Breath, Autonomic Balance, and Health with Sachin Patel, DC

- Breathing is an essential function that provides the body with oxygen to support cellular health and energy production. Breathing and mindfulness are both well-documented stress management techniques that can support mental and physiological health. And as such, breath work can be an important clinical tool to enhance the mental, emotional, spiritual dimensions of wellness. - When people think of breath work, they think of like Wim Hof or they think of intense breathing practices like tummo, or they think of acrobatic breathing techniques. And it doesn't have to be that. The way I define breath work is working on your breath. - On this episode of "Pathways to Wellbeing," we welcome AIC 2025 presenter, Dr. Sachin Patel, to discuss the importance of breathing, mindfulness, and achieving balance from within. Dr. Patel will outline how breathing impacts the nervous system and how breath work is an effective strategy for maintaining autonomic balance. In addition to lifestyle changes, focusing on mindful and intuitive breathing can help patients transform not only their mental health, but their physiological health as well. I know I'm ready to be inspired today. Welcome to the show, Dr. Patel. - Thank you, Kalea, it's an honor to be here, and I'm really excited to share this information. I'm looking forward to speaking at IFM and also facilitating breath work. So, I think this is gonna be a great primer for everyone who's there at the event. - I wholeheartedly agree, and this is so important because we're all breathing. It's something that we all do every day, and because it's such a natural function, I think a lot of us are taking this for granted. We know we need to breathe to survive, but it might not always be something that we're doing really intentionally. So to start our conversation today, will you share with us a little bit about how you personally were interested in breathing and its impact on health? What did that journey look like for you? - Yeah, great question. So, it's a variety of things. I've been introduced to the concept of breathing and breath work, and poo-pooed it and kind of ignored it because it was too simple for me. And of course, some of us practitioners, we like to make things really complicated. And then we eventually learned that simplicity is the answer, and that's the best way for us to actually get our message out there is by finding simple interventions. So my story actually starts by me attending a Wim Hof training, and this was almost eight years ago now. A friend of mine said, "Hey, do you want to go to Wim Hof training?" And I said, "Sure." He is like, "Bring your swim trunks." I'm like, "I thought we were going to a breathing class." And he's like, "Trust me." So we go to this breathing class, and by the end of it, I was able to hold my breath for 3 1/2 minutes longer than I ever have in my life. And then they took us outside. It was February on a freezing cold day, and they had a kiddie pool filled with ice cubes for us to kind of not jump into, but for us to sit in and practice our breathing while immersed in a cold bath or a cold plunge. And we were able to do that and survive the 90 seconds that we were in there. And then we didn't have towels to dry ourselves off. The challenge was to use our breath and our body heat that we generated using a technique called tummo breathing to dry ourselves off. So here we are in the freezing cold winter, February winter in Toronto, coming out of a cold plunge, and then drying ourselves off by moving our bodies and breathing in a rhythmic way. I just felt so alive. If you had told me I was gonna do that, I wouldn't have gone. But after I was done, I felt so, so alive and invigorated, and I just like turned on and piqued my interest about how breathing can have such a profound shift in my mood. And then in 2020, when the world seemed to kind of shut down and everyone went into a cave with a respiratory infection, I read James Nestor's book. And around that same time, my son was going through some dental challenges growing up as a child. We later learned he was a habitual mouth breather, which caused him to have a lot of cavities. Despite the fact that he was eating a very functional medicine-approved diet, no gluten, no dairy, no sugar, no junk, no sodas and all that good stuff, but he had a ton of cavities, but it was actually because he was mouth breathing. But we also went to the dentist this one time, and the dentist told us that there wasn't enough room for his adult teeth to grow in because he had an overcrowding issue. And as a chiropractor, I thought, "That can't necessarily be true, or it doesn't make sense to me because there's no way God made us to have a jaw that can't accommodate our teeth. Something else is going on here." And it turns out because of his habitual mouth breathing, and because his tongue was resting in the bottom of his mouth, it didn't act as a spacer to open up his upper palate, his hard palate. And so he didn't have too many teeth, he had too little jaw. And so we found an airway dentist to actually help expand his jaw. And all of his teeth came in. We didn't have to remove any of them. And now, he's got a beautiful wide smile, which also means he's got a nice open air palate. And around the same time, as we were seeing the airway dentist, my wife, who I've been given permission to share this, who also grew up with cavities, despite having a very clean diet and also having a very good dental hygiene practice. We later came to learn that she was also a mouth breather, and she also sucked her thumb as a child because her tongue would not sit in the roof of her mouth due to a tongue tie. And so she ended up getting a tongue tie procedure done, which is just a small laser surgery. And that completely changed her life. It changed her posture, it got rid of aches and pains that she would complain about. She was able to touch her toes very easily for the first time. And her body just melted. Her fascia just melted with relaxation. So, how we breathe isn't just about the air that's going in and out of our lungs, it's also about how it shapes our facial structure. And so for me, it's impacted my son, my wife. It's impacted me in many, many ways. And in 2021, I became a breath work facilitator, and that's allowed me to allow others to experience transformations through breath by taking them on very mystical journeys. Kind of hard to describe what people go through, but it's pretty magical, and it's been wonderful to be able to do that. And now I educate practitioners all over the world about the science and art of breathing. So that's where my story starts, and I'm just scratching the surface. So, there might be questions I don't know the answer to, and I'm continuing to explore. And there's lots of things that I've learned, which I'm excited and happy to share today. - Well, I can see why you feel so compelled to talk about this and to share with others. I mean, that is a massive impact it's had just on your family. And I'm sure as you train practitioners and even your social networks, you probably see so many stories, kind of transformative stories like that when one starts to work on their breath, right? - Absolutely, yeah, it's so, so many. I mean, it's the one thing that I love because it creates the fastest, most measurable shift in somebody's physiology and the way they feel. And as we go through this conversation, people will learn why, and I hope this inspires them, no pun intended, to take action and take control of their breath. - Well, on that note, can we talk a little bit about, just about this term breath work? Because I think a lot of times, when people think breath work, they think, "Okay, I'm just gonna sit still and I'm gonna take some deep breaths." Will you tell us a little bit about how you define, or interpret, or explain what breath work really is? - Yeah, I think when people, like you said, when people think of breath work, they think of like Wim Hof, or they think of intense breathing practices like tummo, or they think of acrobatic breathing techniques. And it doesn't have to be that. The way I define breath work is working on your breath. So anytime we bring our conscious awareness to our breath, I believe that's breath work. And it could mean different things in different situations, but anytime that we're drawing our attention to our breath, being present to it, and then modulating it and adjusting it to choose how we wanna feel, that's working on our breath. It could be breath work exercises you're doing. It could be breath work experiences you're having. I even think something as simple as mouth taping is working on your breath. So, I do breath work. People ask me, like, "What's your breath work practice look like every day?" I'm working on my breath 24/7. In fact, I do eight hours of breath work every night when I'm sleeping because I use mouth tape. Throughout my day, I'm bringing my awareness back to my breath literally hundreds and hundreds of times. And I'll share with people how they can do that. And when you do that, then you are now in control of your nervous system. In fact, I look at the breath as the steering wheel of the nervous system. And so, because just like when we're driving, we can drive unconsciously, we can get to and from work without even knowing how we got there. We can drive very consciously, right? Both hands on the wheel, being present, and paying close attention to the road around us and the road in front of us and behind us, and all that good stuff. We can do that with our breath. And when we do that, we unlock a whole new level of health that's been waiting for us all along. Literally, the answer is right under our nose. We just have to know how to access it and raise awareness around it. - Right. Okay, there's so much information to dive into there, but I wanna talk a little bit about the physiology of breathing. You've mentioned a few different body systems that might be impacted by a breath work practice. I think the lungs are more maybe most intuitive. So, will you talk to us a little bit about how breathing impacts the lungs, but then also some other organ or body systems that really can benefit from intentional breathing? - Yeah, so one thing that people may not necessarily realize, but our immune system actually starts in our nose. So our defense against the outside world starts with the air that we breathe in. Each day, we breathe in about 30 pounds of air, which means that we consume more air in a day than water and food in a week. And it's something that interacts with our lung microbiome. So the quality of air that goes into our lungs is very, very important, which means the orifice through which we breathe also makes a big difference as well. So our nose is lined with a nasal mucosa, and this nasal mucosa essentially connects with the air that we're breathing in. So the purpose of the nose is to slow the air down. By slowing the air down, we're able to filter it. So we have nose hairs and cilia that filter, mechanically filter the air. We have our nasal mucosa, which is producing nitric oxide. Nitric oxide has many functions. One of its functions is to disinfect the air. We have turbinates, which spin the air and increase the pressure of the air. So we're essentially perfecting the air, we're moisture-regulating it, temperature-regulating it, and pressure-regulating it, so we're able to get more oxygen delivery to our alveoli with each breath that we take through our nose versus breathing in through our mouth. Our mouth, as many people might know, especially those listening to this podcast, is the dirtiest part of our body from a microbiology standpoint. So if we're breathing through our mouth, we're dirtying the air from a microbiology perspective with every breath that we take. So our nose is designed for us to intake the air, and then if anything, our mouth can be designed to express the air or expire the air. But ideally, we want to be breathing in and out through our nose. Now, the other thing that we want to pay attention to is the position of our tongue. When our tongue is placed in the roof of our mouth, which is where it should be, the majority of the time, unless we're speaking or breathing through our mouth, it actually acts as a spacer. So it helps us form our dental arch. So for young children, if you have young children or grandchildren, if you're listening to this, pay attention to their tongue positioning. Nobody talks about this. We might look at their neck posture, or their shoulder posture, or their back, and if they're slouching, we might make a recommendation to them. But the placement of their tongue plays a huge role in how their facial structure is gonna form. So when we're young, or even as adults, gravity is kind of pulling everything down and inwards. Our tongue actually sits in the center of our jaw and our face. It pushes everything outwards. So it naturally creates a nice, beautiful dental arch, prevents overcrowding of the teeth. And there's a magic button at the roof of your mouth that instantly soothes the nervous system. And you may have witnessed this. If you ever see a child sucking on a pacifier, if you take that pacifier away from them, they instantly start crying. And the moment you give it back to them, they instantly relax. If you give a child their mother's nipple, instantly it hits that magic button in the roof of their mouth, and they instantly relax. The thumb does the same thing. So the placement of the tongue is very crucial in the way somebody's breathing. Now, other structures that are affected, so that's physical structures, but other structures that are affected when we breathe is our cardio respiratory system. So if you think about our heart, our hearts sandwiched in between our lungs and our diaphragm. So with every breath that we take, our diaphragm moves up and down. We take about 23,000 breaths a day. Some people more, some people less. And with each breath we take, our diaphragm is assisting the heart in pumping blood. Our lungs, as they expand and contract, is assisting the heart in pumping blood. So the way we breathe takes pressure off of the heart. It takes some of the workload off of the heart if we breathe correctly. But if somebody is a short, shallow breather, now their heart has to work overtime in order for it to pump the blood through their body. The diaphragm is also situated in a very specific and amazing position. There's no other place it should be, except where it is, because underneath our diaphragm, we have some of our largest lymph nodes in our body. And so with each breath we take, we're pumping lymph and removing the sludge and the waste that the organs are producing as well. And of course, one of our most important organs, which has over 800 known functions, is our liver. And our liver is conveniently located right below our diaphragm. So when we breathe correctly, we're also supporting the detoxification and function of the liver and the digestive organs as well. So the diaphragm acts as a piston that mechanically pumps lymph, that helps us digest our food better and move the food through the peristaltic function, and also the mechanical movement of the bowel. And it also helps our liver in moving, sludge through it as well. So there's a variety of systems that are impacted when we breathe correctly. So our facial structure, our immune health, our lung microbiome, our cardiorespiratory system, our heart specifically, and then of course our lymphatic system. But there's another system that's impacted by the way we breathe, and that's our myofascial system. So the myofascial system is like a spider web that connects the cell nucleus of every cell in our body together. And it's like a internal worldwide web. So it's like an internal internet that allows our body to communicate instantaneously with itself. So it's a hydrostatic system, which means the communication and force distribution happens instantaneously. And at the center of all of this is our diaphragm. The diaphragm serves as a conduit to evenly and equally distribute the force through this system. What people may not know is that our diaphragm also is where we store trauma, and our lungs is where we store grief. So mental and spiritual aspects of our health are also affected by our respiratory system. - I have such an awareness of how I'm breathing as you're talking, just like picturing all of these structures and how they're affected as I'm breathing. And it's actually stunning to me to think about all these systems that are impacted. I certainly take this for granted. And I've heard you speak at other events, and you've mentioned that we can use our breath work if we need to change our heart rate, our blood pressure, different markers of health. Can we really get some specificity in how our body's behaving by changing our breath? - Yeah, absolutely. So, one of the things I mentioned, and maybe we will unpack this a little bit more, is our nitric oxide levels. So when we breathe through our nose, we increase nitric oxide production by six-fold. Something as simple as humming increases nitric oxide by 15-fold. Now, people who are habitual mouth breathers, which is about 50% of the population, and those habitual mouth breathers, about 66% of people breathe through their mouth at night. So we have a society where the majority of people, day and night, breathe through their mouth. When we breathe through our mouth, it changes the pH of our mouth. It dries out our saliva, which is very protective of our teeth and oral health. And it's the number one cause of cavities. So more than sugar and other things, of course, you don't wanna eat those things either. But breathing through our mouth is what causes the majority of cavities that people have. When we breathe through our mouth, it also destroys the healthy bacteria that help us make nitric oxide. So nitric oxide has several functions, one of them is to act as a disinfectant. It kills viruses on contact. In fact, during the COVID era, there were companies that were developing nitric oxide sprays that you would spray in your nose to kill COVID. The other thing that we know is the nitric oxide acts as a vasodilator, so it helps increase the dilation of our blood vessels. So now, we get more blood flow going to all parts of our body. And then the other thing that nitric oxide does is it lowers blood pressure because of that dilation effect. Now, Viagra, when it was originally developed, was developed as a blood pressure medication. But most studies, as you know, are done on men. And there was perhaps a side effect of that increase in nitric oxide levels that were circulating that created it, turned it into a blockbuster drug. But if you recall during COVID, people were being prescribed Viagra because of the fact that it increases or it recycles your own nitric oxide. It doesn't necessarily increase it, but eating healthy foods can do that as well. And so something as simple as breathing through our nose can have a profound effect on our physiology, just to say the least. That's like one thing that we can do. And it's measurable, so you can actually, and I'll do this at the event, you can actually measure people's nitric oxide levels with a very simple test strip, a saliva test strip. I believe that every practitioner, if you see people in person, you should be testing their nitric oxide levels. It takes about 10 seconds. You just place it on their tongue, as long as they haven't eaten anything recently in the last like 10 or 15 minutes. And it's gonna measure their amount of... the amount of nitric oxide they're making, usually for men and women after 40, the levels plummet significantly. And as a result, their immune defenses go down, their blood pressure may go up, their circulation, especially microcirculation, becomes compromised. So you wanna start thinking brain fog, hypertension, immune dysregulation, and people who just seem to always be under the weather. Amazing things start happening when we start bringing people's nitric oxide levels back up again. - And maybe this is nuanced because everybody is so individual, but maybe a ballpark or average, how long does it take to see an increase in nitric oxide production? I mean, are we breathing for 10 minutes and we already see improvements? What does that timeframe look like? - Yeah, so it's gonna happen pretty much instantaneously. So something like the vibration that's created by humming is gonna stimulate the nasal mucosa to increase nitric oxide production. Now, one thing I want everyone to know, it also depends on the oral bacteria in your mouth. So if you don't have adequate amounts of healthy nitrates in your diet, arugula, beets are a source of them, for example, and you are a habitual mouth breather or use mouthwash, then you're obviously going to have compromised levels of nitric oxide production. So it's something to keep in mind. It does depend on our nutritional status, and the way we breathe habitually is also gonna impact it. Now, what we do see is if we supplement with nitric oxide support, that within an hour, we can see those levels significantly increase. So directionally, you're gonna be going in the right direction if you start breathing through your nose. But then again, it's gonna depend on your current health state to determine how much those levels go up. - Yeah, right. Well, anyone who's attending our Annual International Conference, that'll be a treat to get to do some experimenting with you. You mentioned humming, and anytime I hear humming, I'm immediately thinking about the vagus nerve. Will you talk to us a little bit about the connection between a breathing practice and the vagus nerve, and what that might mean for our patients who have a trauma history? - Yeah, great question. So as I mentioned, the interesting thing about the vagus nerve is that it is... The word vagus comes from the vagueness, it goes to pretty much every organ in our trunk, and our lungs, and our heart, and wraps around it all. The vagus nerve goes through our carotid sheath. So we have two vagus nerves, one on either side, Cranial Nerve Number X, and it's the only nerve that is wrapped within the carotid sheath. So when we hum, the mechanical vibration of the larynx, it will stimulate the vagus nerve and it will cause us to relax. The other thing that happens when we hum is we extend our exhale, which causes us to relax as well. And so that drives our parasympathetic state when we do that. So you can hum, you can gargle, you can sing, you can chant, even talking will mechanically vibrate our voice box, which stimulates the vagus nerve. And you can mechanically stimulate the vagus nerve just by gently massaging it. Or you can get even vibrational tools to stimulate the vagus nerve, and that will help as well. Now, with trauma, one of the things that we see is that when people go through a very traumatic experience, there's a lot of dissociation that takes place. And what happens is the dissociation occurs, so they experience the trauma, and then that trauma memory, that hologram of that memory is actually stored in the fascia. And so that's why they say, "Our issues are in our tissues." When we start breathing correctly and we start doing breath work, for example, for some people, one of the things that we like to do is we like to start having them massage their diaphragm. So here's one of the things that happens when people experience trauma. Not only do they have a dissociation type of experience that takes place, the trauma is then stored in the fascia as a fascial hologram, so to speak. And then the diaphragm can also be impacted because when we experience something traumatic, there's a few things that happen. One is that we generally hold our breath. So if you're gonna have a blunt trauma, you would hold your breath. Or if you're going through something challenging, it would change your breathing signature. And for some people, when they go through something traumatic, they can't cry. Crying is actually a form of breath work. It's actually one of the most powerful forms of breath work because it releases the trauma and helps us regulate our nervous system. But many people don't cry, and the only way to stop crying is to stop breathing first. And the only way to stop breathing is to stop moving your diaphragm. So the stress and the tension builds up and gets stored in the diaphragm, now the diaphragm develops trigger points. And when the diaphragm has trigger points, then it causes us to have short, shallow breathing. When we have short, shallow breathing, now we have this breathing signature of somebody who is in a chronic fight-or-flight state. And so now our nervous system, our steering wheel of our nervous system, our breath, is now leaning towards more so sympathetic dominance. And so a lot of times, when this changes for people, they show up with low-grade anxiety, they might be easier to trigger, they're sensitive to light and sound because now they're in that more sympathetic state. - Hmm. I've heard you use this term breathing signature before. Is that essentially the pattern of our breathing? And is it associated with certain health outcomes or scenarios? - Yeah, great question. So one of the things that I... So I refer to the way somebody's breathing as their breathing signature. - Mm-hmm. - And the breath, just like the eyes are a window into the soul, the breath is a window into the nervous system. And so when somebody is breathing in a specific way, if somebody is short, shallow breathing, if I was breathing like... You'd probably get a window into what's happening in my nervous system. But if I was breathing inaudibly and you couldn't even tell that I was breathing, you'd probably know, "Okay, this guy's probably in a pretty calm, relaxed state." Laughing is a breathing signature, sighing is a breathing signature, crying is a breathing signature, yawning is a breathing signature. So we can tell the state that somebody is in just by paying attention to the way they're breathing. But we don't think of laughing as breathing, right? We don't think of sighing as breathing. But try doing any of those things without your diaphragm or your lungs. They are all involved in that process. And so these are all breathing signatures that send, either the message is being sent from the nervous system to breathe a certain way, but it's a two-way street, which means that I can override the way I'm breathing to change the way I feel. So there's something called laughing yoga that some people might be familiar with, where you just... You go to an instructor and then they ask you to laugh in different ways. And within a few minutes, you're kind of laughing hysterically without even realizing what you're laughing at or what you're laughing about. And it's because you actually used your breath, the laughter, to change your physiology. You can also do this with a physiologic sigh. So when somebody feels a sense of relief, what's the thing that we do? We sigh, right? So you can actually do a physiologic sigh where you're exaggerating the sigh. You're taking a nice three-stage deep breath in, holding it, and then releasing it, and exaggerating the sigh. And what that does is it tells your nervous system that you're safe. So we can do a variety of different... We can breathe in specific ways to induce a specific state. And our nervous system already does that, right? You have probably sighed in your life without realizing why you're doing it. You've probably yawned at some point without realizing why you're doing it. Yawning helps us. It's a reminder that we need to breathe deeper. Okay, so for short, shallow breathing, we might find ourselves yawning. And that's the body's way of kind of regulating itself. Crying is a way to regulate the nervous system. It's a way to release things that we're holding onto. And then also other breathing signatures could be something like the runner's high. Most people think they get a runner's high from running, but you get the runner's high from the breathing. So you could sit in your chair and get high on your own supply without having to put all the stress and strain on your joints and have that same feeling that you're looking for. So, how we breathe is very closely correlated to how we feel. And it's already happening, whether we like to think of it or not. But if we tap into it, then now it becomes an access point to deciding and choosing how we feel. It's like choose your own adventure through your breath. - I love that, and something you made me think about is, in the clinic when I'm getting ready to take someone's blood pressure or draw their blood, oftentimes I'll see them do a big sigh. It's like their nervous system knows they need to relax into that moment, so that we can get the information we need. - Hmm. Yeah, it's so interesting 'cause it's really fascinating to pay attention to how somebody's breathing, right? If your client's coming to you, and as a clinician, we might read their face, we might try to read their body language, but I invite you to read their breath. Are they breathing through their nose? Are they breathing through their mouth, right? That tells me something right away. When I do Zoom conferences and I can see people on camera, I'm paying attention to how are they breathing. I can tell if somebody is stressed out just by paying attention to... If they're breathing through their mouth or their nose. I can see if they're a chest breather, or if they're a belly breather, or if they're using their shoulder muscles to breathe. Again, that gives me a window into the state that their nervous system is in. And in fact, one of the things that I will do is I will encourage people to start off their sessions by doing a little bit of breath work, perhaps doing some physiologic sighs to get that client's nervous system into a state where they're more receptive to the conversation, right? If somebody is Sympathetic Dominant, they're probably not gonna remember most of what you say. It's going in one ear and out the other. And frankly, it might be wasting their time and money, and your time as well as a clinician because you're sharing this powerful information, but they're not receiving it because of the state that they're in. But a few deep breaths with a few audible exhales, and guess what? Now they feel calm, they feel safe, and their nervous system and brain is far more receptive to what you're gonna be teaching them. - Hmm, so many applications I can think of here. Having conversations with your children, in a discussion with your spouse, about to file your taxes, having some deep breaths so that you can be in the moment and be calm. So beneficial. And I understand that in your practice, a major theme is coherence breathing. Will you tell us a little bit about what that means and what that looks like? - Yeah, it's super simple. And so coherence breathing is a form of breathing technique that increases oxygenation to the brain by about 20%. And it also calms our nervous system, so it balances our nervous system. And one of the other things that it does is it connects our heart and our brain. So many people might be familiar with the HeartMath Institute. They've done a lot of research on coherence, and coherence is when our heart and brain are connected. So coherence breathing is one of the ways to get into that state. As you know, HeartMath is more about the breath than it is about the heart. But we have measured the effects of the breath on the heart, and that's the thing that we're quantifying. So coherence breathing is breathing in for a count of anywhere from four to six and out from anywhere from four to six. Now, I give that range because it might be a little bit different for each person, depending on the state of your nervous system. It might be different based on the size of your body as well and the state of your diaphragm. So, find what works for you, whatever feels relaxing and comfortable. For some people, six seconds can feel a little bit long in the beginning 'cause they may not be used to breathing that way, but that's the place that we wanna eventually get to. If you have a HeartMath device, find which breathing cadence puts you into the highest level of coherence. It might be four, or five, or six, depending on the individual. I find for me, six to seven seconds is what feels really calming and relaxing to me. And it's simply simple. You're gonna breathe in and out through your nose, your tongue is gently placed at the roof of your mouth, and your jaw is nice and relaxed. And this is the way I'm breathing. So every time Kalea, you're speaking, I'm going into my coherence breath. Every time I'm driving, I'm going back into my coherence breath. When I'm checking my email, I'm going into my coherence breath. This is how I like to breathe throughout the day. Whenever I raise my consciousness around my breath, this is the breath that I come back to. I believe that the more we can be connected in our heart and our brain, the better version of ourselves we are. And I believe the world needs more people whose hearts and brains are connected and balanced, right? That's the other part of it. So this balances our nervous system, it gets our heart and brain connected, and you're gonna feel so calm and relaxed. And the other thing that it does is it creates a safe container around you as well. Because we have this toroidal field around us that's produced by our heart. And so when we get our heart in the right state, then we, in a positive way, we impact people around us. So, if you're communicating to a patient, then you want them to feel safe in your presence. And your breath is a sign of safety. And whether you realize it or not, it's gonna be an unconscious sign to that person's nervous system of how you feel and how they feel in your presence is gonna determine whether they want to come back and see you or not, right? Or if they write a review for you or not. Or if they go home and tell their friends about how great the experience was. Something as simple as the way you're breathing as a clinician can make a huge difference. But I also encourage people to pay attention to how their loved ones are breathing, right? Sometimes, we don't know how our child's day at school was. But pay attention to how they're breathing when they come home, right? That might clue you in more than just asking them. When you speak to your spouse, right? Maybe they're having a stressful day or maybe they're having an awesome day. Pay attention to how they're breathing when you ask them a question, right? Viktor Frankl says that between the stimulus and the response, there's a gap. And what I say is that between the stimulus and the response, there is a breath. So pay attention to how somebody's breath shifts when you ask them a question. Maybe it's not time for that conversation right now, or maybe it's time to lean in and have that conversation. So you can get a lot of insights into an individual's state and whether you wanna probe or whether you wanna step back just by seeing how their breath changes when you communicate with them. - Hmm. Beautiful. I mean, we talked about emotional intelligence, but this is a new layer to being aware of the people around you. When you're entering into your coherence breathing throughout the day when you're driving, or even in between our questions today, does it just come naturally to you at this point, or are you over there counting six in and six out, or it's so ingrained in how you exist now? - Yeah, so that's a great question. So some people ask about: How do I become conscious of my breath, right? And one of the things that I'll say is that it's so much easier when you understand the formula for behavior change. And this is for everything. So this formula will apply for any type of behavior change you want to create for your clients. So this is from BJ Fogg, he wrote the book "Tiny Habits." And in that book, he talks about the formula for creating shifts. One is, so B, which is behavior, equals MAP. So, unpack what that is. M is motivation. So hopefully, your client is motivated, and hopefully all of you are motivated to breathe a little bit better today. Even if you breathed 5% better, that's a win, right? Some of you have the opportunity to breathe 50% better. So you could have a huge win by just changing the way you breathe. So motivation is number one, and it has to be intrinsic. It can't be extrinsic motivation 'cause that doesn't last very long. Next is ability. Does the person have the ability to actually change the behavior? And of course, we all have the ability to change how we breathe, even if it's just a little bit better. We all have that capacity to do that. And the third one, which is probably the most important, that's the prompt. So what I do is I ask my clients, and maybe an invitation to ask any of you listening to this is: What's something you think about often throughout the day? And perhaps the question could be: What's the thing you think about the most each day? So for some people, it might be their phone, right? It might be their child, it might be something associated to work, right? Maybe it's email. So then the question then becomes, "Okay, let's piggyback on that thing that you're already thinking about and piggyback your breath onto that." So for example, if it's email, if you think of email often throughout the day, then the next thing I want you to think about is your breath. So we're not creating a new behavior, or a new pattern, or a new task for this person. They're already thinking of something throughout the day. We're just piggybacking the breath onto it. And once you do that, then you start thinking of your breath, several dozen, maybe 50, 100, several hundred times a day, depending on the person. And so it becomes really easy to create that habit change. Now, what happens over time is that as you change your default breathing signature, then that becomes your default pattern. So at first, if your breathing signature is two in, two out, the average person breathes about 15 to 20 times a minute. So the average American, Canadian, whatever human, overbreathes. So we don't need to take as many breaths as we think we do. We actually need to breathe way less than we think we do. And when we breathe less, every aspect of our health improves. It doesn't go backwards. Most people don't realize that. But we actually get more oxygen delivery to our cells when we breathe less, not when we breathe more. So if you wanna feel more energy, breathe less. If you want to feel more calm, breathe less. If you wanna digest your food better, breathe less, not more. And so really simple changes that we can make are using BJ Fogg's MAP formula, behavior equals motivation, ability, and prompt. Find that prompt that prompts you to then think of your breath, slow down your breath, which is gonna be 99 times out of 100, is the thing that you need to do. And then watch what happens, and then find that pace that works for you. It doesn't have to be six seconds. Just slow down your breath, right? That's all I ask. And then if you want to count, then, by all means, count. Some people like to do that. They like to be technical, but anything that slows down your breath is going to move you in the right direction. Particularly if you're slowing down your exhale, that's gonna shift you into a more parasympathetic state. - Hmm, I was so eager to ask you what it means to be a better breather, but I think you just answered it. It's really more intention, slow it down, like a slower, deeper, more intentional breath. - Yeah, and here's the other thing. So it doesn't have to necessarily be deeper. So, 'cause we actually don't need that much air. So for every breath that we take, we only consume about 20% of the oxygen. So there's actually five breaths in every breath. So you can breathe 1/5 of the amount that you're breathing, and it would not affect your oxygen delivery. So we actually don't need to breathe as much as we think we do, and we don't need to breathe as deep as we think we do. Now, it's just like if you were going for a walk, you wouldn't take a full stride with every step. You'd look kind of funny and you'd feel tired after a while, right? If you did that, you just take enough to get to the next step. So we almost want it to feel like that. About 500 milliliters in and out compared to a full breath is five liters. So, we wouldn't wanna breathe that much with each breath. We would feel exhausted at the end of the day if we did that. - Hmm, that was a really good visual. That makes sense. So you've talked so much about the benefits of healthy oxygenation. Can we look at the flip side, and will you tell us a little bit about what does it look like when we have chronic lack of oxygen, and how does that affect our tissues? - Yeah, well, some of you may know this, that our mitochondria is the only place that we use the oxygen that we breathe. And it's really interesting because you would think that we would use it in so many other places, right? But we only use it in one place. And then that oxygen is then converted into water and CO2. So the byproduct of mitochondrial respiration is CO2 and water. The interesting thing about CO2 is that it's heavier than oxygen, obviously. So for every 10 pounds that somebody loses of body weight, 8.4 of those pounds are through the lungs. So we actually exhale our body weight, body fat in particular, or glucose, whatever fuel we're using through our lungs. And 1.6 of it is through our fluids. So very, very fascinating fun fact when you think about it. And when it comes to oxygen, the oxygen, the urge to breathe... This is also kind of interesting. The urge to breathe doesn't actually come from needing more oxygen. The urge to breathe actually comes from not tolerating CO2. And so we can actually increase our tolerance to CO2 by doing specific exercises, one of those exercises would be breath holds. So I like to do something where it's actually a way, one of the easiest ways to measure mitochondrial function and oxygen efficiency is by doing something called a BOLT test. A BOLT test is a Blood-Oxygen Level Test. And what you would do, it's better to do it in the morning, ideal to do it at the same time under the same circumstances every day to kind of measure where you're at. But the way you do this is you take a few cleansing breaths, A cleansing breath is where you fully exhale. Then you would inhale, fully exhale, and then you would take a... Breathe in again and take a relaxed breath. So where you're not pushing the air out, your diaphragm is kind of in a neutral position. You don't have the urge to inhale or exhale, you're just in a neutral position. And then you would plug your nose, and you would count and see how long it takes for you to have your first urge to breathe. You're not holding as long as you can, you're just waiting for that first urge, strong urge to breathe. You want to get up to about 40 to 45 seconds. Most people can't make it. Even elite athletes can't make it to 20. And so you can work on that. So that's one thing that you could measure. It doesn't cost you anything, it's absolutely free. It takes like less than a minute to do it each morning if you decide to do it each morning. And it's a way to measure progress in terms of how efficient your body is at utilizing oxygen. Other things that you can do to increase CO2 tolerance would be slow exhales. So I'll take a full breath in, I'll take the deepest breath I can take, and then I will slowly let the air out of my nose as slowly as I possibly can. And I've gotten up to about a minute and 38 seconds. So about 60 seconds is what you wanna shoot for. But you, again, with practice, the breath is really cool because you'll be able to see rapid improvements in your breathing metrics. So you want to exhale as slowly as you can, and then exhale, and then hold on empty if you need to as long as you can. And then measure that, and that's gonna build up your CO2 tolerance. Another thing you can do is take a few cleansing breaths, a relaxed exhale, plug your nose. And I do this when I'm walking. So I forgot to say that, so when you're walking, you would take a few cleansing breaths, plug your nose after a relaxed exhale, and then take as many steps as you can. And so you would count the number of steps you can take. And I've gotten up to about 30 steps, and then I feel like passing out, and it's harder than it sounds. But that's another way to build up CO2 tolerance. So we actually become more resilient the more CO2 we can tolerate. CO2, when it becomes high, is what causes the urge for us to breathe. And high levels of... chronically high levels of CO2 can also cause chronic anxiety for people. So there's actually a condition that some people have where they don't feel scared or anxious at all. There's nothing you can do to scare these people, but you have them inhale pure CO2, and they go into a panic attack because literally your body thinks you're dying. Now, when this happens, what's really fascinating, as our CO2 levels increase, because of the Bohr effect, you actually dump more oxygen at the tissue. So this is amazing because if you think about this, if somebody stops breathing, they actually extract more oxygen from their blood than they normally would. So the body's kind of created this adaptation, if you wanna call it that or this, it's called the Bohr effect, where we can actually live for several minutes without breathing and still be extracting oxygen before there's no more oxygen left in our blood. - Hmm. I'm thinking of every time I've watched videos of free divers, and they seem to be so efficient with this process. - Yeah. Yeah, I mean, free divers have like immense lung capacity. In fact, lung capacity is one of the greatest predictors of lifespan. So, if you're wanting to increase your client's longevity, for example, get them a incentive spirometer. An incentive spirometer is like a $20 little device that you can get on Amazon, and it measures their lung capacity. And so by getting them to work on that with that device, within a few days, you'll see their lung capacity start to improve. And slowing down the breath also increases lifespan. So if we study animals in nature, a turtle takes about three breaths a minute, lives 150 to 200 years. A dog breathes about 35 breaths a minute and ages about seven times faster than a human does. So, slowing down our breath, increasing our lung capacity, these are also things that are gonna help improve longevity as well. - Hmm. I think anyone who's a healthcare provider listening is understanding the benefit of helping their patients and clients strengthen their breath work practice. But probably, everyone's wondering, "How do I incorporate this into my therapeutic encounter?" And you mentioned a little bit, maybe you should start your visit like this, but do you have any other pro tips, if you will, about how we can... Someone maybe who's in primary care, how we can build some of these practices into those maybe even fairly brief encounters? - Yeah, great question. So, I mean, and there's so many different layers to how you could do this. I mean, one is taking a few deep breaths with your patient. It will serve you, I promise, and it'll serve them. So it's a great way to kind of hit the reset button. And then one of the things that I've created is a guide, and everyone's welcome to use this, but it's a guide called "Breathe Like This, Not That." And basically it shows people how to breathe in different scenarios. So if you're checking an email, there's a way to breathe, right? If you're climbing the stairs, there's a way to breathe. If you want to feel relaxed, there's a way to breathe. If you're having an asthma attack or a panic attack, there's a way to breathe. So by gifting them this guide, it's just a simple PDF that you can download, that could be a great way to show them how to use their breath in different scenarios that they might be experiencing throughout the day. And you don't have to then sit there and teach them all these different breathing techniques. They're pretty simple and straightforward, and the descriptions tell them exactly what to do. Another way that we can incorporate breath into our therapeutic encounters is by paying attention to how our clients are breathing. Right? If we just do that, then we can tell if what we're sharing with them is overwhelming them, we can tell if they're receiving the information or if it's just kind of going over their head, and we can tap into their nervous system by simply paying attention to their breath to see if, "Hey, is what I'm saying landing for this person right now? Am I connecting with this person?" And then also paying attention to our own breath. Creating that safe space for them to share and open up, I think, is also a great way to enhance the therapeutic encounter with our clients. - This is such a lovely way to support that therapeutic partnership. And over the last hour, you've already shared so many clinical insights with us. Without giving too much away, will you give us a little sneak preview of what you'll be talking about at the Annual International Conference this year? - Oh, wow. So I'll be facilitating a breath work experience, which I'm super excited about. So you'll get to experience the power of breathing, especially when you breathe with other people who are on a similar journey. Truth seekers, I like to call us. So you'll be able to experience that. So I definitely encourage people to attend there. I'll be sharing some imagery and showing people the irrefutable connection between some of the things that we talked about today. I'll be testing a few people in the audience for their nitric oxide levels. So you'll get to see that. And then I think we're just gonna have a lot of light bulbs going off for people, and I'll be sharing a few different breathing signatures and ways that we can breathe to help improve sleep quality, to increase energy. There's a breathing technique I'll teach called yogic coffee. So if we're trying to get our clients off of coffee, there's a way that they can breathe to give them a jolt of energy, and also be sharing ways that people can breathe to further regulate their nervous system and balance their left and right hemisphere. So, we'll be sharing a lot of good information that I think people will really value and walk away with tremendous insights and practical application. - Well, I know that I have learned so much from today's episode. Really looking forward to hearing your AIC presentation. Dr. Patel, thank you so much for spending this time with us and for sharing your love and your passion for breath work. - Oh, it's my honor. Thank you, Kalea, I appreciate this opportunity, and I look forward to meeting you. - We'll see you all at AIC. - Discover the latest research and innovative clinical practices at IFM's Annual International Conference. For more information, visit aic.ifm.org. The future is functional.