David Shannahoff-Khalsa is the Director of The Research Group for Mind-Body Dynamics, BioCircuits Institute, University of California San Diego (UCSD) and a Member of the UCSD Center for Integrative Medicine; email dsk@ucsd.edu; websites: Sacredtherapies.com & www.theinternetyogi.com.
Introduction to an Era
My scientific career started in 1970 at The Salk Institute for Biological Studies in La Jolla, California. At that time I was an undergraduate student at the University of California San Diego (UCSD), and I was invited to do an independent research project synthesizing new and potentially important analogues of the nucleosides, nucleotides, and polynucleotides, the building blocks of RNA, DNA, and our genetic code. The purpose of the work on the nucleic acids was to develop analogs that could be used to disrupt the replication of viruses and also to potentially help treat cancers. Those were the golden years when there was a great hope that such analogs could be the panaceas for treating a variety of viral diseases, and especially cancer. However, after four years in the lab, due to the influence of an Indian chemist, my interest shifted more towards the eastern philosophies. I was intrigued by the depth of understanding in this area to the nature of the mind, states of consciousness, health, and what was a new concept for me – enlightenment. I started reading voraciously on the topics, and I eventually found books on yoga with mention of the Kundalini. One day in the summer of 1974 I had an opportunity to take a class on Kundalini Yoga (KY) as taught by Yogi Bhajan. My first class led to a bliss-like state. This experience led to a near daily practice either by myself, or with the woman teaching a local KY class. Besides the near immediate and powerful effects of the exercises and meditation techniques, I was amazed by the diversity and how highly structured these meditation techniques were, and much more so than what I had read about or practiced with other kinds of yoga and meditation. This fed my scientific appetite and my hunger to know the unknown. These philosophies and experiences opened a whole new vista for me. After all, I was, and remain, an experimentalist. Immediately, I wanted to teach the techniques to my friends and to others so they too could have this amazing experience. After a few months of practice, I entered a teachers training program. And four months after starting KY, I met Yogi Bhajan, the master who brought KY to the west. Prior to meeting him, I had never conceived of the value of having a spiritual teacher, or even that enlightened people still existed on the planet. While I had met Nobel laureates and other great scientific wizards, meeting Yogi Bhajan was another experience altogether for me.
In 1976, while still at The Salk, I had committed to do all I could in this lifetime to bring credibility and awareness to this huge ancient technology of the mind. Today we call this “KY as taught by Yogi Bhajan™.” During his lifetime he taught about 5000 different meditation techniques, and 100’s of different and sequence specific exercise sets that all had unique purposes and benefits. With each class he taught something new, to help empty the “mail bag” for techniques that had been kept secret for the last 3000 years. I realized how important it was to bring this ancient knowledge to the forefront of science, and to use science to help validate the techniques.
Work on the Basic Sciences
My first scientific experiment in this field started in 1976. The study was to validate that the two cerebral hemispheres alternated in dominance with an ultradian periodicity that was tightly coupled to the nasal cycle. We published this study in 1983 with the title “Alternating Cerebral Hemispheric Activity and the Lateralization of Autonomic Nervous Function” . Yogi Bhajan had taught his students about this phenomenon, its significance, and that this rhythm exhibited both during waking and sleep. I knew it would eventually set a new precedent for what yogis knew in the arena of the neurosciences, and that it would contribute to a better understanding of the brain, the nervous system, and psychophysiological states. Until this work, brain researchers had thought that the two cerebral hemispheres were significantly different and that they had a static relationship with each other. However, it was not known that one hemisphere dominates over the other with an ultradian rhythm during both waking and sleep. This ultradian rhythm of the autonomic nervous system (ANS) and central nervous system (CNS) averages about 2.5 hours in duration, although with great irregularity and wobble, like all ultradian rhythms. The contemporary idea at the time was that the two hemispheres specialized in different tasks and that different brain regions on each side would activate as needed based on demand. To add to the excitement about the differences in the two hemispheres at the time, the brilliant work of Roger Sperry on split-brain patients made it clear that the two hemispheres also had significantly different “personalities.” In 1981, Sperry won the Nobel Prize in Physiology and Medicine for his seminal work on split-brain patients. This also suggested that we had two basic but somewhat complementary “personalities” that would alternate in dominance over time.
The nasal cycle was first discovered in the west in 1889 by Kayser, a German physician . This so called cycle manifests as an ultradian rhythm whereby the two nostrils alternate in dominance with greater airflow on one side, then switching to greater airflow on the other side, with an average of about 2.5 hours, and with great irregularity. The nasal cycle is regulated by the ANS. While the nasal cycle was studied at several leading research centers in the 20th century, the primary purpose of the work was to discover a cure for the common cold. Over the centuries, in the west, the nose has gained little attention, other than that for the discomfort caused by colds, and to improve esthetic appearances. However, the differences of congestion and decongestion that manifest in the nose are usually only noticed when a person has a cold. Nonetheless, the nasal cycle is in fact the most important physiological marker for mind-body states. But who pays attention to the airflow through their nose? We usually have more “important” things to think about. For many centuries the view of the nose, apart from its esthetics, has been considered a rather banal structure. People tend to laugh when any importance is given to it in science, especially if the idea is that it can tell us something critical about our brain and state of mind.
Yogi Bhajan also taught us that forcing the breath through one nostril or the other could make a “world” of difference. He told us that unilateral forced nostril breathing (UFNB) selectively activates the contralaterial (opposite) cerebral hemisphere and the ipsilateral (same side) sympathetic nervous system on that side of the body. When the sympathetic nervous system dominates on one side the blood vessels in that nostril constrict and thus allow for greater airflow. Simultaneously, the other side will have greater parasympathetic activity, leading to greater blood flow in the vessels and thus greater nasal congestion. Since the sympathetic and parasympathetic fiber tracts do not cross over in the brain, the hemisphere contralateral to the dominant nostril has relatively greater blood flow, due to parasympathetic activity, and thus, that mode of intelligence dominates. We first introduced this work on UFNB to the western sciences using EEG. We published a paper entitled “Selective Hemispheric Stimulation by Unilateral Forced Nostril Breathing” in 1987 . Later, I also published the first reviews on UFNB . Today, many yoga teachers know that breathing through one nostril is different than the other, and that right nostril breathing stimulates the “sun” energy, and left nostril breathing stimulates the “moon” energy. However, very few know what UFNB does to the hemispheres, and that the two hemispheres alternate in dominance during both waking and sleep. So the terms “sun” and “moon” remain rather esoteric concepts, when in fact they can be understood with both a unique simplicity and much greater complexity when the correlates are understood.
Without a serious personal study of this mind-body phenomenon one never really learns about why and how ones moods, interests, drives, desires, emotions, abilities, performance skills, and essentially all of our physical and psychological activities wax and wane throughout the day (and night). When we know it is important to have a conscious relationship with our breath, we also need to have a conscious relationship with the phase of our nasal cycle, and its correlates. Without a conscious relationship to the nasal cycle, we cannot learn to control this rhythm. This ANS-CNS rhythm is the most basic mind-body rhythm. In fact, one can learn to consciously control this rhythm even without altering the nasal airflow patterns by using UFNB or the yoga danda stick. But very few yogis ever develop that conscious skill. There is a specific meditation technique that Yogi Bhajan taught for developing that ability. One who masters it can selectively activate one hemisphere over the other from one breath to the next. That is indeed a mastery of the primary nadis (also called meridians) and state of mind. After all, yoga is about learning to control the mind and states of consciousness.
Another related study compared verbal (left hemisphere) skills and spatial (right hemisphere) skills with nostril dominance. A significant relationship was obtained between the pattern of nasal airflow with normal breathing and relative spatial vs verbal performance. Right nostril dominance was associated with relatively greater verbal performance, and left nostril dominance was associated with relatively greater spatial skills. However, while I was a collaborator on this study that was performed in Canada, I did not oversee the details of how it was run, and the part of the study that employed closing one nostril only used a cotton plug to block the nostril. This experiment did not employ the “forced” action with the breath which has much more powerful effects. So that part of the study did not exhibit an affect on performance. This is one reason why the term UFNB should be employed. UFNB is not meant to be a passive exercise. UFNB is an active exercise where the air is selectively forced through one nostril, regardless of the initial dominance. This makes a huge difference in results.
We conducted two more studies using naïve subjects looking at the effects of UNFB on verbal and spatial skill performance. These studies demonstrated that right UFNB increased verbal performance and that left UFNB increased spatial performance . These two experiments included the “forced” element of the practice. During that period, we also conducted a study on using UFNB to measure beat-to-beat changes on the heart using impedance cardiography with a breath pattern of equal times for inhaling and exhaling at 6 breaths per minute, and another one using a very rapid pattern called “breath of fire,” or kapalabhatti, at 2-3 breaths per second . These experiments demonstrated that right UFNB increases heart rate (HR) compared to left, and that left UFNB lowered HR. We also showed that stroke volume was higher with left UFNB, compensating for lower HR. Left UFNB also increased end diastolic volume. These results demonstrated a unique unilateral effect on the sympathetic stimulation of the heart. This was another seminal study and first of its kind for looking at the effects of UFNB on the cardiovascular system using beat-to-beat measures.
In 1984, I convinced two researchers at UCSD to measure the nasal cycle during complete rest in normal healthy adults, and to simultaneously measure venous blood flow via the arm with high frequency sampling, to see if the catecholamine neurotransmitters would be coupled to the nasal cycle. Previous studies had shown that the catecholamines also had ultradian rhythms with a similar periodicity. Michael Ziegler, an authority on catecholamines and the director of the lab, had the brilliant idea to measure both arms simultaneously, because we might see differences in the two arms. In fact we did. We observed that the ultradians of the catecholamines would exhibit with one arm being high in concentration while the other arm was low, and that this sinusoidal-like rhythm would alternate from side to side, with significant wobble, and parallel the nasal cycle. This was the first study to show that neurotransmitters on the two sides of the body were 180 degrees out of phase with each other during resting states. Physiologists knew about ultradian rhythms in the catecholamines, pituitary hormones, and almost all physiological and psychological phenomenon. But due to the wobble (irregular) nature of these factors, the big picture on mind-body states was elusive. Previous studies on the ultradians would usually only measure one system of the body, and measures on one day were often very different compared to the next. This led to much confusion about the nature of the ultradian rhythms. However, having learned about this mind-body rhythm from what the ancient yogis had discovered, my insights here guided me in my work to know which experiments to do.
In 1990, we decided to measure multiple systems simultaneously during waking rest with relatively high level sampling rates to compare the nasal cycle with other known ultradian rhythms of the cardiovascular system, the neuroendocrine system, and the fuel regulatory system. We included measured of cardiac output, thoracic fluid index, heart rate, ejection velocity index, stroke volume, and ventricular ejection time (averages of 12 heart beats), and systolic, diastolic, and mean arterial pressures using an automated cuff at 7.5-min intervals. Blood samples were taken simultaneously every 7.5 min from both arms with the use of indwelling venous catheters. Assays for adrenocorticotropic hormone, luteinizing hormone, norepinephrine, epinephrine, and dopamine, and insulin, were performed on the samples from each arm. Similar periods were observed with all 4 systems. These results suggested that either a common oscillator (the hypothalamus) or mutually entrained oscillators regulate these systems . We also included a unique model in the 1996 publication for how the hypothalamus integrated, regulated, and controlled this ANS-CNS rhythm. This further suggested that these coupled rhythms were all part of a more pervasive and inclusive rhythm for understanding psychophysiological states. However, prior to this experiment, I had published the same model for hypothalamic regulation five years earlier in a chapter in a prominent scientific book on stress.
I also wrote an extensive review paper on all the studies that demonstrated the ultradian rhythm of alternating cerebral hemispheric activity in humans and other mammals that was published in 1993. This review did not cover the nasal cycle . I had previously published a review in 1991 entitled “Lateralized Rhythms of the Central and Autonomic Nervous Systems,” that was presented at the International Society for Psychophysiology. The latest review on the topic of the ANS-CNS rhythm and mind-body states, that included all the relevant work by others, was published in 2008 as a book in the series International Review of Neurobiology.
A sleep study that measured the ultradians of the nasal cycle, alternating cerebral hemispheric dominance using EEG, and the beat-to-beat measures of the cardiovascular rhythms was published in 2000. This study also showed how the two cerebral hemispheres were coupled to the nasal cycle and the cardiovascular rhythms. Another sleep study published in 2001 showed how the cerebral rhythm was coupled to the sleep stages of Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep. Greater right hemisphere EEG dominance was found during NREM stage 4 sleep, and greater left dominance during REM sleep for total EEG, delta and alpha frequency bands. Theta was similar, but not significant, and beta was equivocal. We concluded that “as observed in earlier ultradian studies, the lateral EEG and left minus right (L-R) EEG power had a common pacemaker, or a mutually entrained pacemaker with the autonomic, cardiovascular, neuroendocrine and fuel- regulatory hormone systems. These results for L-R EEG coupling to sleep stages and multi-variate relations may present a new perspective for Kleitman’s Basic-Rest Activity Cycle (BRAC) and for diagnosing variants of pathopsychophysiological states.”
Kleitman had proposed a brilliant hypothesis that he called the BRAC during the 1960’s, based primarily on his observations of how REM and NREM sleep, would alternate to help account for the ultradian rhythms observed during sleep and during waking . But he did not include the phenomenon of the alternating dominance of the two cerebral hemispheres, or the nasal cycle, or that the ANS alternated in dominance on the two sides of the body. The phenomenon of the lateralized ANS-CNS rhythm is the fundamental determinant and what regulates what Kleitman called the BRAC.
In 2004 we published a study entitled “Hemodynamic Observations on a Yogic Breathing Technique claimed to help eliminate and prevent heart attacks: A Pilot Study”. This paper was based on a pranayama (breathing technique) taught by
Yogi Bhajan, that when mastered involved a technique where each breath cycle takes 1 min and is practiced with this rate for at least 31 min. The pattern involves slowly inhaling through the nose for 20 sec, holding the breath for 20 sec, and slowly exhaling through the nose for 20 sec. We showed preliminary evidence that this pattern at one breath/min for 31 min, when practiced over long periods of time, was able to reset a pacemaker in the brain stem called the cardio-respiratory center. We postulated that this pacemaker was re-patterned and reset using the “20-20-20 breath.” The profiles of how this one breath/min pattern affects heart rate, stroke volume, and mean arterial pressure on a beat-to-beat basis shows breath-to-breath dramatic changes in these measure and a unique effect when practiced regularly. This pattern supposedly also has dramatic benefits for endurance, stamina, and stability when practiced over the long-term. The mental effects are also uniquely beneficial.
Clinical Trials Treating Obsessive-Compulsive Disorders
My prior work on the basic sciences was required to show that perhaps KY meditation techniques could lead to the improvement and possibly a cure for psychiatric disorders. My first attempt to treat a psychiatric disorder in a clinical trial came in 1992 when I was invited to collaborate on the treatment of patients with obsessive- compulsive disorder (OCD) using KY. This trial was a pilot and it did not include a control group. I had devised an 11-part KY protocol that included a pranayam claimed by Yogi Bhajan to be specific for treating and curing OCD. The pranayam was another 1 breath/min technique when mastered. The pattern involved left UFNB that when perfected had 4 phases, a 15 sec slow inspiration, a 15 sec hold the breath in, a 15 sec slow expiration, and a 15 sec hold the breath out, all repeated for 31 min for 90 consecutive days. The claim of the ancients, as told by Yogi Bhajan, was that perfecting this pattern for 90 consecutive days would cure OCD and the OC spectrum disorders.
We ran a 12-month trial with patients who had previously attempted first line treatments and had not benefited significantly from treatment. We had the standard inclusion and exclusion criteria required in any rigorous OCD treatment study. Here is the published Abstract for that trial:
The aim of this study was to investigate the clinical efficacy of yogic techniques in the treatment of eight adults with obsessive-compulsive disorder (OCD). A specific yogic breathing pattern has been prescribed for the treatment of OCD, as well as others for treating generalized anxiety. A one-year course of therapy was followed. Subjects improved on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) comparing baseline with three, six, nine, & 12 month results (one-way ANOVA for repeated measures, F(4,12) = 3.343, p < or = .046). Five patients completed the study (Y-BOCS results were 83%, 79%, 65%, 61% improvement, and one at -18%), group mean improvement of +54%. The Symptoms Checklist-90-R showed significant improvement comparing baseline and 12 months using two-tailed T-tests for OCD (t = 13.856, p < . 001), anxiety (t = 3.167, p < .051), and global severity indexes (t = 7.314, p = .005). Perceived Stress Scale scores showed significant improvement for the five test periods (one-way ANOVA for repeated measures, F(4,12) = 9.114, p < or = .001). Five patients were well stabilized on fluoxetine prior to the study, three stopped medication after seven months or less, and two significantly reduced it, one by 25% and the other by 50%.
These techniques, merit further study under controlled conditions and could help lead to new approaches for the treatment of OCD and perhaps other impulse control and anxiety-related disorders.
The entire 11-part OCD protocol was later published in 1997 in a book chapter in a prestigious and mainstream clinical book for treating OCD, in a short review paper in 2003, in another book chapter in 2008, in my first book published in 2006 by the professional book division by W. W. Norton & Co, Inc., , and in my last book published in 2012 by W. W. Norton & Co, Inc. .
A second clinical trial using the same 11-part KY OCD protocol was conducted and funded by the National Institutes of Health (NIH) in 1994, by their Office of Alternative Medicine at the time, that later evolved into a NIH center. That trial included a meditation control group, that included 30 min of the Mindfulness Meditation, and 30 min of the Relaxation Response. This matched the approximate time required to run the KY group. Patients were blinded to the names and content of the types of meditation prior to entering the trial and to the other group during the trial. The Abstract for that paper is copied:
The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups-matched for sex, age, and medication status, and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children’s Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y- BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student’s independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Student’s paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements.
Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC, SCL-90-R GSI, POMS, PSS, and PIL; P<0.003 (analysis of variance). This study demonstrates that kundalini yoga techniques are effective in the treatment of OCD.
Another similar but not identical study compared to the 1999 published OCD randomized clinical trial, is now in submission to a journal. I have now presented on this 11-part KY OCD-specific protocol 13 times at the American Psychiatric Association (APA) Annual Meetings since 2003. Eleven of those meetings included the practice of the OCD protocol by participants in Full Day 6hr Continuing Medical Education courses. In addition, other protocols have also been taught and practiced during these courses that are now published in my books. The two APA course titles were “Kundalini Yoga Meditation Techniques for Anxiety Disorders Including OCD, Depression, Attention Deficit Hyperactivity Disorder, and Posttraumatic Stress Disorder,” and “Kundalini Yoga Meditation Techniques for Schizophrenia, the Personality Disorders, and Autism.” Both courses were taught on consecutive days in 2010, 2011, and 2012, and the first one again in 2014.
Other Contributions for Treating Psychiatric Disorders
A single case history with a schizophrenic female experiencing hallucinations was published in 2015. The Abstract for this paper is the following:
Nasal dominance, at the onset of hallucinations, was studied as a marker of both the lateralized ultradian rhythm of the autonomic nervous system and the tightly coupled ultradian rhythm of alternating cerebral hemispheric dominance in a single case study of a schizophrenic female. Over 1086 days, 145 hallucination episodes occurred with left nostril dominance significantly greater than the right nostril dominant phase of the nasal cycle. A right nostril breathing exercise, that primarily stimulates the left hemisphere, reduces symptoms more quickly for hallucinations.
My three books with W. W. Norton & Co., Inc., now include more than 100 different KY meditation techniques, and in addition, numerous disorder-specific exercises that often accompany the meditation techniques Shannahoff-Khalsa D: Kundalini Yoga Meditation for Complex Psychi