Putting tape over your mouth—for science!
Putting tape over your mouth—for science!
Is there any evidence behind breathwork, mewing, and return-to-old-traditions like focusing on the breath?
Top of the morning, sapien (I lied, I like this one better, it means wise man in latin). Welcome to Common Sense Medicine, where I try and keep you up to date on the latest and greatest in longevity science.
This week, I’m on leave so it’s not your regularly scheduled post comparing Trad Health and Chad Health. However, I wanted to review a book that I’ve read and talk a little more about the importance of breathing.
Side note: I also wanted to cover a few bits of news which I thought were particularly compelling to this audience.
In longevity research, there are a lot of talks around biotech being integral in age-extensions. However, a large part of clinical longevity focuses on the four big lifestyle “pillars” (sleep, nutrition, exercise, and mental fitness). The exogenous compounds which have been explored using clinical studies by the ITP (intervention testing program) are the large-scale “trad-health” outlet for focusing on age extension drugs in mice. On the biohacker side, most of the experiments are done ad-hoc, on individual subjects, and monitored mostly using a blood test post intervention. Not really well-controlled, replicable, or even able to be assessed using confounders or covariates.
One startup which I think can solve the “controlled” aspect of these n=1 clinical trials is Unlearn (which just nabbed $50M in Series C funding). It focuses on creating a digital twin for clinical trials. It would be really exciting to create this profile, do your own research and then test alongside your experiment how you would have fared if you hadn’t taken that compound (BPC-157, anyone?).
Anyways, back to the main program.
Other items on the differential:
Why cardiorespiratory exercise is associated with a better mortality profile than avoiding heart disease
How bacteria affect the gut microbiome
A hint into why autoimmune disorders may affect more women than men
THE WEEKLY DOSE
Just Breathe, Son
Today, I’m delving into a topic which I hadn’t thought a lot about—my breath. I always knew that meditation is important, but I didn’t really focus on it. I thought it was a tool, sure, but I didn’t know how transformative it could be on the exercise goals that I had. I had long suffered from a litany of pulmonary maladies like exercise-induced asthma, and wanted a better way to combat the breathlessness that I felt when I had a particularly hard cardio session. By chance, I downloaded the audio book of Breath, by science journalist James Nestor.
“It turns out that when breathing at a normal rate, our lungs will absorb only about a quarter of the available oxygen in the air. The majority of the oxygen is exhales back out. By taking longer breaths, we allow our lungs to soak up more in fewer breaths.”
Modern living has forced us to breathe incorrectly
Nestor’s main thesis is that modern living has robbed us of the ability to breathe correctly: the nose, which is the forgotten organ, has largely been forgotten in favor of mouth breathing, which causes myriad pathologies including sleep apnea, obesity, and dental caries. His argument is rooted in a background of deep research, painstakingly cited on his website. If I am to (poorly) summarize what I’ve read, it rests on a few assumptions:
We have largely abandoned our ancestral way of breathing, and have substituted an inferior method of inhaling and exhaling, largely through our mouths
We need to embrace slower and shallower breathing, because we breathe too much oxygen—modern surgeries for improving breathing fall short of other Eastern holistic remedies like hypoventilation training
Western medicine has a lot to learn from “pulmonauts” which are exploring the power of the breath, including Tibetan monks, Wim Hof, and Dr. Mike Mew
Other experts agree that nasal breathing could have effect across various facets of your life
Andrew Huberman covered it in his podcast when he discussed how nasal breathing during Zone 2 exercise can help with reducing nasal breathing during sleep. I haven’t experimented myself (yet), but I am trying to reduce mouth breathing as much as possible in the next few weeks, using surgical tape to keep my mouth shut and train myself to breathe slower and shallower during my working sessions, as well as during exercise.
One fact that I found very interesting: in medical school, I was taught that normal breathing limits are taught as 12 to 20 minutes. Nestor’s father-in-law Dr. Don Storey mentioned (in Nestor’s bibliography) that the normal breathing rate when he started his career 40 years ago used to be 8 to 12 breaths / minute.1
Finally, while we’re on the “Chad Health” perspective—Nestor argues that the anti-inflammatory relief for asthmatics using long-acting bronchodilators (LABAs) might actually be harmful as they increase risk of asthma attacks compared to therapy without LABAs. The traditional thinking around using LABAs is that they’re reserved for more severe cases of asthma, with people already on the standard of care as evaluated by the SMART trial (source). Taking this thinking to its’ natural conclusion suggests that LABAs are making asthma worse, not better, and we should be focused on other preventative measures like breathing to bolster asthma therapy.
Trads are still focused on medication as a treatment for pulmonary problems
In medical school, we’re not taught about meditation and preventative measures pulmonary rehabilitation; however, pulmonologists have a separate fellowship where they specialize in pulmonary medicine so I am the first to say that I am not an expert here. However, one of the things that the global initiative for asthma (GINA) recommends is a low-dose inhaled corticosteroid for asthma, followed by a LABA when the asthma gets more severe (source)
Furthermore, since asthma is a clinical diagnosis, as many primary care physicians don’t necessarily have a spirometer in the office, it’s sometimes hard to really ascertain if patients really do have asthma, leading to over- and under-diagnoses in certain populations. Trad health enthusiasts focus specifically on the mechanistic cure, focusing on the inflammation, and the benefit of this is to focus on how to reduce the aberrant inflammation rather than the environment.
Trad Health enthusiasts do validate some of Nestor’s ideas—particularly around mouth breathing and snoring. The Cleveland Clinic talks about various effects of mouth breathing including bad breath, daytime sleepiness, and malocclusion, backing up a lot of the points in Nestor’s book. However, they don’t mention anything about prana or holotropic breathwork, as it’s pretty out there and is firmly fixed in Eastern medicine.
The takeaway? We need a more holistic effort on pulmonary rehabilitation
Asthma is real, and can’t be solved by breath alone. So when James Nestor talked about “curing” asthma using just the breath to get off of various medications, I was skeptical and remain skeptical. However, I do believe in the power of the breath to help solve various maladies including sleep apnea, hypertension, and more.
I think that some of the narrative that Nestor spins about the breath training like hypoventilation has promise, and I’m going to try and bring it into my training in the next month as I try and train for a longer race. I have had issues in getting faster for a marathon, and I’m curious if I can ditch my albuterol if I am able to breathe through my nose. It gives me some ideas to learn more about the breath, and how I can experiment in my own training so that I can get faster, and go further, than if I was ignoring this very important sense.
What I’m taking away from this is that medication is important, but it’s only a solve for mild asthma after everything else has been exhausted. Focus on the basics like breathwork and breathing through the nose, and then increase to the graded therapy.
THE PRESCRIPTION
I feel strongly about it: Dr. Kay Tye talks about the intricacies about the amygdala and why it’s important to understand its’ effects on the psyche besides its effect on fear
Skip the chickpeas: Dr. Michael Lustgarten explains why chickpeas didn’t increase his nicotinic acid levels, and why he’s testing fenugreek in his diet next month (Shree’s take: great experiment, but I’m not changing my diet just because of this evidence although this is the kind of thing that would help with a digital twin. Jus’ saying)
How do you do, fellow bacteria: Bacteria in the gut changes as mice age rather than solely due to amino acid (methionine) restriction
FIGURE OF THE WEEK
The upshot: Cardio matters. If you increase your VO2 Max from “low” to “below average” (see cutoffs below), then you decrease your mortality by 50%. If you increase it to “elite,” then you can get a 80% reduction.
Context: This matters a whole heck of a lot, because there are no comparisons in how much exercise can help you stave off mortality. It’s the best “drug” that mother nature invented, and it just takes about ~3 sessions / week with aerobic fitness in mind (keeping in your heart rate interval where you’re not producing lactate) and then one where you’re going all out (a la Peter Attia training) It’s important to highlight this because even staving off disease does not matter as much as this. The good part is, that too much cardio exercise isn’t bad for you—”elite” runners still had a decrease in mortality which was significant compared to the people who were in the “high” group. Furthermore, this provides better evidence for the fact that cardiorespiratory fitness matters because of the size of this study—122,007 people were retrospectively examined.
JOURNAL CLUB
To Xist or not to Xist: X chromosome related inactivation may indicate why women have more auto-immune diseases
Chill out, man: Physiologic stress affects mice intestinal secretory cells by increasing the production of indole-3-acetate.
Senolytics are hard: Senotherapeutics, while exciting, have a ways to go because of the limitations of how diseases are classified (D+Q, highlighted in a past issue, for example, is only focused on Alzheimer’s Disease for the time being)
REMEMBER, IT’S JUST COMMON SENSE.
Thanks so much for reading! Let me know what you thought by replying to this email.
See you next week,
Shree (@shree_nadkarni)