Breathing, the immune system, and cold exposure

Breathing, the immune system, and cold exposure

Reading time: 8 minutes

This is a pretty long and dense article. So here are the highlights:

  • Breathing techniques have been used to promote health and longevity for centuries
  • The autonomic nervous system can be influenced with breathing techniques
  • Some breathing techniques may positively affect the immune system
  • Cold exposure may positively affect the immune system
  • Daily energy expenditure falls in a narrow range, with or without exercise
  • We need exercise to be healthy, but if you can’t exercise, cold exposure is an alternative

Most people think they’re crazy, but freedivers intuitively know it. Breath holds and specific breathing techiques are linked to health and mental well-being. They become even more powerful when combined with meditation and visualization techniques. And guess what? Science is gradually starting to confirm our crazy ideas.

Breathing from yoga to therapy

Before we delve into the current science, let’s go back about 1600 years. Patanjali, an Indian sage (or perhaps multiple), wrote the Yoga Sutras. These Sutras are the first organized set of writing about Yoga and are regarded as the foundation for most current varieties of Yoga. In the sutras is an “8 limb system” for reaching enlightenment, including breath control. Fast forward a few centuries and a number of yogis rethink the sutras and come up with a Yoga system to maintain youthfulness and prolong life. All this to say that breathing techniques for health are nothing new.

In 1950 a Croatian doctor by the name of Konstantin Pavlovich Buteyko develops a breathing method to correct chronic hyperventilation. The premise is that chronic overbreathing leads to a variety of diseases and ailments such as asthma and Chronic Obstructive Pulmonary Disease (COPD). Advocates of the method argue that it will cure numerous ailments ranging from diabetes to sleep apnea, but the evidence is obscure.

Breathing is subjective to start with, and difficult to study. In addition, it was hard to figure out whether the chronic hyperventilation is the root of something or vice versa. Does chronic hyperventilation cause anxiety or does anxiety cause hyperventilation? Regardless, Buteyko may be the first westerner to have formally promoted breathing techniques as a practical tool for clinical disorders.

You don’t have to tell a freediver that conscious breathing is healthy. Eric Hanson (Epic Trails TV) breathing up during a freediving session in Soufrière, Dominica. Photo by Luca Sommaruga Malaguti.

Show me the evidence

I feel better (qualitative) is not always clinical evidence than I am better (quantitative). If I can prove that I indeed feel better, I must also be able to prove that I feel better because of my new breathing technique, otherwise that conclusion may not be deemed valid.

Another complication is the reactiveness of some of the gases involved. Take for example nitric oxide. This molecule is practically gone within a second after it comes into existence, but has a large effect on our vascular system and on pathogens in our respiratory tract. Thankfully, we can now circumvent most of these difficulties with well-designed studies and sophisticated laboratory equipment.

Conscious breathing

Our brain is made up of three layers that subsequently evolved (simplistic, I know, but for this purpose the analogy works). The lizard brain controls our most basic functions such as heart rate and breathing. The limbic brain adds emotions and the ability to memorize. The neocortex adds our consciousness and the ability to learn abstract concepts. This made us human. It also enabled us to become chronically stressed and get a variety of stress-related disorders, such as ulcers (paid link), by ruminating about the future.

We cannot control what happens in the limbic and reptillian brain directly. But we can influence it with our breathing, and our breath is influenced by it (good review here). Conscious breathing is our gateway to the depths of our brain, where stress-related disorders live.

Many studies have now confirmed or at least support the idea that stress is alleviated by deep breathing and other breathing techniques (here’s an example). One study has even implied breathing as a primary treatment for anxiety, while an earlier showed hyperventilation treatment reduces panic attacks.

Patrick McKeown, author of the Oxygen Advantage (paid link) has summarized much of the science in case you want more info. My only wish is that the book was more concise. Hence, I like his presentation of the research highlights, though I suspect that at least some of these highlights are still debated. In one sentence his book reads: “Breathe through your nose.”

Federico Mana’s Tecniche di Respirazione per Apnea and Stig Severinsen’s Breatheology both advocate for nasal breathing techniques in freediving preparation.

Lorenza breathing up for her cold water dive (6°C degrees) in Waterton Lakes, Canada.
Photo by Luca Sommaruga Malaguti.

Breathing in the 21st century

Enter the 21st century. Freediving is becoming mainstream (don’t believe me? check this), and more and more people are enjoying themselves holding their breath underwater. Stories of miraculous comebacks from crippling disorders are making the rounds. Take for example the recovery from psoriatic arthritis by Stig Pyrds. Or case studies on people suffering from Lyme disease and Post Traumatic Stress Disorder (PTSD) presented by Breatheology author Stig Steverinsen. These people attribute their recovery to meditation and breathing techniques.

The immune system

Wim Hof teaches cold exposure and breathing techniques to lead his pupils to a better life. The benefits of the Wim Hof method supposedly include heightened focus, improved willpower, enhanced creativity and an improved immune system. A critical journalist, Scott Carney, set out to debunk the Hof myth. He became one of his devout followers while learning his methods. He chronicles his rather hilarious learning path in the book What Doesn’t Kill Us (paid link).

But where is the scientific evidence? Critics have argued that Hof does not have the vocabulary to explain the science behind his techniques. Even so, he has been smart enough to put his techniques to the test. Scientifically. This article by Kox et al. showed that Hof’s students were able to influence their autonomic nervous system, and their immune system via breathing techniques. So even if Wim Hof might be an ice-comet mutant that can sit in ice baths for hours, his alien teachings have merit even for us mortals. The whole study makes me wonder if autonomic nervous system is perhaps the wrong term.

Wim Hof’s explanation of his techniques: “If you don’t give the body something to attack, it will attack itself.”

Now that we have the scientific evidence, we need to ask where those benefits to the immune system come from. The Hof method includes third-eye meditation, exhale breath-holds after hyperventilation, and cold exposure. Kox and coworkers argue that coupled hyperventilation and following hypoxia cause the immune system benefits. However, the immune system might benefit from cold exposure alone (review article here). Perhaps Hof has indeed found the trifecta of immune system maintenance.

Cold exposure is exercise

Even if cold exposure turns out is not related to the immune system, it is still important. It is exercise in itself. It has a profound impact on the cardiovascular system, causes an adrenaline spike, and can cause the brain to release cannabinoids and opiods, just like a long run would.

We all agree on the benefits of exercise, so why not cold exposure? Probably because the cold kills many more people than exercise does. Our blood pressure raises naturally in the cold (a result of peripheral vasoconstriction) and so many more cardiac events and strokes occur in winter than in summer.

Naturally we don’t like the cold! But should we?

What if we weren’t always protected from the cold with puffy jackets, radiant heating, and heated water? Perhaps we would cope better when temperatures do fall. Work by Herman Pontzer has shown that our daily energy expenditure is roughly the same, with or without exercise. That begs the question, where does our energy go if we don’t exercise?

Perhaps Hof is right. We need to give the body something to do, or it will do things we don’t want it to. For many people unaccustomed to exercise, the cold exposure could be a starting point to a better functioning body. It is basically exercise, hidden in the form of mild discomfort. Mild, depending on how cold you make your shower.

Remember, adaptation is stress plus recovery.

Luca appears to suffer from brain-freeze after a very cold freediving session in Canada. Photo by Lorenza Sommaruga Malaguti.

Don’t overdo it

Too much of anything isn’t good for anyone. Apnea walks can make you pass out (I nearly fell of a set of stairs once – stupid idea). You can easily pass out from hyperventilating. Extreme exercise can make you sick (and too little surely will). Jumping in ice cold water can kill you more quickly than hypothermia.

Several people have died using the Wim Hof Method – if you are a freediver, you know that hyperventilation and freediving do not combine. Hyperventilation and breath-holds are safe on the couch, not in the water, riding a bike or driving a car.

Even with something as simple as cold showers, you achieve progress by gradual and consistent exposure. Not giving your body the opportunity for gradual adaptation will only yield negative results, both physically and psychologically.

Jaap

Jaap is a geologist by trade and a freediver by passion. Jaap wrote the book Longer and Deeper in 2018. His book teaches how to train for freediving and spearfishing on land.

This Post Has 7 Comments

  1. Connor Davis

    You are right, its dense, will take me a while to digest this. Thanks for the effort.

    it looks very like any intermittent stress is good for us. Hof looks basically right. Cold, heat, calorie restriction, exercise, all different, but all act on many of the same chemical pathways. I suspect that apnea will be shown to have similar effects.

    CWI seems to fit freediving pretty well. I get deep down cold after an hour or two in Florida Springs. Even in warm Bahama water, the same thing happens if I stay in long enough. Pretty sure most divers are the same.

    Any thoughts on how often we would need to dive to gain much benefit from CWI?

  2. Jaap

    Yes I think you’re right, any intermittent stress, provided that we take the time to recover. I’m not sure how much CWI would be ideal, but it would likely differ per individual and be dependent on the water temperature.

  3. Oleg Gavryliuk

    I can’t imagine how is it possible to breath through the nose during intense exercise.

    1. Jaap

      I couldn’t either – until I started trying it. It took a while to get used to, but I can now run at decent pace while breathing through my nose for a long time, and even run shorter intervals at high pace with nose-breathing. Turns out nose-breathing during exercise is also a great way to keep the sinuses clear!

  4. Howard Teas

    /I’m glad I’m not the only one thinks Wim may not have the ultimate answer. On the Olympic Peninsula where I live the water is seldom over 10C. I neither want nor need more cold, and I really don’t think ice baths would help me with eidther diving or the mess the US is in rignt now!

  5. Jaap

    Unfortunately… Magic pills don’t exist.

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