Breathing

I have long practiced one form or the other of mindful breathing. When I was a grad student in New York years ago, I met a guy who taught yoga. He introduced me to alternate nostril breathing (ANB), which I practiced off and on for a few years and then dropped. I had no idea, then, of its benefits, nor did I think I needed them. Then, when I began zen practice in the 1970s, I learned about breath counting—the basic practice for zen practitioners which simply teaches one to count and observe breaths from one to ten, over and over. If the mind strays into thinking, which it always does, one comes back gently to the breath counting. After many years, most practitioners begin to simply focus on the breath, watching it enter through the nosetip, go down to the lower abdominal region (about two inches below the navel) called the hara in Japanese (sometimes the word tanden is used), and exit with the out breath. In so doing, the upper chest and shoulders tend to relax, as does the mind, and some zen schools counsel focusing almost entirely on this hara as the key to practice. More recently, I have returned to a slightly different phase where one tries to simply become the breathing, as I noted in my blog “Earth Breath” (see my book of blogs with the same title, Earth Breath.) Just before that, on a zen walk or pilgrimage I took around San Francisco Bay, I stopped at one of the zen teaching places I was visiting, this one in Albany run by a Korean monk. There I was introduced to his practice of Sun Do breathing. This took place after morning meditation, and, in the first stage, consisted of lying prone, and breathing deeply into and out of the lower belly, called the tantien in Korean. This lasted for about an hour, with the breathing rate controlled by a musical rendering of the four Bodhisattva vows in Korean, one full breath per vow. It worked magically, I thought, and gave me uncommon energy to complete my walk. In addition to this practice, I also use Andrew Weill’s 4-7-8 breathing method (4 breath counts inhale, hold for 7 counts, exhale for 8 counts) for relaxation. 

            There is, of course, more development of this type of breathing in the various Buddhist and Yoga traditions, and now in many western medical traditions as well, but I have never actively moved towards those until recently. The impetus for this new look into breathing came from my cardiologist in Pt. Reyes. He emailed recently recommending a book and talks by one James Nestor. Nestor is not a doctor but a journalist who initially became interested in the ability of some free divers to hold their breath underwater for far longer than average, sometimes 8 or 10 minutes at a time. He began doing this himself, which eventually led him into a full investigation of the science of breathing. Though I haven’t yet obtained his just-published book, Breath (Riverhead Books), I have watched several videos of him and others discussing the benefits of deep breathing (all available on youtube) including why modern humans do not breathe as our ancient ancestors did.

            What Nestor claims is that proper breathing can heal, or go a long way towards helping with such modern diseases as hypertension (high blood pressure), diabetes, sleep apnea, heart disease, asthma, and many more. Truly fascinating is Nestor’s research into the evolutionary development of the human skull and its nasal opening. He claims that research has shown that, over the centuries, the human facial area of the skull has grown narrower, and the nasal opening smaller, a development that has made full breathing for moderns more difficult. This has also led to more humans having crooked teeth (due to the smaller mouth opening), something that causes more and more of us to need orthodontic work. But that is an aside here. Nestor’s chief investigation involves deeper breathing, and the many techniques that have now been proven by western medicine to improve human health in several areas. This appealed to me because I have been diagnosed in recent years with both high blood pressure and diabetes. If there were a method to help control both without drugs (I mainly control diabetes with diet and exercise, but blood pressure now requires numerous medications), that would be a major boon in my life.

            Of course, the advice to breathe deeply is a commonplace in calming people in stressful situations, most notably women during childbirth. But Nestor is referring to more conscious, regular breathing during all kinds of activities, and rest states as well. So, based on his talks and what I knew of zen breathing and yoga breathing (prana, the Sanskrit word for breath, is considered the foundation for all forms of yoga and spirituality), I decided to look up some of the materials he claimed now have scientific sanction. The literature is voluminous. For example, from Scientific American, a 2019 article by Christophe Andrè titled, “Proper Breathing Brings Better Health, Stress Reduction, insomnia prevention, emotion control, improved attention…but where do your start?” begins with the technique of cardiac coherence, said to help with relaxation. That is to say, slow, deep breathing 

increases the activity of the vagus nerve, a part of the parasympathetic nervous system; the vagus nerve controls and also measures the activity of many internal organs. When the vagus nerve is stimulated, calmness pervades the body: the heart rate slows and becomes regular; blood pressure decreases; muscles relax.

The vagus nerve is said to inform the brain of these changes as well, causing increased feelings of relaxation, but deep breathing may also act “directly on the brain itself.” Andrè cites a 2017 study by Mark Krasnow of Stanford, suggesting that breathing techniques may influence activity in the locus coeruleus (a brain region involved in attention and anxiety) by modulating the activity of a group of neurons that regulates respiratory rhythms—the pre-Botzinger complex in the brain stem. In addition, another study at the Technical University of Munich showed that “attention given to inhaling and exhaling” can “ease stress and negative emotions” by “reducing activity in the amygdala,” a brain section well known to be involved in emotional arousal. And what kind of breathing does this? One cardiac-coherence exercise recommends “inhaling for five seconds, then exhaling for the same amount of time (for a 10-second respiratory cycle).” Such deep, regular breathing is shown to regularize heartbeats. For more calming effect, one can spend more time on the exhale, because heart rate increases some when inhaling, while decreasing when exhaling. In sum, certain therapists recommend the “365 method”— three times a day deep breathing at six cycles per minute (five seconds inhaling, five seconds exhaling) for five minutes.

            This same article also provides several other breathing exercises to relieve stress, most, it seems, derived from yoga breathing exercises. One exercise simply advises following your breath as you breathe; another counsels “abdominal breathing;” another counsels “rhythmic breathing,” holding the breath before exhaling, with a variant to this being “alternate nostril” breathing similar to what is mentioned below. Also mentioned is a breathing exercise of “inhaling for panic,” which suggests rapid inhaling to acclimate to the feel of panic (this may be similar to so-called “holotropic breathing,” a psychological procedure invented by Stanislav Grof for emotional and spiritual advancement, which sometimes induces the bringing forth of hidden emotional traumas so as to deal with them). The website www.healthline.com more clearly lays out the benefits and rationale for alternate nostril breathing (ANB) with detailed instructions. Providing its name in Sanskrit, Nadi Shodhana, the site promotes ANB’s “ability to reduce stress and still the mind,” and asserts also that “it may decrease blood pressure and increase feelings of calm.” This assertion is backed up with results of a “study conducted in 2008” demonstrating that “a 30-minute practice [of ANB] lowered blood pressure, compared to participants who only practiced breath awareness.” The lowering of both systolic and diastolic blood pressure was said to be “significant.” The healthline site also notes that left and right nostril breathing have different effects, as yogis and modern studies have shown: i.e., that “breathing exclusively through the left nostril decreases blood pressure, whereas breathing exclusively through the right nostril increases blood pressure.” Other variants (Kapalabhatiand Bastrika) are also described, and their effects on both activity and mental acuity and lowering blood pressure are noted. What is remarkable is that the site seems to have no spiritual or commercial component, but merely points to the beneficial effects, from a strictly western perspective, of these ancient breathing practices on health. 

            This latter pattern is continued on the NIH-sponsored website, www.pubmed.gov. The article “Immediate Effect of Specific Nostril Manipulating Yoga Breathing Practices on Autonomic and Respiratory Variables,” by Shirley Telles and P. Raghuraj, describes the results of an experiment testing the heart rate, skin conductance, breath rate and blood pressure of practitioners with varying degrees of experience. The results showed that “following RYNB [right nostril yoga breathing] there was a significant increase” in blood pressure; in contrast, “pressure decreased after ANYB [alternate nostril yoga breathing] and the systolic and mean pressure were lower after LNYB [left nostril yoga breathing].” Another study on alternate nostril breathing on the same site indicates that “Alternate-nostril yoga breathing appears to improve performance in the digit vigilance test, along with a reduction in blood pressure.” In other words, alternating nostrils while deeply breathing decreases blood pressure without any loss of mental acuity. 

            With regard to diabetes, a study on the same website, pubmed.com, from the J Med Assoc Thai of January 2008, “Hypoglycemic Effect of Sitting Breathing Meditation Exercise on Type 2 Diabetes at Wat Khae Nok Primary Health Center,” concludes that “SKT1 [Somkorn Kantaradusdi-Triamchaisri, a type of sitting breathing meditation] practice had a post-prandial hypoglycemic [lower blood sugar] effect and a slight reduction to systolic and diastolic blood pressure.” Another site, www.breathing.com, provides a more thorough exposition of the causes and mechanisms of diabetes, and cites from several studies which have “recently discovered that oxygen levels in pancreatic beta cells regulate the activity of pancreatic cells through hypoxia-inducible factor 1-alpha.” Then, noting that “Optimal Breathing exercises can help in controlling blood sugar and bring insulin levels in the normal range,” a study [also on pubmed.com] by Martarelli, Cocchioni, Scuri and Pompei is cited—“Diaphragmatic Breathing controls complications attributed to elevated Blood glucose levels”—to the effect that “relaxation induced by diaphragmatic breathing increases the antioxidant defense status in athletes after exhaustive exercise,” inducing a “lower level of oxidative stress.” Another study from 2014 showed the same beneficial effect from a six-month breathing program. By filling the lungs with fresh oxygen through deep breathing, that is, all cells in the body are oxygenated, which helps burn off fat. More, such breathing helps control oxidative stress—an imbalance of free radicals and antioxidants—which “triggers diabetes-induced inflammation, insulin resistance, and thus elevated blood sugar levels.” By also helping to regulate better sleep, deep breathing works to “decrease levels of inflammatory cytokines” and to “reduce levels of stress-inducing hormones such as adrenaline and cortisol.” If true, all these effects combined can only aid in maintaining overall health, particularly for those with diabetes. My only complaint about this website is that several products to aid in deep breathing are prominently displayed for sale, something that always arouses my suspicion. I would rather go directly to the many pranayama yoga websites for the same information on breathing technique.

            The use of mindful breathing techniques to treat asthma is also worth mentioning. Numerous studies have been done to assess the effects of pranayama to help asthmatics, whose numbers have soared in recent years—probably due to the worsening quality of air in cities around the globe—to breathe without the use of drugs. One such study from the January 2009 International Journal of Yoga, displayed on the NIH National Library of Medicine website (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017963/ ) is titled “The effect of various breathing exercises (pranayama) in patients with bronchial asthma of mild to moderate severity.” Fifty patients were studied and separated into two groups: one to do meditation focusing on breathing, the second to do breathing exercises, including deep breathing through both nostrils, alternate nostril breathing (here called Anuloma viloma), Bhramari chanting (deep breathing with humming for the exhalation), and Omkara, similar to the above, but with forceful exhalation and OM humming. The conclusions were unequivocal: after twelve weeks, there was a significant reduction of asthma symptoms in the pranayama breathing group as compared to the group that did only meditation. The important conclusions are cited:

Firstly, expiratory exercises are helpful. In bronchial asthma expiration is difficult, so exercises that support expiration are beneficial…Secondly, forceful expiratory exercises (expiration) are helpful and this is illustrated in Figure 4. In this figure, air is easily coming in and going out in a normal person, but in an asthmatic patient air is coming in easily but during expiration there is closing of airways and force is required to open the airways; hence, a high pitch/ forceful Omkara OOOOOOOOOO…MMMM was found to be helpful instead of oooo…mmm. Thirdly, prolonged expiratory exercises (expiration) are helpful.

            Finally, the website www.breathmeditation.org discusses the Buddhist tradition of breath meditation, citing from several sutras attributed to the Buddha’s time. One citation follows:

In the Dhatuvibhanga Sutra (M 140:4), Buddha’s entry into meditation is described in this way: “The Blessed One sat down, folding his legs crosswise, setting his body erect, and establishing mindfulness in front of him–that is, establishing his awareness parimukha–in front of his face at the tip of his nose.” So focussing attention on the tip of the nose is a requisite for meditation in general.

This site also references a book by Larry Rosenberg, Breath by Breath, as follows:

“Much of what the [Anapanasati] Sutra describes will turn up naturally if you just sit and follow the breathing, if you persist in that practice over the course of days and months and years. It is natural for your attention to deepen until it includes the whole body, and for that process gradually to calm the body.

The Anapanasati Sutra is said to be the Buddha’s own original teaching on breathing mindfully in meditation both for bodily relaxation, and for cultivating the Seven Factors of Enlightenment. In other words, breathing mindfully—from the very beginning of Buddhism—is said to lead not only to bodily health, but to spiritual advancement. The same is true in most Yoga practice: the end result is not simply bodily health, but spiritual health as well. And in truth, perhaps the two should not be distinguished one from the other: as the Romans used to say, mens sana in corpore sano— “a sound mind in a sound body.” The two are one. And at the core of both, it seems, from the ancients to our own time, is deep and mindful breathing.

            Of course, the problem for us moderns, as noted briefly above regarding asthma, is that we cannot count on the same virgin quality of air as could the ancients. Before industrial pollution, the air in most places, though it could be fetid in large cities, was not, until the last 300 years or so, laced with sulfur compounds or acids or fuel exhaust or, now, plastic micro-fibers that infiltrate and settle into our very lungs. And regarding the latter, no one yet knows what the long-term effects of this plastic lung residue on our breathing will be, though we can guess it won’t be good. But there is no guessing about the negative effects of fuel- and chemical-polluted air on those millions among us whose poverty forces them to live near highways and industrial corridors where the pollution is most concentrated, and where asthma is endemic. Eventually, though, no one, not even those high up in gated communities, will be able to escape the effects of having to breathe polluted air. What those effects will be on the efficacy of deep breathing, or even our ability to continue to practice it, is unknown. Until then, however, we could do worse for our health than just breathe—breathe deeply, breathe mindfully, and breathe as part of a regimen designed to maintain our hearts, our lungs, our blood and cells, our brains, our spirits. 

Which is—do we even have to say it about breathing?—our most fundamental activity.

Lawrence DiStasi