Breathing Retraining: From Sick/Victims to Superhumans

Qs and As from the ebook Normal Breathing: the Key to Vital Health

Q: What were the historical origins of concerns about the dangers of CO2?

A: In the 1780s, French scientist Antoine-Laurent Lavoisier determined the composition of air. He also discovered the mechanism of gas exchange during respiration and burning. Oxygen is consumed for the production of energy and carbon dioxide is expelled as an end product. In his classical experiments, mice died in a closed glass jar in an atmosphere containing large quantities of carbon dioxide and almost no oxygen. A candle also quickly expired in such air.

That was probably the time when a superficial understanding of respiration produced the idea that carbon dioxide was a “toxic, waste and poisonous” gas while oxygen brought life and vigor. “Take a deep breath”, “Breathe more air, it is good for your health”, “Breathe deeper, get more air into your lungs, we need oxygen”, etc. became popular phrases for which there is no scientific basis. Even now, some scientific publications contain such misleading sentences, as “Respiration is the process of oxygen delivery.”

Professor Yandell Henderson gave the following explanation of this ignorance, “Likeness of Life to Fire. - Lavoisier's supreme contribution to science, and particularly to physiology was the demonstration that, in their broad outlines, combustion in a fire and respiratory metabolism in an animal are identical. Both consist in the union of oxygen from the air with carbonaceous material: and both result in the liberation of heat and the production of carbon dioxide…

The human mind is inherently inclined to take moralistic view of nature. Prior to the modern scientific era, which only goes back a generation or two, if indeed it can be said as yet even to have begun in popular thought, nearly every problem was viewed as an alternative between good and evil, righteousness and sin, God and the Devil. This superstitious slant still distorts the conceptions of health and disease; indeed, it is mainly derived from the experience of physical suffering. Lavoisier contributed unintentionally to this conception when he defined the life supporting character of oxygen and the suffocating power of carbon dioxide. Accordingly, for more than a century after his death, and even now in the field of respiration and related functions, oxygen typifies the Good and carbon dioxide is still regarded as a spirit of Evil. There could scarcely be a greater misconception of the true biological relations of these gases…” (Henderson, 1940).


Q: How did the parameter “40 mm Hg CO2” appear in textbooks?

A: This number is important because it is present in all main physiological textbooks used nowadays by western students. This is the current medical norm for CO2 content in alveoli and the arterial blood. The number was established about a century ago by the famous British physiologists Charles G. Douglas and John S. Haldane from Oxford University. Their results were published in the article The regulation of normal breathing by the Journal of Physiology (Douglas & Haldane, 1909). The investigators analysed arterial blood gases of staff members at Oxford University, including scientists and support personnel, and found the average for the group. It is possible to argue that even during those times many University workers had a sedentary life style with little physical activity. Hence, their CO2 concentrations could be lower than those for most healthy people a hundred years ago. Indeed, another old study by the also famous Karl Albert Hasselbalch had about 46 mm Hg aCO2 as the average value for volunteers at rest (Hasselbalch, 1912). Doctor Buteyko suggested about the same value to be the norm for people in good health.


Q: How many people have normal breathing?

A: If we accept medical standards (6 l/min for ventilation, as in most medical and physiological textbooks, and 40 s for the BHT), only a small percentage (less than 10%) of the population satisfies this criterion. Experience shows that on average, only a few, if any, per 1,000 people have breathing with Doctor Buteyko norm (60 s BHT  or more).


Q: How much oxygen is retained in the human organism? In other words, are we efficient in oxygen extraction from air?

A: Typical patients with asthma and heart disease breathe about 15 l/min at rest and have about 15 s BHT. They utilize or absorb only about 10% of inhaled oxygen, the remaining 90% is exhaled back in air. People, who are considered normal by medical standards (6 l/min and 40 s BHT) retain only about a quarter (25%) of the oxygen that they inhale. Their lungs are more efficient at extracting oxygen. Those healthy people, who breathe in accordance with Buteyko norm (4 l/min; 60 s BHT), can extract up to 30-35% of the oxygen they inhale. People with over 3 min BHT (hatha yoga masters. Dr. Buteyko and many of his colleagues, etc.) would have about 2 l/min for minute ventilation and retain up to 60% of inhaled oxygen.


Q: Which body parts or tissues are particularly sensitive to tissue hypoxia? In other words, how long can various organs and tissues survive without oxygen?

A: The time of survival will relate to initial oxygenation (reflected in the breath holding time) and existing pollution of tissues. This table from the British Medical Journal (Leach & Treacher, 1998) reflects tolerance to hypoxia of various tissues for an ordinary person. 

Tissue Survival time
Brain 3 min
Kidney and liver 15-20 min
Skeletal muscle 60-90 min
Vascular smooth muscle 24-72 hour
Hair and nails Several days

Q: Some people claim that overbreathing can help the organism to "expel toxins". Is this opinion correct?

A: Although some medical and physiological textbooks on respiration state that unwanted substances can be removed from the organism through the air passages, their quantities are small. In addition, overbreathing or hyperventilation is unlikely to be useful due to greatly decreased blood supply to other organs of elimination, which will then function less efficiently. Moreover, poor blood supply to the tissues is going to diminish the rate at which these substances are collected by body fluids and eliminated.

Meanwhile, normal breathing (about 6 l/min), in addition to the described normalisation of body physiology, means that smaller amounts of polluted air, smoke, dust, etc. are taken in to the organism through the lungs.


Q: Does deep breathing help to deliver more fresh air to poorly ventilated parts of the lungs filled with old stale air?

A: Often people also ask, “Is it true that, if I breathe little, I do not exercise my lungs and can develop some lungs problems?” Vice versa. All people with asthma, emphysema, bronchitis, and many other problems are heavy breathers. They need CO2 to heal their lungs. In addition, people with heavy or deep breathing are often chest-breathers since the smooth muscle of the diaphragm is in the state of spasm. Hence, their lower layers of the lungs get much less, if any, fresh air. Normal breathing is diaphragmatic allowing homogeneous inflation of the whole lungs with fresh air, similar to what happens in the cylinder of a car due to the movement of the piston.


Q: Can a few deep breaths or sighing relieve tension in the chest?

A: During the first of several deep breaths, not only are all alveoli in the lungs greatly expanded providing more oxygen for all tissues, but also any tightness in the chest muscles can be temporarily relieved, due to their stretching and subsequent relaxation. Periodic sighing (a typical symptom of diabetics, CFS sufferers, cardiac patients, asthmatics, etc.) is an example of chest tension relief, but such deep breaths also remove more CO2, first, from the lungs, and finally, from all cells.

As a result, any beneficial effects of deep breathing are very short-lived. Moreover, lowered CO2 levels lead to worsening of the problems which deep breathing was intended to solve causing: 1) further bronchoconstriction, up to partial or total closure of some lung areas and less effective gas exchange; 2) more muscular tightness due to increased hypoxia, excessive excitability and tension in the chest and other muscles, constriction of arteries and capillaries, and certain other physiological disorders discussed above.

Thus, the temporary relief provided by periodic deep breaths or sighing can become a part of the vicious circle. It is no surprise that various medical professionals, authors of the already cited publications, viewed sighing as a clear symptom of the chronic hyperventilation syndrome.


Q: How does breathing affect the quality of sleep?

A: A normal person needs about 5-6 hours of sleep. He falls asleep within a few minutes, sleeps the whole night in the same position without awakening, does not remember his dreams and wakes up fully refreshed. That corresponds to normal breathing and normal breath holding time (about 40 s).

A typical asthmatic with 15 l/min ventilation and about 15 s BHT tends to have 8-10 hours of sleep. He is likely to need some 5-20 minutes to fall asleep. During the night he can awaken, get anxious, change positions, have dreams, etc. In spite of the long period of sleep, he may still feel tired in the morning. How and why are these abnormalities possible?

As mentioned above, hyperventilation "leads to spontaneous and asynchronous firing of cortical neurons" (Huttunen et. al., 1999). This phrase, from the professional magazine Experimental Brain Research, has very serious personal and even social ramifications (as we are going to see in Chapter 9).

For example, when this asthmatic goes to sleep he has thoughts, which are self-generated by his brain in spite of his conscious attempts to calm down, relax, put everything aside, etc. These “spontaneous and asynchronous” thoughts often cause problems with falling asleep.

Let us consider the duration of sleep. Two main known physiological purposes of sleep are to give rest to the brain (especially to cortical areas) and the muscles. The normal person, due to normal aCO2 concentrations, has had a relaxed, easy attitude, with normal perception during the whole day. He has experienced less stress (since stress in modern people is mainly due to distorted attitudes to outer events and stimuli, not due to life-threatening situations). His muscles have been relaxed (again due to carbon dioxide). Hence, he needs only 5-6 hours of sleep.

The asthmatic, due to chronic hyperventilation, has had tense muscles and over-excited brain during the whole day. Normally, he needs more time for sleep in order to relax and rest his muscles and brain.

Moreover, severely sick and hospitalised people with 5-8 s BHT may need up to 12-14 hours of sleep, usually of miserable quality: with frequent awakenings, changed body positions, dreams, nightmares, etc. The causes are the same: tense muscles and “spontaneous and asynchronous firing of cortical [and other] neurons”.

Certain practical evidence and hatha yoga studies also have found that, when breath holding time is about 1 minute, people need on average only about 4 hours of sleep, while for 2-3 minutes BHT, 2 hours of sleep is sufficient. In my view, that corresponds to the way Nature designed the human organism.

The relationships between sleep and breathing will be considered in more detail later.


Q: Are concentration and other mental skills (like logic, analytical abilities, memory, etc.) similarly affected and why?

A: We know from above, that brain blood flow is proportional to aCO2. In addition, brain oxygenation is impaired in such conditions due to the Bohr effect. Both factors produce predictable effects on all our senses and communication within the nervous system. At some moments of time, these “spontaneous and asynchronous firings of cortical” and other neurons may coincide with the normal image of the world. However, considering long periods of time, it is unreasonable to expect that a chronically hyperventilating brain can function normally.


Q: I have heard that in some places pure O2 can be bought for breathing. Is it good for health?

A: While breathing pure O2, “Free radicals (and other toxic metabolites of oxygen) are generated in most cells as a consequence of normal metabolic processes, but cells are protected from injury by antioxidant mechanisms. Several forms of lung injury appear to result from generation of toxic metabolites of oxygen in quantities which exceed the antioxidant capacity of lung cells…”, as stated at the very beginning of the abstract by Brigham (1986).

Moreover, detailed investigation of lung tissues revealed that, “Exposure of animals to oxidant gases produces a mild emphysema, and O2-derived free radicals are capable of degrading connective tissues in vitro. It is postulated that degradation of connective tissue by O2-derived free radicals leads to emphysema in these models” (abstract, Kerr et al, 1987).

A review, “Data on oxidants and antioxidants”, conducted by Junod (1986), also found that “Since O2 intermediates can affect the general cellular metabolism and inhibit cell replication or reduce protein synthesis, all the biological effects of O2 and its metabolites should therefore be considered in the pathogenesis of emphysematous lesions in the lung” (Junod, 1986).

Another related question is why anti-oxidants are important supplements. They are used in order to diminish the possible damage done by oxidants generated by, among other sources, excessive freely-dissolved O2 concentrations.

Finally, a textbook on medical physiology (Ganong, 1995) contains a section entitled "Oxygen toxicity". It starts with: "It is interesting that while O2 is necessary for life in aerobic organisms, it is also toxic. Indeed, 100% O2 has been demonstrated to exert toxic effects not only in animals, but also in bacteria, fungi, cultured animal cells, and plants. The toxicity seems to be due to the production of the superoxide anion (O2-), which is a free radical, and H2O2. When 80-100% O2 is administered to humans for periods of 8 hours or more, the respiratory passages become irritated, causing substantial distress, nasal congestion, sore throat, and coughing. Exposure for 24-48 hours causes lung damage as well. In animals, more prolonged administration without irritation is possible if treatment is briefly interrupted from time to time, but it is not certain that periodic interruptions are of benefit to humans" (Ganong, 1995).

In subsequent paragraphs, Professor Ganong describes development of lung cysts and serious visual defects due to retinal damage in infants treated with O2 for respiratory distress syndrome. Increased O2 pressure (in some places pure O2 is administered at increased pressure) accelerates the harmful effects of O2.

Meanwhile, breathing O2 for a few minutes would probably not be very harmful. Generally, breathing pure oxygen can be useful as a short-term emergency measure in cases of life-threatening hypoxia.


Q: What is the long-term influence of different air compositions on human health? Has anybody investigated the optimum composition of air?

A: The first experiments in this area were done about a century ago by Yale researchers. Professor John Haldane was, probably, the most prominent scientist of those times. He wrote a classic textbook “Respiration” (Yale University Press, New Haven, UK, 1922) which is mostly devoted to the interaction between breathing and arterial blood CO2 concentrations. During the later years of his career he served in the British Navy, working on air supply for submarines (where people can spend several months). The results of his research are still classified by British government agencies.

Available information about air composition on spaceships indicates that during the first three US space missions astronauts used pure O2. Pure oxygen would be expected to cause impairment of mental performance and physical health, due to decreased blood flow to the brain, as discussed in section 1.2 and other negative effects mentioned above. On later missions US astronauts were provided with much less O2 in the air of their spaceships.

In 1960s Doctor Buteyko was the manager of the laboratory of functional diagnostic and studied various breathing –related effects on cardiovascular and other systems of the human organism. His research was supported and funded by the Soviet Ministry of Aviation and Space Exploration for first Soviet space missions. According to Doctor Buteyko, the optimum air for long-term health benefits should be about 10-12% O2 (as found on high mountains) and 2% CO2 (Buteyko, 1977). Probably, this extra 2% CO2 increases aCO2, improving body oxygen level and producing other positive changes, while 10-12% O2 (twice less than normal air) is small enough to minimize oxidative lung damage.

Surprisingly little information is published about research on optimum air for submarines. Also, very little is published about the growth processes of plants and animals in CO2 rich air, while known results are very encouraging.


Q: Could you [doctor KP Buteyko] please explain us shortly your principle of breathing?

A: Here it is: we know that deep breathing decreases the concentration of carbon dioxide in the blood, lungs and cells. A Russian scientist from Perm, Verigo discovered this law at the end of 19-th century, which is, as it seems, strange: a fall of carbon dioxide increases the chemical link between oxygen and haemoglobin. As a result, it is more difficult for oxygen to get from the blood to the brain, heart, kidneys, and other organs. In other words, the deeper the breathing, the less the oxygenation of the cells in the brain, heart, and kidneys. This law is in the foundation of our discovery. CO2 deficiency causes constant spasms in all organs. Hence, it is necessary to learn right breathing” (Buteyko, 1997).


Q: Why did the western clinical trials not revealed improvements in lung function test in those students who learned the Buteyko method?

A: The lung tests reflect presence of inflammation meaning that, while the Buteyko group could reduce medication, their airways, on average, remained inflamed after they practiced the method for 3-6 months (typical durations of last follow ups). Healing would result in better numbers. It is a big physiological change to eliminate inflammation and it needs large morning CPs (about 30-35 s) with no exposure to triggers for some weeks so that the tissues can get healed. Another expected achievement is elimination of allergies leading to full clinical remission of asthma. This is how the method was and is taught in Russia (so that the patient has no inflammation and no allergies).

Many western students, as we know, progress only until about 25-30 s (no medication, better sleep, ability to exercise, etc.). Why do they not progress further? Practice indicates that usually breathing teachers help their students to achieve the same level as they have.

It is not a surprise then that Buteyko demanded 60 s for his doctors in Russia so that the students learn the method till the level of the teacher. High CP teachers, from the very beginning, target their students to Professor’s golden health standard: 60 s CP. Russian doctors explain to their students that being stuck, during the healing process, at 40 s is a normal phenomenon due to fundamental changes in the organism. Such information about the known future obstacle (40 s threshold) is important for long-term motivation.


Q: Is CO2 the only cause of success for the Buteyko method?

A: CO2 is the most known and investigated factor that relates to breathing and the Buteyko method. There are many other factors that are known to students and practitioners.

 The Buteyko method also includes, for example, psychological factors. The students learn how to stop their symptoms and prevent attacks, how to pay attention to stress and other factors that cause hyperventilation. Hence, they acquire a sense of control over their health. Helplessness and depression are no longer the parameters that define the course of their diseases.

Nasal breathing helps the body to use its own nitric oxide that is produced in nasal passages. The roles and some important effects of this hormone have been discovered very recently and there are still many questions in relation to this substance.

Emphasis on diaphragmatic breathing and relaxation of chest breathing muscles should favour elimination of possible abnormalities in regulation of breathing by the autonomous nervous system. Activity of the chest breathing muscles at rest often points to sympathetic dominance since chest muscles get active during both exercise and hyperventilation. While the Buteyko method is not focused on slow diaphragmatic breathing pattern, this pattern gradually appears by itself, for example, during sleep. This effect promotes lymphatic drainage of the nodes located under the diaphragm.

Passive relaxed exhalation during the breathing sessions should also have good effects on the balance between parasympathetic and sympathetic nervous systems. These systems are often out of balance for many diseases, like asthma, heart disease, chronic fatigue, cancer and other health problems.

Deliberate attention to posture and relaxation of body muscles should also influence the autonomous nervous system. When we relax we again pacify the overexcited sympathetic nervous system which is often too active due to the fight-or-flight mode. Healing and tissue repair are more active when the parasympathetic system is dominant.

Reduced breathing decreases oxygen levels in the lungs and blood creating temporary hypoxia. Such hypoxia is beneficial for various reasons. First, modern air has too much oxygen. Free oxygen in our bodies generates free radicals causing cellular damage and aging. This damage is stronger during hyperventilation. Second, hypoxic training at high altitude has many known published benefits.

It is difficult to tell at the moment what the contributions of these factors are. Clearly, they are individual. Can the various effects of the Buteyko method be separated? Probably yes, for example, using CO2 injections or CO2 chambers or submarines with special air. Can CO2 chambers have similar effects? There are many other interesting scientific questions for further research.


Q: There are many medical studies indicating that acute hyperventilation produces asthma attacks in asthmatics. However, several studies found that acute hyperventilation with CO2 enriched air also results in asthma attacks. Therefore, as some doctors claimed, low aCO2 could not be considered as a single cause of asthma. Is this opinion correct?

A: Before being tested with CO2 enriched air in laboratories, typical asthmatics had many hundreds of times the following course of events. On the background of chronic hyperventilation (all known studies reported presence of hyperventilation for initial stages of asthma), asthmatics experienced the influence of some other triggering factors (like exercise, overeating, oversleeping, allergies, etc.), which resulted in additional hyperventilation and further bronchoconstriction or in further inflammation of airways with the same results: feelings of air shortage (due to airway obstruction), chest tightness, laboured breathing, etc. all signs of an asthma attack. (Sometimes, this airway obstruction could be due to, for example, excessive mucus production or inflammation. That could result in anxiety and panic causing acute hyperventilation.)

In all cases these asthmatics breathed normal air with about 0.04% CO2 concentration. Thus, before the attacks the following physiological changes were repeated many hundred times: abnormally hard work of the respiratory muscles, increased air flow through the respiratory tract, increased amplitude of pressure variations in internal organs, etc. All these changes, before the attacks, were sensed many hundred times by the millions of nervous cells of the nervous system. Finally, further lowered aCO2 and some other factors produced additional bronchoconstriction and the attacks.

Now exactly the same asthmatics arrive in the laboratories, where they perform the same acute hyperventilation, which is accompanied by all these described additional features (again sensed by the millions of nervous cells) with one difference, the inspired air is CO2-rich. Such air has never been experienced by these asthmatics before, but the whole nervous system learned that such situation causes bronchoconstriction. What would be the result now?

The result due to the changed stimulus would be defined by how much of the previous stimulus is left. Low carbon dioxide already created many chronic abnormal changes. Finally, some other triggers which cause the attacks can also be at work when the person deliberately hyperventilates, even with temporary increase in carbon dioxide stores. It was not sudden drop or increase in carbon dioxide stores that causes or prevents asthma attacks, but those chronic changes which affect every cell of the respiratory tract in asthmatics. Therefore, since less than 1% stimulus is absent (low CO2), while the remaining 99% is left, the reaction would be exactly the same, as for the whole stimulus.

But assuming that the human nervous system is incapable of learning from the previous experiences repeated hundreds of times, and that all these events sensed and recorded by the nervous system did not produce habituation and conditioning, one can assert that low carbon dioxide is not the cause of asthma.

Therefore, even in conditions of artificially increased aCO2, the influence of so many areas of the nervous system should be more powerful, than that of the breathing centre. Meanwhile, if such tests with CO2-rich air were repeated many times, the effect of gradual relearning can be observed and acute hyperventilation with CO2-rich air would not cause bronchoconstriction and the attacks.

Moreover, physiological studies found the confirmations of this psychological effect based on physiology of the nervous cells. It is known that, for example, some breathing manoeuvres (chapter 2), e.g., Valsalva and Müller manoeuvres, or breathing air with the same composition at the end of the breath hold, as in the lungs, extends BHT. Why? All previous life, movements of respiratory muscles resulted in new oxygenated air coming into the lungs. Normally, the nervous system learned millions of times, that such respiratory movements are signs of new (fresh) air flow. When, all of the sudden, the conditions are different, only the breathing centre creates the stimulus to breathe, while the rest of the nervous system is “happy” and does not contribute to the urge to breathe.

It is now a clear fact, which has been confirmed by all published studies, that development and first stages of asthma are always accompanied by hyperventilation. The situation with medical respiratory professionals and asthma was accurately reflected by Peter Kolb,

“… asthma is a disorder which is investigated by thousands of respiratory specialists with millions of dollars worth of equipment to measure breathing. Yet after more than half a century of work by all these people measuring patients’ breathing, they haven’t picked up that asthmatics are just breathing too much” (Kolb, private communication, 2001).


Q: Doctor Buteyko claimed that, for example, gastritis is caused by hyperventilation. However, it is known that, poor dietary habits (like eating when not hungry, not chewing food properly, eating spicy and hot meals) can create gastritis without any influence of breathing. How can such facts be explained?

A: Practical studies done by Doctor Buteyko revealed that it was necessary for the patients with GI (gastrointestinal) problems to have low levels of aCO2 pressure (e.g., less than about 40 mm Hg) in order for gastritis and other GI disorders development to take place. That is probably due to appearance of certain pathological substances generated by affected mucosa of the stomach lining. In practical terms, low CPs (less than 40 s) are required for the progress and existence of the disease. At the same time, the ideal CP of 60 s makes such pathological processes impossible due to normal repair, adequate oxygenation and blood supply of the stomach. The ideal CP and GI disorders are incompatible.

Thus, if we accept 40 mm Hg aCO2 level (about 35 s MP) as normal (as it is done by official medicine), then GI problems and hyperventilation are independent events. A person can have GI problems, gastritis included, with or without hyperventilation.

If our norm is 6.5% aCO2 (60 s CP), then gastritis and other GI problems cannot take place, unless this aCO2 level is lowered. Damage to tissues intensifies respiration making the CP less than 40 s.


Q: Which health conditions, while related to breathing and curable by breathing retraining, are not considered as breath-related by ordinary people?

A: “Breath”, in Russian, has the same translation as “spirit”. Similarly, other people consider breathing as something immaterial. Hence, when thinking about breathing, many people believe that breath can only relate to respiratory problems, fatigue, and, maybe, asthma. What would be opposite, in our minds, to the volatile and escapable breath? Of course, our strong bones. Hence, it is difficult for many people to make a mental connection between fragile breath and bones. However, musculoskeletal problems respond to the Buteyko breathing method as nicely as heart disease or diabetes. The short summary of the effects of breathing retraining on various disorders is provided in Appendix 7. Russians even published a study about a greatly accelerated rate of bone healing in chickens who were living in air enriched with CO2.


Q: How can the breathing teacher deal with a student who has some rare disorder or a variety of symptoms related to different diseases? How could one know if the Buteyko method can solve some specific health problems?

A: The names of health conditions, even in official medical literature, often do not have strict definitions. For example, asthma can have wide range of cases with varying degree of symptoms. Many cases of asthma can be close or even diagnosed as COPD, emphysema, bronchitis, etc., by different countries and doctors. Russia, for example, have bronchial asthma, asthmatic bronchitis, etc. Some leading medical authorities claim that the term “asthma” should not be used by medical professionals. The same vagueness relates to many other health conditions, ranging from heart disease to various neurological and GI problems.

This absence of clear criteria in official medicine is based on absence of the understanding of the mechanisms of disease appearance, development, and treatment. However, breathing teachers are armed with understanding of:

- the cause and mechanism of development of various symptoms;

- the method of their treatment.

Doctor Buteyko in his lectures was often going, one by one, through the effects of hypocapnia on different systems, organs and tissues of the body (what happens with cardiovascular system, musculo-skeletal, nervous, GI, etc.). These facts indicate more emphasis on symptoms and specific abnormalities rather than official labels.

It would be logical therefore, to view the “sudden” appearance of various human abnormalities and symptoms with the assumption of increased ventilation. Practically, when a student asks a breathing teacher about possible efficiency of the method for a certain rare health condition (“Can you help me with my …?”), the teacher may ask the student about particular symptoms and tests’ manifestation of the disease, time sequence of their appearance, their severity, and evaluate current breathing (e.g., visually, by voice, posture, and/or CP test). This information could provide the teacher with information related to the likely effects of the method when the certain CP level is achieved (when fatigue is reduced, rigorous exercise is possible, nose is clear, medication can be safely reduced, cold shower can be taken, etc.)

It would therefore make more sense to speak, in many cases, about the same parameters that practically matters: current symptoms, tests’ abnormalities (as manifestations of hyperventilation in respiratory, cardiovascular, nervous, immune, and other systems), and current CP.

Finally, let us look at the dynamic of labelling in Russia. The website in Novosibirsk and early Russian doctors used official medical names (Appendix 3). Later, instead of diseases, many websites have been using the names of symptoms (like coughing, blocked nose, running nose, too much mucus, allergies, cold hands, feeling tired, pains in various body parts, sensation of panic, digestive complaints, insomnia, etc.).

The real life teaches us that there is one disease of deep breathing and many symptoms (asthma, heart disease, diabetes, chronic fatigue, etc.) depending on personal factors.


“Q: What is most important in your method?

A: To decrease deep breathing (the volume of inspiration) until the norm. Not to hold breathing, but gradually normalize it. This is difficult, although primitive people and animals breathe like that…” (Buteyko, 1997).


Q: Which criteria can be used in order to choose a Buteyko practitioner?

A: According to Doctor Buteyko, the CP of the practitioner is probably the best indicator of his/her qualification, knowledge, and ability to teach the method. Dr. Souliagin agreed with this criterion. He also observed that usually practitioners advocate and use those auxiliary methods of breathing normalization, which helped them to achieve their individual CPs.

It was a norm for Buteyko medical colleagues to have over 1 min CP. That indicated deep understanding of the method and qualified teaching abilities. Many of them had about 2 min CP or more, indicating their good professional preparation.

When the CP is below 35-40 s (or the MP is less than 60-70 s), a practitioner may get too excited about abilities of the method or may have other changes in attitudes. At the same time, normal breathing requires long-term commitment from the practitioners, so that they can teach this commitment to their students.

Therefore, ask the practitioner about his/her morning CP.


Q: Do modern western yoga schools teach people traditional ideas and conduct traditional hatha yoga exercises?

A: Most western yoga schools are different from traditional yoga approaches. First, the staff of modern yoga schools has poor understanding of the physiology of breathing. They often believe in the usefulness of deep breathing and hyperventilation. Second, those schools that use breathing exercises usually emphasize deep breathing sessions (without a requirement for improving breath holding time) or high frequency shallow breathing (which is not difficult to do). Those who follow traditional ideas emphasize that the Guru is very important in order to "restrain the breath".


Q: What about modern yoga books? Are they valuable in terms of breathing normalization?

A: Modern books either exclude traditional hatha yoga ideas or change them. Such books usually contain many asanas (postures), where people are, unfortunately, often with their mouths open. However, asanas, when done under proper professional supervision, favour relaxation of muscles and easy breathing. Thus, these exercises and books can be used for gymnastics, body plasticity, relaxation, and slight health improvement.


Q: Hatha yoga suggests having breath holding after inhalation. Can that be practiced?

A: Buteyko believes that sick people (low CP) must not do MP or other long pauses after inhalation. That leads to quick exhalation and problems with breathing control afterwards. Exhalation, as he and old yoga schools teach, in normal life should be smooth and long. Also, there are some medical papers about [add: the] influence of slow exhalation exercises on increased parasympathetic tone. By the way, the pulse is also greatly reduced during exhalation, in comparison with inhalation, in normal health (by 10 or more beats per minute).

For healthy people, (as Doctor Buteyko once said) there is no big difference when to hold the breath.


Q: Many modern yoga books are cautious about breath holding in general. For example, various editions of Iyengar's books on pranayama (e.g., "Light on pranayama") have over dozens of warnings about dangers of breath holds for people with various health problems. Why?

A: Indeed, most modern authors and modern schools (e.g., Iyengar's) suggest that breath holding should not be used by sick people. That probably reflects their experience of dealing with western yoga students, many of whom have different ailments, which can be worsened by the practice of hyperventilation. Those who could manage to raise their CO2 during practices may have cleansing reactions, which can create other problems together with fear and anxiety, often causing the patient to quit the exercises.


Q: There are many statements in traditional hatha yoga teaching about some mysterious "prana" (hence, the word "pranayama"), as a force that should be conserved or accumulated. Is there any physiological sense in such statements?

A: Doctor Buteyko, during his public speeches, once mentioned that prana was simply CO2. Indeed, if one reads old hatha yoga books, while substituting CO2 instead of "prana", deep physiological sense, in traditional yoga teaching, can be found.


Q: There were cases in the past, when some yogis did not survive "burial" feats. What are the possible physiological causes of such deaths?

A: Burial feats were often conducted over the course of days. The amount of air available for breathing during such experiments (a person can be buried alive in a coffin) would be enough for some dozens of minutes or hours only. It would be sensible, then, in order to answer this question, to consider what happens during the hibernation of animals. That is the next topic.


Q: Which other traditional yoga schools realized the importance of restrained breathing?

A: Most, if not all of them. For example, the following extract is taken from “Autobiography of a Yogi” written by Yogananda Paramahansa who practiced Kriya yoga.

“Many illustrations can be given of the mathematical relationship between man's respiratory rate and the variations in his states of consciousness. A person whose attention is wholly engrossed, as in following some closely knit intellectual argument, or in attempting some delicate physical feat, automatically breathes very slowly. Fixity of attention depends on slow breathing; quick or uneven breaths are an inevitable accompaniment of harmful emotional states: fear, lust, anger. The restless monkey breathes at the rate of 32 times a minute, in contrast to man's average rate of 18 times. The elephant, tortoise, snake, and other creatures noted for their longevity have a respiratory rate that is less than man's. The giant tortoise, for instance, which may attain the age of three hundred years, breathes only 4 times a minute.” (p.280, Paramahansa, 1950).

“The mystery of life and death, whose solution is the only purpose of man's sojourn on earth, is intimately interwoven with breath. Breathlessness is deathlessness. Realizing this truth, the ancient rishis of India on the sole clue of the breath developed a precise and rational science of breathlessness.” (p. 564, Paramahansa, 1950).


Q: What are the breath holding abilities in animals?

A: The northern elephant seal can dive for periods of up to one hour and less than 5 minutes surface intervals are required between dives. Even while sleeping on the beaches, elephant seals often have many minutes of breath holding (Castellini et al, 1994).

Hibernating mammals also possess remarkable breath-holding abilities. For example, a garden dormouse can hold its breath for periods of up to 130 minutes and the European hedgehog for up to 2.5 hours. In many other species, prolonged periods of apnoea (5 to 45 minutes) occur regularly and alternate with brief periods of intense respiration (2 to 5 minutes) (Milsom, 1992).

A review of breath holding abilities during diving, sleep, and hibernation of various animals was done by Zoology Professor, Dr. Bill Milsom (Milsom, 2000).

There are 2 physiological gas-related mechanisms that cause humans and other animals to resume respiration at the end of breath holding: CO2 drive (increased concentrations of CO2 in the lungs and the arterial blood) and, to a lesser extent, O2 drive (lack of O2 in tissues). However, during 90% of our evolution (from one half to five billion years ago), the atmosphere had negligible amounts of O2 (less than 1%) and very large concentrations of CO2 (many %). Therefore, it is likely that all those prehistoric creatures had superior breath holding abilities (according to our standards and while breathing their hypoxic air) compared with our performance under present-day conditions.

As it was many times noted by Doctor Buteyko, constant increase in O2 and fall in CO2 in air produced a profound impact on the evolution of animals. Indeed, hyperventilation can provide and did provide more oxygen for tissues in conditions of prehistoric air since CO2 concentrations were much larger. However, ancient creatures did not hyperventilate all the time due to excessive energetic demands of heavy breathing. Therefore, hyperventilation was the tool useful in conditions of stress. Even now periods of hyperventilation in animals, in cases of danger, usually lasts seconds or tens of seconds. That would reduce CO2 stores in the lungs and some blood, while tissue CO2 and brain CO2 concentrations would be unaffected.

Modern air, on the other hand, has so little CO2 that chronic (or prolonged) hyperventilation causes the opposite effect (hypoxia).

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