In 1896 Alfred Nobel suffered a stroke and died. In his will, the majority of his wealth was endowed to provide “prizes to those who, during the preceding year, shall have conferred the greatest benefit to mankind.”
Although the motives of Nobel remain unclear, many commentators, including Albert Einstein, were of the view that this final act was an attempt to relieve his conscience and promote world peace. To ameliorate the negative effects from the invention of dynamite, Nobel ensured that a prestigious ceremony would take place each year to recognize those who make the greatest positive contributions to life.
In an ironic twist of fate, nearly one hundred years after Nobel’s death, three doctors, Robert Furchgott, Louis Ignarro, and Ferid Murad, were awarded the Nobel Prize in Physiology or Medicine for discovering how nitric oxide had many important beneficial effects for the cardiovascular system. Had Alfred Nobel conceded to the wishes of his doctors, it is possible that his life may have been extended.
Sometimes referred to as the mighty molecule, nitric oxide is produced within the 100,000 miles of blood vessels throughout the human body, including the paranasal sinuses surrounding the nasal cavity.
Nitric oxide sends a signal for the blood vessels to relax and dilate. If there is too little nitric oxide, blood vessels constrict and the heart has to raise the pressure to send blood throughout the body. The easiest way to understand this is to imagine a garden hose with a knot in it: The water cannot flow freely and the pressure must rise if the water has any chance of flowing from one end to the other. Persistent high blood pressure or hypertension damages the arterial blood vessels, causing a buildup of plaque and cholesterol and also possibly blood clotting. If the blood clots and leads to an obstruction, this may cause the heart or brain to be deprived of blood and oxygen, resulting in a heart attack or stroke.
Nitric oxide plays a monumental role in human health by reducing cholesterol, reversing the buildup of plaque in the blood vessels, and helping to prevent blood clotting, all of which significantly increase the risk for heart attack and stroke. According to Nobel laureate and distinguished professor of pharmacology Dr. Louis Ignarro: “[Nitric oxide] is the body’s natural defense to prevent all of these things from happening.”
Producing sufficient nitric oxide enables blood flow to be directed effortlessly around the body, ensuring that vital organs receive sufficient oxygenation and nutrients. As blood vessels relax, the heart is able to normalize the pressure required to distribute blood throughout the body. Ways to increase nitric oxide include slow nasal breathing, regular moderate physical exercise, and eating foods that produce nitric oxide.
As nitric oxide is produced inside the paranasal sinuses as well as the blood vessels, breathing gently and calmly through the nose allows the gas to be picked up and carried to the lungs and blood. According to Jon Lundberg, professor of nitric oxide pharmacologics at the world-famous Karolinska Institute in Stockholm, Sweden, large amounts of nitric oxide are constantly released in the nasal airways of humans. As we breathe in through the nose, nitric oxide will follow the airflow to the lungs, where it plays a role in increasing the amount of oxygen uptake in the blood.
Dr. David Anderson of the National Institutes of Health in the United States also believes that how we breathe may well hold the key for how the body regulates blood pressure. It is well known that slow, gentle breathing from the diaphragm relaxes and dilates blood vessels, but the reasons behind this lasting drop in blood pressure is not completely understood. A plausible explanation is that the regular practice of relaxed breathing activates the body’s relaxation response, resulting in improved blood gas regulation and dilation of blood vessels.
As we partake in physical exercise, blood flow increases and stimulates the inner lining of the blood vessels to produce more nitric oxide. An interesting study by a team of researchers from Hiroshima University Graduate School of Biomedical Sciences compared changes to blood flow in response to different intensities of physical exercise. Exercise intensity describes the perceived effort by individuals while physically moving their bodies. For example, most people will agree that walking at a moderate pace is a low-intensity exercise because it is easy to sustain and involves light demands in terms of breathlessness and recovery. The study, which was published in the journal Circulation, found that low-intensity exercise—which expends about the same amount of energy as window-shopping—wasn’t enough to optimally increase blood flow. Conversely, high-intensity exercise—which includes vigorous activity at a fast pace—actually worsened blood flow. But the middle path—moderate-intensity exercise, such as a brisk walk or a light jog or cycle—increased production of nitric oxide and improved blood flow throughout the body.
While physical exercise is an excellent way to increase nitric oxide, diet, dietary supplements, and nasal breathing also play significant roles. In a recent conversation with Irish cross-country running coach John Downes, he told me how he actively encourages his athletes to drink beet juice, explaining how he witnessed an increase in performance and reduction of cramping as a result. Since John isn’t a man to waste energy on unfruitful training practices, I decided to find out more. I soon discovered a study conducted by the University of Exeter that investigated the effects of increased dietary intake of beet juice, which is rich in the nitrates required to generate nitric oxide. A study group of men aged between nineteen and thirty-eight drank about two cups of beet juice every day for a week. This resulted in a “remarkable reduction” in the amount of oxygen required to perform exercise in comparison with a control group who drank water: The beet juice drinkers were able to cycle up to 16 percent longer before tiring. Furthermore, blood pressure within the beet juice drinkers dropped (within normal levels), even though it wasn’t high to begin with. In conclusion, the researchers commented that the reduction of oxygen required for submaximal exercise following the drinking of beet juice “cannot be achieved by any other known means, including long-term endurance exercise training.”
Along with beet juice, essential nitric oxide–producing, heart-protecting food sources to include in your diet include fish, green vegetables, dark chocolate, red wine (a glass per day—not the bottle!), pomegranate juice, green or black tea, and oatmeal. Food sources to be limited in your diet include the usual culprits of meat and processed foods. Along with eating the right foods, supplementing your diet with the amino acid L-arginine has been proven to increase nitric oxide production, although results vary depending on age and genetics. These simple changes to your diet, in addition to simply breathing lightly through your nose, may provide the key to lifelong cardiovascular health.
Most of us never give a moment’s thought to our cardiovascular health, taking for granted that our heart will continue to perform its essential task for seventy years or more. But heart-related problems are not limited to those with a history of heart disease; completely avoidable cardiac issues can be experienced by young and otherwise healthy individuals, and prevented simply by increasing nitric oxide levels and by changing the way they breathe.
In 1909, American physiologist Dr. Yandell Henderson produced groundbreaking work on the relationship between breathing and heart rate that remains relevant today. In a paper entitled “Acapnia and Shock: Carbon Dioxide as a Factor in the Regulation of Heart Rate,” Henderson describes how he was able to regulate the heart rate of dogs to any rate he desired, from 40 beats or fewer per minute up to 200 or more, by altering their pulmonary ventilation. Henderson noted that even a “slight reduction of carbon dioxide of the arterial blood caused a quickening of the heart rate.”
A few years ago, I worked with a thirtysomething woman named Anna who had been experiencing heart palpitations characterized by a fast heartbeat. Her resting pulse was about 90 beats per minute—the average heart rate is between 60 and 80 bpm—leaving her feeling that her “heart would beat right out of [her] chest.” This feeling was a source of major distress for Anna and she had consulted a number of specialists, but there didn’
t seem to be anything physically wrong with her.
In an effort to get to the bottom of the problem, Anna had undergone a number of physical examinations and an electrocardiogram. The good news was that her cardiovascular health was normal. The bad news was that there was still no identified reason or solution for her predicament. Following her diagnosis, she was convinced that she had a medical condition incurable by modern science.
Unfortunately, Anna is not alone. The late chest physician Dr. Claude Lum wrote a number of articles illustrating her experience to a tee, based on patients who presented the very same pattern of symptoms with no physical anomaly. The one thing all these cases had in common was a tendency for overbreathing, the seemingly innocuous habit that is found to be the “mystery” cause behind numerous complaints and conditions in every field of medical practice.
Anna and her husband, having exhausted the traditional routes for a solution, somehow came across my work and were relieved to hear that the effects of overbreathing could indeed lead to palpitations characterized by an abnormally rapid heartbeat. With nothing to lose, they enrolled in my course.
When Anna arrived at the clinic, she appeared to be the picture of health, in her early thirties, slim, and of a petite build. For a few moments I observed her breathing without her noticing. She seemed to be a nose breather, but the one thing that caught my eye was that she would sigh every few minutes, lifting her shoulders and taking in a large breath. I’d seen the effects of regular sighing many times over the years, often in individuals prone to anxiety, and just like mouth breathing, it is a habit that usually goes unnoticed. I explained to Anna that in order to resolve her heart symptoms, it was very important that she retrain herself to stop this regular sighing.
Even though a sigh is often involuntary, taking place before the individual is aware of it, we still have a measure of control to reduce and eliminate the pattern. I explained to Anna that she should hold her breath or swallow any time she felt a sigh coming on. If by chance she missed one, she should hold her breath for 10 seconds to compensate for the overbreathing. I also provided her with a relaxation exercise and taught her the Breathe Light to Breathe Right exercise, which she proceeded to practice diligently for 10 minutes, 6 times per day. In addition, Anna began to pay more attention to her breathing throughout the day, ensuring that it stayed calm and quiet at all times.
When husband and wife returned one week later, Anna explained how much calmer she felt, and brought the fantastic news that her pulse had reduced to a perfectly average 60 to 70 beats per minute. Anna’s case was one of my first experiences of the effect of overbreathing on cardiovascular health, and one that I will never forget—a clear demonstration of how overbreathing can affect us in so many different and potentially serious ways.
To demonstrate the effects of breathing on heart rate, I often ask my students to locate their pulse and take six or seven big breaths quickly through their mouth—within seconds, they are able to feel their pulse getting quicker. I then ask the students to practice gentle, slow, relaxed breathing and notice how the pulse slows down. If breathing rate and volume can have such an immediate and significant effect on the heart, we need to ask what repercussions poor breathing habits might have on the long-term health of our hearts.
The heart performs the most important function of the body, and, like all muscles, it requires sufficient blood flow and oxygenation in order to work properly. As Henderson showed, breathing in excess of normal metabolic requirements causes a reduced concentration of carbon dioxide in the blood.
This state of hypocapnia (which Henderson called acapnia) can affect cardiac functioning by decreasing the circulation of blood in the blood vessels and reducing blood flow to the heart. Since low levels of carbon dioxide in the blood lead to a strengthening of the bond between the red blood cells and oxygen, the result is reduced delivery of oxygen to the heart. On the other hand, increasing carbon dioxide levels in the blood by reducing breathing volume toward normal will result in improved blood flow and increased available oxygen, providing the heart with a ready and reliable supply of oxygen.
Cardiac Arrest in Athletes: A Missing Link
Each year, fit and healthy young athletes die from sudden adult death syndrome or cardiac arrest. These deaths have a far-reaching effect not only on family, friends, and classmates but also on entire communities.
Cormac McAnallen played Gaelic football for his native County Tyrone, winning almost every honor in the game during his career. He was also a student at Queen’s University Belfast and University College Dublin, and was named Queen’s University graduate of the year in 2004.
On March 2, 2004, at just twenty-four years old, he died suddenly in his sleep due to an undetected heart condition. Tributes to Cormac came from all sectors of society, including Irish president Mary McAleese, who hailed him as “one of the greatest Gaelic footballers of his time.”
While undertaking research for this book, my curiosity was roused as to why healthy athletes might experience cardiac arrest or exhibit electrocardiogram (ECG) abnormalities with no other apparent risk factors. After all, most athletes are in the prime of their life, eat a good diet, do not smoke, have normal cholesterol levels and normal blood pressure, and generally care for their health. Aside from genetic predisposition, which of course we have absolutely no control over, what other factors might increase the risk of cardiac arrest in athletes?
In search of the reasons behind unexplained heart failure in young athletes, several studies have explored ECG abnormalities in order to find a connection between the electrical system that controls the heart’s rhythm and unexpected cardiac arrest.
When the heart beats abnormally—either too fast or too slow, or irregularly—this condition is termed arrhythmia. Cardiac arrest happens when the electrical signals that control the timing and rhythm of the heartbeat become completely chaotic. When this happens the heart is no longer able to effectively pump blood around the body, and unless the condition is treated promptly, death is inevitable.
For the best chances of survival, immediate application of cardiopulmonary resuscitation (CPR) followed by defibrillation is essential. Although cardiac arrest often comes with no warning, clues such as abnormal heart rate, chest pain, dizziness, fainting, blackouts, and flu-like symptoms are sometimes present. Just prior to the onset of cardiac arrest, the athlete may feel dizzy or unwell and then collapse, stop breathing, and quickly lose consciousness as blood and oxygen stop flowing to the brain. Unless circulation is restored within a few minutes, irreversible brain damage and subsequently death will result from sudden heart failure and the cessation of circulation.
An electrocardiogram (ECG) is a test used to interpret the electrical activity of the heart, assessing the rate and regularity of the heartbeat as well as the presence of any damage to the heart muscle. In assessing ECG abnormalities, doctors examine various indicators that are linked to a number of life-threatening cardiac conditions.
Studies have found that certain ECG changes in young athletes are common and usually reflect adaptations of the heart as a response to regular physical training. However, certain abnormal ECG readings, such as T-wave inversion and ST segment depression, were found to be potential precursors to sudden and unexpected cardiac arrest during sport or exercise. Markedly abnormal ECGs in young and apparently healthy athletes may also suggest the initial signs of underlying heart disease.
ST segment depression is considered to be a sign of reduced circulation in the blood vessels of the heart, and it has been suggested that there is a link between ST segment depression and the risk of sudden cardiac death. In a study including 1,769 men without evident coronary heart disease, a total of 72 deaths occurred in the eighteen years of follow-up—all of whom showed asymptomatic ST segment depression during exercise on their ECG readings.
Earlier on we discussed how overbreathing reduces blood flow and oxygen delivery to the heart. An opportune question at this point is whether the amount of air we bre
athe plays a role in the onset of cardiac arrest. This, I think, could be an important factor in the investigation of sudden cardiac death in young athletes.
A study conducted by researchers from the University of Patras in Greece revealed how the amount of air we breathe can produce changes in electrocardiogram results. During the study a total of 474 healthy volunteers with no apparent heart disease increased their breathing rate to more than 30 breaths per minute for 5 minutes to create the effects of hyperventilation. ECG readings reported abnormalities in 72 volunteers, including findings of ST depression and T-wave inversion, with 80.5 percent of abnormalities occurring within the first minute of hyperventilation. Interestingly, the study found that age, gender, smoking, and hypertension did not influence the overall incidence of the abnormalities, showing that even perfectly healthy individuals can be susceptible to the abnormalities caused by hyperventilation.
If increasing the breathing rate to 30 breaths per minute over 5 minutes can induce ECG abnormalities, what effects might strenuous exercise have on an athlete’s risks of cardiac disease when you consider that air intake can increase to between 50 and 70 breaths per minute during moderate- to high-intensity activity? Should athletes be taught how to ensure healthy breathing volume during exercise in order to minimize the effects of hyperventilation on their cardiovascular health?
Penny is a cardiac nurse who has worked at a Limerick hospital for the past thirty years. As a fit and healthy woman of normal build, Penny became worried when she began to experience symptoms of arrhythmia in her sixties. The issue had developed gradually over a few years, and Penny described the feeling as “a large butterfly fluttering about in the left side of my chest,” which could occur at any time of the day or night, sometimes going on for eight hours or more.
The Oxygen Advantage: The Simple, Scientifically Proven Breathing Techniques for a Healthier, Slimmer, Faster, and Fitter You Page 20