Bring Back Brown Bag Breathing

JustBreath Even though in recent times it has been given a bad name, carbon dioxide production and retention in the body is part of a process which directly protects against stress and disease.

Put another way, stress – or anything that interferes with thyroid function – hinders the ability of the body to produce carbon dioxide (CO2), lowering overall metabolic performance.

“…there is growing evidence regarding an association between subclinical hypothyroidism and atherosclerosis, coronary heart diseases, and hypertension…Hypothyroidism, particularly at the subclinical stage, results in hyperventilation as demonstrated by a low Et-CO2.”

Stress and the suppression of thyroid energy metabolism has been shown to promote many kinds of disease, and this can be directly connected to hyperventilation and low CO2 levels in the body. As CO2 decreases, lactate production tends to increase, and excess lactic acid is another factor increasing disease.

“Sustained or spontaneous hyperventilation has been associated with a variety of physical symptoms and has been linked to a number of organic illnesses and mental disorders…Raising CO2 levels by means of therapeutic capnometry has proven beneficial…and the reversing of hyperventilation has emerged as a potent mediator for reductions in panic symptom severity and treatment success.”

“Severe sepsis and septic shock are responsible for significant morbidity and mortality among patients admitted to the emergency department…We…demonstrate an inverse relationship between exhaled Etco2 levels and serum lactate levels, and lower mean Etco2 levels in nonsurviving patients.”

“Compared with otherwise similar patients residing at or near sea level, patients living at ≥ 6000 ft had 31%…lower rates of myocardial infarction, 27%…lower rates of stroke and 19%…lower rates of cardiovascular death.”

A well functioning metabolism uses sugar in the presence of oxygen to efficiently produce energy and carbon dioxide. In fact, the presence of carbon dioxide alone is an indicator of effective mitochondrial energy production.

Whenever the by-products of stress interfere with this process, cells begin to produce energy far less fruitfully, shifting towards a less efficient state converting glucose to lactic acid (rather than carbon dioxide) and an increase in the oxidation of fat, more of which today tends to be polyunsaturated.

Thyroid hormone is necessary for the production of carbon dioxide, and the polyunsaturated fats (PUFAs) have been shown to interfere with thyroid function on many physiological levels.

“…profoundly lowered basal metabolic rate and decreased CO2 production, resulting probably from severe hypothyroidism, may have resulted in development of acute respiratory alkalosis…”

“We demonstrated that patients with severe hypocapnia show significantly higher plasma lactate concentrations than those with mild hypocapnia…”

The hypothyroid hyperventilation state, promotes the release of the stress hormones adrenalin and cortisol, which further interfere with mitochondrial respiration, inhibiting thyroid function, shifting towards the oxidation of fat, decreasing CO2 and increasing lactic acid. Lactic acid itself interferes with metabolism and causes stress.

“…baseline fear scores correlated inversely with PCO2 levels and positively with cortisol levels while PCO2 levels correlated negatively with cortisol levels. Significant predictors of lactate-induced panic were prelactate infusion fear and the interaction of high cortisol levels and low PCO2 levels…synchronized elevations of HPA axis activity, self-reported fear, and hyperventilation…predisposes to lactate-induced panic.”

“Several lines of evidence suggest that lactate metabolism may be altered in panic disorder… patients who panicked during hyperventilation exhibited larger increases in serum lactate levels than nonpanicking patients…Hyperventilation-induced panic appears to be associated with metabolic changes leading to elevated serum lactate…”

So although the production of lactate (an important factor involved in cancer growth and spread) can become chronically increased due to continuous metabolic interference, it is also something which can end up making a return to more optimal function – with effective glucose oxidation and carbon dioxide production – more difficult. Metabolic suppression, hyperventilation and low CO2 promotes hypoxia, which is central to cancer progression.

“…the lactate content of tumors from all entities investigated revealed a significant positive correlation with the incidence of (distant) metastases.”

“…hypoxia drives malignant progression in cancers, resulting in poorer survival through resistance to therapy and increased metastatic potential.”

Stress – combined with inefficient metabolic function – promotes the absorption of bacterial endotoxin, damaging respiration and increasing the release of many stress related substances (such as serotonin, estrogen and nitric oxide), which can then further promote stress, inflammation and interference with energy metabolism.

Hyperventilation, low Co2, and rising levels of serotonin and nitric oxide have been shown to be factors involved in the worsening of asthma severity, and there is a relationship between asthma and mood disorders like depression or anxiety, also known to be conditions of stress and hypometabolism.

“Our finding that free serotonin was…closely associated with clinical severity and pulmonary function suggests that this factor plays an important role in the pathophysiology of acute asthma.”

“A high prevalence of anxiety, hyperventilation and depression exists amongst our severe asthmatics. Hyperventilation and anxiety were associated with uncontrolled asthma…”

It’s probably no great surprise that it has also been shown that there is an increased risk of cancer amongst patients with severe asthma, not to mention the metabolic stress related connection between cancer, anxiety and depression. Increased CO2 (and decreased lactate) production is likely to be protective.

“Patients with multiple hospital admissions showed a high risk, particularly for stomach and colon cancers…The relatively stable temporal trends suggest that the asthmatic condition rather than its medication is responsible for the observed associations.”

“Anxiety activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary axis, elevating corticosterone and other stress hormones, such as catecholamines. These hormones could modulate the activity of the tumor microenvironment.”

The stress substances directly interfere with the oxidation of glucose, increasing lactic acid and helping to feed what can become a vicious cycle of degeneration and disease. The production of lactate increases in response to endotoxin, and lactate itself increases the inflammatory anti-metabolic effects of endotoxin.

“LPS [endotoxin] administration leads to consistent increases in plasma lactate concentrations secondary to a stimulation of lactate production…”

“…bacterial infection and LPS increase lactate production, and lactate boosted LPS signaling-mediated inflammatory gene expression as shown by the present study…therefore…the actions of LPS and lactate lead to a vicious cycle that promotes TLR4-mediated inflammation and contributes to a number of diseases, including type 2 diabetes and cardiovascular disease.”

“…LPS [endotoxin] does enter the circulation after ultra-endurance exercise and may, together with muscle damage, be responsible for the increased cytokine response and hence GI complaints in these athletes.”

So from a slightly different view, it can be understood that increasing carbon dioxide levels lowers lactic acid, leading to a reduction in stress hormone release, lower levels of polyunsaturated free fatty acids, less exposure to bacterial endotoxin, and an improvement in thyroid energy production. This then further increases the production of carbon dioxide, lowering stress even more.

Endotoxin exposure increases as a result of the things that promote stress, and when circulation of endotoxin rises, this directly causes inflammation and greater interference with metabolism, potentially resulting in life threatening sepsis.

“Low ETCO2 levels were the strongest predictor of sepsis, severe sepsis, and mortality among all prehospital variables…There were significant associations between prehospital ETCO2 and serum bicarbonate levels…and lactate…”

Hypoventilation leading to increased CO2, has been shown to be an effective method of treatment for panic disorders as well as asthma, and it makes sense that it is a good approach to improving any condition which relates to stress and inflammation, which is basically every condition.

“Hyperventilation-induced hypocapnia is common among asthma patients…capnometry-assisted respiratory training…aimed at normalizing basal and acute levels of end-tidal carbon dioxide (PCO2)…basal levels of PCO2 increased from hypocapnic to normocapnic range over the course of treatment. Improvements were accompanied by improvements in lung function and reductions in diurnal lung function variability. Improvements remained stable throughout follow-up.”

“…the induction of therapeutic hypercapnia by continual inhalation of carbon dioxide…improves respiratory function and mitigates…lung and systemic inflammation…the statistically significant reduction in the levels of local and systemic inflammation by therapeutic hypercapnia may benefit patients by speeding recovery and reducing potential complications in the clinic…”

Insufficient intake of sugar and protein (and some other nutrients) interferes with the production of thyroid hormone, reducing CO2, moving things in the direction of stress and inflammation, and away from efficient oxidative energy production.

It seems as though the things that get a bad name today, including sugar, salt, CO2, saturated fats, cholesterol, testosterone and progesterone, are protective, and the things that can be the most harmful, like estrogen, serotonin, nitric oxide, lactic acid, PUFA and iron, get a free pass. I wonder why?

High lactic acid in the blood is a basic sign of stress and chronic inflammation, and an indication that thyroid metabolism has been suppressed. Anything that helps to promote oxidative metabolism and reduce lactate levels, can be seen as being protective against stress and disease, and CO2 is a pro-metabolism, anti-stress, anti-inflammatory substance.

Chronic metabolic stress, thyroid dysfunction and inflammation have all been shown to be related to the development of cancer, heart disease, diabetes, as well as conditions such as asthma, depression and anxiety. Improving metabolism and CO2 production, helps to lower lactic acid, estrogen, serotonin, nitric oxide, free fatty acids, and other inflammatory disease promoting things.

Stress and the release of the polyunsaturated free fatty acids promotes hyperglycemia, and hyperglycemia increases lactic acid production. Lactic acid is an independent predictor of insulin resistance and diabetes. Measuring CO2 exhalation is powerfully diagnostic. Sugar helps to lower free fatty acids and lactate, increasing CO2, and as such is an anti-diabetes substance.

“Acute complications of diabetes include severe hyperglycaemia, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS)…ETCO2 [end tidal CO2] had a uniquely high diagnostic accuracy overall, and at ETCO2 cut-off of 24.5 mmHg; it was highly sensitive (90 %) and specific (90 %)…”

Some of the dietary measures which can be explored in an attempt to achieve a pro-metabolic state, include the provision of sufficient protein and other nutrients (from milk and cheese and gelatinous meats) the limiting of difficult to digest starches and fibers (from grains, beans, nuts and under cooked vegetables) and plenty of carbohydrate from sources such as sweet ripe fruits and juices, honey and white sugar.

Chronic endurance exercise has been shown to interfere with active thyroid hormone (T3) function (as well as reducing Co2 levels) most likely at least partially as a result of excessive intake of oxygen or hyperventilation.

“Findings of our study demonstrate that exhaustion exercise led to a significant inhibition of both thyroid hormones and testosterone concentrations…”

Both salt and sugar can help to suppress the stress hormones and promote the production of carbon dioxide, increasing thyroid energy production in general, and they can be used as part of an approach helping to protect against some of the damaging effects of excessive exercise or training and other forms of stress.

Some other pro-metabolism, pro-CO2 anti-stress things include thiamine (B1), acetazolamide, methylene blue, aspirin, niacinamide, vitamin D, K, biotin and B6, coconut oil, red light, and cyproheptadine.

A couple of teaspoons of sodium bicarb spread over a day, can have many metabolically beneficial effects.

…these data demonstrate that the ingestion of sodium bicarbonate in youth athletes is an effective buffer during high intensity interval swimming and suggest that such a procedure can be used in youth athletes to increase training intensity as well as swimming performance in competition…

Regular daily bag breathing is a cheap and easy method which can help to increase carbon dioxide levels, lower lactic acid production, improve thyroid energy metabolism, and generally protect against stress, inflammation and disease. Adaptation to a high altitude promotes CO2 and lowers lactic acid, and has been shown to be highly disease protective.

See more here

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Altitude and the risk of cardiovascular events in incident US dialysis patients.

Polyunsaturated fatty acids mobilize intracellular Ca2+ in NT2 human teratocarcinoma cells by causing release of Ca2+ from mitochondria.

Acute respiratory alkalosis associated with low minute ventilation in a patient with severe hypothyroidism.

Endotoxemia stimulates skeletal muscle Na+-K+-ATPase and raises blood lactate under aerobic conditions in humans.

Exhaled NO and iNOS expression in sputum cells of healthy, obese and OSA subjects

Plasma cortisol concentrations preceding lactate-induced panic. Psychological, biochemical, and physiological correlates.

Acute hyperventilation increases the central venous-to-arterial PCO2 difference in stable septic shock patients

Lactate and risk of incident diabetes in a case-cohort of the atherosclerosis risk in communities (ARIC) study.

A lactate-induced response to hypoxia.

Post-hyperventilation hypoxaemia is due to alteration of ventilation and perfusion matching.

Behavioral Hyperventilation and Central Sleep Apnea in Two Children

The effect of sodium bicarbonate ingestion on back squat and bench press exercise to failure.

Low End-Tidal Carbon Dioxide at the Onset of Emergent Trauma Surgery Is Associated With Nonsurvival: A Case Series.

Hyperventilation in Panic Disorder and Asthma: Empirical Evidence and Clinical Strategies

Acute exacerbation of asthma complicated by hyperventilation in emergency department.

Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure.

The effect of exhaustion exercise on thyroid hormones and testosterone levels of elite athletes receiving oral zinc.

A prehospital screening tool utilizing end-tidal carbon dioxide predicts sepsis and severe sepsis.

Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department

Lactate Regulates Metabolic and Pro-inflammatory Circuits in Control of T Cell Migration and Effector Functions.

Role of nitric oxide in hypoxia-induced hyperventilation and hypothermia: participation of the locus coeruleus.

Effect of Therapeutic Hypercapnia on Inflammatory Responses to One-lung Ventilation in Lobectomy Patients

Inhibition of tryptophan hydroxylase abolishes fatigue induced by central tryptophan in exercising rats.

Increased levels of free serotonin in plasma of symptomatic asthmatic patients.

[Effects of carbon dioxide inhalation prior to maximal exercise on blood lactate and physical performance].

The epidemiological association of altitude with chronic kidney disease: Evidence of protective effect

[The effects of thyroid hormones and interleukin-8 levels on prognosis after congenital heart surgery].

Predictive value of capnography for suspected diabetic ketoacidosis in the emergency department.

Cancer risk in hospitalised asthma patients

Psychological triggers and hyperventilation symptoms in asthma.

Lactate at the crossroads of metabolism, inflammation, and autoimmunity.

Usefulness of end-tidal carbon dioxide as an indicator of dehydration in pediatric emergency departments: A retrospective observational study

Fraction of exhaled nitric oxide and bronchial responsiveness are associated and continuous traits in young children independent of asthma.

End-tidal carbon dioxide predicts the presence and severity of acidosis in children with diabetes.

Caffeine inhibits exercise-induced increase in tryptophan hydroxylase expression in dorsal and median raphe of Sprague-Dawley rats.

High altitude and pre-eclampsia: Adaptation or protection.

Dyspnoea, hyperventilation and functional cough: a guide to which tests help sort them out

Exercise training reduces resting heart rate via downregulation of the funny channel HCN4

End‐tidal Carbon Dioxide Predicts the Presence and Severity of Acidosis in Children with Diabetes

Association Between Thyroid Hormones, Lipids and Oxidative Stress Markers in Subclinical Hypothyroidism

The influence of free fatty acids on the free fraction of thyroid hormones in serum as estimated by ultrafiltration.

Effect of hypercapnia on changes in blood pH, plasma lactate and ammonia due to exercise.

Effects of endotoxin on lactate metabolism in humans

Transcutaneous Application of Carbon Dioxide (CO2) Induces Mitochondrial Apoptosis in Human Malignant Fibrous Histiocytoma In Vivo

Association Between Altitude and Regional Variation of ADHD in Youth.

Lactate Boosts TLR4 Signaling and NF-κB Pathway-Mediated Gene Transcription in Macrophages via Monocarboxylate Transporters and MD-2 Up-Regulation1

Reexamining cancer metabolism: lactate production for carcinogenesis could be the purpose and explanation of the Warburg Effect

Elevated serum lactate associated with panic attacks induced by hyperventilation.

End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis

The pathophysiology of hyperventilation syndrome.

Oxidative stress in hypothyroid patients and the role of antioxidant supplementation.

The effects of endurance training and thiamine supplementation on anti-fatigue during exercise

Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of US counties.

Mediation of serotonin-induced hyperventilation via 5-HT3-receptor in European eel Anguilla anguilla.

5% CO2 is a potent, fast acting inhalation anticonvulsant

Exhaled nitric oxide and thermally induced asthma.

Prevalence and characteristics of asthma in the aquatic disciplines

Moderate hyperventilation during intravenous anesthesia increases net cerebral lactate efflux.

Elevated lactate during psychogenic hyperventilation.

Lower mortality from coronary heart disease and stroke at higher altitudes in Switzerland.

Exaggerated compensatory response to acute respiratory alkalosis in panic disorder is induced by increased lactic acid production

Cancer Mortality in Six Lowest Versus Six Highest Elevation Jurisdictions in the U.S.

Effects of voluntary hyperventilation on glucose, free fatty acids and several glucostatic hormones.

The Risk of Cancer in Patients with Generalized Anxiety Disorder: A Nationwide Population-Based Study

Acclimatization to oxidative stress at high altitude.

The Effect of Marked Hyperventilation upon Tissue Levels of NADH, Lactate, Pyruvate, Phosphocreatine, and Adenosine Phosphates of Rat Brain

Land Elevation and Cancer Mortality in U.S. Cities and Counties Using Median Elevations Derived from Geographic Information Systems

End-tidal CO2 levels lower in subclinical and overt hypothyroidism than healthy controls; no relationship to thyroid function tests

Optimization of antitumor treatment conditions for transcutaneous CO2 application: An in vivo study

Hyperventilation and exhaustion syndrome

[Hyperventilation as a fundamental stimulator of pathological processes].

Lactate: panicking doctor or panicking patient?

Dynamics of tumor oxygenation and red blood cell flux in response to inspiratory hyperoxia combined with different levels of inspiratory hypercapnia.

Heart Disease Death Rates in Low Versus High Land Elevation Counties in the U.S

Gas exchange parameters in radiotherapy patients during breathing of 2%, 3.5% and 5% carbogen gas mixtures.

Effect of hyperventilation and mental stress on coronary blood flow in syndrome X.

Carbogen breathing increases prostate cancer oxygenation: a translational MRI study in murine xenografts and humans

The Role of Carbon Dioxide in Free Radical Reactions of the Organism

Carbon dioxide inhibits the generation of active forms of oxygen in human and animal cells and the significance of the phenomenon in biology and medicine.

Carbogen Breathing Differentially Enhances Blood Plasma Volume and 5-Fluorouracil Uptake in Two Murine Colon Tumor Models with a Distinct Vascular Structure

Utility of initial prehospital end-tidal carbon dioxide measurements to predict poor outcomes in adult asthmatic patients.

Monitoring Oxygen Levels in Orthotopic Human Glioma Xenograft Following Carbogen Inhalation and Chemotherapy by Implantable Resonator Based Oximetry

Relationship between gastro-intestinal complaints and endotoxaemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men.

Hyperventilation and asymptomatic chronic asthma

Targeting tumour hypoxia to improve outcome of stereotactic radiotherapy

Changes in the oxygenation of head and neck tumors during carbogen breathing

Human tumor blood flow is enhanced by nicotinamide and carbogen breathing.

Hypoxia and metabolic adaptation of cancer cells

Hyperventilation in asthma: a validation study of the Nijmegen Questionnaire–NQ.

Carbogen gas and radiotherapy outcomes in prostate cancer

Effects of sodium bicarbonate ingestion on swim performance in youth athletes.

Temporal variation in the response of tumors to hyperoxia with breathing carbogen and oxygen

Hypoventilation Training for Asthma: A Case Illustration

Central neurogenic hyperventilation and lactate production in brainstem glioma

Lactate: A Metabolic Key Player in Cancer

Carbogen breathing significantly enhances the penetration of red light in murine tumours in vivo.

Anxiety, depression and hyperventilation symptoms in treatment-resistant severe asthma

Improvement in human tumour oxygenation with carbogen of varying carbon dioxide concentrations.


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