Anti-inflammatory hyperventilation: I’ll huff and I’ll puff and I’ll blow my pain away

I cannot seem to resist the siren song of breathing exercises and cold exposure therapy. My skeptical nature does not make me immune. “What’s the harm?” I think… even as I “blow” another precious few minutes of this all-too-short life hyperventilating and shivering in a frigid shower. Wasting time is more harmful than we typically give it credit for (“opportunity cost”), but apparently I am willing to risk it, because I have been doing this stuff off and on for years, and here I go again.

Why? What keeps me coming back? Why would I keep doing it when I’ve literally never really gotten any clear medical benefit from it?

This time it’s because I read a new study. Stupid Internet.

In my defence, it is quite a fascinating study: a gruelling experimental protocol, involving poisoning (not really an exaggeration) and hours of intense hyperventilation and serious cold exposure. And yet the bottom line is actually useful and promising stuff. So it got me hyperventilating! Again. 🙄

Actually promising data on hyperventilation

The study:

This is one of my rare good-news posts, because I think the study is genuinely promising, maybe useful, and definitely interesting. If you’re new here, know that I very rarely believe that “promising” research is actually promising, and so this one of those rule-proving exceptions. I got to the end of this paper, and I thought, “Welp, I guess I’ll be trying fast breathing and cold showers! Again!”

It’s just a pilot study, but it’s complex, dramatic, and persuasive despite its limitations. The researchers were hunting for the “active ingredients” in a messy cocktail of meditation, breathing, and cold exposure exercises that they had already studied before. (And, yes, breathing + cold = Wim Hof Method. That’s what this is about, but the paper never refers to it directly.)

This time, Zwaag et al. observed a clear anti-inflammatory effect from hyperventilatory breathing exercises both alone and when combined with cold exposure. Cold exposure alone had no effect, but it did seem to enhance the effect of the breathing exercises.

So: instead of taking a pill, hyperventilate and chill? Just how excited should we be here? I recommend an excitement level 4 on a scale of 10.

Hyperventilation is excessive venting of carbon dioxide & using a paper bag just keeps it from getting away (CO2 recapture). We strongly associate hyperventilation with panic attacks & in that situation you certainly want your CO2. But we can also vent CO2 on purpose… to tinker with our physiology, hopefully therapeutically.

Obligatory safety warning

You may feel inspired by this post to do some vigorous breathing and chilling exercise, but (duh) hyperventilation and cold exposure are potentially dangerous. Not anyone can do this, or should. Please do not just dive in recklessly, especially if you have no previous experience. Keep it tame, baby steps. Any doubt about whether you’re fit for this silliness? Run it by your doctor, and I am not just saying that because I have to.

The experiment protocol: savagely intense hyperventilation and cold exposure, then… poisoning?

This experiment was impressively gruelling for the participants: Zwaag et al. put a few dozen healthy young men through several days of intense breathing and/or cold exposure training, for hours at a time … and then they artificially cranked up their systemic inflammation with injections of bacterial lipopolysaccharides. Those are miscellaneous bacterial bits that provoke a strong immune reaction in most animals, as if they had a bacterial infection (“endotoxemia”). Serious business! Lots of care and ethical oversight required to do a study like this safely. (This is what I meant by “dramatic.”)

The breathing exercises mainly consisted of extensive hyperventilation — hours of supervised fast, deep breathing with a couple variations (most notably lots of breath-holding). Most people would find the full protocol prohibitively challenging and exhausting, especially those who might need it the most. Happily, the researchers also tested easier methods… and were convinced by their data that a much tamer and simpler protocol had the same effect. Yahtzee.

The cold exposure protocol was even more intense, and impractical for most people to even attempt: “an intensive 4-day cold exposure training program… consisting of standing in snow with bare feet for up to 30 minutes, lying in snow in shorts for up to 20 minutes, and sitting and swimming in ice-cold water for up to 3 minutes,” plus ending showers with “end their daily shower with a period of 60 seconds of cold water.”

Anti-inflammatory how?

There are a thousand ways to be inflamed, because “inflamed” is just an abbreviation of “the immune system is up to something,” and the immune system gets up to all kinds of things. So two drugs, for instance, can be meaningfully anti-inflammatory in entirely different ways.

The endotoxemia that Zwaag et al. induced in their brave subjects is a decent stand-in for the kind of inflammation we see in certain kinds of sick patients with chronic pain, most notably those with autoimmune diseases like rheumatoid arthritis, and it might even be a particularly good proxy for whatever goes wrong in people with fibromyalgia and ME/CFS. For instance, it may specifically induce neuroinflammation, which is a the kind of inflammation that causes “illness behaviour” — feeling fragile and exhausted.

All of the hyperventilating certainly seemed to reduce objective signs of endotoxemia (assuming no statistical jiggery-pokery, which is always possible of course). The formal official conclusions, for the record:

In conclusion, the present study corroborates previous findings that voluntary activation of the sympathetic nervous system, attenuation of the proinflammatory response, and alleviation of symptoms during experimental human endotoxemia are possible after following a training program consisting of cold exposure and a breathing exercise. Furthermore, these interventions can be provided by an independent trainer and acquired within a short time frame. Although these results provide an important next step in the clinical development of this intervention, they will need to be replicated and generalized before this intervention can be considered appropriate for application in clinical populations with chronic disease.

The simplest practical implication is that hyperventilation exercises alone might reduce some systemic inflammation in ways that could be helpful for some kinds of chronic pain … and that breathing probably works better with a bunch of added cold exposure. There’s plenty of uncertainty here, and in particular the required dosage might just be too much for a lot of people, but the data clearly shows that there is potential in principle.

Breathing fast & deep is a good workout! You have to pull your diaphragm & ribs down hard, over & over again.

My breathe-and-freeze protocol is way simpler than Wim Hof’s

The results of that formal experiment were good enough to get me breathing and cold-showering again, and I’ve done one 5-day personal experiment so far, I’ve just started the second, and will do a third. I made a couple adjustments to my own past techniques, both to make it easier, and more like the science:

1. I have often practiced a form of fast, deep breathing I learned back in my hippie youth, and that kind of breathing does involve some hyperventilation … but the hyperventilation is not the actual goal or focus. Breathing for a hyperventilation goal alone is faster, shallower, and quicker. Although the difference might not be obvious from the outside, I found it much easier to breathe this way.
2. I have done enough cold exposure experimenting to know that I hate it, and I’m bad at it. I find it extremely unpleasant and challenging, especially feeling the way I often do these days (that being “not great”). But based on Zwaag et al., the cold exposure is an optional enhancement. So I thought, Why not just make it easy? So I’m starting with a lukewarm shower (32C/90F), and then slowly dropping the temperature to “fairly cold” for a shower, but not brutal (26C/78F). I’m just starting to shiver a bit when I get out: mildly chilled. It might not be enough chilling to do anything… but it’s this much chilling, or none. I simply cannot handle more at this time.

The actual protocol, which I did twice per day for five days:

1. One set of forty fast, deep breaths before the cold shower.
2. A second set of forty breaths in the shower.
3. A third set of forty breaths after the shower.

I am not ready to deliver a happy anecdote about this. All I will say for now is that I felt better during the days of the experiment than I have in months, which is … not a conclusion. A misleading coincidental improvement is not unlikely! But it was good enough that I’ll be back for more.

I also enjoyed the activity. It felt appealling and sustainable, and I actually started to look forward to doing it!