017 Patrick McKeown – Breathe Easy

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Breathing and Buteyko expert Patrick McKeown joins me to discuss the importance of breathing silently through your nose. How can you tell if you breathing “properly”? Why is nose breathing so important? What is the impact of breathing through your mouth? What does it mean if you are getting up in the night to go to the bathroom? Or perhaps even wetting the bed? We answer all these questions and also talk about taping your mouth at night (yes, you read it right) and the amazing Patrick’s amazing success stories of working with professional athletes and the changes to their performance.

The secret to a long life is to keep breathing for as long as you can. Obvious, I know. But to healthy for as long as you can, think about breathing well.

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Dr. Ron Ehrlich:                   Hello, and welcome to Unstress. I am Dr. Ron Ehrlich. Today, I am speaking to Patrick McKeown. And Patrick is the world’s leading authority in Buteyko. He’s authored … well, I think he’s authored about eight books on breathing, Buteyko. One of his books is called “Asthma Free Naturally: Everything You Need to Know to Take Control of Your Asthma.” So if you thought asthma was just the way it is, think again. You can take control of that with some breathing exercises. The other book that’s he’s written is called “The Oxygen Advantage: The Simple Scientific Proven Techniques for a Healthier, Slimmer, Faster, and Fitter You.” It gives you clues to what Patrick is on about.

Now another thing I love to ask all my guests is, what’s the biggest challenge to us as individuals on our health journey? Now, he’s not a dentist, but if you think about public health messages as being confusing, Patrick’s comments as a health practitioner are really enlightening. And as you’ll hear, then we talk about the importance of nasal breathing as opposed to breathing through your mouth. Now, again, not something you think a lot about. I go through it in my book, but this is why I’m doing this podcast. I describe the book as an exploration, but this is about going deeper into the topic, to expand on those topics, and to talk to world leaders, and Patrick is definitely a world leader.

He also talks about the Buteyko training program, which I’ve done with my own family when the kids were 8 and 11 years old, and it was a really interesting thing to be going through as a family, and to alert us to the difference between breathing and just breathing well. He’ll talk a little bit about improving athletic performance, but I hope you enjoy this conversation that I had with Patrick McKeown.

Welcome to the show, Patrick.

Patrick McKeown:             Thanks very much, Ron.

Dr. Ron Ehrlich:                   You’re out from Ireland. Australia’s a long way. You’ve arrived yesterday, and you’ll be running some courses here in the Buteyko technique.

Patrick McKeown:             Yes, correct. So, I’ve always looked forward to … I’ve been to Australia just a couple times in my lifetime. I always love coming here. It’s a great city, Sydney. It’s a pity it’s so far away, but you know what? It’s the worth the effort, so …

Dr. Ron Ehrlich:                   Yeah, now, look, obviously we’re gonna talk about breathing, but a topic that I feel really is important for us to … Just, I’d be interested to hear your views on it, is we’re in the middle of, well, a health crisis.

Patrick McKeown:             Sure.

Dr. Ron Ehrlich:                   Our chronic diseases are going through the roof, heart disease number one, cancer number two, 80 or so auto-immune diseases going on, diabetes, basically … What do you think our biggest challenge is in healthcare today?

Patrick McKeown:             I’m aware of the statistics as well, and we have to bear in mind that our life has changed so much from that of our ancestors in absolutely every single way. But there’s one factor that has changed. Throughout evolution, it would have been that the patient was responsible for their own health, but that model has changed, and a lot of people feel that they’re not necessarily responsible for their health because the doctor has taken responsibility away.

Now, I’m not negative toward the medical profession. They do a great job. But I feel it’s time, really, that people started realizing that they can make a difference to what they’re doing themselves. It is in the interest of big pharmaceutical companies to adapt and to embrace the existing health model. The more chronic diseases, the more profit for shareholders. And we have to start looking at more preventative ways. We have to start looking at epigenetics, the effect that the environment is having on the genes. And we have to start looking at sleep. We have to start looking at breathing. And we really need to start looking at dentistry.

There’s holes in many of the existing healths… what would have been traditional paradigms or accepted ways of doing things. And there’s so much conflicting evidence out there. Like, I can imagine, I’d be confused at times. I read through the journals and what’s seen as one piece of evidence is totally contradicted by another. I work in clinical practice, and what I’ve seen over 15 years also can be contradicted by the science, because what I’m reading in the journals is not what I’m seeing every day. And if I am being confused in my own field of work, the average customer on the street must be absolutely overwhelmed with conflicting views and different information.

And we really need to ask the question, “Where’s the truth in this?” And also, let’s start with the notion of no side effects. First, do no harm.

Dr. Ron Ehrlich:                   Yeah, yeah. Music to my ears, Patrick, and that’s the theme that’s running through this program, and … Which leads us into the very reason why we’re talking today, and that’s, we’re going to be talking about breathing.

Patrick McKeown:             Sure.

Dr. Ron Ehrlich:                   And breathing is kind of something we just, we don’t think about. So I thought we might just start with explaining to the listener, I mean, we know if we don’t breathe, we die. But there’s an awful lot more to it in between us just being alive and being dead. So, tell us what breathing is meant to do when we’re breathing well.

Patrick McKeown:             Well, breathing should be effortless. If you were to look at what is defined by good breathing, it’s in and out through the nose. It’s effortless, it’s silent, and it’s driven by the diaphragm. Good breathing is light breathing.

But we know from studies and from personal observation that 50% of children are habitually mouth breathing. There’s at least four or five studies on that now. We have no studies on how many adults mouth breathe. It has never been studied to my knowledge, and it’s something if-

Dr. Ron Ehrlich:                   That’s amazing.

Patrick McKeown:             … if you have any answers on that one, please send them on to me.

Dr. Ron Ehrlich:                   Yeah. Yeah, no.

Patrick McKeown:             But I would also estimate it’s 50%. Now, when you consider that in 1975 Dr. Maurice Cottle, he was an ear, nose, and throat consultant, he said that the human nose is responsibility for 30 functions in the human body.

Dr. Ron Ehrlich:                   Wow.

Patrick McKeown:             And he comes up with the Cottle maneuver, which is simply just prizing the nostrils gently apart to start allowing the benefits of nose breathing. We also have to consider the effect of nose-breathing and mouth-breathing versus arterial oxygen uptake. If you breathe through your nose, you bring a gas called nitric oxide from the paranasal sinuses into the nasal cavity, but breathing through your nose carries nitric oxide into the lungs. And nitric oxide in the lungs is a natural bronchodilator, it helps open up the airways for easier breathing, but it also helps sterilize the air.

And another aspect is, it improves what’s called “ventilation profusion”. Now, I don’t want to go too much in detail in this.

Dr. Ron Ehrlich:                   Now, now, Patrick, Patrick, let’s not get too technical here, but go on. Yes.

Patrick McKeown:             When we breathe with our mouth, we use the upper chest. So we’ve got more ventilation into the top part of the lungs, but however, because of gravity, most of our blood concentration is actually in the lower lobes. So we want a distribution where the air is meeting the blood one to one.

Dr. Ron Ehrlich:                   That’s in the lower part of the lung.

Patrick McKeown:             Exactly. We need to get the air deep into the diaphragm, but nitric oxide is the gas that assists with that, which is quite amazing. It’s relatively new to me, even though the paper has been published a few years.

Dr. Ron Ehrlich:                   Yes.

Patrick McKeown:             And this is a gas that is crucial to human life. Nitric oxide, not nitrous oxide, because sometimes people make that mistake.

Dr. Ron Ehrlich:                   Yeah.

Patrick McKeown:             And for anybody with asthma, for anybody with breathing difficulties, but also in helping to deal with stress, because if we’re breathing using our chest, it is more of a sympathetic activation. It’s more of a stress response. That’s why people talk about “take a deep breath,” but a deep breath just means breathing through the nose using your diaphragm. And if you breathe through your nose, you tend to use the diaphragm more than breathing through the mouth.

So, it’s absolutely crucial. We have to ask this question: Why do all animal species breathe through their nose with the exception of a dog on a brief occasion, or an animal that’s very sick? So of all the tens and thousands of species of animal on Earth, they breathe through their noses. And the human being, 50% of us are habitually breathing through our mouth.

And it’s a relatively new phenomenon because when anthropologists unearthed skulls in the 16th century in the UK in England, they started to recognize the change of the skull in response to … For instance, upper-middle-class people, they noticed that their faces were narrower. They were longer. They had overcrowding of teeth. They had a V-shaped maxilla and mandibles that were set back. And when these skulls were examined, the conclusion was that these individuals had switched from nose to mouth breathing. So it’s relatively new.

Dr. Ron Ehrlich:                   Patrick, boy, there’s so much you’ve just said there that we could talk about, but just to recap-

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   … breathing would be, nasal breathing critical?

Patrick McKeown:             Ron, it’s absolutely vital. And it’s vital as well for sleep.

Dr. Ron Ehrlich:                   Yes.

Patrick McKeown:             Not just during the day, but during sleep as well.

Dr. Ron Ehrlich:                   We’re gonna come back to nasal breathing ’cause that’s one of my favorite topics.

Patrick McKeown:             Okay.

Dr. Ron Ehrlich:                   At dinner parties, I could talk about nasal breathing until the cows come home. But anyway, nasal breathing, number one. The breathing should be effortless.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   And that means we should be using our diaphragm. Now, I guess, for our listener, the diaphragm, you know whether you’re breathing through your diaphragm whether you are, on your inhaled breath, if you rest your hand on your stomach-

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   … your single hand should go out.

Patrick McKeown:             Yes. Slightly, yes, there should be very slight movement.

Dr. Ron Ehrlich:                   Very slight movement. So that is taking the air deeper into the lungs, whereas you say we have … What was that wonderful word you used there? “Profusion”?

Patrick McKeown:             Oh, ventilation profusion.

Dr. Ron Ehrlich:                   Ventilation profusion. I’m gonna throw that into my next dinner party, too. But ventilation profusion, which means we’re taking air down deeper into the lungs where more exchange can occur.

Patrick McKeown:             Yes, exactly. And the other thing is, many people talk about taking a deep breath. You hear it from the radio, you hear it on TV, different magazines, et cetera. But usually, when an individual is told to take a deep breath, they take a big breath. A big breath isn’t a deep breath. The best way to determine a deep breath is to look at a cat breathe. The cat has its mouth closed. There’s no sound coming from the cat’s breathing, unless of course we’ve interfered with the cat, and it’s driven by the diaphragm.

So an animal or a very young infant. When we were born, we were born breathing through our noses. An actual fact, we can’t breathe through the mouth because, for the first few months of life, the windpipe is going directly from the back of the nose straight into the lungs. So a young infant, even though they will breathe a little bit faster, when a healthy infant is there, the mouth is closed, it’s diaphragmatic breathing, and it’s effortless breathing.

Dr. Ron Ehrlich:                   You also mentioned nitric oxide, which is great because I want you to talk more about that in a moment. It’s very interesting and little discussed.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   But you also said there are 30 functions from breathing through your nose. And people kinda take this for granted. “I’m breathing, I’m breathing. What does it matter whether I breathe through my mouth or I breathe through my nose?”

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   But there is a big difference, isn’t there?

Patrick McKeown:             Yes, yes. Even if we considered the size of the nasal cavity, like, I always ask my clients, I ask them to put their tongue into the roof of the mouth, and I ask them to drag their tongue along the hard palette all the way back until they feel the soft palette, because the roof of the mouth is the floor of the nasal cavity. Oftentimes when we consider the nose, we look in the mirror and we say, “Okay, this is our nose.” But this is only a small percent of it.

And let’s face it, nature doesn’t waste space. So the nose and the nasal cavity is there for a reason, and everybody is aware of filtration, for instance. How about humidification? It moistens the incoming air, and it regulates the temperature of the incoming air. For instance, on a very warm day, if you breathe through your nose it actually cools it down before it comes into the lungs. And vice versa, on a very cold day it warms it up.

Detection of smell, activation of the diaphragm, the base of nitric oxide, improving arterial oxygen uptake. Like, there are quite a few functions there. And even from a dental point of view, how many dentists are aware of the mouth-breathing children coming in have increased gingivitis, increased gum disease, increased dental cavities, and cranial facial changes, like mine-

Dr. Ron Ehrlich:                   Yeah.

Patrick McKeown:             … from having my mouth open for 20 years.

Dr. Ron Ehrlich:                   Yes. Well, now, you talk about that 50% of children being mouth-breathers, and it’s interesting because my observation, as a dentist, is that almost 95% … When I ask this question about, how many people in the audience, say, have enough room for all 32 of the teeth we have evolved to have? That includes wisdom teeth, that they’re through and functional.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   How many people in the audience have that? And in my experience, and I may have asked this question in live events of over 1,000 people in the last year, I think maybe 20 or 30 have put up their hands. So let’s say 99%-

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   … of people do not have enough room for their teeth. And they just kinda think, “Well, no big deal.”

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   But the big deal is its impact on breathing, isn’t it?

Patrick McKeown:             It’s huge, because if the jaws are very narrow there’s no room for the tongue. And if there’s no room for the tongue, well, the tongue is constantly trying to get out of the airway. So if my jaws are set back as mine are, and there’s no room for the tongue, but what’s happening now is that the tongue is coming into the airway.

Dr. Ron Ehrlich:                   Yep.

Patrick McKeown:             And we have to push our head forward to try to get the tongue out of the airway, so mouth-breathers develop forward head posture, and this changes our whole … I have forward head posture from years of having my mouth open, and once you develop it, it’s not the easiest thing. And I suppose we’re sitting over computers as well, so our lifestyle is not the ideal for it.

But in terms of, if there’s no room for the tongue, it certainly will increase the risk of obstructed sleep apnea. Now, another thing, that when I brought my daughter … ‘Cause I’m really, I’m a full fan of functional orthodontics, and I’m a full fan of early orthodontics, in getting children early. And I had my daughter when she was four years of age, I had a scan done. And the dentist revealed, “Well, your daughter is missing two incisors.”

Now, a new paper come out with Dr. Christian Guilleminault just, I think it was last year or the year before, and he said, “If children are missing teeth, it is very predictive of obstructive sleep apnea.”

Dr. Ron Ehrlich:                   Right.

Patrick McKeown:             So, tooth agenesis. He said, “We can predict it. This can be caught early.” He said, “Sometimes we get people in, a man, say, of 40 years of age, and he’s diagnosed with obstructive sleep apnea, but he has narrow maxilla, et cetera, jaws that are set back. This could have been detected much earlier.”

Dr. Ron Ehrlich:                   Yes.

Patrick McKeown:             So I think, and what you’re saying in terms of not having enough room, I think now there’s another epigenetic change happening that a certain population … Like, I spoke with one orthodontist from South America who’s been measuring the width of maxillas, and she’s saying is that even in her lifetime, she’s seeing a decrease in the width of the maxilla as the years go on.

You know what? I have no idea where this leads. You’ve looked at this a lot more than I have, but from my perspective, and even from my own personal health point of view, I know the effects of having narrow jaws. It wreaks havoc. When I was 15 to 20 years of age, my concentration was affected, I was tired in school, your mood is affected because you’re mouth breathing, you’re more stressed all the time, bad breath. It’s not an ideal situation where self-confidence isn’t at its upmost.

Dr. Ron Ehrlich:                   Yes.

Patrick McKeown:             And then you’ve all of these issues going on as well. And you know how many kids are out there like that?

Dr. Ron Ehrlich:                   Yeah. Well, I think as a parent looking at a young child, and I know I now have a granddaughter who’s one year old, so I’m looking at her, and I’m watching her teeth come through.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   And there is nice spacing between her baby teeth. And I sometimes get patients coming in going, “Oh, my child’s teeth are beautiful. They’re really close together and they’re really straight.” And I tell them, “This is an early sign that we don’t have enough room.” Baby teeth are a lot smaller than adult teeth, and seeing spacing between the upper teeth in the maxilla and the lower teeth in the mandible is a good sign, because it tell us there’s enough space.

And so that’s important. But the other one is seeing whether your child, and this is interesting too, is sleeping with their mouth open or their mouth closed.

Patrick McKeown:             Yes, for sure.

Dr. Ron Ehrlich:                   Big one.

Patrick McKeown:             Absolutely.

Dr. Ron Ehrlich:                   But you raised an issue about how poor breathing affected your health in that mood and energy and that. What are some of the other problems with poor breathing? How do they manifest themselves?

Patrick McKeown:             I think probably the biggest one is in terms of stress. Like, if we look at a child who’s got poor breathing, we have to, let’s face it, that it can set that child up for obstructive sleep apnea lifelong.

Dr. Ron Ehrlich:                   Yeah.

Patrick McKeown:             And I know a lot of children, when they’re five years of age, their adenoids, which is tissue at the posterior, the back of the nose, is prohibiting air from adequately entering the nose into the lungs, so they’ll often mouth-breathe. And this can be a real issue, because the term “adenoids face”, if you go into Google and you just put in “adenoid face”, you’ll see all those features. So children generally-

Dr. Ron Ehrlich:                   Patrick, “those features” being long, narrow faces.

Patrick McKeown:             Yes, and eyes that are sunk down, and flat cheeks, jaws that are set back, a nose that’s bent, some of the features that I have, but I kinda got away with it a little bit. But I see these features all the time. Now, tell me this, but if I had a choice of being growing up with a really good-looking face or a far less attractive face, I’m gonna choose the good-looking face because, again, society rewards good-looking people easier. Good-looking …

And my child. I want my child to have a lovely-looking face. That’s why I started the whole aspect of, of course, nose-breathing, and functional orthodontics, and tongue in the roof of the mouth, so my child can develop so that she can reach her full potential in life.

Dr. Ron Ehrlich:                   Yeah. Yeah.

Patrick McKeown:             How many times, Ron, have you seen a 20-year-old kid come in to you, and they exhibit these facial changes, and you’re thinking to myself, “Well, if I had had this child 15 years ago, I could have changed their life.”

Dr. Ron Ehrlich:                   Yeah.

Patrick McKeown:             So this is not just aesthetics. This is talking about peoples’ confidence, this is quality of life, this is not even talking about their sleep. Just so many different factors to this.

Dr. Ron Ehrlich:                   And I wanted to talk about sleep a little bit later on, but, well, the biggest barrier to people breathing properly may well be the shape of their jaws.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   Literally not enough room to breathe, and so they open their mouth to breathe better.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   There are of course allergy issues, which are huge nowadays. That’s a challenge, too. But then, Buteyko. Tell me about Buteyko, ‘cause you have written eight books, phenomenal. And I’ve just read your last one, “The Oxygen Advantage”, which I’ll ask you about in a minute. But tell us about Buteyko first.

Patrick McKeown:             Sure.

Dr. Ron Ehrlich:                   A little bit of background, and then we can talk a little bit about how to improve breathing.

Patrick McKeown:             Sure. Buteyko, he was a medical doctor, and in 1952 he made the discovery that … possibly his own high blood pressure, he was 26 years of age at the time.

Dr. Ron Ehrlich:                   26.

Patrick McKeown:             And he had high blood pressure.

Dr. Ron Ehrlich:                   26, wow.

Patrick McKeown:             And he taught that maybe it could have been linked to his breathing. So he started slowing down his breath, breathing through his nose, and really slowing it down and quietening his breathing, and he was able to normalize his high blood pressure.

So from that, then, he started doing a lot of research into other peoples’ breathing, and he looked at the effect, “Well, what happens if I breathe through my mouth and breathe a larger breathing volume versus breathe through my nose and breathe a lighter breathing volume?” And I think a very simple way to look at this is to look at how we breathe when we get stressed.

When we get stressed, our breathing gets faster, it becomes more noticeable, we sigh more, it’s often through the mouth, and we take visibly larger amounts of air into the lungs. And it’s very difficult to think straight. And stress prolonged over a period of time causes that biochemical change, so breathing a larger volume of air can become habitual.

We do the opposite. Instead of breathing faster as in the stress state, we breathe slow. And I mean really slow down breathing. Instead of breathing more, we slow breath down, breathing sufficiently so that we’re breathing slightly less air into the lungs. Now, what that does is, the theory of it is based on carbon dioxide, the original Buteyko theory. When you slow down and reduce your breathing, carbon dioxide is going to accumulate in the blood, and carbon dioxide helps to widen and open the blood vessels. So your blood circulation is affected by how you breathe.

So we have 100,000 miles of blood vessels throughout the body. If we breathe hard, our blood vessels constrict. That’s, again, why people feel lightheaded. They take five or six big breaths and they start to feel lightheaded. That’s not because more oxygen is going to the brain, it’s because less oxygen is going to the brain. So we bring a person from a sympathetic state, from a stress state, into a parasympathetic state in three to four minutes. How do they know? Because they have increased watery saliva in their mouths, which is always a good indicator that you’re activating the parasympathetic nervous system. You know, when we get stressed our mouth goes dry, so when we’re going into deep relaxation or into meditation, increased watery saliva.

And here would be some of the benefits. When somebody is doing meditation, they’re going into stillness of the mind. They’re focusing on the breath, bringing relaxation to the body, and everything is slowing down. A decreased metabolism, decreased respiratory rate. Buteyko looks at that, but he says, “Instead of waiting for that period of time for meditation to work, let’s deliberately slow down the breath and get a slighter shortage in order to reset the breathing center in the brain.”

Breathing then becomes lighter, and circulation improves, and also oxygen delivery because the delivery of oxygen from the red blood cells is influenced by carbon dioxide. And if we’re breathing too much, we’re getting rid of too much CO2 from the lungs, hence we reduce it in the blood and in the cells. So we want to be breathing … Light breathing is a good sign of health.

If you went for a run with an athlete and it was a really good athlete, you would indicate that, yes, this athlete has light breathing. Or conversely, if you’ve got somebody who’s really overweight and they’re trying to get up a flight of stairs and they’re really breathless, well, at the very least you’re gonna say that this person is unfit.

So healthy breathing is light. And of course, people are gonna say, “Well, how should you breathe, then, when you’re running?” Well, of course when you’re running your breathing is going to increase, but how much does it increase by? Do you still have relatively light breathing?

Dr. Ron Ehrlich:                   Yes, well, one of the most interesting things that I’ve learnt in my own journey is this sympathetic, parasympathetic story. Like, the sympathetic part of our nervous system is the stress “fight or flight” part, and the parasympathetic is what I like to call the “rest and digest” part.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   And ideally, we should be in that parasympathetic mode for 98% of the time. I mean, we only get into sympathetic when we’re trying to avoid some danger, but the problem today is we’re in sympathetic overload.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   Now, when someone said to me, “The best way of switching on the parasympathetic nervous system is to hold the exhaled breath over a minute or two” … You said three to four minutes. In my experience, you can do it in one or two minutes.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   Holding that, so you’re breathing in, you breathe out, and hold.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   And that’s very much what … Buteyko is very much about that held breath.

Patrick McKeown:             Yeah, no, no, you’re correct. There’s a number of aspects to Buteyko. The real essence of Buteyko is about slowing down the breath and not by holding it. So it’s following, say, the inhalation of air coming into the nose and the exhalation leaving the nose, and it’s about gently slowing down the speed of the air coming in and out of the nostrils.

Like, what we’re dealing with is specifically dealing with the in-breath. The in-breath is active and the out-breath is passive. The out-breath should always be nice and relax because that’s the body breathing out effortlessly. So we’re slowing down the speed of the breath in, and we’re gently bringing a feeling of relaxation to the breath out. Now, that aspect will activate the parasympathetic nervous system.

The other aspect is when we hold the breath, and that greatly disturbs homeostasis. And it could be argued that it could actually activate the sympathetic nervous system. This is how we decongest the nose. If you hold the breath on an exhale, you will actually open up your nose, and there are papers showing this. And, totally aside from Buteyko, two things that decongest the nose: physical exercise and breath holding.

So, it’s doing the two together. So we don’t do breath holding with everybody because say somebody with sleep apnea or if they’re pregnant or whatever, we don’t do breath holding with them because it’s a little bit like high-intensity physical exercise. It’s very suitable for some people, for some it’s not. But gentle, slow, reduced breathing is advisable for everybody. Now, for children, we do the breath holding more, because they don’t have the attention to focus on their breathing to slow it down, so we use more active exercises with the kids.

Dr. Ron Ehrlich:                   How often ideally should one breathe in a minute?

Patrick McKeown:             We look at minute volume. When you look at somebody breathing, I am looking at a number of things. I’m looking at the amplitude of their breath, which is the depth or the size of each breath. And secondary, I’m looking at how many breaths per minute. Now, ideally, somebody would be, say, 10 to 12 breaths. If they got really, really excellent breathing, could be 6 to 8 breaths. But if they’re breathing 20 breaths per minute and each breath is noticeable, it’s over-breathing, by far.

That’s why we use the breath hold time, the control pause. How long can you hold your breath for comfortably? And the longer the control pause, the lighter the person is breathing.

Dr. Ron Ehrlich:                   Now, you mentioned that Dr. Buteyko at 26 found out that he had high blood pressure and controlled that by breathing, because of carbon dioxide’s effect on smooth muscle, as in the blood vessels. Another interesting thing that people don’t often associate with breathing is bed-wetting, I mean, for young children, or for adults needing to get up at night to go the bathroom.

Patrick McKeown:             Absolutely, yes.

Dr. Ron Ehrlich:                   Please explain. What’s happening there?

Patrick McKeown:             I think there’s a huge relationship between breathing through the mouth and … First of all, studies have shown breathing through the mouth can significantly increase the risk of obstructive sleep apnea, and obstructive sleep apnea seems to be implicated with children wetting the bed. That, which is chronic over-breathing or whatever, and also enlarged adenoids, enlarged tonsils, they’re holding the breath, et cetera.

But we notice a lot with adults, when we get adults to change from mouth to nose-breathing and to bring down their breathing volume … and this is even athletes. Like, we have 20-year-old pre-Olympics athletes, and we had one Australian Olympian, by the way, inside the Olympics. But I can’t disclose … Like all athletes, she says, “We want to keep my training a secret.”

Dr. Ron Ehrlich:                   Okay.

Patrick McKeown:             That’s the way it goes. But even with athletes, they often have disrupted sleep from having to get up to go the bathroom during the night. If they’re breathing through the mouth, it’s an issue. So I would encourage anybody, to have a good night’s sleep, it’s really important to breathe through the nose.

Studies have shown … One study that came from a Northern Ireland hospital. With mouth-breathing, the apnea-hypopnea index, which is the number of times you hold your breath or the number of times there’s a reduction in the flow of your breathing, but both are sufficient to cause a drop to the amount of oxygen in the blood, it was 43 breathing through the mouth. Now, changing it to nasal breathing, it reduced it to 1.5. Now, by the way-

Dr. Ron Ehrlich:                   Wow.

Patrick McKeown:             … I wouldn’t expect that. That’s a huge change.

Dr. Ron Ehrlich:                   That’s huge.

Patrick McKeown:             I’ll forward you on the paper.

Dr. Ron Ehrlich:                   I’d love to see it.

Patrick McKeown:             And we wouldn’t see that all of the time, but it has been shown that there’s generally a 33% reduction in the AHI index just by switching from mouth to nose-breathing.

Dr. Ron Ehrlich:                   Yeah, and now, just to explain to our listeners, the AHI index is Apnea, that’s the A, Hypopnea, that’s the H, I is the Index, and if you have these episodes for more than ten seconds, I think it is, where you stop breathing or your breathing’s reduced, that’s considered an episode.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   And then you add it up in …

Patrick McKeown:             Yes, if there’s more than five per hour, it’s clinically significant.

Dr. Ron Ehrlich:                   That’s right.

Patrick McKeown:             So if there’s less … but you really don’t want any disturbance to sleep.

Dr. Ron Ehrlich:                   Yeah.

Patrick McKeown:             With children, you don’t want … Like, how would you know if somebody’s having good sleep? Well, it should be effortless.

Dr. Ron Ehrlich:                   Yes.

Patrick McKeown:             It should be light, there should be very little sound, if any, and it should be through the nose.

Dr. Ron Ehrlich:                   Now, Patrick, two last things I wanted to ask you about. One, ’cause you’re just talking about getting better sleep at night, and I have to admit, I have to admit, that we encourage many of our patients to use micropore tape, a thin-

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   … paper tape at night, and I have two lots of patients. They fall into two categories. There are those who look at me like I’m crazy, and I’m telling them … “Is this guy really telling me to tape my mouth at night?” That’s one group.

Patrick McKeown:             Sure.

Dr. Ron Ehrlich:                   I can live with that group. And the other group go, “Okay, I’ll give it a go.” And they invariably come back two or three weeks later and go, “I can’t believe something as simple as this can make such a difference.”

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   That’s what’s going on, isn’t it? We’re just breathing through our nose through the night.

Patrick McKeown:             Yeah, it’s the way we should be breathing, anyway. And I know we kind of wondered about this earlier on. I’m gonna go back, right back to infancy. Babies who are tongue-tied. I don’t know if this has ever been an area that you’ve looked at, but I think it’s important to bring it up. If the tongue is tied to the floor of the mouth, the baby isn’t able to adequately express milk from the breast. And breastfeeding is not just about the nutrition. Breastfeeding is about working the jaws to develop the muscles of the face. So by the baby working the breast, they have to really kind of … to extrapolate the milk, they really have to work hard, and it develops good muscle tone.

So a lot of babies with tongue-tied, they don’t try from the breast so they give a bottle. But it’s so easy to get the milk out of the bottle, there’s no work involved. It doesn’t develop the muscles. A second aspect is the food, then, that we give the kids. We give them stuff that’s so liquidized that there’s no chewing involved, so they don’t develop the structure of the jaws to be able to adequately kee, so there is poor muscle tone. And I think that’s important.

So I had my mouth open, even though I was breastfed for six months, I still, because of rhinitis, my nose is blocked, et cetera, which is another cause of it, I had my mouth open. And then my mouth would be open during sleep. The tape is just one of those things just to help the jaws, because we have lost muscle tone, and it ensures it. But not safe for very young children if they’ve got adenoids, we don’t recommend the tape. The child has to be able to breathe comfortably through the nose.

And the second thing is, we work with getting the nose decongested by doing the breath holding and by bringing down the bringing volume. Holding the breath on the exhalation, as you pointed out earlier, opens up the nose. But when we bring down the breathing volume, the nose is staying more permanently open. And using the tape, I think it’s a huge way to help in sleep. I’ve seen it with thousands of individuals.

Dr. Ron Ehrlich:                   Yeah. Yeah.

Patrick McKeown:             And it’s so simple. You know, one paper was a review of the CPAP machine, which I know, it was a fine invention that comes out of Australia. But they compared the CPAP machine against the chinstrap of the CPAP machine, and the chinstrap is simply keeping the mouth closed. The chinstrap produced a better result than the CPAP machine.

Dr. Ron Ehrlich:                   Oh, I’d love to see that paper. That’s an interesting one.

Patrick McKeown:             I’ll send it on to you, too.

Dr. Ron Ehrlich:                   Yeah. That’s right. Now listen, you’ve written a book called … I mean, you’ve written eight book. Amazing. But you’ve … latest book’s called “The Oxygen Advantage”.

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   And in it, I mean, I know you work with athletes. You’ve already given that away, although you haven’t told us who that Australian athlete is. But that’s okay. And you relate some stories there about some people who have improved their athletic performance in a counterintuitive way, which is kind of what the Buteyko is, this idea that taking a deeper breath is better for you. Can you relate one or two stories about those athletes and how you helped them?

Patrick McKeown:             Sure. I worked with three sprinters, and three USA sprinters. Patrick Feeney, Chris Giesting, and Jade Barber. And they would be about number 30th in the United States in 400 meters, and Jade is in 100 meters. Just one sport and one example. During a sprint, your oxygen levels are gonna drop slightly, and your carbon dioxide is gonna increase, and you’re primarily in anaerobic stage.

Now, what I wanted to do was, I said, “Okay, I’m gonna use different exercise to greatly disrupt that.” So I dropped down, I got them exercise to drop oxygen saturation during the exercises from, say, what they’d normally have was 93% during a sprint, we dropped it down to 80, and greatly increased carbon dioxide, by doing breath holding as part of their sprinting. So I looked at their sprinting, 400 meters. I had them nasal breathe during some of the practices, up for about, say, 375 meters, and the last 25 meters I had them hold their breath.

Dr. Ron Ehrlich:                   Wow.

Patrick McKeown:             When they were most fatigued, I added on the extra load. And because my premise was, “Let’s greatly disrupt the blood acid-base balance, because what that causes, then, is the body to make adaptations, and it delays the onset of lactic acid and fatigue.” So that’s just one example. Now, we got the guys up from 30th up to 15th overall in the United States, and that was in six months, they moved up 15 positions.

Dr. Ron Ehrlich:                   So-

Patrick McKeown:             And they put it down to what they were doing.

Dr. Ron Ehrlich:                   So instead of the hard breath of …

Patrick McKeown:             Yes.

Dr. Ron Ehrlich:                   Quite the opposite, you’re trying to tell them to slow their breathing down and breathe more through their nose while they’re exercising.

Patrick McKeown:             Yes. But, same with an elite athlete, I don’t want them to breathe through their nose all of the time because it can slow them down a bit that they lose muscle conditioning. So I do it generally 50-50. I add an extra load on to them by breathing through the nose, but then I allow the mouth breathe for half of it to make sure that they’ve got muscle conditioning.

But it is all about … An athlete trains every part of the body, but they never train their lungs, and respiratory muscle strength is very important. When you hold your breath, after a period of time, the brain starts to send a message to the diaphragm to breathe, and the diaphragm starts to contract. So you can actively engage the diaphragm by adding an extra load onto it so it causes the diaphragm to be conditioned.

So, again, a lot of this … There’s a lot of research coming out in the last five to ten years about the changes that we can bring as a result of breath holding and changing breathing into sport. I think it’s a very exciting time.

Dr. Ron Ehrlich:                   So as … we’ve gotta finish up now, but as a takeaway message for our listeners, what would be your parting message to our listeners?

Patrick McKeown:             I think it’s absolutely vital for people to consider their breath, their own breathing, how they breathe, to observe their breathing, but also for the breathing of their children. We have to accept that this is one thing. We can live without food for weeks, we can live without water for days, and we can live without air for just a few minutes. We know that the quantity of food is important, we know the quantity of water that we drink is important, but very few people are looking at, how much air are they breathing?

And modern living is changing the amount of air that we breathe. It’s making us breathe too much. And ironically, the more air we breathe during rest, the harder we breathe during rest, the less oxygen that’s delivered to the cells. So, the two things that I say is: breathe through the nose, and breathe less.

Dr. Ron Ehrlich:                   Fantastic. Patrick, thank you so much for joining us, and again, welcome to Australia. Enjoy your time here.

Patrick McKeown:             Thank you.

Dr. Ron Ehrlich:                   We’ll look forward to catching up again soon.

Patrick McKeown:             Great. Thanks so much, Ron.

Dr. Ron Ehrlich:                   Thank you.

So there it is. Breathe through the nose and breathe less. Now, the more I read about and learn about nasal breathing, the more important I realize it’s becoming. I mean, this difference between mouth-breathing and nasal-breathing is not something people give an awful lot of thought to. And also breathing less, slowing the breathing down. When you think about it, in meditation, it’s all about controlling your breath and, as Patrick and I were talking about, the impact that that has on the sympathetic and parasympathetic nervous system is profound.

And nitric oxide. Boy, if you missed that, nitric oxide. I mean, there have been around 20,000 articles written on this important body regulator, which is about … It’s got antibacterial properties, it’s a bronchodilator, it improves circulation throughout the body, so has a profound impact on our health. We wanted to get more blood supply into the body, and consequently also has a profound effect even on our sex life, which wasn’t something we went into in this talk.

Also using the diaphragm and getting air down into the lower parts of the lungs where more blood is. So, that’s what the lungs is all about, exchanging gases with the blood supply. So, anyway, look, in yoga, they say, “Life is in the breath.” And obviously, the trick to a long life is to keep breathing for as long as you can. Obvious, I know. But to healthy for as long as you can, think about breathing well.

So, until next time, this Dr. Ron Ehrlich. Be well.

This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.

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Dr Ron Ehrlich
Dr Ron Ehrlich

Dr Ron Ehrlich, or ‘Dr Ron’ as he is affectionately known, is one of Australia’s leading holistic health advocates, educators and a holistic dentist. Dr Ron also hosts a free weekly podcast called “Unstress with Dr Ron Ehrlich” and is the author of, “A Life Less Stressed: the 5 pillars of health and wellness”.