Breathing sits in a liminal space where it’s not studied rigorously by any doctors or scientists today, because it doesn’t really fit in anywhere.
Physiologists and Pulmonologists are concerned with lung biology, blood gas levels, and physical dysfunction, pulmonary therapists exist to give people nebulizer and other drug treatments in hospitals, but no medical or scientific discipline studies breathing qua breathing, or anything like different breathing techniques and the effects they might have.
But on the face of it, breathing should be a matter of great interest to athletes, coaches, and sports medicine doctors. Look for a review of Running on Air and The Art of Breath in the upcoming weeks on that front.
Breathing has also been a matter of interest for sages, scholars, and luminaries for as long as we’ve had writing, and likely well before then. Breathing techniques like Tummo, qigong, prana, and various kundalini and yogic breathing techniques were likely refined and promulgated well before writing,1 and are still studied, practiced, and taught today - which if we take Lindy effects at all seriously, we should be willing to give at least some credence to.
But precisely because breathing exists in a sort of intellectual no-man’s-land, and perhaps also because it has no potential for a revenue stream and is not as easy as taking a pill or inhaling from an inhaler, even well-attested techniques which have been rigorously studied by doctors and scientists after the Industrial Revolution have fallen by the wayside and are largely unknown or ignored.
Why am I writing this review in particular?
Because breathing better can have significant and lasting effects for your own health, quality of life, and mental and athletic performance, and it costs you basically nothing but a little time and attention to try to improve.
If I can persuade you to pay more attention to your breathing, to breathe through your nose more often, or to do some breathing exercises, it might be able to improve your quality of life and mental and physical performance, and I think it’s worth laying out the argument to try to persuade you to do those things.
"The adoption of agriculture, supposedly our most decisive step toward a better life, was in many ways a catastrophe from which we have never recovered."
—Jared Diamond
As is ever the case, ancient anthropology beckons us with its siren call and explanatory power.
As we know from paleoanthropology, we descended from a more robust, less gracile ancestor, which we usually call “archaic homo sapiens.”
What you *don’t* see in this picture is the difference in sphenoid sinuses, nasal apertures, and breathing apparatus - along with wider faces, bigger, more forward-reaching jaws, and flawless dentition, Archaic H Sap had significantly larger breathing pathways.
Compare the “sinus holes” at the top of the palate, going into the nose. These are the airways that we breathe through, and they are smaller and have less throughput in modern skulls (on the left), as compared against pre-Industrial Revolution skulls (on the right.)
Let’s detour briefly to talk about another interesting, related phenomenon: the Great Malocclusion Shift.
Most people as recently as 150 years ago (and for most of history before then) had aligned, edge-to-edge bites and dentition, rather than the overbites most moderns have today.
The shift to overbites was caused by fork usage and diet shifts away from roughage and less processed foods requiring more chewing.
The difference is more than just overbites - in general, mouths are smaller now, too small for most people’s teeth, and this causes crowding, misalignment and other problems that are put under the general heading “malocclusion.”2
Our skull and dental morphology is shaped to a greater extent by environment than most people would guess, and agriculture, along with modern processed food, has led to an epidemic of malocclusion, or misformed dentition.
And it’s primarily because we don’t *chew.* We don’t use our jaws and the muscles around them - we’re fed diets of soft, processed food from the day we’re born, and most people continue to eat those diets throughout their lives. This shift towards malocclusion is what we’re seeing up there in the pictures of skulls.
What this causes, in addition to bad teeth and outrageous dental bills, is bad breathing.
You can see that the nasal apertures are visibly smaller in the “modern” pictures - apnea and snoring are way up, because mouths have gotten smaller, but tongues and uvulas have stayed the same size, and bodies and necks have gotten much bigger as the obesity crisis has run rampant.
This is bad, because much like exercise, good sleep is key to good health, and apnea events and snoring wreck good sleep, health, and mental and physical performance.
What can be done about this?
Aren’t you stuck with whatever skull and palate size you’ve grown into, if you’re an adult? Surprisingly, no - even as adults, the skull is malleable, and palate expanding treatments like monoblocks, bioblocks and homeoblocks3 exist.
The other thing you can do is chew - eat more fiber. Eat more beef jerky. Eat more difficult-to-chew things. Chew gum.
And make sure your kids do all this, too! Breastfeeding longer, eating higher fiber and “rougher” foods, and chewing more all help develop kids’ jaws and palates, and you can give them a legacy of better teeth AND easier and healthier breathing if you do this.
The other component of bad breathing is mouth breathing - you should only ever breathe through your nose.
The author, James Nestor, actually undergoes an experiment overseen by Stanford, where he and another participant voluntarily have their noses sealed off for 10 days, forcing mouth-breathing, with health impacts measured comprehensively. Their snoring increases by thousands of percent (1300% and more the first night), sleep apnea events increase fourfold, blood pressure goes up 13 points, heart rate variability plummets.
It’s not just Stanford that thinks mouth breathing is a bad idea - for literally thousands of years, sages, philosophers, doctors, monks, and scholars have advocated nose breathing.
No less than 7 books of the Chinese Tao focus entirely on breathing, and warn you that the nose is the “heavenly door” and that you should never mouth breathe.
The Ebers Papyrus, one of the oldest medical texts ever discovered, describes how the nose is supposed to feed air to the heart and lungs, not the mouth.
Amateur ethnologist George Catlin, who spent time with the Sioux, Pawnee, Omaha, Cheyenne, Blackfeet, and Mandan tribes at their heights, painting 600 portraits and taking hundreds of pages of notes, attributed their height, robust good health, perfect teeth, and vigor to nose breathing, and practiced himself and lived to 76.
Modern science agrees as well - Dentist Dr. Mark Burhenne has written a book on sleep and mouth breathing, and says it contributes to periodontal disease and bad breath and is the number one cause of cavities, even more than sugar. It’s both a cause and contributor to snoring and sleep apnea. Dr. Ann Kearney at the Stanford Voice and Swallowing center swears by nose breathing for her patients with swallowing and breathing disorders, as well as herself. Sports trainer Dr. John Douillard says nasal breathing can as much as halve exertion in professional cyclists, with corresponding increases in time to fatigue.4
The nose warms and conditions and humidifies air, slows it down so you can extract more oxygen from it, and more. It also releases a huge boost (sixfold levels) of nitric oxide when you nose breathe through the night, which affects circulation, immune function, weight, mood, and sexual function.5
For the recreational athletes out there, having higher nitric oxide levels in the blood increases blood flow and oxygen delivery, reduces the oxygen cost of exercise, enhances muscle contraction, and improves time-to-fatigue and recovery.
But I think the biggest argument is: this is a dead simple A/B test.
Just TRY it - if you feel better after a couple of days of rigorous nose-only breathing, there’s your answer right there.
Ok, I believe that nose breathing is important or at least worth a try. But my nose is always clogged!
Nose breathing is a “use it or lose it” thing.
Researchers have plugged monkey’s noses internally such that they can only mouth breathe, and their sinuses literally grow shut. This happens in humans who never nose breathe as well. When the plugs were surgically removed, the monkey’s sinuses opened up again as they tried to nose breathe, and they achieved full and functional sinuses and nose breathing after a while.
But this means that for all the clogged and stuffy noses out there, that forcing yourself to breathe through the nose more will lead to it becoming easier. And for the real hard cases, you might become convinced (like James Nestor), that it’s worth it to get a palate expanding retainer or to try other things to breathe through the nose more.
And what are those things you can do to encourage nose breathing?
A piece of tape over the mouth, to force nose breathing while asleep (or awake for that matter).6
Rhinomed turbines.7
Discipline.8
Negative conditioning.9
Neti pots or rinsing out the sinuses - especially good for those prone to allergies and congestion.
Nasal sprays or other decongestants - but these decline in effect and you can become physically dependent on them.
Palate and jaw wideners.10
Breathing exercises.
“They told crazy stories, about how they’d breathed in ways that expanded the size of their lungs by 30 percent or more. They told me about an Indian doctor who lost several pounds by simply changing the way he inhaled, and about another man who was injected with the bacterial endotoxin E. coli, then breathed in a rhythmic pattern to stimulate his immune system and destroy the toxins within minutes. They told me about women who put their cancers into remission and monks who could melt circles in the snow around their bare bodies over a period of several hours. It all sounded nuts.”
Well, what’s left? How about thousands of years of various breathing techniques? And if sages and monks don’t do anything for you, many techniques have been studied and published upon by doctors, coaches and trainers of elite athletes, and other establishment pillars.
Once again, I think the best argument is that it’s a simple test.
Especially when it comes to trying the best way to breathe, but which is true for trying any of these breathing techniques: Try it sincerely and with rigor for a couple of days - if it does nothing, you have your answer. If it makes you feel better, you have a new tool in your arsenal and a healthier and better baseline to go forward from.
And here, given that there’s thousands of years of tradition, and that Nestor tries more than ten types of breathing exercise in the book, I’m going to narrow it down to what I consider the best supported and most impactful “top 3” breathing exercises to try.
First, what is the best way to breathe?
I’m glad you asked!
Through your nose.
Breathe diaphragmatically - when you breathe in, your lower stomach should move. Most people breathe high up in their chest, and don’t use their diaphragm muscles even for deep breaths, much less regular breaths. But you should be using your diagram for every breath.
Breathe slowly - ideally you should breathe 10 breaths a minute. That’s 6 seconds in, 6 seconds out.11 Time yourself on this cadence with a clock or stopwatch for a few minutes, and come back to that timer in spaced repitition intervals to make sure you have it down and can do it subconsciously. This slower breathing is also good for people prone to anxiety.12
It’s thought that this cadence synchronizes with natural cardiovascular Mayer rhythms.
Breathing more slowly is ALSO a good idea for athletic performance - which we’ll go into in more detail in Buteyko breathing.
Tummo / Wim Hof breathing.
I’m still working on my Scott Carney / Wim Hof reviews, so this will just be a quick preview.
Who’s Wim Hof? A Dutch man with “a beard, thinning lead-colored hair, and a face pulled from a Bruegel painting.” Not a yogi, not a hippie, not a saffron-clad monk - just some dude. But he does stuff many people and doctors thought was impossible.
“Hof submerged himself in a bath filled with ice for an hour and 52 minutes, and he suffered no hypothermia or frostbite. Then he ran a full marathon in the Namib desert in temperatures that reached 104, without ever sipping a drop of water.Over the span of a decade, Hof broke 26 world records, each more baffling than the last. These stunts earned him international fame, and his smiling, frost-covered face soon appeared on dozens of magazine covers, in flashy documentary specials, and in a handful of books.
Hof and his techniques have been studied in various medical and university labs throughout the world. He was the guy in the quote in the beginning who could control his immune response to e coli at will in a study - better, he could train regular people to do it with just a few weeks of training.
I’ll save the bulk of this for my full Wim Hof review.13 Suffice to say, if you want to adapt your body and mind to perform better while under load and with lower oxygen and higher carbon dioxide, it can be valuable.
And what is the Wim Hof technique? First, cold exposure - turning your shower to “full cold” for the last 30-60 seconds, or for the whole shower if you’ve got the guts. Ice baths, snow angels in swimsuits, get creative.
Second, breathing:
Find a quiet place to lay down. Use a pillow under your head or neck if you feel like it, and relax your body.
Take a very deep, diaphragmatic breath into the pit of your stomach, and let it back out just as quickly. If you put your hand on your belly, your hand should visibly move up several inches as you breathe in, and then back down as you breathe out.
It’s a wave, it comes from your nose to the bottom of your stomach, then back out your stomach, up your chest, and out, in one connected wave. Keep breathing like this for 30-40 breaths.
When you’ve done 30-40, breathe out naturally, leaving about a quarter of the air in your lungs, then hold your breath for as long as possible. As LONG as possible.
When you can’t hold it any more, take a giant breath and hold it for 15 seconds.
Breathe out and repeat the whole cycle another 4 times - you’re back to taking 30-40 quick, full diaphragmatic breaths.
To recap the whole thing:
You’re taking 40 deep diaphragmatic breaths, and letting them out just as quickly as you take them in, then breathing out and holding as long as possible when you hit 40, then breathing a giant breath in and holding for 15 seconds after you couldn’t hold your breath any more, then repeating the 40 breaths. You repeat this cycle 4 times, so you’re breathing 160 fast breaths total.
Buteyko breathing.
“We’ve been practicing an extreme version of the techniques Buteyko used on himself and in the asthma ward: limiting our inhales while extending exhales far past the point of what feels comfortable, or even safe. We’re sweating and red-faced and I can feel veins bulging in my neck.”
Dr. Konstantin Pavlovich Buteyko was born in 1923 on a farm near Kiev. He treated asthmatics with breathing, studied breathing exhaustively in a broad array of people ranging from the ill to accomplished athletes, as well as treating himself with breathing - he had a blood pressure of 212 at age 29 and was told he’d be dead within a year, but lived to 80 after adopting his breathing exercises,14 which were focused on greatly reducing the amount you breathe, and matching breathing to the body’s needs.
Buteyko breathing in athletes improves VO2max and performance - it’s like altitude training, but you can do it without gimmicky devices or moving to a place in the mountains.
“Sanya Richards-Ross, a Jamaican-American sprinter, used Buteyko’s techniques to win three Olympic golds in the 4x400 meter relay (in 2004, 2008, and 2012) and gold in the 400 meters in 2012. She was ranked as the top 400-meter runner in the world for a decade.
I’ve actually been incorporating Buteyko into my own training. I’ve been trying to heed the admonition to train 80% of training hours at 66-75% of lactate threshold, and it’s genuinely difficult, because it is indeed “guilt inducingly easy.” So I’ve been dedicating between a quarter to half of an easy session towards Buteyko breathing.15
How do you do Buteyko breathing?
While under light to moderate exertion, breathe in through your nose for 3-4 beats, and then breathe out for twice that many beats, 6-8 beats. Footsteps, strokes, pedal pushes, or seconds all work as “beats,” choose what makes life easy.
You should be aiming for full exhaustion of the lungs on your double-long exhalations.
Do this for as long as you can stand it, but stop if you feel light headed or weird enough that you think it’s dangerous.
Other techniques.
Since I’ve been trying to trim down the reading time of my reviews lately, I’ll simply note the full list of breathing techniques Nestor tries in the book for your own further research if you’re interested:
Pranayama.
Buteyko.
Coherent Breathing.
Hypoventilation.
Breathing Coordination.
Holotropic Breathwork.
Adhama.
Madhyama.
Uttama.
Kêvala.
Embryonic Breath.
Harmonizing Breath.
The Breath by the Master Great Nothing.
Tummo.
Sudarshan Kriya.
What would you get from reading the book yourself?
Many more anecdotes and name checks of several researchers or physicians in the past that got amazing results from treating patients with breathing before they and their work and articles and books descend into total obscurity for various reasons.
Very compelling and visceral depictions of the impacts of his forced mouth breathing study - it made him and the other participant feel miserable all the time, and how much better nose breathing made him feel along with his health metrics was a really compelling argument for nose breathing.
More anecdotes and accounts of his forays into various other breathing techniques.
As one example, the Indus-Sarasvati civilization roughly 5kya, which had charming depictions of people engaged in meditation / deep breathing poses (like this one: https://imgur.com/a/wqo6hNi), but whose script was simpler and shorter than Linear A and was likely used for tallies and record keeping only.
Palates are higher and more v-shaped. Measuring before and after the Industrial Revolution, we measure average palate widths of 2.37 inches before - by the late 1800’s, palates had shrunk to 2.16 inches. If you study societies as they industrialize, 50% will show malocclusion within the first generation of switching to soft and processed foods, 70% by the second gen, 85% by the third, and 90% of post-Industrial-Revolution Westerners have some form of malocclusion now.
The above as studied by Robert Corruccini, who studied mouths and diets all over the world, including Pima Indians, Chinese immigrants, rural Kentuckians, Australian Aborigines, and more, and published 250 research papers and a dozen books on the topic.
Retainer-like devices designed to expand the jaw and palate - the last invented by Dr. Theodore Belfor of New York, where the author gets a homeoblock installed and a year later has grown 1.7cc of new bone in his cheeks and eye sockets, along with widening his airways and sinuses.
Dr. John Douillard, trainer of triathletes, the New Jersey Nets, and tennis star Billie Jean King 20 years ago, tested professional cyclists in one trial talked about in his book (Body, Mind, and Sport, 1995). When mouth breathing, they struggled and panted as intensity increased to 200w steady state. Repeating the tests with nose breathing, their rates of breathing decreased at the 200w stage. One athlete who’d been breathing at 47 breaths per min was nasal breathing at 14 bpm. According to Douillard, nose breathing under load can cut total exertion in half, and offer large endurance gains.
Viagra works by releasing nitric oxide into the blood stream.
The author recommends a small square of 3M medical tape right in the center of the lips. If tape doesn’t work, you can go old school - a bandage, handkerchief, scarf, or headband around the top of the head and the jaw will seal your jaw shut.
I, your humble reviewer, swear by these for both sleep and cardio training. It’s a little plastic dongle you put into your nose that manually opens the nasal passages and keeps them open.
You can simply choose to pay attention and resolve to solely breathe through your nose.
The old rubber band around the wrist, which you snap whenever you catch yourself mouth breathing. Or better, enlist your partner, friends, and / or kids - who may attend to it with an attentiveness, enthusiasm , and for-your-own-good sadism that might surprise you.
The monoblocks, bioblocks, and homeoblocks mentioned earlier - functionally a retainer you wear while sleeping, as Nestor does in the book - but you need to find a dentist like Belfor who will make one for you.
Perhaps NOT coincidentally, he has a fun aside in the book where he points out that religious traditions all over the world for thousands of years follow basically this 6-in, 6-out breathing cadence in various prayers and meditations. the Catholic Rosary, Buddhist “Om Mani Padme Hum,” “sa ta na ma,” Hindu khechari, and “Japanese, African, Native American, Buddhist, Taoist, and Christian” cultures everywhere converged on similar prayer techniques with similar timings.
Anxiety, PTSD, panic attacks, asthma, and many other physical illnesses involve breathing TOO MUCH, not too little - they are characterized by higher than normal breathing rates (often up to 2x higher), and noticeably lower carbon dioxide blood levels coupled with extreme sensitivity to carbon dioxide.
You have chemoreceptors plugged in as deep as the brain stem that monitor carbon dioxide levels in your blood, and they can get sort of rigid and “locked in” to a certain range, and it is thought that this is a major factor for anxiety and panic attacks.
Normal people have carbon dioxide blood levels between 5-6%, or ~5.5%. Serious athletes get up to 6.5 - 7.5%. People prone to anxiety average around 5%, and are more sensitive than other people to CO2 increases - any increases in blood CO2 levels pushes them to breathe more, which can lead to a feedback loop of their CO2 decreasing even more, more sensitivity, breathing more and faster, and literally inducing anxiety or a panic attack, mediated by the faster breathing and accompanying higher heartbeat.
The idea behind breathing less is to break this cycle, normalize CO2 levels in the blood, and to get your chemoreceptors less sensitive by exposing them to a broader range of CO2 levels.
I’ve personally been doing cold exposure and breathing as a result of reading Hof’s and Scott Carney’s books for nearly a decade now. And what do I think I get for that?
More equanamity
More nitric oxide and better health
Better cold tolerance
Better HIIT sprint times
Higher Heart Rate Variability
Two meta-analysis show something like an average 8 point decrease in blood pressure from adopting various breathing exercises, and I’d be willing to bet average adherence isn’t all that great (probably another reason breathing interventions keep falling off the map).
I breathe in for 4 steps or strokes and out for 8 while doing this. Your main target should be “breathing out long enough to fully exhaust your lungs.” You *really* feel it, it’s amazing. Sometimes I’ll do a modified box breathing with 4-in, 4-hold, 8-out. I can’t quite manage a 4 hold after a long 8 out that gets all the air out yet, because I’m straight starved for air at that point.