Michael Roesslein: All right, we are live, and I’m very excited about this episode today. I am joined by Patrick McKeown.

Patrick, thank you.

Patrick McKeown:

Hi, Michael. How are you?

Michael Roesslein:

I’m good. I’m good. This is going to be a lot of fun. Breath, and breathwork and breathing, which we were just chatting about before I came on air, for me personally is my current focus and the thing I’m most interested in. When I lift this current self-imposed ban I have on training programs, breath is where I’m going to be focused, and so I’m probably going to pick your brain about the best options there as part of this conversation for someone who’s interested in learning more, and I’m sure our audience might be, too, after hearing what we’re going to talk about.

Before we get into that, if anybody out there is not already familiar with Patrick and his work, he’s an international breathing expert and author based in Galway, Ireland. Since 2002, he’s worked with thousands of clients, including elite military special forces, Olympic coaches and Olympic athletes. The Oxygen Advantage, which I just finished the audio book myself, Atomic Focus and The Breathing Cure are Patrick’s latest books.

There’s so much more to this topic, I think, than most people have any clue or idea, so my first question to you is you were once one of those people as well who had no idea about any of this stuff, right? You didn’t grow up being like, “I’m going to become an expert in breathing,” so, if you wouldn’t mind just sharing a little bit about how this got started for you, and then we can get into the meat of the conversation.

Patrick McKeown:

Yeah, it was a total accident, my whole teenage years, my childhood and teenage years of having asthma, and when you have asthma, you don’t just have asthma. You have a stuffy nose and, when you have a stuffy nose, you’re more likely to have sleep problems. I was a chronic mouth breather due to my stuffy nose, so I was a faster breather, an upper chest breather.

I got through academia. I got through it, but it took a lot of work because my concentration was not good. At 14, I left school altogether, never to go back, never to set foot in a school again. I was so frustrated with the whole education system. I was the child… In my early years, I was very bright, at the top of the class. At age 11, I went from the top of the class down to the bottom of the class. Nobody picked up on what was going on. It was seen as… I was the… kind of the not necessarily the troublesome kid because I wasn’t troublesome, but I was the disinterested kid, and then I went back at 15. I went back and I was very driven to get into this university. It’s called Trinity College in Dublin. I worked very, very hard to get in there because, again, I still had poor concentration and I had poor sleep, and that was the biggest factor, and faster and upper chest breathing. My physiology was more in that increased stress response.

I got into university, did my degree, got out of it, got into the corporate world, hated every bit of it in the corporate world and couldn’t deal with the stress. It wasn’t necessarily the company, but it was my physiology wasn’t up to par. My background was I did a business degree. I did a business degree, and I was the most unprepared person going into business, but anyway, Michael, I knew I didn’t want to work in that sphere, but I hadn’t a clue what I wanted to work in.

I read a newspaper article. It spoke about the work of Russian Dr. Konstantin Buteyko, and he said the importance of breathing through the nose and also the importance of breathing light, and I was doing neither of those things. I started putting it into practice, and I would have no problem saying it changed my life, but I didn’t make a total transition to work in that sphere. I stayed in the corporate world for a couple of years, and then I was driving from one side of the country to the other and I decided I would really love to start working in this area, and that was it. I quit the following weekend, and I started down this path then.

Intuition and, sometimes, life directs you in wonderful ways, but, yeah, I never came across the importance of nose breathing despite being in a hospital many times with asthma, despite going to a medical doctor every three months for my prescription. Nobody told me about nose breathing during sleep despite falling asleep in class, despite leaving school at 14 years of age, so all of those healthcare professionals and… I’m not unique. There are millions of children. There are millions of children who are having such a challenging time. We know of children with sleep disorder breathing. They have 10 times the risk of learning difficulties.

We, as an adult, if we wake up the odd day feeling pretty lousy, our day is not going to go so well. We’re going to be irritable. Can you imagine that society demands these kids to sit down for six and seven hours, to sit down and to focus on their curriculum, and these children are tired and their physiology is in an increased stress response?

I really feel that, yeah, it was something I’ve been very fortunate. I’ve been teaching this now full time 20 years come March the 17th this year, 2022, and it’s been a wonderful life.

Michael Roesslein:

Wow. There’s almost a vindication, I feel, because I was one of those kids, too. I couldn’t stay awake in school or any time. I was an athlete, too, and I would be tired all the time. I know I was breathing… I have conscious memory of regularly breathing through my mouth as a kid. I had orthodontic problems and dental problems. I had so much nasal congestion in junior high and high school that my doctor suggested to my mother I might have a drug problem, that I was using cocaine or something. I was like, “Really? That’s the best you can come up with?”

I had no idea, and I… and most people had no… Obviously, nobody thought of it or knew about it or anything and… something like snoring. It’s almost like a joke in our culture, in our society. “Oh, they snore like a chainsaw. Listen to that.” Snoring is choking, and so it was really… We mentioned James Nestor’s book, the… It’s called Breath, right?

Patrick McKeown:

Yes.

Michael Roesslein:

Yeah. Yeah, that, there were stories about Buteyko and the technique being used with people with irreversible degenerative lung conditions like COPD and other things that were in our culture. If you’re told you have this, the only option then is for that to continue to get worse until you die, basically. There’s nothing you can do about it just like many people listening to this have probably been told about an autoimmune condition or some other health condition.

That tends to be the way the conventional medical world looks at a lot of these diseases that are degenerative is they’re degenerative because you keep doing the same thing that you’re doing to make it happen in the first place, but practitioners of… him and his… Practitioners of this technique were able to actually arrest the progress of and even reverse some severe asthma, COPD… you probably don’t have the same asthma problem now… and COPD and other lung and breathing conditions that I had no idea it was even remotely possible to reverse.

You mentioned nose breathing and mouth breathing there. I think that’d be a good place to start for the basics. I love you say in the book mouths are for… and I don’t think you… I think you quoted somebody else, but, “Mouths for eating. Noses are for breathing.” This is not new information. I love that you referenced some indigenous cultures. I don’t remember which one specifically, but when they would catch a child breathing out of their mouth, they would cover the mouth, and so this is new.

Patrick McKeown:

This is North-American Indians, and this was written in a book called Shut Your Mouth and Save Your Life.

Michael Roesslein:

Yeah, that’s it. Yeah.

Patrick McKeown:

In terms of the Buteyko, it was written by an American painter called George Catlin back in… God, it was the 1800s, 1830s or thereabouts. You’ll find it on the net. George Catlin is his name. He thought that the traditions of the American Indians were dying out because of the Europeans going in and making a mess of everything, quite frankly, so he wanted to paint and document their traditions, and that’s what he did in the book. He spoke about the young infant with the mouth open and, anytime that the young Indian baby had the mouth open, that the mom would come over and press the lips together. He also spoke about the European infant with the mouth open and European infant gasping through the mouth… well, not quite gasping, but breathing… mouth breathing.

Just coming back to COPD, I can’t honestly say if we can reverse COPD, not with my work over the last 20 years, but what I can say is that we’ve significantly helped to improve quality of life with COPD. I will genuinely say that I’ve seen people coming in with COPD not able to walk, and we were able to get them walking again, that they were so breathless.

The thing here about breathing is that poor breathing often feeds in itself. You can imagine somebody with COPD. COPD stands for chronic obstructive pulmonary disease, and it’s not that 100% of their airways are narrowed irreversibly. There’s usually a good component of reversible airway obstruction, and what I mean by that is, if you think the bronchioles, so we have the main, say, coming from trachea into the bronchi, and then they subdivide into about 23 different branches, and these are the pipes that bring air from the nose or from the mouth down into the small little air sacs, the alveoli, where gas exchange takes place. Some of these pipes can be damaged, and also the alveoli, the small air sacs, can be damaged, but not all of them.

When somebody comes in with COPD, I always want to try and ascertain what’s the degree of reversible airway obstruction here, what can we work with, and we show the person the importance of nose breathing. I also show the importance of breathing light, because carbon oxide and nitric oxide are natural bronchodilators. Nose breathing since 1988 has been showed to increase the pressure of oxygen in the blood by 10%. The PO2 in millimeters of mercury increases by 10% when you continuously nasal breathe.

Nose breathing is there to protect the airways. It’s antiviral and antibacterial. We’ve seen hundreds of people prone to colds and chest infections significantly reduced their colds and chest infections by adopting breathing techniques. People with poor gas exchange, even people with long COVID where their blood oxygen saturation was dropping pretty quickly, we could give them techniques to help to improve alveoli ventilation.

All of this is very simple stuff. Don’t breathe in the mouth fast and shallow because if you breathe in the mouth fast and shallow, it impairs gas exchange. We, as human beings, we spend a lot of our time upright. We are upright now. We’re standing upright. We’re sitting upright during the day. Because of gravity, the greatest concentration of blood flow is in the lower lobes of the lungs, but if we’re breathing through an open mouth, we’re ventilating more of the upper regions, so the ratio of air to blood is not ideal.

I suppose it comes down to this, Michael. If you were to ask any medical doctor what does the mouth do in terms of breathing? Is there any part of the mouth that is devoted? Is there any part of the mouth that performs any role in terms of the breath? The answer is there’s no part whatsoever, so what is the mouth when it comes to breathing? The mouth is a hole. That’s all it is. It’s a hole whereby air could go straight in down your throat into the lungs. There is no purpose of the mouth other than an emergency. I think our ancestors only mouth breathed in those times, in times of emergency.

Now we have to ask the question. If throughout our evolution we reverted to mouth breathing in times of emergency, and mouth breathing causes faster and upper chest breathing, what is happening now today when we are mouth breathing? It’s also causing fast and upper chest breathing and, fast and upper chest breathing, what information is being fed from the body up to the brain? The brain interprets it.

Michael Roesslein:

It’s an emergency.

Patrick McKeown:

It’s an emergency, and I would say that there’s an increased sympathetic drive with people who mouth breathe, but here’s the problem. Nobody has bothered to do any research on the instance of mouth breathing in the population, the Western population during physical exercise. I can only find five or six papers. That’s it. Five or six.

You can imagine all the sports medicine scientists, all these wonderful, intelligent people, these people in the universities, highly intelligent people, and they’ve missed the basic stuff. They’ve missed the basic thing, whether to breathe, what’s the human body, what’s the physiology. Well, I’m going to say this. Why on earth even in a gym are 90% or 95% of people in there with their mouths open because the mouth is doing nothing? Why no research? Why do we not know the incidence of persistent mouth breathing in the adult population? Only two papers. That’s it. No research. Why has mouth breathing been overlooked during sleep? Why has the dental profession debated this for a hundred years, but done nothing about it?

I’m not here to give out, even though sometimes I just wonder how did they miss it? How did those intelligent people miss it?

Michael Roesslein:

I don’t have an answer to that. It’s frustrating and it’s maddening. A lot of things in our society seemingly jump to the most complex solutions possible or the most complex ways so we can fix things possible.

Patrick McKeown:

Yes, of course, because if you’re a young doctor coming up, you don’t want to be doing research on breathing through the nose. What will your colleagues say? Your colleagues would say, oh, my God, here’s a woo woo. [inaudible 00:15:04] get this guy or gal is airy-fairy. If you’re a young doctor coming up, you have to be seen to be most cutting-edge, the stuff that grabs the headlines. Nose breathing doesn’t grab the headlines.

Michael Roesslein:

No, but there’s legit physiological backing to that. You mentioned the increased… was it blood oxygen… 10%, and I think that that’s likely due to the production of nitric oxide. Can you explain that just a little bit? Because nitric oxide is something that, especially with COVID, has gotten more attention amongst the super health-conscious people who are into supplements and into all that kind of stuff like NO2 supplements. People know about beets now and beetroots and the production of nitric oxide. People know about Viagra which is based on, I think, the same principle or has a nitric oxide component to it.

People know nitric oxide in relation, I think, now to circulation and, if you don’t, there’s a lot of… You referenced, I think, you said there’s over a hundred thousand papers on nitric oxide and improved vasodilation or circulation, so what does nitric oxide have to do with nose breathing?

Patrick McKeown:

Well, I suppose there’s a couple of sites of isoforms of nitric oxide in the human body. There’s nitric oxide in the blood vessels, endothelial nitric oxide, and there’s nitric oxide in the nasal airway. When we breathe through the nose, we pick up nitric-oxide-laden air, and we draw that nitric-oxide-laden air into the lungs. Nitric oxide helps to redistribute the blood throughout the lungs. Nitric oxide is antiviral. It is antibacterial. It increases… It helps to open up the airway. It’s a bronchodilator, and it’s likely that it is nitric oxide which helps to improve gas exchange from the lungs into the blood because of a number of different reasons.

Now, the nitric oxide in the blood vessels is different than the nitric oxide in the lungs. I know when I wrote about nitric oxide in The Oxygen Advantage that I made a little bit of an error, I think, in that I didn’t isolate nitric oxide from the airways to nitric oxide in the blood because we actually thought that nitric oxide coming from the lungs would actually get into circulation. There’s debates about whether that’s happening. It’s not fully known. It’s one of those gases. It was first discovered on the exhale breath of the human being in 1991, so even though there are many, many papers on it… and I don’t think anybody can say that nitric oxide doesn’t have a very important role in the airways. Even with COVID, I thought it was so important for people to be nose breathing because whatever chance they have of their body being able to defend itself, you had a much better chance with nasal breathing than with mouth breathing.

Also, if an individual was infected, say, a family member, that you have an infected family member, breathlessness and difficulty of breathing was often associated with COVID, the individual who’s infected will tend to breathe through the mouth, but they are emitting 42% greater water loss into the atmosphere. If they’re in their family home, there’s a greater likelihood that they will then infect if the virus was spread via water particles, which is generally accepted to be.

Nitric oxide got no mention whatsoever. The World Health Organization said nothing about nose breathing. There was no government in any Western society, or any other society for that matter, which spoke about the importance of breathing through your nose to help resist or at least to help produce the likelihood of you getting infected. Now, that was strange.

I did reach out to the authorities here in Ireland, and I sent on a paper, and the paper is called Could Nasal Nitric Oxide Mitigate the Effects of COVID-19? It was published in May of 2020 or 2021 in a journal called Microbes and Infection. It’s an Elsevier publication. Basically, the article is pretty much saying what we’ve been saying for 20 years. Breathe through your nose.

We’ve seen thousands of individuals reduce chest infections. I’ve seen, personally, I can… like hundreds, but we’ve 3,000 instructors throughout the world, so there’s a large accumulation there. I remember doing a video for COVID back in March of 2020. I did a Zoom call which was live, and everything went wrong because we… You were talking about technology beforehand. Everything went wrong. I didn’t even have my laptop plugged in, and I was down to the last. The lighting was off and, of course, everything going wrong, and there were a hundred people waiting and it oversubscribed, et cetera.

In any event, I did the video, and I thought it was… Everything was not good about it, the lighting, the sound, everything. We put it up on YouTube anyway. It’s had over a million views, so… and we included all of the exercises as I knew back then, with a very limited information. This was back in March of 2020. The exercises remained the same today. They absolutely remained the same. The only difference is postural orthostatic tachycardia syndrome that can be associated with long COVID, but we also have exercises to help with that. The autoimmune system with COVID and with long COVID is so dysregulated. It’s really important to help to bring it into balance.

The one thing about breathing is, you as a kid growing up and I as a kid growing up, who had responsibility? Who took control of breathing in the last 50 years? Which community have this? Have they taught it correctly?

Michael Roesslein:

Yoga?

Patrick McKeown:

Have they taught it correctly?

Michael Roesslein:

Maybe yoga?

Patrick McKeown:

Have they missed out… I’m not going to answer.

Michael Roesslein:

Okay.

Patrick McKeown:

Have they missed out something wonderful here? I would say that the community that did take it up was the yoga community. Can you imagine the reach that yoga instructors worldwide would have? Can you only imagine it that if every student who come in their door, that the yoga instructor guided the students both through the biochemistry, how to breathe less in order to improve blood flow, because you can feel it in a few minutes, in order to stimulate the vagus nerve because you can feel [crosstalk 00:21:49] watery saliva.

Michael Roesslein:

Hold on. Hold on. I want to stop you really quick.

Patrick McKeown:

Sure.

Michael Roesslein:

You just said how to breathe less to increase blood flow and oxygen flow to tissues. That was something in James’ book, he mentioned it, and in your book, you talk about it a lot, that I had to listen to that part of the book a few times because it’s like learning that you live an opposite day. You’re saying that… and we can go through the rest of the list. I didn’t mean to cut you off, but I know others would hear that and have the same reaction that I did when I heard it because I’ve been taught, and I have a master’s in exercise physiology, I was working with athletes, the bigger, the deeper, the breath… Oh, wow, there’s way more air there, so there’s definitely going to be more oxygen there, so, then, I’m going to have more oxygen in my tissues.

Even in yoga… because I love your differentiation and how you speak of authentic yoga… I don’t remember the exact word, but authentic yoga teachers and instructors and practitioners versus the modern Western, and this is no shade towards anybody out there because you’re teaching what you were taught.

Patrick McKeown:

Exactly.

Michael Roesslein:

They teach also bigger, deep, big breaths, big breaths, big breaths and loud breaths, big breaths. When I was listening to your book and talking about under-breathing, this sounds very counterintuitive. It sounds the opposite of everything I’ve ever been taught as an athlete or someone who worked with athletes. I’m sure it confuses athletes that you work with at least at the beginning.

Can you explain to us in relatively simple terms, I know this can get pretty complex, how is it that breathing less and under-breathing, if you want to say, or breathing less, increases oxygen uptake into the tissues and oxygen blood flow?

Patrick McKeown:

Discovered back in 1903 or 1904 by a Danish physiologist called Christian Bohr, and he said it’s the partial pressure of carbon dioxide in the blood, that’s the key factor in effecting the hemoglobin affinity for oxygen. Now, what do I mean by that? When we take a breath of fresh air into our body, oxygen is transferred from the lungs into the blood, and 98.5% of oxygen in the blood is carried bound by hemoglobin. You can imagine hemoglobin as being the protein which is carrying the vast majority of oxygen in the blood.

How do we get hemoglobin to release oxygen to the tissues? That’s where carbon dioxide increases. When carbon dioxide increases and blood pH drops, the hemoglobin affinity for oxygen reduces. Hemoglobin releases oxygen in the presence of carbon dioxide and results in drop of blood pH. Now, also, as carbon dioxide increases, it helps dilate the airways. Also, as carbon dioxide increases, it helps to dilate the blood vessels.

It’s really strange because this was one thing that got to me as well when I came across it 25 years ago. I used to always have cold hands and corn feet, Michael, always, and I remember… You’d notice that getting into bed, for example, you’d feel your legs, your feet would be so cold, but I remember just practicing after reading that article, and I practiced under-breathing. I had no idea what I was doing. I just took a really soft and hardly any breath coming into my nose, hardly any breathing. I completely under-breathed for about three to four minutes, and I was able to increase the temperature of my fingers. I knew straight away there was something then.

I did the nose and blocking exercise, breathing into my nose and out to the nose, pinching my nose, nodding my head up and down and holding my breath until I felt a strong air hunger. I was able to open up my nose. That’s what breathing did for me, and I would say to anybody listening to this, listen, I know you’ve been told about the benefits of taking big, full, big breaths. It’s kind of the Western idea, the bigger, the better. Breathing is very subtle.

It’s almost that I compare breathing to the introverted breathing and the extroverted breathing. Which one is getting all of the attention? Of course, the extroverted breathing, the one that’s high-fiving and jumping all around the place, the one that’s hyperventilating and doing long breath holds until they go blue. That’s an extroverted breathing technique. That’s a stressor, but there is a huge role for the introvert as well. There is a role for the introvert in society and also from a breathing perspective. The introverted technique is very subtle.

If you were to practice this, take a very soft, gentle breath coming into your nose and a really, really relaxed and a slow and a gentle exhalation, and then a very soft, gentle breath in, almost when you’re breathing in that you’re under breathing, that you’re breathing hardly any air into your lungs, and then a really relaxed and slow and gentle exhalation, and reduce the volume of air that you are breathing by about 30%. Do it to the point that you feel air hunger.

Don’t worry about doing it perfectly, because the people who are more prone to breathing pattern disorders are people with perfectionist tendencies, so what I’d say is just, listen, give it a go. Focus on breathing in and out through your nose. Take the subtlest of a breath in. Really slow it down almost as if you hardly hear your breathing. Well, you shouldn’t hear it anyway during rest, but really slow it down almost as if you can hardly feel you’re breathing, and you’re taking that subtle breath in and that really relaxed and slow and gentle exhalation, and see what happens to your physiology. Can you change? It’ll take you about four minutes, four minutes of air hunger.

Now, if you’ve prone to panic disorder or anxiety, go a little bit easier just because the air hunger can generate a little bit of panic, but, generally, it’s a bit… a little bit of a discomfort. So, four minutes, can you improve your blood circulation? Can you increase the watery saliva in the mouth, which is a really great thing to be able to do, and I’ll tell you why. Because we are so overstimulated. There’s so much information heading for us, all of those emails every day that we’re receiving.

Modern society, we would think that in today’s day and age, 2022, that we could get by with two or three hours work every day because technology, surely, technology could help us, but technology has increased our workload, and the reason being is because it’s so easy to send people emails. You can send somebody an email in two seconds, but it will take that person quite a while to answer it. If you think that our email boxes are being flooded, and this isn’t even our work, we’re not able to do our own work then, so we are overstimulated. How can we down-regulate last thing at night?

It’s very important to be able to really slow down your breathing, to breathe less air. How do you know if you’re being down-regulated? You have increased watery saliva in the mouth. It’s a brilliant sign because, when the body is ready for the digestion of food, that rest and digest response, there’s increased watery saliva produced to assist with the digestion of food, and, yeah, I would say people practice it.

I would love to see the day that the yoga instructor, because they have such a tremendous reach out there, millions to millions of people, talk about nose breathing to every person who comes in, both on and off the mouth, very important during sleep. No yoga student should be waking up with a dry mouth in the morning. Nobody should be waking up with a dry mouth in the morning, but breathing less air for that period of time, to understand that, yes, your blood circulation and your oxygen delivery and your airways and your physiology, stimulation of the vagus nerve to secrete the neurotransmitter acetylcholine, to cause the slowing of the heart, to strengthen the baroreflex.

Our autonomic nervous system can be influenced via the breath, and it’s not about taking these full big breaths. You can take full big breaths, but what do they do? What does breathe light do? Breathe light is about breathing less air. It’s targeting the biochemistry of your breathing. It improves your blood circulation, your oxygen delivery. It stimulates the vagus nerve, and it strengthens the baroreflex. The baroreflex, the sensitivity of that is a very important indicator of the functioning of your autonomic nervous system. By breathing light, you also help to improve your tolerance to carbon oxide. In other words, carbon oxide is the primary stimulus to breathe, but if we are overly sensitive to the accumulation of carbon dioxide, our breathing is harder and faster.

We don’t want harder and faster breathing. We would have more labor breathing during rest, more labor breathing during sleep, which increases the risk of sleep disorder breathing, and more labor breathing during exercise. That’s the breathe light, and then to focus on the breathe low, and breathe low means that we’ve got good and optimum recruitment of the diaphragm. The diaphragm breathing muscle is connected with the emotions. The diaphragm breathing muscle is also connected with the upper airway dilator muscles in the throat. The diaphragm breathing muscle is also providing stabilization for the spine, and then, to look at the autonomic nervous system, do you want to stress the body and mind to cause that to make adaptations or do you want to strengthen the baroreflex and stimulate the vagus nerve?

This comes up on conversations at the start. Any breathing exercise can be broken down into whether it’s focusing on the biochemistry or the biomechanics, or whether it’s a stressor breathing exercise or whether it’s downregulation. For example, cadence breathing, coherence breathing, slowing down the respiratory rate to between 4.5 and 6.5 breaths per minute, the ideal respiratory ratio also practiced at different times during the day, not all day, but at different times during the day, to help to bring balance in the autonomic nervous system.

Then, if we look at stressor breathing exercise, there’s only two main ones, hyperventilation, and it’s not the speed of the inhalation which is the stressor. It’s the speed of the exhalation. Anytime we, as human beings, if you want to stress your body and mind, breathe out fast, breathe out fast, but if you want to relax the body and mind, breathe out really slow and prolonged because the slow and prolonged and relaxed exhalation, the body is telling the brain that everything is okay, whereas a fast inhalation and a fast and hard explanation, the body is telling the brain that there’s stress, and it’s getting the brain into overdrive. It’s activating that stress response. Your main way to stress the body then is by doing long breath holds.

We work with about 26 different breathing exercises, but they all fall into those three dimensions. If you were to write down any breathing exercise, we can say, well, what is this breathing exercise doing? What’s it doing in terms of biochemistry? Is it making you more sensitive to carbon dioxide buildup, which they can be, or is it making you less sensitive to carbon dioxide? What’s the breathing exercise doing? Is it making you breathe shallow or is it targeting the recruitment of the diaphragm? What’s it doing to the autonomic nervous system? Is it increasing epinephrine or is it causing downregulation by stimulating the vagus nerve?

Any breathing exercise falls into this, and then we could say, well, what is the application of this for sports? What is the application of this for sleep? What is the application of this for mental health? What is the application of this for respiratory care? What is the application of this for dentistry?

Next Monday, I work with elite military snipers, which I’ve worked with a few times, and I’m brought in to bring breathing into when would you pull the trigger of a gun, and then there were some people who said, “It’s not very spiritual, Patrick,” but I was only thinking about it afterwards. If I was in some cafe and some terrorist came in, and the terrorist was there holding everybody hostage, well, I would think it would be wonderfully spiritual to have a sniper outside the door at my back. I think that’s absolutely a very important role. It’s a European group that I work with.

Now, just to give you a little bit of this, these guys are highly trained elite of the elite, and they’re all at that level. They’ll be in association with the Navy Seals and SWAT, et cetera. Their role is to stay in behind the sight of a rifle for one hour at a time, one hour of focus, unwavering attention. To do that, you need to have good physiology and you need to have good sleep. You cannot send in somebody with sleep apnea. You cannot send in somebody who’s breathing fast and shallow because their physiology is off.

That’s what I want to do. We get their everyday breathing patterns right and improve their breath hold time, the BOLT-score, which is an indicator of functional breathing patterns, but then, in terms of the inhalation and the exhalation, the inhalation, the vagus nerve steps back. The foot is taken off the brake, so it’s almost that the inhalation is an acceleration. It’s a stress response. The exhalation during rest is completely under the responsibility or the control of the parasympathetic nervous system.

In terms of pulling the trigger of a gun, do you pull the trigger of a gun during the inhalation or do you breathe in and do you pull the trigger of the gun that’s top of the inhalation, or do you breathe out? Do you pull the trigger of the gun during the exhalation or at the bottom of the exhalation?

What you have to do is understand the breath. During the inhalation, the heartbeat is increasing. It’s getting faster. During the exhalation, the heartbeat is slowing down. If you have a relaxed and slow and prolonged exhalation, you’re stimulating the vagus nerve. It’s secreting acetylcholine. The heartbeat is slowing, and the time to pull the trigger is in between heartbeats, so there’s two aspects to this. One is get a good BOLT score. These guys need to be in control and in charge of their own physiology. The second is to be able to down-regulate during the exhalation and to pull the trigger in between heartbeats, because all it takes is the beat of the heart to knock that focus off.

Michael Roesslein:

Okay, a lot to unpack there. Thank you for sharing all of that. Actually, in between heartbeats, I used to skydive, and I haven’t heard terms like that used since I was in that world. People would say, like, how would you know your heartbeat? If you bring your focus enough to the thing that you’re doing, you know your heartbeat and, you know what, you can sense your heartbeat and feel your heartbeat.

I used to think I was into skydiving because I was a adrenaline junkie, but now that I’ve done a lot of spiritual practices and been involved in that type of… I’ve done a lot of healing work and spiritual practices and I understand present-moment awareness, which is what you talk about quite a bit in the book, that’s what I was chasing with the skydiving, and that’s what I believe everybody in extreme sports is chasing is the present-moment awareness, the zone or the flow state or things like that. It’s not the adrenaline. Adrenaline feels terrible. For anybody who’s ever… Adrenaline feels terrible. It’s like speed and then you crash, and then it’s awful. That’s not fun at all, so it’s not the adrenaline that anybody’s chasing. It’s the present-moment awareness.

The way that you describe that, I can relate to the level of awareness necessary for in between heartbeats. At first, I thought you meant to say in between breath, and then I’m like, “No, I’m pretty sure he meant heartbeats,” and that’s a…

Patrick McKeown:

It’s even just slowing down the exhalation to be able to lengthen the time in between beats, but, Michael, it’s a very simple stuff when you understand a little bit about the breath and the breath. Okay. It’s complex. It is multidimensional [crosstalk 00:38:36] break it down.

Michael Roesslein:

Well, the biochemistry that’s happening is complex, but the rules are simple.

Patrick McKeown:

It’s simple. They are. Yes.

Michael Roesslein:

Yeah. There’s two things I want to touch on for this audience specifically is, one, you mentioned air hunger and under-breathing and actually my feet. I live in a 17th Century, I believe, building here in Italy, and the floors are extremely cold, the stone, everything, and so my feet are cold most of the time no matter what I have on because they’re touching it and it’s too much. The cold comes through whatever I’m wearing.

While you were talking, after you mentioned that your hands and feet are cold all the time, and you said four minutes of under-breathing would raise extremity temperature, I was doing that while you were talking, and it’s actually difficult as a new practitioner of it or a person practicing it to remain focused to you in what you’re saying and following and bring the awareness to do the under-breathing at a level that’s like the right level because what you’re… You’re not looking for and suggesting especially for new people that this air hunger, the under-breathing, gets so extreme that it’s like, if you have to do what I just did, if you have to gasp for breath, that’s too much. These are not breath holds. Air hunger is something that most people are probably pretty uncomfortable with at least at the beginning when you start because it feels like you’re suffocating a little, just a little bit.

I also enjoy in the book how you explain that this is almost like false advertising from the body because at no point during this under-breathing are you actually deficient in oxygen getting to your tissues, and that it is the buildup of carbon dioxide and, what you mentioned, the other thing you mentioned is the tolerance, carbon dioxide tolerance, the level of tolerance that you have for it. So you’re saying that, somebody who’s trained in this and practices it often, they will feel that air hunger later. They can do more activity.

Patrick McKeown:

Yes. Exactly.

Michael Roesslein:

They will feel it later. They can hold their breath more. They can use more oxygen. They can have more of the gas metabolism going on, creating more carbon dioxide before they will feel the need to have to breathe, so that tolerance increases. One, that’s what you mean by carbon dioxide tolerance and, two, can you rest… Can you put people at ease a little bit that they’re not actually suffocating when they do this, and how saturated is the blood with oxygen, and does that really change a lot during an exercise like that?

Patrick McKeown:

Normal blood oxygen saturation is between 95 and 99%. Basically, most people are in around 97, 90 8%. It can fluctuate a little bit. What does that mean? It means that all of your hemoglobin, so the protein in the blood which carries oxygen, what’s the percentage of it is occupied by oxygen? When you take a very soft and subtle breath into your nose and release everything as nice and soft, and that relaxed and slow and gentle breath out, you want to generate a tolerable air hunger. The key is tolerable. If you’re feeling panicked or stressed, you take a rest. If you lose control of your breathing, you take a rest. If you have involuntary contractions of the diaphragm, you take a rest because if the air hunger gets too much, the brain is going to step in and send increased impulses to breathe, and you’ll feel this by having involuntary contractions of the diaphragm.

The air hunger is not due to a deprivation of oxygen because there’s so much oxygen in the body. That oxygen levels have to drop by half before they stimulate breathing. The air hunger is telling you that carbon dioxide has increased in the blood. Here’s the ironic thing. You’re deliberately breathing less air. You’re feeling air hunger. Carbon dioxide is increasing in the blood, and blood pH is dropping. Your blood vessels are dilating, and there’s increased oxygen delivery to the tissues and organs, including the heart and brain, so, even though you feel air hunger, your tissues and organs are getting more oxygen.

Now, contrast that to… I’ll give you an example. I was nervous going into an exam back in the day, 1997, ’96, ’95. I can’t remember what year. I read this book about the importance of taking these full big breaths, to fill your lungs full of air, and I said, okay, this is the solution. I’m going into an exam hall. I want to calm down, but just before I went into the exam hall, I went for a walk for three minutes of my own, my own space, and, during the three minutes of walking on my own, I took these full big breaths, filled my lungs full of air, and I walked into the exam hall, and I was totally spaced out and lightheaded.

I never knew that the full, big breaths that I was taking deprived blood flow to the brain. How much by? All it takes is 30 to 60 seconds to reduce carbon dioxide in the blood by half, so, meaning, carbon dioxide in the blood, if it reduces from normal of 40 millimeters of mercury down to 20 millimeters of mercury, and every one millimeter drop of CO2 reduces blood flow to the brain by 2%, so three minutes of hard breathing can reduce blood flow to the brain by up to 40%. That’s how I went in during my exam.

I think we really need to start shedding light on this because there’s so much information, and it’s even got more so, that the more you hyperventilate, the more extroverted your breathing technique is the better. Listen, of course, there’s a role for hyperventilation. There’s a role for long breath holds, but it has to suit the person.

The only reason, Michael, I’m saying this is I have made plenty of mistakes with this. I have put people into panic attacks. I’ve put people into very severe anxiety. I put one guy into accident in emergency. I floored people with chronic fatigue syndrome, but I did it with good intentions. My intentions were not bad.

I’m 20 years doing this now, and I’ve had many thousands of people through my doors face to face, granted the last couple of years, Zoom, but, still, a lot of people via Zoom. You learn things, and you adjust accordingly. There are many people that I would not do long breath holds with. Because we teach long breath holds, we have been for 20 years, under no circumstances would I, and there are many people that I would not have them hyperventilate because I would be afraid to.

There are people that we have to gauge, especially if you’re dealing with people who have… if their autonomic nervous system, if it’s very dysregulated, I don’t want to be stressing that person further. What I want to do is I want to… I want to be helping to them to recover, and I want to give them the tools, that they can bring this into their everyday life. There is a time for hyperventilation, and there’s a time for long breath holds. I know it’s got very popular. It’s not going to be suitable for everybody, and I would feel that it’s doing some harm because the wrong people are using it.

The thing about breathing exercise is it deserves much more respect, and it deserves much more of an awareness, that it is multidimensional. It’s like somebody going into a gym. You could have somebody going into a gym who’s very obese, who has got a lot of health problems. You’re not going to ask that person to sprint up and down. You’re not going to put them on to high intensity interval training. The gym instructor is going to know that, this person, I’m going to start very easy with him, and I might start him off with walking and will gently condition him.

It’s the same with breathing. We should be gently conditioning the individual to where they are at, and if we can do that and if we can just gently over a period of time, because sometimes like when the autonomic nervous system especially with chronic fatigue syndrome, you could be working with that individual for six months, but what other options do they have? What are their options?

Michael Roesslein:

Thank you for prefacing that. I think that the type of breathing and breathwork that is getting, I don’t know, popular, notoriety, is the hyperventilation and the breath holds and things like that. I’m not going to name organizations or names or anything. I’ve done that at times. It’s been helpful for me. I felt good. I don’t have any of the listed conditions that you listed really clearly and you’re like don’t do breath holds if.

I don’t fall under that, and I appreciate your care in that, and what we’ve been talking about, the under-breathing and the reconditioning, this tolerance for carbon dioxide and increasing oxygenation of tissues and the hemoglobin releasing more oxygen, this is the type of breathing and breath, and the activation of the vagus nerve and the longer exhales that are parasympathetic in nature. A lot of the people that listen to this podcast and that are on our community here, they have chronic diseases. They have autoimmune conditions. They’re starting to learn the significance of an overactive immune system and the fact that… I mean, overactive nervous system, like activated nervous system, more sympathetic will drive the inflammation, will drive the immune response, will drive all these chronic diseases, and they do this diet and supplements and things like that. These are the folks that… They make marginal improvements there. They get a little better, but they keep running into these walls, and they’re looking for more ways to impact their physiology and to show their body that things are safe, because the body has a remarkable ability to heal when it’s in a state of healing.

A state of healing is not an emergency state or a big mouth breath, shoulder breathing, sympathetic state. This type of under-breathing I think can be a very powerful tool if done properly. I like that you mentioned that the diaphragm, this is breathing into the belly. We’re not talking about only filling the little Tippe top of the lungs with air. I think it’s a misconception…

Patrick McKeown:

No, but… It is.

Michael Roesslein:

… for the air to get to the bottom. The lungs don’t have to be full. Right?

Patrick McKeown:

Well, the only thing is… and I don’t mean to contradict you there. When you do light breathing, it doesn’t really matter.

Michael Roesslein:

It doesn’t matter?

Patrick McKeown:

Yeah. The only reason I say that is because you’re only doing it for a few minutes. It’s not that we want somebody to develop shallow breathing techniques, so, normally… and I would say, too, if you have people who are quite unwell and they want to get into where all of these breathing exercises are, I put up a video, Long COVID. This is specifically when people are really, really in a poor condition. I had to start off gently. All of the exercises are there. You’ll find it on YouTube. It would be Patrick McKeown, Long COVID. It’s the same approach.

Michael Roesslein:

I’ll link it in the show notes.

Patrick McKeown:

It’s the technique that I was using with… Remember I said that I floored people with chronic fatigue syndrome, so I had to gear down. Now, when I’m working with anybody, I always start off very gently at the start and just gently gear them up. You want to just see where they are at. I put everything into the Long COVID video because we wanted to just put it out there.

Coming back to when you’re focusing on breathing less air, I only have one golden goal in mind. I want that person to feel air hunger. I’m not too worried if it’s upper chests or it’s diaphragmatic because, if we start focusing on upper chest and diaphragmatic, now they’re having to think of two different things and it’s too much for them. When we’re doing the biochemistry, we only focus on the biochemistry and then, after a couple of weeks when I’m pretty sure that they understand about breathing less air, what’s going on and that they’re making progress because their BOLT score is increasing, now, sometimes we step away from the BOLT score if it puts too much pressure on people, because I don’t want to make breathing a performance either because if you make it a performance, you’re putting a psychological pressure on people. That hampers the very thing that you want to improve.

It depends on the person there as well. It’s a passive approach, that kind of attitude of, “Listen, we don’t care what happens,” but the wonderful thing in the world is you have to give it a go. So, then, we focus after a few weeks on breathe low. Now, the other thing, Michael, is if you’re breathing through your mouth, you’re not going to be breathing as low as you should be. Nasal breathing is the key for optimal movement of the diaphragm, and mouth breathing is very much more upper chest breathing.

I apologize for the noise in the background because we’re building a new clinic here, and we’ve got about 10 builders on site.

Michael Roesslein:

That’s all good.

Patrick McKeown:

You know how it goes. Yeah, we’re putting on another 400 square meters, so… but it’s… When it’s over, it’ll be good.

We then focus on the biomechanics with good recruitment of the diaphragm, and then I bring in cadence breathing, but I just… There’s two things that I’m thinking about when you talked about to people that you’re working with. One is sleep. If these individuals continue to have sleep disorder breathing, they will always have that increased sympathetic drive. So, whether they have snoring now, a little bit of snoring, okay, but obstructive sleep apnea is a problem, and insomnia is a problem. When you think about people, say, working to optimize their heart rate variability, they’re practicing breathing exercises during the day, but they’re not bringing good functional breathing into their sleep, and if they have their mouth open, it’s a problem.

I’ve been taping up for 25 years. It was the best thing that I ever did to get a good night sleep.

Michael Roesslein:

Mouth tape?

Patrick McKeown:

Mouth tape, yes.

Michael Roesslein:

Yeah. I think that’s creeping its way into the functional medicine discussions and circles is a simple mouth tape. You mentioned another thing. I didn’t… I listened, so I don’t know if there was a picture in the book, but something else with snoring. It sounded like a harness or some kind of thing.

Patrick McKeown:

Oh, do you know what, I’ll show you what we use as well for mouth tape because a lot of people are a little bit resistant or reluctant to use mouth tape. I have my own mouth tape. This is our own tape. It’s called Myotape. Now, I developed it for children because… but then, again, it became popular with adults because there’s different sizes. I’ll just show it to you because it takes away the scariness of it.

Michael Roesslein:

I see it has a hole in the middle of it.

Patrick McKeown:

It’s cotton, and it stretches by about 30%. Now, this one here is the orange one. At the moment, there’s skin colored, and then it’s going to be different colors. We’ll have blue next. There’s an elasticated tension pulling my lips together which is pouting my lips, but it’s bringing my lip together, but if there was an emergency, the individual can… They can open their mouth, so, that way, we’re helping to achieve nasal breathing, but without the risk of covering the mouth

Michael Roesslein:

Beautiful. Yeah. I had a hesitation to it when I first… I’ve tried it a couple times. I don’t really, that I know of, have sleep apnea. I don’t wake up with a dry mouth. I don’t. I don’t think it’s a huge issue, so I didn’t use it a lot, but it was weird, and I’ve had people say things like that. I think that would alleviate a lot of the fear around it. We could have a whole nother hour-long conversation on snoring and sleep apnea and insomnia, so maybe we’ll have you come back sometime and chat about that because I know we’re pretty close to out of time.

Oxygen Advantage is the earlier book. That was from about five years ago, and then The Breathing Cure is the more recent book that you think would be the best place for people with health issues who are looking to just improve their overall health and vitality by changing the way that they breathe and by knowing more about their breath, that would probably be what you’d recommend? There we go.

Patrick McKeown:

I think The Breathing Cure, Michael, is a good book. It’s very sciency though.

Michael Roesslein:

Our audience is pretty sciency.

Patrick McKeown:

Okay. Well, do you know what? Maybe they would like it because what I wanted to do was I wanted to show… Actually, do you know what? The first two chapters contain all of the exercises and the programs for different people, and then I put in different chapters for diabetes, high blood pressure, epilepsy, and I tried to reference it as best as I can because I just feel that breathing has got too much woo woo, and there’s been so much left of field associated with it. Breathing is not left of field. It’s crazy. It shouldn’t be left of field. It’s not necessarily right of field either because the science hasn’t caught up with breathing. It is more complex than… and, of course, it does need research, but doctors in the main aren’t necessarily interested.

I’m talking about your conventional medical doctor. They’re not interested in it, so it’s not necessarily right of field. Breathing is for the people. It’s right in the middle, and that’s why I wanted to bring it with The Breathing Cure and, oh, it was because when I started off just 20 years ago, healthcare professionals didn’t want to know about it, so I started writing books and I said to them, “I want,” in my head, “I know this works because it worked for me.” I knew it worked because I could help and I’d see reproducible results with so many people, but yet my whole intent was how do I get it into the hands of the people? I write a book. It costs $10 or $15, and people buy it and they can practice all of the exercises from the book.

Michael Roesslein:

Perfect. I’m grateful for your work. I’m grateful for what you’ve done, and its just… When I first listened to James’ book and then your book and then I… you have a great… Yourself and some of your students, I believe, on Instagram, post really great content. There’s things that I learn about breathing and the effects of raising your shoulders when you breathe or mouth-breathing, or what happens when you nose-breathe or… All these different facts, these aren’t conjectures. This isn’t like, oh, I bet this is what happens.

There’s been so many moments when I’ve learned things that I almost get rage that… I mean, I know quite a bit of stuff when it comes to functional medicine and health and the complexities of nutrition and biology and all these things, and I’m like why the hell didn’t anybody tell me this? Why isn’t this where you start is the thing because breathing is so fundamental. It’s more fundamental than what you’re eating or what you’re drinking or what you’re moving or what you’re… It’s literally the thing that makes you alive. Why is it like I’m discovering some big secret thing and it’s like, no, this shouldn’t be this way?

Patrick McKeown:

Because, Michael, it was monopolized and it wasn’t taught correctly. I really feel that. It is a question that I’ve asked so many times, and it could have helped to avoid suffering with so many people. It was monopolized, but it was not being taught correctly. It’s the biggest secret out there, and I’m not just saying it because I’m in the field, and it’s still very few people know about it.

Michael Roesslein:

No. It is. It is, and I get blown away. I mean, I get blown away when I read your book and his book and any book. Anything I’m reading on breathing now, it just blows me away. It’s like what? How? Nothing impacts your physiology faster or more predictably than the breath, like do this and then this happens right now. There’s very little other things that are that direct. I mean, take this supplement for six weeks and maybe this happens, or do this kind of exercise and you probably will get stronger in some remotely predictable fashion over this amount of time if you lift this much weight. Yes, but the breath, the way you’re breathing, as you’re even listening to this discussion is impacting your physiology right now.

It will impact how well are you able to even explain this or remember it or what can you… because we didn’t even talk about it a lot, about focus in ADD. I have severe… I would’ve been medicated in the ’80s if it was just common to medicate kids then as it is now. I would’ve been medicated. I would’ve had all of that thrown at me. The way you’re breathing influences literally every aspect of your physiology and your health and your experience of life and your ability to concentrate.

Patrick McKeown:

Mm-hmm (affirmative), and I’m going to go more. Since you’ve spoken about ADHD, there was a study by Karen Bonuck, and I’m not sure if I included it in The Breathing Cure. Sorry. I definitely included it in The Breathing Cure, but I’m not sure if I included it in The Oxygen Advantage. Karen Bonuck looked at 11,000 children in Stratford-upon-Avon in the United Kingdom over either four years or a six-year period. She concluded that children who had sleep disorders at five years of age which includes snoring, if these kids were untreated at five years of age, they had a 40% increased risk of special education needs by age eight. This was published in the Journal of Pediatrics in 2012, a population of 11,000 children, a longitudinal study. She talked about in that paper that there are 3 million American kids with ADD and issues related to poor sleep, 3 million American children. Now, I’m talking about teenagers as well.

This is a travesty, and this is a travesty because it’s known in science that the child’s brain grows during the formative years and it grows during deep sleep… develops. Sorry. The brain is developing during deep sleep and, if that child is having continuous fragmented sleep, it’s going to impact the development of that child’s brain. Now, how many parents know that? They don’t. It’s stuck in the Journal of Pediatrics and it’s buried away. Yeah, I’ll send you on the paper when we finish, and you can share it with your audience.

Michael Roesslein:

For sure, yeah, we’ll show it. We’ll put it in the show notes below with the link to your COVID video, and we’ll send to the website. You can find live classes. You’ve trained, I don’t even know how many, practitioners, coaches, people who are doing this work.

Patrick McKeown:

It’s about 3,000 in-

Michael Roesslein:

About 3,000, and so-

Patrick McKeown:

… 50 countries.

Michael Roesslein:

Any here? You’ve got some Italians on your-

Patrick McKeown:

Oh, in the States?

Michael Roesslein:

No. I mean in-

Patrick McKeown:

Yes, we do. We have some wonderful instructors in Italy.

Michael Roesslein:

Okay. Well, I’m going to connect with you because I think I need to go through your training. I’m going to when I’m ready, when I lift my ban. Don’t let me sign up in the next couple months, but when I’m ready. I feel like this is a very honorable crusade that needs to be undertaken. It’s something that’s just an elephant in the room that nobody’s seeing or talking about.

I personally feel that. I know I was impacted by this and I know I was one of those kids, and I know what happened to me because of it. I know the things that were said to me like, “Oh, you’re lazy. You can’t pay attention. You’re not focused. You’re a bad kid. What’s wrong with you? Why don’t you do this? Why don’t you do this?” I’ve done years of work now to undo the damage of some of that, and not everyone’s so fortunate and gets to do the work to undo the damage of things like that or finds ways to do it or finds the people to help with it.

I’m inspired by what you’re doing and others who are doing this work with just very basic… It’s so fundamental. That’s the thing. That’s the kicker there. I’ve read, I know… I don’t know all. I think you referenced 23 or 26 exercises. I don’t know all of them, but the ones that I’ve learned and that I’ve read in that book. This is not super complex rocket science. Most of these breath techniques are very simple, and I’m sure there’s nuances to them and things that can get more advanced, but it’s… you’re not about to… If you’re listening to this and you’re interested in starting, you’re not about to jump into some uber complex new hobby. You’re not learning how to play Mozart on the piano. You’re just learning how to do the thing that your body does and do it in a way that it should be done and that it’s naturally going to do it. You just need to bring the focus back.

Yeah, thank you so much, and where’s the best place for people to start if they want to go somewhere right now and find… I want to… They’re inspired and they want go check it out. Where’s the best spot or best way for them to get started.

Patrick McKeown:

For us, the best place would be buteykoclinic.com, and there is an app as well, Buteyko Clinic app, which is a free download, and it has all of the children’s exercises free, so any parent who might be wondering, “Well, what can I do for my child?” I put up about nine exercise or maybe eight exercises for children. You can sit down the child and go through the exercise with your child. It’s friendly towards kids. I’m working with my own child, so we record it just to put it out there because I think it’s so important that it’s younger kids as well, that they get this information. I didn’t have it as a child. You didn’t have it as a child. It’s very important to kids out there.

Michael Roesslein:

For sure. Well, thank you so much, Patrick. I really enjoyed this conversation. Actually, I was really excited about it, and it was one of the few. I interview a lot of people in the functional medicine and integrative health world, and I’ve interviewed… I don’t know. I’ve interviewed a couple hundred, and I rarely ever the day of an interview feel any nerves or excitement… not excitement, but nerves like, “Oh, I want to get this one right,” or, “I’m really excited to have this conversation,” and I did today because learning about the breath has been such an eyeopener for me.

I’ve learned some pretty advanced meditation techniques. I work with a [Daoist 01:06:19] Qigong master that’s kind of my coach and teacher. You referenced in the… The Daoist Qigong, they mentioned the proper breath. It’s not even that you wouldn’t hear me breathing or I wouldn’t hear me breathing. It’s that I wouldn’t even feel me breathing.

Patrick McKeown:

Yes. [crosstalk 01:06:36].

Michael Roesslein:

So I’ve had some instruction, and I’ve felt the impact of the breath and the awareness on the breath and the present-moment type awareness brought by some of this. It’s changed my life completely, and so, now, that I’ve learned that also, it has all these amazing physiological effects, not only that it’s this mindfulness practice that changes how I live my life, it also influences my physiology and my circulation and all these other things. It’s like, man, this is like the holy grail of things I need to learn, so I will be following up with you, and when I’m allowed from myself to train. I’ll love to dive into your trainings and learn more, but thank you so much for…

Patrick McKeown:

It’s a pleasure.

Michael Roesslein:

… everything you’re doing, for writing books, I know that that’s no small undertaking, for the clinic, for training everybody, for just being a loud voice in this world, for bringing us back to the fundamentals of breathing. It’s necessary, so thank you so much.

Patrick McKeown:

Thank you so much, Michael.