Understanding Asthma - Part 1
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Ray Peat PhD
There are some popular medical ideas that obstruct clear thinking about respiration. One is that high altitude deprives you of oxygen, and is likely to be bad for people with heart disease and cancer. Another is that breathing pure oxygen helps sick people to oxygenate their tissues while exerting less effort in breathing. These are both exactly wrong, and the errors have been explored in quite a few publications, but the ideas persist in the culture to such a degree that our perceptions and intuitions have been misled, making closely related things seem to be unrelated. In this culture, it is hard to see that heart disease, cancer, and cataracts all involve a crucial respiratory defect, with the production of too much lactic acid and too little carbon dioxide, which leads to a "swelling pathology": A pathological retention of water. The swollen heart beats poorly, the swollen lens turns milky, other cells divide rapidly as a result of swelling.
People who live at very high altitudes live significantly longer; they have a lower incidence of cancer (Weinberg, et al., 1987) and heart disease (Mortimer, et al., 1977), and other degenerative conditions, than people who live near sea level. As I have written earlier, I think the lower energy transfer from cosmic radiation is likely to be a factor in their longevity, but several kinds of evidence indicate that it is the lower oxygen pressure itself that makes the biggest contribution to their longevity.
"Mountain sickness" is a potentially deadly condition that develops in some people when they ascend too rapidly to a high altitude. Edema of the lungs and brain can develop rapidly, leading to convulsions and death. The standard drug for preventing it is acetazolamide, which inhibits carbonic anhydrase and causes carbon dioxide to be retained, creating a slight tendency toward acidosis. This treatment probably mimics the retention of carbon dioxide that occurs naturally in altitude adapted people. The reasons for mountain sickness, and the reasons for the low incidence of heart disease, cancer, cataracts, etc., at high altitude, offer clues to the prevention of death and deterioration from many other causes.
The Haldane-Bohr effect describes the fact that oxygen and carbon dioxide destabilize each other's binding to hemoglobin. When oxygen pressure is high, the blood releases its carbon dioxide more easily. In stormy weather, or at high altitude, the lower oxygen pressure allows the body to retain more carbon dioxide. Carbon dioxide, produced in the cells, releases oxygen into the tissues, relaxes blood vessels, prevents edema, eliminates ammonia, and increases the efficiency of oxidative metabolism.
Hyperventilation, breathing excessively and causing too much carbon dioxide to be lost, is similar to being in the presence of too much oxygen; it's similar to being at low altitude with high atmospheric pressure, only worse. Therefore, the physiological events produced by hyperventilation can give us an insight into what happens when the atmospheric pressure is low, by looking at the events in reverse.
Hyperventilation is defined as breathing enough to produce respiratory alkalosis from the loss of carbon dioxide. Lactic acid is produced in response to the alkalosis of hyperventilation.
Breathing too much oxygen displaces too much carbon dioxide, provoking an increase in lactic acid; too much lactate displaces both oxygen and carbon dioxide. Lactate itself tends to suppress respiration.
Oxygen toxicity and hyperventilation create a systemic deficiency of carbon dioxide.
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Understanding Asthma - Part 1
Understanding Asthma - Part 2