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Medically unexplained symptoms

Updated: 6 days ago

Have you been investigated and told there is no medical explanation for your symptoms?

Medically unexplained symptoms are complex however one often overlooked reason for these symptoms may be related to the individual's underlying breathing efficiency. Watch this video to hear how I worked with one of my patients to resolve her medically unexplained symptoms*.

In 1975 Dr Lum a Respiratory Consultant at Papworth & Addenbrookes Hospital in Cambridge published a paper that described 700 patients who had been assessed but 82% had no detectable disease pathology and their symptoms were largely or entirely related to over-breathing (breathing inefficiently). (1) Dr Lum noted frequently patients had been through cardiological (heart) and respiratory (lungs) investigations. Dr Lum stated ‘a collection of bizarre and apparently unrelated symptoms which may affect any part of the body, and any organ or any system...... Such patients.... end up with the label of anxiety state' (1)

Table 1 in his paper lists the main symptoms observed by a general physician in 270 cases. Hyperventilation means over-breathing and it can be very subtle (1)

Symptoms associated with over breathing (hyperventilation)
Table 1 Dr Lum paper

In the paper Dr Lum describes that he is not the first person to have noticed this phenomenon. Dr Lum observed these patients frequently sighed and used their upper chest to breathe rather than the diaphragm. I thought it was interesting he notes 'Nor are these the weaklings. The most prone are the meticulous, hard-working perfectionists, prone to make excessive demands on themselves'

Dr Lum concluded 'two thirds of all patients so treated are completely relieved of symptoms. It is very uncommon to find a patient who does not experience marked improvement. To recapitulate:

1. We each probably see at least one of these patients a week.

2. The type of breathing is utterly characteristic, virtually diagnostic, and seldom recorded in the notes.

3. The size of the case folder is a frequent pointer to the diagnosis.'

When I first read this paper I was tearful. I could not understand how nearly 50 years later this is not widely known. I could visualise patients I had seen in the past whom fitted this category however due to my lack of knowledge I had missed the opportunity to explore if their breathing was impacting their symptoms. I want to change this. From working as a breathing practitioner I have seen how the body changes when breathing efficiency is improved. I do not believe improving breathing efficiency is a cure all however I firmly believe providing a basic efficient foundation of life (breathing) provides the opportunity for every cell, tissue, organ and system in the body to work efficiently.

I find it fascinating the symptoms in table 1 can appear in pre-menstrual syndrome (PMS), perimenopause and menopause. Progesterone is a respiratory stimulant which means it increases how fast the individual is breathing. (2) In those who are breathing efficiently this may not be noticed however in those who are breathing inefficiently it may tip them into symptoms of over-breathing (hyperventilation). I believe it is important for women experiencing symptoms of pre-menstrual syndrome (PMS), perimenopause and menopause to assess their breathing efficiency.

I understand Dr Lum's paper received criticism as not every individual who is over-breathing had reduced carbon dioxide levels in the blood. As a GP & breathing practitioner I am unable to measure the blood carbon dioxide level however I work with carbon dioxide tolerance which is more practical. Click here to understand carbon dioxide tolerance. In my clinical experience I have seen consistently when an individual improves their carbon dioxide tolerance the individual's natural unconscious breathing slows down and their sleep, exercise tolerance and stress resilience improves. See the feedback from those who have taken part in my programmes on the testimonial page and at the bottom of the menopause and webinar page.

However carbon dioxide tolerance is only one aspect of functional (efficient) breathing. Breathing efficiently involves breathing in and out of the nose whilst awake, moving and asleep in addition to the three dimensions of breathing:

  • Biochemical - BREATHE LIGHT – carbon dioxide tolerance

  • Biomechanical – BREATHE LOW- using breathing muscles correctly

  • Psychophysiological – BREATHE SLOW- slowing speed of breathing in order to influence the autonomic functioning of the body and bring calmness to the mind

  • Breathing in and out of the nose during wakefulness, sleep and movement

Three dimensions of breathing with nasal breathing at the centre.
Efficient (functional) breathing

At the beginning of my deep dive into breathing during coil fittings I suggested different ways of breathing in the hope of providing relaxation and pain relief to my patients. I initially started suggesting breathing using their diaphragm at 6 breaths per minute (4 second inhale and 6 second inhale) and this is what I observed:

One patient * who had a severe fight, flight response during a coil fitting (due to a recent traumatic birth) was able to change her autonomic nervous system state to a profound parasympathetic (relaxation) response by breathing silently in and out of her nose, using her diaphragm at 6 breaths per minute. She remained conscious during the procedure however she was unaware I had fitted a coil as she had entered a profound relaxed state. It was at this moment I decided I wanted to embark on my breathing practitioner training. This moment truly opened my eyes to the immense power of breathing.

Whereas other patients had very different responses. Some experienced a significant feeling of suffocation (air hunger) and anxiety when I asked them to breath silently in and out of their nose, using their diaphragm at 6 breaths per minute. Some could breathe using their diaphragm at 6 breaths per minute but could only tolerate this using the mouth to breathe and frequently these individuals felt lightheaded and developed pins and needles around their mouth and in the hands and feet after breathing in this manner.

These experiences combined with my breathing practitioner training opened my eyes to the importance of nasal breathing (24 hours a day 7 days a week) and carbon dioxide tolerance. When I teach individuals to breathe efficiently I generally start with nasal breathing and carbon dioxide tolerance. Carbon dioxide is what drives the next breath (primary driver to breathe) therefore as carbon dioxide tolerance improves the individual breathes slower (psychophysiological dimension) and has time to naturally breath lower before the drive for the next breath arrives (biomechanical dimension). In some individuals with severe carbon dioxide intolerance their drive to take the next breath arrives before they have had a chance to fully exhale. A very distressing symptom and can lead to air trapping in the chest.

Unfortunately, carbon dioxide tolerance is the most difficult aspect to research and teach. Carbon dioxide can make the individual experience air hunger (feeling of suffocation or needing to take a bigger breath or not getting enough air) and can generate a fight, flight, freeze (sympathetic) response therefore this needs to be taught carefully and gently so the individual can slowly improve carbon dioxide tolerance without feeling distress.

* these patients have given me permission to discuss this information anonymously

  1. Lum LC. Hyperventilation: the tip and the iceberg. J Psychosom Res. 1975;19(5-6):375-83. doi: 10.1016/0022-3999(75)90017-3. PMID: 1214233.

  2. Saaresranta T, Polo O. Hormones and breathing. Chest. 2002 Dec;122(6):2165-82. doi: 10.1378/chest.122.6.2165. PMID: 12475861.

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