Five
SLOW
“Could you hand me the oximeter?” Olsson asks from across the dining room table. It’s afternoon on the fifth day of the Recovery phase, and for the past 30 minutes we’ve been testing our pH levels, blood gases, heart rates, and other vital signs. This is the 45th time we’ve been through this drill in the past two weeks.
Although both Olsson and I feel utterly transformed while nasal breathing, the monotony of the days is becoming maddening. We’re eating the same food at the same time as we did ten days earlier, sweating through the same stationary bike workouts in the same gym, and having many of the same conversations. This afternoon we’re discussing Olsson’s favorite subject, his obsession for the past decade. We are, once again, talking about carbon dioxide.
It is hard to admit now, but when I first interviewed Olsson more than a year ago, he was not a source I entirely trusted. On our Skype calls, he liked to hammer the importance of slow breathing, and he’d sent me a half-dozen PowerPoint presentations and reams of scientific studies on how paced breathing relaxed the body and calmed the mind. This part made perfect sense. But when he started in on the restorative wonders of a toxic gas, I began to wonder. “I really think carbon dioxide is more important than oxygen,” he told me.
Olsson claimed that we have 100 times more carbon dioxide in our bodies than oxygen (which is true), and that most of us need even more of it (also true). He said it wasn’t just oxygen but huge quantities of carbon dioxide that fostered the burst of life during the Cambrian Explosion 500 million years ago. He said that, today, humans can increase this toxic gas in our bodies and sharpen our minds, burn fat, and, in some cases, heal disease.
After a while I began to worry that Olsson was nuts, or at least prone to gross exaggeration, and that our hours of conversations had been a waste of time.
Carbon dioxide, after all, is a metabolic waste product. It’s the stuff that plumes out of coal plants and rotten fruit. The instructor at a boxing class I attended used to beseech students to “breathe deep and get all that carbon dioxide out of your system.” This seemed like good advice. Every other day, a new headline detailed how Earth was warming because there was too much carbon dioxide in the atmosphere. Animals were dying. Carbon dioxide kills.
Olsson kept arguing the opposite. He insisted that carbon dioxide could be beneficial, and he warned me that too much oxygen in my body wouldn’t help me but hurt me. “Breathing heavy, breathing quickly and as deeply as you can—I realized this is the worst advice anyone could give you,” Olsson told me. Big, heavy breaths were bad for us because they depleted our bodies of, yes, carbon dioxide.
Several months of this back-and-forth got me intrigued enough, or confused enough, or both, that I decided to fly to Sweden, spend a few days with Olsson, and see his operation in an attempt to learn more about one of the most misunderstood gases in the universe.
I arrived in Stockholm in mid-November and took a train to an industrial co-working space on the outskirts of town. Through the windows of a cavernous lobby, the sunlight had a kind of slant to it. Ominous clouds gathered, and the air was thick with the heavy feeling that precedes a long winter.
Olsson showed up exactly on time, took a seat across from me, and placed a glass of water on the table. He wore faded jeans, white tennis shoes, and a pressed white shirt. He had the kind of calm you see in monks, Amish, and others who spend a lot of time in their inner worlds. When he spoke, it was always softly, and with that annoying habit that all Scandinavians seem to have inherited: flawless English, with no umms or huhs or pauses. He’d even gotten his whoms down and inserted the oft-forgotten “not” when he told me how he could care less.
“I was going to end up exactly like my father,” Olsson said, running a finger along the condensation of the water glass. He told me how his father had been chronically stressed, how he breathed too much, and how he’d gotten severe high blood pressure and lung disease and died at 68 with a breathing tube in his mouth. “I knew that so many other people were going to stay sick and die of the same thing,” Olsson explained. He wanted to educate himself so he’d be prepared if something else happened to him or his family.
After the long days he spent running a software distribution company, he’d come home and read medical books. He talked to doctors, surgeons, instructors, and research scientists. Eventually he sold his business, got rid of his nice cars and big house, got a divorce, and moved into a condominium. Then he scaled down to a smaller apartment and spent six years forgoing any salary, working almost entirely alone, trying to understand the mysteries of health, medicine, and most specifically breathing and the role of carbon dioxide in the body. “There were yogi books about prana and then there were medical books focusing on pathologies—blood gases and disease and CPAP,” he said.
In short, Olsson found what I’d found, but years earlier: that there was a gap in our knowledge about the science of breathing and its role in our bodies. He discovered that we’d done a good job of examining what causes breathing problems but done little to explore how they first develop and how we might prevent them.
Olsson was in good company. Doctors had been complaining about this for decades. “The field of respiratory physiology is expanding in all directions, yet so preoccupied have most physiologists been with lung volumes, ventilation, circulation, gas exchange, the mechanics of breathing, the metabolic cost of breathing and the control of breathing that few have paid much attention to the muscles that actually do the breathing,” one physician wrote in 1958. Another wrote: “Until the seventeenth century most of the great physicians and anatomists were interested in the respiratory muscles and the mechanics of breathing. Since then these muscles have been increasingly neglected, lying as they do in a no-man’s land between anatomy and physiology.”
What many of these doctors found, and what Olsson would discover much later, was that the best way to prevent many chronic health problems, improve athletic performance, and extend longevity was to focus on how we breathed, specifically to balance oxygen and carbon dioxide levels in the body. To do this, we’d need to learn how to inhale and exhale slowly.
How could inhaling smaller amounts of air and having more carbon dioxide in our bloodstream increase oxygen in our tissues and organs? How could doing less give us more?
To understand this contrarian concept, you need to consider the body parts beyond the nose and mouth. Those structures, after all, are simply the gateways for the long journey of breath. The purpose of the 25,000 inhales and exhales we take daily lies deeper inside us. And the farther we follow this air, the more surprising and strange the journey gets.
Your body, like all human bodies, is essentially a collection of tubes. There are wide tubes, like the throat and sinuses, and very thin tubes like capillaries. The tubes that make up the tissues of the lungs are very small, and we’ve got a lot of them. If you lined up all the tubes in the airways of your body, they’d reach from New York City to Key West—more than 1,500 miles.
Each breath you take must first travel down the throat, past a crossroads called the tracheal carina, which splits it into the right and left lungs. As it keeps going, that breath gets pushed into smaller tubes called the bronchioles until it dead-ends at 500 million little bulbs called the alveoli.
What happens next is complicated and confusing. An analogy may help.
Let’s say you’re about to take a river cruise. You’re in a waiting room at the dock when a ship approaches. You pass through security, board the ship, and head off. This is similar to the path oxygen molecules take once they reach the alveoli. Each of these little “docking stations” is surrounded by a river of plasma filled with red blood cells. As these cells pass by, oxygen molecules will slip through the membranes of the alveoli and lodge themselves inside one.
The cellular cruise ship is filled with “guest rooms.” In your blood cells, those rooms are the protein called hemoglobin. Oxygen takes a seat inside a hemoglobin; then the red blood cells journey upstream, deeper into the body.
As blood passes through tissues and muscles, oxygen will disembark, providing fuel to hungry cells. As oxygen offloads, other passengers, namely carbon dioxide—the “waste product” of metabolism—will pile aboard, and the cruise ship will begin a return journey back to the lungs.
This exchange of oxygen and carbon dioxide changes the appearance of blood. The blood cells in the veins that carry more carbon dioxide will appear blue; arterial blood, still filled with oxygen, will appear bright red. It’s these gases that give veins and arteries their distinctive colors.
Eventually, the cruise ship will make its round through the body and back to port, back to the lungs, where carbon dioxide will exit the body through the alveoli, up the throat, and out the mouth and nose in an exhale. More oxygen boards in the next breath and the process starts again.
Every healthy cell in the body is fueled by oxygen, and this is how it’s delivered. The entire cruise takes about a minute, and the overall numbers are staggering. Inside each of our 25 trillion red blood cells are 270 million hemoglobin, each of which has room for four oxygen molecules. That’s a billion molecules of oxygen boarding and disembarking within each red blood cell cruise ship.
There’s nothing controversial about this process of respiration and the role of carbon dioxide in gas exchange. It’s basic biochemistry. What’s less acknowledged is the role carbon dioxide plays in weight loss. That carbon dioxide in every exhale has weight, and we exhale more weight than we inhale. And the way the body loses weight isn’t through profusely sweating or “burning it off.” We lose weight through exhaled breath.
For every ten pounds of fat lost in our bodies, eight and a half pounds of it comes out through the lungs; most of it is carbon dioxide mixed with a bit of water vapor. The rest is sweated or urinated out. This is a fact that most doctors, nutritionists, and other medical professionals have historically gotten wrong. The lungs are the weight-regulating system of the body.
“Everyone always talks about oxygen,” Olsson told me during our interview in Stockholm. “Whether we breathe thirty times or five times a minute, a healthy body will always have enough oxygen!”
What our bodies really want, what they require to function properly, isn’t faster or deeper breaths. It’s not more air. What we need is more carbon dioxide.
More than a century ago, a baggy-eyed Danish physiologist named Christian Bohr discovered this in a laboratory in Copenhagen. By his early 30s, Bohr had earned degrees in medicine and physiology and was working at the University of Copenhagen. He was fascinated with respiration; he knew that oxygen was the cellular fuel and that hemoglobin was the transporter. He knew that when oxygen went into a cell, carbon dioxide came out.
But Bohr didn’t know why this exchange took place. Why did some cells get oxygen more easily than others? What directed billions of hemoglobin molecules to release oxygen at just the right place at the right time? How did breathing really work?
He began experimenting. Bohr gathered chickens, guinea pigs, grass snakes, dogs, and horses, and measured how much oxygen the animals consumed and how much carbon dioxide they produced. Then he drew blood and exposed it to different mixtures of these gases. Blood with the most carbon dioxide in it (more acidic) loosened oxygen from hemoglobin. In some ways, carbon dioxide worked as a kind of divorce lawyer, a go-between to separate oxygen from its ties so it could be free to land another mate.
This discovery explained why certain muscles used during exercise received more oxygen than lesser-used muscles. They were producing more carbon dioxide, which attracted more oxygen. It was supply on demand, at a molecular level. Carbon dioxide also had a profound dilating effect on blood vessels, opening these pathways so they could carry more oxygen-rich blood to hungry cells. Breathing less allowed animals to produce more energy, more efficiently.
Meanwhile, heavy and panicked breaths would purge carbon dioxide. Just a few moments of heavy breathing above metabolic needs could cause reduced blood flow to muscles, tissues, and organs. We’d feel light-headed, cramp up, get a headache, or even black out. If these tissues were denied consistent blood flow for long enough, they’d break down.
In 1904, Bohr published a paper called “Concerning a Biologically Important Relationship—The Influence of the Carbon Dioxide Content of Blood on Its Oxygen Binding.” It was a sensation among scientists and inspired a flurry of new research into this long-misunderstood gas. Soon after, Yandell Henderson, the director of the Laboratory of Applied Physiology at Yale, began his own set of experiments. Henderson too had spent the last several years studying metabolism, and, like Bohr, he was convinced that carbon dioxide was as essential to the body as any vitamin.
“Although clinicians still find it hard to believe, oxygen is in no sense a stimulant to living creatures,” Henderson would write in the Cyclopedia of Medicine. “If a fire is supplied with pure oxygen instead of air, it burns with enormously augmented intensity. But when a man or animal breathes oxygen, or [air] enriched with oxygen, no more of that gas is consumed, no more heat is produced and no more carbon dioxide is exhaled than when air alone is breathed.”
For a healthy body, overbreathing or inhaling pure oxygen would have no benefit, no effect on oxygen delivery to our tissues and organs, and could actually create a state of oxygen deficiency, leading to relative suffocation. In other words, the pure oxygen a quarterback might huff between plays, or that a jet-lagged traveler might shell out 50 dollars for at an airport “oxygen bar,” are of no benefit. Inhaling the gas might increase blood oxygen levels one or two percent, but that oxygen will never make it into our hungry cells. We’ll simply breathe it back out.*
To prove his point, over the years Henderson conducted a number of awful experiments on dogs that are about as difficult to read about as Harvold’s awful experiments on monkeys.
He placed individual dogs on a table in his laboratory and inserted a tube into their throats, fitting their faces with a rubber mask. At the end of the tube was a hand bellows. The contraption allowed Henderson to control how much air each dog took in and how often. He’d connected the tube from the dogs’ throats to a bottle of ether, which would anesthetize them during the course of the experiment. A suite of instruments recorded heart rate, carbon dioxide, oxygen levels, and more.
As Henderson pumped the bellows faster and faster, he watched heart rates of the animals quickly increase from 40 up to 200 or more beats per minute. The dogs would eventually have so much oxygen flowing through their arteries, with so little carbon dioxide to offload it, that muscles, tissues, and organs began failing. Some dogs would spasm uncontrollably or drift into a coma. If Henderson kept pumping more air in, the animals became so full of oxygen and so deficient in carbon dioxide that they died.
Henderson killed dogs with their own breath.
With the dogs that survived, he would pump the bellows slower and watch as their heart rates immediately decreased to 40 beats per minute. It wasn’t the act of breathing that sped up and slowed the dogs’ heart rates; it was the amount of carbon dioxide flowing through the bloodstream.
Henderson then forced the dogs to breathe just slightly harder than normal, just above their metabolic needs, so that their heart rates were mildly elevated and carbon dioxide levels a little deficient. This was a condition of mild hyperventilation common in humans.
The dogs grew agitated, confused, anxious, and glassy-eyed. The slight overbreathing was inducing the same confused state that occurred during altitude sickness or panic attacks. Henderson administered morphine and other drugs to slow the animals’ heart rates closer to normal. The drugs worked partly because, as Henderson observed, they helped raise carbon dioxide levels.
But there was another way to restore the animals to health: let them breathe slowly. Whenever Henderson lowered the respiratory rate in accordance with the dogs’ normal metabolism—from breathing 200 times a minute to a normal rate—all the twitching, stupors, and anxiety went away. The animals stretched out and relaxed, their muscles loosened, and a peacefulness washed over them.
“Carbon dioxide is the chief hormone of the entire body; it is the only one that is produced by every tissue and that probably acts on every organ,” Henderson later wrote. “Carbon dioxide is, in fact, a more fundamental component of living matter than is oxygen.”
I spent three days with Olsson in Stockholm. We pored over tables and graphs and talked about Bohr and Henderson and other storied pulmonauts. By the end of my trip, I finally understood how my own view of breathing had been so limited, and so wrong, for so many years. And I finally understood how Olsson had become so obsessed with this line of research, why he’d given up his life as a software tycoon and downgraded to a tiny apartment, surrounded by shelves of biochemistry textbooks, sleep tape, and carbon dioxide tanks. Why he’d spent so many months recording how carbon dioxide levels changed inside his body with each new breathing technique, how it affected his blood pressure and his energy and stress levels.
I understood why only one person showed up for the first conference he held on breathing, in 2010, and why, after honing his message and building his research base, he was now something of a Swedish media star who filled auditoriums, his grinning, perpetually tanned, rom-com face popping up on newspapers, magazines, and nightly news shows. In these interviews, he championed the therapeutic effects of nasal breathing and beseeched audiences with the same message of slow breathing.
I returned home to San Francisco, and Olsson and I kept in contact. Every few weeks I’d get a new email or a Skype call about some new long-lost scientific discovery he’d just unearthed in a medical library. He’d continued his self-experimentation too, always seeking to use his own body to prove the power of breathing and wonders of the “metabolic waste product,” carbon dioxide.
This is how Olsson ended up, a year after our first meeting, in my living room in San Francisco with a face mask Velcroed to his head and an EKG electrode clipped to his ear.
“Could you hand me the oximeter, please?” Olsson says again across the table.
We’ve just finished our afternoon testing, and Olsson is restrapping himself into the BreathIQ, a prototype of a device that measures carbon dioxide, ammonia, and other elements in the exhaled breath. He clips a pulse oximeter on his finger and starts counting down the seconds.
Maybe it’s the carbon dioxide and nitric oxide boost from nasal breathing, but we’re feeling punchy today. In addition to the five grand we dropped to take before-and-after X-rays and blood and pulmonary function tests at Stanford, Olsson and I also managed to amass several thousand dollars’ worth of equipment at the home lab. We’ve spent two weeks running tests and have yet to push the throttle on it all. That’s changing today.
Olsson wipes a hand on his Abercrombie sweatshirt and scoots over so that I can see the readouts on the machines. All his vitals are normal: heart rate hovers around 75, systolic blood pressure clocks in at 126, oxygen levels at 97 percent. Three, two, one, he begins breathing.
But slowly, very slowly. He inhales and exhales three times slower than the average American, turning those 18 breaths a minute into six. As he sips air in through his nose and out through his mouth, I watch as his carbon dioxide levels rise from 5 percent to 6 percent. They keep rising. A minute later, Olsson’s levels are 25 percent higher than they were just a few minutes ago, taking him from an unhealthy hypocapnic zone to squarely within a medically normal range. All the while, his blood pressure drops about five points and heart rate sinks to the mid-60s.
What hasn’t changed is his oxygen. From start to finish, even though he’s been breathing at a third of the rate considered normal, his oxygen hasn’t wavered: it stayed at 97 percent.
We’d experienced the same confounding measurements during our bike workouts earlier in the week. The beginning of those workouts, like all workouts, sucked. We felt our lungs and respiratory system desperately trying to meet the needs of our hungry tissues and muscles: the dinner rush of the body. Normally, I’d open my mouth and huff and puff, trying to sate that nagging need for oxygen. But for the last few days, as I cranked the pedals harder and faster, I forced myself to breathe softer and slower. This felt stifling and claustrophobic, like I was starving my body of fuel, until I checked the pulse oximeter. Once again, no matter how slowly I breathed or how hard I pedaled, my oxygen levels held steady at 97 percent.
It turns out that when breathing at a normal rate, our lungs will absorb only about a quarter of the available oxygen in the air. The majority of that oxygen is exhaled back out. By taking longer breaths, we allow our lungs to soak up more in fewer breaths.
“If, with training and patience, you can perform the same exercise workload with only 14 breaths per minute instead of 47 using conventional techniques, what reason could there be not to do it?” wrote John Douillard, the trainer who’d conducted the stationary bike experiments in the 1990s. “When you see yourself running faster every day, with your breath rate stable . . . you will begin to feel the true meaning of the word fitness.”
I realized then that breathing was like rowing a boat: taking a zillion short and stilted strokes will get you where you’re going, but they pale in comparison to the efficiency and speed of fewer, longer strokes.
On the second day of using this slower, nasal breathing approach, I’d outdistanced my mouthbreathing record by .13 of a mile. The next session, I pedaled .36 miles farther—a 5 percent increase over mouthbreathing. By my fifth ride on the stationary bike, I pedaled 7.7 miles, almost a full mile longer, in the same amount of time, using the same amount of energy, than I had the previous week. This was a significant gain. It wasn’t quite yet up to the levels Douillard’s cyclists reported, but I was edging closer.
During that ride, I started playing around with my breathing. I tried to inhale and exhale slower and slower, from my usual exercising rate of 20 breaths a minute to just six. I immediately felt a sense of air hunger and claustrophobia. After a minute or so I looked down at the pulse oximeter to see how much oxygen I was losing, how starved my body had become.
But my oxygen hadn’t decreased with these very slow breaths, as I or anyone else might expect. My levels rose.
A last word on slow breathing. It goes by another name: prayer.
When Buddhist monks chant their most popular mantra, Om Mani Padme Hum, each spoken phrase lasts six seconds, with six seconds to inhale before the chant starts again. The traditional chant of Om, the “sacred sound of the universe” used in Jainism and other traditions, takes six seconds to sing, with a pause of about six seconds to inhale.
The sa ta na ma chant, one of the best-known techniques in Kundalini yoga, also takes six seconds to vocalize, followed by six seconds to inhale. Then there were the ancient Hindu hand and tongue poses called mudras. A technique called khechari, intended to help boost physical and spiritual health and overcome disease, involves placing the tongue above the soft palate so that it’s pointed toward the nasal cavity. The deep, slow breaths taken during this khechari each take six seconds. Japanese, African, Hawaiian, Native American, Buddhist, Taoist, Christian—these cultures and religions all had somehow developed the same prayer techniques, requiring the same breathing patterns. And they all likely benefited from the same calming effect.
In 2001, researchers at the University of Pavia in Italy gathered two dozen subjects, covered them with sensors to measure blood flow, heart rate, and nervous system feedback, then had them recite a Buddhist mantra as well as the original Latin version of the rosary, the Catholic prayer cycle of the Ave Maria, which is repeated half by a priest and half by the congregation. They were stunned to find that the average number of breaths for each cycle was “almost exactly” identical, just a bit quicker than the pace of the Hindu, Taoist, and Native American prayers: 5.5 breaths a minute.
But what was even more stunning was what breathing like this did to the subjects. Whenever they followed this slow breathing pattern, blood flow to the brain increased and the systems in the body entered a state of coherence, when the functions of heart, circulation, and nervous system are coordinated to peak efficiency. The moment the subjects returned to spontaneous breathing or talking, their hearts would beat a little more erratically, and the integration of these systems would slowly fall apart. A few more slow and relaxed breaths, and it would return again.
A decade after the Pavia tests, two renowned professors and doctors in New York, Patricia Gerbarg and Richard Brown, used the same breathing pattern on patients with anxiety and depression, minus the praying. Some of these patients had trouble breathing slowly, so Gerbarg and Brown recommended they start with an easier rhythm of three-second inhales with at least the same length exhale. As the patients got more comfortable, they breathed in and breathed out longer.
It turned out that the most efficient breathing rhythm occurred when both the length of respirations and total breaths per minute were locked in to a spooky symmetry: 5.5-second inhales followed by 5.5-second exhales, which works out almost exactly to 5.5 breaths a minute. This was the same pattern of the rosary.
The results were profound, even when practiced for just five to ten minutes a day. “I have seen patients transformed by adopting regular breathing practices,” said Brown. He and Gerbarg even used this slow breathing technique to restore the lungs of 9/11 survivors who suffered from a chronic and painful cough caused by the debris, a horrendous condition called ground-glass lungs. There was no known cure for this ailment, and yet after just two months, patients achieved a significant improvement by simply learning to practice a few rounds of slow breathing a day.
Gerbarg and Brown would write books and publish several scientific articles about the restorative power of the slow breathing, which would become known as “resonant breathing” or Coherent Breathing. The technique required no real effort, time, or thoughtfulness. And we could do it anywhere, at any time. “It’s totally private,” wrote Gerbarg. “Nobody knows you’re doing it.”
In many ways, this resonant breathing offered the same benefits as meditation for people who didn’t want to meditate. Or yoga for people who didn’t like to get off the couch. It offered the healing touch of prayer for people who weren’t religious.
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.
“We believe that the rosary may have partly evolved because it synchronized with the inherent cardiovascular (Mayer) rhythms, and thus gave a feeling of wellbeing, and perhaps an increased responsiveness to the religious message,” the Pavia researchers wrote. In other words, the meditations, Ave Marias, and dozens of other prayers that had been developed over the past several thousand years weren’t all baseless.
Prayer heals, especially when it’s practiced at 5.5 breaths a minute.