(happy pop music) - Welcome my friends to
the Bob and Brad Podcast, produced by Bob and Brad, the two most famous physical
therapists on the internet. I am Bob, and I'm exactly one
half of the Bob and Brad team. Today my guest is Patrick McKeown, who is, I'm just gonna put it very simply 'cause he does go over his background. He is the expert on breathing. And you think, oh, I know how to breathe. I'm breathing, I'm alive. You're gonna be amazed at
how it can affect your life as far as anxiety and sleep and digestion. And I mean, it just goes on and on, the how it affects your health if you're doing it improperly
and most of us are. And I have been on this
journey for at least a year now in trying to improve my breathing, and I have a ways to go, but
it has made a big effect, has had a big effect on my life. Welcome to the program, Patrick McKeown. - Thanks very much, Bob, good to be here. - Yeah, great to have you. Again, as I was mentioning
to you off-screen here, really a topic of interest
of mine is breathing. Maybe we would best be
starting by having you cover your backstory, how you became
interested in breathing, and your training. - Sure. I was a kid growing up with
asthma, as many kids do. And I always had chronic
nasal obstruction, which is very common with asthma because the lungs is not
isolated to the nasal airway, it's one airway. So whatever's happening in one
aspect of the airway travels up and vice versa. And with that, when
you have a stuffy nose, you're more liable to have sleep problems. So I had undiagnosed
obstructive sleep apnea and I didn't realize, it was
only about 20 years later. But I remember as a kid and as a teenager and into university, I was very much caught for breath. I was taking quite a lot
of rescue medication. I had a couple of
hospitalizations for asthma, but I think that the one thing that really got me was my fatigue. And when I was staying in student dorms, I spent one year in Rasmussen, Sweden at University of Uppsala,
and the students told me that they could hear me snoring and I was stopping breathing. - Really? - But of course I had
no idea what that was. It was about four years later,
three or four years later, after I graduated, because even
getting through high school and getting through university, it's tough going when
you have sleep problems. And it's tough going when you
have dysfunctional breathing. And that seldom, I think considered. I was reading a newspaper
article and it was about the work of a Russian doctor, his
name is Konstantin Buteyko. And he was talking about the importance of breathing in and out through the nose, and he was talking about the
importance of breathing light. And I was doing neither of those things. I was a persistent mouth breather, and people would always hear me breathe. I was caught for breath, et cetera. So I started practicing his methods and it's not an exaggeration to say that when I started breathing less air, I could feel the temperature
of my fingers increasing. And I always had cold hands and cold feet. Well, I also tried the
nose unblocking exercise, and I was able to decongest
my nose, not perfectly, but it gave me quite a bit of relief. I started then making
the transition from being a chronic mouth breather
to a nose breather. I was feeling air hunger when
I was making the switchover. - Sure. - I taped my mouth closed the
first night, taped it closed, but I used Breathe Right
strips to keep my nose open just in case. The first morning waking up-- - I've done the same, by the way. Absolutely the same. - And you know, the first
morning kind of waking up, just getting used to it. It was the second morning I woke up, it was the best night's sleep
I had in about 15 years. So I think there's something
really important, Bob, in recognizing the role that
the nose does in human health, because it totally gets overlooked. And when we think about
breathing and nasal breathing, I would always say that nasal breathing is the very foundation. And on top of that, then we
can improve breathing patterns. And I would also say that by
changing breathing patterns, you can influence major
disciplines of health. - I agree a hundred percent. You're preaching to the choir here because yeah, I went through the same thing. A chronic mouth breather. And you can probably see from
the structure of my face. I mean. So I started with the nasal strips, and I found out later that
I no longer needed them. I don't know if your
body, it seems to adapt and structurally and I
haven't used them since. But I would, even with the nasal strips, kind of wake up like, I'm
not getting get enough air. This might be a good time
to mention you actually have a form of tape, I'll
be interested in this. I just use some tape off the internet, hypoallergenic tape. - Which we were using for
about 15, 20 years, you know? But it always came a problem
when it came to children and teenagers. Because I would say about 50%
of the work that I was doing for health, 50% of people
who I was working with were the youngsters. And we really needed to get
them to get the mouth closed and the tongue resting
in the roof of the mouth. Because just as you alluded to, I have the same facial problems. And what it does is it's
not just aesthetically that it's not as pleasing,
even though I have to say, you're a very handsome looking man, Bob. I just put that in now. But where it really messes us
up is it messes up our sleep. - Yes, it does. - Because when the jaws are set back and when the nostrils are pinched and when the nasal cavity is infringed and when the mouth is open
and the tongue is encroaching the airway, and sleep is really important, that deep sleep for recovery. So the tape is Myotape and
I'll do a demonstration of it. So the idea came for
working with children, and then we started noticing, actually it became popular with adults. And I think it makes sense
because a lot of people when they hear about taping the mouth, they feel it's totally off the wall. And it's the one thing
that we do that just seems a little bit off the wall,
but the motive is good. And sorry, this is making
a bit of noise now, so I'll just take it out of the package. - No, I think I was a little
bit of the same mindset that I was skeptical, but
it has been a game changer without a doubt. And I wear it throughout
the day quite often when I'm working at-- - The tape, as well? - Yes, because I'm in such
a habit of trying to breathe through the nose. - So this tape goes, now
this is the medium size. It's the only one I can get my hands on. So I'm gonna stretch it just about 30%. - Interesting. - It's stretchable, it's elasticated. - [Bob] Yeah, that's way different. - And it's pulling the lips together. So that helps to maintain lip closure and then people don't
be apprehensive about it when it comes to sleep. And of course, children, as well. So we have children wear it
during wakefulness to get them transitioning to nasal breathing. And, you know, once the
child is well able to adapt to nasal breathing during the day, then we'd consider it during
sleep under supervision. But, you know, it's just
one of those things. If I was to say the one
tip that can offer the most is getting the mouth closed during sleep. Nobody should be waking up with
a dry mouth in the morning. The sad thing is that
most dentists will realize that their mouth breathing
patients come in, they have more dental cavities, more gum disease, more bad breaths. - Absolutely. - But yet most dentists don't
always say to their patients to breathe through the
nose, but many of them are. So it starting to happen, but it hasn't yet became widespread. - Right, I was never warned about that. And the thing I found I
didn't even realize is I wasn't looking for it,
is my teeth are whiter. I mean, they were yellowing at night and it's funny, I have a
dentist appointment coming up, so I'll be curious to see what they say. But it's just made a huge
difference dental-wise, crazy. And your tape is available at oxygenadvantage.com? - And myotape.com. - And myotape.com. - Yeah, so it's called myo because there's a discipline
called myofunctional therapy. And a myofunctional therapist
is somebody who often works with an orthodontist. - Oh sure. - So when the child is mouth breathing, it's the mouth breathing that
contributes to overcrowding of teeth. And orthodontics who are aware of airway and functional orthodontistry,
they're not just wanting to fix and straighten teeth,
but they also emphasize in terms of developing the
airway and developing the face, but also addressing the
bad habits which have led to overcrowding of teeth
in the first instance. So it's a much different approach. So even in orthodontistry,
there's two schools of thought and one is quite different to the other. - And this has been an epidemic. I mean, as a society, we're
developing these underdeveloped nasal passages and overdeveloped jaws. I mean, to some extent. - Yeah, yeah. And all you have to do
is just to get an idea of this is to go into
any primary school age, junior school, and ask the
number of kids that are 11 years of age or 12 years
of age who are embarking on orthodontic treatment. - Sure, yes, exactly. - And it's likely to be 75%
or it could be even be higher, but overcrowding of teeth
is not just pointing to the problem of the teeth,
it's pointing to the fact that the jaw is too small. And when the jaw is too
small, there's not enough room for the tongue. And when there's not
enough room for the tongue, the tongue has only got one place to go and that's back into the airway. And then this is increasing the risk of obstructive sleep apnea
for the rest of the life. - Yeah, I misspoke. My jaw is bigger on the bottom, but it's under-developed on upper part, so that's what you must be talking about. - Well, it may be due to having
a low tongue resting posture because it's the pressures
exerted by the tongue which help to develop the maxilla. But if the mouth is open, the
tongue is not able to rest in the roof of the mouth
because the person is breathing through the mouth. So as a result, then tongue
is more likely to be midway around the floor of the mouth. And then it could be that the
tongue then is developing, well, it may not be necessarily actually that your lower jaw is too far forward. The problem is that the
maxilla is not forward enough. If the maxilla was-- - Under-developed, too. - Exactly. - I know that it was one
of the, early on in life, I went to a dentist and it was
actually a student training and she thought something
was wrong with my jaw and she took pictures of it and everything because it was so under
developed in the upper part. Now you've written several
books and I've read two of 'em, The Oxygen Advantage
and The Breathing Cure. Would you like to just
mention a few of your books and they're available
everywhere, I believe. Correct (crosstalking) Amazon. - Yes, they're still available. The first book I wrote, I
suppose, when I started off teaching breathing in 2002, nobody really wanted to take me seriously. And I was talking about the
importance of nose breathing and the importance of breathing to change your biochemistry, et cetera. And I was putting it out there
that at the time there were a couple of clinical trials
using the Buteyko method for asthma, but again,
nobody really knew about it. And I didn't feel that the
healthcare profession wanted to know about either. So I started writing my
first book in 2002 and 2003, to get it out into the hands
of the general population and to show them, here are the exercises. So I simply just included, every book, I've always included the exercises and let people practice it for themselves. And then they will know
if there's truth in it by virtue of it works, quite simple. And so the first book I
wrote was a book called, Close Your Mouth. So the title is kind of self-evident. And the second one then
was Asthma Free Naturally. And the third one then was
Always Breathe Correctly, ABC. So that was for young
children, so it was full color. And then I wrote a book
with an orthodontist in 2010 called Buteyko meets Dr. Mew
and Dr. Mew now is about 92 or 93 years of age. But for 50 years, he has been
instructing his patients, mouth closed, tongue resting
in the roof of the mouth. And he says, if you can
get your mouth closed and your tongue resting
in the roof of the mouth, there is no job for me. Because when your mouth is
closed and your tongue is in the roof of the mouth,
nature is going to ensure that the development of your
face as the way it should be. Now unfortunately, he got
a little bit ridiculed by his peers, but now people
are starting to realize that what he has been saying for 50 years has actually been correct. So I wrote that book back in 2010. I used to go over to his clinic in London, and they gave me permission
to sit down on the couch while they were working
with their patients. And his son, Mike Mew, and there would be great banter going across. And yeah, so I thought I was
really getting that insight. And then I wrote a book
called Sleep with Buteyko, looking at the application of breathing for the pheno, well it wasn't
phenotypes of sleep apnea back then because that's
new, but sleep apnea. Anxiety Free was another one. And I remember going around
Ireland between 2010 and 2013, I was giving these kind
of small workshops. There was a lot of anxiety
here because it was the post-economic crash and
a lot of people losing jobs and houses were devalued
and all of that stuff. And 3,000 people attended small
workshops that I was giving over a three-year period. But about 90 to 95% of people
who attended were female. And I couldn't help wondering why are there no males coming in here? Males didn't want to come
into a breathing workshop. And what I had done is I'd
combined functional breathing and mindfulness because
mindfulness, I think is absolutely wonderful, but
I feel it's really, really, really falling short of the mark. And I'll talk about that in a while, Bob. I decided then that we needed to have a breathing technique that's all about improving performance because a lot of men are not
going to go into a bookstore and walk out with a book with
Anxiety under their sleeve. Because maybe, you know, men are men, and that's the way it is. But they'd be happy to
walk out with a book called The Oxygen Advantage because it was all about sports performance. But the very tools that
we were using to generate flow states are the same
tools that we use to bring in quietness to the mind and help reduce anxiety of the mind. And, you know, it worked and
now The Oxygen Advantage. So just, it's amazing how
things kind of evolve. And I think it's very important, the language that we use, as
well, in how we're wanting to achieve an objective because it can really make the
difference between something that is embraced or
something that's rejected. - It makes a difference on
compliance for a lot of people. So just circling back here now, would you say the epidemic of
asthma is in large part due to the breathing techniques? - With asthma, it's very
difficult to pinpoint what's the exact reasons why there's
so much asthma out there. - It's been an explosion. - It has, and it's been
increasing for decades and very much so in the
countries with English speaking. So we're talking about
Australia, New Zealand, the United Kingdom and
Ireland, the USA, and Canada and it seems to be in that
order, at least it was for many years. And it's not necessarily due to pollution because the countries with the
highest instance of pollution in the world don't have
the highest asthma rates. And this was realized back
in East and West Germany prior to unification. So say for example, you
can imagine the early 80s in Eastern Germany, that
real heavy industrial plant, a lot of pollution. West Germany was very
modernized in comparison, but the asthma rates in
West Germany were higher than the asthma rates in East Germany. And then with unification,
the asthma rates then started to soar then in East Germany. So I'm not sure if anybody really knows, but the one thing that asthma increases relative to wealth. Now, we're eating more processed foods. I think it's all of the same factors. I think there's a lot of chronic stresses. And you know, when you're
thinking about the child, as well. The child is going to pick up
on the stress of the parents. - Yes, they are. - And even that the heart rate
variability of the child is actually determined by the mother. So this can actually happen
while the baby's in the womb, in terms of if you have a
mother who's anxious and experiencing high stress, this will actually impact the
vagotone of the young infant. Now the one thing about vagotone is that you can influence it, but I suppose here is
the recognition, Bob. People with asthma breathe too much air. They typically breathe
faster, they breathe harder, and they breathe upper chest. And many healthcare professionals
will recognize that, yes, this is how a person with asthma breathes. And they will say, it's the
narrowing of the airways which is causing dysfunctional breathing. And okay, there's merit there. But it neglects to recognize that the dysfunctional
breathing is feeding back into the narrowing of the airways. That there's a feedback loop there. And that's really what I
wanted to try and connect. And I remember when I switched from mouth to nose breathing and
did breathing exercises to breathe light and
slow down my breathing. And in terms of the airways,
the natural theory is that when you breathe through
your nose, you pick up a gas called nitric oxide. Nitric oxide is antiviral,
it's antibacterial. Nitric oxide also assists
with redistribution of blood throughout the lungs. And it's known since 1988,
that the pressure of oxygen in the blood is 10% higher
with nasal breathing than with mouth breathing. Now, despite this, how many
people with asthma are going around with their mouth
open, not 100% of the time, but if they go for a walk,
if they go to the gym, they're sleeping with
their mouths open at night, they can have their mouths
open when they are distracted. And with asthma, you don't
just have inflammation of the lungs, you have also
inflammation of the nose. And with inflammation of
the nose, it doesn't feel comfortable breathing through the nose, so it's inevitable that the
person is going to breathe through the mouth. Mouth breathing is taking cold, dry, unfiltered air into the airways, and this is going to
cause airway narrowing. So it really just makes
sense because when it comes to the human mouth and the nose, if we were to ask the question, if I was to look into somebody's mouth, and if I was to ask what
part of the mouth is devoted exclusively to breathing? The answer is that there
is no part of the mouth. The mouth has absolutely no function when it comes to breathing. The mouth is simply a hole. So it's an entry point that air can go straight down the throat. It's the nose that does all the work. And even in posture and in
balance, in functional movement, in recruitment of the diaphragm, in oxygen uptake, in oxygen
delivery, in slow breathing. Because slow breathing, too,
during rest and during sleep is very important for balance of
the autonomic nervous system. So we should be seeing mouth breathing as an emergency response. Traditionally, throughout our evolution, our ancestors breathed through their mouth when they were in fight or flight. But now we are breathing
through the mouth chronically and that's going to
increase sympathetic drive. And the problem with that
is that chronic stress physiologically contributes
to inflammation. So there's so many different links. And the other thing about mouth
breathing is that it's known that the resistance to your
breathing during wakefulness, when you breathe through your nose, your nose does impose a
resistance to your breathing that's about two to three
times out of the mouth. But this is beneficial because
it's slowing down the air. It's giving enough time
for oxygen to transfer from the lungs, to the blood. Nasal breathing, when you're
breathing through the nose, it's helping to add an extra
load onto the diaphragm. This may help to maintain
good diaphragmatic tone and good function of the diaphragm. But mouth breathing during
sleep is what causes resistance. So when you breathe through
your mouth during sleep, your mouth imposes a
resistance to your breathing that's 2.5 times that of the nose. You want resistance to your
breathing during the day, but you don't want
resistance to your breathing during sleep. So people who wake up in a
dry mouth in the morning, they're more likely to experience insomnia because of the faster breathing and the upper chest breathing, snoring, and obstructive sleep apnea. And a recent paper, even
in the Laryngoscope, it was published in May of
2020, looked at 95 individuals with established obstructive sleep apnea. Those who were mouth
breathing had doubled the AHI, double the severity of sleep apnea versus the nasal breathing-only group. Now, what does poor sleep do? Well, that's also gonna it put us into increased sympathetic drive. So in terms of the
autonomic nervous system, that's when we have a physiology
that we're in that fight or flight and our sleep is
off, it can really then impact other functions of the body. And this is the one
thing that breathing has because when we can
change breathing patterns, we can change states. We can help to bring a balance in the autonomic nervous system. We can help to stimulate the vagus nerve. We can help to strengthen
the sensitivity or strengthen the baroreflex, and we can
help with that balance then, and this comes across
a number of conditions, including diabetes, including epilepsy, including obstructive sleep
apnea, but also PTSD, anxiety, depression, panic disorder,
irritable bowel syndrome, asthma, COPD, chronic
fatigue, fibromyalgia. And even now working with
people with lung COVID. And I have to say, when I
hear sometimes people say, well, sure COVID is COVID and
there's no problem at all. And I'm not going to
do any scare-mongering, but if you actually see people
who are trying to recover from lung COVID, you will
re-realize that this is a tough, tough condition. - Yes, it is. Yes, it is. - And I've seen and I've
worked with many people with chronic fatigue
syndrome over the years. Chronic fatigue syndrome
can be a tough condition, but lung COVID is worse. - And would you say? Now, would you talk about running? When you run, I know that
people can train themselves to still breathe through the
nose when they're running, but when you have a
high-intensity running, sprinting? I mean-- - Switch to mouth breathing. - Yeah, switch to mouth breathing, yeah. But for long distance, you can
get to the point where you. I found now what I do is I
breathe in through the nose and out through the mouth. I'm not able to breathe back and forth, It just not enough for me, but. - Yeah, nasal breathing during running for the recreational
athletes, we would always say, do your best to breathe in
and out through your nose. It just doesn't make sense
to be mouth breathing during physical exercise,
because mouth breathing is typically fast and shallow breathing. There's increased dead space,
so you're not actually, you're not ventilating the
small air sacs in the lungs as readily as you would
with nasal breathing. With nasal breathing also,
you've got better recruitment of the diaphragm and optimal
movement of the diaphragm is necessary for the generation
of intra-abdominal pressure because the diaphragm
breathing muscle is not just for respiration, but it also provides stabilization for the spine. And 50% of people with
lower back pain have dysfunctional breathing. So in terms of when people
think even of core strength, they're thinking of
strengthening or working the abs, but the absolutely, of course,
are only got one part of it. And we have to think of the core as a box. You've got the diaphragm as the roof. You've got the pelvic floor. You've got the spinal muscles, and you've got the abs to the front. And functional breathing
plays a role with that. So functional breathing and
functional movement go together. Now, when you do physical
exercise with your mouth closed, your nose is also protecting your airway. So we spoke about asthma,
exercise-induced asthma because your nose is moistening
and warming the incoming air and the air is coming in
filtered into the lungs. And it's at the perfect
condition for oxygen transfer to take place. But also when you
breathe through your nose during physical exercise,
it's a little bit tougher. And the reason that it's more difficult is that nasal breathing
will lead to an increase of carbon dioxide in the blood because carbon dioxide number
one, is going to be produced from your metabolism. When you go for your run, you've got an increased metabolic rate. You're working your muscles harder. Those muscles are producing
more carbon dioxide. With nose breathing, the carbon
dioxide is not able to leave the body quickly enough through the nose because the nose is a
smaller exit than the mouth. And as a result, carbon
dioxide increases in the blood during physical exercise. But as carbon dioxide
increases in the blood, the blood vessels dilate. And also, as carbon dioxide
is increasing in the blood, hemoglobin, which is the main
carrier of oxygen, releases more oxygen to those working muscles. If we ordinarily do our physical exercise with the mouth open, our
breathing, our ventilation, will increase proportionately
to carbon dioxide production. So even though we are
producing more carbon dioxide during physical exercise,
if you have the mouth open, the carbon dioxide in the
blood does not increase. But if you do your physical
exercise with your mouth closed, you get the benefit of the
increased carbon dioxide and drop to blood pH. You've got improved basal dilation. So you've got improved blood
circulation as we spoke about, but more importantly, you've got improved oxygen
delivery to the working muscles, better recovery. - That was the biggest surprise
to me in your book is that CO2 is good and that you
really want have it working. And that over-breathing
is really a problem. - Yeah. I think we all, I remember
going into an exam, going back, I don't know
when it was, 95, 1996. I was pretty anxious
going in because I was a chronic mouth breather
anyway, upper chest breather. And about four minutes before
I went into the exam hall, I took a walk. And during this walk, I
took these full, big breaths because that's what I believed. - Exactly and that's what I would do. - And I walked into the exam hall and I was totally spaced out. I never realized that at
the time that the more air you breathe, you're not
improving blood flow and oxygen delivery. You're literally depriving
the brain of oxygen. But you're not just depriving
the brain of oxygen, you're depriving the body of oxygen. There is a myth out there, the myth of the value
of taking a big breath. And unfortunately, you
hear it in so many places. You hear it in the media. - In the movies. - And it just does not make sense. But I suppose what is a deep breath? You know, a deep breath in
the true sense of the word basically just means that you have recruitment of the diaphragm. That if you were to have
your hands, either side of your lower ribs, and as you breathe in, you should feel the lower ribs moving out, but you can have a very
light and a slow deep breath. You don't have to take a full
breath to take a deep breath. So the instruction to take
a deep breath is correct, but the interpretation of
the deep breath is incorrect. And a young infant baby is actually naturally deep breathing. Their mouth is closed. They're breathing in and
out through the nose, and their breathing is primarily
driven by the diaphragm, and that is natural, A dog, when the dog doesn't
have his mouth open, when it's not so hot outside, for example. The cats, all animals
pretty much are breathing with optimum movement of the diaphragm. But the human being,
and it's probably due to certainly a contribution
of chronic stress, trauma, but even excessive talking. Do you think our ancestors
were talking for four or five hours or six
hours a day continuously? Can you imagine some guys
sitting around a cave fire and this guy doesn't stop
talking for four or five or six hours? He'd have driven everybody loony. We didn't do it as part of our evolution, but now we do it as part of our job. And people don't realize
that if you are talking for four or three hours, even a day, that's increasing the respiratory rate, it's increasing the tidal volume. It's causing you to breathe more air. And the more air you breathe, it's reducing blood flow and
oxygen delivery to the brain and that's why we are so tired if we talk for prolonged periods of time. But unfortunately-- - Hard concept for me to understand. It really was. - But you know what? I suppose a good way to
test it out is actually do the opposite. If somebody was sitting there
and I would say to them, what I would like you to
do is really slow down the speed of the air coming into your nose and then have such a
soft and slow and relaxed and gentle exhalation. And as you breathe in, can you
breathe in through your nose almost that you can
hardly feel any air coming into your nose? So you're breathing in so
subtly that the fine hairs within the nostrils do not move. And during the exhalation, you're having such a prolonged and relaxed and a slow and gentle exhalation. And as you do that, it's
likely that you will feel the need for air. And the need for air is
signifying the carbon dioxide has increased in the blood. But as carbon dioxide
increases in the blood, the blood vessels dilate. So I suppose a trick for
any of your listeners is if you practice breathing
less air for four minutes, are you able to influence the
temperature of your fingers? And as you do that, pay
attention to the saliva in your mouth, because very often even though
you would feel an air hunger and the air hunger should be tolerable, it shouldn't be stressful. If you find the air hunger
stressful, of course take a rest. But as you gently soften
and slow down and breathe less air into your body,
carbon dioxide is increasing in the blood because it cannot
leave the body so quickly through the lungs. This will help improve
your blood circulation, but also your oxygen delivery. But it also stimulates the vagus nerve. And the vagus nerve is innervating
all of the major organs and 80 to 90% of the communication
of the vagus nerve is from the body up to the brain. When there's an increase in
carbon dioxide in the blood, it stimulates the vagus nerve. The vagus nerve secretes
acetylcholine, a neurotransmitter, and this causes a slowing of the heart and the brain interprets
then that the body is safe and the brain will send
signals of calm to the body. So when you practice breathing
a little bit less air for about three or four minutes, check the saliva in your mouth. And if you have increased
watery saliva in your mouth, it's telling you that your body is ready for the digestion of food. When we are ready for
the digestion of food, we are in a state of relaxation. And conversely, when we are
stressed, our mouth goes dry. And I suppose the one thing
about this, Bob, is that I was listening to a podcast
by Dr. Rangan Chatterjee. He was interviewing a
brain surgeon, Dr. Rahul, and the brain surgeon said, he said, if I get into a tricky situation. Now you can imagine a
brain surgeon getting into a tricky situation. There's not gonna be too
many more trickier situations than that, but pretty much-- - That's top of the heap. - Absolutely. And he said, if I get
into a tricky situation, he said, the first thing
I do is prevent myself from hyperventilating. And he said, people think that I'm born with nerves of steel. And I was thinking to myself, of course, this doctor knows this, but why doesn't everybody else know it? Why doesn't the young
kid in school know it? Why doesn't the university student, the corporate worker know
it, the family person? We all need to know this
that we can change our state. And if I was to say to somebody listening, if you were to take one thing out of this, when you think of the
breath coming into your nose and the breath leaving the nose, it's not so much the
inhalation that determines the relaxation response,
it's the exhalation. If you breathe out fast
during rest, it's a stressor. And the brain interprets that
the body is under threat. But if you breathe in
soft through your nose, and if you breathe out really
slowly through your nose, the brain interprets that the body is safe and the brain sends signals of calm. So the next time that you
are in a difficult situation, bring some attention onto your breathing. Nobody will know you are doing it. Take a soft breath in through your nose and have a really slow and
relaxed and prolonged exhalation, because this way the
body is telling the brain that everything is okay. And then you will be better
able to make rational decisions and planning. Because if, for example, when we get into a difficult situation
and we start hyperventilating and all hyperventilating means that, it's not that we're having an
acute hyperventilation attack. It just means that our breathing gets a little bit faster and harder. The brain interprets that
the body is under threat. And when the brain interprets
the body is under threat, the brain is here to protect the body, and all the brain wants
to do is to get you the hell out of that situation. It's not a time for planning. And it's kind of ironic, Bob. The time that we need to
have 100% of brain function, we don't, when it's a difficult situation. And this determines a leader because a leader can be
recognized by how well they do when there is a difficult situation. If you think of a football
game, for example, the leader is the person when
the team is losing the match and you've got one individual in the team, and regardless of what's happening, that individual is still
able to rally the troops and get the motivation going, and get the team back on board. That's a leader. And really about changing,
being able to change our state or give us our ability to remain composed in a difficult situation. It's a good place to be. - Well, one thing I have found, and I'm sure you'll agree
with this is I have found that my blood pressure has also dropped. It's dropped about 15 points. And it's the only thing
I changed was the tape over the mouth at night. And we'll talk about anxiety,
too, and the vagus nerve. Maybe if you want to mention now to see where people. You know, first off, I want to make sure that everybody knows we're covering a lot of information here
and that it's gonna be, it might be to your advantage
to grab one of Patrick's books because he takes the time and explains all what he's going over today. But maybe if you want to talk
about the BOLT exercise and-- - Oh, yes, yes. - [Bob] And the (indistinct) test? - Yep. So the BOLT is, we call it
the Body Oxygen Level Test, just so that people can remember it. And this gives you, it's a good indicator of
how well or how poorly an individual is breathing. And this is when you're sitting
down for about five minutes and you're resting and
you're better off doing it in the comfort of your own home where you don't feel any
psychological pressure. And to take a normal breath
in and out through your nose and pinch your nose and hold your nose and time it in seconds. How long does it take until you feel the first definite desire to breathe? And then to let go to
breathe in through your nose. You're breathing at the
end of the BOLT score or your breathing at the
end of the breath hold time, it should be normal. So just repeat that again. So you're sitting down,
you have normal breathing for a few minutes. You take a normal breath
in through your nose and a normal breath out through your nose. You pinch your nose with your fingers and you time it in seconds,
how long does it take until you feel the first
definite desire to breathe? When you let go, your
breathing should be normal. - Patrick, I do want to
ask about that because it's a little bit subjective. Because when do I feel
the need to breathe? You know, I can hold it longer, of course. And I mean, do I get to a
point where I can't hold it? I really had trouble with
this, knowing when to-- - There's a couple of points, Bob. The one thing is that at
the end of the breath hold, your breathing should be normal. So you shouldn't have to
try and force it into place. - Gotcha. I was holding it too long. - And the second thing is that
normally the first definite desire to breathe, it corresponds with an involuntary
contraction of the diaphragm. - Gotcha. - And so say, for example,
so there's three things we could pay attention to. Number one, you're holding your breath until you feel the first definite desire or first stress to breathe. So that's going to be a cognitive feeling. Number two, you're holding
your breath until you feel the first involuntary
contractions of the diaphragm. And also, when you resume breathing, your breathing should be fairly normal. And you know, it is tricky
enough to be honest with you, but even if you get it
fairly reasonably accurate, the main thing is not per se your number, but the real thing is are
you able to improve it? - Gotcha. - And I'll give you some. Sorry to cut across you there. - I was gonna say, use the
same technique every time, obviously. - Yes, exactly. That's it, yeah. And to give you some significance of it, there was a professor Kyle Kiesel. He's a physical therapist
from Evansville University. And he did a study that
was published in 2018. He looked at 51 individuals. He looked at her breathing from
a biochemical point of view and a biomechanical point of view and a psychophysiological point of view. And that's generally how
researchers will investigate breathing. They will look at breathing
across three dimensions. Out of the 51 individuals,
only five of them had normal breathing, only five. The rest of them eat or
failed one dimension or all, or two dimensions or all three dimensions. But his conclusion was the
BOLT score is a good indicator of a person's functional
breathing patterns. You don't have to
measure the biochemistry, the biomechanics, and
psychophysiologically. You simply measure breath hold time. And his conclusion was that
if your breath hold time is above 25 seconds, there is an 89% chance that dysfunctional
breathing is not present. Now he included four questions, as well. Those questions were, do you feel tired? Do you feel tense during the day? Do you wake up in a dry mouth? And do you have cold hands? I wouldn't even worry about
the four questions before, because the four questions
are common symptoms of hyperventilation. And what's the significance
of a BOLT score? Well, if you have a BOLT score
of say less than 20 seconds, it will indicate that your
breathing is a little bit faster, a little bit upper chest, more likely to have irregular breathing, more likely to feel that
you're not getting enough air, more likely to be breathless
during physical exercise. Now, of course, 20 seconds is not too bad in terms of functional breathing because you're heading close to 25. But earlier on, I spoke with COVID and I had a meeting last
night with instructors, 60 of us met up via Zoom. And we spoke with working
with a number of clients with lung COVID. Some of these clients,
their BOLT scores are between three and five seconds. - Oh wow. - They can't talk because
they don't have the air, they don't have the air
to complete a sentence. And all of the exercises
that we do with them, we do breathing recovery
exercises, starting them off because we want to give them exercise that we're not going to tax
the autonomic nervous system. They're not able to do a slow breathing because if you're already
feeling effort for breathing, and if somebody starts saying to you, now I'd like you to slow down your breath, it's not gonna happen. So we do the small breath holds and the small breath holds
may be just holding the breath for maybe one or two
seconds to help stimulate the vagus nerve, but also to
help with breathing recovery. And we do relaxation and we
would even go as far as having them just do the breathing
recovery exercises for five to 10 minutes every hour. So the BOLT score is not
perfect, but at the same time I've used it with about
seven or 8,000 people. It gives us pretty good feedback. - Sure. And so again, when you're
talking about trying to correct the problem, one thing
I saw you mentioned is that you want to breathe
less cycles per minute. And like you said, that's very difficult. I found that very difficult to do. So you had recommended
six cycles during minute. - Yeah. But this is only-- - [Bob] I'm like, how do you do that? - For short term. Okay, so what influences
your BOLT score is your tolerance to carbon dioxide. Because carbon dioxide is the
primary stimulus to breathe. An individual with a lower
breath hold time normally has an increased sensitivity
down to the accumulation of carbon dioxide. So a person with a lower
BOLT score will find it more difficult to breathe slowly. Now, the reason that we have the resonance of six breaths per minute
is because the research over the last. So this is only looking at one dimension, this is looking at influencing
the autonomic nervous system, that the research over the
last 30 years has focused in that an ideal respiratory rate
to practice is between 4.5 to 6.5 breaths per minute. And breathing at this rate
will help to stimulate the vagus nerve and
will help to strengthen the baroreceptors or the baroreflex. So the baroreflex
consists of baroreceptors or pressure receptors in
the major blood vessels. And these pressure receptors
are continuously monitoring our blood pressure. When our blood pressure increases, the baroreceptor sends
signals to the blood vessels via the brain for the
blood vessels to open up so that the blood pressure can come down. And conversely, somebody
with lower blood pressure, the the baroreceptor should pick up that the blood pressure has lowered and the baroreceptors will send
signals to the blood vessels via the brain for the
blood vessels to constrict to normalize blood pressure. The sensitivity of these
baroreceptors provides you very good feedback of
the overall functioning of the autonomic nervous system. And if we can improve the
sensitivity of the baroreflex, we can improve health, we
can help to bring a balance in the autonomic nervous system. Now there's an interesting aspect of this. There's an Italian
cardiologist called Bernardi and I can send you on the papers later. He looked at different
prayers from different faiths, and he looked at the Rosary that's taken from the Catholic religion and he looked at yoga, yoga mantras. And when people were practicing the Rosary or the different mantras in yoga, now he honed in on one in particular. It naturally brought
down the respiratory rate to six breaths per minute. - That's funny you say that. I had this-- - [Patrick] It's amazing. - Yeah, I know I had this sense that part of what the Rosary did
is that the chanting and the breathing, and it
was, I thought there was some benefit to there beyond spiritual. - Yeah, I find it fascinating. - Yes, I do, too. - Can you imagine that
whoever was the creator of the mantra, the Rosary, they were able to get it
right down to that six perfect breaths per minute, the
optimal respiratory rate. Now I suppose some people
are gonna say, well, should I be breathing
like this all day long? No, no, no, no, no. You practice breathing like
this for maybe 10 minutes twice daily. And if you do that, that
will give you benefits and those benefits will carry into your normal everyday life. - I see, that helps a lot. 'Cause I thought, oh my
gosh, I'm way off here and I'll never get that. - The other thing that I'll say is that when you're practicing it,
your breathing should be in and out through the nose and your breathing should be silent. Because a lot of people,
what they will do is they will start slowing
down the respiratory rate, but in the process, they
will be taking such full, big breaths, but this will
throw off their biochemistry. So there's always a balance. There's a balance
between the biochemistry, the biomechanics, and the
speed of your respiration. So that's why I use the
acronym light, slow, and deep because all too
often with breathing, instructors will hone in on one dimension, but they ignore the others. So say for example, you
might have a physiotherapist who's focusing on the biomechanics. You might have a hard mat instructor who's focusing on resonance
frequency breathing. A Buteyko instructor, my
background, is focusing primarily on the biochemistry. But breathing is not just one dimension. And that's what The Oxygen
Advantage kind of gave me the freedom to bring in anything
outside of the tradition, because with breathing,
it's very often taught according to a tradition. And this can be a little bit constraining because if you're taught by your master, you don't want to deviate
outside of the teachings of your master because you
might have a sense of betrayal, but it doesn't provide a
breathing ground for learning. Because with breathing, the science is moving on all the time. And with The Oxygen Advantage,
there was no tradition, there's no master. We can look at breathing from
so many different dimensions and it has gave us a tremendous
freedom, but also I suppose, a thirst for delving deeper
into the whole application of breathing because this
is a vast, vast area. - So again, I want to be
very respectful of your time, Patrick McKeown. Thank you so much. Again, check out his work
at oxygenadvantage.com and he's got many books. Is there a one book we
recommend for the beginner or is it depending on what they're into? - I've got a new one out
it's called Atomic Focus. It's the most simplest
one in terms of people who want to change states. I think the Breathing
Cure, I like the book, but I would say it mightn't
be everybody's read because it's a little bit technical, but if you were to read
the first two chapters, you'll get everything in
the first two chapters. The first 100 pages contains
26 different exercises. And it delves, I suppose,
women's breathing, Bob, which has been overlooked. The symptoms of PMS. Helping people with diabetes,
both type one and type two. And there's a good lot of
research that came out of Italy over the last 20 years (indistinct). Epilepsy, giving people some
forms of epilepsy are brought on by, some seizures are
brought on by hyperventilation, asthma, sleep apnea,
children's development. So I suppose if people
want sports performance, it would be The Oxygen Advantage. If you want to delve into health, it's going to be The Breathing Cure. And if you want to delve
into improving concentration and focus and attention span,
it's the book Atomic Focus. - And I'll tell you, I just,
as a personal testimony, this is not hyperbole. I mean, it's crazy how much
breathing could change your life and your health. So thanks again, Patrick
McKeown for being on, love to have any time. And again, make sure you check
out his books in his website. Well, down below, too, listed. So thanks, everybody, for listening. (upbeat music)
