• Dr. Doug Pooley

Ezekiel: Breathing Is Not Just Air In, Air Out



We often take for granted the very things that most deserve our gratitude.
~ Cynthia Ozick


A little man teaches a big lesson.


In the region where I live and practice, we are blessed to have several Amish communities. I say blessed because they are gentle people who are hardworking, family oriented and possess a strong belief system. They are also intelligent folk who often seek out natural approaches to their health care needs. It’s not that they do not use prescribed medicines, but they prefer less complex intervention whenever possible. As such, we tend to see numerous members of their community for counsel and treatment of the usual wear and tear associated with their physically demanding hands-on approach to life.


One day Ezekiel, a robust eighty-six-year-old elder in the community, approached me with a particularly interesting concern. Approximately three months prior, he had been kicked in the chest by a cranky horse they were trying to shoe on one of their farms. He ended up with several rib fractures as well as a badly bruised sternum. He healed from the fractures, but the process left him unable to draw a deep breath without severe discomfort. He could only shallow breathe, which made him anxious and severely restricted his activities. Prior to the incident, Ezekiel’s only health concern was a diagnosis of type 2 diabetes which he had kept under control with dietary modification.


During the three months following the accident, he had trouble stabilizing his sugars, and his blood pressure was up. To complicate life even more, his pulse rate had increased to the point that his doctor was suggesting medication to slow it down and avoid stroke or heart attack. Ezekiel also experienced severe tension in his shoulders and back and was never without a headache. This is what brought this fine old gentleman to my facility.

Examination revealed that, although the ribs had healed satisfactorily, the muscles and related soft tissues had been severely damaged and had become infiltrated with scar tissue because of the injury. This was restricting chest movement and forcing him to shallow breathe, especially when he was active, due to the pain. This limited breathing and the distress associated with it affected his nervous system, constantly putting him in what is termed a “sympathetic dominant imbalance”—a “flight or fight” state that is intended for short-term physiological and/or neurological bursts and is designed to prepare the body to deal with crisis situations. It impacts hormone production, heart rate, energy metabolism as well as broader neurological activity. This process is a natural, short-term physiological reaction to danger. If a sympathetic dominant state is engaged long-term, this can result in massive multi-system overload and breakdown, which is exactly what was happening to Ezekiel. He was showing the signs of progressive system collapse. He was exhausted and agitated all at the same time and could only sleep (fitfully) while sitting in a chair.


After examining him closely, I explained my diagnosis and suggested a course of therapy to break up the scar tissue and restore proper breathing mechanics. Staff and I worked with him over a three-week period to normalize his respiration and gave him some specific breathing exercises to improve rib expansion and air flow. Although it hurt a bit at the start, Ezekiel responded wonderfully and began breathing comfortably again after three weeks.


That’s when the case got really interesting!


After Ezekiel revisited his doctor a couple of months later, all his other negative systemic changes—from blood chemistry to sleep patterns—seemed to have also normalized, much to everyone’s surprise. That’s when a light went on for me as to the critical impact of proper breathing, and it spurred my research into the breathing component of the Un-Diet Diet program. I needed to find a protocol for breathing that would maximize lung efficiency and improve overall health potential as it had for Ezekiel. If improved breathing could have such a profound impact on an eighty-six-year-old, what could be the potential impact of constructive breathing be on less compromised patients?

Thank God not everyone gets kicked in the chest by a horse. But just look around and it becomes clear the staggering number of people, especially those over the age of fifty-five, who breathe ineffectively and may be negatively impacting their health. I can see an eye or two raising among you, so let’s look closely at the process.


We breathe twenty-three thousand times per day. Human lungs breathe in and out about 2,100 to 2,400 gallons (8,000 to 9,000 litres) of air every day, and the total length of the airways running through the two lungs is approximately 1,500 miles (2,400 kilometres). The two lungs together contain three hundred to five hundred million alveoli at the end of the tiniest of airways and are where the oxygen/carbon dioxide exchange occurs. You can survive three days without water and forty days with no food, but most of us would be dead in three minutes without oxygen, the most important element to our survival. That is why evolution gave us two lungs.


As you prepare to start the program, it is important to know a little about respiration and how our bodies breathe. A big part of my rehabilitation strategy revolves around a series of breathing techniques designed to drive more oxygen into your system to improve overall metabolic function and energy production.


When you breathe in, the muscle on the bottom of your ribcage, called your diaphragm, contracts, and draws the lungs downward, allowing them ample room to expand. Other muscles between your ribs, called the intercostals, contract to pull your rib cage upward and outward. As the lungs expand, air is sucked in through your nose and mouth and travels down your trachea into your lungs. After passing through your bronchial tubes, the air finally reaches the air sacs (alveoli) where oxygen is diffused into the bloodstream. At the same time, carbon dioxide travels into the air sacs from the blood and is expelled as you exhale. On average, around 70 percent of all metabolic toxins are released from the body through our breath, so the better we breathe the more efficiently and effectively we detoxify and expel waste from our system.


Due to lifestyle, infirmed health, stress or just laziness, most of us use little more than the top one-third of our lungs when breathing. Tidal volume (the amount of air displaced between normal inspiration and expiration) is usually half a litre, and total lung capacity is up around five or six litres depending on the size of the person. So, in essence, most of us are only using about 10 percent of potential lung capacity for normal breathing. As we age and become more sedentary, much of our lung capacity can become functionally reduced. This is further complicated by factors such as weight gain, chronic lung dysfunction associated with smoking, the exposure to air pollution, etc. Add to this a general de-conditioning also often associated with getting older or having resident mobility issues, and you have a recipe for impaired lung function and diminished tissue oxidation.


It has been my experience with people over the age of fifty-five that the above-mentioned reduction in respiratory function is usually found in combination with progressive decreases in activity and chronically shallow breathing, which of itself can be a major contributor to poor health. There are various causes of breathing impairment, none of them good, and many that can be improved with the proper rehab strategy which I provide in the program.


Shallow breathing, also referred to as chest breathing, is characterized by a reduced number of breaths per minute as well as a decrease in the volume of air consumed with each cycle of respiration. There are various causes, including trauma, asthma, chronic obstructive pulmonary disease (COPD) infections, inflammation in the airway, obstruction in the breathing passage, anxiety, stress and more. As mentioned, it also a potentially devastating by-product of a sedentary lifestyle.


Most people aren’t even aware that they are chronically slow/shallow breathing or of the more important consequence that they may be weakening their lungs in the process. The negative ramifications are usually insidious, as are the implications to health that often stem from it. The broader and more serious impact of the process is found in the progressive decrease in the oxygenation of tissues. Like a motor starving for gas, general performance is impacted. It is often a slow but progressive breakdown where the patient remains unaware of the damage until it is evidenced by the development of disease. This adversely impacts energy metabolism (no gas, no horsepower), which means the machine starts to run more sluggishly. The fallout over time can be tragic to overall health and well-being and, as mentioned, is a major contributor to the development of other disease.


It is not difficult to understand how any living tissue can be sensitive to oxygen deprivation and is therefore negatively impacted by the effects of shallow breathing, but you may be a little surprised at just how broad that reach is. The following is a list of physiological activities and functions most impacted by oxygen deprivation resulting from shallow breathing:

  • Brain function

  • Disturbed sleep

  • Weight gain

  • Decreased immunity

  • Neurological function

  • Neck and shoulder pain

  • Headaches

  • Cognitive function

We all know that breathing is important, but what functions does oxygenation specifically perform in our bodies? Oxygen is a necessary component in every chemical reaction that is part of human physiology. It nourishes the cells by providing the fuel needed to metabolize carbohydrates. It facilitates chemical transport to break down and eliminate waste products and toxins. Oxygen is pivotal in regulating the pH of body chemistry, and it also stimulates efficiency in the immune system.


If breathing is natural, why do I have to work at it?


There are dozens of studies that support the use of deep breathing for the positive influence it has upon the nervous system, in stress and anxiety management as well as the physical impacts noted prior. I am going to teach you that increasing lung efficiency even just a few percentage points can improve your health, aid in weight management and enhance general vitality. A lot of that change will come from doing nothing more than simply revisiting what it means to breathe naturally and in accordance with how evolution intended us to use our lungs.


The next time you observe a newborn baby as they sleep, take note of the way their whole body is breathing and how the components of respiration are connected. Their back, tummy and chest move together in perfect harmony as each breath is perfectly executed. Through the routines in the program section of the book, I will help you perform a perfectly executed breath.


Cardiovascular and digestive function, muscle tension, lymphatic efficiency, weight management, mental clarity and even how we age are all impacted by the quality of our breathing. The broader health benefits can be quite eye-opening. In a 2013 article entitled “Breathing Exercises Help Veterans Find Peace After War,” Brooke Donald discusses a study on yogic breathing done by Emma Seppala with military veterans suffering from post-traumatic stress syndromes. It found that the use of specific breathing strategies substantially reduced symptoms long-term for many of the victims.[1]


When performed consistently, effective breathing techniques have been shown to positively impact physiological functions on almost every level from digestion, blood pressure, the effectiveness of the immune system, as well as mental health and sleep. Even pain management and the discomfort associated with chronic degenerative arthritis have been shown to be positively impacted by the breathing techniques I am going to share with you going forward.


Controlled breathing activates the parasympathetic nervous system, which is responsible for calm and relaxation. It is a simple fact that techniques that maximize our capacity to breathe effectively will positively influence health and healing.


In a ground-breaking paper by Russo, Santarelli and O’Rourke entitled “The Physiological

Effects of Slow Breathing in the Healthy Human,” the authors examine the broader physiological effects of controlled breathing on the body. “There appears to be potential for use of controlled slow breathing techniques as a means of optimizing physiological parameters that appear to be associated with health and longevity, and that may also extend to disease states,” they write. They go on to remark that “The act of controlling one’s breath for the purpose of restoring or enhancing one’s health has been practiced for thousands of years amongst Eastern cultures.”[2] “Pranayama” is a Sanskrit word that loosely translates to “control of breath” and is a well-known ancient practice of controlled breathing. It is often combined with yoga or meditation for its spiritual and health-enhancing benefits. Various forms of pranayama can be performed at varying rates and depth. In an article posted on the Healthline, Kirsten Nunez notes that “According to research, pranayama can promote relaxation and mindfulness. It’s also proven to support multiple aspects of physical health, including lung function, blood pressure, and brain function.”[3]


Yoga, and hence “pranayama,” have been around for longer than you may think. Although the yogic practices only gained popularity later in the twentieth century, they were first introduced to the West in the late 1800s. The associated breathing techniques have since become increasingly popular due to a rising interest in holistic and wellness approaches to health care. The claimed health benefits and potential to treat a range of medical conditions have recently piqued the interest of the medical and scientific communities, stimulating advanced research into the area. Since the 1990s, a system of breathing therapy developed by Konstantin Pavlovich Buteyko has made its way across several continents. According to the Buteyko International website, “Over the span of four decades, Dr. Buteyko developed a program designed to normalize breathing volume using slow breathing and breath holds following an exhalation. With regular practice over a few weeks, breathing is brought towards normal with resultant improvements to several common complaints such as asthma, rhinitis, anxiety, panic attacks, and sleep disorders.”


As humans we tend to assume that breathing is a normal and natural phenomenon and, as such, often ignore the broader impact to health. Perhaps one of the most important and yet overlooked benefits of proper breathing is that it helps to regulate the acidity of the body. Negative changes in that acid balance, which may lead to a condition called acidosis, can contribute to disease, and accelerate the ageing process. As you have read, there are many real dangers to health from chronically shallow breathing, but some of the most devastating lie in the resultant effects of acidosis. This is what we will examine next.


Acidosis: “Man … even the word sounds bad”


The prestigious medical text Merck Manual, describes acidosis as, “An overproduction of acid that builds up in the blood or an excessive loss of bicarbonate from the blood (metabolic acidosis) or by a buildup of carbon dioxide in the blood that results from poor lung function or depressed breathing (respiratory acidosis).”

The idea of our bodies being in an acidic state is a foreign concept for most; even the thought of it being a contributor to disease susceptibility sounds amazing. The human body, and especially the blood, are naturally in a mildly acidic state of between 7.35 – 7.45. If the pH was to go above 7.45 it is considered an alkaline state, and below 7.35 is considered acidic.


Acidosis has been touted as a bona fide cause of illness for eons within the natural/integrative medicine world but has received very little notice from within traditional Western forms of health care. In fact, this theory that the body can become acidic and then somehow serve as a source of health concern has been actively discounted by authorities from within conventional medicine. Their position is that the measuring of blood pH changes (the marker for measuring acid levels) among people on various types of diets and varying states of health has failed to show significant related adverse change. Up until early in the twenty-first century, little credible research existed to counter this skepticism. In a 2015 article published in Integrative Medicine: A Clinicians Journal, Joseph Pizzorno notes that, “Over the past few years, a growing body of documentation has demonstrated not only that ‘acidosis’ is a real phenomenon, but that it is now believed to be a potential contributor to a wide range of diseases including metabolic syndrome, cancer, osteoporosis, kidney stones, and the growing wave of environmental-related disorders —and new research is adding to the list.”[4]


It is important to clarify that acidosis should not be confused with acidemia, which is a consistent pH change significant enough to alter blood chemistry to a level of less than 7.35. The term acidemia is used to describe a state of low blood pH, while acidosis is the process leading to these states. Acidemia is very unlikely to occur except under extreme circumstances, as the body has multiple mechanisms for ensuring a stable blood pH. Acidosis only leads to acidemia when the body’s inherent combative measures become overwhelmed by weakness or pathology. This is found in advanced disease like kidney and lung failure.


We can consider the rising occurrence of acidosis as the body’s weakening capacity to adapt to all the acid-inducing challenges—diets high in sugars and refined carbohydrates, emotional stress, poor sleep patterns and a sedentary lifestyle—that we experience in the modern world. Although actual blood pH will rarely change substantially, the delicate balance within the cells and intracellular space appears to be much more susceptible to subtle fluctuations. There is evidence that this contributes to adverse cellular metabolic changes, disruption of enzyme function, and, very importantly, the potential loss of insulin sensitivity. When in a state of acidosis, the body tends to hold on to excess fluids as it attempts to neutralize a rising acid imbalance, and this can directly impact capacity for weight loss. I believe that this is a reason that people lose “water weight” when they start just about any traditional diet program. As the removal of sugars and other inflammatory foods immediately starts the process of neutralizing body chemistry, the need for excess fluids to combat and neutralize the acidic environment is reduced.


There are many varieties of acidosis, such as diet-induced acidosis, drug-induced acidosis, and metabolic-induced acidosis. The condition is not only a contributor to disease but is found to be far more common in those already suffering with chronic illness and compromised health (i.e., an ageing population). People with restricted mobility also tend to breathe shallower than others who are active and mobile, which can result in a condition called respiratory acidosis. I believe this condition is much more common than previously acknowledged, so I made it a primary target of the twenty-one-day active breathing program.


Respiratory acidosis occurs when the lungs can’t remove enough of the accumulated carbon dioxide (CO2). Excess CO2 causes the pH to decrease, contributing to the development of an acidic environment, decimating even healthy individuals, and leading to respiratory failure. When the lungs cannot clear accumulated CO2, the kidneys are recruited to excrete the excess carbonic acid, which is a by-product of excess CO2 in the system. The acidifying effect of raised CO2, as found in chronic respiratory acidosis, may not show up in the blood work because of the raised kidney function. However, the compensatory actions of the kidneys are not as effective as the lungs for normalizing acid levels in the brain. This leads to symptoms that can affect cognitive skills, sleep and memory.


Although acidosis itself may not be considered a major health concern, even discrete levels of acid imbalance at a cellular level can seriously impact health over time, especially in those of us over the age of fifty-five. For the many reasons demonstrated earlier in the previous chapter, we tend to lose some of the respiratory efficiency of youth as we age. Combine this with an increasingly sedentary lifestyle often associated with getting older, and the recipe for even minor changes in cellular chemistry are more than just a possibility—just ask Ezekiel, the elderly Amish gent to whom I referred earlier in this chapter.


The lungs are among the most magnificent of human organs with tremendous capacity for healing change. In the Un-Diet Diet program, I am going to provide you with a series of specifically tailored breathing exercises that are designed to maximize your respiratory potential and more efficiently oxygenate tissues. The intent is to reverse the effects of any resident or emerging acidosis and facilitate greater healing by keeping your body in a more oxygen rich state. You will be amazed at how quickly the positive benefits occur when you begin breathing more efficiently.


We have examined Purposeful Movement and Functional Breathing, two of the Five Pillars of Health. Now it’s time to investigate the influence of water on our health, weight loss and energy production.


[1] Donald, Brooke “Breathing Exercise Help Veterans Find Peace After War.” Published Stanford Report May 22, 2013 [2] Santarelli, Russo, Santarelli, and O’Rourke “Physiology Effects of Slow Breathing in The Healthy Human.” Published 2017 In Journal Breathe. [3] Nunez, Kristen. “7 Science-Backed Benefits of Pranayama,” Healthline Website, May 15, 2020. [4] Pizzorno, Joseph. “Acidosis: An Old Idea Validated by New Research,” Integrative Medicine: A Clinicians Journal, 2015.

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