I am writing a YogChikitsa post after a long gap. I hope you all are keeping safe, and taking all necessary precautions during this COVID-19 pandemic.  

There has been breaking news about a Canadian pharma company SaNOtize claiming that its Nitric Oxide Nasal spray (NONS) kills 99.9% COVID-19 coronavirus. The company is now seeking emergency approval from different governments to help in the fight with COVID. This NONS has been found to dramatically reduce Covid-19 viral load in infected patients after completing early-stage clinical trials in Canada and UK. This is good news for humanity!

While it may take some time for trials and commercial availability of NONS (and also cost could be a factor with an expected price of $30 per bottle), I would like to share an alternative way of generating Nitric Oxide – and that too naturally, through the practice of “Bhramari Pranayama”, which is known to elevate the levels of Nitric Oxide in the body. In Yogic texts for centuries Bhramari Pranayama has been known to be beneficial for human health – particularly the respiratory system and the nervous system.

So, if claims about NONS in the context of COVID prevention and treatment are true, and facts/evidence about humming improving the NO production in the upper respiratory tract are to be believed as evident from studies covered below, “Bhramari Pranayama”, even in its simple form, can be of a significant benefit to alleviate the COVID effect. If done regularly, or at least during/before the onset of COVID infection, it can help reduce the spread – possibly from the upper respiratory tract to lungs – which is where most fatalities occur.  

Guideline for Yoga Practitioners for COVID-19 by the Ministry of AYUSH in Government of India, also includes the practice of Bhramari pranayama indicating that it may increase Nasal Nitric Oxide.

About Nitric Oxide

First about Nitric Oxide. Nitric oxide has been known for years to have a broad antimicrobial effect against certain bacteria, fungi, helminths, protozoa and viruses. The healing properties of Nitric Oxide was first discovered by Prof. Ferid Murad of Stanford University, for which he shared the Nobel Prize in Medicine in 1998. Prof Murad, is now a member of the SaNOtize board. As per him, Nitric oxide is an incredibly versatile molecule that regulates almost everything in our body. When used therapeutically, it has a well-documented safety profile and is demonstrated to be effective against a wide variety of viruses, bacteria and fungi.

Bhramari Pranayama

Bhramara in Sanskrit means bumble-bee. Bhramari Pranayama is so called because during the exhalation a humming sound like bumble-bee is produced. Those who are new to Yoga practice – and Pranayama in particular, should note the following. It is generally recommended not to practice Yogasana and Pranayama without guidance of an experience teacher. Just like the SaNOtise is requesting governments for emergency approval of the spray, I am suggesting doing simple Bhramari Pranayama with all the following precautions – just as an exception during this critical time:

• Steps:
  • Sit erect and relaxed in a pose comfortable to you. You can use a chair as well with your back completely rested and relaxed. If you sit on the ground, you can use a pillow or a bolster.
  • Make sure that your spine is straight, shoulders stretched out and arm pits open. Those familiar with Pranayama practice can perform Savasana and Ujjayi Pranayama before Bhramari.
  • Gently plug your ears with your index finger.
  • Inhale deeply as naturally as possible – but without straining yourself. Do not force yourself to overdo it or expand your chest or abdomen. But focus on getting in more air than your regular breathing pattern. You will slowly learn this.
  • Exhale slowly making humming sound from your throat. You will feel the vibrations of the humming on your fingers.
  • This completes one cycle of Bhramari pranayama.
• Precautions:
  • Always breathe from nose – and not from the mouth.
  • Do it on empty stomach.
  • Start the practice of Bhramari Pranayama very slow. Start with 2-3 cycles initially – with three normal breathing cycles between each cycle. You can repeat such cycles after a gap of at least a few hours. Increase the cycles as you get practice. But don’t do more than 8-10 at a time.
  • Slowly you may increase the depth of inhalations and exhalations.
  • DON’T hold the breath – NO KUMBHAK (or breath retention).
  • Don’t overdo. Overdoing may cause nervous system disorders – starting with as simple as dizziness.
• With Shanmukhi Mudra:
  • Bhramari can also be done with Shanmukhi Mudra. In this Mudra, you use your thumbs to close your ears and place the index finger on your forehead, just above your eyebrows. The middle fingers rest gently on your closed eyes. The ring fingers are on the sides of the tip of the nose. The little fingers are gently placed above the lips. Jalandhar Bandha (Chin lock) is not needed, which otherwise is mandatory in Pranayama when you include Kumbhaka (holding of the breath). Since in Bhramari, you are not supposed to hold the breath, no need for Jalandhar Bandha. Start with simple Bhramari covered above – with simply plugging your ears with index fingers. Shanmukhi Mudra is an advance practice, and hence can be done once you have achieved some comfort with simple one.

Scientific Evidence

Now some science. Nitric Oxide plays an important role is upper respiratory tract – involving nose and sinuses. Here is a nice video by a surgeon covering the anatomy and physiology of upper respiratory tract. Nitric Oxide is present in our exhaled breath, which was first confirmed scientifically in 1991. It originates in the upper respiratory tract. It is produced from the blood vessels and mucosa of nose and paranasal sinuses.  This is primarily released from paranasal sinuses, and acts as a neurotransmitter. Nasal Nitric Oxide has a special function called “Host Defense”, which keeps the sinuses sterile against intruders like bacteria, fungi, helminths, protozoa and viruses.

The nitric oxide also plays an important role in situations involving stress and distress. It acts to reverse the effects of norepinephrine and cortisol, and to reverse the dominance of the sympathetic nervous system. It strongly promotes relaxation of the muscular layer within the vascular walls, thereby leading to vasodilation.

Enzymes responsible for Nitric oxide production have been demonstrated both in the nose and in the paranasal sinuses. In the sinuses, the level of Nitric Oxide has been reported to be several-fold higher than in the nose. A research study published in American journal of Respiratory and Critical care Medicine in 2002 and thesis published in Sweden in 2006 concluded that the oscillating airflow produced by humming speeds up the exchange of air between the sinuses and the nasal cavity and thereby increases nasal Nitric Oxide production.

A case study published in 2006, indicated that strong humming stimulated endogenous nasal nitric oxide production and helped in rhinosinusitis.

A study published in 2008 in National Library of Medicine  reveals that relaxation response that increases the dominance of parasympathetic nervous system increases Nitric Oxide (NO).  

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