Full YouTube Transcripts:

Patrick McKeown
00:00

James Nestor, we have finally met. It's been a few years. We've spoken on the phone. We've had emails and a lot of correspondence over the years, but we've never met face to face. We came close. I was in LA and that didn't happen. So yeah, it's great to meet you.

James Nestor
00:16

Great to meet you. I'm happy we're finally here, face to face.

Patrick McKeown
00:19

And it's gonna be interesting. I didn't really want to go down the kind of the the route that most people will ask questions about Brett. You know, we will dig in and out of it and of course that's the book that we're talking about.

James Nestor
00:30

What else are we gonna talk about, Patrick? I mean that's the only thing to talk about.

Patrick McKeown
00:34

I wanna get an insight into the stuff that maybe you might feel most comfortable talking about. So we'll see where this one goes. But anyway, if anybody's into breathing, I think this is going to be unmissable.

James Nestor
00:48

We'll see what happens.

Patrick McKeown
00:50

A huge journey. You knew, you know, in terms of your background in writing the book, it was a long journey. I have to say, I reread the book just recently, in the last couple of weeks, and just in preparation for this. And as any bidding writer, you know, anybody who wants to put a book together, it's amazing how you were able to kind of weave the narrative. You started off with a story, you were able to bring in the science, back into the story, back into the science. And almost you had a story going from start to finish, and interwoven was science, but kept in a usable way. I'd love to get some of your thinking on that one. I know it's a kind of a question that's probably nobody has asked you. How did you plan it? Did you plan it with the story and bring in the science? Like, cause I know looking at a manuscript and standing back, it's not easy because it just seems — you've got what's that, sixty thousand words in that book? I'm not sure, but ninety —

James Nestor
01:49

A ninety.

Patrick McKeown
01:51

thousand words.

James Nestor
01:52

So I think you start off with a plan. I had a very clear plan. And in nonfiction, you sell your book on that plan, right? So you have to chart out exactly what the chapters are going to be, who you're going to talk to, what you're going to do. And I thought I had that all figured out. So that's how I was able to sell that proposal. And the way that nonfiction goes is you sell the proposal, they give you just a little bit of money, just enough to barely almost get by, so that you deliver and then you get the rest of it. And I went out into the field for a number of years and figured out my proposal was completely wrong. I was not approaching this story the right way. I had to rewrite the entire thing. I lost probably two years of research and writing and travel expenses from that because I didn't understand properly how humans had lost the ability to breathe. Like, really, like lost the ability to breathe functionally. Because that story was so many levels deep. And I was just going three levels deep, it was actually ten levels deep. And that's how it is in my job. You think you're going to be able to find everything online on different pages of information. You think you're going to be able to do it nowadays with AI, but you cannot. You have to go out and talk to people and spend years and years and years in the field before you really start to discover where the truth, the truth behind the truth is. And that was the thing that pivoted the book in a big way. Cost me a lot of time, cost me a lot of energy and you know, in the end I think it was a more important story to tell.

Patrick McKeown
03:25

For sure. Like you can see it in the quality of the book itself. And it's always that thing, even though you had some part of the advance up front, there's always a risk. You could have put in a lot of time. The book might have sold five thousand copies. It turned out to have sold, I don't know, several million copies. So it paid off. Did you even consider that end of it, did you ever consider the amount of time that goes into writing a book? And like I can vouch for it from my own point of view. Like I was just writing a book recently and I've shelved it and not to touch it because, you know, I just felt life got in the way. There's so much going on. My work is so busy, and then trying to do a book and I couldn't do it justice, give it the time. So I shelved it. Now whether that resurfaces or not is a different story. Did that come into your mind?

James Nestor
04:14

It did actually because I had a book come out before this. And so I was somewhat versed in the way that these things went. And in that book, I also saw what happens when a book does not perform the way it should. My previous book won some awards, I got some attention, you know, I got good reviews and all of that, but it wasn't able to sell in the volume that the publisher demanded. And they basically just cut me off. It's crazy. You think you have these strong friendships with these people that you work with over years and years. You ask about their family, you ask about Christmas, you know, and then you realize how superficial so many of those relationships actually are. And that is something that I was, I feel so naive saying this and hearing myself say this. But that's a lesson I had to learn that a lot of these relationships in business are transactional. And the moment where you cannot deliver something of great value to someone else, you're disposable. And that's not the world that I was reared in, and that's not the world that I'm comfortable being in. But it was a learning experience for me. I licked my wounds and over a couple of years after that book came out, I didn't think I was gonna write another book. It was just so much work. It was precarious. You know, the payoff at the end was not something that I could sustain myself with. So I was doing other jobs at the time. I was just like, well, I tried that publishing thing and it didn't work out. I mean, it worked out in some ways. The book performed, you know, way better than other books would, but not to the publisher's expectation. I think that's the key, the publisher's expectation.

Patrick McKeown
05:59

Hmm.

James Nestor
06:00

So this book came about just because having my life without something to constantly think about felt very vacant for me. I like having something spinning in the background, and that's how this book came about. I never thought it was actually going to become a book. I thought it was going to become an article. Then I gave it to my agent and we realized, maybe there's a book in here. But to answer your question, no one had any idea what was going to happen with when this book was released, which was right in the middle of the pandemic, like right at the beginning of lockdown. No one had any clue. And I was hoping it would do, you know, the same way that my previous book did, which was like moderate, modest, but enough to get by.

Patrick McKeown
06:43

Mm, I knew I read the pre-publication. I don't know, was it your publisher or you sent it on to me? And I think it was actually printed off in A4 sheets of paper. But I kind of got a sense, I said there's something in this. This is a book like no other. And that's when I was asked then to write a testimonial. I said, literally, this is the book to read on Brett. There's so much covered in it. Like it's almost that I suppose somebody uneducated or not knowing about the Brett, when they come across the book. It's an amazing topic. And were you surprised, you know, in terms of the application of this modality of health, which literally gets very little attention. Now it's getting some attention. It's a hot topic. But it's been kind of ignored, it's been overlooked, and it's got an amazing kind of inroad into all fields of health and medicine. Like we're covering dentistry, we're covering mental health, we're covering respiratory health, we're covering physical movement and fitness. You know, there's so much going on with it and it's just about the breath. Were you surprised?

James Nestor
07:50

I was surprised because so many of the books that I read on this subject were actually good. Like they had the science there. And so when people say, like, this is an interesting hypothesis that you posited here, it's not a hypothesis. These are scientific facts, and all the references are in the back of the book. So in regards to people finding interest in the subject, it was really shocking to me because breathwork has been around for a while, but the book isn't about breathwork. And that's what I think a lot of breathworkers may be a little disappointed when they —

Patrick McKeown
08:25

I don't know if I'd agree with you. I think the book is absolutely about — I don't like the word breathwork anyway, James. You know who came up with that word breathwork? Honestly. Breathing training, breathing re-education, breathing as a tool for self-empowerment.

James Nestor
08:42

I think people more interested in yoga-inspired or yoga-derived breathing techniques assume the book is about — it's all about different practice, do this practice, do that practice. And a lot of that is easy. I can tell you right now, you're the last person on the planet I can tell how to breathe better. But you can pick someone off the street in fifteen seconds, thirty seconds, if they actually follow it — breathe through your nose, breathe into your belly, right? Don't overbreathe. Be sure you're breathing through your nose at night. Like — how long did that take? Twelve seconds? That will absolutely change someone's life. But unless they understand why, and unless they understand how that affects your body, it's not gonna stick. Like I think of all of these podcasts now, you get on Instagram, everyone's throwing out these little nuggets on how to get better, take this supplement, take that supplement. But it's just sort of in one ear and out the other. So my job — I'm not a breathworker, right? I'm new to this field, but I'm a journalist. I've been doing that for quite a long time, is to interpret this stuff from an outsider's view. And to then spit back out the stuff that I found to have most resonance with me. And I did not think it would resonate with people as well as it did with me, because it absolutely changed my life. These simple tricks. And that's what got me so angry about this. Like, why didn't I hear about this from my family physician? Why didn't I hear about it from a school teacher? These are easy, quick and easy things? Why did I get all this crazy dentistry? You know, teeth yanked out and retainers and headgear and braces for years to have my teeth grown crooked and braces again. It's just when you look at that, it's so crazy that people are not even given rudimentary information on how to improve their health and to allow their kids to grow up and not have braces and not live with the things that — I don't know if you had those things, but I certainly did. And I think that is what inspired me to want to keep pushing into this and spread that word.

Patrick McKeown
10:58

So you asked about the why. Why didn't you hear about it? Why didn't your medical doctor tell you about it? And why do you think?

James Nestor
11:07

I think that a lot of the stuff was viewed as flaky, as newagey for a long time. People associate breathing better, a basic biological function, with, you know, crystals and sitting in a corner with a robe, which is so unfortunate because I can't imagine anything more essential to life than breathing better. So I think that's part of it. And also like doctors just don't have time. There are many doctors in my family, right? You're seeing 15 patients an hour, and you have enough time to quickly assess them and make sure they don't die. But you're not really ensuring that they can live a better life. And so what I've done, speaking with so many doctors and speaking at a lot of conferences, is to explain to them — you don't have to teach them these methods. You have to give them a little bit of information and be like, "Hey, your kid's eight years old, your kid has asthma. Asthma is really bad now. I'm gonna give you oral steroids, I'm gonna give you a bronchodilator, and this will help them from not collapsing, but this is not gonna cure the problem. There's this other road which you should go investigate, and it's learning how to control your breathing so you can control the symptoms of asthma." That doesn't take that long to communicate to someone. So coming back to your question, why — I think some of it is time. I think that the other part is willing ignorance towards these things. And the other one is really bad marketing from the breathwork or breath technique community.

Patrick McKeown
12:48

Yeah, I'd agree. I actually think the breathing industry hasn't helped itself. It's —

James Nestor
12:52

No, it's not

Patrick McKeown
12:54

made it so left afield, and even the language just communicated. And that was one of my — like I've made a living out of teaching breathing for twenty-five years. And you know, it's been a wonderful way of life and it's been very, very rewarding. It's been amazing. But I've come across resistance just as you did. I remember I was at an asthma society meeting in Ireland. I've never spoken about this because you never want to put this out publicly. But anyway, there was a panel of doctors and it was all members of the Irish Asthma Society of Ireland, and I attended it. This is in two thousand and five. So I was three years into teaching the Buteyko method. And of course that's quite popular for asthma. And the CEO at the time, she sat down beside me at the conference. And I was thinking to myself, like, why is she sitting down? Like she knew me. And she was talking to me. And then a couple of minutes into the conversation, she said, "Patrick, don't ask any questions." So she silenced me. So she sat down beside me to silence me. Now there's resistance. And you can be sure every person who tried to bring the science into breathing and to put it out there — and we have to bear in mind, anybody who got into breathing got into it because of their own issues, because that was something that propelled you, because you needed that to continue with it. Because all the naysayers and the doubters and the people who were saying that you were doing something that was incorrect and theoretically it wasn't correct — and whenever it was said to me, I was thinking to myself, listen, I've had asthma for twenty-five years. I've had a stuffy nose. I've had chronic mouth breathing. I've had all of the things that you talk about in your book. But I also addressed them using a physician-developed breathing technique back in the nineteen fifties. And you needed that, otherwise you wouldn't have continued with it. So it's really amazing, and I know you talked about in the book as well — you said it was a lot of doctors who were resistant to listening to it, and you said mainly the older doctors. Do you think the younger doctors are open to it?

James Nestor
14:56

No, you're really gonna put me on the spot here. I think that — and there's actually been a few studies on this, so maybe I'll just cite the studies and not my opinion. You know —

Patrick McKeown
15:07

I like your opinion too.

James Nestor
15:09

As you get older, I think you get a lot more set in your ways. I mean, I can't tell you how many doctors I've seen in my life who have given me advice that was not only not helpful to me, but just perfectly wrong. And anyone could see that it was wrong by going home or just writing in your phone and looking at it — like completely wrong. So what would possess someone to do something like that? Because that's how they were taught to do it. And they're just repeating what they were taught to do, and they want to poo-poo everyone else that comes in with another opinion. That's not scientific thinking, that's not medical thinking. If we were thinking like that, if we followed that track, then there would be no progress in science or in medicine, or in any field.

Patrick McKeown
15:54

Would you survive as a journalist if you weren't willing to question everything that came in front of you and to change your ways and your writing style over the years?

James Nestor
16:03

Not only to question everything, but to acknowledge, to say, you know what — ten years ago I wrote this one fact. I thought it was true at the time. I did my work. There was nothing deceiving about it. It turns out that that fact is incorrect. I'm now revising that fact because this is what else I have learned about it. To me, that doesn't put you in a position of weakness. That puts you in a position of honesty with the person you're talking to. And I've found that so many people are resistant on ever saying they were wrong about anything. And that's just not how the system should be working. Medicine is constantly changing. No one's blaming the people that have done these studies. They put forward what they thought was true at the time, but things change. And in some of these studies, sometimes the data is just fudged in one way or the other, to serve the person that is funding the study. And this is not a conspiracy theory, this isn't a hypothesis. This is absolutely true, and there's so many examples of it. So within all of that huge morass of noise, you just have to try to find the signal, the true signal of that. And that can take —

Patrick McKeown
17:49

If you were to look at your book, so just on that basis — you were saying that, say, somebody said something ten years ago, now if they were to do it again, they'd say it differently. All the information in your book that was written, what, seven years ago, six years ago — is there anything that you would look back and say that in hindsight you should have framed it differently, that science has changed your views? Is there any part of it that you would rewrite?

James Nestor
18:15

I have rewritten parts of it. So luckily there's been enough editions of the book that I've found — I talked to doctors and they say, "Hey, the book was cool, but this part should have been phrased differently." I say, "Really? How would you phrase it?" I say, "That's a really good point, I'm gonna make that note and go back and rephrase it in a way that's even clearer." So I've done that probably a dozen times to this book. And in the last edition, the paperback edition, which just came out in January, I was able to revise a lot of it that I was not comfortable with how I phrased things. To be clear, there was nothing incorrect in it — this thing was fact-checked over and over. Certain phrasings were not as clear as they should have been, and so I took that opportunity to correct those things. So luckily, books are — they're a living, I was gonna say a living breathing thing, I'm gonna avoid those puns during this conversation — but it's an amorphous thing to a certain degree, right? And I don't think by me changing those things I'm going back on what I said, I'm just trying to provide a further service to the reader to make it patently clear so they don't feel possessed to send me an email. But when I get criticism about the book and about certain sections in it, I listen to that. And some of it's wrong — I say, "Actually you're wrong, I believe in what I said here and I'm gonna defend it." And some of it's right, and I say, "Thanks for letting me know, I wanna know that." I want to do a better job and have a book that's as honest and as true as I can make it.

Patrick McKeown
19:57

And in terms of what you put out there about breathing that probably would have surprised quite a few people — that's probably the benefits of carbon dioxide and the importance of it and the necessity of it as a gas. Did you come across any kind of rebuttals on carbon dioxide?

James Nestor
20:19

Surprisingly, the biochemistry on that is complicated enough that a lot of people just tuned off on that section of the book. I think you were probably into it because you're like a CO2 geek, just like Anders Olson, is really into this stuff. But that was one of the sections that I was most careful about. So I talked to three or four different doctors, and I talked to a biochemist, and I talked to a regular chemist, and I had them read this over and over and over again. I said, "I have to get this right because it is upturning so much of what people would think about their breathing and about breathing more" — and about hyperventilating, they're getting more — no, you're getting less. So that was one thing that I thought the way that was presented was complicated. I tried to simplify it as much as I could, but I have received no pushback from that. And now what's so interesting about the CO2 thing is when Anders Olson was telling me about this, eight, nine years ago, I was like, this is edgy stuff, but it's true. When I read your books on this, I was like, it's right on the edge, but every time I checked it out, it's true. Like you can prove it. You can measure it. It's in yourself.

Patrick McKeown
21:34

Just normal physiology — like a few things, the Bohr effect, nineteen-oh-four, it's still in every medical —

James Nestor
21:39

But

Patrick McKeown
21:42

the oxygen dissociation curve is still in every single medical textbook with a section on respiratory physiology. So it holds true.

James Nestor
21:49

It holds true for our natural bodies, right? So when you get into inhaling CO2 is when it pushes it a little bit. And so that section specifically, I had to really be careful because I didn't want to overdo it, but I didn't want to underdo it because I wanted to be honest with people. And one thing that's been really interesting the past six years — now there's a surprising amount of science and studies going into inhaled CO2. There was one I read yesterday, right before I came here, showing that breathing in CO2 in Alzheimer's appears to have a positive effect for that. And the irony is a hundred years ago, this stuff was being used by leading doctors, leading researchers at leading institutions, and it was systematically buried. And that's the one thing that I wish I would have expanded more in the book, because at the time I was like, this is starting to sound like a conspiracy theory. But I found a guy — a doctor who wrote a book, an entire 600-page book, about how CO2 therapy was systematically buried by anesthesiologists, because it was invading on their turf. And so it's been very interesting to watch this uptick of interest in inhaled carbon dioxide. Now Anders has these machines — unclear how legal these are — where you can inhale CO2, and people I've met are just like, "This thing's changed my life."

Patrick McKeown
23:28

Why not breathe less? I don't want to spend seven hundred euro on a machine —

James Nestor
23:35

I know, I know, I know. So I'm not defending — I am Switzerland here, I'm a neutral territory, I'm a filter, information comes in, I process it, it comes out the other way. Of course you can breathe less, right? And we know the science is very clear on that. However, you also know some of these techniques require people to really exert some effort. And as you know today, no one really wants to lift a finger.

Patrick McKeown
24:08

No, you know what — and this is like, all of the points that you've made, I'm totally in agreement with, and I agree with that one. People don't want to do anything, but I think if people were made aware of it — you brought in the science there to show people it's not — breathing is so simple. It's breathe in, breathe out. I agree. Like what can you do with it? You can breathe faster, slower, you can breathe fuller breaths, lighter breaths, you can do a breath hold for a short time, for a long time, at the top of the inhale or at the bottom of the exhale. You can breathe nose, mouth, chest, diaphragm. That's it. Every single breathing exercise under the sun is contained within that. It's so simple. But all it is is asking the question — from a breathing perspective, if I change my breathing this way, what's it doing in terms of carbon dioxide, blood circulation, oxygen delivery, vagus nerve stimulation? If I hold my breath, what's it doing? And I think if people understood it — they would actually go for a walk with your mouth closed and just be conscious of breathing a little bit less air, you would have increased blood flow to the brain. I'm going to come back to that Alzheimer study — that is so exciting. I think that's Sophia Ryman from the University of New Mexico, and she published that — that's only out a couple of months, maybe four or five months. So she talked about intermittent hypercapnia, that when there's an increase of carbon dioxide in the lungs and blood, with the increase of CO2 in the blood, it causes vasodilation. So there's increased blood flow to the brain, and that's pushing the cerebrospinal fluid out. And then when you go back to normal breathing, the blood vessels narrow because of the lowering of carbon dioxide, and cerebrospinal fluid comes back into the brain. And it's the movement of the cerebrospinal fluid into the brain and out of the brain that's helping to get rid of the accumulation of different toxins such as amyloid beta, which are implicated in increasing the risk of Alzheimer's, dementia and Parkinson's as well, I think — really promising. So exciting, isn't it?

James Nestor
26:13

It is. And you can get those effects, as you said, with — how many breathwork techniques have you — breathe and then hold your breath, and then breathe again and hold your breath? You look at any modality from ancient Hindu practices, yoga practices, you look at Qigong, ancient Chinese practices, you look at new practices, quote unquote new practices like the Wim Hof technique — you're breathing a lot and you're holding your breath. So I think it goes back to even people that understand the physiology, the biochemistry, that it works. I don't know how it is in Ireland, but in the United States, people need an easy switch.

Patrick McKeown
26:59

Ireland too.

James Nestor
26:59

For everything. And if they don't get it, they won't do it. So I know how easy it is to convert yourself to be a better breather, to become a nose breather — 'cause I did all this the old school way, with a notepad, with little alarms on my phone, and that's how I was convinced this stuff was extremely beneficial to people, because I felt it in myself, because I was in bad shape, bad respiratory shape. But nowadays, because of thanks or no thanks to biohacking techniques, people want everything in a bottle. And I think that this modality of CO2 therapy for people who are not energized enough to get up off the sofa and spend five minutes doing something — my inbox is filled, thousands and thousands of emails of people that are begging me to cheerlead them on to become better breathers. And I'm done with it. I'm done with it because what you need to know is in this book, is in all the books that you've written, is available for free on podcasts, available for free on YouTube, available for free on AI. "How do I become a better breather?" It's actually pretty accurate, right? And what those things don't offer people is the gumption to get up and actually do the thing. It's the same thing with nutritional sciences — we know how to lose weight, we know how to lower blood glucose, we know how to get rid of type two diabetes for a lot of people. How many people actually do the thing? Not many. So I've noticed I've spent so much time, so much energy trying to cheerlead and convince people, "come on, you can do it," and then to watch ninety-nine percent of those people not do the thing and come back and be like, "I need more cheerleading" — I now want to place my energy on people who have the will and the interest to get up and do the thing themselves. Not to hike Everest, but to spend ten minutes a day to improve their health, to go out and get some sleep tape and try to nasal breathe at work for fifteen minutes. That is the area that energizes me, because it's these stories from those people that you hear where their life becomes transformed and the health of their kids becomes transformed, because this stuff is real. So that's what I'm trying to focus on. And that's why I actually think — you will disagree, and I fully respect that — some of these modalities, like if you've ever taken a hit off of CO2, it's instant wow, and it can convince you that there is a lot you can do in a very short amount of time. That's in some ways cheating, you could say, because you can do it while holding your breath as well. But if you're someone who can't hold their breath, or is only gonna be interested if the volume's cranked up to eleven when they do something, then that could be a nice doorway to open and let them walk in through.

Patrick McKeown
30:34

The only thing I'm gonna say — I agree with what you're saying, but I wasn't going to fully agree with it. If somebody has poor breathing, it's not going to address their underlying breathing patterns.

James Nestor
Of course not.

Patrick McKeown
30:34 (cont.)

You know, it might reduce the chemosensitivity to carbon dioxide, but if they're going around with their mouth open, if they have faster breathing, if they're not able to self-regulate in a stressful situation — I don't know about you, but the breathing did something huge for me, in terms of one aspect of my health, and I'm just wondering, does it coincide with yours? What's the single best thing that it did for you — mental health, sleep health, respiratory health, physical fitness, anything and everything in between?

James Nestor
31:25

I do want to answer your question about CO2 therapy. By no means will this help them become nasal breathers or to breathe deep and engage their diaphragm — by no means. What I was saying is for someone who is walking up to a door that is locked and has been locked for a long time, if you can offer just to crack it open a half of an inch to make them say, "Wow, I think I can do this, there is something here" — that thing just blew my mind, what else is there out there to pique their curiosity — the door opens and then they have to do the real work. This is just that slight little push to get them over, which is why when I do talks, I have everyone, even though it's corny, even though people are in a suit, even though they look at me and shoot daggers at me because they don't want to stand up and put their hand on their belly because it's incriminating in some way — if you can just get half the crowd to feel something in 30 seconds, that door tends to just slightly crack open. Then if you have that, they might have the curiosity to go in further. So your question now was what technique —

Patrick McKeown
32:43

No, not so much a technique. Like if somebody was to ask me what has breathing really done for me, I wouldn't straight away — I would say, this. What does it do for you?

James Nestor
32:56

I mean, what doesn't it do for me? That's a corny — sounds like a cheap answer, but — you think about sleep, you think about athletic performance, you think about how your face is gonna grow, if you're younger, you think about anxiety. I think about stress levels when I'm in airports, which is all the time. If I'm not able to walk around and breathe into a count of four and out to a count of four, through my nose, I don't know what I would do. So it really feels like I was living two different lives. I know that sounds corny, but it's true. And the big regret I have about learning all of this later in my life is — man, if I had known this when I was eight years old, if I had known it when I was sixteen years old, if I had known it when I was twenty-five — and that's what burns me up — no one told me it. And I think that I would have been someone that would have glommed onto it and would have actually applied to improving my breathing at those various stages of my life, because the benefits are so pronounced. So there is not one thing that it's done for me. It's done a lot of things simultaneously. And I hear that from people all the time. Once you focus on sleep, then it turns out, "this helps with my focus at work," "this helps with my anxiety, or my COPD, or my asthma," and more. And I think that's what it's all about. It's a truly holistic thing. It's a whole body treatment.

Patrick McKeown
34:36

So if I'm reading it right, it's almost that you've kind of embraced this and you've brought it into your way of life. So I'd love to know your routine — you go to bed at night, do you use nasal breathing support? Do you have some mouth tape? What do you do when you get up in the morning? If you're feeling stressed, okay, you said breathe in for four and out for four. Do you do formal practice? Do you not?

James Nestor
35:03

People ask me this a lot. A lot of breathworkers ask me this because they want to know the secret — they're just like, "you just blew my response, man, there's no secret, Patrick, there's no secret." So I think a lot of people think like my life now is sitting around breathing and trying out different techniques, and that would be a beautiful life if I could live that life, if I could stay at home, sit in different corners of the room and experiment with different modalities — I'd be really, really happy. But that's not my life. It's not — I live a completely deranged, stressed out, very busy life. And so the thing that breathing techniques — and I'm not gonna call it breathwork — has done most for me is I have adopted better habits. And that took probably a few months to really get these habits down. And once you adopt better habits, you don't need to think about how you're breathing all the time. So I instinctively will be able to adapt my body to whatever situation I'm in. Sometimes I have to consciously do it — if I notice I'm in line at an airport, I'm late for my flight, I feel the heart ticking up, because if I miss this flight I'm gonna miss the next flight, if I miss that I'm gonna miss the conference, if I miss that then why am I even on this trip — then I'll really slow things down and take control of it. If I'm walking around, I'm never breathing through my mouth. And previously, the vast majority of my life, I was breathing through my mouth the whole time — every night, whenever I was jogging, whenever I was surfing, whenever I was working. So I think that once you convert, you have fewer boxes to check — "am I doing this, am I doing this" — I'm doing this. And you have a natural ability to sense the stress or the environment and to adapt your breathing to that. In addition to that, I still do breathwork techniques, but they've almost become part of my metabolism and not something I consciously do. When I go to sleep at night, at the end of a very long day, I'll definitely notice I'm gonna be exhaling more than I'm inhaling. If I happen to be reading a book, my body just knows how — I've written about it for so long, I've been doing it for so long that it's just become part of who I am at this time. And having said that, it's nice to have access to so many different actual techniques — I won't call them breathwork techniques, but practices — that if I'm in a hotel and I have ten minutes before I have to go live in front of two thousand people, I'll know what to do, to lift my energy up or to calm myself down. And as you mentioned, it's not that complicated.

Patrick McKeown
38:08

No.

James Nestor
38:09

It's this — all this graph, and it's almost like if you think about those wheels that you use to write music to, like all these chords go, or even complementary colors on a color wheel — you're just sort of doing this and you're making different colors, but it's all within the wheel.

Patrick McKeown
38:25

So the listener's going to be intrigued now — you're going to talk to two thousand people, and today you go out and you're feeling tired. How are you gonna ramp yourself up?

James Nestor
38:37

I'm gonna start to do some breathing, which I don't think Patrick McKeown over here would appreciate so much. But this is what we differ on some things, ladies and gentlemen. I will do some rapid breathing. I will do some kundalini-type breathing. I know where your thought is about this.

Patrick McKeown
38:57

No, fill in the gaps — but when you say rapid breathing, do you really speed up the respiratory rate — is it a count of one and a half in, one and a half out? That wouldn't be really rapid though. One and one. So is it thirty breaths per minute, forty, fifty breaths per minute? Is it very small tidal volume?

James Nestor
39:20

Very small tidal volume.

Patrick McKeown
39:23

Rapid and tiny tidal volume. Yes. Okay.

James Nestor
39:27

This is just the signal to get the system —

Patrick McKeown
39:29

Sympathetic.

James Nestor
39:31

— like to ramp it up all the way and then to hold your breath. And to teach your body, "okay, I can turn on stress, now I'm gonna turn it off, I'm in control, this other monkey in the back of my head is not in control." I'm in control and I'm gonna be in control when I go up on that stage, and I'm gonna be calm about it. So I think that those tricks — a lot of people refer to it as the Wim Hof method, even though he's very clear — this is the modality of breathing very fast and holding your breath, or breathing very fast then breathing very slow. People identify that with, "oh, that's Wim Hof method." That is almost every pranayama that has been around.

Patrick McKeown
40:14

But it depends on the tidal volume there as well — if you're going out on stage, I remember going to do an exam, back in nineteen ninety-seven. I read this book, can't remember the name of it, and the individual said, "Take these full deep breaths." And I was stressed going into the exam, I was a chronic mouth breather, very poor concentration, and it was a university exam, so it was important. So instead of walking into the exam hall, I took a walk for about two minutes, and I took these full deep breaths for two minutes — because of course the belief was there's more oxygen going to the brain, it's gonna make me more alert. And I went in and sat at the table. How do you think I felt?

James Nestor
41:00

Yeah.

Patrick McKeown
41:01

I felt disoriented, and it took me about fifteen minutes and I felt spaced out to get my head together. And that's why, when I addressed my own breathing issues, I didn't address it by hyperventilating — I addressed it by hypoventilating. It wasn't that I wanted to breathe less all the time, it was just that I wanted to address my chronic over-breathing, my mouth breathing, my upper chest breathing. I would have had a fast respiratory rate, my resting heart rate — when I tested it back in the late nineteen-nineties, it was eighty beats per minute, I was twenty-six years of age. So I sometimes I'm curious as to why people go into different camps, if they are different camps. I'd be open-minded now with breathing, genuinely, because the Oxygen Advantage is not based on tradition — we actually do hyperventilation, and it's not the Wim Hof method. We create our own breathing exercises, and breathing exercises are easy to create — all you're doing is dealing with the breath in and the breath out. When you create a breathing exercise, you just need to know what that breathing exercise is doing to the health of that person, taking into consideration their age and their breathing pattern. And the other aspect is what it's doing in terms of the biochemistry, the biomechanics, the immune system, and the psychophysiological. So it's very easy to create a breathing framework. But — were you ever intrigued as to why some people love hyperventilating and some people are trending towards breathing less, doing the opposite?

James Nestor
42:38

'Cause hyperventilating gets you extremely high.

Patrick McKeown
42:40

But I wouldn't have done that — for me, I would have felt shit.

James Nestor
42:43

But that's why — talk about it, if you want people to say, "breathing doesn't do anything, it doesn't matter" — you have them hyperventilate, do some Sudarshan Kriya for ten minutes, they say, "oh my god, what the hell just happened, I felt like I was coming out of my body." So I'm not saying that's good or bad — I think it's beneficial because it gets people out of their limitations. And I'm not saying that's gonna be the right breathing modality for everyone all the time. But again, my job, if I have any job at all, is to take people up to a door that was closed for a long time and to just barely crack it — once you're in, that's your business, that's where my job is over. There's so many other doors in that room, so many other windows, you have to find the thing that works for you. But to me, it's whatever it takes to get someone to do that. And I love hyperventilation techniques. I love them, they make me feel great, I feel clear afterwards, I have insane psychedelic dreams during the nighttime whenever I do those right before bed. I really like them. I don't do them often — there's a time and place for them, but when I do them, I really enjoy them. Am I saying these are right for everyone all the time? I would never say that. I'm just saying for me, they're great. For the rest of the time — breathing slow, breathing low, breathing deep. That's the baseline, right? And then once you're good at that, only once you figure that out, should you start flirting around with other stuff.

Patrick McKeown
44:22

Now I agree with you. And you know where I'm coming from — for example, when I was that kid back in nineteen ninety-eight, and I was already stressed and chronic mouth breathing and over-breathing, and no doubt if my end-tidal CO2 was measured it would have been quite low, I'd say very, very low thirties — so because I was already in that state of hyperventilation, the fact that I did the two or three minutes of these full deep breaths, I blew off so much carbon dioxide, but then it took such a long time to return to baseline and it totally put me off. And it was only then — I remember the day sitting down and I did this exercise to decongest my nose and it worked. I said, "my God, this thing works." And I then started practicing breathing less air, which is the opposite of what you hear — what gets most of the attention is breathing more air. So we're saying breathing less air — well, not always, sometimes we do say breathe more air. But I remember putting it into practice and the temperature of my hands internally increased, not just because I had my hands against my body — I felt calmer and I felt a change come over me. And I lived in my head for twenty-six years. And that's why I asked you — what did you get most out of it? Like for me, reducing rumination of the mind — my thought activity has reduced by about thirty percent.

James Nestor
45:45

It's interesting that both you and I came to generally the same place in our lives in a strange way, but from opposite ends. That was the thing that did it for you, and for me it was the volume up to eleven — this thing just blew my mind, and that's how the book starts, because I needed that convincing of something that was going to be completely over the top for me to understand what might be sitting below it. So going into that Sudarshan Kriya class — God, how many years ago was that, I don't even know now — but that was the thing that just, sweating through my t-shirt, my hair sopping wet, I'm like, how is this physically, biologically possible that I was able to do this? And from my mind, from a journalist standpoint and from my health standpoint, that is what absolutely turned me on to this stuff — is that extremity, whereas you needed to be more balanced and centered, right, and so you finally got the feeling of what it's like to be balanced and centered, and that's what turned you on to it. So I think no matter how you come to it, there's that light bulb moment that you have to have in order to come in deeper and want to learn more about it.

Patrick McKeown
47:07

What's the listener going to make of all of this? They're gonna think here's two — I was gonna say two breathing idiots here having a conversation — and now the listener's going to go away thinking one person is saying this and the other person is saying that. What can they get out of it?

James Nestor
47:21

I think we're saying the same thing. This is not a vegan versus keto argument, in my mind. Maybe that would be —

Patrick McKeown
47:30

But in terms of their practice — so say, for example, they're feeling that they want to go into breathing, and there's two doors. So do they go this door or this door?

James Nestor
47:40

So let's use that analogy of the carnivore versus the vegan. Let's think about what they agree on — they agree on no processed foods, okay, processed food is bad, let's start there and then we can start teasing it apart. You get rid of processed foods, you're probably 80% there on either side of that, and the other 20% really matters, but you're 80% there. I think that what both you and I are saying is we came to this stuff from different ends, but we ended up in — not a hundred percent in the same spot, but like ninety-five percent. And that 5% difference is a matter of our personal preferences. So what you've said in all of your podcasts, in all of your books, to all of your students, is exactly what I'm saying — the same thing. You don't want processed food for your nutrition, you don't want crappy mouth breathing, over-breathing air for what comes into your body. And how you stop yourself from breathing in a crappy way — there's many different ways of doing that. You have your approach to it and I have mine, and I think those two Venn diagrams almost completely overlap. So I don't feel this as an opposing forces thing — I think we're saying the same thing. So if you are that listener, and you are even more confused now because I brought in a vegan-carnivore diet analogy, and you say that still doesn't make any sense — all you need to do, this is it, you're gonna breathe through your nose. Even when you're exercising, maybe up to zone five, you can default to an occasional mouth breath as long as it's conscious. But you are going to focus on nasal breathing, especially at night — 100% of your breaths at night need to be in and out through your nose. You're gonna want to breathe slow and low. You're gonna want to have a relaxed belly. You want to feel that diaphragm descend and come back up. Is that that hard? I think you agree with that.

Patrick McKeown
49:52

Total agreement.

James Nestor
49:54

So if anyone is listening, that's what you do. It could take you a long time to get there. Some people who have severe nasal breathing problems, they have structural problems, they are chronically congested, but —

Patrick McKeown
50:06

But they can even assess that in terms of — do the nose unblocking exercise that's in the book, do it five or six times. Can you breathe through your nose comfortably for three minutes during sitting? That's part one. And then can you go for a walk and breathe through your nose while you're walking, and is it relatively comfortable? And even if you feel a little air hunger — because the air hunger that you experience when you transition from mouth to nasal breathing isn't just because of possible nasal obstruction, the dysfunctional breathing pattern is going to generate air hunger because the individual has a strong sensitivity to the gas carbon dioxide. So bearing in mind that people who might be new — it's carbon dioxide that of course is the driver to breathe, not oxygen. And the question is, if you've been going around with your mouth open for yonks, you can have a strong sensitivity to the accumulation of carbon dioxide, resulting in faster, harder breathing. So when you switch from mouth to nasal breathing, you may feel a little air hunger, but stick with it, because the nose does everything with the breath and the mouth is simply not for breathing.

James Nestor
51:12

I could not agree more. And that nasal piece, just like the processed food piece being 80% of proper diet, the nasal breathing piece I would probably say is 70% of proper breathing — because if you are just breathing through your nose, the other things are very important, to breathe slow, but instinctively, if you're breathing through your nose, you're gonna be much more apt to be taking those fuller, slower breaths. So whenever people ask, "what do I do," I say you start with that, and you figure that out, then come back to me, and then we're gonna start to expand it out. But you have to get the nose thing first — "well, I can't, I want to fast forward to all this other stuff" — too bad, you have to get the nose thing down first, that's just how it is.

Patrick McKeown
51:59

I wonder if we can tease out some of the functions and the benefits of breathing in and out through the nose. Because I've stood up at a conference in Chicago — it was a medical conference, and a professor of medicine stood up and said there was no difference between breathing through the nose — it seems that I'm hitting doctors here now, but it's not.

James Nestor
52:18

Was he an older doctor?

Patrick McKeown
52:19

He was old, total agreement with your book, right? And I was just saying, small little me, "my god, here's this big professor of medicine saying it didn't matter whether you were breathing through your nose or mouth." And luckily enough, Dr. Kevin Boyd was in the audience and he stood up and supported me. Other than that, I would have been — because when you have this heavyweight criticizing you in a public environment, it's not particularly helpful. But that was his criticism, that it doesn't make any difference whether you breathe through your nose or breathe through your mouth. What would you have said?

James Nestor
52:51

You know, I think a couple years ago that would have really gotten me going and I would have shared a bunch of thoughts to him. Now I would just say, if that's what you believe then that's fine — see this new space I'm in, Patrick? Like I'm a quitter now. No, I would have tried to engage him and asked him specific questions on why evolution was so careful in imbuing us not only with a nose, but with all these different sinus passages that are extremely detailed and specific and take up a huge amount of real estate in this very precious head — we don't have a lot of space in the head, the brain does a lot, the eyes take up some, our mouths take up some. So why would that be? These are the same people that say tonsils don't matter, adenoids don't matter, "here, we're gonna take out your gallbladder, that doesn't matter, you don't need a spleen, you don't need an appendix." It's just the same thing. So I would have him, in all of his infinite knowledge in these things, explain what specifically he means. And I think by having someone explain it out loud, they would then see the falseness of it — that is a ridiculous thing. Like I could see someone wanting to get more interested in taking on something like CO2 — because we're taught someone that deals with people with emphysema, "these people have way too much CO2, CO2 is bad" — this is gonna be an interesting conversation from two different perspectives. But something like that, you could just look it up on your phone in two seconds. And the fact that they don't do that, but they're out in public saying these things — what can you do to change someone's mind about that if they don't want to change their mind? I've come to the conclusion not much, but thank God Kevin was there — he knows a thing or two of proper breathing.

Patrick McKeown
55:02

Totally. I was totally relieved Kevin said he totally disagreed with him, and Kevin had no problem saying it. So I'm sure Kevin might listen to this podcast. But yeah, he stood up because I actually felt very uneasy, because it was a medical conference and probably three to five hundred people there, all healthcare physicians, and I'm the only one in there teaching breathing, really, and for somebody to kind of put me down. But that was after I talked about the importance of the nose. And I would always try and support it because I wanted always to move away from left of field — I felt that breathing will never be mainstream if we did left of field. Like, we do need to make it mainstream. And sometimes what I talk about now, in terms of the mouth, to simplify it with people — and it took me a while to get to this very simple place — what's inside your mouth? So what's inside your mouth, James?

James Nestor
56:05

I mean, an hour ago it was some rice and some asparagus, and there's probably bits of that, might even be a little bit of breakfast — no, of course, I've got a tongue, I've got teeth. And what are those for? What role do those play in breathing?

Patrick McKeown
56:26

That's exactly the question. And it really boils down to that — if you isolate every single thing inside your mouth and you ask, "what does this do with breathing?" That's it. The mouth — you can breathe through it, it's an emergency, but it doesn't mean that should be the default way of breathing.

James Nestor
56:43

But you're approaching an illogical question with logic. And what I've noticed is that never works for someone who has no curiosity, who literally can't bother to spend one minute to research what they're about to say to you. So you can try to engage someone like that, but if they aren't even curious to listen to you — this is where I'm trying to conserve my energy, because I've engaged those people a lot. I still get a bunch of crap from people, still to this day. People read the section of the book about Katharina Schroth — this was a person who had scoliosis, and she breathed herself to have a straight spine. And then she taught hundreds, now thousands and thousands of women to do this, who had extreme scoliosis, so much so that the hospital said, "we don't know what to do with you, go sit in bed the rest of your life." So there are pictures of this, of these women — they're breathing and doing stretches, and then they stretch them out like it's a hardcore thing. But the core of this was breathing — breathing into this lung, breathing into this lung, back and forth, over and over and over. The science is there, the school is still there, the pictures are there, the videos are there. People still say, "you can't cure scoliosis" — I was like, "maybe you can't cure it, but you can definitely straighten the spine by adjusting your breathing and doing these postures." They say, "listen, I've been researching this for 30 years, you're a journalist, I'm a doctor, that is impossible, so whoever told you that is wrong." I said, "well, did you see the papers in the back and the pictures?" "Yeah, I saw those, but I'm just telling you that's impossible." So that happens quite a fair amount. And there's something about the scoliosis part of that book that people really have a hard time about. But to me, that is the most patently clear evidence that you could provide to someone. And it's touching to meet people who have gone through that program, who had severe scoliosis, whose spines are perfect —

Patrick McKeown
58:54

[laughs]

James Nestor
58:55

perfectly straight now. They're like, "why isn't anyone talking about this?"

Patrick McKeown
58:58

Totally. But even if you had a parent whose child — God almighty, you'd absolutely want to have a non-invasive way to help improve. And I know you said it's not a cure, but at least it'll teach the child not to do the wrong thing. You're talking about getting better function of the diaphragm, and the diaphragm providing stabilization of the spine — that's exactly the support there. It just makes total sense, between functional breathing and functional movement.

James Nestor
59:27

You know what Andrew Weil told me? He said that he learned from his mentor — his mentor asked him, "why do people get scoliosis?" And Weil was like, "I don't know, is it genetic? We still don't know, if you look it up, we still don't know." His mentor told him that it was caused by improper breathing when you're young, by having improper stance, improper posture — you go to bed at night, your body is curved like this, this lung is constantly inflating, this one is not, and in those years of very quick development, the spine starts growing, you don't fix your posture. So that's what Andrew Weil told me. There's no way to prove that — we can't get a hundred kids and have them breathe one way and have some controls breathe another way — but to me I thought that was interesting, and that's one of those things you can't prove, but intuitively it makes sense to me. So if that's what causes some curvature of the spine, then it's reasonable to think that you could correct it that way. What you were saying about a parent wanting their kid to have the best possible chances of living a healthy and normal life — true, but that parent has to be open-minded and critical enough to take the first step. And what I've noticed is a lot of parents aren't. And I'm not here to rip on parents — it's really hard being a parent, there's a lot of different variables. But —

Patrick McKeown
1:01:07

Mm-hmm.

James Nestor
1:01:08

you have to be willing to look outside the box in which we have all been put into. And it's a box that is very quickly crumbling right now, as far as what we thought was possible with human biology and what we thought was right as far as medicine goes. And you're starting to see that collapse in a lot of ways, and it's being collapsed by leaders in the field, by doctors who are coming out and saying, "we did this thing this way, and it was wrong, so now we're correcting it." An example of this — it wasn't too long ago that doctors were telling parents, "whatever you do, don't introduce peanuts to your kids, because if you do, they're gonna become allergic." So peanut allergies went out of control, up a thousand percent in a decade. And now what do doctors say? First thing you should do is introduce peanuts to kids, because we don't want them to become allergic to it.

Patrick McKeown
1:02:10

And I was on the flight last night — there was an announcement, "there's somebody on the flight, don't eat peanuts," the peanuts wouldn't be distributed because there was somebody with an anaphylaxis reaction to peanuts. Coming back to oral breathing — mouth breathing itself, it's so simple, and one aspect of it is in terms of dental hygiene, and I wasn't giving it enough attention. When the mouth is open and you're breathing through it persistently, the mouth dries up because we lose a lot of moisture from the mouth by exhaling it, and the saliva isn't replaced quick enough. So the mouth will dry, and then the environment of the mouth is dried, it changes bacteria, it changes the microbiome in the mouth, and it increases the risk of dental cavities, gum disease. There's so much going on there, I can't get my head around it. I have to give a presentation to a group of dentists in Boston in about two weeks, so I had to put this PowerPoint together, and it forced me to do a deep dive and make sure all the science was there. But at the end of it, James, how on earth have dentists missed this? And I'm not talking about our airway dentists — there's cohorts of dentists who fully get this, like Dr. Stacy Whitman and others. But we're talking about 95% of dentists have forgotten or overlooked this in terms of dental hygiene, because dental hygiene must be one of the most important things, because your traditional dentist is there to treat teeth, treat cavities, make sure the mouth is in good health, but yet they haven't considered mouth breathing.

James Nestor
1:04:04

I should send you a study I found from like eighteen-ninety where dentists were talking about this exact same thing.

Patrick McKeown
1:04:11

For oral hygiene.

James Nestor
1:04:13

Yes, they said mouth breathing is the worst thing you can do for cavities as well — if you eat a bunch of carbohydrates, if you eat sugar, and then are mouth breathing, it's just a breeding ground for bacteria that's going to cause cavities. So I don't know why dentists aren't sharing this with their kids, with their parents. You could look at this cynically — I'm not saying this is my viewpoint, but a cynic's viewpoint would be: why would a dentist who's making a killing drilling, filling and billing want to make their patients less apt to see them and give them less work? What would be the incentive to have their patients grow naturally straight teeth by breathing through the nose, by swallowing and thrusting the tongue to the roof of the mouth, and not eating a bunch of crackers and goldfish and being a mouth breather? That's what a cynic would say — you were significantly decreasing your client base. So on the other end, if you're a holistic dentist who is more interested in keeping their patients healthy through preventative health, and they have other means of getting an income, and they're an airway-focused dentist, then you want to establish this early and develop these good habits. It's a very simple thing, and that's what's so crazy about this stuff. I've spoken at a lot of dentistry conferences — half the dentists are nodding their head, the other half are pissed off at me, they say, "what right do you have to come in here and spread these rumors?" I say, "if you ever want to sit down and talk about the science, talk about data, I'm here anytime." Not once has anyone actually followed through on that. So I think dentistry right now is splitting in this huge way, where one side is focusing on the airway side, on how to prevent problems — it's almost like moving towards the Chinese medicine model, where the whole model is preventative maintenance, they're less good at dealing with something once it becomes really serious. Then the other side actively just wants to repeatedly be correcting problems without fixing the core issue behind all of them. And the science behind all this is not controversial — it is all out there for anyone who wants to look it up. If people think we're flaky, do your own research, it's all out there. But the fact that the message hasn't been given to kids drives me crazy. That's one of the things that fires me up every time I do a talk — for anyone else, I always include the stuff about kids. "This is what you do." It doesn't take a lot of time to write this down — do this not for you, but do this for your kid, because I promise you they're gonna thank you later on. I wish my mom had known this stuff, I would have been a lot happier and had a lot fewer issues.

Patrick McKeown
1:08:00

Because I could understand from some points why a dentist wouldn't want to get involved with breathing, because maybe the dentist feels it's not their field. But it was only when I started doing a deep dive into it — it's unbelievable — and also the microbiome from the mouth translocating to the gut, and the gastric acids don't neutralize all of the different — there's such a diversity of microbiome in the mouth, and that's not particularly a good thing. They've detected, for example, gingivalis in the brains of people with Alzheimer's. So you'd wonder what's going on there — I don't know the full ins and outs of it, but I would really say to people — number one, if it's a dentist listening, breathing is really applicable in your industry, you don't have to be an airway dentist or an orthodontist. This is about the basic stuff, this is about oral hygiene. Every hygienist in the western world who's looking into the mouth of a child or adult, talking about what can you do to improve oral hygiene, will talk about flossing, brushing teeth, avoiding processed or sugary foods — who is talking about mouth breathing, persistent mouth breathing? And here's the thing about mouth breathing, it's a hard one to quantify — because if somebody comes into you, the two guys earlier on, for example, could you quantify whether one of them was a mouth breather based on the interaction we had? There's no definition of mouth breathing, it's difficult to pin down. Do you think it might have held things back a bit?

James Nestor
1:09:41

I think it maybe is difficult to pin down for yourself, but it's not difficult to pin down for someone else, especially your kid — parents know when their kids are mouth breathing, it's a very obvious thing, and they can hear them in the other room snoring. So I think it's such a disservice to that kid's health to not address that. If you're talking about is it a dentist's job responsibility to train people how to breathe — no, it's not, but it's a human's job to explain something very simply and very quickly to someone who's gonna suffer some serious damage. I think that is anyone's job, not just a dentist, not just a doctor — "hey, Carol, your son here is a chronic mouth breather, you should really get that under control, because it's gonna cause a bunch of problems with how his face is gonna grow, with his oral health, with his respiratory health and more, here's a card of some information you can look up." That does not take that long to do. So I don't understand — what's the resistance? Are you in the business of helping people, or just making a quick buck on the backside? I think you can probably do both — some of the most successful dentists I know, there's a guy, Miguel Stanley, at the White Clinic, is the most famous dentist in the world, and he's established that reputation by looking at the whole body, not just the mouth. Of course he fills cavities and all that stuff, but he tries to make it so his patients don't have to keep coming back, so they can focus on other parts of their health. So if you really want to grow your business and get a dedicated following of people, you take that approach — you really care about them as people, not just as teeth.

Patrick McKeown
1:11:44

But that's what it's about, for the customer to come back — do your best for that person, and doing your best will be encouraging, exactly as you spoke about, the importance of breathing in and out through the nose. It comes back to — one might say, "well, I'm a nose breather, I have my mouth closed during rest," but they forget the considerable time that a lot of people have their mouth open, and that's during sleep. We're talking about six to eight hours, and the stats are around fifty percent — not so much studies backing it up, but where you can find the evidence, typically around fifty percent of people wake up with a dry mouth.

James Nestor
1:12:24

Mm-hmm. Fifty to sixty — I've seen up to 60% of people. So again, hard thing to find quantifiable data, but roundabout figures, that's half the population. So I think when you look at mouth breathing, that is where I would focus the most time. It's important in the day, don't get me wrong, it's important when you're working out, but I tell people to really focus on your sleep, your nasal breathing, when you're sleeping — because what happens in sleep will generally help to carry on into the day, and what happens in the day will carry on to sleep. Because we do these retreats, and we can train people how to breathe better, but I say if after this class you feel good, you go back to your room and sleep with an open mouth, you're taking so many of the benefits that you just worked really hard over the last few days to develop, and they're just going out the window. So focusing on sleep, I think, is actually the most important thing with breathing — I'm saying that out loud, wondering if I agree with myself, I think it might be. Because it's easily diagnosable with somebody else, and what I've found is it is the thing that people will feel the most benefit from the most quickly. So once you convert to nasal breathing and become comfortable with it at night, this is where these light bulbs really go off for people — "my god, if that did that for me during sleep, what's it going to do for the other 16 hours out of the day?" And that was certainly my experience with experimenting with sleep tape and learning how to breathe through my nose. And I use this stuff every single night — it doesn't matter where I am, doesn't matter if I'm camping — because I know what happens when I don't, I know how crappy I feel the next day.

Patrick McKeown
1:14:32

I think it's not just for normal people — in terms of when they switch to mouth breathing, it really has an adverse effect on their sleep quality. They spend less time in deep sleep, more time in light sleep, and they wake up feeling unrefreshed. But people with obstructive sleep apnea — 936 million people are estimated to have OSA on this planet, according to a Lancet review back in either 2017 or 2019. And I'm writing a review article on mouth leak — the traditional form of treatment is continuous positive airway pressure, CPAP machine, designed by an Australian doctor, Colin Sullivan. He actually designed it for nasal administration — his early prototypes were a nasal mask, and the air was going to come in the nose, down the back of the nose, down the throat to splint open the airway. But a lot of people's CPAP compliance is about twenty-six to twenty-eight percent, and what happens is the air comes in the nose, partially down the throat and out the mouth — it's called mouth leak. And mouth leak has been identified since probably the mid-eighties, going back quite a bit, and very little research on it other than they know that people who are mouth leaking have reduced adherence to CPAP, and as a result they just give it up. Because what tends to happen is if you're mouth leaking, you're given this full face mask, and because your mouth is open, the tongue is in the low resting posture, the mandible is set back, the airway is narrow — so now you have to crank up the pressure to splint open the airway, because you're fighting against the tongue and the lower jaw, and the person can't tolerate it. I would love to see the day that CPAP users start getting their mouth closed and trained in nasal breathing, because if you want your client to continue using the CPAP, we need to address mouth leak and oral breathing.

James Nestor
1:16:50

When I said that the most controversial thing in the book that I get the most pushback on was the idea that you can straighten a scoliotic spine with better breathing — I was incorrect, so I'm gonna re-edit what I said — they're close, but I think there's one percent more. Let's talk about it. A lot of people in sleep medicine — I've spoken at a lot of sleep medicine conferences as well, I do the same talk, and I don't edit things out to make it more appealing, so the basis is the same, and then I'll spruce it up in different ways. So people have stood up in audiences and said, "I agree with what you're saying most of the time, nasal breathing at night, but you are 100% wrong when it comes to sleep apnea — it is so dangerous to sleep with a closed mouth if you have sleep apnea." And this has happened numerous times, I've gotten some very angry letters from people. I think what people are confused about is if you're someone with extreme, very bad OSA, and you immediately go out and buy some duct tape and duct tape your mouth and try to sleep, and say "I'm just gonna get rid of my sleep apnea" — that is catastrophic —

Patrick McKeown
1:18:17

Insane.

James Nestor
1:18:18

failure across the board. I would never ever say that, ever. And I said, where did I say that in the book? I don't see that. So if you approach this differently — where you try to nasal breathe for five minutes and then the next day wear a little piece of tape and answer emails for 10 minutes, and the next day maybe 20 minutes — is that comfortable? Why don't you take a nap for 15 minutes, is that still comfortable? Let's ramp it up after maybe a couple weeks — breathing through the nose while you're walking, while you're working, while you're doing dishes, while you're watching TV, are you comfortable? Maybe you can start experimenting with it for a couple hours at night. If at any time you're uncomfortable, be reasonable and logical and take the tape off. Not too huge a leap to make that conclusion. So people say, "okay, that makes sense, but I see what you're saying about snoring and nasal breathing decreasing snoring, but you can't do anything for sleep apnea, it's a different mechanism" — I'm here to say that's completely false. You absolutely can. And the proof is I also get letters from a lot of people who have shown me their AHIs of just switching to nasal breathing, cut in half, cut by three quarters,

Patrick McKeown
1:19:39

Mm-hmm, mm-hmm.

James Nestor
1:19:42

sometimes completely resolved — and these are people who had sleep apnea, not just snoring. So I think it depends on what level you are, it depends how you apply this stuff. I've read your paper on this, I thought it was very informative — if you're looking at the variables included in sleep apnea, like how many of them are related to actual choking, like the tongue falling back — one out of four, right? So if you look at the basic aerodynamics of what happens breathing through the nose, of how much harder it is to make that choking sound when you're breathing slow, when you're breathing low, and if you carry that over to the night, then it makes sense to me that would possibly, for some people, decrease your symptoms of sleep apnea. So what I'm trying to explain is CPAPs are great, they are absolute lifesavers, keep using your CPAP — it is not fixing the core problem, and in some ways it's probably gonna make you worse, so that you will always have to be on a CPAP. If you want to look at the core problem, I would start by looking at nasal breathing. I would start there and then work down, not the other way around.

Patrick McKeown
1:21:03

And to do it the way you say — you're not talking about forcing nasal breathing, what you're saying is this person should start breathing through their nose all the time during wakefulness, during rest, during physical exercise. And they could also wear a nasal dilator — based on the Cottle maneuver, if they just pry their nostrils and that gives them relief. But also you talked about the tongue — ideally we need to have the tongue resting up in the roof of the mouth, three-quarters against the palate, and I train my tongue to rest up there. Did you train yours? If you were a chronic mouth breather, your tongue was not in the roof of the mouth, because it's not possible to have the tongue resting there while mouth breathing. Did you make a conscious awareness of checking in on where your tongue was, and also when you wake up in the morning, do you check where your tongue is? That's a terrible question, but —

James Nestor
1:22:04

No, I hear you, it was a great question. The answer is yes, of course I do. And that was one of the first things I learned about becoming a better breather — it starts with how you're eating. I had never heard this before, that when you swallow, the tongue should be on the roof of your mouth, and you do that, it feels good, and you can swallow more powerfully than this — see how there should be no movement at all here.

Patrick McKeown
1:22:28

You should have — no movement at all here. The only movement you should see is here. No grimacing during the swallow.

James Nestor
1:22:34

So I think I did that because I started nasal breathing, and every single night when I would go to sleep, I would go to sleep with a huge glass of water — sixteen ounces, eighteen ounces of water — and throughout the night I'd wake up and be hitting off it the whole time, my mouth was dry the whole time. I was breathing through my mouth 100% of the time whenever I was sleeping. I never snored loudly — I mean, after in my twenties, after a night of a few beers, that would make you more apt to make sounds when you were sleeping —

Patrick McKeown
1:23:06

Yeah.

James Nestor
1:23:06

but every single night. And so now, with my mouth closed, once you learn to do that when you're sleeping, I found, and this could change for other people, that I'm much more apt to do it during waking hours. And I'm never breathing through my mouth now unless I'm consciously doing it — I'm never unconsciously doing it, not because I'm such a great breather, but because I've just trained myself not to do it, and it feels better doing it that way.

Patrick McKeown
1:23:48

And you also mentioned in terms of sleep apnea, so basically it's an upper airway issue — the soft palate can fall back against the throat, the tongue, the epiglottis, or the throat itself. And I'd come across a paper by Malhotra back in 2014, and he talked about lung volume and the connection between lung volume and the upper airway dilator muscles — because very often we're taught that the upper airway is the upper airway and the lower airway is the lower airway, as if they're two individual airways, but in actual fact they're one — because if we have our chronic mouth breather breathing fast, hard, upper chest breathing through the night, that reduces lung volume and the throat is more liable to collapse. So to increase lung volume, we need to recruit the diaphragm — by actively encouraging breathing low, as you talked about, and also breathing slow, because if you have somebody who's a forceful breather, there's going to be an increased negative pressure that contributes to airway wall collapse. So there's a few things going on there. I really think we can make a difference with people's sleep. So what can we encourage — easy things, whether they're a CPAP user or a normal person: number one is breathe in and out through the nose, number two is have the tongue resting in the roof of the mouth, number three, once you're comfortable with nasal breathing, start off with a nap for 15 minutes with your mouth closed, and check how you're doing with that. And if you really wanted to be sure, do a sleep study, wearing the tape during it — do your baseline sleep study with your mouth open and your tongue in a low resting posture, breathing hard and fast, dry upper airway, increased collapse, and then spend, say, three to four weeks putting what we're talking about into practice, then do your sleep study — that would be interesting.

James Nestor
1:26:10

I think so many people are already tracking their sleep right now, and what's great is it's so accessible to people already tracking their sleep. And this is where I've found people get really convinced on this stuff — they don't want to trust how they feel, because "placebo effect, there's so many different variables," but they'll trust the data that shows up on their phone the next morning. And this is the thing that blew me away — how obvious and how transformational nasal breathing was for stages of deep sleep, REM — the total quality of your sleep is significantly impacted by this. And this is what I've heard from a lot of people — they'd hear me on a podcast or a YouTube video and say, "yeah, I thought what you were saying was all bullshit," and then "I tracked my sleep and I tried it, and my god, look at the difference." So I think you can do a sleep study, and that would be a scientific way of doing it, because people don't want to believe other people's Oura ring data or Whoop band data, but you can also, if you're curious about your own life, get an O2 ring or so many different wearables that are cheap now, and gauge your progress — introduce one thing a week and see how it's impacting your sleep, and once you get that signal on the thing that is really benefiting you, you can go further into it. I've found that even side sleeping — taping something as simple as a ping pong ball to a t-shirt so you're not on your back — people have said, "I've snored my whole life, I've even had sleep apnea my whole life, and it went to zero just sleeping on my side."

Patrick McKeown
1:28:23

Mm-hmm.

James Nestor
1:28:23

And maybe that's not a permanent solution, but to me it convinces them — "I can do something so simple and it can make this big of a difference." So now I'm gonna explore getting the head of the bed tilted up a bit, explore taping my mouth a little bit. So I think you get people on that train, fired up about it, as long as they're people who want to apply a little bit of effort to improving their health, and it can really make a huge difference. And sleep is the thing — luckily, as opposed to ten years ago, when people were showing off how little sleep they were getting — "I only got three hours last night," "what'd you get, four hours, you're a wimp" — now people are showing off, "I got nine hours last night, I got ten hours." So that news is out. But I don't think you can be a good sleeper unless you have proper breathing during sleep — it's impossible.

Patrick McKeown
1:29:18

I don't think you can have a healthy life. I think life is miserable if sleep is off. We are miserable, literally — well, I am anyway.

James Nestor
1:29:27

Me too. Yeah, that's the one thing as I get older and continue traveling — I can deal with a lot of the other stressors, but losing a night's sleep just completely wastes me the next day. So with the limited time I have to sleep on the road, it needs to be quality time — doesn't matter if it's on an airplane, which I hate to do but do way too often, doesn't matter if it's a nice hotel room or a crappy one. The quality of sleep is something I focus on, which is why I travel with sleep tape everywhere.

Patrick McKeown
1:30:03

Totally. Can I talk about sleep tape? I wrote a book in two thousand and three called Close Your Mouth, and in that I was using 3M one-inch microport tape, and I used it for many years. I always felt a bit off about it, especially when it came to kids — I was working with six hundred clients per year, so this has been my full-time occupation. Initially the first six years I only worked with people with asthma, then asthma and sleep, then 2010 I started working a lot with anxiety and panic disorder, then mental health with asthma and sleep. I always felt uneasy about some people wearing tape, and I also felt it with children. So I decided experimenting first with paper tape coming around the mouth, putting the lips together, and then I started using kinesio tape and altering the glue to make sure it's suitable for the face. I think I struck it lucky here, and I'd like to get your comments — sleep doctors are not in favor of sleep tape because they see in obstructive sleep apnea there's a risk of mouth puffing. So the question is, can we allow the mouth to be closed with a nasal breathing support and still allow mouth puffing? Now I'm going to demonstrate it to you — I'm going to give you one as well, this is for beards, by the way, James. I don't plug products, but don't see it as a plug, I want to get a sense of it. So we take the backing off the tape — what is mouth puffing? Have you come across it, did doctors give you a rebuttal? It took me a while to figure out what mouth puffing was, and it's not mouth leak — mouth leak is when the CPAP is on but the air is coming in through the nose and out through the mouth, so it's not splinting open the airway. Mouth puffing is when there's a pressure built up that the person has to breathe hard and fast, and they can't get that air out quick enough through their nose, so it has to come out through some hole — it's going to be the mouth. So here's a demonstration — this is the tape here, and it's for beards. We talked about snoring — there's mouth snoring and there's nasal snoring. Mouth snoring is the most common, in terms of the palate at the back, and it goes like this. So I would like you to make that sound of the mouth snore.

James Nestor
[demonstrates mouth snore sound]

Patrick McKeown
1:33:00

So how does it sound? Very throaty, isn't it? You could differentiate — there's plenty of women who've recorded their husbands, the husband says "I'm not snoring," and she says, "well, I'll soon show you" — she records him snoring, plays it back the next day, and it sounds very throaty, the mouth is dry at the back. Close your mouth and try to snore through your mouth with your mouth closed.

James Nestor
1:33:28

[tries and fails]

Patrick McKeown
1:33:30

That's your no-snore. So my question is, can you snore through your mouth if your mouth is closed? No, of course not. So can we say then, if we get the mouth closed and the person is breathing exclusively through the nose, that we can stop mouth snoring 100%? That's my take on it.

James Nestor
1:33:49

Mouth snoring, yes.

Patrick McKeown
1:33:50

In other words, to snore through the mouth you have to breathe through the mouth.

James Nestor
1:33:55

For mouth snoring, some people —

Patrick McKeown
1:33:57

need a double-blinded randomized control trial, but for mouth snoring, of course.

Patrick McKeown
1:34:04

Okay, so that's the most common form of snoring that we can address. Snoring often coincides with sleep apnea. The next form is nasal snoring, and it goes like this — [demonstrates] — very distinctive, that nasally sound. Now what I'd like you to do is breathe soft through your nose — a soft breath in through your nose and a slow, relaxed, gentle breath out. When you soften and slow down and normalize breathing patterns, the respiratory rate comes down, tidal volume normalizes, so there's less turbulent airflow into the nose. We may not get rid of nasal snoring 100%, because that's also influenced by anatomy — a deviated septum, chronic rhinitis, nasal obstruction — rhinitis we can help. Now mouth puffing — so if you don't mind putting on the tape, or if I'm putting you on the spot —

James Nestor
1:35:03

A little bit. We're here, you know, I've got the tape in front of me.

Patrick McKeown
1:35:08

This is especially for our marketing guy —

James Nestor
1:35:12

Don't you dare put a big ad above me.

Patrick McKeown
1:35:17

So you have to stretch it about thirty percent, covering the top here, and then the bottom, and it should be at a stretch, then you have to seal it. But you should feel a tension there pulling it together.

James Nestor
1:35:30

I sure do.

Patrick McKeown
1:35:31

Do you feel a tension? So can you puff out through your mouth there — say for example you're heavy breathing during sleep, let's do it. It's totally applicable, totally possible. So what happens is if you have somebody with obstructive sleep apnea, especially if they're more severe — their AHI, the apnea hypopnea index, probably 30 plus — with that, that fifty percent of that population are likely to mouth-puff, but you don't know the population by looking at the person. And that is why, when we talk about tape in the conversation — given how it's all over the place in social media, I can understand — see, the problem is that instead of being curious and asking, "what can we do here, what are the good points," instead a sleep doctor says exactly what you said — mouth taping is dangerous, I've heard it accused of contributing to asphyxiation — by the way, there's been no recorded case ever, despite millions of tapes being used — but instead of being curious and saying, where does it work, what can we do to ensure some safety rails, in terms of mouth puffing and everything else — would that be a logical argument?

James Nestor
1:37:21

Of course it is, but again, you're approaching logic with someone that's going to apply an illogical argument to you. Everything you're saying makes sense, and if you wanna wear this or work — may I?

Patrick McKeown
1:37:39

Yeah, of course, yeah, we'll take it off, I just wanted to do it for the demonstration.

James Nestor
1:37:45

And to be clear, about sleep tape — I've never promoted, and I'm not associated or affiliated with any tape brands or anything like that. I've gotten a lot of offers and said absolutely not, because it depends on what you're comfortable with — this requires someone to use their own common sense, if something's uncomfortable, don't do it. So with the tape that I use, it's very simple, I take off some of the adhesive before I put it on, go like this three or four times so it's really light — at any time it comes right off. I would never use a piece of tape that — if I'm trying to open my mouth, this is not a hostage situation, it needs to come right off. Having said that, you don't want to be the parent that gets busted for taping their kid's mouth at night, even though I know a lot of parents who have done it and claimed many benefits. So in that regard, it makes more sense to me to use your MyoTape, and I know a lot of people who use it because it removes that one obstacle of "what if he vomits, whatever" — still the tape is going to come right off.

Patrick McKeown
1:39:06

Yes, yes.

James Nestor
1:39:09

But nonetheless it's an easier transition if that psychological obstacle — because it's not a physical or logical obstacle, it's psychological — is removed, and people can experiment with that and see how it works for them. So this whole sleep tape thing — you remember it was a very minor thing a number of years ago, it was very sketchy, people were criticizing it, and now it's become a burgeoning cottage industry, and I think that's because it just works — it's simple and it works. And people have tried to find all these different ways to extort money from other people for doing it, and you use whatever tape you want, I don't care, but it comes down to the core premise of nasal breathing at night, however you figure that out is the right thing.

Patrick McKeown
1:40:11

So the point we're gonna make with both adults and children — say for example, people at home thinking, "my child is seven years of age and is a chronic mouth breather" — how do I differentiate between allergic rhinitis causing mouth breathing, enlarged adenoids causing mouth breathing, a combination of the two, or a habit thrown in as well? I do a simple test — we have the child put on the paper tape, because of course as soon as a five-year-old does this, they do that — and I check how comfortable is this child breathing through the nose from the outset. Because if the child is comfortable breathing through the nose right now without us having done anything, I know the child is mouth breathing solely because of habit. Then, if the child is feeling uncomfortable, I don't want to force the child, but I have them do the nose unblocking exercise — going back to 1923, it showed that if you hold your breath, it decreases nasal resistance and increases nasal volume, so it's easier to breathe through your nose. If the child can breathe easier through their nose after six repetitions of that, we know rhinitis is a significant contributor, because that won't work as quickly with enlarged adenoids. Then I have the child do the steps exercise, which is Buteyko — breathing in and out, holding the nose and walking, starting with 10 paces, then 15, 20, 25, 30, building up to a point where it gets uncomfortable but nothing extreme. Then I see: can the child walk with their mouth closed, can the child jog with their mouth closed? That's a test I'd say to any parent — if a child is able to jog with their mouth closed, that child's nose is working pretty okay. So there's simple things we can do to allay concerns. It should be done with some degree of understanding in terms of comfort — can the person breathe through the nose, and safety has to be taken into consideration.

James Nestor
1:43:05

Should be done with common sense — with those three bullet points right underneath it. But common sense — you're asking people to use basic common sense, and if you don't want to apply common sense to this, this is not a good fit for you.

Patrick McKeown
1:43:23

I'm intrigued in terms of — I'm not sure how long we'll be talking for —

James Nestor
1:43:28

All night, man, we're just getting going. Bring this crew over to dinner afterwards and see what happens.

Patrick McKeown
1:44:34

I'm kind of intrigued. We spoke about breathing, but I'd like to get an insight into Mr. James Nestor. Life pushes us, and even though we do something that I feel that you absolutely love — your work as a journalist, as a writer, as a researcher, and pulling that book together — it's totally a work of art. I say that because I find it very easy to read from cover to cover, and for the words to land like that, something comes through in the pages. So you love what you do, which I'm sure you're grateful for. Is there ever a time that you feel it gets unmanageable in terms of the workload? Is there ever a time that you feel, "I'm so lucky on one hand, but I'm absolutely pulled in all directions on the other hand"? Is that just me?

James Nestor
1:46:17

Every minute of every day, I feel like — I'd love to say I'm being sarcastic, but the last year has been really difficult on the work front, because what I thought was going to be closed and done with, and what I thought was going to be starting after a nice pregnant pause of three months to catch my breath, never happened — the thing I thought was going to be done ended up taking so much longer, so now it's bled into the other thing I'm starting, and it's been absolutely chaotic, not in a good way. So I'm looking forward to when things calm down. I know that just like with you and a lot of other authors, it's never a flat line — a lot of people work a job that's a flat line, and you make incremental progress. With my work, it's these huge crests, these huge waves of busy, busy, busy, and then internal work, internal work, internal work, and then external, exposure, exposure, exposure, then I fade away. As I get older, I'm looking forward to those times where that wave is coming down, so I can go into the introverted internal work part. I love writing books, I love researching them, I love doing interviews, I love plotting the whole thing out — it's a world you create and immerse yourself in, and I don't want to leave it, but the unfortunate thing is I have to leave it every single day, and it's usually jarring emails, just the noise of life, that I've become more sensitive to than I was before, because it's so precious, that time I have to work on the thing I love to do. So I have to snap out of that, and then in the morning find a way to snap back into it without being disturbed. And my life was simpler when I wrote this book and the previous book, and now it's more complicated. So that time of deep internal work energizes me more than anything else, and it's the thing I'm trying to find a way of getting more of, because I'm following my heart and where my energy wants to go. However, having said that, I'm so grateful for the opportunity to speak with people and go out and do this thing and that thing on stage as well, and I love that. But they should come, in my opinion, at different seasons — to do them both is very challenging. I know this sounds quaint and idiotic compared to someone who has a real job doing real hard work, but in my mind, it's a —

Patrick McKeown
1:49:26

Different pressure though.

James Nestor
1:49:28

Different pressure, but I'm hearing myself, I'm just —

Patrick McKeown
1:49:31

No, James, God almighty, like the pressure to get up on stage to deliver.

James Nestor
1:49:37

No, someone that's digging a ditch all day, like —

Patrick McKeown
1:49:40

And the —

James Nestor
1:49:41

Those are different seasons, like winter and summer —

Patrick McKeown
1:49:44

Different toughness stuff.

James Nestor
1:49:45

it's — but I have found, and this is probably just me becoming too sensitive to stuff, that if I can stay in that external world of going out and doing, I'm perfectly happy to stay in that. But combining both of these is problematic for me. I've been under a lot of pressure because all I want to do is slip away —

Patrick McKeown
1:50:11

To finish —

James Nestor
1:50:11

— to finish the thing. But if you spend too much time in that world, it gets extremely lonely, and then you can't wait to go out on the road and meet people again and have interesting conversations. I've noticed I'm never ever going to get in this position again, because there's the undercurrent that's constant, and then there's the exposure part, and they don't mix well — it's an oil and water situation. So once I close this new book, which will probably happen in the next three, four months, then things are going to be very different, then the pressure will be able to go away. But all I want to do before then is to be left alone and go into this world and make it right. I've been working on this book for five years or so, and it's where my entire head is. So it's interesting talking about breathing and this research, which I'm still very excited to talk about, but it's also switching gears in a major way when you're spending nine hours a day in one world and have to go back and be like, "oh yeah, I remember I did that way back when."

Patrick McKeown
1:51:20

When you get up in the morning, say you get up at seven or eight o'clock, and that morning you know you have no commitments, don't have to answer emails, don't have any Zoom calls, don't have to meet with people like me to do podcasts — that day you know you have eight or nine hours free. Do you find there's a difference in the quality of writing? Just the psychological thing of knowing the day is cleared versus another day.

James Nestor
1:51:48

Never had that. I used to have that — when you're writing a book, by nature you become very self-centered, you have to fall into the thing, and a lot of people around you don't understand — "don't you want to go on the weekend and do this?" I say, "all I want is to be left alone to write this book." So you have to manage family, friends, emotions, psychology, biology — all those things have to be managed. So I cannot remember the last time I was like, "it's Sunday, I'm just gonna wake up and read the paper" — the last few years have been constantly going, and it's starting to wear me down a little bit.

Patrick McKeown
1:52:39

So there's a couple of points to it though — you know strategies to upregulate, downregulate, strategies to improve your sleep, you direct your attention out of your head into your body, onto your breath, to bring quietness to the mind. So you've got a pretty good resilience because of those strategies. But can that also be a negative — that you will take on a lot of stuff?

James Nestor
1:53:03

You're absolutely right. There is no way I would be able to do what I've been doing the last few years without these techniques to lean back on — impossible, without techniques to calm my body down so I can sleep even though I'm wildly jet-lagged, techniques to calm my nerves before I speak at a big event, or techniques to get my energy up so I can entertain people or write. So I think, without those, I wouldn't be able to do what I'm doing. Having said that, it's also in some ways a detriment, because it's giving you this extra volume, this extra energy, this extra capacity to do more. And from someone who's never been in the situation I've been in the last five years, promoting this is a dream, and given this opportunity, I'm gonna take every single opportunity because I know it's gonna fizzle away — so I've said yes to everything. That was fine for the first three, four years — first five years, marginal — six years is too much. So I'm really trying to find a better balance. Without having this back pocket of these different therapies — not just breathing, but nutrition and other aspects of health — there's no way I'd be able to do what I was doing at this stage of my life. But now my focus for the next year is to find a better balance and exhale a little more, figuratively and literally, and try to bring more simplicity to the situation. The problem is all the stuff I'm working on is extremely exciting to me — these are dreams I've taken a long time to put together, a documentary series where I'll be able to go around the world and capture these stories and present them in a different way, something I've been working on for years, and now it's finally come to fruition. It's happening, but we're filming as I'm closing a new book — how do you get your head in these two different places? Also a bunch of other fun, unique opportunities that on paper are an absolute dream. I just need less of it — just like people need to breathe less, I need less volume and more silence in my life, and that's what I'm shooting for in the future.

Patrick McKeown
1:55:52

It's very easy to fall into the trap. I think on one hand, because you have that ability to take on a lot, and the tools you've applied have given you some ability to take on so much, that in comparison to somebody who's not able to take on, they reach their limits — but also a person who has the tools to take on a lot, they also reach their limits. So we all reach our limits. And it's a strange one, because you'd think everything is so much faster, we can get so much more done with emails and everything else, but the problem is our workload has increased enormously. Like I was reading this book called Attention Span by Gloria Mark, and she talked about how if there are so many plates spinning in the air, so many projects going on, and if they're unfinished — ten different things going on, ten different unfinished projects — even though you put nine aside and focus on one, there's residual tension because the nine are still unfinished and you can't get away from it. So if we were to reverse-engineer this, what is your perfect work week next year?

James Nestor
1:57:17

I would have learned to say no. I mean that — I'm starting this year to say no to everything, because I feel like I've reached a maximum, and I want to spend my life doing deep creative work — this is where I am the most happy, the most relaxed, and able to create these different worlds. Closing in on a book — I love writing books, I'm excited about this book, but I have to make sure it's right before it ships off, so there's a lot of pressure on me to make sure it's perfect in the way I want it to be. And the documentary series, we're gonna make sure it's good, that it's different, that it's gonna help people. So I think the combination of those things is the problem, not those things individually. And I'm going to make sure that when I start a new book — I have six different ideas for books — I'm gonna allow myself the luxury of working ten hours a day on one thing and being more present in it, rather than dealing with all the noise, trying to balance all the noise, and that analogy of those half-finished projects — I hate that, I can't stand it, I need to close things out, and I get a lot of satisfaction when something's done and taken off the shelf. So I will work myself sick until that happens, and I need to learn how to bring that down.

Patrick McKeown
1:58:58

And your perfect work week — I've been hemming and hawing, I'd love to go down to a three-day week. You talked about working eight hours, ten days, that doesn't bother you — you're talking about working five days a week. Do you think it's strange that we as human beings wake up on a Monday morning and work right until Friday evening and into Saturday, and Sunday isn't really downtime, it's just to give us some respite so we can go into work on Monday? Do you think that's kind of crazy?

James Nestor
1:59:44

I work through weekends, I'm not taking any days off because I need to close this thing down. But the difference is — what's your dream week? I love what I'm doing, I absolutely love it, it's just the volume of this stuff, it's too many things. So my dream week would be able to work on this stuff every single day of the week, but not for ten hours a day —

Patrick McKeown
2:00:11

Yes.

James Nestor
2:00:11

— and to have the noise gone. I'm trying to find a way of getting off email. If I'm able to hire someone, I'd pay them a lot of money to deal with all of the noise so I can just be left alone — that would be the best use of funds I can imagine. So to answer your question, I'm not trying to do less work, I'm trying to be left alone to do deeper work.

Patrick McKeown
2:00:36

Sure, I get it. It was Dan Martell, he talks about "buy back your time," I'm sure you've come across it. Not so easy to implement though — emails are kind of personal, because even if you have somebody answering your emails, it's gonna come back to you.

James Nestor
2:00:52

I think there's ways of doing it — better than it was, but still not good enough — because I have a lot of personal relationships with people all over the place that I want to hear from, want to interact with. There's the expectation when someone writes you that you have to write back within the next couple hours, but I'm starting to delay that by a few days, and figure — I might just put AI on that to respond to me and see what happens for a while.

Patrick McKeown
2:01:22

Your new docuseries — are you able to talk about that? Is it under wraps? I'm intrigued, let's untangle that one.

James Nestor
2:01:30

Well, I've been talking about this stuff for a long time, spoken on a lot of podcasts, done a masterclass series. Still, everywhere I go where I speak, people say, "how do I reduce the symptoms of asthma?" I say, "it's in the book, it's on every podcast" — "yeah, but can you just tell me real quick," or "my kid has sleep apnea, what do I do," or "I want to exercise at a higher level, how specifically should I be breathing." So I realized — I love reading books, I love researching from books, but a lot of people don't read books, or if they do, it's very superficial, even though every single thing is in that book, there's —

Patrick McKeown
2:02:18

At least just go back —

James Nestor
2:02:19

even an appendix at the end of the book, "do this, this, this." Still not enough — people are visual learners. So we had the opportunity — the book has been optioned quite a few times to do a documentary, but none of it was the right fit, they were just gonna water it down until it meant nothing. So now we're in pre-production on a three-part series, about a 40-minute episode, three of those, and then at the end of each will be modules taught by leaders in the field of exactly what to do and how to do it, so you can refer back to it at any time. There's the entertainment part that explains the why and the how and takes you on the adventure, and then there's the actionable part, which isn't like three-hour-long podcasts, it's just — do exactly this. We're not gonna only tell you, we're gonna show you, and we're not gonna give you any story because the story was already told in this episode — do this, do it this way, do it now. And if this doesn't work, I give up — this is not the last thing I'm doing in breathing, but if we want to start turning this dial, to have a doctor say, "your kid has asthma, well, look at these modules, they're available for free, offer a contribution if it's of value" — and they're all science-based, taught by leaders in the field, and you can learn the why and the how with a forty-minute episode that precedes it. So that's the plan that's now sitting on top of me closing this book, writing a script —

Patrick McKeown
2:04:34

And in terms of the three series, are you going to isolate them — one for children, mouth breathing, breathing exercises for kids, and then an adult one with sleep disorder breathing, insomnia, snoring, obstructive sleep apnea, mental health — is that the way you've done it, or is it totally different?

James Nestor
2:05:11

That is the wireframe of what we're working within, and right now we're starting to flesh this all out. And if only I was having dinner after this podcast with the world expert in breathing — oh, it turns out I am. So I will be asking you —

Patrick McKeown
2:05:26

My head — I won't be able to get out of the room, James, after that one.

James Nestor
2:05:31

We'll talk all about it at dinner. But the short version is that's exactly how it works — it's pointed therapies for each of these things, like these little modules. They don't have to be long — "do this, we're gonna tell you exactly how to do it, set your phone this way, buy this device, do this, this, this, and this." And if that's not gonna work for people, then that's it, the door will be closed on the breathing stuff. But I feel this thing will be distributed for free for everyone everywhere, and the only way we're gonna be able to keep it going is asking for a contribution — if it was of value to you, you can contribute a little bit of cash, and we can take that and continue to do it. This is a total risk — I've taken out loans from a lot of people to do this, but I have faith. They say, "are you sure this is gonna work?" I say, "of course it's gonna work, I have no idea" — but I have faith that when people see this and experience it — we're not asking for people to contribute a thousand dollars, it's just "offer a contribution" — I have faith that this model will be able to get around the world in 20 different languages and affect people in a real way, with actionable steps anyone can do anywhere for free. This is something I've thought about for a long time — if this resource was available, people really wouldn't have any excuse to say "I can't do that," it's just there, it's clear, it's available all over.

Patrick McKeown
2:07:13

I think it's amazing, because ultimately — I could be thinking, "my career is under threat," or I can be thinking another way — there are literally billions of people out there who need help, and no single breathing instructor is going to reach it. We've been banging this door for the last 25 years, even looking at a science-based approach for breathing. We know the application of it, how useful it can be for various conditions — respiratory health, sleep health, mental health. Now, the mental health industry — if there was a good job done in mental health that was a success, we wouldn't be in the situation we're in now, and mental health issues are through the roof, especially with younger kids and teenagers. So I'm sure part of that docuseries is really focusing in on that angle, in terms of getting that reach. I think it's brilliant.

James Nestor
2:08:27

That's exactly what we're gonna do. And we're not gonna answer everyone's questions —

Patrick McKeown
2:08:32

Sure.

James Nestor
2:08:33

The key, as I mentioned, is to open that door for them and provide "start here" — if you can do this, you're gonna be 70, 80% there, and if you want to learn more, you can go deeper into all these other layers. But I haven't seen a central place where people can go to find the real stuff — what do you refer people to if they just want quick information for these twelve different maladies related to breathing? So that's kind of what we're gonna hope to do, and we'll see how it works, because if you're able to get this out in countries where people can't contribute, but they can still watch it for free — some kid in Bangladesh who's suffering from asthma or chronic rhinitis, or even starting to develop some curvature of the spine — if you tell them about proper posture, proper breathing, you could absolutely affect this person's life. So that's the only way I thought about it — to distribute this in a way that is truly global, not behind a paywall of Netflix or HBO, available for everyone.

Patrick McKeown
2:09:51

That's amazing. So when do you expect it to launch?

James Nestor
2:10:02

Hopefully spring of next year, twenty twenty-seven. That's what we're hoping for. We're shooting it in October, November.

Patrick McKeown
2:10:10

We'll be behind it, we'll be putting it out, and I think every breathing instructor will put it out, because it's going to lift — raising tide lifts all boats. And I think the awareness — it's morally, economically, socially — it makes sense.

James Nestor
2:10:29

It might not.

Patrick McKeown
2:10:30

Well, it does in a way — if you think of the healthcare costs with all these different issues, mental health, respiratory health — the BBC did a documentary on the Buteyko method back in nineteen ninety-eight called Breathless, and they interviewed a doctor from Scotland, Dr. Gerald Spence — his asthma budget at that time was fifteen thousand pounds for his cohort of patients, and after teaching the Buteyko method, he reduced it to five thousand pounds. So you'd wonder why — that's why probably you can hear there's a sense of frustration in my voice, and that's why we really need something like this to drive it out there. So there's a future in breathing. Are you excited about the future? Do you think AI is going to threaten it — breathing instructors, do you think I have a career, can I keep teaching this?

James Nestor
2:11:30

You have one of the careers that is actually safe — everyone else, I'm hosed. But it's inspiring to see what has happened so far, at least the interest in better breathing and the explosion of breathwork — I know you hate that word — but to me, if you've turned people onto this stuff even on a superficial level, by just making them high for twenty minutes, that's a plus, it's a gain, because they weren't in that position before, and then they can go deeper into what proper breathing is the rest of the time. So I actually do think the future is bright with breathing. And especially from the aspect of dentistry — a lot of dentists are losing business to mail-order businesses that straighten your teeth with Invisalign — so this is both a benefit to them economically, but I think morally it's even more beneficial, in which they can provide preventative maintenance for their patients, not only better oral health but better overall health, and everyone wins with that. So I am continually inspired about this stuff, which is why I was excited to come down here and do this jam again.

Patrick McKeown
2:13:00

This jam we did six years ago, and the conversation was different this time around, and I wanted to make it different. Six years is quite a long time in that space, and it's amazing where it's gone in terms of the awareness of breathing. Is there any changes that need to happen? Is there anything that's kind of irritating you about the breathing world? Where are we going with this?

James Nestor
2:13:32

I think the changes are happening organically outside of the larger system, which is what needed to happen — just like the wellness industry is happening almost entirely outside of the medical system. It's growing into a multi-billion dollar industry because people are still sick after they go to their doctors too often. There are great doctors out there, I'm very good friends with a bunch of doctors, I'm saying they are limited in what they can do. So right now people are able to get information from a bunch of different sources they weren't able to get before — not everyone likes to go to medical libraries and look up old articles, but people are able to listen to a podcast or read something online that will pique some interest and show them a different way into their health problem. And this is the first time in all of humanity that we've had such immediate access to so much information. So I think it's extremely inspiring, and it's allowing people to make better choices.

Patrick McKeown
2:14:42

In terms of the breathing industry itself, inside the industry, us as instructors — is there a particular way you think it's gonna go? Because it seems, especially to someone new to breathing, like a bit of a minefield. Is there anything that needs to happen within the industry itself? Is there anything we need to be doing as breathing instructors?

James Nestor
2:15:12

No, it'll sort itself out. I don't think there's any parameters, I don't think there's anything you can consciously do to this. The people who are providing quality, who are showing that their clients are benefiting time and time again — these are the people not only will they survive, these are the people that are gonna go to the top. And what happens is it takes those people providing real quality, who are less inspired by constantly doing social media, longer to get up, but once they do, they take over everything. And the people that are very flashy, who have huge budgets for social media but very little knowledge or interest in helping people, they will go up very quickly — they'll get popular and go down just as quickly. So it's a long game, and I'm seeing this happen all over the place — there's already people that have gone up and gone down, now they're onto other things — "breathing's old stuff, I'm into ice plunging," "that's old stuff, I'm into peptides now." So that's how it's always been and how it will always be. So I think you just follow your gut, follow your ethics, and try to benefit people in the best way possible by providing real value and actionable items they can take to benefit their health, and you're gonna be around a long time.

Patrick McKeown
2:16:43

What do you think has to happen? You talked about your docuseries in terms of generating awareness — I'm sure you've talked about the education system, children and teenagers doing various subjects like geography, history, maths, English — should there be a breathing class in there? A class on training these children to direct their attention, differentiate between useful and not-useful thoughts, self-regulate, sleep? Do you think that's the future of our education system? One class, James, one class per week.

James Nestor
2:17:20

No, it's never gonna happen. It's great, but along with that there should be instruction on how to eat better, how to exercise better, the importance of exercise — these are such simple things, and the idea that school districts are gonna adopt these, I just think it's impossible. If you look at the food in the —

Patrick McKeown
2:17:42

Yeah.

James Nestor
2:17:43

— in the schools in the US, seventy, eighty percent of it is corn and wheat — I'm gonna have a Pepsi with a pizza, and this is my lunch that you're feeding an eight-year-old — sounds delicious, but it's not good for an eight-year-old. So I don't have faith in school systems improving this stuff. I'm not bagging on teachers, they have a lot on their plates, but I think it really comes down to the individuals, the families, to take control of your own health, and now we have resources to do that. So I think that's their responsibility. It would be wonderful to have all these different things, but I wouldn't wait for that to happen.

Patrick McKeown
2:18:26

Well, surely education is about training the mind and the brain, and we can't expect a child to do well academically — I left school initially at 14 years of age, never to go back, went back one year later. So I know what it's like to be that child sitting in school looking at the teacher, but my attention stuck in my head. We all have our own stories, and I felt that the education system failed me. I got through the education system, I was driven, got into university, got my degree — it could have been a lot easier. I think there's a lot of kids that are going to fall between the cracks, a lot of kids that don't reach their full potential. And yes, nutrition plays a role, sleep is a bigger one I think, and breathing and sleep go together, and when we bring breathing, sleep, and the mind together, there's three very important inroads into that child reaching their full potential — because I don't think the child is going to reach their full potential with poor sleep, poor breathing, and a poor state of mind. And it's not just that things will be difficult for that child, but for everybody around that child — and it's not just isolated to childhood, we're talking about lifelong.

James Nestor
2:19:50

Once again, at the close of this interview, you were approaching something with pure logic — pure logic to an illogical system. If schools were run on pure logic using reason and science and data, we'd be in a very different situation than we're in now. Hopefully that will be the future — everything's getting shaken up with new technologies, so I can only hope that these technologies will be applied to actually make kids resilient and better able to be more dynamic in the future than a lot of the education I received, which was learning how to spell state capitals. Don't know if that's gonna be super helpful in the future, but breathing should be a part of that. Let's hope for the best and see what happens.

Patrick McKeown
2:20:45

So drawing you to a close, or is that your closure?

James Nestor
2:20:49

I don't know — where else are we going?

Patrick McKeown
2:20:52

We've had a great conversation, I have to say, I really enjoyed it, and we've covered so many different angles, and talking is exhausting as well — I'm sure the carbon dioxide levels in this room are through the roof. But at the same time, thanks very much for your time, given that I've pulled you away from so many things going on and so many plates spinning. I really appreciate that. Let's stay in touch, James. And final word is yours.

James Nestor
2:21:20

Absolute pleasure, thank you for having me. This was, as I mentioned at the beginning of this podcast, yours was the first interview I did, and it could be the last or one of the last to do with this book — so we have bookended this whole breathing adventure with interviews with Patrick McKeown.

Patrick McKeown
2:21:37

And the Brett — I need you to sign that for me. Thank you very much.

James Nestor
2:21:40

I can do that. Thank you.

Patrick McKeown
2:21:44

Right.