking any breathing exercises one should seek medical advice from one’s physician, family doctor or a qualified Buteyko practitioner. The author assumes no liability for the contents of this book, which may or may not be followed at one’s own risk. Thus, any liability for any impact, problems, or damages is expressly disclaimed. Please be aware that breathing exercises, including breath holding, have powerful effects on the human organism. These effects may cause serious health problems in the event of incorrect application of breathing exercises.

Special warnings for people with serious health problems Breathing exercises can cause large and rapid changes in blood flow to the brain, heart, liver, kidneys, stomach, large and small intestines and other organs, as well as changes in blood concentrations of certain hormones. Such changes may result in different adverse effects. There are many other consequences of manipulation in breathing that can lead to stress and various problems. These effects can be particularly dangerous for people with serious existing health problems or special conditions (diabetes, severe renal disease, chronic acute gastritis, intestinal ulcers, Crohn’s disease, inflammatory bowel disease, irritable bowel syndrome, acute brain traumas, any bleeding or acute injury, pregnancy, etc.).

Copyright

_______ This book is copyrighted. It is prohibited to copy, lend, adapt, electronically transmit, or transmit by any other means or methods without prior written approval from the author. However, the book may be borrowed by family members.

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Licensed to: Horatiu Vornica - Calea Caransebesului nr, 2 Resita, Caras-Severin RO 320167 - 0040745625177 - [email protected]

Normal breathing: the key to vital health Content of the book Introduction...................................................................................................................... 9 Chapter 1. Scientific studies about breathing-health connection.........................................10 1.1 Minute ventilation in health and disease ....................................................................10 1.2 Do people notice their over-breathing (hyperventilation)?.........................................13 1.3 The main effect of hyperventilation ...........................................................................13 1.4 Do we need this “poisonous” CO2? ...........................................................................13 1.5 CO2 deficiency: the main physiological effect of hyperventilation ............................14 1.6 Medical studies of hyperventilation ...........................................................................17 1.7 Studies about the hyperventilation provocation test ...................................................18 1.8 Hypoventilation as a health problem..........................................................................18 1.9 End-tidal CO2 and different health problems .............................................................19 1.10 Hypoxia and blood shunting ....................................................................................20 1.11 Critical care patients and arterial CO2 ......................................................................21 1.12 Breath-holding time and its clinical significance .....................................................22 1.13 Role of nitric oxide ..................................................................................................25 1.14 Changes in the ANS (autonomous nervous system).................................................26 1.15 Focus on diseases ....................................................................................................26 1.16 Why breathing? .......................................................................................................33 1.17 Evolution of air on Earth .........................................................................................33 Conclusions.....................................................................................................................34 Q&A section for Chapter 1..............................................................................................35 References for chapter 1 ..................................................................................................39 Chapter 2. The chemical and physiological mechanisms of immediate regulation of breathing ............................................................................................................................50 Introduction.....................................................................................................................50 2.1 Biochemical control of respiration.............................................................................50 2.4 Control of breathing during breath holding................................................................53 2.5 Control of breathing in people with chronic hyperventilation ....................................54 2.6 Breath holding control in diseased states ...................................................................55 2.7 Connection between BHT (breath holding time after normal expiration) and arterial CO2 .................................................................................................................................56 Conclusions.....................................................................................................................57 Q&A section for Chapter 2..............................................................................................57 References for chapter 2 ..................................................................................................58

_______ Chapter 3. Lifestyle factors that matter ..............................................................................60 3


3.1 Stress, anxiety and strong emotions ...........................................................................60 3.2 Physical inactivity .....................................................................................................61 3.3 Overeating .................................................................................................................62 3.4 Deep breathing exercises ...........................................................................................63 3.5 Overheating ...............................................................................................................64 3.6 Talking with deep inhalations, a loud voice, or a high pitch ......................................65 3.7 Mouth breathing ........................................................................................................65 3.8 Morning hyperventilation ..........................................................................................67 3.9 Embryonic and foetal development in a woman hyperventilating during her pregnancy ........................................................................................................................................69 3.10 Special factors for infants ........................................................................................70 3.11 Nutritional deficiencies............................................................................................70 3.12 Exposure to toxic chemicals ....................................................................................70 Conclusions.....................................................................................................................71 Q&A section for Chapter 3..............................................................................................72 References for chapter 3 ..................................................................................................72 Chapter 4. Western methods of breathing retraining...........................................................76 Introduction.....................................................................................................................76 4.1 University of California Medical School, San Francisco, USA..................................76 4.2 Papworth Hospital, Cambridge, UK ..........................................................................76 4.3 Portland Veterans Administration Medical Centre, USA ...........................................77 4.4 St. Bartholomew's Hospital, London, UK..................................................................77 4.5 Institute of Stress Research, Netherlands ...................................................................78 4.6 Department of Psychiatry, University of Oxford, Warneford Hospital, UK ...............78 4.7 Department of Psychiatry, University of Utrecht, Netherlands ..................................79 4.8 Cornell University Medical College, New York, USA ..............................................79 4.9 California School of Professional Psychology, San Diego, USA ...............................79 4.10 Lothian Area Respiratory Function Service, City Hospital, Edinburgh, UK ............80 4.11 Service de Psychosomatique, Hopital du Sacre-Caeur de Montreal, Quebec, Canada ........................................................................................................................................81 4.12 Laboratory of Pneumology, U. Z. Gasthuisberg, Katholieke Universiteit Leuven, Belgium...........................................................................................................................81 4.13 New Zealand Guidelines Group...............................................................................82 4.14 Stanford University, Palo Alto, USA .......................................................................82 4.15 Common features of Western methods of breathing retraining ................................83 Q&A section for Chapter 4..............................................................................................86 References for chapter 4 ..................................................................................................86

_______ Chapter 5. History and advance of the Buteyko breathing method .....................................89 Introduction.....................................................................................................................89 5.1 Some historical facts about the origins of the method ................................................89 4


5.2 Breathing and modern diseases..................................................................................90 5.3 Development of specific health problems ..................................................................92 5.4 Practical discoveries and their application .................................................................96 5.5 Advance of the method in the USSR and Russia .....................................................100 5.6 Advance of the method in western countries............................................................101 Q&A section for Chapter 5............................................................................................104 References for chapter 5 ................................................................................................107 Chapter 6. The control pause............................................................................................110 Introduction...................................................................................................................110 6.1 The HVPT (hyperventilation provocation test) ........................................................110 6.2 The CP test ..............................................................................................................110 6.3 Lifestyle factors that influence the personal CP .......................................................112 6.4 How CP measurements relate to aCO2 values..........................................................114 6.5 Conditions for correct CP measurements.................................................................114 6.7 The CP and general health .......................................................................................118 6.8 CP and various systems and parameters of the organism .........................................119 6.9 The link between the CP and symptoms ..................................................................123 6.10 Maximum, average and minimum daily CPs .........................................................124 6.11 Other pauses and their definitions..........................................................................125 6.12 Potential dangers of long breath holds and strong air hunger .................................125 6.13 Short pauses as safer alternatives...........................................................................126 Q&A section for Chapter 6............................................................................................127 References for chapter 6 ................................................................................................128 Chapter 7. Level 1: First steps for better health ................................................................131 Introduction...................................................................................................................131 7.1 Nasal breathing only................................................................................................131 7.2 Mouth taping ...........................................................................................................131 7.3 Prevention of sleeping on the back ..........................................................................132 7.4 The Emergency Procedure during acute or life threatening situations......................132 7.5 Other possible applications of the Emergency Procedure.........................................134 7.6 Constant basic control of breathing..........................................................................136 Q&A section for Chapter 7............................................................................................137 References for chapter 7 ................................................................................................138

_______ Chapter 8. Level 2: Breathing exercises, sleep, focal infections, and cleansing reactions .139 Introduction...................................................................................................................139 8.1 General goals of the breathing exercises..................................................................139 8.2 Preliminary requirements for learning breathing exercises ......................................139 8.4 More about relaxation and posture...........................................................................147 8.5 Gradualism – an approach to learning air hunger.....................................................149 5


8.6 Which breathing exercises to choose from? .............................................................149 8.7 What are the criteria of success?..............................................................................151 8.8 How much to exercise?............................................................................................152 8.9 Day-after-day progress in breathing retraining ........................................................152 8.10 Evening and morning CPs .....................................................................................152 8.11 General observations about sleep...........................................................................153 8.12 Why breathing gets deeper during sleep ................................................................154 8.13 Modern Western sleep ...........................................................................................154 8.14 Methods to prevent night hyperventilation.............................................................157 8.15 Supplements ..........................................................................................................159 8.16 Steroids .................................................................................................................161 8.17 Order or priorities of actions..................................................................................162 8.18 Focal infections .....................................................................................................162 8.19 Practical actions in relation to focal infections.......................................................166 8.20 Breathing and focal infections: practical cases.......................................................167 8.21 Cleansing reactions: their causes, basic mechanisms, and symptoms.....................169 8.22 Practical steps during the cleansing reaction ..........................................................170 Q&A section for Chapter 8............................................................................................171 References for chapter 8 ................................................................................................175 Chapter 9. Level 2: Personal changes, physical exercise and other useful tools................178 9.1 Personal changes due to the first breathing sessions ................................................178 9.2 Exercise...................................................................................................................178 9.3 Some practical suggestions regarding your personal hygiene and oral health ..........182 9.4 Diet and nutrition.....................................................................................................185 9.5 Heat/cold adaptation................................................................................................191 9.6 Development of correct speaking skills ...................................................................194 9.7 Prevention of hyperventilation conditioned to favourite activities ...........................195 9.8 A typical long session of the Buteyko breathing with light intensity........................195 9.9 What to expect and goal setting ...............................................................................196 9.10 Imagery and visualization......................................................................................196 9.11 Measurements of pulse and its significance ...........................................................197 9.12 Possible intensities and durations of the breathing sessions ...................................198 Q&A section for Chapter 9............................................................................................200 References for chapter 9 ................................................................................................207

_______ Chapter 10. Level 3: CP 60 or excellent health ................................................................212 Introduction...................................................................................................................212 10.1 Constant breathing control.....................................................................................212 10.2 Why it is difficult to break through 40 s threshold .................................................213 10.3 Physical activity and breathing exercises ...............................................................214 10.4 Strengthening the weakest parts of the organism ...................................................214 6


10.5 Posture...................................................................................................................215 10.6 Sleep......................................................................................................................216 10.7 Avoidance of allergies ...........................................................................................216 10.8 Other special activities...........................................................................................217 10.9 Other dietary suggestions ......................................................................................218 10.10 Negative emotions and their relation to muscular tension and physical activity ...219 10.11 The check list of questions for getting CP 60.......................................................222 Q&A section for Chapter 10..........................................................................................223 References for chapter 10 ..............................................................................................224 Chapter 11. Breathing and some GI problems ..................................................................225 Introduction...................................................................................................................225 11.1 Normal digestion and abnormalities ......................................................................225 11.2 Chronic hyperventilation and its effects on the GI system .....................................226 11.3 Interaction of these destructive CHV factors with the organism ............................228 11.4 Factors that define the time of digestion ................................................................228 11.5 Breathing control during and after meals ...............................................................231 11.6 Chewing and particle size of the swallowed food ..................................................232 11.7 Effects of various foods on breathing ....................................................................232 11.8 Focal infections and their GI effects ......................................................................234 11.9 Positive effects of high CPs on the GI tract ...........................................................235 11.10 Triggers of GI problems and the soft diet ............................................................235 11.11 Mechanical shaking of the body ..........................................................................238 11.12 Use of spices........................................................................................................238 11.13 Other observations and suggestions .....................................................................245 Q&A section for Chapter 11..........................................................................................247 References for chapter 11 ..............................................................................................247 Chapter 12. Special topics related to the Buteyko method ................................................251 12.1 Review of some effects that take place at 10 and 20 s CP......................................251 12.2 Emphysema and breathing retraining.....................................................................251 12.3 Sleep apnoea and breathing retraining ...................................................................252 12.3 Hypercapnic vasoconstriction ................................................................................252 12.4 Practical suggestions for the youngest Buteyko students (0-1 years old)................254 12.5 Teaching young children (from 2 up to 14-16 years old) .......................................255 Q&A section for Chapter 12..........................................................................................257 References for chapter 12 ..............................................................................................257

_______ Chapter 13. Various other breathing-related topics...........................................................259 Introduction...................................................................................................................259 13.1 Hatha yoga teaching and breathing ........................................................................259 13.2 Hibernation............................................................................................................262 7


13.3 Breath holding abilities in animals.........................................................................264 13.4 Breathing in relation to metabolic and health states ...............................................265 13.5 Breathing analogy in health and disease ................................................................265 13.6 Homeostasis and various simple parameters that reflect it .....................................267 13.7 Socio-psychological aspects of breathing ..............................................................269 References for chapter 13 ..............................................................................................272 Chapter 14. Future of the Buteyko movement and challenges of Buteyko breathing teachers .........................................................................................................................................274 14.1 Current trends ........................................................................................................274 14.2 The hidden challenge of the modern world: the Buteyko team vs. abnormal lifestyle factors ...........................................................................................................................274 14.3 Teaching the method: what is the core? .................................................................277 14.4 The method and its impact on environmental and lifestyle factors.........................279 14.5 Ten typical mistakes made by breathing practitioners............................................279 14.6 Teaching and promoting the Buteyko method in new places .................................281 References for chapter 14 ..............................................................................................286 Appendix 1. Summary and explanation of normal respiratory and some related values ...287 Appendix 2. Approximate relationship between breath holding time and alveolar CO2 concentration....................................................................................................................291 Appendix 3. Symptoms of hyperventilation syndrome treated in Novosibirsk by Doctor Buteyko and his colleagues ..............................................................................................292 Appendix 4. Clinical effects of the Buteyko breathing method on common health problems (based on work of Russian Buteyko doctors and own experience) ...................................293 Respiratory problems ....................................................................................................293 Cardiovascular problems ...............................................................................................294 Hormonal diseases.........................................................................................................295 Gastrointestinal problems ..............................................................................................296 Diseases of kidneys and urinary tract ............................................................................297 Diseases of the musculoskeletal system.........................................................................297 Skin diseases .................................................................................................................298 Allergies and states of immunodeficiency .....................................................................299 Appendix 5. Macro-minerals and their signs of deficiency...............................................300 • Potassium ...................................................................................................................300 • Sodium .......................................................................................................................301 • Calcium ......................................................................................................................301 • Magnesium.................................................................................................................302 Appendix 6. Typical changes due to the Buteyko breathing exercises and subsequent normalization of breathing ...............................................................................................303 About the author: Dr. Artour Rakhimov ........................................................................305

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Normal breathing: the key to vital health Introduction What do we need in order to be healthy? Most people, including many medical doctors and health professionals, would probably say that a good diet, exercise, healthy environment, and proper rest are all important. Other people may add relaxation exercises, supplements, herbal remedies and other factors. Meanwhile, there is one factor, which is usually missing in typical answers. That is normal breathing (or breathing in accordance with existing medical and physiological norms). Humans can live for days without water and for weeks without food. However, we can survive without breathing for not more than a few minutes. Can it be so, then, that breathing is as important as water and food? In my view, breathing is the missing link in the modern philosophy of health. We know too little about its importance and its effects on various processes, systems, and organs of the human body. This book is written for an inquisitive reader who has keen interest in respiration, its basic theory, hyperventilation and its effects, the regulation of respiration in health and disease and breathing retraining therapies. The book will also separately describe the discoveries and practical work of Doctor Buteyko, a detailed description of his breathing method, and relevant known medical investigations and physiological experiments. Such attention to the Buteyko method seems justified to me due to its remarkable success in the treatment of various chronic health problems, which are often considered incurable. While this book does contain scientific terms and methods, it is not required that the reader be medically trained in order to understand the information presented here. Each chapter of this book starts with an introduction formulating the questions to be discussed. After the main text of theoretical chapters, general conclusions are suggested. Each chapter has a Q&A (Question & Answer) section and chapter-related references. Finally, let me express my gratitude to all people whose help made the existence of this book possible. In particular, sincere thanks to Stuart B. Wiley (Canada), Paul Ryner, Carol Baglia, Roger Young, Suzanne Nicole (USA), Patrick McKeown, Anne Burns (Ireland), Carolina Gane (Holland), Elizabeth MacDomnic and Duncan Robertson (UK) for proofreading and/or valuable remarks which improved the quality of the manuscript.

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Chapter 1. Scientific studies about breathing-health connection Introduction In this chapter we will examine what medical science has been studying during last hundred years. Our goal is to establish a relationship between breathing and both health and disease. How should we breathe? How do sick people breathe? Is there any connection to the severity of the health problems? What has been found out about breathing of severely sick and critically ill patients? How do most people breathe when they die and before that? Are there any simple practical tests, which indicate if personal breathing is normal or not?

1.1 Minute ventilation in health and disease What is the norm of breathing? How many litres of air per minute should we breathe while sitting at rest? The physiological norm of minute ventilation can be found in many physiological and medical textbooks. It is about 6 litres per minute (Guyton, 1984; Ganong, 1995). So, let us keep in mind this important number: 6 litres of air per minute. Table 1.1 summarizes information about minute ventilation at rest in different diseased states. *One row corresponds to one medical study/publication Condition Normal breathing Heart disease Heart disease Heart disease Heart disease Heart disease Heart disease Heart disease Heart disease Pulm hypertension Cancer Diabetes Diabetes Diabetes Diabetes Diabetes Asthma Asthma Asthma Asthma Asthma COPD COPD COPD Sleep apnoea Liver cirrhosis Hyperthyroidism Cystic fibrosis*

Minute ventilation 6 l/min 15 (±4) l/min 16 (±2) l/min 12 (±3) l/min 15 (±4) l/min 13 (±4) l/min 15 (±4) l/min 14 (±2) l/min 16 (±6) l/min 12 (±2) l/min 12 (±2) l/min 12-17 l/min 15 (±2) l/min 12 (±2) l/min 10-20 l/min 13 (±2) l/min 13 (±2) l/min 15 l/min 14 (±6) l/min 13 (±4) l/min 12 l/min 14 (±2) l/min 12 (±2) l/min 14 l/min 15 (±3) l/min 11-18 l/min 15 (±1) l/min 13 (±2) l/min

N. of patients 22 11 132 55 15 88 30 20 11 40 26 45 8 28 20 16 8 39 17 101 12 10 3 20 24 42 10

Prevalence of CHV 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Reference Medical textbooks Dimopoulou et al, 2001 Johnson et al, 2000 Fanfulla et al, 1998 Clark et al, 1997 Banning et al, 1995 Clark et al, 1995 Buller et al, 1990 Elborn et al, 1990 D'Alonzo et al, 1987 Travers et al, 2008 Bottini et al, 2003 Tantucci et al, 2001 Mancini et al, 1999 Tantucci et al, 1997 Tantucci et al, 1996 Chalupa et al, 2004 Johnson et al, 1995 Bowler et al, 1998 Kassabian et al, 1982 McFadden et al, 1968 Palange et al, 2001 Sinderby et al, 2001 Stulbarg et al, 2001 Radwan et al, 2001 Epstein et al, 1998 Kahaly, 1998 Bell et al, 1996

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Cystic fibrosis Epilepsy CHV Panic disorder Bipolar disorder Dystrophia myotonica

11-14 l/min 13 l/min 13 (±2) l/min 12 (±5) l/min 11 (±2) l/min 16 (±4) l/min

6 12 134 12 16 12

100% 100% 100% 100% 100% 100%

Tepper et al, 1983 Esquivel et al, 1991 Han et al, 1997 Pain et al, 1991 MacKinnon et al, 2007 Clague et al, 1994

Table 1.1 Minute ventilation of patients with different health problems. Table 1.1 comments: • 1. There are many dozens of other medical investigations into minute ventilation of patients with chronic heart failure, which show similar results to those listed above. (The reason for this is the commonness of this health problem among people and the popularity of the stress-exercise test for heart patients among respiration researchers). Here I have quoted only the results of some typical recent studies. • 2. “COPD” means chronic obstructive pulmonary disease. • 3. Sometimes, measurement of ventilation produces results, which are smaller than in real conditions. This can happen when the test interferes with the normal breathing pattern, such as when the experiment involves the use of facial masks. Since it is harder to breathe through them, these masks reduce minute ventilation. Breathing through a mouth-piece also leads to breathing less air than in reality. Another effect is connected with body weight: people of a lighter weight need less air, as they normally have lower metabolic rates. All these effects should be taken into account when analysing experimental results. For example, in the quoted study (Bell et al, 1996) patients with cystic fibrosis had minute ventilation of 10.4+-1.4 l/min. Not only were they wearing masks during measurement, but also the average weight of these people was 56.5 kg. Hence, the quoted minute ventilation would probably be equivalent to about 15 l/min for typical adults. • 4. Similarly, weight should be taken into account when analysing minute ventilation of children. For example, it was reported that 12 children with epilepsy had an average minute ventilation of almost 8 l/min (Esquivel et al, 1991). Their average weight was 43 kg, which corresponds to about 12-15 l/min for adults with normal weights, therefore indicating hyperventilation. Numerous other studies also found evidence of hyperventilation in patients with this health condition. Note, that virtually all tested patients with chronic heart failure over-breathe. The same was true for these limited studies in relation to diabetes, asthma, and other disorders. However, more experiments are required for these and other health problems in order to be certain about the existing links between breathing and diseases. It is normal, that such studies can find prevalence of over-breathing in investigated subjects. A few health conditions where patients breathe less than the norm will be considered below. Now we can conclude that many sick people breathe too much. What about breathing rates in modern healthy subjects? This table comprises 14 published medical studies. We see that healthy subjects breathe about 6-7 l/min at rest.

_______ Table. Minute ventilation (or minute breathing rates) at rest in healthy subjects (14 studies)

Condition

Normal breathing Healthy subjects Healthy males Healthy males Healthy males Healthy subjects Healthy students Healthy subjects

Minute ventilation 6 l/min 7.7 ± 0.3 l/min 8.4 ± 1.3 l/min 6.3 l/min 6.1±1.4 l/min 6.1± 0.9 l/min 7.0 ± 1.0 l/min 6.6 ± 0.6 l/min

N. of subjects 19 10 10 6 9 10 10

Reference

Medical textbooks Douglas et al, 1982 Burki, 1984 Smits et al, 1987 Fuller et al, 1987 Tanaka et al, 1988 Turley et al, 1993 Bengtsson et al, 1994

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Healthy Healthy Healthy Healthy Healthy Healthy Healthy

subjects subjects subjects subjects subjects subjects subjects

7.0±1.2 l/min 7.0±1.2 l/min 6 ± 1 l/min 7.0 ± 1.1 l/min 6.6 ± 1.1 l/min 6.7 ± 0.5 l/min 6.7 ± 0.3 l/min

12 10 7 14 40 17 14

Sherman et al, 1996 Bell et al, 1996 Parreira et al, 1997 Mancini et al, 1999 Pinna et al, 2006 Pathak et al, 2006 Gujic et al, 2007

We can also consider historical changes in breathing rates for normal subjects.

Table 3. Historical changes in minute ventilation (or minute breathing rates) at rest for normal subjects Condition Normal breathing Normal subjects Normal males Normal females Normal subjects Normal subjects Normal subjects Normal subjects Normal males Normal subjects Normal subjects Normal subjects Normal subjects Normal subjects* Normal subjects Normal females Normal males Normal females Normal males Normal subjects Normal subjects Normal subjects Normal subjects Normal seniors Normal elderly* Normal subjects Normal subjects Normal subjects Normal females Normal subjects

Minute ventilation 6 l/min 4.9 5.3±0.1 4.6±0.1 6.9±0.9 9.1±4.5 8.1±2.1 6.3±2.2 13±3 9.2±2.5 15±4 12±4 12±2 11±3 8.1±0.4 9.9 15 10 11 13±3 12±1 12±1 10±6 12±4 14±3 17±1 10±0.5 8.5±1.2 10±0.4 12±2

Age 16 27-43 27-43 31±7 42±14 40 (av.) 34±7 28-34 55±10 41±2 53±11 34±2 20-28 20-28 29-60 29-62 36±6 65±2 12-69 39±4 70±3 88±2 41±2 30±8 62±2

N. of subjects 5 46 40 100 11 11 12 12 13 12 43 10 24 63 23 47 42 42 10 10 20 20 14 11 15 10 69 11 20

Reference Medical textbooks Griffith et al, 1929 Shock et al, 1939 Shock et al, 1939 Matheson et al, 1950 Kassabian et al, 1982 D'Alonzo et al, 1987 Pain et al, 1988 Clague et al, 1994 Radwan et al, 1995 Dahan et al, 1995 Clark et al, 1995 Tantucci et al, 1996 Clark et al, 1997 Meessen et al. 1997 Han et al, 1997 Han et al, 1997 Han et al, 1997 Han et al, 1997 Tantucci et al, 1997 Epstein et al, 1996 Bowler et al, 1998 DeLorey et al, 1999 DeLorey et al, 1999 DeLorey et al, 1999 Tantucci et al, 2001 Bell et al, 2005 Narkiewicz, 2006 Ahuja et al, 2007 Travers et al, 2008

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1.2 Do people notice their over-breathing (hyperventilation)? They very rarely do. Usually, people agree that their breathing is heavy when they breathe more than about 20 l/min at rest (or over 3 times the norm!). Why is this? Air is weightless, and breathing muscles are powerful. During rigorous physical exercise or during maximum voluntary ventilation, an average person can breathe about 160 l/min, with about 40 breaths per minute and 4 liters of air for tidal volume for each breath (p.545, Straub, 1998). Some athletes can breathe up to 200 l/min during strenuous exercise. So it is easy to breathe only a small portion of our maximum abilities: for example, "only" 16 l/min (or “only” 10% of the maximum capacity) at rest, throughout the day and night and overlook that it is, in fact, a high rate of breathing. It is nevertheless normal during rigorous exercise to breathe 100 l/min or more since CO2 and O2 concentrations in the arterial blood can remain nearly the same as at rest. Usually it is possible to estimate the breathing rate (or minute ventilation) of a person visually. If the chest is moving at rest, the person is breathing at least twice more air than the physiological norm (over 12 l/min for a 70 kg man). If his shoulders are moving, he is breathing four times the norm. Normal breathing is invisible, inaudible, and regular. Moreover, when healthy people are asked about their breathing, they usually say that they feel nothing, while sick people have various sensations about movements of the air through the nostrils, at the back of the throat, and in the area of the abdomen. Unfortunately, modern medical doctors are not trained to pay attention to the breathing rate of their patients. A patient can come to the doctor's office while heavily panting, even through the mouth, and the GP or MD will not even mention or suggest to breathe through the nose or to reduce his or her breathing rate.

1.3 The main effect of hyperventilation The previous section demonstrated that many sick people chronically over-breathe. It is possible to assume that, maybe these people got sick in the first place, and then started to breathe heavier. Alternatively, it is also possible that they got sick because of over-breathing. In order to find out what causes what let us look at the main physiological effects of such over-breathing for healthy people. What would happen with a healthy person, who starts to breathe too much? Respiration is the process of regulated exchange of two gases, CO2 (carbon dioxide) and O2 (oxygen). The human body, as a form of life, produces energy by oxidizing different substances, mainly fats and carbohydrates. Both these substances are mainly composed of carbon with some hydrogen and oxygen. Hence, the main end products of this energy production are CO2 and water. Normally, one of the functions of breathing, apart from bringing new O2 for cells to use, is to remove excessive (but not all) CO2. When healthy people breathe near the norm, their CO2 level in the organism is also near the physiological norm. However, breathing too much delivers more O2 to the lungs and removes more CO2 from the body. Let us look at the basic course of events in a case of acute over-breathing. When the person starts to breathe deeply and frequently, the total concentration of CO2 in the lungs gets smaller since the person intensively blows off carbon dioxide from the lungs. It takes about one to two minutes to reduce the concentration of CO2 in blood. About 110 minutes later, CO2 concentrations in the nervous tissues, muscles, and most other organs and cells are also reduced due to CO2 diffusion from these parts to the blood. Thus, the first effect of hyperventilation is lowered CO2 concentrations in all body cells. If hyperventilation is chronic, CO2 deficiency is also chronic.

_______ 1.4 Do we need this “poisonous” CO2?

Carbon dioxide gas is used for killing animals. In small mammals (e.g., rats and mice) the loss of consciousness is quick (seconds). In larger mammals (e.g., guinea pigs) the animals first become very distressed and disturbed. They are restless, breathe deeply, and salivate profusely. For discussion of animal euthanasia with the use of carbon dioxide one may see (Coenen et al, 1995) and (Paton, 1983). Very large relative concentrations or pure carbon dioxide gas are normally used. Also, there are many books, newspaper articles, and even some medical publications, which claim that one of the main functions of human respiration is “to remove the poisonous carbon dioxide from the human organism”. In addition, there are many popular health articles, which state that carbon dioxide is a “waste” gas. It follows from this approach that it is better to breathe deeper and faster in order to expel the “poison” at higher rates. However, there are thousands of medical and physiological publications, studies, trials, and experiments that 13


state the opposite. Namely, they strongly discourage over-breathing (hyperventilation), both in its acute and chronic forms. Why? Over-breathing removes too much carbon dioxide from the organism, while carbon dioxide is absolutely necessary to sustain life. When its level becomes about 3-4 times less than the physiological and medical norms, death is an immediate outcome. Probably, these ideas about CO2 appeared after French scientist Antoine-Laurent Lavoisier discovered in 1788 the role of CO2 and O2 in breathing. He explained why mice and candle both died in CO2, but could live longer in O2. What about killing of animals with high levels of carbon dioxide in air? Could we die in similar conditions? Let us look at another related phenomenon, drowning. Thousands of people die every year because of too much water being taken in through the mouth. About 4-5 litres of water in taken at once would be enough to fill the whole stomach and parts of the lungs with water causing death in a few minutes. However, nobody claims that water is a “poison” because water is equally important and vital (in sensible quantities, not 4-5 litres at once) for human and any cellular life. The situation with carbon dioxide is exactly the same. Every living thing needs normal levels (not too much and not too little) of carbon dioxide for healthy functioning. Moreover, numerous medical studies cited in this chapter clearly show that carbon dioxide is the substance that is most needed by patients with various modern chronic degenerative disorders and ailments.

1.5 CO2 deficiency: the main physiological effect of hyperventilation Let us look at some of the known carbon dioxide effects, which are confirmed by professional Western studies. Note that these effects can be found, in varying degrees, in any normal human organism. Stabilizer of transmission of signals between nervous cells The normal work of our senses, conscious thinking, decision making, and all other mental activities require stable transmission of electrical signals between nervous cells. Such transmission is possible when CO2 content in nerve tissues is normal. Logic, sense, reason, wisdom, focus, memory, concentration and many other qualities are based on this stability of signal transmission. The signal is passed from one nervous cell to another only when the strength or voltage of the signal is higher than a certain threshold value so that accidental signals will not be amplified causing disruption in the work of the CNS. This threshold value is very sensitive to the local CO2 content. When we hyperventilate and CO2 content is suboptimal, accidental weak signals can be amplified and transmitted further interfering with the real signals based on senses, memory, logic and other objective factors. Hence, CO2 has a calming effect on excessive excitability of brain areas responsible for conscious thinking (e.g., Krnjevic, 1965). Other researchers (Balestrino & Somjen, 1988; Huttunen et al, 1999) also concluded that increased CO2 pressure generally reduces cortical excitability, while hyperventilation "leads to spontaneous and asynchronous firing of cortical neurons" (Huttunen et. al., 1999). Hence, breathing too much makes the human brain abnormally excited due to reduced CO2 concentrations. As a result, the brain gets literally out of control due to appearance of spontaneous and asynchronous (“self-generated”) thoughts. Balestrino and Somjen (1988) in their summary directly claimed that, "The brain, by regulating breathing, controls its own excitability". These effects of CO2 on brain cells are of special importance in understanding anxiety, insomnia, panic attacks, epilepsy and other psychological and neurological problems and disorders to be discussed later. Besides, this effect is important in order to understand the mechanism of the mind-body connection.

_______ Bohr effect (or supply of oxygen to all body cells) CO2 is a catalyst for the chemical release of O2 from haemoglobin cells. This phenomenon is called the Bohr effect and it can be found in many medical textbooks (e.g., Ganong, 1995, Starling & Evans, 1968). Bohr and his colleagues (1904) first described this effect. How does it work?

In normal conditions (when we breathe about 6 l/min), arterial blood is 96-98% saturated with O2 due to a fresh air supply to the lungs. When the arterial blood arrives at the tissues, some O2 is released by its carriers, the haemoglobin cells (red blood cells). What is the reason for this chemical release? The cells of the organism also breathe, and the more they breathe the more CO2 is produced. These elevated values of CO2 in tissues increase the CO2 level in the blood due to CO2 diffusion from the tissues. As a result, the greater the amount of CO2 in the blood, the 14


more O2 is going to be released from the haemoglobin cells for the tissues to use, since CO2 is a catalyst causing this chemical reaction. This mechanism is especially effective during physical exercise. Indeed, depending on the type of exercise, some of our muscles work harder than others. Those muscles that produce more CO2, are going to get more O2 in exchange (due to the Bohr effect), so they can continue to work at high rates. Were this mechanism to be absent, a human organism would quickly tire at the slightest physical exertion due to lack of oxygen. Therefore, carbon dioxide is a necessary factor for oxygenation of tissues. No carbon dioxide means no oxygen in the tissues, while no oxygen means no energy for various processes and no life. Let us look at the events when people over-breathe. On the one hand, breathing more can raise blood saturation from normal 96-98% to 97-99% (by about 1%). However, it follows from the Bohr effect that those who chronically breathe too much (in comparison with physiological norms) suffer from hypoxia (low oxygen concentrations) in tissues due to the low carbon dioxide level in the blood and tissues. (Low tissue oxygenation is normally found in malignant cells, diseased nervous cells, and inflamed tissues of various organs). Meanwhile, normal breathing (about 6 l/min) provides more O2 for the tissues of the organism. Hence, the paradox of breathing is in the fact that acute over-breathing, while bringing more oxygen during first seconds, creates the opposite effect: in a few minutes (or even earlier). The cells start to suffer from the lack of oxygen. Therefore, chronic deep breathing causes chronic tissue hypoxia. Prolonged forceful over-breathing can have disastrous consequences, as Yale Professor Yandell Henderson and his colleagues demonstrated in their work with dogs almost a century ago (Henderson et al, 1908). In these experiments, forceful respiration was created using a suction and exhaust pump. The dogs after many minutes were disconnected from the machine and died without attempting to draw a single breath due to failure of the cardiovascular system. This result was completely unexpected by the researchers. Later, it became clear that hypoxia was one of the factors contributing to these deaths. However, there was also another factor: constriction of small blood vessels due to low carbon dioxide level.

Local vasodilation CO2 locally dilates arteries and arterioles making the work of the heart easier, creating conditions for delivering more oxygen to tissues, and removing more waste products. Vice versa: low carbon dioxide stores have a local vasoconstrictive effect leading to spasms, hypoxia (this time due to poor blood supply) and accumulation of metabolic wastes in different vital organs and tissues. One may argue that there are many other blood vessels which also contribute to total resistance to blood flow. Why should we concentrate on CO2 effects on arteries and small blood vessels? Basic physiology of the human organism explains, that the total relative resistance to blood flow in arteries and arterioles is about 3-8 times greater than in any other type of blood vessels (Ganong, 1995). The effect of vasoconstriction due to hyperventilation is so powerful, that Soley and Shock (1938) reported their difficulty in obtaining blood samples from fingers of their patients following voluntary hyperventilation. It is more difficult for the heart to pump the blood through the body when small blood vessels, due to low carbon dioxide, are constricted. Moreover, the heart muscle itself receives less blood if the person is over-breathing. Therefore, low CO2 level in the organism produces profound adverse impact on the cardiovascular system and blood supply to the heart and other organs. What about the human brain? Does it suffer from heavy breathing? The following results were obtained by measuring blood flow through the main artery (the carotid artery) leading to the brain. Voluntary hyperventilation led to 35% reduction in the blood flow to the brain in comparison with the conditions at rest. This result is quoted in the medical textbook written by Starling & Evans (1968), while the effect is well documented and has been confirmed by dozens of professional experiments. By the way, do you notice that when people passionately argue with each other, or are angry, or violent, they usually breathe heavily? Would it be reasonable, in the light of these physiological studies, to conclude that it is useless to argue or try to reason with the person whose brain is not normally oxygenated due to excessive breathing? There are numerous studies which indeed do reveal the negative effects of over-breathing on different skills (motor, memory, logic) and general performance, which require combinations of various human abilities. Hence, a low carbon dioxide level not only reduces oxygenation of tissues, but also impairs blood supply to vital organs of physiological functioning.

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Relaxation of smooth muscles CO2, when applied locally, is a relaxant of smooth muscles (e.g., Hudlicka, 1973). Dr. Brown in his article “Physiological effects of hyperventilation” analysed almost 300 professional studies and stated, “Studies designed to determine the effects produced by hyperventilation on nerve and muscle have been consistent in their finding on increased irritability” (Brown, 1953). This fact, together with the properties of CO2 mentioned previously, will help us to understand the mechanism by which normal carbon dioxide concentrations can restore the harmonious work of different muscular groups (such as the heart, respiratory muscles, muscles of the digestive tract, etc.) in order to eliminate muscular spasms (e.g., heart attacks, asthma attacks, constipation, etc.). Moreover, since muscles get irritated it is normal to expect that when people breathe too much, they are more likely to be tense, anxious, stressed, aggressive, and violent. Vice versa, normal carbon dioxide concentrations would result in muscular relaxation, composure, and sensible actions.

Bronchodilation Normal level aCO2 eliminates possible constriction of bronchi and bronchioles which can appear due to low aCO2. The article "The mechanism of bronchoconstriction due to hypocapnia [low CO2 concentrations] in man" (Sterling, 1968) described the following effect of CO2 on air passages. Bronchoconstriction (narrowing of air passages), which is the main problem of asthmatics, is mainly mediated by special nerve cells. Low aCO2 makes them, among many other nervous tissues, more excited, causing narrowing of bronchi and bronchioles. Therefore, over-breathing can cause bronchoconstriction (as it is observed in asthma) leading to the feeling of suffocation.

Blood pH balance CO2 is the most important factor in controlling blood pH, balance of electrolytes and pH of other body fluids (urine, saliva, stomach secretions, etc). Indeed, bicarbonate is the largest CO2 component of the blood, as well as intracellular and extra-cellular fluids, while a typical medical or physiological textbook will indicate its leading role in the control of pH of blood and other body fluids (e.g., medical textbooks by Starling & Evans, 1968; Guyton, 1984; and Ganong, 1995). Hence, changes in bicarbonate concentration must influence the ionic composition of every human cell. As one of the numerous effects in this area, Carryer (1947) found that “While no significant change in total calcium of the blood takes place, the readily available, or ionized portion is affected markedly [due to hyperventilation]… The decrease in available calcium increases excitability of the neuromuscular mechanism, inducing tetany”. These medical conclusions point out the cause of problems (low carbon dioxide due to hyperventilation) with calcium metabolism, which is found in osteoporosis, arthritis, and other health conditions.

Participation and catalisation of chemical reactions CO2 is a participant of numerous other biochemical reactions involving virtually all vitamins, minerals, amino acids, hormones, carbohydrates and other vital substances. Some of the chemical reactions, all requiring CO2 as a catalyst or as one of the reagents, were described by Kazarinov (1990). Apart from these known effects, there are probably many other processes of the human organism that require normal CO2 levels and normal breathing for optimum physiological functioning.

_______ The first respiratory physiologists were called “cardio-respiratory physiologists” since the link between the cardiovascular and respiratory systems, as they found it, was very intimate. Professor Yandell Henderson was one of the most prominent scientists in this area. His article “Carbon dioxide” was published in 1940 in Cyclopedia of Medicine. In the section with the title “Relations of Carbon Dioxide and Oxygen in the Body” he wrote, “Carbon dioxide is, in fact, a more fundamental component of living matter than is oxygen. Life probably existed on earth for millions of years prior to the carboniferous era, in an atmosphere containing a much larger amount of carbon dioxide than at present. There may even have been a time when there was no free oxygen available in the air… Another natural, but very obstructive misconception is that oxygen and carbon dioxide are so far antagonistic that in blood a gain of one necessarily involves a corresponding loss of the other. On the contrary, although each 16


tends to raise the pressure and thus promote the diffusion of the other, the 2 gases are held and transported in the blood by different means… A sample of blood may be high in both gases, or low in both gases. Moreover, under clinical conditions low oxygen and low carbon dioxide—anoxemia and acapnia—generally occur together. Each of these abnormal states tends to induce and intensify the other. Therapeutic increase of carbon dioxide, by inhalation of this gas diluted in air, is often the effective means of improving the oxygenation of the blood and tissues.” In the section “As a factor in the Acid-base Balance of the Blood”, he continued, “Modern physiology has shown that, in addition to the control and regulation exerted by the nervous system, there are many chemical substances produced in the body that influence function and form. To these active principles Starling gave the name of “hormones.” Among the hormones are epinephrine (often called adrenaline), pituitrin, thyroxin, insulin and many other products of the glands of internal secretion and other organs. Carbon dioxide is the chief hormone of the entire body; it is the only one that is produced by every tissue and that probably acts on every organ. In the regulation of the functions of the body, carbon dioxide exerts at least 3 well defined influences: (1) It is one of the prime factors in the acid-base balance of the blood. (2) It is the principal control of respiration. (3) It exerts an essential tonic influence upon the heart and peripheral circulation.” Finally, he stated in the section “In the Control of Respiration and the Circulation”, “Carbon dioxide is the chief immediate respiratory hormone.”

1.6 Medical studies of hyperventilation The previous section described some effects (there are many more as we are going to see later) of hyperventilation on healthy people. While these effects are normal for any human organism, the degree of particular negative changes and the location of the most affected organs are various in different individuals. Therefore, the individual problems created by over-breathing are going to be different. In order to investigate this issue, let us turn our attention to medical studies. Medical doctors and professors have written extensive reviews of professional literature and described their own case histories of hyperventilation (Bass, 1990; Brasher, 1983; Lum, 1975; Magarian, 1982, 1983; Morgan, 1983; Tavel, 1990). These studies showed the symptoms of over-breathing and the profound negative influence of both acute and chronic hyperventilation on the whole biochemistry of the human organism. The first medical article containing a description of the symptoms of hyperventilation, but without understanding their cause, was published by DaCosta (DaCosta, 1871). One group of researchers described the biochemical mechanism by which hyperventilation can gradually cause problems with high cholesterol (hypertension) and high blood sugar levels (diabetes) (Lavrent'ev, 1993). Acute and, especially, chronic hyperventilation, according to these and many other references, affects every system and organ of the human body causing a wide variety of symptoms. Many medical doctors have mentioned that the physiological response to hyperventilation is individual. Thus, individual genetic predisposition and certain other factors define which system or organ is the most affected by hyperventilation. It can be the heart, brain, kidneys, liver, intestines, stomach, lungs or one of many others. Additional references on the negative effects of hyperventilation can be found in the previously cited works. Magarian (1982), for example, quoted over 180 other scientific articles in order to back up his conclusions about the physiological consequences of hyperventilation. Since hyperventilation is an important part of our fight-or-flight response, the blood is generally diverted from vital organs to large skeletal muscles. Studies found decreased perfusion of the heart (Okazaki et al, 1991), brain (discussed above), liver (Hughes et al, 1979; Okazaki, 1989), kidneys (Okazaki, 1989), and colon (Gilmour et al, 1980). Moreover, investigations of blood flow in muscles were not consistent in relation to changes in perfusion, while oxygenation of muscles in some studies is even reduced (Thorborg et al, 1988). That could happen probably due to vasoconstriction and the suppressed Bohr effect. Normally, hyperventilation also compromises oxygenation of vital organs (e.g., Hughes et al, 1979; Hashimoto et al, 1989; Okazaki et al, 1991). Typically, the blood flow to vital organs is directly proportional to aCO2. Such a linear relationship (between brain blood flow and carbon dioxide concentration) can be found, for example, in Handbook of Physiology (Santiago & Edelman, 1986). Chronic hyperventilation interferes with normal digestion. Decreased perfusion and oxygenation of GI organs can lead to lack of digestive enzymes, accumulation of metabolic waste products, slow digestion, putrefaction of certain nutrients and mal-absorption. That should cause problems with protein metabolism (which usually appear before problems with fat and carbohydrate metabolism), thus adversely affecting normal repair of the body (especially

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the GI tract, the largest consumer of amino acids) and the immune system. In order to experience the effects of breathing on digestion, one may voluntarily hyperventilate after a meal. While normal digestion can take 2 hours, hyperventilation may extend this time up to 5-8 hours or more, depending on the degree of hyperventilation. Warning. By mild voluntary hyperventilation, you may almost halt digestion. For many people that can cause GI distress and aggravation of existing gastrointestinal problems. Breathing less (or voluntary hypoventilation) can also make some digestive problems worse. It would be normal to expect that the degree of all these negative effects may vary from individual to individual. Similarly, according to the article entitled "The effects of hyperventilation; individual variability and its relation to personality" (Clark, 1982), not only negative cardiovascular changes, but also psychological effects of hyperventilation had individual variability. Thus, when we over-breathe, there are certain factors (both, genetic and environmental) which create our specific physiological responses to hyperventilation. While the above-mentioned negative consequences of deep breathing are typically found in a normal human organism, genetic predisposition and some other factors (previous events which influenced the organism) probably define the organs, their parts and the systems which are going to suffer most from low carbon dioxide stores and other effects of chronic hyperventilation. More research is required in order to find the effects of hyperventilation and individual differences.

1.7 Studies about the hyperventilation provocation test One may realize the dangers of over-breathing by performing a HVPT (hyperventilation provocation test), during which the person should breathe very quickly and deeply, usually for about 2-3 minutes. (It would be impossible to do it much longer due to losing consciousness, while forceful involuntary over-breathing, when a pump is used, would cause death in dozens of minutes). This short over-breathing test has a well-recorded history of clinical use and was employed by many medical doctors to provoke the symptoms of the main health problem in order to diagnose it, as well as to demonstrate to patients that hyperventilation was the main cause of their symptoms. Thus, using deep and fast breathing, you can reproduce your specific health symptoms. Over-breathing is an excellent tool used by medical doctors around the world to find out the most sick organs and systems in any particulat patient. For example, voluntary over-breathing in asthmatics causes the asthma attack, in people with hypertension – the heart attack, in epileptics – epilepsy attack, etc. Here is a short summary of medical studies regarding different health conditions, number of patients investigated, and the percentage of patients who reproduced their specific health problem. - coronary artery spasms (Nakao et al, 1997) 206 patients, 100% specific; - bronchial asthma (Mojsoski N & Pavicic F, 1990) 90 patients, 100% specific; - panic attacks (Bonn & Readhead, 1984; Holt PE, Andrews, 1989; Nardi et al, 2000), 95% specific; - epileptic absence seizures (Esquivel, 1991; Wirrel, 1996).

_______ Important notice. The hyperventilation provocation test should not be performed by people who have certain severe health problems, without professional supervision, due to possible complications. The symptoms experienced can be reversed by reducing ventilation and raising carbon dioxide stores to previous values. Another important finding of these and other authors is that most people, including numerous abovementioned patients, were unaware of their abnormal breathing pattern and believed that they breathed normally.

1.8 Hypoventilation as a health problem

As shown above, many disease states are characterized by hyperventilation. Are there any health problems in which sick people breathe less than the norm? Low minute volume can be found, for example, in cases of hypothyroidism. Such people usually have abnormally low levels of thyroid hormones. As a result, their cells cannot generate enough energy. Typical symptoms 18


of hypothyroidism are low energy, hypoxia, apathy, sleepiness, and weight gain. Indeed, since little CO2 is produced by cells, less O2 is released to them by haemoglobin cells, due to the suppressed Bohr effect. Chronic mountain sickness patients can have lower than normal ventilation, but this rare health condition is observed only in those who live about 3,000 m or more above sea level. Abnormal breathing may be observed in sleep apnoea, in which sleeping patients stop breathing for 10-20 or even up to 40-50 seconds. Such apnoeic spells interrupt the normal functioning of the nervous system. As a result, these spells can awaken the patients many times during the night, interfering with physiological and psychological recovery. These people can breathe too little during spells. The inter-event ventilation (i.e. between spells) has been observed to be usually more than 20 l/min. Patients with hypothyroidism and sleep apnoea can normalize their breathing patterns using the method described in later Chapters. Moreover, practical work of breathing practitioners revealed that normalization of breathing of these patients dramatically improves their health state. Even more surprising is the fact that these patients can use virtually the same methods and breathing exercises (to be discussed) in order to restore their health.

1.9 End-tidal CO2 and different health problems Minute ventilation, although a very important respiratory parameter, needs special equipment and does not always indicate hyperventilation and small aCO2. Inaccuracies occur in cases of small body weight (found, for example, in children), irregular or very shallow breathing found in some obese patients, and obstruction of airways leading to partial or total closure of some lung areas. This last phenomenon will be discussed in the next section. As a result, many professional researchers, when investigating respiration, often measure etCO2 (end-tidal CO2) as a more accurate characteristic reflecting CO2 content of the lungs. A device called a "capnometer" can continually measure CO2 level in the expired air. The level of CO2 gradually rises during exhalation showing an approximate equalization with the CO2 value in alveoli in the lungs (hence, the phrase "end-tidal"). The normal alveolar CO2 pressure is about 40 mm Hg pressure (Guyton, 1984; Ganong, 1995) or partial pressure of 5.3% of normal air at sea level. According to "Handbook on physiology" (Severinghaus JW, 1965), "A PCO2 below 35 mm Hg is indicative of alveolar hyperventilation" (p.1476). 35 mm Hg corresponds to 4.6% CO2 at sea level (see Appendix 2 in order to find the relationships between aCO2% and absolute aCO2 pressure at different altitudes). All previously quoted studies (section 1.1) indicating hyperventilation should find abnormally low etCO2 for tested patients. Indeed, people who breathe more should generally show smaller CO2 concentrations in expired air. What also follows from many studies is that with the deterioration of health etCO2 tension gets even lower. The investigation of over 100 patients (Tanabe et al, 2001) with different degrees of chronic heart failure revealed that class I patients (light degree) had about 34.5 mm Hg etCO2 pressure, class II patients: 32.5 mm Hg, and class III patients: 30.8 mm Hg. Thus, the heart patients with the more serious heart problems had lower CO2 levels and, therefore, heavier breathing in terms of minute ventilation. American scientists from the Brown Medical School in Providence recently published a study End-tidal carbon dioxide predicts the presence and severity of acidosis in children with diabetes (Fearon & Steele, 2002). They start this publication with, “Patients with diabetic ketoacidosis (DKA) hyperventilate, lowering their alveolar (PACO(2)) and arterial carbon dioxide (PaCO(2))”. Their conclusion was, “End-tidal CO(2) is linearly related to HCO(3) and is significantly lower in children with DKA” (Fearon & Steele, 2002). Expired end-tidal CO2 values are considered by many emergency professionals as an accurate predictor (life/death) of cardiac arrest. For example, authors of the article "End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: a predictor of outcome" investigated 120 French patients during non-traumatic cardiac arrest. The researchers found that "end-tidal CO2 could provide a highly sensitive predictor of return of spontaneous circulation during cardiopulmonary resuscitation (MPR)" (p.791, Cantineau et al, 1996). More recently a large group of medical doctors from several American hospitals tested over 100 patients and wrote an article "End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest" with the same conclusion (Ahrens et al, 2001). There are several other studies written by emergency professionals, with the same conclusions. Therefore, emergency patients (with cardiac arrest) with the most deep and frequent breathing have the least chances of survival. Rosen and his colleagues (1990) in the abstract of the article “Is chronic fatigue syndrome synonymous with effort syndrome?” wrote: "Chronic fatigue syndrome (CFS), including myalgic encephalomyelitis (ME) and postviral syndrome (PVS), is a term used today to describe a condition of incapacity for making and sustaining effort,

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associated with a wide range of symptoms. None of the reviews of CFS has provided a proper consideration of the effort syndrome caused by chronic habitual hyperventilation. In 100 consecutive patients, whose CFS had been attributed to ME or PVS, the time course of their illness and the respiratory psychophysiological studies were characteristic of chronic habitual hyperventilation in 93. It is suggested that the labels 'CFS', 'ME' or 'PVS' should be withheld until chronic habitual hyperventilation - for which conventional rehabilitation is available - has been definitively excluded." Paulley started his article "Hyperventilation" (Paulley, 1990), with "Physicians’ and specialists’ continued failure to recognize, diagnose and treat adequately the majority of hyperventilators is a disgrace. Hyperventilation Syndrome (H.V.S.), incorrectly labelled myalgic encephalomyelitis (M.E.), is the latest example of the profession’s incompetence." These doctors claim that chronic fatigue syndrome, myalgic encephalomyelitis, and postviral syndrome can be directly caused by over-breathing since normalization of breathing results in recovery of the patients with these health concerns. Capnometers (devices to measure carbon dioxide levels in the expired air) have become especially popular among psychologists. For example, Fried and colleagues (1990) studied several groups of subjects with anxiety, panic phobia, depression, migraine, and idiopathic seizures. The abstract claims that "virtually all the noncontrol subjects were found to show moderate to severe hyperventilation and the accompanying EEG dysrhythmia" (p.67). Abnormally low carbon dioxide values (etCO2) were found in all (over 60) patients with neurotic depression and non-retarded endogenous depression (Damas Mora et al, 1976). Asmundson and Stein (1994) measured carbon dioxide concentrations in over 20 patients with panic disorder. Their average CO2 was also below the medical norm. Therefore, various psychological problems are connected and can be the consequences of chronic overbreathing.

1.10 Hypoxia and blood shunting McFadden & Lyons (1968) showed that in mild and severe asthmatic patients, some parts of the lungs could not carry out adequate air exchange due to airway obstruction. This causes an ineffective exchange of CO2 for O2 in venous blood in the obstructed alveoli of the lung. Therefore, this venous blood, after leaving the lungs almost unchanged, is mixed with oxygenated arterial blood. This effect is called “blood shunting”. As a result, hypoxia of such patients becomes worse since less O2 is present in the blood. Meanwhile, aCO2 rises to or even exceeds, in severe cases, the physiological norm (40 mm Hg). Thus, with further deterioration of health, large aCO2 (hypercapnia) is observed. In spite of increased aCO2 pressure and greatly improved Bohr effect, tissue hypoxia is greater than before due to very low arterial oxygenation (it would not be correct to expect that higher aCO2 concentrations can compensate for lack of oxygenation in the damaged lung areas. The balance between these two gases is indeed delicate.) This problem of ventilation/perfusion mismatch (inadequate air supply to some lung parts) and corresponding blood shunting is especially severe in patients with emphysema. Normally, in healthy lungs each lung area requires air ventilation, which is approximately proportional to its volume. Meanwhile, in severe cases of ventilation/perfusion mismatch, the working lung part can hyperventilate, but the total ventilation can be less than the norm. Indeed, if, for example, only one-third of the lungs is functional, as in emphysema, this third may use, say, about 3-4 l of air per minute, indicating general hypoventilation (3-4 l/min is less than the physiological norm). Meanwhile, under normal conditions, this working lung part would need only about 2 l/min. Ventilation/perfusion mismatch is common in patients with mild or severe asthma, emphysema, and cystic fibrosis, and for some patients with obesity, hypertension, and diabetes. However, for most people very low aCO2 does not cause severe airway obstruction and corresponding blood shunting. Taking into account individual variability of the effects of CO2 depletion (discussed in section 1.3), it is possible that asthmatics and other groups of people as above have air passages, which are more sensitive to hyperventilation due to their genetically inherited characteristics. Hypoxic hypoxia can also be the result of the ventilatory failure due to fatigue of respiratory muscles or depression of the respiratory neurons in the brain by morphine and other drugs. (Hypoxic hypoxia is hypoxia resulting from a defective mechanism of oxygenation in the lungs.)

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1.11 Critical care patients and arterial CO2 It was shown above that, in cases of cardiac arrest, carbon dioxide concentration is a reliable predictor of human survival. Meanwhile, critical care professionals often use the most sophisticated and advanced devices to measure different physiological parameters. Analysis of arterial blood usually includes investigation of blood gases (blood concentrations of bicarbonates, total CO2, oxygenation, etc.) of critically ill patients. All 29 patients with severe liver damage (in most cases due to metastatic cancer or cirrhosis of liver) had low CO2, while for 25 patients "it was also clinically evident that respiratory exchange was increased markedly" (p.762, Wanamee et al, 1956). Thus, hyperventilation was visually observed by the authors of this publication, "Respiratory alkalosis in hepatic coma". They also found that heavy over-breathing led to severe electrolyte abnormalities. These abnormalities included decreased sodium ions and increased chloride ions in the blood. Abnormally high lactic and pyruvic acid concentrations were other frequent effects. Blood gases and respiratory patterns provided accurate information for survival prognosis in acute cerebrovascular accidents. When these parameters were normal, patients survived. Out of 11 hyperventilating patients with less than 35 mm Hg aCO2, only one survived (Rout et al, 1971). The same conclusion (regarding aCO2 and survival prognosis) was made for head injuries (Huang et al, 1963; Vapalanti & Trouph, 1971). Summarizing the results of these works and their connection with brain dysfunction, Dr. Plum wrote, "The combination of hyperpnoea [increased breathing] with an elevated pH, and a subnormal or moderately low oxygen tension occurs in many serious illnesses that entirely spare the brain. These include the alveolar-capillary block of diffuse pulmonary carcinomatosis; heart failure; advanced cirrhosis, with or without hepatic coma; acute pulmonary infarction; and many others, including the cryptic pulmonary congestion that accompanies most serious disease in the obtunded and elderly" (Plum, 1972). Interestingly, all above-mentioned effects (low carbon dioxide concentration, elevated pH, and hypoxia) quoted by Dr. Plum are caused by heavy breathing. Hence, one can conclude that over-breathing is a normal feature of these severe diseases. When suffering various serious health problems (heart disease, diabetes, cancer, AIDS, etc.) the patient’s life is usually threatened, not by the main health problem, but by complications and infections, such as in the case of bacteremic shock. Analysing a group of patients initially diagnosed with arteriosclerotic heart disease, cerebrovascular insufficiency, diabetes, arthritis, several forms of cancer, fatty liver, and alcoholism, one study showed that complications due to pathogenic microorganisms in the blood caused 46 deaths in 50 patients (Winslow et al., 1973). Pneumonia and urinary tract infections were the foci of pathogenic microorganisms. Now we may ask the following: what was observed with their breathing, when not only a part of the organism, but even the blood was polluted with pathogens? All 50 patients, according to a table accompanying this article, had very disturbed blood gases corresponding to severe over-breathing. Dr. Simmons and his colleagues wrote an article "Hyperventilation and respiratory alkalosis as signs of gramnegative bacteremia" (bacteremia being the presence of bacteria in the blood). This extract is from the beginning of their abstract: "Visible hyperventilation was observed clinically in patients with Gram-negative bacteremia. Eleven patients with Gram-negative infections and either proved or probable bacteremias were therefore studied to see if hyperventilation might be a common response to such bacteremia. In every case there was laboratory evidence of hyperventilation, and in 8 cases the hyperventilation was visible to the observer. Since only patients were studied who had no other cause for increased ventilation, this appears to be a primary response to the bacteremia..." (abstract, Simmons et al, 1960). Another group of US medical professionals found that the degree of over-breathing has a strong correlation with over-all mortality (Mazarra et al, 1974). Heavier breathing indicated smaller chances of survival. Here is what they wrote in their scientific abstract: "Respiratory alkalosis [blood alkalisation is the normal physiological result of over-breathing] was the most common acid-base disturbance observed in a computer analysis of 8,607 consecutive arterial blood gas studies collected over an 18 month period in a large intensive care unit. Through a retrospective review of the randomly selected hospital records of 114 patients, we defined four groups based upon arterial carbon dioxide tension (PaCO2) and mode of ventilation. Group I, with a PaCO2 of 15 mm Hg or less, consisted of 25 patients with an over-all mortality of 88 per cent. Group II, with a PaCO2 of 20 to 25 mm Hg, consisted of 35 patients with a mortality of 77 per cent. Group III, with a PaCO2 of 25 to 30 mm Hg, consisted of 33 patients with a mortality of 73 per cent, and Group IV, with a PaCO2 of 35 to 45 mm Hg, consisted of 21 patients

_______ 21


with a mortality of 29 per cent (p<0.001). Shock and sepsis were most common in group I patients. These findings suggest that extreme hypocapnia [low level of carbon dioxide] in the critically ill patient has serious prognostic implications and is indicative of the severity of the underlying disease" (Mazarra et al, 1974). This article indicated that the names of the most common diseases to occur in all 4 groups of people were cerebrovascular disease, hepatic coma, bronchopneumonia, and arteriosclerotic heart disease. Finally, let us look at the conclusion drawn by a group of US researchers who recently wrote an article with the title "Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes?" (Salen et al, 2001). "CONCLUSIONS: Both the sonographic detection of cardiac activity and ETCO(2) levels higher than 16 torr were significantly associated with survival from ED resuscitation; however, logistic regression analysis demonstrated that prediction of survival using capnography was not enhanced by the addition of cardiac sonography" (Salen et al, 2001). In other words, they found, probably to their surprise, that monitoring of the heart, as an addition to the monitoring of breathing, does not provide any further information about chances of survival. A review of these professional studies indicates that critically ill patients usually have very low carbon dioxide level due to visible hyperventilation. Laboured breathing of such patients probably corresponds to minute ventilation of 20-25 l/min or more. The analysis of Western medical literature suggests that many critically ill patients die in conditions of heavy and deep breathing. Deep breathing, as we showed above, reduces oxygenation of the body. Are there any simple tests that reflect our ventilation and oxygenation? “Oxygen content in the organism can be found using a simple method: after exhalation, observe, how long time the person can have no breathing without stress” (Buteyko, 1977).

1.12 Breath-holding time and its clinical significance All breathing parameters described above need to be measured using special equipment. Meanwhile, there is a simple test, which can be done at almost any moment by everyone, since only a watch or a clock is required. This is BHT (breath-holding time), or how long one can be without breathing. What are the results of medical studies regarding this test? According to textbook “Essentials of exercise physiology” (McArdle et al, 2000), “If a person breath-holds after a normal exhalation, it takes about 40 seconds before breathing commences” (p.252). Breath holding can be started at different phases of breathing (e.g., after normal inhalation, or exhalation, or taking a very deep inhalation, or a complete exhalation). These different conditions can produce large variations in results (by more than 200%). Moreover, sometimes patients are asked to take 2 or 3 deep breaths before the test. Since researchers use different methods for BHT measurements, the standardization of results is necessary in order for them to be compared. “Handbook of physiology”, after analysing numerous relevant publications, suggested the following proportions for BHT measurements (Mithoefer, 1965). If BHT after full inhalation is 100%; then BHT after normal inhalation is 55%; BHT after normal exhalation is 40%; BHT after full exhalation is 24%. Taking an additional full exhalation or inhalation before starting the test increases BHT by about 5 or 15% respectively for each full manoeuvre. This information allows us to compare different BHT tests done during almost a century of clinical investigations, if we use some standard conditions for the test. In order to do that, let me introduce the BHT: BHT is BHT after quiet or usual expiration. The under-line can remind the reader about BHT measured at the base level, as when we are totally relaxed (as after usual exhalation). Different studies and their results can be now compared by changing their BHTs to the standard of measurements, the BHT. These results are given in Table 1.2.

_______ Warning. Usually BHT in physiological or medical studies is measured for as long as possible. This procedure is dangerous if you have certain serious health conditions with inflammation, irritation, ulcers or any other damage to internal organs (this will be fully explained later). The conditions requiring caution include: certain heart conditions, diabetes, hypoglycaemia, severe kidney disease, gastric or intestinal ulcers, acute gastritis, IBS, panic attacks, migraine headaches, etc.

22


Types of people investigated

Fit instructors Home defence pilots British candidates US candidates Delivery and test pilots Pilots trained for scouts Pilots taken off flying (stress) Normal subjects Neurocirculatory asthenia Normal subjects Anxiety states Normal subjects, class 1 heart Class 2 and 3 heart patients Pulmonary emphysema Functional heart disease Normal subjects Asymptomatic asthmatics Asthmatics with symptoms Normal subjects Panic attack Anxiety disorders Outpatients Inpatients COPD, CHF (cong. heart 12 heavy smokers Normal subjects Panic disorder Normal subjects Obstructive sleep apnoea Normal subjects

N. of subjec ts 22 24 23 7 27 15

BHT , S

BHT, s

30 54 22 62 16 53 3 13 6 7 13

46 s 49 s 47 s 45 s 39 s 42 s 34 s 23 s 16 s 33 s 20 s 16 s 13 s 8s 5s 28 s 20 s 11 s

67 s 72 s 69 s 66 s 57 s 62 s 49 s 58 s 40 s 45 s 28 s 48 s 39 s 23 s 15 s 76 s 55 s 27 s

14 14 14 25 25 7 12 26 23 30 30 76

25 s 11 s 16 s 17 s 10 s 8s 8s 21 s 16 s 36 s 20 s 25 s

74 s 34 s 49 s 43 s 25 s 21 s 21 s 21 s 16 s 36 s 20 s 67 s

Reference

Test conditions (order of actions just before BHT test) Full exhalation, normal inspiration

%BH T for BHT1 70%

Flack, 1920

Full inspiration

40%

Friedman, 1945

Normal inspiration

73%

Full inspiration, full exhalation, full inspiration

33.3%

Mirsky et al, 1946 norm. inspir., alap, Kohn & Cutcher, 1970

Full exhalation, full inspiration Full inspiration

38 %

Davidson et al, 1974

40 %

Deep breath of 50% O2, 50% N22

33.3%

Perez-Padilla et al, 1989 Zandbergen et al, 1992

Full inspiration

40 %

Gay et al, 1994

Normal exhalation

100%

Normal exhalation

100%

Asmudson & Stein, 1994 Taskar et al, 1995

Full exhalation, full inspiration Normal exhalation

38%

McNally & Eke, 1996

38 s Normal subjects 10 38 s 100% 23 s Successful lung transplantation 9 23 s 28 s Successful heart transplantation 8 28 s 29 s Normal subjects 31 32 s Normal exhalation 90% 8s in supine position Outpatients with COPD 87 9.2 s Table 1.2 Breath holding time according to various medical references

Flume et al, 1996

_______ Marks et al, 1997

Table 1.2 comments. • 1. “% of BHT for BHT” means the percentage of BHT used to calculate BHT. • 2. Zandbergen et al, 1992 conducted their experiments with the mixture of 50% O2 and 50% N2. According to Ferris with his colleagues (1945), such mixture increases normal BHT by about 50%. Analysing the results of Table 1.2, the following conclusions can be made. • Normal subjects have the longer BHT (maximum pause) in comparison with sick people who suffer from various health problems. • The stronger the severity of the health problem, the shorter the BHT. 23


•

Recovering and asymptomatic people have intermediate BHT values.

Let us now turn our attention to the comments expressed by medical professionals about the breath holding time of healthy and sick people. In 1919 The Lancet published one of the first articles describing the medical application of BHT investigated by military medical doctor and Lieutenant-Colonel Martin Flack (Flack, 1920). As Dr. Flack indicated, less than 35 s BHT was considered to be sufficient to take pilots "off flying through stress" (Flack, 1920). The possible reason for such a drastic measure was described by him on the next page. On one occasion a medical doctor wanted to suspend from flying one experienced pilot due to his unusually low BHT (23 s BHT). The pilot was allowed to fly, lost control, crashed the plane and was killed. The commanding officers decided that this test was, indeed, an indicator of the personal health state, especially stress. At the end of his publication Flack suggested, "...that these tests would also be of value for measuring trench fatigue, industrial fatigue, and fatigue in women workers..." (Flack, 1920). According to Dr. Wood, who investigated patients with a variety of symptoms diagnosed as DaCosta’s syndrome (one of the previous names for the chronic fatigue syndrome), low BHT was the most common symptom found in his 200 patients (Wood, 1941). A few years later Dr. Friedman, Director of the Harold Brum Institute for Cardiovascular Research, San Francisco, after analysing his patients with neurocirculatory problems wrote, "... the breathholding time was found to be directly related [inversely proportional] to the severity of the dyspnea suffered" (Friedman, 1945). Dr. Mirsky and his colleagues (1946) concluded that "the difference [in breath holding time] between the normal and abnormal patients [with variety of anxiety states] is of clinical significance". Two American medical doctors, Robert Kohn and Bertha Cutcher, in their article "Breath holding time in the screening for rehabilitation potential of cardiac patients" (Kohn & Cutcher, 1970) described the testing of more than 100 cardiac patients. It was found that "...an individual unable to hold his breath for at least 20 sec [7 s BHT] is a poor candidate for vocational rehabilitation". Furthermore, "It is now suggested that the determination of the breathholding time is an effective screening test for rehabilitation potential" (Kohn & Cutcher, 1970). Apparently, healthy obese patients were "unable to hold their breath much beyond 15 s", whilst all normal non-obese subjects could breath hold for more than 30 s (Hurewitz et al, 1987). Similarly, African researchers noticed that, “Significant differences were observed in the mean of the Quetelet index, percent predicted vital capacity and the breath holding time between the normal female and the obese female subjects. A high but inverse relationship was found between estimated body fat and each percent predicted vital capacity and breath holding time in subjects whose Quetelet index was above 30 kg/m2” (Sanya &Adesina, 1998) A review of publications on leprosy (Katoch, 1996) revealed that "respiratory function test studies have shown impaired breath holding time" (abstract). Authors of the article "Rating of breathlessness at rest during acute asthma: correlation with spirometry and usefulness of breath-holding time" (Perez-Padilla et al, 1989) wrote, "These results suggest that: 1) magnitude of dyspnea and breath-holding time correlate with severity of airflow obstruction in acute asthma attacks associated with dyspnea at rest; and 2) breath-holding time varies inversely with dyspnea magnitude when it is present at rest" (abstract). Thus, BHT has correlation with the most important parameters officially accepted for the diagnosis of asthma. Later Mexican scientists published the same result in their article, Estimating forced expiratory volume in one second based on breath holding in healthy subjects. Their conclusion was “FEV1 [forced expiratory volume] can be reliably estimated using BHT” (Nevarez-Najera et al, 2000). Japanese doctors compared breath holding times for normal subjects and patients with COPD (chronic obstructive pulmonary disease). “The period of no respiratory sensation [a certain period of no particular respiratory sensation which is terminated by the onset of an unpleasant sensation and followed by progressive discomfort during breath-holding] was also measured in eight patients with chronic obstructive pulmonary disease. The values of the period of no respiratory sensation in patients with chronic obstructive pulmonary disease were apparently lower than those obtained in normal subjects. These findings suggest that measurement of the period of no respiratory sensation can be a useful clinical test for the study of genesis of dyspnoea” (Nishino et al, 1996). Kendrick and colleagues used breath holding for more accurate measurements of pulmonary blood flow (Kendrick et al, 1989). It was important for testing that the subjects hold their breath as long as possible for better measurements. The researchers had 33 patients with cardiac problems (but without overt cardiac failure) and noticed that, "for very dyspnoeic patients a breath-hold time of less than 10 s would be desirable...e.g., 6 s is acceptable.

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However, in very ill patients, even a 6 s breath hold time may be too long" (Kendrick et al, 1989). The authors were clearly disappointed by the short BHTs of their patients. Magnetic resonance imaging (MRI) is a test in which X-ray films are taken of patients, who must remain motionless during the procedure. Patients must therefore be able to hold their breath for the duration of the test. Sick patients with numerous health problems have been a challenge for MRI professionals since these patients could not hold their breath a sufficiently long enough time in comparison with normal subjects. For example, one abstract claimed that patients with coronary artery disease "found it significantly more difficult to perform a steady breath-hold … or attain the same diaphragm position over multiple breath-holds than normal subjects" (Taylor et al, 1999). In order to solve this problem, new magnetic imaging techniques requiring shorter BHTs (even as short as a few seconds only) were developed. However, some, most seriously ill patients could not achieve even multiple 1 s breath holds, as reported by Posniak and colleagues (1994): "OBJECTIVE. Chest and abdominal CT scans using 1.0-sec scan times are often limited by motion in patients who are unable to hold their breath. With our scanner we can obtain images in 0.6 sec (partial scan)" (abstract). The breathing pattern of some patients was so strong that they could not stop for even a single second. Russian medical Doctor K.P. Buteyko and his colleagues tested thousands of patients with a variety of cardiac and bronchial problems and found that sick people usually have about 10-20 s BHT, and the very sick as low as 3-5 s. With approaching death, the breath holding time gradually, day after day, goes down: 5 s, 4, 3, 2, 1 (last frantic gasps for more air), death… (Buteyko, 1977). Are there any health conditions in which BHT is long in spite of poor, but stable health? It is possible, according to my research, in such rare cases as obesity hypoventilation syndrome, chronic mountain sickness, after carotid body resection (these nervous cells monitor carbon dioxide concentration in the blood and brain and, as a result, control respiration), and curarisation of respiratory muscles (a procedure during which respiratory muscles are cut and cannot obey the central nervous system). Obviously, more research is required before final conclusions can be made. We can see that the BHT (breath holding time after normal expiration) is an excellent indicator of our health. The sicker the person, the lower the BHT. Finally it can be noted that these low BHTs were found for sick and severely sick patients. Apparently, there are certain people who have low BHTs (due to chronically heavy breathing), but are not diagnosed (yet?) with any serious organic disease.

1.13 Role of nitric oxide There are numerous studies published over the past 80 years regarding the negative effects of hypocapnia (low level of CO2). Hence, CO2 is the most known and investigated factor that relates to overbreathing. Which other parameters of the body become abnormal during and because of hyperventilation? Normal nasal breathing helps the body to use its own nitric oxide. This substance is produced, among other places, in nasal passages. During normal breathing, we have quiet prolonged exhalations (that do not prevent accumulation of nitric oxide in some areas of nasal passages) and relatively quick inhalations (that allow inhalation of the accumulated nitric oxide). Duirng hyperventilation exhalations are forceful and quick (as one can observe in many sick people) and inhalations are slow. This reversal of the main stages of breathing decreases the utilization of nitric oxide. The roles and some important effects of this hormone on the body have been discovered very recently and there are still many questions in relation to this substance. Nitric oxide is found and synthesized in endothelial cells that line the lumen of blood vessels, neurons, and macrophages. As a gas, it is routinely found in nasal passages and measured in exhaled air. The known functions of the NO include: 1. Vasodilation of arteries and arterioles (and hence regulation of blood flow to tissues). In this respect, NO is similar to CO2 acting on the smooth muscles of blood vessels. 2. Regulation of binding and release of O2 to haemoglobin. This NO function is again similar to the CO2 function known as the Bohr effect. 3. Destruction of parasitic organisms, viruses, and malignant cells by inactivating their respiratory chain enzymes in mitochondria. 4. Inhibition of inflammation in blood vessels. 5. Neurotransmission. Learning, memory, sleeping, feeling pain, and some other processes require NO for

_______ 25


transmission of neuronal signals. On the other hand, brain cells can probably be killed during a stroke due to excessive production of nitric oxide. 6. Hormonal effects. NO influences secretion from several endocrine glands. It stimulates the release of adrenaline from the adrenal medulla, pancreatic enzymes from the exocrine portion of pancreas, and Gonadotropinreleasing hormone from the hypothalamus. Abnormal NO production and its availability are now associated with hypertension, heart failure, stroke, obesity, diabetes (both type I and II), atherosclerosis, rheumatism, aging, and dyslipidemias (particularly hypercholesterolemia and hypertriglyceridemia). Currently there are numerous studies world-wide related to the role of NO in human health and diseased states. It is beyond the scope of this book to provide these studies. Practice shows that possibly for some people some health improvements can be achieved mainly through the correction of one’s breathing pattern, which can normalize production and utilization of nitric oxide, while CO2 changes could be small. Hence, in these people nitric oxide can play, during some stages of breathing normalization, the leading role in health restoration.

1.14 Changes in the ANS (autonomous nervous system) Most of the time, breathing is regulated by the ANS (autonomous nervous system). In healthy people movement of the diaphragm provides at least 75% of the changes in air volume in the lungs during inhalation at rest, as one may see in many medical textbooks (e.g., p. 312, Castro, 2000; p. 595, Ganong, 1995). Inhalation involves activation of the diaphragm (the initially dome-shaped diaphragm is stretched sideways and becomes more flat), and, hence, inhalation, as a process of muscular activation, is normally controlled by the sympathetic part of the ANS. Exhalation, in health, involves relaxation or passive recoil of the diaphragm (p. 314, Castro, 2000) indicating parasympathetic control of this part of the process. In normal conditions (12 breaths per minute) one breathing cycle (inhalation-exhalation) takes 5 seconds. Inhalation lasts about 2 s and exhalation about 3 s (p. 313, Castro, 2000; p.541, Straub, 1998). Since an average person takes many thousands breaths every day, the parameters of his or her breathing can be considered as a window, through which certain disturbances in the ANS can be detected. Let us consider the typical breathing parameters of sick people. The above studies in minute ventilation show that people with asthma and heart disease breathe about 2.5 times more air every minute (about 15 l/min instead of 6). How is it possible that they breathe so much? Such breathing rates are possible by breathing faster (not 12 times per minute, but 15-20 or even more times per minute) and deeper (up to 700-1,000 ml of air per breath instead of 500 ml as it should be in health). If a healthy person needs about 3 s to exhale 500 ml through the relaxation of the diaphragm, there is no way for a sick person to exhale more air (700-1,000 ml) in less time using only relaxation. Hence, sick people unconsciously apply muscular efforts to exhale air from the lungs at resting conditions. These muscular efforts need sympathetic control indicating that hyperventilation means abnormal control of this vital function (breathing) by the ANS. Moreover, this fast and deep breathing is usually, but not always, accompanied by chest breathing, when the rib cage, not the diaphragm, does the main job of air movement. Hence, hyperventilation also means abnormal innervations or dis-regulation of control of the breathing muscles by the ANS. Furthermore, practice shows that hyperventilation is usually accompanied by the reversal of the two phases of breathing: inhalations often become longer than exhalations. One may notice how sick people take a prolonged inhale and then the rib cage collapses to expel air with force and an audible noise. Finally, the breathing of sick people is often uneven and irregular with sighing, coughing, snorting, sneezing, etc. All these abnormal processes take place 24/7 and they indicate pathologies in the functions of the ANS. The ANS, in its turn, regulates contractions of the heart, digestion, production of hormones and many other vital processes. It is logical to expect then that chronic overbreathing can lead to various health abnormalities through negative effects on the ANS, but too little research about these negative effects is currently available.

_______ 1.15 Focus on diseases

The modern Western approach to respiration is often based on the following understandings about breathing. “Respiration is the total process of delivering oxygen to the cells and carrying away the by-product of metabolism, carbon dioxide”, or “Respiration is the process of taking in oxygen from inhaled air and releasing carbon dioxide by exhalation”, or “Respiration is the process by which animals take in oxygen necessary for cellular metabolism and 26


release the carbon dioxide that accumulates in their bodies as a result of the expenditure of energy”. About a century ago leading world’s physiologists had a different understanding about the role of breathing and CO2 in human health (see Professor Yandell Henderson’s quote above). First of all, it is the primary role of breathing to regulate CO2 (not just to release this by-product). Secondly, while regulation of CO2 is an important factor, there are many other functions of normal breathing. These other functions can be disturbed or disrupted. Possible abnormalities of breathing are: dominance of chest breathing at rest; fast shallow breathing and diaphragmatic flutter; slow inhalations and quick exhalations; periodic breathing; coughing; sighing; and sneezing. All these and many other irregularities and infringements are connected with pathological processes or abnormalities in the respiratory system, autonomous nervous system, endocrine system, musculoskeletal system, cardiovascular system, gastrointestinal and other systems of the human organism. Let us now review some diseases and their relations to breathing.

Asthma In 1968 The New England Journal of Medicine published the results of a large study (McFadden, 1968) in which breathing and blood gases of a group of asthmatics were investigated. The researchers found that all 101 tested patients had chronic alveolar hyperventilation. Those asthmatics who had a light or moderate degree of the disease breathed about 15 l of air per min or 2.5 times more than the official medical norm (6 l/min). More recently, in 1995, American researchers from the Mayo Clinic and Foundation (Rochester) confirmed the same average value (about 15 l/min) for another group of patients diagnosed with asthma (Johnson et al, 1995). This study was published in the Journal of Applied Physiology. Finally, medical professionals from Mater Hospital in Brisbane (Australia) tested 39 asthmatics and found 14 l/min (Bowler et al, 1998). These figures were reported in the Medical Journal of Australia. Clinical Science published in 1968 an article, The mechanism of bronchoconstriction due to hypocapnia in man (hypocapnia means abnormally low CO2 concentrations). In this paper, Sterling explained that CO2 deficiency causes an excited state of the cholinergic nerve. Since this nerve is responsible for the state of the smooth muscles in bronchi, its excited state leads to the constriction of air passages. What about modern textbooks on physiology? One states, “Agents that tend to dilate airways include increased PaCO2 (hypoventilation or inspired CO2)...” (p.545, Straub, 1998). This textbook directly claims that slowing down breathing (hypoventilation) or increased CO2 level dilates airways. Moreover, CO2 is suggested as the chief chemical substance that promotes this effect. Did anybody ever suggest before recent years the connection between asthma and ventilation? Doctor Buteyko proposed this link in the 1950s (his first official publications appeared in the 1960s), when he discovered the central role of overbreathing in the development and degree of asthma. (He and his colleagues also found that asthma patients got immediate relief from their asthma attack symptoms, if they practiced reduced breathing). Dr. Herxheimer independently suggested that low CO2 was the cause of bronchial asthma in 1946 and 1952 (Herxheimer, 1946; 1952). Let us consider the possible mechanism suggested by Doctor Buteyko. Low CO2 values in the bronchi cause chronic constriction of airways (that happens in all people). In addition to this direct effect, chronic hyperventilation makes immune reactions abnormal. The immune system becomes too sensitive in relation to intruders from outside (coming with air or food), but weakens the responses to various pathogens, like viruses and bacteria. (Why? Hyperventilation is a defensive reaction and a part of the fight-or-flight response. Hence, hyperventilation indicates a state of stress, increased alertness and emergency for the whole organism, the immune system included. Hence, various intruders are to be attacked.) The immune system becomes hypersensitive and seemingly innocent events (like breathing cold air or inhaling dust particles, dust mite proteins, cat proteins, tree pollen, etc.) can trigger an inflammatory response in the airways of asthmatics, enlargement of mast cells, excessive production of mucus, a sense of anxiety or panic, more hyperventilation, and further constriction of airways. As a result, mucus makes air passages narrower (or even blocks some of them) creating a feeling of suffocation and causing asthma attacks. During an attack, an asthmatic may try to clear the mucus by coughing it out, but that further reduces CO2 concentrations in the lungs and makes air passages narrower.

_______ Heart disease

In 1995 the British Heart Journal published a study (Clark et al, 1995) done by researchers from the National Heart and Lung Institute in London. The breathing rate of all 88 heart patients at rest ranged from 10 to 18 l/min (or 27


about 2-3 times more than the norm). In 2000, in a study from the Chest magazine, a group of American cardiac professionals revealed that patients with chronic heart failure had breathing rates in the range of 14 to 18 l/min (Johnson et al, 2000). More recently, Greek doctors from the Onassis Cardiac Surgery Center in Athens recorded ventilation values ranging from 11 to 19 l/min for heart patients from their hospital (Dimopoulou et al, 2001). These and many other similar results raise many questions. Are there any heart patients (with primary hypertension, angina pectoris, and other problems) who have normal breathing parameters? Does the normalization of breathing mean no symptoms and no disease for all heart patients? What are the details of interactions between breathing and heart disease? These questions will be discussed later. Above-mentioned physiological effects, resulting from a CO2 deficiency, influence the cardiovascular system. • Low blood CO2 values lead to the narrowing of small blood vessels (vasoconstriction of arteries and arterioles) in the whole body. That causes two problems. First, as a group of Japanese medical professionals found, in conditions of CO2 deficiency, blood flow to the heart muscle decreases (Okazaki et al, 1991). Hence, heart tissue gets less oxygen, glucose and other nutrients. Second, since small blood vessels are the main contributors to the total resistance in relation to blood flow, CO2 deficiency increases resistance to blood flow and makes the work of the heart harder. • The suppressed Bohr effect, due to low CO2 values in the blood, also reduces oxygenation of the heart muscle. That increases anaerobic metabolism and produces excessive amounts of lactic acid. Note that lactic acid is often implicated as a source of pain in any tissue. In the case of the heart, a person can suffer from angina or chest pain. • The excited nerve cells in the heart (the cells that are called pacemakers) interfere with the normal synchronization and harmony in the working of the heart muscle. (The valves should open and close in proper time, much like a welltuned engine.) Desynchronization can make the whole process of blood pumping less efficient or more energy- and oxygen-demanding possibly causing pathological adaptive changes in the heart tissue. • Abnormal metabolism of fats leads, as Russian medical studies revealed, to increased blood cholesterol level in genetically-predisposed people. That condition gradually, over periods of weeks or months, produces cholesterol deposits on the walls of blood vessels. Such deposits can induce primary hypertension. As their published work suggests, the BHT has a linear correlation with the blood cholesterol level. These results are discussed later in more details. • Chronic hyperventilation affects the normal utilization and conversion of essential fatty acids into prostaglandins causing changes in inflammatory responses and the malfunctioning of the immune system. • Mouth breathing (at rest, during sleep, exercise, etc.) is an additional adverse stimulus. It further reduces aCO2 and prevents normal absorption of nitric oxide (a hormone and powerful dilator of blood vessels) synthesized in the nasal passages while the main effect of taking nitroglycerine medication, in case of heart problems, is to provide the organism with additional nitric oxide. • Since heart patients breathe 2-3 times more than the official norm, they usually have a more frequent and deeper breathing pattern. That must result in other breathing abnormalities, for example, chest breathing, as well as slow inhalations and quick exhalations. These irregularities indicate abnormal states of the autonomous nervous and musculoskeletal systems. The father of cardiorespiratory physiology, Yale University Professor Yandell Henderson (1873-1944), investigated some of these effects about a century ago. Among his numerous physiological studies, he performed experiments with anaesthetized dogs on mechanical ventilation. The results were described in his publication Acapnia and shock. - I. Carbon dioxide as a factor in the regulation of the heart rate. In this article, published in 1908 in the American Journal of Physiology, he wrote, “... we were enabled to regulate the heart to any desired rate from 40 or fewer up to 200 or more beats per minute. The method was very simple. It depended on the manipulation of the hand bellows with which artificial respiration was administered... As the pulmonary ventilation increased or diminished the heart rate was correspondingly accelerated or retarded” (p.127, Henderson, 1908). Which parts of the cardiovascular system are going to be most affected? That depends on genetic predisposition, life style and environmental factors. There are so many parameters that can adversely affect the normal work of the cardiovascular system. People are different. Some may get chronic heart failure, others high blood pressure, or stroke, or various abnormalities in the heart muscle. Western experimental studies suggest that the following cardio-vascular problems can appear as a result of hyperventilation (courtesy of Peter Kolb, Biochemical Engineer, Australia): - palpitations (Bass C, 1990; Cluff, 1984; Demeter & Cordasco, 1986; Lum, 1975; Magarian et al., 1983; Nixon, 1989; Sher, 1991)

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- cardiac neurosis (Bass C, 1990; Cluff, 1984; Nixon, 1989) - angina pain (Nixon, 1989) - myocardial infarction (Nixon, 1989) - Wolfe-Parkinson-White syndrome (Nixon, 1989) - arrhythmias (Cluff, 1984; Demeter & Cordasco, 1986; Nixon, 1989) - stenosis of coronary artery (Demeter & Cordasco, 1986; Nixon, 1989; Sher, 1991; Waites, 1978) - tachycardia (Cluff, 1984; Lum, 1975; Nixon, 1989; Tavel, 1990) - failure of coronary bypass grafts (Nixon, 1989) - right ventricular ectopy (Nixon, 1989) - silent ischemia (Nixon, 1989) - elevated blood pressure (Nixon, 1989) - flat or inverted ECG T-wave (Demeter & Cordasco, 1986; Nixon, 1989; Sher, 1991; Tavel, 1990) - vasoconstriction (Cluff, 1984; Demeter & Cordasco, 1986; Lum, 1975; Nixon, 1989; Sher, 1991) - reduced cerebral blood flow (Cluff, 1984; Lum, 1975; Magarian et al., 1983; Sher, 1991; Waites, 1978) - mitral prolapse (Bass C, 1990; Cluff, 1984; Nixon, 1989; Tavel, 1990) - low cardiac output/stroke volume (Waites, 1978). Do you know that it is possible to get abnormal ECG tracing from a healthy heart just by voluntary heavy breathing? Later, many cardiac professionals, while analyzing such ECGs, can claim pathological changes in the heart. These changes are different in different people. Vice versa, normal breathing naturally eliminates, either immediately or in due course of time, various, already detected, ECG abnormalities. Modern medicine and physiology have a very limited understanding of what is going on with the cardiovascular system when breathing gradually change in one or the opposite direction. There are many questions related to individual variability, mechanisms of developing pathologies, and the interaction of hereditary and environmental factors.

Cancer Let us consider some facts about the appearance, growth and development of malignant tumours; their spread to distant tissues and resistance to standard methods of treatment. What is the abnormal background, which is rarely discussed in popular books and articles about cancer, but which is known to professional oncologists? It has been known for decades that malignant cells normally and constantly appear and exist in any human organism due to billions of cell divisions and mutations. These abnormal cells, in normal conditions, are quickly detected by the immune system and destroyed. However, the work of macrophages, enzymes and other agents of the immune system is severely hampered under the conditions of hypoxia. That was the conclusion of various studies. For example, Dr. Rockwell from Yale University School of Medicine studied malignant changes at the cellular level and wrote, "The physiologic effects of hypoxia and the associated micro environmental inadequacies increase mutation rates, select for cells deficient in normal pathways of programmed cell death, and contribute to the development of an increasingly invasive, metastatic phenotype" (Rockwell, 1997). The title of this publication is "Oxygen delivery: implications for the biology and therapy of solid tumors". Summarizing the results of numerous studies, Ryan with colleagues chose the following title of their article, "The hypoxia inducible factor-1 gene is required for embryogenesis and solid tumor formation" (Ryan et al, 1998). In normal conditions, even a group of hypoxic cells dies (or is easily destroyed by the immune cells). What about cells in malignant tumours? Researchers from Gray Laboratory Cancer Research Trust (Mount Vernon Hospital, Northwood, Middlesex, UK) concluded, "Cells undergo a variety of biological responses when placed in hypoxic conditions, including activation of signalling pathways that regulate proliferation, angiogenesis and death. Cancer cells have adapted these pathways, allowing tumours to survive and even grow under hypoxic conditions..." (Chaplin et al, 1986). Moreover, American scientists from Harvard Medical School noted that "... Hypoxia may thus produce both treatment resistance and a growth advantage" (Schmaltz et al, 1998). There is so much professional evidence about fast growth of tumours in the condition of severe hypoxia, that a large group of Californian researchers recently wrote a paper "Hypoxia - inducible factor-1 is a positive factor in solid tumor growth" (Ryan, 2000). As an echo, a British oncologist from the Weatherhill Institute of Molecular Medicine (Oxford) went further with a manuscript "Hypoxia - a key regulatory factor in tumour growth" (Harris, 2002). When the solid tumour is large enough and the disease progresses, cancer starts to invade other tissues. This

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process is called metastasis. Does poor oxygenation influence it? "...Therefore, tissue hypoxia has been regarded as a central factor for tumor aggressiveness and metastasis" (Kunz & Ibrahim, 2003) was the conclusion of German researchers from University of Rostock and University of Leipzig. Since dozens of medical and physiological studies yielded the same result, what about just a title again? "Tumor oxygenation predicts for the likelihood of distant metastases in human soft tissue sarcoma" (Brizel et al, 1996). The harder one breathes, the faster cancer invades. Probably, the reader now can guess about the effect of cancer treatment and the chances of survival for those who suffer from severe chronic hyperventilation. Indeed, "... tumour hypoxia is associated with poor prognosis and resistance to radiation therapy" (Chaplin et al, 1986). "Low tissue oxygen concentration has been shown to be important in the response of human tumors to radiation therapy, chemotherapy and other treatment modalities. Hypoxia is also known to be a prognostic indicator, as hypoxic human tumors are more biologically aggressive and are more likely to recur locally and metastasize" (Evans & Koch, 2003). "Clinical evidence shows that tumor hypoxia is an independent prognostic indicator of poor patient outcome. Hypoxic tumors have altered physiologic processes, including increased regions of angiogenesis, increased local invasion, increased distant metastasis and altered apoptotic programs” (Denko et al, 2003). Could breathing influence the tumors and if so, how? The authors of one of the studies cited above mused about the origins of all these problems, “Surprisingly little is known, however, about the natural history of such hypoxic cells” (Chaplin et al, 1986). Why could they appear? What is the source of tissue hypoxia? We can again suggest that our breathing does influence the breathing process of all body tissues, tumours included. Is there any experimental evidence indicating the usefulness of CO2 for malignant tumours? During the last decade, there has been a steady progress in the investigation and application of CO2-O2 gas mixtures called "carbogen" in clinical practice. Carbogen breathing is usually applied for several hours during administration of certain anti-cancer medications. Let us review some results in this area and the reasons for carbogen application. Several studies from England and the USA found that breathing various carbogen mixtures significantly improves oxygenation of tumours. The general opinion of these researchers is that "Perfusion insufficiency and the resultant hypoxia are recognized as important mechanisms of resistance to anticancer therapy. Modification of the tumour microenvironment to increase perfusion and oxygenation of tumours may improve on the efficacy of these treatments..." (Powell et al, 1997). A large group of British scientists from the Paul Strickland Scanner Centre revealed that when 14 cancer patients breathed various carbogen mixtures (with 2%, 3.5% and 5% CO2 content, the rest was O2) "arterial oxygen tension increased at least three-fold from basal values" (Baddeley et al, 2000). They also found that "There were no significant changes in the respiratory rate, heart rate and blood pH. The results suggest that 2% CO2 in O2 enhances arterial oxygen levels to a similar extent as 3.5% and 5% CO2 and that it is well tolerated" (Baddeley et al, 2000). Another group of British researchers directly measured oxygen pressure in cancer cells and concluded, "This study confirms that breathing 2% CO2 and 98% O2 is well tolerated and effective in increasing tumour oxygenation" (Powell et al, 1999). These results generate the following question. Which gas, CO2 or O2 is the main contributor to increased oxygenation and by how much? The amounts of both gases in mixtures were much higher than the amounts of O2 and CO2 in normal air. Let us, first, consider the influence of O2. There are two O2 states namely O2 that is combined with haemoglobin and dissolved O2, which can increase oxygenation of the arterial blood. As we considered in Chapter 1, the saturation of haemoglobin with O2 under normal conditions (or when breathing normal air) is about 98%. Increased O2 pressure can raise this value to almost 100%. This would cause about a 2% increase in arterial blood in comparison with the initial value. In addition, when patients breathe carbogen mixtures more O2 can be dissolved in the arterial blood (this O2 is not bound to red blood cells). In normal conditions the contribution of dissolved O2 is about 1.5% of the total blood O2 as the remaining 98.5% O2 is combined with haemoglobin. Increasing O2 almost five times increases total arterial O2 content by about 6% in relation to the initial normal value. Hence, increasing the O2 component in breathing air (up to almost 100%) causes about 8% increase in total O2 content in arterial blood. Similarly, British researchers, as mentioned above reported "arterial oxygen tension increased at least threefold from basal values" (Baddeley et al, 2000). How was it possible to get such a large increase in tissue oxygenation

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(about 200%) if arterial blood could carry only about 8% more O2 during carbogen breathing in comparison with initial conditions? The remaining increase in tissue oxygenation could be due to larger CO2 values, which shift the Bohr curves down and enhance O2 release from haemoglobin cells, and due to the dilation of blood vessels. Therefore, the increase in oxygenation of tissues is mainly due to the larger CO2 content. Indeed, the British professionals decided “to assess the relative contributions of carbon dioxide and oxygen to this response and the tumour oxygenation state, the response of GH3 prolactinomas to 5% CO2/95% air, carbogen and 100% O2” (Baddeley et al, 2000). That was done using magnetic resonance imaging and PO2 histography. They found that, “A 10-30% image intensity increase was observed during 5% CO2/95% air breathing, consistent with an increase in tumour blood flow, as a result of CO2-induced vasodilation, reducing the concentration of deoxyhaemoglobin in the blood. Carbogen caused a further 40-50% signal enhancement, suggesting an additional improvement due to increase blood oxygenation. A small 5-10% increase was observed in response to 100% O2, highlighting the dominance of CO2-induced vasodilation in the carbogen response” (Baddeley et al, 2000). It is not oxygen, but carbon dioxide that is the substance responsible for the main improvement in oxygenation of tissues.

Diseases of the brain and the central nervous system Physiology and medicine teach us that a CO2 deficiency produces the following abnormalities in the nerve cells: • Increased excitability of all nerve cells. We are too excited when we hyperventilate since overbreathing “leads to spontaneous and asynchronous firing of cortical neurons" (Huttunen et. al., 1999). • Reduced blood flow to the brain. Our brains get less blood supply. This physiological fact can be found in many textbooks. As Professor Newton from the University of Southern California Medical Center recently reported, “cerebral blood flow decreases 2% for every mm Hg decrease in CO2” (Newton, 2004). That means that with each second decrease in the BHT, blood flow to the brain is less by almost 1%. Less blood means a decreased supply of glucose (the main fuel for the brain in normal conditions), oxygen, and other nutrients. In addition, it causes gradual accumulation of waste products. All these effects affect all aspects of human performance, including concentration, coordination, memory, logic, etc. • The suppressed Bohr effect. Not only is the inflow of oxygen less, but also oxygen release from red blood cells is hampered by low CO2 concentrations in tissues. That further reduces brain oxygenation. In addition, there are similar negative effects due to likely abnormalities with production and delivery of nitric oxide causing hypoxia, lowered blood perfusion, faulty transmission of signals, and inflammation. Imbalances in the ANS and hormonal system are other destabilizing factors. It is likely that there are other effects of abnormal breathing on the nervous system. Hyperventilation is virtually always manifested in abnormal breathing patterns, including a higher frequency of breathing, shorter exhalations and inhalations, absence of periods of no-breathing, abnormalities in the work of respiratory muscles (e.g., chest breathing), etc. Do clinical studies show that patients with mental or psychological problems have heavy breathing? In 1976 the British Journal of Psychiatry published a study of CO2 measurements in 60 patients with neurotic depression and non-retarded endogenous depression (Mora et al, 1976). All patients had abnormally low carbon dioxide values. Later, in 1990, American psychiatrists from Hunter College (City University of New York) reported results from several groups of subjects with anxiety, panic phobia, depression, migraine, and idiopathic seizures (Fried, 1990). The abstract states “virtually all the non-control subjects were found to show moderate to severe hyperventilation and accompanying EEG dysrhythmia”. In addition, it notes that hyperventilation and abnormal electrical signals in the brain took place simultaneously. Canadian scientists from the Department of Psychiatry (University of Manitoba, Winnipeg) measured carbon dioxide concentrations in over 20 patients with panic disorder. Their average CO2 was also below the medical norm (Asmundson and Stein, 1994). There are many other studies that report abnormally low CO2 values for people with various psychological and neurological problems. It has been known in neurology for over 50 years that poor oxygenation and reduced blood supply of the brain are the foundations of virtually all “mysterious” and known neurological and psychological pathologies, ranging from insomnia, depression, addictions and phobias to Parkinson, Alzheimer, and senile dementia. Indeed, if one considers

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the places and people who tried breathing retraining (Chapter 4), almost all of them relate to psychology and neurology.

GI (gastrointestinal) problems How hyperventilation affects the GI system? • Small blood vessels in the digestive organs get constricted. That reduces their blood supply. Physiological measurements confirm this effect on the stomach, liver, spleen, and the colon. Hence, GI organs get less oxygen, glucose, and other nutrients for their normal work and repair. • The suppressed Bohr effect, due to low CO2 values in the blood, reduces the oxygenation of the digestive organs. • The excited state of the nerve cells in the GI system (the enteric nervous system that orchestrates the normal work of the whole digestive conveyor) interferes with the normal work of the GI organs. That can influence the contraction of the muscular layers, the production and secretion of digestive enzymes and other functions. Indeed, a group of American gastroenterologists from the Mayo Clinic in Rochester recently published a study Hyperventilation, central autonomic control, and colonic tone in humans (Ford et al, 1995). They tested the effects of voluntary over-breathing with normal and CO2-rich air. A drop in the CO2 level of the blood (hyperventilation) caused abnormalities in the contractility and peristalsis of the colon. • Chronic hyperventilation can cause autoimmune GI reactions since it is not normal to breathe two-three times the norm 24/7. The immune system, as in case of asthma, can start searching for enemies coming from outside (i.e., with food). This can contribute to the pathology of inflammatory bowel disease, irritable bowel syndrome, Crohn’s disease and other problems and complaints. Hyperventilation can create numerous abnormalities in the GI system. There are no studies that compare these effects or define the individual differences. Similarly, the impact of permanent changes in breathing is also not investigated.

Hormonal problems How do people with hormonal (endocrine) problems breathe? A group of Italian medical researchers from the University of Ancona reported that 28 patients with diabetes breathed from 10 to 20 l/min (Tantucci et al, 1997). A year later German endocrinologists from Gutenberg University Hospital (Mainz) tested 42 people with hyperthyroidism and found 15 l/min (Kahaly et al, 1998). How can deep breathing cause hormonal or endocrine problems? Since hyperventilation is a state of emergency for the whole body, it can interfere with the normal production and secretion of various hormones. For example, the immediate effects of stress include surges of adrenalin and cortisol. Chronic hyperventilation often leads to gradual development of deficiencies in these hormones. In addition, all tissues, hormonal glands included, suffer from reduced oxygenation and blood supply. Above-mentioned abnormalities with nitric oxide production and its bioavailability directly cause problems with several hormones (see above). The function of the ANS is compromised in conditions of overbreathing creating another cascade of imbalances in the circardian cycles regulated by these hormones. However, there were no systematic studies that identified the long-range hormonal changes due to heavy breathing. Individual differences, together with life style and environmental parameters, should play their role when it comes to expected effects.

_______ Other health concerns and summary

What about Western research concerning the breathing of people with various other problems? There were few studies relating the quality of breathing to other health problems. However, medical science knows little or nothing about the breathing/disease interaction for many common health problems like cancer, arthritis, diabetes, etc. That especially relates to the situations when breathing parameters gradually change. What other diseases are related to abnormal breathing? Breathing regulates blood supply and oxygenation of all cells, tissues and organs. Breathing also reflects the state of the autonomous nervous system that regulates the work of all body organs. In conditions of chronic hyperventilation vital organs suffer from reduced blood supply and hypoxia. In addition, chronic hyperventilation interferes with the normal work of the nervous and immune systems. Hence, a wide variety of negative effects is present when we breathe too much. Furthermore, if reduced blood and oxygen supply, together with abnormalities of the immune and nervous systems, are part of the main problem, then breathing can play a role in the further development of this health problem. 32


There is some limited but encouraging practical evidence about the healing influence of normalization of breathing on a variety of health conditions. What diseases are not related to chronic hyperventilation? People with, for example, color-blindness lack certain structures in the retina of their eyes. Whatever their breathing patterns, there are no known cases of the appearance or disappearance of this medical condition. Likely, breathing has nothing to do with this problem. Hemophilia is usually manifested in the absence of one blood clotting substance. Again, this problem is purely genetic and unrelated to breathing. There are over 30,000 various health problems and abnormalities known to modern medicine. Doctor Buteyko and his Soviet (Russian) medical colleagues, based on their clinical experience with over 200,000 patients, hypothesized that about 150-200 health conditions are connected with abnormal breathing. Hence, less than 1% of all health problems might be affected by our breathing. However, many of these health problems are fairly common for modern people. This, for example, relates to our main killers, like heart disease, cancer, and many others.

1.16 Why breathing? Patients with modern degenerative diseases usually have many dozens of physiological and biochemical parameters which seen to be abnormal. For critically ill patients this number is much larger and is often estimated to be many hundreds. That means that the concentrations of numerous minerals, vitamins, hormones and many other substances are out of their norms. Why, then, are breathing in general and CO2 related parameters in particular chosen for our consideration? Based on still limited studies, when breathing is normal, many diseases are absent. When people are sick, they over-breathe. Even partial normalization of their breathing results in better health, as we saw above and are going to consider later. What exact role breathing plays in the pathology of various diseases is a very big and hard question that needs further studies and trials. The unique position of breathing among many other health parameters is due to its semi-automatic nature. Professor Ronald Ley, State University of New York, recently wrote a large review “The modification of breathing behavior” starting with the statement, “Breathing is the only vital function under direct voluntary control as well as involuntary control” (Ley, 1999). Most of the time the "breathing centre" governs human respiration by keeping minute ventilation, carbon dioxide and oxygen concentrations, and breath holding time or the BHT (breath holding time after normal expiration) within relatively narrow ranges at rest. Meanwhile, people can voluntarily change many breathing parameters. For example: minute ventilation, breathing frequency, and tidal volume (the amount of air taken in per breath) can be decreased or increased by at least a factor of two. The duration of such wilful breathing can be sustained for many minutes or even hours every day. Thus, breathing, to some degree, can be controlled in the short run by human willpower and, over long periods of time, can be normalised through self-discipline and persistence. Moreover, there are numerous life style and environmental factors (to be discussed) that directly influence breathing and that can be adjusted to meet the needs of the human organism. A person cannot directly order the heart to slow down, the air passages to open, the kidneys and liver to intensify their work and cleanse the blood of pathogens, or any spasm to disappear. However, these and many other problems can be solved by breathing exercises, as will be discussed later.

_______ 1.17 Evolution of air on Earth

How is it possible that a human being, one of the smartest species on Earth, can kill itself, and over 90% people die this way, by over-breathing? Is it nature so silly to create this way? In order to answer these questions we need to consider changes in air composition on Earth. When there were no life on Earth, air has no oxygen (since oxygen is a very reactive substance), while CO2 was a part of the volcanic gases that formed air during those times. Geological studies suggest that CO2 concentration was up to 10-12% or even more. Thus, when the first organic substances and life forms appeared on Earth (from about 5 billion to 1 billion years ago), our atmosphere did not have any measurable amounts of O2, according to Professor Maina (Maina, 1998), who wrote the book The gas exchangers: structure, function, and evolution of the respiratory processes about development of respiration and breathing in various creatures living on Earth in the past and now. He is one of the leading modern authorities on respiration of different life forms. Appearance of the first vertebrates (about 550 millions years ago) and the development of prototypes of human 33


lungs took place when air was made up of only about 1% O2, while having much higher percentage of CO2 (Maina, 1998), likely over 7%. Normal air today has many times more O2 (about 20%) and only a fraction of the CO2 (0.03%). However, our cells now still live in the air that existed hundred millions years ago: “But the cells of animals and humans need about 7 % CO2 and only 2% O2 in the surrounding environment. This is the way how our cells live: cells of the heart, brain, and kidneys” (Buteyko, 1977). Hence, most of the time our lungs were developing and evolving in conditions when the CO2 content was high (up to 7-12% during the first stages of development), with gradual decline, and low O2 values (about 1% or less during the first stages). During these stages the process of control of breathing by the nervous system was also developed. Since this primitive air had very little O2, our evolutionary predecessors could get more oxygen in tissues by breathing more. Since any stressful situation, digestion, search for food, mating, playing, and any other activity required more oxygen, hyperventilation became the fundamental reflex or instinct. Only totally peaceful stress-free rest had low metabolic rate where heavy breathing would not give any advantage for survival. On the other hand, however heavy was the breathing of these primitive creatures in the past, they would still get the main nutrient, CO2, from air. The CO2 content in tissues had to be even higher than in air and these creatures would never develop spasms of coronary vessels, bronchi, other smooth muscles, or abnormal excitability of the nerve cells, or muscular tension or any other above-mentioned negative effects. Hence, nature did provided primitive creatures with ability to function without all above-discussed physiological flaws. However, the main parameter of our environment, our air, had dramatic change during later stages of our evolution due to advance of green life that transforms CO2 into O2 during photosynthesis. These events could be reflected on the following picture.

> 7% CO2 < 1% O2 Birth and development of our lungs

7% CO2 2% O2

0.03% CO2 20% O2

Our cells now

Modern air

Fig 1.1 CO2 and O2 values in air during early stages of development of our lungs, in our cells now and in modern air. We can see that air had dramatic change during evolution. It now has too much oxygen and almost no CO2. Hence, the chief parameter of our environment (we can survive for days or weeks with no water or food, but only for minutes with no air) became abnormal in its composition. It is only existence of our lungs that protected us from extinction. Nature could not anticipate this cardinal change in air, but it did provide us with the means for survival.

_______ Conclusions

• Many sick people with modern degenerative health conditions chronically breathe 10-25 l/min, or 2-5 times more than the physiological and medical norms (about 5-6 l/min). • Such chronic over-breathing usually reduces CO2 stores in the organism causing, according to physiological laws and studies, the following consequences: - hypoxia of all cells and organs (especially of the brain and heart); - local constriction of arteries, arterioles, and capillaries, leading to poor blood perfusion in the heart, brain and other vital organs; - tension and irritability in smooth muscles; - excessive excitability of many brain areas and other parts of the nervous system; 34


- constriction of air passages; - abnormal changes in blood pH and electrolytic composition of each human cell; - abnormal biochemical reactions involving vitamins, minerals, amino acids, lipids, hormones, carbohydrates and other vital substances. • Medical studies have revealed personal variability of physiological and psychological symptoms due to chronic hyperventilation. • Acute over-breathing, which is produced by the hyperventilation provocation test, often reproduces the symptoms of the main health problem. • There are only a few, rare health conditions, which are characterised by breathing less than the norm. • Since over-breathing causes low CO2 concentrations in the exhaled air, results of such measurements revealed that the carbon dioxide level is low for different groups of sick people, and dangerously low in the severely sick. • Breathing of critically ill patients is usually visible, audible, and corresponds to very low carbon dioxide stores and heavy hyperventilation. • BHT (breath holding time) or the BHT (breath holding time after normal expiration) is a simple and clinically significant indicator reflecting the individual health state of people with asthma and heart disease. • Breathing has a unique position among other vital physiological functions due to the human ability to control it. • During early millennia of evolution of the lungs, hyperventilation, as a reaction to psychological, physiological, chemical, bacteriological, viral and any other stress, became the most fundamental reflex of the human organism. • Despite of dramatic change in air composition during evolution of life on Earth and despite of our ability to kill ourselves just by heavy breathing, Nature provided us with the means of survival: our lungs.

Q&A section for Chapter 1 Q: What were the historical origins of concerns about the dangers of CO2? A: In the 1780s, French scientist Antoine-Laurent Lavoisier determined the composition of air. He also discovered the mechanism of gas exchange during respiration and burning. Oxygen is consumed for the production of energy and carbon dioxide is expelled as an end product. In his classical experiments, mice died in a closed glass jar in an atmosphere containing large quantities of carbon dioxide and almost no oxygen. A candle also quickly expired in such air. That was probably the time when a superficial understanding of respiration produced the idea that carbon dioxide was a “toxic, waste and poisonous” gas while oxygen brought life and vigor. “Take a deep breath”, “Breathe more air, it is good for your health”, “Breathe deeper, get more air into your lungs, we need oxygen”, etc. became popular phrases for which there is no scientific basis. Even now, some scientific publications contain such misleading sentences, as “Respiration is the process of oxygen delivery.” Professor Yandell Henderson gave the following explanation of this ignorance, “Likeness of Life to Fire. Lavoisier's supreme contribution to science, and particularly to physiology was the demonstration that, in their broad outlines, combustion in a fire and respiratory metabolism in an animal are identical. Both consist in the union of oxygen from the air with carbonaceous material: and both result in the liberation of heat and the production of carbon dioxide… The human mind is inherently inclined to take moralistic view of nature. Prior to the modern scientific era, which only goes back a generation or two, if indeed it can be said as yet even to have begun in popular thought, nearly every problem was viewed as an alternative between good and evil, righteousness and sin, God and the Devil. This superstitious slant still distorts the conceptions of health and disease; indeed, it is mainly derived from the experience of physical suffering. Lavoisier contributed unintentionally to this conception when he defined the life supporting character of oxygen and the suffocating power of carbon dioxide. Accordingly, for more than a century after his death, and even now in the field of respiration and related functions, oxygen typifies the Good and carbon dioxide is still regarded as a spirit of Evil. There could scarcely be a greater misconception of the true biological relations of these gases…” (Henderson, 1940).

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Q: How did the parameter “40 mm Hg CO2” appear in textbooks? A: This number is important because it is present in all main physiological textbooks used nowadays by western students. This is the current medical norm for CO2 content in alveoli and the arterial blood. The number was established about a century ago by the famous British physiologists Charles G. Douglas and John S. Haldane from Oxford University. Their results were published in the article The regulation of normal breathing by the Journal of Physiology (Douglas & Haldane, 1909). The investigators analysed arterial blood gases of staff members at Oxford University, including scientists and support personnel, and found the average for the group. It is possible to argue that even during those times many University workers had a sedentary life style with little physical activity. Hence, their CO2 concentrations could be lower than those for most healthy people a hundred years ago. Indeed, another old study by the also famous Karl Albert Hasselbalch had about 46 mm Hg aCO2 as the average value for volunteers at rest (Hasselbalch, 1912). Doctor Buteyko suggested about the same value to be the norm for people in good health. Q: How many people have normal breathing? A: If we accept medical standards (6 l/min for ventilation, as in most medical and physiological textbooks, and 40 s for the BHT), only a small percentage (less than 10%) of the population satisfies this criterion. Experience shows that on average, only a few, if any, per 1,000 people have breathing with Doctor Buteyko’s norm (60 s BHT or more). Q: How much oxygen is retained in the human organism? In other words, are we efficient in oxygen extraction from air? A: Typical patients with asthma and heart disease breathe about 15 l/min at rest and have about 15 s BHT. They utilize or absorb only about 10% of inhaled oxygen, the remaining 90% is exhaled back in air. People, who are considered normal by medical standards (6 l/min and 40 s BHT) retain only about a quarter (25%) of the oxygen that they inhale. Their lungs are more efficient at extracting oxygen. Those healthy people, who breathe in accordance with Buteyko’s norm (4 l/min; 60 s BHT), can extract up to 30-35% of the oxygen they inhale. People with over 3 min BHT (hatha yoga masters. Dr. Buteyko and many of his colleagues, etc.) would have about 2 l/min for minute ventilation and retain up to 60% of inhaled oxygen. Q: Which body parts or tissues are particularly sensitive to tissue hypoxia? In other words, how long can various organs and tissues survive without oxygen? A: The time of survival will relate to initial oxygenation (reflected in the breath holding time) and existing pollution of tissues. This table from the British Medical Journal (Leach & Treacher, 1998) reflects tolerance to hypoxia of various tissues for an ordinary person.

Tissue Brain Kidney and liver Skeletal muscle Vascular smooth muscle Hair and nails

Survival time < 3 min 15-20 min 60-90 min 24-72 hour Several days

_______ Q: Some people claim that over-breathing can help the organism to "expel toxins". Is this opinion correct? A: Although some medical and physiological textbooks on respiration state that unwanted substances can be removed from the organism through the air passages, their quantities are small. In addition, over-breathing or hyperventilation is unlikely to be useful due to greatly decreased blood supply to other organs of elimination, which will then function less efficiently. Moreover, poor blood supply to the tissues is going to diminish the rate at which these substances are collected by body fluids and eliminated. Meanwhile, normal breathing (about 6 l/min), in addition to the described normalisation of body physiology, means that smaller amounts of polluted air, smoke, dust, etc. are taken in to the organism through the lungs. Q: Does deep breathing help to deliver more fresh air to poorly ventilated parts of the lungs filled with old stale air? A: Often people also ask, “Is it true that, if I breathe little, I do not exercise my lungs and can develop some lungs 36


problems?” Vice versa. All people with asthma, emphysema, bronchitis, and many other problems are heavy breathers. They need CO2 to heal their lungs. In addition, people with heavy or deep breathing are often chest-breathers since the smooth muscle of the diaphragm is in the state of spasm. Hence, their lower layers of the lungs get much less, if any, fresh air. Normal breathing is diaphragmatic allowing homogeneous inflation of the whole lungs with fresh air, similar to what happens in the cylinder of a car due to the movement of the piston. Q: Can a few deep breaths or sighing relieve tension in the chest? A: During the first of several deep breaths, not only are all alveoli in the lungs greatly expanded providing more oxygen for all tissues, but also any tightness in the chest muscles can be temporarily relieved, due to their stretching and subsequent relaxation. Periodic sighing (a typical symptom of diabetics, CFS sufferers, cardiac patients, asthmatics, etc.) is an example of chest tension relief, but such deep breaths also remove more CO2, first, from the lungs, and finally, from all cells. As a result, any beneficial effects of deep breathing are very short-lived. Moreover, lowered CO2 levels lead to worsening of the problems which deep breathing was intended to solve causing: 1) further bronchoconstriction, up to partial or total closure of some lung areas and less effective gas exchange; 2) more muscular tightness due to increased hypoxia, excessive excitability and tension in the chest and other muscles, constriction of arteries and capillaries, and certain other physiological disorders discussed above. Thus, the temporary relief provided by periodic deep breaths or sighing can become a part of the vicious circle. It is no surprise that various medical professionals, authors of the already cited publications, viewed sighing as a clear symptom of the chronic hyperventilation syndrome. Q: How does breathing affect the quality of sleep? A: A normal person needs about 5-6 hours of sleep. He falls asleep within a few minutes, sleeps the whole night in the same position without awakening, does not remember his dreams and wakes up fully refreshed. That corresponds to normal breathing and normal breath holding time (about 40 s). A typical asthmatic with 15 l/min ventilation and about 15 s BHT tends to have 8-10 hours of sleep. He is likely to need some 5-20 minutes to fall asleep. During the night he can awaken, get anxious, change positions, have dreams, etc. In spite of the long period of sleep, he may still feel tired in the morning. How and why are these abnormalities possible? As mentioned above, hyperventilation "leads to spontaneous and asynchronous firing of cortical neurons" (Huttunen et. al., 1999). This phrase, from the professional magazine Experimental Brain Research, has very serious personal and even social ramifications (as we are going to see in Chapter 9). For example, when this asthmatic goes to sleep he has thoughts, which are self-generated by his brain in spite of his conscious attempts to calm down, relax, put everything aside, etc. These “spontaneous and asynchronous” thoughts often cause problems with falling asleep. Let us consider the duration of sleep. Two main known physiological purposes of sleep are to give rest to the brain (especially to cortical areas) and the muscles. The normal person, due to normal aCO2 concentrations, has had a relaxed, easy attitude, with normal perception during the whole day. He has experienced less stress (since stress in modern people is mainly due to distorted attitudes to outer events and stimuli, not due to life-threatening situations). His muscles have been relaxed (again due to carbon dioxide). Hence, he needs only 5-6 hours of sleep. The asthmatic, due to chronic hyperventilation, has had tense muscles and over-excited brain during the whole day. Normally, he needs more time for sleep in order to relax and rest his muscles and brain. Moreover, severely sick and hospitalised people with 5-8 s BHT may need up to 12-14 hours of sleep, usually of miserable quality: with frequent awakenings, changed body positions, dreams, nightmares, etc. The causes are the same: tense muscles and “spontaneous and asynchronous firing of cortical [and other] neurons”. Certain practical evidence and hatha yoga studies also have found that, when breath holding time is about 1 minute, people need on average only about 4 hours of sleep, while for 2-3 minutes BHT, 2 hours of sleep is sufficient. In my view, that corresponds to the way Nature designed the human organism. The relationships between sleep and breathing will be considered in more detail later.

_______ Q: Are concentration and other mental skills (like logic, analytical abilities, memory, etc.) similarly affected and why? A: We know from above, that brain blood flow is proportional to aCO2. In addition, brain oxygenation is impaired in 37


such conditions due to the Bohr effect. Both factors produce predictable effects on all our senses and communication within the nervous system. At some moments of time, these “spontaneous and asynchronous firings of cortical” and other neurons may coincide with the normal image of the world. However, considering long periods of time, it is unreasonable to expect that a chronically hyperventilating brain can function normally. Q: I have heard that in some places pure O2 can be bought for breathing. Is it good for health? A: While breathing pure O2, “Free radicals (and other toxic metabolites of oxygen) are generated in most cells as a consequence of normal metabolic processes, but cells are protected from injury by antioxidant mechanisms. Several forms of lung injury appear to result from generation of toxic metabolites of oxygen in quantities which exceed the antioxidant capacity of lung cells…”, as stated at the very beginning of the abstract by Brigham (1986). Moreover, detailed investigation of lung tissues revealed that, “Exposure of animals to oxidant gases produces a mild emphysema, and O2-derived free radicals are capable of degrading connective tissues in vitro. It is postulated that degradation of connective tissue by O2-derived free radicals leads to emphysema in these models” (abstract, Kerr et al, 1987). A review, “Data on oxidants and antioxidants”, conducted by Junod (1986), also found that “Since O2 intermediates can affect the general cellular metabolism and inhibit cell replication or reduce protein synthesis, all the biological effects of O2 and its metabolites should therefore be considered in the pathogenesis of emphysematous lesions in the lung” (Junod, 1986). Another related question is why anti-oxidants are important supplements. They are used in order to diminish the possible damage done by oxidants generated by, among other sources, excessive freely-dissolved O2 concentrations. Finally, a textbook on medical physiology (Ganong, 1995) contains a section entitled "Oxygen toxicity". It starts with: "It is interesting that while O2 is necessary for life in aerobic organisms, it is also toxic. Indeed, 100% O2 has been demonstrated to exert toxic effects not only in animals, but also in bacteria, fungi, cultured animal cells, and plants. The toxicity seems to be due to the production of the superoxide anion (O2-), which is a free radical, and H2O2. When 80-100% O2 is administered to humans for periods of 8 hours or more, the respiratory passages become irritated, causing substantial distress, nasal congestion, sore throat, and coughing. Exposure for 24-48 hours causes lung damage as well. In animals, more prolonged administration without irritation is possible if treatment is briefly interrupted from time to time, but it is not certain that periodic interruptions are of benefit to humans" (Ganong, 1995). In subsequent paragraphs, Professor Ganong describes development of lung cysts and serious visual defects due to retinal damage in infants treated with O2 for respiratory distress syndrome. Increased O2 pressure (in some places pure O2 is administered at increased pressure) accelerates the harmful effects of O2. Meanwhile, breathing O2 for a few minutes would probably not be very harmful. Generally, breathing pure oxygen can be useful as a short-term emergency measure in cases of life-threatening hypoxia. Q: What is the long-term influence of different air compositions on human health? Has anybody investigated the optimum composition of air? A: The first experiments in this area were done about a century ago by Yale researchers. Professor John Haldane was, probably, the most prominent scientist of those times. He wrote a classic textbook “Respiration” (Yale University Press, New Haven, UK, 1922) which is mostly devoted to the interaction between breathing and arterial blood CO2 concentrations. During the later years of his career he served in the British Navy, working on air supply for submarines (where people can spend several months). The results of his research are still classified by British government agencies. Available information about air composition on spaceships indicates that during the first three US space missions astronauts used pure O2. Pure oxygen would be expected to cause impairment of mental performance and physical health, due to decreased blood flow to the brain, as discussed in section 1.2 and other negative effects mentioned above. On later missions US astronauts were provided with much less O2 in the air of their spaceships. In 1960s Doctor Buteyko was the manager of the laboratory of functional diagnostic and studied various breathing –related effects on cardiovascular and other systems of the human organism. His research was supported and funded by the Soviet Ministry of Aviation and Space Exploration for first Soviet space missions. According to Doctor Buteyko, the optimum air for long-term health benefits should be about 10-12% O2 (as found on high mountains) and 2% CO2 (Buteyko, 1977). Probably, this extra 2% CO2 increases aCO2, improving tissue oxygenation and producing

_______ 38


other positive changes, while 10-12% O2 (twice less than normal air) is small enough to minimize oxidative lung damage. Surprisingly little information is published about research on optimum air for submarines. Also, very little is published about the growth processes of plants and animals in CO2 rich air, while known results are very encouraging. Q: Plant respiration is the opposite process: consumption of CO2 and production of O2. Thus, plants fix CO2 for synthesis of other chemical substances. Can animals do the same? A: A review of numerous publications devoted to this subject was given by Waelsch and colleagues (1964) in an article entitled “Quantitative aspects of CO2 fixation in mammalian brain in vivo”. They found that aspartic and glutamic amino acids and glutamine were the substances chemically synthesised in mammalian brains. Glutamine is the most abundant amino acid in the human organism (hence, its popularity among some bodybuilders). It is also the amino acid most required for tissue repair, but “since the supply of glutamic acid from the circulating blood is insufficient for the formation of additional amount of glutamine, the dicarboxylic acid has to be synthesized in the brain.” (Berl et al, 1962) This last substance is a CO2 derivative. Thus, CO2 can be fixed by the human organism in order to rebuild nervous tissues in the brain. The rate of CO2-derived glutamine production is proportional to CO2 concentration in the brain. It follows that low CO2 in the brain not only makes the brain unreasonably excited (possibly causing anxiety, fears, panic attacks, aggression, hostility, violence, or other strong emotions), but also has adverse effects on its cellular repair. There are several other reactions, in which CO2 is one of the necessary components. These reactions relate to biosynthesis of amino acids, carbohydrates, lipids and several other vital substances. The formulas of these reactions are provided in the article “The Role of Carbon Dioxide in the Vital Processes of the organism” (Kazarinov, 1991) [Available at: http://members.westnet.com.au/pkolb/biochem.htm]. “Q: Could you [doctor KP Buteyko] please explain us shortly your principle of breathing? A: Here it is: we know that deep breathing decreases the concentration of carbon dioxide in the blood, lungs and cells. A Russian scientist from Perm, Verigo discovered this law at the end of 19-th century, which is, as it seems, strange: a fall of carbon dioxide increases the chemical link between oxygen and haemoglobin. As a result, it is more difficult for oxygen to get from the blood to the brain, heart, kidneys, and other organs. In other words, the deeper the breathing, the less the oxygenation of the cells in the brain, heart, and kidneys. This law is in the foundation of our discovery. CO2 deficiency causes constant spasms in all organs. Hence, it is necessary to learn right breathing” (Buteyko, 1997).

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Chapter 2. The chemical and physiological mechanisms of immediate regulation of breathing Introduction The next topic (Chapter 2) is to consider the basic mechanism of immediate regulation of breathing. First, we shall consider the chemical foundations of breathing regulation. How does the body know when to breathe? Which body tissues and structures participate in regulation of respiration? Second, we are going to consider some practical situations. How and why is our breathing changed due to some simple physiological activities? How do variations in the composition of the inspired air influence human breathing? Within this portion of the topic, as a first step, we can investigate the control of breathing in healthy people when the human organism is subjected to different tests (voluntary changes in breathing frequency; changes in parameters of inspired air, including barometric pressure and air composition; and physical activity). Later, due to the importance of the BHT (breath holding time) test, we can consider how breathing is controlled during breath holding. Then, we will review the impact of the same tests on the breathing for sick people. The main ideas about breathing regulation in the healthy have been known for about 100 years, and can be found in medical and physiological textbooks. However, there are still debates regarding chemical and neurological control of breathing.

2.1 Biochemical control of respiration The central nervous system control our breathing, using special tissues and cells that sense the concentration of carbon dioxide, oxygen, and hydrogen ions, and then send the information to the brain. There are 2 types of respiratory chemoreceptors: central chemoreceptors, which are located in the medulla oblongata of the brain, and peripheral chemoreceptors. The central chemoreceptors detect changes in the pH of the cerebro-spinal fluid and they are responsible for long-term or chronic changes in breathing. Since CO2 dissolves in the blood and can penetrate through the blood-brain barrier, the main reason for pH variations in the brain are changes in CO2 concentrations. Peripheral chemoreceptors monitor immediate changes in CO2, O2, and pH concentrations of the blood and control our breathing in the short run. It is agreed that peripheral chemoreceptors include; 1) the carotid body, which is situated at the division of the common carotid artery into the external and internal carotid arteries in the neck, becoming the external and internal carotid artries; 2) the aortic body which is located near the aortic arch. Both bodies are small pieces of tissues, which are very well perfused. The carotid and aortic bodies detect acute changes in CO2, pH and O2 concentrations of the arterial blood. The output from both bodies is relayed to the respiratory centre in the brain for immediate regulation of breathing. It is possible that there are additional chemoreceptors, which are often called “paraganglia”, located in the thorax and abdomen (Deane et al, 1975; Easton et al, 1983). In addition, there are other receptors that are connected to the breathing centre, and are located in the lungs. These receptors, too, can influence our breathing by producing, for example, coughing, sneezing, deep inhalations, hyperventilation, breath holding and other effects. These receptors can detect the presence of foreign objects or irritants in the airways, the degree of inflation of the lungs and other parameters. The functions and actions of some of these receptors in the lungs and their relationships to breathing are still poorly understood. More recent evidence suggests the existence of the respiratory rhythm due to dischange of medullary respiratory neurones. The respiratory rhythm,according to Oxford Medical Dictionary, is the rhythm of alternating inspiratory and expiratory movements that take place during breathing. Four respiratory centres are thought to control the respiratory rhythm; the inspiratory centre and expiratory centre in the medulla, and an apneustic centre and pneumotaxic centre in the pons. This rhythm probably plays a central role in situations when we loose consciousness. The respiratory rhythm influences, together with other factors, the duration of breath holding (Parkes, 2005). This study of Parkes Breath-holding and its breakpoint indicates that even such a simple event as breath holding has very complicated mechanism of interactions of various parameters and little is known about exact details of this process. Doctor Buteyko proposed that CO2 deficiency makes the neurons of the respiratory centre excited fuelling

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further hyperventilation and causing reduction in the BHT (Buteyko, 1977).

2.2 The main physiological parameter, which controls the breathing of healthy people Let us consider healthy volunteers, who were asked the following: • 1) to breathe several times slower or faster while allowing the depth of breathing to regulate itself in a natural manner (their respiration rate could change from normal 12-15 to 3-4 per minute for slow breathing and up to 24-60 per minutes for fast breathing); • 2) to breathe normal air at different barometric pressures (from about .5 to 4 atmospheres); • 3) to breathe different air mixtures (consisting of from 0.04% to 4-5 % CO2 and from 12% to 80 % O2); • 4) to walk 3, 5 or 8 km/h. Was there any common parameter, which regulated breathing for all these situations? Practical experiments revealed that most parameters varied within wide ranges during these tests. For example, minute ventilation, the respiration rate, the volume of a single breath (tidal volume), arterial and venous O2 contents changed two or more times in comparison with corresponding values at rest. However, the carbon dioxide concentration in the arterial blood (aCO2) varied as little as 2-5 % in relation to resting numbers. These tests were conducted by Yale Professor John Haldane about a century ago when basic ideas about respiration were established. Analyzing these results, Professor Haldane, in his textbook on respiration (probably the oldest one), stated that under normal conditions, exclusive of heavy work, the breathing was regulated by the carbon dioxide level in the lungs or arterial blood (Haldane, 1922). These classic experiments have been repeated many times by other researchers. Therefore, during normal daily activities, the nervous system preserves a certain level of carbon dioxide concentration in the lungs and the arterial blood. In order to maintain this nearly constant daily CO2 level, the human organism employs, using a feedback mechanism, special groups of nervous cells located in two different places, in the medulla of the brain and near the main arteries close to the heart. This system of cells will be called in this book "the breathing centre". How does this feedback mechanism work? In normal conditions, the immediate aCO2 value of the person corresponds to aCO2 norm established by the breathing centre. However, certain activities can change the aCO2 value in both directions. For example, during acute voluntary over-breathing the current aCO2 value becomes smaller than the aCO2 norm. This change is detected by the breathing centre. The breathing centre instructs (or orders) the respiratory muscles to stop their activity (stop breathing). The organism starts to accumulate carbon dioxide up to the level preset by the breathing centre (aCO2). That causes a gradually increasing desire to breathe. Normal breathing is resumed when this preset level is achieved. In certain other situations, the organism can accumulate excessive (in respect to the preset aCO2 norm) amounts of carbon dioxide. That can happen, for example, during breath holding started after normal breathing. In both cases the breathing centre senses this gradual aCO2 increase and sends impulses to respiratory muscles to intensify breathing until additional carbon dioxide is removed and aCO2 again stabilizes near the initial norm. The same situation takes place during speaking while vigorously exercising since ventilation during heavy exercise can be as large as 150-170 litres per minute. Even during yelling or roaring ventilation numbers are significantly less. Hence, speaking while vigorously exercising causes increases in current aCO2 values. Generally, the drive to increase breathing is proportional to the difference between current aCO2 values and the preset aCO2 norm. When the difference is negative (the current aCO2 values are lower than the aCO2 norm), there is a drive to decrease ventilation, up to its full cessation, as in cases of prolonged voluntary hyperventilation. The breathing centre also monitors oxygenation of the arterial blood using a similar feedback mechanism, but its importance for the above-mentioned tests is almost negligible. Since CO2 forms carbonic acid in the blood, the control of oxygenation is achieved by these cells through sensing hydrogen ions or pH of the blood which is kept, in health, within a narrow range (7.35-7.45). Hence, the breathing centre also monitors blood pH, one of the most important and carefully guarded physiological parameters. Let us look in more details at normal physiological responses for these four tests investigated by Professor Haldane. • 1. Changing breathing frequency from a normal 12-15 times per minute to 3-4 times per minute caused prolonged inhalations and exhalations in normal people. This naturally produced a slow and deep breathing pattern. The amount of air exhaled during such breathing was almost unchanged. Hence, CO2 elimination from the organism

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during this slow breathing was also nearly the same (as before the test). Hence, the aCO2 value remains unaffected. Voluntary breathing with high frequencies (24-60 times per minute) resulted in fast shallow breathing also without significant aCO2 changes. Dogs in hot weather cool their bodies using such breathing. Large amounts of water evaporate from their tongues cooling the blood, while the carbon dioxide level remains almost unchanged. • 2. Breathing normal air at different barometric pressures (from twice less to four times more, than the normal barometric pressure at sea level) did not have an immediate effect on breathing. Indeed, CO2 content of the inspired air changed very little in these situations since normal air had only 0.04 % CO2. Hypoxia at the lowest pressures was too small to produce noticeable changes in breathing. Thus, breathing was almost unaffected. • 3. When the CO2 content of the inspired air suddenly increased, the CO2 pressure in the lungs and, hence, the arterial blood also increased. The breathing centre sensed this aCO2 rise due to blood acidification and that caused increased ventilation. Small increases in inspired air CO2 content (up to about 1%) were almost unnoticeable. Air with around 2% CO2 resulted in marked increase in ventilation. 4-5% CO2 in inspired air produced laboured breathing with minute ventilation over 20 l/min (e.g., Straud, 1959) in order to remove extra CO2 and preserve the preset aCO2. Variations in O2 concentration of the inspired air produced no sensations in wide ranges (from 15% to 100%). Thus, breathing pure oxygen usually does not result in immediate specific feelings or symptoms. Hyperoxia (excessive oxygen in air) has never been experienced by an animal species during evolution. Indeed, air O2 content on the Earth has always been increasing, except for short historical periods when it has had small drops. Thus, breathing pure O2 is usually not felt, although prolonged breathing is harmful to the lungs and the brain. However, for hypoxia, a slight increase in ventilation and a corresponding aCO2 decrease were detected when air O2 concentration became about 1215%. • 4. Physical exercise required additional energy provided by muscles due to oxidation of carbohydrates and fats and the generation of additional CO2. This extra CO2 was transported by the venous blood to the lungs and detected by the breathing centre. The results were increased breathing frequency and minute ventilation. It is possible for ventilation to reach 100 l/min for moderately heavy physical work, but aCO2 would be virtually the same as at rest (25% relative variations in respect to the initial value).

2.3 Hypoxia and its contribution to regulation of breathing Let us look at the influence of O2 content on respiration when CO2 concentrations in the inspired air are negligible. Healthy people usually notice increased ventilation only when O2 content is below 10%. Smaller changes (e.g., when breathing 15-19% O2) are probably also sensed by the breathing centre, but increased ventilation would also result in reduced aCO2 values. The breathing centre mainly controls aCO2. As a result, these two drives cancel each other out for O2 concentrations between 15 and 19%. What happens during heavy work? When intensity of exercise gets higher, the amount of oxygen in tissues and in arterial blood becomes lower. As a result, increasing energy is generated without direct O2 participation (anaerobic metabolism). Such metabolism causes the appearance of lactic acid in the blood. A small amount of lactic acid is present in the blood at rest and its level gets larger, but still remains constant, for exercise with moderate intensities. At higher intensities the lactic acid level is constantly increasing causing blood acidosis, which is sensed by the breathing centre. Fatigue and pain are the normal sensations experienced during and after strenuous physical efforts. According to a textbook on medical physiology, “Fatigue is a poorly understood phenomenon that is a normal consequence of intense exercise or mental effort. In addition, it is a symptom of many different diseases. During exercise, acidosis and other factors contribute to its production” (p. 627, Ganong, 1995). Using these conclusions, it is possible to suggest that the breathing centre can play an important or, probably, the central role in the perception of sensations of fatigue and pain due to physical and mental exercise. Possibly, because it is a part of the nervous system and is sensing blood acidosis caused by increasing blood lactate, the breathing centre sends intensive signals perceived as fatigue or pain. That makes heavy work, at some moment in time, physiologically impossible (blood acidosis to pH=7.0 can be fatal for humans). In order to keep pH closer to the normal 7.4, the organism starts to remove carbonic acid as a compensation for increasing lactic acid. Carbonates are the major CO2 forms in the blood and their level can be kept low due to removal of bicarbonates by kidneys and additional ventilation. In practical terms, only at sub-maximum intensities (80-90% of the maximum possible oxygen consumption), does aCO2 start to decline from the initial resting level (40 mm Hg) down to about 30 mm Hg for maximum possible intensities. This conclusion can be found in textbooks on exercise physiology (e.g., p.201, Brooks et al, 1996).

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2.4 Control of breathing during breath holding When the lungs are not ventilated, as during breath holding under normal conditions, their carbon dioxide concentration builds up. Indeed, incoming venous blood continuously brings more CO2 to the lungs. The breathing centre monitors these changes. During initial stages of breath holding, the discomfort is small or unnoticeable. Gradually, the chemical influence on the breathing centre gets stronger over time, creating, at some moment, the first distinctive urge to breathe. This urge can be suppressed by one’s will power until another aCO2 threshold is achieved. At that moment the continuation of breath holding becomes impossible. This is the main process, which regulates the duration of breath holding time in healthy subjects. Therefore, BHT is mainly defined by 3 parameters: 1) the initial aCO2; 2) aCO2 threshold established by the breathing centre; 3) the rate of aCO2 accumulation. Let us consider different practical situations and how they influence these parameters and BHT. • Initial volume of air in the lungs. Larger initial amounts of air in the lungs allow more carbon dioxide to be left there by the venous blood. Hence, lungs CO2 concentrations are going to increase with lower rates during breath holding. Similarly, the rate of aCO2 increase in the arterial blood leaving the lungs is also smaller. That allows longer BHT. Indeed, as mentioned in chapter 1, an analysis of several experimental studies found that BHT is linearly proportional to the initial lung volume (Mithoefer, 1965). For example, it was found that BHT after complete exhalation is about 4 times less than BHT after full inhalation. At normal exhalation breath can be held for about 40% and at normal inhalation about 55% as long as BHT at maximum inhalation. • Body position. Depending on the body position, the metabolic rate and, hence, the rate of carbon dioxide production are different. For example, standing requires from about 40 to 70% more energy, than lying on one’s back. As a result, the rate of aCO2 accumulation in the lungs is higher when standing. Normally, BHT when lying is larger, while BHT while sitting is going to be in between the other two positions. • Current physical activity. From the previous paragraph it follows that physical activity generally reduces BHT due to faster accumulation of carbon dioxide. That is especially true for higher intensities, when BHT can be several times smaller and is equal to a few seconds at sub-maximum intensities. However, slight physical activity at the end of breath holding can prolong BHT (explained in this section below). • Previous physical activity. Let us compare two situations. The tests, in both considered situations, can be done while sitting, but, in one case, immediately after fast walking and, in the other case, after 5-10 minutes of being at rest. The results are going to be different, since prior muscular activity generates additional carbon dioxide (in muscles which produced this work). This additional carbon dioxide arrives at the lungs, is detected by the peripheral chemoreceptors of the breathing centre and, as a result, causes decrease in BHT. • Previous breathing. Acute hyperventilation reduces CO2 content, first, in the lungs, then in the arterial blood, and finally in all tissues. Therefore, depending on the duration and intensity of hyperventilation, the starting CO2 level is going to be smaller. Hence, additional time will be required in order to achieve, first, the normal aCO2 level preset by the breathing centre and, later, the upper limits of tolerance which define BHT. For example, 2 minutes of forced hyperventilation produced 2 minutes of natural breath holding at maximum inhalation in healthy people (Ganong, 1995). With increasing intensity and duration of over-breathing (up to a few minutes) this time can be even greater. Meanwhile, long and especially chronic hyperventilation resets the breathing centre to lower aCO2 normal values. Indeed, results in Chapter 1 revealed that those people who chronically breathe deeply have a short BHT. However, at the moment we are discussing only healthy people with normal breathing. In later chapters, the effects of hypoventilation (breathing less than desired) will be considered. • Initial air composition. Breathing special mixtures of air before the test or as a last breath before breath holding also influences BHT. For example, the higher the starting CO2 pressure in the lungs, the shorter the BHT (Godfrey & Campbell, 1968). Larger starting O2 concentrations increase BHT (Mithoefer, 1965). • Special chemicals affecting the breathing centre, respiratory muscles or other related systems. Many drugs, medications, steroids, other synthetic and natural substances can influence the breathing centre and BHT (up to several times in both directions). For example, alcohol is known to increase BHT soon after intoxication (larger BHTs may contribute to the feelings of euphoria and powerfulness), while later, during hangover, BHT is significantly reduced in comparison with the initial value.

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• Physical activity at the end of breath holding. Different types of light physical activity at the end of breath holding (for example, stomping, clenching fists, swinging movements of arms, swallowing movements, imitation of inhalation by chest or diaphragm muscles without taking any air in) prolong BHT (Bartlett, 1977). Probably, these activities distract the central nervous system from paying exclusive attention to the breathing centre, which generates distress and pain signals. As it was suggested by Bartlett, “These findings show that a manoeuvre that does not involve the respiratory system can consistently prolong breath-holding time, possibly by providing distraction from the discomfort of the breath hold” (Bartlett, 1968). He found that, practically, 10 to 20% increases in BHT could be observed. In my view, a similar effect of pain reduction due to distraction takes place in cases of light physical activity, while having, for example, toothache. • “Training effect”. Several successive breath holds essentially improve breath-holding performance, as it was documented by Heath and Irwin (1968) and Bartlett (1977). Professionals investigating diving believe that this increase in breath holding time is due to restoration of what is called the “diving reflex” which is observed in many (even land-dwelling) animals, humans included. What they found is that repetitive breath holds “teach” the human organism to divert blood from the skin to the heart, brain and other vital organs (as during cold water immersion). Practically, the degree of this reflex can be defined by the amount the pulse slows during breath holding. Does the “traing effect” relates to the maximum possible breath holding time or the breath holding time until the first stress (the first desire to take breath)? Medical doctors from the School of Medicine in Chiba University (Japan) studied, according to the title of their paper, Changes in the period of no respiratory sensation and total breath-holding time in successive breath-holding trials. They wrote, “Immediately after breath-holding at end-expiratory level, there is a certain period of no particular respiratory sensation which is terminated by the onset of an unpleasant sensation and followed by progressive discomfort during breath-holding. This period, defined as the time from the start of voluntary breath-holding to the point where the onset of an unpleasant sensation occurs, is designated "the period of no respiratory sensation'. Although it has been shown that the maximum breath-holding performance is improved with successive trials, it is not clear whether this training effect exerts a similar influence on the period of no respiratory sensation during breath-holding. 2. Since the training effect seems to be associated with the stresses of breath-holding, we hypothesized that the initial period of no respiratory sensation during breath-holding might be less influenced by the training effect. 3. We studied 13 normal subjects who performed repeated breath holds while continuously rating their respiratory discomfort using a visual analogue scale. In addition, we measured the hypercapnic ventilatory response of each individual and obtained the relationship between the slope of the hypercapnic response curve and breath-holding periods. 4. Our results showed that there was little training effect on the period of no respiratory sensation and that the period of no sensation during breath-holding is inversely related to the slope of the hypercapnic ventilatory response curve” (Nishino et al, 1996). Hence, those people, who frequently perform breath holds (divers, patients with sleep apnoea, etc.), can improve their total or maximum breath holding time without any real improvements in their minute ventilation and actual carbon dioxide stores. However, their breath holding time until the first discomfort (or “the period of no respiratory sensation” as the Japanese doctors called it) has only minor improvement. The “training effect” has important practical implications in relation to BHT measurements, as we will see in later chapters. • An individual attitude or current emotional set. As for any other personal test concerning human performance, the general state of the central nervous system, feelings, attitudes and emotions, all influence BHT. Many studies from Chapter 1 do not specify the exact details for BHT measurements. Obviously, this introduces some level of uncertainty in the measurement process. Note that in all these situations I use the term BHT (breath holding time), not the different term BHT (breath holding time after normal expiration), since BHT is measured under normal conditions (sufficient rest, no breathing control, no breathing manipulations, normal air composition and pressure, etc.) after normal or usual exhalation.

_______ 2.5 Control of breathing in people with chronic hyperventilation

Chronic over-breathing causes numerous negative physiological changes (Chapter 1) due to low CO2 content in the organism. Tissue hypoxia (due to the suppressed Bohr effect), excessive excitability of the nervous system, and reduced blood supply to the brain, heart muscles and other organs and tissues are the typical consequences of chronic over-breathing. Let us compare the regulation of breathing of sick people during physical exercise with our previous findings for healthy individuals. From practical experience it is known that the respiration of most sick people usually gets 54


heavier for moderate and, sometimes even minor physical exertion, like stair climbing. A professional review of medical studies in this area concluded that physical exercise usually caused metabolic acidosis (excessive acidification of the blood) for patients with various health problems (Wasserman & Casebury, 1976). What were the sources and consequences of increased acidity in sick people? Deep breathing causes chronic tissue hypoxia. Hence, these people experience low tissue oxygenation before exercise. Since all cells need oxygen in order to function, anaerobic metabolism (burning fuels without oxygen participation) becomes more pronounced. Therefore, the resting lactic acid level in the blood of sick people is often elevated. Exercise needs even more energy and O2. That results in even a greater incidence of anaerobic metabolism, as compared to healthy subjects, and in further accumulation of lactic acid in the case where physical work is being performed, leading to increased acidity of the blood. That further increases acidity of the blood. If for healthy people high lactic acid levels are normal only for very heavy work, most sick patients have high lactate almost from the onset of light or moderate physical exercise. Such acidosis causes greatly increased breathing and further reduction in body CO2 stores. For example, an analysis of respiratory parameters of different classes of heart patients revealed, “The endtidal CO2 pressure during exercise can be used to evaluate the functional capacity of patients with chronic heart failure” (abstract, Tanabe et al, 2001). Therefore, physical exertion requires more physical and psychological efforts on the part of sick people, while for critically ill patients even light exercise can be fatal, since hypoxia is already near the physiological limits of the human organism. It follows that certain, biochemical parameters (aCO2, tissue oxygenation, lactate values, etc.) for severely ill patients during slight physical exertion or even at rest are close to the same parameters of healthy athletes who are exercising strenuously and are near the full physical exhaustion. The difference is that the athletes can rest and then recover quickly, while the severely ill patients often do not know how to recover to physiological norms. Other previousy mentioned tests also would produce different results in people with impaired health and respiration. For example, breathing 3 times per minute can be difficult or impossible for sick people to perform. Indeed, in order to preserve their usual resting ventilation (breathing over 15 l/min), sick people need to inspire more than 5 l of air during a single breath. That is unattainable even for most healthy individuals. Breathing less air per minute (relative hypoventilation) during long periods of time may cause other problems. Among them are additional tension in the chest muscles due to maximum inhalations and exhalations (causing more stress) and increased anxiety due to unexpected and often feared feelings of air shortage. The reaction to breathing different gas mixtures in sick people is usually abnormal too. For example, hyperventilating sick people are over-sensitive to the presence of small amounts of carbon dioxide in the inspired air. Breathing some gas mixtures (e.g., with 2 or 4 % carbon dioxide content) produces excessive over-breathing in people who hyperventilate as compared to the rection of healthy subjects. A similar reaction (over-breathing) is observed, when breathing air with reduced O2 content. Accordingly, high altitudes are poorly tolerated due to already existing hypoxia. In the abstract of the review "Studying the control of breathing in man", Dr. Foldering wrote, "Disruptions of the control of breathing may have serious consequences for several categories of patients, e.g., those with chronic obstructive pulmonary disease (COPD), asthma, sleep apnoea, sudden infant death syndromes, and the hyperventilation syndrome. Adequate investigation of the control of breathing in these patients is of great importance for their treatment" (Foldering, 1988).

_______ 2.6 Breath holding control in diseased states

As it was shown in section 1.8, BHTs and BHTs for people with various health problems are significantly reduced as compared to healthy individuals. What are the possible reasons? • People who hyperventilate has a lower initial aCO2 as well as lower tissue carbon dioxide concentrations. That causes excessive excitability of nervous cells (see chapter 1, section 1.2), including, the nerve cells of the breathing centre. The breathing centre becomes increasingly sensitive to aCO2 increases, as numerous chemical sensitivity tests and published studies confirm. Thus, the state of excessive excitement of the nervous cells of the breathing centre can make BHTs and BHTs shorter in people who hyperventilate in comparison with healthy people. • Healthy people have larger amounts of O2 in their tissues due to a normal aCO2. Thus, during breath holding they do not suffer, to a large extent, from hypoxia. In many diseased states, the amount of O2 in tissues is smaller. This 55


causes a worsening of the already existing hypoxia during breath holding. Indeed, testing the BHT of patients with neurocirculatory asthenia (another name for chronic fatigue syndrome), Dr. Friedman, Director of the Harold Brum Institute for Cardiovascular Research, San Francisco, found the average BHT of healthy persons after voluntary hyperventilation increased by about 40%, whereas the BHT of his sick patients decreased (!) by almost twice (Friedman, 1945). Why? As we know preliminary voluntary hyperventilation normally increases BHT due to a temporary reduction in carbon dioxide stores. So, what was wrong with the sick patients who breathed deeply? People who hyperventilate normally suffer from low tissue oxygenation due to initially low carbon dioxide values. Additional forced over-breathing removes even more carbon dioxide making the amount of available oxygen even smaller due to the suppressed Bohr effect (no carbon dioxide – no oxygen to release). There are large amounts of O2 in the blood, but this O2 cannot move from red blood cells due to the absence of the chemical catalyser, CO2. Since sick, hyperventilating people normally suffer from chronic hypoxia already at rest, their breathing centre is also hypersensitive to further oxygen reductions. That can also contribute to shorter breath holding pauses in people with heavy breathing. • Human and animal experiments performed by Brown with colleagues (1948, 1949, 1950a, 1950b) revealed that prolonged forced hyperventilation (24 hours) caused the following changes: increased sensitivity to CO2 inhalation, reduced blood buffer capacities due to increased excretion of urinary sodium and potassium, and marked fall in the brain plasma level of inorganic phosphates. In summary it was suggested “this reduction in the buffering ability of the brain for CO2 following prolonged hyperventilation may be the mechanism by which the increased sensitivity of the respiratory centre to CO2 following prolonged hypocapnia [low aCO2] is brought about” (Brown et al, 1950b). In turn, that causes smaller differences between the aCO2 tolerance threshold and the aCO2 usual level leading to shorter BHTs. Thus, there are three factors which can make BHT and the BHT short when people chronically breathe too much: 1) excessive excitability (or irritability) of the breathing centre due to low carbon dioxide level; 2) low tissue oxygenation due to low carbon dioxide concentrations; 3) abnormal brain electrolyte changes (reduced buffering ability). These suggestions are based on known physiological processes but have not been supported by any practical studies. It is possible that there are some other factors that can play a more important role as to why BHTs are shorter for people with chronic hyperventilation.

2.7 Connection between BHT (breath holding time after normal expiration) and arterial CO2 Experimental results from Chapters 1 and 2 suggest that for most people it is possible to establish a relationship between aCO2 and the BHT (breath holding time at normal exhalation). Normal aCO2 values (about 40 mm Hg) correspond to BHTs of about 35 s. When aCO2, due to chronic over-breathing, gets smaller, so does the BHT. Critically low aCO2 numbers correspond to very small BHTs. Russian medical Doctor Buteyko devoted his life to studying breathing. During the 1960s he created a diagnostic complex, which could measure about 40 different respiratory and cardiovascular characteristics in real time including minute volume, breathing frequency, tidal volume, expired gas parameters, blood gases, pulse, blood pressure, ECG, etc.(Inventor and Efficiency Expert, 1961; Buteyko 1961; Buteyko, 1962). Using this unique machine he investigated thousands of sick and healthy people and found that the relationship between aCO2 and the BHT is almost linear. Years later he patented (Buteyko, 1986) the formula:

_______ aCO2% = 3.5% + .05*BHT

(here, aCO2% is the alveolar CO2 concentration in %, 3.5% is the minimum CO2 content, .05 is a coefficient of proportionality, BHT is the breath holding time after quiet expiration, while sitting at rest for 5-10 minutes). Appendix 2 provides the relationships between aCO2% and aCO2 values measured in mm Hg at different altitudes. The patent claimed the same accuracy of aCO2% defining as can be done using professional diagnostic devices. While many Western studies indirectly indicate that BHT is lower when CO2 values are lower, to my knowledge, there are no Western studies that directly focused on this problem. Let us calculate the normal BHT value while applying this formula. Normal arterial and alveolar CO2 pressure is about 40 mm Hg, whereas a normal pressure at sea level is 760 mm Hg. Hence, the normal aCO2 is 5.26% (this is 56


the normal carbon dioxide concentration in human lungs and arterial blood at sea level). That corresponds to 35 s BHT (in order to check that just substitute 5.26% into the formula and calculate the BHT), which is close to the average found in numerous observations quoted in chapter 1 (Table 1.2). It is likely that this formula works very well in the most important ranges of aCO2 and BHT values, when the BHT is between about 10 and 60 s. It cannot be applied with severely sick people, when aCO2 is about 20-30 mm Hg or lower. Indeed, minimum possible aCO2, according to this formula is 3.5% or about 27 mm Hg, while medical studies often quote 20 mm Hg and lower values for critically ill patients. At the other end, for high aCO2 and BHT numbers, there were exceptional people (hatha yoga masters), who could hold their breath for many minutes, but their aCO2 was only slightly above the medical norm. Those people, who routinely perform breath holding, should measure their BHT until the first distinctive desire to breathe due to the “training effect” discussed in section 2.4. This formula also practically helps to evaluate the minute ventilation (how much air we breathe in 1 minute). Normal ventilation (about 6 l/min) corresponds to normal BHT (about 38-40 s). Those who have about 17 s BHT (almost twice less than the norm) breathe about two times more air (12 l/min for normal adults). 12 s BHT corresponds to thrice over-breathing. Therefore, the BHT reflects the intensity of breathing. Shorter BHTs mean chronically heavier and deeper breathing. Many western medical doctors came to the same conclsion as described in Chapter 1. Note about exceptions. The formula cannot be applied for some physiological abnormalities of the respiratory, circulatory, and nervous systems. For example, BHT can be smaller than predicted by the formula, as in cases of blood shunting found in some people with emphysema and severe asthma (McFadden & Lyons, 1968). In certain cases, BHT can be greater than expected, as after surgery of carotid bodies of the breathing centre (Patterson, 1974; Gross et al, 1976) or curarisation of the respiratory muscles (Campbell et al, 1966).

Conclusions • Under normal conditions, except with very heavy work, the breathing of healthy individuals is regulated by carbon dioxide in the lungs or arterial blood. • Only in special cases, like very low O2 content in the inspired air (less than 12-15%), hypoxia affects ventilation of healthy people causing their over-breathing. • Normally, breath holding in health is limited mainly by the aCO2 threshold with little contribution due to hypoxia. Other parameters, which define BHT, are initial aCO2 value and the rate of aCO2 accumulation. • Control of breathing in those who hyperventilate is largely defined by chronically existing hypoxia due to initially low carbon dioxide stores. The contribution of hypoxia is proportional to the degree of deep breathing. • As a result of hypoxia, a more excited state of the respiratory centre, electrolyte changes in the human brain and other factors, the breath holding time of hyperventilators (majority of sick people) is reduced, depending on the degree of over-breathing. • It is possible that the connection between the BHT (breath holding time after normal expiration) and aCO2 can be expressed through a linear relationship, which can be applied for most practical situations. The BHT can also reflect the intensity of breathing (or minute ventilation).

_______ Q&A section for Chapter 2

Q: Are there any special reasons to measure the BHT after a quiet expiration? A: Doctor Buteyko introduced BHTs in order to standardise BHT measurements. BHT is proportional to the volume of air in the lungs. The amount of air after normal or deep inhalation can vary in different individuals. However, after a quiet relaxed expiration there is only anatomical volume of air left in the lungs. Therefore, in order to have better accuracy, it is reasonable to compare the BHT of different people after their quiet expiration (Buteyko, 1977). 57


Q: What are the physiological causes of the “training effect”? A: In other words, why does breath holding time get larger with test repetitions, while measured CO2 values can remain unchanged? Many physiologists who have studied the free diving of humans believe that with humans can develop a good diving reflex, similar to that observed in many diving animals. The diving reflex includes numerous adaptive physiological changes as a response to breath holding: slowing of the heart rate, reduced blood circulation to muscles while maintaining blood circulation to the heart and the brain, and many others. Facial contact with cold water can trigger some of these changes in humans as well. Q: There are various activities mentioned in section 2.3 which extend breath holding time. Are these activities useful for health or not? A: These activities can have a different impact on breathing and were discussed in section 2.3 only as examples which help to understand the physiology of breath holding. This chapter investigated only the immediate physiological builtin mechanism of breathing regulation (how breathing is controlled in healthy and sick people). Finding the real-life factors which make breathing chronically deep (why breathing gets excessive in certain groups of people or why people get sick) will be the subject of the next chapter.

References for chapter 2 Bartlett D, Effects of Valsalva and Mueller maneuvers on breath-holding time, J Appl Physiol: Respiratory, Environ. & Exercise Physiol 1977 May, 42(5): p. 717-721. Brown EB, Campbell GS, Johnson MN, Hemingway A, Visscher MB, Changes to response to inhalation of CO2 before and after 24 hours hyperventilation in man, J Appl Physiol 1948, 1: 333-338. Brown EB, Campbell GS, Elam JO, Gollan F, Hemingway A, Visscher MB, Electrolyte changes with chronic passive hyperventilation in man, J Appl Physiol 1949, 1: 848-855. Brown EB, Hemingway A, Visscher MB, Arterial blood pH and pCO2 changes in response to CO2 inhalation after 24 hours of passive hyperventilation, J Appl Physiol 1950 April, 2: 545-548. Brown EB, Changes in brain pH response to CO2 after prolonged hypoxic hyperventilation, J Appl Physiol 1950 April, 2: 549-552. Buteyko KP, Pneumotahometer with automatic closure of air jet as a part of a medical combine [in Russian], Inventor and Efficiency Expert 1961, 6: 16-17.

_______ Buteyko KP, Oscillographs and hypertension. Is "big" breathing useful? [in Russian], Inventor and Efficiency Expert 1962, 5: 7-9. Buteyko KP, Carbon dioxide theory and a new method of treatment and prevention of diseases of the respiratory system, cardiovascular system, nervous system, and some other diseases [in Russian], Public lecture for Soviet scientists at the Moscow State University, 9 December 1969.

Buteyko KP, Method of defining CO2 content in alveolar air [in Russian], Soviet patent N. 1593627, 17 October 1986. Campbell EJM, Freedman S, Clark TJH, Robson JG, Normal J, Effect of curarisation on breath-holding time, Lancet 1966 Jul 23, 207. Deane BM, Howe A, and Morgan M, Abdominal vagal paraganglia: distribution and comparison with carotid body, 58


in the rat, Acta Anat (Basel) 1975, 3: 19-28. Easton J and Howe A, The distribution of thoracic glomus tissue (aortic bodies) in the rat, Cell Tissue Res 1983, 232: 349-356. Foldering H, Studying the control of breathing in man, Eur Respir J 1988, 1: 651-660. Ganong WF, Review of medical physiology, 15-th ed., 1995, Prentice Hall Int., London. Godfrey S & Campbell EJM, The control of breath holding, Respir Physiol 1968, 5: 385-400. Gross PM, Whipp BJ, Davidson JT, Koyal SN, Wasserman K, Role of carotid bodies in the heart rate response to breath holding in man, J of Appl Physiol Sep 1976, 41(3): 336-340. Haldane JS, Respiration, 1922, Yale University Press, New Haven, UK. Inventor and Efficiency Expert (editorial), A combine against hypertension in the Institute of Experimental Biology and Medicine [in Russian], 1961, 6. McFadden ER & Lyons HA, Arterial-blood gases in asthma, The New Engl J of Med, 1968 May 9, 278 (19): 10271032. Mithoefer JC, Breath holding. In: Handbook of physiology, Respiration, Washington, DC: Am Physiological Society, 1965, sect. 3, vol. 2, chapter 38: 1011-1026. Parkes MJ, Breath-holding and its breakpoint, Exper Physiol 2005, 91, 1, 1-15. Patterson JL, Carotid bodies, breath holding and dyspnea, The New England J of Med 1974 April 11, 290 (15): 853854. Stanley NN, Cunningham EL, Altose MD, Kelsen SG, Levinson RS, Cherniack NS, Evaluation of breath holding in hypercapnia as a simple clinical test of respiratory chemosensitivity, Thorax 1975, 30: 337-343. Stroud RC, Combined ventilatory and breath-holding evaluation of sensitivity to respiratory gases, J Appl Physiol 1959, 14: 353-356. Tanabe Y, Hosaka Y, Ito M, Ito E, Suzuki K, Significance of end-tidal P(CO(2)) response to exercise and its relation to functional capacity in patients with chronic heart failure, Chest 2001 Mar; 119(3): 811-817.

_______ Wasserman K & Casebury R, Acid-base regulation during exercise in humans, in Exercise: Pulmonary Physiol and Pathophysiol, ed. BJ Whipp & K Wasserman, 1976, New York: Marcel Dekker Inc., p. 427-443.

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Chapter 3. Lifestyle factors that matter Introduction Let us look at the main causes of chronic hyperventilation. Why do modern people chronically breathe too much? Which environmental, life-style, and other factors intensify breathing, causing the breathing centre to permanently readjust to lower carbon dioxide values? What are the mechanisms and degree of influence of these hyperventilation-producing factors? Most causes described in this chapter were systematically investigated and summarized by Doctor Buteyko (Buteyko, 1969; Buteyko 1970; p.158, Buteyko, 1991; p.177, Khoroscho, 1982), when he used his unique diagnostic complex in different practical situations. Different Russian publications and Buteyko’s lectures described hyperventilation-producing factors often without providing detailed information about the mechanisms of their influence. In addition, these papers were in Russian. However, there are relevant Western physiological studies showing such mechanisms and often providing measurements of their influence. Many of these factors are wellknown. They are frequently mentioned by medical authorities and various health professionals as factors, which increase the chances of new health problems while aggravating existing ones.

3.1 Stress, anxiety and strong emotions The concept of "stress" can have different meanings. For example, the presence of bacteria and their toxins in the blood is an example of stress to a medical doctor. Such physiological stress, as it was described in section 1.8, produces visible chronic hyperventilation. Similarly, tiny amounts of other toxins in the blood, as a result of, for example, teeth cavities, also cause mild over-breathing, as we will see later. However, let us consider here only influences due to individual perception of threat, challenge, or other psychological stress. There are numerous physiological changes generated by anxiety states, fear, fight-or-flight situations, or other situations accompanied by strong emotions. How do these states and factors influence breathing? An early paper "Some physical phenomena associated with the anxiety states and their relation to hyperventilation" (Kerr et al, 1937) included a chart showing physiological changes caused by these states. Hyperventilation is the main factor causing many of the other consequences described. According to Professor Lum, "Most authors, with the exception of Rice (1950), have described the clinical presentation of hyperventilation as a manifestation of, and secondary to, an underlying anxiety state" (p.197, Lum 1976). Dr. Magarian wrote one of the large hyperventilation reviews, published in "Medicine" (Magarian, 1982), choosing the following title for his paper "Hyperventilation syndromes: infrequently recognized common expression of anxiety and stress". A more recent study "Fear-relevant images as conditioned stimuli for somatic complaints, respiratory behaviour, and reduced end-tidal pCO2" (Stegen et al., 1999) discusses psychological and physiological effects providing numerous references in this area. Dozens, if not hundreds, of professional physiological and medical studies suggest that hyperventilation is a normal outcome of stress and anxiety. Authors of the article "Emotions and respiratory patterns: review and critical analysis" (Boiten et al, 1994) suggested, that "...normo-ventilatory responses (which are identified by stable end-tidal CO2 levels that remain within the normal range) seem to be characteristic for behavioural conditions that may either involve withdrawal from the environment, relaxation or active coping...Thus, hyperventilation appears to signify an unsuccessful outcome of the coping process" (p.121). Researchers from the University of Oxford found that during voluntary over-breathing “subjects in the positive interpretation condition experienced hyperventilation as pleasant, and subjects in the negative interpretation condition experienced hyperventilation as unpleasant …" (Salkovskis & Clark, 1990). Therefore, not only negative emotions and states, but also many positive strong emotions (e.g., delight, excitement, exhilaration, thrill, etc.) produce hyperventilation. Stress, according to TV, radio, newspapers and magazine news about medical studies, contributes to the development of most modern health problems. On the other hand, stress-triggering physiological changes had obvious usefulness in terms of evolutionary survival of our species.

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For example, during the fight or flight response, the diversion of the blood from internal organs and the brain to large skeletal muscles prepares the body for possible vigorous physical activity. Increased nervous excitability helped our ancestors to give different psychological interpretations to the surrounding stimuli and events (“it is me who is in danger now”). Higher blood sugar values and increased concentrations of numerous hormones (e.g., well-known adrenalin rush) were useful for active physical response. Indeed, during peaceful periods, an objective perception of the world, coupled with quiet and thoughtful relationships with nature and with other tribal members, proved to be advantageous. At other times (e.g., during hunting, fight-or-flight responses, group conflicts, or mating), subjective perception, in terms of seeing the world in the light of personal needs, was more beneficial to the specie’s survival. Do we have more stress now? From an objective viewpoint, our ancestors living 1, 5 or more thousands of years ago, often had daily life-threatening situations and challenges. Hence, the level of stress and the likelihood of mortality were much higher in the past. Why then, do modern people chronically hyperventilate and get sick because of stress, while our ancestors mostly died from other, more natural causes (like, infectious diseases, accidents, and conflicts)? A part of the answer lies in breathing. The objective perception of the world for people who suffer from chronic hyperventilation can be difficult and fearful. That predisposes them to strong emotions, excitement, and tendencies to exaggerate, justify, negate, distort, and misinterpret events. Another part of the answer is what happens after one experiences stress in modern society. Our ancestors hunted, struggled, or ran away under stressful conditions. All these are active coping strategies involving physical exercise. These are also responses of healthy wild animals. Therefore, our attention should be directed to the following question. What are the effects of exercise on the breathing of healthy people?

3.2 Physical inactivity The natural lives of our ancestors, or modern primitive people, or modern human-related species and other mammals include many hours of daily exercise of light, moderate, and, sometimes, high intensity. Typical moderate intensities (40-65% from maximum O2 consumption) produce the following effects in healthy people. • While aCO2 remains close to the initial level (about 40 mm Hg), venous CO2 content rises from resting 46 mm Hg to about 60-65 mm Hg due to the greatly increased metabolism of carbohydrates and fats (p.201, Brooks et al, 1996). Hence, during moderate exercise, the human organism accumulates large additional amounts of CO2. Generally, physical activity is characterised by the largest amounts of carbon dioxide stores in the human body, which are significantly higher than during any other activity. • Blood pH in arteries slightly decreases (acidification) from 7.42 to 7.38 (p.201, Brooks et al, 1996), indicating some adaptation of the breathing centre to a more acidic environment. (Lactic acid is the main cause of additional acidity) and higher aCO2 values. This adaptation, if the exercise lasts long enough, can positively influence afterexercise breathing. • Arterial oxygenation is reduced by about 2-5 % and venous O2 partial pressure is decreased from resting 40 mm Hg to 20 mm Hg. Thus, moderate exercise takes place in the condition of mild tissue hypoxia for the receptors of the breathing centre. As a result, after the exercise the breathing centre can tolerate lower oxygen levels in the arterial blood. Note that these lower O2 arterial blood concentrations normally increase tissue oxygenation due to the enhanced Bohr effect. • Exercise is normally accompanied by movements of the limbs causing neuronal discharges from working muscles to the central nervous system. Such muscular movements, as discussed in Chapter 2 (how light physical activity can prolong BHT), suppress the drive of the breathing centre to increase ventilation. Thus, any prolonged physical activity with light, moderate, or moderately high intensity usually has positive effects on the subsequent respiration of healthy individuals. These changes result in increased tolerance to higher aCO2 and lower vO2 values. Indeed, several physiological studies revealed "the increased 'tolerance' for high CO2 and low O2 in breath holding, during and immediately after exercise" (e.g., p.220, Astrad, 1960). All these factors, if exercise is long enough, should cause a favourable adaptation of the breathing centre and subsequent easy and natural breathing when exercise is finished and important physiological parameters (blood sugar, lactate, concentrations of certain hormones) return back to their normal values. That may take from a few minutes to

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many hours depending on the fitness of the person and the intensity and duration of the exercise. Therefore, exercise for a healthy person trains the breathing centre to reset its aCO2 norm (the crucial parameter which, according to chapter 2, controls human respiration) to higher values. As a result, exercise reduces ventilation. “Physical work, sport, and exertion increase CO2 production. Its level increases in the blood, while oxygen decreases. The higher the intensity, the stronger the excitement of the breathing centre and the deeper the breathing, but it is only deeper formally. Breathing becomes not deeper, but shallower: it is less in relation to metabolism. This is the reasoning behind the usefulness of exercise and sport! During prolonged intensive exercise the receptors, which control breathing, adapt to increased CO2. If the person regularly works and toils, then he practically follows our method: he is decreasing his breathing using exercise” (Buteyko, 1977). Vice versa, if we do not exercise after experiencing stress, or anxiety, or strong emotions, we can continue over-breathing that leads to habitual or chronic hyperventilation. Russian medical professionals from the Buteyko Clinic in Moscow currently believe that a lack of physical activity is the main cause of carbon dioxide deficiency in modern people (for more details one may visit their website www.buteykoclinic.ru). “Q: Why does hyperventilation form, since nobody specially practices deep breathing…? A: The main cause is the lack of physical activity, low level of metabolism in general. We must work out at least 4 hours per day, with heavy perspiration. Then you would get high level of metabolism. The method should be practiced until the level of carbon dioxide is stabilized and reached the value when the attacks are impossible. It is practically impossible to maintain this state without physical exercise. If a person, due to some reasons, cannot do physical exercises, he should do the breathing ones. There is nothing wrong with that, since the [breathing] exercises are not hard and can be performed practically in any situation” (Novozshilov, 2003a). An important notice. The positive effect of exercise on breathing is the experience of healthy people. As we saw in Chapter 2, physical exercise does not have the same effect on sick people. The aCO2 of sick people gets lower during exercise with moderate or even light intensities. Thus, in poor health the possible benefits from exercise are limited and, in severe cases, even impossible to achieve. In fact, for critically ill patients any physical exercise can have disastrous health consequences.

3.3 Overeating According to Russian studies, when our breathing gets slightly heavier and aCO2 concentrations decrease, glucose is driven from the blood into fat cells since CO2 influences permeability of membranes of fat cells in relation to blood glucose. Hence, most people, in condition of chronic hyperventilation, gradually accumulate extra-weight. Eating more, on the other hand, is the stress for organs of digestion. Therefore, breathing becomes heavier at the end of the digestive process. The amplitude of these changes is proportional to the caloric value and type of meal eaten. Therefore, with larger meals, especially ones with fats and proteins, these effects are more significant. As Doctor Buteyko suggested, when digested substances are in the blood, they are to be used or metabolised by body cells. This cellular consumption means “inner breathing”. Thus, the respiration of cells (this term is normally used by certain microbiologists), especially in case of overeating, is intensified. That causes increased ventilation in the human organism (Buteyko, 1977). Overeating, according to Doctor Buteyko, has the worst possible consequences for respiration. Doctor Buteyko also found that meals rich in proteins (especially when they are quick absorbing animal proteins) and, to a lesser degree, fats considerably intensify breathing, while fresh fruits and vegetables produce the least impact on ventilation. Why? One reason is due to varying availability of digestive enzymes. Fresh fruits, for example, often have their own enzymes for self-digestion making their digestion easy. Cooked meats and fats are hard to digest. Second, the amino acids cause blood acidification. Therefore, the CO2 removal (or over-breathing) is required to restore the blood’s normal pH. Third, some essential amino acids can directly affect the breathing centre and intensify respiration (chapter 8). An old study by Haselbalch (1912) revealed that after following a vegetarian meal, aCO2 decreased to 43.3 mm Hg (the initial value was about 45 mm Hg); while a meal with meat resulted in 38.9 mm Hg. Such a difference means that a BHT after a meat meal can be about 12 s less, than after a vegetarian one. Explaining this finding in his textbook on respiration, Professor Haldane suggested, that "a meat diet, which causes an increase of sulphuric and phosphoric acids in blood, is acid-forming as compared to a vegetable diet, which contains less protein and relative

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abundance of salts yielding carbonates"(p.183, Haldane, 1922). Thus, the breathing centre compensates for the additional acids (amino acids) in the blood and the resulting blood acidification by reducing carbonic acid and CO2 stores. While with the vegetarian meal, the presence of additional alkaline salts in the blood requires extra acids for blood pH preservation. Among all acids in the blood, carbonic acid is the main component and its concentration can be changed by respiration. These ideas provide some explanation why alkaline diets are considered to be healthy in the management of various health problems (fruits and vegetables yield alkaline residues in the blood, when they are consumed), while acidic diets (that include meats, fish, eggs, dairy products, most grains, legumes and nuts) less so. In addition to the immediate effects on respiration, a lack of normally occurring food substances in the diet such as vitamins and minerals can gradually cause chronic hyperventilation. For example, carbohydrates require for their digestion adequate amounts of B vitamins. These vitamins are naturally present in cereals, whole grains and root vegetables and almost absent in sugar, white bread and white rice. Thus, eating these refined products diminishes the B vitamin content in nervous cells gradually leading to chronic hyperventilation (Buteyko, 1977). Doctor Buteyko and his colleagues particularly emphasized the dangers of sugar and refined products. The lack of some minerals (especially Mg, Zn, and Ca) or their biochemical unavailability is another cause of chronic over-breathing. Therefore, the typical western diets, which are often full of refined products and lack fresh fruits and vegetables, has negative effects on breathing. Most of all, overeating, so prevalent nowadays, is one of the major causes of chronic hyperventilation.

3.4 Deep breathing exercises Deep breathing exercises, according to Doctor Buteyko, were the main cause of hyperventilation in the general population of the USSR (Buteyko, 1977). Indeed, until the 1980s, physical gymnastics combined with deep breathing were encouraged and promoted by central radio and TV programs, magazine and newspaper articles. As a result of such propaganda (“breathe deeper in order to bring more oxygen and remove more “poisons” from the organism”), schools, colleges, universities, boy-scout and military camps, health retreats, sanatoriums, hospitals, many state factories, and other establishments included voluntary deep breathing (hyperventilation), which was synchronised with dynamic movements of body limbs during daily gymnastics. Prolonged and frequent repetitions of such exercises gradually reset the breathing centre to a lower aCO2 value, causing chronic hyperventilation years later (Buteyko, 1977). However, this practice was mostly stopped after the Directive of the Soviet Health Minister "Practical actions for application of the method of voluntary regulation of depth of breathing for treatment of bronchial asthma" (Directive N 591, 30 April 1985, signed by USSR Health Minister S. Burenkov). Thus, Soviet medical authorities officially accepted the Buteyko method of relative hypoventilation (reduced breathing), as a safe and natural alternative to drugs in relation to asthma and bronchitis. Some time ago, when I started to research medical literature on respiration, I found only one study, which suggested the usefulness of hyperventilation (over-breathing), in contrast to the several hundred studies about the dangers of hyperventilation. Having said that, there are those rare conditions (discussed in chapter 1 and 6) when medical professionals may recommend hyperventilation, but they are the exceptions and not the rule. Nevertheless, many people still believe that breathing more is healthy. When I polled people with the question: What is better for human health: to breathe more or less, I found that well over 95% of my respondents believed that over-breathing, deep breathing, and hyperventilation were useful and could be practised. Only less than 5% disagreed. Most of them professionally studied physiology and/or medicine. It follows from these facts that the ideas about the usefulness of hyperventilation and over-breathing are still among the greatest modern health-related misconceptions. The actual physiological effects of these misconceptions are probably limited, since few people routinely practice hyperventilation exercises. However, there are many people, who couple deep breathing with physical exercise, dancing, singing, playing musical instruments, praying and other activities. In addition, periodic and deliberate sighing, excessive coughing, and other over-breathing actions are still considered normal by many people. How is it possible then that people do not notice that acute voluntary over-breathing produces a negative impact on their health? The answer can be found in the results of experiments conducted by researchers at the University of Oxford, England. In their abstract, which was partly quoted above, they wrote, "A cognitive explanation of the association between acute hyperventilation and panic attacks has been proposed: the extent to which sensations produced by hyperventilation are interpreted in a negative and catastrophic

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way is said to be a major determinant of panic. Non-clinical subjects were provided with a negative or a positive interpretation of the sensations produced by equivalent amounts of voluntary hyperventilation. As predicted, there was a significant difference between positive and negative interpretation conditions on ratings of positive and negative affect. Subjects in the positive interpretation condition experienced hyperventilation as pleasant, and subjects in the negative interpretation condition experienced hyperventilation as unpleasant, even though both groups experienced similar bodily sensations and did not differ in their prior expectations of the affective consequences of hyperventilation. When the subjects were given a positive interpretation, the number of their sensations correlated with positive affect; when a negative interpretation was given, the number of bodily sensations correlated with negative affect…" (Salkovskis & Clark, 1990). It follows from these results that, when a person has positive expectations about his activity, which is accomplished with deliberate over-breathing, his brain, due to the resulting excitement and hypoxia, is inclined to select positive interpretations and final effects, while ignoring any certain rational and/or critical thoughts. For example, a deliberately hyperventilating person can have a tendency to exaggerate his abilities and achievements without noticing his wakneses and the possibilities for own improvement. Deep breathing for relatively healthy people usually means increased ventilation. It is rather rare for people to voluntarily practice deep breathing that results in lower minute ventilation (so that they breathe less). Even if it were possible, such deep breathing would produce increased tension. You can check this. First, you must relax completely. You may note that such relaxation causes a naturally quiet exhalation and subsequent automatic breath holds or suspended breathing. Vice versa, large inhalations and exhalations will often result in muscular tension in the respiratory muscles. That increased muscular tension will mean more stress, and more stress is the main cause of hyperventilation. Therefore, deep breathing causes over-breathing to follow, due to the stress generated. Deliberate deep and slow breathing can create another effect due to the large amplitude of chest and/or diaphragm movements. Indeed, such amplitude can be still present many hours later after the practice, but with more normal individual breathing frequency, indicating the initial development of chronic hyperventilation. The person, due to possible nervous excitement and impaired rationality (both caused by low aCO2), may even periodically remind himself to continue deep breathing in spite of possible chest tightness, dizziness and nausea resulting from excessive ventilation. Therefore, deep breathing in most people encourages a more stressful state and subsequent hyperventilation. About exceptions. In my view, only very healthy people (with the usual CP above 60 s) can practice slow deep breathing exercises, like pranayama, while learning hatha yoga. Such people are sufficiently relaxed and their breathing is well mastered. By the way, old hatha yoga manuscripts clearly stated that pranayama could be started by the yoga students only when their bodies were purified and their breath holding time was over 1 minute.

3.5 Overheating Overheating, according to Doctor Buteyko, is another factor that intensifies breathing. That especially relates to many children, who suffer from the belief by loving parents and care-takers, that excessively warm dressing is healthy. A child's metabolism is 2-3 times higher than that of adults. Hence, their bodies normally generate much more energy. Accordingly, healthy children need much less clothing (Buteyko, 1977). Even when children wear minimum clothing, one may see that their hands and feet are usually warm. Only when their hands and feet are cold, adding more clothes or other actions are necessary. Similar considerations can be applied to adults. During summer, most people wear shirts, t-shirts, dresses and other very light clothes, while going anywhere, outdoors and indoors. Here it would be useful to spend less time in hot and warm places. When it gets colder, people start to wear pullovers, sweaters, jumpers, jackets, coats, suits, etc. However, they wear these heavy clothes even when they are indoors where the temperatures are high. You can see that phenomenon in libraries and offices, shops and waiting rooms, cars and public transport. Investigations on the influence of heat on breathing found that changes in air wet-bulb temperature, from 17 to 40 degrees, caused a fall in carbon dioxide pressure from 44 to 33 mmHg for healthy male subjects (Gaudio & Neil, 1968). After some math, it follows, that their BHTs fell from 46 to 8 s due to the effects of the strong heat. Thus, if the assumption of linear influence of temperature on ventilation is accepted (although that may not be true for the whole range of values), one may conclude that each two degrees of increased surrounding temperature produce over 1 mmHg of carbon dioxide down (or minus about 2s BHT). Rapid changes in temperature can increase breathing as well. Sudden cold immersion usually produces severe hyperventilation during the first few breaths. This topic will be discussed in more detail later.

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3.6 Talking with deep inhalations, a loud voice, or a high pitch During lectures and public speeches, or when just talking, it is important not to take deep in-breaths between phrases (Buteyko, 1977). Often, people start their sentences and phrases after deep inhalations quickly blowing out the air, together with precious carbon dioxide, from their lungs. That is a current feature of modern talking style and it can be routinely observed with many TV reporters and commentators. Such a speaking style makes the speech more appealing or even dramatic for viewers. However, it also increases ventilation causing reduced carbon dioxide stores. A study entitled "Influence of continuous speaking on ventilation" (Hoit & Lohmeier, 2000) revealed the following (abstract). "This study was conducted to explore the influence of speaking on ventilation. Twenty healthy young men were studied during periods of quiet breathing and prolonged speaking using noninvasive methods to measure chest wall surface motions and expired gas composition. Results indicated that all subjects ventilated more during speaking than during quiet breathing, usually by augmenting both tidal volume and breathing frequency. Ventilation did not change across repeated speaking trials. Quiet breathing was altered from its usual behaviour following speaking, often for several minutes. Speaking-related increases in ventilation were found to be strongly correlated with lung volume expenditures per syllable. These findings have clinical implications for the respiratory care practitioner and the speech-language pathologist." The authors found that average ventilation increased from resting 7 l/min to almost 14 l/min during speeches. Average initial end-tidal CO2 pressure of these healthy (by year 2000 standards) young American men was almost 38 mm Hg. After 10 minutes of speaking it dropped to about 31 mm Hg. A quick calculation shows that their average initial BHT was about 29 s, after 10 min speaking their average BHT was correspondent to 14s, if the formula connecting aCO2 and BHT is applied. For most subjects even many minutes of recovery were not enough to completely restore initial CO2 levels. Actual BHT values after such speeches are going to be much larger due to effects created by acute overbreathing. When current carbon dioxide value is less than the usual set-point established by the breathing centre due to acute hyperventilation, BHT gets larger in healthy people (chapter 2), while the BHT (or the CP) measurements require 5-10 min of rest with normal breathing. Talking with deep inhalations, raising one's voice in terms of loudness, elongation of vowels, and high pitch phrases will lead to worse results, even when such talking is emotionally neutral. Should this talking be infused with emotions, especially strong ones, higher increases in ventilation can expected. Since nowadays, there are many people, who have to speak for hours daily, the negative effects of poor speaking skills on one’s health can be substantial. More detailed suggestions about correct ways of speaking will be given later.

3.7 Mouth breathing When seeing people on Western city streets and in other public places, one may notice that up to 20-40% of them breathe through their mouths while walking or even while quietly standing or sitting. This phenomenon seems more common among children. What are the negative effects of mouth breathing? Reduced oxygenation and carbon dioxide stores Scientific literature on respiration often mentions a physiological parameter known as dead space volume. It is about 150-200 ml in an average adult: inside the throat, nose and bronchi. This space preserves additional carbon dioxide for the organism, since inhalations take CO2 enriched air from dead space back into the lungs. When the mouth is open, the dead space volume becomes smaller due to a continuous exchange of air. That does not happen with nasal breathing. In addition, nasal breathing provides more resistance to respiratory muscles during breathing as compared to mouth breathing (the mouth-breathing route is shorter and has a larger cross sectional area). During nasal breathing we can either breathe more resulting in more mechanical work for the respiratory muscles or to breathe slightly less while generating less mechanical work. What is the practical result? Due to an in-built tendency to optimise physiological processes, the human organism is ready, as during nose-breathing, to breathe less and tolerate higher aCO2, than to exert more demands on constantly working respiratory muscles. In the abstract of a physiological study "An assessment of nasal functions in control of breathing" (Tanaka et al, 1988) the researchers wrote: "Breathing pattern and steady-state CO2 ventilatory response during mouth breathing were compared with

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those during nose breathing in nine healthy adults...We found the following. 1) Dead space and airway resistance were significantly greater during nose than during mouth breathing. ...These results fit our observation that end-tidal PCO2 was significantly higher during nose than during mouth breathing. It is suggested that a loss of nasal functions, such as during nasal obstruction, may result in lowering of CO2, fostering apneic spells during sleep." This Japanese article, which studied a group of healthy volunteers, gives average end-tidal CO2 43.7 mm Hg for nasal breathing and only 40.6 mm Hg for mouth breathing. Practically, in terms of BHT that means 45 s and 37 s at sea level. Hence, mouth breathing reduces oxygenation of the whole body. Cleaning, warming and humidification of air Our nasal passages are created to clean, humidify and warm the incoming flow of air due to the thin layer of protective mucus. This layer of mucus can trap almost all (95-99%?) dust particles, bacteria, viruses and other airborne objects. This is what long, narrow, and intricate nasal airways are for. When the mouth is used for inhalation, this air route is shorter, wider and almost straight. Now the same airborne objects can easily get into the alveoli and the blood, creating stress, first of all, for the immune system (detection, marking, isolation, and deactivation of intruders) and then for organs of elimination (kidneys, liver, skin, and GI patches). Some pathogens, can even multiply in the lungs causing more severe problems. If you are an asthmatic and endurance athlete, you should train mostly, or better only using your nose, and for really important competitions mouth-breathing can be used, if you have no problems with your asthma. What is important for training is to have an aerobic training effect. That is possible while breathing through the nose, as these western results indicate. “The major cause of exercise-induced asthma (EIA) is thought to be the drying and cooling of the airways during the 'conditioning' of the inspired air. Nasal breathing increases the respiratory system's ability to warm and humidify the inspired air compared to oral breathing and reduces the drying and cooling effects of the increased ventilation during exercise. This will reduce the severity of EIA provoked by a given intensity and duration of exercise. The purpose of the study was to determine the exercise intensity (%VO2 max) at which healthy subjects, free from respiratory disease, could perform while breathing through the nose-only and to compare this with mouth-only and mouth plus nose breathing. Twenty subjects (11 males and 9 females) ranging from 18-55 years acted as subjects in this study. They were all non-smokers and non-asthmatic. At the time of the study, all subjects were involved in regular physical activity and were classified, by a physician, as free from nasal polyps or other nasal obstruction. The percentage decrease in maximal ventilation with nose-only breathing compared to mouth and mouth plus nose breathing was three times the percentage decrease in maximal oxygen consumption. The pattern of nose-only breathing at maximal work showed a small reduction in tidal volume and large reduction in breathing frequency. Nasal breathing resulted in a reduction in FEO2 and an increase in FECO2. While breathing through the nose-only, all subjects could attain a work intensity great enough to produce an aerobic training effect (based on heart rate and percentage of VO2 max)” (abstract, Morton et al, 1995). Autoimmunization effect The layer of mucus moves as a carpet from sinuses, bronchi and other surfaces towards the stomach. Hence, these trapped by the mucus objects are drained (or swallowed) into the stomach where digestive enzymes and HCl (low pH) make bacteria and viruses either dead or weak. Further along the digestive conveyor, some of these substances can penetrate into the blood due to intestinal permeability effect. But now these pathogens are either dead or weakened and would not do much harm while providing a good lesson for the immune system. This is exactly how immunization, done by medical personnel, often works with success: medical doctors inject a vaccine with either dead or weakened bacteria or virus to teach and strengthen the immune response to these pathogens. Hence, nasal breathing is a natural mechanism of autoimmunization. Practically, when some household members are sick with for example, flue or cold, the still healthy people can breathe either through the nose teaching the own immune system how to defeat the pathogenic bacteria or virus, or through the mouth allowing the same pathogens to access, settle and multiply in various parts of the human body causing the infection. Nitric oxide Production and utilization of own nitric oxide that is synthesized in the sinuses depends on the breathing route. Some important functions of this hormone were discussed in Chapter 1. Compare old and modern group photos. They also provide a part of the answer regarding causes of poor health in contemporary society. The mouth, according to Doctor Buteyko, is designed by Nature for drinking, eating and speaking. At all other

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times it should be shut. (Teeth flossing and brushing can be other sensible exceptions.)

3.8 Morning hyperventilation For most people, even healthy ones, breathing is heaviest during the early morning hours. A group of Italian scientists from Centro di Medicina Subacquea e Iperbarica (CEMSI) in Salerno investigated, according to the title of their article Voluntary breath-holding in the morning and in the evening. They revealed that, “During the evening sessions, most of the BHT/Delta P ACO2 ratios… were higher than the corresponding morning values…” (Bosco et al, 2004). In sick people the effect is even stronger. Let us first consider asthma. American pediatricians from the Washington University School of Medicine in St. Louis in their publication note, “BACKGROUND: Symptoms from asthma are often prominent at night. In adults significant circadian variation has been shown with reduced peak expiratory flow rates and increased bronchial reactivity to methacholine in the early morning hours” (Porter et al, 1999). A group of Brasilian medical scientists investigated, according to their title Morning-to-evening variation in exercise-induced bronchospasm (Vianna et al, 2002). Their objective was “to compare morning and evening EIB [exercise-induced bronchospasm] and minute ventilation during exercise (VE)” (Vianna et al, 2002). Indeed, baseline FEV1 was significantly lower during early morning hours, while minute ventilation higher. Over 30 years ago the Thorax published a study Physiological patterns in early morning asthma (Hetzel, et al, 1977). The goal of the study was also to explain “the sudden nature of some asthma deaths as these often occur in the early morning” (Hetzel, et al, 1977). Several other publications were devoted to effects of sleep on patients with COPD (chronic obstructive pulmonary disease). American scientists from the Yale Center for Sleep Medicine (Yale University School of Medicine, New Haven) wrote, “Symptoms related to sleep disturbances are common in individuals with moderate to severe COPD, particularly in the elderly, which is commonly manifested as morning fatigue and early awakenings. One major cause of morbidity in this population is abnormalities in gas exchange and resultant hypoxemia as they can lead to elevated pulmonary pressures, dyspnea and in severe cases right ventricular overload and failure. Sleep has profound adverse effects on respiration and gas exchange in patients with COPD…” (Urbano & Mohsenin, 2006). Moreover, Sheppard and colleagues in the publication from the Chest magazine noted, “Epidemiologic investigation has revealed that patients with pulmonary disease are at increased risk of dying during the early morning hours” (Sheppard et al, 1984). The load on the heart muscle during the episodes of hypoxemia during sleep can be, according to their conclusion, “can be transiently as great as during maximal exercise”. If patients with pulmonary conditions can die due to heart problems at night, what about heart patients themselves? “Coronary spasm occurs most often from midnight to early morning when the patient is at rest”, (Yasue & Kugiyama, 1997) says the Japanese study Coronary spasm: clinical features and pathogenesis published in the Internal Medicine magazine. Intensive care professionals from Department of Anaesthesia and Intensive Care Medicine of the Hadassah Medical Centre in Jerusalem, Israel also decided to investigate, according to their title, In-hospital cardiac arrest: is outcome related to the time of arrest? They wrote, “BACKGROUND: Whether outcome from in-hospital cardiopulmonary resuscitation (CPR) is poorer when it occurs during the night remains controversial. This study examined the relationship between CPR during the various hospital shifts and survival to discharge…CONCLUSIONS: Although unwitnessed arrest is more prevalent during night shift, resuscitation during this shift is associated with poorer outcomes independently of witnessed status” (Matot et al, 2006) Trying to explain the cause of deaths, Turkish cardiologists from Ankara published a study Circadian variations of QTc dispersion: is it a clue to morning increase of sudden cardiac death? They explained, “BACKGROUND: Several studies related to cardiac events including sudden death have shown a peak incidence in the early morning hours. Our data suggest that QTcD has a circadian variation with an increase in the morning hours, especially in patients with coronary artery disease. This finding was thought to be an explanation for the role played by sympathetic nervous system in the occurrence of acute cardiac events and sudden death during these hours” (Batur et al, 1999). A group of American cardiologists from the Georgetown University Medical Center in Washington, D.C. was also interested in the most likely time of death, “The time of death was available in… 96 of the 139 patients who died suddenly. There was a circadian variation of all SCDs [sudden cardiac deaths] compared with other deaths with a

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distinct peak during the morning (p = 0.04)” (Behrens et al, 1997). Swiss medical doctors explained in their abstract, “Prinzmetal's angina is a variant of the classic exertion dependent angina pectoris. Typical is the appearance of the symptoms at rest during early morning hours. It is due to spasms in the coronary arteries. Various provocation tests may be used to trigger spasms, among others hyperventilation which leads to vasoconstriction of coronary arteries” (Jacob et al, 1994). Even healthy people have heavier breathing and lowered oxygenation of the brain during early morning hours, as Australian scientists from Latrobe University in Melbourne revealed. After testing health subjects, these scientists concluded, “These data indicate that normal diurnal changes in the cerebrovascular response to CO(2) influence the hypercapnic ventilatory response as well as the level of cerebral oxygenation during changes in arterial Pco(2); this may be a contributing factor for diurnal changes in breathing stability and the high incidence of stroke in the morning” (Cummings et al, 2007). It is not a surprise then that British researchers from the National Heart and Lung Institute (Imperial College, London) also noted, “The reduction in hypercapnic cerebral vascular reactivity that occurs in the morning after sleep is associated with an increased risk of cerebral ischemia and stroke” (Meadows et al, 2005). Similarly, Californian neurologists wrote, “This reduced morning response to hypercapnia suggests diminished vasodilator reserve during this period, and may be related to the increased stroke risk during the morning hours” (Ameriso et al, 1994). Patients with diabetes also suffer from lower oxygenation in tissues during nights: “Circadian rhythms of tissue oxygen balance and blood rheological properties were investigated in 40 patients with insulin dependent diabetes mellitus... Preserved blood hyperviscosity and increasing tissue hypoxia at night indicated stable disturbance of hemorheological properties and tissue oxygen balance” (Galenok et al, 1988) Japanese doctors from the Department of Pathology for the Handicapped in Ehime University warn that those who care about people with epilepsy should know about higher chances of seizures during nights, “…S-w paroxysms combined with clinical symptoms and continuing for more than four seconds were fewer during the afternoon than the morning and, moreover, during sleep. …Therefore, the observation of typical absence seizures during the morning should be regarded as important” (Nagao et al, 1990) A marker of inflammation, C-reactive protein, was measured during different parts of the day in obese patients (Punjabi & Beamer, 2007). The conclusion of these medical scientists from the Johns Hopkins University in Baltimore was in the title of the study, C-reactive protein is associated with sleep disordered breathing independent of adiposity. Hence, it is not just obesity, but disordered breathing at night that can lead to inflammation: “…the results of this study suggest that mechanisms other than adiposity per se could contribute to the inflammatory state seen in adults with SDB [sleep disordered breathing]” (Punjabi & Beamer, 2007). Since inflammation can get worse during nights in many patients, is it possible that cortisol production (cortisol is one of the key hormones to fight inflammation) also decreases at nights? German researchers suggested, “Some studies found patterns of enhanced or blunted waking cortisol responses observed under chronic stress, burnout, or post traumatic stress disorder… The morning cortisol increase typically observed in healthy subjects and also observed in the control group was absent in the amnesic patients… Further studies are needed to understand the neurological or psychological mechanisms leading to a missing morning cortisol response in amnesic patients”(Wolf et al, 2005) . “Approximately two-thirds of women experience nausea or vomiting during the first trimester of pregnancy. These symptoms are commonly known as morning sickness” (Flaxman & Sherman, 2000). It is known that pregnancy of modern women means chronic hyperventilation (see below). Many of these women have even heavier breathing in comparison with their usual daily chronic hyperventilation. What are the causes of morning hyperventilation? They are numerous. Presence of disease and existing damage in the body Dr. Buteyko, during his public lecture at the Moscow State University, said, “The horizontal position, lying intensifies breathing. Patients with asthma, heart disease, hypertension, and stenocardia often have acute states at night. If they lie down during the day time, or lie for 2-3 hours – the breathing gets heavier, the attacks come. Many severely sick patients sit, afraid to lie down. This is sensible. We should lie down only for sleeping. Our patients cannot control their breathing at night, and hence, sleep is poison for them” (Buteyko , 1977). Sleeping too long Sleeping too long, according to Buteyko, intensifies breathing causing prolonged periods of gradually increasing hyperventilation (p.177, Khoroscho, 1982)

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Sleeping on the back Among body positions, sleeping on the back (supine position) is worst (some people start snoring in this position). Sleeping on the right side also causes increased ventilation in comparison with sleeping on the left side or on the chest. Children's ventilation is minimum when they are sleeping on their tummies (Buteyko, 1977). There are no physiological studies known to me in which such parameters of breathing, as minute ventilation and aCO2, are monitored in different sleeping body positions. Meanwhile, there are at least 8 studies devoted to the physiological effects of different body night positions on the stomach. All these investigations, trials included, advocate the left position due to the least night-time recumbent reflux (e.g., Khoury et al, 1999). That means that the liquid content of the stomach, for the left position cannot escape or leak due to the absence of physical contact with any of the stomach valves. This position is also the most favourable for general peristaltic waves in the large intestine due to the gravitational effect in the transverse colon. There are, possibly, some other reasons to explain the advantages of the left position (e.g., the influence of the heart position). Some people, due to congenital reasons, have their hearts on the right side. In such cases the effects of sleeping positions are also in reverse. A simple "sleeping positions" self-test. By measuring breath holding time in different sleeping positions, one can find out what is the optimum position for breathing and health. Note that one needs to spend about 10-15 minutes in a certain position in order to achieve a stable metabolism correspondent to this position. A ticking mechanical clock can be used for that purpose. Generally, sleeping on the left side will produce the highest BHT, followed by sleeping on the tummy. Sleeping on the back is worst and causes lowest BHT. Other causes Among other causes are poor air quality, soft beds, abnormal thermoregulation, etc.

3.9 Embryonic and foetal development in a woman hyperventilating during her pregnancy Thorp & Rushing (1999) devoted their study to the review of over 50 references regarding umbilical cord blood analysis. They found that "because of the progesterone-induced hyperventilation of pregnancy, maternal PCO2 decreases to 31 to 34 mm Hg from the nonpregnant state value of 39 to 40 mm Hg". Their article also presented a table of studies reporting umbilical cord arterial blood gas values. Average carbon dioxide numbers ranged from 49 to 56 mm Hg, while oxygen content was only between 15 to 24 mm Hg, indicating extreme hypoxia in the embryo. A textbook "Fetal Physiology and Medicine" (Hugh & Hugh, 1984) also revealed that "In comparison to maternal blood, the pCO2 is higher, pO2 and sO2 [oxygen saturation] values are strikingly lower [for fetal blood]..."(Hugh & Hugh, 1984). The oxygenation of the blood of the human foetus is usually about 5-7 times less than that of the normal adults. At the same time, carbon dioxide content of the growing foetus is significantly higher than normal adult values. For example, in the middle of pregnancy Soothill and colleagues (1986) measured the umbilical arterial carbon dioxide as 10 mm Hg greater than maternal arterial CO2 pressure. Hence, the human embryo grows in an environment containing much less oxygen and more CO2 in comparison with normal adult values. But since many women hyperventilate before pregnancies, their aCO2 values during pregnancies are much lower, than their physiological norms. Her embryo receives all its nutrients, carbon dioxide included, through the umbilical cord via the blood. Therefore, the embryo gets exactly the same CO2 concentrations, as his mother. Due to Nature’s design, carbon dioxide concentrations of the embryo are much greater than normal human values, but the lowered aCO2 of the mother tends to reduce the CO2 stores of the embryo. Hence, when the mother hyperventilates, her embryo also hyperventilates in relation to its physiological norms. Such a baby is already developing and will be born in the state of over-breathing. Moreover, studies of pregnant women done by Doctor Buteyko revealed that numerous complications during pregnancies and deliveries are possible only when carbon dioxide stores are low. That relates, for example, to spasms of ovaries, excessive hypoxia of the embryo, and spontaneous abortions. Babies born with over-breathing often suffer from various infections, skin rashes, pneumonia, asthma, eczema, and other problems. These ailments are absent in babies with normal aCO2 (Buteyko, 1977). During the birth there are dramatic changes in CO2 and O2 tensions. The summary of these studies indicates that, on average, carbon dioxide concentration drops from over 8% to about 5% during the first hours of life (Respiration and Circulation, 1971). Scientists often describe the birth as a powerful stress. Indeed, such large changes in blood gases must profoundly affect the biochemistry of the whole organism.

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3.10 Special factors for infants Before the baby is born, the fetus gets all its blood supply from the mother through the umbilical cord. This includes CO2 and O2. Because of this, the breathing of the fetus depends solely on the mother’s breathing and when she hyperventilates, her unborn baby also hyperventilates. Birth itself is a severe shock for the baby. Probably, the central part of this shock is a drastic drop (about 30%) in blood CO2 concentrations. The process of delivery and new environmental conditions cause stress and make their breathing heavy. In order to make the transition more gradual, all primitive and recent cultures used swaddling (or tight wrapping) of babies. When meeting people born and raised on different continents, I was reassured that swaddling was the norm in Africa, America, Europe and Asia. In Asia, due to hot climate, they used, instead of clothes, wooden sticks, which were applied along the trunk and tightly tied using ropes. In Scotland, swaddling blankets were passed from generation to generation. Swaddling prevents unduly deep chest breathing and restricts their total ventilation. In other words, they breathe less. Modern western civilization and our health care systems have gradually lost this wise cultural tradition. In his public lectures, Buteyko said, “But the cells of animals and humans need about 7 % CO2 and only 2% O2 in the surrounding environment. This is the way our cells live: cells of the heart, brain, and kidneys. But now air has 10 times more oxygen and 250 less carbon dioxide, i.e., it is not suitable for our cells and is poisonous in its composition. This is confirmed by embryology. During recent years detailed studies of gas blood exchange in embryos of humans and animals were done. It was found that during 9 months we live in an environment, which has 3-4 times less oxygen and 1.5 times more CO2 (both as partial pressures) in comparison with adults. Obviously, the organism of the mother creates such conditions for the embryo, as they were billions of years ago. This supports the Law of GekkelSevertsev: the embryon, in its development, repeats the filogeneses. After birth, during the first breaths, there is a sudden increase in blood oxygenation and a sudden drop in CO2. It is known that the child is virtually disease-free in the womb of the mother. Only after the birth, do diateses and all other abnormalities of metabolism appear. Why? There is a sudden change in air. The wisdom of East surprises us: the just-born infant is tightly swaddled, and in some places even tightened to a wooden plate. The chest is covered by layers of heavy material [voilok]. Our grandmothers covered the cradle with the infant using material covering [leaving a small hole for air exchange], and used swaddling too… Folk wisdom understood, that this air, so poisonous for the newborn, requires gradual adaptation” (Buteyko, 1977). Another special factor for children relates to their high metabolic rate. Metabolism and heat generation of children is much higher than that for adults. Having simlar clothes, as adults, can damage their health. What is the criterion of feeling cold for the babies? It is too cold for them when their feet or arms are cold. A quick touch by hand and feet can check if the baby is warm or cold. Overheating is one of the leading causes of poor health in modern babies and children. “The metabolism of the child is about 2-3 times higher. When it is cold for an adult, children feel comfortable. But they are provided with 5 layers of clothing and then a hat on top … Overheating intensifies breathing and the child gets a cold, not from a draught, but from own hyperventilation. Then he is even more insulated, more overfed… It is well known: in a large and poor family, where bread and potatoes, there is only one shirt for all [children], [they] run on the snow barefoot and all are healthy” (Buteyko, 1977).

_______ 3.11 Nutritional deficiencies

Due to intensive farming and food refining methods, our food is less nutritious than 100 or more years ago. We get less essential fatty acids (omega oils), calcium/magnesium, fiber, zinc, trace-metals and other essential nutrients. Nutritional deficiencies, depending on one’s personal make-up, create stress for certain organs, body parts, and systems of the human organism. This stress intensifies chronic hyperventilation.

3.12 Exposure to toxic chemicals

Toxic chemicals, once in the human organism, can generate different waste products, interfere with hormonal balance, and influence the nervous, digestive, cardiovascular and other systems. These negative changes sooner or later cause over-breathing. The mere appearance of bacteria or large amounts of waste products from bacteria in the blood would be sufficient to cause heavy over-breathing (chapter 1). Therefore, environmental, professional, dietary and any other exposure to heavy metals, pesticides, herbicides, and chemicals due to pollution are also causes of chronic hyperventilation. Many medical drugs intensify respiration. 70


“Antibiotics (penicillin, streptomycin etc.) intensify breathing. After 2-3 weeks of such treatment, the state [of health] unavoidably gets worse. What is the mechanism? Antibiotics fight microbes, suppressing the breathing of micro organisms. All of the living world has one common foundation: metabolism. Therefore, antibiotics suppress the breathing of microbe cells and our cells. This causes excitement of the breathing centre, its disruption, in the direction of intensification. Moreover, antibiotics create conditions for new allergies. Senseless, widespread use of antibiotics causes tremendous damage. Camfora, codein, cordiamin, adrenalin, theoephedrine, ephedrine – also intensify breathing. People use them senselessly, trying to cure themselves, and cause tremendous harm to themselves” (Buteyko, 1977). Alcohol, soon after intoxication, suppresses the breathing centre and can increase the breath holding time about 2 times. Simialrly, marijuana and cocain can increase the BHT about 3-4 times. This change in breathing, according to considered physiogical laws, profoundly influences perception and feelings of the intoxicated person leading to increased confidence, logic, feeling of energy, coordination, sharper sensations in relations to smells, colours, etc. Later, the abnormal substances are to be removed by the immune system and the liver and kidneys causing heavy breathing and hangover. The breath holding time plunges below the initial values. Low oxygenation, poor blood perfusion generates many negative effects described above. As a short summary that connects this chapter with diseases and individual symptoms discussed in Chapter 1, Doctor Buteyko noticed, “If the cause of hyperventilation is in the wrong lifestyle, that means you are bound to change your lifestyle or to fight with the symptoms all the time” (from Novozshilov, 2003b).

Conclusions The following factors can cause chronic hyperventilation: - Stress, anxiety and strong emotions - Physical inactivity - Overeating - Deep breathing exercises - Overheating - Talking with deep inhalations, a loud voice, or a high pitches - Mouth breathing - Sleeping too much, sleeping on the back or on the right side - Embryonic and foetal development in a woman hyperventilating during her pregnancy - Lack of swaddling - Nutritional deficiencies - Exposure to toxic chemicals. The references of this book provide experimental results in respect to various respiratory parameters of people over a period of about 100 years. By analysing this data and some other articles (all published in respectable medical and physiological magazines), the following average changes for people, who were considered healthy, took place during the 20-th century: • Normal minute ventilation increased from 5-6 to 9-12 l/min. Healthy people breathe more. • Normal breathing frequency increased from 9-12 to 12-15 times per minute. Healthy people breathe faster. • Normal tidal volume (the amount of air for one breath) increased from 500-600 to 600-700 ml per breath. Healthy people breathe deeper. As normal outcomes: • Carbon dioxide concentrations (in the lungs and blood) decreased from 40-43 mm Hg to 36-39 mm Hg. • The BHT (BHT after quiet exhalation) decreased from 40-50 s to 25-35 s. The crucial parameter here is carbon dioxide concentrations, while other characteristics only support the idea that modern people, who are considered to be healthy, hyperventilate in relation to previous healthy generations. In addition to that, there are sharp increases (ten times or more) in chronic degenerative health conditions. As a result, average breathing of the typical modern Earth citizen indicates some degree of hyperventilation. Hence, due to readjustment of the breathing centre to abnormal, from the evolutionary viewpoint,

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environmental conditions and individual choices (discussed in this chapter), people now breathe much heavier than, for example, 100 years ago.

Q&A section for Chapter 3 Q: Do all emotions cause hyperventilation? A: According to Doctor Buteyko, all strong emotions result in over-breathing. However, some emotional attitudes, in my view, do not have a negative impact on breathing. For example, when people experience reasonable shame, their breathing is normal or can be even reduced. Similarly, admiration in respect to art creations, Nature’s phenomena, and human deeds causes naturally reduced breathing. These experiences are often described as “breath-holding” or “breath- taking (away)”. By the way, healthy people, when opening their mouths, cease to breathe. Q: What are the effects of music on respiration? A: They are complex and individual. Studies found that one’s breathing rhythm can follow the musical rhythm. Also, heavy or loud music and music with uneven rhythm cause more muscular tension increasing ventilation. Quiet, soft, and peaceful musical pieces induce relaxation, slower heart rate, and establish easy breathing. Music is another cultural factor, which often adversely influences the breathing of modern people, especially our younger generations. Q: What is the dynamic of changes in ventilation and aCO2 during sleep? A: Healthy people breathe slower, ventilate less, and have higher aCO2 during night sleep. Their sleep is short and refreshing. Many sick people usually also breathe less due to decreased metabolic rate, but their carbon dioxide concentrations get smaller. Therefore, they over-breathe. This process is especially pronounced during early morning hours (4-6 a.m.), as mentioned above. As for the effects of different sleep stages, during deep sleep stages (or slow wave sleep), ventilation is reduced and that helps to deeply relax skeletal muscles. Carbon dioxide, a powerful muscle relaxant (chapter 1), can play a central role in this effect. REM (rapid eye movement) sleep can result in relative hyperventilation and low aCO2 (Krieger, 1986). Q: What is known about breathing and natural processes, like defecation and urination? Can they produce hyperventilation? A: If a person has a desire to defecate but does not have a chance to do that, the breathing can become heavier. Indeed, from chapter 1 it is known, that raised aCO2 increases blood flow to the brain and internal organs, together with the group of muscles, which is responsible for effective elimination (this group includes muscles of the descending colon, sigmoid colon, rectum and sphincter). Vice versa, lowered aCO2 reduces blood flow to these muscles up to the possible spasmodic state. The relief, relaxation, and easy breathing after the defecation indicate reduced ventilation and increasing CO2 stores. The act of urination seems to be less connected with hyperventilation. Meanwhile, distension of the bladder causes more slow and shallow breathing (Schodorf & Polosa, 1980) leading to higher carbon dioxide values. Thus, deliberately keeping one's bladder full, somehow, reduces ventilation and, possibly, is not detrimental to one’s health.

_______ References for chapter 3

Ameriso SF, Mohler JG, Suarez M, Fisher M, Morning reduction of cerebral vasomotor reactivity, Neurology 1994 Oct; 44(10): 1907-1909. Astrid P, Breath holding during and after muscular exercise, J Appl Physiol 1960, 15 (2): 220-224.

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Batur MK, Aksöyek S, Oto A, Yildirir A, Ozer N, Atalar E, Aytemir K, Kabakci G, Ovünç K, Ozmen F, Kes S, Circadian variations of QTc dispersion: is it a clue to morning increase of sudden cardiac death? Clin Cardiol. 1999 Feb; 22(2): 103-106. Bazett HC, The regulation of body temperatures, in Physiology of heat regulation and the science of clothing, ed by LN Newburgh, 1968, Hafner Publishing Co, NY, 109-192. Behrens S, Ney G, Fisher SG, Fletcher RD, Franz MR, Singh SN, Effects of amiodarone on the circadian pattern of sudden cardiac death, Am J Cardiol. 1997 Jul 1; 80(1): 45-48. Biotin FA, Brigade NH, Witnesses CJE, Emotions and respiratory patterns: review and critical analysis, Intern J of Psychophysiol 1994, 17: 107-128. Bosco G, Ionadi A, Data PG, Mortola JP, Voluntary breath-holding in the morning and in the evening, Clin Sci (Lond). 2004 Apr; 106(4): 347-352. Brooks GA, Fahey TH, White TP, Exercise physiology: human bioenergetics and its applications, 2-nd ed., 1996, Mountain View, California, Mayfield. Buteyko KP, Carbon dioxide theory and a new method of treatment and prevention of diseases of the respiratory system, cardiovascular system, nervous system, and some other diseases [in Russian], Public lecture for Soviet scientists at the Moscow State University, 9 December 1969, Science and life [Nauka i zshizn’], October 1977. Buteyko KP, Method of voluntary elimination of deep breathing [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, p.148-165. Cummings KJ, Swart M, Ainslie PN, Morning attenuation in cerebrovascular CO2 reactivity in healthy humans is associated with a lowered cerebral oxygenation and an augmented ventilatory response to CO2, J Appl Physiol. 2007 May; 102(5): 1891-1898. Flaxman SM, Sherman PW, Morning sickness: a mechanism for protecting mother and embryo, Q Rev Biol. 2000 Jun; 75(2): 113-148. Galenok VA, Krivosheeva IA, Dikker VE, Krivosheev AB, Desynchronization of circadian rhythms of the oxygen balance in the tissues and rheological properties of the blood in type I diabetes mellitus [Article in Russian], Ter Arkh. 1988; 60(9): 27-31. Gaudio R & Neil A, Heat-induced hyperventilation, J Appl Physiol 1968, 25(6): 742-746.

_______ Haldane JS, Respiration, 1922, Yale University Press, New Haven, UK. Hasselbalch, Biochem Zeitschr, 1912, XLVI, p.416.

Hetzel MR, Clark TJ, Houston K, Physiological patterns in early morning asthma,Thorax 1977 Aug; 32(4): 418-423.

Hoit JD & Lohmeier HL, Influence of continuous speaking on ventilation, J Speech Lang Hear Res 2000 Oct; 43(5): 1240-1251.

Hugh R & Hugh A, Maternal and fetal acid-base balance and blood gas measurement, in Fetal Physiology and Medicine, ed. by Beard R & Nathanielsz P, Second, revised edition, 1984, Marcel Dekker, New York.

Jakob M, Hess OM, Mayer I, Hu Z, Krayenbühl HP, Prinzmetal's variant angina: a case report [Article in German], Schweiz Rundsch Med Prax. 1994 May 10; 83(19): 579-582. 73


Khoroscho AE, Interview with K. P. Buteyko (1982), in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, 168-180. Kerr WJ, Dalton JW, Gliebe P, Some physical phenomena associated with the anxiety states and their relation to hyperventilation, Annals of Intern Med 1937, 11: 961-992. Krieger J, Sleep apnea syndromes in adults, Clin Respir Physiol 1986, 22: 147-189. Lum LC, The syndrome of habitual chronic hyperventilation, in: Modern trends in psychosomatic medicine, ed. by O. W. Hill, 1976, London, Butterworths: p.196-230. Magarian GJ, Hyperventilation syndrome: Infrequently recognized common expressions of anxiety and stress, Medicine 1982; 61: 219-36. Matot I, Shleifer A, Hersch M, Lotan C, Weiniger CF, Dror Y, Einav S, In-hospital cardiac arrest: is outcome related to the time of arrest? Resuscitation 2006 Oct; 71(1): 56-64. Meadows GE, Kotajima F, Vazir A, Kostikas K, Simonds AK, Morrell MJ, Corfield DR, Overnight changes in the cerebral vascular response to isocapnic hypoxia and hypercapnia in healthy humans: protection against stroke, Stroke 2005 Nov; 36(11): 2367-2372. Morton AR, King K, Papalia S, Goodman C, Turley KR, Wilmore JH, Comparison of maximal oxygen consumption with oral and nasal breathing, Aust J Sci Med Sport 1995 Sep; 27(3): 51-55. Nagao H, Morimoto T, Takahashi M, Habara S, Nagai H, Matsuda H, The circadian rhythm of typical absence seizures--the frequency and duration of paroxysmal discharges,Neuropediatrics. 1990 May; 21(2): 79-82. Nishino T, Sugimori K, Ishikawa T, Changes in the period of no respiratory sensation and total breath-holding time in successive breath-holding trials, Clin Sci (Lond). 1996 Dec; 91(6): 755-761. Novozshilov A, How do you breathe? The interview by Julia Ekareva with Andrey Novozshilov, chief medical doctor of the Moscow Buteyko Clinic (www.buteyko-clinic.ru), Russian national magazine “Argumenti i fakti” [“Arguments and facts”], Health Section, 30 January 2003a, issue 05(442), Moscow. Novozshilov A, The interview of Dr. Andrey Novozshilov with Tatiana Punans, published in the Russian national magazine “Beauty and health”, 2003b. Porter FL, White D, Attaway N, Miller JP, Strunk RC, Absence of diurnal variability of airway reactivity and hypoxic ventilatory drive in adolescents with stable asthma,J Allergy Clin Immunol. 1999 May; 103(5 Pt 1): 804-809.

_______ Punjabi NM, Beamer BA, C-reactive protein is associated with sleep disordered breathing independent of adiposity, Sleep 2007 Jan 1; 30(1): 29-34.

Respiration and Circulation, ed. by P.L. Altman & D.S. Dittmer, 1971, Bethesda, Maryland (Federation of American Societies for Experimental Biology).

Salkovskis PM & Clark DM, Affective responses to hyperventilation: a test of the cognitive model of panic, Behav Res Ther 1990; 28(1): 51-61. Schodorf R & Polosa C, Effects of urinary bladder afferents on respiration, J Appl Physiol: Respir Environ Exercise Physiol 1980, 48: 826-832.

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Shepard JW Jr, Schweitzer PK, Keller CA, Chun DS, Dolan GF, Myocardial stress. Exercise versus sleep in patients with COPD, Chest 1984 Sep; 86(3): 366-374. Soothill PW, Nicolaides KH, Rodeck CH, Gamsu H, Blood gases and acid-base status of the human second-trimester fetus, Obstet Gynecol. 1986 Aug; 68(2): 173-176. Stegen K, De Bruyne K, Rasschaert W, Van de Woestijine KP, Van den Bergh O, Fear-relevant images as conditioned stimuli for somatic complaints, respiratory behavior, and reduced end-tidal pCO2, J of Abnorm Psychol 1999, 108 (1): 143-152. Tanaka Y, Morikawa T, Honda Y, An assessment of nasal functions in control of breathing, J Appl Physiol 1988 Oct; 65(4): 1520-1524. Thorp JA, Rushing RS, Umbilical cord blood gas analysis, Obstet Gynecol Clin North Am 1999 Dec; 26(4): 695-709. Urbano F, Mohsenin V, Chronic obstructive pulmonary disease and sleep: the interaction, Panminerva Med 2006 Dec; 48(4): 223-230. Vianna EO, Boaventura LC, Terra-Filho J, Nakama GY, Martinez JA, Martin RJ, Morning-to-evening variation in exercise-induced bronchospasm,J Allergy Clin Immunol. 2002 Aug; 110(2): 236-240. Wolf OT, Fujiwara E, Luwinski G, Kirschbaum C, Markowitsch HJ, No morning cortisol response in patients with severe global amnesia, Psychoneuroendocrinology 2005 Jan; 30(1): 101-105. Yasue H, Kugiyama K, Coronary spasm: clinical features and pathogenesis, Intern Med. 1997 Nov; 36(11): 760-765.

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Chapter 4. Western methods of breathing retraining Introduction Whenever the breathing of sick people is shown to be abnormal, it is then reasonable to inquire about the available methods of breathing retraining developed by medical professionals. This chapter provides a review of various Western methods, including the types of breathing exercises used, their duration and frequency, length of the therapy, and other auxiliary activities, as well as the immediate and long-term effects of each treatment. The goal of almost all these methods was to reduce breathing and increase carbon dioxide values. The location names given before the titles of the publications listed below, identify the different research centres where a particular breathing retraining method has been employed. It is possible that the researchers, as well as ordinary people, often have a misconception that breath means spirit (something immaterial); hence, breathing retrainig can address only emotional or psychological problems, not organic or metabolic diseases, which are accompanied by damaged organs or tissues or hormonal abnormalities. That was probably the reason why the patients for these therapies were usually diagnosed with “hyperventilation syndrome” or "panic attacks" as their main health symptom and concern. References to the publications, which describe these therapies, are given at the beginning of the appropriate sections. The last section of this chapter discusses the common features and differences of these Western methods of breathing retraining, as well as their advantages and disadvantages. It must be noted that there is one method of breath retraining (the Buteyko method) which has not been considered in this chapter. This method shall be discussed later, as it deserves special attention.

4.1 University of California Medical School, San Francisco, USA Kerr WJ, Dalton JW, Gliebe. Some physical phenomena associated with the anxiety states and their relation to hyperventilation, Ann Int Med 1937, 11: 962-992. In the 1930s, it became obvious to a group of doctors that a large number of their patients (from one-fourth to one-third) had "a variety of symptoms referable to many structures of the body; and in whom hyperventilation precipitates and maintains a state of hyperirritability approaching clinical tetany. The symptoms may be so well localized in some cases that local disease is suspected without discovery of universal functional disturbance” (p. 961, Kerr et al, 1937). As a treatment, the inhalation of O2-CO2 gas (70% O2 and 30% CO2) was found to be most effective both in speed and adequacy. In other situations, “a paper sack, inverted over patient’s head and sealed with adhesive tape, is successful” (p.989, Kerr et al, 1937). Additionally, a prescription with ammonium chloride, in order to reduce ventilation, was given, although the authors noted that chloride ions were probably not as effective as carbon dioxide. This demonstrated to the patient “the mechanism of the physiological difficulties which he himself caused [due to hyperventilation], and the results are so dramatic, that he is able to follow the procedure and to appreciate what the results mean to him” (p.989, Kerr et al, 1937). However, the authors decided that the use of several chemical drugs, which could suppress the heart action and the respiratory rate, should be tried as the way to success.

_______ 4.2 Papworth Hospital, Cambridge, UK

Lum LC, Hyperventilation: The tip and the iceberg, J Psychosom Res 1975; 19: 375-383. Lum LC, The syndrome of habitual chronic hyperventilation, in Modern Trends in Psychosomatic Medicine, edited by OW Hill, Butterworth, London, 1976, vol 3: 196-230. Professor Lum insisted that the therapy must start with the HVPT (hyperventilation provocation test), which demonstrated to the patients that reappearance of their symptoms was directly related to their over-breathing. That brought psychological relief to the patients (normally causing easier breathing), since they were now convinced that one of the causes of their symptoms was proven by the test and could soon be treated by their learning about breathing retraining. Lum found that there are two factors in how soon the patients got well: the duration of symptoms and the 76


age of the individual. Indeed, it is normal to expect that the recovery rates should depend on the previous damage accumulated in the organism. Usually, patients were referred to a physiotherapist in order to learn 3 key components of the therapy: awareness about normal and abnormal breathing patterns, relaxation, and diaphragmatic breathing. Thus, patients were informed about the importance of achieving constant control of their breathing, as well as learning how to prevent such harmful acts as sighing, sniffing, coughing, deep breathing, chest inflation, and other unhealthy habits and factors, which encourage excessive breathing. Relaxation physiotherapy included teaching the patients how to loosen up their habitually tense posture, and especially how to recognise and prevent muscular tension in the chest, shoulders, head and neck. It was found that the majority of his patients had little, if any, control and use of their diaphragm. Hence, the physiotherapist taught them how to control it and to use it almost exclusively at rest, and how to suppress unnecessary thoracic movements or relax the breathing muscles of the chest. In order to achieve normal breathing, "an extremely slow respiratory rhythm is encouraged, in order to gradually persuade the respiratory centre to readjust to a higher level of arterial carbon dioxide: a slow process if the disorder has persisted for many years" (p.226, Lum, 1976). Then "the patient is initially instructed to devote two periods of 20 minutes each day to breathing exercises, and to constantly check his breathing throughout the day" (p.226, Lum, 1976). He treated 320 patients (up to 1974) using this therapy. 70% were rendered completely asymptomatic. 25% had improved and 5% failed to respond. 18 patients were diagnosed by a cardiologist as having organic cardiac disease. Out of these patients, only 3 failed to improve.

4.3 Portland Veterans Administration Medical Centre, USA Magarian GJ, Hyperventilation syndrome: infrequently recognized common expressions of anxiety and stress, Medicine 1982; 61: 219-236. Magarian GJ, Middaugh DA, Linz DH, Hyperventilation syndrome: a diagnosis begging for recognition, West J Med 1983; 38: 733-736. As a first practical step with this approach, it was "important that the patients be confronted with the causeand-effect relationship and their symptoms. A hyperventilation trial is crucial for therapeutic success" (p. 736, Magarian et al, 1983). During the HVPT the patient breathed deeply at a rate 30 to 40 times per minute. Most patients experienced their symptoms within minutes or seconds. Such recognition was a major factor for successful overall outcome of the therapy. Given its nature, the test should be conducted cautiously for patients with ischemic coronary disease, sickle cell disease, cerebrovascular insufficiency and baseline hypoxemia. Meanwhile, "it is of far greater detriment for the patient not to recognise the relationship between over-breathing and their symptoms than the potential risks of performing the test” (p.231, Magarian, 1982). The suggested duration of the test was 4-5 minutes. When the HVPT was done, breathing into a bag resulted in quick alleviation of the symptoms. Finally, the patients were encouraged to use relaxation therapy and also taught how to retrain their own breathing pattern, from thoracic to diaphragmatic. The authors reported about the low efficiency of different medications for the normalisation of breathing.

_______ 4.4 St. Bartholomew's Hospital, London, UK

Bonn JA, Readhead CP, Timmons BH, Enhanced adaptive behavioural response in agoraphobic patients pretreated with breathing retraining, Lancet 1984 Sep 22; 2(8404): 665-669.

21 patients with agoraphobia (sensations of fear, panic, and terror), first, were administered the HVPT (with breathing frequency 60 times per minute, for 3 min maximum, breathing through both mouth and nose as vigorously as possible). Over 95% of patients recognised their symptoms, but which were not as severe as usual. Two thirds of the patients were unable to complete the 3-min HVPT due to dizziness and distress. In contrast, only 4% of the normal subjects were unable to hyperventilate for 3 minutes. The authors emphasised the importance of the HVPT and the subsequent helpful "shock of recognition". After positive recognition of their symptoms, 12 patients were given a 10-week course of the therapy (1-2 77


laboratory sessions per week, 2h for each session). The laboratory sessions included instructions about diaphragmatic respiration. Patients, while lying down, were told to maintain a breathing pattern of 8-10 breaths per minute. Techniques for coping with panic attacks were suggested - "the use of a paper bag for rebreathing or, in public places, breathing into hands tightly cupped over nose and mouth...The establishment of a normal breathing pattern requires regular and persistent practice over several months...Any relaxation technique that entails the use of deep breathing is contraindicated, since it will probably exacerbate hypocapnia [low aCO2]" (p.668, Bonn et al, 1984). The results were recorded at the end of the therapy, and for 1-month and 6-month follow-ups. The improvements were similar for all periods. Breathing rate dropped from 28 to 15-19 breaths per minute. The weekly number of panic attacks was reduced from 4-5 to 0.2. Other somatic characteristics were also significantly better.

4.5 Institute of Stress Research, Netherlands Grossman P, de Swart JCG, Defares PB, A controlled study of a breathing therapy for the treatment of hyperventilation syndrome, J Psychosom Res 1985; 29 (1): 49-58. The researchers employed the HVPT for 3 minutes with the goal to be reached of 2.5% etCO2 (end-tidal CO2). Then the physical and psychological symptoms, experienced by the patients, were discussed. The treatment was 10-weeks long and included 7 laboratory sessions (each for about 30 min) and daily home assignments. A ventilatory training device was individually adjusted to generate a periodic pattern for breathing with slightly less frequency than the initial one. That was achieved by the use of auditory stimuli for inspiration, expiration, and the pause. Verbal emphasis on abdominal breathing was provided. Laboratory sessions also included the CO2 analysis of the expired air. As a result of the therapy, the average breathing rate of the experimental group (25 subjects) decreased from 17 to about 11 breaths per minute, and resting etCO2 increased from 4.2 to 4.7%, while scores in all somatic complaints significantly improved. Although the subjects of this study were free from serious physical ailments, the researchers wrote, "In a broader sense, the findings indicate that by means of direct voluntary training of respiration, it may be possible to effect long-term alterations in ventilatory control mechanisms. This may have implications for the behavioural treatment of other respiratory disorders (e.g., asthma, sleep apnea and emphysema). Since alterations in ventilatory parameters are known to induce substantial changes in a range of other physiological systems (e.g., cardiovascular and CNS; see [16]), long-term modification of ventilatory control, via breathing therapy may also be useful in treating specific disorders of these other systems" (p. 58, Grossman et al, 1985).

4.6 Department of Psychiatry, University of Oxford, Warneford Hospital, UK Clark DM, Salkovskis PM, Chalkley AJ, Respiratory control as a treatment for panic attack, J Behav Ther Exp Psychiatry 1985 Mar; 16(1): 23-30. Salkovskis PM, Jones DR, Clark DM, Respiratory control in the treatment of panic attacks: replication and extension with concurrent measurement of behaviour and pCO2, Br J Psychiatry 1986 May; 148: 526-32.

_______ "Eighteen patients who experienced frequent panic attacks were given a treatment derived from the literature on hyperventilation and anxiety. The treatment consisted of (i) brief, voluntary hyperventilation. This was intended to induce a mild panic attack; (ii) explanation of the effects of over-breathing and reattribution of the cause of a patient's attacks to hyperventilation; (iii) training in a respiratory control technique. Substantial reductions in panic attack frequency and in self-reported fear during a behaviour test were obtained after 2 weeks' treatment and these reductions occurred in the absence of exposure to feared situations. Further reductions in panic attack frequency were evident at 6-month and 2-year follow-up though interpretation of these results is complicated by the addition of exposure and other psychological treatments" (abstract, Clark et al, 1985). In this study all patients were successfully treated "...Large and rapid reductions in panic attack frequency and questionnaire report of fear were observed. Patients' resting pCO2 was significantly lower than controls and rose to normal levels during treatment" (abstract, Salkovskis, 1986). The high success rate of this therapy could be partly explained by the absence of patients with an organic or metabolic illness and absence of the elderly among the subjects (the average mean age was about 30 years, from 26 to 78


44). The patients used a recorded tape, set at 12 breaths per minute. This tape was to be practiced at home daily. Laboratory sessions were organised about once per week involving ongoing respiratory training and homework instructions. Statistical analysis revealed that patients with particularly low resting etCO2 were more likely to recognize the symptoms of over-breathing as being similar to their panic attacks.

4.7 Department of Psychiatry, University of Utrecht, Netherlands Ruiter de C, Ryken H, Garssen B, Kraaimaat F, Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia, Behav Res Ther 1989; 27(6): 647-655. The study was completed with 40 patients diagnosed with agoraphobia. All participants were selected on the basis of their ability to recognize their symptoms during the HVPT. The patients were informed as to how hyperventilation and catastrophic thinking and worrying could cause panic attacks. The treatment consisted of 8 individual sessions lasting about 60 min each, as well as instructions how to practice relaxation and slow breathing in daily situations. The main goal of the therapy was to gradually reduce the respiration rate. For that purpose a pacing tape was used. Each time it was used, the breathing frequency proved to be slightly lower than the previous one. Slow diaphragmatic breathing was “encouraged by suggesting patients put one hand on their abdomen, and breathing ‘against the hand’” (p. 649, Ruiter et al, 1989). “Treatments that included breathing retraining techniques seemed to result in a decrease in respiratory rate, but not in an increase in alveolar pCO2” (p. 652, Ruiter et al, 1989), since etCO2 slightly decreased during the treatment. Meanwhile, “the present study found breathing retraining plus cognitive restructuring ineffective in reducing panic”(p. 654, Ruiter et al, 1989). Professor Ronald Ley, State University of New York, wrote comments on this study, concluding “Efforts to reduce ventilation through exclusive attention to a reduction in respiratory frequency may not only be unsuccessful in reducing ventilation, but may, as in the study in question, produce a paradoxical increase in ventilation, an effect opposite to the express purpose of the breathing retraining. The results here indicate that pCO2 monitoring should be an integral part of breathing retraining process” (p. 304, Ley, 1991).

4.8 Cornell University Medical College, New York, USA Fensterheim H, Wiegand B, Group treatment of the hyperventilation syndrome, Int J Group Psychother 1991 Jul; 41(3): 399-403. "Hyperventilation (hv) is increasingly recognized as being significant in a number of psychological and medical conditions. The core of treatment for hv is breathing retraining, usually on an individual basis. This article describes a group therapy for breathing retraining for patients with hv-induced panic reactions. An analysis of group process suggests that such treatment is helpful in ways impossible for individual retraining and that further exploration of this modality is warranted" (abstract, Fensterheim & Wiegand, 1991) The novelty of this study was the use of group therapy during the breathing retraining sessions. The authors found that their patients had a warm supportive acceptance of each other and of the group itself. That "facilitated cooperative performance of their assignments and taking the risks in life situations that are so necessary for progress in this area" (p. 401, Fenshterheim & Wiegand, 1991). Moreover, it was found, that group processes helped to alleviate the disturbed reaction to symptoms and to accelerate the learning of correct breathing patterns. In particular, the authors emphasized that group treatment sessions, as an addition to individual sessions, should be especially helpful to those patients who had the most difficulty in learning a normal breathing pattern.

_______ 4.9 California School of Professional Psychology, San Diego, USA

DeGuire S, Gevirtz R, Kawahara Y, Maguire W, Hyperventilation syndrome and the assessment of treatment for functional cardiac symptoms, Am J Cardiol 1992 Sep 1; 70(6): 673-677. DeGuire S, Gevirtz R, Hawkinson D, Dixon K, Breathing retraining: a three-year follow-up study of treatment for hyperventilation syndrome and associated functional cardiac symptoms, Biofeedback Self Regul 1996 Jun; 21(2): 191198. 79


"Three methods of breathing retraining (guided breathing retraining, guided breathing retraining with physiologic monitoring of thoracic and abdominal movement plus peripheral temperature, and guided breathing retraining with physiologic monitoring of thoracic and abdominal movement, peripheral temperature and end-tidal carbon dioxide) were compared with a no-treatment control group to determine the effectiveness of breathing retraining on modifying respiratory physiology and reducing functional cardiac symptoms in subjects with signs associated with hyperventilation syndrome. Of 41 subjects studied, 16 were diagnosed with mitral valve prolapse. Results demonstrated that all 3 methods of breathing retraining were equally effective in modifying respiratory physiology and reducing the frequency of functional cardiac symptoms. Results determined that respiratory rate and subject's perception that training had generalized were the best predictors of treatment success. Furthermore, it was found that subjects with mitral valve prolapse responded as well to treatment as did those without prolapse" (abstract, DeGuire et al, 1992). Each person had 6 individual breathing retraining sessions over a 3-week period. During the first laboratory session, all of them were informed about respiratory physiology and the relation between hyperventilation and functional cardiac symptoms. The patients were shown diaphragmatic breathing and their practice was corrected by the experimenter. Although many patients reported discomfort with slow diaphragmatic breathing, they were encouraged to tolerate the discomfort and were reassured that their symptoms would disappear with time. The patients were carefully observed to ensure that they did not increase their tidal volumes. Later sessions were focused on correcting errors in diaphragmatic breathing and setting a slow-paced respiratory rate of less than 14 breaths per min. Average etCO2 in all 3 groups increased from about 35 to 40 mm Hg. It was of special interest to the authors, that some functional cardiac problems could be treated with breathing retraining by the normalisation of etCO2. Four years later, the researchers found that the positive effects of breathing retraining were still present in the tested subjects: “This study was designed to evaluate the long-term effects of paced diaphragmatic breathing on subjects who reported functional cardiac symptoms and who also demonstrated associated signs of hyperventilation syndrome. Subjects were a representative sample composed of 10 out of the original 41 subjects who had participated three years previously in a study designed to evaluate the short-term effects of breathing retraining on functional cardiac symptoms and respiratory parameters (respiratory rate and end-tidal carbon dioxide). The results of this follow-up study indicate that breathing retraining had lasting effects on both respiratory parameters measured. Subjects evidenced significantly higher end-tidal carbon dioxide levels and lower respiratory rates when compared to pretreatment levels measured three years earlier. Subjects also continued to report a decrease in the frequency of functional cardiac symptoms when compared to pretreatment levels. We conclude that breathing retraining has lasting effects on respiratory physiology and is highly correlated with a reduction in reported functional cardiac symptoms” (abstract, DeGuire et al, 1996). Medical professionals often interpret abnormal EKGs to be the result of certain organic conditions or damage to the heart. However, this and other experiments clearly pointed out that EKG results depend on the breathing pattern. When breathing is normal, so are the results. Over-breathing often produces certain abnormal EKG changes (see Chapter 1), in accordance with an individual’s predisposition.

_______ 4.10 Lothian Area Respiratory Function Service, City Hospital, Edinburgh, UK

Tweeddale PM, Rowbottom I, McHardy GJ, Breathing retraining: effect on anxiety and depression scores in behavioural breathlessness, J Psychosom Res 1994 Jan; 38(1): 11-21.

22 patients with behavioural breathlessness were selected for breathing retraining. The HVPT involved 3minute periods of rest, voluntary hyperventilation, and recovery. During an initial assessment special attention was paid to observing the existing breathing patterns of the patients (upper chest or abdominal breathing; nasal or oral breathing; presence of sighing, gulping, or yawning; and inappropriate patterns during speech), identification of hyperventilation-triggering situations and clinical details. During their 7 weekly visits to the laboratory, the patients were taught to develop awareness of their breathing patterns, to practice individual breathing exercises, to implement breathing control during speech, to develop control of hyperventilation-triggering situations, and finally, to achieve an effortless breathing pattern. As a result of such intervention, “both groups [with behavioural breathlessness and chronic fatigue] showed improvements in breathing patterns, end tidal CO2 levels and scores for HV-related symptoms which were sustained” 80


(abstract, Tweeddale, 1994). Moderate increase in BHT was noticed for the patients with lowest initial BHT values. The authors also made an important practical conclusion. “In any patient, if there is either resistance to the idea of breathing being related to symptoms, or lack of commitment to regular performance of breathing exercises or unwillingness to check out breathing patterns and exercise control during daily activities, breathing retraining is unlikely to be of benefit” (p. 20, Tweeddale, 1994).

4.11 Service de Psychosomatique, Hopital du Sacre-Caeur de Montreal, Quebec, Canada Monday J, Gautrin D, Cartier A, Chronic hyperventilation syndrome. The role of respiratory re-training [in French], Rev Mal Respir 1995; 12(3): 291-298. "This study compares three non-pharmacological approaches to the chronic hyperventilation syndrome (CHS). Eighteen subjects were evaluated at the start of the study then one and 6 months after having received in a random fashion one of the following treatments: group I (teaching approach of one hour on the respiratory physiology of the CHS and on breathing techniques; n = 5); group II (same approach as in group I with breathing retraining of 8 sessions; n = 8); group III (same as group II with the addition of a modified Jacobson's progressive relaxation; n = 5). Whereas all three groups had a similar symptomatic score at the beginning of the study (although subjects of group III had in general higher scores and were symptomatic for a longer period), our results show that all subjects improved after 4 weeks, those in group II showing the greatest improvement (p < 0.05). This confirms the relevance of applied and repeated pedagogy in approaching subjects with the CHS" (abstract, Monday et al, 1995).

4.12 Laboratory of Pneumology, U. Z. Gasthuisberg, Katholieke Universiteit Leuven, Belgium Han JN, Stegen K, De Valck C, Clement J, Van de Woestijne KP, Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders, J Psychosom Res 1996 Nov; 41(5): 481-493. "The effect of breathing therapy was evaluated in patients with hyperventilation syndrome (HVS). The diagnosis of HVS was based on the presence of several suggestive complaints occurring in the context of stress, and reproduced by voluntary hyperventilation. Organic diseases as a cause of the symptoms were excluded. Most of these patients met the criteria for an anxiety disorder. The therapy was conducted in the following sequence: (1) brief, voluntary hyperventilation to reproduce the complaints in daily life: (2) reattribution of the cause of the symptoms to hyperventilation: (3) explaining the rationale of therapy-reduction of hyperventilation by acquiring an abdominal breathing pattern, with slowing down of expiration: and (4) breathing retraining for 2 to 3 months by a physiotherapist. After breathing therapy, the sum scores of the Nijmegen Questionnaire were markedly reduced. Improvements were registered in 10 of the 16 complaints of the questionnaire. The level of anxiety evaluated by means of the State-Trait Anxiety Inventory (STAI) decreased slightly. The breathing pattern was modified significantly after breathing retraining. Mean values of inspiration and expiration time and tidal volume increased, but end-tidal CO2 concentration (FETCO2) was not significantly modified except in the group of younger women (< or = 28 years). A canonical correlation analysis relating the changes of the various complaints to the modifications of breathing variables showed that the improvement of the complaints was correlated mainly with the slowing down of breathing frequency. The favorable influence of breathing retraining on complaints thus appeared to be a consequence of its influence primarily on breathing frequency, rather than on FETCO2" (abstract, Han et al, 1996). This study involved 92 patients diagnosed with hyperventilation syndrome. However, the work of the physiotherapists was not targeted to decrease ventilation of the subjects and to raise their CO2 values. The article states, that "the therapy consisted of: (1) a reattribution of the threatening symptoms to faulty breathing habits; and (2) training of slow breathing and learning to use the diaphragm more (abdominal breathing) and less the upper part of the thorax" (p. 482, Han et al, 1996). Results of the therapy revealed that the patients acquired a slow deep breathing pattern. Their average tidal volume rose from abnormal 740 ml/breath (the norm is about 500-600 ml/breath) to 880 ml/breath, while etCO2 was almost unchanged (4.76% before and 4.84% after the treatment). Normal etCO2, according to most medical sources, is about 40 mm Hg or 5.25% CO2 at sea level. 32 patients improved markedly, according to their questionnaires, and were feeling well. Meanwhile, several

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symptoms related to hyperventilation did not improve at all after the treatment. These included "confusion or feeling of losing contact with surroundings, feeling of faster and deeper breathing, bloated abdomen, stiff fingers or arms, tightness around the mouth, and cold hands or feet" (p. 485, Han et al, 1996). That should not be a surprise, since the main problem (hyperventilation or low aCO2) was not identified and resolved in this study.

4.13 New Zealand Guidelines Group The New Zealand Guidelines Group is a large group of medical professionals, including numerous professors and physicians (for more details visit their website at http://www.nzgg.org.nz). The Chairman of the group is Norman Sharpe, Head of the School of Medicine in the University of Auckland. In their “Guidelines for Assessing and Treating Anxiety Disorders, Appendix 6: Slow Breathing Exercise”, the Group states, “You will remember that when you get anxious your rate of breathing increases. This over-breathing is often referred to as 'hyperventilation'. When you over-breathe you breathe out too much carbon dioxide which leads to a decrease in the level of carbon dioxide in the blood. The decreased level of carbon dioxide causes or worsens a number of symptoms such as breathlessness or light- headedness. You may experience these symptoms if you have panic attacks. To get rid of these symptoms, the level of carbon dioxide in the blood must be increased and steadied. One way of achieving increased levels of carbon dioxide is to breathe into a paper bag. A large portion of the air you breathe out is carbon dioxide, therefore, by rebreathing your old air you are taking higher amounts of carbon dioxide into your lungs. Although breathing into a paper bag is simple and effective, it may not always be convenient or socially appropriate to pull out a paper bag in public! Additionally, although breathing into a paper bag is effective during a panic attack, this method cannot prevent hyperventilation in the future. An alternative method which is less obvious to other people and more effective in the long run is the slow breathing exercise. This method will help you to control your hyperventilation. Also, by learning slow and regular breathing habits you will help to prevent future episodes of hyperventilation and other symptoms of panic. The following exercise is to be practised four times every day for at least five minutes each time, AND at the first signs of panic or anxiety. Combining slow breathing with relaxation is particularly helpful. SLOW BREATHING EXERCISE (TO BE PRACTISED REGULARLY AND AT THE FIRST SIGNS OF ANXIETY OR PANIC). If you recognise the first symptoms of over-breathing, STOP what you are doing and sit down or lean against something. If you are driving, pull over and park in a safe place. 1. Hold your breath and count to 5 (do not take a deep breath). 2. When you get to 5, breathe out and say the word 'relax' to yourself in a calm, soothing manner. 3. Breathe in and out slowly through your nose in a six second cycle. Breathe in for three seconds and out for three seconds. This will produce a breathing rate of 10 breaths per minute. Say the word 'relax' to yourself every time you breathe out. 4. At the end of each minute (after 10 breaths) hold your breath again for 5 seconds and then continue breathing using the six second cycle. 5. Continue breathing in this way until all the symptoms of over-breathing have gone. It is important for you to practise this exercise so that it becomes easy to use any time you feel anxious. (Treatment Protocol Project 1997) Among considered methods of breathing retraining, this is the only Western study that involves breath holding as a method of CO2 accumulation.

_______ 4.14 Stanford University, Palo Alto, USA

Meuret AE, Wilhelm FH, Roth WT, Respiratory biofeedback-assisted therapy in panic disorder, Behav Modif 2001 Sep; 25(4): 584-605.

The value of this small study (only 4 patients) is that after the treatment all patients were “below the clinical threshold for the diagnosis of panic disorder” (p. 596, Meuret et al, 2001). The patients performed 5 mild HVPT, each 3 min long. These tests were followed by 8 min quiet sitting 82


period. The therapy had 5 individual sessions, each about 80 min long, over the course of 4 weeks. The major components of the therapy were: - education about hyperventilation and its central role in the mechanism of the panic attack; - teaching techniques to control respiration; - directing attention to dangerous breathing patterns; - instruction in home breathing exercises. Home assignments were performed twice per day, each about 20 min long. The abstract of the publication states, “The authors describe a new methodologically improved behavioral treatment for panic patients using respiratory biofeedback from a handheld capnometry device. The treatment rationale is based on the assumption that sustained hypocapnia resulting from hyperventilation is a key mechanism in the production and maintenance of panic. The brief 4-week biofeedback therapy is aimed at voluntarily increasing self-monitored end-tidal partial pressure of carbon dioxide (PCO2) and reducing respiratory rate and instability through breathing exercises in patients' environment. Preliminary results from 4 patients indicate that the therapy was successful in reducing panic symptoms and other psychological characteristics associated with panic disorder. Physiological data obtained from home training, 24-hour ambulatory monitoring pretherapy and posttherapy, and laboratory assessment at follow-up indicate that patients started out with low resting PCO2 levels, increased those levels during therapy, and maintained those levels at posttherapy and/or follow-up. Partial dissociation between PCO2 and respiratory rate questions whether respiratory rate should be the main focus of breathing training in panic disorder” (abstract, Meuret et al, 2001).

4.15 Common features of Western methods of breathing retraining • Usefulness or necessity of the HVPT (hyperventilation provocation test) Most authors used the over-breathing test and indicated its necessity for the successful outcome of their therapy. Indeed, since many patients (usually over 90%) could recognize their symptoms during the test, these patients realised the cause of their problems (excessive breathing). It is normal to expect that this important practical discovery should immediately bring relief to many patients since anxiety (fear of the unknown) was greatly reduced. In addition, this insight created a better relationship with their doctors that was based on trust, as well as it also sparked a strong interest and enthusiasm of the patients that they would soon be able to play an important role in solving their own problems. When this test was not done, many patients would continue to have reasonable doubts about the value of the whole therapy and the doctors' ability to help. The crucial difference between these two situations (with and without the test) is the positive change in attitude of the patients towards the suggested approach. • Awareness about normal and abnormal breathing patterns The patient must learn the main characteristics of normal and abnormal breathing patterns in order to recognise them in every day life. First, it was explained to the patient that behaviours leading to hyperventilation cause a reduction in carbon dioxide stores. These behaviours included coughing, sneezing, sighing, sniffing, and chest inflation. In order to become healthy, all of those abnormal behaviours must be stopped or prevented. Second, it was important for the patient to know the features of thoracic and diaphragmatic breathing. Diaphragmatic breathing could be characterised by the following adjectives: smooth, quiet, slow, and regular. Thoracic (chest) breathing, on the other hand, is often uneven, noisy, fast, and irregular. • Relaxation Since tension is a normal response to stress and hyperventilation, one can conclude that relaxation, due to a feedback mechanism, reduces minute ventilation, decreases pulse rate, and raises carbon dioxide concentrations. Therefore, relaxation is a valuable therapeutic tool in reducing hyperventilation and in improving one’s health as numerous studies of various medical conditions have validated. Moreover, relaxation can be useful in eliminating the negative consequences of stress, hyperventilation, and their subsequent abnormal physiological changes. In particular, the reduction of tension in the large skeletal muscles, especially of the chest-shoulders-neck-jaws region, results in more calmness and easier breathing. • Diaphragmatic breathing Many authors suggested to their patients that they use the instructions of physiotherapists in order to learn diaphragmatic breathing. Two previously discussed features, which are the awareness of normal and abnormal

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breathing patterns, as well as relaxation, could be considered both the theoretical preparation and the first practical steps in acquiring a normal diaphragmatic breathing pattern. • Durations of daily sessions and the therapy The typical duration of recommended daily sessions was from 20 min to 1-2 hours, in addition to a daily regime of breathing control. Are there any physiological grounds for such programs? The breathing centre has two groups of specialized cells (chemoreceptors) which monitor carbon dioxide and oxygen concentrations (Chapter 2). One group is located near the main arteries close to the heart, and the other in the medulla of the brain. Those cells, which are located near the heart (the peripheral chemoreceptors), can detect changes in carbon dioxide levels in arterial blood in less than a second. Indeed, these cells are in contact with the arterial blood leaving the heart. Therefore, their adaptation and training starts and finishes almost immediately with a voluntary reduction in ventilation. Thus, they are being retrained while simultaneously the person breathes less. (The adaptation of these cells to acute carbon dioxide changes during breath holding causes the “training effect” discussed in chapter 2). The second group of cells located in the brain (the central chemoreceptors) is bathed in the CSF (cerebrospinal fluid). Their trainability depends on carbon dioxide pressure and the pH of CSF. Hence, it is important to know how CO2 in the arterial blood influences CO2 and pH concentrations in the CSF of the brain, since these fluids are separated by a blood-brain barrier. It is a well-established fact that this barrier allows only certain substances to cross it and only at particular rates. What would be the time required for an increase in arterial CO2 to penetrate this barrier in order to influence the cells located in the main part of the breathing centre? There were several studies by physiologists and neurologists devoted to this subject. Measurements of carbon dioxide tension on the cerebral cortex in anaesthetized cats revealed that this parameter reaches a plateau in 5-10 min after aCO2 in the blood experience a 5-10% absolute increase (Seisjo, 1961). In another series of experiments with anaesthetized rats, brain tissue CO2 had an exponential increase, with half-time 6-7 min, as a response to 1 mm Hg CO2 pressure increase in inspired air (Seisjo, 1963). Other physiologists recorded 12 min in maximum specific activity of CO2 isotopes in the brain after their appearance in the blood of rabbits (Coxon & Swanson, 1965). Finally, a more recent investigation found that "changes in pH and pCO2 with hyperventilation and hypoventilation occurred rapidly in both arterial blood and CSF. Steady state values were reached within 15 min for hypoventilation and 30 min for hyperventilation... These results are consistent with previous research" (abstract, Andrew et al, 1994). Therefore, it would be reasonable to assume that about 10-15 min is required in order to achieve maximum influence on the central chemoreceptors of the breathing centre. The optimum duration of this influence (how long it will continue) would probably depend on the amplitude of the change and current trainability of the breathing centre. Too long time of the session would lead to fatigue and other unpleasant symptoms. The recommended length of supervised therapies was from 1 to 3 months, while unsupervised sessions at home would take more time. Meanwhile, most patients experienced decisive improvement in their health during the supervised part. • Respiratory rate Increased initial breathing frequencies of patients participating in these therapies were commonly noticed. Most authors suggested to their patients to practice slower breathing patterns in order to derive the assumed benefits of reduced ventilation and increased aCO2. However, from section 2.2 we know that, when people are asked to voluntarily decrease their respiratory rate, while having naturally regulated breathing, a slow deep breathing pattern is the likely outcome. However, we also know that most hyperventilators already have deep breathing. Is there any likelihood that some of them may start to breathe even deeper after these exercises as a result of such breathing practice? Probably, for just such a possibility prompted Bonn along with his colleagues to suggest that "any relaxation technique that entails the use of deep breathing is contraindicated, since it will probably exacerbate hypocapnia [low aCO2]" (p.668, Bonn et al, 1984). Furthermore, researchers from Stanford University (Meurel et al, 2001) directly questioned (see above) whether the respiratory rate should be the main focus of breathing training. Professor Ley expressed similar ideas (quoted above). Indeed, the main goal of all these therapies was to normalise (increase) carbon dioxide values by diminishing ventilation, or in other words, by breathing less while at the same time experiencing relaxation. That, by itself indeed, is not an easy task, as it requires the persistent use of patient's concentration and will power. In addition, monitoring

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one’s breathing frequency may only result in deeper breathing, causing further tension and more over-breathing. All of this calls for learning to create a delicate balance between both consistent and relaxed effort. There also is one technical aspect involving the use of capnometers. As the reader may remember these devices measure end-tidal CO2 in the expired air. In normal conditions this value is close to the carbon dioxide pressure in the lungs and arterial blood. However, many studies revealed that, in cases of deep breathing or prolonged exhalations, the difference between end-tidal and arterial CO2 gets larger when compaed to normal conditions (Jones et al, 1979; Robbins et al, 1990). Jones and colleagues, for example, found that in different exercise conditions “PETCO2-PaCO2 varied between -2.5 and +9.1 Torr [1 Torr = 1 mm Hg], was inversely related to the frequency of breathing (r = 0.475), and directly related to tidal volume” (abstract, Jones et al, 1979). Hence, the slower the breathing, the larger the difference; and the deeper the breathing, the larger the difference. As a result, in cases of slow deep breathing, the reading of capnometers significantly over-estimates arterial CO2 tension. That creates the illusion that carbon dioxide in the blood and in the whole organism is increasing, whereas real values may in fact remain unchanged or even decrease. • Drug-free nature of therapies Only the earliest study (Kerr et al, 1937), conducted before World War II, relied on the use of chemical substances in order to normalize ventilation and aCO2. Other therapies were drug-free and some authors claimed that drugs were useless when working towards breathing normalization. This commitiment to the use drug-free procedures is what makes these breathing methods different from the traditional approaches practiced and advocated by most medical authorities and doctors. There are many known problems with drugs. In the next section, one of the crucial differences between a traditional drug-based approach and any drug-free therapy is discussed. • Acquisition of control over own health by the patients Let us consider two possible scenarios in which patients seek help for their disease: in one situation, the doctor administers a drug, while in the other, a natural approach is recommended, which requires a change in personal habits, priorities, and routines. Modern medicine usually cannot give a clear explanation as to what causes patient's problems, and therefore, most suggested solutions are useless. The well-meaning doctor often will rely on drugs as a solution. The problems with drugs are numerous and well-documented. A few of those drugs have survived several decades and are still prescribed. A typical scenario is as follows: The patient arrives at the doctor's office with his complaints. The doctor listens, asks question, thinks about the problem, conducts tests, make a diagnosis, and prescribes a chemical substance, which is foreign to the human body. The patient innocently accepts the doctor’s approach because he has little understanding of the nature of the problem. What he does know is that his disease is said to result from a combination of stress, genetics, a deteriorating environment and other factors, all of which are typically outside of his control. The doctor rarely suggests a natural approach (diet, exercise, relaxation, etc.). Instead, the latest miracle drug, recently approved by medical authorities, becomes the key to the treatment. After taking the drug for months or years (if he survives), the patient may realise that it does not work or that it even causes his health to deteriorate further. By that time, this "new" wonder drug may be withdrawn (as many are), or banned due to dangerous side-effects. Nevertheless, the well-meaning doctor is still dispensing the ‘miracle’ pill. The role of the pill is to fuel the imagination and hopes of the excited, hyperventilating patient. Retraining one’s breathing is, in contrast, a natural therapy based on ideas, some of which are expressed in Chapter 1. If this natural approach is accepted by the patient, he then realizes that his breathing was and is the cause of his problems. It is possible that some patients may still dream of a miracle cure. Consequently, breathing retraining, as compared to other methods of treatment, provides the student with the ability to impact the development of his disease with practical coping strategies, which when combined with the patient’s self-discipline, persistence, and determination, can indeed provide a way to recover. • High success rates Most cited studies report a high rate of success, indicating that their patients were soon enjoying easier breathing. Is it always a normal outcome? How long does it take practically to restore normal breathing? As mentioned above, the patients chosen for these experiments did not have any organic damage according to preliminary screening investigations. Therefore, their progress often took only a few weeks or months. However, longer time was required for people who had certain damaged or abnormal organs and tissues.

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Q&A section for Chapter 4 Q: Why are these therapies used mainly for patients diagnosed with panic attacks and hyperventilation syndrome when most other sick people also over-breathe? A: Historically, capnometers (devices to measure CO2 in exhaled air) became popular among psychologists. In addition, there is an almost direct relationship between hyperventilation and panic attacks. It takes longer time for the development of an asthma attack, cholesterol deposits, tumours and certain other pathological tissues and phenomena. With regards to other patients, it is indeed reasonable to ask medical authorities, "Why not treat modern patients with different chronic degenerative conditions from their hyperventilation and then see what happens with their symptoms and complaints, when their breathing is normalized in accordance with medical standards?" Q: Is pursed-lip breathing helpful? A: Pursed-lip breathing involves exhalation against partially closed (pursed) lips, as if one is getting ready to whistle. This technique is supposed to prevent bronchiolar collapse and includes small inhaled breaths and a long pursed-lip exhalation. Its use is advised during exercise and panic attacks. One study of patients with cystic fibrosis managed to demonstrate improved FEV (forced expiratory flow) and FVC (forced vital capacity) (Delk, 1994) without any improvements in their quality of life. Patients with COPD (chronic obstructive pulmonary disease) after pursed-lip breathing sessions increased their exercise performance, while making their blood gases at maximum speed worse (Casciari, 1981). In my view, pursed-lip breathing, pranayma and some other slow deep breathing exercises can be very beneficial for certain groups of people (e.g., with heart disease and sleep apnea) during certain stages of breahing retraining. However, it should be kept in mind, that restoration of normal breathing reuires a program of actions that addresses all the essential factors causing chronic hyperventilation, including strictly nasal breathing, prevention of sleeping on the back, etc.

References for chapter 4 Ambrosino N, Paggiaro PL, Roselli MG, Contini V, Failure of resistive breathing training to improve pulmonary function tests in patients with chronic obstructive pulmonary disease, Respiration 1984; 45(4): 455-459. Andrew RJ, Bringas JR, Alonzo G, Cerebrospinal fluid pH and pCO2 rapidly follow arterial blood pH and pCO2 with changes in ventilation, Neurosurgery 1994 March, 34 (3): 466-470.

_______ Bonn JA, Readhead CP, Timmons BH, Enhanced adaptive behavioural response in agoraphobic patients pretreated with breathing retraining, Lancet 1984 Sep 22; 2(8404): 665-669. Casciari RJ, Fairshter RD, Harrison A, Morrison JT, Blackburn C, Wilson AF, Effects of breathing retraining in patients with chronic obstructive pulmonary disease, Chest 1981 Apr; 79(4): 393-398. Clark DM, Salkovskis PM, Chalkley AJ, Respiratory control as a treatment for panic attack, J Behav Ther Exp Psychiatry 1985 Mar; 16(1): 23-30.

Coxon RV & Swanson AG, Movement of (14)C bicarbonate from blood to cerebrospinal fluid and brain, J Physiol (London) 1965, 18: 712-727. DeGuire S, Gevirtz R, Kawahara Y, Maguire W, Hyperventilation syndrome and the assessment of treatment for functional cardiac symptoms, Am J Cardiol 1992 Sep 1; 70(6): 673-677. 86


DeGuire S, Gevirtz R, Hawkinson D, Dixon K, Breathing retraining: a three-year follow-up study of treatment for hyperventilation syndrome and associated functional cardiac symptoms, Biofeedback Self Regul 1996 Jun; 21(2): 191198. Delk KK, Gevirtz R, Hicks DA, Carden F, Rucker R, The effects of biofeedback assisted breathing retraining on lung functions in patients with cystic fibrosis, Chest 1994 Jan; 105(1): 23-28. Fensterheim H, Wiegand B, Group treatment of the hyperventilation syndrome, Int J Group Psychother 1991 Jul; 41(3): 399-403. Grossman P, de Swart JCG, Defares PB, A controlled study of a breathing therapy for the treatment of hyperventilation syndrome, J Psychosom Res 1985; 29 (1): 49-58. Han JN, Stegen K, De Valck C, Clement J, Van de Woestijne KP, Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders, J Psychosom Res 1996 Nov; 41(5): 481-493. Jones NL, Robertson DG, Kane JW, Difference between end-tidal and arterial PCO2 in exercise, J Appl Physiol 1979 Nov; 47(5): 954-960. Kerr WJ, Dalton JW, Gliebe PA, Some physical phenomena associated with the anxiety states and their relation to hyperventilation, Ann. Int. Med 1937, 11: 962-992. Ley P, The efficacy of breathing retraining and the centrality of hyperventilation in panic disorder: a reinterpretation of experimental findings, Behav Res Ther 1991; 29(3): 301-304. Meuret AE, Wilhelm FH, Roth WT, Respiratory biofeedback-assisted therapy in panic disorder, Behav Modif 2001 Sep; 25(4): 584-605. Lum LC, Hyperventilation: The tip and the iceberg, J Psychosom Res 1975; 19: 375-83. Lum LC, The syndrome of habitual chronic hyperventilation, in Modern Trends in Psychosomatic Medicine, edited by OW Hill, Butterworth, London, 1976, vol 3: 196-230. Magarian GJ, Hyperventilation syndrome: infrequently recognized common expressions of anxiety and stress, Medicine 1982; 61: 219-36. Magarian GJ, Middaugh DA, Linz DH, Hyperventilation Syndrome: a diagnosis begging for recognition, West J Med 1983; 38: 733-736.

_______ Monday J, Gautrin D, Cartier A, Chronic hyperventilation syndrome. The role of respiratory re-training [in French], Rev Mal Respir. 1995; 12(3): 291-298.

Robbins PA, Conway J, Cunningham DA, Khamnei S, Paterson DJ, A comparison of indirect methods for continuous estimation of arterial PCO2 in men, J Appl Physiol 1990 Apr; 68(4): 1727-1731.

Ruiter de C, Ryken H, Garssen B, Kraaimaat F, Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia, Behav Res Ther 1989; 27(6): 647-655.

Seisjo BK, A method for continuous measurement of the carbon dioxide tension on the cerebral cortex, Acta Physiol Scand 1961, 51: 297-313.

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Seisjo BK, The equilibration of (14)CO2 with the acid labile CO2 of brain tissue, J Physiol (London) 1963, 168: 5960P. Tweeddale PM, Rowbottom I, McHardy GJ, Breathing retraining: effect on anxiety and depression scores in behavioural breathlessness, J Psychosom Res 1994 Jan; 38(1): 11-21.

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Chapter 5. History and advance of the Buteyko breathing method Introduction This chapter, first, gives a short history and information about the theoretical findings and practical work of Doctor Buteyko and his pupils in Russia and abroad. Later, some basic features and trials of the Buteyko breathing method are considered.

5.1 Some historical facts about the origins of the method Doctor Buteyko received his medical degree from the First Medical Institute in Moscow, where he studied from 1946 to 1952. During this period he had a medical practice attending and dealing with severely sick and critically ill patients. A series of events helped him to realize the connection between the respiration and health of patients with hypertension, angina pectoris, asthma, and some other serious diseases. He noticed that with approaching death, patients’ respiration got heavier. By visual observation of patients’ breathing in the hospital, he could predict how many days or hours of life were left. Later he discovered that deliberate acute hyperventilation (which we explored as the HVPT or hyperventilation provocation test in previous chapters) quickly worsened the health of patients, while breathing less caused elimination of their symptoms. Buteyko also confirmed these findings in his own problem, hypertension. He then decided to devote his life to studying respiration, in general; and CO2 properties, in particular. After graduation with Honours, in 1952, he joined the Department of Clinical Therapy of the same institute, working as the manager of the Laboratory of Functional Diagnostics in Moscow. Among his concerns were lack of qualified personnel, inadequate equipment, and financial problems. He then had more time to study western publication about breathing. During these years the Soviet state was developing the unique program of outer space exploration for the first space missions. It was of exceptional importance to know and study effects of air parameters (air pressure and its composition) on human health. Hence, Soviet officials were looking for bright young scientists who could lead such projects in physiology and medicine. At the end of 1950’s he was chosen to head such a project in Novosibirsk. Due to importance attached to the project, his laboratory was provided with the best available equipment and best qualified support. Obviously, in this research, as, for example, in any similar NASA research, its people and facilities were heavily guarded by Soviet state officials, including KGB agents. The aims of this research included: - finding optimum air parameters for human functioning during space missions depending on the stage of the flight and initial parameters of astronauts; - breathing of healthy and sick people and interactions between various diseases and respiration; - effects of various environmental factors (sleep, sleeping postures, exercise, posture, meals, diets, daily activities, temperature, thermoregulation, emotions, etc.) on breathing and health. Thus, in 1960 Buteyko became the manager of another Laboratory of Functional Diagnostics organised at the Institute of Experimental Biology and Medicine in Novosibirsk. Buteyko created in his laboratory a unique diagnostic complex, which included several physiological devices to measure 40 important health parameters in real time (or with each breath). According to Buteyko and Dyomin, “One such investigation, lasting about 1 hour, produces about 2,000 recordings of 40 main parameters of respiratory and cardiovascular processes, resulting in about 100,000 numbers…” (Buteyko & Dyomin, 1963). These parameters included pulse, EKG, blood pressure, tidal volume, respiratory rate, minute ventilation, arterial and venous blood gases and chemical analysis of the expired air. The complex produced many thousands of measurements per hour, analysed by a computer. The unique features of this complex were described in the Soviet magazine “Inventor and Efficiency Expert” (Inventor and Efficiency Expert, 1961; Buteyko 1961; Buteyko, 1962). Some characteristics and abilities of this machine were also reported in more than 20 scientific articles written by Buteyko with his colleagues and published in medical, physiological and diagnostic magazines and conference proceedings. Research with the use of this complex was done from 1960 to 1968. That allowed Buteyko to receive information about physiology and respiration of the human organism in health and disease and relationships between respiration and different factors, including those described in chapters 2 and 3.

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Photo 1. This is the unique diagnostic complex created in 1960s for USSR’s first space missions in the Laboratory of Functional Diagnostic in Novosibirsk headed by Doctor Buteyko. The volunteers were to breathe air with varying composition. About 40 physiological parameters of the body were measured by the complex in real time 24/7, thousands of numbers every hour, literally with each breath of the person. The information was recorded and analyzed by a computer. Simultaneously Doctor Buteyko studied the interactions between breathing and diseases, breathing and life style factors and other breathing-related and CO2-related challenges. Not only did he brilliantly conduct and complete these studies funded and initiated by the USSR’s Ministry of Aviation and Space Exploration, he also discovered and practically confirmed the fundamental role of breathing in development and treatment of various health conditions, including asthma, bronchitis and heart disease. Given the confidential nature of the project, it was normal that many results remained classified for years. (Compare Buteyko’s situation with the situation of the famous Oxford Professor John Haldane, who was hired in 1920-1930’s by British Navy to study air in submarines and whose name then disappeared from the world scientific community.) This, however, was not the case with Buteyko and his colleagues. They had dozens of publications in open Soviet literature (in Russian) about their research in 1960’s. Moreover, in 1990’s Buteyko and his numerous pupils were able to travel in Western countries and share the word about the Buteyko method and his discoveries.

_______ 5.2 Breathing and modern diseases

Let us now consider and analyse some ideas and hypothesis discovered by Doctor Buteyko. They can be found in his scientific publications and articles, and described during his interviews and public lectures. Most patients (over 90 %) with a variety of modern chronic health problems (“diseases of civilization”) hyperventilate and have chronically low aCO2 (Buteyko & Shurgaya, 1965; Buteyko, 1969, 1972; Buteyko et al, 2005a, 2005b).

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Acute overbreathing worsens their health state, while reduced breathing improves it (Buteyko & Shurgaya, 1965; Buteyko, 1969, 1972; Buteyko et al, 2005a, 2005b). Chronic forms of the “diseases of civilizations” are impossible without dis-regulation of external respiration (Buteyko, 1969, 1972; Buteyko et al, 2005a, 2005b) Development of these diseases is proportional to the degree of hyperventilation. The lower the aCO2 and BHT, the worse the health of the patient (Buteyko, 1969, 1972; Buteyko et al, 2005a, 2005b). The health state of a person can be defined by own BHT and alveolar CO2 in accordance with the following table (Buteyko 1969, 1972, 1991; Buteyko et al, 2005a, 2005b)

BHT %CO2

Superhealth

Normal health

> 60 s > 6.5 %

40-60 s 5.5-6.5 %

1-st stage of the disease 20-40 s 4.5-5.5 %

2-nd stage of the disease 10-20 s 4.0-4.5 %

3-rd stage of the disease <10 s < 4.0 %

DEATH

Restoration of normal breathing is equal to elimination of these diseases and their symptoms (Buteyko, 1969, 1972; Buteyko et al, 2005a, 2005b) Studies of Russian doctors practicing the Buteyko method, as well as Western publications, reveal that over 150 health conditions relate to heavy breathing, or are possible only in conditions of hyperventilation. These are less than 1% of all health pathologies (about 30,000) currently known to the medical science. “I hear a whisper of indignation and joy: “So, are all diseases from deep breathing?” No, not all. Deep breathing causes one single disease: the disease of deep breathing. It causes a wide spectrum of pathologies. Why? It interrupts the metabolism of the substances – the foundation of life in all cells. These or other symptoms are manifested, and their strong expression is qualified as disease… “(Buteyko, 1977). The theory suggested by Buteyko has some restrictions and cannot completely describe all physiological processes in the following cases: infectious diseases; severe psychological abnormalities; traumas; extreme states due to intoxication, poisoning, radiation, and reanimation; aging; unconscious states; childbirth; sex; and cancer (Buteyko et al, 2005a; Buteyko et al, 2005b). However, application of the Buteyko method allows natural regulation and normalization of these and many other physiological processes. According to the book “Buteyko’s cure” (“Istcelenie po Buteyko”) compiled by the Moscow Buteyko clinic, “1. Essence of the discovery. The essence of the Buteyko’s discovery consists of the idea that during deep breathing too much CO2 is removed from the body. This causes changes in the homeostasis, which are partially neutrloised by various compensatory mechanisms. The developing disbalance of homeostasis, accumulating during long periods of time (for a fetus due to breathing of the mother) leads to disruption of previous biosyntheses and other processes. The symptoms of the patients with carbon dioxide deficiency is worsened due to defensive reactions of the organism, which are expressed in disruptions of the respiratory and cardiovascular systems. However, it is necessary to say that should these defensive reactions, worsening the symptoms, be absent, the death of the person would take place much sooner. 2. The first proposition of the theory. …Respiratory alcolosis is accompanied, as a ruler, by the state of oxygen deficiency,…which leads to appearance of incompletely oxidised products of metabolism, and, hence, to development of metabolis acidosis, which partially compensate pH fluctuations, caused by by the respiratory alcolosis, although it should be noted, that this sompensation is not complete. As a result of these processes, there are following changes in the organism: 1) the electrolytic composition of the extracellular fluid is changes; 2) pH of the extracellular fluid is changes; 3) since the cells are participants of the pocess of pH normalization, their pH changes; 4) since the kidneys try to normalise the PH and remove HCO3, the buffer abilities of blood plasma is reduced; 5) due to changes in the ratio HCO3 of the cell wo HCO3 of the plasma, the rate of diffusion of HCO3 from the cell to

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plasma is changed; 6) [Haemoglobin cells can not release oxygen with the same efficiency.] 7) Synthesis of aminoacids, nitrous bases, lipids, and carbohydrates is disrupted. The results of these changes are: 1. disruption of synthesis of proteins, peptides, nucleoacids, lipids, and carbohydrates; 2. disruption in the work of enzymes, due to changes in pH, changes in the rate of carboxolozation; 3. changes in the energy production of the organism (decreased synthesis of ATP)…” (p. 247, Buteyko’s cure, 2000).

5.3 Development of specific health problems Let us look at the suggested mechanisms of developments of particular health conditions. • Asthma Doctor Buteyko claimed that he knew since 1952 that chronic hyperventilation was the cause of asthma. This was his clinical observations. Normally, during later years it was merely a technical matter for him to establish the causes of asthma. Low aCO2, due to chronic hyperventilation, resulted in chronic moderate bronchoconstriction and abnormal sensitivity of the immune system in relation to various substances or processes (Buteyko, 1964; Buteyko & Odintsova, 1968; (Buteyko, 1977). The final triggers, in order for asthma attack to take place, can be overeating, exercise, allergens, stress, overheating, and other factors which cause autoimmune response in airways, further intensification of respiration, more bronchoconctriction, production of extra mucus, chest tightness, wheezing and other negative effects. Peter Kolb’s web site (http://members.westnet.com.au/pkolb/buteyko.htm ) contains large amounts of practical and theoretical information about asthma, hyperventilation, carbon dioxide, the Buteyko method and its development. Practical evidence and Western clinical trials (see below) suggest that the Buteyko method is successful in dealing with asthma. Normalization of breathing and maintenance of normal CO2 values for certain time leads in elimination of abnormal immune and allergic reactions in former asthmatics. As a result, they have clinical remission and usually can lead normal (in relation to work, diet, exercise, and exposure to allergens) lifestyle. For more details about asthma one may visit the website of the Buteyko Clinic in Moscow (www.buteykoclinic.ru). While Russian practice and Western trials demonstrate the power of the Buteyko method for asthma, it is still unclear what the immunological mechanisms and biochemical causes of its success are. There are certain known CO2 effects discussed above. These CO2-related effects provide the foundation for appearance of asthma. Apart from that, there are other possible causes known to those who are teaching or learned the Buteyko method. What are these? • Prevention of asthma attacks by reduced breathing and relaxation, instead of using reliever medication, provides patients with the sense of control. Since psychological component and accompanying feeling of helplessness were essential parts of asthma attacks in the past, what are the changes on psychological, neurological, biochemical and other levels? How strong are they? • Since many asthmatics are mouth breathers and since nasal breathing provides them with dilator of small blood vessels nitric oxide. What is the influence of nitric oxide when asthmatics patients start breathing through the nose? Does it play a role for those patients who is able to stop their morning asthma attacks (4-6 a.m.) by taping their mouth for continuous nasal breathing? Does nasal breathing reduce irritation of air passages in comparison with mouth breathing? • The effects of transition to diaphragmatic breathing are also poorly investigated. The role of this factor should not be underestimated since abnormal breathing pattern is predominant feature for people with asthma. • Duration of inhalations in many asthmatics are longer than their exhalations. These phases, at the same time, are controlled by parasympathetic and sympathetic parts of the autonomous nervous system. If the therapy reverses the lengths of these phases (exhalations becomes longer), does it affect autonomous nervous system and how? • Similarly, what are the effects of correct posture and relaxation on various components and parameters of the disease? Apart from these general questions, the biochemical and immunological changes due to changes in breathing are poorly understood areas. There are just few limited Russian unpublished studies indicating normalisation of IgA, IgE, IgG, and IgM concentrations as a result of breathing retraining in a small group of children. What are the effects of chronic hyperventilation on the mechanisms of inflammation and allergy? Are the effects of leukotrines on airways

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are different in conditions of chronic hypocapnia for asthmatics? What is the role of mast cells, basophils, eosinophils, and T lymphocytes? Can chronic hyperventilation be a triggering factor in imbalance of helper T cell Type 1 and 2 immune responses? More general question can relate to interaction between respiration and immune responses. Hyperventilation is a defensive reaction and a part of the “flight-or-flight” response, or a state of increased alertness and emergency for the whole organism, the immune system included. It is possible to hypothesise that the immune system should be in the state of increased sensitivity, when certain agents can provoke strong immune reactions. Which immune reactions do become abnormal? How do they appear? Why only asthmatics get certain abnormal processes and cascades of events? There are many other theoretical and practical questions that can help us to better understand the underlying mechanism of asthma pathology and create the optimum program for management of this disease. • Hypertension and angina pectoris Due to his own health concerns, Buteyko had keen interest in cardiovascular problems. According to his public lecture, “In 1952 I had blood pressure of 220-120, headaches, insomnia, and heartaches. Since my professional occupation was the general form of malignant hypertension, I predicted my remaining life span to be about 1.5 years” (Buteyko, 1970). During the 1960’s, while testing patients at his diagnostic complex, Doctor Buteyko, together with his colleagues, found relationships between aCO2 and parameters of the cardiovascular system. In particular, they found that low aCO2 causes low tone and spasmodic conditions in small arterial blood vessels and capillaries (Buteyko et al, 1964a; Buteyko et al, 1964b; Buteyko et al, 1965; Buteyko, 1968) and the relationship between aCO2 and blood cholesterol level for people with hypertension (Buteyko et al, 1965). Practically, for each 0.1% decrease in CO2 (due to chronic over-breathing) there is a resulting increase of 10 mg/dL of cholesterol, for those people who are genetically predisposed to cholesterol deposits. These results are consistent with our findings from chapter 1 and other Western studies. For example, we already know that chronic over-breathing normally causes tissue hypoxia and decreased blood supply to various vital organs. In particular, blood flow to the heart itself is found to be smaller in numerous animal experiments (for example, see Gelman et al, 1985; Karlsson et al, 1994). Such adverse conditions were observed by many Western doctors (see Chapter 1) and cause various cardio-vascular problems listed in chapter 1, including hypertension and angina pectoris. While these heart conditions were investigated in Russia, no studies or trials were attempted in Western countries. As in case of asthma, there are many questions. What are the practical factors of the Buteyko method and changes in breathing that cause these favourable changes? What are the psychological, biochemical and neurological changes due to changes in blood CO2 values? What are the effects of continuous nasal breathing? Since sympathetic dominance is a typical abnormality for many heart conditions, what are the effects of the breathing retraining on the autonomous nervous system? • Other defensive reactions All these problems (asthma, hypertension, and angina pectoris), according to Buteyko, are not abnormal pathological states, but defensive mechanisms of the organism against excessive CO2 losses ((Buteyko, 1977). Indeed, narrowing of air passages (as in asthma), or narrowing of arterial blood vessels (as in hypertension and angina pectoris), or pooling of blood (as in varicose veins) causes delays in CO2 removal. Similar defensive mechanisms are observed in many other situations: blocked nose, polyps, excessive mucus production, varicose veins, spasmodic states of different organs leading to migraine, gastritis, ulcers, Raynoud’s disease etc. One needs just to imagine the mechanism how these created obstacles delay excessive carbon dioxide elimination. As a result, numerous health conditions can be considered as the desperate attempts of the organism to preserve higher carbon dioxide concentrations.

_______ • Gastrointestinal diseases GI (gastrointestinal) diseases are typically accompanied by spasmodic states of small blood vessels leading to hypoxia and problems with an inadequate blood supply to GI organs (Guzman et al, 1999), while hyperventilation leads to reduced perfusion and oxygenation of the liver, colon and other vital organs (for references see Chapter 1). Elimination of hyperventilation was found to be an effective method to deal with gastritis, gastric and intestinal ulcers, IBS, IBD, Crohn disease, and other GI problems. How is it possible that so different health problems can have the 93


same cause? From chapter 1, it is known that the GI tract has its own brain (the second brain), which is located and functions relatively independently from the central nervous system. We also learned that chronic hyperventilation often causes various mental and cognitive problems (panic attacks, anxiety, depression, etc.) depending on individual predisposition of people. Hence, it is possible to suggest that low CO2 stores can affect, in a similar way, this second brain causing variety of GI problems depending on individual differences that include genetic make-up and currently existing abnormalities in the GI tract. Chronic hyperventilation leads to abnormal intestinal permeability and abnormal protein metabolism since GI tract is the main consumer of amino acids. That suggests that the mechanism of development of these conditions is based on overbreathing. Normal breathing, on the other hand, is incompatible with these pathological processes. • Diseases connected with bone metabolism Since low aCO2 causes abnormal changes in ionic composition of the blood, as well as abnormal redistribution of ions in extra-cellular and intra-cellular fluids, that affects regeneration and destruction of bone tissues. In particular, changes in bio-available calcium concentrations were discussed in chapter 1. Therefore, it is sensible to assume that osteoporosis, osteochondrosis, abnormal growth of bone tissues, brittle teeth, and other related conditions are directly influenced by over-breathing. • Allergies and abnormal immune reactions Low aCO2, by interfering with activities of vitamins, catalysts, hormones, and other body chemicals, alters normal human immune reactions. Moreover, physiological studies indicate that low carbon dioxide stores directly affect blood perfusion and oxygenation of the spleen, and other tissues and organs involved in the production of the immune cells (Guzman et al, 1999). As a result of over-breathing, in some cases, pathogenic objects do not cause a normal response of the immune system leading to colds, infections, tonsillitis, while in other cases the reaction of the immune system is excessive, as in hypersensitivity, allergies, and autoimmune disorders. Practical work on breathing normalization revealed efficiency of the Buteyko breathing therapy for colds, respiratory viral diseases, allergies, allergic rhinitis, multiple sclerosis, rheumatism, arthritis, lupus, nephrosis and other related disorders. • Endocrine diseases By affecting production and concentrations of different hormones, chronic hyperventilation can cause problems with thyroxin, insulin, estrogen, epinephrine, norepinephrine, calcitonin, pancreatic endocrine hormone and other hormones. That leads to hypo- and hyperthyroidism, diabetes, hyperparathyroidism, diseases of the adrenal cortex, and other health concerns. For example, Doctor Buteyko suggested the following mechanism for diabetes development (Buteyko, 1962): During times of stress, it is physiologically normal for the organism to have certain hormonal changes in order to prepare the organism for rigorous physical activity (“fight or flight” response). While increased production of adrenalin and nor-adrenalin (the main stress hormones) are well-known effects, decreased insulin level and higher blood glucagon concentrations increase blood sugar level. Such adaptations are obviously useful from the evolutionary viewpoint in order for this physical activity to be efficient. However, chronic stress without physical activity results in chronically high glucagon and low insulin values. These and some other biochemical changes (due to the changed direction of the Krebs cycle) cause hyperglycaemia. Practical studies done by Doctor Buteyko revealed that diabetics usually have 32-34 mm Hg aCO2 and 5-10 s BHT (breath holding time after quiet expiration). Therefore, diabetes can be also viewed as a normal effect of hyperventilation in people with a certain genetic predisposition. More information on diabetes can be found on Christopher Drake’s website at www.buteyko.com.au/Chris.html. Numerous cases of complete remission of insulin-dependent diabetes are described in the next chapter. The practice of Russian doctors revealed that bleeding between menstruations, if present, usually disappears when the CP is above 20 s. Furthermore, females, who have problems with regularity of their monthly cycles, experience normalization in periodicity when their CPs are over 40 s. There are also various infertility problems, which are eliminated when the CP is greater than 40 seconds.

_______ • Cancer

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Let me describe here the possible chain of events. Chronic hyperventilation washes out CO2 from each cell of the human organism. Since CO2 is a powerful dilator of small blood vessels, hypocapnia (low CO2 concentrations) lead to constrictions of arterioles causing problems with oxygen delivery. As a response, the heart work harder, but less blood arrives at the tissues. Moreover, low cellular CO2 values cause inability of red blood cells to release whatever little oxygen they bring (the Bohr effect). Abnormalities with the use of the own nitric oxide roduced in the nasal passages intensify vasoconstriction and hypoxia. The final outcome is no CO2 and no O2 in the tissues. When oxygen supply is near the critical level, due to chronic hyperventilation, the hypoxic cells are in a dangerous state. Moreover, certain cells, tissues and organs can be predisposed to higher, than average, level of hypoxia due to hereditary characteristics. In addition, some cells, tissues and organs can be especially vulnerable, for example, due to direct exposure to harmful substances (like smoking for lungs, certain chemicals for kidneys, liver, brain, stomach, colon, kidneys, etc.,). Such local abnormal environmental parameters can cause death in some clusters of cells. All these processes affect the existence of neighbouring cells and the whole organ where these events take place. As a result, the affected tissue or the organ has two choices: to die or to modify parameters of existence in order to survive. Death of cells can be particularly quick and the whole process can be more invasive if certain gangrene-causing pathogens are present. For example, Clostridium perfringens, Cl. welchii, Cl. septicum, Cl. novyi, Cl. histolyticum, Cl. sporogenes, and various other bacterial strains, including Streptococcus and Staphylococcus cause gas and moist types of gangrene. Hypoxia is a known powerful factor in the spread of gangrene, while dozens of professional studies revealed the usefulness of hyperbaric oxygen therapy in the treatment of gangrene. That is a normal current practice in hospitals of various countries. However, gangrene means death of the tissue. As an alternative to death, the hypoxic cells can change their phenotypes in order to survive in conditions of extreme hypoxia (Charles Maguire, 2003, private communication). The cells can be reprogrammed to the new environment and become similar, in some respect, to the cells of human embryo, which successfully and quickly grows in conditions of severe hypoxia. That causes the formation of a tumour. Let me again repeat a quote from above, "Cells undergo a variety of biological responses when placed in hypoxic conditions, including activation of signalling pathways that regulate proliferation, angiogenesis and death. Cancer cells have adapted these pathways, allowing tumours to survive and even grow under hypoxic conditions..." (Chaplin et al, 1986). Hence, the tumour represents a life form, which adapted to the conditions of the environment. Since severe hypoxia was the norm in the early years of life on Earth, when O2 content in air was less than a few percent, it is likely that primitive animal life forms were similar, in many respects, to tumours (Charles Maguire, 2003, private communication), while development of tumours is a normal defensive reaction of the organism due to changed environmental conditions. Hence, cancer and malignant tumours are due to the interaction of the following factors: 1) level of tissue hypoxia; 2) hereditary predisposition (weakness of certain tissues and organs); 3) life-style factors and environmental influences. Practically, as medical evidence indicates, hypoxia remains the central factor in appearance, survival, growth, and metastasis of tumours. We may conclude that, apart from other positive effects, normalization of breathing (or steps in this direction) is an efficient method to improve tissue oxygenation and fight cancer. Since the Buteyko method is directly intended to restore normal CO2 stores, normal breathing and normal cellular oxygenation, it is no surprise that disappearance of tumours is a normal and frequently reported effect of this therapy. However, it usually takes months or years to get this result. At the same time, optimum anti-cancer treatment also needs special dietary changes, which, fortunately, have been investigated and described by nutritionists and medical and other heath professionals in popular and professional literature. According to published observations of Russian doctors, the Buteyko method is very effective during earlier stages of cancer (stages 1 and 2), while there is a definite improvement in quality of life for patients who have cancer in stages 3 and 4.

_______ • Other health concerns Appendix 3 (from Novosibirsk Buteyko web site) provides a list of health conditions, which are characterised by hyperventilation and low aCO2 and which favourably respond to correct application of the Buteyko method. Appendix 4 (from Moscow Buteyko web site) gives symptoms of hyperventilation syndrome, which are treated in the 95


Moscow Buteyko Clinic. • Formula for aCO2 The maximum pause reflects aCO2, according to the already quoted formula aCO2% = 3.5% + .05*BHT (here, aCO2% is the alveolar CO2 concentration in %, 3.5% is minimum CO2 content in alveoli, K=.05 is a coefficient of proportionality, the BHT is breath holding time after quiet expiration, while sitting, after 10 minutes of rest. Those people, who frequently perform breath holds, do the test until the first desire to breathe (due to the “training effect” described in Chapter 3). This formula was patented during Soviet times (Buteyko, 1986), it was probably considered by Soviet bureaucrats, as a significant achievement of Soviet science. Available Western studies indicate (chapter 1) that both, carbon dioxide and BHT, usually get lower with worsening of health. There were no systematic attempts in western literature to find the connection between usual aCO2 and BHT or to define the connection between the personal BHT and the aCO2. • The relationship between ventilation and the BHT If the official BHT norm is 40 s, it corresponds to about 6 l/min for minute ventilation. Doctor Buteyko’s norm of 60 s BHT corresponds to 4 l/min. As we learned in Chapter 1, patients with moderate asthma or heart disease have about 15 s BHT and 15 l/min for minute ventilation. These and other findings suggest that the approximate relationship between ventilation and the BHT is linear. Hence: If your BHT is 30 s, you breathe twice the norm (about 8 l/min for a 70-kg adult). If your BHT is 20 s, you breathe three times the norm (about 12 l/min). If your BHT is 15 s, you breathe 4 times the norm (about 16 l/min). If your BHT is 10 s, you breathe 6 times the norm (about 24 l/min).

5.4 Practical discoveries and their application Reduction in ventilation and increase in aCO2 are equivalent to health improvement, while normalization of breathing parameters is equal to health restoration. From a practical viewpoint this Buteyko finding literally saved thousands of human lives and can save millions more. The main measuring tool of the Buteyko method is the CP (control pause) or BHT. While the term “BHT (breath holding time)” appeared long time ago in Western medical and physiological literature, there are many variations of this test (see chapter 1) so that the results can differ 3-4 times. Russian doctors, who used the Buteyko method, used the term “CP” (control pause). The strict definition of the CP or the method of its measurement is given in the next section. The concept of the CP, together with its relation to symptoms of various diseases, quality of life and other life factors, is one of the fundamental discoveries of Doctor Buteyko. Let us shortly review his findings or what he observed in his patients with asthma, heart diseases, and bronchitis. When the CP was very short (e.g., about 5 s), indicating very heavy breathing, the patients experienced acute or life-threatening episodes. These periods of acute hyperventilation could be triggered by numerous factors previously described or by allergic responses, as in cases of asthma. Between acute episodes their CPs were about 10-20 s depending on severity of the disease, the medication recently used, meals, time of the day, posture and many other factors. When these patients reduced their breathing, using the Buteyko method, and achieved about 25-30 s CP, they were in a safe zone having no symptoms and no need for medication. Should they experience the symptoms of their main health problem, they could use breathing exercises to alleviate these symptoms. Similar results in relation to symptoms and need in medication were found for epilepsy, sinusitis, primary hypertension, chronic fatigue syndrome, and some other conditions. Generally, cardiovascular and respiratory problems are the conditions that respond quickly to application of the Buteyko method. An exception here is emphysema since these patients need years for restoration of damaged alveoli in their lungs and complete clinical remission. Buteyko and his medical colleagues in the USSR and, later, Western breathing teachers, also applied the method for various other health pathologies, including hormonal problems (diabetes, thyroid abnormalities, etc.), GIliver problems (hepatitis, liver cirrhosis, gastritis, ulcers, IBS, IBD, etc.), urinary problems (urinary infections, nephritis, kidney stones, etc.), musculoskeletal problems (arthritis, osteoporosis, etc.), nervous problems (addictions, sleeping problems, phobias, anxiety, depression, initial stages of schizophrenia, etc.), neurological problems

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(Alzheimier, Parkinson, motoneuronal disease, etc.), oncological problems (cancers, leukaemia, radiation disease, etc.), skin problems (eczema, psoriasis, etc.), and some other pathologies. Generally, to efficiently solve these concerns, one should have over 40 s 24/7 for a certain period of time often ranging from weeks (for younger patiens) up to years. The norm of 60 s CP corresponds, according to Doctor Buteyko, to ideal health and absence of medical pathologies related to so called chronic degenerative diseases or diseases of civilization. These ideas are reflected in Buteyko Table of Health Zones. Discovery of 7 zones of poor health and 5 zones was so important for Buteyko that he filled a patent application for this invention. Buteyko Table of health zones Health state

Type of breathing

Superhealth

Shallow

Normal

Normal

Disease

Deep

Degree

Pulse

Rf

5 4 3 2 1 -1 -2 -3 -4 -5 -6

48 50 52 55 57 60 65 70 75 80 90 100

3 4 5 6 7 8 10 12 15 20 26 30

% CO2 7.5 7.4 7.3 7.1 6.8 6.5 6.0 5.5 5.0 4.5 4.0 3.5

AP

CP

MP

16 12 9 7 5 4 3 2 -

180 150 120 100 80 60 50 40 30 20 10 5

210 190 170 150 120 90 75 60 50 40 20 10

Table’s comments. Pulse – heart rate in 1 minute; Rf – respiratory frequency in one minute (number of inhalations or exhalations); % CO2 - %CO2 in alveoli of the lungs (*or arterial blood if there is no mismatch); AP - the Automatic Pause or natural delay in breathing after exhalation (*during unconscious breathing); CP - the Control Pause, breath holding time after usual exhalation and until first distress); MP (the Maximum Pause, breath holding time after usual exhalation and as long as possible). /Based on various Russian publications, especially: Buteyko KP, The method of volitional elimination of deep breathing [Translation of the Small Buteyko Manual], Voskresensk, 1994. * Note about pulse. Not all people have greatly increased heart rates, as it is given by this table, when their CPs are low. Some categories of people with less than 20 s CP can have a resting pulse of around 60 - 70. However, increased heart rate for lower CPs is the feature of, for example, heart patients and patients with severe asthma. During the 1960's, when conducting his research, and later, Buteyko and his colleagues applied the Buteyko breathing retraining program mainly for heart and asthma patients, who were mostly hospitalized with frequent deficiencies in blood cortisol levels.

_______ Dr. Buteyko developed this table during 1960s, after analyzing hundreds of sick and healthy people in his respiratory laboratory, and presented it during his Lecture for the leading scientists at the Moscow State University in 1969. The Table reflects health of his numerous hospitalized and severely sick patients, who started their journey for health at the very bottom of the table and climbed up, sometimes to the very top of the table. The middle row of the table corresponds to normal health. Below this row are 7 zones corresponding to disease. The borders for these zones are given by 7 rows (from normal down to -6th degree). 5 zones of super-health are above the middle row. Let us start from the very bottom of this table and then climb up. Terminally sick and critically ill patients during acute stages The lowest row of this table corresponds to severely sick and terminally ill patients in critical conditions. When people are at the risk of dying, the table predicts over 100 beats per minute for their heart rate, over 30 breaths per minute for respiratory frequency, less than 3.5% CO2 in the alveoli of the lungs. The CP (Control Pause or stressfree breath holding time after usual exhalation) is less than 5 s. Terminally sick and critically ill patients in more stable conditions The next row from the bottom corresponds to severely sick and terminally ill patients in stable conditions. 97


Typical heart rates of such people are above 90 beats per minute (sitting at rest). Respiratory rate (or breathing frequency) is above 26 breaths per minute at rest. A CO2 concentration in alveoli of the lungs is no more than 4%. There is no automatic pause (period of no breathing after exhalation). The Control Pause is less than 10 s, while the Maximum Pause is less than 20 s. (Numerous medical studies confirmed that over 90% patients with chronic diseases indeed die in conditions of severe hyperventilation, while their heart rate and respiratory frequency become much higher than the norms. Quotes and exact numbers from such studies can be found on my website in relation to heart disease, asthma, cancer, and many other conditions.) These patients usually require numerous types of medication to prevent their multiple symptoms and complaints. Walking is hard and climbing upstairs, due to heavy labored breathing, dyspnea, and low body oxygenation, is often impossible. Most of the time is spent in bed, since even sitting require efforts. Sleep is dreadful since breathing and symptoms get much worse after transition into horizontal position. Early morning hours (4-7 am) is the time when these patients are most likely to die from heart attack, stoke, asthma attack, or complications from cancer, diabetes, and many other pathologies. Patients with moderate degree of their disease The next row (“-4” degree of health) corresponds to patients whose life is not threatened at the moment, but their main concern are symptoms. People with mild asthma, heart disease, diabetes, 1 and 2 stages of cancer, and many other chronic disorders are all going to be in this zone. Taking medication is the normal feature for most of these people. As we see from the table, heart rate for these patients varies from 80 to 90 beats per minute. Breathing frequency is between 20 and 26 breaths per minute (the medical norm is 12, while doctor Buteyko’s norm is 8 breaths per minute at rest). CO2 concentration in alveoli of the lungs is between 4.0 and 4.5%. The CP is between 10 and 20 s. Physical exercise is very hard, since even fast walking results in very heavy breathing through the mouth, exhaustion, and worsening of symptoms. Complains about fatigue are normal. All these symptoms are often so debilitating that they interfere with normal life and ability to work, analyze information, care about others, etc. Living in the chronic state of stress and being preoccupied with own miserable health are normal, while efficiency and performance in various areas (science, arts, sports, etc.) are compromised. Sitting in armchairs or soft couches is the most favorite posture. Parameters of these people get worse during early morning hours with corresponding worsening of symptoms. Many sufferers get less than 10 s for morning CP with all effects accompanying the last stage of the disease. Most modern people Most modern healthy people have between 20 and 30 s CP. Hence, they are going to be in the third row from the bottom (“-3” degree of health). While there is no need for taking medication in this zone, numerous health pathologies are frequent. This relates to gastrointestinal disorders (gastritis, IBS, IBD, etc.), musculoskeletal problems (arthritis, osteoporosis, etc.), hormonal and metabolic problems (mild obesity, light diabetes), initial stages of cancer, and many others. Standing for many hours is hard and they prefer to sit for most part of the day. Physical performance after meals is very poor since respiratory and cardiovascular parameters can shift to the lower zone. Level of energy and desire to work physically are low. The over-excited brain easily invents excuses for own laziness. Morning parameters are much worse (less than 20 s CP) with all effects that present for this zone. Normal health As we continue to climb up the table, we can get the line of parameters that corresponds to norms. The row “minus 2” reflects international norms for breathing: breathing frequency of 12 breaths per minute; 5.5 % for CO2 concentrations in alveoli of the lungs (about 41 mm Hg); 40 s CP and 70 beats per minute for heart rate. People with normal health naturally have so called “automatic pause” or period of no breathing (total relaxation of all respiratory muscles after each exhalation) during their unconscious breathing. The duration of the automatic pause is 2 seconds. People with normal health and able to run with strictly nasal breathing, safely take cold shower (if they follow certain other rules), have good quality of sleep, and reasonably able to function on the social level (family, community, workplace, etc.).

_______ Development of the Buteyko breathing method

The main practical discovery during 1960’s was development of the Buteyko breathing method that is usually tailored for needs of the particular patient. The most poplar version of the Buteyko method includes 2 parts (Fig. 5.1): 98


breathing exercises to be practiced by the patient and common sense activities that reverse chronic hyperventilation.

The Buteyko breathing method

Breathing exercises (usually to be practiced several times per day, for about 1-2 hours in total)

Common sense activities (e.g., breathing only through the nose, prevention of over-eating, prevention of sleeping on the back, etc. )

There is no uniform understanding about the question: What does it mean “to learn the Buteyko method?” Many Russian doctors believed that if you get 60 s CP, then you learned the method. Others were saying that after 2-3 times increase in the CP, patients believe in the tremendous power of the Buteyko method. For many people learning the method meant that they could stop asthma or heart attacks in minutes using Buteyko breathing exercises instead of using medication, like Ventolin or heart pills. In my view, there are 3 levels of learning the Buteyko breathing method: Level 1: The student is able to eliminate the main symptoms of own health problems (e.g., asthma, heart disease, epilepsy, sinusitis, eczema, insomnia, constipation, etc.) using the Emergency Procedure so that the Emergency Procedure can substitute the use of medication or significantly reduce the dosage (e.g., twice). Such students have low CP s (usually about 5-15 s), while elimination or reduction in medication is their main practical result. Only about 10% learners or less are satisfied with this level. It takes about 1-2 days to learn. Level 2: The student partly normalised own breathing until about 25-35 s CP, so that he has no need for medication and does not experience the symptoms of his main health problem, e.g., asthma, bronchitis, heart disease, epilepsy, sinusitis, eczema, etc. However, such learner can still suffer from airways inflammation, allergies, GI problems, hormonal problems, and musculo-skeletal problems. Various medical drugs can be required to control symptoms of these “high-CP” diseases, This is the level achieved by most people on the west. It takes about 1- 3 months to learn. Level 3: The student has no less than 60 s at any moment of the day. Such CPs provide the guarantee about absence of pathologies and symptoms related to many degenerative health conditions (over 150 so called “diseases of civilization”). While achievement of this level requires will power, self-discipline and determination, there are many students world-wide who got there and none has regrets about the time and energy spent. The final goal of the method for Level 3 is normalization of breathing. Among parameters of normal breathing, according to Doctor Buteyko, are: 60 s CP (breath holding time at rest, after quiet expiration, with no stress at the end of test); 4 l/min ventilation rate (for a 70-kg man); and 6.5% CO2 (about 46 mm Hg CO2 at sea level) in alveoli and arterial blood. As we can see here, his parameters are more rigorous than typical medical and physiological norms: 40 s CP; 6 l/min; 40 mm Hg at sea level (or about 5.3%). It often takes 0.5-2 years for an adult to learn. Note that when discussing the CP here, I mean the minimum CP throughout the day and this is usually (for over 90% learners) is the morning CP. The reasons are described in the next chapter. There are several factors that define the rate of learning for a student. The most important are: 1. Age of the person (e.g., young children often can progress from, for example, 5 s up to 60 s CP in 3-5 days; teenagers in 2-3 weeks; elderly people in 2 years). 2. Fat reserves (i.e., obesity makes progress slower since obese students, when their practice breathing exercises, first naturally loose weight with moderate CP growth and later their progress normally). 3. Amounts and types of medication used in the past (i.e., those learners who consumed large amounts of medical

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drugs during previous years have slower progress rates).

5.5 Advance of the method in the USSR and Russia According to official statistics, up to 1967, Buteyko laboratory, using his breathing method, successfully treated more than 1,000 severely sick in-patients with asthma, hypertension, and angina pectoris. Analysing the scope of more than 50 scientific publications written by Doctor Buteyko and his colleagues in 1960’s, one can conclude that most of the papers are devoted to CO2 effects on the cardiovascular system (e.g., tone of arteries, capillaries and veins as a function of aCO2). Over 15 publications are about different technical improvements in measurements of physiological respiratory parameters using his diagnostic complex. There are also several articles on asthma, its causes and treatment. Al least 5 Ph.D. dissertations in medicine and physiology were written on respiration, carbon dioxide properties and hyperventilation under Doctor Buteyko’s leadership. Many medical professionals contributed to the development of the Buteyko breathing method, its theoretical foundation, and practical applications. In particular, articles on the Buteyko method and its theoretical foundations were written by the following Buteyko colleagues: • Dyomin D.V., medical doctor, Ph. D. (Novosibirsk), author of numerous research publications on the relationship between: a) aCO2 and tone of arterial vessels in hypertension and angina pectoris; b) aCO2 and blood cholesterol. • Genina V.A., medical doctor, Ph. D. (Novosibirsk), author of several theoretical and practical articles about the treatment of bronchial asthma using the Buteyko method. • Lapa N.A., medical doctor (Children’s Clinical Hospital No. 8, Novosibirsk), author of publications on the Buteyko method for children. • Odintsova M.P., medical doctor, Ph. D. (Novosibirsk), author of a of Ph. D. thesis on the aCO2 connection with the tone of arterial vessels in patients with coronary insufficiency and hypertension, and articles on: a) aCO2 and its influence on the cardiovascular system in patients with hypertension and angina pectoris; b) hyperventilation and bronchoconstriction of asthmatics. • Paschenko S.H., research scientist and medical surgeon, Ph. D. (Zaporozshski Medical Institute, Ukraine), author of research articles on: a) CO2 influence on bone regeneration; b) tissue oxidation processes due to free radicals in CO2deficient asthmatics. • Samotesova A.H., medical doctor, main endocrinologist of Krasnojarsk region (Krasnojarsk), author of publications and research on the Buteyko therapy for diabetics. • Souliagin S.S., medical doctor (Obskoi Central Hospital, Novosibirsk), author of several practical articles on the Buteyko method (including the influence of focal infections, correct use of physical exercise and other auxiliary methods for health restoration). By 1990’s over 100 Soviet medical doctors completed qualification courses with Doctor Buteyko, while learning how to apply this method in practice. In 1980’s former patients, many of whom were on steroids and with disabilities, literally flooded the Soviet Health Ministry with letters describing their medical histories and success achieved due to the Buteyko method. That resulted in the following practical steps indicating official recognition and approval of the Buteyko method by Soviet medical authorities. • In 1983 the USSR Committee on Inventions and Discoveries issued a patent with the title "The method of treatment of hypocapnia [low aCO2]" (Author's certificate No. 1067640 registered on 15 September 1983). What is unusual about this document is that it has the priority date of the discovery 29 January 1962. Thus, the discovery was officially accepted more than 20 years later. The patent describes the treatment of bronchial asthma and 40 patients with hypertension and angina pectoris (with over 80 % success rate). • In 1985, the method was officially approved by the Soviet Health Minister (Burenkov, 1985). The directive revised old note of the Buteyko method for the treatment of bronchial asthma in various medical establishments. • In 1986 the USSR Committee on Inventions and Discoveries issued another patent "Method of defining CO2 content in alveolar air" using breath holding time (Buteyko, 1986). The formula from this patent was described in the previous section. Up to now, hundreds medical professionals and breathing instructors adopted the Buteyko breathing method in their work in former Soviet states, while the total number of treated people is over 200,000. Most of these former patients were asthmatics. It was found experimentally that asthmatics usually respond quickly to the therapy. Most other patients had problems with the cardiovascular, nervous and endocrine systems.

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More recently, Doctor Buteyko and Andrey Novozshilov, chief doctor of the Buteyko Clinic in Moscow, had several interviews published in central Russian newspapers and magazines. The originals and their translations can be found at www.buteyko-clinic.ru. The advance of the method had and has following challenges. It was not easy to convince ordinary doctors and medical officials that the answer was literally under their nose. Only those medical doctors, who applied and practiced the method themselves, realized the power of this health restoration technique. Therefore, Buteyko was looking and invited those medical professionals, who suffered from asthma, bronchitis, heart disease, CFS, and other disorders, to learn the method. Moreover, Buteyko correctly noticed that, if doctors, after learning the basics of the method, achieved 60 s CP (control pause), then these doctors could become good practitioners or teachers of the Buteyko method. (Up to early 1990’s, the Buteyko method was called in the USSR “the method of voluntary elimination of deep breathing”.) Hence, Buteyko decided to organize special commissions for certification of breathing practitioners so that they had over 60 s CP at any moment. These CP commissions produced ambivalent feelings and contradicting effects among participating doctors. Imagine that some people are given a right to come and check your breathing any time, in order to find out if you are good enough to teach the technique. On the other hand, this idea was a logical part of the totalitarian Soviet state based on total control, suspicion, and belief in (partly) evil human nature. The commissions did the job until the collapse of the USSR. Later, the bottled emotions (resentment, anxiety, fear, suspicion, etc.) came out and promoted disintegration of the previously unified movement of Buteyko medical doctors in former Soviet states. However, they are still the most educated and professional teachers of the Buteyko method in the world. Currently there are more than 20 Buteyko medical centres and clinics functioning in former Soviet states. Apart from medical doctors, in late 1980’s and in 1990’s Doctor Buteyko trained numerous breathing instructors to apply the method. 30 s CP was one of the criteria for the breathing instructors to be qualified. These instructors worked mainly with patients who had severe or moderate forms of asthma, bronchitis and heart disease. This project was a big success during “Perestroika” since the USSR had huge number of sick people, the method was popular in mass media (TV, radio, newspapers) and breathing instructors with 30 s CP saved lives of thousands and helped them to return to ordinary life with about 25-30 s CP. In early 1990’s the first Russians breathing instructors and a few doctors settled in western counties and started to teach the Buteyko method to western people.

5.6 Advance of the method in western countries Among first students to learn the method on the west were people from Australia, the UK, New Zealand, and the Netherlands. Alexander Stalmatsky, author of 2 published books “Freedom from asthma” and “Freedom from insomnia”, taught thousands of people first in Australia and later in the UK. Many his former students later became breathing practitioners. Both these countries currently (2007) have more than 100 Buteyko breathing teachers each. Some of them are united in professional organizations. The largest are BIBH (Buteyko Institute of Breathing and Health) and BBA (Buteyko Breathing Association). There are also several other, smaller organizations. During first years of the 21-th century the method was actively spreading in the USA and Canada so that now there are over 20 breathing practitioners in these countries. Cuba got about 15 practitioners trained by BIBH about 3 years ago. While the Netherlands has only several practitioners, they are very active. Most western practitioners (over 90%) teach the method as their part time job, but few (less than 5%) are working full time. About 7-10% have formal medical education. Thus, there are many GPs, nurses and physiotherapists applying the Buteyko method on the west. Western breathing teachers already saved thousands of lives and helped over 100,000 people to be free from symptoms and medication. Meanwhile, there are great reserves to improve the quality of teaching. These reserves are analyzed later in the chapter about promotion of the Buteyko method.

_______ 5.7 Experimental trials of the Buteyko breathing method

• 1968, Institute of Pulmonology, Leningrad, USSR (bronchial asthma, hypertension and angina pectoris) 50 patients with severe bronchial asthma, hypertension and angina pectoris, all of them with many years of heavy medication, most with steroid deficiencies and organic complications; success rate 95% (Khoroscho, 1982). • 1981, Sechenov's Medical Institute, Moscow, USSR (asthma, with pneumonia, rhinitis, chronic tonsillitis) 101


52 children (34 in-patients and 18 out-patients; 3-15 years old) with regular asthma attacks (once per day or more); 41 of them had pneumonia, 27 rhinitis, 36 chronic tonsillitis. All had problems with breathing through the nose, palpitations, and were bronchodilator users. In 1-5 days the patients were able to stop the attacks, cough, blocked nose, and wheezing, using the method. Observations in 1-3 months showed considerable improvements (cessation of heavy attacks or a total disappearance of the symptoms) in 83%, some improvement (less heavy attacks and considerable reduction in medication) in remaining 17%. Their average CP increased from 4 to 30 s, aCO2 from 25 to 36 mm Hg. Higher blood concentrations of IgA, IgM, IgG, and IgE were found, according to laboratory reports. Blood pressure normalised, forced expiratory volume raised over 5 times. Significant increases in lung volume, expiratory speed, and other parameters were found. Average breath holding time (CP) increased from about 3-6 s to over 30 s. For more information on this trial, visit www.buteyko.com/trials.html#children. • Reports from two conferences in Moscow and Krasnojarsk in 1988 (large variety of health problems) In addition to these trials, there were about 30 published reports (Buteyko method, 1992) of about 40 Russian medical doctors and health professionals, who met during two conferences in Moscow and Krasnojarsk in 1988 in order to share their practical experience of application of the Buteyko method in over 20 medical hospitals and clinics in Russia. The total reported number of treated people, according to the published conference proceedings (Buteyko, 1991), was over 3,000. Although most of them had respiratory (asthma, bronchitis, rhinitis, etc.) and cardiovascular (hypertension, angina pectoris, ischemia, etc.) problems, hundreds were treated or relieved from arthritis, osteoporosis, epilepsy, ulcers, gastritis, kidney stone problems, hepatitis, different infertility conditions, skin diseases (e.g., dermatitis, psoriasis, eczema), etc. Typical reported results were either some or essential improvement for over 90% patients, while remaining patients were not able to normalise their breathing parameters due to absence of desire or motivation and quitting the method during its initial stages. Thus, those patients who achieved large CPs significantly improved their health state. Normalization of breathing always leads to dissapperance of symptoms and no need for medication. • 1990, Shevchenko's Central Hospital, Kiev, Ukraine (radiation disease) 50 patients with radiation sickness due to Chernobyl's nuclear plant disaster. 82% patients had considerable improvement in blood analysis, cardiovascular parameters (blood pressure, pulse, etc.), work of the digestive system, and reduction in medication. No cases of side effects or complications due to the breathing exercises were reported (Bebeshko et al, 1990; p.221, Zimchenko & Romanenko, 1991). • 1991, Kiev Scientific and Research Institute of Epidemiology and Infectious Diseases, Kiev, Ukraine (AIDS) This trial involved 7 young patients with AIDS, two of them had HIV-infection in the lympho-adenopathic stage (Frolov et al, 1991a). Progression of this disease is usually accompanied by a variety of symptoms and complaints in the digestive, immune, cardiovascular, respiratory, hormonal and other systems. The official documents of the Institute provided information about improvements in clinical symptoms and the patients’ quality of life such as emotional stability, irritability, panic attacks, chronic fatigue, insomnia, digestive complaints and some other factors. All symptoms were relieved with no side effects due to breathing retraining.

_______ • 1991, Kiev Scientific and Research Institute of Epidemiology and Infectious Diseases, Kiev, Ukraine (hepatitis and liver cirrhosis) 30 patients, mostly 20-40 years old, diagnosed with acute (6 patients) and chronic (18 patients) hepatitis and cirrhosis of the liver (6 patients) applied the Buteyko method, while continuing to use traditional medication (Frolov et al, 1991b). 28 patients had remissions of their symptoms while 25 showed improvements in their blood test results. The official documents report 93% success rate. • 1995, Mater Hospital, Brisbane, Australia (asthma) 20 patients with a long history of asthma and significant medication. In 3 months, they decreased use of relievers (bronchodilators) by 96%, preventers (inhaled steroids) by 49%. Minute volume decreased from 14 l/min to 9.6 l/min. The symptoms' score was improved by 71% (Bowler et al, 1998). • 1997, Perth Academy of Natural Therapies, Australia (chronic fatigue syndrome) 102


A study by Shellie Gaskin, as a partial fulfillment for a Diploma of Naturopathy, was conducted on 15 people diagnosed with CFS. There were following improvements: fatigue 87%, night sweats 75%, depression 70%, allergies 66%, anxiety 66%, muscular aches 60%, difficulty sleeping 54%, and headaches 50%. After 10-12 weeks all those who continued their breathing exercise regimes reported a 100% reduction in fatigue. • 1999, Alfred Hospital, Prahan, Australia (asthma) 18 patients with mild to moderate asthma were taught the Buteyko method by a video and compared with 18 control subjects (Opat et al, 2000). The study found a significant improvement in quality of life and significant reduction in inhaled steroid use. • 2003, Gisborne Hospital, Gisborne, New Zealand (asthma) In this blinded randomised controlled trial conducted in 38 people with asthma Buteyko Breathing Technique group was compared with control (McHugh et al, 2003). The Buteyko group was taught by a Buteyko practirtioner Russell Stark. As in the previous western trials, the Buteyko group reduced inhaled steroid use by 50% and ß2-agonist use by 85% at six months from baseline. In the conclusions, the medical professionals wrote, “Conclusions BBT is a safe and efficacious asthma management technique. BBT has clinical and potential pharmaco-economic benefits that merit further study.” The instructions for the Buteyko group were provided by Russell Stark. • 2003, Division of Respiratory Medicine, City Hospital, Nottingham, United Kingdom (asthma) 90 patients with asthma taking an inhaled corticosteroid participated in a randomised controlled trial. The groups were followed in 3 and 6 month periods (Cooper et al, 2003). “Symptoms remained relatively stable in the PCLE and placebo groups but were reduced in the Buteyko group…The Buteyko breathing technique can improve symptoms and reduce bronchodilator use…” • 2003, Glasgow, United Kingdom (asthma) According to the recent press release (4 December, 2003) of the British Thoracic Society (the UK’s professional body of respiratory specialists), “Nurse, Jill McGowan, led the world’s largest clinical trial to measure the effects of the Buteyko method (breathing retraining exercises in conjunction with conventional asthma management). 384 of the initial 600 participants (64%) completed the trial… Those patients who were taught the Buteyko Institute Method all experienced significant improvement in asthma, with reduced symptoms, reduced medication and improvement in quality of life: - asthma symptoms decreased by an average of 98%; - use of reliever inhalers decreased by an average of 98%; use of preventor inhalers decreased by an average of 92%.” These results were found after 6 months (McGowan, 2003). This self-funded trial was possible due to heroic and sacrificial, in financial terms, efforts of the Buteyko practitioner Jill McGowan. • 2005, Foothills Hospital, Calgary, Canada (asthma) 64 patients, all of whom were using inhaled corticosteroids, after 6 months improved their asthma control from 41% to 75% (Proceedings, 2006). Decrease in inhaled corticosteroids was found in 39% patients, elimination of steroids in 21%.

_______ • 2006, Royal Prince Alfred Hospital, Camperdown, Australia (asthma) The Buteyko method was applied for 12 weeks. Median reduction in usage of relievers was 86%, preventers 50% (Slader et al, 2006).

• 2006, Gisborne Hospital, Gisborne, New Zealand (asthma) 8 children, from 8 to 14 years old, in 12 weeks reduced their average β2-agonist use (salbutamol) by 66%, inhaled steroid (fluticasone) by 41% (McHugh et al, 2006). While 11 courses of prednisone were given 3 months before the trial, only 1 course of prednisone was required three months after the trial.

None of these trials or reports revealed any complications or side effects due to the Buteyko breathing method, 103


although there are many important practical rules and possible complications in cases of incorrect application of the method. A note about Soviet medical approbations or trials. The Soviet health care system, for political and social reasons, had always been more centralized than Western ones. Innovations in medicine were usually introduced by the Soviet authorities and health care bureaucracy. New ideas and drugs were often tested in hospitals and research Institutes, which provided higher authorities with reports about the results. In the West, as we know, results of scientific studies or trials are usually published in journals. While the Soviet approach was different, the reliability of their information was comparable. Directors, managers and project leaders of corresponding organizations and departments put their signatures to official reports about such Soviet trials and their approbations. These people were personally responsible for the trustworthiness of the results and their names and copies of the relevant documents, related to the Buteyko trials as well, are still archived in Russia and Ukraine.

Q&A section for Chapter 5 Q: Why did the western clinical trials not revealed improvements in lung function test in those students who learned the Buteyko method? A: The lung tests reflect presence of inflammation meaning that, while the Buteyko group could reduce medication, their airways, on average, remained inflamed after they practiced the method for 3-6 months (typical durations of last follow ups). Healing would result in better numbers. It is a big physiological change to eliminate inflammation and it needs large morning CPs (about 30-35 s) with no exposure to triggers for some weeks so that the tissues can get healed. Another expected achievement is elimination of allergies leading to full clinical remission of asthma. This is how the method was and is taught in Russia (so that the patient has no inflammation and no allergies). Many western students, as we know, progress only until about 25-30 s (no medication, better sleep, ability to exercise, etc.). Why do they not progress further? Practice indicates that usually breathing teachers help their students to achieve the same level as they have. It is not a surprise then that Buteyko demanded 60 s for his doctors in Russia so that the students learn the method till the level of the teacher. High CP teachers, from the very beginning, target their students to Professor’s golden health standard: 60 s CP. Russian doctors explain to their students that being stuck, during the healing process, at 40 s is a normal phenomenon due to fundamental changes in the organism. Such information about the known future obstacle (40 s threshold) is important for long-term motivation. Q: Is CO2 the only cause of success for the Buteyko method? A: CO2 is the most known and investigated factor that relates to breathing and the Buteyko method. There are many other factors that are known to students and practitioners. The Buteyko method also includes, for example, psychological factors. The students learn how to stop their symptoms and prevent attacks, how to pay attention to stress and other factors that cause hyperventilation. Hence, they acquire a sense of control over their health. Helplessness and depression are no longer the parameters that define the course of their diseases. Nasal breathing helps the body to use its own nitric oxide that is produced in nasal passages. The roles and some important effects of this hormone have been discovered very recently and there are still many questions in relation to this substance. Emphasis on diaphragmatic breathing and relaxation of chest breathing muscles should favour elimination of possible abnormalities in regulation of breathing by the autonomous nervous system. Activity of the chest breathing muscles at rest often points to sympathetic dominance since chest muscles get active during both exercise and hyperventilation. While the Buteyko method is not focused on slow diaphragmatic breathing pattern, this pattern gradually appears by itself, for example, during sleep. This effect promotes lymphatic drainage of the nodes located under the diaphragm. Passive relaxed exhalation during the breathing sessions should also have good effects on the balance between parasympathetic and sympathetic nervous systems. These systems are often out of balance for many diseases, like asthma, heart disease, chronic fatigue, cancer and other health problems. Deliberate attention to posture and relaxation of body muscles should also influence the autonomous nervous

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system. When we relax we again pacify the overexcited sympathetic nervous system which is often too active due to the fight-or-flight mode. Healing and tissue repair are more active when the parasympathetic system is dominant. Reduced breathing decreases oxygen levels in the lungs and blood creating temporary hypoxia. Such hypoxia is beneficial for various reasons. First, modern air has too much oxygen. Free oxygen in our bodies generates free radicals causing cellular damage and aging. This damage is stronger during hyperventilation. Second, hypoxic training at high altitude has many known published benefits. It is difficult to tell at the moment what the contributions of these factors are. Clearly, they are individual. Can the various effects of the Buteyko method be separated? Probably yes, for example, using CO2 injections or CO2 chambers or submarines with special air. Can CO2 chambers have similar effects? There are many other interesting scientific questions for further research. Q: There are many medical studies indicating that acute hyperventilation produces asthma attacks in asthmatics. However, several studies found that acute hyperventilation with CO2 enriched air also results in asthma attacks. Therefore, as some doctors claimed, low aCO2 could not be considered as a single cause of asthma. Is this opinion correct? A: Before being tested with CO2 enriched air in laboratories, typical asthmatics had many hundreds of times the following course of events. On the background of chronic hyperventilation (all known studies reported presence of hyperventilation for initial stages of asthma), asthmatics experienced the influence of some other triggering factors (like exercise, overeating, oversleeping, allergies, etc.), which resulted in additional hyperventilation and further bronchoconstriction or in further inflammation of airways with the same results: feelings of air shortage (due to airway obstruction), chest tightness, laboured breathing, etc. all signs of an asthma attack. (Sometimes, this airway obstruction could be due to, for example, excessive mucus production or inflammation. That could result in anxiety and panic causing acute hyperventilation.) In all cases these asthmatics breathed normal air with about 0.04% CO2 concentration. Thus, before the attacks the following physiological changes were repeated many hundred times: abnormally hard work of the respiratory muscles, increased air flow through the respiratory tract, increased amplitude of pressure variations in internal organs, etc. All these changes, before the attacks, were sensed many hundred times by the millions of nervous cells of the nervous system. Finally, further lowered aCO2 and some other factors produced additional bronchoconstriction and the attacks. Now exactly the same asthmatics arrive in the laboratories, where they perform the same acute hyperventilation, which is accompanied by all these described additional features (again sensed by the millions of nervous cells) with one difference, the inspired air is CO2-rich. Such air has never been experienced by these asthmatics before, but the whole nervous system learned that such situation causes bronchoconstriction. What would be the result now? The result due to the changed stimulus would be defined by how much of the previous stimulus is left. Low carbon dioxide already created many chronic abnormal changes. Finally, some other triggers which cause the attacks can also be at work when the person deliberately hyperventilates, even with temporary increase in carbon dioxide stores. It was not sudden drop or increase in carbon dioxide stores that causes or prevents asthma attacks, but those chronic changes which affect every cell of the respiratory tract in asthmatics. Therefore, since less than 1% stimulus is absent (low CO2), while the remaining 99% is left, the reaction would be exactly the same, as for the whole stimulus. But assuming that the human nervous system is incapable of learning from the previous experiences repeated hundreds of times, and that all these events sensed and recorded by the nervous system did not produce habituation and conditioning, one can assert that low carbon dioxide is not the cause of asthma. Therefore, even in conditions of artificially increased aCO2, the influence of so many areas of the nervous system should be more powerful, than that of the breathing centre. Meanwhile, if such tests with CO2-rich air were repeated many times, the effect of gradual relearning can be observed and acute hyperventilation with CO2-rich air would not cause bronchoconstriction and the attacks. Moreover, physiological studies found the confirmations of this psychological effect based on physiology of the nervous cells. It is known that, for example, some breathing manoeuvres (chapter 2), e.g., Valsalva and Müller manoeuvres, or breathing air with the same composition at the end of the breath hold, as in the lungs, extends BHT. Why? All previous life, movements of respiratory muscles resulted in new oxygenated air coming into the lungs. Normally, the nervous system learned millions of times, that such respiratory movements are signs of new (fresh) air flow. When, all of the sudden, the conditions are different, only the breathing centre creates the stimulus to breathe,

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while the rest of the nervous system is “happy” and does not contribute to the urge to breathe. It is now a clear fact, which has been confirmed by all published studies, that development and first stages of asthma are always accompanied by hyperventilation. The situation with medical respiratory professionals and asthma was accurately reflected by Peter Kolb, “… asthma is a disorder which is investigated by thousands of respiratory specialists with millions of dollars worth of equipment to measure breathing. Yet after more than half a century of work by all these people measuring patients’ breathing, they haven’t picked up that asthmatics are just breathing too much” (Kolb, private communication, 2001). Q: Doctor Buteyko claimed that, for example, gastritis is caused by hyperventilation. However, it is known that, poor dietary habits (like eating when not hungry, not chewing food properly, eating spicy and hot meals) can create gastritis without any influence of breathing. How can such facts be explained? A: Practical studies done by Doctor Buteyko revealed that it was necessary for the patients with GI (gastrointestinal) problems to have low levels of aCO2 pressure (e.g., less than about 40 mm Hg) in order for gastritis and other GI disorders development to take place. That is probably due to appearance of certain pathological substances generated by affected mucosa of the stomach lining. In practical terms, low CPs (less than 40 s) are required for the progress and existence of the disease. At the same time, the ideal CP of 60 s makes such pathological processes impossible due to normal repair, adequate oxygenation and blood supply of the stomach. The ideal CP and GI disorders are incompatible. Thus, if we accept 40 mm Hg aCO2 level (about 35 s MP) as normal (as it is done by official medicine), then GI problems and hyperventilation are independent events. A person can have GI problems, gastritis included, with or without hyperventilation. If our norm is 6.5% aCO2 (60 s CP), then gastritis and other GI problems cannot take place, unless this aCO2 level is lowered. Damage to tissues intensifies respiration making the CP less than 40 s. Q: Which health conditions, while related to breathing and curable by breathing retraining, are not considered as breath-related by ordinary people? A: “Breath”, in Russian, has the same translation as “spirit”. Similarly, other people consider breathing as something immaterial. Hence, when thinking about breathing, many people believe that breath can only relate to respiratory problems, fatigue, and, maybe, asthma. What would be opposite, in our minds, to the volatile and escapable breath? Of course, our strong bones. Hence, it is difficult for many people to make a mental connection between fragile breath and bones. However, musculoskeletal problems respond to the Buteyko breathing method as nicely as heart disease or diabetes. The short summary of the effects of breathing retraining on various disorders is provided in Appendix 7. Russians even published a study about a greatly accelerated rate of bone healing in chickens who were living in air enriched with CO2. Q: How can the breathing teacher deal with a student who has some rare disorder or a variety of symptoms related to different diseases? How could one know if the Buteyko method can solve some specific health problems? A: The names of health conditions, even in official medical literature, often do not have strict definitions. For example, asthma can have wide range of cases with varying degree of symptoms. Many cases of asthma can be close or even diagnosed as COPD, emphysema, bronchitis, etc., by different countries and doctors. Russia, for example, have bronchial asthma, asthmatic bronchitis, etc. Some leading medical authorities claim that the term “asthma” should not be used by medical professionals. The same vagueness relates to many other health conditions, ranging from heart disease to various neurological and GI problems. This absence of clear criteria in official medicine is based on absence of the understanding of the mechanisms of disease appearance, development, and treatment. However, breathing teachers are armed with understanding of: - the cause and mechanism of development of various symptoms; - the method of their treatment. Doctor Buteyko in his lectures was often going, one by one, through the effects of hypocapnia on different systems, organs and tissues of the body (what happens with cardiovascular system, musculo-skeletal, nervous, GI, etc.). These facts indicate more emphasis on symptoms and specific abnormalities rather than official labels. It would be logical therefore, to view the “sudden” appearance of various human abnormalities and symptoms with the assumption of increased ventilation. Practically, when a student asks a breathing teacher about possible efficiency of the method for a certain rare health condition (“Can you help me with my …?”), the teacher may ask the

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student about particular symptoms and tests’ manifestation of the disease, time sequence of their appearance, their severity, and evaluate current breathing (e.g., visually, by voice, posture, and/or CP test). This information could provide the teacher with information related to the likely effects of the method when the certain CP level is achieved (when fatigue is reduced, rigorous exercise is possible, nose is clear, medication can be safely reduced, cold shower can be taken, etc.) It would therefore make more sense to speak, in many cases, about the same parameters that practically matters: current symptoms, tests’ abnormalities (as manifestations of hyperventilation in respiratory, cardiovascular, nervous, immune, and other systems), and current CP. Finally, let us look at the dynamic of labelling in Russia. The website in Novosibirsk and early Russian doctors used official medical names (Appendix 3). Later, instead of diseases, many websites have been using the names of symptoms (like coughing, blocked nose, running nose, too much mucus, allergies, cold hands, feeling tired, pains in various body parts, sensation of panic, digestive complaints, insomnia, etc.). The real life teaches us that there is one disease of deep breathing and many symptoms (asthma, heart disease, diabetes, chronic fatigue, etc.) depending on personal factors. “Q: What is most important in your method? A: To decrease deep breathing (the volume of inspiration) until the norm. Not to hold breathing, but gradually normalize it. This is difficult, although primitive people and animals breathe like that…” (Buteyko, 1997).

References for chapter 5 Bebeshko VG, Denisyuk AB, Act regarding the clinical trial of VEDB (Volitional Elimination of Deep Breathing) method or the Buteyko method in accordance with the Cooperation Agreement of January 3, 1990 between the USSR AMS (Academy of Medical Sciences) NRMRC (National Radiation Medical Research Centre) and the therapeutic center "Buteyko Breathing" during 1990, Kiev, 1990. Bowler SD, Green A, Mitchell CA, Buteyko breathing techniques in asthma: a blinded randomised controlled trial, Med J of Australia 1998; 169: 575-578. Burenkov S, About practical actions for application of the method of voluntary regulation of depth of breathing for the treatment of bronchial asthma [in Russian], Order No. 591, 30 April 1985, Ministry of Health of the USSR, Moscow. Buteyko’s cure (Istcelenie po Buteyko) [in Russian], Isotext, Moscow, 2000. Buteyko KP, Pneumotahometer with automatic closure of air jet as a part of a medical combine [in Russian], Inventor and Efficiency Expert 1961, 6: 16-17.

_______ Buteyko KP, Oscillographs and hypertension. Is "big" breathing useful? [in Russian], Inventor and Efficiency Expert 1962, 5: 7-9. Buteyko KP & Dyomin DV, Cross-correlation analysis of physiological functions, Newsletter of the Academy of Sciences of the USSR (the Siberian Branch), 1963, N 6, Medicine and Biology Series, Issue 2. Buteyko KP, Instruction for treatment of bronchial asthma, angina pectoris, hypertension, and obliterating endarteritis using the method of voluntary normalization of breathing [in Russian], Preprint, Novosibirsk, 1964.

Buteyko KP, Odintsova MP, Dyomin DV, Influence of hyper- and hypocapnia on tone of peripherial blood vessels [in Russian], Proceedings of the 2-nd Siberian scientific conference of family physicians, Irkutsk, 1964a.

Buteyko KP, Dyomin DV, Odintsova MP, Application of the regressive analysis for differentiation of influence of gas components of arterial blood on functional state of small peripherial blood arteries [in Russian], Proceedings of the 2107


nd Siberian scientific conference of family physicians, Irkutsk, 1964b. Buteyko KP, Dyomin DV, Odintsova MP, The relationship between lung ventilation and tone of peripherial blood vessels in patients with hypertension and angina pectoris [in Ukranian], Physiological magazine 1965, 11 (5). Buteyko KP & Shurgaya SI, Functional Diagnostics of Coronary Disease, In: Surgical Treatment of Coronary Disease (edited by AN Bakulev), Meditsina, Moscow, 1965, pp.117-118. Buteyko KP & Odintsova MP, Hyperventilation as one of the causes of spasms in smooth muscles of bronchi and arterial vessels [in Russian], Proceedings of the 4-th scientfico-practical conference on medical control and therapeutic physical exercises, Sverdlovsk, 1968. Buteyko KP, Carbon dioxide theory and a new method of treatment and prevention of diseases of the respiratory system, cardiovascular system, nervous system, and some other diseases [in Russian], Public lecture for Soviet scientists at the Moscow State University, 9 December 1969, Science and life [Nauka i zshizn’], October 1977. Buteyko KP, Discovery of the theory of deep breathing disease [in Russian], Public lecture for Soviet scientists at the Moscow State University, 1972. Buteyko KP, The method of treatment of hypocapnia [in Russian], USSR Committee on Inventions and Discoveries, Author's certificate No. 1067640, 15 September 1983. Buteyko KP, Method of defining CO2 content in alveolar air [in Russian], Soviet patent N. 1593627, 17 October 1986. Buteyko KP, Buteyko breathing method, in Collection of papers on folk medicine and non-traditional methods of treatment, ed. by GZ Minedjan, Moscow, Bukovitsa, 1993, p. 393-404. Buteyko method. Its application in medical practice [in Russian], ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa. Buteyko KP, Russian national newspaper “Komsomol’skaya pravda” [“Komsomol’s Truth”] 29 October 1997, The direct telephone line of readers with medical doctor K. P. Buteyko. Buteyko KP, Buteyko VK, Buteyko MM, The formalized representation of fundamentals of the Buteyko theory about genesis of illness of deep respiration (section 2), Journal of theoretical and practical medicine, 2005a; 3: 167-173. Buteyko KP, Buteyko VK, Buteyko MM, A rigorous presentation of fundamentals of K.P. Buteyko's theory about a physiological role of respiration in genesis of some diseases Voronezh: Buteyko Co Ltd; 2005, 80 pp., Dep. in VINITI, February 8th 2005b, N 185, 2005.

_______ Cooper S, Oborne J, Newton S, Harrison V, Thompson Coon J, Lewis S, Tattersfield A, Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial, Thorax 2003; 58: 674-679.

Frolov AF, Buteyko KP, Novosselov VA, Fedorchenko SV, Report about the clinical trial of the VEDB (voluntary elimination of deep breathing) method or the Buteyko method on AIDS patients in KSRIEID (Kiev Scientific and Research Institute of Epidemiology and Infectious Diseases) during the first quarter of 1991.

Gelman S, Fowler KC, Bishop SP, Smith LR, Cardiac output distribution and regional blood flow during hypocarbia in monkeys, J Appl Physiol 1985 Apr; 58(4): 1225-1230. Guzman JA, Kruse JA, Splanchnic hemodynamics and gut mucosal-arterial PCO(2) gradient during systemic hypocapnia, J Appl Physiol 1999 Sep; 87(3): 1102-1106.

Frolov AF, Buteyko KP, Novosselov VA, Fedorchenko SV, Report about the clinical trial of the VEDB (voluntary 108


elimination of deep breathing) method or the Buteyko method on AIDS patients in KSRIEID (Kiev Scientific and Research Institute of Epidemiology and Infectious Diseases) during the first quarter of 1991, Kiev, 1991a. Frolov AF, Buteyko KP, Vovk AD, Novosel’tsev VA, Degtyareva RM, Report about approbation of the VEDB (voluntary elimination of deep breathing) method or the Buteyko method in the Clinic of the KSRIEID (Kiev Scientific and Research Institute of Epidemiology and Infectious Diseases) on patients with acute and chronic hepatitis, and liver cirrhosis during 10 January-30 April 1991, Kiev, 1991b. Inventor and Efficiency Expert (editorial), A combine against hypertension in the Institute of Experimental Biology and Medicine [in Russian], 1961, 6. Karlsson T, Stjernstrom EL, Stjernstrom H, Norlen K, Wiklund L, Central and regional blood flow during hyperventilation. An experimental study in the pig, Acta Anaesthesiol Scand 1994 Feb; 38(2): 180-186. Khoroscho A, Interview with Buteyko [in Russian] 1982, in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, p.168-180. McGowan J, Health Education: Does the Buteyko Institute Method make a difference? Thorax December 2003, 58, Suppl. III, p. 28. McHugh P, Aitcheson, Duncan B, Houghton F, Buteyko Breathing Technique for asthma: an effective intervention, New Zealand Medical Journal 12 December 2003, 116 (1187): 710-716. McHugh P, Bruce DP, Houghton F, Buteyko breathing technique and asthma in children: a case Series, New Zealand Medical Journal Vol 119 No 1234 May 2006. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ, A clinical trial of the Buteyko Breathing Technique in asthma as taught by a Video, J Asthma 2000; 37(7): 557-564. Proceedings of the American Thoracic Society, 2006; 3: A530. Slader CA, Reddel HK, Spencer LM, Belousova EG, Thien FC, ArmourCL, Bosnic-Anticevich SZ, Jenkins CR, Impact of breathing exercises on asthma symptoms and control, Thorax 2006, 61: 651-656. Souliagin SS, Treatment of patients with focal infections using VEDB method [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, p.56-63. Zimchenko VN & Romanenko NF, Conclusions on practical trial of Buteyko method, conducted in Department of Radiation Pathology of Central Republican Hospital of Shevchenko region (Ukraine) during 06.03.1990-07.04.1990 [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, p.222-227.

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Chapter 6. The control pause Introduction This chapter starts with a description of the hyperventilation provocation test and its practical applications. The main body of the chapter is devoted to the CP: its measurement, causes of fluctuations, its relationship to various breathing patterns, the connection between the CP and physiological systems of the human organism, the relation of the CP zones of health, and which CP (maximum, minimum or average) during any particular day is indicative of the health state. The last part of the chapter is about descriptions and definitions of different breath-holding pauses and advantages and disadvantages of long and short breath holding pauses.

6.1 The HVPT (hyperventilation provocation test) The HVPT (hyperventilation provocation test) was done by Russian doctors for all patients and could be done repeatedly until the patient realized the simple connection between his health state and his breathing, which he can regulate. Due to possible complications, this test was performed with constant monitoring of the patient's pulse (e.g., every 10-15 s). If the pulse increased by more than 30% during the HVPT, the test was stopped to prevent possible heart problems. For asthmatics this test should be done through the nose only, otherwise, inflammatory processes can appear, due to large movements of cool air in the airways, and it would be much more difficult to stop the asthma attack. According to Buteyko, the test helped to define the most damaged system or organ of the organism (Buteyko, 1991a). In some cases, it helped to diagnose a patient with another, more serious or life-threatening condition. "For example, if an asthmatic gets, during the HVPT, not an asthma attack, but dizziness and other symptoms of brain vessel spasms or spasms of pain near the heart (angina pectoris), then not the lungs' damage, but stroke is the main threat to his life" (Buteyko, 1991a). In addition, the HVPT has lasting and profound impact on the misconception of the student about the usefulness of deep or big breathing. The student can practically experience its effects. Cases, when deep and big breathing (voluntary hyperventilation) improved the health state, while decreased breathing made it worse, have never been observed during over 30 years of clinical practice (Buteyko, 1991a). Immediately after the test, it was suggested to the patient how to eliminate the symptoms of the HVPT and his condition, using the Emergency Procedure described in this chapter. If the patient did not realize the connection between over-breathing and his/her condition, the HVPT, followed by the Emergency Procedure (in order to recover), was repeated. Sometimes, it was done several times in a row, until the patient gained insight. (Repeated use of the HVPT by Russian doctors was possible due to the following and immediate application of the efficient Emergency Procedure). Awareness about normal and abnormal breathing was not just a recommendation or some information to consider. The patient, according to Doctor Buteyko, should constantly, day and night, pay attention to his breathing and use different methods, measures, and actions to normalize his respiration and prevent CO2 losses.

_______ 6.2 The CP test

The CP (control pause) or breath holding time is the accurate and sensitive parameter that reflects, for most people, minute ventilation, CO2 stores and tissue oxygenation. However, for some people breath holds can create, during the initial stages of learning, unpleasant feelings and symptoms. Later, the body will develop a positive response to breath holds and CP measurement will be an easy relaxing experience. Warning. Students with certain health conditions can get negative symptoms after breath holding. This relates, first of all, to a large group of people with cardiovascular problems (heart disease, hypertension, and angina pectoris), panic attacks, and migraine headaches. While short breath holds usually do not cause problems in these people, measurements of the heart rate and Reduced Breathing are the best activities for them (discussed in the next Chapter).

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Measurement of the CP (control pause) Sit down and rest for 5-7 minutes. Completely relax all your muscles, including the breathing muscles. This relaxation produces natural spontaneous exhalation (breathing out). Pinch your nose closed at the end of this exhalation and count your CP (breath holding time) in seconds. Keep the nose pinched until you experience the first desire to breathe. Practice shows that this first desire appears together with an involuntary push of the diaphragm or swallowing movement in the throat. (Your body warns you, “Enough!”) If you release the nose and start breathing at this time, you can resume your usual or previous breathing (in the same way as you were breathing just before the test). Do not extend breath holding too far. You should not gasp for air or open your mouth when you release the nose. The test should be easy and must not cause you stress. The CP does not interfere with your breathing. Some western doctors call such a BHT test “a period of no respiratory sensations” since when the time is voluntarily extended there is a stress that increases with each further second of breath holding.

Is it necessary to pinch the nose? Practice shows that, even with our best intentions, we still breathe through the nose when we try to stop breathing without the nose closed. The air exchange is only 5-15% of usual breathing, but the CP results would be less accurate. Hence, we need to pinch the nose (and close the mouth!). For hygienic reasons, it is better to pinch the nose above the nostrils so that the mucosal surfaces of the nose remain clean. Otherwise, your fingers can contaminate the nostrils with germs. Holding breath longer or for as much as possible is dangerous for many people. For example, patients with hypertension experience a dramatic increase in blood pressure. Other people, who are predisposed to panic attacks or migraine headaches, can suffer from these symptoms due to long breath holds (Asmundson GJ & Stein, 1994; Zandbergen et al, 1992). It would make sense then to stick with a stress-free test, which is done until the first desire to breathe. If you stop the test and resume breathing at your first desire to breathe, you will be able to breathe as before the test: no stress, an easy, comfortable procedure. Look at the diagram below: after the test you can comfortably breathe as before the test.

_______ Fig 6.1 Correct measurement of the CP

If you hold the breath for too long, the first inhale(s) will be deeper, as here:

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Fig 6.1 A typical mistake in the measurement of the CP A person may deliberately suppress deeper breathing after the test by controlling inhalations and exhalations. This also tells that the time was extended and the result is larger than the real CP. Are there any other cautions for CP measurements? Some students should avoid CP measurements when they have food in the stomach. Breath holding intensifies peristalsis. Many modern western people have some inflammation of the lining of the stomach without being aware about it, while breath holds can make existing inflammation worse. Hence, care is required after meals: a few deep breaths can restore the previous gas balance in the lungs. People with panic attacks, heart problems, and migraine headaches may find the test uncomfortable. It can be better for them to temporarily avoid breath holding. When the CP is larger and the symptoms are absent, students can comfortably do the CP and even longer breath holds. (Some Russian doctors successfully teach all their students without any breath holds, including Level 3 for some of the students.)

6.3 Lifestyle factors that influence the personal CP If the usual personal CP is very low (about 5-10 s), the CP changes during any single day are usually as small as a few seconds up or down. In people with larger CPs, e.g. 25-30 s, the changes can be as large as 10-15 or more seconds. If you measure the CP often, you may realize that it can drop down and recover, but there is a certain range of CP fluctuations and certain minimum and maximum values you have throughout the day. Day after day, the personal CP range also changes, but not much unless the person has some serious health complications, like influenza, cold, food poisoning, etc. Let us consider how life-style factors can affect CP values. Meals The CP drops after meals, especially after overeating (eating when not hungry). The effect is particularly strong for heavy foods, like animal proteins and fats. If you are not hungry, but still eat such foods, your CP can easily drop 2-3 times. No wonder, severely sick or old people can die due to one heavy meal. For health reasons, they should rather have many small meals spread throughout the day. This prevents further deterioration of their health problems.

_______ Self-test. Sometimes you may eat more than you want or eat because of, for example, stress or for social reasons. Measure your CP 2-3 hours after eating when not hungry a heavy meal or overeating. Compare it with your usual CP. How large is the drop? (Do you know that professional marathoners do not eat any solid or heavy food for 8 hours before important contests?)

Physical activity During the exercise and soon after, the breath holding time can be short. However, it is what happens later that matters. The after-effects of physical activity are very different. They depend on personal health and factors related to exercise. For healthy people physical activity, when it is done using nasal breathing, is very beneficial. It can be the greatest CO2 and oxygenation booster and this is one of the reasons why they enjoy physical activity. When we are sick or breathe through the mouth, the effects of exercise are often opposite. The CP can become smaller. 112


Self-test. On some days you probably have more physical activity than on others. Try measuring your CP just before the exercise. Immediately after the exercise the CP is usually small. However, if you wait about the same time as the duration of the exercise or twice longer, you would be able to see if this exercise was useful for you. Just measure your CP Sleep When we sleep, one may expect that the CP should become greater in the morning. Why not since sleep is rest? However, this is true only for healthy people or for those who have at least 50-60 s CPs. These people have very short sleep (about 4-5 hours). They wake up having a greater EMCP (early morning control pause) than the previous evening CP. For the modern man (about 25-30 s CP), the situation is opposite. The unhealthy body, due to abnormal processes and chronic physiological stress for organs of elimination and other systems, depresses tissue oxygenation during sleep. Early morning hours are the times of the lowest CPs. That explains why at the end of sleep (4-7 a.m.), the rates of heart and asthma attacks, strokes, and other, often fatal, health problems are highest. These are the hours of heaviest breathing, lowest oxygenation and highest mortality rates. It is a frequent phenomenon that the morning CP is about two times less than the evening CP of the previous evening. Sleeping too long, when we having nothing else to do, further reduces oxygenation. In addition, if one sleeps on the back or breathes through the mouth, the CP drop can be more drastic.

Self-test. If you wake up during the night, check your CP after sleeping in different positions. You need to spend about 15-20 minutes in the same position in order to notice its effects on breathing. Which position suits you best? In addition, there are many physiological abnormalities that affect our breathing due to use of modern Western beds. Just 1-2 hundreds years ago most people around the world had very different beds and corresponding parameters of sleep related to softness of the surface, thermoregulation, and quality of air in the bedroom. The impact of these factors is considered in the next chapter. Infections, psychological stress and strong emotions The CP can drop, due to, for example, influenza, infection or fever about 2-3 times. You may find that when your CP is that low, you have more negative symptoms due to acute episodes of your specific condition. Being angry, depressed, anxious, feeling under stress, and when experiencing many other strong emotions cause drop in the CP. Mouth vs. nasal breathing Breathing through the mouth is a modern health disaster. This topic was discussed in Chapter 3. Nasal breathing warms, humidifies, and cleans the incoming air. Up to 95-99% bacteria, viruses, dust and other air pollutants get trapped on the moist surfaces of the nasal airways. They are designed to be narrow and long. During mouth breathing the irritants and pollutants can reach our bronchi, lungs and blood. Mouth-breathing usually means less than 20 s CP. It is a very rare person who can have greater than 25 s CP, while taking inhales through the mouth.

_______ Self-test. If you sometimes keep your mouth open at rest, measure your CP after keeping your mouth open for about 20 minutes. Compare this number with your CP when your mouth is closed after another 20 minute period.

Posture

Poor posture (the norm for modern people) also results in reduced CPs. Practically, slouching means that the CP is below 25-30 s. 113


Self-test. Measure your CP when you are relaxed with good posture. Spend 15-20 minutes in an awkward or uncomfortable (e.g., slouching) position with chronically tense muscles. Measure your new CP. When the spine is straight, as it should be in health, the diaphragm can easily move (stretch to the sides during inhalations and relax for exhalations) and diaphragmatic breathing, which should provide about 90% of air exchange at rest, is possible. When we slouch, the movements of the diaphragm are restricted. Instead, we start to use chest muscles for breathing. In sick people (less than 20 s CP), chest breathing is almost a norm. Why is it harmful? The lymph system, unlike the cardiovascular system with the heart, has no pump. The nature located lymph nodes of the human body in those places that get natural compression (squeezing) due to movements of, for example, body parts, as in cases of lymph nodes located around the neck, above arm pits and groin area. However, the lymph nodes from stomach, kidneys, liver, pancreas, spleen, large and small colons, and other vital organs are located just under the diaphragm so that nature expects us to use the diaphragm in order to remove waste products from these vital organs all the time, literally with each breath. Hence, chest breathing causes stagnation in the lymph system and accumulation of waste products in vital organs located under the diaphragm. Thermoregulation Having extra clothes and being in too warm an environment for long time are other factors that interfere with oxygen supply. After 10-20 minutes in such conditions, the CP can decrease by 5-10 or more seconds.

Self-test. Measure your CP in normal conditions. Spend 15-20 minutes in warm or hot conditions. You can do that by wearing more clothes. Check changes in your CP.

6.4 How CP measurements relate to aCO2 values In Chapter 2 we discussed that breathing of healthy people is controlled chiefly by current aCO2. Hence, these people and many people with non-life-threatening concerns (over 20 s CP), the duration of BHT (breath holding time) is defined by how soon current aCO2 level reaches the aCO2 threshold established by the breathing centre. Thus, the CP mainly depends on three parameters (chapter 2): • 1) initial aCO2, currently existing in the arterial blood or in the alveoli of the lungs; • 2) final aCO2, the level preset by the breathing centre as a threshold of tolerance; • 3) the rate of CO2 accumulation. As we also revealed in chapter 2, for diseased states hypoxia or low oxygenation becomes the main factor in the CP breaking point. In sick people, the chemoreceptors that sense oxygen content in the arterial blood have a low threshold of excitability (easily irritable). Hence, from the biochemical viewpoint, breathing of sick people is controlled mainly by hypoxia.

6.5 Conditions for correct CP measurements The CP is the central measuring tool of the Buteyko breathing therapy. For that reason, I shall review the main factors and conditions for its correct measurement, together with possible effects of these factors on BHT (breath holding time) duration. • Sufficient preliminary rest (10 min is suggested, according to Doctor Buteyko). For example, if measurements are done minutes after physical activity, BHT is going to be smaller due to elevated initial CO2 concentration in the venous blood, working muscles and their surrounding tissues. If you exercised for long time (e.g., 1-2 hours), you need about the same time to rest before CP measurement. • In a sitting position. Different postures cause different metabolism and, therefore, a different CO2 production rate. The standing position results in shorter BHT, while lying increases BHT in comparison with the sitting position. Both effects are due to different metabolic rates and rates of CO2 production. • With normal breathing before the test. Acute hyperventilation, due to reduction in aCO2, increases BHT for healthy people, while reduced breathing initially decreases it. However, for people with breathlessness and low aCO2 acute hyperventilation does not extend BHT, but can even reduce it (chapter 2).

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Warning. It may be very dangerous for severely sick people to hyperventilate before measuring the CP and other pauses. If the person, first, loses his small remaining CO2 stores (due to voluntary over-breathing) and then suddenly stops his O2 supply (as during breath holding), loss of consciousness is very possible due to greatly increased hypoxia of the brain (due to constriction of the carotid artery and very poor tissue oxygenation). The variation of this effect is known as a “school yard trick” (voluntary hyperventilation and subsequent strong pressing on the chest, done by a “friend”, can cause fainting even in healthy children but is usually safe although strongly discouraged). However, more tragic results were reported in professional diving research (e.g., Craig 1976; Edmonds & Walker, 1999). These authors directly suggested that hyperventilation before breath holding is the cause of numerous deaths. • At the end of the normal expiration. BHT is linearly proportional to the amount of air in the lungs, since the rate of CO2 accumulation is also proportional to this volume. • Without influence of medicines, street drugs, steroids, other respiration-affecting chemicals. Certain chemical substances can influence BHT 2-4 times in both directions. • Preferably on empty stomach. For example, maximum breath holds that are performed soon after meals can significantly intensify peristalsis and may cause vomiting in some people. • Till the first desire to breathe. If we try very hard, we can hold our breath almost twice longer. • Without any muscular movements. Physical movements at the end of the breath-hold distract the nervous system and suppress the signals from the breathing centre. That increases BHT. • With usual or normal parameters of the outside environment (air of normal composition, pressure and temperature). Normal air has about 20% O2, 0.04% CO2, and 80% N2. Normal barometric pressure (about 760 mm Hg) and air temperature (about 20 degrees C) are other important factors.

6.6 CP and various breathing patterns Pattern of normal breathing (in accordance with textbooks) The durations of inhalations and exhalations, breathing rate, amount of air inhaled per breath and other parameters are individual. In addition, these parameters have short- and long-term changes. Medical and physiological textbooks suggest the following numbers (chapter 1): inhalation (about 2 s); exhalation (2-3 s); automatic pause or period of no breathing (1 s); the depth of inhalation is about 500-600 ml; and breathing rate is about 10-12 times per minute.

_______ Fig. 6.3. This schematic picture shows 4 breathing cycles of normal breathing: inhalation (the upward lines), exhalation (the downward lines) and automatic pause (almost horizontal lines) accompanied by relaxation of all breathing muscles.

As mentioned above, the person with such breathing is going to have about 40 s CP. Most inhalation (up to 8090%) is done by the diaphragm, the main breathing muscle. Exhalation is passive and accompanied by relaxation of all breathing muscles. Doctor Buteyko, based on his studies, established different norms for breathing (Chapter 1). They include 60 s CP and 4 l/min for minute ventilation. Pattern of breathing in sick people with 10-20 s CP Their breathing is heavy, visible (likely chest and belly movements) and audible (possible panting, wheezing, sighing, yawning, sneezing, coughing, deep inhalations or exhalations). The mouth may be open. The CP is between 115


10 and 20 s. For sick people, the durations of inhalations and exhalations, breathing rate, amount of air inhaled per breath and other parameters are very individual. Many sick people can have the following parameters of the breathing cycle: inhalation (about 1.5-2 s), exhalation (1.5-2 s), no automatic pause; the depth of inhalation is about 700-1,000 ml; breathing rate is about 15-20 times per minute, the breathing pattern is often irregular and uneven.

Fig. 6.4. This schematic picture shows several breathing cycles of sick people with deep breathing: inhalation (the upward lines) and exhalation (the downward lines). The automatic pause (when breathing movements are absent) is absent. Note that the exhalation is forceful. Breathing muscles are strained in order to push air out of the lungs. Healthy people, as it was shown above, need just to relax all breathing muscles in order to exhale. Sometimes sick people, in addition to chronic hyperventilation, have an uneven or irregular breathing pattern that includes sporadic sighing, bouts of coughing, periods of fast breathing due to anxiety, irregular breathing due to stressful self-talk, etc. All these patterns reduce body oxygenation. They are symptoms of already existing hyperventilation and low oxygenation with less than 20 s CP. These irregular breathing patterns are absent when the CP is above 40 s. (It is known from the “chaos” theory that the regular/periodic behaviour of the system becomes irregular or chaotic after the second bifurcation point. Since 10, 20, 40, and 80 s CPs are the thresholds where certain significant physiological changes take place, and these numbers are part of the geometrical progression with ratio 2, the second bifurcation point, 40 s CP, is the point after which the chaos starts. Hence, the human body is in a state of chaos when the CP is below 40 s. However, it is beyond the scope of this book to dwell on further details.) Pattern of breathing in terminally ill people and during acute life-threatening episodes (CP < 10 s) Most terminally sick people (over 80-90%) have very heavy and deep breathing. They breathe over 20 times per minute taking over 1 litre of air for each breath. Their inhalations and especially exhalations are very short (less than 1.5 s). They need more than 20 l of air for one minute. The CP is about 10 s or less, indicating critically low level of oxygen and CO2. During life-threatening episodes (heart attacks, strokes, asthma attacks, epilepsy attacks, etc.) breathing is even heavier. The CP is only about 5 s.

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Fig. 6.5. This schematic picture shows several breathing cycles of very deep breathing: inhalation (the upward lines) and exhalation (the downward lines). “Therefore, during deep breathing carbon dioxide levels becomes lower, oxygen levels lower, breath holding time is shorter, breathing frequency higher, and the automatic pause is absent” (Buteyko, 1977). Breathing pattern for people with very large CPs Excellent breath holding abilities testify for large amounts of oxygen in tissues. Available practical evidence indicates that when people have very large CPs (up to 60-180 s), they have very easy and light breathing pattern at rest 24/7. The breathing rate can be only 3-8 breaths per minute with slow relaxed inhalation and long automatic pause (period of no breathing), up to 5-10 seconds. This corresponds to breathing only 2-4 litres of air per minute. Such CPs indicate absence of many modern health problems.

_______ Fig. 6.6. This schematic picture shows 2 breathing cycles of breathing with large CP: inhalation (the upward lines), exhalation (the downward lines) and long automatic pause (the horizontal lines). Here are all four typical breathing patterns in one diagram.

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Fig.6.7. Breathing patterns and their relations to health and CPs. Note. There are, of course, many irregular breathing patterns. Some people sigh every 3-5 minutes. Others cough a lot, or have sporadic sniffing activities. Often, breathing through the mouth is a part of the picture. All these irregularities usually are signs of poor health, faulty breathing control, low oxygenation and the short CP.

_______ Here, on the figure, we can see how deep or/and fast breathing leads to reduced oxygenation of body cells and corresponds to worse health. If we get light, shallow, slow and relaxed breathing pattern, oxygenation, CO2 concentrations and the CP will be much higher.

6.7 The CP and general health

The CP, according to Doctor Buteyko, is a simple and effective indicator of individual health. Analyzing CPs of his patients and experience of his medical colleagues, Buteyko suggested 5 zones of health and the table (chapter 5) that he described in his manuals and lectures (Buteyko, 1969, 1972, 1991a): Less than 10 s CP: severely sick, critically and terminally ill patients, hospitalised, and usually on medication. 10-20 s CP: sick patients with numerous complaints and, often, on daily medication. 20-40 s CP: people with poor health, but often without serious organic problems. 40-60 s CP: good health. 118


Over 60 s CP: ideal or excellent or normal health, when many modern diseases are virtually impossible. Russian medical doctors from the Moscow Clinic tell to their patients that: - when we have less than 10 s CP, we are fighting with death; - when we have 10-20 s CP, we are in the grip of the disease, it is holding us tight; - when we have 20-40 s, we are in a state of struggle with the disease; - when we have over 40 s CP, we are winning the battle with the disease; - when we have over 60 s CP, we can enjoy excellent health. However, it is possible that a person may have no complaints and no serious organic or metabolic health problems with a low or even very low CP (e.g., 5 s). It follows from Chapter 1 that the effects of hyperventilation are individual, and these above-given relationships (between the CPs and corresponding health states) reflect measurements in patients with asthma, bronchitis, hypertension, angina pectoris, emphysema, cancer, diabetes and other serious health problems.

6.8 CP and various systems and parameters of the organism Our breathing provides oxygen for the whole body, regulates blood flow to all tissues and organs, and partly eliminates carbon dioxide from the whole body. Hence, breathing is an integrative parameter of the whole organism. It needs to take into account many parameters and various requirements at the same time, including requirements from the cardiovascular, nervous, hormonal, immune, musculoskeletal and other systems of the organism. Hence, the CP is an integrative characteristic of your individual health. It approximately reflects the general state of all systems of the human organism. One’s inability to increase one’s own CP is usually due to the influence of the weakest system or the most vulnerable part or organ of the body. Let us consider in more detail the general connections between the CP and different parameters and systems of the organism keeping in mind that the effects of hyperventilation are individual. • The CP and minute ventilation (or breathing rate). These parameters are approximately inversely proportional (Chapter 5). The heavier one breaths, the lower the CP. • The CP and carbon dioxide stores. They are proportional in accordance with the Buteyko formula (Chapter 5). • The CP and tissue oxygenation. More carbon dioxide indicates the enhanced Bohr effect and better perfusion due to CO2-induced vasodilation. Both factors directly increase tissue oxygenation. • The CP and blood pollution. According to physiological studies, the blood flow to kidneys and liver (the main blood-cleansing organs) is proportional to aCO2 (Okazaki et al, 1989). Similarly, oxygenation and elimination of waste products from blood-cleansing organs are also worsened in conditions of chronic hyperventilation. Hence, the lower the CP, the more polluted the blood. It is not a surprise then, that in chapter 1 we found western experimental evidence that bacteraemia (presence of bacteria in the blood) or sepsis (presence of pathogens or toxic products in the blood) further intensifies chronic hyperventilation (possibly due to stress for the immune systems and organs of elimination), causing critically low aCO2 and, correspondingly very low CPs of probably not more than 5-10 s. Large CPs, on the other hand, ensure normal oxygenation, normal blood supply and efficient elimination of waste products from all tissues and organs, including organs of elimination. This normalises the purity and composition of the blood. • The CP and the state of the nervous system. Chapter 1 described the main effects of hyperventilation on the nervous system. Hence, short CPs indicate a low threshold of excitability of all neurons, quick changes in mood, possible sleeping problems, addictions, anxiety, panics, fearfulness, and other perceptual problems. A large CP and a high aCO2 reflect calmness; concentration; objectivity; and short, deep, and refreshing sleep. There are also dozens of studies revealing the predictable connection between breathing and human performance in relation to various skills. • The CP and the cardiovascular health. Numerous studies and Ph.D. dissertations about CO2 relationships with blood vessels and cholesterol deposits were written in Russia. Western studies (section 1.2) also demonstrated a local vasodilating CO2 effect. Investigating the state of blood vessels, Doctor Buteyko and his colleagues found, as mentioned above, that, when the organism reacts to hyperventilation by increasing blood vessel cholesterol deposits, every 0.1% in aCO2 decrease is equal to about 10 mg/dL of extra cholesterol deposits. This is how hypertension develops. Conversely, every 0.1% CO2 increase (or 2 s CP increase) is equivalent to 10 mg/dL reduction in the blood cholesterol level. Therefore, normalization of breathing is equivalent to normalization of cholesterol level and blood pressure.

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Furthermore, some Russian patients of Doctor Buteyko deliberately tried to eat high-cholesterol foods while having large CPs. It was found that dietary cholesterol did not produce any adverse effects on blood cholesterol, when the breathing was normal (Buteyko, 1969) Numerous medical references, which found the relationship between over-breathing and various heart problems, according to reports of different Western doctors, were kindly provided by Peter Kolb and were quoted in chapter 1. You may review them again. These heart problems disappear when the CP is above 40 s. • The CP and the respiratory system. Two main general parameters of the respiratory system, in terms of their profound influence on the whole organism, aCO2 and aO2, were considered here at the very beginning (points 1 and 2 above). Concerning specific respiratory CO2 effects, the main problem of asthmatics, bronchoconstriction due to low aCO2, was described in chapter 1. As explained in chapter 2, the mechanism of breathing control is different in good health and disease. Hence, the CP reflects the efficiency of this control. Small CPs usually correspond to laboured upper-chest breathing, whereas large CPs and ideal health are characterised by regular, smooth, slow, quiet, invisible, noiseless, and easy diaphragmatic breathing with relatively longer exhalations and automatic pauses after exhalations. In some health conditions (e.g., asthma, COPD and emphysema), the lungs can have uneven distribution of incoming air during breathing due to mechanical obstruction caused by, as in classical asthma cases, inflammation of airways, bronchoconstriction and excessive mucus formation in certain areas of the lungs. Narrowing of airways, according to Doctor Buteyko, is the defensive mechanism of the organism from chronic CO2 losses. Elimination of chronic hyperventilation naturally heals inflammation, dilates bronchi, and normalizes the immune system and mucus production. Those people, who breathe within the physiological norm (about 6 l/min), have even distribution of incoming air due to no obstruction to air flow (Buteyko, 1969). When these and other people are chest-breathers, some parts of the lungs, usually in the upper chest, get more air than others lower parts near the stomach. How can normal breathing, compared to hyperventilation, help with this problem? Low CO2 concentrations in the diaphragm cause muscular tension in this smooth muscle. Hence, sick people often have upper chest breathing with diaphragmatic contribution as little as 10-20% to total ventilation. This ratio in health is reversed. Normalization of breathing and increased CO2 values relax the spasm in the diaphragm making the distribution of fresh air more homogeneous since the diaphragm works as does a piston in the car engine. • The CP and normal concentrations of hormones. Low CPs can result in abnormal blood glucose regulation (Buteyko, 1969; Lavrent'ev, 1993). Most people react to chronic hyperventilation with accumulation of fat deposits since CO2 regulates the permeability of fat cells in relation to blood glucose. Hence, most people accumulate more fat when their breathing is heavier. They need to eat more to keep their blood sugar levels within norms. In addition, heavy breathing reduces perfusion and oxygenation of the pancreas also contributing to abnormal regulation of blood glucose level. That causes delayed, or excessive, or inadequate response of the pancreas to blood sugar variations, together with excessive or ineffective insulin. The proceedings of the Soviet conference of Buteyko doctors published the discussion between Konstantin Buteyko and AN Samotesova, the main endocrinologist of Krasnoyarsk region: Buteyko: “During all previous conferences dedicated to diabetes mellitus the leading specialists declared that in the whole world there isn't a single known case of diabetes having been cured. So, we have nothing to lose: what if we can manage at least to reduce insulin intake? We have such patients. These are 14 people who have undergone treatment in Krasnoyarsk. I wish to express my gratitude to A. N. Samotesova for her active efforts. For 36 years I have been looking for an endocrinologist willing to use DVBM. Now you can see absolutely clearly the changes in diabetes treatment.” Practical work with patients diagnosed with hyper- and hypo-thyroidism also revealed that normalization of the thyroid hormone concentration is proportional to CP growth. Describing the method, Buteyko and Genina wrote: “For patients with hormone dependent forms of disease we use the following tactics. We believe that it is necessary: …to explain that DVBM [the Buteyko method] eliminates hormone deficiency even in Itsenko-Cushing syndrome when a patient reaches 30-40 second control pause…” (Buteyko & Genina, 1991) • The CPs and the GI (gastrointestinal) system. Hyperventilation (both chronic and acute) diverts blood flow from the brain and internal organs to skeletal muscles. Almost a century ago, the above-mentioned Yale Professor Yandell Henderson found that a low aCO2 (due to hyperventilation) resulted in loss of tone in the blood vessels of the abdominal viscera of dogs, producing extreme intestinal congestion. Saturation of the blood with CO2 rapidly eliminated the congestion (Henderson, 1907). Thus, chronic hyperventilation and correspondingly small CPs mean chronic problems with perfusion and oxygenation of the digestive organs. These and other changes (e.g., of biochemical nature) cause various problems

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with the GI system. Studies quoted in Chapter 1 (Section 1.5) found that blood flow, for example, to liver and colon is proportional to arterial CO2. A more recent investigation, entitled "Hyperventilation, central autonomic control, and colonic tone in humans", had the following abstract. "Symptoms attributable to hyperventilation are common among patients with the irritable bowel syndrome (IBS); indeed, some have suggested that hyperventilation may exacerbate the alimentary symptoms of IBS. Hyperventilation changes haemodynamic function through central and peripheral mechanisms; its effects on colonic motor function, however, are unknown. The aim of this study, therefore, was to assess the effects of hyperventilation on colonic tone and motility and on cardiovascular autonomic activity, and to discover if hypocapnia was critical to elicit the response. Phasic and tonic motility of the transverse and sigmoid colon, end tidal PCO2, pulse rate, and beat to beat pulse variability were assessed before, during, and after a five minute period of hypocapnic hyperventilation in 15 healthy volunteers; in seven other subjects, effects of both eucapnic and hypocapnic hyperventilation were evaluated. Hypocapnic but not eucapnic hyperventilation produced an increase in colonic tone and phasic contractility in the transverse and sigmoid regions and an increase in pulse rate and pulse interval variability. The findings are consistent with inhibition of sympathetic innervation to the colon or direct effects of hypocapnia on colonic smooth muscle, or both. These physiological gut responses suggest that some of the changes in colonic function are caused by altered brain or autonomic control mechanisms" (abstract, Ford et al, 1995). It follows from this investigation and several other studies that low CO2 (hypocapnia) due to over-breathing is directly responsible for an irregular peristalsis and an abnormal tone of the GI tract. Normally, various gastric secretions are also influenced by carbon dioxide concentrations, which are controlled by outer respiration. Are there any long-term influences? Since the GI tract is the main consumer of proteins we eat, can chronic hyperventilation cause impaired repair of the small intestine? This process of self-repair is reflected in the measurable parameter that is called the "intestinal permeability". The relation of this factor to breathing will be discussed in more details later (section 8.3). Increased intestinal permeability means that large undigested food particles can go directly into the blood due to a chronically underrepaired gut. The test for intestinal permeability has over a quarter of a century history of clinical use and can be used "for diagnostic screening of small bowel disease" (Bjarnason et al, 1995). There are no direct investigations that link CO2 levels or breathing and intestinal permeability. However, we can look at the results of measurements of intestinal permeability for various health problems. For example, French researchers revealed, according to the title of their article, "Increased intestinal permeability in bronchial asthma" (Benard et al, 1996). A group of Italian investigators found the same GI problem for patients with arthritis (Picco et al, 2000). They also observed that this "test [permeability] seemed to correlate with histopathological features of the gut mucosa" (Picco et al, 2000). Patients with kidney problems frequently have increased intestinal permeability as well (Rostoker et al, 1993). People with all these problems are likely to have abnormal or pathological composition of bowel bacteria. Generally, when the CP is low, the immune system is not efficient in fighting pathogens in the GI tract. That usually causes abnormal bacterial flora in the small and large intestines. In addition, pathogens can thrive in the mouth and stomach in conditions of chronic hyperventilation. Since the GI system has its own relatively independent cluster of nervous cells (the “second brain”, as it is often called) and since CO2 deficiency makes any nervous cell abnormally excited, chronic hyperventilation can cause numerous abnormalities related to motility, secretion and production of hormones, and other GI parameters depending on hereditary predispositions, diet and many other life style factors. As a result, hyperventilation can cause various abnormalities, including GERD, various forms of gastritis, ulcers, pancreatic problems, IBS, IBD, Crohn’s disease, etc. • The CP and the immune system. The experience of patients practising Buteyko breathing revealed that an increased personal CP means fewer viral and bacterial infections. Blood laboratory results found that larger CPs significantly increase white blood cell count (Zimchenko and Romanenko, 1990) and normalizes concentrations of immunoglobulins, including IgA, IgM, IgG, and IgE (Genina et al, 1982). The tissues and organs of the immune system suffer, in conditions of chronic hyperventilation, from: hypocapnia, hypoxia, decreased perfusion, problems with availability of nitric oxide, abnormal flora in the gut, etc. Previous results obtained by Russian Buteyko doctors allow me to suggest the following typical interactions between the immune system and health problems of the organism. • Very large CPs (over 90 s) provide effective a defence mechanism against numerous bacterial and viral infections, parasites, caries, inflammation, and the influence of other inner and outer toxic sources. The organism is clean; the flora of the skin, nasal passages, mouth, stomach, intestines, and other surfaces of the human body (the first

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line of defence against pathogens) is healthy and the immune system can keep unwanted microorganisms and harmful foreign particles and chemicals under control. Should pathogenic organisms or substances try to penetrate the human organism, the immune system can detect, mark, destroy and eliminate them. This is the normal state of the human organism as it was designed and intended by Nature and evolution. • Chronically low CPs (e.g., 20-30 s or less) favour the chances of infections, growth of pathogens and formation of inflamed or diseased tissues in various places of the body. • When these health abnormalities advance in size and composition, they produce more toxic and pathogenic waste. That further increases ventilation and decreases the CP (down to 10-20 s). As in the case of acute infections, the person breathes harder. • The chances of appearance of new infectious sources or diseased states or abnormal tissues are much higher when the CP is already lowered by previous sources of poisoning. For example, it is much more likely for a person, predisposed to asthma, to get lower CPs and problems with asthma, if she has bad teeth or degenerated tonsils. This person would also be predisposed to various infections due to loss of sensitivity of the immune system. • The appearance of certain health problems is not necessarily the result of the work of microorganisms. Many chronic degenerative health problems can be the manifestations of malfunctioning systems and organs of the human body without any pathogens present. For example, many heart problems are reactions to chronic hyperventilation. The same relates to epilepsy, asthma, stroke, cholesterol deposits, malignant tumours, etc. The inflamed and abnormal tissues may remain germ-free for long periods of time. • Inflamed and unhealthy tissues of various organs (as in cases of gastritis, ulcers, nephritis, arthritis, cancer, etc.) are the result of hypoxia, inadequate blood perfusion, abnormal state of the immune system, and poor repair and regenerative abilities of the human organism. Accumulation of waste products, abnormal levels of electrolytes, and other pathological processes are often characteristics of these tissues. These conditions can provoke the further advance of certain pathogenic microorganisms, as it is often seen in gastritis, ulcers, chronic fatigue syndrome, and many other health problems. When the CP is below 10 s, many pathogens can invade the blood, lungs, live, brain, and other organs. • The path from health to disease consists of gradual increase in ventilation (chronic overbreathing) and reduction of CP. This usually reflects the impact of pathogens and waste products on the human organism. Generally, the lower the CP, the more polluted the body. (Children may have low CPs some of the time or most of the time and have relatively clean bodies yet.) • At any given moment of time, the normal immune system reacts mainly to one infectious source or one health problem, which, in the view of the organism, is most dangerous to the current well being of the whole organism. Indeed, humans would be too vulnerable to disease, infections and other abnormalities, should the immune system overreact to some small or minor problems, while ignoring those that are life-threatening. For example, it is known that the overwhelming number of infections is not noticed by the normal person, since the immune system can quickly identify the intruders and promptly and efficiently deal with them. Hence, there is no fever, no fatigue, no problems with digestion, appetite, sleep, etc. However, the immune system of a sick person may not properly respond to some pathogens. Hyperventilation affects concentrations of various immunoglobulins, synthesis of other amino acids, lipids and carbohydrates, changes rates of many other chemical reactions. Hence, some pathogens may thrive without any resistance from the immune system. These pathogens can settle in weak parts of the body and grow there producing toxic load for organs of elimination. For example, fever, in cases of influenza, cold and other infections, indicates that the immune response was delayed. There are now too many pathogens in the body. It would require great efforts of the immune system to fight, in cases of low CPs, for example, a simple cold. In relation to pathogens, the response of the low-CP immune system can be either negligible or absent. Hence, they can remain hidden or dormant, often for years. That often relates to pathogens in the mouth, stomach, and small and large intestines. • The priority of health problems (what is important and what is less important) is usually reflected in breathing and measured by the CP. Statistics of mortality are useful in this respect. For example, severely sick people with heart problems, asthma, stroke, epilepsy, and advanced stages of cancer, diabetes, and AIDS, all are characterized by heavy hyperventilation and about 3-10 s CP. Bacteraemia and sepsis can be fatal for such patients. It is normal then that the immune system, in such conditions, cannot and should not spend its resources to fight relatively harmless pathogens in, for example, cavities or in degenerated tonsils, since the life of the individual is at stake.

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• When the previous main problem is eliminated (or not significant anymore), due to CP increase, the dormant, previously minor, health problems, toxic or unwanted substances, or infections become the main focus of the more sensitive immune system. That reflects the reverse process when the organism gets healthier. This process is caused by normalization of breathing. The path to health consists of elimination of the same obstacles, which created the main disease, but often in the reverse order (in correspondence with the known law of natural medicine). Normalization of breathing and increased CPs make the immune system more sensitive so that smaller problems can be effectively addressed and defeated. • When all previous health problems are eliminated and all systems, organs and tissues of the organism are wellfunctioning and in a good shape, achievement of large CP values (up to 60 s or more) is possible. Conversely, practice indicates, that large CPs (over 60 s) correspond to absence of medical pathologies. Thus, the goal of the Buteyko method, in medical terms, is to normalise blood gases and, therefore, the whole biochemistry of the human organism disturbed by chronic hyperventilation. In practical terms, the goal is to have a stable CP of over 60 s. This goal is achieved by gradual normalization of breathing and training of the breathing centre to adjust to higher aCO2 values, up to the Buteyko norm (6.5% aCO2) and 60 s CP.

6.9 The link between the CP and symptoms This link in relation to asthma and heart disease was considered before. Generally, patients with 20 s CP are almost asymptomatic. 15 s CP is a typical number for most asthmatics (they have moderate asthma) and hypertension patients (mild form of the heart disease; class 2 US classification). It is logical then that over 25 s CP for the whole day means no symptoms and no need for medication for these health conditions. There are many other conditions where Soviet Buteyko doctors found a close relationship between the CP and the symptoms, or the CP and life style factors. Consider some of their quotes. “According to our data, those patients who increased their control pause up to 30-40 seconds, with a pulse rate of 65-70 beat/min., have stopped taking hormone medications because they did not need them any more” (Buteyko, 1991b). “We can switch to jogging when CP reaches 20-30 see., i.e. when the main symptoms come to halt. If one begins jogging by CP equal 10-15 sec., instead of remedial effect we can get hyperventilation and exhaustion of the organism resources” (Souliagin, 1991a). He continues later, “The organism can be greatly affected by dousing with cold water. In patients with control pause under 10-15 seconds (usually we get serious, neglected cases) momentary cold douches cause aggravation of inflammatory processes, make the patient shiver and feel worse, and result in disgust towards tempering. That is why momentary cold water dousing should begin after the control pause has reached 20-25 seconds and when the patient feels well” (Souliagin, 1991a). “A control pause of the ideally healthy person is 40-60 seconds which corresponds with 6.5% of CO2 in alveoli. A control pause magnitude indicates a state of patient's health and reveals factors which assist in lessening of breathing at that particular stage. For instance, a sauna is contraindicated with a control pause equal 5-10 seconds, but useful when it comes to 20-30. The same can be said about jogging, cold water dousing, etc. All of that is to confirm a leading role of breathing in the recovery process once again. A patient achieved 40-60 second control pause becomes his own antipode, a person, healthy physically and spiritually. However, to reach such a higher level is far from easy for a person who was "yesterday" seriously ill. Only a practitioner, who has cured himself by DVBM [the Buteyko breathing method] and gained a sufficient professional experience in that, is really capable to help another person to achieve this similar effect” (Souliagin, 1991a). “When a patient has not got practically any symptoms of his major disease and his control pause has reached 20-30 seconds those latent foci begin to clearly show themselves” (Souliagin, 1991b). “For patients with hormone dependent forms of disease we use the following tactics. We believe that it is necessary: ..... • to explain that DVBM [the Buteyko breathing method] eliminates hormone deficiency even in Itsenko-Cushing syndrome when a patient reaches 30-40 second control pause…”(Buteyko & Genina, 1991). There are many other, more specific conditions and symptoms which have a tight connection with the CP.

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“Mastopathy is fully resolved when a control pause is reaching 40 seconds” (Davidyanz, 1991). “Dysfunctional bleedings with prolonged menstruation. With control pause reaching 20 seconds their duration decreases greatly. With further growth of control pause each next period is getting shorter compared with a previous one and becomes normal in average in three menstrual cycles. Bleedings in between periods with a control pause of 20 seconds stop and does not return”(Davidyanz, 1991). Practical observations indicate that, for example, symptoms of bronchitis and sinusitis are present (mucus in airways can appear or the sinuses can get blocked) when the CP drops below 20 s. However, there are exceptions to all these general observations. For example, the ideas about physical exercise (e.g., jogging is possible when the CP is above 20 s) can not be applied to patients with emphysema. Damage in the lungs and ventilation-perfusion mismatch (some blood is shunted or does not participate in gas exchange) make the physical exercise with nasal breathing only difficult or impossible, even when the CP can be up to 30-35 s. Many psychological and psychiatric conditions (sleeping problems, migraine, depression, addictions, etc.) and symptoms can have relatively wide individual variations. For example, some people notice normalizations of sleep when the CP gets up to 20 s, others up to 40 s. However, general rules about stopping medication (over 25 s CP) and recovery zones (30-40 s CP) remain true for virtually all people and the exceptions are very rare (e.g., when carotid bodies are surgically removed or nerves that provide muscular innervation of breathing are cut).

6.10 Maximum, average and minimum daily CPs It would be of practical interest to define which CP value, during the day, is physiologically most important. Indeed, since the CP fluctuates during the 24 hour period, we have, for example, the maximum CP, minimum CP and average CP to consider. The minimum CP could not appear from nowhere: a certain factor or physiological stress on certain systems intensifies respiration. For example, an asthmatic, who gets symptoms of asthma attack, “earned” these symptoms due to, for example, allergic reaction of the over-sensitive immune system. This reaction causes histamine rush, inflammation of the airways, extra-production of mucus, later, depletion of cortisol reserves to eliminate inflammation, further overbreathing, possible worsening of flora in nasal passages and/or in the GI tract, etc. Hence, there is a cascade of negative events with measurable components of physiological damage. Similarly, a heart or stroke patient, due to some 1-2 hours of acute hyperventilation, as in cases of heart attacks or stroke, can create detectable damage to corresponding tissues. Temporary overbreathing, just 30 minutes, of the patient with sinusitis provides conditions for the pathogens, always present in the nasal passages, to grow and advance. Not only the CP would be low, this patient is likely to get a blocked nose due to drying of the mucosal surfaces (poor perfusion) and extra mucus production. Similarly, a patient with gastritis or ulcers can worsen existing inflammation, increase its area, and get more pathogens in the GI tract due to temporary overbreathing manifested in low CPs. Why? Because of lowered oxygenation, blood supply, and tone of the GI organs, with the temporary weakened state of the immune system. A patient recovering from emphysema can have over 40 s CP during 23 hours of the day, but only 20 s CP during the remaining hour. This hour would be characterized by dried nasal passages (due to acute hyperventilation) and inability of the body to prevent dust and other particles from penetrating into the lungs, due to drying of airways. This results in more damage to alveoli. A cancer patient with usual 30 s CP throughout the day may have only one period (e.g., 3 hours in the morning) with about 15 s CP due to morning hyperventilation, but this would be enough to create hypoxia: “the key regulatory factor in tumour growth” (chapter 1). Hence, the tumour will grow during these 3 hours and will be healed during the remaining 21 hours. This battle may also go on forever making recovery impossible. In all these cases, the resulting physiological state of the body would be defined mainly by the damage which appeared during short periods of over-breathing, not by average or maximum daily CP values. There are, of course, other, rather hypothetical situations in adults when temporary CP drop would not cause much damage. Obviously, very healthy people (over 60 s CP) will not suffer from temporary CP drops. Similarly, healthy young children normally have large CP fluctuations (e.g., from 60 to 10 s and then up), while sick ones are always CP-restricted. Hence, considering health recovery and tissue healing, we need to assume that the current health state of the person, in most cases, is reflected in his minimum CP during any chosen day. Finally, if a person had about 15 s CP during the whole day, but then he had a fatal stroke or heart attack,

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which CP reflects his health state for this day?

6.11 Other pauses and their definitions According to individual conditions, Buteyko and his colleagues used different pauses for their patients during the Emergency Procedure, measurements, and various breathing exercises. So far, we know about the CP (measured until the first desire to breathe). The MP (maximum pause) is measured for as long as possible, but without physical movements. The EP (extended pause) is between the CP and the MP in duration. The EP is done until some distinctive, not slight or not strong, desire to breathe. Therefore, it is an arbitrary pause. In addition to that, some practitioners introduced AMP (absolute maximum pause). The AMP is accompanied by muscular movements (e.g., swallowing/breathing imitations, or stomping, or arms rotations, or fists clenching, etc.) at the end of breath holding in order to prolong breath holding to its maximum. The SP (short pause) is another possible variation. It was suggested using the SP for the Emergency Procedure above. It is shorter, than the CP (e.g., half of your usual CP), and the safest choice for many people. The main differences among different pauses are that the longer pauses (the MP and the AMP), on the one hand, accumulate CO2 quicker. On the other hand, due to temporary lowered oxygenation of the blood, longer pauses can cause temporary vasoconstriction, increases in heart rate and blood pressure. These pauses also make relaxation and the following control of breathing more difficult. Thus, longer pauses are powerful tools, but should be exercised, if one wants to, with caution.

6.12 Potential dangers of long breath holds and strong air hunger There are many health conditions, when MP and AMP measurements must not be done. Let us look at the causes of possible problems with long breath holds. Breath holding causes a fast rate of accumulation of CO2 and reduction in O2 in the lungs. Hence, the arterial blood gets more CO2 and less O2. Hypercapnia and hypoxia produces 2 opposite effects on smooth muscles of blood vessels: vasodilation due to hypercapnia and vasoconstriction due to hypoxia. In 1960’s, when Buteyko was working in the respiratory laboratory, he and his colleagues conducted numerous studies about the effects of inhaled gases with various compositions on the tone of blood vessels (Buteyko et al, 1964a, 1964b, 1965, 1966a, 1966b). He found that the body could maintain its physiological processes normally when changes in the composition of the inspired gas were gradual. Sudden changes caused unpredictable effects. Sudden hypoxia could lead to vasoconstriction, significantly increased heart rate and blood pressure. These could be the long-term effects of cardiovascular adaptation to a new gas composition. This loss of sensitivity to CO2 can be a serious concern for some Buteyko students and it is described later. He used these ideas, when he was developing breathing exercises for his patients. In order to achieve positive effects, Buteyko taught his students how to gradually change one’s breathing without disruptive or sudden variations in blood gases. The reduced breathing was the main tool for ventilation reduction and level of air hunger was light. Here the situations when certain groups of people can experience various problems due to long pauses and sudden changes in the gas composition of the blood. • In a person with hypertension, even the CP result in increased blood pressure often, depending on the severity of the condition, causing unpleasant symptoms. Such a practical result was received in many hypertensives (i.e., Kohn & Cutcher, 1971). Moreover, some of them had a systolic blood pressure increase from about 200 to 260 mm Hg during MPs, making the whole procedure of doing the MP dangerous (Ayman & Goldshine, 1939). Indeed, in rare, but possible cases of undetected serious organic defect in the heart muscle, the MP may cause severe complications, including mechanical damage to the heart muscle. • Similar negative cardiovascular effects can lead to appearance of migraine headaches in those people who are predisposed to such symptoms. • People with frequent panic attacks can experience their negative symptoms because of the CPs or longer pauses and mild or strong air hunger.

_______ As another possible negative effect, long pauses and strong air hunger could cause greatly increased blood flow due to hypercapnic vasodilation. As a result, people with some serious pathologies can experience negative symptoms. • Many acute gastro-intestinal problems (gastritis, gastric ulcers, Crohn's disease, inflammatory bowel 125


disease, irritable bowel syndrome, intestinal ulcers, etc.) can dramatically worsen due to the suddenly incoming blood intensifying peristalsis. Flare-ups, , opening of healed lesions, intensive wear of mucosal surfaces, causing such symptoms as gases, cramps, thirst, and diarrhoea, all are possible complications. • Patients with extensive damage to kidneys' nephrons can experience so sudden an increase in blood flow to kidneys, that remaining working nephrons may be overburdened with the extra work to clean large amounts of the blood. Their possible congestion could result in the kidneys' failure. • Long breath holds can cause metastasis in people with malignant tumours (or cancer). Indeed, long pauses can be considered as light internal massage, due to their strong impact on microcirculation. Malignant cells can travel to neighbouring lymph nodes, leading to the development of cancer in those people who do not increase their usual CPs. (Increase in the CP up to 35-40 s would indicate more normal work of the immune system and its ability to destroy malignant cells.) • Patients with acute brain trauma will experience increase in intracranial pressure (the pressure inside the skull). Moreover, should their blood have recently coagulated and therefore has not yet formed a firm protective layer, this layer can be broken (due to larger pressure from underlying fluids) causing more bleeding and severe complications. • Patients with recent bleeding cuts and other acute skin injuries will have dilation of small blood vessels and increased blood flow. That will cause additional bleeding. If the cut or injury has just started to heal, opening of healed areas due to increased pressure from underlying blood layers is possible. • A blood clot, due to thrombosis in veins, can get loose and block a blood vessel leading to some organ causing severe problems or death. • Maximum pauses, strong air hunger and high CPs (e.g., 30-35 s) can cause problems for people with transplanted organs due to increased sensitivity of the immune system in relation to foreign cells leading to rejection of donated organs. • Spontaneous abortion of the fetus is possible, if the pregnant mother practices strong air hunger or long breath holds. The immune system, in case of serious initial toxicity of the fetus, may decide that it is easier to abort the fetus than to rebuild, repair and readjust polluted tissues of the fetus. In very rare situations (e.g., immediately after a dental or other surgery, or after a brain trauma, or after getting a bleeding cut) any breath holding, any sudden increase in carbon dioxide levels, or strong air hunger during RB could cause sudden dilation of small blood vessels and increased bleeding. Hyperventilation has another extremely useful value in terms of survival of different animals. As it is known, arteries are hidden deeply under the skin in order to prevent bleeding, should a cut or severe open injury occur. Wise Nature anticipated such an unlucky turn of events. Moreover, Wise Nature also provided animals with hyperventilation in order to prevent excessive blood losses and possible death. As one may remember, in chapter 1 I quoted medical doctors who found that they could not draw a blood sample from fingers of their patients who voluntarily hyperventilated. That was a normal result since low carbon dioxide values constrict small blood vessels, hence, greatly reducing their blood flow. One may notice that in natural conditions wild and domesticated animals and humans over-breathe when they have, for example, bleeding cuts. Such over-breathing is done unconsciously due to the pain and vision of their own blood. Later, after coagulation, the breathing is gradually reduced and the pain is also less. In addition, should any further bleeding occur, the emotional shock and vision of the own blood can again generate heavy over-breathing. This mechanism again helps to start the initial stages of wound healing. However, any excessive carbon dioxide increases can immediately cause opening of coagulated and hardened layers due to increased pressure of the blood in the adjacent small vessels. That would result in additional blood losses. The same ideas can be equally applied to the acute brain traumas. These considerations caused wide-spread appearance of prophylactic hyperventilation in the medical practice of neurologists to prevent acute bleeding (for reviews of this practice one may see Marion et al, 1995 or Yundt & Diringer, 1997). Therefore, should you get any bleeding wound or cut (after a surgery or injury, follow your natural impulses and breathe hard! That relates to dental surgeries; tonsillectomy; operations on the brain, internal organs, skin; industrial and domestic accidents, etc., when bleeding or severe haemorrhage is possible or present.

_______ 6.13 Short pauses as safer alternatives

Practical work with patients, done by Doctor Buteyko and his colleagues, resulted in the conclusion that measurement of MPs are not as safe as measurements of, for example, CPs. For example, the Buteyko manual 126


(Buteyko, 1991a) has a warning that MPs should be measured only in the presence of practitioners in order to check if the training session is done correctly. Many patients reported a discomfort, while doing long pauses, and the subsequent heavy breathing. That often resulted in the negative attitude of the patients. Thus, CP became a more popular measuring tool. MPs of novices are physiologically different from MPs of experienced Buteyko students due to the “training effect” (chapter 2). Therefore, with the same subjective perception of air hunger, experienced students have greater accumulation of aCO2, in comparison with those students who are at the initial stages of the breathing exercises. Hence, if you have just started to learn the Buteyko breathing method, you should substitute your MP in the formula for defining your aCO2. If you have performed breath holding many times, substitute your CP in the formula in order to define your aCO2. There is one other aspect, which is not mentioned in the Russian Buteyko literature regarding the difference between the MP and the CP. That relates to those practical situations, when people naturally hold their breath (as it may be expected, these activities are very healthy in order to normalize breathing). For example, gradual cold water immersion, bare foot walking, and certain static yoga postures are such examples. Normally, in these cases breath holding is done until the first desire to breathe, as during CP measurements. Therefore, apart from situations, when people are involved in daily diving, the CP was and can be a part of natural life, while the MP was and is a very rare natural experience. However, many patients and Buteyko practitioners use the MP and AMP in measurements and exercises. They believe in its effectiveness and stronger overall impact on the organism. In my view, a student is likely to obtain maximum benefits from having long pauses (the EP, MP, and AMP), if this student: - does not have any of the health problems described above (in bold font); - is able to relax while performing long pauses; - feels comfortable while doing long pauses and later; - has complete breathing control after such pauses; - gets lowered heart rate 1, 5, and 15 min after the pauses; - feels that these pauses create a stronger overall impact (on relaxation and general well-being) at the end and after the exercises. The fastest progress is usually achieved by those students who practice constant control of breathing from very first days of learning.

Q&A section for Chapter 6 Q: What are the possible dangers of forceful prolonged breath holds for ordinary people? A: When “the person is asked … to hold own breath till the limit, after this breathing is disturbed leading to heavy breathing. This breath hold is dangerous due to deep inhalations which break the normal balance [of gases] inside the lungs. And subsequent deep breathing decreases CO2 in the body, causing damage” (Buteyko, 1977).

_______ Q: I have a CP of 5 s and I go about normal life fine, and a CP of 60 s seems quite hard to achieve… Am I missing something? A: “Chronic hyperventilation affects everyone differently. Some people get asthma. Some get CFS. Some get chest pains. Some get all of them. It just depends on genetic predisposition. Even though [there are] people who habitually hyperventilate, [they] may not experience any immediate symptoms. Don’t forget that Alzheimer, motorneurone disease, Parkinson’s etc. have not been understood and nobody knows what causes them. But the hyperventilation theory could [explain them]” (Peter Kolb, private communication, 2002).

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Q: I sometimes do the breathing exercises in a group with other people. We periodically measure the breath holding time. However, we are all at different stages of breathing when the measurement starts. Is there a big difference in BHTs (breath holding times) at the end of exhalation and end of inhalation? A: As we learned in section 2.3, breath holding time is proportional to the amount of air in the lungs. Usually, those who hyperventilate have larger tidal volumes (they breathe deeper) and as a result would have a greater difference in the BHTs at the end of exhalation and end of inhalation. However, a simple estimation can be made. The normal volume of air in the lungs at normal expiration, as shown in Appendix 1, is 2400 ml. After a normal inhalation that volume increases to 2900, since the normal tidal volume (air volume breathed in during a single breath) is about 500 ml. The difference between these values (2400 and 2900 ml) is about 20%. Therefore, theoretically, the difference in breath holding time at the end of exhalation and at the end of inhalation should be also about 20%. Experimental studies found, as it was discussed in section 1.11 that these breath holds (after exhalation and inhalation) are 40% and 55%, respectively, in relation to the maximum BHT (at full inspiration). The relative difference between these numbers (40 and 55) is almost 38% probably due to measurements from a large number of sick people who chronically hyperventilated. These people had larger tidal volumes due to both deeper inhalations and deeper exhalations. Hence, the difference for them, due to overbreathing, is greater than the normal value (up to about 20%). During reduced breathing of healthy people, the tidal volume is about half the usual figure (e.g., about 250 ml for healthy people instead of 500 ml). Hence, the difference in the BHT values would also be halved to about 10%. Hyperventilating people, on the other hand, would still breathe too deep during the reduced breathing. However, the difference is still likely to be two times smaller, or about 10-20%. For example, instead of 20 s (the CP) a person can record 22-24 s (after inhalation during reduced breathing).

References for chapter 6 Ayman D & Godshine AD, The breath holding test, a simple standard stimulus of blood pressure, Archiv of Intern Med 1939, 63: 899-906. Benard A, Desreumeaux P, Huglo D, Hoorelbeke A, Tonnel AB, Wallaert B., Increased intestinal permeability in bronchial asthma, J Allergy Clin Immunol 1996 Jun; 97(6): 1173-1178. Bjarnason I, MacPherson A, Hollander D, Intestinal permeability: an overview, Gastroenterology 1995 May; 108(5): 1566-1581. Buteyko KP, Odintsova MP, Dyomin DV, Hyper- and Hypoxemia Effects on the Peripheral Vascular Tone [in Russian], Materials of the Second Siberian Research Conference of Therapists, Irkutsk, 1964a.

_______ Buteyko KP, Dyomin DV, Odintsova MP, Regressive Analysis in Differentiating Aerated Blood Gas Component Effects on Peripheral Arteriole Functional Conditions [in Russian], Materials of the Second Siberian Research Conference of Therapists, Irkutsk, 1964b.

Buteyko KP, Dyomin DV, Odintsova MP, Ventilation of the Lungs and Arterial Vascular Tone Interconnection in Patients with High Blood Pressure and l Pectoris [in Ukrainian], Phyziologichny Zhurnal, 1965, V. 11, N 5. Buteyko KP, Dyomin DV, Odintsova MP, Carbon Dioxide Effects on Large Arteries in Patients with High Blood Pressure and Atherocardiosclerosis [in Russian], Zdravookhranenie Kazakhstana, 1966a, N 6.

Buteyko KP, Dyomin DV, Odintsova MP, A Linear Analog of Vascular Tone Regulation by Aerated Blood Gas Components [in Russian], Report at the 9th Regional Research and Technology Conference Dedicated to Radio Day, Novosibirsk, 1966b. 128


Buteyko KP, Discovery of the theory of deep breathing disease [in Russian], Public lecture for Soviet scientists at the Moscow State University, 1972. Buteyko KP, Carbon dioxide theory and a new method of treatment and prevention of diseases of the respiratory system, cardiovascular system, nervous system, and some other diseases [in Russian], Public lecture in the Moscow State University on 9 December 1969, Science and life [Nauka i zshizn’], October 1977. Buteyko KP, Method of voluntary elimination of deep breathing, Buteyko method [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991a, Titul, Odessa, p.148-165. Buteyko KP, The theory of the pathogenesis of diabetes mellitus. Basic principles of hormone therapy [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991b, Titul, Odessa. Buteyko KP & Genina VA, The Principles of Tactics in using DVBM [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa. Buteyko KP, Buteyko breathing method, in Collection of papers on folk medicine and non-traditional methods of treatment, ed. by GZ Minedjan, Moscow, Bukovitsa, 1993, p. 393-404. Craig AB Jr, Summary of 58 cases of loss of consciousness during underwater swimming and diving, Med Sci Sports, 1976 Fall; 8(3): 171-175. Davidyanz LS, The Theory And Practice Of DVBM In Gynecology [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991b, Titul, Odessa. Edmonds CW & Walker DG, Snorkelling deaths in Australia, 1987-1996, Med J Austr, 1999 Dec 6-20; 171(11-12): 591-594. Ford MJ, Camilleri MJ, Hanson RB, Wiste JA, Joyner MJ, Hyperventilation, central autonomic control, and colonic tone in humans, Gut 1995 Oct; 37(4): 499-504. Genina BA & Buteyko KP, Treatment of bronchial asthma in children by the method of voluntary normalisation of breathing in Children's Clinic of the 1-st Moscow Medical Institute [in Russian], Pediatria, 1982, 2. Henderson Y, Production of shock by loss of carbon dioxide, and relief by partial asphyxiation, Am J Physiol 1907, 19: XIV-XV. Lavrent'ev MM, Averko NN, Eganova IA, Hyperventilation as a fundamental stimulator of pathological processes [in Russian], Dokl Akad Nauk 1993 Apr;329(4):512-524.

_______ Okazaki K, Okutsu Y, Fukunaga A, Effect of carbon dioxide (hypocapnia and hypercapnia) on tissue blood flow and oxygenation of liver, kidneys and skeletal muscle in the dog, Masui 1989 Apr, 38 (4): 457-464.

Picco P, Gattorno M, Marchese N, Vignola S, Sormani MP, Barabino A, Buoncompagni A, Increased gut permeability in juvenile chronic arthritis. A multivariate analysis of the diagnostic parameters, Clin Exp Rheumatol 2000 Nov-Dec; 18(6): 773-778. Rostoker G, Wirquin V, Terzidis H, Petit-Phar M, Chaumette MT, Delchier JC, Belghiti D, Lang P, Dubert JM, Meignan M, et al, Mucosal immunity in primary glomerulonephritis. III. Study of intestinal permeability, Nephron 1993; 63(3): 286-290. Souliagin SS, Physical factors in DVBM treatment [in Russian], in Buteyko method. Its application in medical 129


practice, ed. by K.P. Buteyko, 2-nd ed., 1991a, Titul, Odessa. Souliagin SS, Common Mistakes Observed When Using DVBM [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991b, Titul, Odessa. Zimchenko VN & Romanenko NF, Conclusions on practical trial of Buteyko method, conducted in Department of Radiation Pathology of Central Republican Hospital of Shevchenko region (Ukraine) during 06.03.1990-07.04.1990 [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, p.222-227.

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Chapter 7. Level 1: First steps for better health Introduction Usually Level 1 means an ability of the person to stop development of negative symptoms during acute episodes (e.g., asthma or heart attacks) using the Emergency Procedure instead of traditional medication. However, many Level 1 students also apply or use other methods and techniques in order to slow down their breathing and improve oxygenation. For example, the breathing teacher can suggest to the student that it is a sensible step to avoid any mouth breathing or to avoid sleeping on the back. Additional methods and techniques, which are provided in the following chapters, can further enrich the arsenal of the student to combat heavy breathing.

7.1 Nasal breathing only For many people the main progress or learning of the initial stage of the Buteyko method means one thing only: learning how to breathe through the nose 24/7. Just this step alone can make a big difference in health restoration of many people. Consider severely sick usually young people or children who have problems with coordination of their own muscles, low IQs, problems with mental development, digestive and many other breathing related concerns. Such people are often in wheel chairs or/and accompanied by care-takers. Usually these sick people have very short lifeexpectancy with numerous medications taken every day. Their breathing is visible and noisy with up to 30-40 l/min at rest. Most of them have their mouth open all the time. The CP is about 2-3 s. Many other people would die if they have such intensive breathing due to, for example, a heart attack, epilepsy attack, or stroke. Due to a combination of various factors, these people get stuck with very low CPs on the verge of death (often about 2-4 s CP 24/7). Should relatives, care takers and other surrounding people encourage nasal breathing in these patients, these patients can significantly reduce their needs in medication and get rid of many symptoms they experience. Heart patients, who often breathe through the mouth, may notice that their heart problems have a tendency to appear at such times. Apart from all CO2-related effects, they do not normally utilize own NO (nitric oxide) generated in the nasal passages. During the First World War it was noticed that people who worked with explosives had abnormally low blood pressure. Later, the chemical became one of the popular pills to reduce blood pressure, nitroglycerine. The main effect of this chemical is to produce NO (chapter 1). Hence, if these patients close their mouth, their medication needs can be reduced. ` Buteyko, while studying respiration during physical activity, observed that breathing through the nose made a big difference in after-effects of physical exercise. Moreover, physical activity with oral breathing often led to lower CPs and CO2 later, whereas nasal breathing during walking and other physical activities was beneficial.

7.2 Mouth taping In order to ensure nasal breathing during the night, in the 1960s Russian patients invented mouth taping. First of all, it is necessary to find out if one has this problem by checking dryness in the mouth just after waking up in the morning. If the mouth is dry, the person had mouth breathing. It could begin when the person went to sleep or it could appear at 3 or 4 am. In any case, just 20-30 mins of mouth-breathing resets the breathing centre, and such patients, as a ruler, have less than 20 s CP in the morning. For mouth taping one needs a surgical tape and cream to prevent the tape sticking. Both can be bought in the pharmacy. Micropore and vaselin are popular choices. First, put a small amount of cream on the lips so that it is easy to remove the tape in the morning. Then take a small piece of tape and stick it in the middle, vertically, across the closed mouth. Some students prefer to put it along or horizontally, but a small piece in the middle is sufficient. If you are afraid to “seal” your mouth completely, tape only one half of the mouth leaving space for emergency breathing. James Oliver, a GP from the UK, made a presentation 2 years ago to the British Thoracic Society about the safety of mouth taping based on thousands of cases both in Russia and in the west. Previously he conducted a survey among Buteyko teachers and obtained the statistical data. Taping at night normally should be a temporary measure. When one’s CP is above 20-25 s in the morning, mouth taping is not necessary. Some older people may use mouth taping during the day, if they have memory problems or can forget about the role of nasal breathing due to other factors.

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7.3 Prevention of sleeping on the back Sleeping on the back for many sick people means about twice as much breathing and corresponding CP drop. This often causes acute symptoms due to early morning hours and death in severely sick people. There were different techniques invented. Some people were sleeping with a backpack to prevent turning on the back. This is one (“awkward”) option. It is possible to prop oneself from the sides with pillows. Another option is to sew a pocket on the back of your night shirt and put a tennis ball there. Or one can take a sock and wrap it around the middle of a belt making a knot. The belt can be positioned around the chest with the knot on the back of the person. The knot should be big enough to prevent the person from sleeping on the back and it would not wake the person up since it is soft. Currently, the most popular solution is to take a double layer (strip) of bed linen, wrap it around self, make two knots on your chest and move them on your back. Practice shows, that sleeping on the back is the sign of low CP (less than 20 s), but some people can turn on their backs at night due to, for example, too warm blankets or beds that have soft springs. Buteyko and his colleagues suggested using hard beds. Sleeping in the armchair or sitting, with almost vertical position of the trunk (not more than 30 degrees from the vertical line), is an excellent solution of many sleep-related concerns. When the trunk is about 45 degrees or even more horizontal, while sleeping on the back, breathing gets too heavy and such positions are discouraged. According to Buteyko, The sick should be laid down on the tummy. This compresses the rib cage and tummy, decreasing breathing… We suggest sleeping on the tummy, on hard bed, so that the spine is not bended. Severely sick people are suggested to sleep sitting, this decreases breathing (Buteyko, 1977).

7.4 The Emergency Procedure during acute or life threatening situations Patients with mild to moderate asthma, hypertension, epilepsy, and many other health problems usually have chronically low tissue oxygenation and CPs (about 10-15 s). In addition, as with all people, they have many life-style factors (stress, meals, exercise, sleep, hormonal changes, thermoregulation, etc.) causing daily fluctuations in their CPs. The CP, during periods of acute overbreathing, can drop to about 5 s. As a result, these hyperventilators are on the brink of having asthma, heart, stroke, epilepsy and other attacks or acute deterioration of their health problems due to various triggering factors. The Emergency Procedure was developed by Doctor Buteyko in order to prevent such attacks and/or eliminate undesirable problems and symptoms by increasing CO2 stores, improved oxygenation and blood supply of all tissues. Doctor Buteyko provided the following description of the Emergency Procedure, “Practically, a human can change own breathing using will power and experience how the disease relates to breathing. Reduced breathing can alleviate, in 1-5 minutes, all the symptoms we were talking about: bronchial spasms (attacks of asthma or bronchitis), blocked nose (to unblock the nose), eliminate spasms of brain vessels – migraine or headache, spasms of heart vessels, spasms of blood vessels of arms and feet (endarteritis), ulcer pains (spasms of vessels in the stomach), spasms of bile ducts (holecistitis), to prevent an epilepsy attack… during frost to warm up the arms or the nose is simple – decrease breathing. Blood vessels dilate and you are warmed up! You are frightened, excited, you have a nervous shiver – slow down the breathing and in 1-2 minutes you will get peace. Using these mechanisms you can control your own body!” (Buteyko, 1977). Another, often decisive reason for patients to use the Buteyko method is to eliminate or reduce medications they are unhappy about. What to do? Let us consider the typical breathing patterns. During attacks and acute episodes, these people’s breathing is below:

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Their goal is here:

We see that instead of frequent and deep breathing, they need slower and shallower breathing pattern. Very heavy breathing is possible when: 1) they take large inhalations; 2) they forcefully exhale air out of the lungs, instead of simple relaxation of all breathing muscles to produce quiet natural exhale. Hence, one should take smaller inhalations and then relax all breathing muscles for exhalations as shown here:

_______ Here are the steps to take, when one's health or life is suddenly threatened due to asthma attack, heart attack, stroke, epilepsy attack, etc.: • 1. Relax all your muscles in any comfortable position (sitting, lying, etc.), which is favourable for complete relaxation. Such relaxation normally produces quiet spontaneous exhalation. • 2. At the end of this exhalation, pinch your nose with two fingers and hold your breath for about 1-2 seconds. • 3. Since the feeling of air hunger at the end of this breath holding is not strong, take in (or inhale) less air than you did before (“breathe less”) • 4. For exhalation, you need just to relax, while keeping all breathing muscles, including chest-shoulders and 133


diaphragm muscles, completely relaxed. • 5. Again, take in (or inhale) small amount of air (“breathe less”). • 6. And just relax all the body. • 7. Continue to breathe in such a shallow relaxed manner, with constant air hunger for about 1 minute. Repeat again and again this 1 minute cycle from steps 2 to 6: short breath hold (1-2 s) – smaller inhalation – relaxation of all muscles for exhalations. In other words, every minute you do short breath holds (1-2 s) and RB (reduced breathing) between them, as shown here: Breath hold (1-2 s) – Reduced breathing (1 min) – - Breath hold (1-2 s) – RB (1 min) – - Breath hold (1-2 s) – RB (1 min) – - Breath hold (1-2 s) – RB (1 min) –… In 3-5 minutes you need to check your symptoms: Are they as strong as before? If you feel that you cannot alleviate the upcoming attack, use your standard medication in a reduced dose (e.g., 1/3 of your standard medication and compensate the rest using the Emergency Procedure. After taking medication, continue the Emergency Procedure monitoring the severity of the symptoms. If it is still not possible to stop an attack (e.g., angina pectoris), again take 1/3 of your usual dose and do the Emergency Procedure. Russian medical doctors and practitioners found that most patients could eliminate their symptoms in 1-5 minutes (Buteyko, 1977). In some cases, especially when patients were severely sick, the Emergency Procedure could not solve the onset of the attack and traditional medication, as it is suggested above, was used. This procedure, unlike discussed Western approaches, uses breath holding, as a natural method of CO2 accumulation and oxygenation boosting. There are additional practical recommendations in order to have better relaxation. • When you are not sure about chest-shoulders-neck-jaws muscles, tense them maximally or almost maximally for 1-2 s and, then, relax. That can be done with the whole area of muscles or, if difficult, with separate muscular groups, one by one. • Using such tensing-relaxing, clearly and vividly visualise your body or body parts, first, during tensing, as a steel spring, which is hard and strong, and seconds later, during relaxation, as a large soft piece of dough or jelly fish floating in the ocean. Other images, of course, can be used, e.g., during tensing, as an over-inflated water-filled balloon, resilient and firm, which suddenly loses pressure and becomes soft and shapeless and filled with air during relaxation. • Since muscular tension during the breathing exercises should be experienced only in the area of the diaphragm, one can imagine and visualise how all tension, stress and pressure descend or slide down from the head, neck, shoulders, and chest to the area around the diaphragm. • You can massage this area (chest-shoulders-neck-jaws muscles) with your hands or, if you have a relative or friend around, ask him/her to do that. During the Emergency Procedure, the relaxation of the diaphragm and skeletal muscles is possible, only if the amount of air in the lungs is near the physiological volume (such a lung state is achieved, when people suddenly lose their consciousness or are properly relaxed). Having more air in the lungs is undesirable, due to the appearance of tightness in respiratory muscles. There are many other applications of the Emergency Procedure, but to consider them, we need to know about various pauses and precautions.

_______ 7.5 Other possible applications of the Emergency Procedure

Apart from preventing attacks, the Emergency Procedure should be used to prevent bouts of coughing, sneezing, sighing, yawning, hiccups, deep inhalations, sniffing, and other deep breathing activities. Coughing for many minutes is annoying and a health hazard. It not only washes out CO2, reduces oxygenation, but also resets the breathing centre to the state of chronic hyperventilation.

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Prevention of bouts of coughing The first important step during bouts of coughing is to do it only through the nose. One may try this between the bouts first and firmly decide to use it later. The durations of coughing bouts can be reduced about 2 times bringing relief to those people who could not stop their coughing for many minutes, as in cases of bronchitis. The next step is to learn how to cough with both, the mouth and the nose closed. If you achieve this, your bouts will almost disappear. Finally, if you are feeling slight symptoms, use the Emergency Procedure. It will help you to remove mucus and phlegm from airways much faster. You can cough out these secretions in tissue paper or a towel only if you know that they are already in your throat. To make them move up to your throat from bronchi, bronchioles or the lungs, you need to provide the villi doing the job with oxygen and blood by breathing less. Such activities as sighing, yawning, or sneezing are also examples of acute hyperventilation. Effective breathing retraining means the use of the Emergency Procedure instead of these deep breathing situations. Numerous spasmodic conditions, due to local constrictions of arteries, can be effectively eliminated by means of the similar Emergency Procedure. That relates, to cold feet and hands, blocked nose, constipation, etc. However, usually people with these symptoms have larger CPs, for example, about 15-20 s, and these people can safely do longer breath holds depending on their personal circumstances. The main part (RB) of the Emergency Procedure remains the same, but the length of the pause should be adjusted to individual situations. The main precautions were outlined above, and if the person does not have any of these above-mentioned concerns, he or she can use CPs, MPs or even AMPs, as in the case when one needs to unblock the nose as an example. Here are possible actions: - close your mouth and pinch you nose; - start fast walking as long as you can, while keeping your nose pinched (you are likely to make about 15-20 steps before you get very strong air hunger); - sit down and release your nose; - since the level of air hunger is going to be strong, you need to apply some efforts to do RB or breathe little: take small inhales and exhale, while relaxing all body muscles, especially the breathing muscles; - continue RB for about 2-3 min; In 2-3 minutes your nose should breathe much better and many people testify that after this exercise their breathing is easier than in weeks or months. Rarely, when the nose was blocked for weeks or months, it is necessary to repeat the procedure. Some exceptional people cannot unblock their noses due to vegetation, polyps and other severe causes. In such situations RB through the mouth, use of pursed lip breathing, and other techniques that slow down their mouth breathing are applied first. According to Buteyko, the main cause of the blocked nose, not the reduced blood flow due to hypocapnic vasoconstriction (low CO2 constrict arteries and arterioles), as one may expect, but pooling of blood in veins due to the same hypocapnia (Buteyko 1972, 1977). Symptoms of the patients are different, and it is great when the Buteyko teacher can explain to their students, in simple words, what are the causes and mechanisms of their symptoms in terms of CO2 effects. Such explanations provide the students with knowledge and confidence making the progress faster and expected effects stronger. Consider constipation, as another example.

_______ CONSTIPATION Causes Normally, during elimination, the descending colon and all subsequent muscles function together, as a well-trained team. Constipation usually happens as a result of local spasms due to strained muscles, pooling of the venous blood and reduced oxygenation. All effects are consequences of low CO2 stores in the body. Suggested practical actions Relax all muscles (too much strain can lead to diverticuli). Such relaxation will produce spontaneous exhalation. At the end of this exhalation hold your breath as long as you comfortably can. Inhale a small amount of air and exhale with relaxation. Breathe during next 1-2 min in a slow, shallow, relaxed manner with constant air hunger. If no progress (rare, but possible), repeat the procedure. Physiological foundation Decreased ventilation leads to gradual accumulation of carbon dioxide in the lungs, blood, and all body tissues. Since 135


carbon dioxide is a relaxant of all smooth muscles, a dilator of the arteries, restorer of the tone of veins, and a catalyst of chemical release of oxygen from haemoglobin (the Bohr effect), its elevated level naturally produces muscular relaxation, improved blood supply, relief from venous blood congestion, and improved oxygenation removing the spasm and bringing relief. Doctor Buteyko suggested using the Emergency Procedure for many other situations and, together with his colleagues and patients, found it exceptionally efficient for persistent cough, panic attacks, phobias, spasms of the stomach, spasms of the bile duct, oedema and eyes' puffiness, and skin itching (Buteyko, 1972, 1977). When feeling angry or upset, the Emergency Procedure would help you to calm down excited nerves and become reasonable again. Moreover, when the person has other strong emotions, over-breathing is a likely outcome. Therefore, however difficult it can be, remember to breathe less at the sign or onset of strong emotions. CO2 regulates the permeability of the fat cell membranes in relation to glucose. When CO2 gets low, glucose is driven into fat cells and most people feel hunger, eat more in order to function throughout the day, and accumulate, with time, more fat due to chronic hyperventilation. Hence, overbreathing leads to obesity in most people. Breathing less reverses these abnormal processes. Glucose is driven from fat cells into the bloodstream and it is normal to hear from some Buteyko students that they are surprised that they started to eat less, much less, or almost nothing for days after starting to breathe less. For this reason, the Emergency Procedure with walking, breath holds and reduced breathing is useful when blood sugar gets too high, due to acute over-breathing, in diabetics. Insomnia is another situation when the Emergency Procedure and RB are useful. Natural pacification of the over-excited nervous system and feeling of warmth in extremities normally cause smooth and peaceful transition into sleep (provided, of course, that you really want to sleep). Finally, when one has difficulties in waking up in the morning, the CP, or even MP, or AMP, if safe, is an energy-booster.

7.6 Constant basic control of breathing Before reaching this final goal of the breathing exercises (continuous shallow breathing) it is important to learn a more basic skill: how to prevent situations causing over-breathing. In full accordance with Western methods of breathing retraining (chapter 4), Doctor Buteyko also emphasized the importance of constant control of breathing, especially for severely sick patients who can experience attacks in cases of acute hyperventilation. Many useful suggestions, to help remember about breathing less and staying relaxed, can be found in the book written by James Hooper "The Buteyko Manual For Asthma" (available at www.nqnet.com). Stickers left in visible places, importance of the new attitude towards one’s own respiration, and relaxation suggestions are examples of helpful practices discussed there. Breathing, according to Doctor Buteyko, should be controlled, literally day and night. Indeed, what is the sense of doing breathing exercises, when during the following hours a person can sigh every few minutes or keep his mouth constantly open, blowing off accumulated CO2 and resetting the breathing centre to previous positions? Additional activities for control of breathing include the following measures: - check that the mouth is opened only for eating, drinking, and speaking (severely sick patients, who cannot constantly control their mouth, should use mouth-taping during the day time); - cough through your nose with as little ventilation as possible (coughing through the mouth is done only when the phlegm and other secretions are removed); - perform your nose blowing gently and only when nasal discharges are removed, perform breath holding and shallow breathing afterwards; - yawn with lips tightly pressed together; - sneeze through your nose; - instead of sighing, hold your breath for a while and do reduced breathing; - use the Emergency Procedure to stop bouts of coughing, yawning, sneezing, and hiccups; - use the Emergency Procedure at the sign or onset of strong emotions;

_______ Conclusions There are 4 initial steps to learn the basics of the Buteyko method: 1. Breathe only through the nose (even during exercise and when coughing); 136


2. Prevent sleeping on the back; 3. Use the Emergency Procedure at the onset of attacks or symptoms of the disease in order to reduce or avoid the use of medication; 4. Use the Emergency Procedure to prevent bouts of coughing, sneezing, sighing, deep inhalations, sniffing, and other deep breathing activities. Following these steps allows a person to successfully reduce symptoms and medication in cases of asthma, bronchitis, heart disease, epilepsy, sinusitis, chronic fatigue and some other conditions.

Q&A section for Chapter 7 Q: If I feel an asthma attack is to take place, I hold my breath and practice RB, the attack is gone. Similarly, the Emergency Procedure relieves constipation. When I feel sleepy, but cannot fall asleep, the same remedy again works. Even more surprising is that in the morning it does the opposite thing: wakes me up and fills me with energy. How is it possible that the Emergency Procedure can literally cure so many different problems, all the time doing what is right? A: At any given moment of time breathing interacts with the weakest system, or organ, or process of the organism. How? For example, when we get an infection, the physiological stress (for kidneys, liver, the immune system) increases ventilation. If we have an allergic reaction, this reaction suppresses the CP. Hence, at each moment of time, in conditions of carbon dioxide deficiency, the presence of a certain symptom or complaint indicates that a corresponding organ or a system of the human organism can intensify the external respiration making the CP smaller. If we do the opposite job, reduced breathing, then the weakest part of the body is corrected closer to its physiological norm. For example, if we have infection, or constipation, or panic attack, or blocked nose, or itching due to eczema, then correction of breathing addresses this symptom. In case of falling asleep or waking up, these activities are controlled by the circadian cycle and corresponding hormones. Reduced breathing improves blood circulation and creates conditions for these hormones to produce their normal physiological effects (to fall asleep or to wake up). Hence, the same activity (reduced breathing) produces the results that are physiologically normal or required. In a normal human body, if one’s breathing is normal (over 60 s CP), asthma attacks, constipation, insomnia, blocked nose, problems with waking up, and hundreds other complaints and symptoms are impossible. All these abnormalities can appear and exist only in conditions of hyperventilation. Q: Is there a difference between the terms "shallow breathing" and "reduced breathing"? A: Western Buteyko practitioners use these two terms to describe the same process, breathing a lower amount of air both, per single breath and as minute ventilation. Q: I suffer from the morning sickness. It is just hard to get out of the bed and get started. What can be done? A: The symptoms of this problem usually indicate a low level of CO2. Consequently, you need a CO2 boost. This would be another application of the Emergency Procedure. You do not need to do the usual breathing session (although you can), but breath holding with subsequent reduced breathing even when done in bed can do a trick. In addition, you may notice that the duration of this morning pause (it cannot be called the CP due to the horizontal position and lowered metabolism) relates to the degree of the morning sickness you experience. You may check that the larger your morning pause, the less symptoms you have.

_______ Q: How to get a longer EMCP (early morning control pause)? A: The morning pause usually reflects the quality of sleep and is influenced by the activities of the previous day. How to increase this pause? The following steps were kindly shared by Peter Kolb. They were partly modified and expanded. 1. Make sure you get plenty of exercise during the day, so that you are, although fresh and full of energy, really tired. 2. Eat lightly in the early evening, if at all. 3. Do a set of breathing exercises before going to sleep. 137


4. Don't go to bed until you are tired and want to sleep. 5. Keep your room well ventilated with lots of fresh air. 6. Don't overdress at night and don't use blankets that make you feel too warm. Make sure that you are cool enough throughout the whole night. 7. Sleep on the left side or on your stomach. 8. If necessary, wake yourself in the small hours and do reduced breathing exercises. 9. Don't stay in bed once you have woken up. Start moving, stretching, exercising and walking.

References for chapter 7 Buteyko KP, Discovery of the theory of deep breathing disease [in Russian], Public lecture for Soviet scientists at the Moscow State University, 1972. Buteyko KP, Carbon dioxide theory and a new method of treatment and prevention of diseases of the respiratory system, cardiovascular system, nervous system, and some other diseases [in Russian], Public lecture in the Moscow State University on 9 December 1969 [in Russian], Science and life [Nauka i zshizn’], October 1977.

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Chapter 8. Level 2: Breathing exercises, sleep, focal infections, and cleansing reactions Introduction This chapter describes Level 2 or how you can get up to 25-30 s CP. This means no symptoms of asthma, hypertension, bronchitis, epilepsy, sinusitis, CFS, and some other concerns, so that the student does not need medication and experiences many other positive changes related to an improved quality of life. This is the level that is taught by most Buteyko western teachers these days. Previously sick people, sometimes hopeless, terminally sick, or severely ill for years, can return to their professional employments, start exercising and forget about their past health horrors. It usually takes about 1-3 months to achieve this level. The breathing sessions chosen for practice can be different. However, there are certain main features, which are typical for most of them. Besides, there is the so called “short classical breathing session”, which is about 15 minutes long and which has been successfully learned by thousands of Russian and Western patients and students and which was created and used by Doctor Buteyko since the 1960s. Buteyko and his colleagues also developed other types of breathing exercises. Many of them are considered here. It is the goal of the Buteyko breathing teacher to optimise the program so that the student can spend the least time for learning the method with maximum efficiency. The breathing exercises, in order to produce positive effects, require certain conditions. Let us consider them first.

8.1 General goals of the breathing exercises The general goal of the Buteyko method is to eliminate chronic hyperventilation and normalize breathing in accordance with medical and physiological norms. In order to achieve this goal one should gradually reset or readjust the breathing centre to higher aCO2 norms using breathing exercises and common sense activities. At any moment of time, current breathing parameters (aCO2 norm, aCO2 tolerance threshold, CP, minute ventilation, etc.) are correspondent to the general health state of the organism and its current physiological needs. The process of breathing normalization is slow, depending, as practice shows, on 3 main parameters: 1. the age of the student; 2. duration of his disease and medication used in the past; 3. obesity or having extra fat stores. Each student has his or her symptoms related to chronic hyperventilation. It is possible to predict the CP values when some or all of these symptoms are going to disappear since many symptoms are possible when the CP is lower than certain numbers (e.g., for asthma, primary hypertension, bronchitis, diabetes, arthritis, etc). Some other symptoms (related to, e.g., sleeping problems, psoriasis, depression, chronic fatigue, and anxiety), can exist and disappear within different (personal) CP boundaries. By asking and getting information about personal history of symptoms, the breathing teacher can define and evaluate what will happen with the student after application of the chosen plan. Knowledge about the rate of progress and disappearance of symptoms provides the student with long-term enthusiasm and motivation.

_______ 8.2 Preliminary requirements for learning breathing exercises

A quiet place to focus one’s attention A session requires about 15 min of concentrated work without disturbances and interruptions. The student should be silent and the mouth should be closed during the whole session. If the student speaks, for whatever urgent reasons, air hunger is lost and it is necessary to hold breath to restore the light desire to breathe more. Being totally concentrated is important during initial stages of learning. Later, after many hours of practice, breathing exercises can be done while driving a car, watching TV, reading, etc. Empty stomach The exercises are done on empty stomach (water is OK) since reduced breathing and larger aCO2 139


concentrations provide more blood and oxygen for the GI system intensifying peristalsis. Many modern people have inflammation in the stomach they are unaware of, as recent western studies revealed. This inflammation can get worse due to intensification of peristalsis in the stomach and duodenum, if food is present there. (Imagine what could happen if somebody starts to rub vigorously skin areas which are already inflamed.) Having water in the stomach does not cause this problem. Hydration Acidification of blood due to increased CO2 content caused by reduced breathing triggers biological pH buffers in the blood. A part of this process is redistribution of ions in various compartments of the body (intracellular fluid, extra-cellular fluid, blood plasma, intestinal content, etc.). These processes may require additional water. Hence, drink if you get thirsty at any stage. Clean and fresh air The place for exercises should have clean and fresh air so that the student can have a cold and moist nose, as naturally happens outdoors. Backyards of the house or a park are great places, provided that it is not too cold or warm and there is no draught and no direct sunlight. Kitchens with open windows usually provide good conditions. Having long or old and dusty curtains, carpets, books in the room make air stale and dusty, and many students cannot reduce their breathing in such conditions. Those people who are allergic or sensitive to dust mites, mould, proteins from cats and dogs, and other air-born substances should find a trigger-free place where no even mild allergic reaction is possible. Air ionizers can greatly improve indoor air quality. Thermoregulation Find a comfortable place without draught, but relatively cool. You may feel warm or even hot during the exercises. Therefore, be ready for that to happen and take steps to restore your thermal comfort: take some clothes off to normalise your heat exchange. If the place is too warm, it is often impossible to reduce breathing. Posture Severely sick students with low initial CPs (less than 10 s) can do breathing exercises while lying, half-lying or sitting in a comfortable armchair with their backs supported. It is more important for them to have proper relaxation, since physical exertion can significantly intensify their breathing. When the CP is above 10 s, students can practice, while sitting on the edge of a solid chair without using back support, while having their elbows and arms either on the table or their arms on their knees. The spine should be straight and erect. That is another crucial parameter for breathing normalisation. People, who can relax in lotus or other similar yoga postures (e.g., “Pleasant” posture), are encouraged to do so. It is important for the position of the diaphragm that the thighs are either horizontal or inclined downwards when we are in the sitting position. If the thighs are inclined upwards, as when we sit on a low chair, the diaphragm is compressed by the internal organs and it loses its mobility. Diaphragmatic breathing requires straight posture so that the diaphragm, instead of being compressed, is freely suspended and can easily be moved down and up.

_______ The simple mechanics of normal breathing at rest or how the diaphragm works The diaphragm, in a relaxed state (or after exhalation), has a shape of a cone or dome. During inhalation we stretch it in radial directions making it flatter. For exhalations, we just relax the diaphragm and it returns (recoils) back to its original position. Chest muscles are relaxed all the time. Try to visualise this process during own breathing.

One can sit on the low chair with crossed legs, so that the thighs are inclined towards the floor. Then light diaphragmatic breathing is possible. James Hooper, a Buteyko teacher, in his “The breathing workout workbook”, provides a useful analogy for 140


correct posture during the breathing exercises. He suggests making the spine like a broomstick, with shoulders, chest and the belly freely hanging on this solid frame. This posture allows shorter breaths (even during daily normal life) and the right place for various organs in the body. Reduction of unnecessary muscular tension and elimination of internal pressure under the diaphragm allow easier breathing. This posture should be preserved for the rest of the day, but it is particularly important during the exercises. Otherwise, due to muscular tension and stress in vital organs, normalization of breathing during the exercises is very difficult or impossible. There is a test to check own posture. You need only any flat vertical surface (e.g., a wall or door). The “wall test” for correct posture Go to any flat wall (or door) and attach your whole body to this wall so that you can touch the wall with following 6 points on your body at the same time: - both back sides of your shoes; 2 points - your lowest vertebra; 1 point - both your shoulder blades; 2 points - the back of your head. 1 point

Some people find that they looking too high (probably they get used to looking down at the ground in front of them), but what is important that this test helps to correct and restore the normal position of the spine so that breathing retraining is possible. When the student has the straight spine standing near the wall, they are asked to draw the belly (stomach) in and completely relax it for exhale. Some people can easily do this, but for many students this manoeuvre is a challenge and these people need to gradually proceed through the stages of learning described below. The previous chapter did not pay attention to posture during the Emergency Procedure, while here, for Level 2, it is one of the crucial parameters of success. Why? When students use the Emergency Procedure, their CPs are usually small (e.g., less than 10 s) and minute ventilation is above 20 l/min. In such conditions of severe stress (e.g., an asthma or heart attack), these sick people use mainly their chest for breathing and, if they manage to decrease their ventilation, it will still be heavy and with the use of the chest muscles. Hence, it is not absolutely necessary, in such stressful conditions, to pay attention to diaphragmatic breathing. They can sit in comfortable armchairs or on sofas. But straight spine is desirable for them later and diaphragmatic breathing can assist their recovery even during early stages of learning. However, when the CP gets larger, the posture becomes more and more important. For example, when one’s CP is about 15-20 s, slouching means 1-2 s CP decrease, while straight spine 1-2 s more. Moreover, once the student gets about 30 s CP, poor posture can become the main obstacle for further progress.

8.3 Learning the RB (reduced breathing) Healthy people (over 40 s CP) naturally have diaphragmatic breathing while resting. This graph from the previous Chapter shows a pattern of normal breathing.

_______ Fig. 8.1 This schematic picture shows 3 breathing cycles of normal breathing: inhalation (the upward straight lines), exhalation (the curved downward lines) and automatic pause (almost the horizontal lines) accompanied by relaxation of all breathing muscles. If the CP is about 20 s or less, the typical breathing pattern is following.

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Fig. 8.2 This schematic picture shows 6 breathing cycles of breathing for a student with about 20 s CP: the inhalations are bigger (deeper); breathing is faster; and exhalations are forceful (not relaxed). This big and deep breathing usually requires chest muscles to do the main job of air pumping. Why? Low CO2 content makes all smooth muscle tense. Hence, the tense diaphragm, coupled with slouching, restrict diaphragmatic movements making chest breathing the typical feature of people with low CPs. If the student was using your chest muscles during last 5-10 or more years, it would take some days or weeks to restore the normal diaphragmatic breathing. How? The student needs to learn the essence of the Buteyko method, the RB (reduced breathing). Some people master the RB in minutes, but generally, the sicker the student, the longer is the way. The process of learning is divided into 5 stages: Stage 1: Feeling the breath Stage 2: Relaxation of the body’s muscles Stage 3: Tensing and relaxing breathing muscles Stage 4: Relaxed diaphragmatic breathing Stage 5: Light air hunger Stage 1: Feeling the breath Focus on your breathing for 2-3 minutes at rest while sitting with the straight spine. What do you feel? If the sensations are vague, take a deep slow in-breath and slowly exhale. Do you feel how the airflow goes through your nostrils? Do you have any sensations at the back of your throat? Are there any feelings about movement of air inside the chest and bronchi? What do you sense near your stomach? Usually, children have good perception about own breathing. Older people notice fewer sensations. Having these sensations makes the process of learning easier. However, even if the student feels nothing at all (rare, but possible), it is still possible to learn the method. How? First, the student can restore the sensations by doing special exercises and focusing attention on own breathing. Second, if these exercises do not work, as in very rare cases, the teacher can use, for the right students, special breathing exercises that do not need the feeling of own breath. To restore the sensations of own breath, the following exercises can be used. 1. Put the arms around your waist line, as if embracing yourself, and listen to your usual breathing for about 20-30 seconds. You will be able to detect the movements of the diaphragm. 2. Put the arms slightly above the waist (about 10 cm or 4 inches higher) around your waist and listen to your usual breathing for about 20-30 seconds. You will be able to detect the movements of the rib cage. In most cases, repeating these exercises a few times will solve the problem. If the sensations are still not present, the student should practice the exercise with the books and exercise with the belt described below.

_______ Stage 2: Relaxation of the body’s muscles The student is asked to tense some parts of his body muscles and then relax them. This is usually not a problem for a particular arm or leg, but is more difficult when more muscles are involved. To learn tension and relaxation of the whole body gradually, the student can start with some muscles and then add other groups. For our future goals, the student should be able: 142


- to tense the whole body and then relax it; - to tense the upper part of the body (from the rib cage up) and then relax it. Stage 3: Tensing and relaxing breathing muscles As a next logical step, the student tries to tense and relax breathing muscles, which we divide, for our purposes, into 2 groups: - the diaphragm (other names are “tummy”, “belly”, and “stomach”); - all remaining breathing muscles (other names are “chest muscles”, “rib cage muscles”, and “thoracic muscles”). Here all these muscles are tensed and relaxed together. In order to achieve success, do the following simple exercise. Close the mouth and stop breathing through the nose (using our throat lock mechanism). Try to take a strong and big inhale, while there is no way for the air to move into the lungs. This helps to achieve a strong sensation of tension in the breathing muscles. Keep the tension for 1-2 seconds and then relax the muscles and take light inhalation. Stage 4: Relaxed diaphragmatic breathing Can the student breathe for 1-2 minutes using the tummy or stomach only? If the student is uncertain and own sensations are absent or vague, the student takes 2-3 deep and slow inhalations-exhalations, while watching own chest and abdomen movements in the mirror, while having no shirt. For exhalations it is necessary just to relax. Can the student take these slow deep breaths using their tummy or abdomen only, so that the chest does not move? If there is no big mirror, the student can embrace own waist and try to feel own breathing. If not, the exercise with books can help to achieve success. The exercise with books to acquire diaphragmatic breathing Take 2-3 medium weight books and lie down on your back with the books on your tummy. Focus on your breathing and change the way you breathe so that: 1) you can lift the books with each inhalation and then relax to exhale (the books will go down). 2) your rib cage does not expand much during inhalations. Practice it for 2-3 minutes several times per day, e.g., before the RB, to reconnect your conscious brain with the diaphragm.

The student can practice this exercise for some days until is sure that diaphragmatic breathing is the usual way to breathe during the breathing sessions. Once the CP is over 25-30 s, the spasmodic state of the diaphragm is naturally released (for some people with persistently tense diaphragm, magnesium can be the great assisting factor) and it becomes the chief breathing muscle. The chest muscles will, at the same time, get relaxed. The students can also use the belt to restrict their own rib cage and “force” the diaphragm to be the main breathing muscle using the following exercise. A belt for diaphragmatic breathing Put a belt around your lower ribs (in the middle of the trunk) and buckle yourself tight so that you cannot take a deep inhale using your chest. Now for slow deep inhalations your body needs to use your tummy (or abdomen). Try it. While leaving the belt for some minutes or even hours, you can acquire diaphragmatic breathing and corresponding sensations. This process is faster, if you focus your attention on your breathing. The focus of attention makes nervous links between your conscious mind and the diaphragm reinforced so that you can regain control about this muscle.

_______ After the student is able to breathe using mainly the diaphragm, the next step is to learn how to relax it during exhalations. Each exhale should be accompanied by relaxation of all bodily muscles. The changes in the breathing pattern for a person with the low initial CP, who practices relaxation of the diaphragm only (no deliberate air hunger), are shown below.

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Fig 8.3 This graph shows that the usual breathing pattern (straight red lines indicating forceful exhalation) can be corrected using relaxation of the diaphragm making exhalations smooth (note the curved exhalation blue lines of the new breathing pattern). The depth of inhalations remains the same, while the frequency of breathing becomes smaller indicating that relaxation alone makes breathing lighter. This exercise increases aCO2 and the student breathes less, but there is no air hunger. Reduced breathing is achieved using relaxation only. Stage 5: Light air hunger Now the student is able to consciously create and maintain light air hunger. The previous chapter already considered the sensation of light air hunger that appears during the RB (reduced breathing). In addition, the student knows about the requirements described in this Chapter. In particular and most importantly, the student should be able to breathe using the diaphragm (or stomach) and relax it for exhalations. Let us review the process of the RB in more detail. When the CP is below 20 s Instead of taking big and deep inhalation, take a slightly smaller inhalation (only about 5-10% less than one’s usual breathing) using the diaphragm and then immediately relax all muscles, especially upper chest and all other breathing muscles. Then immediately, take another (smaller) inhalation and again completely relax.

_______ Fig 8.4 This picture shows the pattern of RB (reduced breathing) for low CPs (less than 20 s).

With each breath, the student takes progressively smaller inhalations and should then completely relax. In 2-3 minutes the student will experience light air hunger. The goal is to preserve this light comfortable level of air hunger. It is OK that breathing is frequent during this reduced or shallow breathing. Later the breathing centre readjusts one’s breathing making it easier and slower. 144


When the CP is above 20 s If one’s CP is above 20 s, then the pattern of RB (reduced breathing) is usually different. Why? Because usual breathing, while resting or sleeping, is also different. For example, if the actual CP is about 30 s, the student is likely to have short automatic pauses (about 1 s) or total relaxation (no breathing) after exhalations. These automatic pauses are individual and also depend on the actual personal CP. The higher the CP, the longer the automatic pause. Presence of long automatic pauses is a sign of great health. While practising the RB, the students with higher CPs (over 20 s) not only slightly reduce their inhalations and, in addition, they can have short periods of total relaxation with no breathing.

Fig 8.5 This figure shows reduced breathing when the CP is about 25 s. The RB should cause light shortage of air (air hunger) in about 2-3 minutes. It requires some experimentation from the student to find out the depth of inhalations and durations of automatic pauses (no breathing). For example, with about 20 s CP, one’s RB probably does not require any pauses. Each subsequent inhalations immediately follow the previous exhalation, as described in the previous section. If one’s CP is about 30 s, the student takes a smaller inhale, relax for the exhalation and usually can enjoy total relaxation for about 2-3 seconds (no breathing movements). Then this cycle is repeated again and again, until the student gets slight air hunger. Once the right pattern is found (so that the student can maintain light air hunger for 5-10 minutes or more), do mental counting (e.g., “one, two, three”) for automatic pauses after each exhalation. The structure of breathing can be presented in words: “Inhale – Relax all muscles – One, two, three – Inhale – Relax all muscles – One, two, three – Inhale – Relax all muscles – One, two, three – Inhale – Relax all muscles – One, two, three – …” When the CP gets larger, the duration of these pauses is also increased. For example, with 40 s CP, the student can usually have about 5-6 s automatic pauses after each exhalation during the whole RB period. Again mental counting is useful, but the durations are individual. If the student continues the RB for another 1-2 minutes, he or she should get a light feeling of air hunger (the student wants to breathe more but resists the desire and teaches own body to have lighter breathing). The key of the exercise is to maintain this shallow diaphragmatic breathing pattern for about 10-15 minutes or more with relaxation of all muscles and light hunger for air. It is normal though that many students later mention or complain about tension in the diaphragm during the RB. This is a good sign indicating that higher aCO2 in the breathing centre tried to intensify respiration, while the student was doing the opposite job: teaching the breathing centre how to breathe less. The volumes of inhaled air and the durations of the inhalations, exhalations and pauses are different and individual depending on one’s initial CP, health, relaxation, and other parameters. What is important for these exercises is to preserve continuous air hunger (that indicates reduced minute ventilation) and to be relaxed. Another practical suggestion, which was emphasized by Doctor Buteyko, is that under no circumstances is it allowed to have large deep inhalations or quick exhalations. Breathing, especially exhalations, should be under full control. The level of air hunger during the RB session should be light and comfortable, no more than at the end of the CP, (it is felt, but comfortable enough to tolerate). During the first breathing sessions this sensation of air hunger is

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unusual and, for some people, can be unpleasant. Meanwhile, after realizing the relaxing and inspiring effects of first sessions, these unpleasant effects later disappear. The manual written by Doctor Buteyko (Buteyko, 1991), in order to remember the essence of the Buteyko method (shallow or reduced breathing), suggests to use the rule of "The left hand". “This rule contains 5 points (5 fingers, starting from the thumb): 1. decrease 2. the depth 3. of breathing 4. by relaxation of the diaphragm 5. till the sense of air shortage” (Buteyko, 1991). The last point, according to Buteyko, is the most difficult to learn. Note that frequency of breathing is not important in the Buteyko method. Breathing less with the relaxed diaphragm is the key. Most Western methods, as we found in Chapter 4, used low frequency breathing, which often resulted in relatively large diaphragmatic movements and large tidal volume (slow, but deep breathing) since breathing frequency was one of the factors which was controlled by the patient. However, low frequency deep breathing can cause tension in the diaphragm. The Buteyko breathing consists of a shallow, low-volume voluntary breathing pattern, which is later automatically (unconsciously) corrected by the breathing centre to a slow and shallow pattern (with decreased tidal volume) corresponding to larger aCO2 values. Your breathing frequency, for example, at night will be gradually less when your CP gets higher. (You can ask others to measure how it changes.) Rosalba Courtney-Belford also suggested, that “The Buteyko method of breathing teaches people to utilize posture, focus attention on the breath and control breath-holding to raise the level of C02. It is also probably one of the only forms of breathing retraining that teaches people to reduce the volume of air while maintaining a relaxed diaphragm” (Courtney-Belford, 1997). In short, the main factors of the reduced breathing session are: - smaller inhalations using mainly the diaphragm, passive and relaxed exhalations (no any efforts applied and all muscles are just relaxed); - light air hunger; - thorough relaxation of all body muscles; - correct body posture; - comfortably cool environment; - empty stomach (water is OK); - nasal breathing only and no speaking. All of these conditions are important for success. Individuality of adaptation to breathing less Sometimes breathing teachers, especially when teaching groups, try to proceed to the main part of the Buteyko method, the RB, while some students may have difficulties with understanding the instructions and following them correctly. People have different abilities in relation to their ability to control their breathing muscles. The previous detailed description of breathing activities is to ensure that all students can learn the technique. However, some people can still do some elements or exercises incorrectly and remain silent during the group lesson about own difficulties. For this reason, it is important to have an individual meeting with each student in order to check the skills, discuss the existing problems, and correct possible mistakes. The teacher also should realize that not only are people different in terms of their ability to feel the breath, relax the diaphragm, and learn the RB, but their physiological make-up in relation to various breathing manipulations can be very different. Why? In 1960s Buteyko and his colleagues published numerous articles with results of their studies related to reactions of various people to changes in air composition. (This research was funded by the Soviet Ministry of Space Exploration and was exceptionally important for future spaceship missions of the first Soviet astronauts.) The volunteers were inhaling air with varying O2 and, in some other studies, CO2 contents. It was found that human adaptation to sudden hypoxia was very individual. Those people who had cardiovascular problems often could not experience normal adaptation even to mild hypoxia (15% O2). Their arteries and arterioles reacted with hypoxic vasoconstriction, with increased heart rate and blood pressure. Moreover, these people experienced negative or unpleasant symptoms, like headaches, dizziness, and fog in

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the head. It was literally a “yes” or “no” response of the body and within minutes it was clear if a particular person had normal adaptation to new air or not. In another series, the composition of air was changed slowly. The important finding here was, “Mild, gradually increasing hypoxia does not cause any essential changes in the tone of arterial vessels in patients with hypertension and stenocardia [angina pectoris]” (Buteyko et al, 1967). Other studies investigated cardiovascular and respiratory effects of CO2-rich air. Again, many patients with cardiovascular problems experienced various negative reactions, while adaptive abilities of other people, even with serious health problems, were usually normal. The cardiovascular adaptation, in cases with mild CO2 increase, depends on two competing effects: local vasodilation due to the local biochemical effect of CO2 on arterial vessels, and global vasoconstriction due to the CO2 stress on the vasomotor centre. However, it was again found that with gradual changes in air composition (so that inhaled CO2 content slowly increased over a period of several minutes from almost zero up to its maximum), all people could adapt normally even to mildly high CO2 concentrations (Buteyko et al, 1966). During breath holds and breathing less, CO2 level in lungs achieves significantly greater values (hypercapnia) in seconds, while O2 content in the lungs significantly decreases (hypoxia). Hence, a person experiences 3 vascular gas-related effects during and after breath holding or air hunger: 1) vasoconstriction due to hypoxia; 2) local vasodilation due to hypercapnia; 3) global vasoconstriction due to hypercapnia. Not only are people different, practice shows that their health states influence the results. If the person experiences high blood pressure and pulse, as a result of breath hold and subsequent air hunger, then the same person, but with higher CP, can successfully adapt to new concentrations of O2 and CO2 in the lungs and arterial blood. Hence, we have numerous situations with various contributions from these effects. The final response of the body often takes minutes to be revealed, but it is again “yes” or “no”. The organism, depending on many factors, can adapt its cardiovascular system to new conditions or new homeostasis with light changes in the previous metastasis (only some small corrections are required) or not. In the last case, we get greatly increased heart rate and blood pressure, together with unpleasant symptoms. Hence, Buteyko and his colleagues found that many heart patients require a different (or gradual) approach in breathing retraining in comparison with, for example, typical asthmatics and healthy volunteers. Most people with asthma, bronchitis, and many other problems, can comfortably tolerate CPs and light or even moderate air hunger from first attempts. Hence, their breathing retraining program can include CPs and RB from the beginning. Other students, when their CPs are low, require milder gas changes in their lungs. This is possible during: - relaxation of the body only (aCO2 is still higher) with no air hunger; - relaxation of the diaphragm (aCO2 is still higher) with no air hunger; - very light RB with very mild, hardly noticeable, air hunger. Therefore, students with hypertension, susceptibility to migraine headaches and panic attacks usually require light comfortable level of air hunger and no breath holds. The rate of CO2 accumulation should be slow so that distinctive, but light air hunger is experienced in minutes, not in seconds (as at the end of the CP). There are even more severe restrictions, in respect to air hunger, that are required for some people with, for example, loss of CO2 sensitivity, sleep apnoea and heart disease. Their safest exercises are relaxation, progressive relaxation of the body and relaxation of the diaphragm without any voluntary changes in breathing and with no air hunger. Later, when the CP is about 20 - 25 s, even previously severely sick people, can do the CP and practice the RB with air hunger and no unpleasant effects. It is not the degree of air hunger or the type of the exercise, but persistence and self-discipline that are keys to success in these students.

_______ 8.4 More about relaxation and posture

One of the Australian Buteyko practitioners Peter Kolb, who learned the method from Doctor Buteyko, was asked once, "Q: Peter, you say to relax your whole body whilst doing reduced breathing, and I have read in lots of postings that it is important to feel relaxed, but I find the mere fact that I am not breathing as much as my body wants to automatically makes me tense up, and I just don't seem to be able to stop this. A: That's quite a common problem. Tensing up to fight the breathing is a normal reaction. Buteyko himself says that 147


the best way of achieving raised CO2 levels is through relaxation of the respiratory muscles. Implied is that there may be other ways. Souliagin, on the other hand, says it's impossible without the relaxation. I had a lot of trouble with this myself, so I know what you're going through. While the reduced breathing is the essence of the method, you can really help the process along if you stimulate the parasympathetic nervous system. This does more or less the opposite of what the sympathetic nervous system does, which has to do with fighting and fleeing and which promotes hyperventilation. The parasympathetic on the other hand is switched on by relaxation, holidaying, and listening to restful music. What I'd like you to do is stand in front of a mirror with your shirt off, close your eyes for a minute and breathe normally. Now open your eyes and study your breathing. Have a look that your chest is not moving when you breathe and that only the area of your tummy between your naval and breastbone is moving OUT with the INBREATH and IN with the OUTBREATH. Make sure you get them the right way round. Now if this is not happening, don't worry at this stage, but it's what you're aiming to achieve. Make sure you get your posture right. This greatly assists in diaphragmatic breathing. Stand with your back to the wall, look straight ahead and make sure your head, shoulders, bum and heels are all up against the wall. Now drop your shoulders and try to relax them in that position. Take that posture with you and get back in front of the mirror. Now go through all your muscles, especially in your upper body, tense them individually and then relax them. Take special care around the shoulders and neck and also the arms. You might need hubby to give the shoulders a bit of a massage... Now if you are completely comfortable, standing quite still with all the muscles relaxed, just breathing very gently, and your posture is good, you should start getting a warm fuzzy feeling coming over you. It should be very pleasant and this is how you get your parasympathetic stimulated. In this position you should be able to relax your diaphragm sufficiently for the breathing to be correct. Once you've got that right, reduce your breathing by taking in just a little less air than you need at the next inspiration and then let it out naturally. Don't force it. It's not easy, but that's why we have practitioners. (By the way, you don't have to take your shirt off in a Buteyko class, just in case someone is worried). If you don't get all this right first time, leave it and try it again the next day..." (Kolb, private communication, 2002) Relaxation of most skeletal muscles during breathing exercises is easily achieved by many students. However, during breath holding and shallow breathing the breathing centre sends, due to increased aCO2 values, signals to respiratory muscles in order to resume breathing. That is the reason why curarisation (surgical disconnection of respiratory muscles nerves from the central nervous system) leads to greatly increased BHT, as was mentioned in section 2.6. How to achieve complete relaxation, when muscular tension is generated by the nervous system? Most people with hyperventilation, as practice and studies show, are chest-breathers. Since the chest muscles produce very small contribution in normal breathing, the first goal of the student is to give them a complete rest. One solution is to counteract these chest-expanding impulses by forceful resistance using the muscles-antagonists. That would cause more tension, producing more excited and stressful state of the nervous system. Another solution is a gentle dialogue with the breathing centre. Every time your breathing centre tries to take a deep breath by chest expansion, one can calmly and consistently respond by the mental message to relax, which is sent specifically to these chest-shoulders-neck-jaw muscles. Imagine that your chest is, for example, a relaxed, partly deflated balloon. At some moments the balloon wants or even starts to expand by being filled with air and becoming smooth and resilient. Such expansion, to a minimum degree, can be real even during breath holding, due to very small amounts of air travelling from the dead space (air in the mouth, oesophagus and nasal cavities) into the lungs. Imagine how, almost immediately, this balloon gets soft, relaxed, and tranquil, with possible light wrinkles. Such imagery and accompanying relaxation response of chest muscles can be useful at other times too in order to switch from thoracic to abdominal breathing. Only during rigorous physical exercise, when ventilation is well over 40 l/min, the movements of the chest are useful. Similar ideas can be applied in order to learn diaphragmatic breathing. Relaxation of the diaphragm is one of the difficult and very important points of the therapy. The degree of involvement of the diaphragm in breathing at rest is different in different people. Whatever the case, during the exercises it is necessary to preserve the feeling of air hunger of a light, moderate, or high degree, depending on the intensity of the session. In order to make inhalations small and short, while the diaphragm wants to inhale larger volumes of air, relax it using a similar imagery before just before you made the full inhalation. If this

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relaxation is effective, it would again generate passive, slow, and quiet exhalation. One should not resist inhalations during the RB, but gently and partly yield to the breathing centre which is demanding more air. There are many other relaxation techniques, which can be useful in learning Buteyko breathing. That includes transcendental and Zen meditation, Benson’s Relaxation Response (Benson, 1975), Luthe’s Autogenic Training (AT) (Luthe, 1963), The Quieting Reflex (Stroebel, 1978), and Jacobson's Progressive Relaxation (Jacobson, 1970). Robert Fried, Director of the Institute for Rational-Emotive Therapy (New York), in his book “The Psychology and Physiology of Breathing” analysed various popular relaxation techniques and noticed their practical effectiveness for the treatment of the hyperventilation syndrome. Australian Buteyko practitioner Peter Kolb suggests, “Have you ever thought of doing the Buteyko breathing while you meditate? The ideal way to do the Buteyko breathing exercises is to relax completely and just breathe as lightly as possible. You don’t have to do those sessions once you mastered it. This way the Buteyko exercise becomes a wonderful experience” (Kolb, private communication, 2002).

8.5 Gradualism – an approach to learning air hunger When the novice starts to practice, it is important to understand that breath holds and any air hunger, in the lives of many people, are associated in the brain with extra-ordinary situations (e.g., suffocation or drowning). Hence, the mind, instead of getting alarmed, needs to learn how to accept breath holds and air hunger positively. This task is solved faster and easier, if during the first sessions the students know that: 1. the sensations of air hunger are unusual; 2. the level of air hunger for first breathing sessions is to be light so that the muscles of the body can be relaxed. Later, after many sessions, the nervous system will learn that there is no danger in breath holds and air hunger. Then the student can practice longer breath holds and comfortably accept intensive sessions with moderate and strong air hunger, if he or she found them more effective. Reminder. Some students should temporary avoid any breath holds and, in very rare cases, even the RB, as it was described and explained above.

8.6 Which breathing exercises to choose from? The student can have faster progress, if the breathing program is tailored to his or her specific abilities, conditions and needs. The variations are due to existing health problems (cardiovascular, hormonal, respiratory, digestive, etc.), genetic factors, the degree of the disease (or hyperventilation), available time, motivation, preferences, and other parameters. Here are breathing exercises depending on the intensity and magnitude of changes in gas composition of the lungs. The CP and RB separated (light air hunger) During 1960s Buteyko used breathing exercises that were about 15 min long. Most patients (asthma, bronchitis, epilepsy, etc.) were instructed how to measure the pulse and the CP before the period of RB (about 10-12 min) and after it. Their session had the following structure: - Measurement of the initial CP and pulse and focus on own usual breathing (1-2 minutes); - The RB with light air hunger (about 10-15 minutes); - Measurement of the final pulse and CP. All patients were encouraged to practice breathing exercises every hour.

_______ The RB immediately after the CP (light air hunger) Most students can tolerate faster changes in their gas composition doing the RB immediately after the CP. The structure of this type of the session is: - Measurement of the pulse, the initial CP; - The RB with light air hunger (about 10-15 minutes); - Measurement of the final pulse and CP. In 1990s and in the next millennia, these short sessions (about 15 min) became again popular in Russia and among western breathing teachers. These sessions have a light level of air hunger or light intensity. Most people learn this variation and can use it for months or years achieving amazing results in health restoration. 149


Just the RB (with very light air hunger) While most people can enjoy popular breathing sessions with the CPs and immediate RB afterwards, some people (e.g., those, who experience problems with panic attacks, migraine headaches, and hypertension) often find that the CP and following RB are unpleasant. There are also many other conditions when students should avoid the CP and longer breath holds, together with strong and mild air hunger. The teacher should ask the student about any CP-related discomfort or unpleasant symptoms. Usually, heart patients find the CP unpleasant since their main symptom, blood pressure increases dramatically. Obviously, it would be even more difficult for them to practice the RB after the CP, while most people can do that. In case of such difficulties, it is safer for them to avoid any pauses for a while and focus on pulse counting (before and after the session) and the RB. In such cases, the structure of the session is different: - Measurement of the initial pulse; - Light RB (with very mild air hunger); - Measurement of the final pulse. The reduction of the pulse is their main criteria of success, while the CP can be measured occasionally (e.g., only in the morning) or temporary avoided. Here, a very light pleasant level of air hunger is achieved using the RB only. The student is advised “to breathe slightly less, e.g., about 5-10% less air, than you usually do for each inhalation so that you can gradually accumulate light comfortable air hunger”. Relaxation of the diaphragm (no air hunger) If both the RB and the CP are uncomfortable, the student is encouraged to forget about breathing and focus own attention on relaxation of the diaphragm. The structure of this session is very simple: - Measurement of the initial pulse; - Relaxation of the diaphragm (no attention to breathing); - Measurement of the final pulse. This exercise can be the best for students with moderate or severe heart disease. Relaxation of body muscles only (no air hunger) The mildest possible session involves only relaxation of the body with no attention to breathing. Such sessions can be about 10-15 min long. - Measurement of the initial pulse; - Relaxation of the muscles of the body (no attention to breathing); - Measurement of the final pulse. Relaxation can be practised any time during the day. Breathing exercises combined with physical activity During more advanced stages, most students will benefit from combinations of physical activity and breathing exercises. Walking while pinching the nose and holding one’s breath (till moderate of strong air hunger) and reduced breathing for the next 1-3 minutes, while still walking, is a very intensive type of exercise. Then the process is repeated several times. Hence, this exercise has the following structure: Do, while walking all the time: Breath hold (strong air hunger) – RB for 1-3 min – Breath hold (strong air hunger) – RB for 1-3 min – Breath hold (strong air hunger) – RB for 1-3 min – … The duration of the exercise can be about 15min. Students with diabetes achieve best results while applying this exercise. There are other possible types of breathing exercises. For example, the session with the RB immediately after the CP can be done with higher levels of air hunger, e.g., moderate, high or even very high.

_______ A session with moderate intensity It takes many hours of practice before the students get used to moderate level of air hunger. Usually it takes about one-two weeks. Then the teacher can offer to some students to try more intensive sessions, for example, the 150


sessions with moderate air hunger. Breath holds create a desire to breathe more, and practice shows that students, if they start the RB after the CP, usually try to maintain the same level of air hunger during the RB. Hence, doing the EPs (extended pauses) will naturally generate moderate levels of air hunger during the RB. The EP can be, for example, 3, 5 or 10 s longer than the CP. While doing the initial EP, the student can also record and write down the CP. During the RB, it will be more difficult to relax since the higher CO2 increase will create conditions when the breathing centre tries to make muscles tenser, while the goal of the student is to relax all muscles, especially the diaphragm. After the RB and final pulse measurements, the student measures only the CP. The structure of such sessions is here: - Measurement of the pulse, the initial CP and EP; - The RB with moderate air hunger (about 10-15 minutes); - Measurement of the final pulse and CP. The main goals for this type of the session are the same as before. When the students are provided with the choice, some of them prefer the sessions with moderate intensity since they can find this new challenge (moderate air hunger with relaxation) interesting and pleasant. Other students prefer sessions with light air hunger. A session with high intensity It is possible to go further and do the MP and the RB with strong air hunger. The reader can apply the same ideas as in the previous section for sessions with moderate intensity. The structure of the short session with strong intensity is: - Measurement of the pulse, the initial CP and EP; - The RB with strong air hunger (about 10-15 minutes); - Measurement of the final pulse and CP. Some Buteyko teachers can suggest even stronger air hunger levels and use the AMPs (absolute maximum pauses) to “kick” the effect (very strong air hunger). Note that in all situations the reduction in pulse (so that the final pulse is lower than the initial) is a sign of successful adaptation of the body. Buteyko and his colleagues taught their students that there are 2 possible goals of breathing exercises: - to eliminate symptoms; - to increase CP by 5 seconds at least. During the 1980s, Buteyko and his colleagues described in their manuals and applied in practice long sessions (from 20 up to 40 min). These sessions are described in the next Chapter.

8.7 What are the criteria of success? Indeed, how would you know that the student breathed less, not more, during the RB period? The criteria for success are the following signs: - The arms and feet will get warm in about 2-3 minutes after starting the RB; - The nasal passages will become moist and the nose cold in about the same 2-3 minutes. There are many additional individual signs and symptoms indicating that the person breathes less: e.g., tension in the diaphragm (as is described above), clearing of nasal passages, tears in eyes, increased salivation, restoration of the muscular tone of the transverse colon and stomach leading to the natural desire to sit straight, etc. The student may have some of these symptoms or none of them. The most important criterion is easier breathing after the session. The final CP should be at least by 5 s greater than the initial CP. (The final CP is measured 2-3 minutes after finishing the RB). The pulse usually drops by about 23 beats per minute or more after the session (occasionally it can get higher, especially if the student drank coffee before the session). Among other positive immediate after-effects are: the desire to flex and stretch arms, feeling of increased energy (or feeling of being charged), feeling of being focused (instead of confused and indecisive), reduced hunger for food and addictive substances, and easier breathing through the nose (especially if it was blocked or partly blocked before).

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8.8 How much to exercise? When Buteyko wrote his first manuals with the description of the method for medical doctors, he suggested 34 hours of breathing exercises every day. This was the amount of training that he and his colleagues recommended to their patients. Many of these patients were hospitalised and, therefore, had a lot of time and, in most cases, a strong desire to practice. Patients, who followed this rigorous program of breathing retraining, experienced quick and dramatic health improvements. In a typical situation, a former patient with numerous hospitalizations and using various medications in 3-6 months could jog and exercise rigorously while breathing through the nose, climb 5-7 floors up with mouth closed and no signs of the disease that kept him crippled for years. What about those people who have little time but still want to learn the method? In other words, what is the minimum amount of daily practice so that there are positive changes in the right direction (breathing less)? The student should spend about 1 hour per day for breathing exercises in order to experience gradual improvements in breathing. One session lasts about 15-20 minutes. Hence, 3-4 sessions should be done every day. Have no more than 1 breathing session every hour. Personal persistence and self-discipline are the main tools for progress. It was not accidental that the Buteyko method was called in the USSR “wilful liquidation of deep breathing” emphasising the will power. (Some Russian patients invented the other, grotesque name “the Siberian method of self-suffocation”.) Severely sick students, as practice shows, are the most diligent students. However, most people on the West used and use a mild approach with 3-4 sessions per day that is easy and stress-free. As during any learning process, expectations and standards established by the teacher are other important factors for progress. This also relates to the ability of the student to practice with no fear more intensively (more time and with stronger air hunger) without any negative effects.

8.9 Day-after-day progress in breathing retraining Breathing remains easier and the CP higher for some hours after the session. Later, the influence of other factors (stress, meals, lack of physical activity, poor posture, etc.) will make breathing heavier and reduce the CP. However, the student does another session and the process of breathing retraining continues. This process and the dynamic of the CP, pulse and symptoms can be analyzed later. Day after day, the CP usually does not increase steadily. During some days the CP can be lower than during the previous day. However, if the student does at least 3-4 short sessions every day (about 1 hour in total), the CP will improve by at least 2-3 s in a week time. Severely sick people and those who are very motivated often can do one breathing session every hour. As another good alternative, the student can practice the RB all the time while awake. Such a student can progress up to 5-10 s CP per week or even faster. This linear progress usually takes place until the student reaches 40 s CP. This is a very important threshold. The further progress is described in following chapters.

8.10 Evening and morning CPs During the night we do not control our breathing. For most people, as was discussed before, breathing is heaviest between about 3 and 6 am. The CP is lowest during these early morning hours. Meanwhile, the main damage to the body with resetting of the breathing centre corresponds to the minimum daily CP. Many positive changes could be eliminated. The rate of progress is reduced. The student has to start over almost from the same level again. To find out the degree of this problem, every night, just before going to sleep, the student should measure, if there are no contra-indications, the evening CP. It will tell about the progress achieved during that particular day. Each morning, as soon as the student wakes up and is still in bed, he or she should measure the morning CP. The morning CP is not just a test. It also provides us with energy and reminds us about our commitment to breathe less. After several days of measurements, there are many numbers - daily, evening and morning CPs. Then the goal is to find out the emerging pattern related to personal circadian CP changes. Is the morning CP much smaller than the previous evening CP? By how much? Some people have relatively short sleep (e.g., about 6 hours) even when their CPs are about 10 s or less. Usually these people do not have problems with morning CP. It is nearly the same as their evening CP values. However, for most people the sleep is longer (e.g., 7-8 hours or more) and breathing gets heavier because of the duration of the sleep and other factors. The morning CP will be significantly less than the typical daily or evening CP numbers (often by 10 s or more). It is typical that the CP drops about 2 times. In some people the CP can drop 3 or

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5, in exceptional cases, up to 7 times (e.g., from 35 to 5 s). This means that the minute ventilation becomes 3, 5, or 7 (!) times more during the course of the night. This is a real health disaster. In absolute values the morning CP can be 5, 10, up to 30 s less. Even if the morning CP is less by 20% (e.g., from 25 s to 20 s), this is a decrease that can be addressed. Practice shows that over 50% modern students have a large CP drop (at least twice) during the night sleep. For some of these people the drop is even more drastic. Only a small proportion of people (about 5-10%) have almost no difference (e.g., 1-2 s) between the evening and morning CP values. Practising breathing exercises and many other common sense activities gradually restore CO2 level back to usual daily values. During the next night the pattern is repeated again: good daily values with about 30-70% morning drop. Would the morning CP, after weeks of practice, improve, if breathing exercises and common sense activities are practised? Practice shows that usually it will, but it is physiologically obvious that low morning CP would be the greatest factor impeding the general CP progress and health restoration. It would make sense, therefore, to address the problem directly. Before that let us consider the possible causes.

8.11 General observations about sleep When we sleep, one may expect that the CP should become greater. Why not, since sleep is rest? However, this is true only for healthy people or for those who have at least 50-60 s CPs. These people have very short sleep (about 5 hours) and they wake up having the greater morning CP than the previous evening CP. For the modern man, the situation is different. The unhealthy body, due to abnormal processes and stress, depresses tissue oxygenation and CO2 stores during sleep. Early morning hours are the times of the lowest CPs. That explains why at the end of sleep (4-7 a.m.), the highest rates of heart and asthma attacks, strokes, and other, often fatal, health problems occur. These are the hours of lowest oxygenation and highest mortality rates. Lying in bed (after waking up) or sleeping too long further reduces oxygenation. In addition, if one sleeps on the back or breathes through the mouth, the CP drop can be more drastic. Why heavy breathing makes sleep quality worse? In order to answer this question, let us consider the common-sense causes why we need sleep. Our understanding of sleep is very limited and incomplete. Common sense tells us that we need it to provide rest for the brain and muscles. We know that deep breathing makes the brain over-excited and muscles tense. Hence, CO2 deficiency can affect the quality of our sleep due to these effects. Here are some general practical observations about breathing and the quality of sleep. A person with normal breathing (about 60 s CP): - falls asleep in less than 1 minute; - sleeps for about 5 hours and it can be done in the same position or only with one change through the whole night; - does not remember dreams and does not have nightmares; - awakes feeling refreshed and full of energy and vigour with a morning CP of about 60 or more seconds. When the CP is about 15-25 s (as is common for people today), a person: - may need more time to fall asleep (up to 5-30 minutes or more); - can sleep up to 7-9 hours; - can remember dreams and may have nightmares; - awakens feeling tired, often with about 10 seconds CP due to morning hyperventilation.

_______ Why? During the previous day and night, this individual has had chronically low tissue O2 and CO2 stores. The muscles were tense, instead of naturally relaxed, and the brain hypoxic and over-excited, instead of calm. Even during sleep, the brain, due to hyperventilation, remained abnormally excited (remember "spontaneous and asynchronous firing of cortical neurons"?) and hypoxic. Consider severely sick, terminally ill or hospitalized patients with a typical CP of about 5-10 s or even less. These people: - may need even more time to fall asleep (up to 30 minutes or more); - can sleep up to 12-15 hours tossing and moving in bed; 153


- can remember many dreams and often have nightmares; - awaken feeling tired and sluggish. Their quality of sleep is often miserable. Why? Because these people, due to severe chronic hyperventilation, have critically low oxygenation and CO2 values. They are chronically very tense and over-excited. Their muscles and brain need much more time to rest and relax. However, this is difficult or impossible, since O2 and CO2 stores are critically low, during the night as well. Some people (Doctor Buteyko, some Russian Buteyko doctors, Western Buteyko practitioners and students, and hatha yoga masters) have/had very light breathing (about 2-3 l/min for ventilation) with 2-3 minutes CP. Such people need only about 2 hours of sleep during the night. If you achieve the same CP, you will naturally sleep for 2 hours only. Why? High CO2 concentrations keep the muscles relaxed and the brain calm throughout the day and night. Normally these people do not need much sleep at all, since they are resting even while they work. Note that there are people who may have only 5-10 s CP and have no problems or complaints about sleep. Occasionally, some people may have 30-35 s CP and still be concerned or unhappy about their quality of sleep. However, all these cases are exceptions rather than the rule. It can be of important practical and scientific value to find out the exact biochemical, neurological and psychological links between breathing and quality of sleep. These simple CO2-based ideas could be considered as a backbone for further theoretical development and practical applications. There are many questions related to optimisation of sleeping parameters in order to provide best conditions for breathing normalization (or further CP growth). It is unlikely that there are systematic studies and obviously searching for averages or optimum sleep parameters should be based on current breathing (CP), individual needs, preferences, and abilities.

8.12 Why breathing gets deeper during sleep Most modern people have less than 40 s CP in the morning and this indicates presence of pathological tissues and/or processes in the body, including: - inflamed tissues; - malignant and benign tumours, - various types of fibroblasts, plaque, cysts, papillomas or polyps, adenomas, lymphomas, keratoacanthomas, carcinomas, dermatofibroma, granulomas, etc. - abnormal bacterial flora or overgrowth of pathological bacteria in sinuses, large and small intestine, stomach, mouth, on the skin, and in other organs. Presence of these abnormalities is a chronic stress for the immune system and organs of elimination. Immobile state of the body during sleep affects circulation creating areas with poor perfusion causing various negative effects. These are physiological inner sources of hyperventilation during sleep. Apart from these, there are situational factors. Some of these situational factors (mouth breathing, sleeping on the back, and overheating) were considered before. Other causes relate to the duration and sleeping positions. The longer we sleep, the deeper we breathe. The effect is particularly strong when we sleep in the same position for hours. Among the factors affecting our breathing are:. - uneven circulation; - immobility of the body internal organs - restricted blood flow and stagnation in the lymphatic system.

_______ 8.13 Modern Western sleep

When Carol Worthman, the director of the Laboratory for Comparative Human Biology of Emory University discovered that anthropologists knew nothing about sleep, she decided to study the subject in detail using all available sources (books, articles, professionals’ reports, documentary films, conversations, field trips, etc.). She found that sleep comes in many cultural forms. For people from Botswana and Zaire, “sleep is a very fluid 154


state. They sleep when they feel like it – during the day, in the evening, in the dead of night” (Warren, 2007). This, she said, is true for others groups too. “The more Worthman learned about communal and interactive nature of nonWestern sleep, the more she came to see Western sleep as the strange exception… So after collecting all this material I look at my own bed and go, ‘This is really weird.’” (Warren, 2007). She continued,”…, think about it – this thing, this bed, is really a gigantic sleep machine. You’ve got a steel frame that comes up from the floor, a bottom mattress that looks totally machinelike, then all these heavily padded surfaces – blankets and pillows and sheets.” Her final conclusions were that the modern Western bed is alien to our evolution and even recent history of humanity. Moreover, it is abnormal from the physiological viewpoint. The modern Western bed can affect breathing during sleep due to the following effects: - abnormal thermoregulation; - too soft surface we sleep on; - poor air quality. Let us consider them separately. Thermoregulation When heat exchange is abnormal (the human body cannot give off extra heat), we start to breathe heavier in order to eliminate extra heat with exhaled air (Chapter 3, Overheating section). Hence, sleeping in too warm conditions or having too warm/many blankets compromises our quality of sleep. Severely sick people (less than 10 s) are often having risk of viral and other infections due to a very weak immune system. In such states it is advisable to keep the body comfortably warm all the time. When the CP is between 10 and 20 s, overcooling is still a big problem, but feeling just comfortable in relation to thermoregulation is the optimum strategy. When the CP is above 20 s, feeling slightly cool is advantageous for breathing as we are going to learn in more detail later. Sleeping positions Sleeping position should be correspondent to the health state of the student. Critically ill patients often choose to sleep in a sitting position in order to have less ventilation (many Buteyko patients found out themselves that being in any horizontal position intensified their breathing). The severely sick can be laid down on their bellies to restrict ventilation. Sleeping on the left side, when health is better, is possible, if the body is properly propped by pillows to prevent turning onto the back. Other practical suggestions (in order to prevent sleeping on the back) include sleeping with a backpack or a tennis ball fixed on the back (the ball can be attached there in a sewed pocket). More recent suggestions are described below. Hence, during this intermediate stage of learning (10-40 s CP), alternations between chest and the left side is one of the solutions of the problem. When the CP is very large (over 90 s), it is possible to have motionless short (about 4 h) sleep in the same, e.g., left position without any drop in the CP. If a student is uncertain or doubtful about these findings or their application for own health, it is possible to check the effects of own sleeping positions on the CP, as it was suggested in section 3.8 (a simple "sleeping positions" self-test). One needs a ticking or electronic clock which show, at night, seconds. Just pinch the nose after waking up in any position and see its effects. Note that it takes about 10-15 minutes for any position to produce its effects on breathing.

_______ Hardness of the surface for sleep Buteyko made observations of the sleeping person and revealed that sleeping for a long time in the same position (no movements) gradually intensifies respiration. Once the position is changed, breathing immediately becomes easier. Practically, the person on a soft bed can sleep longer in the same position with gradual increase in ventilation (probably due to inadequate circulation) and with progressive CP drop. Another effect of hard beds relates to uneven pressure on various parts of the body. When we hit a finger with a hammer, we naturally hold the breath and accumulate CO2 reducing the sensation of pain. Possibly, there is a similar unconscious reflexive mechanism that influences breathing during sleep: uneven pressure, which is perceived 155


consciously as discomfort, reduces ventilation. This mechanism counteracts poor perfusion of some body parts due to pressure from the outside during the sleep. The soft machinelike bed is one of the recent Western innovations that is physiologically foreign for the human body. It does provide sensation of comfort in the short run (when we fall asleep), but worsens our health and quality of sleep hours later. In the case of a rigid bed, the person wakes up many more times during the night just to change the sleeping position. However the morning CP would be larger than for the softer bed and the sleep probably shorter, while the subjective quality of the sleep worsens. One may simply try to sleep for 2-3 nights on a hardwood floor or piece of wood covered with a blanket and observe the differences. Timing and duration of the sleep Western machinelike beds also influence the timing and duration of our sleep. How? You can fall asleep on a hard surface, e.g., wooden floor, only if you are very sleepy, whereas soft beds make muscular relaxation easier promoting our ability to sleep even when the desire to sleep is not strong enough. Hence, we have a tendency to go to bed too early when the bed is softer, in comparison with natural or primitive conditions. Now consider what is going on in the morning. If the bed is soft (cosy), it is possible to stay in the bed for up to 1-2 more hours promoting laziness and greatly intensifying breathing (section 3.8: Sleeping too much, sleeping on the back or on the right side). Hard beds, on the other hand, “kick” us out of the bed as soon as we wake up. Just try to wake up on the hard floor and see the effects. Therefore, modern Western beds increase the duration of sleep leading to heavier breathing and lower oxygenation of the body. Teaching Russian patients, Buteyko always emphasized two main rules in relation to sleep: 1. Go to sleep when you are really or very sleepy. 2. Get out of the bed in the morning after waking up (of course the morning CP measurement should be done and that promotes feeling more alert right after awakening). Use of hard beds was and is a part of the course taught by Russian doctors with success for decades. Air quality Having many surfaces in the bedroom (carpets, curtains, bed, blankets, etc.) means breathing in particles of dust, dust mites, their proteins, and other air-born substances. Natural conditions of forests and other outdoor places have clean and fresh air with an abundant supply of negative ions. Japanese bedrooms, as well as the whole nation, are healthiest compared to the West: wooden floor, no carpets, no curtains, no books, just a simple bed, blanket, and bed sheets. The easiest tests to check the degree of influence of your bedroom air on your breathing is to sleep, for 2-3 nights, in a place with better air quality, for example, in another room with no carpets or hardwood floor; in the kitchen, backyard, or other outdoor place. If your morning CP is significantly better, then it is good to find out which parameters of the bedroom make your breathing deeper. The reasons can be numerous: the student can be sensitive to dust mites, their proteins, mould or other substances. The pillow casing, which is just under the nose, is often the source of dust and dust mites (according to diffusion laws the concentration being highest near the surface and less further away). When we go to sleep, the nasal passages are moist and trap over 95-99% viruses, bacteria, dust mites and other particles. Slight increase in breathing during the night, due to various causes, increases inflow of dust/mites triggering autoimmune response. It includes histamine rush, mucus production and other effects typical for people with asthma. Even those students, who do not have allergies, can experience very dry nasal passages causing more airborne substances that can lodge or penetrate the lungs and enter the blood. Once these substances and particles are in the alveoli of the lungs, it is a very difficult job for the immune system to detect the intruders, mark them with special markers, disassemble them in smaller pieces, and filter out the blood by kidneys and liver. (Note that we are talking here about many thousand litres of air entering the human body every night.) Practical experience shows that patients with asthma and emphysema accumulate large amounts of this debris in their lungs and the immune system cannot remove these waste products. Comparing the CPs and personal symptoms in various sleeping conditions provides the student with information how to prevent deep breathing and CP drop during sleep.

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8.14 Methods to prevent night hyperventilation If your breathing becomes heavier during night sleep, addressing this problem will greatly improve your general progress. Imagine that you start your day with 3-5 s higher CP in the morning than during the previous days. More progress would be achieved due to the breathing sessions and your other activities. For many students, it is one of the most difficult challenges to find out the exact causes of over-breathing during sleep. Sometimes, a student can always get great results when sleeping outdoors, but can have difficulties in figuring out what is wrong in the bedroom. Let us briefly review possible solutions. If the person sleeps on the back or breathes through the mouth while sleeping, these are the first challenges to solve. Sleeping on the back can increase ventilation about 2 times, while breathing through the mouth produces about the same damage. The techniques to prevent these abnormalities are described in the previous Chapter. For those students who sleep in the horizontal position, alternation between sleeping on the tummy and on the left side is probably the optimum solution for easier breathing in the morning, better oxygenation and highest morning CP. Sleeping on the right side is not as damaging as sleeping on the back, but it is better to avoid it. Having less well insulated blankets or just 1, 2 or 3 bed sheets instead of blankets help to accurately regulate thermo-exchange. Hard beds, in my view, are a must for any student. Fresh air in the room, or sleeping outdoors is an ideal solution for many people in order to find out the reserves for personal health improvement. Taking care about air quality in the bedroom is always a great factor often allowing morning CP growth. Often, just having dusty or cottonmade pillow case (that is in touch with your nose at night) can be the cause of a mild (undetected) allergy resulting in dried nose and morning hyperventilation. Carpets on the floor, old curtains, books or printed papers, old chairs, rugs, and many other objects in the room can be the factors that make your breathing deeper. Getting the large evening CP is usually the main day-related parameter that influences quality of sleep. It is possible using various exercises and activities described here. Having early supper (5-6 hours before sleep), instead of the late one (just 2-3 hours before sleep) is a frequent reserve for many students. If one gets very hungry later, a small snack will not produce any ill effects on the evening CP measured just before going to bed. Breathing exercises to prevent hyperventilation during sleep During the 1960s Doctor Buteyko clinically studied breathing of his patients at night. He found that there was a certain hour of the night, when breathing became much heavier. Very sick people often could have only 1-2 hours of reasonably good sleep. Then their breathing was deeper; oxygenation and the CP sharply fell down, heart rate could increase dramatically (over 100 beats per minute). The quality of the following sleep was miserable. He taught his patients to wake up, using an alarm clock, 0.5-1 hour before this personal critical time and do the breathing session (the same as described above) in a sitting position. This would prevent CP drop, stabilize the internal processes and provide better sleep quality later. Some sick patients were doing a session every 2 hours, but then they could have a much better quality of sleep during the whole night. (Note that we are talking about severely sick and hospitalized patients.) “Our patients cannot control their breathing at night, and hence, sleep is poison for them. Therefore, we wake them up after 1-2 hours and they reduce their breathing. Sleep decreases to 4-5 hours a night, and then they recover [from disease]. When breathing becomes less than the [physiological] norm, the duration of sleep is itself reduced. Many get worried: “Previously I was sleeping up to 8 hours – and it was not enough. Now I sleep for 4 hours and am satisfied.” Yes, it is possible to get enough sleep from 4 hours if breathing is light” (Buteyko, 1977). When health is better, even if you wake up and go for a 20 min walk with light nasal breathing, your health and morning CP will be improved. Physical activity also assists circulation and prevents morning hyperventilation. Among other exercises-related methods is to have the breathing session just before going to sleep (this can give you about 2 extra hours of good sleep).

_______ Mechanical restriction of ventilation The least time-consuming method for easier breathing and better sleep is mechanical restriction of ventilation or swaddling of adults. This method, according to the practice of Russian doctors, is used during the initial stages of the breathing retraining (to have faster increase in CP), temporary critical states, and the cleansing reactions (Souliagin, 1991a). In the past, elastic bandage, stays (corsets), or belts were used. The goal is to prevent deep breathing, and, more specifically, to reduce the contribution of chest breathing and amplitude of inspiration (the same as during the breathing exercise with a belt; see above), while preserving quiet relaxed exhalation. The area of restriction is from the navel to nipples in men, and from the navel to breasts in women. The total time should not 157


exceed 8-10 hours per day. Thus, the restriction can be done during nights or some parts of days. Day-time restriction can be a useful reminder for severely sick patients with poor memory or with stressful work (Souliagin, 1991a). Warning. People with irritable bowel, Crohn disease, duodenal ulcers, and other similar GI conditions should not apply pressure on their belly since it can cause a flare-up and worsening of your health. This is particularly dangerous during the active state of the gut characterized by inflammation, abnormal peristalsis and shortened transition time. In these and other similar situations with existing damage to internal organs, only ribs are the area of mechanical restriction. The method with one or two belts You can use one, or two, or even three belts as it is described below. Belts for mechanical restriction of ventilation Put a belt around your lower ribs (in the middle of the trunk or about 10 cm below the nipples) and buckle yourself tight so that: 1) you cannot take a deep inhale using your chest (now for deep inhalations your body needs to use your tummy or abdomen); 2) it is difficult to insert the index finger between the belt and your chest. Leave the belt tonight. It will allow you to have easier breathing through the whole night, learn diaphragmatic breathing, and have better quality of sleep. Your CP drop will be limited by 5-7 seconds. If you want to use another belt (for better results), buckle yourself just above the navel (belly button). Use the same two criteria for tightness of the second belt. Now your body should learn how to breathe even less.

There are other possibilities used in the past. Find a very strong T-shirt or a shirt made of thick cotton, the same as used for jeans. Cut out both sleeves. Saw 2 rows of buttons, not in the middle (as normally shirts have), but further from the centre. Now you need a strong rope or wire, e.g., long shoe laces to tie the shirt very tightly. Starting from 2 bottom buttons (on the left and right sides) and going left-right-left-right-… higher and higher until you reach the top two buttons. Make a knot at the top. You do the same when inserting the lace in the shoe. Now you can find out that after going up the lower parts of the rope are loose. Go down and tighten them all over again from the bottom to the top winning a few mm at each level. Make another knot at the top. You may need to go once more to achieve more tightness. This method takes longer time, but it produces most homogeneous distribution of pressure on your chest and the rest of the trunk so that it becomes almost completely immobile. Now your diaphragm will work like a piston in a car’s engine evenly filling all the lungs with fresh air and making breathing very light. Alternatively, you may use 3 strong laces to tie lower, medium and upper buttons using these separate laces. Later, each lace should be made tighter and tighter to restrict movements of the rib cage and upper abdomen (above the navel). During more recent years, the following method became popular in Russia. You need a strong partner to help you. Take a bed sheet made of 90-100 % cotton. Cut a strip, about 40-50 cm wide, along the width of the sheet. You would get the strip that is about 40-50 cm wide and over 1 m long. Fold the strip along its width. Now you have a double-layer strip of cotton about 20-25 cm wide (double layer) and over 1 long. This is your swaddling strip. Before going to bed ask a partner to help you with swaddling. It is better to ask an adult male since swaddling of adults needs considerable force. While standing, attach the middle of the strip to your chest so that the strip is perpendicular to the body. The higher edge of the strip would be just below your nipples (or just under the breasts for females), the lower edge would be just above your navel (or belly button). Now wrap the strip around your torso above your sleeping shirt. Insert both ends of the strip under your arm pits and give them to the partner who is behind you. Now your partner should hold both ends. Completely exhale air from your lungs (as much as possible!). After this forceful exhalation hold your breath, while the partner should make the first knot with maximum possible tightness. Before the partner makes the second knot, press with both your hands on the sides of your rib cage (just below armpits) while still holding the breath. Now, while you emptied your lungs as much as possible and pressed on own ribs, the partner should quickly tie the second knot. Check the tightness using the same two criteria: 1) you cannot take a deep breath; 2) it is difficult to insert a finger between the strip and the shirt. If it is easy to insert a finger and the strip is slightly loose, it would be less effective. Usually, it needs some practice (2-3 attempts) until the desired tightness is achieved.

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Now you cannot take a deep inhalation and have the knot on your back. This method solves two problems: first, you will not sleep on the back due to the knot and, second, you cannot have deep breathing. Chest breathing is suppressed and breathing is possible only with the diaphragm. If there is no partner, you can make the knot in front of you (between the lower ribs), but it is usually difficult to move it on your back without losses in tightness. The strip has tendency to slide down when you move the knot around own body. However, even self-swaddling can increase morning CP by 2-3 or even 5 seconds especially if you try to recreate tightness by another forceful exhalation and restoration of the tightness and the shape of the swaddling strip in front of you. In addition to this strip, you can use a belt above the strip too. The knot on the strip will prevent your sleeping on the back, while the belt can play the main role in preventing deep breathing. Tight swaddling can reduce the CP drop to minimum values so that the difference is less than 10%. Obviously, starting the day with much better morning CP values produces big positive physiological shift. During the day, especially due to breathing sessions, even higher CP values can be achieved accelerating the general progress of breathing normalization. Elevation of the head Some people experience migraine headaches and other negative symptoms during sleep. Sometimes, the cause relates only to over-breathing and the Emergency Procedure and elimination of factors causing deep breathing completely solves the problem. However, occasionally there are situations when migraines, headaches, dizziness, etc. persist even when breathing does not become heavier during sleep. In such cases, elevation of the head (by 5-10 cm) can improve sleep quality in cases of insomnia and longer sleep (over 5-6 hours). Take 2 wooden blocks or small bricks and put them under the front legs of the bed.

8.15 Supplements • Correct amounts and proportions of EFAs (essential fatty acids) Russian literature about the Buteyko method does not mention these factors. Why? One of the differences between Russian and Western diets is in the composition and consumption of animal fats. Russians generally eat more butter. Russian cattle are usually grass-fed as it is simply cheaper to let them graze due to the vast areas of uncultivated fields. That favours nearly equal amounts of both EFAs (linoleic and linolenic fatty acids), which are used, among many other vital functions, for production of anti-inflammatory and inflammatory substances. When dietary amounts of these fatty acids are nearly the same, there is a balance between the inflammatory and anti-inflammatory reactions. Western diets usually have much larger relative amounts (up to 10- 20 times) of pro-inflammatory fatty acids due to the following realities: - cattle are usually grain-fed (causing a shift in their fats to pro-inflammatory fatty acids); - fish consumption is low (decreasing consumption of anti-inflammatory fatty acids); - consumption of vegetable fats is large (again causing shift to pro-inflammatory fatty acids). Such diets contribute to the incidence of health problems, where chronic inflammation is an essential part. The Buteyko breathing method can help to correct this problem, due to better absorption of nutrients. However, the effect of the breathing exercises can be limited and, in some cases, negligible if these essential substances are not provided. Numerous clinical studies revealed that supplementation with EFAs (usually fish oil is taken orally) or their precursors improved various GI, cardiovascular, nervous, neuronal, hormonal, skeletal, urinary, and other problems. However, when the CP is low, digestion of fats is often impaired due to pathogenic gut flora and/or impaired abilities of enzyme-producing organs). For example, Dutch researchers found that "...Lipid malabsorption is not only a leading cause of EFA deficiency (EFAD), but also occurs secondarily to EFAD" (Minich et al, 1997). Therefore, abnormal absorption of fats can be a result of poor supply of EFAs. This causes a vicious circle. According to various reports, many weeks or even months may be required in order to correct this deficiency. Some doctors found that many oils (for example, fish, hemp, flaxseed, sunflower, and evening primrose oils) can be rubbed into the skin (e.g., Prottey et al, 1975) when the oral route is not effective due to very poor GI health and pathogenic bacteria in the GI tract. Apart from intravenous infusion, cutaneous application can be a solution of the problem. A practical case. A student with emphysema learned the Buteyko method. He prevented deterioration of own health and avoided being on oxygen 24/7. For over 5 years he religiously practised about 1-1.5 hours of breathing

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sessions every day. After sessions he had up to 90 sec AMPs, was feeling great, but had only about 15 s in the morning, while his daily CPs were about 30-35 s. This pattern was present for years. Later the arterial O2 pressure dropped down to about 80 mm Hg. Doctors suggested to use O2 24/7. Accidentally he decided to start a table spoon of fish oil per day, apart from his usual 2-3 meals per week with oily fish. The fish oil supplementation resulted in consistent 25 s morning CP instead of previous 15 s. Daily CPs remained unchanged, about 30-35 s. • 3 day test in order to identify nutritional deficiencies Should the fish oil be used by all students? Why? Essential fatty acids probably participate in active transport of oxygen to mitochondria in the cells (this is the least understood part in oxygen delivery). Second, EFAs (essential fatty acids) are transformed into prostaglandins 1 and 3, which reduce inflammation. Both functions have direct effect on reduction in ventilation. There are many related questions. How much? For how long? Does every Buteyko student need calcium and magnesium supplements? Are the required amounts the same for the same person when she gets higher CP? There are many questions, like these that could relate to, for example, Zn, Cr, I and other essential nutrients. The answer to these questions could be based on our philosophy of health: restoration of normal breathing. If introduction of, for example, certain nutrients increases the CP by, for example, even 3-5 s (a significant number), after supplementation, while it reduces the CP back to its previous values, then the organism needs these nutrients. Practically, during initial stages or after getting initial statistical data about the morning and daily CPs, heart rate and symptoms, it is good to explain to the student ideas about importance of certain nutrients (depending on current symptoms and the clinical picture) and their possible contribution to student’s symptoms, disease, and breathing recovery (or health restoration). Most modern people would benefit from using fish oil, calcium or magnesium. The deficiencies are manifested in various symptoms: lack of essential fatty acids in dry skin; lack of calcium in nervousness, poorer sleep, and elevated heart rate; lack of magnesium in muscular tension, tendency to slouch, and constipation. When such deficiency is suspected, the student can do a 3-day trial with the supplementation. How? Take the usual dose of the particular supplement for 3 days and record in the dairy or daily log the changes in the CP, heart rate and symptoms. After these 3 days, stop taking the supplement and again record the changes in the CP. If during these 3 days the CP increases and later, when the supplements are not taken, the CP drops, then the supplementation is useful. The morning CP is particularly sensitive to various nutritional deficiencies. It should be also kept in mind that larger CPs later usually means improved absorption, availability and retention of many food substances in the organism. Hence, once the student has large CPs, the needs in many minerals, vitamins, etc. could be less. Later, the student may find his or her new optimum level of supplementation using a similar 3- or 5-day trial. Hence, the amounts of various supplements are individual and should be chosen in according with the following idea. Use such a minimum amount of the particular supplement, so that to achieve maximum CP. If the student increases the dose, but the CP does not change, then there is no need to use more since there are no further improvements in breathing. Another practical aspect relates to antagonistic effects of calcium and magnesium. When one nutrient, e.g. magnesium, is missing and a student starts supplementation, the student would notice improvement, but continuous use of Mg only may result in lowered Ca absorption that can be manifested in Ca deficiency symptoms some 3-5 days later. For this reason, Ca and Mg supplements are often combined in one pill or tablet with about 2:1 ratio (twice more Ca than Mg). Such ratio is optimum for most people. However, due to individual variability, the needs of various people can be very different. It would require some long term experimentation (up to weeks) and recording CP, heart rate and other symptoms to find out the minimum dosages and optimum ratios in order to achieve maximum CP. Most people with low CPs (e.g., 10-20 s) find 2:1 ratios and full dose supplementation (about 1,000 mg of Ca and about 500 mg of Mg) optimum. Others prefer 1:1. In more rare cases, the best benefits are obtained when only taking Mg (especially if dairy products are frequently consumed), or only Ca. When the CP gets higher, less and less supplements are required. During adoption of these supplements or activities, the student should remember that the key remains in breathing, and other things, while being important or even necessary (e.g., minerals or vitamins in diet), remain only auxiliary in relation to breathing. Otherwise, use of supplements may result in the possible shift in priorities (“Aha! We are treated with fish oil!”) , with the erroneous belief that it is not normalization of breathing, but, for example, some supplements, that matters.

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8.16 Steroids While most medications were and are discouraged by Buteyko and his colleagues, steroids (or hormones) are very useful for those people who are temporary deficient since steroids are naturally occurring substances. This includes cortisol, insulin, thyroxin and other hormones. Notice regarding steroids and other medical drugs. You should consult your doctor or medical practitioner before changing or starting any of your medications. Consider cortisol. Many patients with severe asthma have extensive inflammation. Cortisol reserves, due to stress and inflammation, often become insufficient affecting cardiovascular system, the heart rate, and breathing. The same is true for many patients with cystic fibrosis, some patients with chronic fatigue, heart disease, GI and other concerns. Practice of Russian doctors and Western practitioners revealed that, for example, supplementations with cortisol (for severely sick patients with asthma and emphysema) or insulin (for diabetics) are useful or, in some cases, necessary for breathing normalization. The most detailed and most professional suggestions about the use of cortisol can be found in the book (“The Buteyko Method”) written by Dr. Novozshilov (chief doctor of the Buteyko Clinic in Moscow). The book is available from www.buteyko-method.com Peter Kolb wrote the following comments about steroid use. “But Doctor Buteyko has a method for dosing with Steroids based on your physiological need. Rather than taking a fixed amount, he recommends taking a lesser amount, checking if it is meeting your need and if not, take the rest of the normal dose. The dosing is based on your heart rate and your ability to increase your CP. Racing heart and an inability to cut down breathing is often an indicator that your stress levels are higher than your ability to produce cortisol”(Kolb, private communication, 2001) This general intelligent approach is also well explained by Dr. Jefferies in his book “Safe uses of cortisol” (Jefferies, 1996). Part of this book can be found on Peter Kolb’s and Dr. Jefferies’s web sites. In practical terms, the following general guidelines for cortisol use are used. If the patient with asthma has less than 10 s CP, over 90 beats per minute normal sitting pulse, and cannot improve his CP during the breathing exercises, then this patient definitely needs steroids. If the patient’s CP is about 15 s, his pulse is about 85 beats per minute, and he can slightly improve his CP during the breathing exercises (e.g., by 10-20%), then this patient may need steroidal supplements, but it would be better to try to improve without hormones by using, if possible, fasting and other natural methods. Those people, whose parameters are better (the pulse is below 80 beats per min, the CP is above 20 s, and the CP can be increased by 20-30% during the exercises), should be able to progress without steroidal supplementation. Getting off cortisol (tapering) is usually a slow process, which often takes many months. Most patients on the West cannot reduce the dosage without disastrous health effects. However, the Buteyko method often allows the student to quit this medication in 3-7 days. Over 20 s morning CP and a good health state are usually the signs to discontinue its use. Similar ideas are used for diabetics. These groups of patients need professional supervision, since breathing exercises cause an increased level of their own insulin, which may cause hypoglycaemic crisis. A formal session with moderate intensity decreases the elevated blood sugar level in diabetics about two times, reducing their requirements of additional insulin. Having a light snack just before or immediately after the breathing session eliminates these potential problems. In his article The theory of the pathogenesis of diabetes mellitus. Basic principles of hormone therapy, Buteyko wrote “According to our data, those patients who increased their control pause up to 30-40 seconds, with a pulse rate of 65-70 beat/min., have stopped taking hormone medications because they did not need them any more.” (Buteyko, 1991) As a general observation related to different hormonal disorders, Buteyko and Genina wrote, “For patients with hormone dependent forms of disease we use the following tactics. We believe that it is necessary: ..... • to explain that DVBM [the Buteyko method] eliminates hormone deficiency even in Itsenko-Cushing syndrome when a patient reaches 30-40 second control pause…” (Buteyko KP & Genina VA, 1991).

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8.17 Order or priorities of actions When high-CP people describe their Buteyko journey, they mention a long and hard job, together with numerous small obstacles and stumbling blocks, times of cleansing reactions and constant struggle with the breathing centre or some other invisible enemies. In my view, the road can be easy and pleasant if one understands, at any moment of time, which actions are particularly important. Obviously, it is the goal of the Buteyko teacher to select such a program of actions which, on the one hand, will create conditions for fast CP improvements and, on the other hand, will be positively accepted by the student. This subject is particularly important for those students who are going further than Level 2 and, hence, my relevant thoughts and observations are given in the next Chapters. Let us have here a first approach to this fascinating challenge. At any moment of time, there is a certain life-style or environmental factor that intensifies breathing. If this factor is found (the art and detective work for the breathing teacher to learn) and appropriate measures are taken, then progress is smooth and fast. There is no sense in using, for example, belts at night, if the student sleeps on the back or breathes through the mouth. Similarly, when air quality is very poor, or the blankets are too warm, sleeping on the hard bed is almost useless. As we can see, there is a certain order of actions that provides the optimum solution. This order should be individual, and the teacher should understand the whole complex of measures that brings success. Consider the possible sequence of suggestions related to the low morning CP: 1. Two sleep-related rules suggested by Buteyko. 2. Environmental factors (air quality, thermoregulation). 3. Nasal breathing and prevention of sleeping on the back. 4. Breathing exercises just before going to bed. 5. Hard bed. 6. Nutritional deficiencies. 7. Mechanical restriction of ventilation 8. Breathing exercises during the night. 9. Use of cortisol. Many of these measures are addressed at the beginning of the course, and introduction of many changes, with addition to CP growth, make it sometimes difficult to find out later what was helpful. Was the success due to the taped mouth or open window? Is my morning CP improving due to belts or hard bed? For this reason, and especially when students are doubtful about the necessity of all these changes, they are provided with the option to make the changes gradually or even restore something they are still attached to (“I missed my duvet”) and see the effects on morning CP. The goal here is not to make the student sleep under the bed sheet on the wooden floor or in the kitchen with the window open, but to provide him with the best possible health in the morning that he can measure himself. Adoption of such general policy reflects our general policy to various tools and activities and their usefulness. Students often ask questions about the effects of various activities, procedures, treatments, etc. on their health. Generally, if the CP gets larger afterwards, this particular activity is useful. The key remains in breathing, while other things being important or even necessary (e.g., minerals or vitamins in diet) remain only auxiliary in relation to breathing. Otherwise, without an explanation, the possible shift in priorities (“Aha! We are treated with magnesium!”) can result in the erroneous belief of the student that it is not normalization of breathing, but, for example, some supplements, that matters.

_______ 8.18 Focal infections

Western evidence Dr. Frank Billings (MD) was the most visible Western proponent of the theory of focal infections. He was quite an unusual President of the AMA (American Medical Association) by stating, “I place NO confidence in drugs. Drugs are valueless as cures.” He suggested in 1898 that microorganisms could contribute to numerous systemic diseases. His theory was at first very popular among medical professionals, causing widespread surgeries of tonsils (even after the slightest provocation) and extraction of dead teeth. Such over-zealous practice naturally resulted in reasonable criticism from other doctors. As a result, later his theory was largely forgotten. (For a historical review of his theory one can consult the recent paper, “Germs, Dr. Billings, and the theory of focal infection” by R.V. Gibbons published in 1998 in “Clinical Infectious Diseases”). 162


However, recent practical work and numerous studies confirmed the connection between certain local pathological processes (especially in teeth and tonsils) and various systemic diseases. In particular, there is impressive modern research collected by Japanese (Mizutani et al, 1997; Hattori, 1998; Okuda & Ebihara, 1998; Kataura, 2002), Norwegian (Debelian et al,1994; Li et al, 2000), American (Meyer & Fives-Taylor, 1998; Lockhart & Durack, 1999; Joshipura et al, 2000), and other medical professionals (e.g., Meurman, 1997; Gendron et al, 2000) in relation to oral focal infections. The connection between the focal infections and various health problems is now a fact that is proven by detailed biochemical investigations, which show the mechanism of pathological interactions. For example, Japanese researchers summarised, “It is known that primary lesions of these chronic [oral] bacterial infections secondarily cause nephritis, rheumatoid arthritis, and dermatitis. Further, it has been demonstrated in recent years that bacteria inhabiting the oral cavity can cause bacterial pneumonia and endocarditis and that the periodontal-disease-associated bacteria become causative agents for pregnancy troubles and are involved in blood circulation problem and coronary heart disease” (Okuda & Ebihara, 1998). That is the reason why, for example, in Japan certain blood tests and troubles with skin, heart, blood vessels, kidneys and pregnancies can be the indications for tonsillectomy and other steps of oral sanitation. Serious health complications are expected in cases of periodontal problems as American authors of the very recent (2001) article “Periodontal disease and its association with systemic disease” revealed. “…Currently, there is increasing evidence that the relationship between these entities may be bidirectional. Recent case-control and cross-sectional studies indicate that periodontitis may confer a 7-fold increase in risk for preterm low birth weight infants and a 2-fold increase in risk for cardiovascular disease. These early reports indicate the potential association between systemic and oral health. Additionally, these studies support the central hypothesis that periodontal disease involves both a local and a systemic host inflammatory response. This knowledge of disease interrelationships may prove vital in intervention strategies to reduce patient risks and prevent systemic disease outcomes” (Fowler et al , 2001). A recent review by Shay from University of Michigan School of Dentistry suggested that “Dental caries occurs when acidic metabolites of oral streptococci dissolve enamel and dentin. Dissolution progresses to cavitation and, if untreated, to bacterial invasion of dental pulp, whereby oral bacteria access the bloodstream. Oral organisms have been linked to infections of the endocardium, meninges, mediastinum, vertebrae, hepatobiliary system, and prosthetic joints. Periodontitis is a pathogen-specific, lytic inflammatory reaction to dental plaque that degrades the tooth attachment. Periodontal disease is more severe and less readily controlled in people with diabetes; impaired glycemic control may exacerbate host response. Aspiration of oropharyngeal (including periodontal) pathogens is the dominant cause of nursing home-acquired pneumonia; factors reflecting poor oral health strongly correlate with increased risk of developing aspiration pneumonia. Bloodborne periodontopathic organisms may play a role in atherosclerosis. Daily oral hygiene practice and receipt of regular dental care are costeffective means for minimizing morbidity of oral infections and their nonoral sequelae” (Shay, 2002). Are there any Western data about the increased sensitivity of the immune system, for example, in case of caries, when the organism is healthier? That was the subject of part 3 of the review paper “Dental caries: a dent on dogma” written by Dr. John Gabrovsek (Gabrovsek, 1997). The subtitle of part 3 is “Stronger host response to dental caries infection. Result: ‘More dental caries development!’” There he starts with, “Is this an outrageous statement? Just think what a little pollen can do to you? If you are allergic to the pollen your body defences can kill you. The fact that the host defense responce may harm the host itself is recognized in pathology for quite some time. This fact is certainly not taken into account, or recognized in dental caries research” (Gabrovsek, 1997). Is there a known biochemical mechanism that causes such an adverse reaction? As Dr. Gabrovsek explains, “For those who are not familiar with what inflammatory cells can do, I quote a short paragraph from Baer and Benjamin: “These cells are attracted to the site by the presence of bacteria and bacterial by-products, and conjugates of antigen-complement- antibody may not only act beneficially by phagocytizing these elements, with subsequent intracellular digestion, but may also liberate their cellular compliments of acid hydrolases, as lysosomal membrane dissolved. These enzymes are multiphasic in their effects, and serve to invoke collagen resorption, matrix dissolution, vascular dilation, and permeability - the destructive facet of the inflammatory state. The inflammatory cells with the greatest propensity for tissue destruction are neutrophil, and monocyte”” (p.21, Baer & Benjamin, 1974). What are the dangers of the root canals? A group of Norwegian dentists checked their 26 patients with asymptomatic apical periodontitis of single-rooted teeth.

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“…All root canals contained anaerobic bacteria. The frequency of bacteremia varied from 31% to 54%. The microorganisms from the root canal and blood presented identical phenotype and genetic characteristics within the patients examined. These characteristics differed between patients. The present study demonstrated that endodontic treatment can be the cause of anaerobic bacteremia and fungemia. The phenotypic and genetic methods used appeared valuable for tracing microorganisms in the blood back to their origin” (Debelian et al, 1998). For more information on influence of root canals on health, possible problems, and their solutions, one may consult a review written by the Brazilian researcher Siqueira (2001) and available (for example, through Pubmed). The influence of tonsils on psoriasis was investigated by Japanese dermatologists who found, using a tonsillar provocation test, certain negative biochemical changes in the blood contributing to psoriasis (Mizutani et al, 1997). Moreover, fever and other complications can be successfully treated by tonsillectomy (of course, if tonsils are dead), as another group of Japanese doctors reported. “Thirty patients (above 18 years) who had complained of low grade fever were diagnosed as having tonsillar focal infection. We performed tonsillectomies on all the patients. A total of 24 were cured and 6 patients improved after the operation. These results indicate that tonsillectomy is often an effective treatment for tonsillar focal infection. However, the provocation test did not always give a good result” (Takeuchi et al, 1996). Thus, all 30 patients in this study benefited from the operation. “About 15% of the population have fungal infections of the feet (tinea pedis or athlete's foot)” (Bell-Syer et al, 2002), as US researchers report. These infections also seriously affect the immune system. “…Patients with mycoses of the soles with involvement of the nail plates, as well as those suffering from eczemas combined with mycoses developed a most marked reduction of the activity of the leukocyte migration inhibition factor (LMIF) and of the T lymphocyte mediator activity in the presence of the fungal antigen. The studies have detected the pattern of the leukocyte phagocytic reaction disturbances in the patients with mycoses and eczemas of the soles” (abstract, Iutskovskii, 1989). The most successful practical Western methods for treatment of, for example, cancer are also based on due attention to focal infections. Dr. Josef Issels, in his famous book "Cancer: a second opinion", wrote, "The emphasis I place on removal of devitalised teeth and chronically-diseased tonsils is one of the betterknown aspects of my work, but also one of the most criticised and misunderstood. I do not, for instance, recommend that healthy tonsils and teeth be removed from a healthy person. But I believe if they are diseased, they cause the body's natural resistance to be lowered, thus acting as an important contributory factor to tumour development. In these cases, I insist on their removal" (p. 117, Issels, 1975). Interestingly, his chart with the title "Hypothesis of pathogenesis of cancer" lists the following causal (or primary) factors for cancer development: foci, teeth, tonsils, fields of natural disturbance, abnormal intestinal flora, faulty diet, chemical factors, physical factors, and psychic factors (p. 53, Issels, 1975). It is possible to see the large overlap between Issels ideas and Buteyko ideas in this area (What makes us sick?). I separated all these factors into two groups: those over-breathing producing factors described in chapter 3 (these factors can usually be controlled by the person) and focal infections (they need professional medical attention as described here). Ideas developed by Buteyko and his colleagues Only consideration of breathing provides the full picture about the interactions between the focal infections and disease. Buteyko and his colleagues observed, tested and developed the theory of focal infections. Let us consider some of their findings. The presence of focal infections interferes with the ability of patients to increase their CPs, normalize breathing, or even to recover from relapses of the main disease. The problems with focal infections cannot be solved by the breathing exercises. Moreover, the well-being of patients, in cases of focal infections, may get even worse when the breathing exercises are practised. For example, an asthmatic may start with 10 s CP and raise this number to 30-40 s. His asthma is now under his full control (no attacks at all), but if he has, for example, dead tonsils, further progress (beyond 35-40 s CP) would cause high-grade fever and throat pain with coughing, angina, and copious nasal discharges, all due to the severe reaction of the immune system which tries to fight the bacteria and toxins generated by his dead tonsils. That often led to over-breathing and low CPs (e.g., 15-20 s). As a result, he may get asthma attacks due to the breathing exercises, after the previous impressive success (no medication and no symptoms). As another example, the person can improve his breathing, while for example, recovering from hypertension. However, imagine that this person also has cavities in his teeth. When his CP becomes about 30-40 s, his immune

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system can turn its attention to caries-causing pathogens, but cannot defeat them. The harder the breathing exercises, the stronger the immune response, but this enemy (caries) is beyond the immune abilities, when caries is already present. Therefore, no further progress is possible. The quote of Dr. Gabrovsek (the previous section) tells us that local inflammatory processes can provide conditions for cavities-causing bacteria to spread. How does this relate to higher CPs? A more sensitive immune system produces stronger response in the areas where the pathogens can be attacked. That causes local inflammation. However, the inflamed tissue becomes the favourable ground for these pathogens to multiply if there is no access via blood to these pathogens. As a result, the higher the CP, the stronger the response (and the sicker he/she is going to be later). These adverse reactions can cause and have caused the disappearance of enthusiasm in patients practising the Buteyko method and resulted in their quitting therapy. Indeed, why continue something which, seemingly, can bring such harm? Typical practical examples of focal infections, revealed by Russian doctors, included degenerated or inflamed tonsils, cavities in teeth, intestinal parasites (e.g., worms), and feet mycosis. All these infections generate either bacteria or their toxins, which enter the blood stream causing bacteraemia. At the same time, the immune system is unable to defeat these focal infections since the antibodies and other immune cells cannot reach for example, degenerated tonsils (transformed into bags with pus) or dead teeth or caries in teeth due to absence of the normal blood supply to these organs and places. Critically ill patients (discussed in chapter 1) had severe hyperventilation due to a life-threatening degree of bacteraemia. In cases of focal infections, bacteraemia is not that severe. However, it is strong enough to cause moderate chronic over-breathing. As a result, focal infections, depending on the type and amount of released toxins and individual sensitivity to them, usually restrict the CP to the region of 20-40 s (Souliagin, 1991). Moreover, some temporary increases (up to about 50-60 s) are possible. These increases can last for many days until the immune system detects the existing pathogens. When the immune system starts to produce antibodies, large CPs (up to 50-60 s) are still possible, but they can occur only for short periods of time. That happens when the blood is temporarily cleaned (due to eliminative work of, for example, the liver and kidneys stimulated by the Buteyko method). The immune response to breathing exercises can be different depending on the type of the focal infection, strains of bacteria, types of the toxins present in the blood, their amounts, individual susceptibility and ability to deal with them, etc. Very often the patient can be simply stuck at 30 or 40 s without any progress. In other cases, the breathing can be reduced for hours, the CP may get larger, but eventually the undefeated infection strikes back, causing over-breathing and reducing the CP to low numbers. As described by Dr. Souliagin (1991) in his article about focal infections and their effects on breathing, in sick people these focal infections and their symptoms were usually hidden, often for years, and not manifested. The immune system was dealing with the main health problems or other more dangerous systemic infections. Normally, most Russian patients did not have complaints about, for example, their tonsils (or corresponding symptoms: sore throat, angina, fever, etc.). When Buteyko doctors asked these patients to examine their tonsils, some patients reacted negatively, while others did not see any necessity to treat the focal infections. ("Why worry about something which does not cause problems now?"). It follows from the previous ideas that, at any given moment of time, the immune system deals almost exclusively with one problem (by producing large amounts of antibodies and other immune cells). This is the most dangerous and urgent problem, which causes the lowest CP and produces the greatest damage to the organism (that would be indeed a smart approach chosen by Nature to deal with the main existing and detected enemy). As a general conclusion of all these studies, Russian Buteyko doctors suggested, that, ideally, the treatment of focal infections should be done before starting the Buteyko breathing exercises or, during their initial stages, when aCO2 and the CP are low, and the immune system is still dealing with the main disease (Souliagin, 1991). In my view, it is important to explain to a student that the Buteyko method can defeat such conditions, as asthma, bronchitis, heart disease, etc., but breathing exercises will not solve the problems with: 1. cavities; 2. dead or degenerated tonsils 3. feet mycosis; 4. intestinal worms. The student may do best breathing exercises, follow best dietary suggestions and optimum plan for physical activity,

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but if he has any of these focal problems, he will be forever stuck at the level of about 25-40 s CP.

8.19 Practical actions in relation to focal infections Here are some practical steps suggested by Dr. Souliagin and relevant Western studies in these directions. • Infectious tonsils can be hypertrophic (enlarged) or atrophic (small), often infiltrated, cyanotic or congested and have accumulation of pus. Most dangerous tonsils are atrophic, hidden behind arches and filled with pus. The tonsils should be examined by a professional. By depressing the root of the tongue with one spatula and pressing on tonsils from down to up with another spatula, the presence of pus in the tonsils can be checked. Normal tonsils are pusfree, of pale-pink colour, of soft-elastic consistency (not hard), and slightly visible behind arches (Souliagin, 1991). If tonsils have been infectious for several years, it is impossible to restore their functional abilities. In this case, tonsillectomy is necessary for breathing normalization and going beyond 30-40 s CP. Children who have had infectious tonsils for few years only sometimes can restore their tonsils using special conservative and prophylactic measures. Old medical Western publications at the beginning of the 20th century described numerous clinical cases regarding the negative influence of dead tonsils on, for example, liver and kidneys (causing or interacting with, for example, nephritis). Removal of dead tonsils often led to quick recovery from other severe diseases. That is normal to expect since these internal organs clean the blood from pathogens generated by the tonsils. More surprising, but scientifically proven, is the focal connections with various GI (gastrointestinal) diseases, neurological conditions and some other health concerns. • Dental problems (especially cavities) are to be revealed by a holistic dental professional. Use of silver amalgam fillings, which are more than 50% mercury and which are often associated with chronic fatigue syndrome, is discouraged, while the use of other metals may not be desirable due to possible individual sensitivity to them (Andrey Novozshilov, Director of the Moscow Buteyko Clinic, private communication, 2001). When the student rises own CP from about 10-15 s up to about 30-40 s, the immune system starts to perform its natural functions to a higher degree. For example, it becomes sensitive to pathogens in bad teeth. In some situation the tooth can have a nerve and blood supply, it can harbour pathogenic bacteria poisoning the whole organism. Production of antibodies, inflammation of surrounding tissues and other defensive reactions around the tooth can lead to its exposure (as during progressing periodontal disease). The colour of the tooth can change to a dark one indicating degenerative processes inside it. Rejection of such teeth by the body is a frequent outcome. During early stages of this process, it is possible to define the state of the tooth by knocking it with a pen or pencil or biting with this tooth. Russian publications do not have practical suggestions about the impact of root canals (dead teeth) on the personal health and breathing. Meanwhile, Christopher Drake, one of the most experienced Western Buteyko practitioners (www.buteyko.com.au/chris.html), while teaching his own patients with multiple sclerosis, noticed that dental caries or presence of dead teeth is their frequent problem. Quick removal of dead teeth, treatment of caries, and robust application of the Buteyko method create favourable conditions for total success at early stages of this disease (Christopher Drake, private communication). Studying other professional sources in this area, the following is of practical importance. There are two main problems created by root canal treated teeth: - virtually unavoidable presence of anaerobic bacteria-mutants harboured by kilometres of tiny channels within the dead teeth (after root channel operation); - miniscule amounts of powerful toxins (like, low weight sulphur hydroxide generated by these anaerobic bacteria), which can easily pass from the dead teeth into the bloodstream. Properly done root canal treatment, with right disinfection and correct sealing procedures, would probably not cause big problems for a healthy person. In this case, the immune system is strong enough to prevent the interaction of bacteria from dead teeth with other organs, while the toxins can be safely transformed (by the immune system) and eliminated from the organism. However, when the health is compromised (before or after the root canal operation), the interaction between dead teeth and other organs becomes very possible. Clinical tests to check that are very difficult and are currently unavailable. Moreover, long-standing health problems often result in the situation when bacteria from the teeth start to interact with the pathogens existing in other diseased organs (that can probably happen due to their mutations since longer time is available for these enemies to unite against the immune system). As a result, the treatment of other

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health concerns becomes impossible (the teeth bacteria, which are inaccessible, provide a support for other pathogens) unless the dead teeth are extracted. This is in agreement with Dr. Issels’s quote provided above. Therefore, in cases of poor health, long-standing serious health problems or the weakened immune system, it is advisable to extract the dead teeth as soon as possible. Note that virtually all conventional dentists refuse to remove dead teeth which are X-ray negative. That relates even to patients with very severe health problems. Thus, darkened areas on X-ray of the dead tooth are the current official criteria for its re-treatment or removal. The conventional dentists claim that, if they do not see anything on roentgenograms, there are no problems caused by the tooth. That is the reason why you may need to see a holistic dentist who would have a different opinion. Most modern dentists simply say, “Look, the X-ray is clean. Hence, nothing bad is going on in this tooth or surrounding tissues”, in spite of the studies which showed that roentgenograms are not reliable indicators of absence of pathological processes and systemic infection. This interesting medical position reminds me of the situation which took place in the middle of the 19th century, when the microbes were not yet known (they were discovered by Louis Pasteur about 20 years later). However, at those early times “Dr. Zemelweise began washing his hands prior to operations, disinfecting them with a chloride of lime solution. He suggested his assistants also follow this routine. In those times, about one third of all new mothers and surgical patients died of sepsis. A three month experiment confirmed Zemelweise's hypothesis, and he lost no patients thereafter. He informed his society of surgeons and suggested they follow his example. He was declared to be mentally disturbed…” (From the “The man and his discovery” available through many Internet sites). Those official doctors said, “Look at my hands. They are clean”. (Now we hear, “Look at these X-rays…”). The only difference is that those old doctors had no idea about the existence of bacteria, while most modern dentists do know that dead teeth always harbour anaerobic bacteria producing toxic load. • Several stool analyses for intestinal parasites and their eggs (since many parasites have cycles of eggs laying) are suggested. Note, that more than half of Western people, usually when young, have or had worms. The negative effects of intestinal parasites on the host’s immune system are well-documented facts, which can be found in any medical textbook on parasitology. The influence on breathing, due to helminthic infestation, can be different depending on current living cycles of these parasites, the amount of toxins generated and the abilities of the immune system. Large CP increases (up to 50 s or even more during fasting) are possible, but eventual CP decrease, due to the toxic load, is unavoidable. • Feet mycosis, if any skin problems on feet are present, should be investigated and treated, according to Souliagin, by traditional methods, including medicinal creams that do not require prescriptions. If somebody cannot eliminate any of these focal infections (e.g., an aged person with severe periodontal disease does not want all his teeth to be extracted), it is not advisable and even dangerous to increase the CP beyond 30-40 s (Souliagin, 1991). The same relates to people who have transplanted organs due to the likelihood of organ rejection. Visiting a chiropractor When the disks of the spine are not in the right places in relation to each other, various pains can appear, including chest pain, angina pain, stomach pain, appendix pain, etc. The problem is that all these other organs can be in a good shape. In such cases the student and his doctors cannot find the cause of pain since all tests would be negative. If the spine is wrong, only manual correction can help. Moreover, pathological processes in the spine due to displacements of its disks can lead to inflammation, infections, bone overgrowth, intensive wear, and other negative effects. For these reasons Doctor Buteyko and his wife, Ludmila Buteyko learned professional chiropractic techniques to help their patients. If a student has a similar situation or suspect that the spine requires manual adjustment, a visit to a good chiropractor would be as important, in relation to health normalization and CP growth, as fixing dental cavities or removal of intestinal worms.

_______ 8.20 Breathing and focal infections: practical cases

It should be kept in mind that when a person cannot raise the CP above 25-40 s, the dynamic of the CP and accompanying symptoms can be different depending on the particular influence of the offensive agents. In certain cases, the clinical picture can indicate the cause of the problem why breathing remains abnormal. Let us look at these examples.

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Case 1. The student increased his initial CP from 10 to 30 s solving certain health problems connected with asthma. However, he still had kidney and prostate problems. Later the CP could not be raised at all during the Buteyko breathing exercises (the initial and final CPs were almost the same 30-35 s). Fasting (up to 3-5 days) could not normalize his breathing or solve these problems. Moreover, the breathing exercises were followed by more severe problems with infections (colds), arthritic pains, copious nasal discharges during the following mornings, soar throat, more coughing, etc. When the exercises were not done and the CP was lower (e.g., 25-30 s), the well-being of the student was better. A dead tooth (treated root canal) was the suspect in the "stuck" CP phenomenon. He found a holistic dentist who agreed to remove this tooth. After removal of the dead tooth, and after several months of vegetarian diet, night urination disappeared and the function of kidneys improved. Case 2. The student, before starting the Buteyko program, had high blood pressure and elevated levels of "bad" cholesterol. His initial CP was 8 s. After a week of the Buteyko exercises, he experienced a cleansing reaction and within 1 month reached 40 s CP. His blood pressure and cholesterol parameters became normal. However, it was difficult to go further. The increases in the CP after the breathing exercises were temporary. The student found that his nose formed a crust although his nasal passages were clean. He had a root canal and visited a conventional dentist who performed X-ray test and revealed the darkened area near this dead tooth. The dentist removed the dead tooth but did not clean the bone where the tooth was attached. After several months of exercises the crust disappeared and the CP rose above 40 s. X-ray darkened area of the bone, even according to official dentistry, indicates presence of pathogens causing bacteraemia. It is normal to expect that the area of the bone attached to the tooth has the largest concentration of bacteria. Should the dentist drill and clean the bone near the dead tooth just after removal of the dead tooth, the amount of remaining pathogens in the bone would be greatly reduced. That would speed the recovery of breathing and health of the student. Case 3. The student was stuck with 30-35 s CP for weeks. The CP could be raised by 25-40% during the Buteyko breathing exercises (as it normally should), but after the exercises she experienced an unusual breathing pattern manifested in sporadic sudden closure of the glottis during the inspiratory phase (single irregular hiccups). Moreover, the number of these hiccups was proportional to the improvements in breathing achieved during the exercises. However, the student noticed that her breathing, CP and well-being were much better after prolonged mouth irrigation with a powerful anti-bacterial mouthwash. Dental examination revealed two teeth with cavities. Treatment of both teeth immediately resulted in complete disappearance of hiccups and 50 s CP (during the next day). The CP increased almost without the exercises since the student, after the months of diligent work, acquired good breathing control. Such abnormal hiccups probably indicated a specific action of certain bacteria or their pathogens on the respiratory centre. Streptococcus mutans (the primary bacterium involved in plaque formation and initiation of dental caries) is probably the main candidate for such adverse effects on breathing. Case 4. The student had unstable irregular CP pattern with CPs ranging from 20 to 40s. No specific symptoms during CP drops were reported. The exercises could increase his CP by 25-30% (up to 50-55 s in some cases). However, later (during the same or the next day), the unexpected CP decrease took place. The student also noticed that eating more food did not result in weight gain. The stool analysis revealed the presence of eggs of worms. The treatment (elimination of worms) resulted in stable 50 s CP and greatly improved well-being.

_______ Unstable breathing was probably connected with specific activity and impact of worms on the immune system. For example, when the worms fed (that normally happens in the upper part of the small intestine), their toxins were soon absorbed and caused over-breathing and lower CPs. At other meals the worms may not feed at all while remaining in the lower part of the small intestine or in the colon. In this case, their effect on breathing and the CP would be smaller, allowing certain progress during the breathing exercises. Whatever the cause it is obviously important to observe the influence of breathing and physical exercises, diet, supplements and all other activities on the appearance of the specific symptoms, pulse, CP and well-being.

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8.21 Cleansing reactions: their causes, basic mechanisms, and symptoms After the first days of training, students usually notice that their breathing is lighter and CPs become longer. This indicates deep physiological and metabolic changes in the organism. These changes can also be revealed by pulse reduction. As we learned before, raised aCO2 indicates a normalisation in the work of different organs and systems of the organism, including the immune system and the organs of elimination. Becoming more sensitive to foreign and unwanted substances, the immune system is now capable of their better identification and removal. Among the substances to be removed are: - oxidants, as symptoms of cellular aging; - incompletely oxidised products appearing due to chronic hypoxia; - useless salts accumulated and deposited in tissues due to previous alkalosis created by hyperventilation; - medical drugs; - waste products appearing due to systemic and local infections; - cholesterol and other deposits in blood vessels; - deposits of calcium and phosphorous salts in joints, vessels, and other tissues. The job of elimination is facilitated by improved abilities of eliminative organs: the kidneys, liver, lymphatic system and outer and inner surfaces of the body, including the skin, the surface of the small intestine and the respiratory system. They now have better oxygenation and blood supply. Most modern students, who practice only about 1 hour of breathing exercises per day, do not notice how toxins are expelled. However, Soviet and Russian patients practised in the 1960s and 70s up to 3-4 hours per day and Doctor Buteyko and his colleagues, for the first time in the history of medicine, were able to describe, measure and analyze the cleansing reaction of the human organism as a result of rigorous breathing retraining. Here are their findings. The first cleansing reaction is most powerful and it usually starts when the CP becomes 2-3 times greater than the initial value. The reaction may begin in a few hours after the first breathing session or after weeks of daily work. During the reaction CP sharply falls to low values. Cleansing reactions usually correspond to 10, 20, 40, and 60 s CP thresholds. Cleansing reactions for larger CPs are milder in symptoms. Patients usually have some (not all!) of the following symptoms: - nervous excitement; - insomnia, or, in some cases, unusual sleepiness; - fever; - increased body temperature, especially for lung patients; - headaches; - sweating; - total aversion to food; - smell from the mouth; - phlegm secretion; - diarrhoea; - increased volume of urine, often of unusual colour; - increased salivation; - tears; - running nose; - pus from inflamed sinuses; - vomiting; - increased or disappeared menstruation; - peeling skin; - hair loss; - painful muscles, bones and joints; - skin itching, especially near areas of drug injections; - skin rashes or patches with possible unusual secretion. A particular picture depends on individual health conditions, abilities of the eliminative organs, and other parameters. For example, secretion of phlegm is a typical symptom experienced by asthmatics, vomiting by patients with liver or gastrointestinal problems, running nose by sinusitis patients, secretion of dark slimy substances from the

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lungs by smokers, etc. (Buteyko, 1969). Last stages of lungs' cleansing are often characterised by foamy saliva. Urine can have green, red, or very dark colour. Defecation can become so frequent, that pauses can be done only in the washroom, where some patients conducted their breathing exercises during the cleansing reaction (Buteyko, 1969). The duration of the cleansing reaction is from a few hours (e.g., for children) to 2-3 weeks (for severely sick patients). Usually it lasts 2-3 days. For very sick patients, who consumed more drugs during their lifetime, this reaction is stronger. The reaction is clearly manifested in 2/3 patients. Such an exceptionally high rate of people with the cleansing reaction show that the Buteyko therapy is a more powerful method of health restoration than special cleansing procedures; different diets; chelation therapies; use of special products, extracts, and mixtures for detoxification; and different types of fasting. Indeed, while many of these methods occasionally have patients with cleansing reactions, probably, only prolonged water fasting, as medical- fasting experts report, can sometimes, but not frequently, be a trigger in a cleansing reaction (Fuhrman, 1996; Chaitow, 1995). That indicates a profound impact of breathing exercises on the human organism and their superior efficiency in comparison with other health restoration methods. For about 1/3 of patients the reaction is small or not felt. As Doctor Buteyko noticed, some of these patients were disappointed due to absence of visible signs of body self-cleansing. They probably wanted to experience these "sweet" torments of rejuvenation and dirt expulsion. When students practice about 1-1.5 hours of breathing exercises per day, they usually do not notice any of these effects.

8.22 Practical steps during the cleansing reaction The cleansing reaction is one of those areas, where the help of an experienced practitioner, especially for severely sick students, can be valuable. Usually, the symptoms of the reaction can be reduced using the method, but in some cases breathing exercises accelerate cleansing making the reaction and its symptoms more severe, while reducing its duration. In general, it is suggested to be firm and consistent in training continuation. Eating is normally restricted. Due to natural food aversion, that is easy for most people. Often, overeating and allergic reactions, causing low CP and other unpleasant symptoms, including possible attacks of the main disease, are wrongly considered as the cleansing reaction. From this perspective it is important to remember that appetite is almost absent and little, if any, food is consumed, when the cleansing reaction is going on. (This point is especially useful for Buteyko students who may confuse allergic food reactions with the cleansing reaction). Ideas about the necessity of having energy, enough proteins, more vitamins, etc. with subsequent forceful eating can retard or stop the reaction. Instead, well-chewed fruits and vegetables, if appetite is present, are usually good choices. Fluid intake should not be limited, unless one has severe problems with the kidneys. Physical activity is not advised, but more time outdoors is suggested. Help to eliminative organs, in such times, greatly assists recovery. Students with respiratory problems (e.g., asthmatics), but not severe ones, are encouraged to use short and light saunas, where breathing exercises can be conducted. When bowel movements are absent, especially with accompanied abdominal distension, the student should drink laxatives and/or use enemas with warm water, take hot baths or hot showers (if the cardiovascular system is not impaired). Secretions from the mouth should not be swallowed. Instead, frequent mouth washing is suggested. Nausea can be relieved by vomiting induced by drinking a lot of water with table salt (2 teaspoons of salt per l of water) and soda (1 g per l). Some severe patients, with low initial aCO2 and CPs, can experience a lack of certain essential salts in body fluids. These electrolytes were removed from the organism in the past due to chronic hyperventilation, and now salts of Na and K (and, less frequently, Mg and Ca) should be replenished. Their deficiencies produce, for example, headaches, heart pains, liver pains, high pulse, and other symptoms. Salts of these metals (about 1 g of each metal) dissolved in water are used. For example, 2-3 g of sodium chloride (1/2 of a teaspoon of table salt), 2 g of potassium salt, 2 g of Epsom salt (magnesium sulphate), and 2-3 g of calcium carbonate. Organic alternatives can be better assimilated and need smaller doses (about 2-3 times less). These supplements were not available for Russian doctors and, as a result, inorganic salts were used. It is not necessary to consume full amounts of these salts, since the organism's requirements may be less. Instead, one can drink smaller amounts of the corresponding solutions until the disappearance of symptoms. For more information about the four most important metal electrolytes (including deficiency signs), please, read Appendix 5.

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For severely sick students, usual medication, in case of persistent symptoms of the main disease, can be used, but with a half-reduced dose. Such temporary actions are encouraged, since too severe cleansing reactions and complications due to focal infections are the most frequent causes of those rare cases when patients abandon the therapy thinking that it was the breathing exercises, which generated the negative symptoms of their organisms. When the cleansing reaction is complete, the symptoms disappear, the breathing becomes easier, and the CP increases to higher levels.

Q&A section for Chapter 8 Q: Should I try to control my respiratory rate during a breathing session? A: The essence and crucial difference of the RB (reduced breathing) is small tidal volumes (small inhalations and relaxed slow exhalations) in order to achieve complete relaxation of the body. It is much more important to normalise aCO2 due to subsequent improvements in all physiological systems of the human organism. Therefore, those who learn Buteyko breathing, as Doctor Buteyko insisted, should pay no attention to breathing frequency. Russian doctors usually do not mention this parameter to their patients. Breathing frequency during exercises can be higher or lower than usual, but it is not important at all. Doctor Buteyko, after continuous observation of patients, found that with time the breathing centre automatically and unconsciously adjusted the breathing rate to the existing aCO2 level. As a result, the usual breathing rate of patients gradually got smaller. This phenomenon can be checked by asking a relative to measure your breathing frequency at nights and to see the dynamics of changes. Q: I have little time for the breathing exercises. Can I start them without preliminary rest? Does it affect my initial CP? A: When a person is in a rush, the first CP is measured soon after activities with a higher metabolic rate. At such moments tissue CO2 level is higher than at rest. Hence, aCO2 accumulation rate is also higher. That reduces the initial CP. Q: What are the possible reasons of lack of CP growth during a single session? A: Here are some possible causes. • Muscular tension Muscular tension, as we found in chapter 1, can be the direct result of hyperventilation, since CO2 is a powerful relaxant of all smooth muscles and a tranquilliser of the nervous cells. Since the Buteyko exercises restore normal CO2 values, all these problems, with gradual normalization of breathing would be naturally eliminated. At the same time, one can also check (tense and relax) various muscular groups at any time of the day and night, especially during the breathing exercises. • Posture Muscular tension can be a result of, for example, poor posture, while poor posture, in its turn, often reflects poor tone of the large intestine. Abnormal posture leads to muscular tension and stress in vital organs. That causes hyperventilation and inability to progress during the sessions. • Psychological causes Various fears and excessive anxiety lead to tension in various muscular groups causing relative hyperventilation. In some cases, the reduction of anxiety (fears are indeed groundless) and different attitudes are more effective than relaxation exercises. Fears may exist in relation to the pauses, feeling of air hunger, or some other attributes of the method, the exercises, surrounding people or the whole environment. Identification of such causes, their analysis and correction are important for these situations. • Abnormal heat exchange Too high surrounding temperature or too warm clothing can lead to the organism's attempts to remove excessive heat through breathing. That can also cause inability to increase one's CP during a single session. Try to do the exercises while feeling cool. • Dehydration Abnormal intra- and extra-cellular distribution of electrolytes can be often corrected by adequate hydration. However,

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dehydration normally leads to hyperventilation. Therefore, any signs of dehydration should be addressed. • Absorption of food from the small intestine Now we know that Buteyko exercises increase blood flow to abdominal organs including digestive organs. This causes intensification of peristalsis and faster absorption of nutrients if there are food substances in the stomach and the first part of the small intestine (ileum). Appearance of nutrients in blood, as we know, generally increases breathing. That especially relates to protein-rich meals. At the same time, the exercises are targeted to decrease ventilation. Therefore, when exercises are performed too soon after a meal, there is an interaction of these processes which can work in opposite directions to each other. As a result, they often counterbalance each other. Thus, the CP can be nearly the same for 20-40 minutes, while the person would struggle with his/her breathing. It would be more precise to say, that the person would be struggling with the certain processes due to intensification of digestion (faster peristalsis, accelerated production of digestive enzymes, increasing blood glucose levels, appearance of amino acids, proteins and fatty acids in the blood, etc.). • Poor air quality Some people can be sensitive to air quality (for example, due to hidden allergies or impaired kidney function). Their CP can remain unchanged during the session when the air quality is inadequate (e.g., due to carpets, books, paints from walls and furniture, dust due to central ventilation, mites, etc.). Breathing exercises done in fresh air conditions (e.g., outdoors or in clean rooms) and corresponding CP progress can help to reveal if this is the case. • Cortisol deficiency (see above) Q: I am very confused about one thing. Some people recommend doing many sessions during the day, others only two. Some recommend as many as I can some say that too many is bad. I read in the book by James Hooper that the more I do the RB the faster my progress, but some people tell me that I cannot do more than 4 sessions a day? Why they all say different opinions? Shouldn’t the Buteyko method be always the same? A: When we learn the method, we are different in respect to: 1) Hereditary parameters (the weak systems and organs of the body); 2) Actual or initial health states; 3) Abilities, possibilities and motivation to learn the method. Depending on these parameters the optimum plan can be chosen. However, there are common ideas. You can have RB - with light air hunger- all the day (no pauses or only one CP, not MP or EP, per hour.) You can do short sessions, 10-15 min of RB (with 2 CPs) every hour (e.g., when the clock strikes the hour - start the session), but not more often. You can do long sessions (about 25-30 min with 6-7 CPs per session) every 2 hours, but not more often. However, even here there are restrictions. Pregnant women, during certain stages and with low initial CPs, should not follow these suggestions. If you have hypertensions, panic attacks, or migraines, it is better not to do CPs, but only RB (as explained above). In very rare cases, relaxation of the diaphragm for exhalations is the optimum activity during initial stages of health restoration. Q: Sometimes I feel that my neck or jaws are too tense. Is small muscular tension a serious problem? A.: There is an intimate link between any muscular tension and breathing. On the one hand, hyperventilation causes tense muscles as a normal and useful evolutionary response to a "fight or flight" situation. On the other hand, chronic hyperventilators are tense all the time. That can be observed in their posture, walking and other activities. Being relaxed is a difficult problem for them and is something that they need to learn. Normal breathing, on the other hand, is characterized by normal CO2 concentrations. Since CO2 is a powerful relaxant of smooth muscles, reduced breathing produces relaxation. That is also the reason why people feel calm and relaxed after the Buteyko breathing exercises. From a practical viewpoint, it is indeed very important to eliminate all unnecessary muscular tension. For that reason, various relaxation exercises, meditation, massage, yoga postures, Alexander technique, all are useful in breathing normalization.

_______ Q: Can the Buteyko method help me with my poor body posture and prolapse of the colon? A: Since the Buteyko breathing normalizes blood flow, oxygenation and tone of the large intestine, some people normally feel that breathing sessions naturally help to correct the curvature of their spines. They often experience the desire to sit, stay and walk with the correct body posture. Therefore, the Buteyko breathing is a powerful method to correct the prolapse of the colon. Practice confirms this conclusion. Correction of possible Mg deficiency can greatly 172


improve one’s posture and prolapse of the colon. Q: There are many activities and measures that can ensure good health. Eat right, exercise right, sleep right, do relaxation, maintain correct posture, use supplements, etc. Can I just lead a healthy life style without paying any special attention to breathing? A: If you are healthy person and satisfied with the functioning of your organism (amazing vitality, excellent and short sleep, perfect digestion, etc.), than your breathing should be physiologically normal: your CP should be over 60 s CP. Such people breathe only through the nose; they do not sleep on the back; they enjoy physical activity; they like to eat healthy foods and have other health-promoting life parameters. Then you do not need any special breathing exercises. However, if you are chronically sick and you are trying to restore your health using all natural methods (diet, exercise, relaxation, supplements, etc.), except breathing, it would take you much longer time, maybe years, in order to get healthy. The Buteyko method was specially designed for sick people so that they could quickly restore their normal breathing and regain vitality as soon as possible. Q.: When should the last daily set of breathing exercises (before going to sleep) be done? A.: People report that the effects of the last breathing session can be slightly different depending on, for example, timing and type of this breathing session. Therefore, find your optimum parameters. Some people do this last set about 2 hours before going to sleep, while others just before retirement. In addition, many people find that the Emergency Procedure can be done in bed, especially, if the bed is not warm enough, or one got cold hands or feet, or one is too stressed and anxious. Q.: Relative hyperventilation, due to circadian fluctuations, often reaches its maximum in the early hours of the morning from about 4-6 a.m. Why? A.: Possibly poor circulation or inadequate perfusion of some body parts is the main cause. There are many other contributing factors, like poor air quality, sleeping on the back, breathing through the mouth, etc. It is likely that other factors are triggered by the main one. This means that gradually increasing respiration creates favourable conditions for breathing through the mouth, sleeping on the back, over-sensitive immune responses, etc. Once these other factors are triggered, the drop in the CP become especially large. Q: Are capnometers useful in order to check reduced breathing during the Buteyko exercises? A: Capnometers measure carbon dioxide concentration in the expired air. It is accepted that for most modern volunteers or “healthy subjects” the etCO2 (end tidal CO2 or CO2 concentration at the end of the expiration) is the same as the CO2 level in the lungs (alveolar CO2). However, it is an established scientific fact, that voluntarily changes in breathing frequencies, while maintaining about the same arterial CO2, cause large changes in etCO2. For example, very deep and slow breathing can generate abnormally high etCO2 values, while aCO2 can be unchanged. Similarly, shallow breathing, even with higher aCO2, can result in low etCO2. Consider breath holding, etCO2 value under the nose is about 0, but arterial CO2 is steadily growing. The stronger the air hunger, and the less one breathes, the smaller the recorded etCO2 values. For these reasons capnometers can not be used as biofeedback devices when learning the Buteyko breathing exercises. The goal of the Buteyko breathing exercises is to reduce the depth of inhalation. If this goal is achieved, recorded etCO2 values would be smaller than the pre-exercise etCO2: i.e., you breathe less, but the capnometer shows smaller etCO2 reading. Moreover, even etCO2 values of the Buteyko student at rest will not reflect their progress. Doctor Buteyko expressed the same opinion during conferences of Soviet Buteyko doctors. To my knowledge none of the Soviet doctors used capnometers in their practice, while many western teams of health professionals tried to apply capnometers for various health problems (see Chapter 4), but they never claimed or achieved any comparable success in their treatment. Possibly, one can evaluate the difference between etCO2 and aCO2 by knowing their changes in frequency and in mechanics of breathing. The etCO2 numbers can be 10, 20 or even 30% more than in alveoli. (One study deduced the formula to calculate the difference between etCO2 and arterial CO2 if the frequency, dead volume and amplitude are known.) Another way to apply capnometers is to measure etCO2 during sleep.

_______ Q: Why is it necessary to wait for 2-3 minutes to measure the final CP after the RB? A: The goal of the particular session is to have lighter breathing during the next hours. Hence, we should measure the 173


after-effect of the session. If the student measures the final CP immediately after the RB, he or she still has air hunger and the value would be smaller. After sufficient rest with no breathing control, the CP reflects the improvements in reduction of ventilation. It is practically inconvenient, but one can measure the final CP 5, 20 or even 60 minutes after the session. Q: Can I do my first daily breathing session soon after waking up? A: This depends on your evening and actual (morning) CPs. For example, if you wake up and your EMCP is almost the same as the evening CP, you will not be able to further reduce breathing. However, if your EMCP is muck less than the evening CP (e.g, you have 20 s CP in the evening, but only 10 s CP in the morning), then breathing exercises can help you to partially restore or recover your breathing and health state. Q: Apart from capnometers, what are the non-intrusive methods to find out if I or somebody else breathes normally, less or more than the current demands? A: There are several methods. Among them are the following. • Breathing of sick people can be heard. In healthy people, breathing is inaudible. Healthy children, in conditions of danger, often hold their breath. (Sick children and adults, on the other hand, frequently sigh when stressed.) In my view, this involuntary control of breathing during hiding, as a response to danger, is a reflex, which, in addition to health benefits, had important survival value (when we were hunted by predators). With ageing, due to disuse, this reflex gradually disappears. However, one may practise and revive it. Moreover, doctors of the Buteyko Clinic in Moscow suggest this exercise (“Hide your noisy breathing”), when the patient starts to learn the method. • Thoracic breathing of sick people is, in addition, visible, while no motion can be seen on the ribs or cloths of a healthy resting person. • Reduced breathing, both intentional and semi-intentional, often causes the nostrils to expand. When this effect is observed on the faces of other people, these people are often perceived as goal-oriented and determined to do something. You may practise, during daily activities and apart from regular breathing sessions, this "nostril-expansion" or “determination” exercise in order to reduce your breathing. It can be easier, in terms of voluntary control, to pay attention to your nostrils (keeping them wide), than to constantly monitor own breathing. • A cold moist nose is another criterion of reduced breathing. In case of normal thermo-exchange (just enough clothes and cool outer environment), the temperature of the nose and humidity of air passages are other useful parameters. In the healthy state, normal CO2 concentrations cause dilation of small blood vessels. Together with normal blood flow to the head, these are the conditions that naturally generate liberal amounts of thin mucus in order to trap air-borne particles and to make the inhaled air, on its way to the lungs, moist and clean. However, that is not the case during hyperventilation. (There are many books written by nutritionists and other health professionals where they claim that certain foods, for example, dairy products and meat, are mucus forming. However, these foods cause more intensive breathing and reduce blood flow to many vital organs, the brain and the head included. As a possible result, 2-3 hours after a meal the nasal passages get dry and the tip of the nose warm (due to absence of moisture and corresponding evaporation). That can lead to formation of dry crust inside the nasal passages creating an illusion that this mucus was caused by direct influence of the eaten foods.) • This "cold nose" effect can be observed with an aid of infrared cameras. Additional information seen in these cameras, e.g., facial temperature distribution (or what is cold and what is warm on the human face), reflects other important physiological processes. Such cameras can be used as diagnostic tools to reveal certain health problems. • Infrared cameras can also monitor each inhalation and exhalation of the individual (due to air temperature gradient). That also provides useful information about personal physiological and psychological processes.

_______ Q: How could the breathing teacher encourage a student who started the group course, but does not practise breathing exercises? A: When, for example, an asthmatic does not do the exercises every day, put the daily log in front of him on one side, and Ventolin (or his other medication) on another, and suggest to him friendly, “This is the Buteyko method exercises, this is Ventolin. It is your life, you choose what you want.” Q: Why did Buteyko decide that 60 s is the norm of health? A: Buteyko was teaching Russian doctors to use the eyes in order to diagnose the main health problems of their 174


patients. He inherited this idea from his scientific supervisor at the 1-st Medical Institute and taught his colleagues to pay attention to patient’s breathing (its amplitude, frequency, rate, regularity, evenness, etc.), posture, gait, voice, emotions, handwriting, ideas, words, etc. since all these factors are connected to breathing. When the CP grows, he and his colleagues noticed that there are numerous changes in various areas, e.g.: - Writing: If any person provides us with his/her writing, just a few sentences, at the times when the CP was 10, 30 and 90 s, (i.e., imagine there are 3 paragraphs for each CP) it would be possible to define which CP corresponds to which paragraph. (We may find 100-years old physiological articles; or one may read books written by hatha yoga masters and compare them with modern newspapers; or re-read the big Buteyko book written by Russian Buteyko doctors, or …) Over 60 s CP means clarity, logic, objectivity, sense in what was written. This was one of the reasons why he got stuck with 60 s CP. - Posture or gait: If we are again provided with 3 photos/videos of the sitting or walking person (10, 30, and 90 s CP), a keen eye may notice that over 60 s CP means straight spine; excellent (or natural) coordination; beauty, easiness and grace of movements without learning or practising any special technique (these qualities are in our genes, but they need over 60 s CP to get expressed). This was another reason why he got stuck with 60 s CP. - Diet: If the person has a wide variety of foods to choose for their own meals, then knowing the menu available and the choices made (or by opening the refrigerator of this person), it is possible to say, if this person has 10, 30, or 90 s CP. This was another reason why Buteyko got stuck with 60 s CP. - Ideas in the head, words, and mental outlook: Again, there are relationships between these factors and the CP of the person. We are talking here about peace of mind, fears, anxieties, addictions, hostility, resentment, and many other spiritual factors. Of course, the links are individual, but for any given individual, using the comparative analysis, these links can be established. This was an additional reason why he got stuck with 60 s CP. - Sleep: Quality, duration and effects of sleep related to breathing of people. Most people with 10 s CP have suboptimum or poor quality of sleep; they sleep up to 8-10 or more hours; and the morning CP is less than the evening one. When the CP is about 30 s, quality can be almost normal, but sleep is still too long (e.g., about 6-7 hours) and the morning CP is less than the evening CP. It is only when the CP is constantly over 50-60, our sleep becomes short (4-5 hours) and there is no drop in the morning CP indicating absence of pathological tissues. Hence, sleep was the reason too. - Presence of diseases or pathologies follows the same pattern and again the links are individual. However, 60 s CP is the guarantee that over 150 diseases of civilizations are not present in the body. This factor alone (ideal physiological health) would be enough for Buteyko to get stuck with 60 s CP. Hence, he did so. My observations with all people I met and all students I taught are the same.

References for chapter 8 Baer PN & Benjamin SD, Periodontal Disease in Children and Adolescents, Philadelphia, Toronto, 1974, Lippincott.

_______ Bell-Syer SE, Hart R, Crawford F, Torgerson DJ, Tyrrell W, Russell I, Oral treatments for fungal infections of the skin of the foot, Cochrane Database Syst Rev 2002; (2): CD003584. Benson H, The relaxation response, 1975, William Marrow: New York.

Buteyko KP, Dyomin DV, Odintsova MP, Effects of carbon dioxide on large arteries in patients with high blood pressure and atherocardiosclerosis [in Russian], Zdravookhranenie Kazakhstana, 1966. N 6.

Buteyko KP, Odintsova MP, Demin DV, Effects of hyperoxia and hypoxia on the tone of arterial vessels [in Russian] Soviet Medicine 1967, N 3, p.44-48.

Buteyko KP, Discovery of the theory of deep breathing disease [in Russian], Public lecture for Soviet scientists at the Moscow State University, 1972.

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Buteyko KP & Genina VA, The Principles of Tactics in using DVBM [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa. Buteyko KP, The theory of the pathogenesis of diabetes mellitus. Basic principles of hormone therapy [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa. Carroll GC & Sebor RJ, Dental flossing and its relationship to transient bacteremia, J Periodontol 1980 Dec; 51(12): 691-692. Chaitow L, Thorsons principles of fasting, 1996, HarperCollins, London. Debelian GJ, Olsen I, Tronstad L, Anaerobic bacteremia and fungemia in patients undergoing endodontic therapy: an overview, Ann Periodontol. 1998 Jul; 3(1): 281-287. Fowler EB, Breault LG, Cuenin MF, Periodontal disease and its association with systemic disease, Mil Med 2001 Jan; 166(1): 85-89. Fuhrman J, Fasting and eating for health, 1995, St. Martin's Press: New York. Gabrovsek J, Dental caries: a dent on dogma, Apr 1997 (www.priory.com/den/caries04.htm). Gendron R, Grenier D, Maheu-Robert L, The oral cavity as a reservoir of bacterial pathogens for focal infections, Microbes Infect 2000 Jul; 2(8): 897-906. Gibbons RV, Germs, Dr. Billings, and the theory of focal infection, Clin Infect Dis 1998 Sep; 27(3): 627-633. Hattori K, Therapeutic effects and prognostic factors of tonsillectomy for IgA nephropathy in long-term follow-up [Article in Japanese], Nippon Jibiinkoka Gakkai Kaiho 1998 Dec; 101(12): 1412-1422. Issels J, Cancer: a second opinion, Hodder and Stoughton: London, 1975. Iutskovskii AD, The immune status of patients with foot mycosis and eczema [in Russian], Vestn Dermatol Venerol 1989; (1): 52-57. Jacobson E, Modern treatment of tense patients, 1970, Charles C. Thomas: Springfield, USA. Jefferies WMcK, Safe uses of cortisol, 1996, 2-nd edition, Charles C. Thomas: Springfield, USA. Joshipura K, Ritchie C, Douglass C, Strength of evidence linking oral conditions and systemic disease, Compend Contin Educ Dent Suppl 2000; (30): 12-23.

_______ Kataura A, Tonsillar focal infection - Present clinical situation and prospects in the future of tonsillar focal infection, Practica Oto-Rhino-Laryngologica Aug 2002; 95 (8).

Li X, Kolltveit KM, Tronstad L, Olsen I, Systemic diseases caused by oral infection, Clin Microbiol Rev 2000 Oct; 13(4): 547-558.

Lockhart PB & Durack DT, Oral microflora as a cause of endocarditis and other distant site infections, Infect Dis Clin North Am 1999 Dec; 13(4): 833-850, vi.

Luthe W, Autogenic training: method and research and application in medicine. Amer J of Psychotherapy 1963, 17: 174-195.

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Meurman JH, Dental infections and general health, Quintessence Int 1997 Dec; 28(12): 807-811. Meyer DH & Fives-Taylor PM, Oral pathogens: from dental plaque to cardiac disease, Curr Opin Microbiol 1998 Feb; 1(1): 88-95. Mizutani H, Ohmoto Y, Mizutani T, Murata M, Shimizu M, Role of increased production of monocytes TNF-alpha, IL-1beta and IL-6 in psoriasis: relation to focal infection, disease activity and responses to treatments, J Dermatol Sci 1997 Feb; 14(2): 145-153. Okuda K & Ebihara Y, Relationships between chronic oral infectious diseases and systemic diseases, Bull Tokyo Dent Coll 1998 Aug; 39(3): 165-174. Siqueira Junior JF, Aetiology of root canal treatment failure: why well-treated teeth can fail, Int Endod J, 2001 Jan; 34(1): 1-10. Souliagin SS, Treatment of patients with focal infections using VEDB method [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, p.56-63. Stroebel C, The quieting reflex, BSA videocassette series, 1978, Wheatridge, CO. Takeuchi J, Yagisawa M, Nishimura T, Tonsillar focal infection: clinical observations of low grade fever, Acta Otolaryngol Suppl 1996; 523: 204-205. Warren J, The head trip, Random House, 2007. Wright GZ, Banting DW, Feasby WH, Effect of interdental flossing on the incidence of proximal caries in children, J Dent Res 1977 Jun; 56(6): 574-578.

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Chapter 9. Level 2: Personal changes, physical exercise and other useful tools 9.1 Personal changes due to the first breathing sessions Decreased ventilation, raised aCO2, larger CPs, and visible effects of the cleansing reaction all reflect deep physiological changes in the human organism. Different systems of the organism improve their work, and some positive changes in the hormonal system and in feelings and sensations of students are now of special interest. First, people often notice that they start to eat less and that their food preferences sometimes become different. Such changes are normal results of more effective work of the GI (gastrointestinal) tract. Due to reduced hypoxia and improved blood supply to GI organs, nutrients are better absorbed and more effectively used, waste elimination is normalised. Meals now are more food for the organism's systems and organs, rather than food for disease, infections, inflammation and mucus production, as before. Cravings for sugar, caffeine, alcohol, and other unnatural substances are greatly reduced. This is what Dr. Souliagin wrote about that. "Let's analyse a patient's need in sugar as an example of the reorganisation of nutrition. Refined sugar affects the body the same way as food narcotics. When consumed frequently, it creates dependency in the organism. If such a dependency is already formed, to restrict a person from sugar becomes almost impossible. A carbonic acid deficiency in the body breaks a process of glucose assimilation in a cell, destroys membrane permeability, and suppresses oxidizing processes which lead to a sugar level growth in blood as a compensatory action. Not sorting out real causes of the increase of sugar level in blood, we hurry to decrease that with insulin. The fall of sugar leads to further glucose deficiency in cells, creates some general tension, aggravates a patient's state, doesn't allow the body to get relaxed and to decrease the depth of breathing…By using DVBM [the Buteyko breathing method] with the purpose of eliminating CO2 deficiency, we are getting rid of the above mentioned pathogenic mechanisms. As a result sugar craving is reduced and its content in blood goes down. As DVBM treatment includes some theoretical education of our patients, we explain to them, in simple words, all what was said" (p.67, Souliagin, 1991a). Another related effect, which is typically observed in previously sick patients, is that, when the CP reaches 2530 s, they complain less about fatigue and feeling cold. As a result of the breathing exercises, people often feel heat inside the body and experience additional energy, as if it appeared from nowhere and now needs some practical applications. It should be, indeed, an unusual sensation for many patients and students to have energy after years of feeling weak and sick. The above mentioned physiological studies of volunteers, who practiced hatha-yoga exercises (where retraining of the breathing centre to a higher aCO2 is the key), found a 20% average increase in blood thyroxin level (p.74 and p. 206, Funderburk, 1977). The level of this hormone, on the other hand, has a direct relationship with personal feelings of energy. Increased physical activity in such conditions would be not only a correspondence with new physiological needs, but also an important, if not necessary, factor for further normalization of breathing. Similar ideas are true for thermoregulation. Sensations of inner heat normally lead to better reaction to low temperature exposures or, in some cases, even a craving to experience colder environment as a method of natural nervous stimulation. Most students naturally start to sleep less by about 1 hour per night with each 10-15 s CP increase. Such students should be psychologically ready to wake up earlier so that to spend time effectively. In general, as it was noted by Souliagin, "the restoration of metabolic and physiological processes helps patients to start "listening" to their organisms and to satisfy their natural needs" (p.68, Souliagin, 1991a). Normally Russian patients shared their practical experiences (about influence of different activities-on breathing) with Doctor Buteyko and his colleagues. On the other hand, the doctors could use diagnostic equipment in order to monitor patients’ physiological parameters. Therefore, it was possible to discover certain physiological mechanisms, make conclusions and summarize these data in such areas, as diet, exercise, thermoregulation, sleep, etc.

_______ 9.2 Exercise

Physical activity, according to Buteyko, can play the main role in health restoration. “Hence, the diseases can be cured by regular physical exercise. There is no need to spend 3 hours every day for breathing retraining, instead, one should work hard 5 hours per day till perspiration. This will cure asthma, hypertension, angina pectoris, and other diseases” (Buteyko, 1972). 178


In average, it may take 1-2 months of diligent breathing exercises for a student with, for example, asthma in order to rise own CP up to 25-30 s. Such results were often found in clinical trails. However, 4-5 hours of daily physical exercise often reduce this transition time down to 1-2 weeks (Andrey Novozshilov, private communication, 2003). Hence, if one wants quick normalization of breathing, physical exercise is indispensable. For Level 3 students, physical activity is even more important. Western official medicine does not suggest the optimum parameters of exercise. For example, a recent Harvard study of over 10,000 people the authors wrote in the introduction "Physical activity is associated with better health. However, the optimal intensity of activity remains unclear..." (Lee & Paffenbarger, 2000). In their conclusions these researchers suggested, "These data provide some support for current recommendations that emphasize moderate intensity activity. They also clearly indicate a benefit of vigorous activity" (Lee & Paffenbarger, 2000). However, the question remains. What is better? As was discussed in Chapter 2, the general physiological response to exercise in health and in disease especially in relation to changes in respiratory parameters is different. Doctor Buteyko not only confirmed these practical results in his laboratory, but also went further. He reasoned that optimum exercise should produce maximum reduction of ventilation 20-60 minutes after the activity. In order to achieve the optimum effect, the type, intensity and duration of exercise should be adjusted to current physiological abilities and needs, reflected in the CP, pulse and personal symptoms and feelings. Doctor Buteyko and his colleagues developed a set of recommendation regarding physical activity for patients with different health states and CPs. 1. For severely sick and critically ill people (when the usual CP is less than 10 s or within fighting with death zone) concentration on breathing exercises and constant breathing control are the optimum choices. Breathing cold air, while being outdoors, and relaxation of muscles are encouraged. Indeed, a Japanese study found that such a simple activity causes increased nasal resistance even when the person is warmly dressed. “Heart rate decreased significantly with cold exposure” (abstract, Sano, 1992) indicating naturally improved breathing parameters. Moreover, breathing cold air should increase the CP, as it follows from the article with the title “Reducing ventilatory response to carbon dioxide by breathing cold air” (Burgess & Whitelaw, 1984). The results of these experiments point to improved tolerance of the breathing centre to larger CO2 concentrations. 2. When the CP is between 10 and 20 s, long walks, without deliberate breathing control, but with constant nasal breathing and proper muscular relaxation, are suggested. The speed of walking does not need to be fast, while its duration is more important for breathing normalization (p.50, Souliagin, 1991a). Indeed, even in cases of serious health problems, like ischemic heart disease and hypertension, low intensity training can be beneficial, as this Japanese study indicates. “This presentation addressed the researches concerning the effects of the low intensity training on health promotion done in our laboratory. Supervised physical training performed at 50% VO2max or lactate threshold for 60 minutes, 3 or 5 times a week for 30 sessions could induce the improvement in VO2max, lipid profiles, and augment in cardio-pulmonary baroreflex. Thus, training was also applied to patients in ischemic heart disease, hypertension, and obesity. These patients could improve their aerobic work capacity. Hypertensive patients could reduce their blood pressure in association with modulating in humoral factors without changes in body weight and diet. The obese patients succeeded in significant body reduction with mild food reduction. We also found the existence of the breakpoint of double product (BPDP) during graded exercise tests corresponding to lactate threshold. BPDP will be able to be used in estimating lactate threshold. This low intensity training, which is easier and safer, can be recommended to the wide-variety of persons including older persons to promote health” (abstract, Tanaka & Shindo, 1992). Intensive physical activity, like jogging, would result in mouth breathing and cause lowered CO2 right from the beginning of exercise due to existing chronic hypoxia and elevated blood lactate (discussed in Chapter 2) at rest. At this level of breathing, physical activity should occupy about the same amount of time or even more than breathing exercises. 3. When the CP is above 20-25 s and the symptoms of the main disease are absent, physical activity should become the main driving force for further CP growth. . What are the necessary common requirements for doing physical exercises for a student with any health state? 1. Nasal breathing must be ensured during the whole exercise duration. Mouth breathing indicates too high an intensity of exercise and CO2 losses. If the intensity is too high, the student should either reduce intensity or take 1-2 min rest slowing down own breathing. 2. Relaxation of muscles, which at that moment are not involved in work, is an art mastered by a few and to be learned by many. If tension in any particular muscle or muscular group exists, while these muscles do not work, blood

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supply to these muscles is diminished, and hypoxia, stress, and general tension, increase. Due to additional resistance to blood flow, it causes a higher pulse and a relative hyperventilation with aCO2 reduction. Thus, relaxation is an important condition for exercise to have a positive effect. 3. BHT should not be less than 5 s at any moment during exercise. This pause is measured while exercising until the first desire to breathe. Measuring such pauses should not cause subsequent over-breathing or gasping. 4. Pulse during exercise should not increase by more than 20% in comparison with the initial stable pulse, which was achieved soon after starting the exercise. Pulse checking can be done during 6 or 10 s intervals, if one needs to take measurements. 5. Feeling well during the whole exercise should not be ignored, especially by sport enthusiasts. 6. Improvements in CP, pulse, and general well-being after the exercise are indicators of good physiological adaptation to the exercise. Thus, after sufficient rest (it may take from 20 min to 2-3 hours), the CP should be longer, the pulse lower, and the general well-being better. 7. Appearance of feeling of warmth or, better, perspiration, is important. 8. It is preferable to do exercise outdoors, as often and as much as possible. Conditions 1-6 are also used in order to define the optimum duration of exercise (from minutes to hours depending on physical shape, age, health state, and other factors). When at least one of these conditions is not fulfilled, the training session should be stopped. On average, healthy people should jog for 30-60 minutes per day, while the total time spent outdoors should be no less than 2-3 hours for middle aged people. Those who are older or sicker should be outside more while moving and/or exercising, since being indoors is normally tolerated only by young healthy children (p.165, Buteyko, 1991). Specific details regarding the jogging technique, positions of different body parts, their dynamics, etc., are beyond the scope of this book, but general practical suggestions and measures of physiological control can be discussed. During first jogging sessions relaxed brisk walking can be used as an initial part of the session. Jogging should be slow at the beginning (not more than 5 km/h, or speed of fast walking). Landing on the heels of the feet should be accompanied by pleasant relaxed shaking of the whole body. Such landing is a useful massage of internal organs (p.164, Buteyko, 1991). Those who mastered the art of breathing exercises (they can increase their CPs by more than 5 s using short breathing sessions and decrease their pulse by 2-4 beats per minute), can do reduced breathing during jogging. The manual written by Doctor Buteyko does not advise taking MPs during jogging unless in the presence of the practitioner for exercise control (Buteyko, 1991). At the same time, short pauses can be used and they can contribute to the feeling of after-exercise freshness. Such combined sessions are not easy. They do need a thoughtful approach. When the CP is above 20-30 s, brisk walking with light breath holds and reduced breathing between them is possible. Such walking with breathing exercises should satisfy the same basic conditions as the regular Buteyko breathing exercises (in terms of timing, duration, CP progress, relaxation, etc.). Even short breath holds may be problematic for people with cardiovascular problems, panic attacks or migraine problems. These people can practice reduced breathing either when their CPs get higher (e.g., over 25-30 s) or do it very gradually. A Japanese physiological study of the influence of breath holding on blood lactate level revealed the following effect. “Lactic acid concentration of venous blood was determined in healthy male subjects after strenuous exercise with and without breath-holding. It was found that in all subjects the peak and total values of lactate during recovery was higher in the breathing run than in the breath-holding run, though the running time was the same” (abstract, Fujitsuka et al, 1980). Such combined sessions (exercise with reduced breathing and possible breath holds) should also satisfy the conditions regarding intensity of air hunger and exercise duration, which were considered in the previous chapter. Meanwhile, in my view, since the combined training requires proper relaxation, one may try, first, slow relaxed walking with breathing exercises. During such walks nose pinching is not necessary and counting double steps can substitute CP measurements. With experience, a student can figure out the relationship between the current CP and number of steps during breath holding. Such sessions make the transition to jogging with breathing exercises easier. There are some after-training suggestions too. No cold water can be used immediately after demanding physical exercise due to temporary depleted or exhausted reserves of stress hormones and glycogen stores. That often

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causes inadequate response to cold stress. A warm shower is suggested. Lack of appetite immediately after exercise is normal. Thus, meals should be delayed until the appearance of natural hunger, while drinking water is encouraged. Finally, reduced sleepiness at night after late evening training sessions is normal. Following the general advice of Doctor Buteyko about sleeping (“go to sleep only when you really want to”), one may do something useful instead (p.165, Buteyko, 1991). These suggestions about physical exercise were developed for sick and severely sick people. It may happen that sometimes people with a low CP (e.g., about 10-15 s) can exercise with nasal breathing and do not feel worse after physical exercise. Should they stop these exercises until their CPs are sufficiently large (e.g., over 20 s)? Small CPs and chronic hyperventilation do not always mean severe tissue hypoxia and elevated blood lactate levels because the effects of hyperventilation are individual. While, for example, hypoxia due to low aCO2 is a normal effect, some people can have very low tissue oxygen levels, while for others this effect may not be very pronounced. Meanwhile, hypoxia and increased resting lactate are normal for people with hypertension, panic attacks, anaemia, hepatic disease, renal disease, certain endocrine disorders, acute infections, chronic pulmonary disease, chronic fatigue syndrome, and some other disorders (Huckabee, 1961). These patients often complain about breathlessness and tiredness. It is better for these groups of people to increase their CPs to about 20 s or more in order to start light physical exercises. However, if personal parameters (CP, pulse, and well-being) improve after exercises, the positive effect of physical work is obvious. Therefore, exercise is useful if breathing is done through the nose all the time. Observation and participation in sport activities (especially in endurance-type activities, like cycling, running, cross-country skiing, orienteering, triathlon, etc.) help to understand some breathing-related paradoxes and effects. For example, there is a "finish line" paradox. Why do the winners of many sport contests have relatively light breathing at the finish line? They worked at the hardest energy production rate in relation to their weights, but breathed less and are less tired after crossing the finish line. Those who are a little bit behind breathe harder. Finally, those who are the last ones show very heavy laboured breathing and often fall from exhaustion. Moreover, some of them can have heart or asthma attacks. Similarly, when a group of people, for example, run, ski, or cycle together, one of the athletes may start panting. Experience of the other athletes would immediately tell them that this athlete would not be able to keep the pace. He/she is going to give up. Why? Heavier breathing means greater anaerobic metabolism and production of lactic acid that drives respiration up causing the suppressed Bohr effect, vasoconstriction and other symptoms of hyperventilation. The same effects can be observed in a single athlete during different competitions. When the athlete performs well, he/she is fresh at the finish line and breathing is light. The next day (or a few days later), if the performance is worse then so is his/her breathing and after-contest well being. Why? Of course psychological factors play a role, but mental factors alone cannot provide energy and oxygen for the brain and the muscles. The release of O2 is directly proportional to the slopes of the Bohr curves since the ordinate of the graph is O2 saturation. Therefore, the steeper the slope of the practically used parts of the curve, the larger the O2 amounts that are delivered to the tissues. Generally, these curves are quite steep from 0 until about 80-100 mm Hg (O2 partial pressure). After these values (for over 100 mm Hg), the curves become almost flat. That means that haemoglobin cells cannot release oxygen for tissues to use. O2 molecules get glued to haemoglobin cells (the suppressed Bohr effect). Now free O2 (or dissolved oxygen) becomes the predominant source for tissues to use. But the amount of dissolved O2 is less than a few percent of the combined O2 (see Appendix 1 for details). Haemoglobin cells, in such conditions, become redundant. Those who are fit and breathe less, in addition to having higher CO2 concentrations, have lower O2 in the lungs and use the steepest parts of the Bohr curves. These people spend the least amount energy for breathing, while extracting the maximum amount of oxygen from air that arrived in the lungs. Therefore, a typical physical training program for endurance development (how to train during 1-5-10 years in order to achieve the best performance) is targeted, among other things, to the enhanced Bohr effect. This study from the Journal of Applied Physiology measured these effects. “Three O2 dissociation curves from venous blood [taken at rest (A), after in vitro acidification with lactic acid (B), and after exhaustive exercise (C)] were determined in eight athletes twice in a year in detrained and fully trained state. The steepness of the standard O2 dissociation curve becomes greater during the training period (increase in Hill's n from 2.68 +/- 0.10 to 2.96 +/- 0.15). There was a concomitant small rise in the intraerythrocytic organic phosphate concentrations. Bohr coefficients (BC) were calculated for blood O2 saturations ranging from 10 to 80% by

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comparing the dissociation curves A and B ("in vitro" BC) and curves A and C ("in vivo" BC). In detrained and trained state the in vivo BC show their maximal values at low saturation levels, in contrast the in vitro BC exhibit maximal values at middle saturations. During the training period there was an increase in the in vivo BC as well as in the in vitro BC at low saturations. These alterations may lead to augmented O2 extraction from a given volume of blood by up to 15% during heavy work in trained state…” (Braumann et al, 1982). It is clear then, that any professional athlete who wants to excel in an endurance activity with serious aerobic demands is going to benefit from normalisation of breathing. Moreover, physiological science shows that recovery from fatigue and various injuries, together with concentration and coordination during preparation and performance, all depend on normal aCO2 values. Finally, it should be kept in mind that training (as learning) is an eternal process. Once you stop exercising, detraining develops. “We concluded that in normal subjects, long-term physical training increases aerobic work capacity and decreases CO2 ventilatory responsiveness [that means larger CO2 are better tolerated and, hence, longer CPs are possible], and that the ventilatory adaptations with training observed here are reversible through detraining” (abstract, Miyamura & Ishida, 1990). Indeed, according to the current view of Russian Buteyko doctors, about 3-4 hours of daily exercise (even walking is adequate) are necessary in order to maintain normal breathing. “Lack of physical activity is as harmful as lack of vitamins, water or food. 3 hours of good physical labour per day with perspiration or the equivalent physical activity, this is the norm for the average person” (Buteyko, 1972). Those people, who due to various reasons cannot exercise, should practice breathing exercises. In short, the relationships between breathing sessions (the reduced breathing) and PE (physical exercise) for various CP zones are as follows: 1-10 s CP: RB (the breathing exercises were invented by Buteyko for severely sick people who could not exercise); 10-20 s CP: RB + PE (physical exercise becomes the necessary component for further growth); > 20 s CP: PE + RB (physical exercise becomes the driving force to further progress)

9.3 Some practical suggestions regarding your personal hygiene and oral health The mouth is a very frequent source and cause of various health problems including sinusitis, sore throat, frequent respiratory infections, flu, colds, etc. When the CP is large (over 60 s), the composition of saliva does not allow the growth of bacteria that are responsible for caries, dental plaque and other oral problems. Normally, healthy people do not need the extremes described below. However, when the CP is below 40 s, the hygiene is a very important factor in order to prevent the problems given above. Various bacteria and pathogens interact and help each other (that is one of the conclusions followed from the focal infection theory). Therefore, a clean mouth and clean nasal passages invariably indicate better general health. Here are some (by no means all) practical tips how oral and respiratory health can be improved and, as a result, breathing can be further normalized. • The breathing exercises do help to keep nasal passages moist. However, those students who may still have problems with dryness or with chronic sinusitis are going to benefit from hypertonic (5%) saline nasal wash as results of randomized controlled trials revealed (e.g., Shoseyov et al, 1998). Generally, dry nasal passages are favourable for spread of various infections. (By the way, the similar problem “dry mouth syndrome” can be even more dangerous since due to possible uncontrolled growth of pathogenic bacteria in the mouth causing caries, dental plague, and other problems). Therefore, keeping these places in accordance with physiological norms is of great benefit in order to prevent recurrent infections, colds and other respiratory problems. There are different variations and methods in relation to nasal irrigation with the use of sea salt, baking soda, fresh urine, and other mixtures. The reader may also try a neti pot and other methods of nasal irrigation developed by Indian yogi. All this information can be found on the Internet. • Tongue coating promotes formation of volatile sulphur compounds (VSC), powerful toxic substances, and other strong toxins in the mouth, according to a Japanese study (Yaegaki & Sanada, 1992). “…Estimated production of VSC from tongue coating [in patients with periodontal disease] was 4 times higher than the control value, and the methyl mercaptan/hydrogen sulfide ratio was also markedly increased. However, a saliva putrefaction study suggested that saliva does not contribute to the elevated ratio of methyl mercaptan in mouth air. These results strongly suggest that, in addition to periodontal pockets, tongue coating has an important role in VSC production, in particular leading to an elevated concentration of methyl mercaptan, which is more pathogenic

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than hydrogen sulfide” (abstract). Moreover, another Japanese study revealed that, “1. After the tongue brushing program, the number of Candida species at tongue and in oral rinsing decreased significantly. 2. The tongue brushing with denture plaque control decreased in number of Candida species at denture more effectively than without denture plaque control. 3. The number of Candida species at denture bearing mucosa decreased by tongue brushing. 4. It seemed that the tongue brushing was effective to prevent denture stomatitis caused by denture plaque” (abstract, Tamamoto et al, 1990). Therefore, it may be impossible to successfully fight, for example, Candida and frequent colds unless the tongue is properly cleaned. Furthermore, Indian researchers found that formation of dental plaque also depends on the state of your tongue. “Tongue, because of its surface texture contributes significantly in plaque formation and accumulation, has remained a neglected part in the oral cavity. The study conducted on twenty students aged 18 to 23 years, was undertaken to clinically evaluate the role of supplementing tongue brushing to most advocated regime of tooth brushing. In both the phases of the study, plaque scoring was done daily and oral debris was collected on the eighth day. It was observed that tongue brushing when supplemented to the most advocated regime of tooth brushing that is, immediately after breakfast in the morning and immediately after dinner at night significantly reduced the initial rate of plaque formation and total plaque accumulation” (abstract, Gulati & Gupta, 1998). Therefore, frequent and regular tongue brushing or scraping (you may use, for example, a plastic/metal spoon or a tooth brush) must be a normal feature of any Buteyko student. Note that even deep invisible parts of the tongue can be and should be reached using these devices. • Another useful suggestion is regarding the optimum water temperature for teeth brushing. “Brushing with hot water was found to be a more efficient means of removing the plaque than brushing with toothpaste or brushing alone. The study suggests that it is more effective to use hot water for plaque removal in the course of performing daily oral hygiene” (Jakober & Perritt, 1991). • Dental flossing, in addition to other oral habits, is an important factor in prevention of proximal caries (Wright et al, 1977) and in “dramatic reductions of about 67%” of inter-proximal bleeding (Graves et al, 1989). Moreover, Carroll & Sebor (1980) found that flossing affects presence of pathogenic bacteria in the blood, “This study was designed to determine the role of dental flossing in producing transient bacteremias. An improved protocol that provides for repeated samplings of blood was developed. Four patients had 32 blood cultures taken (16 before flossing and 16 after). Two of the patients had no periodontal disease and two had only marginal gingivitis. The results showed that the patients who flossed daily developed no bacteremias but that patients who delayed flossing from 1 to 4 days developed bacteremias 86% of the time. It is important that patients who have a history of rheumatic fever and those who have internal prosthetic devices be cautioned regarding sporadic flossing. While gingival bleeding was not significantly related to bacteremias in this study, further investigation is needed to ascertain how flossing in various types of periodontal disease relates to bacteremia”. Therefore, dental flossing must be a part of after-meal routines. • However, it is dangerous to be too zealous in respect to flossing. It may result in certain problems. “The terminology "flossing cleft" is suggested by the authors to describe linear or V-shaped interdental marginal tissue deformities that result from dental floss-induced injury. While these clefts may serve as a potential source of bacteremia during vigorous flossing and associated oral tissue manipulation, in no instances were they determined to constitute a morphologic impediment to effective plaque control efforts” (Hallmon et al, 1986) • Similarly, proper tooth-brushing techniques (with light strokes and easy pen grip) are also useful to follow, “…More gingival injuries were found when the toothbrush was held with the palm grip than with the pen grip. This difference was statistically significant (P less than 0.01). No statistically significant difference were observed between corresponding plaque scores as measured according to the PLQ-index, irrespective of whether the plaque scores were presented as plaque remaining after experimental brushing or as the difference between the PLQ scores before and after brushing” (Niemi et al, 1987). • Another practical aspect relates to the use of old toothbrushes. According to the study of 20 subjects done by professional Australian dentists (Daly et al, 1996), "progressive toothbrush wear did not lead to a decrease in plaque control". Two groups of people (10 subjects in each group, one group using new toothbrushes, and another one old toothbrushes) had the same decrease in plaque scores. The researchers concluded "that the wear status of a toothbrush may not be critical in ensuring optimal plaque control".

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• There were different results about the efficiency of rotary electric toothbrushes. Some studies found them useful. For example, French dentists (De Beule et al, 1990) found that "the rotary electric toothbrush Interplak is more effective for plaque removal and control of gingival inflammation that classic manual brushing". Other trials did not find any significant differences. For example, Walsh & Glenwright (1984) after investigation of 10 young adults with healthy gingivae concluded, "Further analysis of the proximal scores again showed no significant differences between the powered brush or hand-brush". In a large American trial the effects of four oral hygiene methods (manual toothbrushing, power tooth-brushing, manual tooth-brushing plus irrigation, and power tooth-brushing plus irrigation) were compared in 108 subjects assigned to 4 oral hygiene groups. After 3 and 6 months they were assessed for changes in plaque, stain, gingival inflammation, bleeding to probing, probing depth and attachment loss. The results "showed that all the oral hygiene methods were equally effective in reducing plaque and stain accumulation, gingival bleeding, bleeding to probing ratio and the % of pockets 4 mm or deeper. None of the oral hygiene methods was associated with injury to soft or hard tissues" (Walsh et al, 1989). • Keeping mouth clean is possible using various methods. Self-discipline and consistency are the most important factors here. It is a general current agreement among many modern dentists and researchers that too long or too hard brushing can cause damage. The general advice is following. The optimum brushing parameters are: do it for about 2 minutes, with light pressure (100-200 g), and 1-2 times per day. • There are other serious reasons to completely eliminate sugar from the diet. The negative effects of sugar on formation and spread of caries and growth of other pathogens (e.g., above mentioned Candida) are well-documented facts. However, use of sweeteners is a totally different story as an article in the International Dentistry Journal reported. “Increasingly, sweeteners are being used in the diets of caries-prone individuals to reduce sugar intake. Such substitution deprives the bacteria in the dental plaque of the sugars many of them use to produce the acids that cause demineralization of tooth tissue and development of the caries lesion. Sweeteners are particularly effective replacements for dietary sugars because they also stimulate the flow of saliva which can, through several mechanisms, prevent demineralization and even bring about remineralization of already demineralized enamel, dentine or cementum. More saliva means that more of its nitrogen-containing substances will reach the dental plaque where they can be degraded by plaque bacteria and thus produce base and the alkaline conditions that are conducive to a shift from tooth demineralization to tooth remineralization. At the same time, the additional saliva brings to the plaque more calcium and phosphate ions, the necessary ingredients for the remineralization process. At alkaline pH, saliva also provides a source of easily solubilized calcium phosphate that, in association with salivary carbohydrate protein, becomes part of the dental plaque. Because it is dissolved by acid more easily than is the calcium phosphate of the tooth, plaque calcium phosphate acts as a substitute for the tooth tissues when periods of acid attack occur following sugar ingestion…” (Kleinberg, 1985). One of the sweeteners xylitol even possesses anti-caries properties as large medical studies and trials found (e.g., Isokangas et al, 1991; Makinen et al, 1996). Moreover, Tanzer conducted “an extensive peer-reviewed literature on xylitol chewing gum as it pertains to effects on tooth decay in human subjects, on human dental plaque reduction, on inhibition of dental plaque acid production, on inhibition of the growth and metabolism of the mutans group of streptococci which are the prime causative agents of tooth decay, on reduction of tooth decay in experimental animals, and on xylitol's reported contribution to the remineralisation of teeth. The literature not only supports the conclusion that xylitol is non-cariogenic but it is now strongly suggestive that xylitol is caries inhibitory, that is, anti-cariogenic in human subjects, and it supplies reasonable mechanistic explanation(s)” (Tanzer, 1995). What is important to know that after meals with starches and other carbohydrates pH in the mouth drops (making it more acidic) and that promotes growth of dental plaque and caries-promoting bacteria. Therefore, it is important to remove food particles from the mouth and restore pH soon after meals. That can be done using various means (flossing, tooth brushing, water rinsing with soda, and mouth washing). In addition, chewing xylitol containing gums for 20 min after meals is a proven method of caries prevention. This method can be particularly suitable for children or for adults with busy life schedules. • Finally, a large survey (over 40,000 school children) organized by English dentists resulted in the following conclusions. “…There was a significant relationship between flossing frequency and the time since the last dental attendance, the more recent attenders flossing more frequently…Flossing frequency was also found to correlate positively with frequencies of washing hands after visiting the lavatory and bathing…” Regularity and frequency are important factors for all these hygienic procedures.

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9.4 Diet and nutrition After days or weeks of breathing practice and control, it is normal for the students to notice effects of meals on breathing and CP. The basic mechanism of this influence was considered in chapter 3. Let us review and further analyze findings and ideas revealed by Doctor Buteyko and his colleagues. • Water Among all substances, which are consumed by humans in significant amounts, only water does not affect respiration (Buteyko, 1977). Proper hydration of the organism is a necessary factor for CP progress during the breathing exercises. Normally, students and patients carry water bottles for group sessions. While feelings of thirst and dry lips are usual signs of dehydration, dry air passages are probably more sensitive indicators of either dehydration or hyperventilation. Dehydration can be a consequence of hyperventilation, which causes excretion of some electrolytes by kidneys and an abnormal distribution of water and electrolytes between intra-cellular and extra-cellular fluids. Doctor Buteyko believes that spring water is the optimum choice, while frozen and then thawed tap water is a good alternative. In my view, it is possible that the chemical composition of previously frozen water is different from its source. Crystallization starts from the outer surface of the water volume gradually moving towards the centre. That causes a concentration of impurities in the central part, which is frozen last (this principle is the basis of many processes in metallurgy for purification of various ores). Certain impurities can react with each other in this small volume in the middle forming less harmful substances. Hence, it is possible that such water is better. Also, one can use for drinking only the central purified part which melts first. The middle can be discarded in the sink. • Caloric value of meals While overeating is considered by Doctor Buteyko among the major causes of hyperventilation (Buteyko, 1977), Russian sources do not specify the term “overeating”. Meanwhile, researchers from the College of Physicians and Surgeons of Columbia University, New York, had a long program of investigations in the area of influence of different nutrients on respiration. First, let us look at the ideal situation, when 5% glucose was directly injected into the blood. That normally caused respiratory changes and “the magnitude of the changes was a function of the patient’s clinical state and glucose load” (abstract, Askanazi et al, 1980). The researchers divided the patients into three groups depending on their metabolic rate. Only the depleted group (patients who had undergone prior weight loss, from 10% to 50%, and required total parental nutrition on medical grounds) had moderate increase in ventilation (+32%), while for other groups (patients with mild to moderate injuries, sepsis, or acute injuries and normal or high metabolic rate) minute ventilation increased by about 70-120%. Correspondingly, aCO2 of depleted patients decreased by 7-8%; for other patients aCO2 losses were about 15-30% from their previous levels. Therefore, those people, who had a normal or high metabolic rate or who were acutely ill at the moment (due to sepsis), reacted to glucose infusion with heavy over-breathing since their organisms probably did not need this nutritional support (either due to available energy stores or due to existing problems with infections). Therefore, “glucose may be a metabolic stress when given to patients with injury or infection” (p. 1447, Askanazi et al, 1980). These researchers also analyzed ventilatory responses in normal subjects, as it follows from their numerous publications. The results were not different. Generally, the magnitude of respiratory distress was proportional to caloric value of patient nutrition. “In either case [malnourished or not], the increased need for CO2 elimination results in ventilatory demands, which may precipitate respiratory distress in patients with previously compromised pulmonary function” (abstract, Askanazi et al, 1983). It is now of practical importance to define the main parameters which characterize the resting metabolic rate of the person or who should eat more and who less. According to Italian researchers, resting metabolic rate had very good correlation with the waist-hip circumference ratio with some influence of body fat (Armellini, 1992). German scientists in their article “Effects of fat mass and body fat distribution on resting metabolic rate in the elderly” found that, “Grouping subjects according to their WHR [waist-to-hip ratio], RMR [resting metabolic rate], and RMR adjusted for fat-free mass and fat mass showed a significant increase with increasing WHR in both sexes. Results indicate that RMR not only depends on fat-free mass but also is influenced by fat mass, especially by fat distribution. These findings support our hypothesis of an elevated RMR with increasing abdominal body fat as a direct consequence of its greater metabolic activity” (abstract, Luhrmann et al, 2001).

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Therefore, people with elevated waist-to-hip ratio and/or fat mass generally have the highest resting metabolic rate. We also learned above that people with high metabolic rate react to meals with excessive over-breathing. Hence, people with un-proportionally large abdomens and/or large fat stores are going to have the worst reaction, in terms of breathing, to meals, especially to meals with large caloric values. • Amino acids What about the impact of amino acids (building blocks of proteins) on human nutrition? The Columbia University group also had the answer to this question. 8 normal non-smoking subjects had 5% infused dextrose, as a sole nutrient (apart from essential vitamins, minerals, and fatty acids) for 7 days (440 kcal/day). After this week of semi-starvation and no proteins, infusion of 100 kcal of amino acids (equivalent to 22 g of proteins) caused “significant increases in metabolic rate, minute ventilation, and respiratory chemosensitivity” (p.43, Weissman et al, 1983). “Restoration of normal levels of gas exchange was observed after infusing the standard amino acid solution for 24 h” (p.469, Takala et al, 1988). Therefore, injection of amino acids increases breathing for the next 24 hours. At least the same impact (ideally) should be expected after eating foods with equivalent amounts of proteins. This subject will be analyzed below. The effect of low and high nitrogen diets was studied on two groups of nutritionally depleted patients with 11.2 and 21.1 g of nitrogen, respectively. For high nitrogen diet aCO2 decreased on about 2.3 mm Hg and caused increased ventilatory sensitivity to CO2. “Thus, at an aCO2 of 40 torr [40 mm Hg], ventilation with low nitrogen intake is 5.7 l/min vs. 15 l/min with high nitrogen intake” (p.77, Askanazi, 1983). This result indicates that respiratory changes were not linearly dependent on amounts of infused amino acids, and ventilatory increases were unproportionally high. Hence, larger amounts of amino acids cause un-proportionally heavy over-breathing. Since both these nutrients (carbohydrates and amino acids) are required for the human organism, this large group of medical doctors made the following conclusion. “Because administration of glucose and amino acids in patients with respiratory distress may be limited, physicians should institute nutritional support early and in moderate quantities” (p.43, Weissman et al, 1983). It would be reasonable to conclude from these findings that sicker people can have small and frequent meals and only when really hungry. Most studies, cited above, were conducted in an ideal situation: intravenous infusion of ready-to-use nutrients. Normal foods require digestion, and that causes additional effects, which are considered next. • Proteins During his public lectures, Doctor Buteyko noticed two practical findings: a) vegetable proteins were less influential than animal proteins; b) quickly absorbing animal proteins had the worst effect in comparison with animal proteins which were slowly digested. Why? Russian Buteyko literature does not provide the answer to this question. However, the following mechanism can be suggested. When the individual CP is low (e.g., 20-30 s or less), the gastrointestinal tract suffers from hypoxia and an inadequate blood supply. In such cases, some disturbances with protein metabolism are normal. (Such disturbances are often manifested in slow wound healing). The main part of absorbed amino acids is going to be spent on the repair of the lining of the gastrointestinal tract due to intensive wear of mucosal cells during peristalsis. Hence, low CPs, together with poor dietary and nutritional habits, create conditions for chronic inadequate repair of the small intestine and the stomach. Clinical investigations found that “food protein may be absorbed into the circulation antigenically intact in healthy individuals and that immune complexes containing these antigens are formed” (p.1271, Paganelli et al, 1979), indicating the phenomenon of intestinal permeability (this phenomenon can be evaluated using special medical tests). At the same time, "foreign proteins that enter the circulation provoke the formation of antibodies, and the antigen-antibody reaction occurring upon subsequent entry of more of the same protein may cause allergic symptoms... Certain foods are more allergic than others. Crustaceans, molluscs, and fish are common offenders, and allergic responses to legumes, cow's milk, and egg white are also relatively frequent" (p.435-436, Ganong, 1995). This quote is from the medical textbook. What is the mechanism of the possible allergy? “In normal subjects immune complexes containing these antigens are rapidly cleared from the circulation” (p.1272, Paganelli et al, 1979). When patients were sensitive to certain foods, “the levels of immune complexes were well above those found in healthy adults when subjected to food challenge” (p.1272, Paganelli et al, 1979).

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Are these extra immune complexes harmful? According to another medical doctor Fuhrman, “When the immune system views the animal peptides in the bloodstream and attempts to attack and destroy them, the antibodies created can continue to attack other body tissues later. Because amino acid sequences in human body proteins are similar to those of the animal peptides, these antibodies can attach and cause reaction to one’s own tissues” (p. 148, Fuhrman, 1995). Symptoms that are created by such augmented sensitivity are said to cause various GI problems: epilepsy, asthma, pulmonary diseases, hyperactivity, schizophrenia, otitis, rheumatic disease, kidney problems, and many others (Brostof 1982, 1991; Pahush, 1986). Previously we considered the situation, when amino acids were injected into the bloodstream. Now, during normal meals, large protein molecules, due to intestinal permeability, can penetrate into the blood causing formation of immune complexes which attack (due to hyper-sensitivity of the immune system) these molecules and their own tissues. Why then are vegetable proteins less harmful? According to Fuhrman (MD), “Plant proteins are less likely to cause this reaction, even if their peptides pass into the bloodstream, because they bear little resemblance to human proteins” (p. 148, Fuhrman, 1995). Another important practical finding was that patients with asthma and eczema experienced adverse food reaction (in these cases 40-60% fall in peak expiratory flow and skin itching) at different times, from 2 to 8 hours after being challenged with two soft-boiled eggs (p.1271, Paganelli et al, 1979). Animal proteins are similar in their structure to human proteins. That causes the adverse immune reactions to eating, for example, meat, fish, and dairy products. The structure (sequences of amino acids) of plant proteins is very different from animal proteins and human proteins. They are less likely to cause such food allergies. • Practical test for possible allergic food reactions Doctor Buteyko does not insist that every person must be a vegetarian. Some people are better off, when they eat meat (Buteyko, 1977). However, in times of disease or health crisis, when CP is low or very low, allergic reactions to certain foods are more common. That is normal due to abnormal state of the immune and GI systems. Improved breathing and larger CPs usually reduce problems with allergic food reactions, while for ideal CP (60 s), they disappear or can be eliminated by gradual adaptation of the digestive system. Russian medical doctors, who use the Buteyko breathing method, normally restrict or temporarily eliminate many suspicious food items from their patient’s menu. A typical case of a girl with years of severe asthma and successful treatment showed that she was very allergic to dairy products. When upon her return home her parents treated (challenged?) her with a glass of milk and some cottage cheese, she had an asthma attack (Buteyko, 1977). Since breathing sessions start with pulse and CP measurements, many students and patients use these test results in order to identify possible food allergies. A pulse test, advocated by many nutritional professionals, can be helpful in this respect. If the pulse increases by 5-10 beats per minute 2-3 hours after the meal in comparison with the previous value (although sometimes longer time may be required), the meal is well tolerated. 10-15 beats/min increase can indicate possible problems, while 20-25 beats/min clearly points to a food allergy (or overeating). The same test is useful for patients and students to define the amounts of foods that can be safely eaten since, as was mentioned in the section above, respiratory distress can be disproportionately large, for meals with large caloric values. Small meals would allow better control of breathing, especially in severely sick patients when any stress can provoke an attack of the main disease. It is also important to keep in mind that real hunger, from the biochemical viewpoint, means more digestive enzymes and physiological ability to handle food (which is stress for breathing). Hence, the degree of hunger is an important parameter for effective digestion, possible allergic reactions, and subsequent breathing.

_______ Other practical findings

Russian studies also revealed the following facts: Animal fats cause greater ventilation than fats of vegetable origin. Starches have less influence on breathing parameters in comparison to fats and proteins. Fruits and vegetables are least burdensome for breathing in comparison to foods rich in proteins, fats, and starches. Raw foods are better tolerated than cooked ones, while canned are worst among them. However, there are factors, which are specific and personal (individual allergic reactions to certain foods, specific abilities or disabilities to digest some food substances, presence or lack of certain enzymes, poor state of some parts of the GI tract, specific needs of the whole organism). These factors, in some cases, can be, in practical terms, more important than general conclusions, diets, and recommendations. For example, while raw fruits and vegetables can be a basis for an ideal diet of a healthy person, patients with low CPs have fewer problems when these food items 187


are consumed in smaller amounts, due to the poor regeneration of the intestinal lining. The duration of cooking of vegetables is another important parameter. Healthy people can safely eat most raw vegetables, sprouts and nuts. When health is impaired, cooking helps to increase the solubility of fibres making their impact on the digestive tract smaller. As a result, relatively healthy people often prefer raw foods or short cooking time (when vegetables are still crunchy), while sicker patients often need longer cooking and mushy meal consistency. Skin stimulation is similar in this respect. Healthy skin can withstand and become more strong and elastic after vigorous massage or skin brushing (a raw food analogue). Sensitive skin would be damaged by too strong a stimulation. Therefore, it is better to adjust the diet to the current state of the GI tract, digestive abilities, needs of the whole organism, and other important parameters. General Buteyko recommendations As a result, it is normal that Doctor Buteyko did not advise any particular diet, while suggesting only general ideas supported by his experimental results. Here are some of them. - Do not overeat. That is one of the worst things for breathing. - Eat in moderation and only when really hungry. - With aging, people tend to eat less protein, especially of animal origin. - Milk is good for babies, not for adults. Not once did he express thoughts about certain advantages of the vegetarian diet, a bad cultural and parental habit to overfeed children, the usefulness of days of restricted eating, in general, and fasting, in particular. Salt intake restriction can be useful for certain patients, but other students can benefit from using sea salt dissolved in water and drunk on empty stomach. Buteyko emphasised benefits of spices and this topic is considered in more details in the chapter devoted to diet. Dead cells of the human organism are digested by digestive enzymes circulated in the blood. These enzymes also digest food. It is normal to expect then, that, from biochemical viewpoint, under-eating and fasting spare those enzymes for self-repair. Later, when the damaged tissues and organs (e.g., GI organs, kidneys, lever, etc.) are properly working, weight normalization is quick. Such ideas also easily explain why raw diets and digestive enzymes can be useful for normalization of breathing. Meanwhile, there are some ideas, which may not be essential for Russian patients, but important for Western and other countries. • Food combining Different foods require different enzymes and even different optimum pH for their digestion. For example, animal proteins require vary acidic environment (very low pH) in the stomach, while starches are better digested at higher pH (less acidic digestive juices). When we eat and chew together concentrated starches and concentrated animal proteins, the stomach is in the state of confusion since the strange combination of foods (meat and bread, fish and rice, etc.) is unknown from the evolutionary viewpoints and difficult to digest from the physiological considerations. Hence, such combinations are harder to digest and the meal will be in the stomach for long time (e.g., up to 3-4 hours) preventing the student from breathing control. There are other situations when order and combinations of foods can potentially cause various problems. What are the solutions? Many nutritionists suggest food combining. The main rule is to separate concentrated starches and proteins for their faster and easier digestion. Meat or fish can be eaten together with fruits, greens, or vegetables, while grains and other starches (cooked potatoes and carrots, etc.) can be eaten at different times together with vegetables and greens. More time will be available for physical exercise and breathing control. As another, less strict option, the student may separate concentrated proteins and starches, but still eat them during the same meal. For example, meat can be eaten with fruits and salads, while bread and other starches can be some 10-30 min later. When we chew foods well and do not drink during meals, the foods will be digested in the stomach independently and in the same order. Such sequential eating will also result in faster and more efficient digestion. There are many other ideas related to food combining. For example, it is better to eat fruits first, rather then last since many people have a habit to eat fruits at the end as a desert. Many fruits can easily ferment in the stomach that has good temperature and moisture for pathogens to multiply. The student may search and investigate the suitability of other food combining ideas. • Fibre Large amounts of fibre in the diet not only leads to more effective absorption of toxins which are released for

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elimination into the intestines by special blood-cleansing cells of the digestive tract, but also prevents re-absorption of these and other toxins due to normal transition time. Since our ancestors typically consumed over 80 g of fibre per day, their transition time was about 24 hours (bowel movements after each meal), as studies of healthy aboriginal people indicate. If a western man has much less fibre in the typical diet (with current norms about 20-30 g/day), it is reasonable to expect that such diets should lead to less effective binding of the toxic waste and their partial reabsorption due to slow general peristalsis. Similarly, delayed elimination of some food residues (like fats, proteins, and complex starches) causes their putrefaction in the colon since their residues can ferment for days. Several medical studies found that large amounts of a powerful toxin fecapentaene are formed in the colon, when the transition time is increasing. At the same time, any toxic load directly affects breathing. Therefore, prompt elimination of these residues is important in order to prevent autointoxication. Thus, increased bowel transit time and constipation normally results in the appearance of toxic products in the blood. Slow general peristalsis, in addition, leads to development of unhealthy intestinal flora. All these processes definitely contribute to chronic over-breathing. Studies found that fibre can be a source of energy, when our GI system is in good shape. A textbook on gastroenterology in the section devoted to the colon suggests, “Greater numbers of bacteria (more anaerobes than aerobes) are found within the colonic lumen than elsewhere in GI tract. These bacteria digest a number of undigested food products normally found in the effluent delivered to the colon, such as complex sugars contained in dietary fiber. Complex sugars are fermented by the bacteria, forming the short chain fatty acids (SCFAs) butyrate, propionate, and acetate. These SCFAs are essential nutrients sources for colonic epithelium, and in addition can provide up to 500 cal/day of overall nutritional; needs.” • Lack of other essential substances and certain micro-minerals This problem is better addressed from an evolutionary viewpoint. It would be reasonable to assume that Nature's design of man enables him to have a "clean" body resulting in very large CPs (about several minutes as it was the norm for diving animals and all breathing creatures when the lungs were evolving). Therefore, it is of importance to provide all these substances. That relates to all essential vitamins, aminoacids, minerals, and fatty acids. (Of course, energy sources are also necessary for physiologically normal functioning.) Lack of pyridoxine (vitamin B6), cobalamin (vitamin B12), and folic acid in the diet are frequent vitamin deficiencies in modern people. Those who do not consume animal products may have problem with (marginal) deficiencies of lysine and arginine amino acids. In relation to macro-minerals, modern diets often lack zinc, magnesium, and calcium. It is likely, however, that not all essential elements are yet discovered (by official medicine). Indeed, many researchers and nutritional professionals consider the supply of, for example, molybdenum, chromium, silver, gold, and many other trace elements absolutely vital in order to have normal health. The life and human evolution started from the oceans. Abundance of microelements was probably the norm in the diet of our primitive ancestors who consumed large amounts of sea grasses and sea vegetables. Moreover, intensive agricultural methods cause decreased amounts of many minerals in modern foods. Therefore, daily consumption of sea grasses and vegetables is necessary. That is, by the way, a normal feature of a typical Japanese diet, which has large amount of sea products. It can be noted that Japanese people are probably the healthiest western nation. • Consumption of commercially extracted oils (e.g., sunflower, canola, etc.) These unsaturated oils have double carbon bonds, which are not stable. When the extraction takes place at cold temperatures and the oils are kept in glass containers, the chemical composition will not be very different from the original states. For this reason cold-pressed oils are better. However, many commercial oils can react and do react, in modern food factories with other substances due to high extraction temperatures, long storage time and due to storage in plastic containers. Usually, the reaction takes place with O2. That causes formation of rancid or toxic substances and free radicals. These new chemicals are foreign for the human organism and their elimination from the blood can become the real burden or the main task of the immune system and eliminative organs. As a result, the work of body self-repair can be seriously hampered. Therefore, the general situation here can be the same as that with focal infections or bacteraemia when the CP cannot be raised and health cannot be improved unless the outer or inner toxic sources are eliminated. If these oils are hydrogenated (another "achievement" of industrialization), double carbon bonds are transformed due to attachment of additional hydrogen atoms. These new oils are more stable since they are fully or

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partially saturated. This is the reason why saturated oils are usually harder, while unsaturated oils are often liquids. However, hydrogenated oils have never been a part of our diet. It is quite possible, therefore, that the human organism may have difficulties with the metabolism of these new chemicals. A better way to solve these problems is to consume oils which are saturated in their original or natural states. Coconut oil and butter are such examples. Since these oils are saturated, they are easier to digest and are among the least burdensome for the liver. Many nutritionists agree that cold-pressed oils (hemp, flaxseed, olive, etc.), in moderate amounts, are also safe to use. Moreover, when the health is impaired, sufficient supplementation with essential fatty acids is necessary. Meanwhile, some health professionals (e.g., Dr. Fuhrman and Dr. Norman Walker) do not advise any extracted oils at all. Indeed, consumption of fresh seeds (especially hemp and flaxseed/ linseed), nuts, and vegetables is the most natural method of providing the body with EFAs. • Use of microwaves Microwave treatment causes formation of various oxidants and other abnormal substances. Indeed, the commercially used microwaves influence (resonate) O-H and C-H chemical bonds. The frequencies chosen in microwaves are intended to resonate the O-H bonds in water molecules. However, C-H bonds also respond to these frequencies (due to chemical similarity). That is the reason why water and fats are quickly heated in microwave ovens. Meanwhile, O-H and C-H bonds are normally present in virtually all organic substances. Therefore, it is normal to expect that some complex organic molecules can be broken into new chemicals. These new chemicals can be foreign or toxic for the human organism. They can also be unstable, reacting with other substances and forming harmful free radicals. Their consumption can lead to the permanent pre-cancerous (or cancerous) state. The reserves of the organism, in this case, will be again targeted to eliminate these substances, not to make the body cleaner and healthier. Note that, although there are many studies regarding microwaved foods, they are not conclusive. That is normal since the researchers use different microwave sources, different foods with different moisture and fat distribution, while measuring different radiation effects (destruction of nutrients and formation of toxic substances). • The concept of defensive eating Russian doctors found that when the CP of patients got larger, their food choices and dietary habits improved. Overweight patients, due to normalization of their hormonal profile, lost weight, while too thin people gained it. However, overeating still can be a problem, when the CP is, for example, 30-40 s. Why? Nutrition as a science appeared just a few decades ago, and there are many valuable books and articles in this area. People are now more educated and know about the usefulness of various recently discovered nutrients and chemicals. Paradoxically, that may lead to the following problem. A person, after extensive education in the science of nutrition, may feel that he/she did not get enough of certain useful chemicals (e.g., vitamins, phytochemicals, proteins, fats, etc.). Practically, this person, after some eating, would get signs of satisfaction (or distraction), and it would be a good time then to get busy with life’s problems. However, at that moment the person may think, “I need to eat this steak for its protein content and protein is good for my immune system, muscles, better hormonal balance, etc.” or “I should eat this banana. It will provide me with more potassium and energy” (to lie on the couch) or “This fish has good omega fats” (to be deposited in known places). So, he/she may proceed with these ideas. Is it healthy? Normally, many wild omnivorous animals stop eating as soon as they can be distracted by other stimuli. That often happens before they feel satisfied. Otherwise, overeating would be a serious disadvantage for survival (could such an animal be an efficient runner or fighter in cases of emergency?). Hence, the ideas and choices given above (“I need to eat this ... and I will!”) are seemingly rational, but in this case they represent conscious over-riding of natural instincts. Such an attitude can be described as “aggressive eating”. Analysing wild omnivorous animals and healthy humans, one may realize that they practice “defensive eating” or eating in order to function well in other areas. In this respect it was noted by many nutritional professionals that the effects of many (probably all) useful chemicals is stronger in conditions of under-eating and the required doses can be much smaller in comparison with traditionally accepted amounts. Moreover, dozens of professional studies revealed that restricted eating is a very powerful method to prevent aging and the development of diseases associated with aging. Hence, while absorbing nutrition-related information, it would be sensible to keep in mind that under-eating many foods is probably better then over-eating them. That is especially true for foods with animal proteins and large amounts of calories. However, it is reasonable, especially when the health is impaired, to be concerned about essential nutrients,

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micro-minerals and fibre. Moreover, some people may get stressed thinking that they have certain nutritional deficiencies. In this case raw greens, seaweeds, most vegetables, and supplements can be used, provided that they do not contain too many calories. Hence, supplements can help to normalize breathing in the psychological sense due to reduced stress and decreased amounts of consumed calories. In practical terms, it would be sensible to observe or to monitor one’s own emotions and inspect them with the following questions: - Am I really hungry before meals? (Real hunger, as many health professionals correctly found, is felt at the back at the throat, while many people follow the rumbles of their stomach. However, these rumbles rather reflect chronic inflammation of the lining of the stomach. That indicates a presence of focal infection that needs special attention.) - Can I get distracted at the end of the meal? - Do I, instead of following this natural sign (distraction), continue eating due to thoughts about the necessity of certain nutrients? Or thoughts about finishing the plate? - Do I stop eating as soon as I start to think about my next activities? Generally, these questions can help a person to find out which type of eating he or she practices (aggressive or defensive, Do I eat in order to live or live in order to eat?)

9.5 Heat/cold adaptation The breathing exercises improve the oxygenation of tissues, blood supply to extremities, and elimination of unwanted substances from these areas. That causes a feeling of warmth in hands and feet. Normally, Buteyko students and patients start to wear fewer clothes and feel more comfortable in a colder environment. Fear in respect to cold disappears. These changes can take place after the first breathing sessions, but they are usually distinctively perceived after the first cleansing reaction or when the CP increases 2-3 times (p.50-51, Souliagin, 1991a). Due to his investigations and work with patients, Doctor Buteyko developed a system of thermo-adaptive activities that were helpful for breathing normalization and CP rising. Most of them were described in the article written by Souliagin (1991a) and in Buteyko's public lectures. These sources of information, together with relevant Western studies, are reviewed in this section. Let me consider, first, how these practical actions can be applied by Buteyko students with different degrees of health problems. • Severely sick patients (less than 10 s CP) Warm showers should not be longer than 2-3 minutes, but can be taken several times per day. They were found to be particularly useful during the cleansing reactions. Breathing cold air outdoors for long times, while being warmly dressed, is also encouraged. Western studies about the beneficial effects of breathing cold air were quoted in the previous section. Contrast stimulation of feet and hands using cold and warm water alterations is another safe method. Western investigations of patients with Raynaud's disease revealed improved circulation in extremities due to use of water with alternative (warm/cold) temperatures. In the study quoted below alternative stimulation of the feet improved circulation in the hands. “Patients with vibration syndrome, suffering from Raynaud's phenomenon, are sensitive to cold. Rewarming time, after local cooling, is delayed. The present study evaluated whether rewarming of the hand after cooling is influenced by the temperature of the feet. In five Japanese patients (former forest workers) with vibration syndrome, suffering from Raynaud's phenomenon, and in five healthy controls, temperature changes of the hand after cooling were registered under the two test situations (on different days) with the feet immersed in water of 35 degrees C or 20 degrees C, respectively. In both patients and controls (in both groups, in four of five cases) rewarming of the hand after cooling was faster when the feet were immersed in cold water, compared with when the feet were immersed in warm water. In this test situation, the systemic thermoregulative counterreaction appears to be more important for rewarming of the hand after cooling than a possible synchronous passive reaction accompanying warming of the feet. A deliberate training of the systemic counterreaction may prove beneficial for patients with Raynaud's phenomenon” (abstract, Falkenbach et al, 1997). Increased blood supply to extremities was also reported by Chang (1976) who found immersion in 10 degrees C water to be effective. Another study about “the effects of alternating cold and hot water therapy on walking ability and systolic blood pressure in claudicants” found that “ Showering the legs of claudicants improved walking ability and blood pressure which remained up to 1-year later. This therapy might be an additional alternative to conservative treatment of intermittent claudication” (abstract, Elmstahl et al, 1995). Probably, reduced pain and improved ability to walk in

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these patients were the results of normalization of circulation. • Sick patients (over 10-15 s CP) In addition to previous activities, cold air baths (being outdoors with minimum clothes or with bare arms and feet) should be accompanied by personal comfort. Overcooling and excessive shivering should be prevented. Contrast showers should be also regulated, in relation to their duration and water temperature variations, in accordance with the personal well-being during and after the procedure. It is said that “a cold air bath has one ardent champion- Benjamin Franklin. He got up at night, removed his clothes and sat silent and still for five minutes with all the windows open. He thought cold air baths were even superior to cold water baths, especially for the prevention of cold and cough. Persons of nervous temperament will find cold air baths very beneficial” (From “Bath and health” by M. Seetharam & MRL Rao). As a next step, one can rub water into exposed body parts, while taking air baths. • Patients in stable conditions (20-25 s CP) Pouring cold water over oneself (especially outdoors) can be preceded by short physical exercise and warm shower douche. Cold shower is a good alternative to this method. With time and increased tolerance, cold water douche outdoors can be considered as a final goal of this program (Souliagin, 1991a). A German study found positive effects of such body hardening on certain blood parameters. “Whole-body cold stimuli lead to a dosage-depended decrease of uric acid level in blood plasma. This could be observed in own studies on winter-swimming and cold shower application and in studies on patients treated by cold-chamber-therapy. This uric acid decrease is due to an accelerated oxygen radical formation during cold exposition rather than to an inhibition of purine metabolism. The acute oxidative loading due to cold exposure and the long-term antioxidative adaptation may be interpreted as a new molecular mechanism resulting in body hardening” (Brenke et al, 1994). Sauna, according to Souliagin (1991a), can be safely used by people, who can jog or take a brisk walk for 3 km, because their physiological effects are similar. Severely sick people (less than 10-15 s CP) often have adverse reaction to sauna. When the CP is over 20 s, the physiological response is positive. However, these findings relate to the normal sauna procedures which are indeed physiologically demanding. For asthmatics, during the cleansing reaction, the duration and intensity of sauna should be adjusted to the personal health. Sauna should be short and light at such times. Later, when health is better, the normal procedure becomes possible. Similar opinion about personal regulation of sauna can be found in, for example, a review by Kauppinen “Facts and fables about sauna”. “In summary, sauna baths are well tolerated and pose no risk to healthy people from infancy to old age, including healthy women in their uncomplicated pregnancy. The normal sauna bath, with moderate cool-off phases, increases the cardiac work load about as much as a brisk walk. It has been well established that the sauna bath, no matter what the cool-off type, does not pose any circulatory risk to healthy people. Cardiovascular patients with essential hypertension, coronary heart disease or past myocardial infarction, who are stable and relatively asymptomatic in their everyday life may also take sauna baths without undue risk. As a rule of thumb, if a person can walk into a sauna, he or she can walk out of it. Misuse and abuse of the sauna are another matter” (abstract, Kauppinen, 1997). Many other investigations have similar conclusions about use of saunas. Let us look now at other effects reported in Western physiological studies on human adaptation due to repetitive or continuous cold and hot stress. While measurements of respiratory parameters have been done only in a few investigations, the reduction in pulse with repetitive heat and cold exposures is a typical feature found in adapted subjects (e.g., Keatinge & Evans, 1961; Frisancho, 1993). It can happen that even subjects with initially low etCO2 (about 36.5 mm Hg) can have an increase in their CO2 stores after several minutes spent in 15 degrees C water (p.85, Keatinge & Evans, 1961). Moreover, “the men usually found the eighth immersion more pleasant then the first, they appeared to shiver less during it and their metabolic rates and pulmonary ventilation were lower in their eighth then their first immersion” (p.93, Keatinge & Evans, 1961). Thus, the positive effects of the repetitive cold stress became stronger in time. Different studies found greatly increased breathing during the first seconds of water immersions (both, cold and hot) and cold water showers (e.g., Keatinge & Evans, 1961, Goode et al, 1975). However, as it was noticed by Goode and colleagues, “the results in subject 101 suggest the drive to inspire on the first few breaths can be partially overridden by consciously controlling the breathing pattern. The technique will minimize the fall in alveolar CO2”

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(p.310, Goode et al, 1975). This phenomenon of over-breathing due to sudden temperature variations deserves special attention. According to the textbook "Physiology of heat regulation and the science of clothing" (ed. by L. H. Newburg), a rapidly rising temperature reduces CO2 tension due to slow deep breathing (p.123, Bazett, 1968). During the nervous reaction to cold, increased sympathetic activity leads to elevated adrenalin level also causing hyperventilation (p.126, Bazett, 1968). But gradual exposure to cold leads to an increase in the alveolar CO2 tension (p.126, Bazett, 1968). Doctor Buteyko advises, for example, when taking a cold bath or a shower, gradual immersion, starting from the feet. Spending about 7-10 s while watering the feet, one would feel that the organism has already partially adjusted to the new temperature. Now one can go up to the knees (again about 5-10 s), then the hands can be watered, etc. This procedure prevents thermal and nervous shock (which happens when cold exposure is sudden) and should cause natural breath holding. (However, with growing experience the immersion can be done much faster due to personal adaptation.) Such Buteyko advice (about importance of gradual water immersion) is based on real life situations, like outdoor swimming. Some people jump or run into water very quickly and, if they stop, it is possible to see that they breathe hard and sometimes produce sounds indicating hyperventilation. Other people, first, reach some depth gradually (holding their breath) and then suddenly immerse themselves into water. They also breathe heavier. Finally, there are people who go very slowly, wait for a while, then pour some water on their arms, wait again, water their chests, faces etc. They are usually silent and hold their breath. Why? This phenomenon probably has strong evolutional connections. Sudden exposure to cold water could take place, in real lives of our ancestors, in cases of fight-flight-hunting-fishing. For all these situations (just imagine them), skeletal muscles could benefit from extra blood supply, while the physiological changes due to the sympathetic stress could also prepare other body organs for hard physical work. Gradual cooling could take place in other, more peaceful situations, like river-crossing. Here warming of extremities and extra blood to the brain, in order to be more alert but not excited or anxious, and internal organs would be beneficial. One should also keep in mind the influence of clothes and surrounding air temperature on breathing discussed in chapter 3. Wearing even light winter clothes or excessively warm clothes indoors has nearly the same effect on the organism as several degrees increase in air temperature or a several second decrease in the CP. At the same time, for people with a 25-30 s CP, feeling slightly cold (without excessive shivering) during the day and prevention of overheating at nights have a beneficial effect on breathing. During and after all these activities the patients and students should experience feelings of comfort, energy and improved well-being and breathing. That indicates good adaptation of the human organism to these natural challenges. Excessive degree of thermal stress, either due to its duration and/or intensity, leads to shorter CPs, higher pulse, and weakness (Souliagin, 1991a). Finally, in my view, it is important to understand the basic mechanism and sense of thermoregulatory activities. Most of them are directed to cold adaptation. At the same time, both acute and moderate chronic cold exposures normally cause vasoconstrictive effects and lower temperatures on the surface of the human body. As a result, more blood is delivered to internal organs (provided that there is no over-breathing). Such cold exposures produce the effects that are opposite to stress since stress diverts blood from internal organs to large skeletal muscles including arms and legs. Although cold exposure is often considered as stress too, as we can see here, correct thermoregulatory exercises are effective methods to improve relaxation, well-being, breathing, and health.

_______ Summary of rules and requirements for taking cold shower: 1. Over 20 s current CP and good well being. 2. Start with warming up bones and deeper body tissues with warm water , if they got cold after prolonged cold exposure. 3. Very gradually change water temperature from warm to cold (or apply cold water to various body parts in sequence) so that transition to cold is very gradual. 4. Apply cold shower for about 30-60 s. 5. If you use contrast shower (cold-warm-cold-warm…), always finish with cold water.

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9.6 Development of correct speaking skills The recommendations regarding correct speaking skills can be divided into 4 groups. • Technical skills As Doctor Buteyko teaches, one should start a phrase without a deep inhalation, but at the end of on exhalation. Indeed, when the lungs are inflated with large amounts of air, this air will be quickly blown off due to greatly reduced resistance to air flow since the mouth is open. Large pressure differences (inside lungs and in outer space) and small resistance to air flow produce hyperventilation. When the lungs have little or no extra air inside, as after exhalation, the pressure difference is smaller or absent. Therefore, one should even apply additional force in order to speak. Due to natural economy of the human organism, this activity is accompanied by minimum energy spending. Ventilation, in this case, is going to be minimal and the volume of air per syllable small (this parameter was considered to be important by the study quoted in chapter 3.6). Practice also shows that hyperventilation during speaking is often accompanied by a high pitch voice and extended syllables. Hence, deliberate attempts to keep the voice low and quiet and syllables short can be helpful in better breathing control. • Emotional and psychological components Speakers, apart from transference of objective information, also produce an emotional impact on their listeners. For some speakers these effects are too important or too strong. The speeches can become compassionate, pleasing, intimidating, indignant, etc., promoting strong emotions in the listeners. One of the effects of such speeches is transmission of strong emotions (and, hence, hyperventilation) from the speaker to listeners. When the speaker is interested in sharing objective information, finding mutually acceptable solutions of problems, and producing cooperation with the listener(s), his speech would be less emotional. That would also cause rational responses in the listener(s), who could be more inclined to cooperate and find solutions with the speaker. Both sides can be characterized, in such cases, by normo-ventilation. This effect is normal, as you may remember, for active coping strategies (chapter 3). Therefore, if before speaking, the person tries to analyze the concerns of his listener(s) and possible points of interest in order to establish cooperation, both, the speaker and his listener(s), are going to benefit from better breathing during such healthy communication. Similarly, during the speech, conversation, or meeting, the speaker’s attempt or desire to analyze the possible impact produced on the listener(s), is important for normal breathing and health of both sides. • Relaxation Hyperventilating speakers, in addition to the above-mentioned qualities, often have tension in the chestshoulders-neck-jaw muscles. It can be that their perception of imminent stress produces muscular tension and hormonal rush resulting in hyperventilation and muscular tension during speaking. Whatever the mechanism, periodic conscious control of this muscular group can reduce its possible tension and total ventilation. It can be done by short deliberate tensing and immediate relaxation of these muscles or by light massage. Such activities can be done easily before the speeches while later they may not always be socially acceptable. Meanwhile, gentle bending of the head in different directions, turning it left and right, and its gentle rotations are frequently used and are usually normally tolerated by others. Relaxation is impossible without a proper posture during speaking. That especially relates to the position of the head, which is unfortunately often stretched forward in many people. Periodic control of the head’s position, position of shoulders, spine, and other body parts and their relaxation/tension characteristics is another useful idea for better breathing. • Breath holding and reduced breathing These activities can be done during possible breaks in speeches. The effect of breath holds for experienced students can be significant due to conditioning of the nervous system to reduced ventilation and relaxation to this stimulus. Indeed, during previous breathing sessions breath holds were followed hundreds of times by relaxation and reduced breathing. Normally, such response should also work, as a result of conditioning, during the breaks in speaking. • Pulse hyperventilation test Can a person check his or her speaking skills? Is the CP, for example, shorter after 10 or 20 min of continuous speaking with relative hyperventilation? During the initial stage, acute hyperventilation reduces aCO2, while the breathing centre remains unaffected. According to section 2.3, a longer time, during breath holding, would be required in order for aCO2 to reach the

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threshold established by the breathing centre. Hence, the greater the degree of acute hyperventilation, the longer the BHT. For example, after about 10 min of speaking, with hyperventilation, the breathing centre will be in the process of gradually resetting its aCO2 threshold to lower values. At that moment current aCO2, due to continuing hyperventilation, will be low. Hence, BHT is going to be larger than the CP defined by the usual aCO2 content. In about 30 min, as we learned in Chapter 4, brain CO2 concentration will be nearly the same as aCO2, but aCO2 in the blood is still at the lower end of values admissible by the breathing centre. It is probable that it will take many hours before the breathing centre completely readjusts to a new ventilation rate and concentrations of electrolytes stabilize (values up to 6-24 hours are cited in certain studies). Meanwhile, the cardiovascular system reacts to hyperventilation almost immediately with an increased pulse. Hence, checking the pulse is an effective method to evaluate the presence and degree of acute hyperventilation. This reaction is individual, although, on average, the pulse is increased by 25-30% due to strong acute hyperventilation. It should be kept in mind that when acute hyperventilation is stopped, the pulse quickly slows down. Hence, the duration of pulse measurement should not be long (e.g., 10 or 15 s is usually enough). If the pulse increases 10% or more when one is speaking, that should be considered as an indication of existing acute hyperventilation.

9.7 Prevention of hyperventilation conditioned to favourite activities Section 3.4 shortly described those situations when people deliberately use deep breathing during different activities, like sports, arts, singing, dancing, praying, etc. The presence and degree of hyperventilation for such activities can also be noted using the pulse hyperventilation test. Also, drying of nasal passages is another useful tool. With increasing skills in breathing control (that usually takes months of breathing exercises), most people are sensitive enough to feel that there is too much air going in and out. In spite of such experience, it can still be difficult to change the acquired pattern of increased ventilation due to concentration on a much-loved and dear activity. The most radical and sure solution is to take a long break (e.g., 1-2 months), concentrate on the breathing exercises and breathing control, and gradually resume the activity later, starting with the basics because of the possibility of losing constant breathing control when the performance is technically difficult. Within the following several weeks the person would be able to achieve his/her previous level of skills, but with new eyes. Abilities to see one’s own hidden reserves, fine details in unexpected places, intrinsic harmony, ease and enjoyment in training and performance would be the expected characteristics of the normally breathing person. This is, in my view, an optimum approach when short term goals are sacrificed, but the final outcome (e.g., in 1-2 years) is of superior importance. If the connection between the activity and hyperventilation is not very strong, it may be suggested to the person to relearn the easiest elements of the activity while doing RB (reduced breathing). If this is possible (by the way, real masters are always capable of very slow execution of whatever they professionally do), it can be proposed to spend more time on the breathing exercises leaving the activity alone. If RB during the easiest elements of the activity is possible, some days can be spent while doing that. Later, one can gradually increase technical demands and speed of execution. This approach is the same as a second half of the radical one. In both cases, breathing has priority over the activity, since in the long run, not only personal health, but also new acquired skills and future depend, to the large extent, on breathing normalization.

_______ 9.8 A typical long session of the Buteyko breathing with light intensity

The initial conditions for long sessions are the same as for short ones (empty stomach, hydration, posture, thermoregulation, etc.). Measure and record your initial pulse during 30 or 60 s (for accuracy). (The significance of pulse dynamic will be clear from the material of this chapter.) After pulse measurement, write the number in your daily log. Measure and write down your CP and immediately start the RB (reduced breathing) with light air hunger (if you suffer from cardiovascular problems, panic attacks, migraines, etc., you need to have a different structure of the session as previously described.) Continue the RB for 4 minutes. All the time you should use your stomach (or diaphragm) for breathing and relaxed and slow exhalations. After 4 min of the RB, repeat the whole cycle (CP + SB) again and again. As a result, you will get the following sequence of your actions: Pulse measurement - CP - 4 min RB - CP - 4 min RB – CP - 4 min RB - CP - . . . . . Practice this pattern for about 30 minutes and measure your final pulse after your last CP. It may happen that 2-nd and 3-rd CPs can be smaller than your initial CP. However, for the following 195


measurements, the CP normally gets larger than the initial value. The session should be discontinued when the CP is near its maximum. For this type of session (light air hunger) it usually takes about 30-35 minutes. After that, due to fatigue, the CP sharply falls below the initial value. That will be a definite sign to rest and measure your pulse again. With practice and experience, you will be able to predict when to finish before your nervous system gets too tired. This was a description of the training session with light intensity. Such exercises became most popular among Russian doctors during 1980s. The feeling of air hunger here is light. It is about the same as at the end of the CP. More intensive breathing exercises are considered below.

9.9 What to expect and goal setting Apart from the previously discussed symptoms (warm hands and feet, colder and moister nasal passages, etc.), during the second half of the session this effect is normally accompanied by tranquillity, serenity, and better relaxation. Sometimes, it usually happens that 2-nd and 3-rd CPs is smaller than the initial CP value. Why? This phenomenon reflects reduced ventilation. You accumulated additional carbon dioxide in your blood before measuring 2-nd CP. Therefore, less time during 2-nd breath holding is required to achieve the aCO2 tolerance threshold set by the breathing centre. Generally, the higher the training intensity, the lower the 2-nd and 3-rd pauses. Too large a drop in pauses (e.g., 40-50%) is indicative of excessively intensive sessions, which can cause problems with breathing control between pauses and increasing tension. Typical CP reductions for light sessions (for 2-nd and 3-rd CP measurements) are about 15-30%. Meanwhile, 4-th and subsequent CP measurements usually produce larger, than initial CP values. Why? This effect can be explained by the fact that in 10-12 minutes increased aCO2 concentrations in the blood penetrate blood brain barrier (that was discussed in details in chapter 4). This penetration resets the main part of the breathing centre (central chemoreceptors), located in the middle of the brain. In its turn, resetting of the breathing centre is the direct and main goal of the training session. The dynamic of the CP during a single breathing session depends on many parameters, including its intensity, degree of relaxation, thoughts pattern (or attitude), biochemical composition of the blood and cerebro-spinal fluid, current alkaline reserves (to counterbalance pH decrease due to larger CO2 concentrations), presence and composition of food in the GI tract, concentrations of different hormones and waste products in the blood and other tissues and organs, etc. However, at the end of the session the final CP should be about 25-40% greater, than the initial one. How long should you train and why? The duration of CO2 influence should be long enough to produce a considerable impact on the breathing centre (especially those parts which are located in the brain), but not too long to cause excessive fatigue. Such fatigue can generate stress causing and after-session over-breathing and reduce your trainability during the following training sessions. The situation here is similar to physical exercise for healthy people. One can train long enough, but not too long in order to recover soon. Practice indicates that the optimum length of the sessions with light intensity is about 30 minutes. If you train longer, your CP will become smaller than the initial CP indicating mental fatigue and you will over-breathe. It is necessary to stop the session before your CP starts to decrease or as soon as it happens. Too long sessions can over-excite some parts of the nervous system preventing recovery and producing general stress in the organism. The higher the intensity of the session, the sooner the fatigue. Therefore, it is ineffective to go beyond this point. It is better, if one wants to train more, to have another breathing session after 1-1.5 hour break. Usually, novices perform 2-4 breathing sessions per day spending in total 1-2 hours for breathing normalization. However, these values are individual. Severely sick patients may need much more time on breathing normalization (fortunately they usually have this time and are often willing to do that). Thus, severely sick patients and students are encouraged to do these breathing exercises every 1-1.5 hours, in addition to constant breathing control. Later, the control of breathing becomes semi-automatic and less time is required for formal sessions, since exercises can be done in other, more difficult conditions. Measurements of pulse and CPs should be recorded in order to reveal the CP dynamic and individual factors, which hinder breathing normalization. A daily log for that purpose is very useful.

_______ 9.10 Imagery and visualization

When being involved in any long-term activity where a psychological component is important, imagery and 196


visualization are powerful tools for successful goal achievements. Currently, well over half of professional athletes use such methods during their training and sport contests. In some technically-demanding sport disciplines, the rate of users is over 90%. Numerous physiological studies revealed strong practical effects of these methods. Several theories, which explain the detailed mechanisms why imagery and visualization work, were created and are currently tested. In section 8.4 you probably noticed some elements of imagery and visualization in order to have better relaxation. However, more can be done in order apply these methods to, for example, goal setting and a formal session. When having different ailments and health problems, from light to severe, it is not correct to blame your respiration and the breathing centre for such a state of affairs. Your breathing centre has always been an obedient and restless servant of your organism, reacting to environmental and inner physiological changes. Thus, he is your friend in the task of eliminating abnormal states, damages, pathologies and other currently existing health problems. A session of Buteyko breathing can be imagined as a gentle dialogue with your currently sick, old friend (whose pitiful state has been caused by your unwilling and unknowing contribution). What you are trying to do now is to give him a support and help for improvement. You should be consistent, considerate and respectful in your actions in relation to him. Remember, every time he can improve, but only a little. If you overdo or press too hard, he can hide or even violently rebel. The trust and foundation for further growth could be temporarily lost. Forget him for a while, and he may get worse. But once he is better, his generous rewards may come unexpectedly. More specific dialogue is possible during a single breathing session, for example, to ensure relaxation. Feeling of air hunger, due to raised aCO2, calms many brain areas, but excites the breathing centre, which sends impulses to different respiratory muscles in order to restore previously existing homeostasis. Therefore, your old friend wants to preserve peace and order in his kingdom by breathing more. (Note that hyperventilation, in general, is a result of unnatural conditions of modern man. Therefore, the breathing centre simply adjusts to these modern life conditions). It is normal to have a desire to resist chest expansion by tensing, as mentioned above, the opposite muscles. But that is a struggle, not a dialogue. Instead, when sensing these chest-expanding impulses, calmly and resolutely respond to your old friend, “Relax, these muscles are not for breathing now”, while simultaneously visualising that your upper chest or the whole body is like a large piece of dough, an under-inflated balloon, or a jelly-fish floating in the ocean. Whatever image you choose, it should be specific, vivid and bright. Practical studies found that imagery and visualizations are especially effective when the person can see mental images in colour and see himself as if using own eyes, not from outside. During breath holding, you can imagine, with closed eyes, that you return to our evolutionary original environment Water, the cradle of Life, and dive. Your body gets relaxed and cleaned. All worries are behind. You are safe here. Relaxing the diaphragm is another already discussed challenge. Here, again, the breathing centre, disturbed by large aCO2, periodically sends messages to intensify breathing. Depending on the desirable intensity of this particular session, some messages, when breath holds are done, are counteracted by immediate responses to relax with clear and vivid body images. For other messages, you can yield, but not much. You may tell to your temporarily distressed friend, “OK, just a little air in, but we are going to breathe less now for our future benefits”.

9.11 Measurements of pulse and its significance

_______ Checking the patient's pulse has been for centuries a good tradition of most medical doctors in order to check the general state of a patient's health. For most sick people, lowered pulse values usually reflect health improvements. Does aCO2 participate in pulse regulation and to what extent? For Yale University Professor Yandell Henderson, who performed experiments with anaesthetized dogs on mechanical ventilation and who wrote several articles on this subject, the answer was literally in his hands. For example, in the publication "Acapnia and shock. - I. Carbon dioxide as a factor in the regulation of the heart rate", he stated, "... we were enabled to regulate the heart to any desired rate from 40 or fewer up to 200 or more beats per minute. The method was very simple. It depended on the manipulation of the hand bellows with which artificial respiration was administered... As the pulmonary ventilation increased or diminished the heart rate was correspondingly accelerated or retarded" (p.127, Henderson, 1908). Practical measurements done by Doctor Buteyko during the 1960’s showed that, for example, 5 s CP in his patients usually corresponded to the heart rate, while sitting, of about 100 beats/min, 10 s to 90 beats/min. For ideal health (60 s CP), the typical pulse was about 62 beats/min. It should be noted, however, that during this time Doctor Buteyko worked with sick and severely sick patients who often had years of medications. Furthermore, most of his patients had asthma or cardiovascular problems. The pulse of these groups of people is normally elevated. Therefore, it 197


is possible that some people can have low CPs (e.g., 10-20 s) and nearly normal pulse (about 60-70 beats/min). That usually reflects their better cardiovascular health. Why are pulse measurements important? In some practical situations, as we are going to see later, pulse measurements can be more informative than CPs. In addition, in rare cases when pauses are problematic, gentle RB without pauses, but with pulse checking is a good alternative to the already described standard Buteyko sessions. From personal experiences it is known, that, with growing mastery of breathing regulation, many people prefer continuous control of respiration with RB and without any breath holds. The pulse, in such situations, is a measure of breathing. Finally, as some nutritional professionals found, a pulse test is a useful method for revealing food allergies (see below). Practice of Buteyko practitioners found that pulse measurements is an excellent additional tool to measure the efficiency of the breathing sessions. Because of all these reasons it was suggested above to check your pulse (for 30 or 60 s for accuracy) before the first and after the last CP measurements. Normally, the long session of breathing exercises should reduce your resting pulse by about 5-7 beats per minute.

9.12 Possible intensities and durations of the breathing sessions The manual written by Doctor Buteyko proposes three possible intensities of breathing exercises (Buteyko, 1991): 1. Light intensity, when the session is done with a slight air hunger and 30-35 min duration. For this whole session the experienced sense of air shortage is about the same as at the end of the CP. 2. Medium intensity, when the session is done with a moderate air hunger and 20-30 min duration. 3. High intensity, when the session is done with a strong air hunger and 15-20 min duration. Here, the sense of air shortage is the same as at the end of the MP. It is normal to expect that when patients and students measure pauses and then do reduced or shallow breathing, the intensity of this shallow breathing (how much less air they breathe) is proportional to the difficulty of the pause. For example, after performing the MP, the student normally continues to have strong air hunger during the RB. Hence, breath holds usually set up the intensity of the breathing session. Therefore, the following discussion can be considered as a continuation of the past sections which discussed advantages and disadvantages of different pauses. During the 1988 Moscow conference of medical doctors practicing the method in Russia, Doctor Buteyko commented on the effectiveness of different intensities. He said that which session was the best would be revealed in the future. This question (about optimum intensity of breathing exercises and use of different pauses) has been debated for years among Western Buteyko practitioners. However, for some students (discussed before), strong air hunger created by MPs and use of MPs or sudden changes in the gas composition in the lungs can be dangerous. Even the effect of a CP with its slight air hunger can sometimes be too strong, while gentle reduction in breathing or just relaxation of breathing muscles is safe. At the same time, many practitioners and students found that in some people MPs and high intensity sessions are more effective in breathing normalization. A clear advantage of such sessions is a time economy. Due to the effectiveness of different sessions on the breathing centre, the final results are probably similar, since light sessions are longer in time, while high intensity sessions have larger average aCO2 values. In all cases the duration of sessions is defined by the fatigue developed in the breathing centre and the nervous system. In my view, it is not the type of the breathing session, but final relaxation, which is the most important parameter defining the effect of any particular session. This final relaxation is reflected in the after-session pulse, larger CP and greatly reduced, in some cases to stillness, breathing. Therefore, almost the same practical suggestions, as in section 6.6, can be provided. You are likely to benefit from the sessions with high intensities, if you: - do not have any of the acute problems described in section 6.4; - are able to relax while performing long pauses; - feel comfortable while doing long pauses and having strong air hunger; - have complete breathing control after such pauses and shallow breathing; - feel that these pauses and strong air hunger create a stronger overall impact on your relaxation and general well-being at the end and after the exercises. The AMPs (absolute maximum pauses) are not mentioned in the Buteyko manual. The breathing control, during the initial stages of breathing retraining, after such pauses is very difficult or even impossible. Normally, such pauses result in gulping for air and carbon dioxide losses later. Therefore, these pauses for novices have superficial

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meaning by producing large numbers. However, for experienced Buteyko students, MPs and AMPs can save a lot of time, since very long breath holds can, in some people, produce permanent or sustained changes in breathing regulation, without any air gulping and carbon dioxide losses immediately after such pauses since the body learns, after hours of the RB, that breath holds are safe and relaxing experiences. As it was described in Russian sources, some people were able to experience a kind of click at the end of very long breath holds. Such pauses require willpower. After this click, oxygen drive is suppressed, and breathing is regulated by carbon dioxide (as it should be in very healthy people). Control of breathing becomes very easy. In my view, those students who mastered the exercises and who have no contraindications should try longer pauses in order to experience this effect. While very few people are able to achieve the permanent changes described above, many students can have strong temporary effects of a similar nature. At the same time, novices have serious problems with breathing control after AMPs and very long breath holds. The organism should be conditioned first to relaxation, and that takes weeks of practice, before one can proceed to safe uses of long pauses. Let us review which intensities and pauses are favoured by different Buteyko doctors. Doctor Buteyko’s colleague, Dr. Souliagin suggested, "Often sessions are conducted for 40 minutes without a break. But you shall not forget that longer than 30 minutes sessions make the patient tired and their parameters go down" (Souliagin, 1991). Also, another of his findings is that "patients allow themselves to overdo pauses which leads to the deepening of breath and also they do not stick to 3-5 minutes intervals between pauses" (Souliagin, 1991c). He obviously favoured the standard long classical light sessions described above. Australian Buteyko practitioner James Hooper advises 10 min intervals of RB between CP measurements (p. 44-45, Hooper, 1998). According to Doctor Buteyko, the CP should be the useful measuring tool, while sustained relaxed efforts to reduce ventilation are more important than any pauses. Pauses help novices to experience air hunger. Since this sensation is new for most people, during the initial stages pauses are useful as educational experiences. Besides, with growing mastery and conditioning of the nervous system the following important phenomenon is to take place. In normal people (who have not practiced the Buteyko method) breath holds often produce anxiety and stress (as in longer pauses) due to messages sent to the respiratory muscles. However, when the person mastered the Buteyko method, his nervous system learns that these breathing exercises eventually lead to relaxation and other positive effects of physiological normalization due to the carbon dioxide. Therefore, the influence of breath holds and their individual perception both change to the opposite. As a result, just doing the CP or any other pause for an experienced student can neutralize the negative influences of stress, strong emotions and other factors. For these long breathing sessions, 3-5 minute intervals of the RB between the CP measurements are, probably, optimal for beginners. During longer intervals the feeling of air hunger fades and an inexperienced student may be unsure if ventilation is reduced. Shorter than 3-minute intervals of shallow breathing would make breath holds too frequent not allowing the student to concentrate on the main part of breathing exercises, reduced breathing and relaxation. Moreover, continuous semi-automatic reduced breathing can be considered as a final long-term goal (see Level 3). Indeed, it is better to have such continuous shallow breathing rather than the breathing sessions only, since after the sessions the effects of other factors (like meals, speaking, or strong emotions) can decrease the effect of the exercises. At the same time, pauses exert certain pressure on the breathing centre making prolonged shallow breathing and prolonged sessions, as practice shows, more difficult or impossible (due to accumulated fatigue). Why? Let me look at this problem in more detail. Here are the relationships between pauses and optimum durations of sessions: CPs and slight air hunger for light sessions - 30-40 min; EPs (extended pauses) and moderate air hunger for sessions with moderate intensity – 20-30 min; MPs and strong air hunger for intensive sessions – 15-20 min. After any of these sessions 2 hours of rest is suggested, since the student would be very tired if these long sessions are practiced, for example, every hour. Now the question is: how to practice the reduced breathing during the whole day? In all above-mentioned sessions the pauses are measured every 3-5 min. It is normal to expect that you may have longer period of shallow breathing by having less demanding breath holds (easier pauses) or/and by having them less often. For example, an experienced student can have a one-hour light session (constant RB with light air hunger) while measuring the CPs

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only 1 times. Such procedure would not generate fatigue in the breathing centre with the drop in parameters (the CP and pulse). Practice shows that it is possible, as a final goal, to learn how to have slight air hunger, shallow breathing and good relaxation all the time, when you are awake.

Q&A section for Chapter 9 Q: What is the normal CP and MP dynamic during the long breathing session with 3-5 minutes RB between CP measurements? A: Normally, after 12-20 min of exercises the CP and MP values are greater than the initial numbers. As about 2-nd and 3-rd CPs, they may be less than the initial CP value. The Russian Buteyko manual states that the difference between the MP and the CP (the volitional pause) gets smaller for 2-nd and 3-rd measurements. The decrease in this pause is said to be proportional to the reduction in ventilation. For example, if a person breathes twice less air, his 2-nd and 3-rd volitional pauses (after 3-8 min of the exercises) are about twice smaller than the initial volitional pause. Q: Is it correct to say that 2-nd and other following pauses are CPs? The CP should be measured after the rest. A: You are correct, according to our definition 10 min of rest is required in order to measure the CP. However, it is implied in Russian manuals and articles on the Buteyko method that the same abbreviation, as an exception, is used for the training sessions. (The morning CP is also an exception since it is done in the horizontal position.) Q: Sometimes, I probably overdo the long exercises since my last CP gets even smaller. What is wrong and how dangerous are such sessions? A: If your CPs (or other pauses) after 15-20 min of the exercises were essentially greater (e.g., by 20-40%) in comparison with the initial value, your training was right. You breathed less and you reset your breathing centre. Furthermore, your CO2 level at the end of the session can be very close to the CO2 threshold of the breathing centre. Note that this threshold was already reset once during the exercises. As a result, your CP might be small since the difference between your current CP and the new threshold is again small. In this case you are likely to be in the state of breathing suspension (one of the finest effects of the method). That can create a paradoxical situation, when soon after exercises the CP is small or even very small, while the pulse is also small. It is a good “post-training” effect possibly leading to a further increased CO2 threshold (after the session provided that you are not too anxious about your temporarily lowered CP. It is clearly more important to have more CO2). This effect also indicates usefulness of pulse control. It may happen that your after-session pulse is larger than before. In this case, whatever the causes of the low after-session CP and large pulse, these effects should be quietly (with easy breathing and possible relaxation) analysed in order to make reasonable corrections in the future. Tension is probably a frequent trouble-maker in such situations.

_______ Q: I want to do fast walking together with the Buteyko breathing, but my current CP is 15 s. Can I proceed with this idea? A: First of all, this depends on your genetic make-up. If you suffer from cardiovascular problems, panic attacks or migraine headaches, you should not combine fast walking with any breathing reduction when your CP is only 15 s. Second, there is a certain relationship between the optimum posture for the breathing exercises and the current CP. The link between these two is provided by the factor of relaxation. Very sick people (less than 5 s CP), are usually so tense, that they often cannot achieve CP progress, when they do exercises while, for example, sitting on a solid chair. Hence, they often do their sessions while sitting in a bed or in an armchair to ensure proper relaxation. Sick people (10-15 s CP) can either sit in an armchair or a solid chair with or without back support. Should they try to do the Buteyko breathing while, for example, standing, muscular tension may become a serious problem. As a result, it could be difficult or even impossible for them to achieve CP progress. Walking with breathing control would be even more challenging than that. When the CP is above 20 s, the current level of relaxation allows the person to try the breathing exercises in 200


more difficult conditions. The general tendency here is, first, to choose, according to the current CP, a posture, which provides sufficient muscular relaxation. Second, the Buteyko breathing, due to its physiological mechanism, normally produces more relaxation and higher CO2 stores and CPs. Step by step, more difficult (and more natural) conditions, in terms of posture (and surrounding distracting-stressful factors), should be tried. Q: I am confused about amounts of time that I should spend practicing breathing exercises and doing physical activity. What would be the most efficient way, if I have only 2 or 3 hours per day devoted to my health? A: This depends on your health state. The breathing exercises, where reduced breathing is the central component, were invented by Buteyko for severely sick people or patients who were fighting with death (0-10 s CP). These patients could not exercise and even walking with nasal breathing-only was either very difficult or impossible. It made sense that these people spent all available time on reduced breathing with the goal to get more than 10 s CP. When the CP is just over 10 s, walking is possible and physical activity becomes the main assisting factor in restoration of normal breathing. At this stage, if you have only 3 hours per day, you can spend about 2 hours for breathing exercises and 1 hour for physical activity (e.g., walking). When you get closer to 20 s CP (15-18 s), you can give equal share to both activities increasing the intensity of walking. Once the CP is above 20 s, physical activity, with nasal breathing only, becomes the driving force in further CP growth. Out of 3 hours, 2 could be devoted to physical exercise (jogging, cycling, swimming, etc.), and 1 hour on breathing sessions. Q: Which intensity of physical activity is the most efficient for breathing normalization? Let say that I got only 1 or 2 hours per day. How should I exercise? A: The strongest impact on the breathing centre is achieved at the highest possible intensity with breathing only through the nose all the time. Q: Is there any particular physical activity that was recommended by Doctor Buteyko? A: Jogging, according to Buteyko, is useful massage of internal organs. Indeed, this natural activity improves their lymphatic drainage and blood supply. There are other additional benefits of jogging due to shaking or vibrations of the tissues. Likely Buteyko would also encourage trampoline jumping due to similar stimulation and cleansing of internal organs and other tissues. Q: Can I fast for 5-7 days on water without supervision? A: For sick people (who are learning the Buteyko method), cleansing reactions during such fasts are normal. However, these reactions usually cause electrolyte imbalances. Some people may suffer from calcium deficiency, others from potassium, sodium or magnesium deficiency or their combinations. The consequences can be severe and very unpleasant. The symptoms of these deficiencies are different, and, in addition, individual (although some general features given in Appendix 5). Prolonged severe deficiencies can be fatal for humans. That is the reason why fasting professionals do not advise water fasting for more than 2-3 (rarely 5) days. Knowledge of these symptoms and immediate availability of most important electrolytes are necessary for longer fasts.

_______ Q: Are non-essential supplements, like colostrum or bromelain, necessary for breathing normalization? A: Various non-essential supplements (often extracts) with clinically proven properties can indeed, do very useful job for the human organism. This relates to such supplements as, for example, picnogenol (pine bark extract), bromelain, human growth hormone, various lactobacillus cultures, antioxidants, colostrum, and many others. However, the effect of these supplements can be significantly reduced or almost cancelled due to lack of other substances, which we regard as essential. Indeed, primitive diets did not include these supplements, while excellent health and exceptionally high CPs were the norms for our ancestors. Therefore, sufficient supply of the essential substances should be of the first priority. When these physiological deficiencies, together with breathing normalization, are solved, the effects of various supplements can be tested. Q: Is it right that some amino acids reduce ventilation?

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A: Tryptophan (a precursor of serotonin) was found to be a respiratory suppressant (Askanazi et al, 1983). Meanwhile, clinical investigations suggest that amino acid solutions with high content of branched chain amino acids (leucine, isoleucine, and valine are also called stress amino acids) are most effective in order to restore body cell mass. These three amino acids compete with tryptophan for crossing blood-brain barrier and are respiratory stimulants (Takala et al, 1988). Q: How can I practically check possible allergic reactions to animal proteins or other foods and which measures can be useful? A: You can monitor your after-meal pulse dynamics and/or your breathing. One day you may eat, for example, your normal meal with meat, or dairy products, or two eggs. The amount of proteins can vary from, for example, 10 to 30 g. Keep in mind that the rate of meal absorption is a very important parameter. Thus, one day you may try to have the least amount of fats and carbohydrates with this meal choosing, for example, some fruits and non-starchy vegetables in addition to the above-mentioned proteins. That would help quick absorption of nutrients. On another day add liberal amounts of fat (e.g., 2-3 g of fat per each g of protein eaten) and some starches to slow the digestion. Such food combinations spend more time in the stomach allowing better actions of digestive enzymes on protein molecules. (For some people with chronic digestive problems and very high intestinal permeability, the ratio of fat to protein can be as large as 4 or 5 in order to avoid adverse reactions to animal proteins). It is also important to keep in mind that your degree of hunger is extremely important parameter here. Should you be not hungry enough, the quantity of digestive enzymes will be significantly reduced. That will make your digestion less efficient. As a result, the possible allergic reaction will be stronger. This is another reason to follow the advice “eat only when you are really hungry”. Check your pulse in both cases for 30 or 60 s each 20-30 min after the meal for about 2-4 hours. The normal increase in pulse will not be more than 10-12 beats per minute in comparison with the pre-meal values. When food allergies are present, the difference can be as high as 20-25 beats per minute. In this case your over-sensitive immune system can attack your body organs (for example, the brain, kidneys, or joints). (In particular, there are over 20 medical studies that found a special usefulness for fasting and a vegetarian diet for arthritis.) Thus, every time you eat the offensive foods some of your organs are attacked by special immune cells. The damage may not be felt or sensed until it is substantial enough to create pain or cause, for example, an asthma attack. In these conditions, it would be sensible to slow the digestion using more fats and some starches. However, keep in mind that such dietary changes should not greatly affect your total consumption of different foods. Also, fibre intake is an important parameter. Therefore, dietary consultation, careful planning and monitoring of changes can be useful steps. If the reaction is still present, you may restrict the consumption of allergic foods (by eating them, for example, 1-3 times per week) or, for the time being, to remove the offensive products from your menu. After your CP is above about 40-60 s, allergic reactions usually disappear and you can really enjoy your meals without thoughts about adverse effects. Q: Are vegetarians healthier? A: There are different studies indicating smaller percentage of people with hypertension, arthritis, and certain other degenerative health conditions among vegetarians. Thus, on average they are healthier. However, eating meat and other animal products is not necessarily an obstacle for normalization of breathing and large CPs. For example, during 1990’s Doctor Buteyko was a meat-eater while his normal CP was over 2 min.

_______ Q: Are centenarians usually vegetarians? A: Paradoxically, gerontological surveys found that they are, as a rule, meat-eaters. Meanwhile, their common feature is moderate eating habits. It is possible that consumption of animal proteins is a kind of mild stress for these people too. But, as with many other natural types of stress, it can be useful provided that the organism can handle it.

Q: Doctor Buteyko found certain ideas in relation to diet. Can some of these ideas be specific in relation to those conditions, which he had in Russia? A: That is probably right in several areas. • He found, for example, that sea salt made significant difference in comparison with usual table salt. However, while working in 1960's in Novosibirsk, it is unlikely that he and his colleagues could use seaweeds in order to 202


normalize the requirements in micro-minerals. At the same time, presence of micro-minerals is the only difference between chemical compositions of ordinary and sea salts. Therefore, he probably found that, while sea salt was effective, it was not the factor that could make a big difference during initial stages of the application of the method. Why? Because daily consumed amounts of these elements in sea salt would be miniscule and, hence, it would take long time before their physiological effects could be observed. • It was also unlikely that Russian doctors and their patients had all-year access to good vegetable protein sources. During those times only few vegetables could be eaten, during winter and spring months, in raw, not even fresh form (they were carrots, cabbage, beetroots, winter varieties of apples), while soy proteins and greens were not available. Limited choice of vegetables could cause problems with, for example, certain amino acids (like lysine and arginine). That probably caused Doctor Buteyko to conclude, after practical observations, that some people need animal proteins. At the same time, traditional hatha yoga teaching insists on vegetarian diet until the CP is well over 1 min. • Russian sources do not mention sprouting beans, grains, seeds, etc. as a powerful tool for normalization of breathing. Q: What are the practical problems with raw vegetarian diets? What are solutions? A: Raw vegetarian diets require large amounts of time devoted to rigorous chewing. Wild omnivorous animals spend hours for chewing every day. Many of them do not swallow at all, but chew the food so well, that it can be squeezed between closed jaws. Why is it important? Swallowing large food particles of vegetables and greens would result in reduced absorption of many nutrients, especially proteins and other large intercellular molecules and ions. In addition, large food particles would increase wear of intestinal mucosa. At the same time, intestinal lining is the largest consumer of blood amino acids (self-repair). Hence, poor chewing habits can gradually lead to chronic under- repair of the GI tract causing various problems. Following a vegetarian diet under such conditions can make the problem of low blood protein levels worse. In addition, putrefaction of undigested materials in the colon would create a toxic load in the blood. This effect, in its turn, should cause chronic hyperventilation, inadequate GI perfusion (blood supply) and abnormal peristalsis. Are there any solutions? Norman Walker proposed in his books to lighten the work of chewing with a blender (mixer). First step is to make a semi-liquid base for a meal. Choose some fruits, like bananas, apples, pears, mangoes, kiwis, pineapples, etc. Egg yolks or small amount of cream can be added. Certain seeds (flaxseed, sesame, hemp, etc.) and nuts can be also used at this stage. When all these ingredients are in the blender, mix them on high power for about 1 min to get a smoothie. The next step is to cut (or chop) various greens and vegetables (pieces can be up to 1-3 cm large) and mix them manually in the jar of the blender with the smoothie. If this mixture were blended using a steady speed, it would be a pulp that could be drunk or quickly eaten with a spoon. Dr. Mercola suggested in his books and articles to eat pulp of vegetables left after their juicing. However, Dr. Walker found that this was not the optimum solution for digestion. Instead, he suggested turning the blender on several or many times just for 1-2 seconds (using "Pulse" speed). If it is done about 20-30 times, the food particles would be much smaller, but chewing time can be reduced about 2-3 times (e.g., 20-30 min instead of 1 hour required for the large bowl of raw greens and veggies). Dr. Walker also noted that such pulsed blending can be repeated many more times, but further chewing would still be needed, while the total time for a meal would be further reduced. This process of chewing is important, while the total time for such a meal can be as small as 10-15 minutes. More details about selections of foods can be found in his book "Fruit & salad suggestions". His general suggestions, in cases of various GI problems and parasites, should be modified. For example, in cases of Candida overgrowth sweet fruits and many other simple sugars should be excluded. Problems with roughage are normal in cases of gastritis, or ulcers, or irritation and inflammation in the small bowels. Some people with these problems may find that frozen vegetables and greens are easier to digest. Why? The structure of fibre changes after freezing/thawing process since freezing of water causes its expansion and destruction of the outer cellular matrix. Hence, the digestion is easier. At the same time, loss of useful nutrients is minimum during freezing/thawing process. Moreover, due to absence of shelf life (or display) for frozen products, they usually have much fewer nitrites, nitrates and other harmful chemicals.

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When GI problems are more severe, short cooking (frozen veggies and greens again could be good choices due to shorter cooking time) and thorough blending should be used. Finally, for people with severe GI problems the choice of foods, as many health professionals found, can be very limited (e.g., winter squashes, zucchini, cauliflower, broccoli, Brussels sprouts, carrots, blended spinach, etc.). Q: What are the practical problems in those people who decided to become vegetarian? A: As it was noticed by Doctor Buteyko, many people, when they learn the Buteyko method and reduce their breathing, become vegetarian or significantly reduce the amount of animal proteins they eat. At the same time, Buteyko also observed that some people are like “rabbits” (they are better of health-wise when they are vegetarian), while others are “wolves” (indicating that it is good for them, in terms of their breathing and general health, to eat meat products). Practice show that many vegetarians, first of all, eat too little protein. The daily amount of proteins, in grams, should be at least as much as the body weight in kg or even higher (i.e., a 70 kg person needs about 70-80 g protein per day.) Nutritionists are usually aware about possible deficiencies related to: B12 (cobalamin) and Fe (iron). Possible solutions for B12 are one tablespoon spirulina powder every day, or little cheese/yoghurt daily, or 2 egg yolks only (white -proteins), and, for Fe, one tablespoon spirulina powder every day, or fresh spinach, or Fe supplement. However, having balanced composition of amino acids is also important especially when the CP is low and some amino acids are not synthesised in the body. Many vegetarians eat large amounts of grains (bread, pasta, rice, oats, etc.), as their main sources of proteins. But grains are low in lysine. At the same time, beans, soy products, and lentils are high in lysine and eating them during the same day will provide the required ratios of all essential amino acids. Another possible missing factor is arginine as it is high in meat and fish. Production of nitric oxide in our tissues is based on consumption of arginine. There are only few vegetarian foods that are high in arginine. They include nuts, carob powder, chocolate, and coconut meat. Q: Is honey useful? A: Only in its raw (or unheated, or unpasteurised) state. Consider the following abstract from a study of American scientists, “Twenty-seven honey samples from different floral sources and geographical locations were evaluated for their ability to inhibit the growth of seven food spoilage organisms (Alcaligenes faecalis, Aspergillus niger, Bacillus stearothermophilus, Geotrichum candidum, Lactobacillus acidophilus, Penicillium expansum, Pseudomonas fluorescens) and five foodborne pathogens (Bacillus cereus, Escherichia coli O157:H7, Listeria monocytogenes, Salmonella enterica Ser. Typhimurium, and Staphylococcus aureus) using an overlay inhibition assay. They were also tested for specific activity against S. aureus 9144 and B. stearothermophilus using the equivalent percent phenol test-a well diffusion assay corresponding to a dilute phenol standard curve. Honey inhibited bacterial growth due to high sugar concentration (reduced water activity), hydrogen peroxide generation, and proteinaceous compounds present in the honey. Some antibacterial activity was due to other unidentified components. The ability of honey to inhibit the growth of microorganisms varies widely, and could not be attributed to a specific floral source or demographic region produced in this study. Antibacterially active samples in this study included Montana buckwheat, tarweed, manuka, melaleuca, and saw palmetto. Furthermore, the bacteria were not uniformly affected by honey. Varying sensitivities to the antimicrobial properties were observed with four strains of S. aureus thus emphasizing the variability in the antibacterial effect of honey samples. Mold growth was not inhibited by any of the honeys tested. B. stearothermophilus, a heat-resistant spoilage bacteria, was shown to be highly sensitive to honey in both the overlay and well diffusion assays; other sensitive bacteria included A. faecalis and L. acidophilus. Non-peroxide antibacterial activity was observed in both assays; the highest instance was observed in the specific activity assay against B. stearothermophilus. Further research could indicate whether honey has potential as a preservative in minimally processed foods.” (Mundo et al, 2004) Honey was used for centuries as food and as an antiseptic agent to prevent bacterial growth and contamination of skin after burns, injuries, spread of gangrene, etc. However, many commercial varieties are pasteurised and this destroys its useful properties. Heated or pasteurised honey can become the food for pathogens to grow and multiply in the GI tract. For patients with severe GI problems (peoples with later stages of AIDS, radiation disease, many forms of cancer, multiple organ failure, bacteraemia, etc.) the use of heated vs. raw honeys can directly influence their survival.

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Q: Use of cold water, cold showers, contrast showers and cold air baths gradually decreases shivering response during cold stress. Which immediate methods are effective to prevent overcooling without doing physical exercise? A: That was the subject of the study by Israel and colleagues. “Four methods of suppressing cold-induced shivering were evaluated in 26 young male volunteers exposed to 0.0 +/- 1.0 degrees C air for 135 min. Voluntary relaxation of musculature (R), breath holding (BH), warm (50 degrees C) water ingestion (W), and performance of a mental arithmetic task (MA) were applied in a counterbalanced order following 2 h of cold exposure. Surface electromyograms of seven muscles were recorded and converted to root mean square voltage (RMS) as a measure of shivering intensity. Mean skin and rectal temperatures decreased significantly, 4.9 degrees C and 0.3 degrees C, respectively (p < or = 0.01). Mean reduction of EMG activity was 35% during R, 24% during BH, 18% during MA, and 5% during W. R was significantly more effective than BH, MA, and W, and BH and MA were significantly more effective than W in reducing shivering. These results indicate that, at small decreases in rectal temperature, shivering can be voluntarily suppressed to some extent during relaxation, breath holding, and mental arithmetic” (abstract, Israel et al, 1993). The Buteyko breathing technique can combine together these three most successful methods of shivering suppression. Q: Overheating and faulty speaking habits cause acute over-breathing. In case of faulty speaking, BHT increases. Does BHT become larger during overheating too? What can be said about the changes in pulse? A: Physiological changes due to different types of overheating (acute, sudden, or prolonged) are different from that of faulty speaking. But pulse increases can be found for all adverse changes, especially for prolonged overheating. Therefore, the pulse test can be used in order to measure the effects and presence of overheating. Prolonged overheating will also cause a decrease in BHT, whereas the effects of sudden heat exposure on BHT may be different and individual. Q: How can I practically find out that dust in the air or air quality causes hyperventilation? A: Again, use the pulse test. Note, that opening windows often results in more dust in the air. It is also possible that an increased pulse is caused by certain chemicals in the air (due to paints, furniture, fumes, etc.), or by warm temperatures. Hence, pulse checking can be used to choose the optimum rooms or optimum conditions in the rooms for work, study, sleep, meals, etc. Similar ideas can be applied for choosing optimum clothes to wear, linens, blankets, beds and their position, etc. For example, synthetic clothes often result in increased breathing. It is wise practice popular in Scandinavian countries to use linoleum, wooden and concrete floors and electrical heating in buildings. Houses in, for example, the USA, UK and Canada often have carpets and central ventilation which practically make quality of air much worse. Q: Are there any systems of health, methods or techniques, which are useful for breathing normalization? A: This book mentions the Alexander technique, various relaxation methods, yoga postures, massage, fasting, vegetarian diet, and some other methods. Acupuncture, reflexology, and raw diet are other useful therapies. As for systematic approaches, two schools of natural health developed certain activities that are similar to the Buteyko program. These are traditional hatha yoga ("hatha yoga" means “the master of breath”) and natural hygiene movement.

_______ Q: What is in the system developed by natural hygienists? A: This school recommends many natural methods and factors that decrease ventilation, including raw and vegetarian diets, fasting, cold environment and cold showers, bare foot walking, massage, and skin brushing. Besides, hygienists are against synthetic clothes, chemicals in the house and in the kitchen, use of toxic paints, etc. All these factors intensify ventilation. As for breathing exercises, there is no special program here, but there is one example suggested by Dr. Norman W. Walker, who established in 1910 the Norwalk Laboratory of Nutritional Chemistry and Scientific Research in New York, and who advocated natural hygiene principles until his death, when he was 119 years old. “There is a very effective exercise which I indulge in nearly every time I take a walk. It consists of blowing through the teeth to the sound of "SHOO-SHOO-Shoo-shoo-shoo", repeated over and over again” (p.69, Walker, 1979). This exercise means reduced ventilation or shallow breathing with tiny inhalations between sounds, but it would be impossible or very difficult for people with less than a 60 s CP to practice it without subsequent gulping for air. 205


Meanwhile, it is implied that inhalations are small and in between when they are done “as if by a vacuum, you unconsciously draw into your lower lungs a supply of fresh air. When I take my mile walk I always practice this, the ground seems to just slide past me, and I return feeling refreshed” (p.69, Walker, 1979). Q: Do free radicals affect breathing? A: For a modern person, excessive exposure to free radicals is among the leading causes of chronic hyperventilation if we consider the problem of breathing on a biochemical level (or the life of molecules and cells) or the "cellular breathing". The detailed influence of free radicals on cellular breathing and corresponding chemical reactions are beyond the scope of this book. However, a general note is possible. Large amounts of harmful agents require more attention of the immune system for their removal and cellular repair. That causes the heightened body metabolism, increased rate of many reactions, higher temperatures and increased ventilation. This is the reason why this book also pays attention to, for example, effects of microwaves, vegetable oils, etc., in addition to inflames tissues, infections, ineffective digestion and self-repair. All these processes cause the organism to produce excessive amounts of its own free radicals, which, apart from doing a useful job, also contribute to cellular aging. Q: What are the sources of free radicals? A: Low CP (below 20 s) can be the main source or free radicals in many people due to: • formation of incompletely oxidized chemicals due to the suppressed Bohr effect, reduced perfusion, tissue hypoxia, and inefficient aerobic mechanism of energy production causing anaerobic chemical reactions • activities of the immune system (mainly, controlled production and release of free radicals by white cells and the liver, especially during illness or infection) • faulty protein, fat or carbohydrate metabolisms • physical or emotional stress or trauma • oxygen we breathe • free radicals entering the blood due to constipation (such as, fecapentaenes, apcholic acid and 3-methyl cholanthrene). Some other sources include: • natural radiation • some substances in any food • extracted unsaturated vegetable oils • hydrogenated vegetable oils • foods that have been fried, grilled, broiled, or cooked at high temperatures (including foods that have been browned or burned) • processed foods (due to microwaves; due to mechanical destruction, as for flours or powders; due to various chemical treatments, etc.) • spoiled or tainted foods (including rancid and heated fats) • chemical food additives and preservatives • aluminium (due to cooking in pans made from this metal) • over-the-counter and prescribed medications and drugs • excessive alcohol intake • cigarette smoke • motor-vehicle exhaust • other chemical factors (air pollutants such as asbestos, benzene, carbon monoxide, chlorine, formaldehyde, ozone, and toluene; chemical solvents such as cleaning products, glue, paints; paint thinners; perfumes; pesticides and herbicides; water pollutants such as chloroform and toxic metals; radon gas; etc.) • nuclear and excessive solar radiation and X-rays (medical, dental, etc.) This information can be also useful in order to approach the problem of low CPs from the biochemical viewpoint and find the causes of problems. It should be kept in mind, however, that, for example, any food is a source of free radicals and anti-oxidants. At the same time, raw organic foods provide much larger amounts of useful substances and much smaller amounts of free radicals, in comparison with, for example, the same commercial or cooked varieties. As another example, eating raw sprouts can be considered as a method to reduce damage due to free radicals.

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Q: Are there any specific recommendations for aged people? A: If for young people daring exploration of the environment and adaptation of various system of the organism are important (for example, many young mammals eat dirt in their habitats so that the immune system can adapt to local bacterial flora), it is normal to expect that for aged people the goal is to slow the aging process. Hence, the measures are more of defensive nature. That relates to all areas and activities. Apart from known ideas of moderation (e.g., in relation to diet, exercise, and other activities), elimination of chemical sources of aging is important. Practically, that also includes stricter adherence to hygiene (care about mouth, teeth, skin, hair, nails, etc.), defensive eating, clean and fresh air, more time spent outside. Q: Which types of shoes are better to wear? A: According to Buteyko, sandals are most practical since they provide better air exchange than, for example, sport shoes or boots. When the air exchange through the extremities is restricted, hyperventilation results. It is the same situations as for children with overly-warm clothing. When extremities are exposed, the organism has a certain range to adjust its thermo exchange with the surrounding environment without hyperventilation. Indeed, thermal losses are different from minute to minute due to interior processes (e.g., digestion, blood sugar variations, hormonal changes, etc.), changes in air flow and temperature variations. Different rooms and other parameters (like presence of sun, thermo radiation, etc.) also produce different impacts. It would be impractical to constantly change clothes in all these circumstances. However, exposed hands, head, legs and feet help to avoid possible overbreathing. Besides, elimination of unwanted substances (through the numerous pores on the soles) is impaired when shoes are worn. No shoes at all (or barefoot walking) is another natural measure to normalize the health. One can easily notice that his or her breathing gets naturally reduced during and after bare foot walking. It was also noticed that when a student achieve higher CP, at certain stage the feet become larger is size and some shoes can become too small or uncomfortable. Q: Which criteria can be used in order to choose a Buteyko practitioner? A: According to Doctor Buteyko, the CP of the practitioner is probably the best indicator of his/her qualification, knowledge, and ability to teach the method. Dr. Souliagin agreed with this criterion. He also observed that usually practitioners advocate and use those auxiliary methods of breathing normalization, which helped them to achieve their individual CPs. It was a norm for Buteyko medical colleagues to have over 1 min CP. That indicated deep understanding of the method and qualified teaching abilities. Many of them had about 2 min CP or more, indicating their good professional preparation. When the CP is below 35-40 s (or the MP is less than 60-70 s), a practitioner may get too excited about abilities of the method or may have other changes in attitudes. At the same time, normal breathing requires long-term commitment from the practitioners, so that they can teach this commitment to their students. Therefore, ask the practitioner about his/her morning CP.


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Chapter 10. Level 3: CP 60 or excellent health Introduction Without doubt, the discovery of the simple parameter (CP 60) that indicates excellent health was one of the greatest achievements of Dr. Buteyko and world medicine. While many students report and notice fundamental changes in their well being, energy level, sleep, digestion, feelings, etc., when they increase their oxygenation, in terms of the CP, 2-3 times (e.g., from about 10 s up to 25-30 s), the changes that take place for over 60 s CP are equally profound. Moreover, breaking through the 40 s CP threshold is the most difficult part of the breathing retraining, and further progress, up to 2-3 min CP, is usually smoother and easier. Among “side effects“ of the very high CP are: very short sleep (down to 2-4 hours); amazing clarity of mind and an ability to reflect on reality without one’s own emotional involvement; resistance of the body to plaque on teeth (no dental cleaning is required) and cavities; appearance of certain extrasensory abilities; painless childbirth; etc. The experience of Russian doctors and breathing instructors shows that one of the key factors for success of the student (to get over 60 s CP) is the confidence of the teacher. This confidence is based on experience, a wide arsenal of tools to reduce ventilation, and high own CP. For example, since the Russian doctors in the 1970s and 80s were required by Buteyko to have over 60 s CP, it was normal that many their students were able to learn Level 3. Later, in the 1990s Buteyko trained breathing instructors with 30 s CP requirement. These instructors, on the one hand, saved hundreds of lives and returned thousands of people to ordinary life, but, on the other hand, they had fear, confusion and a misunderstanding that 60 s CP is something that is difficult to achieve. More details about these psychological factors and the possible mistakes of breathing teachers are provided in the special section later. This chapter describes the 40 s threshold and the reasons why the CP can remain below 40 s, together with broad review of old and new additional tools that are useful to get CP 60.

10.1 Constant breathing control Practice shows that constant breathing control through the day, except sleep, takes place and should be encouraged in the following situations or the following groups of people: 1. Students with high current or existing CPs (i.e., about 40-50 s or more) achieved such an efficient level of the work of the CNS that various daily activities can be harmoniously combined with constant RB without significant deterioration in quality of the work done. It is true that many people find it more enjoyable just to enjoy doing various things without thinking about breathing. However, this is a short term joy since when the 40 s CP threshold is not broken, the sick organism, due to existing pathologies and abnormal processes, is under chronic stress and will require heavier breathing and correspondingly lower CPs (about 30-35 s or less) later. Hence, in the long run, even for the sake of performance in various areas, it is better to practise breathing control with slight deterioration of current results, than to achieve better results now but lose CP-wise, breathing-wise, health-wise, and performance-wise later. Hence, high CP students should be encouraged to combine various activities (walking, reading, listening, watching TV, working on PC, exercising, house chores, shopping, etc.) with constant breathing control: mild after meals, when food is in the stomach, and rigorous at all other times. Such constant RB is possible due to achieved levels of perception of reality, focus of attention, logic, concentration, memory, and other qualities. 2. Severely sick people with very low initial CPs (i.e., less than 10 s), who have been sick for years and suffered physically, emotionally, and spiritually from a prolonged and miserable existence, are able to realize that breathing retraining is the only way and often the last chance to experience life. Note that sometimes, when sick, we may try and get certain unhealthy benefits from other people while using the disease as an excuse. Hence, it is a matter of attitude and the teacher should encourage and assume the ability of the sick person to recover and lead a full life. It is known that such students better acquire the new ideas related to the method, become more diligent in breathing practices, and learn the method faster. Some of these initially very sick students have a very fast rate of progress due to this realization that the method is the last chance they have. The final goal for these students is usually established by the breathing teacher, who is the main source of information about the method. Hence, if the teacher assumes or has a spirit that, for example, 30-35 s is sufficient and there is nothing special or different beyond, then the student quickly gets there and has no reason or motivation to progress further to full health restoration. Therefore, the expectations of the teacher (guru) are of great significance for students and this conclusion is universal for any educational setting.

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3. Many other, so-called spiritually oriented or open-minded people with any initial CP are also able realize, due to the right attitude, the central role of breathing in physical and spiritual health. Hence, these people also have due motivation and are able to “lock the system” with the conviction that CO2 is the source and the foundation of health and spirit (or “prana” as yoga-masters taught). How and why are some people able to practise it, while others not? Practising constant breathing control is a decision of the student. One’s own conviction and resoluteness are the keys here as well as for other situations, like a decision to breathe only through the nose, or a decision to give up smoking. In particular, the student, after making a decision to practice constant breathing control, should be ready for various obstacles: the most serious one is own inability to practice it all the time from the very beginning. While some people are able to “switch” to the constant breathing control immediately (due to months or years of previous practice, motivation, available time, less stressful jobs, favourable personal traits, and other positive factors), many students require many days to achieve this. Gradual increase, day after day, in the total SB time is another positive option, which leads to the same result. The role of the breathing teacher then is to provide the aspiring student with benefits of CP 60 and practical examples of success.

10.2 Why it is difficult to break through 40 s threshold When the student masters Level 2 and continues to reduce breathing and increase own CP, she will notice the following effect: the daily CPs, due to breathing sessions, constant breathing control, physical activity and other tools, can get up to 50 or even 60 s. However, the morning CP would be only about 35-37 s or even less. This pattern, in most adults, can continue for weeks indicating that the 40 s threshold is not broken. Why? Virtually all modern people have pathological tissues and/or processes in the body, including: - inflamed or damaged tissues; - abnormal bacterial flora or overgrowth of pathological bacteria in sinuses, large and small intestine, stomach, mouth, on the skin, and in other organs; - degenerative processes in bones, especially in the jaw or spine; - malignant and benign tumours; - various types of fibroblasts, plaque, cysts, papillomas or polyps, adenomas, lymphomas, keratoacanthomas, carcinomas, dermatofibroma, granulomas, etc. Presence of these abnormalities is a chronic stress for the immune system and organs of elimination. Moreover, the organism has an in-built system of detection of these abnormalities and information about their presence is transmitted to the breathing centre in order to intensify respiration. Why? Internal organs have an ability to regulate their own blood flow. This phenomenon, autoregulation, is particularly well developed in kidneys (Guyton, 1984). For example, Sladen & Landry recently suggested that "Renal blood flow and renal perfusion pressure are regulated by two control mechanisms. The first, extrinsic, actually involves a complex interaction of vasomotor effects between opposing neurohormonal systems. The second, intrinsic mechanism, renal autoregulation, depends on changes in afferent arteriolar tone in response to the renal perfusion pressure itself" (p.791, Sladen & Landry, 2000). The small intestine increases its own blood supply twice after a meal and sustains it 2 hours later, even when aCO2 decreases. Brain and liver also have good autoregulative abilities. However, this mechanism alone cannot compensate for vasodilative effects of CO2 when the CP is very high. At the same time, reduced blood flow (or perfusion) of damaged or pathological tissues, as in cases when the CP is below 40 s, is exceptionally important for survival of the biological system. Should the person be able to increase perfusion to very high values (by breathing less and getting very high CPs), then bleeding to death through the injured organs or tissues, or quick spread of pathogens throughout the body could be fatal. Hence, intensification of breathing reduces blood flow to all vital organs and tissues preserving life. Note that the person can have various health abnormalities that restrict his CP, but official medicine would not be able to find any serious abnormalities due to the confusion that relates to diagnosis and drug-based treatment of diseases and symptoms. Hence, it would be the goal of the Buteyko student and his breathing teacher to find out what are the particular parts of the body or abnormal processes that need to be normalized. This inability to break through 40 s threshold and its relation to the “unclean”, in a physiological sense, body is particularly noticeable in children. The CP of a sick child is always restricted (e.g., less than 10 s 24/7). A healthy child can have large CP fluctuations during the day and this is normal. The difference is that the healthy child with no abnormalities can recover the CP in a matter of minutes (e.g., from 10-20 s up to 60-90 s), while the sick child may

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require days or weeks for body repair before high CPs are achieved.

10.3 Physical activity and breathing exercises When the CP gets up to about 40 s or more, the student can have air hunger during physical exercise and this ability can become the main driving force to boost own CP. It is of particular importance that the student may notice that rigorous exercise, up to 1-2 hours, is more pleasant and easier if breathing is under constant control. After the exercise, the RB helps to recover from the physical activity as well. Walks during the day can be naturally done with constant air hunger and possible breath holds. Separate breathing sessions can result in getting very high CPs (up to 50-60 s or even more) and amazing sensations of focus, clarity of mind, ability to reflect reality without emotional involvement, great energy level, etc. Practising constant breathing control after such sessions is easy and maintaining high daily CP is usually not a problem.

10.4 Strengthening the weakest parts of the organism All CP levels result in specific symptoms indicating the struggle between health and disease. The same is true for over 40 s CPs. Virtually any part of the body or organ can become the battlefield of this struggle. The student may notice slightly sore throat, unusual sensations in the mouth, nasal drip, coated tongue, discharges from the lungs, urinary problems, GI concerns, itchy scalp or other skin areas or some other symptoms that are usually not strong or even hardly perceivable. Whatever the symptoms and sensations, the student should carefully listen and think about their possible causes since assisting the body in the right place can greatly improve the recovery rate and achievement of 60 s CP. Note that most gastrointestinal, urinary, billary, hormonal, musculoskeletal, neurological and psychological concerns get completely and quickly resolved only when the CP gets up to 30-35 s or more 24/7. Only symptoms of asthma, hypertension, angina pain, bronchitis, sinusitis, eczema, sleep chronic fatigue and a few other problems disappear at 20-25 s CP. The majority of other health concerns require higher CPs for their resolution. Assisting organs of elimination during cleansing reactions was considered before. Such cleansing reactions chelate medical drugs and other toxins out of the body. As to breaking through CP 40, it is rather a repair or restorative process of certain tissues. Consider a Russian trial on patients with liver cirrhosis or Russian experience with nephritis, gastritis, ulcers and other conditions. In most cases it takes about 3-4 weeks of high CP to normalize the work of these organs (liver, kidneys, and small intestine). Practical evidence related to patients with type 2 diabetes suggests that they usually need about 10% time of their disease (e.g., if a patient had diabetes for 5 years, she needs about ½ year to recover). Recovery from emphysema is also notoriously slow often taking years of diligent work. What are the possible actions that can shorten the recovery time? Let us consider the above mentioned situations. Sore throat possibly means attempts of the immune system to ward off pathogens that were residing there probably for years. Gargling natural antiseptic solutions and eating spicy foods are some of the options. Hatha yoga system suggests headstand since many of these problems are located in the head. Starting with only 1 min for the first day, the hatha student can gradually built the total time with greatly improved perfusion of the head up to 5-6 hours. While such extremes may not be necessary, 30-60 min per day can dramatically shorten the restoration of tonsils and other organs and tissues in the head. Unusual sensations in the mouth can be caused by cavities, root canals, infection in the jaw due to dead teeth, periodontal disease and other problems. Good oral care (described in the previous chapter) is one of the steps. Headstand again does the job correctly. Thinking about and checking all these options, including a visit to the dentist, would be important. Nasal drip is likely caused by languid attempts of the immune system to eliminate the pathogens from the sinuses. Sniffing yoghurt (to repopulate the good bacteria), grapefruit seed extract (to eliminate fungi and yeast), or sea salt dissolved in water (for mechanical elimination of the mucus using, for example, a neti pot) are the possible steps. Discharges from the lungs in patients with asthma, broncheostasis, emphysema, and smoking can be addressed using the massage described below.

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Massage for removal of mucus from the lungs (asthma, broncheostasis, emphysema, smoking, etc.) Posture - lying or sitting, relaxed. Start from the lowest part of the spine. Raise skin with both hands (thumbs and indicative fingers) in the form of small hill perpendicular to the spine. Roll it up with these 4 fingers along the spine till the neck. Repeat the same slightly to the left side from the spine; repeat on the right. Move further to the sides. At the top, perform strong massage of shoulders. It should not be painful. If it is, do just light pinching. Only once per day, combine with SB.

To accelerate the removal of mucus and phlegm from the bottom of the lungs, high CP and headstand are great in a mechanical sense: high CPs provide cilia (tiny hairs beating in unison and moving the layer of mucus even against gravity) with blood supply and oxygen, while headstand or even horizontal position will make the removal faster (no gravity at such times). Herbs can also accelerate the process. Dull pain under the right lower ribs or redness around the liver area on the abdomen can indicate detoxification of the liver that can be damaged due to medical drugs, alcohol, and other toxic chemicals. Among correct steps are: eating less fats, good chewing, raw diet, supplementation with enzymes, betaine HCl (hydro chloride), milk thistle, and black cherry juice (they all powerful liver detoxifiers). Those students, who had low CP for months or years, can also try lemon juice/olive oil liver cleanse. It helps to mechanically eliminate gallbladder stones and debris from the billiary ducts connecting the liver and gallbladder with the duodenum. Inability of kidneys to concentrate urine and some other urinary problems requires neutral urinary pH for their improvement. Most people have too acidic urine due to the diet and low CP. This creates conditions for the appearance of stones in the urinary tract. Western medical trials found that citric acid or its salts can normalize pH. Practically, 2-3 oranges or 2 small lemons every day can solve the problem. Those who cannot tolerate citrus fruits may try to use citric acid or its salts. Changes in the diet can include: eating less protein and avoidance of animal proteins (see the section on autoimmune disorders in the previous chapter.) Dealing with diabetes and poor blood sugar control is based on rational diet (timing, glycaemic index, amounts of food, etc.), good chewing, chromium supplementation, and use of spices, onions, gymnema and other natural or herbal supplements. Solving many GI concerns needs equally persistent efforts in two directions: breathing normalization and dietary changes. This topic is considered in a special chapter. Itchy scalp or other skin areas can indicate pathogens, e.g., yeast or fungi, in hairs and in other places. Using anti-dandruff shampoo can quickly resolve the problem. Recovery from emphysema is faster when the quality of breathing air is nearly ideal 24/7. Presence of carpets in the house, shelves with books, long dusty curtains and other objects generating tiny airborne particles just during sleeping hours can halt any progress. There are also various spices, herbs, supplements, and functional foods that can be useful for recovery and repair of certain organs and tissues. At the same time, the student should keep in mind that higher CP would be the crucial factor for learning Level 3 with success.

_______ 10.5 Posture

Preferable postures of most people reflect their CPs and health. When our CPs are very small (1-10 s), we prefer to lie down. When we are between 10 and 30 s, we favour sitting. During the previous part of our evolution, very high CPs, as it was the norm for millions of years, meant standing most of the day. Standing, according to Doctor Buteyko, is the most natural posture for lighter breathing and great health. Therefore, an aspiring Level 3 student should spend most of the day (up to 10-16 hours) standing. There are literally dozens of physiological mechanisms and processes that will be optimized during standing in comparison with sitting or other postures. (Since headstand is equivalent to the mild physical activity, it is probably even better than standing.) Practically, the student should create conditions when virtually all reading, watching TV, computer work, etc. are done while standing with straight spine and relaxed body organs hanging freely on the spine. Spending most of the day in a sitting posture would be a hindrance for the Level 3 student. 215


Russian experience show that in the right conditions high CP has a tendency to increase itself. Standing posture would be one of these factors.

10.6 Sleep As before, it is important for the student to daily record a statistical information about evening and morning CPs so as to know the effect of sleep on breathing and health. For Level 1 and 2 students the crucial thing is to find the relative or absolute values of CP reduction so as to choose the optimum strategy. The optimum situation for these Levels (1 and 2) is when the CP drop (from the evening to the morning value) is negligible (e.g., less than 5-10% or about 2-3 s CP only).For Level 3 students, the morning CP will likely be about 35-37 s or even less, while the daily values can be much higher and the main goal would be to achieve the morning CP values which are as close to 35-37 s as possible. [I personally believe that the main CP thresholds are not 10, 20, 40 and 70 s, as most Russian sources claim, but are about 9, 18, 36 and 72 s, or doubles of each other, in accordance with the chaos theory applicable to any biological system. Round values were probably chosen by Buteyko for their simplicity and safety reasons (e.g., when to exercise, take cold shower, etc.) so that even those who slightly overdo the CPs would still get a safety gap and would not harm themselves.] At this higher level of learning even more close attention should be paid to all parameters related to good quality of sleep, including: - thermoregulation (generally it is better if one feels rather on the cold side); - air quality (open windows and absence of any surfaces that can generate anything that can get airborne or absence of carpets, curtains, clothes, exposed books or newspapers, etc. Even surfaces of modern beds, blankets, and pillow cases can be causes of increased breathing at night. Ideally, the bedroom should have wide open windows; wooden, plastic, linoleum or other dust-free and smell-free floor, nothing there but a very simple wooden bed, if any, hypoallergic materials for blankets, pillows, etc.); - hardness of the bed (the question was discussed in the chapter devoted to Level 2); - ability to alternate between sleeping on the left side and on the chest during sleep; - mechanical restriction of ventilation (this technique is useful not only for Levels 1 and 2. Use of 2 or 3 belts with very tight compression or use of a special strong shirt with 2 rows of buttons can greatly assist in keeping the CP at higher values); - physical activity before going to bed (or having long 20-30 min power walks with reduced breathing); - breathing sessions just before the sleep; - taking cold shower before sleep, etc. It would require some detective work and experimentation to find out the easiest steps in order to improve the quality of sleep and to achieve minimum natural sleep with the morning CP about 35-37 s. Experience of Russian doctors and my own observations revealed the following effect. If all previously described parameters are correct, the high CP student should wake up naturally when their breathing gets heavier during sleep. This is a very useful effect preventing episodes of hyperventilation at night, at their very beginning, due to adaptation of the breathing centre to high CO2 during the daytime. Hence, diligent work, self-discipline, very easy breathing, and high CP during the days, pays back even during nights.

_______ 10.7 Avoidance of allergies

Many allergies, which are related to dust or dust mites, may disappear when the CP gets up to 30-35 s. Other allergies require desensitization of the immune system. What does this mean and how does it work? The immune system has certain memory in relation to allergens. This memory is manifested in the presence of antibodies capable to produce an autoimmune response resulting in histamine rush, inflammation and other pathological processes. The allergic response can reduce the CP down to 15-25 s depleting our cortisol reserves (to fight inflammation) and, hence, draining our vitality and energy. In addition, inflammation is a favourable ground for pathogens to multiply. Moreover, repair of the inflamed tissues is a long term process that requires absence of new allergic reactions. If, for example, the person is exposed to the trigger only once per week, the recovery would never take place. Each new inflammation will begin in the places that are still not recovered from the previous damage. However, if the trigger is avoided for sufficient time (e.g., 3-4 weeks) not only complete healing is possible, but, since the immune cells have only limited life span, all immune cells responsible for the abnormal allergic response 216


can die and the person will be allergy-free. Hence, Level 3 student should create conditions when triggers are avoided for about 1- 2 months and such desensitization will be possible.

10.8 Other special activities • Bare foot walking The temperature of the human brain and body core temperature are maintained and controlled by the nervous and endocrine systems with exceptional precision. This control is accomplished by heat generation and heat losses through skin and respiration. Normally, increased heat losses through the skin reduce ventilation causing larger aCO2 values. The head, arms and legs are the places of most intensive heat losses. As a result, bare foot walking decreases ventilation (Souliagin, 1991a). Moreover, due to extensive nervous connections between the feet and all other organs, bare foot walking causes natural stimulation of the whole organism. Even immediate response to this activity is a natural breath holding. Souliagin believes that initial stages of feet adaptation should include alternating immersions of the feet in cold and hot water (1-2 times per day) and wearing open shoes (e.g., sandals) without socks outdoors. In cases of feet overcooling, they should be rubbed with a towel until the feeling of warmth. There are various possibilities for how one can stimulate one’s own feet: - walking on the grass, sand or stones outdoors; - use of a small rubber mat for feet with hundreds of small knobs (about 1-2 cm high); - putting small stones or pebbles inside the shoes; etc. Both breathing exercises and physical work increase blood circulation and temperature in the feet. As a result, more intensive feet stimulation, even walking on snow, gradually becomes possible and comfortable. • The shaking effect This is another wise observation of Doctor Buteyko in relation to healing and repair of various tissues. How does it work? The work of many vitamins, proteins, enzymes, hormones, messengers, and other chemicals in the body is based on their ability to reach certain tissues or parts of some target cell in order to trigger certain processes and reactions. This ability to reach the target areas is improved by higher CPs due to vasodilation and improved blood supply. However, transport from the blood to cells (the distance to travel can be as large as 2-4 cell diameters) is often based on diffusion with possible active transport through cellular membranes. The process of diffusion is rather slow. Imagine that a drop of ink falls into a glass of water. It may take about a minute before ink gets homogeneously dissolved in the whole volume slightly changing the colour of the solution. Now imagine that the same glass vibrates or shakes and the same drop falls there. The time for dissolving would be reduced down to 5-10 s only. Shaking is a tremendous stimulus for acceleration of chemical reactions. Hence, any inflammatory condition, tumours, or any degeneration of tissues and bones will benefit from appropriate level of mechanical stimulation. In fact, the ideal level of shaking or mechanical stimulation should be slightly less than the strength of the corresponding areas. The time of stimulation is another important factor. Warning. Many health problems, including GI ulcers, various lesions, and cracks in bones, can get worse from too intensive mechanical stimulation or vibrations. Each healing process and each individual should adjust the level of mechanical stimulation according to the states of the target organs and tissues.

_______ What are the possible practical implications? The shaking effect is possibly the main reason why Buteyko and his colleagues suggested that jogging with a bouncing type technique is the best form of exercise for most people. Using trampoline or vibrating devices are other options. Even driving in cars, buses or trains that have natural vibrations over hours or sometimes days can produce very positive effects. Uses of massaging pads, chairs, and beds are other options to consider. • Yoga postures Although yoga postures are not mentioned in Russian articles, Doctor Buteyko said that these static postures caused natural breath holding (Buteyko, 1977). He practised them himself and that is another indication of their usefulness. Moreover, different experimental investigations on the effects of asanas (static yoga postures) revealed that practising some of them for long periods of time (1-2 months for at least 30 min per day) increased BHT by about 1015 s (Funderburk, 1979). Such healthy physiological response can be attributed to two factors. First, asanas involve 217


static muscular tension in antagonist muscles. That causes their relaxation when the exercises are done. Better relaxation normally produces reduced breathing and higher CPs. Second, many postures are done with constant maximum muscular tension, which do not allow deep breathing. Moreover, some postures can be done only for as long as one can hold his/her breath. Hence, these exercises normally cause easy breathing and higher CPs. • Massage and self-massage These methods are recommended by Souliagin (1991a) for elimination of back-pain, during the cleansing reaction, and in cases of excessive muscular tension. Many other special activities (paying attention to relaxation, use of cold shower, sauna, learning correct speaking skills, etc.) were described in the previous Chapter. All these tools are important for success.

10.9 Other dietary suggestions Benefits of spices Summarizing conclusions and general physiological ideas about benefits of spices (see Chapter 11), it is good to explain to Buteyko students, in simple terms, that: Spices suppress pathogenic (or bad) bacteria in the gut (especially large intestine), while promoting good bacteria. Hence, instead of pathogens and their toxins, which are manifested in various negative symptoms (changes in mood, depression, headaches, fatigue, weakness, fever, etc.) and stress kidneys, liver and the immune system, the good bacteria is flourishing and working for our health: - to ferment fibre (providing us with clear mind and the sense of wellbeing); - to bind toxins; - to synthesise vitamins. This is the general effect on the GI flora. Apart from it, there are benefits that are due to the following properties of spices: - antioxidant properties; - anticarcinogenic properties; - anti-inflammatory properties; - antimicrobial properties; - antiviral properties; - and other properties related to specific health conditions. It is not a surprise then that one of the Buteyko’s pupils wrote, “The [dining] table, according to Buteyko, should have: salt, pepper, mustard, vinegar, onions, dark bread [rye bread], greens, and spices…” It is likely assumed here that these ingredients are not just for decoration of the table. This is a possible single meal and large total amounts of spices can be used. Indeed, one may practically find out the following practical effect. Imagine that you can eat only a certain amount of pepper with a piece of bread, so as to have a distinctive, strong and pleasant taste of pepper. If you add more pepper, you would feel it too hot or strong. Similarly, there is a certain maximum amount of mustard that you can spread on the piece of bread. You would enjoy no more than a small bulb of onion with the same piece of bread. The same relates to vinegar, salt, and other spices that are agreeable with your digestive system. (Of course it would not be a good idea to use any foods or spices that your body does not accept.) Now you can take the same piece of bread and add all these spices together. You would find out your taste buds would not be offended by this hot-looking combination: the effects of spices are not accumulative (or the reasonable use of the different spice does not make the meal stronger or hotter). Since spices promote good bacteria and suppress bad bacteria in the GI system (starting from the mouth and ending in the large colon and further), you can have a small meal with a huge positive synergetic effect on your GI flora. Moreover, spices can be a staple food that is combined with salads, fruits, grains, or virtually everything that we eat. Note that the effects of spices are usually gradual. They would not increase one’s CP in a matter of hours, as it is the case for EFAs, Ca, Mg and other essential nutrients. Various positive effects of spices are cumulative and may require many days or weeks. Cautions As with foods, spices can spoil and loose their properties, if conditions of their processing and storage are not right. While spices do have powerful antimicrobial and antifungal properties, virtually all of them can decay due to activities of certain pathogens they are not resistant to. As the healthiest European is defenceless against some tropical

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diseases, so is garlic, peppers, or onions. Therefore, it is important to ensure good quality of spices used. Another caution relates to possible allergic reactions. Regular use of the chosen spices should not produce any GI distress, e.g., gas, burping, flatulence, diarrhoea, etc. Obviously, if a person is allergic to certain spices, they should be avoided. This is a very individual question. Often our GI system is content with those spices (and foods) which were staple foods of our childhood and predecessors.

10.10 Negative emotions and their relation to muscular tension and physical activity We know that PE (physical exercise) is useful at any stage of learning the method, and our colleagues from Russia encourage and teach their students to do up to 4-5 hours of vigorous physical activity every day. Practice shows that usually such students progress much faster at any stage. Indeed, as we discussed above, physical activity with nasal breathing only is a form of retraining for the breathing centre to higher aCO2 levels. Hence, PE is at least as effective, due to the immediate physiological benefits, as breathing exercises. (In my view, the main advantage of sitting sessions is in the conditioning of the body to react with relaxation and RB in response to breath holds. Weeks or months of practice, with thousands of breath holds, will result in the development of the combined diving and easy– breathing reflex: breath holds results in lower heart rate, reduced oxygen consumption, relaxation, and light breathing later.) There are other additional benefits of exercise, including improved perfusion of all body tissues, shaking of the body, normalization of sleep, digestion, emotional life, and other health parameters due to variety of mechanisms where CO2 effects play the leading role. Hence, for the aspiring Level 2 or 3 students, PE is very beneficial. What about people with excellent health? Russian breathing doctors observed that, if a student achieved high CPs (about 60 s or more), PE remains the key factor for excellent health maintenance. Buteyko suggested 3 hours of PE daily with perspiration for a healthy person. Then the CP will remain high (about 50-60 s) and breathing will be very light. However, practice also proved that this amount, for maintenance of ideal health, can vary among individuals. Why? What are the factors that define individual needs in PE? Why do most people with excellent health need a lot of PE? Who are those healthy people who need very little PE? It was, of course, not an empty claim made by Doctor Buteyko and other Russians, e.g. Vladimir and Marina Buteyko, that religion, prayer, and morality are natural CP boosters. From a physiological viewpoint, PE is necessary health-wise (or breathing-wise) to eliminate muscular tensions. PE means tension and relaxation of muscles. Hence, it is a normal effect, that after PE, muscles are more relaxed. Higher CO2 values also favour better muscular relaxation. Indeed, while the muscles are relaxed, breathing is OK. Gradual accumulation of muscular tension (which can take seconds, minutes, or hours), due to insufficient PE, gradually causes hyperventilation. What are the causes of increasing muscular tension when the person does not experience any apparent stress and is busy with a book, computer, house errands, or friendly people around? When, how, and why do we get more stressed? Are our minds supposed to get anxious without a cause? Roots of the stress and muscular tension Obviously, they are in past negative personal experiences. Which ones? Probably, those, which were most traumatic. There are very few people on Earth now who have never suffered due to injustice or verbal, physical, or psychological abuse. Such emotionally heated events often take place in childhood. Often a child was hurt by somebody, or sometimes she was exposed to traumatic experience with relatives or other people. These old events remain imprinted in her nervous system. They can produce three effects. First, they provide a matrix, or framework, or cliché that can be used later in order to relate, judge, evaluate, and choose other people as friends, or even in choosing a spouse, while ascribing old roles to them and herself. Second, conscious thinking about old traumas can result in re-experience of the same emotions: anger, helplessness, guilt, resentment, alienation, and hostility. These toxic emotions can poison the well-being, breathing included, of the person years later. Often the traumatic events may even be almost forgotten, but emotional and non-emotional clues and surrounding triggers of the past trauma (accompanying sounds, smells, shapes, mood, clothing, weather, and many more) can and are to be expected to unconsciously trigger past emotions. As a result, we again experience anger, helplessness, guilt, resentment, alienation, and hostility without realizing the roots of these emotions. In more dramatic cases, we seek justice and revenge, and no peace of mind seems possible unless the perpetrators repent to us and are duly punished. But the perpetrators can be far away and unconcerned with the past. We, on the other hand, carry the heavy burden of emotional hostility on our shoulders even when nobody is around.

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What are the effects? All health schools around the world teach the importance of muscular relaxation, and we say, “During the sessions, forget about all your worries and problems, relax all your muscles…” Some of us even use imagery, visualization, meditation, and other techniques to clear the mind of those pains, hurts, and traumas. Also, it is known that re-experience of these negative events and accompanying emotions can drive respiration up and the CP down by as much as 5-10 seconds immediately or even more over a longer time. Probably, it would be better to simply let those traumas go so that we can get busy with our real life, while having clear minds, cheerful dispositions, and easy breathing. Note that I am not talking about forgetting about those events. I also do not mean to imply that we must agree in any way that the perpetrators were right. In fact, in most cases, it could be better, for society and our own well-being, for us to take legal actions against the perpetrators when possible. What I mean by this emotional and spiritual shift is to stop to hold the perpetrator personally responsible to ourselves and letting it go. I do not mean forgetting, or agreeing or condoning the past actions. The optimum solution means having such a mental state when past actions do not have their destructive impact on emotions and behaviour of the person now. If there are practical actions to be taken it should be done. If it is better for the general well-being to have the perpetrator in a prison, it is also an option (social, not personal), but having those feelings (anger, helplessness, guilt, resentment, alienation and hostility) now is not. There is no a single side that is winning from these emotions since they generate, in most cases, a complimentary response from the opponents, should the victim get a chance to meet with the perpetrator. Coming back to the Buteyko method, in my view, the need in PE or daily breathing control in healthy people (over 60 s CP) is individual and depends on the ability to let them (past traumas and hurts) go. Those physically healthy people who hold them within, who are seeking revenge, who still remember and bring to others anger, helplessness, guilt, resentment, alienation and hostility would need more PE and breathing exercises in order to eliminate muscular tension. Those physically healthy people who manage to achieve peace of mind, due to an ability to forgive, do not need high metabolic rates and hours of heavy work every day. Note that that sick people, who are able or unable to forgive, still need PE. It is known that “disease makes breathing deeper” with the implication that for 2 people with, e.g., 30 s CP (one – free of diseases and healthy body and another with health problems), presence of disease will drive ventilation up and the CP down for the sick person. We clearly see it during sleep. Hence, it makes absolute sense, that Buteyko and his numerous colleagues, year after year, kept repeating that 4-5 hours of PE is good for sick people to generate CO2 and intensify metabolism so that to boost the repair of the body. These ideas provide the foundation to understand the relation and interactions between physical and spiritual health of the person. Hence, even during early stages of learning the Buteyko method (i.e., Levels 2 and 3), the ability to let it go, would definitely accelerate the rate of progress of the student towards the ideal physical health. Anthropological evidence The same problem of relation between physical and spiritual health can be considered from another viewpoint. There were many societies, tribes, and social groups where relationships between members were very different from modern times. They had: no violence, no verbal or psychological abuse of each other, no desire to possess property of other, no police, no lawyers, no courts, no armies, no prisons, etc. The idea of hurting another human being was probably as alien to them as the idea to walk backwards to us. It was the attitude fostered in the young that created this social stability existed in many places for generations. Since we have the same genes, this historical fact generates the following conclusion: The modern man has a potential of being a non-violent individual who can live in such peaceful societies when conditions for development are right. Which conditions? Is breathing the only factor? Breathing, in my view, is just the soil that does not make people good or bad, but creates conditions for growth in certain directions. Hyperventilation means weakened resistance not only to cold and infections, but also to greed, addictions, promiscuity, anger, hostility, emotional swings, depression, etc. However, some people (e.g., religious ones) can remain “on the right track”, in terms of emotional wellbeing, even when getting very sick with very heavy breathing. Why? If the religion is not just a matter of words, then forgiveness, common sense, and thoughts about ever existing and everywhere present Creator should be practiced daily. “The main goal of the sensible creature is to understand the universe and God. The laws of Nature rule

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everything that takes place in the micro-cosmos – the living cell and the macro-cosmos – the universe. The set of these laws is the most precise definition of God. We must realize that we never can get the exact definition of what is God, because our brain is limited, but God is infinite. We must comprehend these laws and live in accordance with them. Since man cannot understand and follow all laws, he must choose and follow the main ones. The first law is common to all matter, which I divide into lifeless and alive. A stone, grass, and tree also think and feel, but in their own way. The main law is the law of cause and effect; it is irreversible in time. The cause results in the effect. As my grandmother used to say, “Nothing takes place without a cause.” Therefore, the truth is the law of Nature; and sin is a violation of this law. The first sin is deep breathing. Look what is suggested by all religions: fasting, pray, work, restraints, and the attitude to others as to yourself. The commandment “Love each other” means do not get excited. Isn’t it clear? All of what is suggested by all real thinkers is connected with normalization of breathing” (Buteyko, 1998). How can I check that I have this problem? The student may think about the following statements and relate own life experiences to them: 1. I'm going to get even. 2. I'll make them pay. 3. I have bitter feelings when I replay the offence in my mind. 4. I think about them with anger. 5. Sometimes my mind dwells on the past traumas. 6. I have a clear ability to see their good points. 7. I prayed for them, asking God to bless them. 8. I told God I forgive them. 9. My resentment is gone. 10. I feel at complete peace thinking about these events. 11. I keep as much distance between us as possible. 12. I live as if they don't exist, or never existed. 13. I looked for the source of the problem and tried to correct it. 14. I took steps toward reconciliation: wrote them, called them, showed concern. Are these statements true in some situations or at certain moments of your life? Years ago I visited different leading practitioners-trainers of the NDT (New Decision Therapy), which I also call The Forgiveness Therapy, and asked them, if they met people who did not have traumas. (Muscular kinesiology is an integral part of the NDT and it allows defining if the body of the student stores negative and destructive emotions related to past events.) These practitioners tested thousands of modern people and did not see yet a single person for whom all three points on the body were strong indicating good emotional health. What can be done? As it was previously discussed, from a spiritual or psychological viewpoint, muscular tension, negative emotions, and decreased CP are the direct results of: 1) past traumas; 2) our emotional attachment, in terms of negative emotions (anger, guilt, regret, hostility, confusion, etc.), to these past traumatic situations and all accompanying elements (people, place, time, weather, smells, shapes, etc.). Therefore, past trauma can worsen one’s health due to the self-defeating attitude and conditioning effect so that various stimuli sporadically trigger corresponding emotions and behaviours. What is the definition of the term “forgiveness”? For example, Wikipedia suggests, “Forgiveness has been described as a quality by which one ceases to feel resentment against another for a wrong he or she has committed against oneself. Forgiveness can be granted with or without the other asking for forgiveness. Some people also believe that persons can forgive themselves, that it is possible to forgive groups of people, or that it is possible to be forgiven by God. Forgiveness can be seen as a religious value. However, belief in a deity is not necessary for forgiveness. It can be motivated by love, philosophy, appreciation for the forgiveness of others, empathy, or personal temperament. Even pure pragmatism can lead to forgiveness, as it is well documented that people who forgive are happier than those who hold.” There are various methods and techniques that were developed by humanity in order to deal with this huge and old problem that is present, to a certain degree, in every human being. Virtually all schools and teachings in this area come to us with the word “forgiveness” (or letting it go). There are various forgiveness techniques that can be found in numerous books and on the net (e.g., www.forgivenessweb.com). One, particularly uplifting book (“Why forgive?” by

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Johann Arnold) can be downloaded for free from www.bruderhof.com. Steps to forgiveness involve mostly mental exercises. The goal of these exercises is to change different aspects or parameters of your current attitude. Introspection. Explain to yourself, in words, what happened to you, how you felt during those event(s), how you feel about them now, and what you think about the abuser(s). Past responsibility. Acknowledge your part if any. Were you honest about your hurt or did you hide the fact that the behavior hurt you? Did you seek peace by reassuring the perpetrator that it was all right? Did you stay when you could or should have left? If so, then you, too, have some responsibility. (Here you start to move away from being a victim. Note that by taking responsibility you also take the first step toward self-forgiveness. Why? Because if you do not acknowledge your part, you assume that you were and is a permanent looser***) Current responsibility. Did you take steps to prevent new abuses by the same perpetrator? If not, you are a part of the conspiracy to abuse new people. Sharing. Share these experiences with most trusted people. Distancing. Try to look on the whole situation from outside, as if it was in a movie. What would be your perception of the same situation? Relating. Try to relate this movie to other events on Earth. Are there other events and situations where people experienced more severe stress? Are there any wars, povetry, sadism, rape, torture and many other events when people cannot find agreement or cannot cooperate. Understanding. Your abuser(s) had their own reasons to do what was done. What do you know about their lives? Can you imagine their life experiences leading to the event(s)? Could they have a problem-free life? Communicating. Spend a few minutes 2-4 times every day (e.g., each morning and evening), wishing peace of mind to people who abused you. Future-related imagery and visualization. Imagine that some person had the same traumas that you had. Now visualize that this person became stronger, more independent, and smarter after the events. The traumas became the lessons to learn. Moreover, this person is successful now in various areas in spite of the past traumas. How could this be possible? Apart from DIY approach in relation to own past traumas, there is a developing technique called “New Decision Therapy”. This amazing technique requires help of the qualified practitioner who can reveal presence of negative emotions in the body using muscular kinesiology and remove these emotions using clearing denial procedure, testing probably suspects (again using muscular kinesiology), going back in history, and forgiving them using a mirror and statements of the abused person. One of the unique features of this technique is an ability of the practitioner to check that the negative emotions do not reside in the body anymore.

10.11 The check list of questions for getting CP 60 These questions relate to activities that are important and often necessary for achieving CP 60. 1. Do you exercise for about 3-5 hours per day with exclusively nasal breathing? This can include walking and other activities with movements of the whole body. The student should keep in mind that more intensive activities, e.g. power walking, jogging, and activities that involves shaking of the body are most beneficial health-wise. Possibly, 3 hours is suitable for very intensive exercise (maximum possible intensity with nasal only breathing), while lighter intensities require more time to produce the same effect on the breathing centre. 2. Do you practice constant breathing control during all waking hours with light air hunger after meals, when food is present in the stomach, and medium or strong air hunger at other times? If not, the student may need a program of actions based on gradual increase in the amount of time spend daily on breathing control (e.g., each next day has 1 more hour for breathing control). Note that for over 35 s CP student, neither hours of physical activity nor constant breathing control are hard tasks. 3. Do you use many long breath holds (EPs, MPs, and AMPs) every day for further pressure on the breathing centre? Note that, regardless of your genetic predispositions (e.g., cardiovascular problems), when your CP is over 3035 s, long breath holds are safe, useful and important for further progress. 4. Are you able to do 80-120 s breath holds? 5. Are you getting over 40-50 s CP during the main part of the day? 6. Is your EMCP is about 35-37 s? Do you sleep for about 5-6 hours? If not, go again through the sleep factors and techniques previously described. 7. Are you able to wake up from your night sleep naturally during onset of hyperventilation so that

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overbreathing does not harm your health? Presence of this effect indicates that you indeed work hard to normalize your breathing. 8. Do you spend most of the day, about 9 hours or more, standing? If the sleep is 6 hours or less, there are about 18 or more hours left. Hence, standing should occupy at least 9 or more of these hours. If not, develop new habits: - eat while standing; - read and watch TV standing; - work on computer standing; etc. 9. Do you strengthen the weakest parts of your body, the parts that originates the main resistance to your further progress? (See section 10.4 above). 10. Do your GI symptoms indicate optimum state of your GI flora? There are many related tools (e.g., exceptionally good chewing, use of spices, raw foods, and other changes and ideas) described in the next chapter. 11. Do you practice days of reduced eating? If a student eats only half of their ordinary meal, this greatly increases the time available for breathing exercises (see chapter 11). 12. Do you chew food so well that you can practice reduced breathing after meals? 13. Do you take cold shower every day? 14. Do you walk barefoot for at least 30-40 min daily? 15. Does your body get at least 2-3 hours of shaking (e.g., jogging, or jumping, or power walking, or riding, etc.) every day? 16. Did you forgive all your “enemies” and let all your negative emotions go? 17. Do you constantly remind yourself to relax all muscles? 18. Is your thermoregulation on the slightly cold side for the most of the day? Note that many of these life-style parameters are not in accordance with behaviour of the modern man. For example, modern people breathe through the mouth; we exercise, in average, about 20-30 min per day; we sit for the most part of the day; we eat too large amounts of refined foods, etc. All these parameters are not problems of Doctor Buteyko and the Buteyko method. These are the problems of the modern world. Different students have variable abilities to grasp this simple truth. This ability to understand, as practice shows, depends on: 1. Life style during upbringing; 2. Influence of parents; 3. Influence of peers; 4. Influence of TV, radio, newspapers and other mass media; 5. Teaching of the Buteyko practitioner; 6. Quality of information about the Buteyko method. Therefore, the Buteyko student, in order to be successful and learn the method, should search and find some techniques and methods in order to prevent influences of health-destructive tendencies of the modern world. It relates both, to abilities to persist in the right actions and abilities to explain to others, if necessary, importance of normal life style factors that existed in humanity for millennia.

_______ Q&A section for Chapter 10

Q: How will I know that I passed through the 40 s CP threshold? A: After long and persistent efforts to reduce efforts, you will find out one morning that your morning CP is about 50 s or more. It will also likely to be the night when your sleep was about 1 hour shorter than before. Those who have over 40 s CP usually sleep about 4-5 hours. If you were dealing with a certain symptom or organ, you will notice that your body does not have those old symptoms anymore. (The immune system will get busy with new, but less significant challenges and the next and last threshold, according to Russian Buteyko doctors, corresponds to 70-80 s CP threshold that is much easier than the 40 s one.) Q: What are the best proteins to get very high CPs? A: Buteyko and his colleagues found that animal proteins are among the heaviest foods according to their effect on breathing. Of course, they implied cooked meat, fish, eggs or dairy proteins. Cooking is important in order to prevent 223


infections due to bacterial contamination of commercial foods. Find safe raw meats or fish is one of the solutions. Presence of live enzymes in the lysosomes of raw foods greatly assists their digestion producing minimum effect on breathing. Use of soy milk, as some students noticed, is another alternative to larger final CPs, especially when it is used on an empty hungry stomach with constant breathing control later. In such conditions, soy milk can be used to achieve even higher CP. Q: Are there better clothes for over 60 s CP people? A: Russian studies revealed that when the CP is over 40 s, our skin becomes more sensitive in relation to synthetic clothes that are in mechanical contact with the skin. There are 2 possible mechanisms of this effect: 1) synthetic clothes favour the spread or advance of pathogenic micro-organisms along its fibres, as western studies revealed; 2) synthetic clothes can influence the measurable weak electromagnetic field that exists as an integral part of the nervous system. Hence, natural materials should be used for clothing that is in contact with the skin. Generally, the outfit of the Buteyko student is simple, comfortable, and fit and loose at the same time. It corresponds to natural, gracious, easy and elegant gait and other body movements.

References for chapter 10 Buteyko KP, Carbon dioxide theory and a new method of treatment and prevention of diseases of the respiratory system, cardiovascular system, nervous system, and some other diseases [in Russian], Public lecture in the Moscow State University on 9 December 1969, published in Science and life [Nauka i zshizn’], October 1977. Funderburk, J, Science Studies Yoga, A Review of Physiological Data, Glenview, IL, Himalayan International Institute of Yoga Science & Philosophy of USA, 1977. Guyton AC, Physiology of the human body, 6-th ed., 1984, Saunders Hall Int: London. Sladen RN & Landry D, Renal blood flow regulation, autoregulation, and vasomotor nephropathy, Anesthesiol Clin North America 2000 Dec; 18(4): 791-807. Souliagin SS, Use of physical factors during application of the VEDB [Buteyko] method, [in Russian], in Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991a, Titul, Odessa, p.48-55.

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Chapter 11. Breathing and some GI problems Introduction If a breathing teacher or a student decides to learn more about how to deal with GI problems, to understand the normal work of the GI (gastrointestinal) system can be the first step. It will include learning about: - basic anatomy of the GI system; - main stages of digestion and functions of the digestive organs; - the work of the ENS (enteric nervous system). When these norms are known, study of GI disturbances can be the next preliminary step. It can include understanding of pathological changes and interpretation of lab tests (endoscopy, scans, permeability, gastric probes, various blood results and others). This information can be found in textbooks. The information below is provided with the assumption that the reader has some minimum understanding in these areas.

11.1 Normal digestion and abnormalities The normal goal of the digestive system is to be a harmonious part of the organism, or to provide energy and nutrients for all systems (nervous, cardiovascular, hormonal, GI itself, etc.) and eliminate waste products from the system. The GI system can be imagined as a sophisticated or complicated conveyor, which is similar to the conveyor belt that we can see on, for example, car assembly lines where hundreds or thousands of processes take place. Delays, problems with parts, absence of important components, mistakes in communication and many other abnormalities can slow down or speed up the whole conveyor, causing various abnormalities. Our GI conveyor is not just a mechanical assembly line where only one type of cars is manufactured. There are many other organisms (bacteria, fungi, etc.) that influence the work of the conveyor by producing its own, useful or harmful, substances and effects. The complexity of the work of the GI conveyor is extraordinary. Just think about such known facts: - The work of our GI system is more complicated than all mechanical, chemical and biochemical controlled plants created by humans on Earth. - Even the work of the single cell of the human body is still not understood completely. Visible parameters of digestion Which symptoms or factors indicate good digestion and which ones GI abnormalities? When our digestion is healthy, we just do many other things using our brains, muscles, spirit and imagination. We do not notice various GI processes and effects. Indeed, they probably should not be the focus of our lives. However, sometimes the act of eating generates, later in time, certain effects that we do not like. For example, we can get pains and aches due to some foods; we may bloat; nausea, gas, diarrhoea, confusion, headaches and many other effects can be results of faulty digestion. Why? The GI system cries for help. We need to do something to restore its normal work. Hence, we need to pay close attention to these sings. Possible symptoms The GI tract is hidden from our eyes. However, various symptoms and signs can point out to places and types of these abnormalities. Each seemingly tiny sign can say us something important. Among questions are: What are the triggers of problems? What are their effects? Which foods are well tolerated? Is there any pain, or gas, or burping, or thirst, or bowel movements triggered by wrong foods, or ear buzzing after some meals and activities? What are the locations, intensities and durations of these signs? What is the time sequence of appearance of the symptoms? The results of digestion can be found in the sinks of the toilets (or washrooms) after defecation. Analyzing own faeces is probably not a favourite human activity, if we compare it with music, meditation, prayer, and many other things that are more appealing and pleasant from the emotional or spiritual viewpoint. However, if one gets and has GI problems, this analysis is rather a necessity. Otherwise, many other activities become less meaningful. 1. What is the transition time? When digestion is normal, we may expect that there is no diarrhoea or constipation, the GI conveyor is slow enough to re-absorb minerals, bile and other useful nutrients, but dynamic enough to prevent self-intoxication that takes place in case of constipation when harmful substances from the faecal matter stay for too long time and enter the blood system due to this delay in their elimination. To find out your time, you may swallow about 10-12 corn grains. They will not be digested and, due to their bright yellow colour, it would be possible to notice some of them later. As an alternative you may use seeds of

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oranges, lemons or grapefruits. Activated charcoal tablets or powder will make your faeces very dark. The normal transition time is about 24-36 hours. 2. Are bowel movements regular in relation to food intake? This question relates to the first one since both of them reflect the mechanical parameter (velocity) of the digestive belt (although occasionally some parts of the conveyor can malfunction speed-wise, while other can remain normal or nearly normal). 3. What is the shape of the faeces after they fall in water or on hard surface? Are they regular, well-formed, smooth, homogeneous in colour, etc.? Normal transition time usually creates good conditions for making the shape of faeces regular. Diarrhoea results in irregular or watery faeces. Constipation makes them dry and hardened (at least in the frontal part). 4. Does the water in the sink change its colour after defecation? Normal re-absorption of nutrients means no colour changes. Diarrhoea, depending on degree, results in less clear water. Constipation is often combined with dried initial and watery final part of faeces. 5. When faeces are in contact with the clean surface of the sink (sinks are usually white), do they leave marks or traces? Normal faeces leave no marks indicating good absorption of nutrients and right bacteria in faeces (faeces are over 50% bacteria). Faecal matter with abnormal bacterial content can have a tendency to stick to the walls of the sink (as well as to the lining of the colon causing faecal impaction!). 6. Are marks or traces on the anus present after defecation? In other words, do you need to use toilet paper or tissue to wipe yourself after defecation? Normal faeces should not pollute the body. Wild animals are not provided with toilet rolls or water. How, for example, are bears or elks supposed to clean themselves? Faecal matter with abnormal bacterial content has tendency to leave residues. Presence of various marks indicates that these pathogens would also try to stick to the walls of both colons affecting absorption of nutrients, removal of waste products and many other normal physiological processes. The healthy body needs normal healthy bacteria in the GI tract. 7. Do you produce gas? Is the smell offensive or neutral? Normal digestion may result in small amount of odourless gas. These findings could be summarized in the following simple table.

1. Transition time 2. Regularity of bowel movements 3. Shape of faeces 4. Water in the sink 5. Marks or traces on the sink 6. Residues on the anus 7. Gas

Normal digestion

Diarrhoea

Constipation

24-36 hours

Less than 24 hours

More than 36 hors

Yes

No

No

Well-formed large regular sausage(s) …remains clean

Flaky, watery, or irregular pieces …does not remain clean

None

Very likely

Hardened or dried in the front part, while often more watery at the end … can remain clean or change colour Possible (when the final part is watery) Possible Offensive, can be frequent

_______ None Very likely Little, if any; odourless Offensive, can be frequent Table 11.1 General parameters of digestion

11.2 Chronic hyperventilation and its effects on the GI system

A wide variety of abnormalities are normal outcomes of heavy breathing: • Due to low CO2 concentrations, arteries and arterioles in the digestive organs get constricted. Vasoconstriction reduces blood supply to all GI organs. Published physiological evidence confirms this effect on the stomach, liver, spleen, and the colon. Hence, GI organs get less oxygen, glucose, amino acids and other nutrients necessary for their normal work and repair. Reduced rate of removal of waste products can also be expected. • The suppressed Bohr effect, due to low CO2 values in the blood and tissues, further reduces the oxygenation of the digestive organs. • Hypocapnia causes abnormally excited state of all nerve cells, including the nerve cells in the GI system or the ENS 226


(the enteric nervous system). The ENS comprises various nerve cells located in the lining of intestines, stomach and other parts of the GI tract. This nervous system evolved well before the appearance of the primitive brain and the hypothalamus. Since normal functioning of any nerve cells requires normal CO2 concentrations, tissue hypocapnia (low CO2 concentrations) could make various parts of the ENS over-excited contributing, for example, to various problems with peristalsis. Instead of regular waves that have certain predictable patterns, the excited nerve cells may intensify or hamper certain processes or peristalsis in parts of the GI tract. • Hypocapnia can influence the contraction of the muscular layers, the production and secretion of digestive enzymes and other functions. Indeed, a group of American gastroenterologists from the Mayo Clinic in Rochester recently studied Hyperventilation, central autonomic control, and colonic tone in humans (Ford et al, 1995). They tested the effects of voluntary over-breathing with normal and CO2-rich air. A drop in the CO2 level of the blood (hyperventilation) caused abnormalities in the contractility and peristalsis of the colon. Irritable bowel syndrome is one of the conditions where irritability of the nerve cells can cause abnormal peristalsis. While hypocapnia in the brain can create a favourable ground for epilepsy, depression, panic attacks, addictions, and many other abnormalities, similar effects can be expected in the ENS. It is possible to draw rough analogies between mental and GI problems. For example, epilepsy and Crohn’s disease both can be characterized by powerful massive discharges of neuronal activity. Clinical depression can be compared with constipation, diarrhoea with hyperactivity syndrome, and bipolar disorders with alternating diarrhoea / constipation periods. Since normalization of breathing leads to normal state and, hence, normal work of the nerve cells in the brain, similar effects should be expected in the nerve cells of the ENS. • Alveolar hyperventilation (e.g., 15-20 s CP or less) indicates the general state of stress for the body. As such, CHV often produces abnormal changes in the immune system. The normal immune reaction and ability to fight many parasites and pathogens can disappear. That can favour, in case of the digestive tract, uncontrollable growth of, for example, Candida Albicanis, Helicobacter Pylori, Blastocystis hominis, and salmonella-related, botulism-related and other pathogens. Moreover, the immune system, due to CHV, can become over-sensitive to relatively harmless food substances, like gluten, animal proteins, substances in peanuts, corn, chocolate, citrus fruits, and many others. CHV means chronic state of emergency when various intruders from outside are perceived as damage-causing agents. It is normal then to launch an attack for their destruction as a defensive mechanism of the fighting for life organism. In case of asthma, the allergic reactions in airways can be triggered by dust, dust mites, pollen, proteins from dogs and cats, and other triggers. Avoidance of such triggers is a necessary step for recovery. The digestive tract can become the stage of similar battles. Hence, a breathing teacher who has clear vision of development and treatment of asthma has theoretical basis for understanding of GI problems, including their development and treatment. • CHV interferes with normal inflammatory responses. Excessive inflammation again makes sense due to the chronic emergency state. This can contribute to inflammatory bowel disease, Crohn’s disease, ulcers, gastritis and other problems and complaints where inflammation is an important component. Here, again inflammation of airways and enlarged mast cells in asthma are analogous effects. • Hypocapnia makes the nerve cells of the brain excited. Increased excitability interferes with normal perception causing over-reacting to various stressful situations, confusion, depression and mood swings. These psychological abnormalities can hamper production of digestive enzymes and normal work of the GI system since the GI system serves the whole body and controlled by both, the CNS (central nervous system) and ENS. In addition, CHV can lead to dis-regulation of food tastes and preferences, abnormalities in appetite and abnormal changes in blood sugar regulation. Most people react to hyperventilation by gaining weight. According to some Russian evidence, permeability of cellular membranes in relation to blood glucose is connected with CO2 concentrations. Hypocapnia creates conditions when glucose is driven from blood into fact cells. Hence, most people get hungrier. To go on through the day, they need to eat more just because of heavy breathing. Occasionally, small number of people gets abnormalities in nervous regulation of appetite. They can suffer from lack of appetite and bulimia nervosa. • Since many HV people often breathe through the mouth, they can’t utilize their NO (nitric oxide) synthesized in nasal passages. Even when nasal breathing is present, other effects of CHV (like quick exhalations, slow inhalations, reduced blood and oxygen supply of nasal passages, etc.) do not allow normal production and absorption of NO. This gas is a recently discovered powerful hormone that dilates blood vessels, participates in transmission of messages in the nervous system, and creates normal conditions for the work of the immune system. There are still many questions in relation to this substance.

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• Since most people with HV are chest breathers, normal massage and drainage of the lymphatic nodes of the GI system (they are located under the diaphragm) is not possible. Keeping in mind, inadequate blood supply and suppressed Bohr effect, all these processes make the GI tissues polluted with free radicals, products of anaerobic metabolism, and other waste products. • CHV usually means more frequent breathing (about 15-20 times per minute instead of physiologically normal 10-12 times corresponding to about 40 s CP) and shorter phases of inhalation and, especially, exhalation. Often, with increased CHV, exhalation becomes shorter than inhalation. This indicates an abnormal state of the autonomic nervous system. Indeed, inhalations are modulated by the sympathetic nervous system and exhalations by the parasympathetic. Breathing, therefore, is a window through which we can get information about the work of the autonomic nervous system, which apart from orchestrating breathing muscles, regulates digestive processes. Likely dominance of the sympathetic nervous system during CHV can hamper normal healing and tissue repair since these processes are more active when the parasympathetic system is dominant. • Alveolar HV leads to slightly higher concentrations of free oxygen in the blood. Free oxygen in our bodies generates free radicals causing cellular damage and aging of all tissues, GI organs included. This damage is stronger during hyperventilation. • Since production of digestive enzymes is not normal, metabolism of proteins can be hampered due to heavy breathing. At the same time, the GI tract is the main consumer of the eaten proteins. Therefore, repair of the GI tract is less efficient. • Deficiencies in essential minerals and other elements are frequent due to chronic overbreathing. Any particular deficiency can create its own negative impact on the normal work of the GI conveyor.

11.3 Interaction of these destructive CHV factors with the organism It can be difficult to tell at the present time what the isolated effects of these factors are. Clearly, they are individual. There are no studies that compare these effects or define the individual differences. Similarly, the impact of permanent changes in breathing, in both directions, closer and further from the norms, is also not investigated. Moreover, since hyperventilation creates combinations of abnormalities, their possible number can be very large. And, indeed, during last decades the number of known GI abnormalities has been continuously growing. It is well known that the effects of CHV are very individual, from both physiological and psychological viewpoints. Hence, possible development of specific GI problems in a particular person is based on interactions of variety of factors, including: - hereditary characteristics that can be revealed due to CHV (weak or predisposed to damage systems, organs and tissues, appearance of abnormal chemical and immune reactions, reversal or disappearance of some processes, etc.); - historical and environmental influences (quality, quantity and types of food, water, air, radiation, etc.). One can see that appearance and development of GI problems have very large number of initial variables and that makes prediction of the behaviour of the biological system or development of pathologies practically very difficult unless all these factors are known and are carefully monitored and analyzed. On the other hand, normalization of breathing, when the CP approaches 35-40 s, should gradually and significantly reduce or even eliminate all these CHV-based abnormalities creating conditions for repair and restoration of normal GI processes.

_______ 11.4 Factors that define the time of digestion

Current CP CHV generally leads to decreased GI perfusion, hypoxia and slower peristalsis. The time required to empty stomach after an ordinary meal can increase up to 2-3 or more hours, depending on current CP, meal and other factors. This effect (slower digestion when breathing is heavier) is known even to healthy people who may occasionally have infection, flue, fever or other stressful state with CHV and low CPs. During such times, appetite is suppressed, and desire to eat, for example, fats and proteins are greatly reduced due to their burden on the GI system causing more stress and increased HV. At such times, we drink water or juices and may snack on fruits. Very large CPs greatly facilitate digestive abilities of the human organism due to, for example, increased blood supply and oxygenation of the GI organs. The immune system becomes more sensitive and can effectively fight pathogens in the GI tract so that they cannot attach themselves and remain in the GI tract. This leads to normalization of the flora in the digestive tract. 228


It was mentioned by Doctor Buteyko that people with over 90 s CP could eat almost nails. Probably, he implied increased digestive abilities of the human organism in relation to roughage (like bark, leaves, flowers, etc.). Ancient hatha yoga manuscripts noticed that hatha masters (over 3 min CP) would not get intestinal worms since their eggs would be digested in the stomach. Presence and degree of hunger Presence of real hunger is the factor that, according to Doctor Buteyko, is crucial for preservation or restoration of normal breathing. Real hunger means presence and sufficient amounts of various digestive enzymes (in the mouth, stomach walls, pancreas, liver, and the small intestine). Hunger also indicates current needs for diminishing reserves in energy, amino acids, minerals and other nutrients. When the CP is about 40 s or higher, the organism is intelligent enough to make right choices in foods so that the physiological needs can be satisfied and food is the fuel for the body, brain and soul. Low CPs, on the other hand, create grounds for food addictions. This is especially true for coffee, alcohol, sugar and other refined and junk foods. To stop eating at the first earliest signs of satiety (or even just before they appear) is another important rule emphasized by Buteyko. Extra food needs additional enzymes to digest it. In addition, appearance of additional nutrients in blood, after the meal, creates stress for other organs in order to normalize their concentrations. However, when the amounts of the enzymes are not sufficient, the only way to produce them is by slowing down peristalsis so that these chemicals can be produced. Slowing down the GI conveyor would also make the work of regulation of nutrients concentration easier. The wise step of the biological system is to hyperventilate slowing the digestive process. Why? The alternative for the GI tract, in case of over-eating, is to continue the work of the conveyor with the same rate. However, since some part of the meal would not be digested, this would cause putrefaction of these food substances, production of toxic or harmful chemicals, their absorption by the blood and stress for the immune system and the whole organism. Similar stressful situations appear during bacteraemia or food poisoning. It is likely that the ENS possesses a certain in-built or acquired mechanism of self-defence that can prevent these abnormalities by signalling us to stop eating and get busy with the real life challenges. However, human beings may rationalize continuation of eating so that meals and eating become the main battling grounds. Simple diagrams reflecting these ideas can be useful. When we are hungry: - our organism prepared or will secrete in time certain amounts of various enzymes to digest the meal; - there are certain depots that have needs and space for glucose (e.g., liver and muscles), amino acids (repair of GI and other tissues, cells of the immune system, etc.), and other nutrients. Case 1 (the usual meal). Let us assume that the person finished the meal just at the first signs of satiety. This can be shown on the following simplified way: Container 1: Enzymes

Container 2: Meal

CP

_______ 0

1

2

3

4 hours

These are three containers. One has enzymes, another is the meal, and the third one is empty for storage of the mixture. The amount of enzymes corresponds to the amount and type of the meal. Let us assume that it would take 2 hours to digest this meal. We mix containers 1 and 2 together and put everything in container 3 for the chemical reaction to take place. The normal duration of the reaction (until completion) is 2 hours. 229


The graph on the right shows the CP as function of time. First, breathing gets heavier, and the CP gradually decreases. When the meal left the stomach, the CP quickly restores to the pre-meal values. Case 2 (overeating). Let us assume that the person finished the meal, but decided to ignore the first signs of satiety and ate more food. According to chemical laws governing slow chemical enzyme-involved reactions, if the amount of the main reagent is just slightly more, the time for completion of the reaction will be much longer. Practically, probably as much as 10-20% more food could mean about 50% increase in time to empty the stomach. Excessive eating also means that there is not enough space to store the consumed nutrients. For example, excessive amounts of carbohydrates means more stress for the pancreas (to secrete insulin), higher blood sugar level, and the need to store more carbos in fat cells. Excessive amino acids (from eaten proteins) mean the need for the kidneys to eliminate them from the blood. All these processes indicate stress for various organs and systems of the body. This further intensifies breathing. This reduces blood and oxygen supply for the GI system and makes peristalsis slower. Due to this effect and inadequate amounts of enzymes, pathogenic bacteria would be able to snatch larger portion of nutrients (simple sugars, fermented carbohydrates, proteins, fats, etc.). These bacteria will produce their toxins, absorbed into blood stream and to be eliminated by the immune system. This is another stress for the biological system, this time for organs of elimination and the immune system. It is not surprising to conclude that extra food would not feed the organism but will produce variety of negative effects manifested in lower CPs. The diagram below demonstrates steep CP fall for next 3 hours and the CP is not recovered completely later due to the likely toxic load created by extra food. Container 1: Enzymes

Container 2: Meal

CP

Enzymes

0

1

2

3

4 hours

The CP drop due to eating can be as high as 2-3 times meaning that breathing can become about 2-3 times heavier. It is no surprise then that severely sick people can experience acute attacks and even die from overeating. Having many small meals or snacking through the course of the day makes sense for many of them.

_______ Case 3 (restricted eating). Here only some part of the meal (e.g., 60-70%) is consumed. The meal is completed with the signs of hunger still present. The ample amounts of the enzymes mean that the digestion will be completed much sooner (in about 1 hour). There are no problems with deposition of the digested nutrients (the systems and organs of the body needs them: the CP digested substances are welcome). The CP dip is small. The essential part of this decrease can be due to the energy required for peristalsis. Hence, CO2 concentrations may remain nearly the same and slightly increased breathing indicates greater production of CO2 and generation of extra energy due to muscular activity of peristalsis. Moreover, getting enough essential elements (e.g., minerals, EFAs, amino acids, etc.) could create conditions for achieving even higher CPs.

230


Container 1: Enzymes

Container 2: Meal

CP

0

1

2

3

4 hours

Finally, practical measurements reveal that the CP, for example, during fasting can often increase up to 5080%. However, when the initial CP is low and the body is in the likely state of deficiency in relation to certain substances, prolonged water fasting would not be the optimum solution. It is not a surprise then that numerous studies found benefits of restricted eating (in terms of calories, first of all) and its positive effects on longevity of various species. From health restoration viewpoint, restricted eating has another great advantage. Reduced breathing and breathing sessions can safely be resumed as soon as food left the stomach. Not only the initial CPs will be higher, but also more time can be spent on breathing normalization since daily time with empty stomach is much longer. Note that it is not the goal of the Buteyko method to be undernourished or feel hungry all the time. Restricted eating can be used as a temporary measure to increase the CP and normalize breathing. When we control our breathing, blood sugar control is also more efficient and hunger is not as strong. From these views, walking, mechanical restrictions of ventilation, use of supplements, and restricted eating are all temporary measures to reduce breathing. After achievement of the new level of homeostasis with higher CP values, the person has new (smaller) needs in air, water and food due to improved absorption, utilization and retention of food substances. The biological system will function more efficiently in terms of physical and mental outputs. Hatha yoga teachers noticed that when they students achieve very large breath holding times (3-5 minutes), these students can have only 1-2 meals per day or to go on for 2-3 days with no food, no water and no sleep while still having excellent CP and excellent health. At the opposite end, we have severely sick people who often need frequent small meals to recover sooner. These and other observations confirm the general ideas that: - When the CP is very high we can “abuse” ourselves, in various respects, without large negative effects; - When the CP is low, we have to be more (or very) careful about food, exercise, sleep, water balance, etc.

11.5 Breathing control during and after meals

_______ Breath holds and RB (reduced breathing) intensify peristalsis. That can be dangerous for people with existing GI problems or inflammation. About half of modern Westerners, according to recent studies, have some inflammation in the lining of the stomach that is usually accompanied by the presence of Helicobacter Pylori. These people often do not have any essential symptoms or complaints. It would make sense then to discourage students from doing any RB or pauses after meals or while food is still in the stomach. This is one of the requirements of Doctor Buteyko and his numerous pupils in relation to breathing exercises: on empty stomach. CHV has great protective value preventing further damage to the GI tract in cases of various digestive problems accompanied by inflammatory processes, ulcers and other structural or mechanical abnormalities. How? HV, by slowing down peristalsis after meals, preserves structural integrity of the GI tract in areas with ulcers, inflammation, or bleeding. That relates, first of all, to the stomach and the first part of the small intestine (duodenum). Mild voluntary hyperventilation, when the meal is in the stomach, slows down peristalsis. Can it have good effects and for whom? In order to understand the effects, think about the analogy with skin brushing. When the skin is inflamed or 231


bruised, it would make sense to give it rest and apply something very gentle in mechanical and chemical sense, for example, mild creams or water. Rubbing, stretching, strong massage, or application of irritating substances would retard recovery. Moreover, when open wounds are present, especially bleeding ones, even more care is required. However, when the skin starts to heal, very gentle massage can help to increase blood supply, increase strength and improve the tone of the smooth muscles. Similarly, even when inflammation is absent, the optimum level of stimulation should correspond to the current state of the skin. For example, if an ordinary modern person takes a rough skin brush and vigorously brushes an arm or a leg just with several strokes, this could result in appeared inflammation. However, gentle skin brushing for some days and gradual increase in its intensity makes the skin strong and resilient. Later, more rigorous brushing is possible and even beneficial. This analogy also helps to understand why during prolonged water fasting (2 or more days) the lining of digestive organs become thinner and weaker so that gradual transition to more rough food (both in mechanical and biochemical senses) is necessary. It also becomes clearer why healthy skin needs strong stimulation in order to remain strong and healthy. CO2 content (or intensity of breathing) can be compared with the intensity of skin brushing: the higher the CO2 or CP, the stronger the peristalsis. The sizes and solubility of meal particles are comparable with thy type of the skin brush one uses. This also explains how HV reduces mechanical wear of the lining of the stomach and the small intestine. This can be very useful, when GI inflammation or damage is already present. Moreover, voluntary after-meal HV can be beneficial in acute stages of Crohn’s disease, ulcers, IBD, IBS, etc. during flare-ups, when chronic diarrhoea, gas production, or blood in the stool are the observable symptoms. As the strong skin can withstand and even need vigorous prolonged brushing, raw diet with well-chewed greens, nuts, and seeds provide such stimulation for the healthy GI tract. Healthy people with high CPs and no digestive problems can, therefore, practice breathing control (RB) after meals. Moreover, breathing control after meals (very light air hunger) is a positive factor to break through the 40 s CP threshold.

11.6 Chewing and particle size of the swallowed food The analogy with skin brushing helps to understand the variable effects of chewing, cooking and particle size of digested meals depending on the current state of the GI tract. When food is well chewed, up to 80% starches, 15% fats, and 5% proteins can be digested in the mouth reducing the burden of digestion for the stomach, liver, and, especially, pancreas. Moreover, good chewing helps the ENS to better identify the incoming substances and prepare the appropriate enzymes for efficient processing down the conveyor. When chewing is insufficient, some food particles remain large. As a result, many nutrients remain locked in their cells and become unavailable for the organism. Instead of providing nourishment, these large particles, with locked-in goodness, become a burden for the GI tract causing more wear of the GI linings even for very health people. What would happen if one blends an ordinary meal with proteins, complex carbohydrates, and fats and drinks it in a minute? The GI distress is almost certain. It would be very hard for the stomach and other GI organs to find out which enzymes to produce and how fast to propel the chum along the conveyor. Such meal can stay very long time in the stomach indicating confusion and stress in the GI system. Recent archaeological studies of teeth and jaws of Europeans living during medieval times showed that our recent predecessors were spending up to 4-5 hours per day on chewing. Why is it good for the GI system and health? We reduce a burden on the digestive organs, like the stomach, pancreas, liver, and the small intestine due to small particle size, pre-digested state of the chum, ability of the ENS to prepare the whole GI conveyor to processing such meals, easier control of blood sugar, and our ability to control breathing after the meals.

_______ 11.7 Effects of various foods on breathing

As discussed above, it is presence of real hunger during the whole meal that matters most for effective digestion. Chewing is another important factor. Obviously, the food should fit current needs of the organism. Apart from these factors, we have usually choices in what to eat. Methods of food preparation/processing and their effects on breathing Generally, processing destroys enzymes and other nutrients, while generating free radicals and introducing 232


toxic chemicals. Let us look at the impact of various food preparation techniques on breathing.

Small

Moderate

Large

Very large

Fig. 11.4 Impact of various food preparation techniques on breathing. Canned foods, which are not shown here, can be at the right end of this row, depending on the methods of preparation, types of food, packaging, and conditions and durations of storage. Russian doctors observed that canned foods could produce the worst effect. Raw foods are most natural due to maximum amounts of own enzymes and minimum damage due to processing. Freezing causes destruction of some vitamins and other useful nutrients. During drying enzymes and some other nutrients can be destroyed. Milling and making flours greatly increase the surface area of the food generating more free radicals due to oxidation. Heating eliminates enzymes and, depending on temperature, pressure and duration, destroys other nutrients and introduces free radicals and other dangerous chemicals. Frying, for example, causes oxidation of oils (causing again formation of free radicals). Changing food colour reflects the degree of chemical and structural transformations. For example, formation of dark brown or black crust on breads or meats, e.g. during baking, grilling or deep-frying, means appearance of carcinogenic substances. There are many other parameters, like duration of storage and appearance of molds, fungi, pathogenic bacteria, etc. due to spoilage or inappropriate conditions of storage that can greatly affect the nutritional value of any particular product. In some cases heating or pasteurization, while destroying enzymes and other nutrients, can be beneficial due to hygienic reasons in order to prevent, for example, bacterial infections in raw milk. Conventional non-organic foods have some harmful chemicals, especially in animal products, and have slightly decreased concentration of minerals and other useful nutrients. Types of the food Considering various types of foods, the following approximate order can be suggested:

_______ Small

Moderate

Large

Very large

Fig. 11.5 Impact of various foods on breathing.

This simple diagram roughly reflects the degree of stress of various foods on the GI organs. For example, raw fruits and their freshly-squeezed juices usually have the least impact on breathing due to minimum requirements from 233


the GI system (they have abundant minerals, very little proteins, presence of own enzymes). However, biologically, for example, buckwheat and avocado are fruits, but their nutritional compositions are very different from typical fruits. Hence, their effects on breathing would be closer to grains-nuts. Dairy products can have wide concentrations of fats (from 0 to about 80%), proteins (from 0 to over 30%), lactose, etc. Additionally, one needs to take into account possible allergic reactions in predisposed people and individual differences in abilities of digestive organs. Processing, as mentioned above, greatly influences the effects on breathing. Sprouting of grains, legumes and nuts increase bio-availability of many nutrients making them similar to raw fruits and vegetables. Cooked animal proteins and fats are at the other end and are most burdensome for breathing. One might be surprised by very small negative effect of, for example, raw fish or meat due to presence of self-digestive enzymes in lysosomes of raw cells. The particular effects of foods in people with GI problems are often individual and depend on current needs and existing GI pathologies. Some of these effects will be considered below.

11.8 Focal infections and their GI effects Focal infections, while being dormant for low CPs (below 20 s), can directly affect possible recovery from various GI problems. In some cases, there is a simple mechanism of such influence. Cavities For example, cavities in teeth mean presence of various types of pathogens in the mouth. These pathogens, which are often anaerobes, generate exceptionally powerful toxins swallowed with saliva. Even tiny amounts of these toxins produce 2 effects: - the global impact on breathing (the CP will remain below 30-40 s unless the source of infection is eliminated); - the local impact on the regions located further along the digestive conveyor, especially on the stomach and the duodenum intensifying, for example, existing inflammation. A case study. A person with bad teeth and chronic acute gastritis or gastric ulcers fasted on water, but burping (passing gas through the mouth) took place about every hour during fasting since he swallowed those cariesproducing pathogens and they generated further inflammation, degradation of damaged stomach surfaces, leading to putrefaction of the affected lining. Normally, fasting is supposed to be the time of self-repair of the system with no need to deal with food digestion. (The same enzymes would be used for digestion of own malignant, inflamed and other abnormal cells). Here the biological system was dealing with self-generated pathological process instead of selfrepair. Hence, recovery from the GI problem, even while fasting, was not possible. Infected tonsils Similar effects can be expected when tonsils are dysfunctional or dead. They can be inflamed and enlarged or in the state of atrophy and almost invisible. Such tonsils harbour pathogens that are inaccessible for blood and, hence, cells of the immune system. Swallowing of the generated toxic substances can produce similar symptoms as in case of cavities. The situations with bad tonsils can be even worse. Larger CPs (up to 30-35 s) will lead to increased sensitivity of the immune system. The cells of the immune cells will attack the areas neighbouring to tonsils and create even more inflammation. This can result in fever, headaches, soar throat and other symptoms of acute tonsilar infection. Successful recovery, according to Russian Buteyko experience, needs surgery (tonsillectomy). Helmints or intestinal worms Similar ideas can be applied for cases of helmintic infestation (presence of intestinal worms). Large and medium parasites often reside in the first part of the large colon near the appendix since they are probably are not very comfortable up the GI stream due to digestive juices present there. During meals the worms travel along the small intestine against the chum flow to duodenum, in order to feed on nutrients before they get absorbed in blood. This migration of large bodies upstream is accompanied by spread of small pathogens to the parts of the GI tract, which should normally be almost sterile (e.g., most of the small intestine). In addition, the immune system is chronically challenged by waste products generated by worms and absorbed into the bloodstream. Depending on severity of the infestation, the CP is restricted by 25-35 s. Further normalization of breathing and repair of the GI tract, without elimination of worms, is impossible. Athlete’s feet Another focal infection relates to athlete’s feet. This contagious skin infection is usually caused by a fungal species of Trichophyton or Epidermophyton. It is often called tinea pedis. As with cavities and dead tonsils, larger CPs (up to 35-40 s) causes stronger immune reaction, but due to inaccessibility of the infectious source (the blood can not reach the skin), the resulting inflammation near the infected areas creates more favourable conditions for further spread

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of the infection. Hence, higher CPs favour, as in case of caries, further spread of the infection. While being far from the GI system, presence of this focal infectious source also restrict the CP below 30-40 s. Being a burden that distract the immune system, athlete foot also makes normalization of breathing impossible unless special measures against the focal source are taken. Application of special creams against these fungi assists elimination of the pathogens and helps to increase the CP. However, the situation with athlete’s feet, in relation to GI problems, can be different. Its treatment may not be as necessary as other factors. Imagine an asthmatic with allergy to dust mites, gastritis due to Helicobacter Pylori, athletes feet infection, and round worms. In order to naturally eliminate gastritic inflammation (using the innate ability of the immune system), the student needs high CPs (about 30-40 s). It would be necessary to avoid allergic reactions due to dust mites and eliminate worms. However, the fungi in feet will not be attacked by the immune system, unless the gastritis is over. Only when Helicobacter is eliminated, the immune system starts to deal with the fungi in feet. There are certain priorities for the immune system in what it sees as a most urgent problem of the human organism. Periodontal problems and root canals There is too little information about effects of pathogens due to periodontal problems on the CP and digestion. It is possible that anaerobic bacteria that can be present in root canals or periodontal bones can temporary suppress the immune system retarding treatment of the GI problem. The conditions for these processes are still unclear and need systematic studies. It is obvious though that since bones have very limited blood supply, restoration of tissues and elimination of pathogens are slow. Root canals are not considered focal infections, and it is possible to achieve large CPs (up to 1-3 minutes), while having dead teeth. However, their presence, when the CP is below 20 s, can lead to spread of bacterial infections from dead teeth to surrounding bones. This can hinder breathing normalization.

11.9 Positive effects of high CPs on the GI tract As it is indicated by Russian medical professionals, when the CPs are about 30-40 s, the immune system can successfully deal with pathogens in the digestive system due to intrinsic immunity. That relates to, for example, elimination of Helicobacter Pylori usually present in cases of gastritis and duodenal ulcers. Candida, another frequent culprit of various digestive disorders, can often be subdued at about 25-30 s CP. Note that while medical doctors suggest use of antibiotics and other drugs, normalization of breathing naturally eliminates many unwanted pathogens, indicating hidden wisdom of the human body and strength of the immune system when right conditions for health restoration are created. Repair of damaged tissues, elimination of inflammation, improvements in blood perfusion, oxygenation, muscular tone, neuronal communication, these and many other processes are enhanced when the morning CP is approaching 30-40 s. Moreover, there is some evidence that, if these CP values are maintained for some weeks, not only tissues will be repaired, but autoimmune reactions will disappear due to desensitization of the immune system to previously allergic stimuli. As in cases of asthma, one needs to maintain high CP (30-40 s) for some weeks in order to be allergy free in relation to previous triggers (like dust mites, cats, dogs, pollen, etc.), so are the allergic reactions in cases of GI disorders. However, one should keep in mind that not all GI problems can be successfully solved using breathing normalization and avoidance of triggers. In some rare cases, the damage to the GI tract and other systems can be so extensive that, for example, any meal would result in toxaemia and further health deterioration. This can happen after gun or knife wounds, deep fire burns, poisoning, industrial accidents, and in other extreme conditions due to mechanical damage to the GI organs. Such cases are usually addressed using parietal nutrition (intravenous injection of ready to sue nutrients) so that the GI tract can take care of itself (no need to deal with food). When its integrity is restored, food consumption through the mouth can be resumed. Let us assume then that it is possible to pull the body out of the abnormal situation without parietal nutrition. In other words, we assume that the student can improve own health and get nutrients using the own GI system.

_______ 11.10 Triggers of GI problems and the soft diet

The triggers, as in cases of asthma, are numerous and individual, and successful treatment depends on a correct plan and strict adherence. Just one factor, as in asthma, can, if it is present on a daily basis, provoke acute episodes 235


retarding the recovery or making it impossible. However, most triggers in asthma produce their effects almost immediately, and, hence, they are identifiable. In cases of GI problems, it may take up to 3-4 hours for the abnormal reaction to take place and the abnormal symptoms can be sometimes attributed to irrelevant causes. While there are various GI abnormalities and different symptoms known to the medical science and reported by the students and patients, let me consider triggers in cases of severe GI disturbances when, for example, ulcers and GI inflammation present in the duodenum and the stomach. (The duodenum, due to its central role in digestion and absorption of most nutrients, is the most trouble-some part of the GI system.) Such cases can be accompanied by bleeding in the affected areas. For many GI problems their triggers are CP-dependent. For example, symptoms of gastritis, heartburn, pancreatic insufficiency, etc. are strong when the CP is low (e.g., 10-15 s or less) and may disappear when the CP gets higher (up to 35-40 s). Successful dealing with serious GI problems requires not only high CPs, but many other factors, like good chewing, right choice of foods, proper timing, avoidance of allergens and triggers, etc. Some GI concerns are relatively easy to solve. Here, we consider more difficult situations with inflammation, active state of the gut and other aggravating factors. Soft diet and its examples Western medical professionals understand and use special diets for various diseases (including arthritis, colitis, IBS, ulcers, Crohn’s, lupus, etc.). For example, in Fasting and Eating for Health (A Medical Doctor’s Program for Conquering Disease) by Joel Fuhrman, in section Inflammatory Bowel Disease: Ulcerative Colitis and Crohn’s Disease, Dr. Fuhrman writes, ”…Frequently, when the disease is active and there is bleeding, individuals cannot tolerate any uncooked food. They are best fed with stewed vegetables exclusively. Persons who are bleeding should consume a diet of soft (steamed or stewed) vegetables until they can embark on a fast. The diet should be composed of vegetables such as stewed zucchini (courgettes), sweet potatoes, squash, and new potatoes (no skin). All foods should be chewed exceptionally well. No fruit juices, citrus fruits, or tomatoes should be eaten; even other fruits may need to be avoided. Avoid cereals and all grains except well-cooked rice…” The soft diet should satisfy two important requirements. It is to be exceptionally soft and gentle: 1) in mechanical terms (no skin of fruits or vegetables, no rough fibres as in celery, white cabbage, etc.) 2) in biochemical terms (as for most spices, fresh citrus fruits, tomatoes, green and yellow peppers, etc.) Baby foods would be well tolerated, while any food that is even slightly crispy during chewing would be damaging. It is doubtful if one can chew brown rice, even well cooked, to such a consistency that it can be squeezed between teeth. Porridge or gruel from organic brown rice flour cooked with liberal amounts of water can be tried instead. Some rice cakes, rice bread made with, for example, baking soda or rice puffs, depending on processing, may be agreeable. Thorough chewing of all these foods, even when they are in the state of the paste, is important. Raw vegetable juice (cabbage or lettuce juice with a little carrot juice added) is usually non-irritating. Taking large amounts of essential fatty acids, such as flax oil, borage oil, evening primrose oil, or fish oils, is sometimes helpful as a natural anti-inflammatory to help patients avoid or lessen the need for medication. Why does it happen that the body does not accept normally certain foods? What could be wrong with eating raw vegetables or skins of fruits? The ENS (enteric nervous system) was designed by Nature to protect its owners from damage when various dangerous creatures and foods were consumed. For example, eating some sharp objects can result in severe bleeding and death, should normal (slow) digestion take place. Indeed, normal digestion would move the sharp object back and forth inside the stomach and intestines causing damage and bleeding. Hence, the protective mechanism of the ENS should include intensification of peristalsis along the digestive tract so that to vomit or propel damaging foods forward faster minimizing the damage to the GI tract. Absorption of nutrients would suffer but less damage would be done to the organs of digestion. This is the question of survival. In other words, imagine that a primitive man swallowed some small creature similar to a hedgehog or porcupine. Normal digestion could result in death, while very intensive peristalsis would minimize the damage. Severe GI problems need exceptional attention to chewing, cooking and types of the food used. In case of severe problems, as pointed above, very few foods are well tolerated. The above list of allowed foods, suggested by Dr. Fuhrman, can be expanded and explained. Cooking of vegetables should be done till very soft or mushy consistency. This changes the chemical structure of fibres so that they attract large number of polarized water molecules and reduce the mechanical friction with the

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lining of GI organs. Generally, several different fibre types known, depending on their ability to attract water molecules. Any food, which remains crispy when chewed, would be a problem. For example, raw potatoes or sweet potatoes are crispy no matter how well they are chewed. Cooking makes them acceptable but thorough chewing of starches is necessary. For example, 30-40 min of cooking can make even cauliflower, broccoli, or Brussels sprouts very soft and possibly suitable (unless they provoke an allergic reaction). When cooking is shorter (e.g., 10-15 minutes), they may still be crispy. When these vegetables are over-ripe, the structure of their fibres becomes different (more rough and strong like grasses or woods), making even long cooking inefficient. Younger varieties are generally softer and better digested. It is almost impossible to chew cooked whole carrots till the state of the paste, even if they were cooked for 30-40 minutes. However, if one blends these carrots and cooks them only for few minutes, they would not produce GI problems. Similarly, one can cook their pulp left after juicing. Frozen foods (many countries have frozen cauliflower, broccoli, and Brussels sprouts) might be even advantageous. They have less or no chemicals, which are required for long shelf or display life. In addition, freezing ruptures cells making the food softer after defrosting. They become less crispy. As a result, frozen vegetables need less cooking. That should favour preservation of vitamins and other useful nutrients in comparison with long cooking of fresh varieties. Other vegetables, like beets, celery, and numerous greens are poorly tolerated, in severe GI cases, due to various reasons. For example, most greens and cabbages remain crispy and no cooking, chewing or blending can change their insoluble rough fibres. Probably, among greens, only spinach might be blended and then cooked so that to become suitable. (Spirulina powder should not cause problems too.) Skin of many vegetables, like peas, beans, carrots, and others, are poor attractors of water even after cooking. Many vegetables, like beets, cucumbers, peppers (green, yellow, and red), tomatoes, and others, even when peeled and cooked, usually produce adverse effects, probably due to some adverse chemical effects. Possibly, some of their substances produce more irritation for already inflamed GI surfaces. When one eats rice cakes, they are crispy in the mouth at the beginning of chewing, but sufficient chewing can make them smooth and acceptable. For example, 100 g rice cakes may need about 30-40 minutes to chew. Hence, one needs patience and discipline. Some foods can be made soft, but their particles may still be a problem, even after very long cooking, like in case of carrots. The test for good chewing is simple: if you can squeeze the content between your teeth and nothing left than it can be swallowed. Practically, such rigorous chewing usually results in small and gradual leakage of the food to the stomach. That means that any swallowing should be discouraged. One can check that, for example, with bread one bite may need as many as 50-100 chewing movements. The amount of required saliva would be much greater than the amount of food. Chewing is exceptionally important even for liquefied foods. For example, one can liquefy cooked rice, pumpkin, zucchini, sprouts, broccoli, carrots and many other vegetables and drink them. This can result in GI stress with indigestion, burping and other unpleasant symptoms. Symptoms related to urination It is sometimes possible that frequency of urination can reflect how irritable the GI tract currently is. During “flare up”, the person may go to urinate more frequently since the intestines have more intensive and more frequent waves of peristalsis causing, due to physical proximity, irritation of the urinary bladder. When flare up is over, more urine can be accumulated in the bladder without discomfort. When the bladders accumulate more urine they press stronger on neighbouring GI organs helping them to restore their normal positions. However, when the GI organs inflamed, the tissues are over-sensitive and urinations, during flare-ups are frequent. From respiratory viewpoint, voluntary suppression of the desire to urinate decrease breathing and hence can help to increase the CP. Suppression and postponement of defecation, on the other hand, lead to hyperventilation. Chemical factors or triggers Patients with an active gut and on soft diet are usually aware about negative effects of: - spices (black pepper, ginger, etc.); - salt; - essential oils, like mint, peppermint, menthol, camphor, etc. (even in tooth pastes or chewing gums); - coffee and chocolate; - acidic substances (un-buffered vitamin C, citric acid present in many modern foods, various supplements, etc.); - gluten;

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- smoking; - chemicals in non-organic foods (pesticides, herbicides, antibiotics, hormones, etc.). In some cases, the list of adverse parameters can also include: - animal proteins; - air pollution; - excessive radiation (from sun, computer screens, TV, etc.); - rigorous mechanical shaking. As in case with asthma, the only way forward is to avoid these “flare-up” triggers. Essential nutrients and their deficiencies Chronic hyperventilation interferes with chemical reactions related to activity of vitamins, enzymes and minerals. In addition, absorption and retention of various nutrients can be hampered. In order to maintain the normal work, the hyperventilating organism requires larger amounts of some nutrients. The needs in others can get smaller. Practical actions and typical suggestions were considered before.

11.11 Mechanical shaking of the body Doctor Buteyko indicated that mechanical shaking has numerous positive effects and can be very useful for restoration of normal breathing. Why? Biochemical processes in our bodies are usually governed by various messenger-substances, which are produced, stored and secreted by various organs and tissues. Numerous body chemicals can do their job much faster if they can quickly access the whole cell or any other area or tissue. Prevention of accumulation of faecal impaction, mucus, and other debris on the walls of the gut, is essential for good absorption of nutrients, suppression of pathogens and general GI health. Possibly, jogging is one the natural methods how this can be achieved. However, healing of various GI parts sometimes require absence of vigorous shaking and, indeed, a patient with severe GI problems can notice that shaking causes worsening of the symptoms. For example, imagine a patient whose fast walking or running results in burping every 5-10 minutes or gas, thirst and diarrhoea. What are the causes? It is possible that shaking can tear apart the healing sides of the stomach ulcer. This would cause self-digestion in the stomach and production of gas passed out through the mouth. Similar pathological processes can take place in the small intestine and, through the pyloric valve, the gas can be produced. Thus, just healed surfaces can re-open and get in contact with GI juices and pathogenic bacteria. The unprotected tissues can be partly digested by secreted digestive enzymes, with possible putrefaction due to pathogenic bacteria. These processes will lead to inflammation of the lining causing appearance of thirst. Practical factors that can trigger this abnormal reaction with intensive peristalsis (flare up) can include: - shaking (due to movements of the body, including walking, running, cycling on bumpy or uneven surface; riding in vehicles, for examples, in cars, trains, or buses; holding vibrating devices, like mowing machine, vacuum cleaner, etc.; tooth brushing; rubbing of body parts during self-washing; and many other activities); - mechanical compression of the belly after meals due to: tight trousers or belts, bending forward with slouching, caring boxes with pressure on the stomach, caring a backpack of the chest, etc; - large size and poor solubility and digestibility of the food particles. Any of these factors alone can produce flare-up with GI distress.

_______ 11.12 Use of spices

Using of large amounts of spices is one of the significant features in the diet suggested and used by Doctor Buteyko and his colleagues. What are the reasons? Spices, used for millennia to preserve and enhance the taste and flavour of foods, have numerous beneficial properties, according to recent scientific evidence. Antimicrobial properties Scientists from Cornell University (Ithaca, NY) investigated and confirmed, according to the title of their paper, Antimicrobial functions of spices: why some like it hot published in Quarterly Review in Biology. Specifically, they concluded, “In support of this is the fact that spice plant secondary compounds are powerful antimicrobial (i.e., antibacterial and antifungal) agents” (Billing & Sherman, 1998). Lampe from the Fred Hutchinson Cancer Research Center in Seattle wrote,” Thousands of chemical structures have been identified in plant foods. Many are found in spices… In plants, these compounds function to attract beneficial and repel harmful organisms, serve as photoprotectants, and respond to environmental changes. In humans, 238


they can have complementary and overlapping actions, including antioxidant effects, modulation of detoxification enzymes, stimulation of the immune system, reduction of inflammation, modulation of steroid metabolism, and antibacterial and antiviral effects. Embracing a cuisine rich in spice, as well as in fruit and vegetables, may further enhance the chemopreventive capacity of one's diet” (Lampe, 2003). Indian microbiologists Arora and Kaur from Guru Nanak Dev University in Amritsar studied Antimicrobial activity of spices (Arora & Kaur, 1999). They found that “Some bacteria showing resistance to certain antibiotics were sensitive to extracts of both garlic and clove. Greater anti-candidal activity was shown by garlic than by nystatin. Spices might have a great potential to be used as antimicrobial agents” (Arora & Kaur, 1999). Numerous publications, according to their titles, revealed various specific effects of spices. Turkish scientists published an article Inhibitory effects of spice essential oils on the growth of Bacillus species. They studied such popular spices as black thyme, cumin, fennel (sweet), laurel, marjoram, mint, oregano, pickling herb, sage, savory, and thyme and found that” All of the tested essential oils (except for cumin) showed antibacterial activity against one or more of the Bacillus species used in this study” (Ozcan et al, 2006). An Egyptian researcher El-Maraghy from Assuit University wrote, “The high antimycotic activity of four kinds of spices, viz, Chinese cassia, cinnamon, clove and thyme, were tested as preservatives for agricultural commodities. Clove, thyme and a mixture of the four kinds of spice completely inhibited aflatoxin production on lentil seeds during eight weeks of incubation” (El-Maraghy, 1995). Danish biotechnologists from the Technical University of Denmark published a study Inhibition of fungal growth on bread by volatile components from spices and herbs, and the possible application in active packaging, with special emphasis on mustard essential oil (Nielsen & Rios, 2000). A large group of Mexican scientists published a study Antifungal activity of Mexican oregano (Lippia berlandieri Shauer (Portillo-Ruiz et al, 2005). Several food and environmental hygienists from the University of Helsinki examined Antibacterial efficiency of Finnish spice essential oils against pathogenic and spoilage bacteria. They found that “Oregano, savory, and thyme showed the broadest antibacterial activity by distinctly inhibiting the growth of all the organisms tested” (Nevas et al, 2004). Japanese health professionals from the National Research Institute of Fisheries Science in Yokohama studied Antimicrobial effect of spices and herbs on Vibrio parahaemolyticus (a foodborne pathogen). They found that “Basil, clove, garlic, horseradish, marjoram, oregano, rosemary, and thyme exhibited antibacterial activities at incubation of 30 degrees C… These results suggest that the spices and herbs can be practical for protecting seafood from the risk of contamination by V. parahaemolyticus and used in hurdle technology with low temperature” (Yano et al, 2006). There are many other studies of the similar nature. Their results, as well as the findings from the just mentioned references, are summarized in the following table.

Spices and their extracts used

Pathogens or toxins inhibited

Place of the study

Reference

_______ Chinese cassia, cinnamon, clove and thyme

Aflatoxin

Garlic bulbs, green garlic,

Aspergillus niger and Aspergillus flavus (fungi)

green onions, hot peppers, ginger, Chinese parsley, and basil 35 different Indian spices including clove, cinnamon, bishop's weed, chilli, horse raddish, cumin, tamarind, black

Bacillus subtilis,

Escherichia coli and Saccharomyces cerevisiae

Botany Department, Faculty of Science, Assiut University, Egypt Institute of Nutritional Science, Chungshan Medical and Dental College, Taiwan

El-Maraghy, 1995

Department of Biochemistry, University College of Science, Calcutta, India

De M Krishna et al, 1999

Yin & Cheng, 1998

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cumin, pomegranate seeds, nutmeg, garlic, onion, tejpat, celery, cambodge Essential oils of oregano (Origanum vulgare), mint

Aspergillus ochraceus and ochratoxin A production

Dpto. Biotechnología, Facultad Ingeniería Química, Universidad Nacional del Litoral, Santiago del Estero, Santa Fe, Argentina

Basílico & Basílico, 1999

Penicillium commune, P. roqueforti, Aspergillus flavus and Endomyces fibuliger (most important spoilage fungi of bread) Shigella sonnei and Shigella flexneri (vegetable pathogens)

Department of Biotechnology,Technical University of Denmark

Nielsen & Rios, 2000

Laboratory of Food Microbiology and Food Preservation, Faculty of Agricultural

Bagamboula et al, 2001

(Menta arvensis), basil (Ocimum basilicum), sage (Salvia officinalis) and coriander (Coriandrum sativum) Mustard, cinnamon, garlic, oregano and clove

Cloves, thyme, oregano, rosemary and basil

Licorice

Methanol extracts of Myristica fragrans (aril); extracts from Barringtonia acutangula (leaf) and Kaempferia galanga (rhizome); Cassia grandis (leaf), Cleome viscosa (leaf), Myristica fragrans (leaf), Syzygium aromaticum (leaf) Pouzolzia pentandra (leaf), Cycas siamensis (leaf), Litsea elliptica (leaf) and Melaleuca

Bacillus subtilis, all gram-positive bacteria tested 18 strains of Helicobacter pylori (the primary etiological agent responsible for the

and Applied Biology Sciences, University of Gent, Gent, Belgium Research Laboratory, Higashimaru Shoyu Co., Tatsuno, Hyogo, Japan Department of Plant Science, Faculty of Science, Mahidol University, Bangkok, Thailand

Tsukiyama et al, 2002 Bhamarapravati et al, 2003

development of gastritis, dyspepsia, peptic ulcer disease and gastric cancer)

_______ quinquenervia (leaf) Chilli, cinnamon, cloves, ginger, nutmeg, oregano, rosemary, sage, thyme

Aeromonas hydrophila, Listeria monocytogenes and Yersinia enterocolitica (foodborne pathogens)

Laboratorio di Microbiologia, Arcispedale S. Maria Nuova, Reggio Emilia,

Fabio et al, 2003

Italia

240


Juniperus essential oils from different species of Juniperus

Nutmeg, mint, clove, oregano, cinnamon, sassafras, sage, thyme, rosemary

Oregano, savory, and thyme

Leaf extracts from Japanese persimmon, white cedar, and grape

Aspergillus flavus (fungi, an aflatoxin B1 producer) Bacillus cereus (vegetable pathogen)

12 bacterial strains, including spoilage and pathogenic bacteria (Clostridium botulinum and Clostridium perfringens) Vibrio parahaemolyticus, Staphylococcus aureus, Listeria monocytogenes, Escherichia coli and

Department of Experimental Biology, University of Cagliari, Sardinia, Italy Departamento de Producción Vegetal y Microbiología, Escuela Politécnica Superior de Orihuela, Universidad Miguel Hernández, Alicante, Orihuela, Spain Department of Food and Environmental Hygiene, Faculty of Veterinary Medicine, University of Helsinki, Finland

Cosentino et al, 2003

Valero & Salmerón, 2003

Nevas et al, 2004

Department of Microbiology, National Institute of Health Sciences, Setagaya-ku, Tokyo, Japan

Hara-Kudo et al, 2004

Centre for Infectious Diseases and International Health, Royal Free and

O'Mahony et al, 2005

Salmonella Enteritidis

Turmeric, cumin, ginger, chilli, borage, black caraway, oregano and liquorice, Columbo weed, long pepper, parsley, tarragon, nutmeg, yellow-berried nightshade, threadstem carpetweed, sage and cinnamon

(foodborne pathogens) 4 strains of Helicobacter pylori (the primary etiological agent responsible for the development of gastritis, dyspepsia, peptic ulcer disease and gastric cancer) Aspergillus parasiticus

University College London Medical School, the UK Department of Food Engineering, Faculty of Agriculture, Selçuk University, Konya, Turkey

Ozcan, 2005

Twenty-one fungal strains, which included Penicillium, Geotrichum, Aspergillus, and Bipolaris 13 bacterial strains and 6 fungi, including

Facultad de Ciencias Químicas, Universidad Autónoma de Chihuahua, México

Portillo-Ruiz et al, 2005

Department of Pharmacy, Faculty of

Bozin et al, 2006

_______ Anise, basil, cumin, dill, Aegean sage, fennel (sweet), laurel, mint, oregano, pickling herb, rosemary, sage, savory, sea fennel, sumac, and thyme (black) Mexican oregano

Essential oils of Ocimum basilicum L., Origanum vulgare

241


L., and Thymus vulgaris L

Black thyme, cumin, fennel (sweet), laurel, marjoram, mint, oregano, pickling herb, sage, savory, and thyme Basil, clove, garlic, horseradish, marjoram, oregano, rosemary, thyme and turmeric

multiresistant strains of Pseudomonas aeruginosa and Escherichia coli Bacillus brevis, B. cereus, B. amyloliquefaciens, B. megaterium, B. subtilis, and B. subtilis var (all are foodborne pathogens) Vibrio parahaemolyticus (foodborne pathogen)

Cinnamon, bearberry, chamomile, sage, rosemary, …

Arcobacter butzleri, Arcobacter cryaerophilus, and Arcobacter skirrowii

Vanillin

4 bacteria (Pantoea agglomerans, Aeromonas enteropelogenes, Micrococcus lylae, and

Medicine, University of Novi Sad, Serbia and Montenegro Department of Food Engineering, Agricultural Faculty, Selçuk University, Konya, Turkey Seafood Safety Section, National Research Institute of Fisheries Science, Fukuura, Yokohama, Japan Department of Analytical Chemistry, Faculty of Chemical Technology, University of Pardubice, Czech Republic Faculty of Technology, Khon Kaen University, Thailand

Ozcan et al, 2006

Yano et al, 2006

Cervenka et al, 2006

Ngarmsak et al, 2006

Sphingobacterium spiritovorun), 4 fungi (Alternaria sp., Aspergillus sp., Penicillium sp., and Fusarium sp.), and 3 yeasts 4 fungi (Aspergillus flavus, Penicillium roqueforti, Mucor plumbeus and

_______ Cinnamon and clove oils

Faculty of AgroIndustry, Department of Product Development, Kasetsart

Eurotium sp.), 4 yeasts (Debaryomyces hansenii, Pichia membranaefaciens, Zygosaccharomyces rouxii and Candida lipolytica), and 2

Matan et al, 2006

University, Bangkok, Thailand

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bacteria (Staphylococcus aureus and Pediococcus halophilus) Many spices, as these and other studies revealed, retain their properties at low temperatures and after heating or boiling. The GI tract of the human being harbours billions of bacteria, fungi and other organisms. When we are healthy, these bacteria, for example, produces vitamins, generate energy, help to bind toxins with the fibre. Antioxidant properties Spices also have antioxidant properties and are able, for example, to prevent oxidation of oils: “The results indicate that rosemary and oregano are more effective HOCl scavengers than the other substances analyzed, which, in decreasing order, were propyl gallate, annatto, sweet and hot paprika, saffron, and cumin. The effect of Mediterranean food spices on the oxidative stability of refined olive oil tested by the Rancimat method was compared with common food additives during storage (72 h, 2, 4, and 6 months) at room temperature. The results showed that the spice extracts analyzed have significant stabilizing effects (P < 0.05)” (Martínez-Tomé et al, 2001). This study was conducted at the Department of Food Science of the University of Murcia in Spain. Indian biochemists from the Central Food Technological Research Institute in Mysore wrote, “Spices and vegetables possess antioxidant activity that can be applied for preservation of lipids and reduce lipid peroxidation in biological systems. The potential antioxidant activities of selected spices extracts (water and alcohol 1:1) were investigated on enzymatic lipid peroxidation. Water and alcoholic extract (1:1) of commonly used spices (garlic, ginger, onion, mint, cloves, cinnamon and pepper) dose-dependently inhibited oxidation of fatty acid, linoleic acid in presence of soybean lipoxygenase. Among the spices tested, cloves exhibited highest while onion showed least antioxidant activity. The relative antioxidant activities decreased in the order of cloves, cinnamon, pepper, ginger, garlic, mint and onion. Spice mix namely ginger, onion and garlic; onion and ginger; ginger and garlic showed cumulative inhibition of lipid peroxidation thus exhibiting their synergistic antioxidant activity. The antioxidant activity of spice extracts were retained even after boiling for 30 min at 100 degrees C, indicating that the spice constituents were resistant to thermal denaturation. The antioxidant activity of these dietary spices suggest that in addition to imparting flavor to the food, they possess potential health benefits by inhibiting the lipid peroxidation” (Shobana & Naidu, 2000). Two years later the scientists from the same institute published a study about the effects of curcumin, capsaicin, quercetin, piperine, eugenol and allyl sulfide “on copper ion-induced lipid peroxidation of human low density lipoprotein (LDL) by measuring the formation of thiobarbituric acid reactive substance (TBARS) and relative electrophoretic mobility (REM) of LDL on agarose gel” (Naidu & Thippeswamy, 2002). All spices “inhibited the formation of TBARS effectively through out the incubation period of 12 h and decreased the REM of LDL” (Naidu & Thippeswamy, 2002). Their conclusion was that “These data suggest that the above spice active principles, which constitute about 1-4% of above spices, are effective antioxidants and offer protection against oxidation of human LDL” (Naidu & Thippeswamy, 2002). Antioxidant properties of spices were the focus of research for a group of biologists from the University of Hong Kong. Their study Antioxidant capacity of 26 spice extracts and characterization of their phenolic constituents was recently published in the Journal of Agriculture and Food Chemistry (Shan et al, 2005). These biologists observed that “Many spices contained high levels of phenolics and demonstrated high antioxidant capacity. … phenolic compounds in the tested spices contributed significantly to their antioxidant capacity. Major types of phenolic constituents identified in the spice extracts were phenolic acids, phenolic diterpenes, flavonoids, and volatile oils (e.g., aromatic compounds). Rosmarinic acid was the dominant phenolic compound in the six spices of the family Labiatae. Phenolic volatile oils were the principal active ingredients in most spices. The spices and related families with the highest antioxidant capacity were screened, e.g., clove in the Myrtaceae, cinnamon in the Lauraceae, oregano in the Labiatae, etc., representing potential sources of potent natural antioxidants for commercial exploitation. This study provides direct comparative data on antioxidant capacity and total and individual phenolics contents of the 26 spice extracts” (Shan et al, 2005). Moreover, “A wide variety of phenolic compounds and flavonoids present in spices possess potent antioxidant, antimutagenic and anticarcinogenic activities” (Prasad et al, 2004), as Indian researchers claim. They continue, “We examined whether 5-lipoxygenase (5-LO), the key enzyme involved in biosynthesis of leukotrienes is a possible target for the spices. Effect of aqueous extracts of turmeric, cloves, pepper, chilli, cinnamon, onion and

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also their respective active principles viz., curcumin, eugenol, piperine, capsaicin, cinnamaldehyde, quercetin, and allyl sulfide were tested on human PMNL 5-LO activity by spectrophotomeric and HPLC methods.” The conclusions are: “The inhibitory effect of quercetin, curcumin and eugenol was similar to that of synthetic 5-LO inhibitorsphenidone and NDGA. Moreover, the inhibitory potency of aqueous extracts of spice correlated with the active principles of their respective spices. The synergistic or antagonistic effect of mixtures of spice active principles and spice extracts were investigated and all the combinations of spice active principles/extracts exerted synergistic effect in inhibiting 5-LO activity. These findings clearly suggest that phenolic compounds present in spices might have physiological role in modulating 5-LO pathway” (Prasad et al, 2004). Synergetic effects Two of the above-mentioned studies (Shobana & Naidu, 2000; Shan et al, 2005) emphasized the synergetic effects, when even weak inhibitory effects of separate spices are greatly amplified, if the same spices are used together. For example, Shobana and Naidu claim, that “Spice mix namely ginger, onion and garlic; onion and ginger; ginger and garlic showed cumulative inhibition of lipid peroxidation thus exhibiting their synergistic antioxidant activity” (Shobana & Naidu, 2000). Diabetes, heart disease, cancer and GI problems Spices can have effects on particular health conditions. In 2005 the International Journal of Food Science and Nutrition published a study Plant foods in the management of diabetes mellitus: spices as beneficial antidiabetic food adjuncts conducted at the Central Food Technological Research Institute in Mysore, India. The abstract states, “Diet has been recognized as a corner stone in the management of diabetes mellitus …spices are also known to exert several beneficial physiological effects including the antidiabetic influence. This review considers all the available information from animal experimentation as well as clinical trials where spices, their extracts or their active principles were examined for treatment of diabetes. Among the spices, fenugreek seeds (Trigonella foenumgraecum), garlic (Allium sativum), onion (Allium cepa), and turmeric (Curcuma longa) have been experimentally documented to possess antidiabetic potential. In a limited number of studies, cumin seeds (Cuminum cyminum), ginger (Zingiber officinale), mustard (Brassica nigra), curry leaves (Murraya koenigii) and coriander (Coriandrum sativum) have been reported to be hypoglycaemic” (Srinivasan, 2005). American study at the US Department of Agriculture, Beltsville Human Nutrition Research Center, MD revealed that “Among the spices, apple pie spice, cinnamon, cloves, bay leaves, and turmeric potentiated insulin activity more than three-fold… Spices are generally used for flavor and taste in food preparations, but cinnamon, cloves, bay leaves, and turmeric may have an additional role in glucose metabolism” (Khan et al, 1990). Australian scientists from the National Centre of Excellence in Functional Foods, University of Wollongong reviewed available research in the paper Health benefits of herbs and spices: the past, the present, the future. Among the findings are: the antioxidant properties of herbs and spices in the development of atherosclerosis (e.g., use of garlic for cholesterol-lowering effect, blood pressure reduction and anticlotting effects; effects of bioactive compounds in herbs and spices on cancer; effects of herbs and spices on type 2 diabetes mellitus; and use of food extracts as alternatives to non-steroidal anti-inflammatory agents in the management of chronic inflammation (Tapsell et al, 2006). This historical review suggests, “At present, recommendations are warranted to support the consumption of foods rich in bioactive components, such as herbs and spices. With time, we can expect to see a greater body of scientific evidence supporting the benefits of herbs and spices in the overall maintenance of health and protection from disease” (Tapsell et al, 2006). The Table above includes 2 studies on Helicobacter pylori (HP), a bacterium and well recognized primary etiological agent responsible for the development of gastritis, dyspepsia, peptic ulcer disease and gastric cancer. Among the useful spices are turmeric, cumin, ginger, chilli, borage, black caraway, oregano and liquorice, Columbo weed, long pepper, parsley, tarragon, nutmeg, yellow-berried nightshade, threadstem carpetweed, sage and cinnamon, as well as methanol extracts of Myristica fragrans (aril); extracts from Barringtonia acutangula (leaf) and Kaempferia galanga (rhizome); Cassia grandis (leaf), Cleome viscosa (leaf), Myristica fragrans (leaf), Syzygium aromaticum (leaf) Pouzolzia pentandra (leaf), Cycas siamensis (leaf), Litsea elliptica (leaf) and Melaleuca quinquenervia (leaf). Additional evidence relates to stimulating abilities of herbs on secretion of stomach acid, bile and various GI enzymes. Indian medical professionals from the Rajah Muthiah Medical College in Annamalainagar studied the effect of spices on gastric acid secretion. They found that “All the spices tested increased acid secretion in the following declining order: red pepper, fennel, omum, cardamom, black pepper, cumin, coriander. Red pepper increased acid secretion (mean [SEM] 0.93 [0.16] mL 0.1N HCl) to about 7 times the basal secretion (0.14 [0.05]; p < 0.005). The

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increase in acid secretion by the other spices was as follows: fennel 0.42 (0.11) mL 0.1 N HCl from basal secretion (0.12 [0.03]) (p < 0.02); omum 0.33 (0.05) from 0.09 (0.02) (p < 0.01); cardamom 0.28 (0.04) from 0.10 (0.03) (p < 0.005); black pepper 0.19 (0.03) from 0.04 (0.01) (p < 0.005); cumin 0.12 (0.02) from 0.08 (0.01) (p < 0.05); coriander 0.18 (0.03) from 0.09 (0.02) (p < 0.005)” (Vasudevan et al, 2000). Another group of Indian scientists wrote, “The present study examined the favourable influence of three spice mixes derived from a few commonly consumed spices of known digestive stimulant action on digestive enzymes of pancreas and small intestine, and on bile secretion and composition in experimental rats. The common ingredients of these mixes were coriander, turmeric, red chilli, black pepper and cumin, while the spice mix II additionally had ginger, and spice mix III contained onion. All the three spice mixes favourably enhanced the activities of pancreatic lipase, chymotrypsin and amylase when consumed during the diet. In addition, these spice mixes brought about a pronounced stimulation of bile flow and of bile acid secretion. Among the three spice mixes examined, spice mix III which is customized so as to include spices that are desirable from the point of view of stimulation of digestion, had the highest stimulatory influence particularly on bile secretion, bile acid output and the activities of pancreatic enzymes. While activities of pancreatic lipase, amylase and chymotrypsin were elevated by 40, 16 and 77%, respectively, the bile volume as well as the bile acid secretion were almost doubled in spice mix III treatment” (Platel et al, 2002). Therefore, use of spices can be very beneficial for students with pancreatic insufficiency and other disorders related to poor digestive abilities. Moreover, anybody who has abnormal gut flora will be able to better digest meals providing less chance for pathogens to multiply.

11.13 Other observations and suggestions Gluten When a person has GI inflammation and various symptoms of abnormal GI flora, it is better to avoid gluten for days, follow the good diet, get high CP, and see the effects. This relates not only to people with the diagnoses of the celiac disease. Many more people have gluten sensitivity that can be revealed by the allergies-revealing prick test (solutions of various substances are injected under the skin and the effects are observed). Many people with GI problems cannot efficiently digest proteins. Undigested gluten proteins act like a sandpaper on the villi of the duodenum greatly reducing the area for absorption of nutrients, creating inflammation of the GI mucosa, depleting cortisol reserves, and causing various other negative effects. In many cases eating, for example, bread, would not cause any serious symptoms or problems after the meal, but the practical effects are: 1. Efficiency of absorption of nutrients is greatly reduced. 2. Inflammation is created. 3. Pathogenic bacteria, feeding on broken villi, multiply producing pathogenic GI flora and generating toxins. All these effects are slow to be revealed. It is only after some days with avoidance of all triggers and with the CP at least 30-35 s 24/7, the student can notice improvement in symptoms. Another interesting effect relates to the ability of gluten to clean the mucus and other residues that can accumulate on the walls of the intestines when the person follows soft diet for long time. Roughage acts like a brush and when there is no such stimulation, the residues can stick to the walls of the intestine for days or even weeks. In such conditions, the person may notice that sporadic eating gluten-containing food will improve the CP and well being, but it can be a better idea to chew very well some vegetables when the state of the gut is improved. Fruits When GI problems are present and the gut flora is abnormal, there are often several pathogens that can dominate the GI tract. Candida yeast is one of them. In such cases, avoidance of fruits is beneficial. High morning CPs (30-35 s) and avoidance of simple sugars prevent Candida from attachment to the wall of the gut, but it can take 2-3 weeks for its suppression and control. Candida Albicanis This yeast is probably the most common GI concern for modern man. The main problems with Candida is that when the person eats simple sugars (e.g., fruits and table sugar), Candida grows and divides without producing any significant symptoms. The yeast attaches to the gut, especially the duodenum, and the snatch whatever is available. But when it is starved to death (after days of good diet with no simple sugars), it dies releasing powerful toxins that are able to penetrate the blood-brain barrier causing mood swings, depression, and anxiety. Among other symptoms is thirst if Candida participates in the inflammatory processes in the gut. When the CP gets below 20 s, Candida easily spread through the small intestine and can even colonise the mouth, sinuses, oesophagus, and other surfaces of the

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body. When the CP is below 10 s, Candida can be found in blood and it can freely colonize the mouth and tissues of internal organs. How could one know that Candida is present and active in the gut? Try taking grapefruit seed extract (about 57 drops in a glass of water) and see the effects. A person without Candida would not notice any effects. The severity of negative symptoms reflect the degree of the problem. Doctors usually treat Candida with antibiotics and nystatin. However, if the CP of the person remains low (e.g., about 15-20 s), Candida can come back. The keys to success are in high CP (over 30 s) and good diet for about 23 weeks. Further CP growth makes the immune system even stronger. As about the diet, avoidance of simple sugars is crucial. Even refined foods, like white bread and white rice, are better to avoid too. Among spices, in trials, garlic showed higher activity against Candida than nystatin. Onions, ginger and many other spices are useful. Note that efficiency of these natural remedies, as well as medical drugs, is CP-relevant. When the CP is high (e.g., 35 s or more) 24/7, small amounts are sufficient to do the job. When the CP is below 20 s, even large amounts can be useless or have limited effects. Chewing food well, days of reduced eating, and raw diets are other possible steps. Later, when the CP is high for weeks, gradual introduction of fruits is possible. Ideally, over 60 s CP is the best guarantor against Candida recurrence. Helicobacter Pylori overgrowth It is typically found in patients with gastritis, ulcers, and certain other digestive problems. Medical doctors usually suggest a course of antibiotics, but antibiotics kill other (good) bacteria in the gut too making chances of Candida higher in future. Besides, rates of H. Pylori recurrence is high since the gastric or duodenal mucosa usually does not heal (elimination of inflammation requires over 30 s CP for about 2-3 weeks). Hence, the solution is again in high CP and good diet (eating only when hungry, stopping in time, chewing very well, etc. ). Some spices and Manuka honey are known partners in H. Pylori eradication, but their efficiency depends on one’s CP. Helicobacter Pylori is usually treated by most western doctors with antibiotics. However, these bacteria can be defeated by the immune system within 1-2 weeks (in most cases), if the CP of the patient is about 35-40 s. as practice of Russian Buteyko doctors revealed. Blastocystis Some years ago, many medical experts and authorities re-classified Blastocystis Hominis, a common parasite found in the GI tract of most people, as a dangerous disease-producing organism, as opposed to just a harmless organism. The resultant disease Blastocystosis has presented a challenge to the medical and scientific community due to the diversity of hosts the organism can infect, the diversity of Blastocystis species which exist, and the fact that most species of Blastocystis found in mammals and birds are able to cause infection in humans. Blastocystis is generally considered to be a weak parasite. It attacks those people who have a low CP (e.g., less than 20 s) and, hence, the weakened immune system and a weakened digestive tract. It often occurs together with other parasites, like Candida. Almost 50% IBS patients have Blastocystis in their samples. The average person with Blastocystis may not have any symptoms. Those who are affected may complain about abdominal pain, constipation, diarrhoea, allergies, and skin problems, which appear and disappear unpredictably depending on the CP fluctuations, diet, and other parameters. Blastocystis likes fats and grains. Some sufferers, especially with weak liver and problems with fat digestion, may notice that eating fats and oils result in production of offensive gas and very cold hands and feet. The amoeboid form of the Blastocystis (it exists in 4 different forms), is strongly adhesive. This form is particularly frequent in symptomatic individuals and is very difficult to get rid of. It hides in the mucosal surface of the intestines, sticks, and holds there making elimination, without high CPs, very difficult. Medical drugs for its eradication are highly toxic. Taken over long periods of time, they damage one's liver or kidneys. Herbs and spices, in addition to breathing- and diet-related steps, are better solutions. Michael Biamonte, CCN suggests, “These herbs must be rotated--meaning taken by themselves for a period of 4-5 days, then stopped, a new one introduced and taken for 4-5 days, stopped, and then another new one introduced, etc. In this way, the Blastocystis will not build up an immunity to any of these items. Herbs and Dosages: Black Walnut, 300mg Wormwood, 500mg Cloves, 300 mg

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Oil of Oregano, 5 drops Quassi Amara, 200mg Gentian, 100mg Coptis chinensis Extract (10:1), 100mg Forsythia suspense Extract (20:1), 50mg Lonicera japonica Extract (7:1), 150mg Allium sativum Extract (Allicin 13mg/g), 200mg Commiphora myrrha powder, 200 mg Echinacea angustifolia (4% phenolics), 250mg Citrus Bioflavonoid Complex 40%, 200mg Zinc (citrate), 10mg Vitamin A, 10,000 IU Vitamin C (pure ascorbic acid), 500mg Recommended dosage: 2 or 3 capsules or tablets, 3-4 times daily. Colon cleanses are necessary in order to eliminate Blastocystis” (www.health-truth.com/118.php). Enzymes that digest fats can also assist eradication. Elimination of other parasites and shaking of the body (for mechanical detachment of faecal impaction, old mucus, and other residues, which harbour Blastocystis, from the GI mucosa) is another crucial step. Hence, jogging, if tolerated, is an excellent choice. Even riding in a car, bus or train can produce good results. Hatha yoga school developed a variety of similar applicable techniques, including nauli (drawing the belly in and then relaxing it hundreds of times per day) and bhastika (a high frequency low-volume breathing exercise that does not reduce CO2, but mechanically stimulates the lymph nodes and organs located under the diaphragm). Here, again, higher morning CP will be the leading factor in restoration of GI strength and integrity. Over 3035 s CP 24/7 for some weeks provide the crucial part of the natural solution, but serious dietary changes, good chewing, and use of spices and herbs can also be necessary for some students.

Q&A section for Chapter 11 Q: Why do Buteyko breathing teachers, even in Russia avoid treating patients with ulcers, Crohn’s disease, gastritis and other GI problems? A: Western breathing teachers, in general, have very little, if any, experience with GI problems. An average breathing practitioner would rather teach the method to a student with emphysema or severe heart disease, than with complex GI problems. In the past, in Russia it was more common in the past to deal with GI concerns. Why did the situation change? Practice shows that teaching students with emphysema, or asthma, or heart problems does not require rigorous discipline of the students in relation to diet. The main requirements are in the simple rules: eat only when you are really hungry and stop in time. When allergies to foods are present, the students are taught to avoid them. GI disorders require, in addition to breathing retraining, deep knowledge and understanding of effects of diet on health. These disorders also need much more time to educate students about diet, nutrition, triggers, inflammation, and various other effects. Finally, students should be self-organized and consistent in both areas: breathing control and meals. Hence, the time and energy that the breathing teacher needs to spend on the student with serious GI problems are about 2-3 times more than for many other conditions. These were also the reasons why this edition of this book had much more information about GI disorders and useful steps in this area.


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Bagamboula CF, Uyttendaele M, Debevere J, Inhibitory effects of spices and herbs towards Shigella sonnei and S. flexneri, Meded Rijksuniv Gent Fak Landbouwkd Toegep Biol Wet. 2001; 66(3b): 523-530. Basílico MZ & Basílico JC, Inhibitory effects of some spice essential oils on Aspergillus ochraceus NRRL 3174 growth and ochratoxin A production, Lett Appl Microbiol 1999 Oct; 29(4): 238-241. Bhamarapravati S, Pendland SL, Mahady GB, Extracts of spice and food plants from Thai traditional medicine inhibit the growth of the human carcinogen Helicobacter pylori, In Vivo. 2003 Nov-Dec; 17(6): 541-544. Billing J & Sherman PW. Antimicrobial functions of spices: why some like it hot, Q Rev Biol. 1998 Mar; 73(1): 3-49. Bozin B, Mimica-Dukic N, Simin N, Anackov G, Characterization of the volatile composition of essential oils of some lamiaceae spices and the antimicrobial and antioxidant activities of the entire oils, J Agric Food Chem. 2006 Mar 8; 54(5): 1822-1828. Cervenka L, Peskova I, Foltynova E, Pejchalova M, Brozkova I, Vytrasova J, Inhibitory effects of some spice and herb extracts against Arcobacter butzleri, A. cryaerophilus, and A. skirrowii, Curr Microbiol. 2006 Nov; 53(5): 435-439. Cosentino S, Barra A, Pisano B, Cabizza M, Pirisi FM, Palmas F, Composition and antimicrobial properties of Sardinian Juniperus essential oils against foodborne pathogens and spoilage microorganisms, J Food Prot. 2003 Jul; 66(7): 1288-1291. De M, Krishna De A, Banerjee AB, Antimicrobial screening of some Indian spices, Phytother Res. 1999 Nov; 13(7): 616-618. El-Maraghy SS, Effect of some spices as preservatives for storage of lentil (Lens esculenta L.) seeds, Folia Microbiol (Praha). 1995; 40(5): 490-492. Fabio A, Corona A, Forte E, Quaglio P, Inhibitory activity of spices and essential oils on psychrotrophic bacteria, New Microbiol. 2003 Jan; 26(1): 115-120. Fuhrman J, Fasting and Eating for Health (A Medical Doctor’s Program for Conquering Disease), St.Martin’s Press, New York, 1995. Hara-Kudo Y, Kobayashi A, Sugita-Konishi Y, Kondo K, Antibacterial activity of plants used in cooking for aroma and taste, J Food Prot. 2004 Dec; 67(12): 2820-2824. Khan A, Bryden NA, Polansky MM, Anderson RA, Insulin potentiating factor and chromium content of selected foods and spices, Biol Trace Elem Res. 1990 Mar; 24(3): 183-188.

_______ Lampe JW, Spicing up a vegetarian diet: chemopreventive effects of phytochemicals, Am J Clin Nutr. 2003 Sep; 78(3 Suppl): 579S-583S. Martínez-Tomé M, Jiménez AM, Ruggieri S, Frega N, Strabbioli R, Murcia MA, Antioxidant properties of Mediterranean spices compared with common food additives, J Food Prot. 2001 Sep; 64(9): 1412-1419.

Naidu KA & Thippeswamy NB, Inhibition of human low density lipoprotein oxidation by active principles from spices, Mol Cell Biochem. 2002 Jan; 229(1-2): 19-23.

Nevas M, Korhonen AR, Lindström M, Turkki P, Korkeala H, Antibacterial efficiency of Finnish spice essential oils against pathogenic and spoilage bacteria, J Food Prot. 2004 Jan; 67(1): 199-202.

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Ngarmsak M, Delaquis P, Toivonen P, Ngarmsak T, Ooraikul B, Mazza G, Antimicrobial activity of vanillin against spoilage microorganisms in stored fresh-cut mangoes, J Food Prot. 2006 Jul; 69(7): 1724-1727. Nielsen PV & Rios R, Inhibition of fungal growth on bread by volatile components from spices and herbs, and the possible application in active packaging, with special emphasis on mustard essential oil, Int J Food Microbiol. 2000 Sep 25; 60(2-3): 219-229. O'Mahony R, Al-Khtheeri H, Weerasekera D, Fernando N, Vaira D, Holton J, Basset C, Bactericidal and antiadhesive properties of culinary and medicinal plants against Helicobacter pylori, World J Gastroenterol. 2005 Dec 21; 11(47): 7499-7507. Ozcan M, Effect of spice hydrosols on the growth of Aspergillus parasiticus NRRL 2999 strain, J Med Food. 2005 Summer; 8(2): 275-278. Ozcan MM, Sağdiç O, Ozkan G, Inhibitory effects of spice essential oils on the growth of Bacillus species, J Med Food. 2006 Fall; 9(3): 418-421. Platel K, Rao A, Saraswathi G, Srinivasan K, Digestive stimulant action of three Indian spice mixes in experimental rats, Nahrung. 2002 Dec; 46(6): 394-398. Portillo-Ruiz MC, Viramontes-Ramos S, Muñoz-Castellanos LN, Gastélum-Franco MG, Nevárez-Moorillón GV, Antifungal activity of Mexican oregano (Lippia berlandieri Shauer), J Food Prot. 2005 Dec; 68(12): 2713-2717. Prasad NS, Raghavendra R, Lokesh BR, Naidu KA, Spice phenolics inhibit human PMNL 5-lipoxygenase, Prostaglandins Leukot Essent Fatty Acids. 2004 Jun; 70(6): 521-528. Shan B, Cai YZ, Sun M, Corke H, Antioxidant capacity of 26 spice extracts and characterization of their phenolic constituents, J Agric Food Chem. 2005 Oct 5; 53(20): 7749-7759. Srinivasan K, Plant foods in the management of diabetes mellitus: spices as beneficial antidiabetic food adjuncts, Int J Food Sci Nutr. 2005 Sep; 56(6): 399-414. Tapsell LC, Hemphill I, Cobiac L, Patch CS, Sullivan DR, Fenech M, Roodenrys S, Keogh JB, Clifton PM, Williams PG, Fazio VA, Inge KE, Health benefits of herbs and spices: the past, the present, the future, Med J Aust. 2006 Aug 21; 185 (4 Suppl): S4-24. Tsukiyama R, Katsura H, Tokuriki N, Kobayashi M, Antibacterial activity of licochalcone A against spore-forming bacteria, Antimicrob Agents Chemother. 2002 May; 46(5): 1226-1230.

_______ Valero M & Salmerón MC, Antibacterial activity of 11 essential oils against Bacillus cereus in tyndallized carrot broth, Int J Food Microbiol. 2003 Aug 15; 85(1-2): 73-81.

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Chapter 12. Special topics related to the Buteyko method 12.1 Review of some effects that take place at 10 and 20 s CP. When the CP is below 10 s (fighting with death): The immune system is so weak, that pathogens can easily colonize various surfaces of the body (sinuses, bronchi, nasal passages, GI surfaces, mouth, etc.), but also can settle and grow in tissues of the lungs, liver, bones, etc. and in the blood (bacteraemia). Malignant tumours can metastasise. When the CP is below 20 s (in the grip of disease): Exhalations are forceful, and the automatic pause is absent. We are likely to use the chest as our main breathing muscle, even at rest, and our diaphragm becomes immobile causing lymphatic stagnation in the lymph nodes located under the diaphragm. (These lymph nodes drain all vital organs located under the diaphragm.) Krebs cycle (or citric acid) cycle can get reversed (leading to tissue hypoxia), so that aerobic production of energy in mitochondria is not possible, and the anaerobic processes take place, generating elevated lactic acid and fatigue in most people. Voluntary hyperventilation (e.g., 3-5 deep big breaths just before the test) does not increase the breath holding time since increased tissue hypoxia, not temporary hypercapnia, is the main respiratory drive. Our heat tolerance is very poor. Slight overcooling can be dangerous, and keeping oneself warm is important. It is easy to get a cold. Taking a cold shower, in most cases, results in infection, fever, and feeling sick. Attempts to exercise vigorously (e.g., jogging) result in failure (mouth breathing and feeling worse afterward). Viruses and bacteria can easily colonize sinuses, nasal passages, airways, the GI tract, and other surfaces of the body. Bouts of coughing, if present, are very difficult to stop. Resistance of the immune system to pathogens in the lungs, sinuses, the GI tract is low, and infections are frequent. Malignant and benign tumours are growing. Periodontal problems and inflammation in the jaw near the tip of the root canals both increase. Blood vessels can build up cholesterol deposits in predisposed individuals. Inflammation in any area of the body (airways, stomach, intestines, liver, etc.) is impossible to heal. Cracks and separation of bones after injuries will not heal. Menstrual bleeding between periods is possible. New allergies to foods, airborne particles, and substances can appear. Blood glucose control can be impaired. The tissue of any endocrine gland can become abnormal causing disorder with production, storage, and concentrations of hormones. The region between 20 and 40 s morning CP indicates a struggle with the disease, and we start to recover only when the CP gets closer to 40 s.

_______ 12.2 Emphysema and breathing retraining

In some rare cases, e.g., as for patients with emphysema and other conditions characterized by ventilationperfusion mismatch, their chemoreceptors can lose CO2 sensitivity. What does that mean? Normally, inhalation of CO2-rich air and breath holding increase CO2 concentration of the arterial blood. This increase is detected by peripheral chemoreceptors sensitive to both the pH of the blood and its CO2 content. This information is transmitted, through nerves, to the breathing centre (the medulla oblongata in the brain), producing the desire or urge to breathe. This sensation normally gets stronger in time. This is the chain of events in normal people. Their breathing is mainly controlled by the CO2 content in the arterial blood or alveoli. Patients with emphysema chronically have abnormally high CO2 content in blood and their chemoreceptors become less sensitive to CO2 changes. Their breathing is mainly controlled by O2 variations. The degree of the ventilation-perfusion mismatch generally reflects the degree of hypoxia in such people, while doctors measure oxygenation of the arterial blood to evaluate the efficiency of the lungs. 251


It is normal to expect that in many emphysema patients, their high CPs (up to 25-35 s) are not indicative of their general and especially physical health. For example, intensive physical activity and jogging are nearly impossible when the damage to the lungs is extensive. Hence, these students usually cannot exercise when their CP is above 20 s. However, walking, shaking of the body, use of special supplements to restore the lung tissue and other steps are beneficial. Another unusual feature is that, if they do not suffer from cardiovascular problems, they can do MPs and even AMPs without any negative effects.

12.3 Sleep apnoea and breathing retraining The strategy with sleep apnoea depends, first of all, on predisposition to cardiovascular problems since many sleep apnoea sufferers have hypertension and other heart problems. If this is the case, even CP can be avoided during the initial stages of learning the Buteyko method. Relaxation of the diaphragm and gradually increasing CO2 with very light air hunger are safer options for such students. If there is no genetic cardiovascular component, normal breathing exercises can be done (CP+ RB etc.). During nights, these patients have hyperventilation periods mixed with breath holds. Such “training” often, but not always, leads to reduced CO2 sensitivity and abnormally high CP. Probably, the main physiological effects of apnoeic episodes is in abnormal sleep pattern so that deep stages of sleep can be absent causing daily fatigue, poor concentration, sleepiness, and other negative effects. The CPAP (constant positive air pressure) machine helps then to rest better during sleep, however, the role of the breathing centre in breath regulation is greatly reduced when the CPAP machine is used. Prevention of sleeping on the back is important for these patients and other sleeping postures are suggested. For some patients, 20 s morning CP is the threshold when the machine is not required. There are various practical tactics in order to wean off the machine at a certain stage of breathing retraining. For example, the patient may try to sleep with surgical mask or dust mask that suppress large fluctuations in tidal volumes making breathing pattern deeper but much slower and causing, therefore, a stabilizing effect. Sleeping in the sitting position for 3-4 nights with many breathing sessions, to boost the morning CP, is another alternative. Gradual readjustment of the machine to smaller air pressure, when this is possible, can also be useful.

12.4 Hypercapnic vasoconstriction This effect can be present in students, who are genetically predisposed to cardiovascular problems. Practical study of hypercapnic vasoconstriction In 1960s Buteyko and his colleagues published numerous articles with results of their studies related to reactions of various people to changes in air composition. (This research was funded by Soviet Ministry of Space Exploration and was exceptionally important for future spaceship missions of first Soviet astronauts in 1960s.) The volunteers were inhaling air with varying O2 and, in some other studies, CO2 contents. It was found that human adaptation to sudden hypoxia was very individual. Those people who had cardiovascular problems often could not experience normal adaptation even to mild hypoxia (15 % O2). Their arteries and arterioles reacted with hypoxic vasoconstriction, with increased heart rate and blood pressure. Moreover, people experienced negative or unpleasant symptoms, like headaches, dizziness, and light-headedness. It was literally “yes” or “no” response of the body and with in minutes it was clear if a particular person had normal adaptation to new air or not. In another series, the composition of air was changing slowly. The important finding here was, “Mild, gradually increasing hypoxia does not cause any essential changes in the tone of arterial vessels in patients with hypertension and stenocardia [angina pectoris]” (Buteyko et al, 1967). Other studies investigated cardiovascular and respiratory effects of CO2-rich air. Again, patients with cardiovascular problems experienced various re actions, while adaptive abilities of other people, even with certain health problems, were normal. These reactions, in cases with mild CO2 increase, depended on two competing effects: local vasodilation due to the local biochemical effect of CO2 on arterial vessels, and global vasoconstriction due to the CO2 stress on the vasomotor centre. However, it was again found that gradual changes in air composition (so that inhaled CO2 content increased over a period of several minutes up to its maximum), then all people could adapt normally even to mildly high CO2 concentrations (Buteyko et al, 1966). During breath holds and breathing less, CO2 content in lungs in seconds achieves significantly greater values (hypercapnia), while O2 content in the lungs significantly decreases (hypoxia). Hence, a person experiences 3 vascular

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gas-related effects in arteries and arterioles during breath holding or reduced breathing: 1) vasoconstriction due to hypoxia; 2) local vasodilation due to hypercapnia; 3) global vasoconstriction due to hypercapnia. Not only are people different, their health state influence the results. Hence, we have numerous situations with various contributions from these effects. The final response of the body often takes minutes to be revealed, but it is again “yes” or “no”. The organism, depending on many factors, can adapt its cardiovascular system to new conditions or new homeostasis with light changes in the previous metastasis (blood vessels with smooth muscles around them dilate, and only some small positive corrections for the new state of the organism are required) or not. If not, we get greatly increased heart rate, blood pressure, and negative personal symptoms. Hence, from these times, Buteyko and his colleagues knew that heart patients required a different (or gradual) approach in breathing retraining in comparison with, for example, typical asthmatics and healthy volunteers. Most people with asthma, bronchitis, and many other problems, can comfortably tolerate CPs and light or even moderate air hunger after breath holds from first attempts. Hence, their breathing retraining program can include CPs and RB. Other students, when their CPs are low, require milder changes in their lungs, like light RB with very light air hunger without breath holds or even the relaxation exercise only with no breathing control. Therefore, students with hypertension, susceptibility to migraine headaches and panic attacks require light comfortable level of air hunger and no breath holds. The rate of CO2 accumulation should be slow so that distinctive air hunger is experienced in minutes, not in seconds (as at the end of the CP). There are even more severe restrictions, in respect to air hunger, that are required for some people with, for example, hypercapnic vasoconstriction, sleep apnoea and heart disease. The safest exercises for them are relaxation, progressive relaxation and relaxation of the diaphragm without any manipulations with breathing and with no air hunger. Later, when the CP gets over 20 s, even previously severely sick people can safely do CPs and practice RB. These Buteyko’s studies showed that patients with cardiovascular problems can have abnormal response to hypercapnia expressed in elevated heart rate, vasoconstriction, and unpleasant symptoms. Other effects Apart from elevated pulse, unpleasant sensation in the head (due to reduced perfusion and oxygenation), the student can have increased anxiety, nervousness, apnoeic episodes at night (hence, poor quality of sleep). Breath holds lead to light-headedness, dizziness, and sensation of fainting due to reduced blood and oxygen supply. Reduced breathing or accumulation of CO2 further constricts blood vessels and makes the symptoms worse. The effect can be present only for minutes, or hours, or days and weeks. Students, who are predisposed to cardiovascular problems and who perform breath holds or accumulate CO2 too quickly, can have this effect only for minutes. Later, due to bigger breathing, they can restore the normal state of the blood vessels. These students are likely to give up the Buteyko method with an illusion that “it does not work” for them. Those students, who practice breathing sessions, will get higher final pulse (after the session), indicating vasoconstriction. The desire to learn the method can disappear. Since the tone of blood vessels has a tendency to get naturally restored at night, if sleep parameters are favourable, patients with sleep apnoea can develop hypercapnic vasoconstriction for days, weeks, or more time. Presence of abnormal tissues, like malignant tumours and inflammation of GI organs, liver, kidneys, airways, etc. create stronger predisposition to hypercapnic vasoconstriction. Factors that can strengthen or trigger the hypercapnic vasoconstrictive effect: - inflammation in the body; - cortisol deficiency; - poor quality of sleep (presence of noises, lights; absence of deep sleep stages); - abnormal thermoregulation (strong overcooling or mild overheating); - psychological stress; - overeating; - allergic reactions; - nutritional deficiencies; - physical inactivity; - poor posture; - toxins, pollution, radiation, etc.

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Recovery or restoration of hypercapnic vasodilation While the pulse (heart rate) is usually an additional parameter of the Buteyko student, here it becomes the main measuring tool. Breath holds and RB are contraindicated. They worsen the parameters and symptoms of the student. Slow deep breathing, humming, slow voluntary hyperventilation, Frolov’s device, pranayama, alternative nostril breathing, all can be useful, probably due to nitric oxide effects, to slow down the heart rate. Generally, whatever makes the pulse smaller should be encouraged and used. Cold air bathing or even cold shower can produce dramatic improvements and immediate restoration of the normal tone of blood vessels. Constriction of blood vessels of the skin (veins), due to cold, displaces the volume of blood in the inner parts of the body, especially into arteries and arterioles, causing their dilation. This is exactly what the body needs. Many other auxiliary activities of the Buteyko method can be very useful, including physical exercise, good thermoregulation 24/7, correct posture, etc. The main goals in relation to sleep are to create right conditions and prevent possible apnoeic episodes that interfere with normal sleep stages and contribute to the vicious circle. Wearing a dust mask or any other device, which can increase dead volume, makes breathing less frequent and more regular during sleep. It is another possible solution.

12.5 Practical suggestions for the youngest Buteyko students (0-1 years old) Swaddling or mechanical restriction of ventilation is a very efficient and vital for health method to normalize breathing of the youngest Buteyko students (0-2 years old), as it was reported by Russian Buteyko doctors. Tight wrapping was a normal practice in old times (Buteyko, 1977), but, due to “freedom” and “anti-oppression” movements, it is less popular now. (“Children were swaddled in the past in order to prevent them from getting more oxygen and more freedom!” say physiologically uneducated people.) Another practical tip to have a healthy baby is to cover the cradle or bassinet (with the sleeping baby inside) with a piece of cloth, so that only small hole, about inch by inch (or 2.5 cm by 2.5 cm), is left for air exchange. Such practice was also used by our grand-grand parents (Buteyko, 1977). That usually results in peaceful refreshing sleep due to increased carbon dioxide concentrations in the air breathed. Probably, babies in such conditions dream about quiet months in mothers’ wombs where they had very different air composition (chapter 1, Q&A). Another practical method is their frequent diving (up to hundreds dives per day), which they often adore. The duration of dives can gradually be increased. Since CP measurement is not simple in infants, ability to dive could be used to roughly evaluate the CP. Many babies often keep their mouth open. If attempts to gently close the mouth with fingers are failing (the mouth open again), use a baby soother or dummy to encourage nose breathing, both during daily activities and sleep times. Everything possible should be done in order to have a breast-fed baby. One should keep in mind that their metabolism is about 3-4 times greater than that of adults. Overwhelming majority of parents are over-protective in this respect keeping their children in too warm conditions. Check the baby’s thermo comfort by touching baby’s hands and feet which remain warm in right conditions. Only if the arms and feet get cold, more clothes or warmer environment is required. However, you may find that even when the outside environment is too cool for you; their extremities remain warm indicating their good thermo-adaptation and better breathing. If climate or weather is hot or warm, conventional swaddling may result in overheating. It is crucial, in such conditions, to keep the head of the infant uncovered so that to create better heat exchange (infants can loose most of their heat through their heads in such conditions). Constant overheating of infants causes disastrous effects on their breathing and health. In Asian countries this problem was solved by using wooden sticks and cords to tightly wrap the baby around the trunk (a variation of swaddling). This technique provides air access for better heat removal. Keeping the baby outdoors during sleeping times would be also useful, especially if the house is too warm. In short, the main tools for infants (0-1 years old) are: - very tight swaddling during all sleeping times; - nasal breathing only (use a dummy, pacifier, or patch) 24/7; - daily water procedures, including showering, teaching to swim and dive (up to 200 times per day); - help with physical activity; - normal heat exchange;

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- breast feeding and rational nutrition.

12.6 Young children (from 2 up to 14-16 years old) While at this age children can quickly understand and learn breathing exercises, their long- term success virtually always depends on commitment and discipline of their parents (primary caretakers). Practice shows that it is necessary, as a first step, to teach these adults the method. When the adults learned the theory and started classes for learning breathing exercises and other aspects of the method, additional lessons with children are effective. Practically, more time would be spent on teaching these adults than their children. Often, children needs only 2-3 groups sessions (e.g., to learn “steps”), while the adults have to do the whole course and normalize their breathing and CPs. The adults need to understand that bodies of children are physiologically different. They have much better adaptive abilities and can often progress with amazing speed (e.g., in 3-7 days from 5 s CP to 60-90 s). Children, especially younger ones, have best results when they learn the “steps” exercise, that combine breath holds, while walking, and reduced breathing with relaxation of all muscles in a standing position. Older children (1216 years) can join adults for some of the sessions, but “steps” should still remain the main exercise. Running, with breathing only through the nose, is another great form of exercise and it should be used when the CP of the child is around 20 s or more. To combine large amounts of physical activity with sufficient rest in between is important for the overall success and dynamic nature of the lesson. Having several, up to 4-6 children, or at least 2 children, better with the similar age, during special children lessons greatly increases their interest to learn and excel, and their friendly competitiveness should be encouraged. The following exercises were used by Dr. Lapa during her work with 1-3 years old in Novosibirsk: “1. Sitting in front of the mirror we are breathing "like mice" - one can't see or hear us. 2. The "Rabbits - wolves" game. After running around for 2-3 minutes we stop and hold our breath. Children are "rabbits" and a doctor or a parent or one of the kids is "a wolf". The wolf is walking around and listening for rabbits' breathing. If he can hear this then he "eats" that rabbit. 3. To cover a distance between two balls on the floor keeping a control pause, to climb a gymnastic ladder holding a breath, etc. 4. Sitting after a control pause we become "as soft as a cloth" and breathe "like mice" (a doctor checks an ability to relax” (Lapa, 1991).

It is crucial for adults to participate in all these activities. The “step” exercise The “step” exercise includes walking while breath holding and standing straight with relaxation in between breath holds. Ask children to keep the elbow of the arm, which pinched the nose, high so that there is no cheating and the mouth is visible all the time. During very first sessions make sure that keeping the mouth should be closes 24/7, including breathing exercises. Start with a small number of steps and check that the child can breathe only through the nose after steps with breath holds. Gradually increase the number of steps emphasizing importance of nasal breathing. Between the steps, when the child is standing, explain, in simple words, how to relax, have correct posture and breathe little. “We give children the following explanation. This is: 1 - the continuous (day and night); 2- decrease (holding still chest and stomach); 3 - of the depth of breathing (breath so quietly nobody can notice nothing); 4 - along with a relaxation (be soft "as a cloth"); 5 - until slight shortness of breath is felt (desire to inhale deeper)” (Lapa, 1991).

_______ Another analogy “breathing as a mouse” and keeping the index finger under the nose of the child works too. Coloured pictures for children (showing how the witch-disease can penetrate into they body from the mouth causing pains and feeling bad, and how to hide own breathing “as if there is a hungry tiger searching for food near you”) can be found in Dr. Novozshilov’s book “Living without asthma”. When child learns how to keep the mouth closed after maximum number of steps and how to breathe easy after the breath hold (with straight spine and muscular relaxation), the structure of the whole session can be explained. It takes about 10-12 minutes. - Measurement of the initial pulse and the CP while sitting; - Walking with the nose pinched (the adults can count steps); - The nose is released and the child stands (air hunger is strong, but the mouth should be kept close, the posture is straight, and the muscles relaxed) for 1-1.5 minutes. (This period of rest can be increased up to 2 minutes later if the number of steps is large, e.g., about 100 or more.); - Walking with the nose pinched (the adults can count steps); - The nose is released and the child stands (air hunger is strong, but the mouth should be kept close, the posture is 255


straight, and the muscles relaxed) for 1-1.5 minutes. (This period of rest can be increased up to 2 minutes later if the number of steps is large, e.g., about 100 or more.); … (7-9 sets with the same structure: walking with breath holds + standing for 1-1.5 min) ... - About 2-5 minutes after the session, the pulse and CP are measured in a sitting position. Special attention should be given to correct CP measurements. Teach children to check the CPs of their parents (or caretakers). Keep in mind that the CP of the healthy child can have wide variations throughout the day. During teenager’s years this tendency disappears. This exercise can be learned individually, but should be later practiced in a small group of children of close ages. Diet and thermoregulation Adults should have clear understanding about dangers of overfeeding and overheating (due to different metabolic rate) in children. Two central Buteyko rules in relation to meals (eat only when you are really hungry and stop in time) can even eliminate unnecessary authoritarianism and tension. Even more attention should be paid to thermoregulation. When the CP of the child is very small (around 5 s), she or he can easily get cold or infection, and having comfortable cloths is important. When the CP of the child is above 20 s (or it can do 30-40 steps with the nose pinched), and this result can often be achieved in 1-2 hours, many children themselves prefer to remove extra-clothes. Morning hyperventilation Similarly, if the morning hyperventilation is a big problem (and that is for the adults to check), the same ideas as for adults should be applied in order to find the causes. First of all, all environmental factors should be analyzed and normalised (good air quality, normal heat exchange), together with nasal breathing and prevention of sleeping on the back. According to Buteyko, children sleep best on their tummies on hard bed. Adults should check if the child opens the mouth at night. Often when the CP is below 15-20 s, this is the case. Younger children (3-6 years) may dislike mouth taping at night. In order to achieve success, the adults should demonstrate cheerfully to the child for 2-3 evenings that before going to bed they were taping mouth. Even older (over 7 years) children may have a smoother transition to mouth taping, if the adults do the same. Similarly, adults should find out if a child sleeps on the back. Its prevention is described below in the text box. If the morning CP after all these steps still much less than the evening CP, tight swaddling of the child can be applied. Here again, swaddling of adults should be first shown to the child for 2-3 nights since many, especially younger ones, could ask about the same themselves. The box below describes the procedure.

Prevention of sleeping on the back and swaddling of the child The procedure requires can be done during his or her sleep. Ask a child's permission in the evening before sleep to do such a swaddling (so that you do not scare him or her during sleep with this procedure). When the child is sleeping, gently turn him on the chest while inserting the cotton strip (about 15-20 cm wide and about 1.5 long) between the nipples and the belly button (navel). Now the ends of the strip are on different sides of the body, below armpits and above the back of the sleeping child. Gradually make the first tie on the child’s back tighter and tighter, while observing and listening child's breathing. At some moment of tightness the breathing of the child will change. Make the second tie or the knot at this level of tightness. The child should not wake up. Such procedure for children would produce slightly less tightness than the above method for adults. Such a procedure will prevent excessive breathing later during the night and early morning hours. In addition, sleeping on the back is avoided.

_______ If the adults suspect, unsure or experience child’s rejection of the procedure, even when the adults did the same, gradual changes in the right direction could be the key to success. First, a few layers of thin cotton bandage around the trunk could be used during child’s sleep. In 3-4 days, the bandage can get a small knot on the back of the child. A week later, the previously described cotton strip can be used with small, if any, pressure. After a few more days, the whole procedure can be applied.

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Q&A section for Chapter 12 Q: How can a breathing teacher know if the Buteyko method can help students with more rare or uncommon diseases? A: The breathing teacher may get ambiguous feelings: desire to help conflicting with lack of knowledge. Acceptance of such students for breathing retraining is an indication of their belief that the method should work. Would it? Even for rare conditions? How far? The attached names of health conditions, even in official medical literature, often do not have strict definitions. For example, asthma can have wide range of cases with varying degree of symptoms. Many cases of asthma can be close or even diagnosed as COPD, emphysema, bronchitis, etc., by different countries and doctors. Russia, for example, has bronchial asthma, asthmatic bronchitis, etc. The same vagueness relates to many other health conditions, ranging from heart disease to various neurological and GI problems. This absence of clear criteria in official medicine is based on absence of the understanding of the mechanisms of disease appearance, development, and treatment. However, breathing teachers are armed with the method and the mechanisms of its influence on various systems of the organism. Doctor Buteyko in his lectures was often going, one by one, through the effects of hypocapnia on different systems, organs and tissues of the body (what happens with cardiovascular system, musculoskeletal, nervous, GI, etc.) emphasizing a single cause (heavy breathing) and individuality of symptoms. It would be logical therefore, to view the “sudden” appearance of various human abnormalities and symptoms (or “rare diseases”) with the assumption of increased ventilation. Practically, when a student asks a breathing teacher about possible efficiency of the method for a certain rare health condition (“Can you help me with my …?”), the teacher may ask the student about particular symptoms and tests’ manifestation of the disease, time sequence of their appearance, their severity, and evaluate current breathing (e.g., visually, by voice, posture, and/or CP test). This information could provide the teacher with information related to the likely effects of the method when the certain CP level is achieved (when fatigue is reduced, rigorous exercise is possible, nose is clear, medication can be safely reduced, cold shower can be taken, etc.) It would therefore make more sense to speak, in many cases, about the same parameters that practically matters: current symptoms (like fatigue, pains and aches, blocked nose, chest tightness, dizziness, etc.) and tests’ abnormalities (or manifestations of the hyperventilation in respiratory, cardiovascular, nervous, immune, and other systems), and the CP. Let us look at the dynamic of labelling in Russia. The website in Novosibirsk and early Russian doctors used official medical names (something to start with). Later, instead of previous diseases, websites have been using the names of symptoms (like coughing, blocked nose, running nose, too much mucus, allergies, cold hands, feeling tired, pains in various body parts, sensation of panic, digestive complaints, insomnia, etc.). This approach makes more physiological sense due to the implication of the single cause.


Buteyko KP, Dyomin DV, Odintsova MP, Effects of carbon dioxide on large arteries in patients with high blood pressure and atherocardiosclerosis [in Russian], Healthcare in Kazahstan [Zdravookhranenie Kazakhstana], 1966. N 6.

Buteyko KP, Odintsova MP, Demin DV, Effects of hyperoxia and hypoxia on the tone of arterial vessels [in Russian] Soviet Medicine 1967, N 3, p.44-48. Buteyko KP, Interview with reporter N. Zubritskaya, Regional newspaper “Sovetskaya Sibir’” [“Soviet Siberia”] No. 257


19, 31 January 1998. Lapa NA, Some features of using DVBM [the Buteyko method] for children in The Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa.

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Chapter 13. Various other breathing-related topics Introduction This chapter considers various theoretical subjects that do not have direct relationships to the practice of the Buteyko breathing method. Each of these sections may be a topic for a separate book, and the information provided here is just a short review of certain main relationships. Please, note that Q&A sets can appear here within the sections.

13.1 Hatha yoga teaching and breathing Among various yoga schools, hatha yoga pays special attention to breathing ("hatha yoga" means "master of breath"). The founders of this school invented special breathing exercises ("pranayama"), which are discussed below. The traditional hatha yoga teaching can be found, first of all, in ancient manuscripts and in certain old books written over 30 years ago. Some of these books are: 1. Theos Bernard, "Hatha yoga" 2. S. S. Goswami, "Hatha yoga" (most systematic) 3. J. Hewitt, "The complete yoga book" 4. S. Sivananda, "Yoga practice" 5. T. K. V. Desikachar, "The heart of yoga" There are many other books, which describe the teaching of hatha yoga; however, virtually all modern books distort the traditional teaching (more details are below). What are their general traditional hatha yoga ideas about ideal breathing? One of the most popular hatha yoga ancient manuscripts ("Hatha Yoga Pradipika") directly states, "...Death consists of the passing out of the air. It is, therefore, necessary to restrain the breath". This is one of the typical indications found in hatha yoga papers that points out the importance of minimum breathing in normal life. Are there any other indications of the importance of small ventilation and large breath holding time? Here are some quotes: - The Yoga Sutra of Patanjali (another manuscript): "Pranayama is the cessation of inspiratory and expiratory movements." - Dr. Theos Bernard in "Hatha Yoga": "Kevala is absolute suspension, the ultimate aim of all breathing practices...For a single suspension I could hold my breath several minutes longer [than 5 min standard] as a test of my general condition." - Prof. S. S. Goswami in "Hatha Yoga": "Breath-control exercise may be classified into two main groups: long-slow type and short-quick type. Breath suspension forms the most important part of long-slow type..." - J. Hewitt in "The complete yoga book" (about heat generation practice): "By combining advanced breath control with intensive use of concentration and imagination, naked or skimpily-clad Yogins, sitting cross-legged and immobile, meditate for hours on exposed mountains slopes in sub-zero temperatures." - S. Sivananda in "Yoga Practice": "The stopping of breath cleans the organs of breathing and the nostrils. It cures the spasmotic conditions of the bronchial tubes and thereby also cures asthma ..." - T. K. V. Desikachar in "The heart of Yoga": "Maintaining the link between breath and body, particularly in lengthening the exhale and pausing after the exhale, has more significance to the purpose of yoga than achieving a classic asana [posture] for its own sake." Is there any other practical evidence indicating that old yoga masters had large CO2 levels and breath holding times? - Old yoga masters were famous for their ability to retain their breath for 5-10 minutes. - There were personal reports and anecdotal evidence in the past about yogis who could put plugs in the nostrils and sit in the lotus posture for dozens of minutes without any signs of breathing (the secret of the yogis was to insert a horse's hair so as to leave a tiny hole for very light breathing). - Yoga masters had better tolerance to CO2 in inspired air in comparison with healthy people, as physiological tests indicated (Funderburk, 1977). - Yoga masters better tolerated, again in comparison with normal subjects, confinement in closed volumes (Funderburk, 1977). Such confinements (similar to "burial" feats) are normally accompanied by increasing concentrations of CO2 and decreasing concentrations of O2 in the air. - Yogis, according to anecdotal evidence and private reports, could be buried for days and then be dug out alive.

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Survival in the conditions of severe air shortage is possible only when the organism can easily tolerate very large CO2 concentrations and enter metabolic states similar to hibernation. - Yogis could regulate their heart rate from about 20 and up to about 200 beats per minute (such regulation is based on regulation of breathing and its physiological mechanism, which was tested in dogs by Yale Professor Henderson, as is described in section 7.6). - Yogis could control many other physiological functions, which are automatic in most humans (e.g., contraction and expansion of the stomach, peristalsis in different parts of the small intestine and colon, temperature of different body parts, etc.). These abilities were demonstrated in various European and US scientific centres and institutions. These skills are also possible due to advanced control of breathing. Let us look in more details at their breathing exercises. First of all, according to traditional teaching, pranayama can only be started by those yoga students who can comfortably hold their breath for at least 1 minute. In order to reach this level, various cleansing methods are employed, e.g., vegetarian diet, cleansing exercises (for the tongue, teeth, stomach), bhastika (fast and very shallow breathing in order to activate the lymphatic nodes located under the diaphragm and clean the internal organs), asanas (various postures to ensure thorough relaxation of the body and more harmonious work of muscles-antagonists), etc. This initial system of cleansing for students is usually practised for many months (depending on the initial health of the student). In my view, this system is targeted to eliminate pathogens and inflamed/diseased tissues, including possible focal infections and their bacterial causes. After these problems are eliminated, ideal health, according to Buteyko standards, is achieved. Minute ventilation is about 45 l/min and the CP is above 1 min. As a next step, hatha yoga students (to be masters) are supposed to further improve their health. For that reason, pranayama-breathing exercises should be performed. The goal of pranayama is to develop exceptionally slow breathing during these special exercises, i.e., 1 breath per minute during the initial stages and thereafter diminishing (for yoga masters). Let us look at the exercises themselves. A classical set of pranayama uses the ratio 1:4:2 that reflects the durations of various stages of breathing (1 unit of time for inhalation, 4 units for breath retention, and 2 for exhalation). As an initial step, the student may use, for example, 10 s for slow inhalation, 40 s for breath holding, and 20 s for quiet smooth exhalation. Therefore, the practice employs 10:40:20 seconds proportions. The exercises are practiced for about 20 minutes, on an empty stomach, in lotus posture, with thorough muscular relaxation, 3-4 times per day. The practice should be separated by sufficient time from other rigorous activities, like asanas and physical exercises. (One may note numerous similarities here in relation to the conditions for the Buteyko breathing exercises). The rate of breathing during the initial stages is about 1 breath per minute. Since tidal volume is not at its maximum, although large enough, one may assume that tidal volume (expressed in litres) and minute ventilation (in l/min) are both about 2-3 units. Therefore, pranayama is a practice of reduced breathing with frequent breath holds. These numbers can be used in order to evaluate the usual ventilation of yoga students. Normally, motivated people, when doing intensive breathing exercises for at least 20 minutes, can reduce their breathing about two times. Hence, their usual ventilation is about 4-6 l/min. After each week the students can increase all periods. For example, the next week the proportions are 11:44:22 seconds. A week later, 12:48:24 is used, etc. Such practice is accompanied by a system of rigorous physical exercises and hours of asanas (headstand and other postures). For more detailed description of classical pranayama, one may consult the books of Swedish Professor Goswami (Goswami, 1964) and Dr. Bernard (Bernard, 1944). In my view, in the past, many Western people and some Western hatha yoga schools and teachers picked up the idea about deep breathing of hatha yoga masters and ... encouraged and promoted the practice of deep breathing in the general population. If a healthy person normally has shallow breathing (in terms of tidal volume), he/she may start the deep breathing exercises and move either in the direction of chronic hyperventilation or chronic hypoventilation, depending on breathing frequency. The results of such breathing exercises for sick people (low initial CPs) are hard to predict. Changes in CO2 stores, during the exercises, are going to be important factors. Clearly, sick people do not need to make their breathing deeper. Pranayama was not intended for sick people, as is indicated in traditional hatha yoga teaching, while the system invented by Doctor Buteyko is directly targeted to normalize the breathing of sick people. Doctor Buteyko said the following about hatha yoga breathing exercises, “We should not confuse the full breathing of the yogi with deep breathing. Proponents of deep breathing confuse these notions saying, “Yogi breathed deeply for thousands of years. They are super people.” In reality,

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everything is vice versa. The deep breathing of the yogi is shallow breathing. It is done very slowly, with maximum breath holds after inhalations and exhalations. If the lungs’ ventilation is measured, then it is revealed that with such training the ventilation of the lungs is decreased, and CO2 gets higher. Therefore, the deep breathing of the yogi, according to its physiological parameters, is analogous to our reduced breathing. Hence, so many people are curious about yoga. It is a surprisingly wise system of exercises… Yogi instinctively selected almost everything that decreases breathing: the majority of their asanas decrease breathing, and the name of the breathing exercise is “pranayama”. Literally, this means slowing breathing down. Whatever yogi do with their breathing, their ultimate goal is to harness it, slow it down, and achieve breathlessness and deathlessness” (Buteyko, 1977). Q: Do modern western yoga schools teach people traditional ideas and conduct traditional hatha yoga exercises? A: Most western yoga schools are different from traditional yoga approaches. First, the staff of modern yoga schools has poor understanding of the physiology of breathing. They often believe in the usefulness of deep breathing and hyperventilation. Second, those schools that use breathing exercises usually emphasize deep breathing sessions (without a requirement for improving breath holding time) or high frequency shallow breathing (which is not difficult to do). Those who follow traditional ideas emphasize that the Guru is very important in order to "restrain the breath". Q: What about modern yoga books? Are they valuable in terms of breathing normalization? A: Modern books either exclude traditional hatha yoga ideas or change them. Such books usually contain many asanas (postures), where people are, unfortunately, often with their mouths open. However, asanas, when done under proper professional supervision, favour relaxation of muscles and easy breathing. Thus, these exercises and books can be used for gymnastics, body plasticity, relaxation, and slight health improvement. Q: Hatha yoga suggests having breath holding after inhalation. Can that be practiced? A: Buteyko believes that sick people (low CP) must not do MP or other long pauses after inhalation. That leads to quick exhalation and problems with breathing control afterwards. Exhalation, as he and old yoga schools teach, in normal life should be smooth and long. Also, there are some medical papers about [add: the] influence of slow exhalation exercises on increased parasympathetic tone. By the way, the pulse is also greatly reduced during exhalation, in comparison with inhalation, in normal health (by 10 or more beats per minute). For healthy people, (as Doctor Buteyko once said) there is no big difference when to hold the breath. Q: Many modern yoga books are cautious about breath holding in general. For example, various editions of Iyengar's books on pranayama (e.g., "Light on pranayama") have over dozens of warnings about dangers of breath holds for people with various health problems. Why? A: Indeed, most modern authors and modern schools (e.g., Iyengar's) suggest that breath holding should not be used by sick people. That probably reflects their experience of dealing with western yoga students, many of whom have different ailments, which can be worsened by the practice of hyperventilation. Those who could manage to raise their CO2 during practices may have cleansing reactions, which can create other problems together with fear and anxiety, often causing the patient to quit the exercises.

_______ Q: There are many statements in traditional hatha yoga teaching about some mysterious "prana" (hence, the word "pranayama"), as a force that should be conserved or accumulated. Is there any physiological sense in such statements? A: Doctor Buteyko, during his public speeches, once mentioned that prana was simply CO2. Indeed, if one reads old hatha yoga books, while substituting CO2 instead of "prana", deep physiological sense, in traditional yoga teaching, can be found.

Q: There were cases in the past, when some yogis did not survive "burial" feats. What are the possible physiological causes of such deaths? A: Burial feats were often conducted over the course of days. The amount of air available for breathing during such experiments (a person can be buried alive in a coffin) would be enough for some dozens of minutes or hours only. It would be sensible, then, in order to answer this question, to consider what happens during the hibernation of animals. That is the next topic. 261


Q: Which other traditional yoga schools realized the importance of restrained breathing? A: Most, if not all of them. For example, the following extract is taken from “Autobiography of a Yogi” written by Yogananda Paramahansa who practiced Kriya yoga. “Many illustrations can be given of the mathematical relationship between man's respiratory rate and the variations in his states of consciousness. A person whose attention is wholly engrossed, as in following some closely knit intellectual argument, or in attempting some delicate physical feat, automatically breathes very slowly. Fixity of attention depends on slow breathing; quick or uneven breaths are an inevitable accompaniment of harmful emotional states: fear, lust, anger. The restless monkey breathes at the rate of 32 times a minute, in contrast to man's average rate of 18 times. The elephant, tortoise, snake, and other creatures noted for their longevity have a respiratory rate that is less than man's. The giant tortoise, for instance, which may attain the age of three hundred years, breathes only 4 times a minute.” (p.280, Paramahansa, 1950). “The mystery of life and death, whose solution is the only purpose of man's sojourn on earth, is intimately interwoven with breath. Breathlessness is deathlessness. Realizing this truth, the ancient rishis of India on the sole clue of the breath developed a precise and rational science of breathlessness.” (p. 564, Paramahansa, 1950).

13.2 Hibernation Let us, first, consider, the air in the burrows of active or sleeping animals. Normal air that we breathe has about 0.04% CO2 and almost 21% O2. The air in physiologically normal human lungs contains about 5.3% CO2 and nearly 14% O2. The normal arterial blood has about the same percentages of these gases. Professor Maina wrote a scientific manuscript (Maina, 1998) about the evolution of the respiratory system. The book is backed up by many hundreds of references, and it reviews gaseous composition in the lairs of different animals. Concentrations of CO2 and O2 vary greatly. CO2 content in air can be above 10%, while O2 concentration can be below 10%. Birds can have from 1.2 to 9% CO2 in their nests, while 0.5-2% CO2 were found for some rodent species and 3.8% CO2 for the burrows of the pocket gopher. Up to 13.5% CO2 and down to 4% O2 were observed in the dens of hibernating mammals. Such extreme hypoxia and hypercapnia affects cardiac function, respiration, and the general metabolism of the hibernating animals. Usually their pulse, minute ventilation, and breathing frequency are greatly reduced, sometimes about a hundred times in comparison with normal values. For example, Roger Ransome, who studied the life of hibernating bats (Ransome, 1990), wrote "As the body cools, the heartbeat rate falls from a level of several hundred beats per minute to an erratic figure of perhaps 5-20 in deep torpor, and blood is stored in the spleen, which swells enormously...Breathing rates also fall and become more erratic at the same time as the heartbeat rate declines" (p.79, Ransome, 1990). Indeed, professional physiologists from Canada concluded, "For many animals, the best defence against harsh environmental conditions is an escape to a hypometabolic or dormant state. Facultative metabolic rate depression is the common adaptive strategy of anaerobiosis, hibernation, and estivation, as well as a number of other arrested states. By reducing metabolic rate by a factor ranging from 5 to 100 fold or more, animals gain a comparable extension of survival time that can support months or even years of dormancy. The present review focuses on the molecular control mechanisms that regulate and coordinate cellular metabolism for the transition into dormancy..." (Storey & Storey, 1990). These researchers suggested a certain biochemical mechanism for how these metabolic states, hibernation included, can be triggered. Their model is based on interactions of certain enzymes, proteins, and messenger molecules. However, Californian biologists believe that "In mammals that undergo torpor and hibernation, a period of CO2 storage is often a prelude to, and may be required for, the onset of a bout of torpor. Storage of CO2 has been hypothesized to induce an energy-conserving metabolic suppression in torpid mammals..." (Bucher & Chappell, 1997). The above-quoted researcher of bats, R. Ransome noticed"... The body [during hibernation] becomes more tolerant of increased carbon dioxide levels which more rapid breathing would normally flush out" (p. 79, Ransome, 1990). Similarly, a group of Ukrainian biochemists wrote the following in their abstract, "The paper presents results of investigations on some mechanisms of metabolic adaptation in mammals. There are four sections in the tissue metabolic system of acid-base homeostasis: polyamines as factors of metabolic adaptation; significance of carbon dioxide for metabolic response formation in hypobiosis; polyamines metabolism in hypobiosis... Some new data on mechanisms of formation and control of metabolic status of animals in the natural and

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artificial hibernation have been presented. The key idea is that in the state of hypobiosis the carbon dioxide (HCO3-) appears as a regulatory factor of metabolic adaptation, which is able to realize its action directly via affecting numerous biochemical events..." (Mel'nychuk et al, 2000). Therefore, it is possible to conclude that CO2, with probable and likely contributions of low temperatures and lack of food, is the main triggering factor for hibernation of many animals, mammals included. Indeed, let us think about the bear just before the onset of hibernation. The animal gets into the den, seals itself from inside, and goes to sleep. Since the air exchange with the surrounding atmosphere is limited, CO2 concentrations rise, while O2 falls. (That was measured for many animals.) What about those animals who cannot create this special air? "As to the suspension of breathing in hibernators, the fact is proved sufficiently in the instances of the raccoon and the woodchuck. When they have laid themselves away for the winter sleep they roll themselves up comfortably and press their noses in such a position against their hinder parts that it would be an absolute impossibility for them to draw a breath..." (from "Science made simple", a US educational company that has publications at www.sciencemadesimple.com). Is hibernation useful? The medical professionals of PetPlace write about their practical experience with pet turtles, "We are only beginning to understand the physiology of hibernation in reptiles, but it is becoming clear that it has health benefits. Healthy specimens deposit fat stores in preparation for hibernation. If not allowed to hibernate, these animals may be at risk for obesity. Hibernation is believed to be necessary for the normal function of the thyroid gland. There is also evidence that hibernation helps maintain the immune system. Hibernation is most likely required if a tortoise is to achieve his expected life span" (from "Hibernation in Turtles", by: PetPlace Staff, www.PetPlace.com, 2001). However, it is a known fact that many animals do not survive hibernation. Why? The causes can be different. Let me again quote the PetPlace staff, "... Only healthy specimens who have been eating well and who have not experienced recent or unresolved illness or stress should be allowed to hibernate. It is vital to know the animal's history" (from "Hibernation in Turtles", by: PetPlace Staff, www.PetPlace.com, 2001). Clearly, the presence of any uncontrolled pathogenic bacteria, inflamed tissues or toxic sources makes, according to these professionals, hibernation dangerous. Moreover, if you have a ready for hibernation tortoise pet animal, "Begin by withholding food, but not water, for 10 to 14 days. Smaller animals or species should fast for a shorter time than should larger species or individuals. During the fast, maintain the tortoise within his POTZ (70 to 80 F or 22 to 28 C). This will allow him to clear his digestive tract of all food. This is important; undigested material will slowly rot, releasing toxins as the animal hibernates. The toxins can depress the immune system and shut down the digestive system" (from "Hibernation in Turtles", by: PetPlace Staff, www.PetPlace.com, 2001). Therefore, toxic sources from the digestive system are equally hazardous for hibernating animals. Similarly, Paula Morris suggests, in the section “Health”, “...Examination by either you, a qualified vet, or an experienced keeper is mandatory. If there's any discharge from either the nose, mouth, eyes or cloaca you may have to overwinter the animal and put it on a regimen of antibiotic treatment; respiratory distress is fatal in hibernation. Wounds or lesions or any shell rot must also be treated until healed prior to hibernation... [from the section "Diet"] ...In the wild an herbivorous tortoise will have fed upon vegetation dried by the summer heat; this mass will "swab out" the intestines prior to hibernation. Turtles and tortoises usually instinctively stop eating on their own prior to hibernation, but it's best if you regulate food availability. Andy Highfield draws a correlation between the size of the animal and its metabolic rate (determined by temperature) and the amount of time it takes to start winding down to hibernation through fasting. A larger animal may require up to three weeks to clean out its system while a box turtle or a Horsfields tortoise may need only two weeks. Dr. James Jarchow believes that a bit of grass ingested prior to hibernation isn't harmful, but large of amounts of food are. Omnivorous species like turtles must be kept from feeding at least two weeks prior to being put into hibernation to avoid food decomposing in the upper part of the digestive system; tympanic gas will form and suffocate the sleeping turtle. Fruit whose sugars ferment are particularly dangerous" (Morris, 1994). All these observations are indirect confirmations of the focal infection theory. They support the idea that high CO2 concentrations (probably about 6.5-7%) are possible when there are no inner or outer sources of body pollution.

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One may also note here a parallel between diets before hibernation in animals and fasting in humans. It is indeed a normal recommendation of many fasting experts to have a vegetarian diet during the last 1-3, sometimes 7, days before starting water fasting. That is done, as the fasting experts claim, in order to exclude the possible toxic sources, due to, for example, fermentation of animal proteins and, to a lesser degree, starches or fruits. What about the immune system during hibernation? Normally, the immune system reacts to foreign substances by producing antibodies and other cells and chemicals in order to keep the functioning of the organism in order. However, that is not a case in hibernation since "...The immune system isn't effective in hibernation and a sleeping animal has no resistance to infection, either internal or external" (Morris, 1994). Therefore, a poorly reacting immune system can be considered as a cause, together with sources of toxins, of the deaths of hibernating animals and those humans who attempted to hibernate. Probably, low body temperatures, poor blood supply to certain vital organs and some other factors make the immune system weak and the organism vulnerable to infections and diseases during hibernation. When above-quoted Yogananda Paramahansa (he was a master Kriya yoga) decided that it was a time for his soul to leave the body, the following note, after his physical death, at the end of his autobiographical book was added. This note seems relevant to ideas about focal infections. “Mr. Harry T. Rowe, Los Angeles Mortuary Director, Forest Lawn Memorial-Park (in which the body of the great master is temporary placed), sent Self-Realization Fellowship a notarized letter from which the following extracts are taken: ‘The absence of any visual signs of decay in the dead body of Paramahansa Yogananda offers the most extraordinary case in our experience... No physical disintegration was visible in his body even twenty days after death... No visible indication of mold was visible on his skin, and no visible desiccation (drying up) took place in the bodily tissues. The state of perfect preservation of a body is, so far as we know from mortuary annals, an unparalleled one... At the time of receiving Yogananda's body, the Mortuary personnel expected to observe, through the glass lid of the casket, the usual progressive signs of bodily decay. Our astonishment increased as day followed day without bringing any visible change in the body under observation... No odor of decay emanated from his body at any time... The physical appearance of Yogananda on March 27th, just before the bronze cover of the casket was put into position, was the same as it had been on March 7th..’” (p.575, Paramahansa, 1950)

13.3 Breath holding abilities in animals The northern elephant seal can dive for periods of up to one hour and less than 5 minutes surface intervals are required between dives. Even while sleeping on the beaches, elephant seals often have many minutes of breath holding (Castellini et al, 1994). Hibernating mammals also possess remarkable breath-holding abilities. For example, a garden dormouse can hold its breath for periods of up to 130 minutes and the European hedgehog for up to 2.5 hours. In many other species, prolonged periods of apnoea (5 to 45 minutes) occur regularly and alternate with brief periods of intense respiration (2 to 5 minutes) (Milsom, 1992). A review of breath holding abilities during diving, sleep, and hibernation of various animals was done by Zoology Professor, Dr. Bill Milsom (Milsom, 2000). There are 2 physiological gas-related mechanisms that cause humans and other animals to resume respiration at the end of breath holding: CO2 drive (increased concentrations of CO2 in the lungs and the arterial blood) and, to a lesser extent, O2 drive (lack of O2 in tissues). However, during 90% of our evolution (from one half to five billion years ago), the atmosphere had negligible amounts of O2 (less than 1%) and very large concentrations of CO2 (many %). Therefore, it is likely that all those prehistoric creatures had superior breath holding abilities (according to our standards and while breathing their hypoxic air) compared with our performance under present-day conditions. As it was many times noted by Doctor Buteyko, constant increase in O2 and fall in CO2 in air produced a profound impact on the evolution of animals. Indeed, hyperventilation can provide and did provide more oxygen for tissues in conditions of prehistoric air since CO2 concentrations were much larger. However, ancient creatures did not hyperventilate all the time due to excessive energetic demands of heavy breathing. Therefore, hyperventilation was the tool useful in conditions of stress. Even now periods of hyperventilation in animals, in cases of danger, usually lasts seconds or tens of seconds. That would reduce CO2 stores in the lungs and some blood, while tissue CO2 and brain CO2 concentrations would be unaffected. Modern air, on the other hand, has so little CO2 that chronic (or prolonged) hyperventilation causes the

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opposite effect (hypoxia).

13.4 Breathing in relation to metabolic and health states The above given data suggests that there are certain links among the following seemingly irrelevant phenomena: - breathing - focal infections and diseased or inflamed tissues - death of animals during hibernation - death of humans during burial feats and freezing in natural conditions. Based on the previous observations, the following relationship between breath holding ability and metabolic or health states can be suggested. 0 s - death 1-5 s - very sick (usually hospitalised) people 5-30 s - modern population burdened with chronic degenerative conditions 40-60 s - few contemporary people and people living about a century ago 1-3 minutes - primitive people 3-10 minutes - hatha yoga masters and many hibernating animals 2-150 minutes - diving animals (including aquatic mammals, such as whales and seals) and all creatures and animals living from 5 to .5 billion years ago.

13.5 Breathing analogy in health and disease This part provides an analogy of breathing that reflects the general processes, which underlie breathing in health and disease. It would be more accurate to present the human organism as a chemical factory, which is more sophisticated than all existing factories combined. However, for simplicity, let us imagine that the human organism is like a car that needs certain substances and maintenance for normal functioning. According to the design of its engineers, the new car should be able to last for a certain number of years and run during a certain amount of time. Now the question is: "Which part or system of the car is going to break first due to wear and other negative influences?" The answer to this question can be provided by any mechanic. The location of the weakest place in a car depends on: 1. the type of the car (its make or initial state, including strong and weak parts and systems); 2. the outer conditions of use (environmental parameters, like temperature, humidity, types of roads used, etc.); 3. what was done with the car during its history, including quality of practical driving and quality of car maintenance (ability to detect the problems and to solve them; systematic care about various parameters, like oil levels, braking fluid level, washing fluid, etc.; regularity of various checks and inspections). Cars are made differently. Some cars have more durable engines, others stronger bodies, still others are famous for their excellent chassis. At the same time, the cars normally have certain weak points, in some parts or systems. The car will run longer, if environmental conditions are more favourable (the weather is not too cold or too hot and dry, the roads are smooth, etc.). If the driver is careless in driving (speeding, especially on bad road surfaces; sharp and fast turns; too sudden release of the clutch; etc.), the car is going to last less time. Vice versa, the driver can be too cautious (driving too slowly; delayed release of the clutch; etc.). That also can create certain problems for the car. Some drivers are sensitive and pay due attention to all possible abnormalities of the car. Such cars, as people say, are in good hands. Other people can either neglect possible problems or can be too attentive to some insignificant details. Problems with the car are possible in both cases. Maintenance of the car and its systematic check are other qualities that drivers may or may not have. In addition, the same driver can be, for example, intelligent in relation to certain parts or systems of the car, while neglecting some others. The possible problems depend on the interplay of the above-mentioned factors. Now let us return to humans in health and disease. The possible development of a disease (human's inability to function normally) depends on the following factors: 1. his initial state (strong and weak parts and systems or genetic characteristics of the person);

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2. outer conditions of functioning (environmental parameters, like temperature, humidity, and radiation; influx of pathogenic and toxic substances, like bacteria, viruses, free radicals, etc.; stress experienced, etc.); 3. choices he has made in the past (food, drink, exercise, breathing, personal philosophy, etc.). How to check a car? The first thing is to observe its ability to start or to breathe. Then the quality of breathing should be observed. Finally, the car is caused to move and its breathing at different speeds and conditions is tested. Breathing of the car is not the only important parameter. However, it is the most important general characteristic. Let us now consider the development of disease. Why do some people develop, for example, asthma? Why do other people get cardiovascular problems? Why do still others suffer from chronic fatigue? Is it inevitable for these people to have these problems? Do hereditary factors play any role here? The theory of hyperventilation developed by Doctor Buteyko provides us with clear answers to these questions. In all these cases, the cause of the problems is the same – chronic hyperventilation. If these people breathe according to physiological norms, they are going to remain healthy. Should they start to overbreathe, the effect of chronic hyperventilation is going to lead, sooner or later, to pathological changes. For example, in some people excessive bronchoconstriction is a normal outcome of hyperventilation. Therefore, these people would be diagnosed by official medicine with asthma. As some cars are more predisposed to certain problems, so are some people genetically programmed to develop, in cases of chronic stress, asthma symptoms. Other people, in case of chronic overbreathing, develop cardiovascular problems. The possible scenario here is exactly the same. Genetic predisposition, environmental factors, and personal choices are all important factors for these health problems to develop. Still others are going to experience chronic fatigue due to a complex of pathological changes triggered by chronic hyperventilation. That is the reason why most modern chronic degenerative health problems are often considered (partly) hereditary. For example, if one biological parent has asthma, the chance of a child developing asthma is almost 50%. If both parents have asthma, the chance is over 90%. Why? Because this child inherited the genes which carry the ability of excessive bronchoconstriction in conditions of hyperventilation. It would be normal to expect that scientists should discover, sooner or later, that virtually all modern chronic degenerative diseases are inherited. These scientists would be able to pinpoint the place(s) where these genes, in human DNA, are located. Hence, discoveries of genes responsible for certain health problems neatly fit into this theory of hyperventilation. If the next time you hear that scientists discovered the genes responsible for a certain (scary and officially incurable) health problem, this is a likely confirmation that this health problem is caused by chronic hyperventilation. One can also expect that certain factors (like lack of exercise, overeating, overheating, etc.) will be called, by official medicine, the triggers of this disease. However, in some people, it can be difficult to predict which health problems they are going to have. Why? It can happen that these people have nearly equal chances of developing seemingly different problems (although in reality these problems are the symptoms of the same disease, chronic hyperventilation). Environmental parameters and individual choices are then going to play the decisive role. For example, certain toxic substances can target specific organs (e.g., the lungs, heart, liver, kidneys and other organs) depending on individual makeup. Similarly, individual needs in many nutrients and diets can be different for different people. These factors also predispose people to certain problems. This predisposition interacts with other environmental factors. For example, the presence of certain pathogenic microorganisms and the general microbial flora can weaken certain systems or organs (e.g., the respiratory system, skin, liver, GI organs, cardiovascular system, etc.). Therefore, whatever the case, there are three general factors which define the possibility and the scenario of the disease development: 1. hereditary parameters; 2. environmental conditions; 3. individual choices. What is the role of breathing in this model? In some cases, hyperventilation can be considered as the direct cause of the health problem. That relates to asthma, hypertension, epilepsy, panic attacks, and some other conditions. Hence, in these cases breathing is a general integrative parameter (or indicator) of health that reflects the degree of these health problems. How do these health problems develop? Poor environment and personal conditions and choices cause hyperventilation. Overbreathing, in its turn, through heredity, triggers the health problem to which the person is predisposed.

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For many other health concerns, hyperventilation is an important characteristic that usually contributes to, and reflects the degree of, these problems and the direction of their development. For example, experience of Russian medical Buteyko professionals indicates that arthritis, diabetes, cancer and many GI problems cannot co-exist with normal (6.5%) CO2 concentrations and high CPs. Usually the stronger the degree of chronic hyperventilation, the more serious the health problem.

13.6 Homeostasis and various simple parameters that reflect it In order to analyse any object as a biological functioning unit (with certain inputs and outputs of various substances and characteristics), scientists used the notion of homeostasis. It refers to the maintenance of the internal environment within certain limits. Therefore, homeostasis can be defined as the maintenance of equilibrium, or constant conditions, in a biological system by means of automatic mechanisms. One of the goals of these mechanisms is to counteract influences tending toward disequilibrium. However, even non-living material objects cannot have constant states and conditions due to, for example, internal processes and environmental influences. For instance, a diamond with initially perfect structure is to age: its initially perfect crystalline lattice will be gradually changed and eventually destroyed. Similarly, all biological systems are aging. Therefore, homeostasis can only exist within certain time intervals. As a result, many chronic diseased states can be considered as examples of homeostasis if we are talking about days, weeks, or months. Hence, it is possible to consider different health states as examples of temporary homeostasis. Each system of the biological organism has many important parameters, some of which are measured by special medical tests. However, for our purposes and for the sake of simplicity, let me suggest some simple parameters that should be easily understood. (Note. It should be kept in mind that there are many other parameters that can be, for some health conditions, more informative and important. The suggested ideas are approximations of typical changes that occur during the development of many diseased states.) • The immune system The efficiency of the immune system in the state of homeostasis is defined in the presence, distribution, and concentrations of pathogens (including bacterial balance of the oral cavity, GI tract, skin, other mucosal surfaces and tissues), inflamed/diseased tissues within the system, and adequacy of the response of the immune system to these pathogens. The adequacy can be measured by the presence of various antibodies and other specialized cells. • The cardiovascular system The work of the cardiovascular system can be reflected by pulse and blood pressure. • The musculoskeletal system Physical well-being and joy of physical work characterise the efficiency of this system. • The digestive system The work of digestion can be measured by the required amounts of various food substances (in order to keep the whole system running), amounts and types of toxins eliminated, and degree of auto-intoxication (due to, for example, putrefaction of food residues accompanied by constipation). • The urinary system Water intake, ability to balance electrolytes and ability to concentrate urine (so that it contains maximum amounts of unwanted substances) reflect the efficiency of the urinary system. • The endocrine system The state of this system is manifested in the feelings of energy, well-being, self-acceptance, positive attitude, normal rhythm of the circadian activities (e.g., breathing, work, exercise, sleep, eating, drinking, urination, defecation, etc.), resting metabolic rate and body temperature • The nervous system The state of this system reflects the ability for objective perception of the outside environment and efficiency of inner communication • The respiratory system Its efficiency can be characterised by the amount of required air (in order to support life processes).

_______ Generally, the functioning of a human organism (or another physiological unit) is considered here from the viewpoint of optimisation: to have maximum productivity (in terms of physical and mental output) with the least 267


requirements in water, nutrients, and air. Now we can investigate homeostasis during different health states. Since normal hibernation requires superior health, let us consider this state first. • Homeostasis for hibernation During hibernation there are no active pathogens in the organism and no diseased tissues. Normally, the immune system is virtually dormant. Due to very high CO2 concentrations: - muscular relaxation is perfect (small hibernating animals, when they are held in hands, look lifeless) - blood vessels leading to the heart and the brain are maximally dilated - the nervous system is at complete rest - the work of the cardiovascular system is very light. As a result, the pulse, blood pressure, temperature, and resting metabolic rate are very low. The ability to concentrate urine is so strong that the animal often needs to awake only once in, for example, a week in order to urinate. Need for food is absent, while the amount of required air is very small (breathing can be detected only using special devices and methods). Scientists usually refer to hibernation as a different metabolic state (a special method of adaptation) since hibernation is qualitatively different from all other states of the biological unit in many respects. However, safe hibernation, as we found above, is possible only for very healthy bodies. Therefore, successful hibernation, according to its physiological parameters, can start only from the state of excellent health. The (only?) problem with this health state is no physical and mental output. • Homeostasis in the state of excellent health In the state of excellent health, as for yoga masters in the past, all physiological systems work very efficiently. As a result, needs in water, food, air, and rest are minimum. For example, one meal and one drink per day can be sufficient. Very small needs for air reflect very high CO2 concentrations. That leads to all those processes and changes that are summarized in Appendix 7. • Homeostasis in the state of normal health In cases of normal health, the work of various systems is good, and the organism still functions well in terms of efficiency and various needs. The typical "normal" ranges for many parameters can be found in medical books. Needs in water, food, air, and rest are relatively small. • Homeostasis for compromised health states There are certain typical changes in each system when the health state is abnormal or gradually starts to deteriorate. The biological unit gets more polluted due to larger amounts of pathogens on the skin, in the mouth, intestines, and other parts of the organism. Gradual increase in the amounts of inflamed and diseased tissues, with further health deterioration, is another typical feature. All these events impose more stress on the immune system. The cardiovascular system is more strained due to increased friction (greater resistance from the blood vessels due to their constriction) and less efficient work of the heart muscle (due to reduced perfusion and hypoxia). Pulse and blood pressure are higher as a result. Certain norms of good and excellent health (e.g., optimum physical abilities and joy of physical work) are gradually replaced by fatigue and boredom, as for very sick people. The required amounts of food and many nutrients are larger (due to putrefaction, less effective digestion and absorption, and greater demands of the immune system). A greater number of meals (due to decreased digestive abilities) are often required. Similarly, water intake and its frequency are usually increased, while the kidneys' abilities to balance electrolytes and to concentrate urine are less perfect. All these processes are accompanied by various hormonal changes and disturbances indicating less efficient performance, possible troubles with sleep, and other physiological activities. Resting metabolic rate and body temperature are higher. The outside environment looks more hostile reflecting some degree of chronic stress (or being in a permanent "fight or flight" mode). That can cause panic attacks or other irrational thoughts and emotions (since the whole nervous system or some its parts are excessively excited). Table 13.1 summarizes these changes.

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Hibernation

Excellent health

Normal health

Poor health

Very sick

Absent

Very mild

Mild

High

Very high

Absent

High

Normal

Inadequate

Very inadequate

Absent

Very mild

Mild

Moderate

Strong

Absent

Good

Normal

Poor

Very poor

Very low

Low

Normal

High

Very high

Pulse Resting metabolic rate Efficiency of digestion Needs in nutrients

Very low

Low

Normal

High

Very high

Very low

Low

Normal

High

Very high

Absent

High

Normal

Low

Very low

Absent

Small

Normal

Large

Very large

Needs in water a CO2 concentration CP

Absent/tiny

Small

Normal

Large

Very large

Very high

High

Normal

Low

Very low

Over 5 min Almost absent

1-5 min

40-60 s

15-35 s

Below 15 s

Light

Normal

Heavy

Very heavy

Activity of pathogens Sensitivity of the immune system Defensive efforts of the immune system Results of efforts of the immune system Core body T

Breathing

Table 13.1 Approximate relationships between health states and various parameters of the human organism. Q: Are these parameters the most important indicators of health? A: No, they are chosen due to their simplicity. For certain health problems, some other parameters can be more significant. Consider, for example, blood sugar and insulin levels. However, it is possible to include both of them in the similar manner. Blood sugar and insulin concentrations are very low during hibernation, are low in a healthy state, and they usually get higher for the diseased states. There are also many health problems for which these general tendencies are not true.

_______ 13.7 Socio-psychological aspects of breathing

Changes in breathing produce profound impact on: • Personal behaviour, attitudes and views; • Personal relationships with friends and family members; • Social relationships in communities, unions, teams, workplaces, and other social groups; • Relationships within and between societies. Let me consider these effects of hyperventilation in the suggested order. • Personal behaviour, attitudes and views Certain psychological individual changes, due to changes in breathing, are described in Appendix 7. The person with a critically low CO2 levels in the brain and other nervous tissues is usually very different from the same person, [comma not necessary] who has normal CO2 values. It is a normal physiological result that, as a part of the evolutionary fight and flight response, a hyperventilating person sees the outside world through the glasses of possible threats. These threats can come from all possible (and sometimes even impossible) sources. While being in this abnormal state, an individual can jump to unreasonable conclusions and have unfounded fears and panic attacks. (This 269


is a reason why breathing retraining is so successful in the treatment of panic attacks, as it was reviewed in Chapter 4.) Therefore, hyperventilation distorts the work of the senses and objective perception of the surrounding environment. In my view, the following emotions are the logical and frequent consequences of hyperventilation: greed, envy, fear, anger, revenge, suspicion, paranoia, hostility, and many others. Note that I do not claim that all these emotions are caused by hyperventilation and cannot co-exist with normal breathing. However, hyperventilation leads to “spontaneous and asynchronous firing of cortical neurons” (see Chapter 1) and that makes the chances of these emotions (and corresponding actions) higher due to the resulting abnormal states of various brain regions. The performance of the hyperventilating person and the results of different tests are far from optimum as numerous psychological studies revealed. Among other things, the person has less self-awareness and a distorted attitude towards various elements of reality. For example, he cannot objectively evaluate his abilities, both in the short and long run. He may, for example, start various grand projects, which are never to be completed. At some moments, he can be confident and feel invincible. However, hours or days later, he can become hopeless and depressed in relation to his abilities. Some of the causes of these effects are poor brain blood flow (hence, inadequate supply of fuel for the brain) and excessive excitability of the nervous cells. The brain, in such conditions, can behave like an illuminated Christmas tree. The pattern of thoughts, attitude, emotions and mood of the person depend on current illumination, not on the outside parameters of the external environment. For some people, this process of illumination can be fixed (as during chronic hyperactivity or depression); for others, it changes. The whole goal-achieving complex is affected, including the following abilities: - to choose realistic and meaningful goals; - to have clear ideas about the methods of their implementation (plan); - to firmly stick to this plan and, day after day, persistently work in the chosen direction, in spite of problems and hardships. As a general social outcome, when the number of hyperventilating people increases, the numbers of patients diagnosed with panic attacks, addictions, depression, schizophrenia and other neurological disorders also get larger. • Relationships with friends and family members These cognitive problems also affect the perception, attitude, and expectations from other people - first of all, family members, relatives, and close friends. Due to the chronic fight and flight mode of behaviour, the hyperventilating individual has difficulties in accepting other people as they are. He wants to make them in accordance with his distorted imagination. The dynamic of his personal relationships, especially with those people who also chronically over-breathe, can be dramatic. That was the subject of discoveries described by Eric Berne in his books (Berne, 1976; Berne, 1996). Such abnormal relationships, as it was suggested, are based on game playing with constant role switching (victim-persecutor or victim-persecutor-saviour, as in cases of three or more people involved). Similar games and role switching (prey-predator and prey-predator-saviour) are the foundations of hostile relationships in the wild. However, healthy animals do not remain in the state of chronic hyperventilation. They are usually stressed and immobilised for short periods of time when there are real dangers. In the meantime and for the most of the time, they have other, more constructive, activities to accomplish. As to relationships between chronically hyperventilating humans - violence, abuse, quarrels, and conflicts are possible outcomes. Increasing numbers of children growing up in broken families; divorces; poor, weak, or lost connections with family members, old friends, and important others are the general results reflecting the prevalence of chronic hyperventilation in the general population. • Relationships in employment-related groups, communities, unions, teams, and other social groups When a person interacts with other people, these other people have certain individual qualities and characteristics, which are manifested in their actions. For this person, his/her inability for objective perception also relates to the inability to see what is meaningful and what is irrational in our spiritual and material worlds. That often creates irrational mental and behavioural patterns. These tendencies are true for his/her relationships in various groups, communities, unions, teams, etc. As a result, the foundations and the interests of various human groups become different. A group of hyperventilating people can have the same cognitive problems, as it is indicated above for a single individual. First of all, the performance of such groups is going to suffer. More importantly, the desire to solve various problems and conflicts using peaceful means would be less strong. Instability, conflicts, and lawsuits are the likely results. • Relationships within and between the societies Similar processes can take place on a larger scale. Indeed, chronic hyperventilation causes the appearance of

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certain emotions and feelings among political leaders, affecting their performance (or abilities to solve various economical, political, cultural, social and other problems). One can, for example, evaluate the chances of peace and military conflicts among hyperventilating political leaders. On the other hand, it is normal for other people to be critical in relation to these leaders. It is also possible to hear or have certain negative thoughts in relation to, for example, other nations, races, and countries. These thoughts, in cases of chronic hyperventilation, due to increased excitability of the brain, can be amplified, while rational approaches can be suppressed. These processes can result in serious practical consequences. Some of us can become violent, others depressed, and many would frequently alternate between these two positions. Whatever the case, such physiological abnormalities can explain, for example, some of the roots of international terrorism and wars. There is another relevant problem that for many generations puzzled historians, archaeologists, sociologists, and other scientists. During human history, many civilizations accomplished amazing achievements in various areas and, then, without a clear cause, these civilizations collapsed (or gradually declined) and disappeared. Why? The suggested explanations include: - political disputes among the leaders and their heirs; - natural disasters (droughts, floods, earthquakes, etc.) - infectious diseases and other health problems. However, according to the general opinion of most researchers, these reasons are unsatisfactory because these factors often accompanied the development of the same and many other civilizations. Why did political disputes become problematic during the collapse, although the previous generations of political leaders peacefully cooperated with each other? Why did natural disasters become insurmountable during the collapse, although they were just natural challenges, which were to be enjoyed and overcome during the previous history of the same society? Why did people suddenly become susceptible to infections and other diseases, even though these people were resistant before? I do not claim that chronic hyperventilation is the only answer to all these questions. However, it is a very powerful factor that can partly (in some cases fully) answer these questions. What are the implications for the modern situation? Many concerned people of the Earth spend large amounts of time and energy in order to find answers to various problems, which are now faced by humanity. Among these are the issues of optimum social order (capitalism, communism, monarchy, anarchy, etc.), ideas of different political parties, questions of war and peace, and many others. All these problems are important. Meanwhile, let us assume that we did solve these problems. What for? What are our final goals? Considering the final goals implicated in modern cultures, one may find that among them are: - abundance of food and drinks (so as to eat more) - mechanisation of labour (so as to have less physical activity) - more time for sleep and rest in a warmer environment. This is exactly how paradise in modern movies, books, and personal dreams is described. These goals are supposed to be accomplished due to the financial earnings or economic efficiency of the social system and its individual members. However, all these goals are in the opposition to the way Nature designed a human being. All of them lead to chronic hyperventilation. Moreover, since chronic hyperventilation is to be inherited by our children, their health state is going to be worse. Then, the same factors (eat more, rest more, breathe more, etc.) are going to make them sicker. Hence, that means the gradual death of a civilization. Nature invented the human organism to withstand certain harsh environmental conditions; survive diseases; find food in the wild; build a shelter; make, feed [add comma] and teach children; live in peace (that is a normal and stable state) with neighbours; invent tools and investigate itself and Nature; etc. All these activities need normal breathing. There are many important problems and issues (environmental and social, economic and political, and many others) for us to solve. However, the problem of chronic hyperventilation can make all of these other problems and their solutions meaningless since there could be no people to do the job. These considerations help us to look at the problem of breathing from another perspective. We are normally looking for causes. From the physiological viewpoint, one person can get chronic overbreathing due to physical inactivity, another from stress, somebody else due to overeating, still others from a combination of these and other factors. Whatever the particular details are, all these people will hyperventilate. That is going to be the common cause leading to their various health problems.

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Looking at the same problems from the social or evolutionary viewpoints, one finds that there are other, more deep causes. Animals, according to the Nature's design, are supposed to exercise after being stressed (fight or flight). However, modern popular culture promotes laziness. People have deficiencies of certain nutrients, because our diets and farming methods are based on values of taste (of hyperventilating people), convenience, and profit, not on the physiological and social effects of depleted foods. Similarly, overeating has never been a sign of health. Therefore, the problem of abnormal breathing is wider and has its own causes, which lie in the foundation, implications, and goals of modern cultures. We can live and behave as if our goals are: do nothing, get excited, eat more, rest more, work less, breathe deeper, get warmer, etc. In this case, instead of the Paradise, we, and especially our children, are to face the consequences of this package: chronic hyperventilation with physiological and psychological disturbances on the individual level and collapsed relationships and civilizations on the social. As an alternative, we can choose to live in accordance with the laws of Nature or the conditions of our evolution. Investigating the main topics of the discussions, conversations, and speeches of Doctor Buteyko, one may find the following dynamics. During the 1980s and before that, he criticised deep breathing with referral to a large body of medical and physiological evidence. However, in the 1990s and during his last years (Doctor Buteyko died in May 2003), his main concerns were the values of modern societies, especially greed for money, food, and air. Indeed, it follows from the discussion above that these are the social causes of chronic hyperventilation and modern degenerative diseases. Professional medical literature has accumulated thousands of facts, which completely support the idea of the crucial role of chronic hyperventilation in modern degenerative health problems. Virtually all publications and discoveries in medicine and physiology can be analysed from the position of respiration effects, and virtually all of them are in favour of the general ideas partly reflected in this book. That relates to such diverse subjects as genetic predisposition to various health problems; the effects of many drugs, nutrients, and foods; interaction between various systems of the human organism; hormonal effects; causes of diseases; and cases of successful treatment of many health problems. On the other hand, alternative health practitioners usually approach the human organism from more holistic viewpoint. However, respiration is a missing link that allows them to achieve decisive progress in the results of their health care. For example, the use of such a simple test as breath holding time and/or devices to monitor respiration can greatly advance the quality of their work. Both these groups of healers can be united, using one general physiological factor of the human organism, its breathing.


Bernard T, Hatha yoga: The report of a personal experience, Columbia University Press, NY, 1944. Berne E, Beyond games and scripts, Grove Press, NY, 1976.

Berne E, Games people play: The psychology of human relationships, Balantine Books, NY, 1996.

Bucher TL, Chappell MA, Respiratory exchange and ventilation during nocturnal torpor in hummingbirds, Physiol Zool 1997 Jan-Feb; 70(1): p.45-52.

Buteyko KP, Carbon dioxide theory and a new method of treatment and prevention of diseases of the respiratory system, cardiovascular system, nervous system, and some other diseases [in Russian], Public lecture in the Moscow State University on 9 December 1969, Science and life [Nauka i zshizn’], October 1977.

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Castellini MA, Milsom WK, Berger RJ, Costa DP, Patterns of respiration and heart rate during wakefulness and sleep in elephant seal pups, American Journal of Physiology 1994, 266, R863-R869. Desikachar TKV, The heart of yoga: developing a personal practice, Inner Traditions Intl, 1999. Goswami SS, Hatha yoga: An advanced method of physical education and concentration. Funderburk J, Science studies yoga, a review of physiological data, Glenview, IL, Himalayan International Institute of Yoga Science & Philosophy of USA, 1977. Hewitt J, The complete yoga book, NY: Schocken Books, 1977. Mel'nychuk DO, Mykhailovskyi VO, Mel'nychuk SD, Mechanism of metabolic adaptation [Article in Ukrainian], Ukr Biokhim Zh 2000 Jul-Oct; 72(4-5): p.70-80. Milsom B, Breathless - by choice, Biologist 2000; 47, p. 239-242 Milsom W. K. (1992) Control of breathing in hibernating mammals. Physiological adaptations in vertebrates. Lung Biology in Health and Disease, 56, 119 - 148. Morris, P, Hibernation guidelines for turtles and tortoises, The Bridge, September 1994. Paramahansa Yogananda, Autobiography of a yogi, Rider, London, 1950. Ransome, Roger, The natural history of hybernating bats, Christopher Helm, London, 1990. Sivananda S, Yoga practice. Storey KB & Storey JM, Metabolic rate depression and biochemical adaptation in anaerobiosis, hibernation and estivation, Q Rev Biol 1990 Jun; 65(2): p. 145-174.

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Chapter 14. Future of the Buteyko movement and challenges of Buteyko breathing teachers 14.1 Current trends As was mentioned before, in 1960s-80s, Doctor Buteyko trained about 200 Soviet medical professionals to use the method. All of them were required to have over 60 s CP in order to be qualified breathing teachers. While this standard was hard, it ensured amazing productivity, in terms of the treatment of Soviet people with various diseases, together with the advancement of the theoretical and practical aspects of the Buteyko breathing method and related discoveries. Later, during Perestroika, Buteyko also trained dozens of breathing instructors to apply the method for patients with asthma, bronchitis, heart disease, and certain other conditions. These instructors also achieved spectacular results in curing thousands of people and saving hundreds of life. In the 1990s and following years, some of these instructors brought the method to Australia, the UK, the Netherlands, the USA, Canada, Israel, New Zealand, and other countries with similar triumph. The typical morning CPs of breathing instructors in Russia and practitioners in the West were and are about 25-30 s. Were there many differences between the teaching methods of medical people and instructors trained by Doctor Buteyko? One of the most experienced colleagues of Buteyko Dr. Souliagin wrote, “A patient who achieved 40-60 second control pause becomes his own antipode, a person, healthy physically and spiritually. However, to reach such a higher level is far from easy for a person who was "yesterday" seriously ill. Only a practitioner, who has cured himself by DVBM and gained a sufficient professional experience in that, is really capable to help another person to achieve this similar effect” (Souliagin, 1991). The end effect for both, the teacher and the student, was the same, to achieve 40-60 s CP, and there are observations of others that breathing teachers usually lead their students to the same CP level as they have. Hence, those teachers who have 30 s CP usually teach their student to get about 30 s CP. We can conclude here that breathing practitioners would be inclined to teach the easier version of the method by, for example, avoiding certain tools of health restoration and introducing their own interpretations and views on the method, ideal health, 60 s CP, etc. The astounding achievements of western breathing teachers (thousands of their students recovered from chronic diseases, returning to an ordinary life, as well as hundreds of students defeated death and became symptomfree) should not prevent us from analyzing their potential in order to improve the quality of teaching the Buteyko method in the West.

14.2 The hidden challenge of the modern world: the Buteyko team vs. abnormal lifestyle factors It was beyond doubt that all Soviet medical doctors practising the Buteyko method in 60-80s had one standard and one goal in mind: normalization of breathing of their patients (or how the patients could get to a 60 s CP). This was not the case with breathing instructors in the 1980s and later. A similar situation is taking place with many western Buteyko teachers now. Let us have a truth-seeking quest and find out what are the current challenges. Little is known, for various reasons, about the practical work of most breathing teachers. However, we can analyse clinical trials of the Buteyko method based on published results. Note that trials are conducted by the most devoted and knowledgeable Buteyko breathing teachers and trainers. The titles of clinical trials and their abstracts already provide us with certain information and shape a certain attitude in relation to the Buteyko method. Here are some of the western titles (in italic) and sentences from their abstracts: Buteyko breathing techniques in asthma: a blinded randomised controlled trial OBJECTIVE: To evaluate the effect of Buteyko breathing techniques (BBT) in the management of asthma… A clinical trial of the Buteyko Breathing Technique in asthma as taught by a Video Our study was designed to examine whether the Buteyko Breathing Technique, as taught by a video, is an efficacious asthma therapy… Buteyko breathing technique for asthma: an effective intervention To assess the impact of the Buteyko Breathing Technique (BBT) on medication use in asthma…

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Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial The effects of the Buteyko breathing technique, a device which mimics pranayama (a yoga breathing technique), and a dummy pranayama device on bronchial responsiveness and symptoms were compared over 6 months in a parallel group study… Health Education: Does the Buteyko Institute Method make a difference? This study aimed to determine the effectiveness of this method for individuals being treated for asthma… Buteyko breathing technique and asthma in children: a case series Generally, abstracts of clinical trials on the Buteyko method claim that a certain number of people “learned the Buteyko breathing technique” or that “the Buteyko method was taught by …” And the readers, participants, and spectators believe that some people teach the method, others learn the method, and we can, after completion of the study, objectively evaluate the method. Later, depending on the results, Buteyko can be praised, in case of good results, or blamed for his method, if some participants did not get any improvements. Why? Because the subjects “learned the method”, while the teachers “taught” it. Often, all involved people anticipate the results of the trial with some anxiety, as during a lottery. Who are going to win this time: Buteyko or his opponents? However, before taking these ideas for granted, let us focus on a few other questions. Did the subjects really learn the method? What does it mean “to learn the method”? Did the researchers really study the findings and claims of Doctor Buteyko and his colleagues, or have they study something else? Doctor Buteyko, for example, never claimed that practitioner X, in 1, 2, or 3 months, can cure 50, 90, or 100% asthmatics from the control group. None of the Russian doctors predicted that practitioner Y, however good he or she can be, would achieve 50, 90, or 100% reduction in a certain medication for most of the patients after a certain time. But these are the typical objectives and results of the trials. Russian doctors never claimed that moderate reduction in minute ventilation (e.g., from 15 l/min down to 8-9 l/min) or increasing their CP up to about 20-30 s, as it was the case for many trials, is a cure for asthma. What were their claims then? What do the Russian doctors say about asthmatics with 20-30 s CP? The Russian doctors actually taught us that 20-40 s CP is the struggle zone. Hence, it is unclear what is going to happen with students who have 20-30 s CP. The organism may solve some asthma related symptoms, but healing of the airways and disappearance of allergies are doubtful. Why? Because the student with asthma needs over 35 s CP 24/7 for over 3 weeks to heal airways and be free from allergies, medication, and symptoms. What do they study then during those trials? This question, while looks simple, requires more attention. There is only one title (A clinical trial of the Buteyko Breathing Technique in asthma as taught by a Video) that clearly indicates the source of information: video. Somehow, when the live Buteyko practitioner is present, the participating medical doctors are so nice and polite, that they take it for granted that this Buteyko teacher knows the method and is going to teach it to the control group. When there is a lifeless video, the doctors claim already in the title that the Buteyko method “as taught by a Video” may have limitations and possible misrepresentations of the method. Consider the teaching and the results of the application of the method. Why do western students not get higher CPs? Being more specific, why could the controls not get over 35 s C 24/7 for more than 3 weeks so that to get rid of asthma? The reasons are often in the life-style factors: 1. Very few, if any, control subjects exercised enough. Most of the controls probably had less than 1 hour of physical activity per day, while Buteyko and his colleagues taught 4-5 hours per day. 2. Probably, very few, if any, controls used hard beds. 3. Probably, very few, if any, controls used cold shower and other hardening techniques. Yes, it is hard to convince or make the modern students exercise for hours daily, but this is not the problem of the Buteyko method. Instead of focusing on the abnormal lifestyle factors (like insufficient physical activity, soft beds, etc.), the attention of many trials is displaced on Buteyko and his method: is it good or bad? Obviously, Buteyko practitioners and trainers did an amazing job to organize these trials and increase public awareness about the method. It was doctors’ idea that the controls learn the method and that they could study the Buteyko method. Hence, the trials were not only about the method, but also about abnormal lifestyle factors and their effects on health of asthmatics. These published papers produce an impression about doctors, who tried to crucify the Buteyko method and the practitioner who taught the control group, but the real enemies of humanity (physical inactivity, soft beds, etc.) remain hidden from their and our attention. There is an accumulated history of over 40-years work by about 200 Soviet and Russian medical doctors with over 200,000 patients. Based on this stunning amount of medical information and clinical cases, together with his

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practice, Doctor Buteyko clearly explained what it means to learn the method. One has learned the method, if and only if, their breathing parameters at rest are: - 40-60 s CP; - 5.5-6.5 % aCO2 (about 42-49 mm Hg CO2 at sea level); - 4-6 l/min for minute ventilation (70 kg man); - 8-12 breaths per minute for frequency, etc. It is even better health-wise, according to Buteyko, if this person has better parameters: even higher CP, more CO2, less ventilation, less frequency, etc. Sometimes, very rarely, people already learned and possess the method but do not know about it (i.e., they breathe in accordance with standards established by Doctor Buteyko). The vital health of these people is another confirmation of the method. If one’s parameters are worse, the person is still facing a challenge to learn the method. Note that most western students these days achieve significant improvements in their life using elements of the Buteyko method, but they do not learn the method in a way implied and taught by Doctor Buteyko and his medical colleagues. In relation to asthma, the findings are the following: - 0-5 s CP: an acute life-threatening episode (an asthma attack); pure oxygen and medication can be life-saving. - 6-10 s CP: very poor health or a chronic state of severe asthmatics; various medical drugs, including steroids, are usually required; - 10-20 s CP: a typical health state of most asthmatics; the symptoms are controlled using bronchodilators and/or other drugs; - 20-30 s CP: symptoms are absent, no medication is required; the person can resume ordinary life, including employment, physical activity, etc., but inflammation and allergies can still be present; - over 30-35 s CP 24/7: the organism starts to fight inflammation and the immune system can be desensitized, after about 3 weeks of high CP, in relation to former triggers (dust mites, cat proteins, dog proteins, tee pollen, dust, etc.). If western doctors participating in trials know more about the method and about the specific claims made by Russian doctors, then any clinical trial can focus on the activities and lifestyle factors of those subjects who learned the method. What else did they do in order to normalize breathing, in addition, to, let’s say, 1 hour of reduced breathing per day? What are the crazy things in the modern culture or environment that harm our health? Can asthma be cured without 4-5 hours of daily physical exercise? What are the other requirements? Etc. In this situation, western doctors will be forced to study the causes of improvement, and, hence, they will have chances to discover what is harmful, for our health, in our modern lifestyle. Let us provide medical professionals with clear facts and discoveries. Then these western health researchers will be forced to struggle with own lifestyle factors, social norms, and activities of the enrolled subjects. This is indeed their job: to study what matters for asthma cure and health recovery. What would be the effects for the involved Buteyko practitioners? Instead of arguing about the learning, the testing, and the wording of the results of the trials, as is the case right now, they, together with all others, will also focus their attention on the main obstacles to better health: abnormal lifestyle factors. What are our reserves? Could the method be taught better? Easier? Within shorter time? How? Hence, better wording can help us to expose the real enemies of the humanity: some abnormal lifestyle factors. What would be the conclusions of a trial or a study if correct words are used? If a group of asthmatics increased their EMCP from about 10 s to about 20 s (this is a great result!), these asthmatics in effects learned only 33% of the Buteyko method because the challenge of the method is to get to at least EMCP 40. Instead of 10 s CP increase, these asthmatics should have, if they actually learned the method, a 30 s CP increase. This wording will also explain or will direct the researchers’ attention in the right direction, if they want to learn why the lung function test, allergies, and inflammation are still problems for some patients, or why some asthmatics still require medication or experience asthma symptoms. Presence of these problems in some people is again methodologically not a problem of the method. Hence, the correct wording can be “a group of subjects learned elements of the Buteyko method, as it was taught by …, with the following (moderate?) success: …”. The specific ideas of Russian doctors can be explained in simple words in our publications so that people can know what the method is about. In my view, any study can reveal many important ideas that are often known to Buteyko teachers and their students, but have very little documented scientific confirmation. This relates to only nasal breathing during exercise, mouth taping at night, prevention of sleeping on the back, use of cold shower, etc. Note that physiological science, medicine, history, and the Buteyko method all do not care if getting EMCP

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40-60 is hard, or very hard, or too demanding, or seems even impossible for some people. These are human, psychological, social, and cultural factors. Buteyko established the standard for normal breathing of the human organism, explained the significance of breathing, trained over 200 doctors up to the norm, was an example of vital health himself (with almost 3 min CP and 2 hours for sleep only), and showed the way there for other people to follow. This truthful wording will be our best expression of objectivity, scientific truthfulness, and simplicity. Moreover, it will also reflect our respect and gratitude in relation to Doctor Buteyko and his discoveries. Moreover, it will help us to work as a TEAM with suffering people and involved health professionals. How do modern environment, society, and culture influence us? Imagine 2 situations. Situation 1. Every day your neighbours on the left go jogging: 1 hour in the early morning (6-7 am) and 2 hours in the evening (e.g., 7-9 pm), in addition to regular power walks throughout the day. They are loaded with cheerfulness, energy, and enthusiasm. You see this day after day. Your neighbours on the left, a couple and their 3 kids, swim for over 2 hours per day and spend about 2 more hours dancing. They are examples of power, vigour, and liveliness. An invalid, living a block away, with one leg only, spend 3 hours in the gym every day and also full of cheerfulness and zeal. (Why? Because all of them are at least CP 60, and it is a thrill to exercise with almost no breathing.) Note that all your neighbours, since they are over 60 s CP, are natural and simple. They do not pretend to have enthusiasm and cheerfulness when they meet you or other people. All these qualities are innate in great health. What would be your lifestyle in such conditions? Would you still try to cling to your old ideas that 3-4 hours of physical activity is hard for humans, in general, and for you, in particular? Situation 2. Your neighbours on the left often look enthusiastic and cheerful, when they meet or see you even though you know that one suffer from asthma, another from CFS, and both use medication. They do not exercise much and lead the ordinary modern lifestyle. Your neighbours on the right all are hyperventilators without diagnosable problems: they are outgoing and noisy, but their mood is unpredictable. They all get easily excited about various topics and objects. There are other neighbours around you who have heart disease, cancer, diabetes, etc. They were trained and conditioned to look energetic and confident. How would you conduct yourself when surrounded by people with such behaviour and lifestyles? Considering these situations, it becomes clear that the Buteyko practitioners, as well as their students, may require some spiritual power, inner strength, and conviction in order to survive and even thrive in such conditions. It is a known fact that, without support and encouragement, many students, who are isolated, have difficulties to maintain their CP and healthy lifestyle. How does environment affect us? First, there are two powerful social instincts: group conformity and obedience to authority. Second, there are numerous situations, when abnormal lifestyle factors are portrayed with confidence, and even as happiness or delight.

14.3 Teaching the method: what is the core? In my view, there are two general approaches in relation to teaching the Buteyko method. We either teach to our students: 1. That 60 s CP is the norm of health (and hence, we have to explain the 40 s threshold and changes that takes place there) established by Doctor Buteyko and his colleagues. 2. Or we do not teach these things to our students avoiding these keystones of the Buteyko method. Practice shows that our students like, respect, cherish, and promote the method, if they increased their CPs at least 2-3 times (e.g., from 10-15 s to 25-30 s, as in the case of most asthmatics and many other western students). These CP values (about 25-30 s) are currently the standards of Western Buteyko teachers. Why? Professor and other Russian doctors taught us about the 60 s norm. Why do we neglect, deny, suppress, and distort years of Russian experience? He could establish 30 s CP as a norm. However, this is not good enough even to cure asthma. 30 s CP is enough to live with no symptoms and no medication for asthma, and to eliminate most allergies, but in order to heal inflammation and swelling in airways, and eliminate phlegm and mucus deposits from the lower parts of the lungs, the student should achieve and maintain a higher CP (about 35-40). The cure, in case of asthma, should also include normal lungs’ function test results. This fundamental change or “innovation” (CP 60 is not necessary) has roots in ourselves. Most Western

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practitioners have less than 30 s CP (morning value). What does this mean? Many things: 1. A teacher who never broke 40 s threshold and never had 60 s morning CP is likely to teach the method adjusted to his/her personal achievements and experiences. 2. Such a practitioner is very unlikely to target his own students, from the very beginning, to 60 s CP (it would rather be the same 25-30 s). 3. Such a practitioner is likely to have an illusion or fantasy that 60 s CP is unnecessary for self and students. The possible excuses are: “My breathing is great and my CP does not reflect my real health”; “The Buteyko method is only to reduce medication and better control asthma”; “My brain gets enough blood and O2 with my existing CP”; “Over 60 s CP is only for super-achievers”; “Buteyko was too demanding and strict about CP 60”; etc. Such ideas and own failure to break through 40 s also reflect: - poor understanding of the physiology of breathing and power of the method in relation to non-traditional diseases (immune, GI, hormonal, etc.); - inability to be objective in relation to one’s own thought process; - developed mentality of the loser. Would such a practitioner talk to the students about 40 s threshold and 60 s standard targeting them to go there? If he or she tries, some students may ask, “Do you have over 60 s CP?” or “What is your CP?” In order to avoid these uncomfortable questions the teacher would rather avoid this subject altogether or quickly mention it as something insignificant while talking in general terms about breathing, CO2, and various other effects. As a result, his/her students will get a vague understanding of what they are learning. They do not know the final goal of their program. Hence, they may achieve about 25-30 s, improve their initially miserable quality of life, be thankful to the practitioner, and get excited about the method; but this is only a (small) part of the method. It would be a rare, inquisitive, and daring student who would try to advance further by, for example, going from practitioner to practitioner, experimenting with his or her own health, likely making mistakes, searching, asking, reading more, etc. But these (over 60 s CP) people are the most useful and persistent promoters of the method, the people whom the Buteyko movement needs and wants most. In opposition, 25-30 s CP students and their teachers still live in a world of confusion, fantasies and fear (in relation to 40-60 s CPs), and seemingly hostile outside environment. Besides, such students and teachers may have a fantasy that their bodies are free from pathologies. If the body is physiologically clean, then it is not the problem for the person to get CP 60 and more in minutes or hours. This is a physiological law discovered by Buteyko. Who are the current leaders who teach practitioners the 60 s CP norm both practically and theoretically? Doctors from the Buteyko medical clinics in Moscow and Voronezsh and, if we consider their results, then these doctors do the right job in spite of the differences they have. Why? Because they teach the 60 s norm. Not in all cases, but with much higher frequency than many other Buteyko teachers. It was not and is not my intention to be individual or to criticise, undervalue, suppress, or discourage or even promote and encourage some people, groups or organizations. Hundreds of western people who, instead of death, now have ordinary lives, can testify about the opposite. Western practitioners do an excellent job in existing conditions. The Buteyko method for me is a system of activities targeted to restore certain breathing parameters so that an average student, while applying minimum efforts, time, and energy, is able to achieve maximum results. It is a problem of optimization. How can the students have explained that CP 60 matters for their health? I tell, with no hostility or criticism, to, for example, Mike, ”There are 3 different people with the name Mike: Mike with 10-15 s CP needs help from others, he is sick and lives in a world of symptoms, medication, fears, and addictions, while fighting non-existing enemies and struggling with problems that are only in his head. Mike with 25-30 s CP is still sick and addicted to various abnormal things. What he knows about the world and how he functions in his job, family, hobbies, etc. are still far from optimum. He is less than half of the real Mike. Mike with over 60 s CP starts to reflect the reality. He becomes a creature who functions closer to what was intended by Nature. You choose where you are going to be…” What would be an objective evaluation of our teaching, let say, 20-50 or 100 years later? Some breathing

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teachers say and believe that we just provide our students with various choices and it is up to them to decide which CP and health level they want to achieve and maintain. It is implied here that it was the choice of most of the students to be at e.g., 25-30 s CP so that no symptoms or medication for, e.g., asthma is required, but the students do not want to go further. Why? The real question then is: Do these students have a clear understanding about the vibrant health correspondent to CP 60? Do they know that cleansing the lungs and elimination of inflammation is possible when the CP is high for a certain period of time? 25-30 s CPs of these asthmatic students mean that these students still have lungs full of residues and they still live in an emotionally unstable presentation of reality. When a practitioner teaches the course or just gives a talk, it is already there, his/her attitude towards the final goal, towards what the abilities of the method are, and towards the expectations. These are the parameters that shape the attitudes and progress of our students. If the teacher clearly states the options and explains how to go there, what would it take, how long, then many, probably, most, students will go further up to 60 s provided that the teacher equips them with the right tools. Here the problem is again that the tools may be missing and the students then will fight with unknown enemies hidden in the environment (not enough exercise, a soft bed, no cold showers, poor thermoregulation, a lot of sitting during the day, convenience foods, etc.)

14.4 The method and its impact on environmental and lifestyle factors The struggle for health is hard these days due to the high rate of various innovations and changes that have taken place during last 100 years. Adequate physical exercise, by far, is the most significant and demanding feature of the Buteyko method. In my view, if a student has 1 hour of breathing exercises per day, the ultimate achievement of this student will be: - 20 s EMCP (early morning CP) with 0.5 hour of physical activity; - 25 s EMCP with 1 hour of intensive physical activity; - 30 s EMCP with 2 hours of intensive physical activity; - 35 s EMCP with 3 hours of intensive physical activity; - 40 s EMCP with 4 hours of intensive physical activity. We have not only polluted water, air, and food, but also unnatural clothes, too soft beds, too big pillows, to warm blankets, horrible armchairs and couches, etc. The further one progresses, in terms of the CP, the more changes, in the direction of simplicity and practical utility, are required. The method, due to its simple foundations and uncomplicated main test (the CP), has something to say about many abnormal things we take for granted now. And it should be our duty to open our eyes and ears to listen to the truth. Consider such a simple thing as carpets. I have never seen a single student yet, who can do the session or sleep in two places (with and without carpets) with no difference. The final CP in case of exercises and morning CP after sleep are always worse for any carpet even for the most beautiful one. The method and CP could be the tools to find out more, as scientific studies and investigations, about mercury amalgams, microwaves, electromagnetic fields, radiation, and many other health-related innovations. Similarly, no high tech equipment is required to study the effects of exercise (with nasal vs. mouth breathing), swaddling vs. “freedom” from restraints (to be sick) for infants, raw vs. cooked meals, cold vs. hot shower, hard vs. soft beds, standing vs. sitting posture, fresh vs. stale air, etc. Many of these studies and investigations can be conducted on a personal level as was mentioned and suggested previously in this book.

_______ 14.5 Ten typical mistakes made by breathing practitioners

1. Patients with predisposition to cardiovascular problems, panic attacks, and migraine headaches are advised to use the same breathing exercises as for typical patients with asthma, sinusitis, or bronchitis. This especially relates to teaching a group of students, where some students have heart problems, but exercises are the same for all students. Doing the RB, even with light air hunger, immediately after the CP or other pauses, causes unpleasant sensations, dizziness, and light-headedness in many heart patients. Their parameters get worse after the session. Poor understanding of this effect was and is one of the main causes why the Buteyko method is not popular among the heart patients, while the number of heart patients is higher than the number of asthmatics. Unpleasant sensations and symptoms create unwillingness on the part of these students to enjoy the practices causing them to leave classes and drop the courses. 279


2. The teacher brings his past experience or background (nutritional science, herbal science, acupuncture, colonic irrigation, etc.) into their teaching believing that this modification of the Buteyko method is useful for their own students. One can eat tonnes of super foods, kilograms of herbs, and use hundreds of acupuncture and colonic irrigation procedures, but will never achieve CP 60. The Buteyko method is about breathing, while other methods and techniques can have very positive measurable impact on certain students during certain stages of their learning. While these breathing teachers have their best and sincere intentions to help their students, uually the main cause of this “enrichment” of the Buteyko method is a low CP of the breathing teacher and corresponding illusions and fantasies. 3. Water dowsing or taking cold shower is not encouraged with enthusiasm and verified later. The likely cause of this mistake is in the fact that the breathing teacher does not use it regularly themself. This slows down the recovery rate of the students, create conditions for their poor thermoregulation, and prevent them from getting CP 60. 4. Using a hard bed for sleep is not encouraged with enthusiasm and verified later. Again the cause is in the lifestyle of the teacher. Sleeping on a soft surface makes breathing heavier and since morning hyperventilation is the problem for over 90% students, soft beds greatly slow down the recovery rate of the students and make achievement of CP 60 very difficult. 5. Standing posture for most of the day is not encouraged with enthusiasm and verified later. Standing is the most physiologically natural and evolutionarily normal posture. The diaphragm gets its real and gracious buoyancy to be the main breathing muscle at rest. One cannot keep this bird in the (rib) cage all the time. Sitting for most of the day, even with the RB, breath holds, and some PE, is not enough to get CP 60. 6. Too little is said about the 40 s CP threshold, physiological changes there, and importance of self-discipline and persistence in order to break it. The cause of this mistake is probably in anxiety of the teacher about the topic. Anxiety, by definition, is fear of unknown, and it makes sense, if the breathing teacher never experienced passing through this threshold. 7. Insufficient emphasis is placed on physical activity. This is another issue of attitude indicating one’s own predisposition to a certain amount of PE (physical exercise). It can be added here that Russian doctors had and have more authority (they are medical people) then most western practitioners, but one’s own example here remains the key for improvement. 8. CP 60 is not the ultimate preferable goal of the program and the whole teaching is not targeted to getting the students there. This is normal since previous mistakes (2, 3, 4 and 6) imply that the use of these tools (cold shower, hard bed, standing posture, and 40 s threshold) is limited or poorly understood. Note that knowing that there is more to the method (hidden from the eyes), than just getting freedom from symptoms and medication (25-30 s CP), will provide the students with a more realistic attitude towards the role of breathing in general health, without robbing them from the enthusiasm and passion they naturally develop toward the method after their own recovery from some diseases. 9. The history of the method in the USSR, Russia, and on the West, is presented as a history of suppression, rejection, denial, and persecution. It is possible to find in some Russian, as well as in some western sources, that Buteyko was viciously persecuted, that his laboratory was closed, and its unique diagnostic complex destroyed. In reality, Doctor Buteyko in 1960’s got an exclusive opportunity to study the interaction between breathing and diseases using almost unlimited support in relation to equipment, personnel, and finances from the Soviet Ministry of Aviation and Space Exploration. At the end of 1960s he brilliantly completed the project and it was logical that closure of the finished project resulted in liquidation of the diagnostic complex he created, dismissal of the staff, and big changes in the lives of involved people, including Doctor Buteyko. 10. A teacher has confusion about the zones of health, the CP and breathing patterns. Instead, there are talks about some “right breathing”, “wrong breathing”, or “correct breathing” without providing clear definitions and details. Why? The method helped to the teacher in the past, but now the motivation and enthusiasm is less since the organism is in a state of greatly improved, but still not optimum homeostasis (e.g., about 25-30 s CP). Hence, the teacher has ambivalent emotions and feels that breath has some mysterious power. However, the teacher is not completely recovered physically and his or her body still has some abnormalities and pathologies. 11. A teacher believes in one of the 2 extremes: a) MPs, AMPs, and other long breath holds are good for health and should be intensively used for all students or b) MPs, AMPs, and other long breath holds are bad for health and should not be used at all. While strong air hunger, quickly changing parameters of air in the lungs, and long pauses are dangerous and damaging for some students, these and many other students, can benefit from the same procedures, including AMPs, during later stages of learning (i.e., when their CP is over 30 s).

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The theory of breathing developed by Buteyko is not very complex or sophisticated. There are the CP zones, or zones of health, corresponding CO2 values, minute volumes, approximate heart rates, etc. However, the teacher may sincerely believe that there is something more to it. Hence, the teacher may focus on very rare cases of people who have abnormally high CP or CO2 as if Buteyko, a former Honours student of the Moscow Medical Institute, did not spend years studying breathing of sick and healthy people 24/7 with the world’s best equipment available and qualified personnel. These are other mistakes that are less frequent. a) The teacher suggests large dietary changes, avoidance of coffee, sugar and other useless foods from the very first lessons. This idea misplaces the accents in the learning the method. Breathing should be first. Thus, normally, the students should increase own CPs and this will naturally lead them to gradual dietary changes in the right direction. b) The teacher suggests counting own breathing frequency as a part of the method assuming that deliberate changes in the breathing frequency can result in health improvement. Depending on the current CP level and individual parameters, breathing frequency during the RB can be higher or lower than at rest before the session. (Usually, when the CP is below 20 s, the students breathe more frequently during breathing sessions. When the CP is more than 20 s, the students breathe slower during the RB and have the automatic pause.) c) The teacher doesn’t know how to measure their own CP. Instead of the own CP (period of no respiratory sensations and no stress), he/she measures the EP. One may train and improve the EP and the MP due to the training effect, while the CP, alveolar and arterial CO2, tissue oxygenation and other parameters would be the same, since they are related to the CP, not the EP. For example, a breathing practitioner has about 30 s CP. During first stages of the learning his MP was about twice more, about 60 s. After years of doing EPs or MPs many times per day, due to the training effect, his/her MP grew up to 90 s. Now the practitioner can easily do very long breath holds and 60 s is not that hard to achieve. He/she now would sincerely believe that his/her own CP is 60 s forming false enthusiasm without practical health improvement since he/she may still suffer from allergies, GI problems, hormonal disturbances, etc. But even after 40 s breath hold, he/she needs to control the breath after the test indicating that the real CP (period of no respiratory sensations) is below 40 s. The lower morning CP would be another “discouragement”, instead of the source of information. Now the challenge is to solve this conflict (“Buteyko said that 60 s CP is an ideal health, but I am kind of deficient”.) How? By changing, denying, ignoring, distorting or neglecting ideas, observations, and discoveries made by Buteyko with a sincere belief in one’s own rightness. Therefore, as Doctor Buteyko found, it is important for the successful Buteyko practitioner to have over 60 s CP and to inform students about the standard of ideal health (CP 60), developed by Doctor Buteyko, and what it takes to get there.

14.6 Teaching and promoting the Buteyko method in new places When a Buteyko practitioner or teacher tries to launch a practice in a new place, there are various challenges to deal with. They are of social, cultural, and psychological nature. Their clear understanding and development of successful strategies to deal with them would benefit the advance of the method, health of the population and personal realization of potentials hidden in the method and the teacher. This part of the book deals with analysis of these problems and suggests possible solutions that can be practically implemented by the teacher. What we promote Formally, the Buteyko method includes two parts (Fig.14.1)

_______ The Buteyko method

Common sense activities

Breathing exercises

Fig. 14.1 Two components of the Buteyko method

Common sense activities include practical actions like breathing only through the mouth, prevention of 281


sleeping on the back, eating only when hungry, etc. Considering a human body as a physiological mechanism with various biochemical and electrical processes and reaction, the Buteyko method can be defined as a set of practical activities that is directed to realize, in practical sense, a way (or a program) of optimum restoration of breathing parameters manifested in minute volume, diaphragmatic breathing, CO2 values, the CP (control pause), and others. By “optimum”, I mean such a program when a student spends minimum time and efforts while achieving maximum progress in the direction of restoration of breathing parameters. However, even this description remains too narrow since it does not include various psychological factors related to behaviour of the student and his or her practitioner. A Buteyko teacher, for example, may simply lose a student due to a mistake in promotion or application of the method during the initial stages. Considering the same problem from another angle, each person is unique including the factors that make him or her hyperventilate. In addition, there are factors related to level of intelligence, physiological and practical knowledge, self-discipline, motivation, availability of time, etc. Hence, the set of optimum actions is often hard to model and even check. Often, the teacher may only speculate, “What would happen if I did … instead of… for this particular student?” Therefore, the optimum program can often remain a mystery when Truth would still be partly unknown to any person. Typical reactions of ordinary people in relation to current promotional approaches What are the main problems in promotion of the method among ordinary people in new places? Promoting Buteyko in a new place means that most local people have never heard about the Buteyko method and role of breathing. Moreover, most people are likely to believe in the usefulness of deep breathing (to get more O2) and negative effects of CO2 (“toxic, waste, poisonous gas”). The word “Buteyko” is meaningless for them. The practitioners usually have an opposite opinion in all these areas. Moreover, taking into account the degree of chronic hyperventilation among the modern population, it would make sense for some people to become hostile, suspicious, or indifferent in relation to various health therapies, healers (quacks), and their advertisements. All these factors of reality indicate that the teacher has the following challenges (Fig. 14.2).

Health superstitions “Deep and big breathing is good for health. It brings more oxygen to the body.”

“CO2 is a toxic, waste, poisonous gas that needs to be expelled.”

“The Buteyko method is probably another form of quackery.”

Fig. 14.2 Three main health superstitions to deal with Practically, when a practitioner tries to launch the practice, the following situations or conversations are possible.

_______ Person: “What is your job?” (Or “Who are you?”, or “What do you do for living?”) Teacher: “I am a Buteyko breathing practitioner (or teacher)”. Person: “What do you do?” (or “What does it mean?”) Teacher: “The Buteyko breathing method addresses chronic hyperventilation …” (or “I teach people how to breathe correctly”, etc.)

The range of possible reactions in new people is wide depending on personal experiences and understanding of breathing, their desire to discover drug-free solutions to health problems, presence and degree of personal health problems or concerns about problems existing in their children or relatives. Practice show that most people, before they decide to take a course, need 2-4 independent sources of information (information from TV stations, newspaper articles, radio, encouragement from friends or relatives) in order to try the method. Hence, if the person has never heard about the method, he or she is unlikely even to attend an introductory lecture. Statistically, the results of such new conversations (as described above) are likely to be governed by the 282


10/80/10 effect, when only 10% people would genuinely get curious or interested in the method, while most people, since they have never heard about it, would just accept the information (with likely indifference). Typical reactions of medically educated people The situation with medically educated people is different in terms of their views on hyperventilation and CO2. Why do they deny, or neglect, or mock, or “suppress”, as many say, the method? They have knowledge about hyperventilation, but most of them are drug-oriented people who view disease, after years of systematic conditioning from the state health care system, as something that is coming from outside and, hence, the need for outside interventions (chemicals, surgeries, radiation, etc.) to cure it. Each medical personnel has a certain place in the existing system of medical care with years of work in this environment and thousands of advices, suggestions, and ideas received from others and given to patients and colleagues. Most of this advice and ideas reflect the drug-based philosophy and a sincere belief in finding better drugs. How we can verify this? Most medical personnel not only use drugs for their patients, they use (better) drugs for themselves and search for better drugs for their friends and relatives. This practical observation clearly shows that medical people are, indeed, sincere believers in medication, surgeries, chemotherapies, etc. Many practitioners, including experienced ones, often get frustrated with doctors due to chronic personal failures related to attempts to convince doctors of the usefulness of the Buteyko method. Indeed, it is the doctors’ job to heal others. They get state salaries for this job, but their efficiency is very poor. In most cases, the visit to a doctor produces more harm than good. Some drugs can be useful in emergency (life-death) situations, but they perform poorly in prevention and treatment of common diseases. Often practitioners claim that doctors ignore or suppress the method. Over 90% doctors have no idea about the basics of the method. Why do they not get interested in the method then? Again, a multitude of factors plays its role. Since they are hyperventilating, normal perception of reality is almost impossible for them. They are excited about using or finding (better) drugs. They have theories and ideas about medication similar to the justifications and excuses of our students addicted to, for example, table sugar or other junk foods (coffee, white bread, various drinks, etc.). Meanwhile, the Buteyko teacher, rather than being even slightly cautious and reserved anticipating incoming failure to convince medical people, should be cheerful, enthusiastic, positive and open-minded. We know the truth. Hence one needs to be ready to share our knowledge, to shine (like a million dollars), even congratulate or hug doctors with successes in medical history due to Buteyko discoveries and … be rejected. Be ready to be ignored. Be ready to have slightly diminished enthusiasm, knowing that this was the best you could do in these circumstances. In my view, such promoting activities, while being financially useless and, in the short run, emotionally draining, on the other hand, together with trials, ads, interviews, and healthy students, are the events that are most useful in terms of improvement of the health of modern and future generations. Also, keep in mind that, sooner or later, you may find a doctor or nurse or physiotherapist who might get armed with the most powerful tool of health restoration. We still have few Western practitioners (probably about 1020% only) with a medical background. If you know them, think about the great contribution made by them in relation to health of the modern population and promotion of the method. Social norms and instincts as causes of possible negative reactions Both, ordinary people and medical professionals, are parts of the modern health care system based on a faulty human body, unknown mysterious causes of diseases, innocence of the individual, belief in better drugs, better surgeries, etc. As parts of the social system, we are always subjects to two powerful socio-biological instincts (or drives) that may work against the advance of the method. These are conformity (to existing social norms) and obedience to authority. Both these factors are exceptionally useful for stability of the society and gradual nature of innovations, including the critical mass effect. These ideas may create an impression that obedience and conformity are among the dark forces undermining not only the advancement of the method, but the whole progress of humanity. This is how all (!) psychology and sociology books and articles portray and describe socio-psychological studies done by Milgram (obedience to authority), Asch (group conformity), Zimbardo (Stanford prison experiments), and many others similar field investigations. Are these instincts that bad? Each of us got over 99% of our knowledge due to learning from authorities (parents, caretakers, relatives, teachers, coaches, supervisors, etc.) and peers while taking things for granted. Our experimentation occupies less than 1%. Since the amount of information we store in our brains is huge, it cannot be

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otherwise. We simply do not have time to check anything we’re told. Hence, we do take things for granted and we do conform to existing social standards in thousands of situations. Hence, these two drives made the progress, to whatever level we have got, possible. Learning of the method by our students is again based on the same "dark" drives and instincts (obedience and conformity). First, the students trust the breathing teachers while taking many things for granted and second, due to conformity, they learn better in groups. Are there any other drives or instincts that can help us to push the method forward. Our socio-biological nature also has curiosity or search for truth / logic / consistency in ideas and theories about the world. (We all need to have coherent views of reality, when no contradictions present.) This is why and how many (all?) of us found and learned the method (due to contradictions and inconsistencies in our past knowledge or due to seeing that past solutions did not work.) What about the future? Which drive is dominant or who is to win? Truth about anything, including laws of psychology, sociology, human history, the human brain, physiology, health, etc., do not need Doctor Buteyko, me or anybody else because it is out there, while our theories are just the reflections of reality. We can only discover some of these laws and use or follow them for our own good, or, these laws, as Doctor Buteyko taught, can crash and destroy us. (This was, as Ludmila Buteyko told me, how Doctor Buteyko understood God who establishes the rules of the game.) If we do not follow a natural lifestyle, the laws of physiology destroy us, as it is the case with modern hyperventilating population. They do not know the truth, so they suffer on all levels, physiologically, socially, in terms of achievements, quality of life, etc. It is easy to acquire enemies in a modern hyperventilating world. Self-fulfilling prophecy is a law of social psychology. We expect doctors to be enemies/ culprits/ scoundrels in relation to us or what we do or promote, they will become such. This choice (seeing or labelling others as enemies) would have nothing to do with truth about health and the role of breathing. We can call doctors evil, waste our time, drain our energy, strain our muscles and vocal cords, generating hyperventilation, hostility and alienation in us and them while acting out of our fears, past traumas, paranoias, and anxieties. Or we can view ourselves as messengers of Truth and Light, teach more students, and make friends even (or especially?) among doctors, when an opportunity arises or is even created. All previous factors are parts of the modern reality. Now let us focus on those things that are under our control. What is required from the teacher The parameters of the teacher in various situations are, of course, important. It can be kept in mind that the Buteyko practitioner “competes” with numerous health practitioners and healers who know the methods of promotion and accumulated many years of experience in persuasion of people. These methods include study and understanding of various parameters. Consider a simple conversation with somebody, public lecture or meeting with a mass media person. What would be useful to understand? - Situational factors (what is discussed, what are the time limits, how well the speakers know each other, etc.) - Emotional factors (positive attitude, cheerfulness, willingness to help and accept other people, posture, etc.), - Factors of personal appearance (tidiness, cleanness, etc.). One negative factor can easily undermine or nullify the possible positive effect. Inappropriate timing for the remark or the start of the conversation, or noisy or disruptive environment, or untidy clothes can lead to a poor result. Often, it is difficult to convince relatives to use the method. If initial attempts failed (these attempts are often done when the CP of the teacher is still low), only practical work and impressive parameters in own health may later lead to progress. Any new verbal attempts would usually only increase the gap of misunderstanding or even alienation and hostility. Whatever the situation, the promotion of the method is not about converting people into a new religion. It is about bringing truth, relief, and healing. When the CP of the practitioner is below 40 s (I am talking about the morning CP meaning that the daily values would be even higher), the practitioner is in the state of chronic hyperventilation. Instead of having clear vision of reality, the teacher is (over)excited about the possibilities of the method and is likely to experience ups and downs instead of consistent efforts in promotion. The reasons of failure in current promotional efforts, in my view, often lie in the desire and attempts to solve three huge problems (Fig. 2) at once. In particular, talking about breathing less (“Inhaling less oxygen?”) sounds strange for ordinary people. Well-meaning desire to share about CO2 (“Toxic, waste, …”) and the name “Buteyko” often creates only more confusion in others.

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Possible alternatives When we hyperventilate, we generally become greedy, lazy and silly, as Doctor Buteyko claimed. We become greedy for food, pleasures, and oxygen. The idea that “oxygen brings life” is known even to teenagers. On the other hand, the method, among many other effects, is about bringing oxygen to tissues and our main test (the CP) is, in most cases, an accurate indicator of body oxygenation. Hence, what we practically do: we teach people how to drive more oxygen into cells by enhancing the Bohr effect. Therefore, it would be correct to say that a breathing practitioner teaches students how to drive oxygen into cells. Now imagine the following scenario. Person: “What is your job?” (or “What do you do? Who are you?”, or “What do you do for living?”, etc.) Teacher: “I teach people how to get oxygen into the body” (or “I teach people how to drive oxygen into the cells”, or “I am a breathing practitioner who teaches people how to breathe so in order to get more oxygen in tissues.”) These responses, when they are calm and confident, are thought-provoking. They make people to wonder and to think about themselves and generally, “How should I (we) breathe to get more oxygen”. Note that it is not the best idea to start with CO2 or the Buteyko method. These are two other superstitions to be dealt with later. For now, it is better to “exploit” the likely greed for more air. From this point, depending on available time, presence of medical education, and interest of the listener(s), the teacher may ask a practical question, ”Do you know which breathing pattern provides maximum body oxygenation?” or “Do you know how to breathe for maximum oxygen in tissues?”. Later the teacher can speak about related subjects, for example, practical tests “We measure breathing using the breath holding time test that reflects oxygenation of the body. When people breathe heavier, this time is short. When breathing is light, invisible, and inaudible, the time is long” or “If you take 100 deep and fast breaths through the mouth, you can pass out or faint. Why?” The main idea here is to educate people about breathing using their greed for air and oxygen and refute the superstition about usefulness of deep breathing. Should the listeners ask for more info, various facts can be provided: amazing achievements of Russian doctors in relation to asthma and heart disease, forceful hyperventilation of dogs by Yale Professor Henderson, the Bohr effect, BHT numbers for healthy and sick people, etc.) Note that it is unlikely that this particular person(s) will take the course. The goal is to educate and create a good reputation about the method. Does this approach forget the name “Buteyko”? People can realize the meaning and significance of the name after they learn the method and see its spectacular power. Otherwise, it is just another therapy. Hence, this approach, due to educational value, is the one that really cares about the name “Buteyko”. Saying that the Buteyko method is great or CO2 is very important is technically right, but to refute 3 superstitions at once is very hard. It may work if you do this with, for example, your child or a friend when, in addition, you can demonstrate which problems are gone due to the method. There are many other facts that can raise interest or curiosity of listeners, e.g.: - Forceful hyperventilation for 15-20 min caused deaths in all dogs and horses due to tissue hypoxia and cardiac failure; - More breathing means less oxygen and blood for all vital organs (brain, heart, GI organs, liver, kidneys, spleen, etc.); - Sick people (asthma, sleep apnoea, insomnia, fatigue, heart disease, etc.) breathe 2-4 times more air than the medical norm; - The sicker we are, the faster and deeper we breathe and the shorter our breath holding time (index of oxygenation). - Breathing gets heavier due to: stress, physical inactivity, breathing through the mouth, overeating, sleeping on the back, poor posture; - Restoration of normal breathing means no symptoms and no medication for many common health problems; - There is only one breathing retraining method (the Buteyko method) approved by the Health Ministry (of Russia). It has over 40 years of clinical research, was tested by Russian and western published medical trials, and is practised by over 200 MDs in Russia. Regarding slogans or emails, I found that the easiest and the most efficient way to get people’s minds engaged in thinking in the right direction is to send them, “RE: Over 99% people do not know how to breathe for maximum body oxygenation www.normalbretahing.com”

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This short message exposes ignorance and poor education of people in the area of breathing, while focusing them later on the Buteyko method as a technique that indeed provides us with better oxygenation. Motivation Excessive enthusiasm and corresponding expectations about the growth and acceptance of the method can result in “the rebound effect”. From physiological and neurological viewpoint, such changes in the hypocapnic brain are normal. While the method has had explosive growth during last 10-15 years in many western countries, and doing well world-wide, the low CP practitioner, after few victories and many losses, is likely to experience dissatisfaction, disappointment, and frustration in relation to own well-meaning attempts. Now the practitioner can experience unreasonable emotions in relation to other people (“They do not understand importance of the method and power of the method”, “They do not want to get healthy”, etc.) and yourself (“They deny or neglect me”). An inability to achieve the initial goals may lead to formation of the complex of the looser. How and where breathing teachers can get their energy and persistence from? When a breathing teacher has a flourishing practice, gratitude of the students is the source of motivation and enthusiasm. There are also other situations which do not have immediate positive effects. Let me provide here two examples. 1. Doctor Buteyko goes on the central Soviet or Russian TV/radio station and organizes an interview/presentation about dangers of deep breathing. He also speaks about nasal breathing, importance of physical activity, and other elements of the method. There are no any material rewards, but clear knowledge of physiology and the method tells him that this right step can result, in the long run in saving hundreds of lives. 2. Peter Kolb, a biomedical engineer from Australia, after recovery of his son from asthma (using the Buteyko method) organizes a large website, maintains it for years, and organizes a Buteyko Support Group [BSG] and Buteyko Practitioners Support Network [BPSN]. He also does not expect any material gain, but his website, as a source of information, encouragement, and motivation, in a long run, also saved hundreds of lives worldwide. (In the past, for many years, day after day, my first daily encounter with a PC with internet access was the same: www.google.com; search phrase “Buteyko Kolb”; the first hit was always his website.) There are many other examples and people I do not know about. All these events, however small and unspectacular they were, are as important for wellbeing of humans, as practical activities of breathing teachers. We all do the same job. Vital health is a human right. For various reasons, modern culture and societies do not foster and provide conditions for realization of this right. However, there is an excellent method for restoration of health: the Buteyko method. Hence, the right to have vital health can become real for any interested person. Who is going to bring this news to the world? Various people have been contributing to the advance of the method: - former patients, whose radiant health is the best testimony of method’s power; - scientists, researchers, doctors, state officials, journalists, and many others for whom truth and health on Earth matters; - and, finally, Buteyko breathing teachers who walk cheerfully on Earth and believe and claim that there is a good breather in each person.


Souliagin SS, Common mistakes observed when using VEDB [the Buteyko] method, [in Russian], in The Buteyko method. Its application in medical practice, ed. by K.P. Buteyko, 2-nd ed., 1991, Titul, Odessa, p.63-71.

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Appendix 1. Summary and explanation of normal respiratory and some related values Normal parameters of lung volumes IC - Inspiratory capacity (difference between maximum lung volume and normal expiration) 3600 ml ERV - Expiratory reserve volume (air volume which can be exhaled after normal expiration) 1200 ml VC - Vital capacity (difference between maximum inhalation and maximum exhalation) 4800 ml RV - Residual volume (air volume left in the lungs at full exhalation) 1200 ml FRC - Functional residual capacity (volume of air in the lungs at normal expiration) 2400 ml TLC - Total lung capacity (maximum air volume in the lungs at full inhalation) 6000 ml

Normal parameters of lung ventilation Vt - Tidal volume (air volume breathed in during a single breath) 500 ml f - Respiratory frequency (number of breathing cycles per minute) 12 breaths/min V - Minute volume (air volume breathed in and out during one minute) 6,000 ml/min VA - Alveolar ventilation (air volume breathed in and out of the alveolar space in one minute) 4200 ml/min Vd - Dead space volume (air volume in airways that does not exchange its oxygen with blood) 150-200 ml MVV - Maximum voluntary ventilation (the largest air volume that can be moved into and out of the lungs in 1 minute by voluntary efforts) 170 L/min FEV - Forced expiratory volume (air volume that can be forcefully expired in 1 or 3 sec divided by the vital capacity) 83% or 97%, respectively Work of quiet breathing (amount of energy spent on quiet breathing at rest) 0.5 kg*m/min Maximum work of breathing (maximum amount of energy that can be spent on breathing) 10 kg*m/min Maximum inspiratory and expiratory pressures (maximum pressure gradients that can be voluntary created between the lungs and the outer air) 60-100 mm Hg

% saturation of hemoglobin with oxygen and amount of dissolved oxygen at different O2 pressures (for blood with 15 g/dl of hemoglobin, 38 degrees temperature, and 7.40 pH) PO2 mm Hg % saturation of Hb 30 57 % 40 75 % 50 84 % 60 90 % 70 93 % 80 95 % 90 97 %

Dissolved O2, ml/dl 0.09 0.12 0.15 0.18 0.21 0.24 0.27

_______ 100

98 %

0.30

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Normal gas content of the arterial blood (with 95 mm Hg O2 pressure, 40 mm Hg CO2 pressure, 15 g/dl of hemoglobin): O2: 0.29 ml/dl dissolved; 19.5 ml/dl combined; CO2: 2.62 ml/dl dissolved; 46.4 ml/dl combined; N2: 0.98 ml/dl dissolved; 0 ml/dl combined.

Normal gas content of the venous blood (with 40 mm Hg O2 pressure, 46 mm Hg CO2 pressure, 15 g/dl of hemoglobin): O2: 0.12 ml/dl dissolved; 15.1 ml/dl combined; CO2: 2.98 ml/dl dissolved; 49.7 ml/dl combined; N2: 0.98 ml/dl dissolved; 0 combined.

Normal components of work of quiet breathing Non-elastic work 35%, including viscous resistance (7%) and airway resistance (28%) Elastic work 65%

Normal gas exchange parameters at sea level Composition of outer air O2 - Oxygen 158 mm Hg (20.9%) CO2 - Carbon dioxide 0.3 mm Hg (0.04%) H2O - Water 5.7 mm Hg (0.75%) N2 - Nitrogen 596 mm Hg (78.4%) Composition of the expired air O2 - Oxygen 116 mm Hg (15.3%) CO2 - Carbon dioxide 32 mm Hg (4.2%) H2O - Water 47 mm Hg (6.2%) N2 - Nitrogen 565 mm Hg (74.3%) Composition of the alveolar air O2 - Oxygen 100 mm Hg (13.2%) CO2 - Carbon dioxide 40 mm Hg (5.3%) H2O - Water 47 mm Hg (6.2%) N2 - Nitrogen 573 mm Hg (75.4%)

_______ Composition of the arterial blood O2 - Oxygen 95 mm Hg (11.6%) CO2 - Carbon dioxide 40 mm Hg (5.3%) Composition of the venous blood O2 - Oxygen 40 mm Hg (5.3%) CO2 - Carbon dioxide 46 mm Hg (6.1%)

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Respiratory mechanics Intrapleural pressure Ppleu: at the end of tidal expiration -5 cm H2O at the end of tidal inspiration -8 cm H2O Lung compliance 0.2 l/cm H2O Airway resistance 2 cm H2O/sec/l

Lung perfusion Pulmonary systolic arterial pressure (Ps) Pulmonary diastolic arterial pressure (Pd) Mean pulmonary arterial pressure

25 mm Hg 8 mm Hg 13-14 mm Hg

Diffusion of respiratory gases Alveolar membrane area

50 - 90 square meters

Transport of respiratory gases VO2 Normal oxygen consumption 0.2 l/min VCO2 Normal carbon dioxide production 0.25 l/min RQ (R) VCO2/VO2 Respiratory quotient 0.7 - 1

Some parameters of normal values in human whole blood CO2 content 24-30 mmol/l Arterial CO2 pressure 35-45 mm Hg or 4.7-6.0 kPA Arterial O2 pressure 75-100 mm Hg or 10-13.3 kPA Hemoglobin 13-17 g/dl Total protein 60-80 g/L Chloride 100-108 mmol/l Osmality 280-296 mmol/l Sodium 135-145 mmol/l Potassium 3.5-5.0 mmol/l Calcium 2.1-2.6 mmol/l Lactic acid 0.5-2.2 mmol/l pH 7.35-7.45 (These values are typically quoted as normal for a 70-kg man in medical and physiological textbooks.)

_______ Survival time of various organs and tissues without oxygen supply for an ordinary man

Tissue Brain Kidney and liver Skeletal muscle Vascular smooth muscle Hair and nails

Survival time < 3 min 15-20 min 60-90 min 24-72 hour Several days

From Leach RM, Treacher DF, ABC of oxygen, Oxygen transport, 2. Tissue hypoxia (Clinical review), BMJ 1998; 317: 1370-1373 (14 November). 289


Resting O2 consumption of various organs in a 70-kg adult man with a mean blood pressure of 90 mm Hg and an O2 consumtion of 280 mL/min Region Liver Kidneys Brain Skin Skeletal muscle Heart muscle Rest of the body Whole body

Mass (kg) 3.5 0.4 1.8 4.5 33 0.4 26 70

Arteriovenous difference (mL/L) 34 14 62 25 60 114 129 46

Oxygen consumption

Oxygen consumption

mL/min 56 21 51 14 56 32 49 280

mL/100g/min 2.0 6.0 3.3 0.3 0.2 9.7 0.2 0.4

Percentage of total 20.4 7.2 18.4 4.8 20.0 11.6 17.6 100

Resting blood flow of various organs in a 70-kg adult man with a mean blood pressure of 90 mm Hg and an O2 consumtion of 280 mL/min Region Liver Kidneys Brain Skin Skeletal muscle Heart muscle Rest of the body Whole body

Mass (kg) 3.5 0.4 1.8 4.5 33.0 0.4 26 70

Blood flow mL/min 1666 1390 835 506 930 276 372 6000

Blood flow mL/100g/min

Resistance (R units), absolute

Resistance (R units), per kg

57.7 420.0 54.0 12.8 2.7 84.0 1.4 8.6

3.6 4.3 7.2 11.7 6.4 21.4 16.1 1.0

10.2 1.4 11.3 47 224 7.1 420.2 70.0

Percentage of total cardiac output 27.8 23.3 13.9 8.6 15.6 4.7 6.2 100

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Appendix 2. Approximate relationship between breath holding time and alveolar CO2 concentration The Buteyko formula The control pause reflects aCO2% (alveolar CO2 concentration) according to the formula aCO2% = 3.5% + .05*MP Here, aCO2% is the alveolar CO2 concentration in %, aCO2min%=3.5% is the minimum CO2 content, K=.05 is a coefficient of proportionality, the MP is breath holding time after quiet expiration, for as long as possible for beginners and till the first desire to breathe for experienced students, while sitting, after 10 minutes of rest, while breathing normal air. The results of the calculations, according to this formula, are given in the Table below. The Table also provides the values for alveolar CO2 pressure in mm Hg at different altitudes (at sea level, at 500 m, and at 1,000 m). Duration of the CP (MP for beginners), s 5s 10 s 20 s 30 s 40 s 50 s 60 s

aCO2%

aCO2, mm Hg at sea level

aCO2, mm Hg at 500 m

aCO2, mm Hg at 1,000 m

3.75% 4.0% 4.5% 5.0% 5.5% 6.0% 6.5%

28.5 mm Hg 30.4 mm Hg 34.2 mm Hg 38.0 mm Hg 41.8 mm Hg 45.6 mm Hg 49.4 mm Hg



The formula was described in Buteyko KP, Method of defining CO2 content in alveolar air [in Russian], Soviet patent No. 1593627, 17 October 1986. Note. Arterial CO2 pressure is usually very close to alveolar CO2 pressure. Significant differences can be found in cases of blood shunting and ventilation/perfusion mismatch.

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Appendix 3. Symptoms of hyperventilation syndrome treated in Novosibirsk by Doctor Buteyko and his colleagues 1. Preasthma: respiratory allergy; polyvalent allergy; laringospasm (loss of voice); allergic conjunctivitis; food allergy; drug allergy; pseudocroup; pharyngitis; laryngitis; tracheitis) 2. Asthmatoid bronchitis 3. Bronchial asthma 4. COPD (chronic obstructive pulmonary disease): chronic bronchitis; obstructive bronchitis; chronic pneumonia; pneumosclerosis; pulmonary emphysema; silicosis, antracosis etc. 5. Chronic rhinitis 6. Vasomotor rhinitis 7. Frontal sinusitis metopantritis 8. Maxillary sinusitis 9. Sinusitis 10. Adenoiditis 11. Polyposis 12. Chronic rhinosinusopathy 13. Polinosis (hay fever) 14. Quincke’s edema 15. Urticaria (hives, nettle rash) 16. Eczema (tetter): neurodermit; proriasis; diathesis; vitiligo; ichtyosis (fishskin disease, xeroderma); juvenile acne (comedones, blackheads) 17. Raynaud’s disease (vasospasm of upper limbs) 18. Obliterating endarteriitis 19. Varicosis of veins (varix) 20. Thrombophlebitis 21. Hemorrhoids (piles) 22. Hypotension (hypotony) 23. Hypertension (hypertony, high arterial blood pressure) 24. Vegetovascular dystonia (VVD) 25. Vitium cordis congenitum (congenital heart diseases) 26. Articular rheumatism 27. Rheumatic heart diseases 28. Diencephalic syndrome 29. Heart ischemia 30. Chronic ischemia (CHI): angina pectoris; postmyocardial infarction cardiosclerosis 31. Irregularities of cardiac rhythm: tachnycardia (tachyrhytmia, tachysystole); extrasystole; paroxismal tachycardia; ciliary arhythmia (cardiac fibrillation) 32. Generalised atherosclerosis 33. Arachnoiditis (posttraumatic, influenzal etc…) 34. Postinsultus states (conditions): paralysis (palsy); paresis

35. Parkinsonism (initial form) 36. Hypothyroidism 37. Hyperthyroidism 38. Basedow’s disease 39. Diabetes mellitus 40. Irregularities of the menstrual cycle 41. Toxicosis of pregnancy (disgravidism) 42. Pathologic climacterium (menopase) 43. Cervical erosion 44. Fibromyomes 45. Fibrotic mastopathy 46. Sterility 47. Impotence 48. Abortion's prevention 49. Radiculitis (nerve root syndrome) 50. Osteochondrosis 51. Metabolic polyarthritis 52. Rheumatoid polyarthritis 53. Dupuytren’s syndrome (tendon osteal contracture) 54. Cout (podagra) 55. Pyelonephritis 56. Glomerulonephritis 57. Nocturia (bed wetting) 58. Cystitis 59. Urolithiasis 60. Obesity of any degree 61. Lipomatosis 62. Chronic gastritis 63. Chronic cholecystitis 64. Biliferous tracts dyskinesia 65. Chronic pancreatitis 66. Cholelithiasis 67. Duodenal ulcer 68. Spastic colitis 69. Peptic ulcer 70. Multiple sclerosis 71. Epilepsy (spastic syndrome) 72. Schizophrenia (at the initial stage) 73. Collagenoses (dermatomyitis) 74. Glaucoma 75. Cataract(a) 76. Strabismus (heterotropia) 77. Hypermetropia (far-sightedness) 78. Radiation sickness 79. Virus hepatitis 80. AIDS (acquired immune deficiency syndrome)

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Appendix 4. Clinical effects of the Buteyko breathing method on common health problems (based on work of Russian Buteyko doctors and own experience) Respiratory problems Asthma - An immediate decrease and, later, complete elimination of medication. - Increase in the CP is accompanied by normalization of immunity. - With the increased CP, allergic reactions become less severe and the number of allergens, which can provoke asthma attacks, decreases. - Improved physical endurance and improved quality of life. - Avoidance of triggers and high CPs (over 35 s 24/7) for 2-3 weeks leads to complete disappearance of allergies, disappearance of swelling and inflammation in airways, and normalization of lungs’ tests. - Significant improvements in the quality of life.

Chronic bronchitis - An immediate decrease and, later, elimination of the main symptoms of the disease (cough, dyspnea, heavy breathing, general tiredness, and fatigue). - Reduction in swelling and hyper-secretion from the mucosal surfaces of bronchi, and elimination of elements of bronchoconstriction. - Increase in the CP is accompanied by normalization of immunity. - Prevention of complications (e.g., pneumonia). - Significant improvements in the quality of life.

Acute respiratory diseases, including influenza and cold - Reduction of recovery time from 5-7 days to 1-2 days. - Prevention of complications (e.g., sinusitis, laryngeal tracheitis, pharingitis, bronchitis, pneumonia, etc.). - Increase in the CP is accompanied by normalization of immunity. - Prevention of complications from chronic diseases, such as bronchial asthma, chronic obstructive bronchitis, hypertension, and myocardial ischemia.

Pneumonia - An immediate decrease and, later, complete elimination of the main symptoms of the disease (cough and dyspnea) and symptoms of intoxication (general weakness and fatigue). - Increase in the CP is accompanied by normalization of immunity. - A decrease in swelling and hyper-secretion of mucus from the bronchi. - Significant reduction of the time of recovery.

_______ Rhinitis, sinusitis (frontal sinusitis, metopantritis, maxillary sinusitis)

- Immediate complete or partial restoration of nasal breathing. - Decrease in doses of vasoconstrictive medications. - Prevention of appearance of pain and symptoms of intoxication. - Increase in the CP is accompanied by normalization of immunity and disappearance of inflammatory changes, decrease in swelling and hyper-secretion of mucus from the nasal passages, and decrease in frequency of acute episodes of the disease. - Surgical interventions become unnecessary. 293


Emphysema - Immediate prevention of progression of the disease, improvement in arterial blood oxygenation tests, and reduction in medication (e.g., cortisol, beta-antogonists, etc.). - With the increased CP, gradual reduction in production of mucus, if it was present, ability to walk faster with nasal breathing, and improved ability to walk upstairs. - Use of oxygen 24/7 or lung transplantation becomes unnecessary. - Years of high CP (about 35 s or more) 24/7 results in gradual regeneration of alveoli and complete restoration of the lungs with normal X-ray results. - Significant improvements in the quality of life.

Cardiovascular problems Primary hypertension - Immediate elimination of symptoms connected with elevated blood pressure: headache, dizziness, heart palpitations, pain near the heart, shivering, general fatigue, etc. - Increase in the CP is accompanied by, in case of hypertension of 1-st or 2-nd class, by normalization of blood pressure, gradual elimination or significant reduction in doses of medications, which reduce blood pressure (or transition from multi-medication to mono-therapy). In case of hypertension of 3-rd class, it is possible to significantly reduce corresponding medications or make transition to mono-therapy. - When the CP is 20-30 s or more, the symptoms are absent and no medication is required. This usually takes less than 1-2 months of practice. - Natural weight normalization. - Prevention of development of insulin resistance, diabetes mellitus, hyperlipidemia, and hypertrophy of the left ventricle. - Prevention of injuries in targeted organs for 1-st stage of the disease (myocardial infraction, stroke, angiogenesis of retina, nephropathy, etc.).

Ischemic heart disease - Immediate elimination of symptoms of stenocardia (angina pectoris) attacks and prevention of their appearance (or decrease in angina-like pains). - Increase in the CP is accompanied by transfer from the current functional class of the disease to a less severe one. - Increase in the CP is accompanied by reduction and elimination of medication (to reduce angina-like pain) - Significant improvements in the quality of life.

_______ Chronic cardiac insufficiency

- Increase in the CP is accompanied by reduction of the symptoms of chronic cardiac insufficiency (oedema of lower extremities, panting, heart palpitations, heartache, general fatigue, tiredness, etc.) - Increase in the CP is accompanied by decrease in the doses of medications and their number, natural reduction in triglycerides and cholesterol. - Significant improvements in the quality of life.

Arrhythmia

- Immediate elimination of heart palpitations and various accompanying symptoms: unpleasant feelings and pains near the heart, feelings of breathlessness and panting, chill and sweating, general fatigue, etc. - Increase in the CP is accompanied, in case of chronic forms of tachycardia, by steady reduction in the heart rate, recovery of coronary circulation and perfusion of injured parts of myocardium. That prevents reappearance of paroxysms of pulsating arrythmia, ventricular tachycardia etc. 294


- Significant improvements in the quality of life.

Varicose veins - Immediate decrease and, later, elimination of unpleasant symptoms: heaviness and legs cramps, puffiness around the feet, and weakness and fatigue of the lower extremities. - Increase in the CP is accompanied by decrease in the extent of the capillary bed and enlarged veins. - Prevention of possible complications due to chronic venous insufficiency: trophic ulcers, thromboembolism, and varicose eczema. - Significant improvements in the quality of life.

Neurocirculatory dystonia - Immediate decrease and, later, complete normalization blood pressure and eliminate various symptoms (sweating, heart palpitations, feelings of inner shivering and obstructed throat, etc.). - Increase in the CP is accompanied by normalization of emotional life, restoration of sleep, disappearance of pains and aches in various body parts. - Significant improvements in the quality of life.

Hormonal diseases Diabetes mellitus - Immediate decrease in insulin dosage twofold, use of insulin of short duration. - Increase in the CP is accompanied by decreased requirements in insulin and, at 35-40 s CP its complete elimination. - Prevention of complications. - High CP values (over 35 s) 24/7 leads to complete clinical remission (cure). The time of recovery is usually about 1/10 of the disease time (use of insulin). - Normalization of the emotional life of the students and significant improvement in the quality of life.

Hypothyroidism - Immediate intensification of metabolism, energy level, and reduction in the thyroidal hormone dose - Increase in the CP is accompanied by increased energy, disappearance of possible feeling cold (e.g., cold extremities) and other negative symptoms. - High CP values (over 35 s) 24/7 leads to complete clinical remission and no need for medication. - Prevention of complications. - Significant improvements in the quality of life.

_______ Obesity

- Immediate intensification of metabolism and changes in dietary preferences in the direction of “healthier” choices (eating less with better energy). - Increase in the CP is accompanied by redistribution of fat with its subsequent metabolism and increase in the muscular mass due to the catabolic effect. - With the increased CP, the ability and desire to exercise is gradually restored. Moreover, use of physical exercise leads to dramatic acceleration of the recovery rate. - Prevention of complications. - Significant improvements in the quality of life.

295


Gastrointestinal problems Chronic gastritis - Immediate decrease and, later, complete elimination of pain and symptoms due to dyspeptic effects (heartburn, regurgitation, nausea, etc.). - Increase in the CP is accompanied by normalization of colonic tone, phasic contractility of the GI tract, perfusion, metabolic processes in the mucosal surface of the oesophagus and stomach causing accelerated healing of erosions and ulcers, together with regeneration of the mucosal surface of the stomach. - When the student achieved 35 s morning CP and maintained this level for more than 2 weeks, normalization of the immune profile leads to eradication of Helicobacter Pylori. - Prevention of complications due to chronic gastritis, and complete clinical remission for many years (cure). - Significant improvements in the quality of life.

Chronic non-ulcerative colitis - Immediate decrease and, later, complete elimination of pain and symptoms due to dyspeptic effects (bloating and rumbling in the belly, regurgitation, nausea, inconsistencies in bowel habits, etc.). - Increase in the CP is accompanied by normalization of colonic tone, phasic contractility of the GI tract, perfusion, and metabolic processes in the mucosal surface leading to its regeneration. - When the student achieved 40 s CP or more and maintained this level for more than 2 weeks, normalization of the immune profile leads to normalization of the GI flora with elimination of pathogenic bacteria and inflammation in the lining of the large intestine. - Prevention of complications. - Complete clinical remission for many years (cure). - Significant improvements in the quality of life.

Chronic pancreatitis - Immediate decrease and, later, complete elimination of pain and symptoms due to dyspeptic effects (bloating and rumbling in the belly, regurgitation, nausea, vomiting, alternating bowel habits, etc.). - Increase in the CP is accompanied by normalized colonic tone, phasic contractility of the GI tract and recovered internal secretion. - Prevention of complications (diabetes mellitus, pancreonecrosis, secondary diseases of the biliary tract, etc.). - Complete clinical remission for many years (cure). - Significant improvements in the quality of life.

Chronic cholecystitis

_______ - Immediate decrease and, later, complete elimination of pain and symptoms due to dyspeptic effects (bloating and rumbling in the belly, regurgitation, nausea, vomiting, alternating bowel habits, etc.). - Increase in the CP is accompanied by normalization of colonic tone, phasic contractility of the GI tract, perfusion, metabolism in the lining of the intestine, tone of the bile-conducting organs and elimination of inflammatory processes in the bile-conducting system. - When the student achieved 35 s morning CP and maintained this level for more than 2 weeks, normalization of the immune profile leads to normalization of the GI flora, disappearance of pathogenic bacteria and elimination of inflammation in the biliary tract. - Prevention of complications. - Inhibition of formation of stones in the gallbladder. - Complete clinical remission for many years (cure). - Normalization of the emotional life of the students and significant improvement in the quality of life. 296


Gastro-oesophageal reflux (GERD) - Immediate decrease and, later, complete elimination of pain and symptoms due to dyspeptic effects (heartburn and regurgitation). - Increase in the CP is accompanied by improved perfusion and normalization of the metabolic processes in the mucosal surface of the oesophagus and stomach, with accelerated healing of erosions and ulcers. - When the student achieved 35 s morning CP and maintained this level for more than 2 weeks, normalization of the immune profile leads to normalization of the GI flora, disappearance of pathogenic bacteria and elimination of inflammation in the biliary tract. - Prevention of recurring appearances of erosions and ulcers. - Normalization of the emotional life and significant improvement in the quality of life.

Diseases of kidneys and urinary tract Chronic pyelonephritis - Quick elimination of the symptoms (pain and unpleasant sensations during urination, frequent urination, etc.). - Decrease in the duration of antibacterial therapy and the achievement of positive results using monotherapy (e.g., use of a single antibiotic medication). - In case of chronic states of the disease, the CP growth gradually increases parameters of the immunity. - Prevention of development of acute complications due to chronic pyelonephritis, and, in future, complete recovery. - Prevention of more severe forms of pyelonephritis (obstructive urinary pathologies, i.e., urinary stones, polycystic kidney disease, urinary tract reflux, benign prostatic hyperplasia, etc.) and structural changes in the kidneys and urinary tract, as a result of diabetes mellitus, neutropenia, kidney disease, polyarthritis, and other severe conditions. - Regression of the obstructive effects, pH normalization, prevention of appearance of new stones, and dissolution of old stones and their elimination. - Significant improvements in the quality of life.

Kidney and urinary stones - Quick elimination of the symptoms (pain, unpleasant sensations due to presence of stones in the urinary tract). - With the increased CP, gradual normalization of the urinary pH, ability to hold more urine without any symptoms, and disappearance of symptoms of the disease - Prevention of shock wave therapy, surgery, and medication. - Prevention of complications. - Significant improvements in the quality of life.

_______ Diseases of the musculoskeletal system Osteochondrosis

- Elimination of the symptoms (pain and unpleasant sensations due to bony necrosis). - With the increased CP, gradual normalization of restorative processes in the affected areas and bone regrowth. - High CPs (over 35 s) for some weeks result in healing of the bone in a relatively normal shape and absence of any symptoms. - Prevention of surgery, as in case of Legg-Calvé-Perthes disease, and the need for joint replacement. - Prevention of complications (e.g., arthritis). - Significant improvements in the quality of life. 297


Polyarthritis - Immediate reduction or elimination of pain. - With the increased CP, gradual reduction in joint swelling, and their stiffness and restrictions of movements. - When the student achieved 35 s morning CP and maintained this level for some weeks, normalization of the regenerative processes in the affected areas leads to elimination of degenerative processes, inflammation, and joint damage and complete disappearance of symptoms. - Prevention of surgery and the need for joint replacement. - Prevention of complications. - Normalization of the emotional life of the students and significant improvements in the quality of life.

Chronically poor healing of bone fractures - Immediate reduction or elimination of pain. - With the increased CP, gradual reduction in possible swelling, stiffness, and restrictions of movements. - When the student achieved 35 s morning CP and maintained this level for some weeks, normalization of the regenerative processes in the affected areas leads to elimination of degenerative processes, inflammation, and healing of the fracture and complete disappearance of symptoms. - Prevention of surgery and the need for joint replacement. - Prevention of complications. - Significant improvements in the quality of life.

Skin diseases Eczema - Immediate decrease, and with higher CP, total elimination of skin itching. - Normalization of psychological and emotional states of the student. - Increase in the CP and its maintenance within 30-40 s range are accompanied by gradual decrease in the area of skin rash with its subsequent complete disappearance. - Significant improvements in the quality of life.

Psoriasis - Immediate decrease, and with higher CP, total elimination of skin itching. - Normalization of psychological and emotional states of the student. - Increase in the CP and its maintenance within 30-40 s range are accompanied by gradual decrease in the area of skin rash with its subsequent complete disappearance. - Prevention of complications (arthropathy, psoriasis erythrodermia, skin infections, amyloidosis, etc.). - Improvement of the general state of the students (stabilization of the respiratory symptoms of the allergy and the dynamic of the accompanying chronic diseases, i.e. diseases of the GI tract, chronic infections, etc.). - Significant improvements in the quality of life.

_______ Neurodermitis

- Immediate decrease, and with higher CP, total elimination of skin itching. - Normalization of psychological and emotional states of the student. - Increase in the CP and its maintenance within 30-40 s range are accompanied by gradual decrease in the area of skin rash with its subsequent complete disappearance. - Restoration of the sleep (in cases of its abnormalities). - Improvement of the general state of the students (stabilization of the symptoms of the allergy, such as rhinoconjunctivitis, symptoms of bronchial obstruction, etc.). - Significant improvements in the quality of life. 298


Allergies and states of immunodeficiency For allergic rhinitis and nasal polyps - Immediate restoration of nasal breathing, decrease in nasal discharges, decrease in the dosages and frequency of application of vasoconstrictive medication. - The growth of the CP is accompanied by stable remission with complete elimination of swelling, medication and full restoration of nasal breathing. - Prevention of surgery. - Normalization of the emotional life of the students and significant improvement in the quality of life.

Allergic conjunctivitis - Immediate reduction of symptoms (e.g., itching) and decrease in the amount of medication. - The growth of the CP is accompanied by complete elimination of skin itching, decrease the area covered with rash, and decrease the duration of use of medication. - Normalization of the emotional life of the students and significant improvement in the quality of life.

States of immunodeficiency (secondary) - Immediate elimination of clinical symptoms of secondary immunodeficiency, such as frequent infective and inflammatory processes in the lungs, bronchi, nasal passages, urinary system, GI tract, eyes, skin, and soft tissues. - Further CP growth prevents development of similar complications. - Significant improvements in the quality of life. - Transition of children and adults from the “frequently sick” category into the “practically healthy” one.

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Appendix 5. Macro-minerals and their signs of deficiency During the cleansing reaction there are many abnormal changes and unusual physiological processes (see sections 7.11 and 7.12). These processes often create additional demands in four main macro-minerals: potassium, sodium, calcium, and magnesium. Without sufficient supply of these electrolytes, normalization of breathing is impossible. Therefore, it is necessary to recognize these deficiencies (by observing the signs and symptoms of the patient) and timely correct them. The information given below is intended to facilitate this process of unmasking of deficiencies for quick recovery. Please, note that the usual dose used by Russian doctors was about 1 g for all these minerals. Note that the signs of deficiencies are individual and in many cases only blood analysis can conclusively define a particular deficiency.

• Potassium General information: - about 140 g in the normal human body - comprises 5% of the total mineral weight - over 95 percent of the total body's potassium is in cells. Potassium is crucial for having normal: - water balance and distribution - muscle and nerve cells functions (in conjunction with Ca and Mg) - heart, kidney and adrenal functions - conversion of blood sugar into glycogen - regulation of blood pressure. Some facts about potassium: - is the main electrolyte to keep the cells alkaline - reduces free radical formation - activates a number of enzymes, particularly those concerned with energy production - stimulates normal movements of the intestinal tract - used in medicine for treatment of high blood pressure and heart arrhythmias - the levels are regulated by the kidneys - primarily excreted by kidneys through the urine (especially as a result of acute hyperventilation) - easily lost by sweating, diarrhea (since digestive juices are not properly absorbed in the lower gut), frequent colonic irrigations, during prolonged fasting, due to polyuria and consuming aspirin, laxatives, alcohol, caffeine, and sugar - often deficient in elderly, athletes and hypertensives - should be kept in proportion to sodium ((this ratio is very different for modern salt-rich and acid diets). Deficiency signs: - mild deficiency signs and symptoms include: muscle weakness, abdominal distension, abnormal posture, fatigue, mental confusion, irritability, heart disturbances, and problems in nerve conduction and muscle contraction (some people experience palpitations, others find they are not processing information quickly, etc.) - severe deficiency signs and symptoms include: vomiting, acute muscular weakness, paralysis, pins and needles, loss of appetite, low blood pressure, intense thirst, drowsiness, concussion, and eventually coma. Safety issues: - usually, extremely safe; however, individuals taking potassium retention drugs, with dehydration or kidney disorders often need to restrict their potassium intake. RDA or RNI: 2,000-5,500 mg. Therapeutic doses: 2.5-5 g.

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• Sodium General information: - about 70 g in the normal human body - about 40% of the body’s sodium is contained in bone, approximately 2-5% occurs within organs and cells and the remaining 55% is in blood plasma and other extra cellular fluids - comprises about 45% of the total electrolyte concentration and about 90% of the total extra cellular osmotically active solute - 40% of table salt. Sodium is crucial for having normal: - water balance in the body and blood pH - digestion, nerve function, and muscle contractions. Some facts about sodium: - easily absorbed in the small intestine and stomach - lost with diarrhea, vomiting or excessive sweating - baking soda is used intravenously to treat metabolic and respiratory acidosis, excessive potassium levels and to produce alkaline urine. - optimal health requires a potassium-to-sodium ratio of about 2:1. Deficiency signs: - nausea, dizziness, muscle weakness, appetite loss, flatulence, diarrhea, intestinal gas, fatigue, headache, poor concentration, mental apathy, irritability, neuralgia, stomach cramps, and vomiting. Safety issues: - excess sodium levels in the body pull water from cells and can lead to water retention (i.e. puffy eyes, swollen feet and hands) - can be dangerous for people with congestive heart failure, hepatic cirrhosis, hypertension, edema, blood vessel disease, bleeding problems, epilepsy, and kidney disease. RDA or RNI: 1,000-3,500 mg (although 300-500 mg may suffice). Therapeutic doses: 2 to 12 g.

• Calcium General information: - about 1,700 g in the normal human body - 99% of all calcium (about 1 kg) is in the skeletal system - teeth comprise about 1% of total Ca. Calcium is crucial for having normal: - glycogen storage (ATP component) - muscle tone and contractions (including heart beat regulation) - nerve relaxation and conduction - fat digestion and blood clotting. Some facts about calcium: - absorbed mainly via active transport in the duodenum - absorption rate is about 20-40% and is greatly facilitated by the action of vitamin D, lactose, and certain amino acids - better absorbed with food in small divided doses (e.g., 200-500 mg with each meal) - absorption is hampered by: aluminum-containing antacids, tobacco, alcohol, tea, coffee, oxalates, and phytates - excreted with urine, faeces, and sweat - at risk for low calcium are: women over 45, men over 65, people who consume alcohol, have inactive lifestyle, low calorie diet, high protein diet, pregnant women, smokers, with lactose intolerance, frequent use

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of magnesium antacids and cortisone medication. Deficiency signs: - irritability, nervousness, insomnia, heart palpitations, hypertension, brittle nails, loss of muscle relaxation and contraction abilities, muscle cramps, numbness in the arms and legs, aching joints, poor blood clotting; - convulsions, depression and delusions at later deficiency stages. Safety issues: - excessive calcium supplementation could result in kidney failure even if you don't have kidney disease - caution is required for people with kidney disease. RDA or RNI: 800-1,200 mg. Therapeutic doses: 250-5,000 mg.

• Magnesium General information: - about 42 g in the average 70 kg adult body - about 65% of it is in the bones and teeth Magnesium is crucial for having normal: - synthesis of proteins and other vital substances, since magnesium is a cofactor in more than 300 enzymatic reactions (many of which contribute to the production of energy, and are involved in cardiovascular health) - muscular relaxation and tone of the intestines. Some facts about magnesium: - most of magnesium is inside the cells - needs can be individual and different. Deficiency signs: - hypertension, numerous and various heart problems, premenstrual syndrome or menstrual cramps, tetany (sustained contractions and convulsions), insomnia, anxieties, chronic constipation, and hyperactivity (particularly with children). Safety issues: - frequent and excessive use of magnesium supplements can eventually trigger a number of medical problems resulting from other minerals (such as calcium, sodium, iron, or potassium) getting out of balance. RDA or RNI: 300-400 mg. Therapeutic doses: 50-2,500 mg.

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Appendix 6. Typical changes due to the Buteyko breathing exercises and subsequent normalization of breathing Although the effects of chronic hyperventilation are variable and individual, there are certain changes that are experienced by most people who either normalized their breathing or have made certain progress in this direction. These changes are summarized below. • Physiological and neurological changes These changes are based on the more stable autonomic nervous system, with a tendency toward parasympathetic dominance (rather than the usual stress-induced sympathetic dominance). That usually includes the following changes: - respiratory efficiency increases (respiratory rate decreases, respiratory amplitude and tidal volume decreases (for the CPs up to 1-2 min), breathing smoothness increases, vital capacity increases, FEV increases) - cardiovascular efficiency increases (pulse rate and blood pressure decrease) - electrical skin resistance decreases ((less sweating, more relaxation) - EEG changes: alpha waves increase (theta, delta, and beta waves also increase during various stages of the breathing exercises) - EMG activity decreases - gastrointestinal function normalizes ((gut flora improves, intestinal tone normalizes, stool consistency improves, bowel movements become easier and more regular, constipation disappears) - skin gets stronger, shining, more resilient and elastic (sebaceous glands produce more oil); skin rashes, skin sagging, easy skin bruising, skin dryness and noxious sweat odor disappear; wound healing time is decreased - skin flora, skin respiration, skin sensations, and skin excretory functions improve - wound-healing time and accompanied inflammation around wounds decrease - water balance and kidney function improve (less water is required for proper hydration, urinary frequency decreases and urinary volume increases, puffiness and excessive water retention disappears) - various endocrine functions normalize (energy level increases, weight normalizes, appetite improves) - sleeping quality improves (less time is required for falling asleep; sleeping time is decreased; more time is spent in deep, dreamless sleep; the number of awakenings is smaller (down to 0 when the CP is above 60 s); less or no discomfort or pain is experienced; the number of body's movements and changing positions during the sleep is decreased (down to 0)) - musculoskeletal and joint flexibility increases - posture improves - strength and resiliency increase - endurance increases - immunity increases - pain threshold increases. • General psychological and social changes Psychological changes are manifested in more efficient work of the nervous system and permanent changes in personal attitudes towards surrounding environment, self, and other people. These changes are possible due to increased blood supply to the brain (section 1.4) and increased threshold of neuronal excitability (also section 1.4). The person has an increased ability to remain calm under stressful conditions. Among these are the following changes: - anxiety and depression decrease, mood swings disappear - well-being increases - self-acceptance and self-actualization increase - cognitive function and perception improve - attention, concentration, memory (both, short and long-term), learning efficiency, and various logical abilities improve

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- more objective perceptions of the outside world, other people, own place in this world, and own abilities and limitations are possible - hostility decreases - tolerance and social adjustment increases - addictions, cravings, and unhealthy attachments disappear - the desire to find the truth and essence of objects, processes and activities increases • Biochemical effects Normalization of various biochemical processes is revealed in the following changes (these are confirmed by blood analysis): - blood glucose and insulin levels decrease, insulin sensitivity increases - plasma sodium decreases - total cholesterol decreases (triglycerides decrease, HDL cholesterol increases, LDL cholesterol decreases, VLDL cholesterol decreases, cholinesterase increases) - thyroxin level and ATPase increase - hematocrit and hemoglobin level increase - lymphocyte count increases, total white blood cell count decreases - total serum protein increases. • Technical skills Changes in technical skills are possible due to better communication between the nervous system and muscles. Various technical and psychomotor functions improve, including: - dexterity and fine motor skills - grip strength - eye-hand coordination - reaction time and choice reaction time - steadiness and balance - execution of complicated movements. • Changes in physical and general sport skills Psychology-related and physiology-related changes are also manifested in improvements in various physical and sport skills. They are based on domination of subcortical regions of the brain and domination of the parasympathetic part of the autonomic nervous system. These changes are in comparison with previous states (corresponding to chronic hyperventilation) during similar physical exercise. It can be noticed and often measured that now the person has: - more accurate and goal-oriented movements ((in the past, the movements during the periods of depression were too slow, while during excitements and bursts of activities were too fast and imprecise) - normalization of muscle tone - lower risk of injuring muscles and ligaments - lower energy spending (efforts are minimum, irrelevant muscles and the rest of the body are more relaxed, activity of opposing muscle groups is more balanced) - increased maximum oxygen uptake - increased maximum tolerated lactate level - non-competitive, goal-oriented, more detached and objective attitude.

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About the author: Artour Rakhimov, PhD * High school Honour student (Grade “A” for all exams) * Moscow University Honour student (Grade “A” for all exams) * Moscow University PhD (Math/Physics), accepted in Canada and the UK * Winner of many regional competitions in mathematics, chess and sport orienteering (during teenage and University years) * Good classical piano-player: Chopin, Bach, Tchaikovsky, Beethoven, Strauss (up to now) * Former captain of the ski-O varsity team and member of the cross-country skiing varsity team of the Moscow State University, best student teams of the USSR * Former individual coach of world-elite athletes from Soviet (Russian) and Finnish national teams who took gold and silver medals during World Championships * Total distance covered by running, cross country skiing, and swimming: over 100,000 km or over 2.5 loops around the Earth * Author of the publication which won Russian National 1998 Contest of scientific and methodological sport papers * Author of the most comprehensive book in English (“Normal breathing: the key to vital health”) about the Buteyko breathing method * Buteyko breathing teacher (up to now since 2002) and trainer * Health writer and health educator (www.NormalBreathing.com)

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Normal-Breading.pdf

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