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Is Alternate Nostril Breathing Really Just Placebo? A Response To The Atlantic

in Science, Yogitorials

by Timothy McCall, MD

As many of you have undoubtedly heard, presidential candidate Hillary Clinton used yogic alternate nostril breathing to help get over her electoral defeat. She’s been singing the praises of the ancient pranayama technique in her bestseller What Happened as well as on CNN. This caught the attention of James Hamblin, MD, a senior editor at the venerable magazine The Atlantic.

In his article, “How Alternate-Nostril Breathing Works,” Dr. Hamblin sets the tone early: “When I came to the part in Hillary Clinton’s new book where she describes how she treated her anxiety with a practice called alternate-nostril breathing, I thought, that sounds impossible. I tried breathing through only one nostril at a time. I couldn’t do it.”

“Then I read a little further and saw that she recommends using her fingers to cover one nostril. Got it. Okay, that makes it much easier.”

Later Hamblin wonders why the practice could possibly be calming? “Inducing partial suffocation,” he writes, “isn’t the most intuitive anti-anxiety ritual.”

What Hamblin proves with this last piece of snark is that he actually knows next to nothing about the subject he is addressing. If you are practicing pranayama and are feeling short of breath, you are doing it incorrectly. That’s why yogis recommend—even more than for other practices—that you learn pranayama directly from a teacher. That’s especially true if breath holding is involved as Clinton, probably unwisely, recommended (the practice is usually contraindicated in people with heart disease, asthma, etc.).

Of course, knowing little or nothing about the subject rarely stops some physicians and skeptics from dissing a wide variety of holistic health measures from yoga to acupuncture. Even well-meaning doctors are sometimes quoted in the press saying things like they are not surprised that some study found yoga effective because exercise is good for you, as if that were the total explanation.

Dr. Hamblin is willing to dismiss the various “studies” (in scare quotes to emphasize their dubious nature) in support of alternate nostril breathing. He rejects the scientific research cited by CNN because the studies mostly had small numbers of participants and were published in journals like the International Journal of Yoga, which “conceivably has some degree of pro-yoga bias.”

But what Hamblin most effectively uses to skewer alternate nostril breathing is a quotation from Clinton’s book: “The way it’s been explained to me,” she wrote, “this allows oxygen to activate both the right side of the brain—which is the source of your creativity and imagination—and the left side—which controls reason and logic.”

Hamblin gleefully responds that given the stress she was under when she wrote the book: “She has more pressing concerns than considering how inhaled air goes down into the lungs, where oxygen is transferred to capillaries filled with blood that then go to the heart. The heart has a single left ventricle, and it shoots blood up to the head, oxygenating the brain’s hemispheres with the same blood.”

And, of course, in this regard, the good doctor is absolutely correct. The explanation Clinton gave, that she more than likely got from a yoga teacher, is not quite right. And probably that teacher heard it from his or her teacher and passed it on with the best of intentions.

There is, in fact, research that suggests that breathing through the left nostril preferentially stimulates the right hemisphere of the brain, and vice versa. This and another study by the same author, David Shannahoff-Khalsa of the University of California- San Diego’s Center for Integrative Medicine, elaborate on the link between hemisphere dominance and the breath cycle, which flips between dominance by the right and left nostrils several times per day. Both were published in The International Journal of Neuroscience, which admittedly could have a pro-neuroscience bias. It is also known that right nostril breathing stimulates the sympathetic nervous system’s (SNS) fight or flight response. Left nostril breathing has similarly been linked to the parasympathetic nervous system’s (PNS) “rest and digest” response. Alternate nostril breathing could thus help balance these two branches of the autonomic nervous system, potentially helping a condition like anxiety typically associated with dominance of the SNS over the PNS.

Like Hamblin, New York Times science writer William Broad, in his infamous book The Science of Yoga—in which he among other things asserted that yoga started as a sex cult, could make you fat, and results in hundreds of strokes and many deaths per year—seems to attack the dumbest things he could find that anyone has said about the practice. In suggesting that the profession has turned a blind eye to yoga injuries, Broad quoted one Indian guru that most western yogis have never heard of who said that yoga is as safe as mother’s milk as if that were the party line. Despite all the book’s shortcomings, Broad correctly pointed out, for example, that Kapalabhati breathing does not increase the oxygen levels in the brain. I’ve personally heard that canard several times over the years in yoga classes.

Or consider the commonly-invoked explanation that yoga shoulderstands can improve thyroid function by increasing blood flow to the gland. As far as I know there is not a lick of scientific support for this notion. Having been in an O.R. and seen a scalpel cut into the thyroid, it’s hard for me to imagine an organ with a better blood supply even without going upside down.

What is known is that the yoga tradition tells us that shoulderstand can help the gland’s functioning as, for example, in the case of hypothyroidism. But there seems to be a strong temptation among teachers to not want to depend on the tradition alone but to dress up their claims in science-y language. And that is precisely what opens the door to science writers like Broad and Hamblin—looking for a click-worthy, man-bites-dog hot take—to spread misinformation about yoga in influential places like The Atlantic and The New York Times.

Here’s my suggestion: If you are a yoga teacher and are not that well-schooled in science, tread carefully. Realize that the people who taught you may also have not understood physiology or medicine that well. Be careful when propagating scientific-sounding information that may not be accurate. For some scientifically-minded students, a single bogus claim could lower their opinion of you and maybe of yoga itself.

If you have read research on yoga that had an interesting result you want to discuss with your students, by all means do so. If possible, also mention where and when the study was published. If all you did was read a news story about it, say that.

Acknowledge your sources, whether a claim comes from the yoga tradition, your teacher, or is the fruit of your own personal yoga practice or teaching. It may not sound as impressive as invoking science, but it’s a lot less likely to get turned on you or on the ancient practice you love by a skeptical journalist or scientist in your midst.

And for the record, the yoga tradition, my teachers, my own direct experience as a long-time practitioner and yoga therapist—and a growing body of scientific research—suggest that alternate nostril breathing can be a most valuable tool for improving health and well-being. I do it every day.


Timothy McCall, MD is a board-certified internist, Yoga Journal’s medical editor since 2002 and the author of the bestselling Yoga as Medicine (Bantam). He co-edited the 2016 medical textbook, The Principles and Practice of Yoga in Health Care (Handspring Publishing). He practiced medicine for more than 10 years in the Boston area before devoting himself full-time to investigating, practicing, writing about and teaching yoga therapy. He is the founder and director of Yoga As Medicine Seminars and Teacher Trainings, teaching and lecturing worldwide. He lives in Burlington, VT and can be found online at DrMcCall.com


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16 comments… add one
  • Melissa Gatlin

    For the “doctor” that couldn’t breathe that way I recommend going and getting checked by an ENT doctor .. yes of course if you have a really bad deviated septum you may not be able to breathe via one side of the nose .. I had that problem until I finally had the deviated septum repaired. But most people without a medical issue can easily get enough oxygen via one nostril or the other. Otherwise side sleepers would be dying in thier sleep from suffocation on a regular basis.

    For me, personally, I use alternate nostril breathing when I’m having a problem meditating. esp during high stress periods. I have used “focusing on the breath” for meditation most of my life as my first teacher taught me to use that form as it didn’t require any “outside props” so it could be done anywhere, anytime. But when I’m having a problem settling the mind using my regular breathing pattern, using alternate nostril breathing takes just enough concentration that my monkey brain has a harder time taking over.

    • Melissa, I also have a deviated septum, and just doing the practice over the years has made the air flow much better. The tradition teaches that when you do nadi shodhana, it balances the ida and pingala, After doing the practice, the breath tends to flow evenly between the nostrils, said to open sushumna, facilitating deeper meditation. That could be what you’re observing.

  • Thank you Dr. McCall for the article.
    I have copied various sections of yoga articles for my personal documents with some from yoga tradition and note that I have such “claims” such as bridge stimulates the thyroid gland, Fish pose improves circulation to parathyroid gland which controls how much calcium we store in our bones and our blood. Shoulderstand helps to improve blood circulation throughout the body, provides essential nutrients to all organs of the body. Assists to regulate parathyroid and thyroid glands by forming a chin lock that squeezes old blood from the region. As you come out of the asana and let go of the lock, your neck area gets bathed in fresh, oxygenated blood. Professed to flush out lymph nodes. I am aware of what I do not know. My notes above sound lovely and beneficial for the body yet which study indicates essential nutrients are flowing to all organs to the body? I did not record my source and I am not expressing this in classes I teach.
    I have read yoga tones internal organs and massages them. Massaging internal organs does make me smile and wonder how this is known. Can a doctor of radiology see me in upward and say “wow look how Jill’s ovaries are being massaged.” Some of the material or benefits of yoga we read sound great, however I have often felt wondered how they arrived at the statement.
    I agree to citing sources when giving the benefits of a pose or pranayama.

    • That is a great list of dubious claims! I do think there’s something to moving the body is various ways “massages” the organs, whether via yoga, dancing or other activities.

      • How much that helps things, who knows. And, of course, this is in the realm of speculation, not science, at least not any I’m aware of.

  • Doug Keller

    An additional resource is ‘Recognizing and Treating Breathing Disorders’ by Leon Chaitow, which includes a peer reviewed study, ‘A Review of the Use of Yoga in Breathing Disorders,’ which is very good, includes alternate nostril breathing. Interestingly, they (Shirley Telles and Nilkamal Singh) found that ALL forms of uninostril breathing — both left and right — stimulate the right hemisphere ( a good thing). A previous study of forced uninostril breathing DID show that the lateral hemisphere was activated; but in the ‘yogic’ version, the right hemisphere was activated by all forms of nostril breathing, including alternate. This was determined by testing on hemisphere-specific tasks.

    The two nostrils were shown to have an effect on blood pressure: for instance, right nostril breathing practiced over a one month period for 45 minutes per session increased oxygen consumption and caused sympathetic activation, including slightly raised mean blood pressure along with peripheral vasoconstriction, verifying the ‘energizing’ effect. Based on this, they found the one contraindication was that right nostril breathing should be avoided by those predisposed to chronic hypertension. Left nostril breathing had a parasympathetic effect.

    Some of the strongest and most positive findings were on brahmari: practicing brahmari every day combined with left and alternate nostril breathing over an 8-week period reduced symptoms in patients diagnosed with anxiety neurosis. Additional results of measurable effects were cited in several studies. These are just a few examples from this study, and the peer reviewed studies cited within it.

  • As a certified yoga therapist schooled in pathophysiology and mental health, I have long believed that the way to raise the level of awareness (and credibility) of this growing profession is to educate the established medical community. When my response to a client’s statement of “my doctor told me to do yoga” is “that’s wonderful; did your doctor explain how it can help you?”, I get an answer in the negative. If more physicians had a good understanding of the scientific relationship between a yoga practice–and I’m referring to a comprehensive practice that includes all aspects of yoga–and overall health and well-being, we wouldn’t be reading ignorant statements and empty claims by people like Hamblin and Broad. More physicians are open to learning, but we still have a ways to go.
    I’m grateful for the accessibility of yoga in our culture, but I’m also disappointed in how the practice has been diluted and reduced to “exercise,” without enough emphasis on understanding HOW a yoga practice–which includes various forms of pranayama and meditation (that are sadly missing from a lot of classes)–can benefit one’s overall health. I personally have been able to stabilize my mental health through these practices, some form of which I do every day.
    Thank you, Dr. McCall, for being a valuable voice of authority in bridging the field of science with this sacred practice.

  • This is the greate story and very inspiring, thanks!

  • This article interested me very much. You described it great.

  • I simply like different ways of focusing on the breath, and sometimes it works better for me than at other times, when other ways work better

  • This is the greate story and very inspiring, thanks!


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