Introduction

“In transporting the breath”: Primordial Breath: An Ancient Chinese Way of Pro­longing Life through Breath Control, vol. 1, Seven Treatises from the Taoist Canon, the Tao Tsang, on the Esoteric Practice of Em­bryonic Breathing, trans. Jane Huang and Michael Wurmbrand, 1st ed. (Original Books, 1987), 3.

master the art of breathing: I wrote about freediving and the human connection to the sea in my first book, Deep (New York: Houghton Mifflin Harcourt, 2014).

books of the Chinese Tao: The Primordial Breath: An Ancient Chinese Way of Pro­longing Life through Breath Control, vol. 1,Seven Treatises from the Taoist Canon, the Tao Tsang, on the Esoteric Practice of Em­bryonic Breathing, trans. Jane Huang and Michael Wurmbrand, 1st ed. (Original Books, 1987); Christophe André, “Proper Breathing Brings Better Health,” Scientific American, Jan. 15, 2019; Bryan Gandevia, “The Breath of Life: An Essay on the Earliest History of Respiration: Part II,” Aus­tralian Journal of Physiotherapy 16, no. 2 (June 1970): 57–69.

ancient Tao text: The Primordial Breath, 8.

confirmed this position: In the December 1998 issue of The New Republic, the editor of the New England Journal of Medicine argued that health determines how we breathe, and how we breathe has no effect on the state of health. In the introduction to Teresa Hale’s book Breathing Free: The Revolutionary 5­Day Program to Heal Asthma, Emphysema, Bronchitis, and Other Respiratory Ailments (New York: Harmony, 1999), Dr. Leo Galland, Fellow of the American College of Nutrition and the American College of Physicians, described exactly how the ways in which we breathe directly affect health. Galland’s account was one of several that I discovered in the initial research for this book and subsequent conversations with professors, doctors, and others in the medical field.

Chapter One: The Worst Breathers in the Animal Kingdom

dental arches and sinus cavity: Karina Camillo Carrascoza et al., “Consequences of Bottle-Feeding to the Oral Facial Development of Initially Breastfed Children,” Jornal de Pediatria 82, no. 5 (Sept.–Oct. 2006): 395–97.

increasing his chances of developing: A retrospective review of more than 7,300 adults associated a 2 percent higher risk of obstructive sleep apnea with every tooth lost. If five to eight teeth were removed, that percentage increased to 25 percent; nine to 31 teeth showed a 36 percent increase. Those patients who had all their teeth removed suffered a 60 percent greater chance of acquiring sleep apnea. Anne E. Sanders et al., “Tooth Loss and Obstructive Sleep Apnea Signs and Symptoms in the US Population,” Sleep Breath 20, no. 3 (Sept. 2016): 1095–102. Related studies: Derya Germeç-Çakan et al., “Uvulo-Glossopharyngeal Dimensions in Non-Extraction, Extraction with Minimum Anchorage, and Extraction with Maximum Anchorage,” European Journal of Orthodontics 33, no. 5 (Oct. 2011): 515–20; Yu Chen et al., “Effect of Large Incisor Retraction on Upper Airway Morphology in Adult Bimaxillary Protrusion Patients: Three-Dimensional Multislice Computed Tomography Registration Evaluation,” The Angle Orthodontist 82, no. 6 (Nov. 2012): 964–70.

Twenty-five sextillion molecules: Simon Worrall, “The Air You Breathe Is Full of Surprises,” National Geographic, Aug.13, 2012.

around half of us: Mouthbreathing estimates are murky and range from 5 to 75 percent. Two independent studies in Brazil showed that more than 50 percent of children are mouthbreathers, but the condition may be more common than that. Valdenice Aparecida de Menezes et al., “Prevalence and Factors Related to Mouth Breathing in School Children at the Santo Amaro Project—Recife, 2005,” Brazilian Journal of Otorhinolaryngology 72, no. 3 (May–June 2006): 394–98; Rubens Rafael Abreu et al., “Prevalence of Mouth Breathing among Children,” Jornal de Pediatria 84, no. 5 (Sept.–Oct. 2008): 467–70; Michael Stewart et al., “Epidemiology and Burden of Nasal Congestion,” International Journal of General Medicine 3 (2010): 37–45; David W. Hsu and Jeffrey D. Suh, “Anatomy and Physiology of Nasal Obstruction,” Otolaryngologic Clinics of North America 51, no. 5 (Oct. 2018): 853–65.

The causes are many: “Symptoms: NasalCongestion,” Mayo Clinic, https://www.mayoclinic.org/symptoms/nasal-congestion/basics/causes/sym-20050644

When mouths don’t grow: Michael Friedman, ed., Sleep Apnea and Snoring: Surgical and Non­Surgical Therapy, 1st ed. (Philadelphia: Saunders/Elsevier, 2009), 6.

9 4 billion years ago: Keith Cooper, “Looking for LUCA, the Last Universal Common Ancestor,” Astrobiology at NASA: Life in the Universe, Mar. 17, 2017, https://astrobiology.nasa.gov/news/looking-for-luca-the-last-universal-common-ancestor/

oxygen waste in the atmosphere: “New Evidence for the Oldest Oxygen-Breathing Life on Land,” ScienceDaily, Oct. 21, 2011, https://www.sciencedaily.com/releases/2011/10/111019181210.htm

16 times more energy: S. E. Gould, “The Origin of Breathing: How Bacteria Learnt to Use Oxygen,” Scientific American, July 29, 2012, https://blogs.scientificamerican.com/lab-rat/the-origin-of-breathing-how-bacteria-learnt-to-use-oxygen

straight teeth: Not all the skulls had teeth. But Evans and Boyd could tell from the shape of the jaw and tooth cavities that the teeth that had been there were straight.

Harvard biologist Daniel Lieberman: Lieberman defines dysevolution as “the deleterious feedback loop that occurs over multiple generations when we don’t treat the causes of a mismatch disease but instead pass on whatever environmental factors cause the disease, keeping the disease prevalent and sometimes making it worse.” A “mismatch disease” begins “when we get sick or injured from an evolutionary mismatch that results from being inadequately adapted to a change in the body’s environment.” You can read more about dysevolution in Lieberman’s book The Story of the Human Body: Evolution, Health, and Dis­ease (New York: Pantheon, 2013); the quote is from p. 176. See also Jeff Wheelwright, “From Diabetes to Athlete’s Foot, Our Bodies Are Maladapted for Modern Life,” Discover, Apr. 2, 2015, http://discovermagazine.com/2015/may/16-days-of-dysevolution

sharp enough to carve tongues: Briana Pobiner, “The First Butchers,” Sapiens, Feb. 23, 2016, https://www.sapiens.org/evolution/homo-sapiens-and-tool-making

Tenderizing food: Daniel E. Lieberman, The Evolution of the Human Head (Cambridge, MA: Belknap Press of Harvard University Press, 2011), 255–81.

Grilling food: For instance, animals can use only 50 to 60 percent of the nutrients from a raw egg but more than 90 percent from a cooked egg. The same is true with many cooked plants, vegetables, and meats. Steven Lin, The Dental Diet: The Surprising Link between Your Teeth, Real Food, and Life­Changing Natural Health (Carlsbad, CA: Hay House, 2018), 35.

800,000 years ago: Likely much earlier. At the Koobi Fora in Kenya, researchers found evidence of a fire that had been intentionally made 1.6 million years ago. Amber Dance, “Quest for Clues to Humanity’s First Fires,” Scientific Ameri­can, June 19, 2017; Kenneth Miller, “Archaeologists Find Earliest Evidence of Humans Cooking with Fire,” Discover, Dec. 17, 2013.

saved even more energy: How much brain did we gain from a smaller gut? Nobody really knows for sure, but it’s significant. An exhaustive overview is available in Leslie C. Aiello, “Brains and Guts in Human Evolution: The Expensive Tissue Hypothesis,” Mar. 1997, http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-84551997000100023

50 percent larger: Richard Wrangham, a Harvard University biological anthropologist, has studied ancient hominin diets extensively. Read more from various perspectives: Rachel Moeller, “Cooking Up Bigger Brains,” Scientific American, Jan. 1, 2008.

second glance: “Did Cooking Give Humans an Evolutionary Edge?,” NPR, Aug. 28, 2009, https://www.npr.org/templates/story/story.php?storyId=112334465

vertically positioned nose: Colin Barras, “The Evolution of the Nose: Why Is the Human Hooter So Big?,” New Scientist, Mar. 24, 2016, https://www.newscientist.com/article/2082274-the-evolution-of-the-nose-why-is-the-human-hooter-so-big/; “Mosaic Evolution of Anatomical Foundations of Speech,” Systematics & Phylogeny Section, Primate Research Institute, Kyoto University. Nishimura Lab.

the tighter our airways became: “The surface area of their nasal cavity is about half of what the scaling suggests, and the volume is even only about 10% of the prediction In fact, the volume of the human nasal cavity is almost 90% smaller than expected.” David Zwickler, “Physical and Geometric Constraints Shape the Labyrinth-like Nasal Cavity,” Proceedings of the National Academy of Sciences, Jan. 26, 2018.

make clothes: Colin Barras, “Ice Age Fashion Showdown: Neanderthal Capes Versus Human Hoodies,” New Scientist, Aug. 8, 2016, https://www.newscientist.com/article/2100322-ice-age-fashion-showdown-neanderthal-capes-versus-human-hoodies/

Homo naledi: “Homo Naledi,” Smithsonian National Museum of Natural History, http:/humanorigins.si.edu/evidence/human-fossils/species/homo-naledi

we adapted wider and flatter noses: Ben Panko, “How Climate Helped Shape Your Nose,” Smithsonian.com, Mar. 16, 2017, https://www.smithsonianmag.com/science-nature/how-climate-changed-shape-your-nose-180962567/

more efficient at inhaling: Joan Raymond, “The Shape of a Nose,” Scientific American, Sept. 1, 2011, https://www.scientificamerican.com/article/the-shape-of-a-nose

larynx sank: Whether enabling speech was the driving factor or a lucky by-product, for one reason or another the Homo sapiens larynx sank. Asif A. Ghazanfar and Drew Rendall, “Evolution of Human Vocal Production,” Current Biology 18, no. 11 (2008); Kathleen Masterson, “From Grunting to Gabbing: Why Humans Can Talk,” NPR, Aug. 11, 2010, https://www.npr.org/templates/story/story.php?storyId=129083762

wider range of vocalizations: How much this lowered larynx benefited early humans in developing a complex spoken language is hotly debated. Nobody knows for sure, but, as I’ve found, anthropologists are more than willing to offer up opinions. Ghazanfar and Rendall, “Evolution”; Lieberman, Story of the Human Body, 171–72.

human species, that could easily choke: Choking on food is the fourth leading cause of accidental deaths in the U.S. “We have paid a heavy price for speaking more clearly,” wrote Daniel Lieberman, in Story of the Human Body, 144.

Nasal obstruction triggers: Terry Young et al., the University of Wisconsin Sleep and Respiratory Research Group, “Nasal Obstruction as a Risk Factor for Sleep-Disordered Breathing,” Journal of Allergy and Clinical Immunology 99, no. 2 (Feb. 1997): S757–62; Mahmoud I. Awad and Ashutosh Kacker, “Nasal Obstruction Considerations in Sleep Apnea,” Otolaryngologic Clinics of North America 51, no. 5 (Oct. 2018): 1003–1009.

Chapter Two: Mouthbreathing

into a state of stress: This blog entry includes a thorough explanation with 43 scientific references: “The Nose Knows: A Case for Nasal Breathing During High Intensity Exercise,” Adam Cap website, https://adamcap.com/2013/11/29/the-nose-knows/

swore off breathing through their mouths: More explanation from Douillard on the importance of nasal breathing in exercise: “Ayurvedic Fitness,” John Douillard, PTonthenet, Jan. 3, 2007, https:/www.ptonthenet.com/articles/Ayurvedic-Fitness-2783

body doesn’t have enough oxygen: A good, simple explanation of anaerobic and aerobic energies: Andrea Boldt, “What Is the Difference Between Lactic Acid & Lactate?,” https://www.livestrong.com/article/470283-what-is-the-difference-between-lactic-acid-lactate/

an excess of lactic acid: Stephen M. Roth, “Why Does Lactic Acid Build Up in Muscles? And Why Does It Cause Soreness?,” Scientific American, Jan. 23, 2006.

feeling of anaerobic overload: Anaerobic exhaustion, and its associated lactic acidosis, isn’t always triggered by strenuous exercise. It can also occur through liver disease, alcoholism, severe trauma, or other conditions that deprive the body of the oxygen it needs to function aerobically. Lana Barhum, “What to Know About Lactic Acidosis,” Medical News Today, https://www.medicalnewstoday.com/articles/320863.php

anaerobic muscle fibers: Human muscle fibers are an interwoven mixture of aerobic and anaerobic fibers, whereas other animals, such as chickens, have entire muscle systems that are either aerobic or anaerobic. The dark meat in a cooked chicken is dark because these muscles were used to provide aerobic energy and are filled with oxygenated blood; white meat is anaerobic, and so is lacking in these red pigments. Phillip Maffetone, The Maf­fetone Method: The Holistic, Low­Stress, No­Pain Way to Exceptional Fitness (Camden, ME: Ragged Mountain PressMcGraw-Hill, 1999), 21.

eventually break down: Dr. Valter Longo, director of the Longevity Institute at the University of Southern California–Davis School of Gerontology, offers some interesting perspective here: https://www.bluezones.com/2018/01/what-exercise-best-happy-healthy-life/

37 trillion: Eva Bianconi et al., “An Estimation of the Number of Cells in the Human Body,” Annals of Human Biology 40, no. 6 (Nov. 2013): 463–71.

16 times more energy efficiency: The actual numbers work out to 2 ATPs per glucose molecule for anaerobic energy and 38 ATPs per glucose molecule for aerobic energy. For this reason, most textbooks say that aerobic energy has a 19-fold increase over anaerobic energy. But what most textbooks don’t account for is inefficiencies and waste in the ATP process, which usually suck up about 8 ATPs. A more conservative estimate, then, is that aerobic respiration produces something closer to 30 to 32 ATPs, or around 16 times the energy that anaerobic produces. Peter R. Rich, “The Molecular Machinery of Keilin’s Respiratory Chain,” Biochemical Society Transactions 31, no. 6 (Dec. 2003): 1095–105.

standardized workouts could be more injurious: To be clear, Maffetone never argued against occasionally entering into anaerobic exercise. Rowing, lifting weights, and running can all have a profound effect on strength and endurance. But to be effective, these exercises needed to be kept in context of larger training, and can’t be prioritized over aerobic training. High-intensity interval training only works because well-designed programs are built around spending the vast majority of time in periods of slower, gentler aerobic exercise. Author and fitness trainer Brian MacKenzie argues that the key to high levels of performance fitness is combining aerobic and anaerobic exercise effectively. The Maffetone Method, 56; Brian MacKenzie with Glen Cordoza, Power Speed Endurance: A Skill­Based Approach to Endurance Training (Las Vegas: Victory Belt, 2012), Kindle locations 462–70; Alexandra Patillo, “You’re Probably Doing Cardio All Wrong: 2 Experts Reveal How to Train Smarter,” Inverse, Aug. 7, 2019, https://www.inverse.com/article/58370-truth-about-cardio?refresh=39

subtract your age from 180: Those with heart disease or other medical conditions should subtract 10 from Maffetone’s equation; if you have asthma or allergies or have not exercised before, subtract 5. Competitive athletes who have been training for more than two years, add 5. This works out to around 80 percent of maximum capacity for a man of my age. Anaerobic states usually hit at 80 percent, or the stage at which it becomes difficult to speak in full sentences. “Know Your Target Heart Rates for Exercise, Losing Weight and Health,” Heart.org, https:/www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates; Wendy Bumgardner, “How to Reach the Anaerobic Zone during Exercise,” VeryWellFit, Aug. 30, 2019, https://www.verywellfit.com/anaerobic-zone-3436576

below this rate but never above it: Two thousand years ago, a Chinese surgeon named Hua Tuo prescribed only moderate exercise to his patients, warning them: “The body needs exercise, only it must not be to the point of exhaustion, for exercise expels the bad air in the system, promotes free circulation of the blood, and prevents sickness.” The most efficient state of exercise where we reap the most benefits, Maffetone found, was around or below 60 percent of maximum capacity. The Cooper Institute, a research foundation that for 50 years has been studying the links between physical activity and chronic disease, has found that exercising at 50 percent leads to massive gains in aerobic fitness, improved blood pressure, prevention of various diseases, and more. Several other studies over the past several decades confirm this. Meanwhile, overexercising above 60 percent, toward that anaerobic zone, has been shown to induce a stress state, increased cortisol, adrenaline, and oxidative stress. Charles M. Tipton, “The History of ‘Exercise Is Medicine’ in Ancient Civilizations,” Advances in Physiology Education, June 2014, 109–17; Helen Thompson, “Walk, Don’t Run,” Texas Monthly, June 1995; Douillard, Body, Mind, and Sport, 205; Chris E. Cooper et al., “Exercise, Free Radicals and Oxidative Stress,” Biochemical Society Transactions 30, part 2 (May 2002): 280–85.

troop of rhesus monkeys: Peter A. Shapiro, “Effects of Nasal Obstruction on Facial Development,” Journal of Allergy and Clinical Immunology 81, no. 5, part 2 (May 1988): 968; Egil P. Harvold et al., “Primate Experiments on Oral Sensation and Dental Malocclusions,” American Journal of Orthodontics & Dentofacial Orthopedics 63, no. 5 (May 1973): 494–508; Egil P. Harvold et al., “Primate Experiments on Oral Respiration,” American Journal of Orthodontics 79, no. 4 (Apr. 1981): 359–72; Britta S. Tomer and E. P. Harvold, “Primate Experiments on Mandibular Growth Direction,” American Journal of Orthodontics 82, no. 2 (Aug. 1982): 114– 19; Michael L. Gelb, “Airway Centric TMJ Philosophy,” Journal of the California Dental Association 42, no. 8 (Aug. 2014): 551–62; Karin Vargervik et al., “Morphologic Response to Changes in Neuromuscular Patterns Experimentally Induced by Altered Modes of Respiration,” American Journal of Orthodontics 85, no. 2 (Feb. 1984): 115–24.

happens to our own species: Yu-Shu Huang and Christian Guilleminault, “Pediatric Obstructive Sleep Apnea and the Critical Role of Oral-Facial Growth: Evidences,” Frontiers in Neurology 3, no. 184 (2012), https://www.frontiersin.org/articles/10.3389/fneur.2012.00184/full; Anderson Capistrano et al., “Facial Morphology and Obstructive Sleep Apnea,” Dental Press Journal of Orthodontics 20, no. 6 (Nov.–Dec. 2015): 60–67.

changes the physical body: A few of the better studies: Cristina Grippaudo et al., “Association between Oral Habits, Mouth Breathing and Malocclusion,” Acta Oto­ rhinolaryngologica Italica 36, no. 5 (Oct. 2016): 386–94; Yosh Jefferson, “Mouth Breathing: Adverse Effects on Facial Growth, Health, Academics, and Behavior,” General Dentistry 58, no. 1 (Jan.–Feb. 2010): 18–25; Doron Harari et al., “The Effect of Mouth Breathing versus Nasal Breathing on Dentofacial and Craniofacial Development in Orthodontic Patients,” Laryngoscope 120, no. 10 (Oct. 2010): 2089– 93; Valdenice Aparecida de Menezes, “Prevalence and Factors Related to Mouth Breathing in School Children at the Santo Amaro Project—Recife, 2005,” BrazilianJournal of Otorhinolaryngology 72, no. 3 (May–June 2006): 394–98.

Patrick McKeown: Patrick McKeown and Martha Macaluso, “Mouth Breathing: Physical, Mental and Emotional Consequences,” Central Jersey Dental Sleep Medicine, Mar. 9, 2017 https://sleep-apnea-dentist-nj.info/mouth-breathing-physical-mental-and-emotional-consequences/

When seasonal allergies hit: W. T. McNicholas, “The Nose and OSA: Variable Nasal Obstruction May Be More Important in Pathophysiology Than Fixed Obstruction,” European Respiratory Journal 32 (2008): 5, https://erj.ersjournals.com/content/32/1/3; C. R. Canova et al., “Increased Prevalence of Perennial Allergic Rhinitis in Patients with Obstructive Sleep Apnea,” Respiration 71 (Mar.–Apr. 2004): 138–43; Carlos Torre and Christian Guilleminault, “Establishment of Nasal Breathing Should Be the Ultimate Goal to Secure Adequate Craniofacial and Airway Development in Children,” Jornal de Pediatria 94, no. 2 (Mar.–Apr. 2018): 101–3.

obstructive sleep apnea: Sleep apnea and snoring are common bedfellows. The more and louder we snore, the more the airways become damaged and the more susceptible we are to sleep apnea. Farhan Shah et al., “Desmin and Dystrophin Abnormalities in Upper Airway Muscles of Snorers and Patients with Sleep Apnea,” Respiratory Research 20, no. 1 (Dec. 2019): 31.

“More wholesome to sleep”: Levinus Lemnius, The Secret Miracles of Nature: In Four Books (London, 1658), 132–33, https:/archive.org/details/b30326084/page/n7; Melissa Grafe, “Secret Miracles of Nature,” Yale University, Harvey Cushing/John Hay Whitney Medical Library, Dec. 12, 2013, https://library.medicine.yale.edu/content/secret-miracles-nature.

lose 40 percent more water: Sophie Svensson et al., “Increased Net Water Loss by Oral Compared to Nasal Expiration in Healthy Subjects,” Rhinology 44, no. 1 (Mar. 2006): 74–77.

During the deepest, most restful: Mark Burhenne, The 8­ Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness (Sunnyvale, CA: Ask the Dentist, 2015), 45.

vasopressin, which communicates: Andrew Bennett Hellman, “Why the Body Isn’t Thirsty at Night,” Nature News, Feb. 28, 2010, https://www.nature.com/news/2010/100228/full/news.2010.95.html

report from the Mayo Clinic: In 2001, researchers at the University of Pittsburgh surveyed several hundred people and found that half of those with insomnia also suffer from obstructive sleep apnea. Then they surveyed people with obstructive sleep apnea and found that half had insomnia. Years later, a study published in the Mayo Clinic Proceedings of 1,200 chronic insomniacs found that all 900 of the patients prescribed some kind of drug to help them sleep, including antidepressants, had “pharmacotherapeutic failure.” The more than 700 patients taking prescription drugs reported the most severe insomnia. These drugs not only are ineffective for the patients taking them, but can actually make sleep quality worse because insomnia for many people isn’t a psychological problem; it’s a breathing problem. Barry Krakow et al., “Pharmacotherapeutic Failure in a Large Cohort of Patients with Insomnia Presenting to a Sleep Medicine Center and Laboratory: Subjective Pretest Predictions and Objective Diagnoses,” Mayo Clinic Proceedings 89, no. 12 (Dec. 2014): 1608– 20; “Pharmacotherapy Failure in Chronic Insomnia Patients,” Mayo Clinic Proceedings, YouTube, https://youtube.com/watch?v=vdm1kTFJCK4.

millions of Americans: Thomas M. Heffron, “Insomnia Awareness Day Facts and Stats,” Sleep Education, Mar. 10, 2014, http://sleepeducation.org/news/2014/03/10/insomnia-awareness-day-facts-and-stats

“increased respiratory effort”: Guillemainault argued that paying too-close attention to specific scores muddles the larger problem of snoring and sleep apnea. Any disturbances in breathing during sleep, be it apnea, snoring, heavy breathing, or even the slightest constriction in the throat, can reap heavy damage to the body. Christian Guilleminault and Ji Hyun Lee, “Does Benign ‘Primary Snoring’ Ever Exist in Children?,” Chest Journal 126, no. 5 (Nov. 2004): 1396–98; Guilleminault et al., “Pediatric Obstructive Sleep Apnea Syndrome,” Archives of Pediatrics and Adolescent Medicine 159, no. 8 (Aug. 2005): 775–85.

making me dumber: Noriko Tsubamoto-Sano et al., “Influences of Mouth Breathing on Memory and Learning Ability in Growing Rats,” Journal of Oral Science 61, no. 1 (2019): 119–24; Masahiro Sano et al., “Increased Oxygen Load in the Prefrontal Cortex from Mouth Breathing: A VectorBased Near-Infrared Spectroscopy Study,” Neuroreport 24, no. 17 (Dec. 2013): 935–40; Malia Wollan, “How to Be a Nose Breather,” The New York Times Magazine, Apr. 23, 2019.

The breath inhaled: The Primordial Breath: An Ancient Chinese Way of Prolonging Life through Breath Control, vol. 2, trans. Jane Huang and Michael Wurmbrand (Original Books, 1990), 31.

And here we are: The stats for malocclusion vary. Kevin Boyd, a pediatric dentist, and Darius Loghmanee, a physician and sleep specialist, noted that “75% of children, ages 6 to 11 and 89% of youths, ages 12 to 17, have some degree of malocclusion.” In addition, an estimated 65 percent of adults have some degree of malocclusion; this population includes those adults who have already had orthodontic procedures. Given this, the actual number of these adults had not received treatment would be closer to 90 percent. Other estimates I found put the figure for children even higher. Suffice to say, it’s a lot. A few slide presentations (with references) and in-depth interviews about malocclusion: Kevin L. Boyd and Darius Loghmanee, “Inattention, Hyperactivity, Snoring and Restless Sleep: My Child’s Dentist Can Help?!,” presentation at 3rd Annual Autism, Behavior, and Complex Medical Needs Conference; Kevin Boyd interview by Shirley Gutkowski, Cross Link Radio, 2017; “Malocclusion,” Boston Children’s Hospital, http://www.childrenshospital.org/conditions-and-treatments/con ditions/m/malocclusion

Forty-five percent of adults snore: “Snoring,” Columbia University Department of Neurology, http://www.columbianeurology.org/neurology/staywell/document.php?id=42066

Twenty-five percent of American adults: “Rising Prevalence of Sleep Apnea in U.S. Threatens Public Health,” press release, American Academy of Sleep Medicine, Sept. 29, 2014.

an estimated 80 percent: Steven Y. Park, MD, Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired (New York: Jodev Press, 2008), 26.

than there were 10,000 years ago: Index of world population estimates throughout the decades: https://tinyurl.com/rrhvcjh

slack-jawed and narrowed faces: Several studies have shown similar restoration in humans. In the 1990s, Canadian researchers measured the facial and mouth dimensions of 38 children suffering from chronically enlarged adenoids, the glands located on the roof of the mouth that help fight infections. The swollen glands made it almost impossible for the children to breathe through their noses, so they all adopted mouthbreathing, and all had the long, slack-jawed, narrow-faced profiles that come with it. Surgeons removed the adenoids from half the children and monitored the measurements of their faces. Slowly, surely, their faces morphed back into their natural position: jaws moved forward, the maxilla flared outward. Donald C. Woodside et al., “Mandibular and Maxillary Growth after Changed Mode of Breathing,” American Journal of Orthodontics and Dentofacial Orthopedics 100, no. 1 (July 1991): 1–18; Shapiro, “Effects of Nasal Obstruction on Facial Development,” 967–68.

Chapter Three: Nose

Smell is life’s oldest sense: Interview with Dolores Malaspina, MD, professor of clinical psychiatry at Columbia University in New York; Nancie George, “10 Incredible Facts about Your Sense of Smell,” EveryDay Health, https://www.everydayhealth.com/news/incredible-facts-about-your-sense-smell/

stores memories: Artin Arshamian et al., “Respiration Modulates Olfactory Memory Consolidation in Humans,” Journal of Neuroscience 38, no. 48 (Nov. 2018): 10286–94; Christina Zelano et al., “Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function,” Journal of Neuroscience 36, no. 49 (Dec. 2016): 12448–67.

suffer from asthma: A. B. Ozturk et al., “Does Nasal Hair (Vibrissae) Density Affect the Risk of Developing Asthma in Patients with Seasonal Rhinitis?,” Inter­national Archives of Allergy and Immunology 156, no. 1 (Mar. 2011): 75–80.

an Indian surgeon: Ananda Balayogi Bhavanani, “A Study of the Pattern of Nasal Dominance with Reference to Different Phases of the Lunar Cycle,” Yoga Life 35 (June 2004): 19–24.

called nasal cycles: Sometimes referred to as an “ultradian rhythm,” meaning a cycle shorter than the period of circadian rhythm.

first described in 1895: A comprehensive review of the nasal cycle can be found in Alfonso Luca Pendolino et al., “The Nasal Cycle: A Comprehensive Review,” Rhinology Online 1 (June 2018): 67–76; R. Kayser, “Die exacte Messung der Luftdurchgängigkeit der Nase,” Archives of Laryngology 3 (1895): 101–20.

30 minutes to 4 hours: This is an estimate. Some studies have shown that the nasal cycle fluctuates between 30 minutes and two and a half hours; others show the cycle can last up to four hours. Roni Kahana-Zweig et al., “Measuring and Characterizing the Human Nasal Cycle,” PloS One 11, no. 10 (Oct. 2016): e0162918; Rauf Tahamiler et al., “Detection of the Nasal Cycle in Daily Activity by Remote Evaluation of Nasal Sound,” Archives of Otolaryngology–Head and Neck Surgery 129, no. 9 (Feb. 2009): 137–42.

“honeymoon rhinitis”: “Sneezing ‘Can Be Sign of Arousal,’” BBC News, Dec. 19, 2008, http://news.bbc.co.uk/2/hi/health/7792102.stm; Andrea Mazzatenta et al., “Swelling of Erectile Nasal Tissue Induced by Human Sexual Pheromone,” Advances in Experimental Medicine and Biology 885 (2016): 25–30.

nostrils cycled: Kahana-Zweig et al., “Measuring”; Marc Oliver Scheithauer, “Surgery of the Turbinates and ‘Empty Nose’ Syndrome,” GMS Current Topics in Otorhinolaryngology–Head and Neck Surgery 9 (2010): Doc3.

body to flip over: In addition, nasal cycles appear to be associated with the duration of deep sleep. A. T. Atanasov and P. D. Dimov, “Nasal and Sleep Cycle—Possible Synchronization during Night Sleep,” Medical Hypotheses 61, no. 2 (Aug. 2003): 275–77; Akihira Kimura et al., “Phase of Nasal Cycle During Sleep Tends to Be Associated with Sleep Stage,” The Laryn­goscope 123, no. 6 (Aug. 2013): 1050–55.

become inflamed: Pendolino et al., “The Nasal Cycle.”

back and forth quickly: A lagging nasal cycle in some cultures was considered a harbinger of disease. A nostril plugged for more than eight hours meant a serious illness was imminent. If breathing was one-sided for more than a day, death was expected. But why? Ronald Eccles, “A Role for the Nasal Cycle in Respiratory Defense,” European Respiratory Journal 9, no. 2 (Feb. 1996): 371–76; Eccles et al., “Changes in the Amplitude of the Nasal Cycle Associated with Symptoms of Acute Upper Respiratory Tract Infection,” Acta Otolaryngologica 116, no. 1 (Jan. 1996): 77–81.

feed more blood to the opposite: Kahana-Zweig et al.; Shirley Telles et al., “Alternate-Nostril Yoga Breathing Reduced Blood Pressure While Increasing Performance in a Vigilance Test,” Medical Science Monitor Basic Research 23 (Dec. 2017): 392–98; Karamjit Singh et al., “Effect of Uninostril Yoga Breathing on Brain Hemodynamics: A Functional Near-Infrared Spectroscopy Study,” International Journal of Yoga 9, no. 1 (June 2016): 12–19; Gopal Krushna Pal et al., “Slow Yogic Breathing Through Right and Left Nostril Influences Sympathovagal Balance, Heart Rate Variability, and Cardiovascular Risks in Young Adults,” North American Journal of Medical Sciences 6, no. 3 (Mar. 2014): 145–51.

lowers temperature and blood pressure: P. Raghuraj and Shirley Telles, “Immediate Effect of Specific Nostril Manipulating Yoga Breathing Practices on Autonomic and Respiratory Variables,” Applied Psychophysiology and Biofeedback 33, no. 2 (June 2008): 65–75. S. Kalaivani, M. J. Kumari, and G. K. Pal, “Effect of Alternate Nostril Breathing Exercise on Blood Pressure, Heart Rate, and Rate Pressure Product among Patients with Hypertension in JIPMER, Puducherry,” Journal of Education and Health Promotion 8, no. 145 (July 2019).

negative emotions: Neuroanatomist Jill Bolte Taylor offers an emotional and astonishing primer of the functions of right and left brain in her 2008 TED Talk, “My Stroke of Insight,” which, as of this writing, has been viewed more than 26 million times. View it here: https://www.ted.com/talks/jill_bolte_taylor_my_stroke_of_insight

researchers at the University of California: David Shannahoff-Khalsa and Shahrokh Golshan, “Nasal Cycle Dominance and Hallucinations in an Adult Schizophrenic Female,” Psychiatry Research 226, no. 1 (Mar. 2015): 289–94.

alternate nostril breathing: Studies conducted at research labs and published in the International Journal of Neuroscience, Frontiers in Neural Circuits, Journal of Laryngology and Otology, and more have demonstrated clear links between right and left nostrils and specific biological and mental functions. You can find several dozens of studies here: https://www.ncbi.nlm.nih.gov/pubmed/?term=alternate+nostril+breathing

heat up my body and aid my digestion: When yogis finish a meal, they lie on their left side so that they will breathe primarily from their right nostril. The increase of blood flow and heat via right-nostril breathing, yogis believe, can aid in digestion. A few years ago, researchers at Jefferson Medical College in Philadelphia tested this claim by feeding 20 healthy subjects a high-fat meal on different days, having them lie on their right or left sides. Those ordered to lie on their left side (breathing primarily through their right nostril) had significantly less heartburn and measured much lower acidity in their throats than subjects lying on the right side. The study was repeated with the same results. The extra heating in the body triggered by right nostril breathing likely influenced the rate and efficiency of digestion, but gravity certainly helped. The stomach and pancreas will hang more naturally when the body is positioned on the left side, which allows food to more easily move through the large intestine. In short, it feels better and is more efficient for digestion. L. C. Katz et al., “Body Position Affects Recumbent Postprandial Reflux,” Journal of Clinical Gastroenterology 18, no. 4 (June 1994): 280–83; Anahad O'Connor, “The Claim: Lying on Your Left Side Eases Heartburn,” The New York Times, Oct. 25, 2010, https://www.nytimes.com/2010/10/26/health/26really.html; R. M. Khoury et al., “Influence of Spontaneous Sleep Positions on Nighttime Recumbent Reflux in Patients with Gastroesophageal Reflux Disease,” American Journal of Gastroenterology 94, no. 8 (Aug. 1999):2069–73.

interior of the adult nose: The average nasal cavity and four paranasal sinuses of an adult male nose works out to about 6.43 cubic inches; an inch less for females. Inge Elly Kiemle Trindade, “Volumes Nasais de Adultos Aferidos por Rinometria Acústica,” Revista Brasileira de Otorrino­ laringologia 73, no. 1 (Jan./Feb. 2007).

all the grains: All the world’s beaches contain somewhere in the neighborhood of 2.5 to 10 sextillion grains of sand. Meanwhile, that breath of air you just inhaled contains around 25 sextillion molecules. Fraser Cain, “Are There More Grains of Sand Than Stars?,” Universe Today, Nov. 25, 2013, https://www.universetoday.com/106725/are-there-more-grains-of-sand-than-stars/

keep invaders out: And copper and cadmium. A. Z. Aris, F. A. Ismail, H. Y. Ng, and S. M. Praveena, “An Experimental and Modelling Study of Selected Heavy Metals Removal from Aqueous Solution Using Scylla serrata as Biosorbent,” Pertanika Journal of Science and Technology 22, no. 2 (Jan. 2014): 553–66.

“first line of defense”: “Mucus: The First Line of Defense,” ScienceDaily, Nov. 6, 2015, https://www.sciencedaily.com/releases/2015/11/151106062716.htm; Sara G. Miller, “Where Does All My Snot Come From?,” Live Science, May 13, 2016, https:/www. livescience.com54745-why-do-i-have-so-much-snot.html; B. M.Yergin et al., “A Roentgenographic Method for Measuring Nasal Mucous Velocity,” Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology 44, no. 6 (June 1978): 964–68.

tiny, hair-like structures: Maria Carolina Romanelli et al., “Nasal Ciliary Motility: A New Tool in Estimating the Time of Death,” International Journal of Legal Medicine 126, no. 3 (May 2012): 427–33; Fuad M. Baroody, “How Nasal Function Influences the Eyes, Ears, Sinuses, and Lungs,” Proceedings of the American Thoracic Society 8, no. 1 (Mar. 2011): 53–61; Irina Ozerskaya et al., “Ciliary Motility of Nasal Epithelium in Children with Asthma and Allergic Rhinitis,” European Respiratory Journal 50, suppl. 61 (2017).

16 beats per second: The hotter it is, the faster cilia move. J. Yager et al., “Measurement of Frequency of Ciliary Beats of Human Respiratory Epithelium,” Chest 73, no. 5 (May 1978): 627–33; James Gray, “The Mechanism of Ciliary Movement. VI. Photographic and Stroboscopic Analysis of Ciliary Movement,” Proceedings of the Royal Society B: Biological Sciences 107, no. 751 (Dec. 1930): 313–32.

Cilia closer to the nostrils: Crying will drain tears into the nose, which mix with the mucus, making it thin and watery. Cilia can no longer hold onto the mucus, so it starts running with the flow of gravity: a runny nose. Thick mucus is worse. Excessive dairy, allergies, starchy foods, and more increase mucus weight and density. Cilia slow down, become overwhelmed, and eventually come to a dead stop. This is how the nose gets congested. The longer the nose is stopped up, the more microbes build up, resulting sometimes in a nasal infection (sinusitis) or a common cold. Olga V. Plotnikova et al., “Primary Cilia and the Cell Cycle,” Methods in Cell Biology 94 (2009): 137–60; Achim G. Beule, “Physiology and Pathophysiology of Respiratory Mucosa of the Nose and the Paranasal Sinuses,” GMS Current Topics in Otorhinolaryngology– Head and Neck Surgery 9 (2010): Doc07.

turbinates will heat: Scheithauer, “Surgery of the Turbinates,” 18; Swami Rama, Rudolph Ballentine, and Alan Hymes, Science of Breath: A Practical Guide (Hones-dale, PA: Himalayan Institute Press, 1979, 1998), 45.

Around 1500 bce: Bryan Gandevia, “The Breath of Life: An Essay on the Earliest History of Respiration: Part I,” Australian Journal of Physiotherapy 16, no. 1 (Mar. 1970): 5–11, https://www.sciencedirect.com/science/article/pii/S0004951414610 850; Gandevia, “The Breath of Life: An Essay on the Earliest History of Respiration: Part II,” Australian Journal of Physiotherapy 16, no. 2 (June 1970): 57–69, https:/www.sciencedirect.com/science/article/pii/S0004951414610898?via%3Dihub.

a portrait painter: The following details, quotes, and descriptions about George Catlin are taken from the following books and writings: George Catlin, North American Indians, ed. Peter Matthiessen (New York: Penguin, 2004); Catlin, The Breath of Life, 4th ed., retitled Shut Your Mouth and Save Your Life (London: N. Truebner, 1870). The 1870 edition of Shut Your Mouth may be read and downloaded for free at https:/buteykoclinic.com/wp-content/uploads/2019/04/Shut-your-mouth-Catlin.pdf

“I am traveling”: Catlin, Letters and Notes on the Manners, Customs, and Condition of the North American Indians (New York: Wiley and Putnam, 1841), vol. 1, 206.

“the first, last, and only”: Peter Matthiessen, introduction to Catlin, North American Indians, vi.

all 50 tribes: Later, anthropologist Richard Steckel confirmed Catlin’s descriptions, claiming that the Plains tribes in the late 1800s were the tallest people on Earth at the time. Devon Abbot Mihesuah, Recovering Our Ancestors’ Gardens (Lincoln: University of Nebraska Press, 2005), 47.

teeth that were perfectly straight: Shut Your Mouth, 2, 18, 27, 41, 43, 51.

The Breath of Life: Reviewed in Littell’s Living Age 72 (Jan.–Mar. 1862): 334–35.

to be 76: By the 1900s, Catlin was all but forgotten. His mentors, the great Plains Indians, were all but destroyed: killed off by smallpox, shot, raped, or enslaved. The few left often turned to alcohol. The silver-haired Mandan, the broad-shouldered Pawnee, the gentle Minatree—all gone. And with them, so vanished their knowledge of the art and science of breathing.

breathe through the nose: Decades after Catlin’s treatise on all things mouth and nasal breathing, the physician-in-charge at Mount Regis Sanatorium in Salem, Virginia, a man named E. E. Watson, announced at the annual meeting of the Medical Society of Virginia that mouthbreathing was the primary culprit in the spread of tuberculosis. “To say that seventy-five percent of our unquestioned tuberculous larynx cases have occurred in mouth-breathers would be no exaggeration,” announced Watson. Respiratory disease didn’t affect populations randomly, and they weren’t genetic. What Watson was saying, essentially, was that some diseases were a choice. And health or sickness was determined in large part by whether his patients breathed from the mouth or from the nose. E. E. Watson, “Mouth-Breathing,” Virginia Medical Monthly 47, no. 9 (Dec. 1920): 407–8.

written a book: Mark Burhenne, The 8 ­Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness (Sunnyvale, CA: Ask the Dentist, 2015).

mouthbreathing contributed: J. E. Choi et al., “Intraoral pH and Temperature during Sleep with and without Mouth Breathing,” Journal of Oral Rehabilitation 43, no. 5 (Dec. 2015): 356–63; Shirley Gutkowski, “Mouth Breathing for Dummies,” RDH Magazine, Feb. 13, 2015, https://www.rdhmag.com/patient-care/article/16405394/mouth-breathing-for-dummies

for a hundred years: “Breathing through the Mouth a Cause of Decay of the Teeth,” American Journal of Dental Science 24, no. 3 (July 1890): 142–43.

contributor to snoring: M. F. Fitzpatrick et al., “Effect of Nasal or Oral Breathing Route on Upper Airway Resistance During Sleep,” European Respiratory Journal 22, no. 5 (Nov. 2003): 827–32.

a huge boost: To many researchers, nitric oxide is as essential to the body as oxygen and carbon dioxide. Catharine Paddock, “Study Shows Blood Cells Need NitricOxide to Deliver Oxygen,” Medical News Today, Apr. 13, 2015, https://www.medicalnewstoday.com/articles/292292.php; J. Lundberg and E. Weitzberg, “Nasal Nitric Oxide in Man,” Thorax 54, no. 10 (Oct. 1999): 947–52.

18 percent more oxygen: J. Lundberg, “Nasal and Oral Contribution to Inhaled and Exhaled Nitric Oxide: A Study in Tracheostomized Patients,” European Respira­ tory Journal 19, no. 5 (2002): 859–64; Mark Burhenne, “Mouth Taping: End Mouth Breathing for Better Sleep and a Healthier Mouth,” Ask the Dentist (includes several study references), https:/askthedentist.com/mouth-tape-better-sleep. Additionally, the increased air resistance through nasal breathing increases the vacuum in the lungs, and helps us draw in 20 percent more oxygen than through the mouth. Caroline Williams, “How to Breathe Your Way to Better Memory and Sleep,” New Scientist, Jan. 8, 2020.

my own experiments: Sleep tape has its critics. A Guardian newspaper story from July 2019 claimed that sleep taping was dangerous because “if you started vomiting there would be a good chance you would choke.” This claim, Burhenne and Kearney told me, is as ridiculous as it is unfounded and under-researched. “Buteyko: The Dangerous Truth about the New Celebrity Breathing Sensation,” The Guard­ian, https://www.theguardian.com/lifeandstyleshortcuts2019jul15buteyko-the-dangerous-truth-about-the-new-celebrity-breathing-sensation.

Chapter 4: Exhale

known as a lover: Publisher’s introduction to Peter Kelder, Ancient Secret of the Fountain of Youth, Book 2 (New York: Doubleday, 1998), xvi.

lung-expanding stretches: The directions I followed were on Wikipedia, “Five Tibetan Rites.” Cardiologist Joel Kahn suggests performing each rite for 21 rounds, as the ancient Tibetans did. For beginners, ten minutes a day for all the exercises is a good starting point.

extended life: A half century later, Kelder’s booklet was rereleased as Ancient Secret of the Fountain of Youth. It became an international sensation, selling more than two million copies. A review of some of the cardiopulmonary benefits of practicing the Five Tibetan Rites can be found in an article by Dr. Joel Kahn, “A Cardiologist’s Favorite Yoga Sequence for Boosting Heart Health,” MindBodyGreen, Sept. 10, 2019.

according to the researchers: William B. Kannel and Helen Hubert, “Vital Capacity as a Biomarker of Aging,” in Biological Markers of Aging, ed. Mitchell E. Reff and Edward L. Schneider, NIH Publication no.82-2221, Apr. 1982, 145–60; W. B. Kannel et al., “Vital Capacity as a Predictor of Cardiovascular Disease: The Framingham Study,” American Heart Journal 105, no. 2 (Feb. 1983): 311–15.

comparing lung capacity: Holgar Shunemann, the researcher who headed the Buffalo follow-up study, reported: “It is important to note that the risk of death was increased for participants with moderately impaired lung function, not merely those in the lowest quintile. This suggests that the increased risk isn’t confined to a small fraction of the population with severely impaired lung function.” Lois Baker, “Lung Function May Predict Long Life or Early Death,” University at Buffalo News Center, Sept. 12, 2000, http:/www.buffalo.edu/news/releases/2000/09/4857.html

results were the same: The lung-size metric extended to those with lung transplants. In 2013, Johns Hopkins researchers compared several thousand patients who had had lung transplants and found that those who received oversized lungs had a 30 percent increased chance of survival a year after the operation. “For lung transplant, researchers surprised to learn bigger appears to be better,” ScienceDaily, Aug. 1, 2013, https://www.sciencedaily.com/releases201308/130801095507.htm; Michael Eberlein et al., “Lung Size Mismatch and Survival After Single and Bilateral Lung Transplantation,” Annals of Thoracic Surgery 96, no. 2 (Aug. 2013):457–63.

14 liters: Brian Palmer, “How Long Can You Hold Your Breath?,” Slate, Nov. 18, 2013, https://slate.com/technology/2013/11/nicholas-mevoli-freediving-death-what-happens-to-people-who-practice-holding-their-breath.html; https://www.sciencedaily.com/releases/2013/08/130801095507.htm; “Natural Lung Function Decline vs. Lung Function Decline with COPD,” Exhale, the official blog of the Lung Institute, Apr. 27, 2016, https:/lunginstitute.comblog/natural-lung-function-decline-vs-lung-function-decline-with-copd/

15 percent: I’ve been asked by more than one musician over the past few years if playing wind instruments boosts lung capacity. Some studies conflict, but the consensus is that, no, wind instruments do not increase lung capacity in a significant way. Further, the constant pressurized air within the lungs appears to increase the risk of chronic upper airway symptoms and even lung cancer. Evangelos Bouros et al., “Respiratory Function in Wind Instrument Players,” Mater Sociomedica 30, no. 3 (Oct. 2018): 204–8; E. Zuskin et al., “Respiratory Function in Wind Instrument Players,” La Medicina del Lavoro, Mar. 2009; 100(2); 133–141; A. Ruano-Ravina et al., “Musicians Playing Wind Instruments and Risk of Lung Cancer: Is There an Association?,” Occupational and Environmental Medicine 60, no. 2 (Feb. 2003); “How to Increase Lung Capacity in 5 Easy Steps,” Exhale, July 27, 2016.

Katharina Schroth: Descriptions and details about Schroth and her work were adapted from Hans-Rudolf Weiss, “The Method of Katharina Schroth—History, Principles and Current Development,” Scoliosis and Spinal Disorders 6, no. 1 (Aug. 2011): 17.

became so renowned: Descriptions, quotes, and other information regarding Carl Stough and his methods were taken from his 1970 autobiography, coauthored with Reece Stough: Dr. Breath: The Story of Breathing Coordination (New York:William Morrow, 1970), 17, 19, 38, 42, 66,71, 83, 86, 93, 101, 111, 117, 113, 156, 173; a short bio, “Carl Stough,” at https://www.breathingcoordination.ch/en/method/carl-stough; and the documentary film written by Laurence A. Caso, Breathing: The Source of Life, Stough Institute, 1997.

making the condition worse: This was the same “chest” breathing Stough would see in schizophrenics and others with behavioral disorders. They all shared the same tight chest and rib cage, and were unable to move freely or breathe any way but in several hasty breaths. As a result, all the “stale” carbon-dioxide-rich air would sit stagnant in their lungs, creating “dead space.”

couldn’t get enough stale air out: In each exhale, we expel about 3,500 compounds. Much of this is organic (water vapor, carbon dioxide, and other gases), but we also exhale pollutants: pesticides, chemicals, and engine exhaust. When we don’t breathe out completely, these toxins sit in the lungs and fester, causing infections and other problems. Todor A. Popov, “Human Exhaled Breath Analysis,” An­nals of Allergy, Asthma & Immunology 106, no. 6 (June 2011): 451–56; Joachim D. Pleil, “Breath Biomarkers in Toxicology,” Archives of Toxicology 90, no. 11 (Nov. 2016): 2669–82; Jamie Eske, “Natural Ways to Cleanse Your Lungs,” Medical News Today, Feb. 18, 2019, https://www.medicalnewstoday.com/articles/324483.php.

once a minute: “How Quickly Does a Blood Cell Circulate?,” The Naked Scientists, Apr. 29, 2012, https://www.thenakedscientists.com/articles/questionshow-quickly-does-blood-cell-circulate.

2,000 gallons of blood: “How the Lungs Get the Job Done,” American Lung Association, July 20, 2017, https://www.lung.org/about-usblog2017/07how-your-lungs-work.html

“the second heart”: An overview of Stephen Elliott’s theories and observations on the thoracic pump can be found at Stephen Elliot, “Diaphragm Mediates Action of Autonomic and Enteric Nervous Systems,” BMED Reports, Jan. 8, 2010, https://www.bmedreport.com/archives/8309; also see “Principles of Breathing Coordination” summarized at Breathing Coordination, http://www.breathingcoordination.com/Principles.html

said Dr. Robert Nims: Caso, Breathing: The Source of Life, 17:12.

asthma, and other respiratory problems: And the risk of asthma, which in turn affects cardiovascular health. “Adults Who Develop Asthma May Have Higher Risk ofHeart Disease, Stroke,” American Heart Association News, Aug. 24, 2016, https:/news archive. heart . org adults-who-develop-asthma-may-have-higher-risk-of-heart-disease-stroke; A. Chaouat et al., “Pulmonary Hypertension in COPD,” European Respiratory Journal 32, no. 5 (Nov. 2008): 1371–85.

was relatively easy: When muscles in the body get strained, other muscles in the area step in to lighten the load. Should we strain our left ankle, we’ll place more weight on the right. But the diaphragm doesn’t have that option. No other muscle does what it does. It just keeps laboring on at whatever cost, because if it doesn’t, we’ll quickly run out of air and die. Over time, the body learns to do what it can to compensate and engages “accessory” respiratory muscles in the chest to help air get in and out of the lungs. This chest-centered breathing becomes a habit.

asthma, and other respiratory problems: And the risk of asthma, which in turn affects cardiovascular health. “Adults Who Develop Asthma May Have Higher Risk of Heart Disease, Stroke,” American Heart Association News, Aug. 24, 2016, https://newsarchive.heart.org/adults-who-develop-asthma-may-have-higher-risk-of-heart-disease-stroke/; A. Chaouat et al., “Pulmonary Hypertension in COPD,” European Respiratory Journal 32, no. 5 (Nov. 2008): 1371–85.

said Lee Evans: Caso, Breathing: The Source of Life, 11:18.

greatest performances: Bob Burns, The Track in the Forest: The Creation of a Legendary 1968 US Olympic Team (Chicago: Chicago Review Press, 2018); Richard Rothschild, “Focus Falls Again on ’68 Olympic Track Team,” Chicago Tribune, June 19, 1998.

power of harnessing: Along my journey researching this book, I visited Dr. J. Tod Olin, a pulmonologist at National Jewish Health, a leading respiratory hospital and research center in Denver, Colorado. Olin had specialized for the past several years in a condition called exercise-induced laryngeal obstruction (EILO), in which the vocal cords and surrounding structures obstruct the airway during high-intensity exercise. Five to 10 percent of the adolescent population shares this condition, and it is most often misdiagnosed as asthma and treated as such without success. Olin’s techniques, which he unimaginatively named Olin EILOBI (Exercise-Induced Laryngeal Obstruction Biphasic Inspiration Techniques), involved restricted and pursed-lip breathing exercises developed by Konstantin Buteyko 60 years earlier, and to a lesser extent, Stough. The only difference was that Olin’s techniques were focused through the mouth, because, he said, athletes couldn’t inhale fast enough through their noses during high-intensity exercises. One wonders how any of them would have fared if they could. Sarah Graham et al., “The Fortuitous Discovery of the Olin EILOBI Breathing Techniques: A Case Study,” Journal of Voice 32, no. 6 (Nov. 2018): 695–97.

nearly 4 million Americans: “Chronic Obstructive Pulmonary Disease (COPD),” Centers for Disease Control and Prevention, National Health Interview Survey, 2018, https://www.cdc.gov/nchs/fastats/copd.htm; “Emphysema: Diagnosis and Treatment,” Mayo Clinic, Apr. 28, 2017, https:/www.mayoclinic.org/diseases-conditionsemphysemadiagnosis-treatment/drc-20355561

Chapter Five: Slow

100 times more: John N. Maina, “Comparative Respiratory Physiology: The Fundamental Mechanisms and the Functional Designs of the Gas Exchangers,” Open Access Animal Physiology 2014, no. 6 (Dec. 2014): 53–66, https://www.dovepress.com/comparative-respiratory-physiology-the-fundamental-mechanisms-and-the--peer-reviewed-fulltext-article-OAAP

“Until the seventeenth century”: Richard Petersham; Campbell, The Respiratory Muscles and the Mechanics of Breathing.

more than 1,500 miles: “How Your Lungs Get the Job Done,” American Lung Association, July 2017, https://www.lung.org/about-us/blog/2017/07/how-your-lungs-work.html

begin a return journey: Each blood cell offloads only about 25 percent of the oxygen; the remaining 75 percent stays on board and goes back to the lungs. The oxygen that doesn’t get off is considered a reserve mechanism, but if the hemoglobin doesn’t pick up new oxygen in the lungs, it will be essentially totally empty after about three circulations, which takes about three minutes.

!!! REVISED !!! appearance of blood: The statement phrase should have been stated and explained more clearly. To wit…Both veins and arteries carry blood that is red: one is red and the other is a darker red, which can “appear” blue, as written. Oxygen and carbon dioxide do indeed influence these colors. Deoxygenated blood is darker due to the difference in shape of the red blood cell when oxygen binds to hemoglobin in the blood cell. But the “blue” appearance of this darker red blood is caused by the way in which light penetrates skin. Blue light has a shorter, stronger wavelength than other colors, which is also why the ocean and sky appear blue at a distance. This note has been revised in all forthcoming editions. “Why Do Many Think Human Blood Is Sometimes Blue?,” NPR, Feb. 3, 2017, https://www.npr.org/sections/13.7/2017/02/03/513003105/why-do-many-think-human-blood-is-sometimes-blue

the body loses weight: Ruben Meerman and Andrew J. Brown, “When Somebody Loses Weight, Where Does the Fat Go?,” British Medical Journal 349 (Dec. 2014): g7257; Rachel Feltman and Sarah Kaplan, “Dear Science: When You Lose Weight, Where Does It Actually Go?,” The Washington Post, June 6, 2016.

By his early 30s, Bohr: If that last name sounds familiar, it should. Christian Bohr was the father of the famed quantum physicist and Nobel laureate Niels Bohr.

Bohr gathered chickens: L. I. Irzhak, “Christian Bohr (On the Occasion of the 150th Anniversary of His Birth),” Human Physiology 31, no. 3 (May 2005): 366–68; Paulo Almeida, Proteins: Concepts in Bio­chemistry (New York: Garland Science, 2016), 289.

to separate oxygen: Albert Gjedde, “Diffusive Insights: On the Disagreement of Christian Bohr and August Krogh at the Centennial of the Seven Little Devils,” Advances in Physiology Education 34, no. 4 (Dec. 2010): 174–85.

This discovery explained: And, of course, the shift in the oxyhemoglobin disassociation curve, the graph which described the relation between partial pressure of oxygen and oxygen saturation of hemoglobin.

Bohr published a paper: An HTML version is available at https://www1.udel.edu/chem/white/C342/Bohr(1904).html

Yandell Henderson: John B. West, “Yandell Henderson,” in Biographical Memoirs, vol. 74 (Washington, DC: National Academies Press, 1998), 144–59, https://www.nap.edu/read/6201/chapter/9.

“Although clinicians”: Yandell Henderson, “Carbon Dioxide,” Cyclopedia of Medicine, vol. 3 (Philadelphia: F. A. Davis, 1940). (Several sources list the date as both 1940 and 1934; it’s likely the article appeared in both editions.) Lewis S. Coleman, “Four Forgotten Giants of Anesthesia History,” Journal of Anesthesia and Surgery 3, no. 2 (Jan. 2016): 1–17; Henderson, “Physiological Regulation of the Acid-Base Balance of the Blood and Some Related Functions,” Physiological Reviews 5, no. 2 (Apr. 1925): 131–60.

of no benefit: This post sums it up nicely with several quotations from researchers in the field: John A. Daller, MD, “Oxygen Bars: Is a Breath of Fresh Air Worth It?,” On Health, June 22, 2017, https://www.onhealth.com/content/1/oxygen_bars_-_is_a_breath_of_fresh_air_worth_it. Additional context can be found in this heavy tome: Nick Lane, Oxy­gen: The Molecule That Made the World (New York: Oxford University Press), 11.

awful experiments: Yandell Henderson, “Acapnia and Shock. I. Carbon-Dioxid [sic] as a Factor in the Regulation of the Heart-Rate,” American Journal of Physiol­ ogy 21, no. 1 (Feb. 1908): 126–56.

“of the word fitness”: John Douillard, Body, Mind, and Sport: The Mind­Body Guide to Lifelong Health, Fitness, and Your Personal Best, rev. ed. (New York: Three Rivers Press, 2001), 153, 156, 211.

On the second day: I should note that on the first day I switched from mouthbreathing to these slow, nasal breaths, my performance suffered: a .44-mile drop in distance compared to my best mouthbreathing performance a week before. This was to be expected. Conditioning the body to constant, slower nasal breathing takes time. Douillard warned his athletes that they should be prepared for a 50 percent decrease in performance after they first switched to nasal breathing. Some athletes had to wait several months to see gains, which is one reason so many of them, and other non-athletes, give up and just return to mouthbreathing. It’s also important to note that these kinds of long inhales and exhales aren’t beneficial, or even possible, for very high intensity exercise. Running 400 meters, for instance, would require much more oxygen to keep up with metabolic needs. Some elite athletes can breathe 200 liters of breath per minute during moments of extreme stress—that’s up to 20 times what’s considered a normal resting volume. But for steady, medium-level exercise like bike riding or jogging, long breaths are far more efficient.

Japanese, African, Hawaiian: Meryl Davids Landau, “This Breathing Exercise Can Calm You Down in a Few Minutes,” Vice, Mar. 16, 2018; Christophe André, “Proper Breathing Brings Better Health,” Scientific American, Jan. 15, 2019.

Ave Maria: Luciano Bernardi et al., “Effect of Rosary Prayer and Yoga Mantras on Autonomic Cardiovascular Rhythms: Comparative Study,” British Medical Journal 323, no. 7327 (Dec. 2001): 144649; T. M. Srinivasan, “Entrainment and Coherence in Biology,” International Journal of Yoga 8, no. 1 (June 2015): 1–2.

a state of coherence: Coherence is the measurement of the harmony of two signals. Whenever two signals increase and decrease in phase, they are in coherence, a state of peak efficiency. Much more about coherence and the benefits of breathing 5.5 times a minute with 5.5-second inhales and exhales can be found in the following: Stephen B. Elliott, The New Science of Breath (Coherence, 2005); Stephen Elliott and Dee Edmonson, Coher­ent Breathing: The Definitive Method (Coherence, 2008); I. M. Lin, L. Y. Tai, and S. Y. Fan, “Breathing at a Rate of5.5 Breaths per Minute with Equal Inhalation-to-Exhalation Ratio Increases Heart Rate Variability,” International Journal of Psychophysiolology 91 (2014): 206–11.

peak efficiency: A good, doctor-reviewed overview of this type of paced “coherent” breathing: Arlin Cuncic, “An Overview of Coherent Breathing,” VeryWellMind, June 25, 2019. https://www.verywellmind.com/an-overview-of-coherent-breathing-4178943

5.5-second inhales: 5.4545 breaths a minute, to be exact

results were profound: Richard P. Brown and Patricia L. Gerbarg, The Healing Power of the Breath: Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions (Boston: Shambhala, 2012), Kindle locations 244–47, 1091–96; Lesley Alderman, “Breathe. Exhale. Repeat: The Benefits of Controlled Breathing,” The New York Times, Nov. 9, 2016.

required no real effort: In 2012, Italian researchers found that breathing at six breaths a minute had powerful effects at high altitudes of 17,000 feet. The technique not only significantly reduced blood pressure but also boosted oxygen saturation in the blood. Grzegorz Bilo et al., “Effects of Slow Deep Breathing at High Altitude on Oxygen Saturation, Pulmonary and Systemic Hemodynamics,” PLoS One 7, no. 11 (Nov. 2012): e49074.

“Nobody knows you’re doing it”: Landau, “This Breathing Exercise Can Calm You Down.”

were in the range of 5.5: Marc A. Russo et al., “The Physiological Effects of Slow Breathing in the Healthy Human,” Breathe 13, no. 4 (Dec. 2017): 298–309.

Chapter Six: Less

From around 1850 to 1960: “Obesity and Overweight,” Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/fastats/obesity-overweight.htm; “Obesity Increase,” Health & Medicine, Mar. 18, 2013; “Calculate Your Body Mass Index,” National Heart, Lung, and Blood Institute.

offers a troubling picture: The breathing rate for an average male, according to a study in the 1930s, used to be about 13 times a minute for a total of 5.25 liters of air. By the 1940s, the rate of breathing hovered a bit over 10 breaths a minute for a total of 8 liters. By the 1980s and 1990s, several studies placed the mean breathing rate at closer to 10 to 12 breaths per minute, with a total volume, in some cases, that rose to 9 liters and higher. I discussed this with Dr. Don Storey, a prominent pulmonologist who’d worked in the field for more than 40 years (and who is my father-in-law). He told me that when he was first starting out, the normal respiratory rate was about 8 to 12 breaths a minute. The high end of that rate is nearly doubled today. Beyond the anecdotes, dozens of studies suggest we could indeed be breathing more than we used to. Most studies compare subjects with respiratory illnesses against healthy controls. It’s the data from the healthy controls that was used for this assessment. Several studies were discovered in Artour Rakhimov’s book Breathing Slower and Less: The Greatest Health Discovery Ever (self-published, 2014). Those studies that could be independently verified were included. In the meantime, here are several studies: N. W. Shock and M. H. Soley, “Average Values for Basal Respiratory Functions in Adolescents and Adults,” Journal of Nutrition 18 (1939): 143–53; Harl W. Matheson and John S. Gray, “Ventilatory Function Tests. III. Resting Ventilation, Metabolism, and Derived Measures,” Journal of Clinical Investigation 29, no. 6 (1950): 688–92; John Kassabian et al., “Respiratory Center Output and Ventilatory Timing in Patients with Acute Airway (Asthma) and Alveolar (Pneumonia) Disease,” Chest 81, no. 5 (May 1982): 536–43; J.E. Clague et al., “Respiratory Effort Perception at Rest and during Carbon Dioxide Rebreathing in Patients with Dystrophia Myotonica,” Thorax 49, no. 3 (Mar. 1994): 240–44; A. Dahan et al., “Halothane Affects Ventilatory after Discharge in Humans,” British Journal of Anaesthesia 74, no. 5 (May 1995): 544–48; N. E. L. Meessen et al., “Breathing Pattern during Bronchial Challenge in Humans,” European Respiratory Journal 10, no. 5 (May 1997): 1059–63.

quarter of the modern population: Mary Birch, Breathe: The 4­ Week Breathing Retraining Plan to Relieve Stress, Anxiety and Panic (Sydney: Hachette Australia, 2019), Kindle locations 228–31. An overview of how poorly we’re breathing can be found here: Richard Boulding et al., “Dysfunctional Breathing: A Review of the Literature and Proposal for Classification,” European Respiratory Review 25, no. 141 (Sept. 2016): 287–94; Robert Fried, The Psychology and Physiology of Breathing: In Behavioral Medicine, Clinical Psychology, and Psychiatry (Springer, 1993); Robert Fried, Hyperventilation Syndrome: Research and Clinical Treatment, Johns Hopkins Series in Contemporary Medicine and Public Health, (The Johns Hopkins University Press, 1986).

chinese doctors: Bryan Gandevia, “The Breath of Life: An Essay on the Earliest History of Respiration: Part I,” Australian Journal of Physiotherapy 16, no. 1 (Mar. 1970): 5–11.

nine and a half breaths per minute: It’s worth mentioning that early Hindus calculated a normal respiratory rate at a much higher rate of 22,636 breaths a day.

“start extending your exhales”: This kind of long inhale and exhale isn’t possible for very high intensity exercise. Running 400 meters, for instance, would require much more oxygen to keep up with metabolic needs. (Endurance athletes can breathe 200 liters of breath per minute during moments of extreme stress—that’s up to 20 times what’s considered a normal resting volume.) But for steady, medium-level exercise like this, long breaths are far more efficient. Maurizio Bussotti et al., “Respiratory Disorders in Endurance Athletes—How Much Do They Really Have to Endure?,” Open Access Journal of Sports Medicine 2, no. 5 (Apr. 2014): 49.

increases VO2 max: Using “slow and less” breathing techniques, subjects in an experiment conducted at the Universitas Muhammadiyah Surakarta, Faculty of Health Science in Indonesia, and presented at the 3rd International Conference on Science, Technology, and Humanity (ISETH) in December 2017, showed a significant VO2 max increase over a control group. Dani Fahrizal and Totok Budi Santoso, “The Effect of Buteyko Breathing Technique in Improving Cardiorespiratory Endurance,” 2017 ISETH Proceeding Book (UMS publications); Several more study summaries are available at Patrick McKeown, “Oxygen Advantage,” https://oxygenadvantage.com/improved-swimming-coordination

“diagnosed machine disorders”: K. P. Buteyko, ed., Buteyko Method: Its Application in Medical Practice (Odessa, Ukraine: Titul, 1991).

shot to 212: Details from this biography were taken from several sources. “The Life of Konstantin Pavlovich Buteyko,” Buteyko Clinic, https://buteykoclinic.com/about-dr-buteyko; “Doctor Konstantin Buteyko,” Buteyko.com, http://www.buteyko.com/methodbuteyko/index_buteyko.html; “The History of Professor K.P. Buteyko,” LearnButeyko.org, http:/www.learnbuteyko.org/the-history-of-professor-kp-buteyko; Sergey Altukhov, Doctor Buteyko’s Discovery (TheBreathingMan, 2009), Kindle locations 570, 572, 617; Buteyko interview, 1988, YouTube, https://www.youtube.com/watch?v=yv5unZd7okw

headed to Akademgorodok: “The Original Silicon Valley,” The Guardian, Jan. 5, 2016; https://www.theguardian.com/artanddesign/gallery/2016/jan/05/akademgorodok-academy-town-siberia-science-russia-in-pictures

Laboratory of Functional Diagnostics: See an amazing photo of the lab below.

6.5 to 7.5 percent carbon dioxide: A copy of Buteyko’s carbon dioxide chart can be found here: https://tinyurl.com/yy3fvrh7

Buteyko developed a protocol: Buteyko’s papers and musings can be downloaded for free on Patrick McKeown’s website: https://tinyurl.com/y3lbfhx2

Zátopek developed: More about hypoventilation training is available on Dr. Xavier Woorons’s website: http:/www.hypoventilation-training.com/index.html; “Emil Zatopek Biography,” Biography Online, May 1, 2010, https://www.biographyonline.net/sport/athletics/emile-zatopek.html; Adam B. Ellick, “Emil Zatopek,” Runner’s World, Mar. 1, 2001, https://www.runnersworld.com/advanced/a20841849/emil-zatopek. For what it’s worth, Zátopek’s height is something of a mystery; some references state he was six feet tall but others, such as ESPN, have him as five-six. The consensus, according to Runner’s World, is that he was about five-eight.

widely derided: Timothy Noakes, Lore of Running, 4th ed. (Champaign, IL: Human Kinetics, 2002), 382.

would later be named: “Emil Zátopek,” Running Past, http://www.runningpast.com/emil_zatopek.htm; Frank Litsky, “Emil Zatopek, 78, Ungainly Running Star, Dies,” The New York Times, Nov. 23, 2000, https://www.nytimes.com/2000/1123/sports/emil-zatopek-78-ungainly-running-star-dies.html

“hurt, pain, and agony”: Joe Hunsaker, “Doc Counsilman: As I Knew Him,” SwimSwam, Jan. 12, 2015, https:/swimswam.com/doc-counsilman-knew/

swim faster: Some interesting context on the possible dangers of Counsilman’s approach in training for younger athletes by swim coach Mike Lewellyn: https://swimisca.org/coach-mike-lewellyn-on-breath-holding-shallow-water-blackout/ An alternative view by Dr. Rob Orr can be found at “Hypoxic Work in the Pool,” PTontheNet, Feb. 14, 2006, https://www.ptonthenet.com/articles/Hypoxic-Work-in-the-Pool-2577. What I’ve surmised from these and several other posts is that hypoxia training works, but it should not be employed as one-size-fits-all training regimen. Physiological, psychological, and numerous anatomical factors must all be considered, as with most any other, training technique. And like any other underwater training, hypoxic training must always be under the close supervision of professionals.

Counsilman used it: “ISHOF Honorees,” International Swimming Hall of Fame, https://ishof.org/dr.-james-e.--doc--counsilman-(usa).html; “A Short History: From Zátopek to Now,” Hypoventilation Training.com, http://www.hypoventilation-training.com/historical.html

U.S. Olympic swim team: Braden Keith, “Which Was the Greatest US Men’s Olympic Team Ever?,” SwimSwam, Sept. 7, 2010, https://swimswam.com/which-was-the-greatest-us-mens-olympic-team-ever/; Jean-Claude Chatard, ed., Biomechanics and Medicine in Swimming IX (Saint-Étienne, France: University of Saint-Étienne Publications, 2003).

boost in red blood cells: To be clear, Woorons’s research is directed at elite athletes looking to get an edge on the competition. Nobody knows the long-term effects of consistently pushing the body into a highly anaerobic state, and several researchers suggest such constant anaerobic workouts may break down the body and cause damaging oxidative stress. Meanwhile, with just a few weeks of Olsson’s lighter, milder training, several of his clients registered significant gains in red blood cell counts. More blood means more oxygen delivered to more tissues. Lance Armstrong, the disgraced cyclist, didn’t get busted for taking adrenaline or steroids but for injecting himself with his own blood and increasing his red blood cell count, which would allow him to carry more oxygen. What Armstrong was essentially doing was an instant fix of breath restriction training.

Breathing way less: Xavier Woorons et al., “Prolonged Expiration down to Residual Volume Leads to Severe Arterial Hypoxemia in Athletes during Submaximal Exercise,” Respiratory Physiology & Neurobiology 158, no. 1 (Aug. 2007): 75–82; Alex Hutchinson, “Holding Your Breath during Training Can Improve Performance,” The Globe and Mail, Feb. 23, 2018, https://www.theglobeandmail.com/life/health-and-fitness/fitness/holding-your-breath-during-training-can-improve-performance/article38089753/

Just a few weeks: E. Dudnik et al., “Intermittent Hypoxia-Hyperoxia Conditioning Improves Cardiorespiratory Fitness in Older Comorbid Cardiac Outpatients without Hematological Changes: A Randomized Controlled Trial,” High Altitude Medical Biology 19, no. 4 (Dec. 2018): 339–43. And much more. A British study of 30 rugby players showed those trained in “normobaric” levels of 13 percent oxygen (equivalent of an altitude of 12,000 feet) had “twofold greater improvements” over controls training in normal sea-level air after just four weeks. A European study of 86 obese women showed hypoxia training led to a “significant decrease in waist circumference” and significant reduction in fat over controls. (More available oxygen in the cells meant that more fat could be burned more efficiently.) And even diabetes! Twenty-eight adults suffering from type 1 diabetes showed that hypoxia training reduced glucose concentrations, keeping the subjects more in line with normal levels over controls. The simple method, the researchers wrote, “may induce significant prevention of diabetes cardiovascular complications.” 

This list goes on: See a photo of Sanya Richards-Ross competing below.

our lungs are roughly half full: Throughout our jogging, Olsson and I used a Relaxator, a device Olsson designed to restrict airflow during exhalations and increase the positive pressure on the lungs, which helps them expand and increase space for gas exchange. Breath resistance devices like the Relaxator can help monitor a consistent flow of air and measure the amount of resistance, but they are optional. The most effective technique in hypoventilation training is to extend exhales and then hold the breath with lungs half-full as long as possible and do it all over again. This can happen anywhere, at any time. The more “air hunger” you create, the more EPO will release from the kidneys, the more red blood cells will release from bone marrow, the more oxygen will upload into your body, the more resilient the body will become, the farther and faster and higher it will go. In the 1990s, Dr. Alison McConnell, a London physiologist and a leading expert on breath training, had cyclists use a resistance device that forced pressure on the inhale. She found that the athletes gained a shocking 33 percent increase in endurance performance after just four weeks. Just five minutes of this training can lower blood pressure by 12 points, about twice what aerobic exercise delivers. Alison McConnell, Breathe Strong, Perform Better (Champaign, IL: Human Kinetics, 2011), 59, 61; Lisa Marshall, “Novel 5-Minute Workout Improves Blood Pressure, May Boost Brain Function,” Medical Xpress, Apr. 8, 2019,https://medicalxpress.com/news/2019-04-minute-workout-blood-pressure-boost.html; Sarah Sloat, “A New Way of Working Out Takes 5 Minutes and Is as Easy as Breathing,” Inverse, Apr. 9, 2019, https://www.inverse.com/article/54740-imst-training-blood-pressure-health

50 scientific papers: An exhaustive list of Buteyko’s studies and other research, in both English and Russian, are available at the following links provided by Breathe Well Clinic (Dublin, Ireland) and Buteyko Clinic International. A compilation of Buteyko’s studies can be found at https:/buteykoclinic.com/wp-content/uploads/2019/04/Dr-Buteykos-Book.pdf

Buteyko Breathing Technique Research

Adelola OA. et al. 2013, Role of Buteyko Breathing Technique in asthmatics with nasal symptoms, Clinical Otolaryngology April; 38(2):190-191; http://buteykoclinic.com/wp-content/uploads/2016/11/Buteyko-Hayfever.pdf

Afle GM and Grover SK To study the effectiveness of Buteyko Breathing Technique versus diaphragmatic breathing in asthmatics I J Physiother, Vol 1 (3) 116-119, August 2014

Arden-Close E et al. Patients’ experiences of breathing re-training for asthma: a qualitative process analysis of participants in the intervention arms of the BREATHE trial, Primary Care Respiratory Medicine, 27, Article number: 56 (2017); https://www.nature.com/articles/s41533-017-0055-5

Austin G. et al. 2009. Buteyko Breathing Technique Reduces Hyperventilation Induced Hypocapnia and Dyspnoea after Exercise in Asthma, Pulmonary Rehabilitation B58 A3409.

Birch M (2012) Clinical Review: Sleep Apnoea – A survey of breathing retraining, Australian Nursing Journal, October, Vol 20, No. 4, pp. 40-41, https://buteyko.info/wp-content/uploads/2017/12/OSA_article_2012.pdf

Bruton A et al. Physiotherapy breathing retraining for asthma: a randomised controlled trial, THE LANCET Respiratory Medicine, Vol 6 January 2018, https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30474-5/fulltext

Bowler SD. et al. (1998) Buteyko breathing techniques in asthma: a blinded randomized controlled trial. MJA, Dec 7-21; 169 (11-12). 

 Burges J et al. (2011) Systematic review of the effectiveness of breathing retraining in asthma management, Expert Rev. Respir. Med. 5(6), 789–807. http://buteykoclinic.com/wp-content/uploads/2016/11/Buteyko-Clinic-Trial-Review.pdf

 Chavda MV and Shah HM. (2016) To compare the efficacy of pursed lip breathing and Buteyko breathing technique to reduce the symptoms of exercise induced asthma in obese children, International Journal of Current Research, Vol. 8, Issue 07, pp. 35058-35064. http://www.journalcra.com/sites/default/files/16028.pdf

Cooper S. et al (2003) Effect of Two Breathing Exercises (Buteyko and Pranayama) in asthma: A Randomised Controlled Trial. Thorax, Vol. 58, No. 8, pp. 649-659,https://thorax.bmj.com/content/58/8/674

 Courtney R. Dysfunctional Breathing: Its Parameters, Measurement and Relevance: A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, School of Health Sciences, Science and Technology Portfolio, RMIT University, February 2011, https://researchbank.rmit.edu.au/eserv/rmit:11996/Courtney.pdf

 Cowie RL et al. 2008 A randomized controlled trial of the Buteyko technique as an adjunct to conventional management of asthma, Respiratory Medicine; May; 102(5):726-32, https://www.resmedjournal.com/article/S0954-6111(07)00511-2/fulltext

Elnaggara RK and Shendy MA (2016) Efficacy of non-invasive respiratory techniques in the treatment of children with bronchial asthma: a randomized controlled trial, Bulletin of Faculty of Physical Therapy, 21:1–10; http://buteykoclinic.com/wp-content/uploads/2017/02/BullFacPhys-08-feb-2017.pdf

Hassan ZM. et al. (2012) Effect of Buteyko breathing technique on patients with bronchial asthma, Egyptian Journal of Chest Diseases and Tuberculosis, 61, 235–241; https://www.sciencedirect.com/science/article/pii/S0422763812000520

Holloway, EA and West RJ (2007) Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial, Thorax, Dec; 62 (12): 1039-1042; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094294

Huidrom K. et al, 2016, Effectiveness of Buteyko breathing technique on respiratory physiological parameters among patients with bronchial asthma, International Journal of Recent Scientific Research, Vol. 7, Issue 5, pp. 11328-1133, http://www.recentscientific.com/sites/default/files/5183.pdf

 Lina, RC. et al. (2014) Effectiveness of Buteyko Method in Asthma Control and Quality of Life of School-age Children, academia.edu, https://www.academia.edu/6072726/Effectiveness_of_Buteyko_Method_in_Asthma_Control_and_Quality_of_Life_of_School-age_Children

 Mendonca KMPP et al (2017) Buteyko Method for children with asthma, American Journal of Respiratory and Critical Care Medicine, 2017; https://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A2203

 Mendonca KMPP et al (2017) Buteyko Method for children with asthma and mouth breathing: a randomised controlled trial, American Journal of Respiratory and Critical Care Medicine, 2017; https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A2204

McGowan, J. 2003. Health Education: Does the Buteyko Institute Method make a difference? Thorax Vol 58, Suppl III, page 28, December. https://buteyko.info/scientific-research/health-education-does-the-buteyko-institute-method-make-a-difference

 McHugh P. et al (2003) Buteyko Breathing Technique for Asthma: An Effective Intervention. Vol. 116, No. 1187.

 McHugh P et al (2006) Buteyko breathing technique and asthma in children: a case series, New Zealand Journal of Medicine, Vol. 119. No. 1234

 O’Connor E et al. Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness, Comparative Effectiveness Reviews, No. 71, Agency for Healthcare Research and Quality (US) 2012. https://www.ncbi.nlm.nih.gov/books/NBK109355

 Opat AJ et al. (2000) A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video Journal Asthma, 37(7):557-64, https://www.ncbi.nlm.nih.gov/pubmed/11059522

Prasanna KB. et al 2015 Effect of Buteyko breathing exercise in newly diagnosed asthmatic patients International Journal of Medicine and Public Health; Jan-Mar, Vol 5, Issue 1,  http://www.ijmedph.org/sites/default/files/IntJMedPublicHealth_2015_5_1_77_151267.pdf

Prem V. et al (2013) Comparison of the Effects of Buteyko and Pranayama Breathing Techniques on Quality of Life in Patients with Asthma- A Randomised Controlled Trial. Vol. 27, No.2, pp.133-141, https://journals.sagepub.com/doi/pdf/10.1177/0269215512450521

Ravinder N. et al. 2012, A Study of effects of Buteyko Breathing Technique on Asthmatic Patients. Indian Journal of Physiotherapy and Occupational Therapy – An International Journal 6(2), 224 228 http://www.indianjournals.com/ijor.aspx?target=ijor:ijpot&volume=6&issue=4&article=045

 Schmid T et al. Buteyko technique (BT) as an adjunct in pulmonary rehabilitation (PR) in patients with asthma and dysfunctional breathing – First results of an ongoing prospective controlled study, European Respiratory Journal 2012 40: P3527 http://erj.ersjournals.com/content/40/Suppl_56/P3527

 Slader CA. et al (2006) Double Blind Randomised Controlled Trial of Two Different Breathing Techniques in the Management of Asthma, pp. 651-656, https://thorax.bmj.com/content/61/8/651

 Thomas M and Bruton A (2014) Breathing exercises for asthma, Breathe, December 1, Vol. 10, No.4 pp 312-322, http://breathe.ersjournals.com/content/10/4/312

 Villareal, M C et al. (2014) Effect of Buteyko Method on Asthma Control and Quality of Life of Filipino Adults with Bronchial Asthma, Journal of Macro Trends in Health and Medicine, Vol 2, Issue 1, http://macrojournals.com/yahoo_site_admin/assets/docs/5HM21Gi.1220536.pdf

25 million Americans: Stephen C. Redd, “Asthma in the United States: Burden and Current Theories,” Environmental Health Perspectives 110, suppl. 4 (Aug. 2002): 557– 60; “Asthma Facts and Figures,” Asthma and Allergy Foundation of America, https:/www.aafa.orgasthma-facts; “Childhood Asthma,” Mayo Clinic, https:/www.mayoclinic.org/diseases-conditions/childhood-asthma/symptoms-causes/syc-20351507

fourfold increase: Paul Hannaway, What to Do When the Doctor Says It’s Asthma (Gloucester, MA: Fair Winds, 2004).

Pollutants, dust, viral infections, cold air: “Childhood Asthma,” Mayo Clinic, https:/www.mayoclinic.org/diseases-conditions/childhood-asthma/symptoms-causes/syc-20351507

asthma can be brought on: Duncan Keeley and Liesl Osman, “Dysfunctional Breathing and Asthma,” British Medical Journal 322 (May 2001): 1075; “Exercise-Induced Asthma,” Mayo Clinic, https:/www.mayoclinic.org/diseases-conditions/childhood-asthma/symptoms-causes/syc-20351507

exercise-induced asthma: R. Khajotia, “Exercise-Induced Asthma: Fresh Insights and an Overview,” Malaysian Family Physician 3, no. 2 (Apr. 2008): 21–24.

worldwide annual market: “Distribution of Global Respiratory Therapy Market by Condition in 2017–2018 (in Billion U.S. Dollars),” Statista, https://www.statista.com/statistics/312329/worldwide-respiratory-therapy-market-by-condition/

worsened asthma symptoms: When a group of medical doctors, professors, and statisticians wanted to know how medicine and procedures actually affected patients, they didn’t look up reviews in WebMD. They noticed that the numbers in many studies were funded by private drug companies and the outcomes were either fudged or grossly misleading. So these researchers gathered studies from dozens of different treatments and reanalyzed the data to offer an accurate measurement of the impact of a medicine or therapy. To give a real-life view into how effective drugs and treatments are, the researchers’ outcomes estimated the number of patients who need to be treated to have an impact on one person. They called their organization The NNT, a simple statistical concept: “Number Needed to Treat.” Since starting in 2010, NNT (https://www.thennt.com) has surveyed more than 275 drugs and therapies in fields ranging from cardiology to endocrinology to dermatology. They rated each of these drugs and therapies on a color scale: green (the therapy or drug has clear benefits); yellow (it is unclear if it has any benefits); red (no benefits); and black (the treatment is more harmful to patients than helpful). They reviewed 48 trials, including tens of thousands of subjects, of a standard asthma treatment: long-acting beta-agonists (LABA) with corticosteroids, an inhaled combination drug treatment with trade names Advair and Symbicort, designed to keep smooth muscles in the airways constantly relaxed. Of the 48 trials represented, 44 were sponsored by the pharmaceutical maker of long-acting beta-agonists, one of the two drugs in combination. This drug was not only approved, but used by likely millions of asthmatics every year. NNT crunched the numbers and found that combination LABAs and steroid inhalers were not only totally ineffective but harmful. Only 1 in 73 asthmatic patients who used the drug reduced their chances of mild to moderate asthma attack. Meanwhile, the drug provoked a severe asthma attack in 1 in 140 people. According to NNT, the drug “seems to have caused an asthma-related death” for 1 in every 1,400 asthmatics. LABAs were equally ineffective for children. More context on this subject: Vassilis Vassilious and Christos S. Zipitis, “Long-Acting Bronchodilators: Time for a Re-think,” Journal of the Royal Society of Medicine 99, no. 8 (Aug. 2006): 382–83.

David Wiebe: Jane E. Brody, “A Breathing Technique Offers Help for People with Asthma,” The New York Times, Nov. 2, 2009, https://www.nytimes.com/2009/11/03/health/03brod.html; “Almost As If I No Longer Have Asthma After Natural Solution,” Breathing Center, Apr. 2009, https://www.breathingcenter.com/testimonials-by-category

asthma and overall health: Sasha Yakovleva, K. Buteyko, et al., Breathe to Heal: Break Free from Asthma (Breathing Normalization) (Breathing Center, 2016), 246; “Buteyko Breathing for Improved Athletic Performance,” Buteyko Toronto, http://www.buteykotoronto.com/buteyko-and-fitness

Sanya Richards-Ross: “Buteyko and Fitness,” Buteyko Toronto, http://www.buteykotoronto.com/buteyko-and-fitness

They all breathed better: Thomas Ritz et al., “Controlling Asthma by Training of Capnometry-Assisted Hypoventilation (CATCH) Versus Slow Breathing: A Randomized Controlled Trial,” Chest 146, no. 5 (Aug. 2014): 1237–47.

“very strange happening”: “Asthma Patients Reduce Symptoms, Improve Lung Function with Shallow Breaths, More Carbon Dioxide,” ScienceDaily, Nov. 4, 2014, https://www.sciencedaily.com/releases/2014/11/141104111631.htm

A half-dozen other clinical trials: “Effectiveness of a Buteyko-Based Breathing Technique for Asthma Patients,” ARCIM Institute—Academic Research in Complementary and Integrative Medicine, 2017.

real damage from overbreathing: It’s worth noting that overbreathing can also cause calcium levels to drop in your blood, which can result in numbness and tingling, muscle spasms, cramps, and twitching.

Weeks, months, or years: If the body is forced to constantly compensate by excreting bicarbonate, levels of this chemical will begin to taper off, and the pH will waver from its optimum functioning at7.4. John G. Laffey and Brian P. Kavanagh, “Hypocapnia,” New England Journal of Medicine 347 (July 2002): 46; G. M. Woerlee, “The Magic of Hyperventilation,” Anesthesia Problems & Answers, http://www.anesthesiaweb.org/hyperventilation.php

becomes even more difficult: Jacob Green and Charles R. Kleeman, “Role of Bone in Regulation of Systemic Acid-Base Balance,” Kidney International 39, no. 1 (Jan. 1991): 9–26.

stave off further attacks: “Magnesium Supplements May Benefit People with Asthma,” NIH National Center for Complementary and Integrative Health, Feb. 1, 2010.

“The yogi’s life is not measured”: Andrew Holecek, Preparing to Die: Practical Advice and Spiritual Wisdom from the Tibetan Buddhist Tradition (Boston: Snow Lion, 2013). Animal metrics were taken from these studies: “Animal Heartbeats,” Every Second, https://everysecond.io/animal-heartbeats; “The Heart Project,” Public Science Lab, http://robdunnlab.com/projects/beats-per-life/; Yogi Cameron Alborzian, “Breathe Less, Live Longer,” The Huffington Post, Jan. 14, 2010, https://www.huffpost.com/entry/breathe-less-live-longer_b_422923; Mike McRae, “Do We Really Only Get a Certain Number of Heartbeats in a Lifetime? Here’s What Science Says,” ScienceAlert, Apr. 14, 2018, https://www.sciencealert.com/relationship-between-heart-beat-and-life-expectancy

Chapter 7: Chew

Twelve thousand years ago: “Malocclusion and Dental Crowding Arose 12,000 Years Ago with Earliest Farmers, Study Shows,” University College Dublin News, http://www.ucd.ie/news/2015/02FEB15/050215-Malocclusion-and-dental-crowding-arose-12000-years-ago-with-earliest-farmers-study-shows.html; Ron Pinhasi et al., “Incongruity between Affinity Patterns Based on Mandibular and Lower Dental Dimensions following the Transition to Agriculture in the Near East, Anatolia and Europe,” PLoS One 10, no. 2 (Feb. 2015): e0117301.

first widespread instances of crooked teeth: Jared Diamond, “The Worst Mistake in the History of the Human Race,” Discover, May 1987, http://discovermagazine.com/1987/may/02-the-worst-mistake-in-the-history-of-the-human-race; Jared Diamond, The Third Chimpanzee: The Evolution and Future of the Human Animal (New York: HarperCollins, 1992).

The dead were downstairs: Natasha Geiling, “Beneath Paris’s City Streets, There’s an Empire of Death Waiting for Tourists,” Smithsonian.com, Mar. 28, 2014, https:/www.smithsonianmag.com/travel/paris-catacombs-180950160; “Catacombes de Paris,” Atlas Obscura, https://www.atlasobscura.com/places/catacombes-de-paris

largest graveyards on Earth: The largest being Wadi-us-Salaam in Iraq, which contains tens of millions of bodies.

the average Briton: Gregori Galofré-Vilà, et al., “Heights across the Last 2000 Years in England,” University of Oxford, Discussion Papers in Economic and Social History, no. 151, Jan. 2017, 32, https://www.economics.ox.ac.uk/materials/working_papers/2830/151-final.pdf C.W., “Did Living Standards Improve during the Industrial Revolution?,” The Economist, https:/www.economist.com/free-exchange/20130913/did-living-standards-improve-during-the-industrial-revolution

teeth removed altogether: According to a civil servant at the National Health Service, up to the mid-1990s it was common for women to be given vouchers to have all their teeth removed before their 16th or 18th birthday in areas around the northeast of England. Letters, London Review of Books 39, no. 14 (July 2017), https://www.lrb.co.uk/v39/n14/letters

Victorian dentist observed: Review of J. Sim Wallace, The Physiology of Oral Hygiene and Recent Research, with Special Reference to Accessory Food Factors and the Incidence of Dental Caries (London: Ballière, Tindall and Cox, 1929), in Journal of the American Medical Association 95, no. 11 (Sept. 1930): 819.

In the 1800s: I’m talking about Edward Mellanby, a British researcher who would be knighted for his work and would blame our shrinking faces on deficiencies of vitamin D in the modern diet. An American dentist named Percy Howe Thought crooked teeth were caused by lack of vitamin C.

“Since we have known”: Earnest A. Hooton, foreword to Weston A. Price, Nutrition and Physical Degeneration (New York: Paul B. Hoeber, 1939). “Let us cease pretending that toothbrushes and toothpaste are any more important than shoe brushes and shoe polish. It is store food that has given us store teeth,” Hooton wrote in his own book, Apes, Men, and Morons (New York: G. P. Putnam’s Sons, 1937).

Price found communities: When Price later examined samples of the bread and cheese from the village of Loetschental in his laboratory in Cleveland, he found that it contained 10 times the amount of vitamins A and D of all the foods in a typical modern American diet at the time. Price researched the dead as well. In Peru, he painstakingly analyzed 1,276 skulls that ranged from a few hundred to a few thousand years old. Not a single skull had any deformity in its dental arches, not one face was deformed or misshaped. Weston A. Price, Nutrition and Physical Degeneration, 8th ed. (Lemon Grove, CA: Price-Pottenger Nutrition Foundation, 2009).

food was wild animals: The Native Americans whom Price visited in northern Canada had no access to fruits or vegetables during the long winters, and thus no vitamin C. Price noted that they should have all been sick or dead from scurvy, yet they appeared to be in vigorous health. An elder chief described to Price how the tribe would occasionally kill a moose, cut open its back, and pull out two small balls of fat just above the kidneys. They’d cut up these balls and distribute them among the family. Price later discovered that these balls were the adrenal glands, the richest source of vitamin C in all animal and plant tissues.

But some complained: “Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects,” Journal of the American Medical Association 114, no. 26 (June 1940): 2589, https://jamanetwork.com/journals/jama/article-abstract/1160631?redirect=true

Balloon sinuplasty: Nayak was careful to point out that these patients were a highly selected cohort and that patients needed no other procedural treatments over an additional one-year period. He told me that balloon sinuplasty worked for these patients, but wouldn’t work for everyone.

the Cottle’s maneuver: Jukka Tikanto and Tapio Pirilä, “Effects of the Cottle’s Maneuver on the Nasal Valve as Assessed by Acoustic Rhinometry,” American Journal of Rhinology 21, no. 4 (July 2007): 456–59.

have a deviated septum: Shawn Bishop, “If Symptoms Aren’t Bothersome, Deviated Septum Usually Doesn’t Require Treatment,” Mayo Clinic News Network, July 8, 2011, https://newsnetwork.mayoclinic.org/discussion/if-symptoms-arent-bothersome-deviated-septum-usually-doesnt-require-treatment/

50 percent of us have: Sanford M. Archer and Arlen D. Meyers, “Turbinate Dysfunction,” Medscape, Feb. 13, 2019.

75 percent of his turbinates removed: Peter’s story was particularly heart-wrenching. After his surgeries doctors prescribed antidepressants and told him he just suffered from age-related problems. He spent the next three years learning to construct an elaborate threedimensional model from X-rays that he would then use to measure something called “Computational Fluid Dynamics.” These before-and-after models and the data allowed him to determine the exact changes to airflow velocity, distribution, temperature, pressure, resistance, and humidity levels that were affected by his previous turbinate surgeries. Overall, his nasal cavity was four times larger than what is considered normal or healthy. His nose had lost the ability to properly heat air, and air was moving through it twice as fast as it should. And still, Peter says, a large proportion of the medical community argues that empty nose syndrome is a psychological problem, not a physical one. Read more about Peter’s research: http:/emptynosesyndromeaerodynamics.com

contemplated suicide: The medical community at large viewed empty nose syndrome as a problem of the mind, not the nose. One doctor went so far as to refer to empty nose syndrome in the Los Angeles Times as “empty head syndrome”; Aaron Zitner, “Sniffing at Empty Nose Idea,” Los Angeles Times, May 10, 2001; Cedric Lemogne et al., “Treating Empty Nose Syndrome as a Somatic Symptom Disorder,” General Hospital Psychiatry 37, no. 3 (May–June 2015): 273.e9–e10; Joel Oliphint, “Is Empty Nose Syndrome Real? And If Not, Why Are People Killing Themselves Over It?,” BuzzFeed, Apr. 14, 2016, https://www.buzzfeed.com/joeloliphint/is-empty-nose-syndrome-real-and-if-not-why-are-people-killin; Yin Lu, “Kill the Doctors,” Global Times, Nov. 26, 2013, http://www.globaltimes.cn/content/827820.shtml

hundreds of people: Dozens of researchers have confirmed so much of what Peter and other empty nose syndrome sufferers have reported: that the condition is the result of real, measurable damage that has occurred from surgery.

Select Empty Nose Syndrome Research

Chris Martin, Having Nasal Surgery? Don't You Become an Empty Nose Victim! (Nashville: Cold Tree Press, 2007).

Chengyu Li, Alexander A. Farag, James Leach, Bhakthi Deshpande, et al. "Computational Fluid Dynamics and Trigeminal Sensory Examinations of Empty Nose Syndrome Patients," Laryngoscope, Jun 1, 2018, E176-184, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5445013

Jennifer Malik, et al. "The Cotton Test Redistributes Nasal Airflow in Patients with Empty Nose Syndrome," International Forum of Allergy & Rhinology, Jan. 2020, 539-545, https://onlinelibrary.wiley.com/doi/abs/10.1002/alr.22489

Jamie Manji, Jayakar Nayak, et al, "The Functional and Psychological Burden of Empty Nose Syndrome," The International Forum of Allergy & Rhinology, June 2018, 707-712, https://onlinelibrary.wiley.com/doi/10.1002/alr.22097

Boris V. Balakin, et al. "Aerodynamic Evaluation of the Empty Nose Syndrome by Means of Computational Fluid Dynamics," Computer Methods in Biomechanics and Biomedical Engineering, Vol. 20, 2017, Issue 14, https://pubmed.ncbi.nlm.nih.gov/29064287

Chengyu Li, et al. "Investigation of the Abnormal Nasal Aerodynamics and Trigeminal functions Among Empty Nose Syndrome Patients," International Forum of Allergy & Rhinology, March 2018, 444-452, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015742

Anupriya Dayal, et al. "Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics," Otolaryngology Head Neck Surgery, Sept. 2016, 518-525, https://pubmed.ncbi.nlm.nih.gov/27165673

Guilherme J.M. Garcia et al, “Atrophic Rhinitis: A CFD Study of Air Conditioning in the Nasal Cavity," Journal of Applied Physiology, Oct 2017, 1082-92, https://pubmed.ncbi.nlm.nih.gov/17569762

up to 20 percent: Oliphint, “Is Empty Nose Syndrome Real?”

linked to obstruction: Michael L. Gelb, “Airway Centric TMJ Philosophy,” CDA Journal 42, no. 8 (Aug. 2014): 551–62, https://pdfs.semanticscholar.org/8bc1/8887d39960f9cce328f5c61ee356e11d0c09.pdf

risk of airway obstruction: Felix Liao, Six­Foot Tiger, Three­Foot Cage: Take Charge of Your Health by Taking Charge of Your Mouth (Carlsbad, CA: Crescendo, 2017), 59.

Friedman tongue position scale: Rebecca Harvey et al., “Friedman Tongue Position and Cone Beam Computed Tomography in Patients with Obstructive Sleep Apnea,” Laryngoscope Investigative Otolaryngology 2, no. 5 (Aug. 2017): 320–24; Pippa Wysong, “Treating OSA? Don’t Forget the Tongue,” ENTtoday, Jan. 1, 2008, https://www.enttoday.org/article/treating-osa-dont-forget-the-tongue/

clog the throat: An overview of this dilemma can be found on Dr. Eric Kezirian’s website: https://sleep-doctor.com/blog/

more than 17 inches: Liza Torborg, “Neck Size One Risk Factor for Obstructive Sleep Apnea,” Mayo Clinic, June 20, 2015, https:/newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-neck-size-one-risk-factor-for-obstructive-sleep-apnea

Ninety percent of the obstruction: Gelb, “Airway Centric TMJ Philosophy”; Luqui Chi et al., “Identification of Craniofacial Risk Factors for Obstructive Sleep Apnoea Using Three-Dimensional MRI,” European Respiratory Journal 38, no. 2 (Aug. 2011): 348–58.

especially effective for children: Babies who have breathing issues at six months have a 40 percent greater chance of having behavioral issues (including ADHD) starting around age four, according to Gelb. Michael Gelb and Howard Hindin, Gasp! Airway Health—The Hidden Path to Wellness (self-published, 2016), Kindle location 850.

kids with ADHD: Chai Woodham, “Does Your Child Really Have ADHD?,” U.S. News, June 20, 2012, https://health.usnews.com/health-news/articles/2012/06/20/does-your-child-really-have-adhd

problems that come with it: More on this very expansive and very depressing subject: “Kids Behave and Sleep Better after Tonsillectomy, Study Finds,” press release, University of Michigan Health System, Apr. 3, 2006, https://www.eurekalert.org/pub_releases/2006-04/uomh-kba032806.php; Susan L. Garetz, “Adenotonsillectomy for Obstructive Sleep Apnea in Children,” UptoDate, Oct. 2019, https://www.uptodate.com/contents/adenotonsillectomy-for-obstructive-sleep-apnea-in-children  It’s worth noting, as well, that according to several studies, most mouthbreathing children are also sleep-deprived, and lack of sleep will have a direct impact on growth. Yosh Jefferson, “Mouth Breathing: Adverse Effects on Facial Growth, Health, Academics, and Behavior,” General Dentistry 58, no. 1 (Jan.–Feb. 2010): 18–25; Carlos Torre and Christian Guilleminault, “Establishment of Nasal Breathing Should Be the Ultimate Goal to Secure Adequate Craniofacial and Airway Development in Children,” Jornal de Pediatria 94, no. 2 (Mar.–Apr. 2018): 101–3. A study that followed 1,900 children for 15 years found that children with severe snoring, sleep apnea, and other sleep-disordered breathing were twice as likely to become obese compared to children who didn’t snore. Those children who had the worst symptoms had a 60 to 100 percent increased risk of obesity. “Short Sleep Duration and Sleep-Related Breathing Problems Increase Obesity Risk in Kids,” press release, Albert Einstein College of Medicine, Dec. 11, 2014.

Norman Kingsley: Sheldon Peck, “Dentist, Artist, Pioneer: Orthodontic Innovator Norman Kingsley and His Rembrandt Portraits,” Journal of the American Dental Association 143, no. 4 (Apr. 2012): 393–97.

Pierre Robin: Ib Leth Nielsen, “Guiding Occlusal Development with Functional Appliances,” Australian Orthodontic Journal 14, no. 3 (Oct. 1996): 133–42; “Functional Appliances,” British Orthodontic Society; John C. Bennett, Orthodontic Management of Uncrowded Class II Division 1 Malocclusion in Children (St. Louis: Mosby/Elsevier, 2006); “Isolated Pierre Robin sequence,” Genetics Home Reference, https://ghr.nlm.nih.gov/condition/isolated-pierre-robin-sequence

retractive orthodontics: Edward Angle, considered the “father of American orthodontics,” was opposed to extracting teeth; meanwhile, his student, Charles H. Tweed, would go on to champion extractions. In the end, Tweed’s approach won. Sheldon Peck, “Extractions, Retention and Stability: The Search for Orthodontic Truth,” European Journal of Orthodontics 39, no. 2 (Apr. 2017): 109–15.

Dr. John Mew: Mew had spent three years as a facial surgeon at Queen Victoria Hospital in West Sussex studying how the mouth worked. He knew that the 14 jigsaw-puzzle bones that made up the face needed to develop together in just the right way; any disruption of any of these bones could affect the function and growth of the entire mouth and face.

who’d gotten extractions: That tooth extractions cause a flattening of the face is not widely accepted in the orthodontics industry. Several studies have claimed that extractions cause retrognathic facial growth, while others show little or no change in the face. Still others say results will vary and can only be determined by first considering the width of the palate. Antônio Carlos de Oliveira Ruellas et al., “Tooth Extraction in Orthodontics: An Evaluation of Diagnostic Elements,” Den­tal Press Journal of Orthodontics 15, no. 3 (May–June 2010): 134–57; Anita Bhavnani Rathod et al., “Extraction vs No Treatment: Long-Term Facial Profile Changes,” American Journal of Orthodontics and Dentofacial Orthopedics 147, no. 5 (May 2015): 596–603; Abdol-Hamid Zafarmand and Mohamad-Mahdi Zafarmand, “Premolar Extraction in Orthodontics: Does It Have Any Effect on Patient’s Facial Height?,” Journal of the International Society of Preventive & Community Den­tistry 5, no. 1 (Jan. 2015): 64–68.

Brothers and sisters measured: John Mew, The Cause and Cure of Malocclusion (John Mew Orthotropics), https://johnmeworthotropics.co.uk/product/the-cause-and-cure-of-malocclusion-e-book/; Vicki Cheeseman, interview with Kevin Boyd, “Understanding Modern Systemic Diseases through a Study of Anthropology,” Dentistry IQ, June 27, 2012.

Several other dentists: More than two dozen scientific studies dating back to the 1930s available at “Right to Grow,” https://www.righttogrow.org/the_research

“quack,” “scammer”: The half century of resistance from the orthodontics industry against John Mew, I’d learned, likely had less to do with Mew’s data than with his take-no-prisoners approach to disseminating it. Even one of Mew’s most ardent and vocal detractors, a British orthodontist named Roy Abrahams, admitted to me in an email exchange that it wasn’t Mew’s theories that were necessarily the problem, but that Mew had never proven his theories when given a chance and instead constantly “rubbish[es] traditional orthodontics and orthodontists to further his claims.”

famed evolutionary biologist: Sandra Kahn and Paul R. Ehrlich, Jaws: The Story of a Hidden Epidemic (Stanford, CA: Stanford University Press, 2018).

in his late 70s: Mew told me that most of his foes use the castle as an example of how he’d profited from orthotropics. The total cost of the castle was about 300,000 pounds, he said, about a third of the cost of a dilapidated two-bedroom modern condo up the road.

A 2006 peer-reviewed study: G. Dave Singh et al., “Evaluation of the Posterior Airway Space Following Biobloc Therapy: Geometric Morphometrics,” Cranio: The Journal of Craniomandibular & Sleep Practice 25, no. 2 (Apr. 2007): 84–89, https:/facefocused.com/articles-and-lectures/bioblocs-impact-on-the-airway/

neck extended outward: Assuming this open-mouthed posture throughout childhood can directly influence the growth and development of the jaws, airway, and even the alignment of the teeth. Joy L. Moeller et al., “Treating Patients with Mouth Breathing Habits: The Emerging Field of Orofacial Myofunctional Therapy,” Journal of the American Orthodontic Society 12, no. 2 (Mar.–Apr. 2012): 10–12.

“that’s what we’ve become”: Modern humans could be the first Homo species to suffer from this malady. Even our Neanderthal cousins were not the knuckle-dragging, stooped-over beasts they’d been depicted as for the past hundred years. Their posture was upright, perhaps even better than our own. Martin Haeusler et al., “Morphology, Pathology, and the Vertebral Posture of the La Chapelle-aux-Saints Neanderthal,” Proceedings of the Na­tional Academy of Sciences of the United States of America 116, no. 11 (Mar. 2019): 4923–27.

“cranial dystrophy”: M. Mew, “Craniofacial Dystrophy. A Possible Syndrome?,” British Dental Journal 216, no. 10 (May 2014): 555–58.

“a new health craze”: Elena Cresci, “Mewing Is the Fringe Orthodontic Technique Taking Over YouTube,” Vice, Mar. 11, 2019, https://www.vice.com/en_us/article/d3medj/mewing-is-the-fringe-orthodontic-technique-taking-over-youtube

viewed a million times: “Doing Mewing,” YouTube, https://www.youtube.com/watch?v=Hmf-pR7EryY

survival of the fittest: Quentin Wheeler, Antonio G. Valdecasas, and Cristina Cânovas, “Evolution Doesn’t Proceed in a Straight Line—So Why Draw It That Way?” The Conversation, Sept. 3, 2019, https:/theconversation.com/evolution-doesnt-proceed-in-a-straight-line-so-why-draw-it-that-way-109401

Women will suffer: “Anatomy & Physiology,” Open Stax, Rice University, June 19, 2013, https://openstax.org/books/anatomy-and-physiologypages6-6 -exercise-nutrition-hormones-and-bone-tissue

most apparent: “Our Face Bones Change Shape As We Age,” Live Science, May 30, 2013, https://www.livescience.com/35332-face-bones-aging-110104.html

lead to airway obstruction: Yagana Shah, “Why You Snore More As You Get Older and What You Can Do About It,” The Huffington Post, June 7, 2015, https://www.huffpost.com/entry/how-to-stop-snoring_n_7687906

power of the masseter: “What Is the Strongest Muscle in the Human Body?,” Everyday Mysteries: Fun Science Facts from the Library of Congress, https://www.loc.gov/rr/scitech/mysteries/muscles.html

more dense into our 70s: Belfor wasn’t the first researcher to discover this. In 1986, orthodontist Dr. Vincent G. Kokich, a professor in the Department of Orthodontics at the University of Washington and one of the world’s experts in dentistry, postulated that adults “retain the capacity to regenerate and remodel bone at the craniofacial sutures.” Liao, Six­Foot Tiger, 176–77.

the more stem cells release: We create stem cells throughout the body as well. The stem cells made in the sutures and jaws are often used for local maintenance in the mouth and face. Stem cells will ship off to whatever area needs them most. What they are attracted to are stress signals—in this case, the signals that come with vigorous chewing.

two to four years of age: “Weaning from the Breast,” Paediatrics & Child Health 9, no. 4 (Apr. 2004): 249–53.

lower incidence: Bottle-feeding requires less “chewing” and sucking stress, and, as such stimulates less forward facial growth. For this reason, Kevin Boyd, the Chicago pediatric dentist, recommends cup feeding infants if breastfeeding isn’t an option. James Sim Wallace, The Cause and Prevention of Decay in Teeth (London:J. & A. Churchill, 1902). Indrė Narbutyte et al., “Relationship Between Breastfeeding, Bottle-Feeding and Development of Malocclusion,” Stomatologija, Baltic Dental and Maxillofacial Journal 15, no. 3 (2013): 67–72; Domenico Viggiano et al., “Breast Feeding, Bottle Feeding, and Non-Nutritive Sucking: Effects on Occlusion in Deciduous Dentition,” Archives of Disease in Childhood 89, no. 12 (Jan. 2005): 1121– 23; Bronwyn K. Brew et al., “Breastfeeding and Snoring: A Birth Cohort Study,” PLoS One 9, no. 1 (Jan. 2014): e84956.

stimulates the stress: Every time I bite down while wearing the Homeblock I’ll be eliciting cyclical intermittent light force in combination with the light springing pressure that will send a signal to the ligament around the roots of the teeth to encourage the body to, according to Belfor, “begin a cascade of events” which produces more bone cells. The process is called morphogenesis and it all sounded brutal. But Belfor assured me I won’t even notice it happening because I’d only need to wear the retainer while I am sleeping.

“An early soft diet”: Ben Miraglia, DDS, “2018 Oregon Dental Conference Course Handout,” Oregon Dental Conference, Apr. 5, 2018, https://www.oregondental.org/docs/librariesprovider42/2018-odc-handouts/thursday---9122-miraglia.pdf?sfvrsn=2

ancient skulls measured: Specifically, from 2.12 and 2.62 inches before the Industrial Age to 1.88 to 2.44 inches afterward. J. N. Starkey, “Etiology of Irregularities of the Teeth,” The Dental Surgeon 4, no. 174 (Feb. 29, 1908): 105–6.

“gradually becoming smaller”: J. Sim Wallace, “Heredity, with Special Reference to the Diminution in Size of the Human Jaw,” digest of Dental Record, Dec. 1901, in Dental Digest 8, no. 2 (Feb. 1902): 135–40, https://tinyurl.com/r6szdz8

feeding a group of pigs: Yucatan minipigs, that is. Russell L. Ciochon et al., “Dietary Consistency and Craniofacial Development Related to Masticatory Function in Minipigs,” Journal of Craniofacial Genetics and Developmental Biology 17, no. 2 (Apr.–June 1997): 96–102.

some form of malocclusion: These round averages were summarized and verified by Dr. Robert Corruccini. Further overview context can be found in Mirigama, “2018 Oregon Dental Conference Course Handout.”

Chapter Eight: More, on Occasion

twelve hundred men: Micheal Clodfelter, Warfare and Armed Conflicts: A Statistical Encyclopedia of Casualty and Other Figures, 1492–2015, 4th ed. (Jefferson, NC: McFarland, 2017), 277.

30 or more times: J. M. Da Costa, “On Irritable Heart; a Clinical Study of a Form of Functional Cardiac Disorder and its Consequences,” American Journal of Medical Sciences, n.s. 61, no. 121 (1871).

The same symptoms: Jeffrey A. Lieberman, “From ‘Soldier’s Heart’ to ‘Vietnam Syndrome’: Psychiatry’s 100-Year Quest to Understand PTSD,” The Star, Mar. 7, 2015, https://www.thestar.com/news/insight/2015/03/07/solving-the-riddle-of-soldiers-heart-post-traumatic-stress-disorder-ptsd.html; Christopher Bergland. “Chronic Stress Can Damage Brain Structure and Connectivity,” Psychology Today, Feb. 12, 2004.

20 percent of soldiers: “From Shell-Shock to PTSD, a Century of Invisible War Trauma,” PBS NewsHour, Nov. 11, 2018, https:/www.pbs.org/newshour/nationfrom-shell-shock-to-ptsd-a-century-of-invisible-war-trauma; Caroline Alex-ander, “The Shock of War,” Smithsonian, Sept. 2010, https://www.smithsonianmag.com/history/the-shock-of-war-55376701/

breaths are so relaxing: As well, the lower lungs contain from 60 to 80 percent of blood-saturated alveoli, for easier and more efficient gas exchange. Body, Mind, and Sport, 223.

has an opposite role: Phillip Low, “Overview of the Autonomic Nervous System,” Merck Manual, consumer version, https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/autonomic-nervous-system-disorders/overview-of-the-autonomic-nervous-system

Heart rate increases: “How Stress Can Boost Immune System,” ScienceDaily, June 21, 2012; “Functions of the Autonomic Nervous System,” Lumen, https://courses.lumenlearning.com/boundless-ap/chapter/functions-of-the-autonomic-nervous-system/

pupils dilate: Joss Fong, “Eye-Opener: Why Do Pupils Dilate in Response to Emotional States?,” Scientific American, Dec. 7, 2012, https://www.scientificamerican.com/article/eye-opener-why-do-pupils-dialate/

heightened sympathetic alert: The sympathetic control center is located not in the brain but in the vertebral ganglia along the spine, while the parasympathetic system is located further up in the brain. This may not be a coincidence. Some researchers, such as Stephen Porges, suggest that the sympathetic system is a more primitive system while the parasympathetic system is more evolved.

an hour or more: “What Is Stress?,” American Institute of Stress, https:/www.stress.org/daily-life

man named Naropa: “Tibetan Lama to Teach an Introduction to Tummo, the Yoga of Psychic Heat at HAC January 21,” Healing Arts Center (St. Louis), Dec. 20, 2017, https://www.thehealingartscenter.com/hac-news/tibetan-lama-to-teach-an-introduction-to-tummo-the-yoga-of-psychic-heat-at-hac; “NAROPA,” Garchen Buddhist Institute, July 14, 2015, https:/garchen.net/naropa

wrote David-Néel: Alexandra David-Néel, My Journey to Lhasa (1927; New York: Harper Perennial, 2005), 135.

Professional surfers, mixed martial arts fighters: Nan-Hie In, “Breathing Exercises, Ice Baths: How Wim Hof Method Helps Elite Athletes and Navy Seals,” South China Morning Post, Mar. 25, 2019, https://www.scmp.com/lifestyle/health-wellness/article/3002901/wim-hof-method-how-ice-baths-and-breathing-techniques

His primary focus is the vagus: Stephen W. Porges, The Pocket Guide to the Poly­ vagal Theory: The Transformative Power of Feeling Safe, Norton Series on Interpersonal Neurobiology (New York: W. W. Norton, 2017), 131, 140, 160, 173, 196, 242, 234.

call it fainting: Specifically, when the vagus nerve is stimulated, the heart rate slows and the blood vessels dilate, making it harder for blood to defeat gravity and be pumped to the brain. This temporary decrease in blood flow to the brain can cause the fainting episode.

organs cut off from normal: Steven Park, Sleep Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired (New York: Jodev Press, 2008), Kindle locations 1443–46.

lessen these symptoms: “Vagus Nerve Stimulation,” Mayo Clinic, https://www.mayoclinic.org/tests-procedures/vagus-nerve-stimulation/about/pac-20384565; Crystal T. Engineer et al., “Vagus Nerve Stimulation as a Potential Adjuvant to Behavioral Therapy for Autism and Other Neurodevelopmental Disorders,” Journal Of Neurodevelopmental Disorders 9 (July 2017): 20.

less invasive way: There was also swinging. Rocking chairs and porch swings were very common in houses before the first half of the twentieth century. They may have been so popular because swinging shifts blood pressure, which allows messages to more easily travel back and forth along the vagus nerve. This is why so many autistic children (who often have poor vagal tone and feel constantly under threat) respond so well to swinging. Cold exposure, like splashing cold water on the face, also stimulates the vagus nerve, which sends messages to the heart to lower the heart rate. (Place your face in cold water and your heart rate will quickly drop.) Porges, Pocket Guide to the Poly­ vagal Theory, 211–12.

speed up our heart: Some very rare exceptions are demonstrated by yogis; these are discussed in the final chapter.

when to breathe: Roderik J. S. Gerritsen and Guido P. H. Band, “Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity,” Frontiers in Human Neuroscience 12 (Oct. 2018): 397; Christopher Bergland, “Longer Exhalations Are an Easy Way to Hack Your Vagus Nerve,” Psychology Today, May 9, 2019.

Willing ourselves: Moran Cerf, “Neuroscientists Have Identified How Exactly a Deep Breath Changes Your Mind,” Quartzy, Nov. 19, 2017; Jose L. Herrero et al., “Breathing above the Brain Stem: Volitional Control and Attentional Modulation in Humans,” Journal of Neurophysiology 119, no. 1 (Jan. 2018): 145–59.

consciously access the autonomic: The nervous system helps explain why breathing into a paper bag to control hyperventilation often doesn’t work and can be very dangerous. Yes, capturing your exhaled breath will increase carbon dioxide levels, but it very often won’t curb the sympathetic overload that could have triggered the panic attack to begin it. A paper bag might elicit more panic, and even deeper breathing. Further, not everyone who is suffering an attack in the respiratory system is suffering from hyperventilation. A study in The Annals of Emergency Medicine found that three patients believed to have been hyperventilating were given a paper bag to breathe into and died. These patients weren’t suffering from a panic or asthma attack; they were suffering from a heart attack, and needed as much oxygen as they could get. Instead, they got lungs full of recycled carbon dioxide. Anahad O’Connor, “The Claim: If You’re Hyperventilating, Breathe into a Paper Bag,” The New York Times, May 13, 2008; Michael Callaham, “Hypoxic Hazards of Traditional Paper Bag Rebreathing in Hyperventilating Patients,” Annals of Emergency Medicine 19, no. 6 (June 1989): 622–28.

feeding and breeding: Moran Cerf, “Neuroscientists Have Identified How Exactly a Deep Breath Changes Your Mind,” Quartzy, Nov. 19, 2017; Jose L. Herrero, Simon Khuvis, Erin Yeagle, et al., “Breathing above the Brain Stem: Volitional Control and Attentional Modulation in Humans,” Journal of Neurophysiology 119, no. 1 (Jan. 2018): 145–49.

biologically impossible: Matthijs Kox et al., “Voluntary Activation of the Sympathetic Nervous System and Attenuation of the Innate Immune Response in Humans,” Proceedings of the National Acad­emy of Sciences of the United States of America 111, no. 20 (May 2014): 7379–84.

17 degrees Fahrenheit: I wrote about Benson’s work briefly in previous books and other writings, but in no instance did I explore what happens to the body and how, which is what I’m doing in this chapter.

esteemed scientific journal: Herbert Benson et al., “Body Temperature Changes during the Practice of g Tum-mo Yoga,” Nature 295 (1982): 234–36. Decades later, not everyone was impressed by Benson’s data. Maria Kozhevnikova, at the National University of Singapore, claimed there was “no evidence, however, indicating that temperatures are elevated beyond the normal range during g-tummo meditation.” While she never dismissed the stunning effects of Tummo, Kozhevnikova wrote that the way in which the data was presented is misleading. With that, it should be noted that many Tummo practitioners told me that the exercise doesn’t so much get them hot; rather, it keeps them from getting cold, which has been clearly demonstrated both by the Buddhists and by Wim Hof and his crew. Either way, body heat is only a very small part of Tummo’s transformative effects, as we’ll soon learn. Maria Kozhevnikova et al., “Neurocognitive and Somatic Components of Temperature Increases during g-Tummo Meditation: Legend and Reality,” PLoS One 8, no. 3 (2013): e58244.

Arctic Circle shirtless: “The Iceman— Wim Hof,” Wim Hof Method, https://www.wimhofmethod.com/iceman-wim-hof

deepening his practice: Erik Hedegaard, “Wim Hof Says He Holds the Key to a Healthy Life—But Will Anyone Listen?,” Rolling Stone, Nov. 3, 2017.

Andrew Huberman:“Applications,” Wim Hof Method, https://www.wimhofmethod.com/applications

two dozen healthy male volunteers: Kox et al., “Voluntary Activation of the Sympathetic Nervous System.”

battery of immune cells: “How Stress Can Boost Immune System,” Science Daily, June 21, 2012, https://www.sciencedaily.com/releases/2012/06/120621223525.htm

self-produced opioids: Joshua Rapp Learn, “Science Explains How the Iceman Resists Extreme Cold,” Smithsonian.com, May 22, 2018.

50 million people: The National Institutes of Health estimates that up to 23.5 million Americans suffer from autoimmune disease. The American Autoimmune Related Disease Association says this number is a gross underestimate because the NIH only lists 24 diseases associated with autoimmune disorder; however, there are several dozen other diseases not listed which have a clear “autoimmune basis.” You can read the sobering statistics at https://www.aarda.org/

Hashimoto’s disease: New research shows that narcolepsy is also an autoimmune disease, and perhaps even asthma. That children with asthma have a 41 percent increased risk of getting type 1 diabetes is likely no coincidence. Alberto Tedeschi and Riccardo Asero, “Asthma and Autoimmunity: A Complex but Intriguing Relation,” Expert Review of Clinical Immunology 4, no. 6 (Nov. 2008): 767–76; Natasja Wulff Pedersen et al., “CD8+ T Cells from Patients with Narcolepsy and Healthy Controls Recognize Hypocretin Neuron-Specific Antigens,” Nature Communications 10, no. 1 (Feb. 2019): 837.

I’d heard dozens: Before trying Tummo, Matt had been diagnosed with psoriatic arthritis and had C-reactive protein (CRP), which contributes to the inflammation and soreness in his disease, of over 20, about seven times the normal level. After three months of practicing Tummo breathing with exposure to cold, Matt’s CRP levels were 0.4. All of the soreness in his joints, the stiffness, the flaky red skin, and the fatigue were gone. Another Matt, from Devon in England, was diagnosed with lichen planopilaris, an inflammatory disease that mainly affects the scalp and results in scaling and permanent patchy hair loss. Matt was put on a prescription for hydroxychloroquine, a medicine invented in 1955 to treat malaria that suppresses the immune response. Common side effects of hydroxychloroquine include cramps, diarrhea, headaches, and worse. Within a week Matt was having trouble breathing and was coughing up blood. His doctor told him to push through. Matt got sicker. He learned Tummo breathing and followed Hof ’s protocol, practicing the Wim Hof Method every day. Wim Hof, YouTube, Jan. 3, 2018, https://www.youtube.com/watch?v=f4tIou2LnOk; “Wim Hof—Reversing Autoimmune Diseases | Paddison Program,” Paddison Program, https://www.paddisonprogram.com/wim-hof-reversing-autoimmune-diseases/; “In 8 Months I Was Completely Symptom-Free,” Wim Hof Method Experience, Wim Hof, YouTube, Aug. 23, 2019, https://www.youtube.com/watch?v=1nOv4aNiWys

reducing inflammatory markers: In 2014, Hof took a group of 26 random people, aged 29 to 65, up Mount Kilimanjaro. Many in the group suffered from asthma, rheumatism, Crohn’s, and other autoimmune dysfunctions. He taught them his version of Tummo breathing, exposed them to periodic bouts of extreme cold, then hiked 19,300 feet to the top of Africa’s tallest mountain. Oxygen levels at the top are half of what they are at sea level. The success rate of experienced climbers is about 50 percent. Twenty-four of Hof ’s students, including those with autoimmune disorders, made it to the summit in 48 hours. Half the group ascended barechested, wearing nothing but shorts in temperatures that dip to minus 4 degrees Fahrenheit. None experienced hypothermia or altitude sickness, and none used supplemental oxygen. Ted Thornhill, “Hardy Climbers Defy Experts to Reach Kilimanjaro Summit Wearing Just Their Shorts and without Succumbing to Hypothermia,” Daily Mail, Feb. 17, 2014; “Kilimanjaro Success Rate—How Many People Reach the Summit,” Kilimanjaro, https://www.climbkilimanjaroguide.com/kilimanjaro-success-rate/ An older estimate put the number at 41 percent; the current estimate is probably closer to 60 percent. I’ve split the difference.

David-Néel used: It’s worth noting that David-Néel eventually became a national hero in France, an idol to the Beat writers, and had a tea and a tram station named after her, both of which are still in use today.

Maurice Daubard: “Maurice Daubard— Le Yogi des Extrêmes [The Yogi of the Extremes],” http://www.mauricedaubard.com/biographie.htm; “France: Moulins: Yogi Maurice Daubard Demonstration,” AP Archive, YouTube, July 21, 2015, https://www.youtube.com/watch?v=bEZVlgcddZg

Stanislav Grof: This interview and my experience with Holotropic Breathwork happened several years before the Stanford experiment, and just a year or so after that jarring experience with Sudarshan Kriya that sent me on the path to deeper research.

It was November 1956: Grof had told me this event took place in 1954; however, other sources claim it occurred in 1956. “The Tim Ferriss Show—Stan Grof, Lessons from ~4,500 LSD Sessions and Beyond,” Podcast Notes, Nov. 24, 2018, https://podcastnotes.org/tim-ferris-show/grof/

The experience would guide: “Stan Grof,” Grof: Know Thyself, http://www.stanislavgrof.com

By 1968, the U.S. government: Mo Costandi, “A Brief History of Psychedelic Psychiatry,” The Guardian, Sept. 2, 2014.

Eyerman led more than 11,000: James Eyerman, “A Clinical Report of Holotropic Breathwork in 11,000 Psychiatric Inpatients in a Community Hospital Setting,” MAPS Bulletin, Spring 2013, https://maps.org/news-letters/v23n1/v23n1_p24-27.pdf

“figure out why”: Eyerman continued: “When you think about it, Western industrial civilization is the only group in entire human history that doesn’t hold non-ordinary states of consciousness in high esteem, [that] doesn’t appreciate and want to understand them,” he told me. “Instead, we pathologize them, we numb them with tranquilizers. This works as a band-aid works, as a temporary fix, but it does not address the core problem and just leads to more psychological problems later on.”

smaller studies followed: Sarah W. Holmes et al., “Holotropic Breathwork: An Experiential Approach to Psychotherapy,” Psychotherapy: Theory, Research, Practice, Training 33, no. 1 (Spring 1996): 114–20; Tanja Miller and Laila Nielsen,

“Measure of Significance of Holotropic Breathwork in the Development of Self Awareness,” Journal of Alternative and Complementary Medicine 21, no. 12 (Dec. 2015): 796–803; Stanislav Grof et al., “Special Issue: Holotropic Breathwork and Other Hyperventilation Procedures,” Journal of Transpersonal Research 6, no. 1 (2014); Joseph P. Rhinewine and Oliver Joseph Williams, “Holotropic Breathwork: The Potential Role of a Prolonged, Voluntary Hyperventilation Procedure as an Adjunct to Psychotherapy,” Journal of Alternative and Complementary Medicine 13, no. 7 (Oct. 2007): 771–76.

having less oxygen in the brain: Specifically, all that huffing depletes our bloodstream of carbon dioxide, and thus, cuts off blood flow the brain needs to function properly. Stanislav Grof and Christina Grof, Holotropic Breathwork: A New Approach to Self­Exploration and Therapy, SUNY Series in Transpersonal and Humanistic Psychology (Albany, NY: Excelsior, 2010), 161, 163; Stanislav Grof, Psychology of the Future: Lessons from Modern Consciousness Research (Albany, NY: SUNY Press, 2000); Stanislav Grof, “Holotropic Breathwork: New Approach to Psychotherapy and Self-Exploration,” http://www.stanislavgrof.com/resource-Holotropic-Breathwork;-New-Perspectives-in-Psychotherapy-and-Self-Exploration.pdf

During rest, about 750 milliliters: “Cerebral Blood Flow and Metabolism,” neurosurg.cam.ac.uk, http://www.neurosurg.cam.ac.uk/files/2017/09/2-Cerebral-blood-flow.pdf

Blood flow can increase: Jordan S. Querido and A. William Sheel, “Regulation of Cerebral Blood Flow during Exercise,” Sports Medicine 37, no. 9 (2007): 765–82.

decrease by 40 percent: On average, cerebral blood flow will reduce about 2 percent for every 1mmHg decrease of carbon dioxide in the blood (PaCO2). During one heavy breathing exercise recording at a laboratory at the University of California, San Francisco, my PaCO2 clocked in at 22 mmHg, which is about 20 below normal. During that time my brain was receiving about 40 percent less blood flow than normal. “Hyperventilation,” OpenAnesthesia, https://www.openanesthesia.org/elevated_icp_hyperventilation

The areas most affected: An interesting summary, including several scientific studies, is available on this webpage: http://www.anesthesiaweb.org/hyperventilation.php

signals throughout the body: “Rhythm of Breathing Affects Memory and Fear,” Neuroscience News, Dec. 7, 2016, https://neurosciencenews.com/memory-fear-breathing-5699/

Chapter 7: Hold It

A couple years later: Details of Kling’s research and the following account of S. M. were drawn from Justin S. Feinstein et al., “A Tale of Survival from the World of Patient S. M.,” in Living without an Amygdala, ed. David G. Amaral and Ralph Adolphs (New York: Guilford Press, 2016), 1–38. Other details were pulled from Kling’s articles, including Arthur Kling et al., “Amygdalectomy in the Free-Ranging Vervet (Cercopithecus aethiops),” Journal of Psychiatric Research 7, no. 3 (Feb. 1970): 191–99.

alarm circuit of fear: “The Amygdala, the Body’s Alarm Circuit,” Cold Spring Harbor Laboratory DNA Learning Center, https://dnalc.cshl.edu/view/822-The-Amygdala-the-Body-s-Alarm-Circuit.html

cluster of neurons: We have two kinds of chemoreceptors in our respiratory system: peripheral and central. Peripheral chemoreceptors, in the carotid artery and aorta, are for the most part responsible for detecting changes in the amount of oxygen in the blood as it leaves the heart. Central chemoreceptors, located in the brain stem, detect very minute changes in the levels of carbon dioxide within arterial blood via the pH of the cerebrospinal fluid. “Chemoreceptors,” TeachMe Physiology, https://teachmephysiology.com/respiratory-system/regulation/chemoreceptors/

flex and shift with changing environments: People with injuries in the area of the brain stem that holds the central chemoreceptors lose the ability to gauge and react to carbon dioxide levels in the bloodstream. With no autonomic  trigger to alert them that carbon dioxide is building, each breath they take requires a conscious and concerted effort. They’ll suffocate in their sleep without a respirator because their bodies won’t know when to breathe. The condition is called Ondine’s disease, and gets its name from a water sprite in a European folk tale. Ondine told her husband, Hans, that she was “the breath in [his] lungs,” and warned him that if he ever cheated on her he would lose his ability to unconsciously breathe. Hans cheated and suffered from Ondine’s curse. “A single moment of inattention and I forget to breathe,” Hans said before he died. Iman Feiz-Erfan et al., “Ondine’s Curse,” Barrow Quarterly 15, no. 2 (1999), https://www.barrowneuro.org/education/grand-rounds-publications-and-media/barrow-quarterly/volume-15-no-2-1999/ondines-curse/

altitudes 800 feet below and 16,000 feet: Twelve thousand years ago, ancient Peruvians inhabited enclaves 12,000 feet above sea level. The current highest inhabited city is La Rinconada, Peru, at an elevation of 16,728 feet above sea level. Tia Ghose, “Oldest High-Altitude Human Settlement Discovered in Andes,” Live Science,    Oct.    23,    2014,  https://www.livescience.com/48419-high-altitude-setllement-peru.html

some elite mountain climbers: According to some reports, athletes like freedivers tend to have about the same carbon dioxide tolerance as people who are not acclimated to taking repeated, very long breath holds. The hypothesis is that such top-tier athletes have much larger lungs and may also be able to slow their metabolism down to such a level that they consume less oxygen and produce less carbon dioxide, allowing them to hold their breath for longer without feeling anxious. But this doesn’t explain why people with chronic anxieties and other fear-based disorders almost always have very limited breath-holding ability, regardless of their lung size or how much they inhaled or exhaled before the test. Some interesting (if not limited) context can be found on the Deeper Blue freediving forum: https://forums.deeperblue.com/threads/freedivi-leading-to-sleep-apnea.82096 ; Colette Harris, “What It Takes to Climb Everest with No Oxygen,” Outside, June 8, 2017, https://www.outsideonline.com/2191596/how-train-climb-everest-no-oxygen

Eighteen percent of Americans: Jamie Ducharme, “A Lot of Americans Are More Anxious Than They Were Last Year, a New Poll Says,” Time, May 8, 2018, https://time.com/5269371/americans-anxiety-poll/

offered this advice: The Primordial Breath: An Ancient Chinese Way of Prolonging Life through Breath Control, vol. 1, trans. Jane Huang and Michael Wurmbrand (Original Books, 1987), 13.

“terribly damaging”: I’ll be posting a detailed explanation of the damages caused by oxidative stress and nitric oxide synthase by Dr. Scott Simonetti within this website as soon as possible.

continuous partial attention: Megan Rose Dickey, “Freaky: Your Breathing Patterns Change When You Read Email,” Business Insider, Dec. 5, 2012, https://www.businessinsider.com/email-apnea-how-email-change-breathing-2012-12? IR=T; “Email Apnea,” Schott’s Vocab, The New York Times, Sept. 23, 2009, https:/schott.blogs.nytimes.com/2009/09/23/email-apnea/; Linda Stone, “Just Breathe: Building the Case for Email Apnea,” The Huffington Post, https://www.huffpost.com/entry/just-breathe-building-the_b_85651; Susan M. Pollak, “Breathing Meditations for the Workplace,” Psychology Today, Nov. 6, 2014.

out of our control: Dozens of studies are accessible through the United States National Library of Medicine at the National Institutes of Health website PubMed. Here’s a few that were helpful to me: Andrzej Ostrowski et al., “The Role of Training in the Development of Adaptive Mechanisms in Freedivers,” Journal of Human Kinetics 32, no. 1 (May 2012): 197– 210; Apar Avinash Saoji et al., “Additional Practice of Yoga Breathing With Intermittent Breath Holding Enhances Psychological Functions in Yoga Practitioners: A Randomized Controlled Trial,” Explore: The Journal of Science and Healing 14, no. 5 (Sept. 2018): 379–84; Saoji et al., “Immediate Effects of Yoga Breathing with Intermittent Breath Holding on Response Inhibition among Healthy Volunteers,” International Journal of Yoga 11, no. 2 (May– Aug. 2018): 99–104.

to war wounds: Serena Gianfaldoni et al.,“History of the Baths and Thermal Medicine,” Macedonian Journal of Medical Sciences 5, no. 4 (July 2017): 566–68.

“cured almost with certainty”: George Henry Brandt, Royat (les Bains) in Auvergne, Its Mineral Waters and Climate (London: H. K. Lewis, 1880), 12, 18; Peter M. Prendergast and Melvin A. Shiffman, eds., Aesthetic Medicine: Art and Techniques (Berlin and Heidelberg: Springer, 2011); William and Robert Chambers, Chambers’s Edinburgh Journal,  n.s.  1, no. 46 (Nov. 16, 1844): 316; Isaac Burney Yeo, The Therapeutics of Mineral Springs and Climates (London: Cassell, 1904), 760

“The study” . . . a British doctor: After Brandt returned to Britain and  raved about Royat, another doctor and fellow at the Royal College of Surgeons left to visit Royat to confirm Brandt’s findings, and reported them “quite in accordance with my own experience and observations.” George Henry Brandt, Royat (les Bains) in Auvergne: Its Mineral Waters and Climate (London: H. K. Lewis, 1880), 12, 18.

scientific research disappeared: According to Dr. Lewis S. Coleman, a California anesthesiologist and medical researcher, the backlash against carbon dioxide probably had less to do with the facts and more to do with private interests. Carbon dioxide was an inexpensive by-product of oil processing, whereas other clinical treatments were expensive and required real expertise to administer. Lewis S. Coleman, “Four Forgotten Giants of Anesthesia History,” Journal of Anesthesia and Surgery 3, no. 1 (2016): 68–84.

skin disorders: See dozens of studies on the benefits of carbon dioxide bathing at https://www.ncbi.nlm.nih.gov/pubmed/?term=transdermal+carbon+dioxide+therapy

Joseph Wolpe . . . Donald Klein: In the late 1950s, Wolpe was looking for alternative treatments for free-floating anxiety, a form of stress for which there is no specific cause, which today affects about 10 million Americans. He was floored by how quickly and effectively carbon dioxide worked. Between two and five inhalations of a 50/50 mixture of carbon dioxide and oxygen, Wolpe found, was enough to lower the baseline level of anxiety in his patients from 60 (debilitating) to zero. No other treatment came close. “It will be hoped that the recently awakened interest in carbon dioxide will lead to active research,” wrote Wolpe in 1987. But the same year Wolpe published his carbon dioxide call to arms, the Food and Drug Administration approved the first SSRI drug, fluoxetine, which would become better known by its trade names Prozac, Sarafem, and Adofen. A decade after Wolpe’s study was published, Donald F. Klein, a Columbia University psychiatrist, found what he thought was the mechanism that triggered panic, anxiety, and related disorders. It was a “physiologic misinterpretation by a suffocation monitor [that] misfires an evolved suffocation alarm system,” wrote Klein in his paper “False Suffocation Alarms, Spontaneous Panics, and Related Conditions.” And that false suffocation was coming from chemoreceptors that had grown to become too sensitive to fluctuations in carbon dioxide. Fear, at its core, could be as much a physical problem as a mental one. Joseph Wolpe, “Carbon Dioxide Inhalation Treatments of Neurotic Anxiety: An Overview,” Journal of Nervous and Mental Disease 175, no. 3 (Mar. 1987): 129–33; Donald F. Klein, “False Suffocation Alarms, Spontaneous Panics, and Related Conditions,” Archives of General Psychiatry 50, no. 4 (Apr. 1993): 206–17.

half of us will suffer: This is Feinstein’s estimate. Hard numbers are difficult  to pin down because so many people with anxiety disorders suffer from depression, and vice versa. For instance, an estimated 18 percent of the population suffers from anxiety disorders; some 8 percent suffer from major depressive disorder, and millions more with milder systems; one quarter suffer from a diagnosable mental disorder; and one half of all Americans are expected to suffer from some mental illness throughout their lives. “Half of US Adults Due for Mental Illness, Study Says,” Live Science, Sept. 1, 2011, https:/www.livescience.com15876-mental-illness-strikes-adults.html; “Facts & Statistics,” Anxiety and Depression Association of America, https://adaa.org/about-adaa/press-room/facts-statistics

13 percent: Further, depression, anxiety, and panic are all closely related, each rooted in the same misinterpretation of fear. A third of patients currently on SSRIs suffer from other forms of anxiety and many will be treated with different drugs for those conditions. Laura A. Pratt et al., “Antidepressant Use Among Persons Aged 12 and Over: United States, 2011–2014,” NCHS Data Brief no. 283 (Aug. 2017): 1–8.

described as “weak”: These findings, as you might imagine, were controversial. You can read more about the ongoing debate of this study in Fredrik Hieronymus et al., “Influence of Baseline Severity on the Effects of SSRIs in Depression: An Item-Based, Patient-Level Post-Hoc Analysis,” The Lancet, July 11, 2019, https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30383-9/fulltext ; Fredrik Hieronymus, “How Do We Determine Whether Antidepressants Are Useful or Not? Authors’ Reply,” The Lancet, Nov. 2019, https://www.thelancet.com; Henry Bodkin, “Most Common Antidepressant Barely Helps Improve Depressive Symptoms, ‘Shocking’ Trial Finds,” The Telegraph (UK), Sept. 19, 2019, https://www.telegraph.co.uk/science/2019/09/19/common-antidepressant-barely-helps-improve-depression-symptoms

exposure therapy: An overview of treatments and efficacy is available here: Johanna S. Kaplan and David F. Tolin, “Exposure Therapy for Anxiety Disorders,” Psychiatric Times, Sept. 6, 2011, https://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders

anorexia or panic: Some 40 percent of panic disorder patients suffer from depression, and 70 percent have some other mental health condition. All of these conditions, Feinstein says, are rooted in fear. Paul M. Lehrer, “Emotionally Triggered Asthma: A Review of Research Literature and Some Hypotheses for Self-Regulation Therapies,” Applied Psychophysiology and Biofeedback 22, no. 1 (Mar. 1998): 13–41.

holding their breath: Panic sufferers visit the doctor five times more often than other patients, and are six times more likely to be hospitalized for psychiatric disorders. Thirty-seven percent of them will seek some treatment, usually drugs, behavior therapy, or both. But none of these therapies directly address what could be contributing to this condition: chronic poor breathing habits. That 60 percent of people with chronic obstructive pulmonary disease also have anxiety or depressive disorders is not a coincidence. These patients are very often breathing too much, too fast, panicking in anticipation of not being able to take another breath. “Proper Breathing Brings Better Health,” Scientific American, Jan. 15, 2019, https://www.scientificamerican.com/article/proper-breathing-brings-better-health/

hypersensitized to carbon dioxide: Eva Henje Blom et al., “Adolescent Girls with Emotional Disorders Have a Lower End Tidal CO2 and Increased Respiratory Rate Compared with Healthy Controls,” Psychophysiology 51, no. 5 (May 2014): 412– 18; Alicia E. Meuret et al., “Hypoventilation Therapy Alleviates Panic by Repeated Induction of Dyspnea,” Biological Psychiatry CNNI (Cognitive Neuroscience and Neuroimaging) 3, no. 6 (June 2018): 539–45; Daniel S. Pine et al., “Differential Carbon Dioxide Sensitivity in Childhood Anxiety Disorders and Nonill Comparison Group,” Archives of General Psychiatry 57, no. 10 (Oct. 2000): 960–67.

Alicia Meuret: “Out-of-the-Blue Panic Attacks Aren’t without Warning: Data Show Subtle Changes before Patients’ [sic] Aware of Attack,” Southern Methodist University Research, https://blog.smu.edu/research/2011/07/26/out-of-the-blue-panic-attacks-arent-without-warning/; Stephanie Pappas, “To Stave Off Panic, Don’t Take a Deep Breath,” Live Science, Dec.   26,   2017,   https://www.livescience.com/9204-stave-panic-deep-breath.html

capnometers, which recorded: “New Breathing Therapy Reduces Panic and Anxiety by Reversing Hyperventilation,” ScienceDaily, Dec. 22, 2010, https://www.sciencedaily.com/releases/2010/12/101220200010.htm

soundless room: Floatation, as Feinstein has found through five years of clinical research, was particularly effective in treating anxiety, anorexia, and other fear-based neuroses. “The Feinstein Laboratory,” Laureate Institute for Brain Research, http://www.laureateinstitute.org/current-events/feinstein-laboratory-publishes-float-study-in-plos-one

“super endurance”: See Buteyko’s chart of optimum (and dangerously low) carbon dioxide levels at https://images.app.goo.gl/DGjT3bL8PMDQYmqL7

180 reports from pulmonauts: Recently, carbon dioxide therapy has made a bit of a comeback, not just with Olsson and his crew of DIY pulmonauts. It’s now being used, again, to treat hearing loss, epilepsy, and various cancers. The U.S. health care provider Aetna offers carbon dioxide therapy as an experimental treatment for patients. “Carbogen Inhalation Therapy,” Aetna, http://www.aetna.com/cpb/medical/data/400_499/0428.html

chemoreceptors are normally: Chemoreceptors designed to analyze the tiniest fluctuations in carbon dioxide, a fraction of one percent.

Chapter Ten: Fast, Slow, and Not at All

heavy dose of stress hormones: Even an hour after the Tummo practice ended. Think of the lungs as a solar panel; the larger the panel, the more cells there are to soak up sunlight, the more available energy. Wim Hof’s heavy breathing can increase available space for gas exchange by about 40 percent—a tremendous amount. With this bonus space, Hof, for instance, was able to consume double the normal amount of oxygen 40 minutes after he finished the exercises. Isabelle Hof, The Wim Hof Method Explained (Wim Hof Method, 2015,   updated   2016),   8, https://pdfs.semanticscholar.org/c57d/b7b4a6eaa9885ec514b0e3b436c22822292d.pdf

snow for hours and not: Joshua Rapp Learn, “Science Explains How the Iceman Resists Extreme Cold,”  Smithsonian.com,     May     22,     2018,   https://www.smithsonianmag.com/science-nature/science-explains-how-iceman-resists-extreme-cold-180969134/

breathe slow and less: Herbert Benson et al., “Body Temperature Changes during the Practice of g Tum-mo Yoga,” Nature 295 (1982): 234–36; William J. Cromie, “Meditation Changes Temperatures,” The Harvard Gazette, Apr. 18, 2002.

they certainly are not: I queried this conundrum to Dr. Paul Davenport, a renowned physiologist and Distinguished Professor at the University of Florida. He replied within a few hours. “Interesting problem,” he wrote in an email. “My answer will be appropriately, academically vague :) Bottom line, the effect of voluntary hyperventilation depends on multiple factors including regional blood distribution, degree of blood gas changes, reduced buffering capacity of cerebrospinal fluid (CSF), changes in cardiac output, pH balance compensation, time and factors yet unknown. (Is that ambiguous enough?) Research on the physiological response of blood and CSF to voluntary hyperventilation is relatively straightforward. However, the cognitive responses to the physiological changes is much more ambiguous and complex.” At the end of the email, he told me he was working on a detailed analysis of the problem, which would take some time to put together. As of this writing, he was still writing it. You can peruse a few studies here: I. A. Bubeev, “The Mechanism of Breathing under the Conditions of Prolonged Voluntary Hyperventilation,” Aerospace and Environmental Medi­cine 33, no. 2 (1999): 22–26; J. S. Querido and A. W. Sheel, “Regulation of Cerebral Blood Flow during Exercise,” Sports Medicine 37, no. 9 (Oct. 2007), 765–82.

mechanism behind these techniques: Iuriy A. Bubeev and  I.  B.  Ushakov, “The Mechanism of Breathing under the Conditions of Prolonged Voluntary Hyperventilation,” Aerospace  and Envi­ronmental Medicine 33, no. 2 (1999): 22–26; Seymour S. Kety and Carl F. Schmidt, “The Effects of Altered Arterial Tensions of Carbon Dioxide and Oxygen on Cerebral Blood Flow and Cerebral Oxygen Consumption of Normal Young Men,” Journal of Clinical Investigation 27, no. 4 (1948): 484–92; Querido and Sheel, “Regulation of Cerebral Blood Flow during Exercise”; Shinji Naganawa et al., “Regional Differences of fMR Signal Changes Induced by Hyperventilation: Comparison between SE-EPI and GE-EPI at 3-T,” Journal of Magnetic Resonance Im­aging 15, no. 1 (Jan. 2002): 23–30; S. Posse et al., “Regional Dynamic Signal Changes during Controlled Hyperventilation Assessed with Blood Oxygen Level Dependent Functional MR Imaging,” American Journal of Neuroradiology 18, no. 9 (Oct. 1997): 1763–70.

same time in India and China: More specifically, written references to prana appeared in India about 3,000 years ago, and in China during the Ying and Zhou periods about 2,500 years ago.

prana power lines: Ancient Indians believed the body contained from 72,000 to 350,000 channels. How they might have counted them, nobody knows.

never observed prana: Sat Bir Singh Khalsa et al., Principles and Practice of Yoga in Health Care (Edinburgh: Handspring, 2016).

confirmed that it exists: There was, however, some very weird, and fascinating, government-supported research into the possibilities of moving this “vital energy.” Check out this gem of a study from 1986 that somehow seeped through the cracks of the CIA website: Lu Zuyin et al., “Physical Effects of Qi on Liquid Crystal,” CIA, https://www.cia.gov/library/readingroom/document/cia-rdp96-00792r000200160001-8

a group of physicists: Justin O’Brien (Swami  Jaidev  Bharati),  Walking  with  a Himalayan Master: An American’s Odyssey (St. Paul, MN: Yes International, 1998, 2005), 58, 241; Pandit Rajmani Tigunait, At the Eleventh Hour: The Biography of Swami Rama (Honesdale, PA: Himalayan Institute Press, 2004); “Swami Rama, Researcher/Scientist,” Swami Rama Society, https://www.swamiramasociety.org/project/swami-rama-researcherscientist/

By the age of three: “Swami Rama, Himalayan Master, Part 1,”  YouTube,  https://www.youtube.com/watch?v=S1sZNbRH2N8

a small, pictureless office: “Swami Rama at the Menninger Clinic, Topeka, Kansas,” Kansas Historical Society, https:/www.kshs.org/index.php?url=km/items/view/226459

Veterans Administration hospital: Dr. Daniel Ferguson, chief of the medical hygiene clinic of the Veterans Administration Hospital in Minnesota, had shown a few months earlier that Swami Rama had the ability to make his pulse “disappear” for minutes at a time. Erik Peper et al., eds., Mind/Body Integration: Essential Readings in Biofeedback (New York: Plenum Press, 1979), 135.

for 30 seconds: Actual recorded time was 17 seconds, but Rama had entered into this heart-fluttering zone several seconds earlier before the technicians were prepared. This detail was taken from Justin O’Brien’s The Wellness Tree: The Six­ Step Program for Creating Optimal Wellness (Yes International, 2000).

The results of the experiment: Gay Luce and Erik Peper, “Mind over Body, Mind over Mind,” The New York Times, Sept. 12, 1971.

Within 15 minutes: Marilynn Wei and James E. Groves, The Harvard Medical School Guide to Yoga (New York: Hachette, 2017); Jon Shirota, “Meditation: A State of Sleepless Sleep,” June 1973, http://hihtindia.org/wordpress/wp-content/uploads/2012/10/swamiramaprobe1973.pdf

television talk shows: “Swami Rama: Voluntary Control over Involuntary States,” YouTube, Jan. 22, 2017, 1:17, https://www.youtube.com/watch?v=yv_D3ATDvVE

French cardiologist: Mathias Gardet, “Thérèse Brosse (1902–1991),” https://re penf.hypotheses.org/795; “Biofeedback Research and Yoga,” Yoga and Consciousness Studies, http://www.yogapsychology.org/art_biofeedback.html; Brian Luke Seaward, Managing Stress: Principles and Strategies for Health and Well­Being (Burlington, MA: Jones & Bartlett Learning, 2012); M. A. Wenger and B. K. Bagchi, “Studies of Autonomic Functions in Practitioners of Yoga in India,” Behavioral Science 6, no. 4 (Oct. 1961): 312–23.

with the goal of reaching: “Swami Rama Talks: 2:1 Breathing Digital Method,” Swami Rama. YouTube, May 23, 2019, https://www.youtube.com/watch?v=PYVrB36FrQw ; “Swami Rama Talks: OM Kriya pt. 1,” Swami Rama.  YouTube, May 28, 2019, https://www.youtube.com/watch?v=ygvnWEnvWCQ

Rama obviously had learned: Rama, apparently, wasn’t all peacefulness and light. In 1994 a female student who’d attended the Himalayan Institute charged that Rama had initiated sexual abuse when she was 19 and he was in his late 60s. Four years later, after Rama’s death, a jury awarded the woman almost two million dollars in damages. Management at the Himalayan Institute contend the trial was unfair, as Rama was not even present to offer his side of the story. Nonetheless, the incident stained Rama’s legacy at home and abroad. William J. Broad, “Yoga and Sex Scandals: No Surprise Here,” The New York Times, Feb. 27, 2012.

Albert Szent-Gyorgyi: Biographical information is summarized from the following sources: Robyn Stoller, “The Full Story of Dr. Albert Szent-Györgyi,” National Foundation for Cancer Research,   Dec.   9,   2017,  https://www.nfcr.org/blog/full-story-of-dr-albert-szent-gyorgyi/?gclid=Cj0KCQjwncT1BRDhARIsAOQF9LlOSPfF0RxhLyiukV-yvL4VSIRZ0NYfIk-kGq-W3YN4m4RS69v6ZoIaAvDKEALw_wcB ; Albert Szent-Györgyi, “Biographical Overview,” National Library of   Medicine, https://profiles.nlm.nih.gov/spotlight/wg/feature/biographical ; Robert A. Kyle and Marc A. Shampo, “Albert Szent-Györgyi—Nobel Laureate,” Mayo Clinic Proceedings 75, no. 7 (July 2000): 722; “Albert Szent-Györgyi: Scurvy: Scourge of the Sea,” Science History Institute, https://www.sciencehistory.org/historical-profile/albert-szent-gyorgyi

“All living organisms”: Albert Szent-Györgyi, “Muscle Research,” Scientific American 180 (June 1949): 22–25.

the more alive it is: According to researchers at the University of Arizona, in Tucson, what separated animals with small brains from those with large and rapidly evolving brains was their capacity for endurance exercise. The higher the capacity, the larger the brain. What fueled this capacity, and these brains, were larger lungs capable of better respiratory efficiency. This helps explain why mammals have larger brains than non-mammals, and why human, whale, and dolphin brains kept growing so rapidly over millions of years as reptilian brains didn’t. Oxygen equals energy equals evolution. Our ability to breathe large and full breaths, in some ways, helped make us human. David A. Raichlen and Adam D. Gordon, “Relationship between Exercise Capacity and Brain Size in Mammals,” PLoS One 6, no. 6 (June 2011): e20601; “Functional Design of the Respiratory System,” medicine.mcgill.ca, https://www.medicine.mcgill.ca/physio/resp-web/TEXT1.htm ; Alexis Blue, “Brain Evolved to Need Exercise,” Neuroscience News, June 26, 2017, https://neurosciencenews.com/evolution-brain-exercise-6982/

millions of years: Bettina E. Schirrmeister et al., “Evolution of Multicellularity Coincided with Increased Diversification of Cyanobacteria and the Great Oxidation Event,” PNAS 110, no. 5 (Jan. 2013): 1791–96.

“the living state”: Albert Szent-Györgyi, “The Living State and Cancer,” Physiological Chemistry and Physics, Dec. 1980.

“simple but subtle”: Szent-Györgyi attributes this phrase to personal communication with P. Ehrenfest, an Austrian-Dutch theoretical physicist.

begin to break down: G. E. W. Wolstenholme et al., eds., Submolecular Biology and Cancer (Hoboken, NJ: John Wiley & Sons, 2008): 143.

environments of low oxygen: J. Cui et al., “Hypoxia and Miscoupling between Reduced Energy Efficiency and Signaling to Cell Proliferation Drive Cancer to Grow Increasingly Faster,” Journal of Molecular Cell Biology, 2012; Alexander Greenhough et al., “Cancer Cell Adaptation to Hypoxia Involves a HIF-GPRC5A-YAP Axis,” EMBO Molecular Medicine, 2018.

“In every culture and in every medical tradition”: This quotation has been attributed to Szent-Györgyi’s lecture “Electronic Biology and Cancer,” which he presented at the Marine Biological Laboratory, Woods Hole, Massachusetts, July, 1972.

filled with copies: “Master DeRose,” enacademic.com, https://enacademic.com/dic.nsf/enwiki/11708766

now Afghanistan, Pakistan: The Indus Valley descriptions and details are taken from the following: “Indus River Valley Civilizations,”  Khan  Academy,  https://www.khanacademy.org/humanities/world-history/world-history-beginnings/ancient-india/a/the-indus-river-valley-civilizations ; Saifullah Khan, “Sanitation and Wastewater Technologies in  Harapp/Indus Valley Civilization (ca. 2600–1900 bce),” https://www.academia.edu/5937322/Chapter_2_Sanitation_and_wastewater_technologies_in_Harappa_Indus_valley_civilization_ca._26001900_BC

largest geographically: To put this in perspective, 300,000 square miles is equivalent to all East Coast states from Florida to New York. Craig A. Lockard, Societies, Net­ works, and Transitions: A Global History (Stamford, CT: Cengage Learning, 2008).

A seal engraving: Yan Y. Dhyansky, “The Indus Valley Origin of a Yoga Practice,” Ar­tibus Asiae 48, nos. 1–2 (1987), pp. 89–108

birthplace of yoga: A thorough description of the history, epistemology, and evolution of Samkhya and the earliest yoga can be found in this excellent academic paper at the Internet Encyclopedia of Philosophy, https://www.iep.utm.edu/yoga/

of Nazi lore: The word Aryan comes from the Sanskrit ērān, which was the basis for the modern country name of Iran. The term never had anything to do with white supremacy until the Nazis appropriated it some four thousand years later.

language of Sanskrit: Steve Farmer et al., “The Collapse of the Indus-Script Thesis: The Myth of a Literate Harappan Civilization,” Electronic Journal of Vedic Studies 11, no. 2 (Jan. 2014): 19–57, http://laurasianacademy.com/ejvs/ejvs1102/ejvs1102article.pdf

Chandogya Upanishads: From a philosophy called Samkhya. Samkhya was based on reason and proof. The noun root of Samkhya means “number”; the verb root means “to know.” “Either you know or you don’t,” DeRose told me. “Spirituality had nothing to do with it!” The foundation of Samkhya was secular, based on empirical studies, not opinions. He told me that there was no mention of any praying hands or standing yoga postures in the earliest Upanishads because these exercises were never part of the practice. The earliest yoga was a technology developed to influence and control prana. It was a science of meditation and breathing. Possibly the earliest reference to pranayama (the ancient Indian art of breath control)  is listed in hymn 1.5.23 of the Brihadaranyaka Upanishad, which was first documented around 700 BCE. “One should indeed breathe in (arise), but one should also breathe out (without setting) while saying, ‘Let not the misery that is dying reach me.’ When one would practice that (breathing), one should rather desire to thoroughly realize that (immortality). It is rather through that (realization) that he wins a union with this divinity (breath), that is a sharing of worlds.” The  Brihadaranyaka  Upanishad,  book  1,  trans. John Wells, Darshana Press, http://darshanapress.com/Brihadaranyaka%20Upanishad%20Book%201.pdf

India, China, and beyond: By the sixth century BCE, Siddhartha Gautama, the  son of an Indus Valley warrior king and queen, found his way beneath a ficus tree in northeast India. He sat down and started practicing these ancient breathing and meditation techniques. Gautama became enlightened, and took off to teach the wonders of breathing, meditation, and enlightenment throughout the East. Siddhartha would later become known as the Buddha, founder of the Buddhist faith.

By around 500 bce: Michele Marie Desmarais, Changing Minds: Mind, Consciousness and Identity in Patanjali’s Yoga­sutra and Cognitive Neuroscience (Delhi: Motilal Banarsidass, 2008).

extending exhalations: The actual passage is much more vague. According to DeRose, it translates to something along these lines: “The fourth type of pranayama transcends inhalation and exhalation.” Interpretations of the Yoga Sutras vary broadly; the interpretation I listed, by Swami Jnaneshvara, I found the most elucidating and accessible. More here: http://swamij.com/yoga-sutras-24953.htm

the instructors would yell: Mestre DeRose, Quando É Preciso Ser Forte: Autobiografia (Portuguese edition) (São Paulo: Egrégora, 2015).

only in the twentieth century: After Patanjali, yoga was further compressed and rewritten. The Bhagavad Gita described it as more of a mystical and metaphysical practice, a spiritual tool to be used to bring self-realization and enlightenment. The Hatha tradition of yoga, which was formally developed in the 1400s, used the ancient techniques to honor the Lord Shiva and converted the seated asanas into 15 poses, many of them in a standing position. “Contesting Yoga’s Past: A Brief History of Āsana in Pre-modern India,” Center for the Study of World Religions, Oct. 14, 2015,   https://cswr.hds.harvard.edu/news/2015/10/14/contesting-yoga%E2%80%99s-past-brief-history-%C4%81sana-pre-modern-india

An estimated two billion people: “Two Billion People Practice Yoga ‘Because It Works,’” UN News, June 21, 2016, https:/news.un.org/en/audio/2016/06/614172; Alice G. Walton, “How Yoga Is Spreading in the U.S.,” Forbes, https://www.forbes.com/sites/alicegwalton/2016/03/15/how-yoga-is-spreading-in-the-u-s/#3809c047449f

But what have we lost: In his book Pranayama (I received a prepublication copy), DeRose details 58 breathing techniques whose roots go back thousands of years to the origins of Samkhya. A few of these techniques are offered at the end of this book.

Krishna to Jesus Christ: “The Most Ancient and Secretive Form of Yoga Practiced by Jesus Christ: Kriya Yoga,” Evolve+ Ascend, http://www.evolveandascend.com/2016/05/24/ancient-secretive-form-yoga-practiced-jesus-christ-kriya-yoga ; “The Kriya Yoga Path of Meditation,” Self-Realization Fellowship, https://www.yogananda-srf.org/The_Kriya_Yoga_Path_of_Meditation.aspx

tens of millions of people: “Research on Sudarshan Kriya Yoga,” Art of Living, https://www.artofliving.org/us-en/research-sudarshan-kriya

Art of Living: I can’t describe how to do Sudarshan Kriya because there are no written instructions. Shankar is the only one who conducts these sessions, and does so through a crackly old recording like the one I heard so many years ago. Anyone who wants to try Sudarshan Kriya will need to head out to an Art of Living outpost or scour the Internet for a bootleg. I’ve done both.

or any other breathing practice: This is one reason why randomly hyperventilating or practicing nontraditional breathing techniques can be so damaging and dangerous.

Epilogue: A Last Gasp

“More than sixty years”: Albert Szent-Györgyi, “The Living State and Cancer,” in G. E. W. Wolstenholme et al., eds., Sub­molecular Biology and Cancer (Hoboken, NJ: John Wiley & Sons, 2008), 17.

the top killers: “The Top 10 Causes of Death,” World Health Organization, May  24,  2018, https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death ; “Leading Causes of Death,” Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Genes can be turned off: Danielle Simmons, “Epigenetic Influences and Disease,” Nature Education, https://www.nature.com/scitable/topicpage/epigenetic-influences-and-disease-895/

30 pounds of air: “Each day about 30 pounds of air participates in this tidal flow, compared with less than 4 pounds of food and 5 pounds of water.” Dr. John R. Goldsmith, “How Air Pollution Has Its Effect on Health (2)—Air Pollution and Lung Function Changes,” Proceedings: National Conference on Air Pollution U.S. Department of Health, Education, and Welfare (Washington, DC: United States Government Printing Office, 1959), 215.

“If I had to”: Andrew Weil, Breathing: The Master Key to Self Healing, Sounds True, 1999.

bacterial infection: I still had remnants of bacterial infestation in my nose, but it was almost nonexistent. The results: “A 2+ Corynebacterium propinquum: Rare number Gram Positive Cocci; rare to small number of Gram Positive Rods; No polymorphonuclear cells.”

“The difference in breathing”: Carl Stough and Reece Stough, Dr. Breath: The Story of Breathing Coordination (New York: William Morrow, 1970), 29.

rougher, rawer, and heartier foods: Charles Matthews, “Just Eat What Your Great-Grandma Ate,” San Francisco Chronicle, Dec. 30, 2-17 https://michaelpollan.com/reviews/just-eat-what-your-great-grandma-ate/