We have a potential new 2 step biomarker for bipolar illness.

In order to meet one’s metabolic needs, humans need nutrients and air in the correct proportions and amounts. The function of the brain and of the mind depends on one’s metabolic needs being met. Metabolism is a chemical process which we cannot easily see. Adequate amounts of air reaching the lungs is a key part of metabolism. We can measure this. Testing lung function is not enough. We need to test the neural and motor part of breathing also. Both are crucial for good physical and neurological and mental health. Breathing is especially important for mood.

We can measure whether the person is exchanging enough air to meet their metabolic needs. It takes 2 steps. The first is to obtain resting awake respiratory rate per minute. This skill can be taught in a basic first aid class and does not need a health professional to obtain. The second is to measure tidal volume and this takes a spirometry test from lung function lab or from a doctor with a portable spirometer. Multiply to obtain MINUTE VENTILATION. Minute ventilation will tell you how many litres of air the person is exchanging per minute. Minute ventilation will tell a health professional how well the neural and motor units of breathing are working. You can have healthy lungs, like Paula yet you can still have neural or motor injury limiting the responses to internal and external stressors such as accidental malnutrition, dehydration, hypercapnia, infection, inflammation, wound healing, etc.. Adequate breathing is vital to the function of mood, behaviour, thermoregulation, digestion and mind. Testing lung function is not enough. We need to test the neural and motor part of breathing also. Both are crucial for good physical and neurological and mental health. Breathing is especially important for mood. Breathing is especially important for mind and may explain reversible loss of mind. Our brains track the amounts of carbon dioxide [a product of metabolism we need to exhale] in our blood because our brains “know” that this is key to normal function of the mind and of the body.

This is what the data obtained on a single subject [Paula] over the past 20+ years tells us. This is what Dr Emile Kraepelin’s data shows in thousands of people. https://archive.org/details/manicdepressivei00kraeuoft, 1921Topics Psychiatry — Early works to 1900, Manic-depressive illness, ParanoiaPublisher Edinburgh : LivingstoneCollection gerstein; toronto; medicalheritagelibrary; university_of_torontoDigitizing sponsor MSNContributor Gerstein – University of TorontoLanguage English

This data suggests that the complex neural and motor act underlying the movement of air in and out of our lungs is incredibly flexible, robust, stable over time and fascinating.

Paula, we now understand, exchanges 1.5 Litres of air per minute [at rest, when awake]. She does not exchange 6 – 8 Litres as is assumed by the scientific literature. Science and medicine evolve as we obtain new data.

We have a new 2 step BIOMARKER to evaluate in many different populations of patients. This new biomarker is MINUTE VENTILATION, because breathing is a neurally mediated motor act as well as involving the lung. And neurological part of breathing has been neglected because it is so seamless and completely arranged for us involuntarily and in ways we are not conscious of. No wonder we took breathing for granted.

We can now do endless studies that have never been done before. We can get data on babies [like Paula] resuscitated at birth and follow this biomarker through life compared to babies who did not need to be resuscitated. We can look at adults who smoke to see if their neural and motor systems underlying the ability to exchange air in and out of their lungs is a factor in their addiction. We can look at first episode major depressive patients [unmedicated] to see if some are depressed because of acquired or genetic respiratory depression- as shown by minute ventilation. Lung function may be completely normal

This is the understudied neural and motor component of breathing. This is something that is vital for being alive, feeling good, and able to think and remember to our maximum abilities.

We have a new 2 step BIOMARKER for family doctors and neurologists and neuroscientists as well as students of biology.