Dr Jim Bartley: Breathing & Vitamin D Matters

Every time I speak to somebody about breathing, I learn something new. And as the world we live in becomes increasingly more complex, the theme of this podcast is that many of the solutions to enjoying good health are remarkably simple, cheap, accessible, and, most importantly, effective. And what can be more accessible than focussing on breathing?

Dr Jim Bartley is an ear nose and throat specialist with more than 30 years of experience. He is an honorary associate professor in surgery at the University of Auckland. He’s based in New Zealand. He’s written over 60 articles in refereed journals, he’s contributed chapters to 17 books and wrote two books himself. “Breathing Matters” and “Healing Headaches”.

Dr Jim Bartley: Breathing & Vitamin D Matters Introduction

Well, today we’re going to continue our exploration of medical specialists with a very holistic approach to health. And I think I’m really excited about showcasing and introducing you to this type of medicine because it is, after all, a form of medicine that takes into account anatomy, physiology, biochemistry, and pathology. It uses nutritional and environmental medicine, which are the drivers. 

Nutritional environmental problems are what drive the vast majority of diseases in our modern world and also incorporate pharmaceuticals into their mix. I think the alternative approach to medicine focuses on two subjects pathology and pharmacology. And it’s for that reason that the pharmaceutical industry has revenues of $1.2 trillion a year. 

And if you are a person who doesn’t think that any of these things are important, you probably wouldn’t be listening to this podcast in the first place. But you have definitely an industry waiting to greet you with open arms. We continue our exploration and my guest today is someone who, in his knowledge, is far and wide. 

He is Dr Jim Bartley is a specialist ear, nose and throat specialist for over 30 years. He is an honorary associate professor in surgery at the University of Auckland. He’s based in New Zealand. He’s written over 60 articles in refereed journals, he’s contributed chapters to 17 books and wrote two books himself. “Breathing Matters” and “Healing Headaches”. I hope you enjoyed this conversation I had with Dr Jim Bartley.

Podcast Transcript

Dr Ron Ehrlich: [00:00:02] I’d like to acknowledge the traditional custodians of the land on which I am recording this podcast, the Gadigal people of your nation, and pay my respects to their elders past, present and emerging. Hello and welcome to Unstress. My name is Dr Ron Ehrlich. 

Well, today we’re going to continue our exploration of medical specialists with a very holistic approach to health. And I think I’m really excited about showcasing and introducing you to this type of medicine because it is, after all, a form of medicine that takes into account anatomy, physiology, biochemistry, and pathology. It uses nutritional and environmental medicine, which are the drivers. 

Nutritional environmental problems are what drive the vast majority of diseases in our modern world and also incorporate pharmaceuticals into their mix. I think the alternative approach to medicine focuses on two subjects pathology and pharmacology. And it’s for that reason that the pharmaceutical industry has revenues of $1.2 trillion a year. 

And if you are a person who doesn’t think that any of these things are important, you probably wouldn’t be listening to this podcast in the first place. But you have definitely an industry waiting to greet you with open arms. We continue our exploration and my guest today is someone who, in his knowledge, is far and wide. 

He is Dr Jim Bartley is a specialist ear, nose and throat specialist for over 30 years. He is an honorary associate professor in surgery at the University of Auckland. He’s based in New Zealand. He’s written over 60 articles in refereed journals, he’s contributed chapters to 17 books and wrote two books himself. “Breathing Matters” and “Healing Headaches.” I hope you enjoyed this conversation I had with Dr Jim Bartley. Welcome to the show, Jim. 

Dr Jim Bartley: [00:02:09] Thanks very much. Ron, it’s nice to talk to you.

Dr Ron Ehrlich: [00:02:11] Well, I’m looking forward to talking to you because we have had an opportunity to have a chat before we’ve recorded, and here we are. But I just thought we’d start because there’s so much, you know, you’re an ENT specialist. 

You’ve written so many book, you’ve written two books, you’ve been involved in so many published papers. But I wondered if you might just share with us your journey. And you know, I know there are a few aha moments that occur in one’s professional life, but how did you have you got to this point in your career?

Dr Jim Bartley: [00:02:40] Well, I’ll start with my journey and a few of the aha moments when I had finished my house years as a junior doctor. I didn’t know what I wanted to do, and I saw a job advertised up on the east coast of the North Island, and I thought going up there for the summer would be very good. 

So I went to a place called Tafoya Springs, which is an hour and a half north of Gisborne. And the moment I arrived, the only other doctor there took off, leaving me in charge of medicine on the East Coast. And it was very interesting because when I was there, I had to do my own obstetrics. I was doing some of my own setting of fractures. 

And the other thing I also was doing was I was giving patients the choice. Did you want to go down to Gisborne to have your tooth pulled out? Well, pull your tooth out of here. So I’d actually practised on lists and Nelson Hospital before I went up there. So I was also pulling out a few teeth. 

Dr Ron Ehrlich: [00:03:38] Wow, this is character-building.

Dr Jim Bartley: [00:03:41] And when you’re working in an Indigenous population because 90% of the population up there is New Zealand, Maori, all I was seeing up there was the problem ears, and so I thought this is really interesting. And then, I decided I’d go back to hospital training and become an ear, nose and throat specialist, and I was going to focus largely on Maori ears. 

So I did my training, and then I went over to London, and when I was there, endoscopic sinus surgery was coming out, and so I went to a course there, and I also we had visited a surgeon over there. He was doing endoscopic sinus surgery. So I came back to New Zealand, and my job at Rotorua had fallen through. So I started doing endoscopic sinus surgery, and the problem with endoscopic sinus surgery, it was totally new and considered a waste of time.

Dr Ron Ehrlich: [00:04:33] This is the passing of a camera, using a camera to guide you. 

Dr Jim Bartley: [00:04:36] You stick a telescope up the nose, and you have instruments going up the nose. And it dramatically changed sinus surgery because it meant you didn’t have to have a whole lot of cuts on the outside of the nose.

Dr Ron Ehrlich: [00:04:48] Wow. Revolutionary

Dr Jim Bartley: [00:04:49] And it was at that stage. But one of the things that happened was the textbooks had taught that if you had a pain in your sinus, like your frontal sinuses up here or your maxillary sinuses if you went and opened that sinus up, the pain would go away. And the problem was the new technology showed that the pain did not go away. 

And so, all of a sudden, I had to try and work out what was going on with these patients. And one of the things I started reading around was trigger points. And so, I then started looking at trigger points in the neck and shoulder muscles. I started exploring things like acupuncture. And I also started looking at the psychological issues in relationship to pain. 

And all of a sudden, I had started a clinic where I was with physiotherapists we were working on treating neck and shoulder pain with physiotherapy and a bit of breathing and relaxation work. And the next aha moment was, what then happened was I got invited to work at the pain clinic because I was seeing all these difficult facial pain patients. 

And one of the things that happened when I was there I had a patient come in. And what also then happened was the patient came in, and I’d heard something on the radio about vitamin D and fibromyalgia in this lady was an African American lady, and she had uncontrollable pain. She couldn’t use a hand because of the pain. And I’d been asked to adjust her narcotics, and I did a vitamin D level on her, and it was 18. 

And so I then rang up the registrar. How do you prescribe vitamin D? So I gave her some vitamin D, and she came back six weeks later. She was forgetting to use the narcotics because the pain was so much better. And the day before, she’d been out, water blasting her path. And one of these another, aha moment and the other Aha moment I had was I’ll be seeing patients coming along complaining that their noses were blocked and that had three or four operations. 

And I look in their noses, and I couldn’t find anything wrong, and I thought, Hmm, if the structure looks okay. How they’re using their nose? And I noticed that many of these patients were actually hyperventilating. And as soon as I started treating them to breathe in a relaxed diaphragmatic fashion, the nasal obstruction got better, and then a whole load of other conditions that they had also got better. 

And so I then wrote a paper on this, and I also end up writing a book called “Breathing Matters,” because what happened was all my colleagues said, this is complete and utter rubbish. Where’s the science? So I wrote a book saying, Look, here is the science. And it’s been that way, at least for the last 40 or 50 years. And many of my colleagues have taken it on board. But many of my colleagues also say this is complete and utter rubbish.

Dr Ron Ehrlich: [00:07:44] Mm hmm. I know a lot of professionals feel that that’s a better way of dealing with new knowledge rather than exploring it. I mean. Yeah. Anyway, but you’ve said so much. My God, we could stop and talk about trigger points and remind or just tell our listener what in fact, the trigger point is. Because the kind of headache the trigger points give us refer is so often described as that as a sinus headache because it’s over the sinuses, isn’t it? 

Dr Jim Bartley: [00:08:12] You’re exactly right. And part of the problem you’ve got to do is you’ve actually got to try and persuade your patient that they haven’t got sinus pain because their GP has told them and all sorts of other doctors have told them. And I normally go through a video, a video presentation, but one of the trigger points, as we were talking about the other day with first described by a lady called Janet Travelle, who was John F Kennedy’s personal physician. 

And basically, when I see a patient who’s got a bad headache, I’ll find that they’ve used to go to trigger point in the mid part of their shoulder where they’re really sore are normally fine that I really sore all down this muscle here called the mastoid muscle.

Dr Ron Ehrlich: [00:08:53] Down the side of the neck for all this now.

Dr Jim Bartley: [00:08:56] It’s a bit difficult to palpate that. And the other thing that happens is that often their heads will be way forward and the tender in the muscles at the junction of the skull and the base of the neck. And it reaches a stage that patients are saying, how do you know it’s going to be is going to be sore there? 

And look, they’re also sore down at the upper part of what’s called the scapula or the bone at the back. And they’re often got low back pain, and they’ve also often got pain in the forearm. And the Chinese have described all this for two or 3000 years because many of these trigger points that Janet Travell described also correlate with traditional Chinese acupuncture spots. 

Dr Ron Ehrlich: [00:09:36] I mean, what a thing for an ENT specialist to be aware of. I mean, that would you would think that would be basic training in your speciality as a differential diagnosis is.

Dr Jim Bartley: [00:09:49] Well, I do give that is in the registrar training.

Dr Ron Ehrlich: [00:09:53] Now now?

Dr Jim Bartley: [00:09:55] But one of the problems also is, is that if I give a talk on this at a conference, I’ll probably only get two or three people because people are interested in that. They’re more interested in new surgical techniques and ideas. And the other problem I also have, as soon as I got interested in facial pain and difficult facial pain patients, all of a sudden, my colleagues didn’t want to deal with them. 

They completely dumped them on me. And usually, these patients have what’s called the thick file syndrome. There’s a great big, thick file going on. And the other interesting thing that fits in with you, Ron is when I was working at the pain clinic, I’d also get sent all the difficult dental pain patients. 

Dental pain can be very difficult, and you’d see patients who had had every tooth removed and their upper jaw trying to get rid of the pain. And this was no better. Yeah, I can I can talk a little bit about, as you know, there’s a lot of theories about dental pain.

All of them have sort of come, come and gone. But I can only say that trying to work out dental pain can also be extremely difficult, as you know as well.

Dr Ron Ehrlich: [00:11:00] Yes, well, we might do a whole podcast on that one because there are no it really is. And I mean, sometimes if someone comes in with the pain and they’ve got a big hole in their two sets of often, not always, often very obvious, but often it’s not obvious. But continuing on this on this path, sinus headache. 

Let’s just talk for a moment about what is the defining symptoms of a sinus headache. I’ve always thought it was involving posture. Is that a part of it? If you bent over or postural changes, what defines a sinus headache?

Dr Jim Bartley: [00:11:35] With.

Dr Ron Ehrlich: [00:11:37] A real sinus headache.

Dr Jim Bartley: [00:11:38] Where it’s related to sinus or just pain over the sinus.

Dr Ron Ehrlich: [00:11:41] Where it’s related to sinus?

Dr Jim Bartley: [00:11:43] Well, they do have… There are strict criteria that have been laid down by the American Academy of Otolaryngology. And basically, to have a strict sinus headache, you’ve got to have a loss of a major. Criteria and minor criteria. A loss of sense of smell, nasal obstruction, infected nasal discharge. 

You’ve got to be able to see evidence of infection when you actually look into the sign. Look into the nose with an endoscope, or you’ve got to be able to see it when you’re on a CT scan. If you get a CT scan and facial pain or facial discomfort is very much written down as a minor as one of the minor criteria. 

And two minor criteria make a major criterion. But one of the things that is absolutely different in my book because when this all happened to me years ago. When I was trying to work out facial pain and sinuses, I went away, and I read all the textbooks going back to the 1920s about sinus pain with I tried to research it. 

But if you’ve got a sinus infection in the sphenoid sinus, that is very, very much associated with facial pain and sinus pain. For some reason, the sinus a lot there is finally sinus right at the back of the head is more sensitive. You do see a minor degree of pain with the frontal sinuses, but the sinuses underneath our eyes, maxillary sinuses, are relatively pain insensitive. 

Dr Ron Ehrlich: [00:13:11] Interesting.

Dr Jim Bartley: [00:13:12] And if you think about it, what? There was no rational or theological role for the sinuses to actually get strictly innervated or highly innervated with with with pain fibres. But you can actually show that there are certain pressures where the sinuses do become painful. But you’re looking at about 80 or 90 millimetres of mercury. 

So you’ve got to get a very, very high pressure before you’ll get pain. Because, as you know, some of us, when we’ve gone flying with people, patients have had problems with their sinuses. Well, I’ve seen divers who’ve had problems with their sinuses when they’ve actually gone diving. And I’ve actually written I’ve got a number of divers back to work by just simply opening up their sinuses properly. Hmm.

Dr Ron Ehrlich: [00:13:55] And I think it’s also noting that the molar teeth and the pre-molar teeth are so intimately related to the sinus that this is where a diagnosis of dental infections is still pretty common. Very common, in fact. And personally, we’ve noted in our practice the use of 3-D X-rays has been. Absolutely. It’s been a revelation to us.

Dr Jim Bartley: [00:14:20] Well, you know, I always check out the piece on this on the CT scans. And if the radiologists get very upset with me, because every now and then, I point out that they’ve actually missed an apical abscess going on there. But. Well, we could talk about apical abscesses as another totally different picture. Yeah.

Dr Ron Ehrlich: [00:14:42] Mm hmm. Which. Which, for our listener, is just infection at the tip of the root. When a nerve in a tooth has died. And. And that can be painful. Or it can be not painful, but it’s an infection. The other one is fibromyalgia, which you mentioned and you mentioned responded so well to vitamin D. But fibromyalgia is another one of those very frustrating. They’re the ones that come in with a pile of a history of many, many pages. Tell us a bit about fibromyalgia.

Dr Jim Bartley: [00:15:10] Was not quite my area of expertise. Okay. Okay. But the issue is, is that, now, vitamin D doesn’t have a relationship to it. One of the things that I did talk to the fibromyalgia society that I found really useful, interestingly enough, is actually working on breathing and relaxation in the fibromyalgia group that I have spoken to years ago said that of many interventions that were the most useful. 

The other thing, which is is is low dose naltrexone yet can also be useful. Naltrexone is an opioid antagonist. And Stanford University has shown that that can be useful to some fibromyalgia patients. And there is we get into another very controversial area, and that is the role of diet. 

And there is certainly a group of patients who find that if they go on to a ketogenic diet where they get an improved energy supply to the mitochondria. They do find an improvement. But we are still struggling to help many of the patients with fibromyalgia.

Dr Ron Ehrlich: [00:16:19] The other thing you mentioned, too, was people who have a blocked nose, who are hyperventilating, and you look in their nose, and there’s no obstruction, but there’s a biochemical thing going on there or what’s going on there?

Dr Jim Bartley: [00:16:32] What happened? And I have got a graph to show if we want to have a look at it because the Mayo Clinic about 20 years ago showed that nasal resistance was inversely related to expired carbon dioxide levels. So the slower you breathe, the higher your expired carbon dioxide levels and the more your nose becomes unblocked. So if you can train people to breathe slowly, then their noses will unblock. 

There’s also a relationship to expired carbon dioxide levels, and you can show that if you’ve got high expired carbon dioxide levels, you’re less likely to have an allergy or allergic symptoms going on in the nose. And you can show that different groups of the population have different settings for their carbon dioxide levels. 

So there are some people who are very anxious. And if they’re really anxious and breathing rapidly, their carbon dioxide levels stay at around 35 or so millimetres of mercury, and they can’t hold their breaths for very long. Whereas if you’ve got Buddhist monks and say people who practise underwater hockey have set their carbon dioxide receptors to about 44-45 with a normal is about 40. 

And so, there is a breathing technique out there called the Buteyko breathing technique, where people are taught to breathe slowly through their noses, diaphragmatically. And they’re also taught to practise breath holding, to try and reset their carbon dioxide receptors. And there is one paper out there where they have shown that this is published in the conventional literature, that if you get people to practise the Buteyko breathing technique, then that actually makes a big difference to their asthma, to the asthma control and a whole lot of other symptoms. 

So holding your breath, and there’s a book out there called “The Oxygen Advantage.” That’s why the guy actually argues that if you want to improve your performance on the sports field, then you should practise holding your breath. Because when you do that, you means that you’ve got more of it, more of an acid in your blood, which means there’s something called the ball effect. Your delivery of oxygen to the muscles and everything else like that is significantly improved. 

Dr Ron Ehrlich: [00:18:53] Because people think of breathing as all being all about oxygen. But actually, the key is our carbon dioxide level in our lungs, which you’ve mentioned the various levels of being 35, 40 or 45, 44. And then that kind of has a really important effect on acid-alkaline. It is, in fact, what balances out acid-alkaline in the body, isn’t it?

Dr Jim Bartley: [00:19:17] That’s exactly right. And basically, sort of the slightly more acidic your blood for everyday use, the better oxygen supply you will get to all the tissues around the body, including the brain and things like that. And you can once again you can show not just the tissue delivery but your delivery of the oxygen to the brain, the artery to the brain opens up directly in relationship to the carbon dioxide levels in the blood. 

So as soon as you start hyperventilating, you can actually start constricting the arteries to the brain, and people start feeling faint. And I had that experience myself where I was climbing Kilimanjaro, and I was going around something called the Barranco Wall. And I must have started to hyperventilate because my oxygen was already a bit low at 80, and all of a sudden, my head was completely, completely swimming. 

Well, and I don’t know. You’re a schoolboy. We used to have this trick. And when you’re young schoolboy, we would hyperventilate, and then you’d hold your tummy so that you provided oxygen for getting to the brain, and then you would faint in the playground. Now, that is something we used to do as a fun thing. I don’t know. How do you treat to that as a party trick? And there’s also something. I’ll tell you another story then. 

Shallow water blackout. Hmm. Because what happens is, if you hyperventilate and then go down diving, you’ve by hyperventilating. You’ve actually constricted the arteries to your brain. And then, all of a sudden, the oxygen, the carbon dioxide levels go up and you blackout. Hmm. And we were diving once with a friend, and there was it was a friend’s anchored down the bottom, and it was stuck. 

And I sort of said to this guy, Well, I’ll go down and get it. So I started hyperventilating to get down there. And the guy said, Don’t do that. You’ll get shallow water blackout. So I went down, I retrieved the anchor, and then I could see the bubbles on the surface. And the next moment, a friend was giving me mouth-to-mouth resuscitation on the surface. 

Obviously, he said, I got to the surface, and then I started dropping, and he sort of didn’t work hard. I was having him on or not all over picked me up and started giving me mouth-to-mouth resuscitation.

Dr Ron Ehrlich: [00:21:35] Now you know that whole thing about hyperventilating, and people pass out, or they put a paper bag over their mouth to re-breathe. This is all about that carbon dioxide balance. But there’s another one that comes with nasal breathing, too, which is not just carbon dioxide level, but there’s another gas that we need to be or compound that we need to be familiar with, which is nitric oxide, too. That’s an important one as well, isn’t it? 

Dr Jim Bartley: [00:21:59] Nitric oxide is a very interesting gas, and most of the nitric oxide that we inhale comes from our noses. And when we inhale nitric oxide, it goes down into the lungs, and it improves ventilation-perfusion as the gas goes to the blood. 

And if you’ve got nitric oxide actually in your bloodstream, when the capillaries or the little blood vessels get to the final part, they then the nitric oxide comes off and then dilates the dilate, dilates the blood vessels. 

And of course, one of the very popular medications, Viagra, is a nitric oxide inhibitor. So it improves the nitric oxide supply to the male genitalia, and we get a corresponding result. Also, a very interesting relationship between what we’re eating and if we have sort of beetroot, for example, we increase the amount of nitric oxide that the body gets, and that is said to improve athletic performance. And if you go out to the sports drink places, there’s a lot of beetroot drinks to improve nitric oxide before.

Dr Ron Ehrlich: [00:23:12] Going, no, no, go, go.

Dr Jim Bartley: [00:23:13] And there’s also another interesting thing that happens is that when you hum, the sinuses somehow vibrates and actually improve nitric oxide delivery into the nose. So if you’re actually humming, you’re improving nitric oxide delivery. And there is one study published a couple of years ago where they got yogic people to actually hum. 

And we know people with chronic sinusitis, if they hummed, they got dramatically better with the symptom score with respect to sinusitis. So no one’s ever looked at any further, but going around humming could be an important treatment for chronic sinus disease. 

Dr Ron Ehrlich: [00:23:50] Hmm. I also read that after the SARS-CoV-1one virus, there was an article in the Journal of Virology which was amazing. It made the statement that nitric oxide disrupts the reproductive cycle of the Sars-Cov-1 virus. So it’s also anti-microbial. It’s not anymore. 

Dr Jim Bartley: [00:24:10] But I never followed it up, but they were looking at it as a treatment for COVID. And it doesn’t get applied in adults, but for neonates, they actually add nitric oxide to the ventilators to improve their ventilation and reduce their elect assists in the young. So it is recognised as a treatment. 

But one of the problems we do have is that if it’s too high a dose, then you can get side effects from it being being being too high. And people with asthma, some of them actually produce because of the inflammation, do produce high levels of nitric oxide. And so on the other side of things. It is used as a marker of asthma, inflammation or inflammation in the lungs of asthmatic patients.

Dr Ron Ehrlich: [00:24:57] Oh, right. Okay. Interesting. Another area while I while I’m consulting with the ENT specialist, another area that’s often interesting is tinnitus. And I’d love to hear your, you know, your view on tinnitus because it’s a frustrating problem for many people and practitioners.

Dr Jim Bartley: [00:25:16] Well, one of the problems with tinnitus is a bit like facial pain, is that people run a mile because, unfortunately, there aren’t any quick and simple answers. I saw something advertised the other day, but I didn’t look at it. I’ve looked at all sorts of options. And certainly, if you’ve got a hearing loss, if you’ve got a hearing loss in about 50% of patients benefit from hearing aids. 

When I had trained, one of the treatments was actually breathing and relaxation work as an effective treatment. And one of the other options is a quick options is Trigger points or tinea spots, particularly in the sternocleidomastoid muscle but more in the masseter muscle here. 

As I said, with tinnitus and I have had only a few patients where we have looked at try to work on their breathing and their posture and reducing the tension in their muscles. And the tinnitus has got better. 

Now, the other thing that’s also happened is that the audiologists have got into cognitive behavioural therapy where they play sounds to patients in their ears, and they try and get them to relax and get their brain to actually adapt to the tinnitus, so it’s less stressful. But one of the things that happens is that in a very, very quiet room if there’s no sound coming in, 80% of people will get tinnitus. 

So sounds coming, in turn, the sort of the volume control down in in the brain. So one of the things we often tell people to do, if they’re having tinnitus, having difficulty going to sleep, just a little bit of soft music will actually turn there in the background as they’re going to sleep. Will actually turn their tinnitus down.

Dr Ron Ehrlich: [00:27:06] Yeah. Because I know whenever I’ve been dealing with people with headache, neckache, jaw ache and tinnitus, I always say in order of easiness, you know, getting rid of the headache, neckache and jar ache I think we could get a quicker result. Tinnitus is frustrating, but it’s interesting to hear you say that as well. 

Vitamin D now, you know, to hear you be so focussed on vitamin D, and I know you’ve written on it in various journals, is such an interesting one. And I was really impressed by how widely explored it. How do you mention that one woman who had a level of 18? What is an ideal level of vitamin D? How common are deficiencies?

Dr Jim Bartley: [00:27:48] Well, if you start, it depends on how you start defining deficiencies. But one of the things that happen is if you go and look at animals in the wild, they look at chimpanzees and monkeys and things like that. They have vitamin D levels, about 140 nanomoles per litre. And if you start looking at traditional tribesmen in the jungle, they have levels of about 120 nanomoles per litre. And if you look at the, there has been discussion about what is an optimal level for the books. 

Talk about a level of 50 nanomoles for a litre. And one of the interesting, interesting things, as you can show, if you graph it out, that you start getting benefits around sort of 75, even up to 100 nanomoles per litre, if with a variety of health conditions. And that includes a reduction in cancer, mainly sort of breast and colon cancer. 

You can show that walking time improves, vitamin D has a role in muscle strength. And you can also actually show if you look at gum restriction that vitamin D also influences gum restriction up to about 80 to 90 nanomoles per litre. 

But one of the fascinating things is, is that we’ve known for over a hundred years that vitamin D prevents tooth decay. And these were studies done in the late 1920s in boys’ homes in New York, where they gave some groups Vitamin D and the others didn’t give vitamin D to. And they had exactly the same diet. Everything else was the same. And there was a dramatic reduction in tooth decay. 

And you can actually also do just graphs going down the States, and you can show the further north you go, the higher incidence of tooth decay, and the closer you are to the equator, the States you have less tooth decay. So there are numerous studies out there showing that taking vitamin D prevents tooth decay, and we hear absolutely nothing about it. 

The other interesting one is there is a study out there showing that if you take if your vitamin D levels are relatively high and it is actually only about 50 nanomoles per litre, and this was a study out of Israel. And they you can show that people with COVID often have low vitamin D levels, but it’s a cause. 

Was that is that an effect of the COVID virus? And so they looked at vitamin D levels three months and earlier and basically three months in early. If you had a vitamin D level of greater than 50, your risk of severe COVID was about 3%. If your level was 15 nanomoles per litre, your risk of severe COVID was 24%. 

So there was a dramatic improvement. If you can get your vitamin D levels up sensibly. And a petition went to the British Parliament saying look at vitamin D supplementation for COVID, and this was over a hundred respected doctors, and it was completely turned down by the time and then turned down by the British government.

Dr Ron Ehrlich: [00:30:51] Yeah. Now we had the same story here in Australia and most recently, there was a government forum on treatment of COVID 26 months after the beginning of the pandemic. So came a bit late. But vitamin D levels are just that’s too simple. It’s too cheap. It’s not promoted by the pharmaceutical, so it is of no interest to the majority of the medical profession.

Sadly, very sadly, it’s a topic we’ve covered a few times on this podcast. Jim, I know this sounds obvious to you’re an anti-specialist, and of course, you would be interested in breathing. But no, it’s much more nuanced than that. You’ve written a book on it, “Breathing Matters,” but just remind us what breathing well is. How do we define it?

Dr Jim Bartley: [00:31:41] Well, we breathe according to different situations, situations that we are in. And if we are meeting a situation of stress, brief stress, one of the things that we would do is that we would breathe rapidly in our upper chest. And what that does is that would make our bodies, our apoplectic. And when our bodies became, our muscles would react faster, and also our brain would react more quickly. 

But if we do that on a long-term basis, we can run into problems. Now, if you actually inject bicarbonate into horses and athletes, you can make them apoplectic. And you can show that if you inject athletes or horses at the beginning of the race, they will actually perform actually better. But as one horse trainer said to me, it’s not the beginning of the race that’s important, but the end.

Dr Ron Ehrlich: [00:32:40] And you still need to be a front in front at the end that’s the critical point.

Dr Jim Bartley: [00:32:45] For you see, horses take off with the bicarbonate. And I’m not totally up with it, but it’s actually it’s not allowed to be done as part of horse doping. But when we designed to breathe, to breathe and relax, and that’s when our immune system takes over. 

And when we’re sort of looking at body recovery, then we just we are designed to breathe in a relaxed fashion diaphragmatically, and that involves our abdomens sort of breathing, moving. And when it moves, we actually get circumferential expansion of the abdomen. When I start off teaching people to breathe, and I don’t know, Do you want me to stand up?

Dr Ron Ehrlich: [00:33:25] No, no, it’s okay, because this is audio too, so you just describe it. 

Dr Jim Bartley: [00:33:28] What happens is that they just push their abdomens in and out, and that’s what we have to do to start over. We had a patient today who could not breathe in a relaxed diaphragmatic fashion, lying down, relaxed. And in that situation, we did look at other ways to try and encourage her relaxed diaphragmatic breathing. And that involves bending the knees up to relax the abdomen. 

If you put your hands behind the head, it also helps just relax the shoulders a wee bit. And I did this about six months ago. When I get people to do that, I will often get them to breathe, try and breathe through their noses with their tongues up against their hard palate. But if you’re really desperate, if you start getting people to breathe through their mouths, that can be a start of trying to get them breathing in a relaxed diaphragmatic fashion. 

So if you can breathe in a relaxed diaphragmatic fashion, you can show that the amount of oxygen that is delivered to the blood is increased. And this is just once again, respiratory physiology, which is a fundamental respiratory physiology textbook. So if you can breathe in a relaxed diaphragmatic fashion, it takes 3 to 4% of your body’s energy. 

Yet if you have a vigil adding up here, it takes up to 30% of the energy in your body. Just working on your breathing is a great way to actually promote it, to promote the conservation of energy. And that might be one of the reasons why fibromyalgia patients possibly have found it so useful.

Dr Ron Ehrlich: [00:35:00] Hmm. Wow. And of course, this mouth breathing, nasal breathing thing, which is very common, is another aspect of this whole picture as well.

Dr Jim Bartley: [00:35:10] As well as we’ve talked about, we’ve got nitric oxide, but basically, we were designed to actually breathe through our noses most of the time. And if we stop breathing through our mouths, then we actually change the overall resistance in the body. And there was an interesting study out which just published in The Lancet about 15 years ago, where they saw people who had fractured jaws. 

And so what they did is they measured their oxygen levels and their lung functions, and then their jaws all got wired up for six weeks while their jaws healed. And then, they measured their lung function tests and the oxygen levels before they took the wires off of their fractured jaws. And I find this really hard to believe, but the oxygen concentrations in the blood went up 4 or 5%.

And all the functions of lung function improved, total lung capacity improved by 5%. And you can also show this is what they do in the laboratory. If they get athletes and they get them to breathe solely through their noses or solely through their mouths, by putting clamps on, the oxygen extraction improves with nose breathing and the carbon dioxide excretion improves with noise breathing as opposed to mouth breathing. 

So basically, physiologically, if we breathe through our noses, we improve oxygen delivery and carbon dioxide extraction from our body.

Dr Ron Ehrlich: [00:36:34] But the more I hear about breathing, the more amazing I think it is, particularly the diaphragm. Jim, I had an integrative gastroenterologist, Dr Pran Yoganathan, on when I asked him about acid reflux, you know, the big, big seller of protein pump inhibitors and antacids. He said it was a function of he felt in the majority of cases it was a function of diaphragmatic sarcopenia or underdevelopment of the diaphragm. And I thought that was really interesting.

Dr Jim Bartley: [00:37:04] Once again, this will been published about six or seven years ago. There was a paper in the American Journal of Gastroenterology.

Dr Ron Ehrlich: [00:37:13] Right.

Dr Jim Bartley: [00:37:13] What they did is they got people with reflux, and I put a metre in the lower oesophagus and then got them to change their breathing, whether they breathed in their upper chest or whether they breathe diaphragmatically. And as soon as you started breathing in your upper chest, you showed acid going up into the lower oesophagus. 

And what they did is they got patients, these reflux patients, to go away and practise relaxed diaphragmatic breathing and worked on it. And three months later, the use of antacids and proton pump inhibitors had gone down 70% in those patients who were able to practise good, relaxed diaphragmatic breathing. Wow. 

It’s not quite my area of expertise, but I do see patients with reflux because quite often, if you get reflux, you can get acid coming up here and complaining of lumps in the throat and throat discomfort. And I’ve only got a handful of patients, but I’ve had a number of patients have gone away that worked on relaxed diaphragmatic breathing for their reflux. And it’s made a dramatic difference.

Dr Ron Ehrlich: [00:38:20] The other podcast and mentioning it to you because I know you’re going to might come up with an interesting perspective on it. We did one on Men’s Health, and when he said diaphragmatic breathing improved pelvic floor tone, which is particularly important as we all get older, but women also after they’ve had a child. That was interesting, too. I mean, the benefits of diaphragmatic breathing run through the whole body.

Dr Jim Bartley: [00:38:43] Well, once again, the pelvic floor becomes important because it gets stimulated once again by the diaphragmatic movement. I don’t have a lot of knowledge of it, but we know that respiratory physiotherapists, when dealing with people with pelvic floor problems, work on relaxed diaphragmatic breathing to try and help patients with the pelvic floor tone. 

The only other comment I’ll make is if you’re a top-class female athlete, you’ve actually got really, really good pelvic floor tone. And these top-class athletes sometimes have difficulty when it comes to delivering babies because their pelvic floor tone is so high.

Dr Ron Ehrlich: [00:39:18] Hmm. Interesting. Interesting. Now, listen, if you were going to leave our listener with a few hints on improving their health in general or breathing in particular, what would be some of the things you’d recommend to people?

Dr Jim Bartley: [00:39:31] Well, a very, very simple one. A very, very simple one is actually thinking about. Sensible sun exposure and taking a little bit of vitamin D. Now you can show, and this is a meta-analysis in the British Medical Journal, that if you take regular low dose vitamin D and I take sort of two or 3000 IU a day over the winter, then that dramatically reduces your risk of respiratory infection. And it’s twice as effective as the flu vaccine that’s looking at protective data. 

The flu vaccine data I’m quoting comes from the Cochrane database, which is the most rigorous source of evidence-based medicine. And the study I’m talking about has been published in the British Medical Journal. So if you really want to have a good winter and I haven’t, I’ve never had a day off work being sick. I’ve broken a few bones but never off sick.

And taking a look at a low dose vitamin D, 2000 to 3000 IU a day for going out in the middle of the sun and seeing a little bit of sun, because it will also help you, melatonin and your sleep. And the next one, it’s a bit harder to actually talk about, and that is thinking about your breathing and where you’re breathing. And indeed, what does happen is some people go away, they practise their breathing, but it takes 8 to 10 weeks to change everything. 

And that can help people with their sleep and their sleep quality. And if you’re a meditator, relaxed diaphragmatic breathing is one of the prime things that you do when you’re actually breathing. And that also makes a whole lot of difference to other electrical activity in the body. You can certainly show that it changes something called heart rate variability, which relates to the contraction of your heart. 

And there are also some very interesting studies. I haven’t been able to find it again. Whereas if you’re breathing in a relaxed offering medication, you can actually show that your brain wave activity becomes synchronous with your breathing pattern. So there’s maybe a degree of sort of synchrony between the heart rate variability that is being generated by your breathing pattern and your brainwave activity.

Dr Ron Ehrlich: [00:41:42] Hmm. Now, listen, we just want to finish up one last question because we are all on a health journey in this modern world as individuals. And so, taking a step back from your role as a medical specialist, as an author, as a teacher, you know, what do you think the biggest challenge is for us as individuals on that journey?

The Biggest Health Challenge

Dr Jim Bartley: [00:42:06] It’s a very good question because I have to stop and think about it. And I think one of the big challenge is that when you start talking about vitamin D, and you start talking about breathing even to your friends, people will look at you as if you’ve gone completely mad. And what I do is if I say to a patient that I have discussed, say, vitamin D supplementation or I’ve discussed breathing and relaxation work with the patient, I will actually often put the specific references down at the bottom of my letter to the GP. 

So the GP can’t turn around and say, Well, you’re not practising scientific-based medicine. So when I tell people that it might be useful for their reflux, I then put the reference at the bottom of the list. If I say vitamin D might be useful for eczema, then I put the reference at the bottom of the list. 

And the problem is that many of your GP, so many of you, even your hospital specialists, aren’t aware of… They’re not up to date with the conventional scientific literature because the thing that gets to a medical school is drugs and operations and nutrition and other issues like that. I don’t receive a lot, a lot of time.

Dr Ron Ehrlich: [00:43:20] Yeah, well, Jim, that is exactly why I was so looking forward to having you on here today. And we’ve learnt so much, and I want to thank you for joining us and sharing your knowledge and your wisdom with us. Thank you so much.

Dr Jim Bartley: [00:43:33] Thanks very much for the invitation, Ron. It’s a pleasure talking to you, and hopefully, we’ll stay in communication. 


Dr Ron Ehrlich: [00:43:40] Every time I speak to somebody about breathing, I learn something new, and I’ve been interested in it for a long time. I hope you find it interesting as well because as the world we live in becomes increasingly more complex, the theme of this podcast is that many of the solutions to enjoying good health are remarkably simple, cheap, accessible, and, most importantly, effective. 

And what can be more accessible than focussing on breathing? And it’s why sleeping and breathing we consider, I consider on this Unstress podcast in my Unstress Health programme to be foundational pillars and Jim kind of reinforces that also vitamin D here it comes again, vitamin D, vitamin D, we’ve spoken up before. We’re going to do a whole programme on vitamin D. 

It keeps cropping up in every element of health because like thyroid hormone, vitamin D receptors and thyroid hormone receptors on every cell in your body. And that is why vitamin D is critical to reducing physical and mental health problems. So Jim kind of reinforced that in spades and reinforced the power of good breathing. 

Now I’ll have links to some of Jim’s books, “Breathing Matters” and “Healing Headaches.” And we’ll be following up on these themes in coming podcasts. So I hope this find you well, until next time. This is 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.