insulin sensitivity

How Modern Science Supports Ancient Yoga, plus Comfort in Breathwalking

 
 

Listen Instead of Reading

 

The way you breathe might affect your insulin sensitivity. And the way you walk definitely affects your ability to withstand discomfort.

Let’s find out how…

 
 
 
 

4 Thoughts


1. Longer Exhalations are Naturally Relaxing

“It's helpful to extend your exhalations because the ‘rest and digest’ parasympathetic nervous system handles exhaling while also slowing your heart rate. So, longer exhalations are naturally relaxing.”

- Rick Hanson, Ph.D., Neurodharma

Just a friendly reminder that extending the exhalation is one of the fastest ways to naturally relax. That is all : )

***

Related: Longer Exhalations Are an Easy Way to Hack Your Vagus Nerve

Related: BBC: Why slowing your breathing helps you relax

2. How Breathing Might Help with Insulin Sensitivity

“These observations demonstrate that hypoxia rapidly regulated the inhibition of the insulin signaling pathway […] During reoxygenation, the ability of insulin to stimulate phosphorylation of insulin receptor and signaling proteins was restored after 45 min.”

– Hypoxia Decreases Insulin Signaling Pathways in Adipocytes

Insulin resistance is a critical factor in diabetes and overall metabolic health. In this paper, we learn that low tissue oxygen (hypoxia) can trigger insulin resistance. Encouragingly, however, reoxygenation restored it.

This is one reason why optimal breathing is so essential for metabolic health, especially for people with diabetes. By practicing slow nasal breathing, we increase our blood and tissue oxygenation. This could potentially maintain, or even restore, insulin sensitivity.

Of course, there is no research showing that slow nasal breathing does this—no one is going to fund that study : ) But, given what we know about slow breathing, tissue oxygenation, and blood flow, it seems reasonable to hypothesize that it would help. I know have certainly noticed a difference.

***

Related: The Lesser-Known Benefits of Nasal Breathing, Designed for Diabetes

3. “Role of respiration in mind-body practices: concepts from contemporary science and traditional yoga texts”

“Traditional yoga texts also suggest a solution for the imbalance in prana, through slow, deep breathing. … The beneficial effects of deep breathing are supported by contemporary science.”

- Telles et al. (2014), Frontiers in Psychiatry

I’ve shared a quote from this paper before, but if you haven’t read the full thing, it’s well worth it. It describes how modern science supports ancient yogic breathing, for example, how “Conventional physiology has found benefits of deep breathing supporting the importance given to regulating the breath in yoga.”

Another interesting idea they mention is that breathing “acts as both a top-down and bottom-up mind-body practice.” It makes perfect sense, but I hadn’t thought about it that way.

Ancient Yogic Wisdom + Modern Science = A Fantastic Read

Enjoy!

4. Finding Comfort in Breathwalking

“To take my mind off the discomfort, I settle into a respiratory rhythm. I take one step as I breathe in, then two steps as I breathe out. One step breathing in, two steps breathing out. Over and over, focusing only on the breath.”

- Michael Easter, The Comfort Crisis

Easter spent more than a month in a remote region of Alaska. And this book that came out of it is incredible—a perfect blend of science and storytelling.

Of course, this part stood out to me : )

Easter is making a ridiculous walk back to camp with a ton of weight. He naturally settles into his breath, and this gives him comfort and endurance.

As he puts it, “There's science behind this. Brazilian researchers found that people who are able to detach from their emotions during exercise, for example, not thinking about or putting a negative valence on their burning legs and lungs, almost always perform better.”

So aside from the mechanics and oxygenation, here’s another way in which breathwalking can be beneficial. It helps you detach from your emotions. As Easter tells us, you’ll “almost always perform better.” Sounds good to me.

***

Related: Breathwalking with Gandhi

 
 
 
 

1 Quote

“He let me see that, because the breath is so unassuming, I had been undervaluing it. I was looking for a complicated path to enlightenment, when this simple one was right before me.”

- Larry Rosenberg, Breath by Breath

 
 
 
 

1 Answer

Category: Hypoxia

Answer: A blood oxygen saturation below approximately this value is considered hypoxic.

…

(Cue the Jeopardy! music.)

…

Question: What is 90%?

P.S. Different places give slightly different numbers…sometimes it’s 94%, sometimes 92%.

In good breath,

Nick Heath, T1D, PhD
“Breathing is the compound interest of health & wellness.”

P.S. What if?

 
 
 

Sign Up For The Breathing 411

Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

Coherent Breathing, Diabetes, and How All Top Performers Use The Breath

 
 

Listen to this post:

 

Thanks for clicking on another issue of The Breathing 411.

Here are 4 thoughts, 1 quote, and 1 answer for this week. Enjoy!

 
 
 
 

4 Thoughts

1. Why We Should Practice Coherent Breathing, in just Two Sentences

“When oscillations of two or more systems are synchronised it increases physiological efficiency by enabling the functions of these systems to be coordinated. This prevents energy being wasted on non productive functions.”

- The Functions of Breathing and its Dysfunctions and Their Relationship to Breathing Therapy

Coherent (or resonant) breathing synchronizes different body systems, and I thought those two sentences perfectly summarized why it’s so important:

It improves efficiency and conserves energy.

To experience this yourself, you might think finding your particular resonant breathing rate requires special biofeedback equipment…and you’d be right. 

Fortunately, however, a 2006 study found that we get most of the benefits by simply breathing at 5-6 breaths per minute. Meaning you can get started right now without any fancy gear. It’s as simple as using a phone app.

Here’s to synchronizing our breathing for optimal efficiency today.

Related Quote: “Did it matter if we breathed at a rate of six or five seconds, or were a half second off? It did not, as long as the breaths were in the range of 5.5.” - James Nestor, Breath

P.S. The two apps I recommend are iBreathe and BreathWrk.

2. All Things Breathing and Diabetes

Patrick McKeown and I sat down a couple of months ago to talk about all things breathing and diabetes. It was a surreal experience to be chatting with the person who has taught me so much. We covered a lot of material from both personal and scientific perspectives.

Watch the full interview on YouTube here.

I hope you enjoy watching and listening.

Related Links:

3. Mick Fanning’s Breathwork is the Key to His Success

“Fanning’s performance coach, Nam Baldwin says breathwork is the foundation of mental and physical performance.”

- Mick Fanning’s scoliosis led him to breath work. Now, it’s key to his success

Aside from diabetes, one reason I became interested in breathing was surfing. So, when I saw this headline, I couldn’t wait to read it.

And it was better than expected. It was impossible to pick just one quote to share, so here’s another gem from Mick himself:

“You can change your moods, your thought patterns, just by concentrating on breath… and the better you breathe the better you perform.”

Enjoy the great read!

4. Maybe All Top Performers Focus on Their Breath?

And it’s not just Mick Fanning. In The Mindful Athlete, we learn that many top-performing teams and athletes use breathing as a critical component of their practice. They might not use “breathwork,” but they certainly make focusing on their breath a daily routine, especially before games:

“If they're mindful athletes, most of them are actually bringing their attention not to the game ahead, but to the present moment: fully concentrating on their breathing and, in doing so, centering themselves in that calm place where they are able to be in touch with the space between stimulus and response.”

- George Mumford, The Mindful Athlete

We’re all athletes in the game of life. (Having a chronic disease like diabetes makes each day like the Super Bowl.) We might not have personal trainers, nutritionists, or millions of dollars. But we all have the breath. And we all have access to the same control and awareness that these top performers do.

Let’s use it wisely.

 
 
 
 

1 Quote


“What do Mahatma Gandhi, the martial artist Bruce Lee, Buddhist meditators, Christian Monks, Hawaiian kahunas, and Russian Special Forces have in common? They all used breathing to enhance their physical, mental, and spiritual well-being.”

- Richard P. Brown & Patricia L. Gerbarg,
The Healing Power of the Breath

 
 
 
 

1 Answer

Answer: The cardiovascular system shows resonance at approximately this frequency.

…

(Cue the Jeopardy! music.)

…

Question: What is 0.1 Hz?

In good breath,

Nick Heath, T1D, PhD
Diabetes is Tiny. You are Mighty.

P.S. …and the money will come

 
 
 

Sign Up For The Breathing 411

Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

Breathing Through Negative Feedback Loops, and the WHM in 2.5 Minutes

 
 

Listen to this post:

 

Welcome back to another issue of The Breathing 411.

Here are 4 thoughts, 1 quote, and 1 answer for the week. Enjoy!

 
 
 
 

4 Thoughts

1. The Epiphenomena of Breathing

“However, a lightbulb also produces heat. Heat is not the function of the lightbulb, nor is it the reason we originally fashioned it […] It is an unintended by-product of the operation, not the true function. Heat is an epiphenomenon in this case.”

- Matthew Walker, Why We Sleep

Depending on you and your perspective, breathing can have many epiphenomena. For example, you might do a breathing practice to relax. But, as a by-product, it will also improve autonomic and cardiovascular function.

Perhaps your breathing practice is for better sleep. In this case, you’ll still experience the epiphenomena of better insulin sensitivity and better focus.

In fact, optimal breathing has so many “epi-benefits,” it’s hard to keep track. Luckily, you don’t have to. You simply pick one or two reasons that make sense for you, and let the rest happen on its own, like heat from a lightbulb.

Related Quote: “Replace the habit of taking short shallow breaths into the top of the lungs with the practice of taking a full deep breath. Nearly all of the benefits begin with this one simple change.” - Al Lee, Don Campbell, Perfect Breathing

2. The Negative Feedback of Stress in Diabetes, and What We Can Do About It

  • Diabetes is a chronic stressor. [1]

  • Chronic stress worsens blood sugar control. [2]

  • It also reduces HRV, increasing susceptibility to more stress. [3]

  • This then can increase anxiety. [4]

  • Leading to more stress and worse blood sugar control. [2]

  • Which then leads to the subjective feeling of more stress. [1]

It’s a merciless cycle.

Encouragingly, however: “Emerging evidence strongly suggests…that interventions that help individuals prevent or cope with stress can have an important positive effect on quality of life and glycemic control.”

You probably know where this is going : )

Slow breathing immediately helps:

  • It reduces chronic stress by increasing vagal tone. [5]

  • It improves both short- and long-term HRV. [6]

  • It reduces anxiety. [7]

  • It improves blood sugar control. [8]

The negative feedback loop of stress and diabetes won’t just go away. But slow breathing gives you an effective intervention you can use to help offset its harmful effects and prevent it from getting out of control forever.

Related Quote: “Slow breathing could be a simple beneficial intervention in diabetes.” - Nature Scientific Reports

3. How The Wim Hof Method Works, In 2.5 Minutes

“So what happens when you breathe this way is you stress your body out. […] You control your stress to a specific amount of time so that, for the rest of the day, you can chill out. So that is probably why Wim Hof’s method works so well.”

- James Nestor

Tomorrow is Wim Hof’s birthday. In that spirit, here’s a quick 2.5 minute clip of James Nestor explaining how the WHM works.

Enjoy!

Related: 20 One-Sentence Thoughts on the Wim Hof Method

Related Quote: “I’m not afraid of death, I’m afraid not to have lived fully.” - Wim Hof

4. We Are All Living Nasal Breathers

“All living things on our planet undergo a unescapable and predictable daily change in their environment: Day becomes night. […] To cope with this predictable daily change in light and dark, almost every living organism has developed an internal timing system, or circadian clock.”

- Satchin Panda, PhD, The Circadian Code

In The Circadian Code, we learn that, try as we might, we cannot override our circadian rhythm. Evolution programmed it into us. Trying to fight it with more coffee (talking to myself here) will only hurt us in the long run. We’re much better off aligning with it to achieve our best health outcomes.

This reminded me of a seemingly unrelated, yet similar concept: we’re all nasal breathers.  We can optimize our diets, exercise, and so on, but if we don’t breathe how evolution designed us to—through our nose—we’ll never reach our full health potential.

Related: Chronic sinus inflammation appears to alter brain activity

Related Quote: “Around 1500 BCE, the Ebers Papyrus, one of the oldest medical texts ever discovered, offered a description of how nostrils were supposed to feed air to the heart and lungs, not the mouth.” - James Nestor, Breath

 
 
 
 

1 Quote

“The power of the breath has been used not just to heal, but to attain extraordinary feats that appear to defy laws of physiology. […] With mastery of his breath and his meditative practices, Hof is redefining what is considered physiologically possible for a human.”

- Michael J Stephen, MD, Breath Taking

 
 
 
 

1 Answer

Answer: Although known as the Ice Man, Wim Hof has also completed a full marathon without water in this desert.

…

(Cue the Jeopardy! music.)

…

Question: What is the Namib Desert?

P.S. Here’s short clip of him walking. He’s mainly nose-breathing, probably to conserve water : )

In good breath,

Nick Heath, T1D, PhD
Diabetes is Tiny. You are Mighty.

P.S. Do drugs and stay out of school

 
 
 

Sign Up For The Breathing 411

Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

How To Be a Straight-A Breathing Student, and Why Diabetics “Get It”

 
 

Listen to this post in 5 min 51 sec:

 

Yesterday was 4-11.

Yesterday was World Breathing Day.

Yesterday was also my birthday.

It’s almost as if it was meant to be this week…

Alright, here are 4 thoughts, 1 quote, and 1 answer for the week. Enjoy!

 
 
 
 

4 Thoughts

1. How To Be a Straight-A Breathing Student

One of my favorite stories is the “50 lbs = A” parable. I even kept a post-it of that phrase on my monitor during my post-doc. As it goes, a professor found that grading ceramics students based on quantity—50 lbs gets you an A—led to better quality than grading them on one “masterpiece.”

The moral of the story: Quantity leads to quality.

Quality is obviously essential to breathing. We do take more than 20,000 breaths per day, as it is. But, perhaps what’s more important is just starting and sticking to a consistent breathing practice.

So for breathing, we might say: Focused quantity leads to quality.

You might not begin with perfect diaphragmatic breathing, proper tongue placement, or proper volume. But with a consistent practice, you’ll naturally start noticing and improving these things.

So how about we write our own parable, where 50 breaths = A.

Or maybe just 5 breaths or 5 minutes. Regardless, it’s the focused, consistent quantity that counts. Here’s to becoming straight-A breathing students today.

Related: “If you want to master a habit, the key is to start with repetition, not perfection […] You just need to practice it.” - James Clear, Atomic Habits

2. Why the Power of Breathing is Actually Easy to Explain to People with Diabetes

Ask a diabetic what affects their blood sugar. They’ll either start laughing, or immediately blurt out “everything!”

So then, when you tell them that breathing literally impacts almost every bodily function, they’ll get it:

Everything affects my blood sugar. Breathing affects everything.

It just makes common sense for us diabetics to optimize it.

Related: The Lesser-Known Benefits of Nasal Breathing, Designed for Diabetes

Related Quote: “Breathing isn’t everything. But, breathing impacts everything.” - David Bidler

3. This Breathing Exercise Can Calm You Down in a Few Minutes

“Many people find benefit, no one reports side effects, and it’s something that engages the patient in their recovery with actively doing something.”

- Cynthia Stonnington, Chair, Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, AZ

Here is yet another excellent article from Vice: This Breathing Exercise Can Calm you Down in a Few Minutes. In it, we learn about the power of resonant breathing from Cynthia Stonnington (above) and gain invaluable insights from a pioneer in breath research, Patricia Gerbarg.

Enjoy the awesome read!

Related: Decrease stress by using your breath (Mayo Clinic)

4. The Universal Structure of the Respiratory System

“There is something transcendent in the very structure of our respiratory system…Other examples of this configuration in nature abound—streaks of lightning converging into a single bolt only to diverge again as they approach the ground;

the tributaries of a riverbed unifying into one main waterway; the human body itself, branching from its trunk to arms and legs, then fingers and toes.

The lungs tap into something universal in their structure, maximizing uptake of the life force that surrounds all of us.”

- Michael J Stephen, MD, Breath Taking

Here's another gem from Breath Taking's prologue, reminding us just how remarkable, yet universal, the structure of our respiratory system is.

 
 
 
 

1 Quote

“The daily use of breath practices can turn back the tide of stress, counteract disease progression, and improve overall quality of life.”

- Richard Brown & Patricia Gerbarg

The Healing Power of the Breath

 
 
 
 

1 Answer

Answer: For every tooth you lose as an adult, your risk of this increases by 2%.

…

(Cue the Jeopardy! music.)

…

Question: What is obstructive sleep apnea?

(I learned this in Breath)

In good breath,

Nick Heath, T1D, PhD
Diabetes is Tiny. You are Mighty.

P.S. 100% me. (Looking at you Wibbs)

 
 
 

Sign Up For The Breathing 411

Each Monday, I curate and synthesize information from scientific journals, books, articles, and podcasts to share 4 thoughts, 1 quote, and 1 answer (like "Jeopardy!") related to breathing. It’s a fun way to learn something new each week.

 
 

A Danger of Breathwalking, and How I Almost Stepped on It

 
 

Listen to this post in 6 min 28 sec:

 

Welcome to another issue of The Breathing 411,

Here are four thoughts, one quote, and one answer to consider this week.

There’s also a fun bonus thought on the “Dangers of Breathwalking.”

I hope you enjoy it!

 
 
 
 

4 Thoughts

1. The Lungs Lead, Heart and Mind Follow

“This knowledge is spreading back to the West through disciplines such as yoga and mindfulness, but also through techniques aimed at improving endurance, and even intimacy. These practices demonstrate that the mind and the heart follow the lungs, not the other way around.”

- Michael J. Stephenson, MD from Breath Taking

Study after study has shown that breathing gives you access and control over your heart and mind, in ways such as increasing heart rate variability and synchronizing brain waves. That is, the lungs lead, the heart and mind follow.

But even with all this research, sometimes it takes an eloquent quote from a respected pulmonologist to make it seem so obvious.

Related: HBR: Why Breathing Is So Effective at Reducing Stress

Related Quote: “The obvious is that which is never seen until someone expresses it simply.” -Kahlil Gibran

2. Why Slow Nasal Breathing Could Be More Important in Type-2 Diabetes

Both type-1 and type-2 diabetes benefit from slow nasal breathing.

However, it could be more beneficial in type-2 diabetes since the primary issues there are reduced insulin production and reduced insulin sensitivity.

And it just so happens that slow breathing increases insulin production and improves insulin sensitivity. But maybe most importantly, nasal breathing helps you sleep better, which will indirectly boost insulin sensitivity.

Obviously, slow breathing isn’t going to cure you of type-2. But it’s safe, effective, and super practical. It seems like a no-brainer.

P.S. For T1Ds like me, all these things are still very helpful. We just won’t get the added benefit of increased insulin production…stupid pancreas…

3. How to Improve Concentration Using Your Breath

“by focusing on and regulating your breathing you can optimize your attention level and likewise, by focusing on your attention level, your breathing becomes more synchronized.”

- How to Improve Concentration Using Your Breath

In this great short article, you’ll learn that to improve your concentration, “It’s as simple as breathing through your nose.”

You’ll also get some excellent quotes from James Nestor and the director of the Yale Stress Center. Well worth the quick read. Enjoy!

Related: The nose knows: How breathing through your nose improves your health (This was linked in the Thrive article—it’s an excellent deep dive into the benefits of nose breathing, mainly from clinical doctors. I absolutely loved it. I just didn’t agree with the very last sentence.)

4. John Wayne’s Perfect Breathing Advice (almost)

“Talk low, talk slow, and don't talk too much.”

- John Wayne, Advice on acting

If we replace “talk” with “breathe,” we arrive at the perfect breathing advice:

Breathe low, breathe slow, and don’t breathe too much.

Extra Thought: The “Dangers” of Breathwalking

I’ve become somewhat obsessed with breathwalking. I use it in short 1-3 min intervals several times a day. It’s phenomenal. Thanks again, Louise!

Last Tuesday, I was walking around my backyard, completely focused on my breath. Then, I came about this close 🤏 to stepping on a snake. The snake had its head up, ready to bite. And here I am, Mr. Breathwalker, completely oblivious…lol.

Luckily, I managed to jump over it (maybe letting out a quick scream) and immediately starting laughing at the irony of the situation.

Focusing on your breath most certainly improves your concentration. But in the comfort of your backyard, that concentration might backfire!

Related: Thanks to M.C. for sharing this excellent 4.5 min video:

Breathwalking With Dr. Jim Nicolai | Andrew Weil, M.D.

 
 
 
 

1 Quote

“Few of these scientists set out to study breathing. But, somehow, in some way, breathing kept finding them.”

- James Nestor, Breath

 
 
 
 

1 Answer

Answer: In 2018, it was estimated that this percentage of the U.S. adult population had diabetes.

…

(Cue the Jeopardy! music.)

…

Question: What is 13%? (and 90-95% of those cases are type-2)

In good breath,

Nick Heath, T1D, PhD
Diabetes is Tiny. Breathing is Mighty.

P.S. Easter family get together

 
 

The Lesser-Known Benefits of Nasal Breathing, Designed for Diabetes

 

As a person with type 1 diabetes, my experience with nasal breathing has been nothing short of miraculous.  It's been such a simple change, yet its impacts on my energy and blood sugars have been profound. I feel it would be irresponsible not to share it with other people with diabetes.

Luckily, people much brighter than me have become fascinated by the nose too.  Whole books have now been written on the topic.  It has been featured in popular sources such as Outside Magazine and the Cleveland Clinic.  An article published in Frontiers in Human Neuroscience even concluded that “nasal stimulation represents the fundamental link between slow breathing techniques, brain and autonomic activities and psychological/behavioral outputs.”

But after several years of research, I have come to realize that the reasons nose breathing is so helpful for diabetes go far beyond the “obvious ones.” 

Of course, the usual suspects are essential, such as the warming and humidifying of the incoming air and the natural slowing of the breath.  But to fully understand the benefits for diabetes requires a synthesis of research from different fields, such as diabetic complications, the metabolites of nitric oxide, chronic stress, and sleep.

Let’s start with diabetic complications.

Oxidative Stress and Inflammation Reduce Blood Flow

Over time, the oxidative stress and chronic inflammation associated with diabetes can damage blood vessels, resulting in poor circulation. 

Less blood flow means that less oxygen reaches the cells, tissues, and organs. 

As a result of this poor circulation (and other complications), people with diabetes have an increased incidence of retinopathy, kidney disease, and foot problems.

Nose breathing—specifically inhaling through the nose—immediately helps with this.  For example, one small study showed that just five minutes of inhaling through the nose and exhaling through the mouth increased tissue oxygenation by 10%.  This increase was due to nitric oxide.

Nitric oxide is continuously produced in the paranasal sinuses.  When you breathe in through your nose, nitric oxide is carried into the lungs, where it opens up the blood vessels and improves blood flow in the lungs.  This results in better gas exchange and better blood oxygenation.

But that’s only the beginning of NO’s benefits.

How Nitric Oxide Helps with Blood Flow and Oxygenation

Typically, the nitric oxide produced in your nose is treated separately from the nitric oxide produced throughout the rest of your body.  Although it is known that that inhaling nitric oxide has effects outside of the lungs, scientists have not known how. Researchers at the Cleveland Clinic have recently shed light on the issue.

In a 2019 study, they did something simple yet meaningful.  The researchers had participants inhale extra nitric oxide, and they measured what happened in the blood afterward.  If nitric oxide’s journey ended in the lungs, they wouldn’t see any signs of it in distant blood samples.

The results showed the opposite. 

They found that inhaling nitric oxide significantly increased circulating levels of a specific form of the molecule, SNO-Hb.  These findings matter because, in a separate study published in PNAS in 2015, a different group of researchers found that SNO-Hb played an essential role in whole-body oxygenation.  Without it, mice received less blood flow to the heart and even had smaller litter sizes.

Why This is Important to Diabetes

The complications of diabetes also impact nitric oxide.  Sustained high blood sugars alter how hemoglobin stores nitric oxide. 

The end result is that people with diabetes generally have less SNO-Hb. 

And, as we just learned, SNO-Hb is critical to blood flow and tissue oxygenation. 

So, putting it all together:

  • People with diabetes suffer from poor circulation and insufficient oxygen.

  • Our noses are a source of nitric oxide—breathing through our nose utilizes it.

  • Inhaling nitric oxide increases an essential form of NO called SNO-Hb.

  • SNO-Hb is critical to improving blood flow and increasing whole-body oxygenation.

Therefore, nose breathing could be especially helpful in diabetes by maintaining normal SNO-Hb levels and hence helping improve blood flow and oxygenation throughout the body.*  Mouth breathing would not provide these benefits.

How High Blood Sugars Reduce Oxygen Delivery

In addition to altering how nitric oxide is stored, high blood sugar also modifies the relationship between oxygen and hemoglobin.  Specifically, it tightens the bond between them.

As a result, less oxygen can be delivered to the places it is needed.  (For the breathing nerds out there, it causes a left shift in the oxyhemoglobin dissociation curve.)  This problem might be further exacerbated by stress.

Chronic Stress and Carbon Dioxide Alter Oxygen Availability

Diabetes also causes chronic stress—a less intense but sustained fight or flight stress response.  This stress causes people with diabetes to have anywhere from 14% to 20% more cases of anxiety than those without it.  Moreover, it has been reported that up to 40% of the diabetic population show symptoms of anxiety.  A 2013 meta-analysis, including over 12,000 people with diabetes, also found significant associations between diabetes and an increased probability of anxiety disorder or anxiety symptoms.

Chronic stress and anxiety, such as that experienced in diabetes, are often associated with overbreathing.  Overbreathing, or hyperventilation, simply refers to breathing more than your metabolic demands at any given moment, and is often associated with mouth breathing. Consequently, the body gets rid of too much carbon dioxide, which alters the pH of the blood.

This has a similar effect on oxygen and hemoglobin as high blood sugar. 

That is, it tightens the bond between them, reducing the amount of oxygen that can be delivered to the cells and tissues (this is known as the Bohr effect).

Together, we see that the high blood sugar and chronic stress associated with diabetes combine to reduce oxygen availability to the cells and tissues.

When we switch to nose breathing, the volume of each breath is naturally reduced.  This helps normalize carbon dioxide levels and restore blood pH to normal levels, which will improve oxygen delivery.** 

Combining this with the earlier discussion on nitric oxide, we see how this one simple change (nose breathing) helps offset some diabetic complications.

Nose Breathing, Sleep, and Diabetes: The Missing Link to Better Blood Sugar Control

If we breathe nasally during sleep, all of the benefits of nose breathing continue throughout the night. Of all the things nose breathing helps with, this might be the most critical for diabetes.

We have already discussed that diabetes causes chronic stress, which can lead to more rapid breathing.  Nose breathing helps naturally slow down the breath.  This will help you shift from a stressful sympathetic state to a calming parasympathetic state.  This shift is significant for people with diabetes who exhibit less parasympathetic tone at night than non-diabetics.  Thus, nasal breathing at night helps us increase parasympathetic tone and enjoy better sleep.

Receptors in your nose also act to maintain rhythmic breathing during sleep.  This might help explain why nose breathing reduces the risk of obstructive sleep apnea when compared to mouth breathing.  Diabetes is associated with a significantly increased risk of obstructive sleep apnea. So, if nasal breathing at night can help reduce this risk, it could be especially beneficial.

Lastly, we know that inadequate sleep causes insulin resistance.  By getting deeper, more restorative sleep, insulin sensitivity can be improved.  This could potentially lead to better morning blood sugars (that was my experience), setting you up for a better day of glucose control.

The More Subjective but Most Important Benefit of Nasal Breathing for Diabetes

Altogether, nasal breathing increases blood flow, improves tissue oxygenation, and appears to increase an essential form of bioactive nitric oxide that people with diabetes have less of.  It also improves sleep quality by helping us flip to a more calming state and by reducing the incidence of sleep apnea.  This can help improve insulin sensitivity.

When we combine all of these together, nasal breathing's net benefit can be simply stated as:

It gives you more energy. 

And it’s harder to objectively measure, but perhaps the best aspect of increased energy levels is more motivation to take care of your blood sugars. 

Diabetes is an exhausting full-time job that can lead to physical and emotional burnout.  Having more energy and enthusiasm to manage the disease could be the most valuable aspect of something as simple as breathing through your nose.

Footnotes:

*The levels of NO inhaled in the 2019 Cleveland Clinic study were greater than those produced in the nose.  But, the study validated that there is a mechanism by which NO that is introduced into the lungs can be transported throughout the body as SNO-Hb.  Thus, nasal breathing would only act to bring SNO-Hb up to normal physiological levels, whereas mouth breathing would rob the body of this important physiological process.

**This discussion is centered around the regular blood sugar fluctuations associated with diabetes and not diabetic ketoacidosis.

 
 

Become A World-Class Breather

 

Greetings,

Here are four thoughts, one quote, and one answer to start off February. Enjoy!

 
 
 
 

4 THOUGHTS

1. Become a World-Class Breather

"World-class performers are less about complexity and more about optimizing simplicity…It’s about the fundamentals. But small, daily improvements on the fundamentals every day done with ridiculous consistency creates insane revolutions over time."

- Robin Sharma, Optimize Interview

Becoming a world-class breather is actually quite simple: reduce the complexity, optimize the simplicity.

Of course, you can still utilize a variety of advanced techniques. Kobe Bryant didn’t only practice shooting free throws, and Tom Brady doesn’t only practice taking snaps. But it all starts with optimizing the fundamentals.

The best way to do that? Nose, belly, quiet, slow, repeat. Let those benefits compound into "insane revolutions over time."

P.S. Don’t forget James Clear’s advice: We have to start before we can optimize.

P.P.S. I condensed the quote, but I’ve never heard so many buzzwords stringed together so eloquently and with so much conviction : ) Enjoy listening.

2. What Optimal Breathing Can Do for Diabetes 

Although it’s not a panacea, improving our breathing might be the simplest thing we can do for our overall health. And for diabetes, in particular, optimal breathing has several direct and indirect benefits that are especially useful.

For example, it can improve cardio-autonomic function, reduce stress and anxiety (see next thought), improve blood flow, and improve sleep. These benefits can lead to better insulin sensitivity, more stable blood sugars, and less risk of long-term complications. Not bad for something as simple as breathing.

3. Harvard Business Review: Why Breathing Is So Effective at Reducing Stress

"So what makes breathing so effective? It’s very difficult to talk your way out of strong emotions like stress, anxiety, or anger…But with breathing techniques, it is possible to gain some mastery over your mind."

- Harvard Business Review,
Research: Why Breathing Is So Effective at Reducing Stress

So much goodness in this quick article. It’s a nice complement to last week’s thought on using breathing instead of thinking, and much more. Enjoy!

4. A Breathing Competition?

Compete: from Latin competere,

in its late sense 'strive or contend for (something)'

from com = 'together' + petere = 'aim at, seek'

- Apple Dictionary

So to "compete" literally means to strive for something together. In that case, we can consider this newsletter to be a breathing competition, with all of us striving to become world-class breathers together.

I hope you enjoy this competition as much as I do.

This thought was inspired by this Optimize +1

 
 
 
 

1 QUOTE

"The pattern of your breathing affects the pattern of your performance. When you are under stress, deep breathing helps bring your mind and body back into the present."

– Gary Mack, Mind Gym

 
 
 
 

1 ANSWER

Answer: This is the longest recorded breath-hold that didn’t use pure oxygen inhalation.

…

(Cue the Jeopardy! music.)

…

Question: What is 11 min 35 sec?

 
 

Can Breathing Improve Insulin Sensitivity? (+ 35 hours & 291 miles)

 
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On Valentine’s Day, the CDC published a report documenting trends in diabetes incidence from 2002-2015. The take-home message: Rates of diabetes, both type-1 and type-2, are increasing in people less than 20 years old, especially in racial and ethnic minority populations.

Results like this make no-cost interventions more important than ever. (I will not get into the cost of diabetes here. But, I’m fortunate to have a job with great benefits, and I still feel the cost of diabetes daily.)

Which brings me to this week’s paper. It is a follow-on to the one I shared last week, which showed that relaxation breathing lowers blood sugar spikes.

Here, the same author published a review paper on breathing, glycemic response, and insulin sensitivity:

Review: Can yoga breathing exercises improve glycemic response and insulin sensitivity?

(Click Here to Read Full Summary)

Overall, this review concluded that slow breathing exercises can improve glycemic control and increase insulin sensitivity.

The glucose-lowering effect of slow breathing is likely due to reduced sympathetic activity and, subsequently, reduced glucose production by the liver.  That is, slow breathing reduces your body’s internal production of glucose.

The improved insulin sensitivity is likely related to reduced sympathetic output, but could also be due to improved tissue oxygenation.

These breathing techniques are so simple, yet they could be life-changing to diabetics.

If you feel inspired, please share the CDC study and this paper (or my summary of it) with someone you know with diabetes or pre-diabetes.

It’s a small, no-cost step in the right direction toward improving the lives of diabetics.

In good breath,
Nick

 
 

P.S. 100 Mile Ruck Thank You!

Thank you all for the support during the 100-mile ruck! It was the hardest thing I’ve ever done, but I finished.

Overall, it took me 35 h 45 min to finish and I took approximately 225,000 steps to cover the 100 miles.

Including those who walked with me, we put in a combined 291 miles for chronic disease and raised ~$2K for HHPF! Simply amazing! THANK YOU!

 

Relaxation Breathing Reduces Blood Sugar Spikes

 
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This week, I am sharing one of those amazing papers that I read and underline the whole thing. Despite having a small sample size, it hints at the incredible benefits of breathing for optimal blood sugars.

Relaxation Breathing Improves Human Glycemic Response

(Click Here to Read the Full Summary)

The study participants were randomized into a control group (n=13) and a relaxation breathing group (n=13). The relaxation breathing (RB) protocol used a constant inhale with a progressively longer exhale:

  • Inhale 2 sec, exhale 1 sec.

  • Inhale 2 sec, exhale 2 sec.

  • Inhale 2 sec, exhale 3 sec.

  • …

  • Inhale 2 sec, exhale 10 sec.

The participants performed this exercise once every 10 minutes for 30 minutes prior to an oral glucose tolerance test. Then, they did it every 10 minutes for 90 minutes after the test. Overall, they did the RB technique 3 times before and 9 times after the test. The control group simply took the glucose tolerance test.

The results showed that the RB group had a significantly lower blood sugar (~37 mg/dL lower) thirty minutes after the glucose tolerance test.  After an hour, the two groups were approximately the same. Thus, relaxation breathing reduced the blood sugar spike associated with the glucose tolerance test.

Although the exact mechanisms are not clear, it seems likely that activation of the parasympathetic nervous system improved the insulin response of the RB group, and might have also improved insulin sensitivity.

This study provides another scientifically-validated breathing technique we can use to improve our blood sugars. After reading this paper, I started using it quite often.  I’ve found it’s nice to do while lying in bed before sleep.  I also find it helpful at the beginning of a breathing/meditation session just to calm everything down. 

And, with how simple it is, you do not need a watch or app. You can simply count in your head. It only takes ~75 seconds to complete one cycle and it will leave you feeling calm and relaxed (and potentially lower your blood sugar).

Give it a try before your next meditation or breathing session as a way to prepare you for relaxation.

In good breath,
Nick

P.S. I am finalizing this post on Friday, Feb. 28, and do not plan to look at it again before Monday (I am assuming my body/mind will not be in any capacity to do so). Hopefully I made through the 100 miles with no major issues. If you still want to donate, it’s not too late. HHPF is always accepting donations to further their mission. Thank you for your support!

 

Exercise and Hypoxia Increase Insulin Sensitivity (& 100 Mile Ruck Website)

 
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There are many paradoxes in breathing. For example, breathing less air delivers more oxygen to your cells.

Here is another one. Many diabetic complications (for example, insulin resistance) are rooted in tissue hypoxia. Yet, the deliberate practice of intermittent hypoxia (IH) can improve insulin sensitivity, as shown by the study I’m sharing this week.

Acute hypoxia and exercise improve insulin sensitivity (Si2*) in individuals with type 2 diabetes

(Read the Full Summary)

This research examined four different protocols:

  1. Rest at normal O2 levels for 60 min

  2. Rest in hypoxia for 60 min

  3. Exercise with normal O2 for 60 min

  4. Exercise in hypoxia for 60 min

All participants were type 2 diabetics. Oxygen levels for the hypoxic group were maintained at ~14.6%, and the results showed that the participants’ SpO2 never fell below 88% (well within the therapeutic range).

Here were the main findings:

  • Hypoxic rest increased insulin sensitivity more than rest at normal O2 levels

  • Hypoxic exercise improved insulin sensitivity greater than exercise in normal O2 levels

Together, these results imply that exercise and hypoxia can be added together to improve insulin sensitivity.

However, before jumping in, we must remember that hypoxia does induce stress, and stress hormones increase the body’s production of glucose. Thus, the increased insulin sensitivity could just be the body’s preemptive response to the stress: It knows more sugar is coming, so it primes itself to use it.

We should keep this in mind as we practice intermittent hypoxia: It’s important to find our Goldilocks zone, where we’re experiencing hypoxia, but not inducing too much stress. I recommend starting slowly with walking breath holds. You get the benefits of exercise and hypoxia in a safe, easy-to-perform way.

Try adding 3-5 walking breath holds to your morning routine. They don’t have to be intense, just enough to feel it. And, make sure you can recover normal breathing within 3 breaths after the hold…this ensures you do not push too hard.

Give it a shot, and remember, consistency over intensity.

In good breath,
Nick

P.S. Here is the link to the 100 Mile Ruck fundraiser page:

https://www.hhp-foundation.org/donate

Please share the link with friends and family. And consider walking a mile or two with me virtually. Or, if you can, come out to Gleason Park in Indian Harbor Beach, FL between 8 AM - 10 PM on Feb. 29th to walk in person!

 
 
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Staying healthy on vacations and “party weekends”

“You should sit in meditation for twenty minutes every day – unless you’re too busy; then you should sit for an hour.” – Zen Proverb

Hi everyone,

I am a pretty structured person. I go to bed at 8 PM and wake up at 4 AM, even on the weekends. And I am consistent with my breathing routine:

Although I’m pretty crazy about all this breathing stuff, I try to maintain a decent balance of “normal life” as well.

I recently went to a Bachelor Party weekend and stayed in a house with about 10 other people. My sleep routine was out. But getting in some “breathing” wasn’t.

I didn’t have to look weird or do anything special. I taped up once I got into bed so very few would see. When I woke up, I put my headphones in and did 15 minutes of box breathing (in bed) using the iBreathe app. Finally, I laid there and did 5 static breath holds:

Hold 45 sec after exhale —> Rest 1 min
Hold 45 sec after exhale —> Rest 45 sec
Hold 45 sec after exhale —> Rest 30 sec
Hold 45 sec after exhale —> Rest 15 sec
Hold 45 sec after exhale —> End

The point of all of this is to show you that incorporating breathing exercises into your day is fairly easy, regardless of your situation. And the benefits are many.

Just a few minutes of slow breathing can increase heart rate variability, improve autonomic function, and reduce stress and anxiety.

And a few breath holds can improve immune function, improve insulin sensitivity, and increase O2 carrying capacity.

Breathing is not only one of the easiest self-care practices to perform, but it also provides the greatest return on investment.

While on vacation or during a “party weekend,” it might be easy to ignore our normal self-care routines. But, this is precisely when we need them the most.

In good breath,
Nick

———————————————————————————————————————

* My current Principle 1 practice is 15 minutes of box breathing. After 2 months, I’m up to a 10-10-10-10 box: 10 sec inhale, 10 sec hold, 10 sec exhale, 10 sec hold. (I started at 5-5-5-5)

** My current Principle 3 practice is 3-5 walking breath holds of at least 45 sec each. Then, I perform 2 minutes of Advanced Simulation of Altitude from the Oxygen Advantage®