Full podcast transcripts:

Patrick McKeown
0:00

James Nestor is here with me, and if you want to read one of the best books that I have ever read about breathing, his is that the name of the book is called Brett. I only have a galley copy, but you'll see the title there, and it's Brett: The New Science of a Lost Art. So I'm speaking with James, and I'm intrigued. I've been working with breathing for 18 years, and I suppose I'm going to approach it from a biased perspective, because that's my work. And James has an independent mind, he's an investigative journalist. Well, I'm not sure about investigative, but certainly journalists will be investigators anyway. And I'm intrigued, James. Thanks very much. This is a podcast I'm very interested in having a chat with you about, and I think this could be a tremendous your book in paving the way for recognition, or at least a debate about breathing. So, I, for a little bit of background, How did you get into it?

James Nestor
1:02

It's completely random. This is not something I set out to do on purpose, and I guess the first instance that stimulated some thought about where the subject could go was about 13 years ago when a doctor friend of mine suggested I attend a breathing class because I had had a number of respiratory problems, it was wheezing a bit, I had had pneumonia for the past few years in a row, bronchitis, you name it, was even snoring a little bit, so I attended this breathing class and had this extremely strange physiological reaction. I just sitting there cross-legged in a room with other people, breathing very slowly and then very fast, over and over again. Within about 15 to 20 minutes of this, I noticed that I was sweating, my entire body was sweating, so there were sweat blotches on my jeans, on my shirt, on my sweater. My hair was sopping wet, and I thought, "Wow, that was a pretty interesting experience." Went and asked my doctor friends about it, and they said, "Oh, you had a fever, you were wearing a jacket that was too big," which is all false. So I filed that away in the back of my brain. I didn't know what to do with it, because it was a subjective experience, and I usually don't write from that perspective. I'm a journalist, I focus a lot on science, and I look at things that are based on facts and studies, and people have studied things.

So, about five years after that, I was asked to cover something called the World Freediving Championship. It's a very strange sport in which athletes challenge one another to see how deep they can dive on a single breath and come back to the surface conscious. If that sounds insane, because it absolutely is, but I remember being out on this boat and watching this one diver, William Trubridge, take a single breath of air, was wearing no fins, nothing but a wetsuit, and completely disappear into the ocean for about five minutes and come back to the surface, take a breath, get back on the boat, go back to land. So he had just dived about 330 feet on a single breath of air. So when I started talking to these free divers, said, How do you do what you do? They said, Oh, we can only hold our breath by breathing, and you not only get these benefits by learning how to breathe in the water by being able to dive very deep, but they also benefit on land. And one of the divers told me, he's like, "Right now, take your hand, hold it on your heart, and breathe extremely slowly, and exhale to a count of about eight, and feel how your heart lowers." So he explained that how we breathe affects our blood pressure, it affects our respiratory health, it affects the bone density in our skeleton, on and on and on. Things that sounded completely crazy, but it was intriguing enough that after I wrote a book on freediving, I filed away all these stories, this very large file, and I figured this was what I was going to do next, to explore breathing, not that we're breathing, but how we're breathing in those nuances.

Patrick McKeown
4:23

Yeah, and the title is The New Science of a Lost Art, and I find that interesting, because I know when I, whenever I, I talk to a stranger about breathing, their eyes will often glass over, and they're not too interested, and you know that's that's often the way it is in your interpretation. Why is it a lost art?

James Nestor
4:43

I think it's because of the medicine, you know, that you're prescribing air. There are very few people that think how we inhale and exhale those 25,000 breaths a day will affect the skeleton of our faces, how it will affect our asthma, how it will affect our allergies, our snoring, our sleep apnea, our hypertension, our psoriasis. I mean, I could go on and on and on, and everyone is extremely skeptical that something so basic that is within our power can be so transformative, and I certainly was skeptical as well, which is why I was hesitant to go into this world and explore these subjects at the beginning, because I thought, well, what if this is a complete bust, right? What if these stories that these freedivers were telling me are completely fabricated, they're pseudoscience? So it took me years of research, and luckily I was able to find leaders in the field, top institutions, Harvard, Stanford, University of Pennsylvania, who were doing this research, so I was able to learn from them. They took me into their worlds and showed me their science, and then showed me studies from 20 years ago, 50 years ago, and 100 years ago, all of these studies were saying the same thing, but for some reason nobody really listened, which I still, that's a bit of a mystery to me. When the science is solid and there's a century of it, and yet still people have been hesitant about accepting it, but I'm definitely seeing a change in that now with, with COVID and our awareness of respiratory health.

Patrick McKeown
6:30

Yeah, no, I agree, and you were, you were finding it frustrating writing about it. Try teaching it for so many years, and there's plenty of resistance you meet over the years, I tell you one thing, it really gives you a very kind of different eye into medicine, health, and silos that people operate in, that you know professions are very stuck to their what they have learned and seldom go outside of the box, but what really kind of shocked me was back in 2007 or 2008, I got a call from a dentist, Dr. Hugh McDermott, and he said, "I'd love you to give a talk about the importance of nasal breathing to my group of dentists." And then I got speaking with them, and they told me all about craniofacial growth, and I know you've went down this path, and you've spoke with different people, and nobody seems to know about this. The parent who is bringing their child in for orthodontic treatment is not aware, or are they, of the impact of mouth breathing on the development of that child's face.

James Nestor
7:35

Yeah, and this was something where this, my path into this research, really took a strange turn, where in nonfiction writing you submit a proposal, and it's about 50 pages, and you say, these are the people I'm going to talk to, these are the subjects I'm going to check out, this is what I'm going to do for the next two years. So I did that, and got a contract to write this book that I thought I had it all figured out, and it wasn't until about six months into this research, that I realized the real story is several layers below that, and I had to throw out my entire contract and six months of work and start over again, and it started with a conversation I had with a biological anthropologist who looked at the changes in the human body. I was talking to people who are looking at the changes in the human face, and they asked me a rhetorical question, and it was, Why do humans have crooked teeth? And I was like, Well, we have crooked teeth because of genetics, right? That's, we're just heritage. Well, that doesn't make any sense, that you can go into the wild and look at 5,400 different mammals, and they all have perfectly straight teeth. Or you can take a human skeleton from 1,000 years ago, or 10,000 years ago, or 100,000 years ago, or a million years ago, and they have straight teeth. They never needed to get their wisdom teeth removed, they never needed braces, they have perfectly straight teeth. So I started thinking about this question more and more, and then they started explaining to me that in the last 300 to 400 years, because of our diet and the softness of our diet, our mouths have grown so small that our teeth no longer fit, so they grow crooked. Now, there's another problem with having a mouth that's too small: your airway is smaller, which means it's harder to breathe. And if your mouth is also small, the very top of your mouth, the V-shaped arch, can penetrate into the sinuses and can inhibit nasal breathing. So, because of these changes humans are now the most plugged up animals on earth. This partly explains why we snore, we have sleep apnea, certain problems, asthma is correlated with this, even ADHD, on and on and on. So this is really the keystone of why we are breathing so bad, and yet from what I found, nobody's talking about this, and nobody knows. Like, why aren't we being told this in school? Why aren't we being told this before we get braces? And I was absolutely shocked about why so much of this has been... I won't say buried, but ignored for so long, and even though the data, the science is absolutely proven. And I thought, what else is out there? If something this big is out there, what else is out there? I mean, you know these stories, and you've known them for 10 years, so this is old news to you, but for someone coming in out of left field into this world, I just couldn't believe it.

Patrick McKeown
10:47

Yeah, but I love to see that you've went out there and you've found it out, and because we've been shouting this from the rooftops, and you know sometimes it can be met with resistance. Even with asthma, because I was a kid growing up with asthma, I was the child who was snoring, having obstructive sleep apnea, I didn't even know it at the time, but I was tired in school, I was falling asleep, my grades were affected, I really had to work hard, and nobody told me in 20 years to breathe through my nose, and I found this out for myself, and you know, I often felt very frustrated, and I feel very let down that 25 to 50% of study children are persistently mouth breathing, and with the exception of a few, you know, there are some really tremendous doctors and orthodontists, but they are the minority in terms of the knowledge that they have and the advocacy in terms of getting children to breathe through the nose, and you spoke about the high upper palate. Dr. Christian Guilleminault published a paper a few years ago, and he looked at young infants who died as a result of sudden infant death syndrome, which must be the most traumatic thing that any parent would have to go through, all of these kids had a high upper palate, and that could have been easily addressed, and the only thing that they had preceding death was a runny nose. Can you imagine that a runny nose led to the death of these kids?

James Nestor
12:15

Hearing more stats like this, more data like this, like even though the book has been done, it's been done for a while, I keep collecting these stories to put in a revised edition, because it really feels like awareness, even with this. And he's down at Stanford, top institution.

Patrick McKeown
12:30

Yeah, and you still have to dig several layers deep to read any of his papers.

James Nestor
12:38

Yeah, I don't understand why more people aren't discussing these topics.

Patrick McKeown
12:44

I think it's because it's buried in medical journals. Sadly, he passed away about six months ago, but you were talking about the science being available there. Dental Cosmos, back in 1909, wrote about the effect of mouth breathing in kids. Have you came to a conclusion, you know, why hasn't it got out there? Is it because we are stuck in our silos? Is it because there's too much money to be made? Am I being cynical by asking that question? Is there too much money to be made by the current scheme of things with children having crooked teeth, allowing these kids to mouth breathe, or is it that people don't have the time, or what's the reasons?

James Nestor
13:24

I think there's too many guilty parties, and you can't pin it on one group or another group, really can't. I think awareness is the number one thing, and especially, and that starts with parents teaching their kids the awareness of not mouth breathing. I look at pictures of me as a kid, and I was probably mouth breathing the entire time. I didn't know better. No one was talking about this, and the distinction is important. If you're out on a soccer field, or you're swimming, you're breathing through your mouth. I swim all the time in the ocean. I try to breathe through my nose. It's not going to work when you're ducking up and down, but that's an hour out of the day. The rest of the time you have to be breathing through your nose. I think a lot of the resistance is, at least from what I've heard from people, including runners or other athletes, or even people who snore, or people who are otherwise feeling healthy, that they say, "Well, I can't. You tell me to breathe through my nose. I can't breathe through my nose," and so that's where I think it's interesting. A conversation I had with Anne Kearney down at Stanford, a breathing therapist down there, and she mentioned that the nose is really a use-it-or-lose-it organ. So she looked at 200 patients with laryngectomy, who had a hole drilled in their throat for one reason or the other, mostly due to cancer, and she found that within two years their nose is completely 100% plugged up, so the less the nose is used, the less the nose can be used. She was a chronic mouth breather herself, this breathing therapist at Stanford, and she was scheduled for surgery, and she said, "I don't want surgery, I'm going to try to fix this myself." So she started using sleep tape. She's really focused on breathing through her nose. A couple months later, she is now a visual nose breather, and she was so convinced of the power of this, that she's now trying to round up a study of 500 people to study the effects of nasal breathing on sleep apnea and snoring. So, Stanford, big researcher, pretty good institution, and still doesn't seem like there's a lot of awareness about this, and again, I do think it goes back to people just say, well, I can't, so why bother, and for some people that's true, they do need surgery, but I would say from my experience, the vast majority, they just need to try a little harder and focus on it.

Patrick McKeown
16:01

Yeah. No, it's... I've had 7,000 people in front of me, so over about 18 years. And primarily I was working with teaching nasal breathing, for asthma, for sleep, for anxiety, for panic disorder, children for craniofacial development. There were only about 15 people that we weren't able to establish nasal breathing with. And since 1923 it has been known that if you do breath holding and physical exercise with your mouth closed, it opens up your nose. When human beings hold their breath, their nose opens up. Now it's not exactly known how it's happening, but whenever I talk to medical doctors, I always steer away from the theory of carbon dioxide, because sometimes when a medical doctor asks me what's going on here — like I'll give you an example, I gave a talk to 150 ear, nose and throat doctors in Madrid last year, and I had them all do the exercise, all nodding up and down, nodding their heads, and I seen them then starting to look at each other, so obviously they were feeling a difference to their nose, but these ear, nose, and throat doctors, they weren't aware of the exercise, obviously. But if we were to talk about what was going on there, carbon dioxide is... it doesn't attract the most accepted reason. But I really like what you said, I read that in your book about Kearney, and that when we do breathe through the nose, the nose works absolutely better, and you did point out that 60 to 75% of people have deviated septums, as I have, where the line going down is crooked, but the human nose is an amazing organ once we start using it, and I suppose what you're saying to people is start breathing through your nose, even if you feel a bit of air hunger, keep on doing it.

James Nestor
17:46

For sure. And hearing stats from a clinician like you, someone who deals with people daily, is really interesting, because I'm usually talking to scientists or researchers who are in the lab, they're not in the field. So if you say you've taught 7,000 people how to nasal breathe, and 15 of those 7,000 people couldn't figure it out, that's a pretty good percentage, a 99.4% success rate. So when I hear things like that, it inspires me, because I have to be very careful in how I present this stuff, because an ENT is going to come at me and say, you know, 40% of the people do need surgery, and this is why, here are the cat scans — which is why, I'm speaking from my own perspective and from my own experience, I had a cat scan of my nose, it is a complete mess, deviated way over here, concha bullosa, these growths... I mean, the ENT, Dr. Jayakar Nayak, who helped me with the study and some of the research for the book, he said, "You are a perfect candidate for surgery. If I saw this, you're a perfect candidate." I thought I'd take another route and start habitually breathing from my nose, and I feel absolutely no need for that surgery. This is my personal experience here. I exercise all the time, pretty high volumes, and I don't feel like I need more air. I know that my nose is moderating and allowing me to gain about 20% more oxygen breathing through my nose, so that's 20% less air I would have to take in through my mouth. So you start doing the math here and it just makes more sense across the board.

Patrick McKeown
19:34

Yeah, yeah, yeah, totally. We have a rule of thumb, we do the nose unblocking exercise, and if the person can breathe through their nose for one minute, they can do it for life, so even if they feel a little bit of air hunger. Now, I'm not saying that all 7,000 people that I've worked with switched to nasal breathing, but what I am saying is that they could switch to nasal breathing, because there's also a bit of work in changing the behavior. And you know, when we bear in mind all of the children who are getting tonsillectomy and adenoidectomy, there's very little follow up in terms of restoring nasal breathing with these kids, and most notably, these children will be mouth breathers, because if you have an obstruction to the back of the nose, you don't feel that you have enough air, so you revert to mouth breathing when you feel air hunger, but even when the obstruction is removed, the behavior continues, and that's why I think there should be respiratory rehabilitation in hospitals, but for these children coming out of tonsillectomy and adenoidectomy, and also adults who have had no surgery — I had no surgery in 1994, but nobody told me to breathe through my nose afterwards. So I kept breathing through an open mouth until about 1998, and it was a newspaper article where I read about the importance of nasal breathing. That newspaper article completely changed my life. Now, coming back to that, there's a 65% worsening in the AHI index in children, which is the apnea hypopnea index, within three years, unless nasal breathing is restored, so it's only a short term outcome if we don't change the behavior. So it really comes back to the intelligence of the human body, there is so much in the human body, if we can tap into it, as you say, with that awareness. So you plugged your nose for 10 days, I know Anders as well, by the way, Anders from Sweden, so the two of you plugged your noses for 10 days. I'm intrigued. Tell me about it.

James Nestor
21:47

So, working with Nayak, who is the chief of Rhinology Research at Stanford, I had this idea. We know that it's well established now, mouth breathing is bad news, taking in unfiltered, unheated, unconditioned air, everything about it is bad, but nobody really knew how quickly the problems associated with mouth breathing came on. They knew after years it could be bad, but could a few months of mouth breathing be bad, a few weeks, even a few days? Nobody knew, and I knew nobody was going to do this study. So I convinced Nayak to do a 20 day experiment with me, and I wanted one other person, because otherwise it's just an N of one, somewhat meaningful, but not really meaningful. With two people, at least you can look at both data sets and compare them. So for 10 days we plugged our noses completely, no air was getting in, silicone earplugs in the nose with tape, especially at night, really, really bad news. And the point of this wasn't to do some super-size-me stunt, really, as you had mentioned, from 25 to 50% of us are mouth breathers, and maybe a slightly smaller percentage is mouth breathing all the time, so in many ways we're lulling ourselves into a state which a huge swath of the population is already experiencing, and I had certainly experienced as a kid. So we took every imaginable data marker, pulmonary function test, blood work, cortisol levels, hormones, CO2 on and on, and within the first night of forced mouth breathing, my snoring increased by 1,300%. A couple days later, I was snoring four hours throughout the night. I went from snoring about two minutes to four hours in about three days. I suddenly got sleep apnea. Anders had the exact same experience, his was even worse, and the day we took all this crap out of our noses and were able to breathe through our noses, as opposed to our mouths, all that snoring disappeared, and all of the sleep apnea disappeared, and all of our scores changed, stress levels changed, heart rate variability shot through the roof — heart rate variability is good, so you want that. I mean, I could go on and on, and beyond just how we felt — fatigue, awareness on an emotional level, not constantly dehydrated — there was a tremendous difference, and I was lucky enough to feel both sides of this, the really bad part of it and the really good part of it after I had restored proper breathing. But a lot of people don't, because they're conditioned to constantly breathe through their mouth. Their bodies are acclimated to struggle to keep up with mouth breathing, to constantly have to defend the body against all the pathogens that come in, against the dry air, the cold air, and all the rest. So it was an extremely valuable lesson for me. Nayak, who's a research scientist, was very interested in it, Anders thought it was fascinating as a breathing therapist, but it's also something I'm never ever going to do again, and I do not suggest anyone else do it. All of our data sheets are going to be available online, so everyone can see our weight, our blood pressure — that's another thing, my blood pressure, just through mouth breathing, shot up about 15 to 20 points. When I switched to nasal breathing, it just plummeted.

Patrick McKeown
25:54

Yeah, yeah. No, it's... I got it, I was there. And when you consider the populations who are mouth breathing, they're often, you know, individuals who aren't fit like you guys, who aren't healthy like you guys. And there is a relationship that, as we get sicker, our breathing becomes labored, and we will often switch to mouth breathing. And old folks in an old folks' home, you know, they're mouth breathing. And a question that will often come up is that there are so many different breathing techniques, and everyone — one person is saying this thing, another is saying that thing — and everybody seems to be contradicting each other. What's your take on it? When you look at slow breathing, nose breathing, hard breathing, using holotropic or the Wim Hof technique, yoga breathing, and the list goes on, can you give us a commentary on that?

James Nestor
26:45

Yeah, I was lucky enough to go into this world with no ulterior motive. I had absolutely no slant. There was no benefit to me to say nasal breathing was really good, and I might have had a much more interesting book had I said, "I just discovered something amazing, mouth breathing is so good for the body, so don't believe 3,000 years of ancient research." But I found that almost everything that the ancients had figured out thousands of years ago is now, in regards to breathing, and especially breathing through the mouth or the nose, supported by modern science. So, what's interesting, you mentioned something about seniors and mouth breathing. I think a lot of this is due to what happens to the lungs as we age. Starting at around the age of 30, we're going to start losing our lung capacity, so by the time we're 50, we'll have about 12 to 15% less. By the time we're 80, we'll have about the lung capacity of someone in their late teens. So it shrinks up, and it keeps shrinking, and if you look at charts of this, it's really scary, because when we're very old is when we need respiratory health the most, and we don't have it. So, I believe that's why some people switch from nasal breathing to mouth breathing, because they feel they're not getting enough air, but what they need to do instead is take slower, deeper breaths and engage their diaphragm, so that they can get more oxygen, get out more toxins with each breath, instead of taking tons of little breaths to do the same thing. An analogy that I learned was that breathing should be looked at like rowing a boat — you can take a million short little strokes and get to where you're going, but it pales in comparison to a few very deep, very long strokes. I really think breathing needs to be considered like that. And again, I was lucky enough to go into this world not knowing much about it, not knowing the researchers, so I talked to everybody — the heavy breathers, the Wim Hof people, the Tummo people, holotropic people, Buteyko people, slow breathers, on and on — and was able to form in my mind what I believe to be a fair assessment of the benefits of all of these things. What I learned is they all have benefits. So if someone is going to tell you you can only breathe very shallow, very slowly, right into your chest, that has very profound benefits for some people in the population at some time, but there are a zillion different ways of breathing, as many ways to breathe as there are foods to eat. If you think of all the nutritious foods to eat, there are a lot of them, so why not access all of them for various conditions and learn about them. That's what I tried to do in this book, and I think our books are very close, where I did not find this generalist view of these different approaches and how to incorporate them elsewhere. Again, I think the how of this — there's a zillion books on how to breathe right, you can go online and find steps on how to breathe right, but unless you know why it's important, where it came from, and what it's going to do for you, a lot of people will dismiss it, and that's what I try to do, is focus on that backstory of how this has been an essential part of human health for thousands of years, and how it's just coming out in modern science of how effective and transformative it can really be.

Patrick McKeown
30:39

Yeah, no, I think we're stuck in silos. You know it's... Buteyko is my background, of course, and with Oxygen Advantage, I opened it up for sport, because we weren't getting healthy people doing Buteyko. I felt a freedom with Oxygen Advantage, so we've now brought in coherent breathing, cadence breathing, deep breathing. Because if you train in a particular field, it's not up to me to change Buteyko, Buteyko is the Buteyko method. So it was when I started on this journey that I felt a freedom that I could start opening it up, and possibly that's what's happening with other therapists as well. The yoga world, for example — Buteyko was very much about the biochemistry, and yoga is very much about the biomechanics, and coherent breathing is about heart rate variability, but Buteyko is not really looking at the biomechanics and HRV, so that's what I felt I had to open up as well, and you've certainly touched on it in great detail in this book. So the other thing is, I was always wondering about holotropic breathing, how it was bringing benefits. I was teaching people to reverse chronic hyperventilation for almost 20 years, and then I went to do a talk on holotropic, and I nearly ran out of the room because they were doing the absolute opposite. I better get out of here, I thought, but I didn't, I stayed. What's your take, how does it work?

James Nestor
32:08

Well, if you look at the original yoga, it was not intended to heal people of problems, you were supposed to do yoga once you were already healthy, and this would allow you to go the next rung up in human potential. So something like holotropic — if you're dealing with someone who was a constant hyperventilator, that's probably the worst thing you could do, is have them go and hyperventilate somewhere else. So this is another reason why I think you have to be a generalist about this stuff. I've seen how profoundly holotropic breathing works with people with certain conditions, absolutely works for trauma —

Patrick McKeown
32:47

Pardon, I'm sorry, for trauma?

James Nestor
32:48

For trauma, for chronic anxieties, there was a study where someone used it with 11,000 patients in St. Louis, and studied 480 of them, and found this therapy worked better than any other therapy for serious mental disorders, even schizophrenia, depression and addiction. So it's a great tool, but I've also seen on the other end how effective Buteyko is. I've talked to several people who both teach Buteyko and several people who have been cured, or healed, or bettered their life through Buteyko breathing, no doubt it absolutely works. But when you talk to a lot of Buteyko teachers, they say this is the one way you have to breathe all the time, limit your air intake, never want to take deep breaths, never sleep on your back, and that's true for a lot of people some of the time, but not for all of the people all of the time. And so I really think, just like how the medical community needs to start looking outside of their specific silos, start looking beyond pathologies and looking at prevention, I think the breathing community would benefit from doing the same, looking at all of these different ways of breathing, all of these different therapies, and adjusting them for the clients who are coming in, as far as what they need. So, specifically to your question, I would consider holotropic once you have the foundations of healthy breathing — you know how to breathe slow, breathe less, you're always breathing through your nose, big exhale — then you can go to this next step up. I call it in the book, in the last section, "Breathing Plus," because you need to have that foundation before you go into it, because it gets pretty wild. But I was interested enough in it, and I tried it out, talked to Stan Grof, who invented this in the '70s, and looked at the science of it, and what I found so interesting was that a lot of the therapists I talked to said breathing like this oxygenates the body, that's why you're having these hallucinations, that's why you're able to remove yourself from normal consciousness and go into your subconscious and unconscious thought. But what you're doing is actually the opposite — if you are denying yourself and your brain of oxygen up to 40%, which is an incredible amount, that's not to say this isn't therapeutic, it's completely therapeutic, but to be able to understand this from a scientific perspective, and to acknowledge that you're not oxygenating your body, you're depriving it — but there is a benefit in consciously depriving yourself of oxygen, as counterintuitive as that sounds, and that's why I call these therapies "breathing plus," because they're the step up, they're going to kick your butt in a lot of ways, but they can also work pretty tremendously.

James Nestor
36:01

So it's really hyperventilation over a sustained period of time, and it's almost that you're trying to reset the system. If you look at someone with anxiety, and how slow breathing would benefit them, you're helping them increase their tolerance for CO2, I think that's a big benefit. You're engaging their diaphragm, so they're able to calm themselves, and most importantly, they're able to put themselves back in their bodies, so they can control their mental states. Whenever you're feeling panicked or anxious, just stop for a moment, breathe through your nose, and breathe slowly. Absolutely works, and I've talked to psychiatrists who've used this for patients with depression, anxiety, or bulimia, absolutely works. But for some people they need a little harder shove in that direction, and they're willing to take that, so for them, this conscious over-breathing can be effective, because it shows them how to turn on acute stress, and it shows them how to turn it off. You're not relaxing yourself when you're breathing for three hours in a room with layered music, breathing as hard as you can. I don't know if any of your listeners have done this, but it's a pretty wild experience. There's nothing relaxing about that. The benefit of this is you try to blow a fuse in your brain and reset your system, so that afterwards you're going to spend the next few weeks, few months, few years in a state of relaxation. So it's turning on stress specifically to turn it off, and that's what Wim Hof does as well — that is a stress state you're putting yourself in with his version of Tummo, and then after you do that for 20 minutes, you can spend the next 23-and-a-half hours in a state of relaxation, which is where you really want to be. You're not half stressed and half relaxed, you're either fully stressed or fully relaxed. I do Tummo, I do heavy breathing every other day, a big fan of it, I can definitely feel a difference in myself, being able to control my nervous system and even my immune function this way, and that's backed up by various studies.

Patrick McKeown
38:38

Yeah, there's an interesting study about Wim Hof from Matthijs Kox back in 2014 where they injected endotoxins, and I think it's very appropriate in today's climate with COVID. And I really like the paragraph that you used about doctors — one doctor made a comment about TB patients back in the 1920s about mouth breathing.

James Nestor
39:05

Yeah, so this again, I call this "the new science of a lost art," because it seems like we figured this stuff out numerous times, forgot about it, and it keeps popping up in a different culture at a different time. But in the '20s the head of a large hospital had studied people with tuberculosis, and he said — I forget the percentage, it was up to 60 or 70% — are chronic mouth breathers, and there's an absolute correlation between the onset and infection rates of tuberculosis and the pathway in which we're breathing. This was in the '20s, and even before him this had been something that was known. I had heard from another researcher, I haven't been able to find the study, I've looked and looked, that somebody did a large study of sailors on the same ship at the same time, those who were mouth breathing versus those who were nasal breathing, and the onset of illness between those two groups. I don't know if there's anyone willing or curious enough to do a study like this today, but I do think it would be interesting. We do know, in regards to COVID, that respiratory health absolutely affects the level at which you're going to be suffering from symptoms of COVID. So this isn't something we should think about once we get COVID, it's something we need to focus on now to help prevent us — it's not going to stop you from getting the virus, but it is going to help you deal with the symptoms of it much better, and we do know that.

Patrick McKeown
40:44

Yeah, yeah, just even the gas nitric oxide is an antiviral emanating from the nose and the nasal cavity, and there's clinical trials now underway in the United States looking at nitric oxide and COVID. But one aspect was this person, Stough — can you talk a little bit about him? I actually felt sorry for the individual at the end, he did such tremendous work. Maybe a little bit out there, but some of us are a little bit out there, you know, you don't go into something on the fringes of society unless you're a bit of a pioneer, a bit left of field, because if we were all mainstream we'd be accountants. Stough, I think his story is — is it a man or a woman, I can't remember —

James Nestor
41:41

Yeah, so this is just another example of someone who was brought into breathing and the research of breathing and using breathing as a therapy, who had absolutely no interest or motive to do so, but just found it was the one thing that worked. He was a choral teacher, and found that so many of his singers weren't singing well because they weren't exhaling properly, so he taught them a way of inhaling fully, engaging their diaphragm, and really exhaling properly, because if you think about singing or talking or any vocalization, it's always made on the exhale, so you really have to focus on exhaling if you're going to become a better singer and have better tone and resonance. So he developed this method of diaphragmatic breathing, these exercises to develop the respiratory health of the lungs and the ability to exhale more thoroughly, and he became quite famous, famous enough that the Met Opera hired him to train opera singers. He did this for a number of years until he got a call from the chief of emphysema management at a very large VA hospital on the East Coast, who said, "You seem to know something about breathing that we don't, come down here, we've got a bunch of patients for you." So he went to the hospital and was absolutely horrified — for the past 50 years, they would take people with emphysema, roll them into a room, put an oxygen mask on them, and leave them there to basically die. They had no way of treating them, they got infections, they gave them antibiotics, and beyond that, they would prop a pillow on their back so their chest would be craned up. Stough knew enough about breathing to know that having a pillow on your back is the worst thing you could possibly do, knowing that more of the lungs flex in the back than in the chest, so if you have someone with emphysema, you don't want to place them on their back all the time, you want to sit them up or have them on their sides. So they started training these patients, and they suddenly had these remarkable recoveries, just by engaging their diaphragms — because that had been the only muscle memory of breathing they had, high in their chest — just by turning that 5% of diaphragmatic capacity to about 10%, then 20%, then 50%, just half of where it should be —

Patrick McKeown
44:23

Yeah,

James Nestor
44:24

— had such a tremendous impact. They stopped using oxygen, several of them, after several weeks — it wasn't a next-day kind of thing —

Patrick McKeown
44:30

Yeah,

James Nestor
44:31

— they started walking around, they hadn't walked around in years, and several left the hospital and were fine. So Stough worked within the hospital system for about 10 years, and this wasn't a placebo effect, because they started taking X-rays of what was happening, and even the staff found that what he was doing was considered medically impossible — you weren't supposed to be able to develop an internal organ, they said you can't develop the lungs, you can't develop...

Patrick McKeown
45:08

In other words, the irreversible damage in the lung tissue was being healed.

James Nestor
45:11

That lung tissue damage was still irreversible, when the alveoli is —

Patrick McKeown
45:20

When it's gone, it's gone.

James Nestor
45:22

The bronchioles are detached, there's no way to get that back. What he was doing, though, was expanding their lung —

Patrick McKeown
45:29

Capacity.

James Nestor
45:31

Maybe they had lost 10% of their lungs, but they still had 90% of the healthy lung, and by just doing that he was able to really restore these patients to health. And when he left the hospital system, all of his therapy left with him.

Patrick McKeown
45:50

And that was such a pity.

James Nestor
45:53

And today, look at the treatments for emphysema — there's 4 million Americans who have emphysema, it's bronchodilators, antibiotics, diet training, helping to quit smoking. There's no talk about the diaphragm.

Patrick McKeown
46:16

Yeah, yeah, I think it's really important with emphysema, you know, it's inevitable when we're suffocating that we are going to have labored, fast, upper chest breathing, and as you said, it's totally inefficient, because all we are doing is bringing air into dead space. And with the human lungs, the greatest concentration is in the lower lobes, so with Stough's work in terms of bringing the breath down into the region of the diaphragm — as the patient breathes in, the ribs move out, and as they breathe out, the ribs move in, and he did manual manipulation there as well. If you can breathe slower, you waste less, because slower breathing is more economical — if we're breathing 20 breaths per minute, and 150 mils of that air is dead space, well, 20 times 150 is lost to dead space, so there's three liters not going to get down into the alveoli for gas exchange to take place. And if you do the calculations — I took them from Bernardi's work, and I see you've cited Luciano Bernardi as well — 12 breaths per minute and a tidal volume of half a liter gives you six liters, and of that, 4.2 liters gets into the alveoli. But when you reduce the respiratory rate from 12 breaths down to six breaths per minute, and allow the tidal volume to increase, alveolar ventilation increases significantly, which is very close to the 20% figure you gave earlier. It's amazing. Even with physical exercise — why do people not breathe with their mouth closed during physical exercise? I know that's another topic of conversation. I want to come back to the Wim Hof technique and the injection of endotoxins — did you look at that paper, and what was your take on it?

James Nestor
48:08

Yeah, it seemed irrefutable what they came up with, and what really throws people off about the Wim Hof technique is the benefit — you're stimulating adrenaline, norepinephrine, cortisol, and we've learned in our lives that having these things in your body is bad, get that cortisol down, get the adrenaline down. But what people don't understand about this is that when you consciously do this, when you willingly place yourself into a state for 20 minutes and hold your breath, this has tremendous benefits. If you look at people with incurable autoimmune diseases — type one diabetes, rheumatoid arthritis, psoriasis, eczema — these people, nothing else had worked for them. Once they learned how to control their nervous system, they were able to help control their immune system, and once they controlled their immune system, so many of the symptoms of these chronic conditions abated. It's the combination of occasional cold therapy, but mostly breathing — and I say mostly breathing because I've gotten some flack from Wim Hof people, they say no, the cold therapy is the most important thing, breathing is secondary. It's not. If you look at other heavy breathing techniques like Sudarshan Kriya, which is pretty close to the same thing — heavy breathing to very slow breathing — it has almost the same list of benefits and helps lessen the symptoms of almost all the same conditions as Wim Hof. So when I look at that, the cold therapy absolutely works, it's great, but breathing is the anchor here, it really is.

Patrick McKeown
50:08

Yeah, I think we have to be very careful what we say about Wim Hof, because anything that I say, I get a lot of flack as well, and it can be meant with the best of intentions, because all I'm trying to do is explore breath. I think that's very interesting — so there's a therapy that goes fast breathing, which stimulates and stresses the body, and then slow breathing, which does the complete opposite, stimulating the vagus nerve to activate the parasympathetic response, and back to fast breathing. It's amazing stuff. You've written your book, and I know it's out, available in the United States, and we're currently in May —

James Nestor
51:00

It's May 26th, so I don't know when you're going to be putting this out, a couple weeks —

Patrick McKeown
51:03

I'll put it out next week.

James Nestor
51:04

Oh, perfect. And then in July it'll be out in the UK — it was supposed to come out the same time, but this pandemic thing got in the way with distribution.

Patrick McKeown
51:15

And your overall take, from your journey as an independent person looking into the breath — do you feel that breathing is going to become more mainstream, get more science?

James Nestor
51:32

It's already happening. I wasn't the one to really dig this up, and I'm not going to be the big catalyst to get people thinking about it, but I hopped on a wave at the right time, with what is happening in the scientific community and how people are talking about this stuff. I think 10 years ago it would have been a different story, but there is so much awareness right now, even in pulmonology, even in ER, even in rhinology, about the importance of breathing. This stuff is being studied at top institutions, and I knew that a lot of people were going to be apprehensive about these facts, which is why I put the bibliography on my website — there's 557 scientific references, so if you don't agree with my conclusions, you can check that stuff out yourself and come to your own conclusions. But from what I've learned, and I really believe this at this point — a researcher told me years ago that how we breathe is as important as how much we exercise and what foods we eat. It's this missing pillar of health, and it needs to be considered alongside those things if you really want to have a long and healthy life. And I absolutely, at this point, agree with that more than at any other time.

Patrick McKeown
52:58

We will leave it at that. Thank you very much, James.

James Nestor
52:59

Thank you, Patrick.