Mim: That’s very kind. A bit dated now, but thank you.

Andrew: Well, let’s go back to…

Mim: There have been others to the collection since then.

Andrew: Yeah. Well, let’s go back to around that time. Maybe before that time even, when you first began your practice as a naturopath, can you take us through the beginnings and also when you first became interested in Buteyko breathing?

Mim: Yeah. Well, I’ve been practising since 1988 as a naturopath, so that officially makes me a dinosaur, I think. And it was not too many years after that that I had heard about Buteyko, because it came out to Australia from Russia. And I heard about it that it was good for asthma and I…at the time, I had a radio show in “JJJ” the radio station. And it was an hour every week, which was pretty amazing. Anyway, the guy that was teaching Buteyko, I think he just basically wanted me to promote him. So he offered me a course and I had asthma. So, I did a course, and it was just one hour a day for three days in a row. And it totally cured my asthma, of which…I did have suffered from asthma. And I was pleased. I don’t know why I wasn’t more pleased. But I’m kind of “glass half empty,” as you know me. And so, it wasn’t until 2011, a long time later that I decided to train as a Buteyko teacher, because I realized that it’s something…that it’s difficult to get from a book or video. And so, I found the teacher that I wanted to train with. I think he’s one of the best breathing educators in the world. And his name is Patrick McKeown, and he’s an Irishman. And he had actually gone to Russia to study with Konstantin Buteyko. Buteyko died in 2003. So, Patrick had studied with him before that time, and…obviously. And so, I decided to study with Patrick and he was in the States. And so I flew to Los Angeles and did a 10-day training. And it really, really affected me deeply, I suppose and transformed the way I looked at health. And I’ve been very, very interested in breathing and teaching breathing since that time.

Andrew: Okay. Can you take us through the dysfunctional breathing, as opposed to Buteyko breathing? What’s the difference? Or forgive me, before you do that, I just have to pull you up on something. You said you had a radio program on “JJJ,” but you said in the 1980s, that’s when it was two… “JJ,” wasn’t it?

Mim: Yeah, no, it started with the…the ’88 was when I started practising. It was later than that, but I had the…I was actually it was…it was “JJ” when I started, and then they went to “JJJ”, and then went to…the adults’ radio anyway, they’re nighttime radio, can’t remember now what it’s called. Anyway…

Andrew: I’m showing my age too as well.

And now, I can’t remember. Anyway, so dysfunctional breathing.

Andrew: So, dysfunctional breathing as opposed to Buteyko?

Mim: Well, Buteyko, is a particular kind of breathing that is not normal breathing. They are exercises that are designed to bring your breathing to a functional state. So, examples of dysfunctional breathing would be, you know, asthma is clearly dysfunctional breathing condition, but things like do you yawn a lot, do you mouth breathe? Do you snore? Do you sigh? Can you hear your breathing? Can you see your breathing when you’re at rest? All of these are signs that your breathing may be dysfunctional. And the exercises are designed to change that. And it’s via neuroplasticity. So basically, they’re changing…the exercises are changing your breathing centre in the brain. So, your breathing will change automatically as a result of doing these exercises.

Andrew: So is it basically training your breathing centres to cope with…would it be higher CO2 or low oxygen?

Mim: No, no, it’s about carbon dioxide. So, carbon dioxide is our driver to breathe. But very strangely, although you know, oxygen is king, it’s not…inspires breathing. We can tolerate relatively low oxygen before the brain takes note, but a slight rise in carbon dioxide and it’s all hell breaks loose. But basically, if your breathing is dysfunctional, in general, your tolerance to carbon dioxide is poor. So that all of the Buteyko exercises are increasing carbon dioxide levels so that you tolerate them better. So that you will breathe quieter, you will…you know, your breathing rate, the respiratory rate will be less per minute, and ultimately you’ll be breathing low and slow.

Andrew: Gotcha. What about the deep breath though, you know, we’re sort of attuned to the yogic type deep breathing, is that different or is that same functional breathing?

Mim: I think it’s semantics really. So, we say you don’t want big breathing. But deep breathing is fine. So deep breathing is basically using the diaphragm muscle. So I’m breathing into the lower parts of my lungs, but I’m not breathing big. And I think that that’s the difference. Because you know, I think before I did the training, if I’d heard anything about breathing, it would be “Take a big deep breathe in and a big deep breathe out and breathe out through your mouth.” And this is totally the opposite of what you’re taught in Buteyko, which is only nasal breathing. And Buteyko, the method itself didn’t actually emphasize diaphragmatic breathing. And this is why I like Patrick McKeown, because he’s really, you know, taken the tenets of Buteyko and added on the other things of good breathing. And he’s, you know, at the forefront of the research of breathing, which, although we have been doing for quite a long time, the actual information about breathing, there’s a lot of recent research, which is absolutely fascinating. And, you know, the effects of breathing on things like sleep apnea, and so on, which I’m particularly interested in.

Andrew: Yeah, that one, that’s a huge health issue, but can I first…

Mim: Well, yeah. They’re very underrecognized again.

Andrew: Yeah, massively. Can I first ask, though, with regards to you mentioned using the accessory muscles? How do we assess whether a patient is using the accessory muscles to breathe rather than diaphragmatic breathing?

Mim: Well, I mean, the diaphragm will always work slightly, but you know, often it’s kind of a very poorly used muscle. And it’s this huge muscle underneath the ribcage that separates the chest from the belly or the thorax from the abdomen. And, you know, it attaches to the ribs, it attaches to the spine, and it goes up and down 20,000 to 30,000 times a day. And it should be about four millimetres thick. But apparently, when people don’t use it enough, it’s only one millimetre. So, when you’re not using this main breathing muscle, you’re using what we call the accessory breathing muscles. And these are the scalenes, the trapezius, the sternocleidomastoid. And so, you can actually see and particularly on a slim person or a child, you can see the shoulders going up and down. And so that person is…you know, you shouldn’t be able to see anyone breathing when they’re at rest. So, if you can see any movement of the chest, then we’d call them a chest breather. And things like…you know, so that can lead to all sorts of problems. So, when people say “Oh, I hold all my stress and my shoulders,” well, the fact is you’re probably just not using your diaphragm properly. So it can lead to headaches, it can lead to temporomandibular joint pain, it can lead to you know, neck and shoulder pain.

So, there are all sorts of things. And of course, the diaphragm is amazing, you know, the muscle that through the diaphragm goes the aorta and the inferior vena cava and also the esophagus. So it helps the circulation from the lower body to the upper body, it helps the…you know the diaphragm is the lower esophageal sphincter. So, this is thought to be up to 40% of reflux is due to poor diaphragmatic breathing. There’s also a really big lymphatic vessel underneath the reservoir of lymph underneath the diaphragm. And so it’s loads right. Yeah, exactly. Throughout the whole, you know, improving lymph flow. So, it’s this amazing muscle that we don’t recognize enough.

Andrew: In my mind

Mim: And so I teach that breathing, but that’s not Buteyko. So, Buteyko is all about, as you alluded to, before, all about the gas, carbon dioxide. So why do we wanna increase carbon dioxide? Well, there’s a whole host of reasons. So carbon dioxide…and I thought, Andrew, by the way, maybe we can do a couple of the exercises so people could experience this.

Andrew: Sure. Yeah, I love that.

Mim: Yeah, but first…the benefits of increasing carbon dioxide, if they’re too low, so it’s…if someone is dysfunctionally breathing, i.e., they’re mouth-breather, you know, that symptoms that I mentioned before, and perhaps I can actually…I don’t know whether we can have the notes to the show, but I can put a symptom checklist through to you.

Andrew: Absolutely.

Mim: And people can actually see whether they may in fact be dysfunctional breathers themselves.

Andrew: Sorry. I cut you off there.

Mim: That’s

Andrew: Like, I cut you off. We’ll put them up on the show notes later.

Mim: Thanks, Andrew. So, the benefits of increasing carbon dioxide, there’s several. First of all, it’s a very tranquillizing gas. So in the old days, when people had panic attacks, to get them to breathe into a paper bag, recirculating carbon dioxide. And so it switches on the parasympathetic nervous system. And, Andrew, as you know, as a naturopath, we’re always very eager for people to get less sympathetic dominant, more parasympathetic.

Andrew: Yeah.

Mim: So, these exercises are fantastic at that. The other thing about carbon dioxide is it helps to relax smooth muscle. So, you know, we’ve got skeletal muscle, which we’ve got conscious control over, so we’ll flex and will stretch, smooth muscle, which lines all the hollow surfaces of the body. So, it’s the tubing if you like. So, it’s the blood vessels. It’s the airways, it’s the gastrointestinal tract, it’s the bladder, the uterus, but relaxing or getting that smooth muscle into its relaxed state, that’s exactly how the Buteyko helps with asthma. Because of course, with asthma, the airways are always slightly constricted, very twitchy. So in response to any trigger, whether it’s stress or dust or cats, whatever, they will go into the asthmatic episode, with constriction of the bronchi, bronchioles. And you know, with that tissue producing mucus in response to the constriction, so when you’re allowed to have the airways in their natural relaxed state, they’re less likely to be triggered, so the smooth muscle of the blood vessels, so we’re improving blood flow, we’re improving circulation.

Buteyko, himself, was studying breathing in relation to hypertension, which he had. And so of course, if you’ve got a blood vessel, an artery that’s constricted, the pressure is going to go up. So it’s a very simplistic look at blood pressure. But it is one of the mechanisms whereby we can bring blood pressure down, I’ve seen that time and time again, you know, take someone’s blood pressure, do an exercise, take the blood pressure again, and both systolic and diastolic has come down. And another area where…yeah.

Andrew: I was just gonna say that that is so interesting because if you think about what is it 95% of hypertension is essential hypertension, i.e., no cause. Could it be that when underutilizing the diaphragm in most people?

Mim: Well, this one’s more about the blood gas, the carbon dioxide. So, there is a relationship between breathing and blood pressure, but with respect to this is training the body to tolerate higher amounts of carbon dioxide or normal amounts of carbon dioxide, to relaxation of the smooth muscle of the blood vessels. And another area of, you know, why this gas part is so important is that increasing carbon dioxide will actually improve oxygenation of the body. And that kind of gets people in a bit of a…like, it sounds like a paradox what increasing carbon dioxide increases oxygenation, but it’s actually the border effect, or the oxyhemoglobin dissociation curve, where the hemoglobins holding onto the oxygen as it’s on the red blood cell going around the body. But it’s when there’s more carbon dioxide, that the hemoglobin will release the oxygen to the tissues. So, we’re improving circulation, we’re improving oxygen delivery. So this is…you know, and improves concentration and it improves energy. And then there’s the ..

Andrew: So everybody needs [crosstalk 00:15:49] everybody needs to get and review oxygen gradients.

Mim: Yes, yeah…it’s yes.

Andrew: I think just the…

Mim: It changes the paradox, but it…you know, that the Bohr effect was 1903.

Andrew: Yeah, it’s like a stretched elastic band, that you need that tension before it can release.

Mim: Yeah.

Andrew: I mean, I could go other ways, you know, patent foramen ovale, the reason that the foramen ovale closes at birth is because of oxygen gradients and carbon dioxide gradients.

Mim: Yeah, but that…I need to learn that one.

Andrew: Anyway, But I can see so many opportunities for therapy here. Like with Buteyko, if you’re talking about smooth muscle relaxation, what about IBS? What about PMT? You spoke about essential hypertension, but what about conditions like?

Mim: You know, potential…I have had some success there. But of course, you know, that being you know, whether or not that’s part of an autoimmune response, you know, we’d need to be looking at that as well. But definitely people with…just with who feel the cold, don’t feel the cold, you know, that their circulation’s improved. So it’s…you know, and I think you kind of mentioned, it’s got…the application to so many conditions. And so, as I said, when I did the training, I just thought, “I’m gonna look at each patient very differently now, and see whether or not their dysfunctional breathing may be contributing, if not, the whole bit,” but it’s really that, you know, we’re very complex beings and so, I’ll look at the patient, they’ll come in for whatever condition and I’ll look at their breathing. “Is their poor breathing, contributing to their condition?” And you know, sometimes…well very often, the breathing will help so even with it…well, even with anxiety, especially with anxiety, just giving them a couple of very simple breathing exercises, which we could do in a moment if you’d like to, is a really powerful tool. In addition, of course, we’ve got gorgeous herbs and supplements, magnesium and so on. But, you know, as a lifestyle skill, it’s a life skill. It’s fundamental. Do you know?

Andrew: Absolutely.

Mim: So, it’s a wonderful addition to the toolkit that we all have.

Andrew: Can I ask you before we do this exercise, can I ask you first about you mentioned nose-breathing, and what about overcoming physical barriers, like polyps or, you know, busted noses and bent septums and all that sort of thing? How do you cope with that with nose-breathing or training to nose-breathe?

Mim: Well, interestingly…I mean, in the entire time that I’ve been teaching it, I have had probably one person and I know Patrick, who’s taught thousands and thousands. He said that there’s just a handful of people that they…that because of the structural issues cannot breathe through their nose, you know, and then, you clearly will require surgery. But if someone can breathe through their nose for 30 seconds, they can breathe through their nose.

Andrew: Gotcha. All right.

Mim: So, s but it…like if the mucosa is inflamed, and so there’s an occlusion of the airways that way, nose-breathing will actually…so mouth-breathing will inflame the airways, nose-breathing, has an anti-inflammatory action itself. I mean, there are nose-clearing exercises that we teach, but you know, maybe as a naturopath that that’s what I need to recommend. Perhaps it’s a dietary, sensitivity or, you know, we often recommend saline rinses, and so if someone’s nose is congested, there are nose-clearing exercises and then there are the nasal rinses. So it’s all about trying to get that nasal area clear.

Andrew: Gotcha.

Mim: So, yes…but polyps are usually because of dysfunctional breathing, and if the ENT takes the polyp out without restoring good breathing, that polyp will grow back.

Andrew: Right, gotcha.

Mim: So, yeah. Yeah.

Andrew: You’ve preponderant really. Okay, I’ve readied myself. Take me through a breathing exercise.

Mim: No, actually I just wanted to…I know you’re joking, but it’s really interesting, how many people do fear breathing. And it took me quite a while to realize that, that sometimes I say, “Well, you okay, about doing a breathing exercise?” they’re actually very scared. And that’s often a very early childhood thing. So, you know, imagine if you’re a child with asthma being taken to the hospital, you can’t breathe. So talking about breathing or doing breathing exercises can be very fearful. And early childhood, like near-drownings or the cord being around someone, you know, as the baby’s being born. It’s a very cellular, deep-deep fear around breathing.

So, you know, you’re joking about it, but people can be very stressed. So, this is what’s wonderful that there are very many different styles of breathing exercises, that all have the same outcome. But you just…I just now…and it took me a few years to realize that, so I’ll just say that if anyone feels anxious with this, you must let me know because we can try different things. So, I’ve just had a thought last day and this morning, you know, one of the things is that we ask people to have their mouth taped at night so that they’re not mouth-breathing at night. And gee, well we use…just excuse me, I’ll just…we now use…sorry, a tape that what usually, we…this is called “Myotape.” So that goes around the mouth, and it’s elasticated, so it draws the lips. So, you’ve got lips sealed.

Andrew: Right, okay.

Mim: Let’s go…well, actually…

Andrew: Not actually a physical barrier, and you can breathe if you need to.

Mim: If you need to. Because up until recently, we were using micropore, so over the lips. And basically, you know, and we…they’ve got tabs on either side, so you know if someone has difficulty with…that they wanna breathe, they’ll just remove it. So it’s not a big issue. But anyway Patrick’s created this micropore, but I always mention I had a client this morning, she’s actually a university lecturer, totally terrified, will not countenance wearing this. So, I’ve now had all consultations with her. And she’s said that she might wear it for an hour during the day.

Andrew: Wow. That’s cool.

Mim: And she’s got extreme anxiety. I mean, it’s so…so we’re doing…we’re making great headway, and she’s really improving her symptoms, but if she’s mouth-breathing at night, which she is, then we will only go so far. Anyway, so I can still see the whites of your eyes. So, shall we commence? So this is…

Andrew: Yeah.

Mim: … a little exercise where we’ll just do it for…close your mouth, Andrew.

Andrew: Now, I remember your advice previously about sitting back in my chair.

Mim: Oh, yes, yes. So, the back needs to be straight. The mouth is closed, tongue resting on the roof of the mouth, the tip of the tongue behind the front teeth. And we can talk about tongue posture later because that’s really interesting too. But what I’m going to ask you to do is I’m going to ask you to take three breaths and a breath is an inhalation with an exhalation through your nose. So, three

breaths, inhale, exhale, inhale, exhale, inhale, exhale. At the end of the third exhalation, I’d like you to pause for a count of three. So one Mississippi, two Mississippi, three hippopotamus, and then you do the three breaths again. So we’re gonna do a bit of a sequence of three breaths, and a pause, three breaths, and a pause. Are you good? Good to go? Fantastic. Let’s start. We’ll start now. We’ll start now.

Okay. So taking three breaths, just three normal breaths. And then at the end of the third breath, just pause…for a comfortable count of three, and then you start the breathing again. Okay. Shoulders dropped and belly soft. And the tongue is resting at the roof of the mouth, the tip of the tongue behind the front teeth. If that feels too short to three, then you can reduce it. But if you feel you can comfortably extend that pause to more than three, then I’m gonna ask you to do that. See, if you…how long you can comfortably extend the pause. Just comfortable. I don’t want you to be stressed by this exercise.

So, Andrew, is there any more saliva in the mouth? Little bit? Do you feel any warmer? Maybe not. Okay. So, after a while…we’ll just keep doing this, we’ll do this for another few cycles. It’s good. Just what’s comfortable. And just noticing if there’s more saliva in the mouth if you feel warmer, and sometimes you can see the glossiness of the eyes, you can feel more colour in…you can see more colour in people’s faces.

Okay, so that’s about a couple of minutes. Usually, Andrew, before we start, I ask people if they’re feeling, you know, what their sensations are, do they feel anxious and so on, so how’re you feeling now, Andrew, so we’ve done that for a couple of minutes? Are you feeling good?

Andrew: Absolutely. Sorry, I’ve just held it for a count of 10. Forgive me. So, for our listeners out there, what I was doing is deep breathing, diaphragmatic breathing, I felt quite relaxed, a little bit shaky on the first breath. And what I was doing for our viewers, I was showing my inspiration and expiration with a rising and the lowering of my hand. And then I was counting with my fingers each second at the end of the three breaths that I held my breath. That was really incredible because that increased from what was at 6 to 9, 10 over three breaths?

Mim: Yeah. So, what the goal of that one is actually we don’t put…that that one is a Buteyko-style. So, we don’t need it to be diaphragmatic. It’s really about the pause. What the thing is that the pause is increasing carbon dioxide. So, it’s just having a pause, it doesn’t need to increase. But that was very impressive that it did. But just holding the breath that will mean that you’ve got an increase in carbon dioxide. So those prompts that I was asking of, you know, do you have more saliva? It’s a sign that your parasympathetic nervous system has been switched on. Do you feel warmer? It’s a sign that the smooth muscles relax, you’re getting more circulation. And so that’s what I’m assessing throughout that.

Andrew: Yeah, definitely a warmer face.

Mim: Yes, yeah. So that…you know that depends. And it’s quite a good indicator when I’ve got someone who I’m assessing for how stressed they might be, or people have been getting saliva, cortisol is you know how long it takes them to have more saliva in the mouth, which is an indication of parasympathetic nervous activity. So if sympathetic, you got a dry mouth, parasympathetic, you’ve got more saliva in the mouth.

Andrew: Gotcha. Okay, so what about cautions though? So, you know, so CLAD, COPD, is when you’re…and I might be wrong on the physiology of this, but my archaic knowledge of this is that the oxygen or the breathing signalling flips in COPD so that you instead of high CO2 your body is signalling off low oxygen, is that right? And, that’s why…

Mim: Well, with those chronic conditions, we actually might be looking more about…so, diaphragmatic breathing, I’m just is not Buteyko, Buteyko that was not part of it. But with someone like that, they probably do have higher carbon dioxide. And what we call the chemoreceptors are blunted. So the Buteyko exercises themselves may not be appropriate for that cohort. But you know, I would be looking at them using that, because they would be using the accessory muscles a lot. So, I would be teaching more about diaphragmatic in that regard. So but, you know, there are different Buteyko exercises, and the one I gave you was relative, you know, I could…I would be happy with someone who was pregnant doing that, we know someone with AF doing that, but there are stronger exercises where you are holding the breath for much longer, where there would be contraindications.

So someone with type-one diabetes, someone with atrial fibrillation, as I mentioned, pregnancy, you know, so there are certain exercises that you don’t teach, but there are many exercises, so you kind of have this kind of collection, a repertoire that you’re gonna give for…you know, will suit certain conditions or in fact certain patients as well.

Andrew: Right. What about emphysema by the way?

Mim: That would be similar. It’s just that the actual Buteyko itself is probably not as valuable as helping them with their breathing muscles, like their diaphragm, but it still might, you know, particularly you’d be training them not to mouth-breathe and just kind of like, you know, could to get the breathing as good as possible. But with any damage to the lung tissue, you know, you’re not going to remedy that. But you got to improve how they breathe.

Andrew: Right. Gotcha. Okay. And so, Patrick McKeown, now he came out to Australia, was it last year, was it 2020, or was it 2019?

Mim: He…2020, he was putting a foot on the plane to come out for training and COVID struck. That was in March. And then, so we do that by Zoom. And we just did another training by Zoom. And now, he’s saying he wants to come out to Australia in 2022. So, we’re gonna have another training. Yeah, yeah. And it’s a lot of people, there’s a book by James Nestor called “Breath,” which I think a lot of people have read and it’s got a lot of people interested breathing. And Patrick also has released, I think it’s his ninth book called “The Breathing Cure.” And so, it’s become internationally, much more widely talked about, it seems crazy. And I find it really interesting, because, in Australia, we’re very good at diet and exercise. But you know, the fundamental thing is breathing. That’s got to be right before a good diet, before exercise.

Andrew: Absolutely. Now, you teach practitioners how to teach patients how to breathe, correct?

Mim: Well, it’s mainly Patrick, but I do…yeah, I am teaching now one part of those, but mainly I teach to the general public. And I assist Patrick with practitioner training.

Andrew: Gotcha. Okay. So we’ll definitely put those resources up on the show notes upon the “Designs for Health” site…

Mim: Thanks, Andrew.

Andrew: …on the web. There’s so much that we could talk about, Mim, I’m just…there’s so much in your brain. And I hope you don’t you know, have a very long career, but it’s an illustrious career. And I thank you so much for taking us through just a little bit of not just functional breathing, but also what Buteyko can do or how Buteyko can help patients. So thank you so much for joining us on “Designs for Health.” Forgive me, on “Wellness by Designs” today.

Mim: My pleasure. Thanks for having me, Andrew.

Andrew: Our pleasure. And of course, as I said, we’ll put all the show notes and all of the other resources up with all of the other podcasts on designsforhealth.com.au. Thanks so much for joining us today. I’m Andrew Whitfield-Cook, and this is “Wellness by Designs.”