#143 | Heart, Lung & Brain Injury from Chronic Over-Breathing | George Dallam, PhD

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We all want a healthy heart, lungs, and brain. Can you guess at the single behavior that connects the dots on solving: the ability to run or ride at the same speed using 25% less breathing, reducing the occurrence of the so called exercise induced asthma or bronchoconstriction (EIB), eliminating side stitches while running, avoiding frequent sinus infections and bronchitis, and even dodging aFib and dementia?...and what if it cost you nothing but your attention? Well, listen to this: The latest science is showing us that while breathing with an open mouth allows for an increase in ventilation, increases work capacity (think: vo2max), and actually feels more comfortable and normal, doing so also predisposes us to a variety of potential health problems over time. Right, today we are going to talk about nasal breathing.

while nasal breathing may have fallen off the internet talk circuit as a popular biohack, wise athletes should always pick the low hanging fruit.

so coming back to our show on episode 143, the one and only Dr George Dallam walks us through his personal benefits from adapting to nasal breathing nearly 20 years ago, and the latest research into the health and physical performance benefits available to us all...without ingesting any chemicals, or changing our diet, or buying a single thing. All you have to do is breath through your nose. Its a simple prescription; ....if only it was easy to learn.... i say since i have failed to fully adapt in the two years since i first spoke with dr dallam...

All right, let's talk to George Dallam, author of the just published book, the-nasal-breathing-paradox-during-exercise

George Dallam PhD

Dr. Dallam holds the rank of Distinguished Professor in the School of Health Science and Human Movement at Colorado State University - Pueblo (CSUP). Dr. Dallam has been involved in numerous research studies examining various aspects of triathlon performance and training, diabetes risk factor modification, and the effects of functional movement improvement on running. His primary research interest recently is focused on the capability of human beings to adapt to nasal only breathing during exercise as a way to improve both health and performance.

Dr. Dallam has received both the United States Olympic Committee's Doc Counsilman Science in Coaching award (2004) and the National Elite Coach of the Year award (2005) for triathlon. Finally, Dr. Dallam has been continuously training and competing in triathlon since 1981.

Bullet points -- The Nasal Breathing Paradox Benefits of nasal breathing: 

• Better filtering of particles and viruses (less nasal infection, bronchitis). Filtering becomes even more important when exercising because we take in so much more air.
• Less water lost though breathing
• Less energy spent on breathing (more energy for locomotion); higher O2 extracted per breath (higher efficiency)
• Recovery from “EIB” exercise induced bronchoconstriction (exercise induced asthma)
• Provides a powerful training stimulus to improve fitness…make you faster even if you go back to mouth breathing in high intensity efforts, such as races
• Improved stress management
• Better sleep, and overall improved recovery from exercise (lower stress, avoidance of snoring)
• Better posture and movement ability with improved diaphragm activity
• Functional movement benefits —diaphragm is a major core muscle that is under strength when we mouth breathe. 
• Avoids possible damage to the heart from over breathing (a hypothesis from Dr Dallam) 
• Effect of nasal breathing during exercise on brain health (https://digitalcommons.wku.edu/ijesab/vol2/iss15/103/)

Myths about breathing:

• I feel the need to breath faster when I need more oxygen — mostly false.  It is the presence of higher than usual CO2 in the blood that causes the “air hunger”
• CO2 is bad, and needs to be removed as fast as possible — false; CO2 is necessary for normal bodily functions.  Too much AND too little CO2 are bad for the body.
• Breathing faster brings in more oxygen (superoxygenation) — no; red blood cells are generally 95-98% oxygenated after passing by lungs.  You don’t get more oxygen into red blood cells, you just lose more CO2 from blood plasma, which creates problems for the body
• Breathing doesn’t take much energy or use much oxygen to do — false.  During exercise, breathing can use as much as 15% of the total energy burn of the body…15% of the oxygen being used.  If we can save 25% of that by breathing more efficiently (less breathing for same oxygen), we’ll have more oxygen left over for other muscles to use.
• An athlete cannot get enough oxygen for exercise though just nasal breathing — false.  It is easy to see why people would come to this conclusion after one attempt, but with adaptation, many elite athletes compete using just nasal breathing.

What does the nose do for us?

• Conditioning of the air:  humidifying the air and warming up the air.  Reduce lung dehydration and related wheezing and breathing problems
• Filtering:  particulates (dust, smoke), viruses are captured instead of putting in lungs.  Avoid damaging lungs long-term (emphysema, cancer) and reduce infections impacting lungs.
• Increasing air resistance…forces a recruitment of the diaphragm which is the best muscle for efficient breathing.  Breath through the nose, then you will breath diaphragmatically without thinking.  You can stop trying to train yourself to “Belly Breath”.
• Calming.  Reducing stress.  Deep slower breathing vs. quicker shallow breathing activates the parasympathetic nervous system…lowers the stress level of the body.  This is definitely true at rest.  For athletics, peak performance comes of being able to relax into the effort..not by trying as hard as possible, so stress level might also play a role in athletic performance.
• More efficient breathing:  breathe less to get the same amount of oxygen.  25% less breathing when nasal breathing.  So the 15% of total energy expenditure being spent on breathing is lowered to 11.5%….a 3.5% point reduction in energy used for breathing that can now be used elsewhere.  This is the same level of economy improvement that elite endurance athletes seek to obtain from using weight training…and this is just from breathing through your nose.
• Avoids the over breathing associated with mouth breathing. Over-breathing MAY be a cause of damage to the heart seen in endurance athletes as a higher incidence of AFib….lowering of CO2 in blood (from over breathing) results in blood flow restriction, which may be a cause to a lack of blood flow (a lack of oxygen) to the heart.  

Related to Exercise Induced Asthma / Bronchial restriction (EIB)

• The lungs are filled with alveoli … the little sacs that allow the body to exchange gases.  Single cell thick, covered in a surfactant that allows the sacs to stay open even at low pressure.
• The lung environment is very liquid and very delicate.
• Imagine blowdrying wet tissue paper with a hairdryer…not good.
• When the air comes into lungs via the mouth, the air is not treated. Everyone has experienced coughing…the only way we have to get stuff out of our lungs that shouldn’t be there. It also is what happens when we have damaged our lungs, whether from breathing air that is too cold or too hot or too dry or too wet or filled with damaging particulates or just through over extertion.
• Our body creates “broncho constriction” to protect the lungs. If you ever had a wheeze at the end of your exhales, you’ve had this thing.
• This correlates very highly with mouth breathing athletes. Bronchio restriction is vey common among elite athletes…cycling, swimming, running. 20-50% of population vs. 5% among sedentary population. The more you breath, the more important it is to treat the air you breath and protect the lungs.
• The availability of broncho inhalers may just be serving to allow us to overcome our natural defense again damaging our lungs from mouth breathing.

HOW TO NASAL BREATHE?

• The transition to nasal breathing is easier for some people.  Some people feel a terrible air hunger while others get used to it very quickly.  The path forward for everyone is to find your way to just the threshold point that your body can do it…with just a suggestion of air hunger…and then move higher over time.   
• It takes 6 weeks to 6 months.  Three key variables that impact time to adapt:
• Existing sensitivity to CO2.  If low sensitivity, then short time to adapt.
• How well developed is the diaphragm muscle.  The more you need to build, the longer it will take.
• How dedicated is the effort to adapt.  The more you nasal breath, the faster you will adapt.
• What do you need to do to be able to nasal breathe all the time?
• Break / Start the Habit
• Break the habit of mouth breathing.  Do it whenever you realize you are not nasal breathing.  Set reminders.  (See Episode 45 - Build Strong Habits  )
• During exercise, put a little water in your mouth so you don’t have to think about nasal breathing.
• According to Dr. Dallam, “I also found that focusing on nasal breathing during exercise facilitated focusing on it throughout the rest of my life as well.   While subjective at best, I consider that I am more relaxed, more thoughtful, sleeping better and happier as a direct result.” 
• Once you can do your endurance & recovery workouts while nasal breathing, the adaptation will go very fast because that is most of your training.  And, if you are nasal breathing outside of exercise as well, you are essentially always nasal breathing at this point.
• You’ll adapt even faster if you will take down the level of effort to match your ability to perform while nasal breathing, and only increase as your nasal breathing improves.
• Separately work toward nasal breathing during sleep.  This is harder as you will be unconscious, but this will have a gigantic impact on your health and ability to recover from exercise.  Look into mouth taping and breathing exercises to open nasal passages before sleeping.

Reduce CO2 sensitivity:

• By nasal breathing more, you will have less CO2 in your blood.  Your body will get used to that …meaning it will start to feel normal quickly (in days).  Keep pushing on the edge of discomfort to keep lowering your sensitivity.  Pushing too hard will backfire, so take your time.  This is not the place to develop a psychological problem.  And, this adaptation will happen faster than the muscle development so there is no payoff from pushing harder than just enough. 
• “Breathe light” exercises:  just breathe more slowly while resting…until you feel an urge to breath more….just experience the feeling (from Patrick McKeown)
• Do breath holds while moving (walk, light jog).  Hold until the air hunger is strong.  Recover your breath fully, then repeat (from Patrick McKeown)
• Do HIIT intervals breathing nasally...start short and build up longer and longer.
• Muscle development:
• Training the breathing muscles to get stronger.  This happens simply by using nasal breathing.  Just give the muscles some time to adapt.  It’s like getting used to using a bigger gear on the bike….You can do it for a short time right away, and over time you will get more muscular endurance as you get stronger.
• The Diaphragm muscle has to adapt.  At first, you won’t be strong enough to keep nasal breathing (i.e., pulling air through the nose and down into the bottom of the lungs) for a long time.  But the diaphragm muscle will get stronger and eventually you will be able to breath diaphragmatically for as long as you need and train for.  This might be the slowest part of the adaptation..
• The nose muscles have to adapt as well.
• Nasal passage recovery:
• If you haven’t been using your nasal passages in this way, you will have to get them adapted to this level of use.
• The most important thing is to just breathe through your nose as much as possible.
• It will probably help to start using a Neti pot or Neti bottle (there are many varieties).  Use distilled or boiled water, not tap water.  Remember to not blow your nose too hard after rising nasal passages with water…you may inadvertently push water into your ear tubes which may cause irritation.  I do it first thing to let the water fully drain out before I sleep. The first few times will be unpleasantly reminiscent of getting water up your nose at the beach.  But do you remember how amazingly good your nasal passages felt after a day in the surf?  This is the same thing.  After doing it for a week, you will never want to stop.  And it will make nasal breathing so much easier
• Use BreathRight strips or the like to hold open the airways in your nose.  George says his nose muscles got stronger after a while, so this may be a temporary thing.  But it does make an enormous difference in the beginning.  There are other nasal dilator devices to try if you like the idea of stuff up your nose.  I don’t.
• Try the Buteyko (bu-tek-o) method for clearing mild nasal congestion
• Metrics:
• It can help to track improvement if you use metrics but you don’t have to do so because the goal is NOT to breathe less, it is to use nasal breathing.  The rest comes naturally.
• HRV — your HRV level should start to increase, especially if you can nasal breath while sleeping
• HR — you may find your HR starts getting lower for the same power / speed.  This doesn’t occur for everyone.
• Breaths per minute — monitor your natural breathing.  Oura ring & Whoop strap do this for sleep, which is a good way to see if it is falling.  You want to get to 14 or less breaths per minute.  10-14 breaths per minute is normal, according to Patrick McKewon.
• Length of time until air hunger —  5 normal breaths. Exhale. How long until impulse to breath?  25 seconds minimum. 40 seconds target. 
• Maximum breathlessness test:  normal breath in and out of nose.  Exhale, then hold and see how many steps you can take.  60 steps is minimum for “good” CO2 sensitivity.  
• How to get started with nasal breathing during exercise, According to George:
• Get on an indoor device you like to use:  stationary bike, treadmill, etc.  
• Get going at a pace that is lower than normal
• Breathe nasally.
• Every 3 minutes increasing the pace just a little, and rate how much the air hunger you feel.
• When you find the level at which you feel you cannot keep going, back off just a little so you can keep going.  It will feel hard but not feel like you are suffocating. The effort should be in the challenge of pulling the air in and out, not in staying conscious or in dealing with the fear of suffocating.  Another thing to watch is a rising HR…if your HR is higher than it should be for that level of power / pace, then you are struggling too much…just back down a little until the HR stabilizes 
• The next workout, try to go a little harder while nasal breathing to see if you can do it.  You will probably find you can go harder every time for a while.  The early, beginner gains will be the easiest, as in most things.
• Continue the upward progression over time
• Feel free to mouth breathe once in a while if you want to go harder.  It won’t be a set back, but it won’t help you progress toward 100% nasal breathing.  Just don’t lose track of the behavior change you are trying to instill as a habit.

Related info and episodes:

• breathing-well-is-a-skill-w-george-dallam-phd
• protecting-lung-health-meilan-k-han-md/

More Dallam info:

• George Dallam CSU-Pueblo profile
• Book: the-nasal-breathing-paradox-during-exercise-george-dallam

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