September 28th, 2024

                                                                                                                           Stephen Elliott

                                                                                                                           COHERENCE LLC

                                                                                                                            417 South Jefferson St.

                                                                                                                            Pilot Point, Texas 76258

Office of the U.S. Surgeon General

Vice Admiral Vivek H. Murthy, M.D., MBA

U.S. Department of Health & Human Services

Hubert H. Humphrey Building

200 Independence Avenue, S.W.

Washington, D.C. 20201

Dear Dr. Murthy,

Please allow me to introduce myself. I am Stephen Elliott, President, COHERENCE LLC, and developer of the Coherent Breathing method (2004). I own and operate www.coherentbreathing.com. Since inception, I have been researching the psychophysiology of breathing and advocating its importance to both physical and mental health.

Your New York Times article of August 28th, “Parents Are At Their Wits’ End. We Can Do Better,” caught my attention. I commented on your article to say the single most important thing parents can do it to “teach their children well – to breathe.” To do this, parents must first learn for themselves how to breathe well, and experience what breathing well can do for one’s health and well-being, both body and mind.

To this end, I am writing to urge you and the Office of Surgeon General to put forward a simple health recommendation to the people of the United States, and by extension, the rest of the world. I consider it a matter of utmost urgency.

This recommendation is to communicate a correct model of the human circulatory system to the American people, and in keeping with the correct model, to advocate the importance of “breathing” in a healthful manner, this manner being relatively slowly, deeply, and rhythmically. The act of breathing keeps the blood in the body flowing properly, and when blood is flowing “in a circle”, arterial pressure cannot be high. (Here I am speaking of a steady state metabolic rate, i.e., not during exercise.) Simply stated, “Breathing is a circulatory function!”, although there is little to no recognition of this fact by modern medicine, or by our national health institutions.

The 2024 guidance of the FDA states in their article “High Blood Pressure – Understanding the Silent Killer”, that “nearly half, more than 119 million, American adults have high blood pressure.” Given a population of 345 million, half of the population equals 172M. It goes on to say, “But only 1 in 4 of those people (hypertensives) have their condition under control”, this leaving 129M Americans to live with hypertension and its deleterious consequences – this making clear that the past and current guidance regarding hypertension by our national health agencies has been and continues to be a failure. 

FDA and NIH statistics clearly show that “heart disease” is the number one cause of death in the United States, and that hypertension is the number one cause of heart disease. I posit that sub-optimal breathing (failure to move the diaphragm effectively) is the number one cause of essential hypertension, “the form of high blood pressure with no known etiology”, making up ~90% of all cases of hypertension worldwide. I argue that the etiology is known, but is not being communicated. The causes for this failure to communicate the truth regarding essential hypertension are well known, but here I will not digress.

I had this discussion with Dr. Francis Collins in ~2006, (then Head of the NIH Heart, Lung, & Blood Division). I was making the same argument that sub-optimal breathing is the root cause of essential hypertension, and this was not being communicated to the American public. I went so far as to accuse the NIH of lying by omission about it. Our exchange ended politely with a letter from Dr. Collins saying that the NIH would take my urging under advisement. ~20 years and ~14M deaths later, nothing has changed, regarding education. We find the same basic advice across governmental health agencies, advice being devoid of the recommendation to “breathe” with increased depth and rhythmicity, this facilitating the upward movement of venous blood, thereby drawing blood from the extensive capillary circulation upward against gravity, through the right heart, and into the lungs.

The dire matter coming to the fore, is that “heart disease” and its corollary, arterial disease, does not just affect physical health, but also mental health. This is because “circulation” affects every cell in the body including the brain. Is mental health possible when the brain is not functioning properly due to suboptimal circulation? The answer to this question is inevitably, “No.” Is the pandemic of hypertension resulting in a pandemic of mental dysfunction in this nation?

Evidence is mounting that long term heart disease and related arterial disease results in disorders of the brain, stroke, dementia, and Alzheimer’s. While there are many potential factors, hypertension is known to be the primary cause of heart and arterial disease.

To compound the situation, we have COVID-19, which is known to cause clotting, specifically of venous blood, this often resulting in DVTs which can end up in the pulmonary arteries causing embolism. I had a personal friend die of this condition 3 months ago. This is all the more reason to keep the blood in the body flowing, which breathing facilitates.

The simple fact is that human physiology is arranged such that blood flows successfully against gravity, the imperative being that blood flows upward from the feet and legs to the chest, and from the chest upward to the brain. Diaphragm movement (inhalation) generates the motive force behind blood flowing upward against gravity, when the body is in an erect position, most of the time when we are awake and active. When blood is moving upward in the venous tree, despite gravity, this motive force being the negative pressure generated in the chest due to inhalation, arterial pressure cannot be high. Here I refer to non-exercise situations, where exercise requires us to breathe with more depth and rhythmicity in order to generate the energy necessary for exercise. It also causes blood flow to quicken in both arterial and venous trees, where the equality of flow is necessitated by exercise. This is a key reason why exercise is so healthful – but as a recommendation to combat hypertension exercise is not sufficient.

When we are breathing sufficiently blood is flowing in a circle, where the volume of blood in the venous tree during inhalation is equal to the volume of blood in the arterial tree during exhalation, again, blood flowing in a circle. Breathing is a critical circulatory function! When we fail to inhale with depth, blood in the venous tree languishes and arterial blood has nowhere to go. Hence, the autonomic nervous system goes to work to increase flow, it does this by pressuring up the arterial tree to get blood moving – essential hypertension in the making.

We are staring into a future where the health of the American population is in rapid decline, both physically and mentally, this for a number of reasons. But, there is one fundamental root cause that we can do something about, poor circulatory health due to sub-optimal breathing. Correcting this simply requires an education campaign, addressing all ages. I am not writing to promote “Coherent Breathing”, but to promote conscious resonant breathing, relatively deeper breathing at a healthful rate below 10 breaths per minute, where the average adult is barely breathing – at a rate between 17 and 19 breaths per minute. We know that breathing in this manner results in chronic autonomic nervous sympathetic emphasis, the consequence being chronic internal tension and mental angst. Breathing more slowly and deeply facilitates venous blood flow, and with it increased circulatory performance. With improved circulatory performance internal tension and mental angst are mitigated. The trillions of cells throughout the body and specifically those of the brain benefit.