Patrick McKeown: The Breathing Cure

Patrick McKeown is the Founder and Director of the Training and Education Institute, the Buteyko Clinic International. Throughout his childhood and into his twenties, he suffered from severe asthma, breathing problems, poor concentration and disturbed sleep but Buteyko Breathing Technique changed this.

Patrick McKeown: The Breathing Cure Introduction

Well, today we are going to be exploring breathing again. And I actually feel that in exploring this theme of breathing, which is something each and every one of us do all the time and something we give very little thought to. So actually, I think raising it to a conscious level is a worthwhile thing to do. And for me, as I know a reasonable amount of breathing, I still find all of these discussions uncover new information and give me a different perspective.

Well, my guest today is Patrick McKeown. And Patrick is the Founder and Director of the Training and Education Institute, the Buteyko Clinic International. Throughout his childhood and into his twenties, he suffered from severe asthma, breathing problems, poor concentration, and disturbed sleep. And on occasions, his asthma was so bad that it led to hospitalisations and ever-increasing medications. 

Now, that may sound familiar to many of you. It’s certainly familiar to many of my patients. Since first experiencing the power of Buteyko breathing technique, which he often says has changed his life for the better in unimaginable ways. Well, the Buteyko Clinic International is the result of that and Patrick’s commitment to share that knowledge and his work with as many people as possible.

Buteyko, of course, was founded in Russia in the 1940s, and it’s a technique which is practised globally. We covered that in one of the first episodes I did in the Unstress podcast with Patrick, and we discussed the Buteyko. Today we take a much broader view of breathing and cover a whole range of topics. I mean, Patrick’s long-term goal is actually to educate professionals, including yoga teachers, physiotherapists, speech and language pathologists, and dentists, especially paediatric dentists, about Buteyko training methods so they can help their clients.

Patrick’s written some amazing books, The Breathing Cure and The Oxygen Advantage, and we actually do discuss aspects of both those books. So it was great to reconnect with Patrick. I hope you enjoy this conversation I had with Patrick McKeown.

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] I’d like to acknowledge to 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.

Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Well, today we are going to be exploring breathing again. And I actually feel that in exploring this theme of breathing, which is something each and every one of us do all the time and something we give very little thought to. So actually, I think raising it to a conscious level is a worthwhile thing to do. And for me, as I know a reasonable amount of breathing, I still find all of these discussions uncover new information and give me a different perspective.

Dr Ron Ehrlich: [00:00:57] Well, my guest today is Patrick McKeown. And Patrick is the Founder and Director of the Training and Education Institute, the Buteyko Clinic International. Throughout his childhood and into his twenties, he suffered from severe asthma, breathing problems, poor concentration, and disturbed sleep. And on occasions, his asthma was so bad that it led to hospitalisations and ever-increasing medications. 

Now, that may sound familiar to many of you. It’s certainly familiar to many of my patients. Since first experiencing the power of Buteyko’s breathing technique, which he often says has changed his life for the better in unimaginable ways. Well, the Buteyko Clinic International is the result of that and Patrick’s commitment to share that knowledge and his work with as many people as possible.

Dr Ron Ehrlich: [00:01:49] Buteyko, of course, was founded in Russia in the 1940s, and it’s a technique which is practised globally. We covered that in one of the first episodes I did in the Unstress podcast with Patrick, and we discussed the Buteyko. Today we take a much broader view of breathing and cover a whole range of topics. I mean, Patrick’s long-term goal is actually to educate professionals, including yoga teachers, physiotherapists, speech and language pathologists, and dentists, especially paediatric dentists, about Buteyko training methods so they can help their clients.

Patrick’s written some amazing books, The Breathing Cure and The Oxygen Advantage, and we actually do discuss aspects of both those books. So it was great to reconnect with Patrick. I hope you enjoy this conversation I had with Patrick McKeown. Welcome to the show, Patrick. 

Patrick McKeown: [00:02:50] It’s great. Thanks very much, Ron. Good to be here. 

Dr Ron Ehrlich: [00:02:52] Patrick. Well, you’re in Australia, so welcome. You’ve been doing some training courses for the Buteyko for instructors. You’ve been mentioning that the whole thing has been going crazy. People’s interest in breathing is unprecedented.

Patrick McKeown: [00:03:09] Oh, it’s phenomenal. It’s really great to see because I know when I started off back in 2000 to nobody was really aware of us. And there was a lot of work in putting out the ground’s foundations, even just to make a living. 

And it was one person, myself, for about 13 years and, you know, putting out information about nose breathing, the very simple stuff that we do, teaching you how to improve your blood circulation, talking about oxygen delivery, improving sleep, having correcting resting posture, and the most simple information was overlocked, and it has taken off, which is great. So yes, so we were doing training here with Mim Beim and the So it was super.

Dr Ron Ehrlich: [00:03:54] Yeah. Well, Mim of course, is a naturopath down in the Southern Highlands, I think. And this did for many years run breathing workshops in our own practise in the city. And I know you also connected with another guest on this podcast. Dean Gladstone.

Patrick McKeown: [00:04:10] Yeah.

Dr Ron Ehrlich: [00:04:11] A Bondi lifesaver extraordinaire, you know. Yeah.

Patrick McKeown: [00:04:14] He’s cool.

Dr Ron Ehrlich: [00:04:14] He’s great. He’s great. 

Patrick McKeown: [00:04:15] So I’m meeting him tomorrow.

Dr Ron Ehrlich: [00:04:17] Yeah. Oh wow.

Patrick McKeown: [00:04:17] Yeah. We would catch up.

Dr Ron Ehrlich: [00:04:18] Yes. Now, listen, as you travel around the world, what sort of what are you seeing? What are some of the problems we’re seeing with breathing? Because it’s not something, people give much thought or any thought to. What sort of problems are you seeing as you’ve gone around the world?

Patrick McKeown: [00:04:35] I think it’s a bigger recognition. I think the problems were always there. Getting breathing right is absolutely imperative for sleep quality and also for state of mind. And probably, we are seeing a greater instance of burnout, exhaustion syndrome, and high-stress levels, but we can’t really differentiate or isolate one from the other because breathing and sleep, and stress, each are feeding into each other. 

You know, if your sleep is off, you’re going to be pretty messed up anyway the next day. You’re not going to focus. You’re not going to be the guy for your jetlag. So I know I’m not firing on all full cylinders.

Patrick McKeown: [00:05:11] See if your sleep is off. It definitely affects your cognitive ability and your mood. And if your breathing is off, that’s putting you into that increased stress response, which is going to affect, of course, your cognitive ability and mood. And there’s a really strong link between even obstructive sleep apnoea and insomnia. When they go together, it increases the risk of depression. 

But I think, Ron, one of the major failures in looking at people in mental health because I know we’re going to be talking about stress, is that psychotherapists and psychologists and people in the field who are helping these people with anxiety, panic disorder, and depression, they are not looking at their sleep and they’re not looking at their breathing. How can they really help these people if they’re failing to address two major factors which are contributing to their mental health issues?

Dr Ron Ehrlich: [00:06:02] Well, I think this actually speaks to our approach to health care in general, you know, a very reductionist model. But you mentioned stress. And of course, this program’s called Unstress, a made-up word, which could be to decrease the stress levels or just understand stress. But talk to us about the role of breathing in stress. What potentially is good and bad?

Patrick McKeown: [00:06:28] First of all, through your breathing, you can change your physiology. Is there any other way to actively and directly change your physiology but through the breath? And there has been a misunderstanding out there because very often, when a person is stressed or if they’re feeling anxious, they’re told to take this deep breath, and these deep, big, full breaths can impair their breathing from a biochemical point of view. Really, when we think about stress, we should be thinking about the speed of the exhalation. 

And just even focussing on that. If you were to isolate one simple thing and stress, when we get stressed, we as human beings respond to it faster breathing and upper chest breathing, and irregular breathing. And there’s a direct relationship between the speed of our breathing, the irregularity of our breathing, an upper chest, and the degree of anxiety, and they’ve looked at this with students before performing exams.

Patrick McKeown: [00:07:23] I was listening to a podcast by Dr Rangan Chatterjee and going back about a year or so, and he was talking to a brain surgeon called Dr Rahul. And Dr Rahul said, “The first thing I do when I get into a tricky situation is preventing myself from hyperventilating.” And I was just thinking to myself like, we know this stuff. Dr Rahul knows this stuff, but very few people know it. 

Why doesn’t a student going into doing exams know it? I was that student, and before I went into an exam hall, I took these full big breaths and walked into that exam hall, and I can genuinely say this is going back now since 1996. I can genuinely say I was sitting there at the table. My head was all over the place. I was disoriented, I was dizzy. I deliberately hyperventilated because this is the information that you hear.

Patrick McKeown: [00:08:13] So coming back to then, Ron, a very simple tool that if you’re feeling stressed or if you’re feeling anxious, don’t breathe out fast because if you’re breathing out fast, it’s the speed of the exhalation, not so much the inhalation. You could have a fast breath in. But if you have a really slow and relaxed breath out, when you have that slow, relaxed breath out, your body is telling the brain this everything is okay. 

So it’s almost that we’re hardwired with the communication from the body up to the brain, that when we have that fast exhalation, the brain is interpreting that the body’s under stress and all the brain wants to do is to protect the body.

Patrick McKeown: [00:08:51] And the same thing is happening during our sleep. So if, for example, we’re too warm in bed, or if we have dysfunctional breathing during wakefulness, which in turn is going to, you know, we’re not going to have great breathing patterns during sleep. So if we’re breathing fast in bed, the brain is going to arouse us from sleep. So when we’re feeling stressed, bring your attention onto your breathing. I know it’s not always the easiest thing to do, depending on the situation, but nobody will even know that you’re doing it. And don’t wait until the difficult situation. 

Start focussing your attention as best you can during your everyday life. And then when there’s a difficult situation, you can automatically tune in on your breathing, take that soft breath, enter your nose and that really relaxed and slow and gently breathe out. And by doing this, you stimulate the vagus nerve. It secretes the neurotransmitter acetylcholine. Acetylcholine is causing a slowing of the heart, and the brain interprets that the body is safe.

Patrick McKeown: [00:09:49] But there’s also another aspect. In 2017, Stanford researchers identified a new structure in the brain, in the locus coeruleus. And it’s spying on our breathing. So you can imagine that, yes, there is feedback from the body up to the brain, but the brain is also spying breath on itself. 

And if you are breathing fast, this structure then will signal are relay triggers of arousal to the rest of the brain and also arouse you from sleep. But if you’re breathing slow, you’re training the brain that everything is okay. So then we have to ask the question, what about people who naturally breathe faster all the time?

Patrick McKeown: [00:10:24] I was just a kid, you know, like the first time that I spoke about leaving school, I left school at 14 years of age, never to go back. And I suppose it wasn’t something that I want to be bringing up, but I’m nearly 50 now, and I’m comfortable, and I’ve done all right in my career. And I wrote about it in a book called Atomic Focus. I was a kid who was not driving because you’re required as a child to sit there for 6 hours, 8 hours, and be able to focus and be attentive to watch the teacher saying. 

Day in, day out, day in, day out. And your intelligence is determined by how well you do academically in grades. But to do well in grades, you need to be able to concentrate. You need to have an attention span. I had sleep disorder breathing. But not only do they have sleep disorder breathing, which is common when you’re breathing as a kid and your nose is all stuffed up. Very fine art of passion.

Dr Ron Ehrlich: [00:11:20] Yes.

Patrick McKeown: [00:11:22] I had a very narrow maxilla, which, of course, but I used to go over to Dr William Hanks in California, so he helps to widen it and also Dr John Mu. And, you know, it’s coming back to society like you can have children. They’re required to do well academically. They’re not being trained on how to concentrate. And in order to do well academically, you need concentration. 

Education doesn’t teach you how to concentrate full stop. But to be able to concentrate, you need optimal sleep quality. And these kids are being labelled as lesser intelligent as I was. I went from the top of the class as an 11-year-old, and we call it primary school. I’m not sure what you call it here.

Dr Ron Ehrlich: [00:12:05] You consider the same here.

Patrick McKeown: [00:12:07] In primary school to secondary school, which will be high school. I went from to the top of the class in primary school to the bottom of the class in secondary school. 

Dr Ron Ehrlich: [00:12:15] Hmm. It’s interesting. We did a programme with respiratory paediatrician Dr Jim Papadopoulos, who said that 50% of kids diagnosed with ADHD have an undiagnosed sleep-disordered breathing condition.

Patrick McKeown: [00:12:32] Yes, which we’ve been talking about this. Why don’t parents know about it, though? You know, look at the study by Karen Barrack. And she looked at 11,000 children in Stratford upon Avon, and she looked at their sleep from age six months to 57 months. So it was a longer children’s study with was large population. It was published in the Journal of Paediatrics either in 2010 or 2012. 

And her conclusion was that children with sleep disorder breathing and behavioural sleep problems at age five if untreated, had a 40% increased risk of special education inspiration. And she spoke that it’s during slow wave sleep and deep sleep with the young child that their brain is developing. Hmm. But if the child is having a rouse, it is sleep fragmentation, are having disruption to their sleep. And even snoring.

Patrick McKeown: [00:12:35] Snoring is not good. That then, in turn, is going to cause the child a mouth breathing, of course, as well during sleep. The child is going to have a lighter sleep, and the brain doesn’t develop the way it should. So I think any parent if you were to read Karen Barrack’s paper and it’s an okay read, it’s not too scientific, but it really drives home the message here.

Dr Ron Ehrlich: [00:13:46] Yes. It’s such an important one. I mean, we’ve gone through an evolution. We haven’t had to think about breathing. What’s gone wrong?

Patrick McKeown: [00:13:55] Oh, it’s so many factors, and it’s difficult really to isolate it. You know, if you think of our ancestors living in a natural environment, doing lots of physical exercises all day, everything that we’re doing was how we’ve evolved over that time. Hmm. And then it all shifts. Everything has shifted. Stress levels. 

The food that we’re eating you know. It’s just so many different factors. Probably the diet is one of the biggest ones. And in terms of hard food versus soft food, lack of breastfeeding, there’s lack of attention as well in many countries in terms of tongue-tied. 

So if the baby is tongue-tied, the baby is not able to nurse from the mother, and the baby then doesn’t drive. The mother is getting sore, and then the bottle is introduced. And the bottle, of course, is not going to cause manipulation of the muscles of the face necessary for any facial growth.

Patrick McKeown: [00:14:44] I think in adults the biggest impact of stress and I think there’s a genetic component like I look at my parents, my parents have wide facial structures. And we all had narrow-like crooked noses because of the maxilla’s setback. The mandible was set back. You have to jowls like jowls are really they’re a health risk because they’re telling you that the airways compromised. But my daughter is missing teeth. 

So she’s got two of her genesis. So here is in one generation to the next, it’s getting narrower. So what’s happening? What’s happening to the size of the human face? You know what’s happening the size of the human airway? And what does that mean for the human race? I don’t know.

Dr Ron Ehrlich: [00:15:27] Hmm. But it is, as you say, in the last few years, the awareness of this breathing is so important. And you’ve mentioned a myth there. When you’re under stress, you know, breathe, take a deep breath. What are some of the other myths that that, you know, we’ve kind of inherited along the way? Well, we got things so wrong?

Patrick McKeown: [00:15:50] It’s very difficult to know how we got things so wrong. I feel that the people who have been teaching breathing for decades have not done a good job. They’ve made a mess of it. And probably because they’ve been teaching us according to tradition, there’s a guru, and the guru was saying, it’s my way. 

And I do feel that the original breathing techniques that are evolved from the Eastern world they did include the biochemical dimension of breathing, but that’s overlooked. Like when I first came across this in 1998, my nose was stuffy. I took a breath in and out through my nose, I pinched my nose and pulled my nose, and jutted out my head up and down. And I could feel relief coming to my nose. 

So you can decongest your nose by simply breathing in and out through your nose, pinching your nose fully. And holding it until you feel a moderate, stronger hunger, then letting go and breathing in. And even though rhinitis is so common, nobody seems to know about it. I always had cold hands and cold feet.

Patrick McKeown: [00:16:52] I remember sitting down also in the early stages and actually breathing less air, which is the total opposite of what we normally hear. We’re not really told to take the bigger breath. And of course, it was a very popular breathing technique now that’s going around the world involving hyperventilation along breath tools, which is a stressor technique, is an extreme stressor technique, but that can be done by individuals who are suitable to it. 

But we also have to think about functional breathing patterns here. So I remember slowing down my breathing and under breathing to the point that I was feeling that I wasn’t getting enough air, and the temperature of my hands increased. So when we think about breathing, the potential here is absolutely enormous. But even the potential just with nose breathing. So how come the custodians of breathing didn’t talk about nose breathing, not just while you were in a studio, but also outside the studio, during sleep, during exercise? 

How come sports medicine scientists have not investigated nasal breathing so much? There are a few papers now coming out during sports. So even when we asked the question, what does your mouth do when it comes to the breath?

Patrick McKeown: [00:18:04] So, Ron, you’re looking into the mouth every day. Is there any part of the mouth that’s devoted to breathing that will help to improve the condition of that air before it comes into the lung? And the answer is just not. So the mouth as a whole. And yes, like I remember sitting at a conference which and a debate come up, and a medical doctor who is actually a professor of medicine teaching university students said there’s no difference between the mouth and nose breathing. 

And I stood up, and I said, “Dr, there really really is. I was that mouth-breathing kid you do not reach your full potential.” If you think about nose breathing, it increases oxygen uptake in the blood by 10%. And that has been written by Dr Jim Bartley, an ENT from New Zealand.

Dr Ron Ehrlich: [00:18:56] We’ve interviewed, we’ve just done this interview, he’s coming onto the programme as well. Jim is just wonderful, ENT specialist.

Patrick McKeown: [00:19:04] Well, if you can just tell him thank so much because he is an ENT specialist who was talking about the importance of nose breathing.

Dr Ron Ehrlich: [00:19:12] Mm hmm.

Patrick McKeown: [00:19:13] And that doesn’t happen. I had surgery on my nose in 1994 to breathe, but nobody told me to breathe through it afterwards. And children as well. How many children undergo tonsillectomy and nodulectomy. They’re not getting respiratory rehabilitation afterwards and there’s a 65% worsening in their sleep within three years unless nasal breathing is restored. 

So as the words come about your question, Ron. I don’t know it. You know, I just feel that there was a major part of breathing that was overlooked. See, breathing is a little bit more complex and multidimensional. You have the biochemical dimension, which is focussed on chemosensitivity to carbon dioxide. So, in a nutshell, if you breathe too hard and too fast that the volume of air that you’re taking into your lungs per minute is just too much. 

That can cause a lowering of carbon dioxide in the blood, but it can also increase as well as increase the chemosensitivity to carbon dioxide. But when you have a stronger human sensitivity to carbon dioxide and carbon dioxide is the natural stimulus to create the primary stimulus to breathe, your breathing as harder and faster.

Patrick McKeown: [00:20:20] Now, it’s not so black and white either, because there are people with the symptoms of hyperventilation that don’t necessarily have low CO2. But we still have to look at the physiology of carbon dioxide. What does it do? This is not just a waste gas that we breathe out and get rid of from the body. 

We always need a certain pressure of carbon dioxide in the lungs, and we need 40 millimetres of breath are approximately carbon dioxide taps to open up our blood vessels. It helps to relax mood muscles throughout the body. It’s the primary regulator of blood pH, but carbon dioxide also stimulates the vagus nerve. 

And I suppose coming back to the theme of this in terms of stress, when we’re teaching breathing exercises, and we’re having people under breathe, we’re creating a feeling of air hunger. And sometimes, people with anxiety and panic disorder have a very exaggerated response to that feeling of air hunger, and it drives them into symptoms.

Patrick McKeown: [00:21:19] So our goal is that when we’re working with our students, we’re gently softening the breath to the point of air hunger, but keeping that person in relaxation and not going into stress. And the way that we know that we’re keeping them in relaxation is by the saliva in the mouth because when we activate the body’s rest and digest response, there’s increased water in saliva in the mouth. 

But if, for example, somebody has a background of anxiety or especially panic disorder, that air hunger can put them into that fight or flight response now, and their mouth full go dry, and our hands go cold. We still work with them because it’s really important to give them and exposed them to the feeling of air hunger, to desensitise your body’s reaction to the fear of suffocation because it’s suffocation which is driving their symptoms.

Patrick McKeown: [00:22:10] So the stress response, I would say that the biochemical dimension of breathing is vitally important. And the other aspect here is normally when you have got somebody with stress and anxiety and panic disorder. People would raise your mind. And I’m not saying you don’t have to be anxious to have your physiology not increase stress response. 

But say, for example, you have somebody who’s breathing upper chest. Why are they breathing using their upper chest? It’s not ideal because the greatest concentration of blood flow is in the lower lobes, and upper chest is also telling the brain that things are not okay. But it’s very common for people to breathe upper chest when they’re feeling air hunger. 

So they’re feeding our hunger during their everyday breathing, so they breathe faster and the upper chest to compensate. So then we have to ask for what’s driving the air hunger. This is when they’re breathing from a biochemical dimension. It’s not ideal.

Patrick McKeown: [00:23:08] So if we just focus on the biomechanics without addressing the biochemistry. We may not get that long-term result. And the other thing is if we just focus on addressing upper chest breathing and breathing with greater recruitment of the diaphragm if that individual continues breathing through an open mouth while the mouth is engaging the upper chest and to in order to have good recruitment of the diaphragm, we need to breathe in the neck of the nose. 

And that also, I’ll always say to my students, look down at your chest and take a breath through your mouth. And when you take a breath through your mouth, what part of the body has been activated, and it’s the upper chest?

Patrick McKeown: [00:23:48] So with breathing, then we have these three dimensions, and they’re all overlapping each other. And so from when somebody is coming in, I will look at their breathing from a biochemical point of view and give them exercise to target that. From a biomechanical point of view, we give them exercise to target that, and then we give them paced breathing. 

So we slow down the respiratory rate to between 4.5 and 6.5 breaths per minute to help bring balance in the autonomic nervous system. Because it’s not just a difficult situation that’s changing our breathing patterns. So if we get stressed, of course, our breathing changes. Yes. 

And we do have some control over that. And some people are more resilient than others, and that will be influenced by how well they are breathing in their every day. So if you have somebody that already is breathing fast in upper chest, they are already in that increased stress response. If they’re confronted with a difficult situation, they are not going to cope with it so well as somebody with good, functional breathing patterns.

Patrick McKeown: [00:24:52] Now, I was just a person here, and your resilience, your concentration, your focus, it’s not ideal. You can change this with breathing. So, yeah, my point went there in terms of what I was going to say. 

But at the person’s ability to cope with the difficult situation is really being influenced by their everyday breathing patterns and then having some degree of control over your breathing when you’re in that state because the one thing about a human being we cannot cope with long-term stress. And that’s known. We’ve never had to cope with long-term stress. We’re very fine with short-term stressors. Psychologically, physical stress is fine. Long-term stress is not. But we have some degree of control.

Patrick McKeown: [00:25:42] So if anybody is feeling that their breathing is faster in upper chest and they’re sighing a lot and they’re in that stress response, sit back, just focus on breathing in and out that through your nose. Take a soft breath and through your nose in a very gentle, relaxed, and slow, gentle breathe out. And really focus on slowing down the exhalation. And when you’re breathing, have silent breathing and even soft and the breath somewhat that you’re slowing down the speed of the air coming into the nose by about 20 to 30%. Okay. If you have air hunger, it’s good.

Now, if you have somebody with anxiety, they get anxious, sometimes focussing on their breath. So what can you do? You could then do a small breath-holds. So you breathe in through the nose and through the nose, pinch the nose and hold 5, 4, 3, 2, 1. Let go. Breathe in through the nose. So this way, you can also help to stimulate the vagus nerve. 

And by holding the breath and the exhalation, you have to increase blood flow to the brain and oxygen delivery and normalise blood pH. And this has a calming effect on the brain itself. So there are just little tricks. And even I would say to somebody with anxiety, if you feel very anxious about focussing on your breath, which is a normal thing anyway, with some people with anxiety, go for a walk with your mouth closed. 

It’s absolutely the best breathing exercise ever because when you have your mouth closed, carbon dioxide is going to increase in the blood because your nose during wakefulness imposes a resistance to your breathing. That’s 2 to 3 times that of the mouth.

Patrick McKeown: [00:27:18] Now, during sleep, it’s different. Your mouth during sleep imposes a resistance to your breathing. So if you’re breathing through your mouth during sleep, you’re more likely to have sleep disorders. But during the nose, if you go for a walk with your mouth closed, carbon dioxide is going to increase in the blood. You know, it’s increasing because you feel air hunger. 

You know, because what’s causing that sensation of air hunger, it’s due to an accumulation of carbon dioxide. So you go for your walk. You’ve got increased carbon dioxide in the blood. The increased carbon dioxide has happened to open up your blood vessels. It’s improving your blood circulation. Also, because of the poor effect, as carbon dioxide increases and blood pH drops, haemoglobin is releasing oxygen more readily to the working muscles. 

As you breathe through your nose, you’re protecting your throat. You’re protecting your lower airways. Not sure about your mouth. Your mouth is drying it out, your mouth is drooling, and you can be more prone to exercise-induced bronchoconstriction. If you’re a mouth breather. By breathing through the nose, you’ve got better recruitment of your diaphragm. And it also helps to add an extra load to your breathing to have possibly strengthened and maintained form of the diaphragm.

Patrick McKeown: [00:28:29] Now, if you have good function of the diaphragm, it provides stabilisation for the spine. So 50% of people with lower back pain have this function of breathing. Is it the lower back pain which is causing dysfunction or breathing, or is it the dysfunctional breathing which includes upper chest breathing was reduced recruitment of the diaphragm, and because of that, it’s the spine is not getting the stabilisation that it should be getting. So yeah, it’s interesting. And that’s just a humble nose, you know.

Dr Ron Ehrlich: [00:29:04] Well, you’ve said so much there, Patrick, and there are so many pearls there. I’m actually coming back to the professor who said there was no difference between mouth breathing and nasal breathing. And you’ve used the word several times, which I think goes a long way to explain why they would say that. And you’ve used the word biochemistry. 

And biochemistry is a subject that we all studied in medical and dental school as undergraduates and could not wait to get rid of that subject. Like, just get this. I’ve learnt all the processes. I’ve learnt all the things. I’ve memorised them. Now I’ve passed that subject. Great. Now I can get on with being a doctor or a dentist. I don’t have to worry about that anymore. And therein, I think, lies so many problems. 

And you’ve alluded to them in breathing. We could talk about them in nutrition as well in a whole range of things, but that your reference to biochemistry time and time and time again is really the key here, isn’t it? Because it’s so, it has such a profound influence.

Patrick McKeown: [00:30:12] When I’m working with somebody, it’s the one dimension that I really want to place the most emphasis on. Even though, you know, when researchers are looking at breathing, they do look at breathing from a biochemical, biomechanical, and psycho-physiological point of view. So there are three separate mechanisms, of course, but they are overlapped. 

If you can improve the biochemistry, you’re more likely to have good recruitment of the diaphragm and also by improving the biochemistry. From a psychological point of view, the increased carbon dioxide happens to stimulate the vagus nerve. And that’s what I’d say to people, like whatever breathing exercise you’re doing. Check out what’s happening on your physiology. 

You know, tune into your body because you know the breathing exercises done that are working for you. And think of breathing exercises as that they can have two effects in the body. They can either bring the body and mind into relaxation, or they can stress you. So how do you bring the body and mind into relaxation, nose breathing during sleep, tongue resting in the roof them out. You tend to have a deeper sleep. You’ve got your less prone to sleep disorders. You wake up feeling more refreshed. 

You should never wake up to dry out in the morning. Nose breathing first. Light breathing. So if you see somebody sitting down and during rest, they’ve got very noticeable breathing and faster breathing, it’s not a good sign. Low breathing. So having less movement of the chest and more movement of the diaphragm. So an easy way to think about it is nose, light, slow, deep LSD. So that can that’s an easy way to remember it.

Patrick McKeown: [00:31:48] So whenever you are breathing, that’s where you’re activating the body’s relaxation response. And if you want to stress the body and mind by practising breathing exercises, you can do it two or three ways. You’re going to hyperventilation, so you’re taking a full big breath and a full, big breath out and full big breath in, full, big breath out. It’s a stressor. 

So that can have was emotional release. But bear in mind just when you’re stressing the body and mind, it’s causing your blood vessels to constrict. It’s causing a left shift of the oxygen. What happens? Association of less oxygen is getting throughout the body, and it can contribute to your airways constricting. And the second way, main way than to cause stress by using breathing techniques is to do a lng breath hold. So if you take a normal breath in and out through your nose, your pinch your nose and hold, and you just keep on jogging until you feel a stronger air hunger. 

Your blood oxygen saturation is dropping, and that would put you into an increased stress response. Now, there is a benefit to doing both, like we will look at the relaxation, and then we stress the person. We relaxed, and we stressed. We relaxed, and we stressed. And it’s almost that we’re getting the autonomic nervous system, the automatic functioning of the body, just giving us a little bit of shake. 

And that can improve resilience. And this can be measured objectively then via heart rate variability. So we can help to strengthen what’s called the viral reflex, how to improve at all. And this will manifest then with improved heart rate variability, which is feedback of resilience. 

Dr Ron Ehrlich: [00:33:21] Now, heart rate variability requires a little bit of explanation because I think it is a really important point, and it’s poorly understood. Can you just give us a little bit about heart rate variability 101?

Patrick McKeown: [00:33:32] Yes. I suppose the very simple way to do it is just to locate your pulse, where you can get it just at the angle of your jaw. And while you’re paying attention to the speed of your heart rate, also pay attention to your breathing. And during inhalation. Just notice the speed of your heartbeat. And then, during exhalation, notice the speed of your heartbeat. So during inhalation, the vagus nerve steps back. So it’s more of a stress response, and the heart rate should be faster. 

And then, during exhalation, which is entirely under the control of the body’s relaxation response, the heartbeat should slow down. So the timing between the heartbeats and the inhalation should be short. And the timing between the heartbeats and the exhalation should be longer. In other words, your heartbeat should be faster during inhalation. When the lungs are richest for oxygen, and the heart’s heartbeat should be slower during exhalation when the lungs are richest for carbon dioxide. 

So the heart doesn’t beat well shouldn’t beat at the way it shouldn’t. They send a signal via the brain to the blood vessels to dilate and the heart rate to come down. So your blood pressure comes out. Or if there’s a drop of blood pressure, you want to pressure receptors to pick up on this and to send again a message via the brain to the blood vessels to constrict and the heart rate to increase, to normalise your blood pressure, but we can lose the sensitivity of the power reflex, and that’s evident when you look at people who are chronically unwell with diabetes, for example, asthma, COPD, irritable bowel syndrome or panic disorder, anxiety, with depression. And we can influence this.

Patrick McKeown: [00:35:57] And it’s very important to have to bring balance back in the autonomic nervous system. I suppose the group of individuals from releasing an imbalance in the autonomic nervous system as people that are suffering with long-covid. And in terms of what I can do is only do the gentlest of exercises. Their breathing rate can be so fast that they have difficulty even talking. They are running out of air. The length of their breath-hold time is 4 seconds. 

That’s having a normal breath in and out through your nose, pinching your nose, and holding. 4 seconds of a breath hold before they need to breathe in again. They’re struggling for breath. So they have really disregulation of the autonomic nervous system. And what we do is use the most gentlest of breathing exercises for very short periods of time with the hope that we can help to stimulate the vagus nerve. 

Now, humming can be helpful too, but because our breathing is so fast, they will find it difficult to hum because they run out of air. Gargling, massage. So, you know, it’s just I think when we think of recovery, can the body heal itself if the body is in that increased stress response? Hmm. 

You know, can we is it worthwhile bringing the body back into balance, a balance between the rest and digest and stress response, which is very important because then we’re setting the groundwork for healing to take place?

Dr Ron Ehrlich: [00:37:30] And that HRV or heart rate variability, I think the higher the variability, the more adaptive your nervous system is. And that’s a good sign. So, for example, 60 beats per minute. If they were 1 second every beat, that would be a very poor, in fact, no heart rate variability. And that would show your autonomic nervous system just isn’t adjusting second by second. Where is a higher heart rate variability, is that… 

And you’ve mentioned the vagus nerve a few times and improving vagal nerve. That’s another area that’s really increased in knowledge in the last five or ten years, isn’t it? The understanding of the importance of the vagus nerve.

Patrick McKeown: [00:38:19] Yeah. Just quite a lot. And even, you know, suppose ten, 20 years, Paul was one of the individuals, but more so focussing on heart rate variability. So the vagus nerve gets his name from a vagabond. So you have this nerve wandering throughout the human body. And it’s innovating in the major organs, including the diaphragm. And 80 to 90% of the communication by the vagus nerve is from the body up to the brain. 

So we can think of this nerve, sending all of this wonderful information. And we can help to influence the communication of the body to the brain via our breathing. So when you breathe light, you have to stimulate the vagus nerve, and this is not like the vagus nerve was first identified back in 1905.

I think it was a researcher called Louie, and he was experimenting with a frog. Or maybe it’s 1913, and he was able to stimulate the vagus nerve, and it’s secreted what he called was vagus stuff, and the heart rate slowed down. So this is not new.

Patrick McKeown: [00:39:21] And there was a very interesting experiment done by a neuroscientist in New York called Kevin Tracy. He was experimenting with rats. And he wanted to stimulate the vagus nerve to stop inflammation. Now, his colleagues were outside in the corridor, and they were apparently they were placing bets that it wasn’t going to work. So what he proved was that if you can stimulate the vagus nerve, it can help to block harmful pro-inflammatory cytokines. 

So these are the messengers that are triggering inflammation. Now and we think as human beings, when we get into stress, especially long-term stress, it can trigger inflammation. So can we counter inflammation by stimulating the vagus nerve, which is going to block the triggers of inflammation? And the promise here could be amazing if there was more work done on this and more research, especially with conditions that are they’re chronic. 

And there there’s an inflammatory response to this, which is asthma, which Ireland, Australia, New Zealand, and the UK have the highest incidences of asthma in the world. It’s about 8% of the population. And I would talk as being that kids and teenagers, and young adults with asthma. Your sleep is impacted, but also, you’re more likely to be in that increased stress response. So here is inflammation of the airways, which could be helped by changing your breathing patterns. And it does need a lot more research.

Patrick McKeown: [00:40:45] The only problem is, Ron, and I don’t know if I’m being cynical, but it’s very difficult to make money from teaching breathing exercises. You can’t commercialise it. You can’t put it into a product. But now, what is happening actually is technology. So, you know, you think of us, we were on the coalface of teaching, breathing for 20 years, working with clients like I was working with and still do with people with asthma, people with anxiety, people with sleep issues, and then sports performance and learning all of that information. 

And then you have the technological sector, which is seeing all of this information and putting it into a gadget and putting in a lot of money. That way, it’s been commercially made viable, but I think that’s what has held breathing back a little bit in terms of the lack of research. And the other thing is, it’s been seeing too much of woohoo over here. That was a mess. You know, it’s not true. It’s right down to centre.

Patrick McKeown: [00:41:44] And like I spoke at the probably talking too much now, but I know I spoke at the World Sleep Congress in March 16th of this year, and it was attended by 2700 sleep specialists, a huge event in Rome. And maybe I shouldn’t have been saying what I was saying, but I said that sleep medicine hasn’t moved on in 20 years. 

I said the failure of sleep medicine specialists to address mouth breathing during sleep, which is not being addressed, still has been a major, major failure. The lack of attention on breathing patterns during wakefulness and how it influences your breathing during sleep and sleep medicine has moved on a little bit since 2013 with a paper on obstructive sleep apnoea. 

And it’s not talking about obstructive sleep apnoea. It’s so common. And if you have obstructive sleep apnoea physiologically you’re going into that stress response, and you’re more likely to have reduced heart rate variability, and it impacts, of course, your cognitive function. 

Patrick McKeown: [00:42:49] So Denny Accura identified that obstructive sleep apnoea is not just anatomical. That there are four characteristics or traits. And the first one is peak pressure. So peak pressure is the pressure which deal with lapses, and you want your airway to be able to withstand a high suction pressure. 

You don’t want your airway, which I’m talking about, the space at the back of that, the mouth, the throat, the party epiglottis is the throat itself, but also the tongue falling into the chose. You don’t want your airway to collapse at the slightest suction pressure. You need your airway to be able to withstand that. So that’s peak pressure.

Dr Ron Ehrlich: [00:43:26] Say that again. Peak…?

Patrick McKeown: [00:43:28] So it’s the pharyngeal, so P for pharynx. Yep. The pharyngeal closing pressure, the second one. So he made it simple by using the word PALM. A is the second phenotype or characteristic, and this is an arousal threshold. And lower as the threshold is when you’re a very light sleeper. 

So if somebody was insomnia, for example, and typically somebody who is a light sleeper, they don’t have a very high severity of sleep apnoea. And the reason being is because when they stop breathing during sleep or there is a reduction in the flow of their breathing during sleep, they wake up. And then they don’t score highly because they have so much sleep fragmentation. 

But this is the big problem. And there was a study done with 6000 individuals, and it was published by the American Trust Society. The individuals with lower thresholds had increased mortality over in older individuals. But say, for example, a person who was stopping breathing for a longer period of time.

Patrick McKeown: [00:44:36] The third phenotypes that he looked at is look in. And high loop gain implies that the chemosensitivity of your body to carbon dioxide is quite high, and you can recognise high loop gain by measuring your length of breath-hold time during the day. 

So what this means is that if you’ve got a very strong reaction to the accumulation of carbon dioxide and carbon dioxide as the drive to breed, you can imagine somebody is sleeping. Their airway has collapsed. They’ve stopped breathing. Carbon dioxide is increasing in the blood because it cannot leave the body through the nose because they’ve stopped breathing. 

Patrick McKeown: [00:45:14] So carbon dioxide is increasing, but these people have a really strong reaction to the build-up of carbon dioxide. So when breathing kicks in. They resume breathing with such exaggerated ventilation. That feeds into the next stop there. And also, the brain doesn’t send a signal to breathe from carbon dioxide and goes too low. So it’s like a vicious circle. 

So high loop and would imply that you’re breathing is a little bit all over the place and then recruitment, muscle recruitment. So this is the amp. So we have about 20 muscles in the chosen subset of these muscles are responsible for helping to open and maintain an open airway. But these muscles get lazy. So how do we have didgeridoo playing, by the way? Right. Country fires here can help to reduce sleep apnoea by I think it was 50% in mild to moderate. 

Dr Ron Ehrlich: [00:46:00] Just by toning up those muscles.

Patrick McKeown: [00:46:02] Yes. And of course, myofunctional therapy as well. So those are the two main modalities for that phenotype. So now, sleep medicine now has evolved. Even though I said it hasn’t moved on, but it has evolved now because if you then tailor a solution according to the phenotypes of that individual, you improve the outcome. So, for example, people with high Lukin don’t do so well with mandibular advancement devices, and they don’t do so well with surgery. 

And people who in terms of how have arousal threshold, it’s very important to be able to help overstimulation of the mind because if they have a racing mind and high-stress levels, they can find a difficulty falling asleep. But also, if they’re breathing as fast and heart, they’re more likely to wake up during the middle of the night.

Dr Ron Ehrlich: [00:46:53] How do you measure Loop gain one?

Patrick McKeown: [00:46:56] There’s only one paper on this by a Harvard doctor called Maseno. And you can measure, look, and by the length of your breath, total time during wakefulness.

Dr Ron Ehrlich: [00:47:06] Right now, you mentioned breath hold a few times. Yeah. What to do when? When you run classes, you see lots of people. What’s a healthy breath hold? I mean, what should, you know? Go. Wow, you’re doing really well or. No, that’s not good. I mean, I know 4 seconds would not be good.

Patrick McKeown: [00:47:22] No, 25 seconds would be healthy. Well, ideally, it’s 40, but I’d say, for example, we’re starting off for people who are unwell. We want to try and bring them up to 25 seconds. And this is when you take a breath holds as measured as follows you take a normal breath in and out through your nose and a pinch your nose, and hold your breath. 

And your time is in seconds until you feel the first definite desire to breathe or the first involuntary movements of your breathing muscles. And then you let go. But your breathing should be normal. So it’s the length of time of your comfortable breath, total time. It’s not a maximum.

Patrick McKeown: [00:47:59] There was a study done by Kyle Kiesel. He looked at 51 individuals. He looked at their breathing from the three different dimensions. And he concluded a simple and easy way to assess whether a person is breathing functionally is to measure the length of the breath at all time, exactly as I described as well. 

And he said if your breath to all time is above 25 seconds. You have an 89% chance that your breathing is functional. So it would come back then as an example. Two days ago, there was somebody with sleep apnoea. His on time was 12 seconds. It’s likely he has high look.

Dr Ron Ehrlich: [00:48:37] Hmm. Hmm. Hmm hmm. Hmm hmm.

Patrick McKeown: [00:48:38] Because he’s got a strong chemo sensitivity to carbon dioxide. So he’s holding his breath for 12 seconds that he has to let go. Now, you can imagine if he stops breathing during sleep and that carbon dioxide is accumulating. So how do you then reduce how can you reduce it with the breathing exercises during wakefulness? Because that then is going to increase your breath over time, which in turn is going to do you’re going to have later and slower breathing during sleep.

Dr Ron Ehrlich: [00:49:03] Now, I know you’ve also written a book called The Oxygen Advantage, and you’ve mentioned it in passing a little earlier. People may have missed it, and that is during sport where we’re kind of told breathing through the mouth, you know, you really draw it in. And yet and yet, there’s another way of looking at this. You’ve written about it. Can you give us a little bit of talk to us about that?

Patrick McKeown: [00:49:26] Yeah, I think it’s very important to breathe in the nature of the nose during exercise. I do understand that when exercise intensity gets too high, you do have to switch to mouth breathing. But we should be thinking of the nose as it’s the primary organ in the human body to do all of that work to the air before it comes into the lungs. And there’s about like Mars. Carter said there were 30 Dr. Morse code as an EMT back in the 1970s. They said the human nose is responsible for 30 functions.

So during physical exercise, we would always encourage people to do their walking with their mouth closed and their tongue resting up on the roofs of mount athletes when they’re warming up. Athletes during low to moderate exercise to nasal breed, even to the point that you feel that little bit of a stronger air hunger. 

It’s not about pushing yourself until you go through, but it’s about challenging yourself to do physical exercise and to allow your nose to determine the intensity of what exercise you’re doing. And then you’ve got a reduced risk of overtraining. You’ve got a better recovery. You’ve got reduced lactic acid.

Patrick McKeown: [00:50:35] But here’s the thing, Ron. If you get somebody breathing through their nose for six weeks during physical exercise, their body adapts to lighter breathing during exercise. Now they can do that same exercise, but less ventilation. So there’s more reserve in the tank. 

So their fitness levels are improving. But think of the other benefits. Protection of the airways, increased oxygen delivery, increased oxygen uptake, increased tolerance to carbon dioxide, better recruitment of the diaphragm, but also the connexion between the nose and the brain. So researchers in Israel, they looked at visual-spatial awareness.

And visual-spatial awareness is that, say, for example, you’re on a football field, and you’re watching, you’ll have your focus on the ball. But also, at the same time, you’re watching everything that’s going on around you that increases with nasal breathing versus mouth breathing. And this might be something that is true over evolution. 

We select our partners based on the sensors that are originating from the nose, not from the mouth. Our memory is higher with nasal breathing. They’ve done experiments. When you breathe in through your nose, when you’re exposed to inflammation, breathing in through the nose increases your attention versus your mouth. 

So there’s so many different little things there that are very interesting with us. But I’ll come back to as well. Functional breathing and functional movement go together. And when individuals were assessing, using the functional movement screen, 87.5% of people who passed the functional movement strain have functional breathing. 

So, in other words, they are breeding from a biochemical and biomechanical point of view is okay. And what would imply then does a few have enough space but dysfunctional breathing? There are more breathholds on the field. They’re gassing out too soon. But also, they’re states of mind because the harder and the faster you’re breathing, it can be putting you into this fight or flight response. It’s driving up your heart rate. Your recovery is reduced.

Patrick McKeown: [00:52:33] So there’s these things that be, you know, an artist with dysfunctional breathing, it’s going to hold them back. And it’s really important for that athlete to think about your performance. And the field is not just because due to your physical performance. Your breathing is a huge role, your sleep has a huge role, and your mental states have a huge role. 

And we have to ask the question, can we access flow state, which is this state of mind whereby we are fully absorbed in what we are doing, that there is no differentiation between the individual and the game that they are so immersed in what they’re doing. In order to access flow, we need concentration. But in order to have concentration, we need functional breathing, and we need optimal sleep. So again, it comes full circle.

Dr Ron Ehrlich: [00:53:23] And you mentioned it takes six weeks for an athlete to train with their mouth closed to really do that. To get on top of that, it’s not just I’m going to go out for a run now, but I’m going to really make sure I know that didn’t work. I tried to breathe through my nose, but it just didn’t work. What do you do? Do you do tape your mouth up? We want we should talk a little bit of mouth taping, but would you just type your mouth up while you train?

Patrick McKeown: [00:53:48] Some people could be brought out of sports tape, which is a tape that surrounds them out. Now, we also use it for sleep. I’m not sure if you’re aware of it, but we have a tape because we have a problem with kids for so many years because we want them to restore nasal breathing. And we were getting fearful of putting the tape across their lips, you know. And so I brought out this new tapes, which is my own tape. It’s called my old tape.

Dr Ron Ehrlich: [00:54:11] Oh, yes, we used to, Patrick. We use it in our practise. It’s like reproducing muscular. What’s lying underneath?

Patrick McKeown: [00:54:19] Yes, yes. I spoke with physios, and they said that could, could be helping to stimulate the optic our source muscle, which is great. I think when you when you start doing a physical exercise with your macros just understand that yes, the air hunger is going to be a bit stronger. And originally, you might have to slow down a little bit. 

But bear in mind that air hunger is not because your oxygen levels have dropped just because your carbon dioxide is increased, which in turn is going to cause more oxygen to be delivered to the body. 

So it’s just a case of, you know, adding an extra load to your body by breathing in and actually the nose. And then your body adapts to that because your body then adapts to a higher tolerance of CO2 in the blood carbon dioxide. So then you can sustain these little breathing easier. And the one thing about the human nose is the more you use it, the better it works for you.

Patrick McKeown: [00:55:11] Now, when you start doing your physical exercise, your nose now starts getting runny. So you have to bring it tissue, which if you’re in the little stage, we’re not expecting you to do all of your breathing in a natural nose. But we are we would absolutely encourage you to adopt names of breathing where you can to get those adaptations. 

Dr Ron Ehrlich: [00:55:31] Mm hmm. Well, that is brilliant and must say, I congratulate the myotapes. A wonderful little invention. I didn’t realise that was your invention, Patrick. Well done.

Patrick McKeown: [00:55:43] Yeah, in that sense. But it’s become popular. We didn’t think it was either. Like we only provide for children and, and then for the adults and not for anxiety. We always had problems too, you know, because they would be apprehensive for obvious reasons about tapering my toes. 

So and I think getting to sleep from breathing in a to the nose is absolutely so imperative, even just for dental health. I wrote an article recently, and I’ve written a couple of books that since The Oxygen Advantage as well. I wrote a book called The Breathing Cure because I wanted to kind of I wanted to delve deeper into the science. So it’s 190,000-word book.

Dr Ron Ehrlich: [00:56:18] Wow.

Patrick McKeown: [00:56:18] It’s quite scientific. And I looked at breathing across a number of different conditions, including epilepsy. It is. And I also spoke about the role of the dentist in sleep medicine. And this is another thing that is really bugging me because I’m almost 50 years of age, and my age group and male were prime candidates for obstructive sleep apnoea as we get older. But I haven’t. 

I’ve only been to a medical doctor once in 20 years, and I’m no different than any of the other males out there. We don’t tend to go to medical doctors, but we go to our dentist every six months. And if I’m lying back in the chair, wouldn’t it be wonderful if the dentist was able to say, Patrick, I see you’ve got a really high polish. See, your jaws are set back. I see you’ve got indentations in your tongue, and this dentist is able to spot all of the risk factors that Patrick can watch. 

You kind of have some of the science. There might be good for you to go into a sleep study, or the dentist sees the kids coming in and spots all of these things. And I don’t understand why dentists haven’t picked up on this. It’s really, really important because we are just following two males, especially. 

We are falling between the two schools of medicine and dentistry. And I know that you know, if these two disciplines came together because sleep is not just the domain of medicine. I wrote about this in the book, and I think it’s so important that the dental industry steps up to the market. I understand that there are brilliant individuals like you, but if they are not all like that.

Dr Ron Ehrlich: [00:57:54] Well, that’s a hell of a note to finish on, Patrick. But you’ve given us such a great overview and given us such great information here today, and we’re going to, of course, have links to your website and your books. I’m definitely going to be looking up The Breathing Cure, that sounds.

Patrick McKeown: [00:58:09] I would send you a copy.

Dr Ron Ehrlich: [00:58:11] Well, I’ll send you a copy of my book, but it’s great. But anyway, so great to reconnect with you, Patrick, and gee, if this is you with jetlag, I can’t wait. We’ll have to do this again when you’re on what you call top of your game. Thank you so much for joining us. Thanks.

Patrick McKeown: [00:58:27] Thanks very much, Ron. It’s a pleasure.


Dr Ron Ehrlich: [00:58:32] Well, there is always so much to learn in breathing, and I’ve been studying it for years. I’m studying it right now. I’m doing a postgraduate programme, a six-month programme to increase my knowledge of it. And every time I talk to someone about breathing, I learn something new. 

And I thought that parm model, that m pharyngeal collapse ability, that’s the p, and that’s what happens as we get older, our muscle tone becomes less toned and the likelihood of our airway to collapse is greater. It stands for arousal threshold. How easily you are aroused from sleep. The L. This is something that I am really going to need to explore. Loop Gain is an engineering term about feedback loops, and when output is more than input, and it’s a whole other area, it’s about the chemo sensitivity of receptors in our body to carbon dioxide level. 

But I need to explore that. That’s a whole new area. And the M of Pal M stands for muscle recruitment because when we breathe, ideally, we there are many muscles that use, but the diaphragm is the main breathing muscle, along with perhaps intercostal muscles in the ribs. But many of us use our neck and shoulder and breathe very shallowly. 

And that is a problem in and of itself because if you’ve got a whole set of lungs, why not use all of them? And the other thing I find amazing, I keep learning more about the diaphragm, and I know that the diaphragm is important for lung function. It’s also important for lymphatic drainage. It also is a great way of stimulating the internal organs of the abdomen. 

I know when you use your diaphragm, your pelvic floor muscles become more toned, and that’s important if you’ve had children or as we get older, and particularly if we’ve had urinary incontinence problems and prostate problems, so using the diaphragm but also to stabilise the lumbar spine, I mean it just keeps getting the body just keeps getting more and more connected, and I keep learning more and more about it. I hope you do too. 

Look, we’ll obviously have links to Patrick sites in his wonderful books, The Breathing Cure and the Oxygen Advantage. 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. 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.