Who knows it’s all in the NOse?

How you breathe may be just as important as what you breathe. My final report of the year reveals my biggest discovery of the year – something that increases chronic disease, facial aging, bad breath, cavities, poor concentration, poor immunity, and poor sleep. Something you can prevent!

Several months ago I decided to tackle my sleep disturbances. My nights were filled with disturbing dreams, dry mouth, and annoying trips to the bathroom. I tried reducing water intake, changing pillows, even sleeping on the couch. Nothing helped.

Sleep apnea runs in my family, so I tried a chin strap to keep my mouth closed. This “muzzle” helped some of the time when I could keep it on. But in the mornings I would find it on the floor where I unconsciously ripped it off in a fit of midnight madness.

The next solution promised to improve my breathing with patented nasal adhesive strips. This clever product is curious science, with the strips pulling the nasal passages open as they reflex to their original shape. The extra strength model worked some of the time, but I dreaded the morning “sacrifice” of skin across my nose. Thinking about skin grafts after several months of continuous use made me desperate for something else. And I was not ready to make the lifelong commitment to CPAP (continuous positive airway pressure) – the cumbersome air mask successfully used for sleep apnea.

It was clear that sleep-disordered breathing (SDB) left me feeling more wired and tired than usual. Finally I found a few adventurous sufferers touting a simple solution online – mouth tape. I was eager to try something else, anything else, to wake up refreshed.

Five inches of 3M First Aid Paper tape and eight hours later I had my first perfect night’s sleep in months!

No, I didn’t panic for air, as the tape is porous and comfortable. No, my skin didn’t peel off in the morning. And no, I don’t recommend luring your partner to bed with this treatment.

Mouth taping continued to work for days, then weeks, then months. Though still a night owl, I woke earlier with more energy and enthusiasm than ever before. I started noticing how often I was “mouth breathing” during the day, and how much better it felt to breathe through my nose!

Online testimonials recommend gentle products like 3M’s Nexcare Micropore tape or 3M’s Nexcare Gentle paper tape. Using tape at least 1″ wide allows coverage of the lips horizontally. Some people prefer to keep the mouth closed by taping vertically over the lips – this technique may require experimenting for the perfect combination of comfort and prevention.

So, what’s wrong with mouth breathing?

Mouth breathing is part of a vicious cycle of upper airway disturbance and sleep-related disorders. The first trigger is usually an allergic reaction to the environment or food that causes sinuses to swell from histamine and other body chemicals. Mouth breathing becomes a survival tactic, especially during sleep. Bacteria then builds up in the mouth when saliva dries up, leading to bad breath, gum inflammation, cavities, and crooked teeth. Some people slowly develop facial and dental deformities and painful conditions like TMJ. Children who mouth breathe have abnormal postures and reduced respiratory muscle strength. Even worse, new research shows that resulting bacterial infection in the mouth can lead to systemic diseases such as cardiovascular disease, diabetes, respiratory disease, and osteoporosis.

According to a 2010 study published in General Dentistry, “if mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.” Swollen tonsils, long narrow faces, crowded teeth, and poor concentration can be signs of mouth breathing. “Mouth breathers have a lower oxygen concentration in their blood than those who have optimal nasal respiration; low oxygen concentration in the blood has been associated with high blood pressure and cardiac failures.”

Nitric oxide – our secret potion

Most importantly, mouth breathing prevents nasal breathing! And nasal breathing stimulates our nasal passages to produce an essential gaseous compound called nitric oxide (NO). Nitric oxide is usually created within the body from a combination of oxygen, l-arginine and special enzymes. Locally, nitric oxide works to limit bacteria in the our vulnerable sinuses that filter everything from industrial pollution to fungus. We inhale this nitric oxide which increases blood flow, increases oxygen uptake in the lungs, relaxes blood vessels, prevents inflammation in blood vessels associated with heart disease, and limits calcification in the arteries. Nitric oxide activity is also associated with insulin sensitivity. In this manner, the nose helps regulate blood pressure and plays a huge role in cardiovascular disease and diabetes.

Experts at Buteyko Institute of Breathing and Health point to hundreds of years of research that show how mouth breathing and obstructed nasal breathing lead to snoring and sleep apnea – a growing epidemic associated with chronic disease. In sleep apnea, a person unknowingly experiences reduced or paused breathing during sleep, resulting in daytime fatigue and concentration problems. Bed partners suffer with insomnia and reduced quality of life. Sleep apnea reduces oxygen and nitric oxide in the body, promoting inflammation and chronic disease. In fact, a new study found that obesity wasn’t causing blood vessels to malfunction and increase risk of cardiovascular disease, it was sleep apnea!

Nitric oxide helps with wound healing and reduction of certain bacteria. Pain is relieved by nitric oxide in multiple ways and is the secret to how opoids work their magic. Increasing nitric oxide can help pain patients with conditions like diabetic neuropathy and osteoarthritis.

Nitric oxide deficiency has far-reaching consequences. Research has found reduced nitric oxide levels and associated nerve degradation in patients with erectile dysfunction. Similarly, sleep apnea is affiliated with sexual dysfunction in both genders. Long-term nitric oxide deficiency caused overactive bladder activity in rats.

Certain conditions produce low levels of nitric oxide in the nose, including cystic fibrosis and some types of chronic sinusitis. Nitric oxide is reduced in chronic kidney disease. High concentrations or chronic use of alcohol lowers nitric oxide activity. Research found that stress reduced nitric oxide activity in lab animals.

Sinuses are one of many locations in the body that produce nitric oxide, including neurons, kidneys, lungs, liver, and colon. Nitric oxide is formed differently based on location as well as the conditions of the cells, organ and entire body! This complex dynamic between distant forces in the body is referred to as organ crosstalk and will likely define the next chapter of medical research (though it has been the keystone of Chinese medicine for the past two millenia).

NO limits

The shadow side of nitric oxide surfaces when conditions favor disease, as in the case of oxidative stress. Oxidants increase when the body experiences high blood sugar, high-fat, environmental pollution, radiation, or infections. Oxidants then react with nitric oxide to produce peroxynitrite, the T-rex of our cellular world that leaves a path of destruction.

Like so many other aspects of health, nitric oxide is only beneficial when things are running smoothly. Normal levels of nitric oxide in the brain support memory and learning. Abnormal nitric oxide activity links to neurodegenerative disorders such as Parkinson’s and Alzheimer’s and major depression. In Alzheimer’s disease, oxidative stress causes plaque to build up on brain cells which leads to loss of nitric oxide, cell degeneration and cell death.

Nitric oxide also helps regulate our immune “T” cells, and when this process goes awry we’re seeing development of autoimmune diseases like rheumatoid arthritis and lupus. According to an exciting new study, “NO is an endogenous negative regulator of Th17-cell development and may prevent autoimmune diseases, including those induced by environmental toxins.”

Normal levels of nitric oxide appear to reduce bacteria and other pathogens, just as sodium nitrate in cured meats helps prevent botulism poisoning. But now we are discovering that some harmful bacteria are actually protected by nitric oxide – particularly gram-positive varieties. Spirochetes, a type of bacteria found in the brains of patients with Lyme and Alzheimer’s disease, generate a substantial amount of nitric oxide and inflammation.

The harmful effects of excessive nitric oxide may be magnified when the body is unable to regulate it, as in the case with potassium or calcium imbalance in the cells. Maintaining mineral balance in the body will hopefully become easier in the future with monitoring technology using fluorescence with living cells.

How can we increase healthy levels of nitric oxide?

First, it is vitally important to eliminate sources of sinus congestion or infection that could potentially alter breathing patterns and reduce oxygen and nitric oxide. HEPA air filters can reduce airborne toxins inside the house, while nasal rinse systems like NeilMed’s Sinus Rinse can help remove allergens in the sinus passages after exposure. Foods including dairy and grains can increase mucus production and sinus congestion, while pollen, dust mites, and mold are common environmental triggers. Determine allergies early with testing as needed, and thoroughly remove the triggers from your environment. For early symptoms of sinus infection, take 1 tsp Echnicea tincture in water between meals, then 1/2 tsp every 2 hours for 3 days beyond the absence of symptoms.

Not surprising, exercise increases nitric oxide levels which leads to increased circulation and general improvements in health. (Diabetics with coronary artery disease don’t appear to benefit from this response, so start exercising before it’s too late!) Antioxidant supplements vitamin C, E and CoQ10 enhance the nitric oxide activity during exercise. Antioxidants supported CPAP therapy to reduce nighttime urination associated with sleep apnea; this diuretic phenomena is proposed to be the result of nitric oxide activity related to oxidative stress.

Nitrates in food break down in the body to form nitric oxide. Did you know that eating your veggies really means eating your nitrates? Nitrates naturally occur in green leafy vegetables, broccoli, celery and beets, a new preventative food group for cardiovascular disease and diabetes. Vegetable nitrate content is dramatically affected by fertilizer, and organic crops may contain safer levels of nitrates.

Dietary nitrates increased nitric oxide activity and reduced visceral fat and triglycerides in animals. Beetroot juice was used to substantially lower blood pressure as well. Even flavonoid-rich apples increased nitric oxide activity. Oranges contain a citrus flavonoid hesperidin that increases nitric oxide in our blood vessels for potential benefit.

What about added nitrites/nitrates in foods like hot dogs? Sodium nitrate (common in cured meats) actually lowered diastolic blood pressure in studies. This is puzzling when we find a higher risk of pancreatic cancer in men who consumed processed meats earlier in life. Similarly, cured meat consumption was associated with higher rates of chronic obstructive pulmonary disease (COPD).

The difference here is that nitrates are harmful when they convert to nitrosamines in the body in the presence of amines. Foods high in amines include aged/smoked fish or meat, fermented foods, chocolate, citrus and vegetable juices, aged cheeses, and spicy snacks. Amines increase in foods as they ripen, age, or otherwise degrade in storage – and even the refrigerator. Browning, grilling or charring increases the amine content of food as well. The amine trimethylamine occurs in moist air around agriculture and livestock areas; it is also derived from choline which recently associated with artherosclerosis in high consumption.

Nitrates appear most beneficial to the body in moderation in organic vegetables where they are consumed away from inflammatory or carcinogenic elements.

Nitric oxide requires the conversion of oxygen and amino acid L-arginine. Studies are showing benefit of L-arginine in conditions related to diminished nitric oxide, namely cardiovascular disease, memory disorders, and high blood pressure. Vitamin E may also help, as it restored damaged memory cells that produce nitric oxide in diabetic rats. Both vitamin C (ascorbic acid) and amino acid N-acetyl cysteine increased nitric oxide activity in tests on diabetic hearts.

Turn up the tunes, because a recent study found that listening to joyful music associated with increased endothelial (blood vessel) circulation. “Self-selected joyful music was associated with increased [dilation] to a magnitude previously observed with aerobic activity or statin therapy.” It is theorized that endorphins help release the nitric oxide that produce this effect.

On a similar note, humming dramatically increases nitric oxide produced in the nose. This effect is caused by sound waves in the sinus cavity that speed up the exchange of gases.

Think before gargling. Saliva takes up dietary nitrates and converts them to useful nitrites with the help of oral bacteria, and antibacterial mouthwash actually limits the beneficial effects of these nitrates. Some studies are cautioning the use of alcohol-based mouthwash that may lead to increased cancer risk in some populations.

Technology enthusiasts may be intrigued that new low level laser therapy (LLLT) increases nitric oxide activity, one of many benefits in rapid healing, pain relief, and bacteria reduction, to name a few. Low level lasers use light in the infrared spectrum. Similarly, sauna treatment (radiant heat or far-infrared units) associates with benefits for cardiovascular disease and other conditions. Animal experiments show that nitric oxide activity is increased by repeated sauna therapy.

Last and most importantly, continuous positive airway pressure (CPAP) treatment helps NO levels and airway inflammation return to normal. CPAP machines pump air at prescribed pressures into sealed face masks to ensure unobstructed breathing. While some people find this treatment uncomfortable, it has proven to reverse signs of heart disease and diabetes.

Nitrosamines – the dark side

Our normal nitric oxide processes are disrupted when we are exposed to external compounds – usually a combination of nitrates and amines called nitrosamines. Nitrosamines are known carcinogens and exposure is linked to insulin resistant diseases like type 2 diabetes, liver disease, and Alzheimer’s disease. Common sources of exposure include:

• Cured meats, including bacon
• Dried salted fish
• Smoked food
• Pickled vegetables
• Tobacco smoking
• Malted beer and whiskey
• Nonfat dry milk
• Drinking water (affected by disinfection process and increased by pharmaceuticals and personal care products)
• Swimming pools and hot tubs (affected by cleaning products or urine)
• Certain types of rubber/latex products
• Some cosmetics
• Soil pollution (resulting from pesticides)
• Airborne pollution

Research cannot yet tell us how we absorb nitrates differently from these sources, but some associate with disease more than others. One study on foods found that vegetables contain the highest amount of nitrite, meat and bean products contain the highest amount of nitrate, and alcohol, meat and dairy products contain the highest amount of nitrosamines. Alzheimer’s disease was recently associated with lowered consumption foods that are high in amines and/or fat, namely high-fat dairy products, red meat, organ meat, and butter.

Evidence also shows a link between nitrite/nitrosamine intake and gastric cancer and rectal cancer. In Taiwan, increased nitrates in drinking water associated with childhood brain tumors. High nitrates and nitrite compound consumption also associated with thyroid cancer and colon cancer, particularly through smoked and salted fish (NDMA). We need improved detection of our food, air, and water to prevent exposure and disease risk.

Vitamin C (ascorbic acid) normally assists with the conversion of nitrates to NO, reducing the formation of harmful nitrosamines. In fact, most meat manufacturers add ascorbic acid to their products in order to reduce nitrate health hazards. But the presence of fat may turn the tables, leading to an increased formation of nitrosamines. This theory could explain why vitamin C cannot lower cancer risk – and why you may want to avoid eating fatty bacon with morning juice. It may also help explain why supplemental vitamin C is associated with increased risk of cardiovascular disease in postmenopausal women with diabetes.

Garlic may be a worthy substitute for vitamin C for this purpose, as studies showed garlic similarly suppressed cancer-causing nitrosamines – possibly through sulfur compounds. Perhaps we should consider avoiding fats in our green leafy salads and adding garlic to our sauteed spinach!

Sleep disordered breathing as a natural defense

An intriguing theory is emerging to explain why we experience sleep disordered breathing. The lack of oxygen that occurs in conditions like sleep apnea is called chronic intermittent hypoxia – the ongoing experience of low-oxygen followed by reoxygenation. While chronic intermittent hypoxia can lead to hypertension, liver disease, and unhealthy fat or cholesterol levels, animal studies show that it may lead to some protection against stroke and arthritis. This correlates with research that associates living at high altitude (chronic hypoxia) with some protection against heart disease.

It is possible that our bodies might be desperate at times, adjusting breathing patterns to eliminate an offending bacteria or lingering allergen. Maybe we get stuck in this mode, unable to breathe as before, much like forming an unhealthy posture or nervous habit. Or perhaps our bodies have exhausted all other methods of protection and are using this last, high-risk approach to adapt to suboptimal conditions. Unfortunately, the high mortality rates for untreated sleep-disordered breathing show that this hypothetical natural defense is insufficient in the long-term.

Body defense mechanisms are muffled by research and drugs aimed at obliterating symptoms, though we are beginning to glimpse our own insanity. For example, the obesity paradox in medical research describes how overweight and obese people with existing cardiovascular disease have a shockingly better survival and outcome than their leaner counterparts. Sleep disordered breathing and obesity may be two very important methods of biological defense that require further, open-minded investigation.

But first, uncover your sleep disordered breathing problems before they shorten your life.

Wrap-up:

• Recognize and treat sleep-disturbed breathing as early as possible
• Use CPAP to treat sleep apnea if other methods fail
• Prevent sinus congestion by identifying and avoiding allergens or pollutants
• Prevent mouth breathing and low levels of nitric oxide/oxygen, taping the mouth if necessary during sleep
• Avoid high consumption of nitrosamines in cured and smoked meats, tobacco smoke, polluted drinking water and toxic environmental sources
• Consume nitrates in beets and green leafy vegetables like spinach, cabbage, lettuce, broccoli and celery along with vitamin C-rich foods or supplements – consumed away from fatty foods
• Reduce consumption of amines high in bacon, aged/smoked meats, pickled foods, tobacco smoking, polluted air and water
• Exercise regularly to improve nitric oxide activity and reduce disease risk
• Take antioxidant supplements to enhance nitric oxide activity – vitamin C, E, CoQ10 and selenium also support cardiovascular health
• Hum and listen to your favorite music

Breathe well and sleep well long past 2012!

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A useful summary of nitric oxide biology is online by Dr. Richard Klabunde, while a more thorough review is available in the Journal of Biological Chemistry. Jon Lundberg at the Karolinska Institutet in Sweden has done extensive research on nasal breathing and helped publish a recent overview “The Nitrate–Nitrite–Nitric Oxide Pathway in Mammals.” Nathan Bryan presents a comprehensive review of research and its holistic impact in Nitrite and Nitrate in Human Health and Disease

Dr. Colmean with Millhouse Medical in New Zealand compiled a useful list of natural ways to enhance nitric oxide. Nearby, Australia’s Buteyko Institute researches breathing and educates practitioners around the world on proper techniques for wellness. (Deep breathing exercises are not recommended!)