Breath: The New Science of a Lost Art

by James Nestor

Schroth spent five years doing this. At the end, she’d effectively cured herself of “incurable” scoliosis; she’d breathed her spine straight again.

The German medical community derided Schroth, claiming that she was neither a professional trainer nor a physician and was not qualified to treat patients. She ignored them all; she kept doing things her way, having the women strip down bare-chested in a dirt lot beneath a copse of beech trees, stretching and breathing themselves back to health.

Toward the end of her life, the medical community had changed its tune and the German government awarded Schroth the Federal Cross of Merit for her contributions to medicine.

“What the bodily form depends on is breath (chi) and what breath relies upon is form,” states a Chinese adage from 700 AD. “When the breath is perfect, the form is perfect (too).”

This former scoliosis patient, who as a teenager had been left to wither in bed, would die in 1985, just three days shy of her 91st birthday.

Stough broke all the rules; he expanded lungs and extended life spans. And yet, most people today have never heard of him. Martin had worked with Stough for more than two decades.

What Stough had discovered, and what Martin had learned, was that the most important aspect of breathing wasn’t just to take in air through the nose. Inhaling was the easy part. The key to breathing, lung expansion, and the long life that came with it was on the other end of respiration. It was in the transformative power of a full exhalation.

He moved to North Carolina to conduct church choirs that went on to win national competitions, and his choir appeared on a weekly program broadcast nationally by Liberty Radio Network. Stough became so renowned that he moved to New York to retrain singers at the Metropolitan Opera.

“You must know something about breathing that we don’t,” said Dr. Maurice J. Small, the chief of tuberculosis management. Small was wondering if Stough might be interested in training a new group of students. None of them could sing, and a few couldn’t walk or talk. They were emphysema patients, and they were in desperate need of help. When Stough arrived at the East Orange hospital weeks later, he was horrified.

“I foolishly had assumed that everyone had at least a rudimentary knowledge of physiology,” Stough wrote in his autobiography, Dr. Breath. “Even more foolishly I had assumed that a universal awareness of the importance of breathing existed. Nothing could have been farther from the truth.” Emphysema is a gradual deterioration of lung tissue marked by chronic bronchitis and coughing. The lungs become so damaged that people with the disease can no longer absorb oxygen effectively.

Emphysema, he realized, was a disease of exhalation. The patients were suffering not because they couldn’t get fresh air into their lungs, but because they couldn’t get enough stale air out.

Stough discovered that the diaphragms in all of the East Orange emphysema patients had broken down. X-rays showed that they were extending their diaphragms by only a fraction of what was healthy, taking only a sip of air with each breath. The patients had been sick so long that many of the muscles and joints around their chests had atrophied and stiffened; they had no muscle memory of breathing deep. Over the next two months, Stough reminded them how.

He’d begin the treatments by putting patients flat on their backs, running his hands across their torsos, and gently tapping on rigid muscles and distended chests. He’d have them hold their breath and count from one to five as many times in a row as they could. Next, he massaged their necks and throats and lightly coaxed their ribs as he told them to inhale and exhale very slowly, trying to wake the diaphragm from its long slumber.

After several sessions, some patients learned to speak a full sentence in a single breath for the first time in years. Others began walking. “One elderly man who had not been able to walk across the room not only could walk but could walk up the hospital stairs, a remarkable feat for an advanced emphysema patient,” Stough wrote. Another man, who hadn’t been able to breathe for more than 15 minutes without supplemental oxygen, was lasting eight hours.

Before-and-after X-rays showed that Stough’s patients were vastly expanding their lung capacity in only a few weeks. Even more stunning, they were training an involuntary muscle—the diaphragm—to lift higher and drop lower. Administrators told Stough that this was medically impossible; internal organs and muscles cannot be developed, they said. At one point, several doctors petitioned to ban Stough from treating patients and kick him out of the hospital system. Stough was a choral teacher, not a doctor, after all. But the X-rays didn’t lie.

Over the next decade, Stough would take his treatment to a half-dozen of the largest VA hospitals on the East Coast, sometimes working on patients seven days a week. He’d go on to treat not only emphysema, but asthma, bronchitis, pneumonia, and more. The benefits of breathing, of harnessing the art of exhalation, Stough found, extended not just to the chronically sick or to singers, but to everyone.

After several rounds of deep breaths to open my rib cage, Martin asked me to start counting from one to ten over and over with every exhale. “1, 2, 3, 4, 5, 6, 7, 8, 9, 10; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10—then keep repeating it,” she said. At the end of the exhale, when I was so out of breath I couldn’t vocalize anymore, I was to keep counting, but to do so silently, letting my voice trail down into a “sub-whisper.”

At the end of each breath, it felt like my chest had been plastic-wrapped and my abs had just gone through a brutal workout.

This was what made the exercise so effective for Stough’s bedridden patients. The point was to get the diaphragm accustomed to this wider range so that deep and easy breathing became unconscious. “Keep moving your lips!” Martin egged me on. “Get out the last little molecule of air!”

I stopped and took a break and felt my diaphragm chugging away like a piston in slow motion, radiating fresh blood from the center of my body. This is the feeling of what Stough called “Breathing Coordination,” when the respiratory and circulatory systems enter a state of equilibrium, when the amount of air that enters us equals the amount that leaves, and our bodies are able perform all their essential functions with the least exertion.

In 1968, Stough left the VA system and his thriving private practice in New York to train yet another group of students.

They were the runners on the Yale track and field team, among the best in the nation at the time. When Stough arrived at the track fieldhouse, the athletes were so excited that they hung a poster on the bulletin board outside: Dr. Breath Is Here Today!

He warned them to never hold their breath when positioned at the starting line at the beginning of a race, but to breathe deeply and calmly and always exhale at the sound of the starter pistol. This way, the first breath they’d take in would be rich and full and provide them with energy to run faster and longer.

They took half the time to recover between races and were soon breaking personal bests and edging toward world records. On the heels of the Yale success, Stough moved to South Lake Tahoe to train runners preparing for the 1968 Summer Olympics in Mexico City. Same therapy, same success. A decathlete went out to the track and broke his previous record. Another broke his lifetime record. A runner named Rick Sloan broke his two life records for three events.

The Americans were the only runners to not use oxygen before or after a race, which was unheard of at the time. They didn’t need to. Stough had taught them the art of breathing coordination, and the power of harnessing a full exhalation.

I’d seen a video recording of Stough at the 1992 Aspen Music Festival—the only existing footage that demonstrates what he did and how he did it. It opened with a frame that read: An Introduction to Respiratory Science: The Preventative Medicine of the Twenty-First Century. Stough was at the center of a conference room, a massage table in front of him.

Stough was deeply tanned and dressed in a black blazer with brass buttons and a pocket kerchief, as if he’d just flown in on a Concorde from Monte Carlo. He started off by inviting a tenor named Timothy Jones to lie on the table and proceeded to jiggle Jones’s jaw, dig his hands into his waist, and rock him back and forth. “You see, I have to keep tapping right on the chest,” said Stough, his yellow polka-dot tie dangling in Jones’s hair.

“Everything’s loosening very fast!” Stough announced. He wiggled Jones’s hips and neck so violently that the singer almost fell off the table. It was a bizarre spectacle, and the grabbing and pushing and deep stroking looked at times like borderline molestation. After my own experience in Martin’s studio for an hour, babbling numbers and having my chest poked and ribs squeezed, it became more clear to me why Stough’s work never caught on.

Stough wasn’t a doctor; he was a self-made pulmonaut, a choir conductor. He was just too far out there. His therapy was just too weird.

when I first interviewed Olsson more than a year ago, he was not a source I entirely trusted. On our Skype calls, he liked to hammer the importance of slow breathing, and he’d sent me a half-dozen PowerPoint presentations and reams of scientific studies on how paced breathing relaxed the body and calmed the mind.

“I really think carbon dioxide is more important than oxygen,” he told me. Olsson claimed that we have 100 times more carbon dioxide in our bodies than oxygen (which is true), and that most of us need even more of it (also true).

He said that, today, humans can increase this toxic gas in our bodies and sharpen our minds, burn fat, and, in some cases, heal disease.

Every other day, a new headline detailed how Earth was warming because there was too much carbon dioxide in the atmosphere. Animals were dying. Carbon dioxide kills. Olsson kept arguing the opposite.

“Breathing heavy, breathing quickly and as deeply as you can—I realized this is the worst advice anyone could give you,” Olsson told me. Big, heavy breaths were bad for us because they depleted our bodies of, yes, carbon dioxide.

“I was going to end up exactly like my father,” Olsson said, running a finger along the condensation of the water glass. He told me how his father had been chronically stressed, how he breathed too much, and how he’d gotten severe high blood pressure and lung disease and died at 68 with a breathing tube in his mouth.

After the long days he spent running a software distribution company, he’d come home and read medical books. He talked to doctors, surgeons, instructors, and research scientists.

Then he scaled down to a smaller apartment and spent six years forgoing any salary, working almost entirely alone, trying to understand the mysteries of health, medicine, and most specifically breathing and the role of carbon dioxide in the body.

Olsson found what I’d found, but years earlier: that there was a gap in our knowledge about the science of breathing and its role in our bodies.

so preoccupied have most physiologists been with lung volumes, ventilation, circulation, gas exchange, the mechanics of breathing, the metabolic cost of breathing and the control of breathing that few have paid much attention to the muscles that actually do the breathing,” one physician wrote in 1958.

most of the great physicians and anatomists were interested in the respiratory muscles and the mechanics of breathing. Since then these muscles have been increasingly neglected, lying as they do in a no-man’s land between anatomy and physiology.”

the best way to prevent many chronic health problems, improve athletic performance, and extend longevity was to focus on how we breathed, specifically to balance oxygen and carbon dioxide levels in the body. To do this, we’d need to learn how to inhale and exhale slowly.

How could inhaling smaller amounts of air and having more carbon dioxide in our bloodstream increase oxygen in our tissues and organs?

you need to consider the body parts beyond the nose and mouth.

Let’s say you’re about to take a river cruise. You’re in a waiting room at the dock when a ship approaches. You pass through security, board the ship, and head off. This is similar to the path oxygen molecules take once they reach the alveoli. Each of these little “docking stations” is surrounded by a river of plasma filled with red blood cells. As these cells pass by, oxygen molecules will slip through the membranes of the alveoli and lodge themselves inside one.

Oxygen takes a seat inside a hemoglobin; then the red blood cells journey upstream, deeper into the body. As blood passes through tissues and muscles, oxygen will disembark, providing fuel to hungry cells. As oxygen offloads, other passengers, namely carbon dioxide—the “waste product” of metabolism—will pile aboard, and the cruise ship will begin a return journey back to the lungs.

Eventually, the cruise ship will make its round through the body and back to port, back to the lungs, where carbon dioxide will exit the body through the alveoli, up the throat, and out the mouth and nose in an exhale. More oxygen boards in the next breath and the process starts again.

The entire cruise takes about a minute, and the overall numbers are staggering. Inside each of our 25 trillion red blood cells are 270 million hemoglobins, each of which has room for four oxygen molecules. That’s a billion molecules of oxygen boarding and disembarking within each red blood cell cruise ship.

What’s less acknowledged is the role carbon dioxide plays in weight loss. That carbon dioxide in every exhale has weight, and we exhale more weight than we inhale.

We lose weight through exhaled breath. For every ten pounds of fat lost in our bodies, eight and a half pounds of it comes out through the lungs; most of it is carbon dioxide mixed with a bit of water vapor. The rest is sweated or urinated out. This is a fact that most doctors, nutritionists, and other medical professionals have historically gotten wrong. The lungs are the weight-regulating system of the body.

Danish physiologist named Christian Bohr discovered this in a laboratory in Copenhagen.