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Kathy Smith: Patrick, welcome to the show.

Patrick McKeown: Thanks very much, Kathy.

Kathy Smith: Love that accent by the way. I’m talking to Patrick and he’s in the coast of Ireland right now. We were just talking, the Saint Patrick’s Day Parade got cancelled because of the Coronavirus. So we’ll have to figure out other ways to drink the beer.

Patrick McKeown: To drink it on the 17th of March. I say don’t worry. They’ll have no problem drinking Guinness regardless of the parades.

Kathy Smith: That’s so true. So true. Well, a little background story here is that I have a daughter– most of my listeners know that I have a daughter who’s an Olympic runner. She went to the finals in Rio. She made it to the finals in 2016. And now, she’s training for the Tokyo Olympics in 2020 if they happen.

She’s always had a bit of sinus congestion and was starting to experience some exercise-induced asthma. So one of the trainers she works with up in Portland– she runs for the Nike team– mentioned your book. And she started practicing the techniques you recommended. Now each week, she was telling me about a different breathing technique and what a difference it was making in her training.

So I picked up the book and a few short months later, I am noticing such a positive impact. So the technique’s powerful. But tell me what prompted you to get involved? I want to get involved with what the techniques are, but what prompted you to get involved in this field in the first place?

Patrick McKeown: Well, as a child growing up, I had a tendency towards asthma as a very young kid. Even though I had symptoms from about four years of age, I think I was diagnosed maybe around eight or nine years of age. And I was on medication all the way through teenage years into my mid-twenties. And if you have a breathing problem, you don’t just have asthma. Because if you have asthma, you’re more likely to have a stuffy nose. And if you have a stuffy nose, then your sleep is impacted or at least more likely to be impacted.

So as a kid, going into high school and going into university, I had fast upper-chest breathing, I was a mouth breather, and I had dreadful sleep quality. I was snoring. But I was also told that I stopped breathing during my sleep. At the time, I didn’t know what it was, but it turned to be obstructive sleep apnea.

So I was quite driven. I really put myself through school and I studied 10/12 hours a day and I got my grades, but in hindsight, I could have done it a lot easier if I had concentration and if I had the energy to focus.

I got my degree, and I was in the corporate world, and then I read a newspaper article in 1998 about the importance of breathing through your nose – the vital importance of breathing through your nose – and the importance of breathing slow. And I was doing neither. Because I had such nasal congestion, I was always breathing through my mouth, and it was kind of one of those things. I never felt that I could take a deep breath. I always felt that my breathing, there was something wrong with it. And I was on medication for asthma, etc., but my breathing wasn’t optimal.

So I started practicing one exercise to open up my nose, which involved holding my breath. And it’s easy to open up your nose if it’s stuffy because of rhinitis. Then I switched to nose breathing. I felt very suffocated when I first switched to breathing through my nose. And this is during rest and during walking, etc.

At night, then I taped up my mouth and I wore Breathe Right strips across my nose to open up my nose. The first morning, I woke up feeling okay, not a whole lot. But the second morning, I woke up and completely changed my life. I woke up feeling fully rested and a degree of concentration and also, the calmness of the mind, because I suppose we don’t always appreciate the connection which the breath has. It’s not just about your breathing. It’s the impact that your breathing has on the autonomic nervous system and the automatic functioning of the body and the direct connection with the breathing on your emotions, the breathing on your sleep quality and how all three are interrelated. Because if you’re breathing is off, your emotions are off, and your sleep is off. 

And if your emotions are off. If, for example, you have agitation of the mind, you’re more likely to have fast upper-chest breathing. And also, if you have agitation of the mind, it impacts your sleep quality. And if your sleep quality is impacted, that in turn is going to cause agitation of the mind. And if you’re breathing hard, it’s also going to impact your sleep.

So I think the connection here is, now, breathing is really getting a lot of attention. When I started with this, it was back in 2002 and was really about putting an awareness out there of the importance of nose breathing – and I would say the vital importance of nose breathing, the functions of the nose, what the nose does.

And people may say, “Well, I have my mouth closed all the time.” But do you really? Do you have your mouth closed when you go for a walk, if you go for a jog, or if you sleep? Is your mouth closed when you’re watching TV, if you’re on a computer, if you’re driving your car?

Kathy Smith: Well you know what is funny since I’ve read your book, I know become a–

Patrick McKeown: You can improve the calmness of the mind and so much from just making some simple changes.

Kathy Smith: Oh. Well I cut you off there, because you cut out for a second. Sorry about that.

Patrick McKeown: Sorry.

Kathy Smith: That’s okay. But I was saying that I have become a people watcher now because of your book, and I notice what you’re saying – that I’m on a plane or I’m in a class. I’m in an exercise class. I was in a spin class this morning. Even during the warmup, everybody dropped their jaw, mouth open, and they start breathing even in the first few minutes of exercise. So since I’ve read your book, I’ve been trying to do almost the entire class with my mouth closed and through my nose.

But let’s back up for a second and talk about this idea of oxygen versus carbon dioxide. I know we always hear people say, “Take a deep breath. Breathe a little deeper.” Or, “Fill up your lungs with oxygen.” “I’m running out of air. I need some more oxygen.” And yet, what’s fascinating to understand is what you talk about in your book is that actually, it’s the buildup of carbon dioxide that’s triggering the breaths, so can you describe the relationship between the O2 and the CO2?

Patrick McKeown: Sure. People often say, “You’re cracked.” People say oxygen is good and carbon dioxide is bad. And what they don’t realize is that you need a certain concentration of oxygen in the lungs and the blood. It’s five percent of atmospheric pressure. The amount of carbon dioxide in the atmosphere is very, very low. It’s about .03 of a percent, so your body holds onto carbon dioxide and it’s produced from your metabolism. So your metabolism is producing carbon dioxide. Carbon dioxide is in the blood. And it’s the degree or how much air you breathe will determine the carbon dioxide in the blood.

If you breathe a lot of big breaths, you get rid of a lot of carbon dioxide from the blood through the lungs. And as you lose carbon dioxide, it causes blood vessels to constrict. And also as you lose carbon dioxide, your red blood cells hold onto oxygen more readily. So it’s kind of ironic that it’s often encouraged to take a big breath in the belief that you’re taking more oxygen into the body, whereas an actual fact, the big breath is getting rid of too much carbon dioxide, your blood circulation’s impaired, and there’s reduced oxygen delivery to the tissue. So the harder you breathe relative to your metabolic need, the less oxygen that gets delivered to your tissues.

Kathy Smith: And that’s, again, because it requires the CO2 (the carbon dioxide) to get the oxygen to the tissues? Or–

Patrick McKeown: Exactly. It’s a catalyst. Yeah. It’s a catalyst. This was discovered back in 1904 by a Danish physiologist called Christian Bohr, and it’s called the Bohr effect. That as carbon dioxide increases in the blood, blood pH drops and the infinity of hemoglobin for oxygen reduces. It’s not enough just to bring in oxygen into our lungs and for that oxygen to pass into the blood and for that oxygen to do a round trip around the body and then to breathe that oxygen back out again. That’s not what we want. We need the blood to release oxygen to the tissues and organs, and the catalyst for that is carbon dioxide.

Kathy Smith: And so, once again, as you’re breathing in and you take a deep breath through your nose, oxygen goes in, the carbon dioxide comes out. But one of the things that I’ve been practicing – and maybe we can share this with the listeners – is this technique that you teach where you take a breath in – a normal breath in, a normal breath out. You pinch your nose and then you see how long you can hold your breath before you have to take a breath again.

I have been doing that exercise. I do it about six times in the morning and how it affects me is that first of all, my focus, boom. I wake up right away. And if I do that right within the first 10 minutes of getting up, I notice my brain and my focus just becomes laser focus.

Also, I find that when I do that before I go to my workout, that I’m more likely to do nasal breathing and continue the nasal breathing throughout the day. So tell us about that exercise.

I know there’s a range. When I first started, it was really hard for me to almost even hold it. I was shocked. Now I live at altitude, so I want to preface that by saying that I do live at altitude. But 15 seconds for me was like, oh, my god. I can’t go any further. Tell me about this exercise and why it’s so good.

Patrick McKeown: Sure. We have a measurement. It’s called the BOLT score, and this involves you taking a normal breath in and out, pinching your nose and you’re holding your breath. And you time it in seconds until you feel the first definite desire to breathe. And then you let go. And you’re breathing at the end should be fairly normal.

So the measurement gives you a good indicator of how well are you breathing. If your breathing is dysfunctioning or if it’s suboptimal, it will lead to increased breathlessness. Your breathing tends to be fast or more shallow, and you’re probably not using your diaphragm as effectively as you should do. And with physical exercise, it would lead to muscle fatigue and premature breathlessness and also athletes gassing out too soon.

So the breath hold time gives you a good indicator of functional breathing. Now to improve your functional breathing, first of all what measurement would be ideal? Well anything above 25 seconds is generally regarded as functional breathing. And if it’s less than 25 seconds, it’s regarded as generally dysfunctional breathing.

So we want people to change their breathing patterns in order to improve their breath hold time. And we do that by switching to nose breathing both during wakefulness and also during sleep and also by slowing down the breath to generate a lighter hunger to reduce the chemo sensitivity of the body to carbon dioxide, but basically to make the breathing slower.

Now we also do a breath holding, and breath holding, I’m glad that you kind of found out some of those benefits. When you do a breath hold, you increase blood flow to the brain. So if I’m giving a presentation and say, if I’m giving a talk to about 500 or 600 people, I want to be very focused going out there. I often do the presentations without PowerPoints, so I speak off the cuff for an hour, maybe two or three hours. And with that, I want to have a stillness of the mind and I want to have a clarity and I want to enter the zone or to be in a state of flow whereby the information is just coming simultaneously, that it’s really effortless and that the content is good as well. So how do I prepare myself for that?

Well about an hour or so before the talk, I sit down and I do 20 minutes of really slow breathing with my eyes closed. I will even slow down the breath to the point of air hunger. I do this because it activates the parts of metabolic response. My attention is on my breathing, which helps to anchor my mind so I’m not going to get distracted by any kind of distracting talks coming in. And it increases water and saliva in the mouth and it also improves my body temperature. When you reduce your breathing, you can improve the circulation. And pretty often, people with cold hands, they don’t have good breathing. Because if you have poor breathing patterns, and if you are breathing too hard, your hands tend to be colder.

So after I do 20 minutes of slow breathing, then I will do five strong breath holds. And the reason that I do the five strong breath holds is to open up my nose, open up my airways, but also to activate a sympathetic response. Because remember, I’ve just done 20 minutes of slow breathing. Now I’m focused, but I’m too relaxed. I don’t want to go out into an event speaking to 600 people and being too relaxed. I want to go out on fire. I want to go out pumped up, and that’s why I do the strong breath holds. Because when you take a normal breath in and out through your nose, pinch your nose.

Then I would walk and fast walk and even sometimes go into a jog, holding the breath and keep jogging, keep holding the breath until it gets fairly strong near hunger, and then I let go and breathe in through my nose and count my breathing through my nose, and then wait about a minute and I do it again. I do five of those repetitions. And that increases blood flow and it really puts you into the present moment awareness and it puts you into a state of an alertness, then I go out and give my talk.

So to open up your nose, it works – and breath holding. And also to increase blood flow to the brain. You don’t increase blood flow to the brain by deep breathing, by big breathing. It causes the opposite effect. And I’ve made that mistake.

I remember reading a book back maybe 25 years ago and I was doing a final exam at university, and I was anxious about it, so I went for a walk. During that walk, I started taking these big flowed breaths and it made me very light headed. And I went into the exam with total light-headedness, which is absolutely the wrong way to feel when you’re going in to do an exam.

We have to turn upside down the current thinking about breathing. It’s not about taking the big breaths. Big breathing doesn’t increase your blood oxygen saturation. It gets rid of too much carbon dioxide, and it’s the loss of carbon dioxide that reduces blood flow to the brain.

Kathy Smith: It’s interesting, because probably 40 years ago when I started doing yoga, I was doing pranayama techniques. And there was some nasal breathing and there was some alternate nasal breathing, the breath of fire. There are these different techniques. So I’m sure there’s some of these techniques are a crossover. Why don’t you talk just for a second about Buteyko? Because I know he worked with the Russian astronauts. What was his big breakthrough? Did he use some of these eastern techniques when he was developing these breathing patterns?

Patrick McKeown:  Yes. He took them from the East. But he was a medical doctor, so he was able to look at the science that was available at that time. And also working with patients, so there’s a story that I’ll share. He had hypertension, and his blood pressure was quite high. And he started experimenting with slowing down his breathing, and he started to notice that whatever sensations or pain he was having started to reduce. Then he was observing sick patients in hospitals and he was noticing that patients who got quite sick, they started to breathe hard and fast. And he wondered was it their sickness which caused the hard and fast breathing or was it their hard and fast breathing which fed back into their symptoms?

So he started teaching these people to slow down their breath and to breathe through their nose. And noticed that with people with hypertension, he was able to help lower their blood pressure. In people with asthma, he helped make a significant difference in terms of their asthma symptoms.

Yeah. There’s also reports that he had worked with Russian cosmonauts and in helping to determine that the composition of air that would be in a space ship. So he made a discover back in 1957 and the science available at the time was primarily on carbon dioxide. But now we know that there’s more going on than just CO2, and there’s more going on than just the biochemistry of the breathing.

For example, another gas was discovered in 1991 that the nose was a primary source of this gas. It’s called nitric oxide. And nitric oxide performs huge roles in the human body and also in the nose. And just in case of I forget, COVID-19 is very topical at the moment. Your nose is a natural defense against viruses. I can’t say, well, your nose inhibits COVID-19. But what I will say is your mouth certainly won’t.

And your nose produces a gas called nitric oxide, and nitric oxide is produced in very high concentrations in the nose. And this is known to have antiviral effects. And even there’s paper looking at the factor of nitric oxide in the Coronavirus, the SARS virus back in 2005 and that nitric oxide inhibited the cycle and the replication of the virus.

I was in London there on Thursday, and I was in this subway. It was rush hour. I had to get out to Archway. The train was absolutely packed full of people, and I did two things when I was on that train. I covered my clothes, I breathed through my nose. But I breathed with hardly any air through my nose. I really slowed down my breathing, because I wanted to intentionally take as little air as possible. Because the less air that you take in a public space, if any of that air is contaminated, you’re going to take less air into your body. And when you take it in through your nose, your nose has got the potential to be able to sterilize that air, and your mouth doesn’t.

I’m really surprised that the World Health Organization hasn’t put it out there. It’s not just about washing your hands. Why not use the body’s natural defense? And yes, we don’t know for sure if the nose can contain or can inhibit or prohibit COVID-19, but there’s no side effects from nose breathing. It’s good advice anyway. And even on the basis that your nose slows down your breathing, you’re going to be taking less air in.

Back in the 1920s, doctors, reported that the patients who were more prone to tuberculosis, the individuals who were catching TB were mouth breathers much more than nasal breathers. I think it’s time that we start to listen to that advice.

Kathy Smith: Yeah. I know. There’s definitely some logic to all that especially when I’m in a class as I was this morning and everybody’s got their mouth dropped open. And you just kind of look at it like it’s an entryway.

But a couple of different things that get triggered when you sparked a few of these questions and that is, let’s say– because there’s a big group of people that have stuffy noses. I know that even when Kate started this whole technique, it was a process to unclog her nose so you could breathe through your nose. So that’s one thing.

One of the techniques that I’ve used through the years and I just wanted to ask you about – is I boil some water, and I let it cool down obviously and then I put some good salt in there. Then I put it in a bowl and I actually stick my nose in the bowl with my mouth closed, inhale through the nose, and it comes out through my mouth and I spit it out. That seemed to help me, and I don’t seem to have many problems with nasal congestion. But I do know– and I have a lot of friends and a lot of people that write to me that do. So what do you tell them?

Patrick McKeown: Yep. Number one is if your BOLT score is above 25 seconds, you’re much less likely to have nasal obstruction. So anybody who comes in with a stuffy nose, I will say to my clients, “I need to get your BOLT score above 25 seconds, because then I know–“

Kathy Smith: Mine, by the way, is– I did it for 40 seconds. What is yours by the way? I don’t mean to interrupt.

Patrick McKeown: Excellent. Well done. And that’s the goal. Not everybody is going to achieve this. It will vary as well. It will go down to 35. It can go down to 30 if I’m really doing a lot of talking. And then it can come back up to 40 and 45. It can go back down again. So it tends to hover. It will hover with everybody. I really put this information into my own daily practice, because it’s made a huge difference for my own way of life.

But if someone comes in with a stuffy nose, we show them how to decongest, using the nose and blocking exercises. They simply involve– you could do it sitting, for example. Take a normal breath in and out through your nose. Pinch your nose. Hold your nose. And gently nod your head up and down as you hold your breath, and hold your breath for as long as you can. And when you feel that you really need to let go of your nose, let go of your nose, but breathe in. Because as you held your nose, nitric oxide is pooling in the nasal cavity. So when you release your nose, you want to carry that nitric oxide from the nose into your lungs.

Wait a minute. Do it again, and do that exercise five or six times, and your nose will temporarily be free. Then start breathing through it. The more you breathe through your nose, the better it works.

Then slow down your breathing and do the exercises to build up your breath the whole time and then your nasal stuffiness will be much reduced. We’ve seen it even with athletes having hay fever. If you have hay fever, it’s likely that it disrupts your sleep, and that’s a big problem. We want athletes to have a higher BOLT score, because if they have a low BOLT score, they will have excessive breathlessness anyway.

The other aspect that you spoke about is also very good. Usually, we do something similar. We get boiling water, good quality sea salt, normally Celtic sea salt, and we put in maybe half a teaspoon of Celtic sea salt into a cup, pour in the boiling water, allow the salt to dissolve, allow the water to cool, and then just simply pour the water into the palm of one hand and snort that water through one nostril and take the water in such a large quantity that it’s going back down the back of the nose, and then you hock it and spit it out as you explained. And then, do it to the other nostril. Hock it, spit it out. And it’s very good for bad breath.

Because people who have, say, a compromised airway are people with post nasal drip or nasal congestion. Mouth breathers are much more prone to halitosis or bad breath. And bad breath is often caused as well if there’s a pooling of mucous. So if the mucous doesn’t clear out quickly– this is for the sea salt and the water– and it’s not just enough to bring it in the front of the nose and out the front of the nose, you need to get it right down the back of the nose, down the throat, hock it, spit it out. And also gargle with salt water. It’s good for stimulating the vagus nerve as well, gargling is.

So yes, I would say nose breathing all times. It was good you mentioned about spinning with your mouth closed. Most people, when they do physical exercise, they do it with their mouth open. But it doesn’t make sense. Of course, the reason that they breathe through their mouth during physical exercise is because it’s easier. It’s easier to sustain physical exercise when the mouth is open. But if you switch to nose breathing for a period of, say, six months– or not even six months– eight to ten weeks, at the start, it’s tough. You’re doing your physical exercise with your mouth closed, you’re feeling a strong air hunger. But the air hunger diminishes over time.

And as the air hunger diminishes, your body is better able to cope with the increased CO2 (or carbon dioxide) in the blood. And now, you can perform the same physical exercise, the same intensity with much less ventilation but also with better recovery post physical exercise with less trauma to the airways, less likely of the exercise to reduce bronchial constriction, increased oxygen uptake, increased oxygen delivery, reduced fraction of expired oxygen, and a better ability to tolerate carbon dioxide.

So the benefits of nose breathing are huge, but you have to kind of say, “Well, now I’m going to stick to nasal breathing.” And at the start, slow down the speed of your exercise so that you can sustain nasal breathing.

Now if you’re like your daughter who’s competing for the Olympics, don’t switch to nasal breathing 100% of the time. Do nose breathing when you can, especially during warmup. Do breath holding during the warmup. Bring in five breath holds to increase blood flow, open up airways, etc.

But also, if the intensity gets so much, switch to mouth breathing for a short period of time but then back to nose breathing. And with the breath, we have to bear this in mind. It is your respiration that is determining the oxygen uptake and delivery through the tissues. We have to breathe optimally because we can influence that. And a working muscle needs oxygen. You can influence that by changing your breathing patterns.

Kathy Smith: Well, a couple of things. And Patrick, I love to hear you say this because, again, in this class, I’m using this class kind of as my test ground, because it’s easy when I’m on a bike to focus on nasal breathing for me. We’re doing sprints, and I’m maintaining the nasal breathing. But when I talk to other people in the classroom about it, they look at me like, “That is crazy. That’s not possible. How can you be doing that?”

And to your point, it took me about that six to eight weeks of feeling slightly more uncomfortable to now where I feel so much more comfortable. Recovery’s better. Everything you mentioned. So I do like that.

I didn’t follow up quick enough, I think, on the nitric oxide. I just want to make sure the listeners are understanding that nitric oxide, you might have heard that it’s an important gas. Viagra, it’s a blood dilator so the term became popular when Viagra came it, because it dilates the blood flow through your body, all parts of your body.

But I didn’t realize so much of the nitric oxide– because there are certain things you eat to increase nitric oxide. But so much of the nitric oxide, what? It transfers in the nose or there’s so much nitric oxide that’s available in your nose? Can you explain that one more time? The nasal breathing and nitric oxide.

Patrick McKeown: Sure. Nitric oxide is produced in different sites in the body, and one of the sites is the nose, the nasal cavity and the paranasal sinuses. So it’s produced inside the nasal cavity and the paranasal sinuses. Most of our nitric oxide in the airway is produced in the upper region, so it’s produced in the nose. It’s not produced necessarily in the lungs. It can be produced in the lungs if there’s inflammation, but most nitric oxide is through the nose.

When you breathe through the nose, with the air that you’re taking in through your nose, you pick up nitric oxide. And then you carry that nitric oxide laden air down your throat, into your lungs. And nitric oxide in the lungs sterilizes the air. It also helps to redistribute the blood throughout the lungs. It is a bronchial dilator. In other words, it opens up the airways. It’s also a signaling molecule for upper airway dilator muscles, especially during sleep. And this is why it’s important to breathe through your nose during sleep so that the muscles in the throat do their job to keep the airway open so that you’re not having stopping of the breath during sleep due to collapse of the airways.

This gas, nitric oxide, is, as I said, antiviral, antimicrobial, and it’s antibacterial. And it’s the body’s only defense against airborne pathogens. That’s why I really can’t get my head around it – why is there no emphasis on nasal breathing. Our ancestors were nose breathers. The animal kingdom, the vast majority of animals, with the exception of a dog and a couple of other animals, are innate nose breathers. Newborn babies are innate nasal breathers. And a human being is the only animal that’s going around with the mouth open. Twenty-five to fifty percent of study children persistently mouth breathe. It’s having a huge detrimental impact in these kids’ health and their academic achievement, cognitive development, and their cranial facial development.

The shape of the face is influenced by whether you breathe through the nose or mouth during childhood. Because we need the mouth closed with the tongue resting in the roof of the mouth. And the shape of the maxilla, the top jaw– the shape of the top jaw, the width of the top jaw is shaped by the tongue resting in the roof of the mouth. And that only happens when we have our mouth closed and we breathe through the nose with correct tongue-resting posture.

The other thing I would say is, Kathy, yoga for example, the emphasis in yoga is often in the biomechanics of breathing – breathing using the the diaphragm. That’s all very well, but we can’t just look at breathing in terms of one dimension – just focusing on the biomechanics – but what about the biochemistry of the breath. Because all to often, I hear somebody saying, “Now, I want you to breathe deeply. Breathe using your diaphragm, but I want you to start taking that air, take a large breath or a big breath of air into your lungs.” And you start hearing people breathing around you.

During a yoga studio session, we shouldn’t hear anybody breathing. Because if you can hear people breathing during light movements, they could be breathing too much air, and this will have a reduced oxygen delivery to the tissues. There is a book written by an American yoga instructor. She’s 30 years teaching yoga. I think she’s nearly in her late 50s. Her name is Robin Rothenberg, and she developed a sleep apnea– yeah, that’s her. She’s in Fall City. And she developed either chronic fatigue or exhaustion, poor sleep, asthma. And her yoga was helping her, but it was only when she started really changing the volume of air that she was breathing, by changing the biochemistry of the breath. By doing the Buteyko method, she really started noticing huge improvements.

Kathy Smith: She’s up in Seattle, right? Is she up in Seattle?

Patrick McKeown: Yes.

Kathy Smith: So help me understand this for a second. Because for instance, when I– let’s just hear this breath for a second. If I go [breathing in 00:35:52] and at the end, for me personally, so you’ll be my instructor. I’m trying to at the end to fill, fill, fill, fill, fill. But you’re saying that maybe I shouldn’t be going to that fill to the max point?

Patrick McKeown: 35:56 You could. You can fill, but don’t fill for over four seconds. Do what yoga– what Robin Rothenberg did was started looking back. How were ancient yogis doing this? And they described the breath as subtle. They said it wasn’t good to have hard breathing. And hard breathing is if you can hear your breath. So if somebody is deliberately increasing the speed and the volume of their breathing, their breathing is hard.

But this is not what yoga was about 2,000 years ago or whenever it was being developed. And she wrote her book then. It’s called Restoring Prana. When you go through that, you really see the connection, the research that she did. The ancient yogis, they knew about the biochemistry of the breath. Yes, they didn’t have the science around at the time, but they were on to something. So some people, in terms of breath hold time, a yogi could have a BOLT score of up to 180 seconds. These individuals were capable of achieving major control of bodily functions that are totally outside the control of the normal individual. And they could do that through their breathing and, invariably, they had a very long breath hold time.

So theories about deep breathing – deep breathing is basically using the diaphragm or taking the air deeper into the lungs, but we can do it so light. Say for instance, you have an individual and you took your breath in there for over, say, five seconds. But how about taking the same volume of air in over 20 seconds. Then you will feel air hunger. So you can be breathing deeply and light and slow all at the same time. So when I’m working with my clients, I’ll always use the acronym light, slow, deep breathing or LSD, because some of the ones that they tend to remember is a bit easier. So light breathing is the biochemistry. Slow breathing, because we can tap into the vagus nerve, we can stimulate the bioreceptors, we can increase heart rate variability, and we can influence the functioning of the autonomic nervous system.

That’s where the research is. The research is on slow breathing. So the three dimensions of breathing are biochemistry, biomechanics, and cadence of the breath – slow breathing. And it really offers us a huge potential in terms of helping bodily systems disturbed by stress and, of course, motor functions as well.

Kathy Smith: Got it.

Patrick McKeown: No. You’re fine.

Kathy Smith: Well, it makes so much sense to me except when you’re talking. I know I have to let you go. I have so many questions for you.

So talking, I notice for me– and I don’t know if it’s true of everybody, but when you’re talking like I’m doing this interview right now or I’m talking to my girlfriends and we’re chatting when we’re on a hike, I start to feel like I’m almost gasping for air a little bit. I feel a little bit less in control of the air when I’m hiking, talking, and going at a pretty good pace and talking. And then it starts to be a little bit like [gasping sound 00:39:33], kind of that sort of feeling. I feel it in my upper chest, and if I do that for long periods of time, I get tired in that area. There’s an uncomfortable feeling.

So let’s talk about when we talk and how we talk. It doesn’t seem like you can do nasal breathing when you’re talking.

Patrick McKeown: No, it’s difficult. You could do nasal breathing when you talk, but you would end up slowing down your talk so much and your audience would totally go to sleep on you. The main thing about talking is try not to hear your breathing during speaking.

The other thing is to realize the effect that your talking has on your breathing. If you talk all day long as many people do as part of their occupations, during talking the respiratory rate gets faster and the volume of air that the person is breathing into their lungs gets bigger. So the person is breathing harder. But hard breathing is causing reduced blood flow and oxygen delivery to the brain. And the person, at the end of the day talking, is exhausted.

They often think it’s because of concentration. It’s not because of concentration. It’s because of your talking. So it’s very beneficial if you a decent BOLT score, because then there’s conservation of the breath whether you’re talking or singing or playing a musical instrument or a wind instrument. It’s very important to be efficient with your breathing.

But if you have a low BOLT score, your breathing is fast and hard and you often run out of air while talking. And if you have a high BOLT score, your breathing is light and calm, and it’s easier to sustain the nose. So that’s very important.

I would say to people to try and breathe through your nose in between at least some of the sentences. And at least, if you hear your breathing during talking is to stop talking.

Now other people we had, including professional singers who were losing their voices and we had them close their mouths during sleep using tape, and they were able to, of course, nasal breathing was helping to moisten and warm and protect the upper airways. And this led to a reduction in upper respiratory tract issues that they were having, which impacted their voice.

So we have to think of the airway and the nose. Your nose protects your airway, but it also protects your voice box. It’s protecting the throat. Breathing and speech go hand in hand. And singing, of course, that ability to have a clear voice, to be able to hold a note and not to run out of air. Also if you have a singer with an abnormal breathing pattern, they may be more likely to have stage fright, panic disorder, because fast breathing is feeding back into that.

That’s one aspect of it. And you could, if you’re talking a lot, maybe even drink a glass of carbonated water. I know it sounds a little bit French, but carbonated water can be beneficial if you are talking a lot every day, all day, every day.

Kathy Smith: And I heard you talk about that before. But explain to the audience why is carbonated water going to help you.

Patrick McKeown: That we don’t know. But carbonated water has got carbon dioxide in it. So in some way, by drinking water, it’s possible that we are able to increase the CO2. I know people found an even better way to do it is soda water. So I don’t know in the states what you call soda water, but we can go into a supermarket. We just pick up soda water.

Kathy Smith: We call it like a seltzer maybe or a club soda or a seltzer. Yeah.

Patrick McKeown: I think so. Club soda. Yeah, it’s not sweet. It’s just normal water, but it’s carbonated. But it also has bicarbonate in it. Because CO2 in the blood associates into hydrogen on the bicarbonate. So ingesting bicarbonate–athletes used to do it traditionally to reduce lactic acid. Because if you’ve got an increase bicarbonate in the blood, it’s able to buffer the hydrogenate coming from muscle so that you’re able to delay lactic acid and fatigue.

So the food that we ingest is going to have some impact on the acidity and alkalinity of the blood. And the whole purpose of that is to take in bicarbonate, to increase the buffing capacity, and your breathing becomes lighter. I wouldn’t say to people to do it every day all the time. It’s not about that. It’s about having a glass of carbonated water or soda water with normal water – eight to one or six to one. Six glasses of normal water and have one glass of soda water. That can be very useful if you’re talking.

Or if you have symptoms as a result of talking, and a common symptom as a result of talking is coughing. Coughing is very much caused by hard breathing through an open mouth, because if you breathe through an open mouth, it’s drying out the upper airway. It’s drying out the mouth, it’s drying out the throat, and this can irritate the throat. And this can bring on the symptom of a cough. So when we get people switching from mouth to nose breathing and slowing down their breathing and keeping their mouth closed during sleep, we can see a great reduction in their cough.

Kathy Smith: Well, you mentioned the sleep and you mentioned the tape. Kate is now using the tape, and I’m going to go buy the tape. But she said, “Mom, try using it 15 minutes before bedtime when you first buy it, because there’s a bit of a claustrophobic feeling about it.” But it’s a tape that can come off very easily. What tape are you recommending?

Patrick McKeown: Yeah. There are a couple of tapes. We actually brought out our own tape as well.

Kathy Smith: Oh, you do?

Patrick McKeown: We brought it out for children, because it’s always an issue. We’ve worked always with lots of kids, especially from a cranial facial point of view, dental point of view. But we didn’t want to be taping their mouth. So we have a tape called MyoTape. It’s named after myo functional therapy, which is a therapy used by orthodontists who help ensure that children breathe through their nose. And the tape surrounds the mouth, but it’s elasticated. So it’s based on Kinesio tape. It’s a round piece of tape that you place around the lips, but the elastic tension of the tape draws the lips together.

But the child, if they want to communicate during the day, they can have their mouth open. Or if they have to have their mouth open during sleep, they can open their mouth, but the tape is there to encourage them to breathe through the nose. So it’s safer.

Also for adults, if they’re apprehensive about wearing the tape– people may be having anxiety or panic disorder. And it’s really important. People with panic disorder and anxiety, 80% of that group of individuals, according to the literature, have dysfunctional breathing patterns. They do cognitive behavior therapy, but we really need, in addition to doing cognitive behavior therapy, is that they change the respiratory physiology. Because if they continue breathing hard and fast and through an open mouth, all they are doing is feeding into their panic, feeding into their anxiety. That’s why it’s very important to change the physiology.

The other tape that we use is LipSeal tape. It was developed by an American dentist called Dr. Frank Seaman. It’s really nice tape, cotton tape, soft. And that’s placed over the lips, so that would be suitable for adults.

So the two tapes are LipSeal tape and MyoTape.com.

Kathy Smith: And you can go and get the MyoTape at MyoTape.com. What is your particular website? The name of your website? Is it Oxygen Advantage or Patrick McKeown?

Patrick McKeown: It’s OxygenAdvantage.com. That one’s for sports. Then we have ButeykoClinic.com is more so for health.

Kathy Smith: Okay.

Patrick McKeown: About two weeks ago, we released all of the videos. If any of the listeners have children, all of the videos for kids are free. They’re free of charge.

We put them up onto YouTube, but you get access to them through ButeykoClinic.com. If your child is breathing through the mouth or if your child is anxious or poor sleep and you want breathing techniques, I put every single exercise up there. The complete program is there for free.

Kathy Smith: That’s so nice of you. It’s so interesting how everything is impacted by your breathing. I can go on and on including what I’ve learned through the years as far as performance anxiety. When anybody asks me, it’s all about these types of techniques. And now, I’ve added to the techniques. But Patrick, I will have to say, your techniques have been transformational for me in exercise, in my morning routine. I’ve added certain things that you’ve talked about in your book. We’ll make sure we have all of this in the liner notes. But again, the Oxygen Advantage. Is there anything else as well as the two sites that Patrick has just mentioned?

I will continue to be spreading the word for you and what you’re doing, because I really do think this is something that even though it’s out there and I know you’ve come out and you’ve been talking about this for years, I think it’s one of these things that’s somewhat counterintuitive. And therefore, people are resistant. I notice that, again, in this class that I’m taking, they’re a little resistant like, “Oh no. That can’t be. You can’t breathe through your nose during exercise. That’s impossible.” Or, “Why is it so important?”

And then you start to become this people watching, and you start to see– and I know what you’re saying, because even an adult, as you start dropping the jaw, it drops back a bit, they have kind of a really [gasping 00:49:38] type of sensation. And you think to yourself, “You know? None of this seems right. Germs are getting in.” The jaw, the facial positioning and especially like as adults, it’s different. But as children, it just has a huge impact.

Thank you for all the work you’re doing. Thank you for coming on from across the Atlantic. The next time I’m over in Ireland and London, hopefully, I can come up to the clinic and see what you’re doing firsthand. So thank you again.

Patrick McKeown: Great. Absolutely. You’re very welcome, Kathy. It was a pleasure. Thanks very much and thanks for helping to talk about the importance of breathing through the nose and functional breathing.

Kathy Smith: Okay. Well we’ll be spreading it with all of my listeners, fans. And any time I go and talk anywhere now, I’ll be spreading the word about you and your book. So I appreciate it. Have a good day and drink the Guinnesses whether the parade’s happening or not.

Patrick McKeown: Will do. Bye.

Kathy Smith: Bye-bye now.