Breath, James Nestor

Breathing is one of the most fundamental acts for living organisms, but humans are doing it all wrong - or so claims James Nestor in his insightful book Breath. Nestor says that “as a species, humans have lost the ability to breathe correctly, with grave consequences”. In Breath, he lays out what led him to this depressing conclusion, and how we can undo the damage of our terrible breathing habits.

To show just how bad it is, Nestor starts with a vivid description of a patient who illustrates many of the problems which stem from improper breathing. This patient had chronic nasal congestion, his mouth was “so underdeveloped it could not accommodate 32 permanent teeth”, and his tongue did not fit properly between whatever teeth he did have. His airways were obstructed and, because of all these problems, his breathing was “laboured and dysfunctional”. This “atrophied, underdeveloped mouth, throat, and skull” we learn, belongs to the author himself. For Nestor, and many others like him, breathing is a very real problem.

The first flaw in our breathing is that too many of us still use our mouth. I was very surprised to learn that more than half of humans claim to be mouthbreathers. To illustrate the bad consequences of mouth breathing, Nestor describes an experiment he was a part of at Stanford. First, he would breathe only through the mouth for ten days and then he would be allowed to breathe from the nose. He would record data such as blood oxygen level and then compare the results from the mouth and nose breathing phase.

The difference was startling. Over the mouth breathing phase his blood oxygen levels began falling to 90%, right at the boundary at which the body can’t supply tissues with enough oxygen. While sleeping, his snoring levels increased by over 4000%, and he averaged 25 “apnea events” where breathing stops. When the nose plugs came out, all these effects disappeared.

People typically assume it doesn’t matter whether the air comes in from the nose or mouth, as long as it reaches the lungs. This ignores the nose’s many functions. Most people are vaguely aware that the nose has a role in filtering air, but its influence goes far beyond this. For example, nasal breathing produces nitric oxide. This chemical boosts blood circulation and oxygen absorption by cells. It even has an impact on sexual function and you might know it by its more common commercial name: Viagra. Unlike the mouth, the nose has evolved specifically for the purpose of breathing. It is so specialised that the “nostrils of every living person pulse to their own rhythm” in response to our mental and physical states.

Mouth breathing doesn’t offer any of these benefits. In fact, Nestor shows us that mouth breathing begets mouth breathing in a vicious cycle. Inhaling from the mouth decreases pressure and causes the tissues in its back to loosen and flex inward. This constricts the airway and makes breathing more difficult, encouraging stronger mouth breathing. In contrast, nasal breathing creates a virtuous cycle of more nasal breathing and all the associated benefits that come with it. Therefore, **the first step on the path to respiratory redemption is to shut your mouth**.

After this, we have to go deeper into the body to the lungs themselves. Nestor informs us that when we breathe today, we barely push our lungs close to their maximum capacity. This naturally means less efficient oxygen transport. A study carried out in 1980 on 5200 people showed that the best indicator of life span wasn’t diet or exercise, but lung capacity. He goes on to describe some fairly hardcore ways people have expanded their lung volume, such as diving hundreds of meters underwater while holding the breath. Fortunately for us mortals, moderate exercise like cycling has been shown to also boost lung size by up to an impressive 15%.

To unlock greater lung performance, we also need to talk about the diaphragm. This is a muscle that sits below the lungs. As it contracts and relaxes, the pressure in our chest changes, allowing us to move air into and out of the lungs and blood into and out of the heart. This motion happens about 50,000 times each day, but we typically use the diaphragm to only 10% of its full range. The key to fully activating the diaphragm is to exhale deeply. The diaphragm lifts when we exhale and relaxes when we inhale. By exhaling very slowly, we can make our diaphragm contract more and reach its full range of motion.

Nestor tells us how Carl Stough, an eccentric choir conductor, was able to enhance the lung capacities of opera singers, saxophonists, and Olympic sprinters through deep exhalation techniques. Through exhalation exercises he also managed to control the symptoms of patients of emphysema, a disease where the lungs deteriorate and can’t absorb oxygen effectively. By exercising their diaphragms, they could increase their lung capacity to compensate for the extra lung deterioration. Exhaling fully gave them the ability to fight back against an incurable disease.

The next step to correct breathing is to breathe slowly. This is based on the important role of carbon dioxide (CO2) in the body. Usually, we think of CO2 as completely undesirable - we breathe it out for a reason after all. However, a slightly higher CO2 level can actually enhance oxygen absorption by cells. If we just breathe quickly, we may inhale more oxygen overall in a given time, but most of the extra oxygen will never make it to the cells. We’ll just breathe it back out. According to Nestor, breathing at a typical rate will allow us to absorb only a quarter of the oxygen available. By breathing slower, we can increase the absorption by allowing CO2 levels to increase slightly in the blood.

One surprising manifestation of slow breathing turns out to be prayer. Prayers from religions all around the world seem to be chanted with a peculiar breathing pattern. Nestor gives the example of Buddhist and Indian chants split into 6 second segments of singing (exhalation) and inhalation. Such patterns are in chants from Buddhism, Hinduism, Native American religions, Taoism, and Christianity. Somehow all these religions, which emerged on different continents at different times, evolved the same slow breathing patterns. If you wanted some more encouragement to breathe slowly, where better to get it than from the Divine itself?

You don’t need to pray or be religious to breathe correctly. Experiments based on these religious prayer patterns reveal the secret ingredient: 5.5 second inhales followed by 5.5 second exhales. Try breathing like this deliberately for a few minutes, and you realise just how different it is from how we normally breathe. It was at this point that it personally began to dawn on me just how suboptimal my own breathing was.

Next we learn that we should breathe less. This shouldn’t be confused with breathing slowly. Instead this means, very counterintuitively, that we need to take in less air. Nestor tells us how Indian yogis and Tibetan monks have learned to decrease their air intake at rest for centuries. Average lungs hold about 4-6 litres of air, but normal breathing patterns can very easily result in more air intake than necessary.

One of the first Western observers of this less is more phenomenon was the Ukrainian Konstantin Buteyko. During his time as a doctor in the Soviet Union, Buteyko performed a series of observations on his patients’ breathing patterns. The sick ones consistently breathed too much, inhaling up to 15 litres of air per minute. They also tended to be mouth breathers, which explains the much larger air intake they could have. In contrast, the healthy patients breathed less, with an intake of 5-6 litres per minute.

Breathing less and breathing slower form two sides of the same coin - one gives rise to the other in a virtuous cycle. By breathing slower, one breathes less and enhances the efficiency of oxygen absorption. Combining the two, Nestor pinpoints the common thread running through the lore of breath accumulated by various cultures around the world: **the optimum breathing rate is 5.5 breaths per minute and the optimum air intake is 5.5 litres per minute**. This naturally gives the 5.5 second inhale/exhale pattern which arises magically in the religious chants of the world.

One wonderfully simple breathing exercise you can do is simply breathe the perfect breath. You can do it for as long as you want, and it is discreet enough to do anywhere. I’ve personally enjoyed doing it while colleagues ramble on at meetings.

Remember how we started the book with Nestor’s terrible mouth and clogged airways? It turns out a lot of that damage comes from changes in the structure of bones in the face. As our agriculture has gotten more efficient, our food has become more processed and soft. Because of this, we need to chew way less than our ancient ancestors, which has caused our facial/jaw bones to narrow. This leads to the shrinking mouth, crooked teeth, and narrowing airways that Nestor is a victim of.

For this reason, the earliest orthodontics (i.e. braces) weren’t designed to straighten teeth but to widen the mouth. Nestor tries one himself in an attempt to coax his facial bones into widening. After a year, the results are stunning - he gained more than 1000 mm3 of bone in his cheeks and jaws. His airways widened and his jaw became better aligned. Breathing was never easier for him.

Nestor was a bit of a drastic case, but for those whose mouth is less ravaged, simpler habits will also work wonders. He recommends nibbling on “hard, natural foods and chewing gum”, although he doesn’t offer any specifics of what counts as the former. I suspect nuts and some fruit may be examples. Another habit we can adopt is to maintain good “oral posture”. This is the default state of your mouth, which should be lips together, teeth slightly touching and tongue on the roof of the mouth.

Up till now, Nestor has described the basics of good breathing which can be practiced by anyone. The final part has examples of extra techniques that require special effort. An example of this is the Tibetan tummo technique. Through a deliberate and aggressive breathing style, tummo engages our sympathetic nervous system and creates heat inside the body. He describes how Westerners such as Wim Hof learned this technique from monks in the Himalaya and went on to perform superhuman feats such as climbing Everest to 7200m wearing nothing but shorts and shoes.

The book finishes with a speculative attempt to explain ancient breathing concepts such as the Indian prāṇa and Chinese chi in terms of modern science. One theory Nestor explores was put forward by Hungarian Nobel Laureate Albert-Szent Györgi which claimed a link between breathing and electron excitability in molecules. The more excitable the electrons, the more reactive and “alive” something. While I appreciated this chapter’s acknowledgement of the importance and advancement of non Western cultures in understanding breathing, I didn’t find the scientific speculation too insightful.

When I first bought this book, I didn’t realise just how bad our breathing habits had become. As someone who practices prāṇāyāma (yogic breathing techniques), I was aware of the importance of breath, and thought maybe Nestor will tell us how to get even better at it. Instead, he takes us on a step by step journey to show us how much of our breath we’ve lost thanks to the advances of modernity. The lessons to fix our breathing are simple. First, instead of using the mouth, we must breathe from the nose which is exquisitely engineered for that very purpose. Then, we must exhale deeply to fully activate our diaphragm and maximise our lung capacity. Both of these should be done in the optimal breathing rhythm of 5.5 second inhales and exhales. To accompany our perfect breath, we must also improve our facial structure by chewing more and maintaining good oral posture. Once we get to this stage, breathing allows us to experiment with more advanced techniques that could lead to even better performance as shown by Wim Hof. While I won’t quite start aiming for Mount Everest after reading this book, it has made me think a lot and challenged me to try changing my own breathing habits.