Breathwork Practice: Breathwork is trending in the health sphere, but not all breathing practices are created equal. Today we explore two breathwork practices that will help you expand your capacity to hold carbon dioxide (CO2). We will explore why this is important and how the solution to your chronic fatigue symptoms or generally low energy may be rooted in dysfunctional breathing.
This article has been medically reviewed by Dr. Charles Penick, MD
How to Breath to Build Cellular Energy
How Breathing Dysfunction is Related to Chronic Fatigue
The medical paradigm has four leading solutions to chronic fatigue: stimulants, walking, therapy, or pharmaceutical drugs 1. For those who have suffered the symptoms of chronic exhaustion, walking around the block can seem like an impossible task. Whether your fatigue has gotten that bad or not, taking drugs or stimulants does not address the root cause.
Although many functional medicine practitioners try to address adrenal fatigue more holistically as an HPA-axis dysfunction, the reality is that the science simply doesn’t support this hypothesis. The studies on stress-related exhaustion disorder or burnout disorder show no link between cortisol levels, HPA-axis function, or adrenal depletion 2. About 15% with fatigue reported an association with slightly lowered morning cortisol level, 10% said the opposite, and about 65% said no difference in cortisol levels whatsoever.
What is the real science of what regulates human energy levels? New discoveries in the last decade mean that many people only have a part of the answer. Mitochondria has two prominent roles: one is energy mode or peacetime metabolism, and the other is defense mode or wartime metabolism 3-4.
Many people know that mitochondria are the cell’s powerhouse; they generate ATP, which gives the cell energy. The missing part of the story is that mitochondria are not mindless cellular energy generators; they are also environmental sensors and energy regulators. Mitochondria can better be understood as the central hub of the wheel of metabolism 5.
So your mitochondria are extremely sensitive and constantly sensing to see if the body is under threat. Such threats may be any number of stressors, including physical, mental, or emotional. In response, the cell will shut down energy production and shift resources towards cellular defense. This response is called a cell danger response 4.
Mitochondrial energy or defense modes are mutually exclusive, so the more you’re in one, the less you’re in the other. Therefore your energy is a reflection of the degree to which your mitochondria are being shut down by the way your cells believe to be under threat.
Your mitochondria’s capacity to withstand stress is also dependent on how healthy and abundant they are. Studies show that between age 40-60, your mitochondria are reduced to half, making it even more important to preserve its resilience to stress with age 6.
Stress is Stress
All stress is stress. This statement may seem obvious, but many people seem to place a hierarchy on stress, believing some to be worse than others. The reality is that all stress influences your mitochondrial cell danger response, in the same way, so you need to be mindful of all types of stress: physical, chemical, and emotional 4. Your mitochondrial energy is impacted by all forms of stress, including pathogens, refined sugar, vegetable oils, allergens, toxins, bacteria, fungus, too much exercise, EMFs, not enough daylight, artificial light after sundown, or dealing with a bad job or relationship.
Although our human bodies have a great capacity and resilience for stress, our bodies often cannot keep up with the chronic and abundant stress exposures of modern life. A useful analogy is to see your stress capacity as a rain barrel, and each raindrop accumulates over time. Although your body has a great capacity to hold stress (the rain barrel), every drop of rain (stress) accumulates. A simple drop of rain is seemingly insignificant, but over time that barrel will overflow!
Breath and Mitochondrial Health
If you are breathing dysfunctionally, this can be one of the most problematic sources of stress– simply because of how vital and regular breathing is in the body. We only eat (about) three times a day, so however much damage you can do through a lousy diet, imagine the magnitude of inducing stress through poor breathing all day and night, every day of your life!
Rarely do people suspect that their breath may be one of the most significant sources of mitochondrial dysfunction because breathing is something we do without thinking. But just because you do it doesn’t mean you’re doing it well. Many people’s nervous system is aired to regulate their breathing habits in a dysfunctional way 7. The problem with dysfunctional breathing is twofold:
- It Generates Too Low of A Co2 Threshold 8
If your nervous system is imprinted with a dysfunctional breathing pattern, you are unknowingly breathing too much, which causes a chronic stress response and a chronic state of sympathetic arousal.
- It Prevents Inadequate Oxygen Delivery to the Cells 9
Even though the blood-filled oxygen is present, it isn’t effectively delivered to the cells and mitochondria when a dysfunctional breathing pattern occurs.
The result of a low CO2 threshold and inadequate oxygen delivery to the cells is too much stress and anxiety on your cells, which triggers your mitochondria into chronic stress mode, where they shut down energy production mode, which causes symptoms of “chronic fatigue.”
The Biggest Breathing Myths
One of the most prominent myths in the world of breathing is that deep breathing is good breathing. You may have heard it in yoga class or during a breath workshop: take a deep, expansive belly inhale and deep exhale. The problem with these deep breaths is that they are typically performed under stress (think hyperventilation during exercise) 9-10. So although a few slow breaths can be calming, chronically deep breathing is stress breathing!
On the other hand, soft and subtle breathing is our healthy natural state of breathing. Look no further than a baby breathing while it sleeps. Some people have to watch their baby for 20-30 seconds before seeing an inhale. This is because their breaths are soft, gentle, and slow.
The second breathing myth is that CO2 is often seen as a “waste gas.” People understand that oxygen is good; we breathe it in and then assume CO2 is what we exhale as waste material. On the contrary, we don’t get rid of the CO2; we actually retain a lot of it and have a certain amount in our body 11.
Your oxygen comes into your lungs, which then enter your capillaries and chemically bond to molecules in your blood cells called hemoglobin. The oxygen knows how to get released into your muscle and organ cells thanks to carbon dioxide! It changes the pH of the environment, which allows the oxygen to release from the blood cell, and oxygenate the cell and mitochondria.
If you are in chronically low states of CO2 or have a low threshold to it, it decreases the ability for oxygen to get dropped into your cells. Less oxygen to the cells leads to less energy, leads to more fatigue.
How to Identify Dysfunctional Breathing
An easy way to identify dysfunctional breathing is using the BOLT score, which stands for Body Oxygen Level Test developed by Patrick McKeown 12. It measures the CO2 threshold, which is how the brain regulates the urge to breathe. If you’ve been wired into hypersensitivity to carbon dioxide, it speeds up the breathing rate and creates chronic stress that makes you more susceptible to anxiety and low energy.
How to do it correctly:
- This breath hold test is rooted in normal breathing, not an extreme inhale and hold.
- After taking a normal inhale and normal exhale, you pinch your nose and close your mouth, and start to count your seconds.
- You release at the first sign of discomfort: no holding until you need a big gasp for air.
Typically, even athletes can only hold for around 25-30 seconds. Ideally, people should be approximately 40 seconds above. Anything below 20 is a sign of severely dysfunctional breathing.
Resetting the Brain’s Co2 Tolerance
To increase the brain’s threshold of CO2, there are various exercises you can implement. With a higher tolerance to CO2, your brain isn’t constantly trying to blow off excess CO2, so your nervous system stops over-breathing.
Air Hunger Exercises
Train the brain to get used to higher levels of Co2 so that it can begin to regulate light slow breathing instead of deep over-breathing. 13
- Half breaths: with two fingers along your upper lip, breathe normally for a few breaths, just feeling the air come in and out of your nose. After a few breaths, start taking half breaths in and half breaths out. Notice the air slowly and gently moving across your fingers, and focus on how soft you can get the air over your fingers. Take 5-10 of these breaths. You may feel a strong desire to take a deep breath, and you can release it at any time. Build that soft breath to 1 minute, then 2, and even 3 minutes. Air hunger exercises like half breaths that encourage slow, gentle breathing should be the baseline practice for anyone with severe disfunction (under 20-second hold in the BOLT test).
- Intermittent hypoxic breathing: Adequate BOLT scores (25-40 seconds, but ideally 40+ seconds) can start focusing on more aggressive practices to build massive air hunger and reset the Co2 dramatically. These include practices like intermittent hypoxic breathing or breath-holding techniques. These more intense practices induce hormesis, a kind of stress that forces adaptation in the body. To perform this kind of exercise, exhale completely and hold at your deepest exhale, and hold.
It’s essential for someone with chronic fatigue symptoms to stick to the half-breath air hunger exercise for a few weeks up to a few months until their threshold increases to at least 40 seconds on the BOLT test before moving to the intermittent hypoxic breathing exercise. This is because hormetic stress can be too dramatic a stressor for someone with extreme breathing dysfunction.
You can perform these exercises once a day or more, but consistency is key. Be mindful not to push it too hard when you’re starting; the key is a gentle, slow increase in your capacity to hold Co2 in the body. None of these exercises should result in a big gasp of air through the mouth.
A final note that you should never perform these breath exercises under, in, or around water! They are best performed somewhere away from any sharp edges. Although fainting is rare, best to ensure that your environment is safe, in case you do.
Your mitochondria are not purely an energy-making machine. Although they make ATP and generate cellular energy, they are also responsible for sensing stress and can shut down this process to defend the body. Defense mode downregulates energy mode, so stress directly impacts how much energy your cells produce. All stress impacts this cell’s danger response, chemical, physical, and emotional. Breathing is one of the most critical stressors to fix because you do it all day long. Dysfunctional breathing is a significant source of chronic stress.
The idea that deep breathing is calming and beneficial is a myth. Deep breaths are stress responses that shut down cellular energy production. Another breathing myth is that CO2 is “bad” or simply waste material. Your capacity to hold CO2 is what generates slow, gentle, calm breathing.
To measure dysfunctional breathing, you can use a BOLT test. From there, you can increase your CO2 threshold using air hunger exercises like half breaths and intermittent hypoxic breathing.
Medical Disclaimer: This article is based upon the opinions of Dr. Daniel Pompa. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Pompa and his associates. This article has been medically reviewed by Dr. Charles Penick, MD for accuracy of the information provided, but Dr. Pompa encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional.
1 “Chronic Fatigue Syndrome.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 24 Sept. 2020, https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/diagnosis-treatment/drc-20360510.
2 Cadegiani, Flavio A., and Claudio E. Kater. “Adrenal Fatigue Does Not Exist a Systematic Review.” BMC Endocrine Disorders, vol. 16, no. 1, 2016, https://doi.org/10.1186/s12902-016-0128-4.
3 Tonkonogi, M et al. “Mitochondrial function and antioxidative defense in human muscle: effects of endurance training and oxidative stress.” The Journal of physiology vol. 528 Pt 2,Pt 2 (2000): 379-88. doi:10.1111/j.1469-7793.2000.00379.x
4 Naviaux, Robert K. “Metabolic Features of the Cell Danger Response.” Mitochondrion, vol. 16, 2014, pp. 7–17., https://doi.org/10.1016/j.mito.2013.08.006.
5 Breda, Cristiane Naffah de Souza et al. “Mitochondria as central hub of the immune system.” Redox biology vol. 26 (2019): 101255. doi:10.1016/j.redox.2019.101255
6 Terman, Alexei et al. “Mitochondrial turnover and aging of long-lived postmitotic cells: the mitochondrial-lysosomal axis theory of aging.” Antioxidants & redox signaling vol. 12,4 (2010): 503-35. doi:10.1089/ars.2009.2598
7 Courtney, Rosalba et al. “Relationship between dysfunctional breathing patterns and ability to achieve target heart rate variability with features of “coherence” during biofeedback.” Alternative therapies in health and medicine vol. 17,3 (2011): 38-44.
8 Boulding, Richard, et al. “Dysfunctional Breathing: a Review of the Literature and Proposal for Classification.” European Respiratory Review, vol. 25, no. 141, 2016, pp. 287–294., https://doi.org/10.1183/16000617.0088-2015.
9 Depiazzi, Julie, and Mark L. Everard. “Dysfunctional Breathing and Reaching One’s Physiological Limit as Causes of Exercise-Induced Dyspnoea.” Breathe, vol. 12, no. 2, 2016, pp. 120–129., https://doi.org/10.1183/20734735.007216.
10 Hansen, Dr Sven. “Take A Deep Breath Is Bad Advice.” The Resilience Institute, 1 Oct. 2016, https://resiliencei.com/2016/10/take-deep-breath-bad-advice/.
11 Cherniack, N S, and G S Longobardo. “Oxygen and Carbon Dioxide Gas Stores of the Body.” Physiological Reviews, vol. 50, no. 2, 1970, pp. 196–243., https://doi.org/10.1152/physrev.19188.8.131.52.
12 “Measure BOLT.” Oxygen Advantage, 12 Mar. 2020, https://oxygenadvantage.com/measure-bolt/.
13 Levine, Benjamin D. “Intermittent hypoxic training: fact and fancy.” High altitude medicine & biology vol. 3,2 (2002): 177-93. doi:10.1089/15270290260131911