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THE AUTONOMIC BREATHING TEST (ABT)

Results of a Standardized Test in 232 Patients

Majid Ali, M.D.

There is a need for a test to optimally manage chronic stress-related disorders with the following characteristics: (1) it should be simple and convenient for the staff to perform; (2) the results obtained should be objective and quantitative; (3) it should provide clear metrics for measuring the effects of self-regulatory measures; and (4) it should be easily teachable to patients as a self-administered test for follow-up use at home. In 2007, I designed a test to meet these criteria and designated it as the "Autonomic Breathing Test (ABT)." Here I present the results obtained with the test performed for 232 patients. I organize this column in seven sections: (1) the development of the ABT; (2) training of the staff and patients in ABT in practitioners' offices; (3) the test results observed in 232 chronically ill patients; (4) discussion of the results; (5) the value of the ATB in acute illness; (6) improved mitochondrial function with Limbic Breathing; and (7) the clinical application of the test in cardiovascular disorders. Below, are introductory comments to provide a framework of reference.

Altering the Health Script of Life

One can radically alter one's medical history by simply altering breathing. In The Cortical Monkey and Healing (1991), I described the development of the principles and practice of Limbic Breathing and its physiologic benefits observed during the preceding five years.1 Specifically, I presented the results of experiments performed to objectify and quantify changes observed with Limbic Breathing in: (1) the blood levels of oxygen and carbon dioxide; (2) blood pH; (3) blood lactic acid; (4) white blood counts; and (5) electrophysiological parameters, such as electromyopotentials, electrodermal conductance, pulse pressure, and others. In What Do Lions Know About Stress (1996) 2 and Healing Miracles and the Bite of the Gray Dog (1997),3 I furnished additional clinical and laboratory data to establish the clinical value of Limbic Breathing and related self-regulatory methods. In Integrative Cardiology (2000),4 I presented a large body of data concerning autonomic responses to Limbic Breathing as measured by power spectral analysis of heart rate variability. In my column of July 2007,5 I summarized many earlier observations and illustrated simple steps for beginner, intermediate, and advanced methods of Limbic Breathing.

1. The Development of the Autonomic Breathing Test

We overbreathe to breathlessness—and sicken ourselves in many ways. Rapid and shallow breathing—"subclinical hyperventilation" seems an appropriate designation for it—is the mark of our time. It steadily disrupts oxygen homeostasis. Since the core issues in the health/dis-ease/disease continuum are oxygen signaling and oxygen-driven cellular energetics and most of the mechanisms of disruption are mediated by the autonomic nervous system, it seemed appropriate to base the test on the mode of breathing and select autonomic parameters—the heart rate and blood pressure —as quantitative metrics. The next issue was to standardize the training methodology and select the periods of breathing for optimal yield. This was done by testing the effects of various time periods, carefully considering the factors of simplicity, feasibility in a clinical setting, availability of staff, and the clinical usefulness of the data obtained. The previously described method of Beginner Limbic Breathing 1 was modified, designated as "Feather Breathing," (described in the next section) and selected for training in slow breathing. Tables 1 and 2 show the steps for performing the test and recording the results respectively.

Table 1. THREE PARTS OF THE AUTONOMIC BREATHING TEST

Name: ___________________________ Age: ___________ Date: _______________

Main Diagnoses ________________________________________________________

Part A

The test subject breathes as usual for one minute. The practitioner takes the pulse rate, measures blood pressure, asks the subject to describe in three words how she/he feels, and records the findings on the ABT Record Sheet (Table 2).

Part B

The subject is given instruction in Feather Breathing (described below), and then asked

to practice it for three minutes.

Part C

The subject is asked to continue Feather Breathing for one minute without

further guidance. The practitioner then takes the pulse rate, measures blood pressure,

and asks the subject to describe in three words how she/he feels, and records the

findings on the ABT Record Sheet.

 

Table 2. Autonomic Breathing Test Record Sheet

Before Training Part A

After Training Part C

Date

Breaths/

Minute

Pulse/

Min

BP

Use 3 words to describe how you feel

Breaths/

Minute

Pulse/

Min

BP

Change in Total Heart Beats/Day*

Use 3 words to describe how you feel

Week 1

               

Week 2

               

Week 3

               

Week 4

               

Week 5

               

Week 6

               

*Change in Total Heart Beats/Day is calculated as follows: The difference between the pre and post heart rates X 1440. Example: Pre rate is 90 and post rate is 70, then the number of hear beats saved is:

20 (90 minus 70) X 1440 = 28,800

Feather Breathing

Feather Breathing is the term used for a simple form of Limbic Breathing in which the focus is purely on effortlessly prolonged exhalation. In Feather Breathing, one:

Imagines that there is a thin feather almost touching the nostrils;

Breathes out through the nostrils so slowly as not to move the delicate pringle of the feather;

Exhales for as long as possible, but comfortably;

Completely ignores the mode and duration of breathing in—exhalation after a gentle prolonged inspiration is always good and the issues of breathing through one or the other nostril or mouth breathing are not relevant in Feather Breathing inspiration;

Does not allow the mind to compete with simple mechanics of Feather Breathing; and

After initial training, slides in and out of Feather Breathing at work and at home without conscious effort.

The primary strength of Limbic Breathing is the prevention and/or reversal of the adverse effects of subliminal hyperventilation on oxygen homeostasis. Feather Breathing dramatically improves oxygen transport and functionalities in times of stress and autonomic dysequilibrium. I return to this subject in the section entitled "Improved Mitochondrial Function with Limbic Breathing."

2. Training of the Staff and Patients in ABT in Clinical Practice

It should be evident from the above description of the ABT that it does not require any special staffing, equipment, or space. The test can be administered to patients singly or in groups. At the Institute of Integrative Medicine, the ABT was administered by all members of the staff—doctors, nurses, and office assistants—depending on the staff availability and workload. For this study of 232 patients, the participation of a large number of staff may be considered as a source of variability. However, in my view, it should be considered as a strength since it more closely reflected the reality and imperatives of busy clinical practice at a large center. In one area, however, there was complete agreement among the staff: everyone emphasized strongly to the patients that the benefits of Limbic Breathing last long after the period of slow breathing is complete.

 

 

 

3. The ABT Test Results Observed in 232 Patients

No attempt was made to select patients for this study. The Institute only draws chronically ill people with autoimmune, environmental, nutritional, degenerative, and neoplastic disorders. All 232 patients were included sequentially. This approach maximized the clinical relevance of the test as applied to integrative practices in which the focus is on caring for the whole person rather than on a disease. The data for all patients are presented in Table 3.

Table 3. The Autonomic Responses to Limbic Breathing in 232 Patients With Chronic Disorders. Groups A-D Represent Decreasing Differences Between Pre-instruction and Post-instruction Values. Group E Comprises Subjects With Higher Post-instruction Values Than the Pre-instruction Values

 

Group A

Group B

Group C

Group D

Group E

Patients (n)

7

19

66

122

18

Breathing Rate, Pre-instruction

25

18

16

14

14

Breathing Rate, Post-instruction

11

9

10

11

17 (-3)

Heart Rate, Pre-instruction

71

72

72

71.5

68

Heart Rate, Post-instruction

66

61

63

64

65

BP, Pre-instruction

139/86

124/73

144/90

132/84

132/82

BP, Post-instruction

120/82

120/80

125/77

120/80

117/79

Average difference, Breathing Rate

14

9

6

3

3 (post value higher)

Average difference, Heart Rate

5

11

9

7.5

3 (post value higher)

Average difference, BP

19/4

4/7

19/13

12/4

15/3

Average Heatrbeats Saved

Per Day

7,200

15,840

12,960

11,420

(4320 more beats)

 

4. Discussion of the Results

Not unexpectedly, some patients showed anomalous responses during the first application of the ABT, such that their post-instruction blood pressure and heart rate values were higher than the pre-instruction values. All 18 patients in this category (group E) had serious and/or advanced disorders, including disseminated Cancer and neurodegenerative disorders.

Comparative review of values obtained with regular patterns of breathing (pre-instruction) and Feather Breathing (post-instruction) of the subjects in Group A-D shows remarkable consistency of a pattern of reduction in the values of lowered blood pressure and heart rate with Feather Breathing. Specifically, the average systolic pressure values were reduced by 19, 4, 19, and 12 mmHg for groups A-D respectively. The corresponding values for the heart rate were 5, 11, 9, and 7.5 respectively.

One feature of the ABT study data requires special note: the values for heartbeats saved per day (if the rate of breathing documented during Feather Breathing were to be maintained) were dramatic for Groups A-D (7,200 in A; 15,840 in B; 12,960 in C; and 11,420 in D). This proved to be the most telling part of the test for the patients. Cardiac beat is an energetically expensive proposition. Even subjects without medical background recognize the enormous significance of this finding. For some patients, the number of heartbeats saved with Feather Breathing exceeded 40,000 beats per day.

5. The Application of the ATB in Acute Illness

Serendipity brought an opportunity to investigate the value of the ABT in acute illness. A 61-year-old man presented with dyspnea while on continuous nasal oxygen inhalation. His clinical diagnoses included pulmonary emphysema, bronchial asthma, hypertension, congestive heart failure, inhalant allergy, and anxiety. During the preceding year, he was hospitalized on four occasions for congestive heart failure and respiratory insufficiency. Surgical resection of non-ventilating segments of lung parenchyma was considered at a New York City university hospital, but deferred because the procedure was considered too high risk to justify the potential benefits. He consulted me in the hope that his general condition could be so stabilized as to allow his surgeons to proceed. During the visit, he said, "I was told I would be dead in one year and that was seven years ago"

The patient was on continuous nasal oxygen and was receiving sequential intravenous hydrogen peroxide and nutrient infusions. I recognized the risk of trying Feather Breathing under such contency circumstances. I also saw an opportunity to demonstrate to him the potential clinical benefit of such breathing. He was reluctant to discontinue nasal oxygen but agreed to do so after gentle and persistent persuastion. Table 4 shows chnages in oxygen saturation and other parameters during three separate periods of Feather Breathing. Note the initial drops in oxygen saturation followed by dramatic phases of recovery. His companion reported periods of reduced anxiety and slower heartrate during Feather Breathing done at home. Table 5 shows data with two trials of Feather Breathing done five months later.

 

 

 

Table 4. Oct. 22, 2008 Changes in Oxygen Saturation and Heart Rate With Limbic Breathing in a 61-year-old Man on Continuous Oxygen Therapy for Pulmonary Emphysema, Asthma, Hypertension, and Congestive Heart Failure

Trial One

Trial Two

Five Mintes later

Trial Three

Seven Minutes Later

Time

O2 Sa%

Pulse

Time

O2Sat%

Pulse

Time

O2Sat%

Pulse

Begin

98

82

Begin

97

76

Begin

95

78

2 Min

88

84

2 Min

95

76

1 Min

94

 

5 Min

89

80

4 Min

93

78

3 Min

94

74

7 Min

90

80

5 Min

89

79

4 Min

93

81

8 Min

89

80

6 Min

89

78

5 Min

93

74

     

7 Min

92

78

6 Min

95

80

     

8 Min

90

78

7.18 Min

   

 

Table 5. Same Case as in Table 4. Changes in Oxygen Saturation and Heart Rate With Limbic Breathing Observed on March 18, 2009

Trial One with Nasal Oxygen

Trial Two, without Nasal Oxygen

Five Mintes later

Time

O2 Saturation%

Pulse

Time

O2Saturation%

Pulse

 

Begin

86*

64

Begin

88

65

2 Min

99

65

2 Min

98

62

5 Min

95

66

4 Min

99

64

7 Min

98

68

5 Min

97

64

8 Min

98

69

6 Min

97

64

     

7 Min

97

64

     

8 Min

96

66

 

6. Improved Mitochondrial Function With Limbic Breathing

Subclinical hyperventilation (habitual and unrecognized rapid and shallow breathing) profoundly affects oxygen homeostasis. It steadily disrupts the finely orchestrated balance between oxygen, carbon dioxide (CO2), acidity, and free radical activity in the lungs, circulating blood, and mitochondria (the cellular structures that generate energy with oxygen-driven energetics).

Carbon dioxide (CO2) passes through the pulmonary membranes twenty times faster than oxygen. This explains one of the mechanisms by which subclinical hyperventilation causes excess loss of CO2 from the lungs and diminished diffusion (absorption) of oxygen. These changes in blood gas equilibrium reduce mitochondrial efficiency by several mechanisms. First, the reduced concentrations of blood CO2 cause vasoconstriction and decreases both the blood flow and delivery of oxygen to tissues. Second, the lower CO2 levels shift the oxygen dissociation characteristics of hemoglobin with further reduction in peripheral oxygen delivery. Third, the reduced concentrations of CO2 disrupt the acid-alkali balance in the body, affecting peripheral as well as central chemical sensors. Fourth, oxygen deficit leads to oxidosis which impedes tissue oxygenation. Fifth, all of the preceding elements increase intracellular acidity which further disrupts oxygen homeostasis. Sixth, vasoconstriction and changes in hemoglobin oxygen dissociation induced by low CO2 levels, oxidosis, and acidosis disturb the clotting-unclotting equilibrium in the bodily fluids and contribute to the degree of dysoxygenosis. All these disturbances have significant adverse effects on oxygen homeostasis, including oxygen signaling and oxygen-driven mitochondrial ATP generation. For professional readers, I present detailed scientific explanations of these relationships in Darwin and Dysox Trilogy, the tenth, eleventh, and twelfth volumes of The Principles and Practice of Integrative Medicine.6-8 For readers interested in practical demonstration of various aspects of Limbic Breathing and additional information on clinical and laboratory aspects of such breathing, I suggest my 2-DVD video (four hour program) entitled "Healing" for energetic and spiritual approaches (available at www.majidali.com as well as by calling 973-586-4111).

7. The Clinical Application of ABT in Cardiovascular Disorders

It should be evident from the data concerning the autonomic parameters presented in Table 3-5 and the brief discussion of the profound changes in oxygen homeostasis observed with Limbic Breathing described above that patients with cardiovascular disorder would benefit most from the clinical application of ABT. It indeed was true in this instance. Specifically, 4.7% of the subjects showed a reduction in the systolic blood pressure of 21 to 30 mmHg, and another 4.7% of the subjects showed a reduction in the systolic blood pressure of 31 to 40 mmHg. 21.5% of subjects decreased their heartrate by eleven to twenty beats per minute. The significance of these impressive benefits was not lost on the participants of the study. I will cite two cases to make additional points.

A woman asked me to see her listless 21-year-old daughter, who left college because of disabling symptoms. Her diagnoses included hypertension (peak values 200/105), proteinurea, urticaria, chronic fatigue, orthostatic intolerance, and persistent stress. She had two abortions at age 16 and 19 respectively. Pertinent laboratory data included elevated levels of: (1) plasma renin activity (3.23 ng/mL), (2) aldosterone (46 ng/dL), and (3) 24-hour urinary cortisol (69.6), all indicating severe adrenal overactivity. Benicar prescribed by her doctor failed to bring the blood pressure to a safe level. She was prescribed a second anti-hypertensive agent. That is when the mother decided to consult me. During extended consulation, she strived valiantly on several occasions to appear upbeat but her exhausted body failed her. I looked at the results of her ATB and said, "Your arteries do not lie because evolution did not teach them how to. With Feather Breathing, your arteries loosened up and the blood pressure fell. Hypertension is merely addiction of arteries to tightness. That is the simple truth about hypertension." Then I showed her the test results. A mere four minutes of Feather Breathing lowered her blood pressure values from 150/90 to 124/90. For the first time during her extended visit, there was a glint of hope in her eyes.

A 47-year old man consulted me for obesity (weight, 270 pounds), hypertension, frequent episodes of heart palpitations, dysautonomia, tinnitis, allergy, sleep apnea, ADHD, and anxiety. He was on Lisinopril and Hytrin. Nutritional therapies and desensitization for IgE-mediated responses improved his general health but failed to relieve heart palpitations. Then on December 10, 2008, I asked him to sharply focus on self-regulation and regularly practice Feather Breathing while at work. On April 2, 2009, he reported complete freedom from palpitations during the preceding three months, and attributed the results to Feather Breathing.

In closing, I hope that many readers will put Feather Breathing to the test, as described in this article, to discover how well this simple procedure improves the results of the integrative treatment plans for their patients with diverse disorders.

References

1. Ali M: The Cortical Monkey and Healing. Bloomfield, New Jersey. Life Span Books 1991.

2. Ali M: What Do Lions Know About Stress? Denville, New Jersey, Life Span Books 1996.

3. Ali M: Healing, Miracles, and the Bite of the Gray Dog, Denville, New Jersey, Life Span Books 1997.

4. Ali M. Oxygen and Aging. 1st edition. New York, Canary 21 Press. Aging Healthfully Book 2000.

5. Ali M. The Principles and Practice of Integrative Medicine Volume VI: Integrative Cardiology and Chelation Therapies: The Oxidative-Dysoxygenative Model and Chelation Therapies. New York. Canary 21 Press. 2000. 2nd edition 2006.

6. Ali M. The Principles and Practice of Integrative Medicine Volume III: Darwin, Oxygen Homeostasis, and Oxystatic Therapies. 3 rd. edition. New York. Insitute of Integrative Medicine Press.

7. Ali M. The Principles and Practice of Integrative Medicine Volume XI: Darwin, Dysox, and Disease. 2000. 3rd. editionn. 2008. New York. Insitute of Integrative Medicine Press.

8. Ali M. The Principles and Practice of Integrative Medicine Volume XI: Darwin, Dysox, and Integrative Protocols. 2008. New York. Insitute of Integrative Medicine Press.

9. Ali M. Healing: Energetic and Spiritual. 2007. Insitute of Integrative Medicine. New York. (a two-DVD set with four hour programming on Feather Breathing and related methods of self-regulation available from the Institute (973-586-4111 or from www.majidali.com).

 

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