Why You’re Still Stuck: Oxygen, Stress & Breathing

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Do you feel like flares of your symptoms come out of nowhere with no rhyme or reason? You try to fix everything from your diet to your daily routine, and yet you don't make progress. I see this all the time in our practice, and what I've found is sometimes the real problem isn't what you think it is. And frequently two of the levers that we help patients identify and pull in order to get well are actually about breathing and the acid-alkaline balance or pH of their body. So that's what we're talking about today. So we had a recent case in the practice of a patient who was doing all the things, eating carefully, batch cooking healthy, nutritious food, taking care of other family members, holding it all together. And yet during her day-to-day life, she was struggling with pain, inflammation, anxiety, all kinds of other symptoms that were really derailing her from getting on with life, and taking care of the people she loved. We see this, as I said earlier, all the time. What she didn't realize, as many of our patients don't realize, is that a big part of their problem is actually linked to breathing, and breathing is linked to pH or the acid-alkaline balance of the body. What does all of this mean? So the way that I explain breathing to patients is that most people think that breathing is about oxygen, but really breathing and what drives us to breathe is carbon dioxide. What many patients don't realize is that as their anxiety and their stress levels rise, it triggers the body naturally to breathe more. When the body gets used to this level of chronic heightened anxiety and tension and stress, what happens is the body's set point for carbon dioxide drops, and patients end up with what we call hyperventilation syndrome. This is one of the first things we screen for in the practice, and the reason why, to be totally honest with you, is that what I found in practice and through mentors of mine who identified this problem for me is that if you tried to fix things without first fixing dysfunctional breathing mechanics, you would often make no progress. And I want to explain the mechanism behind this because it's actually really important. So we breathe in response to the buildup of carbon dioxide, and when you live in a state of constant nervous system arousal and anxiety and stress, your carbon dioxide threshold or tolerance drops, and you end up breathing more than you should per minute. What does this do to the body on a cellular level in our cells, tissues, joints, vital organs, brain? Carbon dioxide actually opens blood vessels and causes oxygen to come off the hemoglobin molecule and enter the tissue where it can be used to generate energy. What happens when we chronically hyperventilate is that carbon dioxide levels remain low, and as a result, blood flow is restricted throughout the body and oxygen delivery is impaired. Now, this level of impairment isn't visible to, say, a doctor. On casual observation. You can't even measure it with sophisticated and advanced lab techniques unless you're really tight with your collection, which means your procedures for how you collect the lab sample and then process it. And in the end, you don't need to be, because what we find in practice is if you just screen patients for hyperventilation syndrome and give them practical tools that they can take home and do every single day, you can solve this problem. Because arguably, it's not even medical in nature. This is something breathwork coaches, personal trainers, strength and conditioning coaches often work with clients on, whether they call it this or not. What happens at the cellular level as we reduce carbon dioxide levels is the body and its cells wind up in a state of relative hypoxia, or lack of oxygen. As this worsens, all physiologic processes worsen as well. This is why you will find in the literature, if you bother to go and read it, that across an incredibly broad range of problems and medical issues, hyperbaric oxygen is incredibly effective. Whether you're talking about stroke, heart attack, autoimmune disease, idiopathic and unusual inflammatory disorders, the list goes on and on and on. Hyperbaric oxygen— why does it do this? It does what CO2 is supposed to do in normal day-to-day life. Hyperbaric oxygen increases the pressure of oxygen in the blood thereby increasing the pressure of oxygen in the tissues, right? When you look at all these illnesses, like I said, what they have in common is this foundational deficit in oxygen delivery and utilization. Oftentimes patients don't even realize that this is not a hemoglobin problem. It's not a lack of red blood cells or an anemia problem. It's not a lack of cofactors like nitric oxide. It's not a lack of any of that stuff. What's actually happening is they're not breathing optimally for their physiology,, and the result is a lack of oxygen delivery to cells and tissues. Patients have a tendency to get wrapped up in or curious about supplements, medications, procedures, biohacks, all kinds of things that we call shiny objects, which to be clear, have a place. What gets very little attention I've found is breathwork and the importance of optimizing breathing mechanics for optimal physiology. This to me is not just about the prevention of illness, which is very much important and part of optimal breathwork. It's also about long-term health, wellness, and longevity. What does this have to do with pH or acid-base balance in the body? So quick overview, what are acids? What are bases? This has to do with the relative abundance of protons within a solution. In very general terms, vinegars, for example, are acids. Something like baking soda is a base. Big deviations from optimal pH, and pH varies around the body in different compartments, and particularly within the cell, significant deviations always go along with chronic disease. And so what happens is we hyperventilate the body. What we tend to see is that these patients wind up with more and more and more of a metabolic acidosis, not bad enough to land them in the urgent care or the ER, but bad enough chronically that over time it saps their restores of minerals. It's very hard to see this in most lab testing for various reasons, but you see it in clinical practice that when you give these people back the minerals that they're missing and you normalize their pH, some very profound improvements in their clinical state. Can result, which is why we pay very close attention to breathwork, pH, acid-base balance, and we try to correct all of these things at the same time when we're taking care of our patients. So 3 things I share with patients that I'm going to share with you today. So notice your breathing, particularly when your symptoms are at their worst. What's going on in your life that may be triggering you to what we call overbreathe? Notice not just how often you're breathing, but how you're breathing. Are you breathing shallowly? Are you taking deep breaths? Are you breathing with your belly, your abdomen? Your neck, your traps, your chest. Notice all of these things because when we coach patients into a better or more functional breathing mechanics pattern, always looking at these little details because they can make an enormous impact. As we like to say, small hinges swing big doors, and this is absolutely true of breathwork. We track urinary pH in patients, not all of them. The way that we do this is we look for a fasting morning urinary pH, so a first morning void. We want that averaged over 7 days, and the reason why we want it averaged over 7 days is that there's a lot of day-to-day variability. And if you just trust one number, particularly if you just trust, say, like a number you get at a commercial lab like LabCorp or Quest, you're only getting one data point, and that's just not enough. You're gonna see that there's a huge variability here. We'll even extend this in some cases and do 4 urinary pHs throughout the day. Some people track salivary pH. I won't get into that here. We rely mostly on urinary pH. This is one of the metrics in the Repair Deficit Score, uh, or survey, which is the lab panel that I really focus on as far as optimizing blood and biomarkers in patients with inflammatory and autoimmune conditions for best outcomes. If you want to learn more about that, I've got a long article on the repair deficit panel at my Substack, drstillmanuncensored.com, where you can learn more about why I run that panel and what it means. Anyway, we track urinary pH and we seek to optimize it as we replete minerals in the body and correct lifestyle factors like hyperventilation that are chronically causing this low-grade acidosis. And then last, look at the sleep environment, look at the lighting environment, and look at what I call the energetic environment. So what people also don't realize is that their environment is creating their stress. They're very quick to say, it's my in-law, it's my kid, it's my lawsuit, it's my job, it's my boss, it's my spouse. There's all sorts of people in life who we can blame our stress on. However, what you'll see is that when patients fix their environment, they'll often realize that the environment was creating a lot of stress that they weren't even aware of. Artificial lights often have flicker that you don't see that triggers an enormous amount of stress in the brain. So swapping out artificial light for natural light can be a huge win. Integrating 3 10-minute walks during the day. These are periods of time during which I want patients to slow down, relax, calm their nervous system, connect with nature. Don't do it with earbuds in your ears, listening to something. Just soak in all the energies in nature, which we know have a calming effect on the nervous system. And one thing we know about inflammation, about pain, about autoimmunity, is the patients who have the worst symptoms also tend to have the most overactivated nervous systems. They often are in a state of what I would call hyperarousal, which by the way goes along with the breathing mechanics I just explained. We also want to look as much as we can on not just on at the daily environment that's creating stress with things like light or sound, high-pitched noises, appliances that don't work right, have a weird noise that's coming out of them. Sometimes electronics just create a low-grade hum that when you unplug them disappears. You might be surprised at how your nervous system relaxes and downregulates when you reduce these little tiny, seemingly inconsequential stresses. Last, sleep. We want the sleep environment, the bedroom, to be an absolute sanctuary where there's near complete darkness, silence, and I really believe strongly in minimizing the electromagnetic pollution within the bedroom during sleep. I've covered that in a podcast recently with an MD named Loretta Ritter, who specializes in sleep medicine and is a pediatric neurologist by training. Electromagnetic fields from Wi-Fi, Bluetooth, cell phones, et cetera, they have a meaningful impact on sleep quality and architecture, which is really just becoming something that more and more people are waking up to because they're experiencing the proof of the pudding in the eating. They're turning off their Wi-Fi router, they're moving things out of the bedroom, they're making that sleep sanctuary, and they're waking up feeling better and rested and just ready to tackle the day in a way that they haven't sometimes for years. I've been astonished at the testimonies patients give me about this. All of this comes back to affecting how you breathe, your state of arousal, and your nervous system that then controls your immune system, all your vital organs, the outcomes in our health and wellbeing. Very important things that most people don't notice. Most doctors don't talk about that. I'm passionate about because of what I see them doing for my patients in our practice. A lot of this, what we do to correct all this is packed into the 14-Day Reset, which is where I start all of my patients. And I share this with you to give you some insight into what we see being the most important, most impactful habits for health, wellbeing, happiness, and vitality. So thank you as always for joining me. Take care and have a great day.