Deep Breathing Disease in the Age of COVID-19

Buteyko Breathing Science

Dr. Butekyo’s C02 Discovery Is Still a Big Secret. Why? 

Millions of Chinese practice the health remedy T’ai Chi, and scientific evidence backs it up. How have so many Chinese accepted T’ai Chi, and why did it spread so widely? The answer is found in the shift from martial art to healing art, and decisions made at the highest level of the Chinese Communist Party. 

It was the public health plan of a government willing to acknowledge a health reality.

Reasoning that healthcare for millions would be impossibly expensive, the Chinese government under Mao ZeDong decided to require T’ai Chi of all citizens. The Chinese Sports Committee created a simplified version under Mao’s guidance in 1956. And so the people were educated, outdoor spaces were set aside, and T’ai Chi became part of Chinese identity.

American health is our own responsibility, a truth we can no longer ignore as COVID-19 rages all around us. We have something, however, that cannot be easily found in China: a free society with an abundance of choices.

Our choice today is to seek fresh, new ways to conquer COVID-19.

The Buteyko Method (also called the Buteyko Effect, Breathing Normalization, and the Carbon Dioxide Theory) is a conservative, safe health practice grounded in science that directly addresses breathing.

As a breathing method, it is one of our best defenses against COVID-19, but as a theory it has never been fully embraced by the Western medical establishment.

Created by Russian medical doctor and physiologist Konstantin P. Buteyko (MD, Ph.D.) in the 1950s, over 100 scientific studies in Russia, UK, Australia, and other countries show the Buteyko Effect is quite real.


The Connection between Hyperventilation and Health

Dr. Buteyko observed that hyperventilation, or over-breathing, is correlated with poor health-- whether it comes in the form of involuntary “fight or flight” breaths, or over-breathing due to forced oxygen from mechanical ventilation.

When we hyperventilate, the larger exhale reduces C02 supply in the lungs. And since C02 is our precious regulator of pH and metabolism, by reducing it our overall cell oxygenation is reduced.

Dr. Buteyko’s theory rests on a paradox: to get more oxygen we must breathe less. It is not a simple concept, even for medical professionals to grasp.

The link between hyperventilation and health has been twice noted in scientific literature, and twice ignored. An American medical doctor and professor named Jacob Da Costa coined the term, “hyperventilation of the lungs” in the 1870s. He was working with Civil War veterans and observed that all sick patients hyperventilated, naming the syndrome “irritable heart” while specifically referring to shortness of breath and anxiety.

Eighty years later, Dr. Buteyko found the same pattern and introduced “deep breathing disease” into the literature—this time, with the benefit of the Verigo-Bohr Effect, demonstrating the link between pulmonary hyperventilation, pH, cellular respiration and poor health.

If hyperventilation is the enemy of health, it stands to reason that mechanical ventilators are potentially dangerous machines and may be contributing to COVID-19 fatalities when used with high-pressure oxygen. 

Ventilator use for COVID-19 is associated with twice the usual ARDS fatality rate. To turn this grim statistic around, we must consider a new paradigm that better explains the physiology of respiration and acknowledges the dangers of all forms of hyperventilation.

Although the Buteyko Effect is proven, its slow acceptance is unfortunately not unique in the history science, especially when research postulates an original paradigm. When alternative scientific paradigms clash with the dominant model, the paradigm is often wholly rejected and its proponents discredited or worse.

In the hospital setting, heroic (and extreme) ventilator use seems necessary, but are we creating needless deaths, not unlike those women centuries ago who died in childbirth--before we understood the difference between clean and dirty hands?

The biography of Dr. Ignaz Semmelweis shows all too clearly what can happen when great science meets great resistance. Semmelweis paid a high personal price for his keen observation of what was killing women in one 1840s Austrian hospital.


Dr. Semmelweis Had a Simple Request

A Hungarian doctor specializing in obstetrics began to spread the word after he observed very different death rates among women in two hospital maternity wards. He knew the two hospitals well: the first had higher death rate and the second a much lower one. He saw that women would strenuously avoid the first hospital, even choosing risky “street births” (on the way there) instead.

When he looked at the numbers and realized that literally giving birth in the street was safer than visiting the first hospital, he began a detailed investigation. After meticulous study, and the death of a good friend who was treated at the first hospital, he concluded that interaction with cadavers was the key factor. The second hospital trained only midwives, and did no autopsies. The answer was in transfer of “cadaverous” materials from doctors doing autopsies—who then switched to delivering babies.

Semmelweis advised medical doctors to thoroughly wash hands with antiseptic prior to procedures. This message did not go over well, and his incomplete explanation (this was before the germ theory) was mocked and rejected throughout his adopted city of Vienna.

He was able to lead medical staff in implementing hand-washing with a chlorine solution. Women rarely died in childbirth at his hospital. When he tried to convince other doctors to do the same, he was removed from Vienna and sent back to Hungary. Doctors took offense to the suggestion that they were unclean and should wash! 

The germ theory would become common knowledge just a few decades later, and forever change the paradigm of safe medical treatment. Today, medical training requires hand washing as a basic, routine practice. 

Semmelweis was committed against his will to a mental hospital, where he died from a gangrenous wound at the age of 47 after receiving a severe beating. It took decades for this pioneering scientist to receive recognition—yet today we would laugh at the notion of any doctor practicing medicine without sterilizing hands and medical instruments. 

One reason historians speculate that Semmelweis was roundly rejected was his insistence that there was “one cause” for high death rates in delivery rooms. A new paradigm (germ theory) was considered too extreme.


CO2 Is an Oxygen Delivery System

Dr. Buteyko discovered that because C02 build-up drives metabolism and enables oxygen to get into cells, hyperventilation (either short or long term) depletes C02 in and this way is destructive to all bodily systems.

In modern terms, poor C02 levels drive metabolic syndrome, a cluster of problems that are precursors for diabetes, obesity and heart disease (among others).

Again, the paradox: we build up C02 by less breathing.

Since we readily accept that oxygen is a powerful nutrient that must reach our cells, Buteyko’s ideas about C02 tend to sow confusion and sometimes hostility, even (perhaps especially) among doctors educated in the physiology of respiration.


Welcome to the Carbon Dioxide Theory

The medical establishment characterizes C02 as the result rather than the driver of 02 metabolism and sometimes even calls C02 a waste gas, or the byproduct of inhalation. It is more accurate to picture C02 and 02 in a continuous, intimate dance—but who is leading?

Dr. Buteyko’s groundbreaking theory asserted that pulmonary carbon dioxide (C02) levels drive metabolism and cellular oxygen (02) uptake. This is based on the known biochemical principle called the Verigo-Bohr effect, established around 1900, which proved that C02 levels affect blood pH.

Low C02 levels in our lungs influence the production of bicarbonate, which in turn makes blood more alkaline. Since blood pH is critical to balancing all metabolic processes, when bicarbonate turns the blood more alkaline, a cascade of reactions (including immune response) occur in an attempt rebalance blood pH.

Buteyko’s “deep breathing disease” is a result of lower C02 which ultimately LOWERS oxygen levels in the cells.


Anatomy of a Breath

Respiration occurs not just in the lungs but throughout the body as atmospheric oxygen is carried deep into our cells from lungs, then into the bloodstream via oxyhemoglobin (oxygen-rich blood cells) to its final destination: our cells.

The trachea (also called a windpipe, arguably a better name) carries air inward. The windpipe is like the trunk of a tree, with branches that descend into the lungs. These upside-down tree branches are two bronchi, several bronchioles, and millions of alveoli.

Each bronchi leads into each lung, where numerous bronchioles branch further. Finally, the last level of branching leads to air sacs (like grapes) called alveoli. 

It is the surface of the alveoli where gas exchange occurs. If the windpipe is the tree trunk, the alveoli are the leaves. 

It is helpful to understand that there are over 300 million alveoli in the average human, and their total surface area is between 75 to 100 square meters. About the size of a basketball court, the vast lung surface area is where the oxygen moves into cells that make up our tissues, muscles, and organs.

Each alveoli is surrounded by tiny blood vessels (capillaries) full of oxygen-rich blood.

The alveoli are the field, as it were, for gas exchange.

To recap the fundamental structure to get air into usable oxygen: nose, trachea, bronchi, bronchioles, alveoli/capillaries à gas exchange.

COVID-19, ARDS, and pneumonia are examples of diseases that lead to decrease in the gas exchange surface area after fragmented destruction of lung tissue down to as little as a quarter of the original surface area.

The bottom line is that the actual percentage of hemoglobin (oxygen-rich blood cells) will determine oxygen saturation in the blood. Health depends on oxygen reaching its final destination and on encountering a large surface area for gas exchange.

Without adequate C02, oxyhemoglobin is insufficient to provide 02 to cells.


The C02 Theory Is the Better Paradigm

We all carry a certain sensitivity to C02 and when there is a build-up, we inhale. Conditioned athletes have a low sensitivity to it—they can breathe less, and less often, even with exercise.

The rest of us (and some athletes) over-breathe, walking around with a high sensitivity to C02. It doesn’t take much C02 in our systems to cause a breath. So, most of us hyperventilate chronically.

Here is where things get confusing: Isn’t more oxygen good? If I’m breathing a lot, am I not taking in MORE oxygen?

If blood is already fully saturated, more air (via more breaths) does not add more oxgyen. It is just the opposite: by hyperventilating, we exhale more, and lose more CO2.


The Study of Asthma

Buteyko asthma researchers get impressive results: a majority of asthma patients get off most, if not all medications after they learn Buteyko Breathing Technique.

Researchers do not fully accept Dr. Buteyko’s C02 theory as the reason for positive outcomes. Modern medical researchers seem unable to adequately prove or disprove the mechanisms of the Buteyko Method. For example, a 2006 study (McHugh et al) that had positive results concluded:

Clarification of the mechanism(s) underlying the effectiveness of BBT [Buteyko Breathing Technique] is a further goal, given that BBT appears to represent a safe, efficacious alternative for the management of asthma.

In 1998, a blinded, randomized, controlled trial (RCT) was conducted on Buteyko breathing normalization. (The RCT is known to be the “gold standard” of scientific investigation because it sets up the experiment so a positive outcome isn’t due to a placebo effect, and patients can’t choose which group they want).

 In its abstract, the authors concluded:

<<Those practicing BBT reduced hyperventilation and their use of β2‐agonists [a medication]. A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without objective changes in measures of airway calibre.>> 

The results are the same in several studies: Buteyko works, but the researchers are continually befuddled because they cannot point to a specific, measurable number. The quote above does state, however, that “BBT reduced hyperventilation.”


Defense Mechanisms

In the publication Biofeedback, Dr. Rosalba Courtney reviewed Buteyko’s theory. Her article examined evidence for and against the soundness of what she terms the “Buteyko Effect.”

<<It is known that low carbon dioxide affects many systems of the body either directly or through subsequent depletion of bicarbonate, pH disturbance, and reduced tissue oxygen levels (Folgering, 1999; Gardner, 1995; Hardonk & Beumer, 1979). However, Buteyko and his Russian colleagues elaborated on the conventionally accepted effects of hypocapnia and argued that depletion of carbon dioxide affected the core processes of energy production in the cell known as the Krebs cycle, vital chemical reactions requiring carbon compounds and other key homeostatic processes. In Buteyko’s view, because carbon dioxide was so vital, the body created a series of defense mechanisms to retain carbon dioxide, including constriction of airways and blood vessels, and gave rise to conditions such as asthma and hypertension (Buteyko, 1990; Stark & Stark, 2002). >>

Summarily, Dr. Buteyko asserted that lack of C02 affected basic gas exchange, impacting homeostasis mechanisms.

Homeostasis is any attempt by the body to rebalance back to a normal state.

It is these defense mechanisms that help explain the true nature of asthma. The cycle goes like this: an asthmatic over breathes, the body rejects too much air, so the bronchioles constrict to reduce airflow to allow C02 to build up. Those small restrictions can lead to a vicious cycle, where larger restrictions (asthma attacks) become severe and frequent.

Western medicine is willing to accept that C02 plays an important role in pH regulation and even effects tissue oxygenation, but medical doctors are more hesitant to swallow theories about defense mechanisms. Insufficient C02 in the lungs might create a temporary crisis within the metabolism—but researchers seem to balk at the prospect of chronic health problems based on C02 deficiency.


The Cart Before the Horse

When it comes to 02 and C02, we are putting the cart before the horse.

The Buteyko breathing paradigm has not yet captured the serious attention of the medical community because it is a new paradigm that threatens a simple, enduring bias: we believe 02 is better than C02.

Our prejudices about the superior role of oxygen are everywhere in respiratory theory, and even show up in common language: the word “inspiration” has positive connotations of life and creativity while “expiration” is associated with endings and death. Our language betrays our attitude toward breathing.

Yet basic science supports the Carbon Dioxide Theory, especially given what we have learned about chronic Western diseases, the role of inflammation and the reality of metabolic syndrome in causing disease.

We desperately need to rewrite our outdated paradigm and acknowledge the true role of C02 in driving metabolism and oxygenating blood. With a clearer view of reality, we can acknowledge the dangers of hyperventilation and stop pushing 02.