Dr Rosalba Courtney: How the Power of Breath and an Integrative Approach to Breathing Therapy can Transform Your Life Introduction

Rosalba Courtney has a Ph.D. in dysfunctional breathing and breathing therapy and has been published widely in the scientific literature. Rosalba believes breathing combined with movement, mind-body techniques, and other health practices can heal the mind and body and has developed a system called Integrative Breathing Therapy based on models and tools from her Ph.D.

Rosalba offers online and face-to-face programs for individuals and groups. These programs include Breath Mind Body, Functional Breathing Retraining, Healthy Breathing Healthy Child, and Altitude Power Breathing. In addition, she sees private patients at the Breath and Body Clinic in Avalon and Genbiome in Edgecliff, Sydney.

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] Hello and welcome to Unstress Health. My name is Dr Ron Ehrlich. I’d like to acknowledge the traditional custodians of the land on which I am recording this podcast, the Gadigal People of the Eora Nation, and pay my respects to their Elders – past, present, and emerging.

Dr. Ron Ehrlich: [00:00:20] Well, today we revisit breath and hey, you know, breathing is something we should revisit constantly. Like sleep, it’s always good to be reminded of how important it is, what effects it can have, and how much control you have over it. 

One of the things I’m really proud of in a lot of the information we have on our podcast and on our platform, Unstress Health, is the things that we are as the world in which we live becomes more complicated, the solutions are remarkably simple most of the time. And what I mean by that is that things like sleep and breathe are so accessible, cheap, and profound, affecting every system in your body. 

And they lay the foundations for how you move, how you nourish yourself, and how you think the amount of emotional stress you’re under a whole range of things. So sleep and breathe are so foundational, so profound and so cheap. And my guest today is Dr. Rosalba Courtney.

Dr. Ron Ehrlich: [00:01:27] Now, Rosalba is on our advisory panel. She’s been on the podcast before. And I just love catching up with Rosalba because every time I do and I know a reasonable amount about breathing, I always learn something new, and I’m sure you will too. We cover a very wide range of topics today. 

Many of you will have heard of Wim Hof the Ice Man, many of you will have been familiar with the Buteyko breathing. Of course, we have had on people, practitioners Patrick McKeown and Roger Price, who have spoken about Buteyko and have spoken to Dean Gladstone, the Bondi Surf Lifesaver, and Marc Cohen about Wim Hof. So I thought this was a great opportunity to ask Rosalba and put that into a more integrative breathing perspective. I hope you enjoy this conversation I had with Dr. Rosalba Courtney. 

Dr Ron Ehrlich: [00:02:26] Welcome back, Rosalba.

Dr Rosalba Courtney: [00:02:30] Thank you, Ron. 

Dr Ron Ehrlich: [00:02:31] Rosalba. You know, you are my go-to person for breathing and yet you have this incredible CV in your professional career. And at a certain point, I think you were about 50 at the time. You said to me you decided, given all the expertise you had behind you, that this was an appropriate thing to do, a Ph.D. in breathing. I wondered if you could just give us a little bit of background about Rosalba Courtney. Tell me how you got to that point.

Dr. Rosalba Courtney: [00:03:03] Okay. The story, my story, my origin story.

Dr Ron Ehrlich: [00:03:07] Yes.

Dr. Rosalba Courtney: [00:03:07] Very important, these origin stories, because they do explain things. So I started in my twenties. I was a naturopath osteopath, acupuncturist, herbalists. So in those days, which was the 1970s, it was sort of the beginning of the, you know, holistic, integrative health movement. And I was interested very broadly in, you know, the healing process and what made people heal. That was non-medical, I suppose. 

And I had a number of patients who had interesting and unusual breathing presentations, you know, unusual breathing difficulties that weren’t explained by any particular disease. So I started looking into this whole breathing thing and I realized that you know, there was actually a field of using breathing as a healing tool.

Dr. Rosalba Courtney: [00:04:04] So back in the early nineties, which I wasn’t 50 then, or I’d be 100 now, that that can be back in the early nineties, I, I took a break from practicing because I had my youngest child is now 30 years old.

Dr Ron Ehrlich: [00:04:19] Mm hmm.

Dr. Rosalba Courtney: [00:04:20] And I got very interested in the Buteyko Method, which was a breathing technique that was just new in Australia that came out of Russia. And I actually became chairperson of the association and wrote the first training courses back in the nineties, went to Russia, studied with Dr. Buteyko. 

And it’s like the more I learnt, the more questions I had. I saw some fantastic results with patients. But there are a number of things that were sort of confusing to me, and the contradictions made me personally feel like I had to really get to the bottom of this before I could, you know, go ahead and be a sort of a leader or a teacher, let alone working with patients.

Dr. Rosalba Courtney: [00:05:06] So then in 2002, I went off to do that Ph.D. and my Ph.D. was called Dysfunctional Breathing. It’s parameters, measurement, and clinical relevance because the whole Buteyko idea was that all diseases were caused by hyperventilation. But in the nineties there was a big sort of explosion in the respiratory scientific world of people who were interested in hyperventilation, saying, “Hey, wait a minute, hyperventilation is not what we the hyperventilation syndrome is not what we thought it was. People can have all the symptoms of this syndrome and carbon dioxide can be normal.”.

Dr. Rosalba Courtney: [00:05:48] And so I actually decided to repeat some of Dr. Buteyko’s research. Looking at the links, you know, between breath holding time and CO2. And then I just explored this question of… Because the name Hyperventilation Syndrome got dropped and people started talking about dysfunctional breathing. No one quite knew how to define it. 

So I set about this task of trying to define it and find a way of assessing it and working with it in a sort of structured way. Because as a practitioner, if you want to work professionally with something, you need to have enough clarity about it that you can check in on your own, you know, ideas about what’s happening with patients. 

You know, have they got this thing that you think they’ve gotten at? Is it the intervention that you’re doing? Is the treatment that you’re offering them, is it actually making a difference? Or is it just a placebo effect, you know, coming from their own, you know, brains, production of symptoms?

Dr Ron Ehrlich: [00:06:56] Yeah. I mean, yeah. I mean, in order to solve a problem, often say this to patients, in order to solve the problem, it always helps to know what that problem is. That’s a really good first step. Before we go in and dive in and you mentioned dysfunctional breathing. And just very quickly, what defines well, I guess, firstly, we should define what defines good breathing. 

Dr. Rosalba Courtney: [00:07:21] Yeah. So functional breathing, as you know, because you’ve heard me talk about it. Good breathing has EAARs, right? Meaning that that’s an acronym for Efficient, Adaptive, Appropriate, and Responsive, and it Supports breathing. Supports the function of multiple body systems, which maybe sounds a little bit complicated. But basically, you know, a lot of people talk about dysfunctional breathing as it’s just one thing. 

It’s breathing through your mouth or it’s breathing, you know, into the upper chest and shoulders or it’s excessive sighing and yawning or something like that. And people will often try and correct their breathing or fix their breathing by breathing in some sort of rigid, static, and fixed way where they’re always trying to breathe through their nose or they’re always trying to breathe, you know, down into their belly.

Dr. Rosalba Courtney: [00:08:15] So the whole idea is I mean, it is good to breathe through your nose, of course, and it is good to breathe, you know, in the lower rib cage and belly when you’re relaxed and this that I have no argument with that. But people becoming excessively controlling and rigid about their breathing and it can actually lead to more problems. 

And one of the characteristics of dysfunctional breathing is that people sometimes are overly focused on their breathing and its evaluation. You know, if they get caught up in a vicious trap, the breathing doesn’t feel quite right. So they keep trying to fix it by focusing on it and breathing in a particular way. 

And, you know, normal breathing should actually be somewhat variable. It should be responding to if I’m angry, I’m not wrong or bad for being angry and my breathing isn’t bad or wrong for reflecting my anger. You know, if I’m scared, okay? There’s nothing wrong with being scared. That’s all part of being human. It’s normal for my breathing to reflect that. And, you know, if I’m particularly obstructed in my nose, you know, it’s actually quite functional to breathe through my mouth until somebody can fix my nose or give me more space to breathe to some extent. Okay. 

But of course, nasal breathing, the more you use your nose, the better it works. But being, you know, in nasal breathing, when that when your nose doesn’t do its job sufficiently for you to actually function well with nasal breathing makes nasal breathing dysfunctional. I know that’s a challenge, but it’s all about context.

Dr. Ron Ehrlich: [00:09:56] Well, this is about you making that point about adaptive and appropriate that it needs to be adaptive and appropriate and actually coming back to efficiency because it’s worth reminding ourselves why we breathe. I mean it. Yeah. I mean, why do we breathe Rosalba?

Dr. Rosalba Courtney: [00:10:17] If we don’t, we’re dead.

Dr Ron Ehrlich: [00:10:18] Yes. Okay, that’s the high level. Let’s go into a little more detail than that. There’s more to it than that, isn’t there?

Dr. Rosalba Courtney: [00:10:26] So I always say breathing has many functions. It’s got primary and secondary functions. So one of the most important fundamental primary functions of breathing is to take oxygen from the air, get it into your bloodstream, deliver it to the cells, and that’s internal and external respiration, but it’s about the uptake transport of oxygen and the elimination of carbon dioxide. So that’s a primary function of breathing.

Dr. Rosalba Courtney: [00:10:57] Another primary function of breathing is that breathing is like a pump. It’s a pump. So you’ve got this movement of a rib cage where the size and shape is changing and that’s allowing the movement of air into our body because of the change in pressure that’s created from the change of shape and size of the rib cage. But that respiratory pump influences other pressures throughout the body. It influences the pressures, you know, that affect lymphatic circulation, that affect the flow of venous blood, that affect cerebrospinal fluid. So its breathing is a pump.

Dr. Rosalba Courtney: [00:11:35] So the two functions, biochemical and biomechanical, and then breathing has these secondary functions that are really well known since the beginning of recorded history. We know that people have used their breath to regulate their mood, their stress, you know, their level of arousal to focus their mind, and so on. 

And we know that because it’s written on stone tablets and, you know, I think existed in the Indus Valley, you know, back in the way back in those times. And we know even in the writings of Hippocrates and Galen and so on, people for a long, long time have known to use their breath to regulate themselves. 

So that’s a secondary function of breathing. And then there are other things that I won’t go into in detail, but breathing’s very tied up with the function of our posture and movement systems. So all our breathing muscles play a role in posture and movement as well. And so on. Speech that vocalization and other things.

Dr. Ron Ehrlich: [00:12:39] But coming back to efficiency, people do tend to think that breathing is just about oxygen delivery. And you mentioned the carbon dioxide and a lot of people are very focussed on, oh, my body has to be more alkaline, you know, this acidic body, I better drink alkaline water, and when I hear someone say that I kind of think, wow, talk about reductionist thinking. I mean, our stomachs are acidic for a reason, but breathing plays a really important part in balancing out the acid alkaline, doesn’t it? Can we talk a little about that? Isn’t that really what the Buteyko is focussed on?

Dr. Rosalba Courtney: [00:13:19] Well, yeah, not just Buteyko, you know, like the whole idea with the hyperventilation story is that you know, okay, so when we said the basic function of breathing is an exchange of oxygen and carbon dioxide, but also carbon dioxide regulates our pH. And the most important regulators of pH in our body are our lungs and our kidneys. 

So the lungs do it by altering how much CO2 is expelled and the kidneys do it by regulating how much bicarbonate is either retained or expelled. And carbon dioxide and bicarbonate the body is always regulating its carbon dioxide and bicarbonate together to maintain this lovely, perfect, sweet spot of pH around 7.4. 

And it’s such a powerful system and it so sorts of complexly regulated and it impacts on so many other aspects of cell chemistry that this idea that you might be able to drink some alkaline water with a bit of squeeze of lemon juice, which will neutralize pH anyway, and then you, you know, change your pH is just sort of not really getting the point.

Dr. Rosalba Courtney: [00:14:41] So, yeah, the most common cause of respiratory alkalosis, which is a big problem, right, is hyperventilation and over breathing. It’s not more ideal to be more alkaline, just like it’s not ideal to be more acidic. Nobody wants to really maintain its p h in this very narrow range compatible with life and health. 

And to be more alkaline is not giving your body a gift, you know. And anyway, it’s not something you can do that well with even diet actually, you know, although things like taking bicarbonate can have a bit of an effect. So you can take the bicarbonate and work with your breathing together to try and bring your pH into a better range.

Dr Ron Ehrlich: [00:15:32] Hmm. But coming back to Buteyko because I mean, we’ve had well, we’ve had James Nestor on our program and we’ve had Roger Price on and, and Patrick McKeown of course, who is the CEO of Buteyko International. And tell me what you know the idea. Come back to Buteyko a little bit and give us Buteyko 101 and why it may not be the answer for everybody.

Dr. Rosalba Courtney: [00:16:01] So Buteyko, you know did some research back in the fifties and sixties where he, you know, it sort of came to the conclusion that you know, carbon dioxide was more important than oxygen because carbon dioxide influenced the uptake of oxygen into the body. And that, you know, that’s just standard physiology. There’s no problem with that. Carbon dioxide does affect oxygen, but also oxygen on its own. 

It is important, you know. So it’s not all about CO2. One of the big bits of sort of misunderstanding out there in people who are just getting the edges of the breathing thing is that, well, oxygen doesn’t matter at all right now. It’s all about carbon dioxide, which is absolutely, totally not true. You know, so you need to be getting enough oxygen.

Dr. Rosalba Courtney: [00:17:03] Carbon dioxide has an effect. If at the cellular level, you know, because of this BAU effect, it has an effect on whether hemoglobin is releasing carbon dioxide to the cell. But there are so many other factors, you know, like the ventilation-perfusion, equality in the lungs, the adequacy of ventilation, the adequacy of blood flow to the lungs, the matching of those, the strength of the diaphragm, you know, the efficiency of the breathing pattern, the strength of the heart, the health of the lungs. 

All of these things are super important. And many people who are suffering from respiratory disease will have an issue where they’re not getting enough oxygen. And this CO2 is really high because they’re not getting the gas exchange that they need to be getting.

Dr. Rosalba Courtney: [00:17:56] So the thing about Buteyko is that he came up with a really elegant theory, you know, for, you know, sort of an elegant theory in that it was sort of a very simple story, which is that, you know, most of the world is over breathing or hyperventilating. And, you know, many people in the Western world in particular have these chronic illnesses related to stress. So he goes, well, it’s all related to hyperventilation and to the physiology of carbon dioxide. 

And it’s not that there’s no truth to that story, but it’s an oversimplified story. And that’s why many people in the medical profession we sort of so rejecting of Buteyko because of this oversimplification and a bit of a cultish element. Do you know where it was like, oh, all you needed to do was understand this little piece and you had it all. But the story is more complex. And for example, with asthma, you know, Buteyko said, oh, asthma is not a disease, it’s just a defense mechanism against hyperventilation. So asthma doesn’t really exist because, you know, asthmatic, a hyperventilating. And that’s causing their asthma.

Dr Ron Ehrlich: [00:19:06] Hmm.

Dr. Rosalba Courtney: [00:19:07] And so all you need to do is control the hyperventilation, and asthma will go away. But, you know, that’s actually a huge oversimplification because asthma is many diseases, but it’s very much it’s got a genetic component is a true inflammatory thing going on. And you’ve got asthmatic are more prone to hyperventilate, but often that’s a consequence of their asthma rather than a cause. 

And in about 30% of people with asthma, you will have dysfunctional breathing. And that dysfunctional breathing isn’t necessarily causing their asthma, but it’s contributing to their symptoms and it’s reducing asthma control. So it’s a more complicated story, you know, and just saying asthma is not a disease, it’s just a defense mechanism against hyperventilation.

Dr. Rosalba Courtney: [00:20:00] And 90% of asthmatics are misdiagnosed. You know, it’s like it just gives the wrong impression. And so that leads to situations where people, you know, just go, “Oh therefore I don’t need medication. I don’t need a doctor to diagnose me because the diagnosis will be wrong and the medication will just be covering up the disease.” 

And the thing is that you really need to be, you know, giving treatment that’s appropriate for that person. So you want to assist their dysfunctional breathing, but also have, you know, a doctor assess their asthma. So asthma will be asthma often be misdiagnosed in general practice. But as a medical specialist, working with respiratory scientists will take very careful steps to do a proper diagnosis. 

They will give to diagnose asthma properly, you have to go through a very uncomfortable test, really, which is that mental challenge test. And they will look to see if the mannitol is bringing on bronchospasm. If you get a 15% reduction in airflow from the mannitol challenge, it’s showing that you’ve got asthma. And so that’s, you know, so the nuances are… The devil’s in the detail.

Dr. Ron Ehrlich: [00:21:24] And sometimes the breathing is assessed through breathing, you know, the what is that? The tube that they breathe into and…?

Dr. Rosalba Courtney: [00:21:36] Spirometer?

Dr Ron Ehrlich: [00:21:36] Spirometer. And one of the criticisms is in a similar way to sleep studies, how typical is the test actually triggering an event which confirms the suspicion that you’re trying to… 

Dr. Rosalba Courtney: [00:21:54] It wasn’t in an honest experiment. Spirometry testing will not cause bronchospasm in the known asthma in someone who doesn’t have collapsible airways. And that’s why it’s a valid test. You’ve got decades of research on spirometry. It’s a strongly validated test. It’s not. I know this is what Buteyko people will say that spirometry is causing asthma, but this is just not true. It’s like a healthy person. I do spirometry. I have spirometry in my clinic and I will get people to do spirometry. 

And they, you know, a healthy person will show normal lung function. They do the same procedure, which is the big breath or breathe in and breathe out, breathe out, breathe out. Keep going, keep going. It’s a tough test. It’s a bit stressful, but someone with healthy lungs doesn’t get a problem. But if I get an abnormal reading, I don’t give the diagnosis myself. I refer them to a respiratory laboratory to have proper testing.

Dr. Ron Ehrlich: [00:23:00] And you mentioned mannitol, just run us through. What are they looking for there? What is it?

Dr. Rosalba Courtney: [00:23:05] It’s a sugar that you inhale a little, you know, a pill that gets crushed into a thing. People inhale it. It’s and if you’re asthmatic and they will get you to do that, like, for a while. And then if you do that test, you’ll get a bit of bronchospasm from the mannitol that if you’re asthmatic, you’ll get an extreme response to that you’ll get a more than 15% reduction.

Dr. Ron Ehrlich: [00:23:35] You’ve mentioned hyperventilation and I think one of the things I mean people are familiar with if I sat here now and hyperventilated, I’d be pushing out all of my carbon dioxides to a point where I would eventually pass out. Which would then force the body to produce more carbon dioxide to build up back into the lungs. And then I would regain consciousness. Is that’s what happens with extreme hyperventilation? Or is that an oversimplification?

Dr. Rosalba Courtney: [00:24:07] Okay. So hyperventilating to the point of passing out is not something that you can do very easily. Holding your breath to the point of passing out is something you can do. And if you hyperventilate and then hold your breath, you will pass out. So it’s that combination that I’m aware of that will make you pass out, hyperventilate, and then hold your breath. 

But if you hyperventilate and blow off your CO2, a normal person will then lose the urge to breathe and the CO2 will build up. If you do something like a Wim Hof technique where you hyperventilate and then hold your breath, you will be able to hold your breath much, much longer. And then at a certain point, you know, you get the urge to breathe and start breathing again. But if you’re underwater, you might not get the urge to breathe fast enough, and then you might oxygen might drop to the point where you pass out.

Dr. Ron Ehrlich: [00:25:11] Now, he does say not to do this while you’re in the water.

Dr. Rosalba Courtney: [00:25:16] Super important. 

Dr. Ron Ehrlich: [00:25:17] But let’s talk about Wim Hof because I’ve tried this technique, too, because my partner in the practice my nephew Dr. Lewis Ehrlich and I often do well icebox and prepare ourselves for them using the Wim Hof technique and that needs to be underlined with the fact that I will rarely go into the water down the beach for under 20. So for me to get into an ice bath is a stretch. What’s the theory behind the Wim Hof technique? Because it does utilize hyperventilation, doesn’t it?

Dr. Rosalba Courtney: [00:25:54] Yeah. And I’ve got to say, Ron, you’re looking very well, so it suits you.

Dr Ron Ehrlich: [00:25:58] Thank you. It’s amazing what photoshop can do. One of the things about this platform is it just is very kind.

Dr. Rosalba Courtney: [00:26:05] No, but you know, a lot of people really enjoy Wim Hof with it and it can feel great very energizing and the thing I think what came out of Wim Hof’s own personal practice, you know, and he’s very much an experiential fellow who, who really has done interesting explorations into, you know, exploring the edges in the extremes of things, you know, with his tolerance for cold and tolerance for holding the breath and all of that sort of stuff. 

And I think people are really attracted to it because particularly young men because this idea of, you know, becoming stronger and more resilient through stress is really appealing. And I must say, you know, I like it myself, but it’s all going to be done quite carefully. I think what maybe doesn’t happen sometimes with Wim Hof’s method is that people who are not it’s not suitable for them, you know, might undertake it and not know that it’s not suitable for them.

Dr. Rosalba Courtney: [00:27:18] So someone with a good, healthy, resilient, breathing system that’s resilient enough, they can hyperventilate and hold their breath and they will just balance out and they’ll go into a bit of alkalosis, but their body can deal with that and they’ll come back into a sort of a balance. A lot of people kind of think, “Oh, well, Wim Hof is really good because it’s making my body more alkaline.” 

And as I mentioned before, there’s nothing particularly beneficial about being more alkaline. What you want is to be at a normal pH, not more alkaline. And anyway, it doesn’t happen with Wim Hof, particularly because your body will self-correct all the time, your kidneys will kick in, they will excrete more bicarbonate, you’ll go back to normal. pH. And someone who’s handling the Wim Hof method has got the resilience in their system to, you know, come back to balance. 

And people do get great benefits. You know, psychologically inflammation reduces, pain reduces, it’s all great stuff. But then the people who don’t do so well sometimes think that it’s something wrong with them. And I suppose it is. There is something wrong with them, but could also be just in their genetics or just in their body chemistry with they’re more fragile in terms of not being able to recover from hyperventilation. 

And if you’ve got a bit of a predisposition to having seizures or heart attacks, you know it just might cause a bit of dysregulation there in brainwave patterns. And it can cause spasms to coronary arteries that can put you in trouble. 

Dr Ron Ehrlich: [00:28:57] Mm hmm.

Dr. Rosalba Courtney: [00:28:59] Certainly, there have been people who have died from hyperventilation techniques. You know, I got to tell you this. I, you know, many years ago, probably I didn’t know it would be going. 40 years ago, 35 years ago, I was in the U.S. doing teaching. 

And, you know, someone wanted me to teach at Iselin, this fabulous place on the California Coast between L.A. and San Francisco, where a lot of the, you know, a person, what they used to call that human potential movement stuff, you know, really went on there in that time. And they wouldn’t have anyone do any breathing work because they’d had a few fatalities from breath work.

Dr Ron Ehrlich: [00:29:41] Wow.

Dr. Rosalba Courtney: [00:29:41] From people doing, you know, intense hyperventilation, breathing stuff. And, you know, you just to you know, there were particular vulnerabilities in those people perhaps. We don’t want to throw out the baby with the bathwater. But I just think that you know, it’s important to… If you’re not getting a good result, doing something like Wim Hof, just drop it. Do something else. Get your breathing assessed perhaps with someone who knows how to assess for dysfunctional breathing. Hmm. 

Dr. Ron Ehrlich: [00:30:12] You mentioned you’re teaching. And I know you are teaching because you’re teaching me the integrated breathing therapy course, which interestingly, Rosalba, I always said that if I went back and studied anything, I can study Anatomy, Physiology, and Biochemistry, which is exactly what we are studying with this Integrative Breathing Therapy program, six-month program that you’re doing. 

I wonder if you could just because people are becoming aware of the breath. I mean, people who did yoga have always been told life is in the breath. Then along came Buteyko and then along came James Nestor, who’s really popularised the fact that there’s a difference between just breathing and breathing well. 

And then Wim Hof throws a sort of a spanner in not a spanner, but, you know if Wim Hof. If you Buteyko about breathing slower and da da da to raise these CO2 levels and Wim Hof comes along doing all these amazing things. It’s a little bit confusing, but your Integrative Breathing Therapy kind of includes and attempts to understand all of that. What are some of the takeaways for people who are looking at breathing and what should they be looking at in an integrated way? You mentioned EAARS and I wonder whether we might expand on that a little bit.

Dr. Rosalba Courtney: [00:31:32] Sure. I was just going to say with James Nestor, he actually does try and make sense of, you know, the fact that there are different things. And I think he comes he sort of comes to he doesn’t completely answer it, but he does say, look, you know, with this sort of stressful breathing, he says if you apply stress in a conscious, controlled way, it stops really being a stress because you’re doing it in this conscious, deliberate way. 

And I think in the book, he actually starts off with Sudarsan Kriya, where he’s at, as he does on a workshop, and he has this great experience. And, you know, that takes him into the breathing world. And then he looks at all the different angles. And he actually emailed me and said that he was really confused himself. And that reading my Ph.D. was really helpful for him because it made some sense of it.

Dr. Rosalba Courtney: [00:32:22] And I guess, you know, he came at it as a journalist who spent three years. Do you know, as a good journalist, really exploring the topic is going off and reading people’s Ph.D.? You know, he did a pretty good job with all that. And I really did it through my page, same sort of journey. But I probably went a bit deeper. And coming out, coming at it from this thing of, well, you know, this is like functional breathing is breathing that’s efficient, adaptive, appropriate, responsive, and supportive of body functions.

Dr. Rosalba Courtney: [00:32:56] But there are few other things, you know, like breathing. You’ve got to think about, like the breathing, training, and therapy that I teach is it’s you know, one of the fundamental principles is that it’s individualized, meaning that individualized in that you need to consider the context, the causes and the consequences of a person’s breathing. 

The context would be, you know, the context of their health, their life, their psychology, their trauma. You know, you need to think the causes as well of why the breathing is, how it is and the consequences for them. And then when you’re working with helping someone to optimize their breathing, to use their breath for healing, because I always say about breathing this breathing therapy, two ways of doing it.

Dr. Rosalba Courtney: [00:33:50] One is that you heal the breath and the other is that you heal with the breath. You use the breath as a tool for healing, which doesn’t mean that you need to have messed up breathing to start with. Some people have messed up breathing, so you’re trying to heal the breath. But most people, whether they’re breathing is good or not. Can you use the breath as a tool for healing so you can still heal with the breath? 

So when you’re healing the breath or healing with the breath, another thing that you want is to consider. You want to be sort of comprehensive because breathing is just this great gift. It’s this great tool that we’ve got, this body process that’s unconscious that we can consciously alter. Fabulous tool we’ve got. There’s nothing else like that. So you want to really use it properly. 

Dr. Rosalba Courtney: [00:34:38] So I say, you know, consider that breath is multi-dimensional. So it’s got a biochemical component, CO2 pH a biomechanical component, the respiratory pump, you know, the muscles of breathing, the patterns of breathing, the muscles that affect the nose, the larynx and pharynx, you know. 

So the other muscular systems that work with the breathing, like the pelvic floor, you know, and so you want to take care of that biomechanical component, be aware of it, be savvy about it. And then there’s the psycho-physiological aspect of breathing where basically our mind and emotions affect our breath and our breath affects our thinking and feeling. So that’s the other model from Integrated Breathing Therapy, that breathing has these three dimensions.

Dr. Rosalba Courtney: [00:35:30] So Buteyko really focuses on the biochemical dimension kind of really. And, you know, people who have taken and who have taken sort of Buteyko altered it and so on into the modern era. You know, they’ve started to talk more about breathing patterns and this and that and a lot of modern, you know, Buteyko practitioners are sort of doing something that’s broader than what Buteyko himself originally was doing. But, you know, I think that it’s good to pay attention equally to all these parts. The chemistry of breathing, the biomechanics of breathing, and the psychology of breathing. And they’re all a beautiful deep dive. Aren’t they, Ron?

Dr Ron Ehrlich: [00:36:14] Oh, they are. They are incredible.

Dr. Rosalba Courtney: [00:36:15] They’re a lovely deep dive. And they’re incredible, you know, interesting and fascinating. And I think the other thing about, you know, breathing is that because it comes from this science and this art and this the science of breathing, which many people are not aware of, but there’s actually a lot of science there about breathing. 

And then in the art of breathing, you’ve got some really great stuff, you know, wisdom and traditions that have been handed down. But often that’s a little bit muddled, you know, and there’s a bit of an element sometimes of some cultish ness that can get into the breathing thing. And so I think with Integrative Breathing Therapy, one of the things I’ve been trying to do is to marry the art and the science in a sort of an ethical and evidence-based way, you know, you know, trying to follow the rules of professional ethical practice, that it’s never about the breathing method, it’s not about the breathing method. 

It’s about the person and what they need. It’s not about what the breathing practitioner, you know, wants to sell. I was avoiding saying that word because it sounds a bit, you know, confrontational, but, you know, sell meaning not necessarily sell commercially, but you’ve got to really constantly be humble and learning and questioning your own personal beliefs. And certainly, in this field of breathing, people get very excited about it. 

Everyone’s an expert on the breath in a way because I know when I was doing my Ph.D. and people would say to me, What are you doing your Ph.D. on? And I would say, breathing. And they then glaze over or they would say, Oh, that’s fascinating. And then they would proceed to tell me all about breathing, you know? Yeah. And I go, Yeah, okay, sure. Yeah.

Dr. Ron Ehrlich: [00:38:13] Well, I mean, you know, you talking really about a patient-centered approach, which is really I mean, it’s a theme that we have explored on this podcast in my professional career for a long time, and we recently had the pleasure of speaking to a sleep physician called Dr. Dave McCarty in Colorado, who has got a beautiful patient-centered approach. But this appropriateness and look, I mean, I just love the course that I’m doing with you. 

I wanted to share you again with everybody because you bring and breathing is such something that we well hopefully we do all the time it has such a profound impact and it’s so accessible to us for people embarking on breathing retraining. And I think this is one of those things that you have to keep tapping the hoop along all of your life, really in your experience when you’re dealing with patients, how quickly, how long do you see changes that are positive within a patient when they start to focus on their breathing? Using the Integrative Breathing Therapy. 

Dr. Rosalba Courtney: [00:39:26] Yeah. Do you know, my fundamental program, which is functional breathing retraining runs over six weeks, six sessions. And to really cover all the parts of the breathing system and the dimensions of breathing, it really takes around six weeks. And it depends what problem you’ve started with, but breathing sometimes need to go hand in hand with other therapies. 

Do you know and I don’t know. This is the question you’re asking, Ron, but you know, it needs to go hand in hand with the therapy. Some people need to get fitter. Some people need to strengthen their breathing muscles. Some people need to go and see a dentist. Some people need to go and see an ENT, some people need to work with a psychologist. 

But breathing is a wonderful thing to go side by side with all of these things. And so how soon does one see changes? It really depends on what you’re trying to achieve and what’s been happening and what other thing needs to be done, you know.

Dr. Rosalba Courtney: [00:40:31] So for example, you’ve got someone say clear hyperventilation. They come to see me and I see low resting CO2, short breath holding time, and they’ve got the classic symptoms of hyperventilation, which is the classic neurovascular symptoms or tingling numbness, you know, that kind of thing. 

To work with them, it takes at least seven or eight weeks to get their CO2 up to normal. Do you know if they’re really bad and I’m doing well doing it that quickly? Because other researchers around the world who work with people with severe chronic hyperventilation. They say it can’t be done once people’s pH has gotten really dysregulated and they’re, you know, they’re breathing, they’re set pointers changed and they’re constantly over breathing can’t be done. But I just know it can be done, but you’ve got to be persistent. 

You’ve got to give comprehensive and sufficiently intensive training, and they’ve got to do the work. And it takes quite a bit of skill and nuance to really get the results. And so certainly, you know, research that I’ve done saying do panic disorder, you know, you’ll get 40% of people will get significant improvement in their panic symptoms in one month. But in a year 95% of people will have significant improvement in their panic symptoms, working with breathing retraining. So I’m sure that’s not answering the question. 

Dr Ron Ehrlich: [00:42:09] No no. But it is. It is, it is. It’s giving two examples of just how nuanced it is, and this is what a patient-centered approach means. Everybody is different and everybody responds differently and they need to incorporate a whole range of things. And I think I should explain to our listeners too that the course that I’m I’m doing with you is a practitioner course that goes over six months and is, I have to say, very intense, very stimulating, and an excellent program. 

The course you just spoke of was directed at patients, and the public, and that’s that six-week program which I think is just a great way to get started. And it is getting started because it requires a commitment just like, well, how often should I sleep well? Gee, I don’t know. Every single night, if you can. How often should I breathe? Well, well, every single breath if you can. But it doesn’t always happen. So this is just an ongoing thing, isn’t it? 

Dr. Rosalba Courtney: [00:43:07] Exactly. Yeah. But, you know, like because I’ve sort of become a bit of a specialist in the breathing world, I see people who have quite complex problems. And I don’t want your readers to be just readers and listeners to be disheartened, because most people, a simple instruction to just about anyone is just relaxing your breathing, relax your breathing muscles. 

Don’t over-focus on your breath, but do be aware of it and aware of how it changes in different circumstances and spend a bit of time just being with your body and being with your breath however it is, and do some gentle breathing modulation of different sorts. And it’ll just do you good, you know, it’s like giving a workout for your brain, really, because breathing is a brain exercise. It’s also muscle exercise and it’s also creating chemical changes that are a quite good stimulus for your body’s homeostatic system. 

Dr. Ron Ehrlich: [00:44:07] Well, I think that’s a great note to finish o, Risalbat, but thank you as always. I always say I love catching up with you like this. And we’ll have links for our for those for the public to go on and try that six-week breathing retraining program. And I will continue my learning. Thank you so much. 

Dr. Rosalba Courtney: [00:44:25] Thank you. 

Dr. Ron Ehrlich: [00:44:26] So an Integrative Breathing Approach to breathing is very patient-centered. And here we are revisiting the word patient-centered because it is all about you as an individual patient and everybody is different and everybody needs to be to share their own story, which puts things into context. It also talks about cause, for example, when we’re talking about cause, it may be that you have narrow jaws and crowded teeth and not enough room for your tongue, which means you are a mouth breather, not a nasal breather. 

It may mean that you have environmental toxins within your home as in mold or dust mite, which cause you to be hyper allergenic, be very allergic, and blocks your nasal passages, making it impossible for you to breathe through your nose. It may be that you suffer from chronic laryngeal reflux, which we covered with the whole story about pharyngeal and laryngeal reflux, asylum reflux which manifests itself as a chronic cough. It may mean that you are under enormous psychological and physical pressure. 

Dr. Ron Ehrlich: [00:45:45] So there is a whole range of things. And what are the consequences of the treat of your breathing on your general health? Because we all have various adaptive capacities. Some people can be shocking breathers and yet seemingly enjoy reasonable health. So this is all about that. 

And I love also the fact that Rosalba, in her integrative breathing approach, looks at the biochemical aspects of breathing because it is worth reminding you that the breath is one of the most profound ways of influencing body chemistry. It is the way our body balances out body chemistry in tandem with our kidneys. And that acid-alkali balance. 

So chemical balance is really important. The biomechanics of breathing about jaw structure, and head posture, and the psycho-physiological ones are about being stressed and being anxious and the impact that that has. Look, there is just so much in resolve as integrative. There’s something in the word integrative that gives it away. It’s a more holistic approach to breathing retraining. And it’s why I am so proud to have Rosalba Courtney on our advisory panel. 

We will, of course, have links to her breathing retraining program. And I particularly invited Rosalba because, within the Unstress Health platform, I’m not going to pretend that we have all the answers for breathing or sleep or meditation or anything like that. So this is why I’m collaborating with practitioners in who I have absolute confidence. 

And if I was going to be pointing you to a breathing retraining program, I don’t think you could go too far wrong by looking at Rosalba Courtney’s. We’ll have links to that in the show notes. I hope this finds 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. This 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 expressed their own opinions, experiences, and conclusions.