81- Meditation, Breathing, and End of Life Care with Dr. Brad Lichtenstein

Announcer: 00:01 Welcome to the summit for wellness podcast where we help you climb to the peak of your health and now here is your host, Bryan Carroll.

Bryan: 00:16 Hello, hello and welcome to episode 81 of the summit for Ana's podcast. I'm your host, Bryan Carroll and today's guest, Dr Brad Lichtenstein is going to take us through a journey about death. You see the thought of death scares most people, especially since there is so many unknowns that go along with it and also the recognition that you may not have done everything in life that you planned on doing. Dr Brad has actually been a part of a huge study around hospice patients where they were testing different methods to make the passing process easier. His focus was on breath work and meditation practices to help with the transition and there's a lot of other topics that we talked about in this episode, so since we have a lot to cover in this episode, let's get started. Dr [inaudible] being Steen's approach integrates naturalpathic medicine, mind body medicine and biofeedback depth in somatic psychology, eastern contemplative practices, Yoga and movement and end of life care. He serves as an attending physician for the mind, body medicine and chronic pain clinics at best year. Thank you Dr Brad for coming onto the show.

Dr. Brad: 01:26 Thank you.

Bryan: 01:28 And that, looking briefly at your bio here, it looks like you've had a ton of experience with different, alternative practices for medicine. So can you go into your background a little bit and tell us like what got you into this pathway and why did you want to learn about all these different areas of health?

Dr. Brad: 01:47 Oh, yes. Well, growing up I never thought I was going to go into healthcare at all, anything, not even alternative healthcare. growing up I thought I was going to be a, an actor and on Broadway. and that didn't happen. Although when I go to Broadway sometimes I do dance down the street. But I got into this, it was really circuitous route when I went to college. I went to Emerson College in Boston because they had a speech pathology department and I thought it was something I could fall back on. Right. So it was like one of those things. They had a huge theater school, but I got into interested in speech pathology. And the more I got into it, the more I learned about psychology and brain science. And how it evolved is that I thought, Oh, you know what? I think I really want to be a medical doctor.

Dr. Brad: 02:45 So after a long time I finally switched and I applied to conventional medical school. But that didn't seem right. So simultaneously it was, I was going through this. I was a vegetarian, I was a vegetarian since 13 but the main source of food and my main source of protein was dairy. And I had ECZEMA. I had GI issues every day and no one, all the doctors I went to, no one ever said food could be connected to your health. So when I was in college at the same time I was at Emerson, I ended up in the hospital a few times with GI, really severe GI issues and no one told me anything. So I finally found a cookbook looking for vegetarian foods by, I think it was Anna Marie colbane about healing with whole foods and she has this whole quote from a doctor about how dairy could cause food problems.

Speaker 4: 03:46 Okay.

Dr. Brad: 03:47 Took me six months, gave up dairy, never had any problems again. My eczema cleared up, everything got better. Wow. So that was the first thing that was saying food is really important. And then I got into herbal medicine, so he's going to go to a medical school in Chicago. Sat there for four hours after I packed up to go and said I can't do this. Turned around and that's when growing up in Pittsburgh I found out about natural pathic medicine. My acupuncture said there's a place called, she didn't say it best year, I think she said bastard, but she said there's this place in Seattle. This was in the late nineties early nineties so I went to the library, did research and came out here. So just like my experience, that's a winding answer because there was so many other factors. I mean that was just the factor that said, food, nutrition, alternative care is really helpful. And I had no idea what a naturopath was. I didn't know anything about it and I just showed up here and decided to be here. so during that time of being here, you know, natural pass learned so many things. We learned diet and nutrition, we learned physical medicine. We also learned about homeopathy and herbal medicine.

Dr. Brad: 05:16 The real interesting thing I kept coming back to though is how do we live our lives? It was more than just the choices that we make. It's, it's really coming back from intention and saying, well, how am I participating in my life? And so my career as a naturopath also changed because of that as well.

Bryan: 05:37 And so you actually ended up doing a very large study with hospice patients. So with your desire to learn more about life, is that why you started working with people at the end of life so that you can learn from them what they thought of life? Well, well

Dr. Brad: 05:54 that's, that was a result of it. I, when I was in medical school that again, that was in the early nineties, mid nineties, I started doing some HIV work. we had an HIV clinic at best year. And then I started working with other organizations in Seattle. So even before I worked, graduated, I had been doing work with the Scientific Review Committee of the Seattle Treatment Education project and other things. And my background is that I was also in those, during those Emerson college days, misdiagnosed with being HIV positive,

Dr. Brad: 06:33 probably one of the most, probably the most, life altering experiences. so because it was 86 back then, I 86, 87, I thought, you know, that's it. My life is over, I'm going to die. And then I was told that that was not the right results. Those weren't mine and a number of other things happen. So that was really profound in influencing my life. And one of the things that happened as a result of that, after I found out that I wasn't HIV positive, I thought, well, I'm just going to get it someday anyway. So what's the point? It didn't lead me to feel better. I felt actually worse at first. but through that work and then when I went to fast year and I had a chance to work with people who are HIV positive, that also was the most life affirming thing because now I'm working with a group of people at least originally in the 90s who in the life expectancy was two to five years after protease inhibitors. That all changed but it was not like cancer. Even with cancer, you know, people keep thinking, well if I do chemo and there's some, there's some treatments. Yeah with HIV there wasn't at that time. And so I was working with people about okay, how do you want to take this breath? How do you want to live this life right now? And we did all the biochemical stuff that we knew. We did the diet nutrition herbs and I did a lot of naturopathic medicine that help them tolerate their medication

Speaker 4: 08:15 [inaudible]

Dr. Brad: 08:16 but that part of the visit lake was 10 15 minutes. The rest of the hour, cause they would spend an hour to two hours with people was saying, how are you living? You know, how are you engaging in this life? And so there was such an immediacy to it that I really appreciated it. I felt more alive in my work. I felt really present when I'm talking to people and having those conversations about being present. So my own experience, my experience with my patients. I mean my experience with patients have shaped my life. They don't realize that I learned from them every day that I'm always from people because it's reminding me about how I want to live. So that's like such an opportunity and gift.

Bryan: 09:02 Yeah. In the sense you worked with so many people that got that diagnosis where there's no hope of, you know, extending your life at that time. what was kind of the mental process for these people? Like dude, do all of them go through a certain pattern of like missing out on life or depression or anything like that? Or is it a very widespread and people have different reactions to the diagnosis?

Dr. Brad: 09:31 So Elizabeth Kubler Ross, who wrote a book on, on death and dying and talked about the five stages of grief, Elizabeth Kubler Ross said, and I'm going to misquote it, that people die as they lived themselves. So however they were when they were living, it's often how they, they were dying. And you did mention something about the end of life study. So I'll add that to this. The process was a little bit different when I worked with people in the 90s and the, in the early two thousands who age, who were diagnosed with HIV,

Dr. Brad: 10:10 it affected everybody. It affected all ranges. And so I was working with people who are 20 years old. I was working with people who were 30 years old. I didn't work with a lot of people who were in their sixties. It was different. I was working with twenties, thirties, and forties when I started doing oncology work, doing mind body medicine and oncology care. And then doing that hospice study. I did see people in the hospice study who were of all diagnoses and stage Parkinson's, end stage cancer, cancer. all, all differences, different diagnoses. MS,

Dr. Brad: 10:52 they were primarily 40 and over. I did have some teenagers with cancer but most of those, so it was a different population. So when I was working with younger people who were HIV positive, what often happened was they were saying, you know, I just didn't have a life yet. I didn't get to live my life. And they were talking about the lack of fairness in it. When I would work with people who were older, what I often saw was I still haven't lived my life. You know, I have the regret and so I would see regret versus, it's not fair. I mean I saw it's not fair a lot. That's often one stage [inaudible] most of the people I've encountered in my hospice study, most of them where we're still regretful saying they missed out, they wished they had different, made different choices. There were a few amazing people who are, I'm going to live this life.

Dr. Brad: 11:57 I got the diagnosis and I'm just going to continue to live as fully as I can. Not the most common. It really, it really was not the most common responses. And since then, in the last five or six years or so, I've been doing something called death cafes where, I was doing the monthly where a bunch of people would come together, we'd get a bunch of people together and talk about death. It was not structured. I would just throw out questions like, you know, what, what brought you here tonight? People would say they can't talk about this with their families. And they didn't even have diagnoses. do were young, older people and they said, you know, we have to look at death, but most of the people are, are frightened to talk about it. They're frightened to look at it, because it's just hard for them to confront.

Dr. Brad: 12:55 But the reason I like to do those conversations is I believe talking about death helps us cultivate the life we want more. in Buddhism we talk about practicing for death every day. And I actually have an app on my phone, it's called, we croak. And what it does is five times a day it sends you a quote reminding you that you're going to die. The notice notification comes up saying, remember you're going to die. And then it has a quote about death because, in that culture at Butan culture, they say contemplating death helps you live your life more fully.

Speaker 4: 13:33 Hmm.

Dr. Brad: 13:34 And so that's, that's the reason I liked this work. Would you say most people are fearful of death?

Speaker 4: 13:44 Yeah,

Dr. Brad: 13:46 I would say the majority of people I encounter do, they probably don't come and talk to me if, if they are peaceful about it. I find that at certain ages, it depends on your life experience. I have met people in their forties who said they really haven't had anybody close to them die yet. And then I see people, who by the time they're 20, they've lost a lot of their family. So I think that culture shapes belief, life experience, shapes, belief. I know people who've had a lot of depth in their, their life and are even more terrified about it. And spiritual practices, not just religious practices, spiritual practices really can influence it. I had a patient just the other day say to me, and I've heard this several times, so it's not just this patient that she's envious of, some of her, Jewish and Christian friends who have a strong faith in God because they're comfortable with death because they already have an idea of what's going to happen. And this one person who was talking about his Buddhist, and she has an idea too, but worried about Karma. And again, I've not heard that just from one person. I've heard that from several patients, who are Buddhist. So our worldview can really influence how we look at it.

Bryan: 15:21 Now, when you're working with hospice patients, what's the time frame left on their life? Is it a couple of weeks? Is it a couple months?

Dr. Brad: 15:28 So average life expectancy in hospice is three and a half weeks, three and a half weeks. When I started that, hospice study. So the hospice study that I did, it was a joint study between University of Washington and best year and there were three arms, you know, so the control was just friendly visit, meaning it's standard of care in hospice. Somebody comes to visit you twice a week, asked you what you need to do, they do some errands or sit and talk to you. The other two arms were massage and then, and, and several of the people who met me said, oh, I really wanted the massage. And I was the meditation side. So I came in and did meditation and it was randomized. So people signed up for the study. They didn't know what they were going to get. The very first patient I worked with, we did the study for three, three years.

Dr. Brad: 16:17 She was alive. She was the first patient and she was alive several months after the study. Wow. that's amazing. Yeah. So I told her she ruined our data, but she, and she told me her secret to being alive was that she never listened to what her doctors told her. She said, that's the reason I'm still alive. All my doctors are dead. But, the majority of people I worked in with that study were a for about a month and a half. I'm the last person. So that's the first person I worked with. The last person I worked with, the study was ending in August. I saw him this first week in August. He died by the end of August. And in that study, what I did was a 20 minute guided meditation twice a week. I would go to their, their bedside twice a week until they died. So we had pre, pre practice, inner, you know, an interview the very first time I met them when we would do an interview and I'd ask them like, if you were to go into a coma, would you want me to still come back and lead you through the meditation? you could fall asleep. But, and many of them did. So I was even at the bedside of patients just right before they died, moments before they died. Lee leading them through a guided meditation, whether they heard it or not. So that was so powerful

Bryan: 17:40 with the, with that study. What were you or what was the studied trying to look for because you have these different variables? Is it like the calmness of passing on

Dr. Brad: 17:50 or what are you looking for? Great question. What to be in that study? Each person had to have a primary caregiver caregiver, like a a spouse or family member who was with them the whole time because what we were doing is we were doing interviews with the patient every week in between the meditations or massage and we were also doing post-mortem interviews with their caregiver and we were looking at the quality of death, not the quality of life that was part of our evaluation, but we were looking at how they died and how they approached their death and did any of these help with it. You know, when I was doing this meditation, you know I was taking notes as well. It was so powerful. I had patients with severe anxiety patients in chronic intense pain and doing that 20 minutes a 30 minute meditation seem to help them in some way that they shifted their focus and their pain abated.

Dr. Brad: 18:59 They could breathe better, sometimes their mood improved. Now the major downside of the study, and this is what I, I've said many times, is that we didn't give them a CD. We didn't give them instructions. We didn't give them anything to do in between our visits. You know, cause we couldn't compare that to massage. How would we do that with massage? And I had family members who would sit down sometimes and do the meditation with their, with their father or mother and they would watch the change in their parents and their themselves and they say, we need to do this. Like, like in the middle of the night when you wake up in pain. Most people didn't remember that. So it was amazing to see the changes. I also saw the other changes though. I recall one patient who we started doing just a, a breath meditation, just a mindfulness meditation and it brought up all these thoughts and fears about her death and it actually, triggered her a little bit more.

Dr. Brad: 20:06 so meditation didn't make everything better. The majority of times it helped significantly. but there were certain times people just didn't want to go inward because going inward was too scary for them. Most of the patients learn that by going inward you can let go of a lot of your rumination and thoughts about like, I didn't do this and I didn't do that. And they could just focus on this one breath. They can focus on just being here now. Where would they could even focus on what they were grateful for and that shifted things for them. So let's, let's talk more about meditation. So we hear a lot, a lot

Bryan: 20:48 about my invitation from like yoga practices. And if you look at a lot of, like Middle Eastern practices, India, places like that, they do a lot of meditation. So what is it about meditation that is so beneficial for people?

Dr. Brad: 21:02 Well, I think first thing is everyone meditates. I believe that meditation simply comes from the root Meta Taray the word metatarsal to just mean concentrate directly. You know, it's about directing your attention. It's a mental practice and it's beneficial because it's training for the mind. I think most of us, I think most of us today can recognize how much our mind is so easily distracted. And when I say to people is if, if I told you I pay $1 million, if you do a marathon next week, most people would get up today and start training because they recognize to do a physical thing you have to train, you know, and if the stakes are high enough, right? Million dollars, you'll train and, and in fact you might even, you might even ache that day. You might be in pain that day, but you will get up and you will jog anyway cause you're like $1 million, $1 million.

Dr. Brad: 22:06 One because it's a mental focus. You have something to direct your attention. Most of us have no awareness of where our mind goes all the time. And like, I don't know if you heard, but like I got a notification on my, on my computer, it popped up and, and I didn't look at it. But there's that temptation. It's like what is that? And we get the that happening in an ache in our foot and something and we just bounce back and forth all the time. And so meditation is simply the practice of directing our focus on our concentration. And there's so many types of meditations, like, just like there's so many types of, I heard Richard Davidson who, who is a meditation practitioner and researcher say it just like sports. You don't just say there's all one sport. You know there's, there's, there's a football, baseball, basketball, there's gymnastics, everything.

Dr. Brad: 23:04 So it's not a one size fit all. But all of them involve some training. They all involve focus. So it's, it's vital for us to be able to train our mind. Other wise, we're a victim to every thought that comes in our head and we follow it. So there are meditations from every spiritual tradition. It's not just Buddhist or yoga, there's Christian meditations. Any prayer actually is a meditation. If you allow yourself to focus your mind. So that's the first thing. You're training your brain, you're training your mind and you would do that with your body. But we don't do any of that. When it comes to our thought process or emotions, we think that our emotions just arise spontaneously or we chalk it all up to serotonin imbalance or something else. But we don't even look at how our thoughts and how we think, how we think as a behavior leads to emotional states. So that's the sh that's a short answer is surprisingly, that's a short answer as to what's the benefit or the purpose of meditation helps train us, helps us be able to focus more.

Bryan: 24:23 And I liked that you mentioned that there's a bunch of different ways to meditate and it's not just the one way that we envision where you're sitting with your legs crossed and perfect posture with your fingers touching together. Because I feel like when people think of it only in that way, then it kinda turns them off from it. Or they, they think about it and they don't have enough time to sit there for 30 minutes. But like in your study, these people were probably laying down, so we all were living, they were all like down. Yeah. Yeah. So you can meditate in a lot of different ways. And you don't have to be in that perfect posture. Now, the other thing that you focus on too is a lot of breath work. So being in that type of posture does allow you to breathe in certain ways. So can you talk about how breathing is also important? Yeah.

Dr. Brad: 25:12 my business is called the breast space. I, I love the breath, because I think it is a conduit to all of this. And then we can get spiritual in there because we could say every s every religious tradition talks about the breath. You know, God breathed life into Adam. But in Yoga and Ayurveda and Chinese medicine, we talk about life forces riding on the breath. So I think we can do so much with the breath. We can work on our posture with our breath and change our breath. It's something that's under voluntary control and involuntary control. so the breath is an important conduit. Most, I think most people who know the word mindfulness, who have heard the word mindfulness, might have some idea that one of the most common mindfulness meditations is simply watching the breath. But that's so challenging for many people. The idea of mindfulness breath meditation is to not alter the breath at all. Not to change the breath at all, but just to focus on one part in the body, the nostrils, the belly, wherever you feel that breath and just focus on that sensation.

Dr. Brad: 26:29 And if you really think about isn't that like what a challenging exercise and what such an important skill to learn. Can I focus on something? And every time my mind wanders, come back to that. And mindfulness meditation, I think many people do mindfulness meditation that not realizing they're doing it. It's, it's being focused on one specific thing and bringing your attention, what we call the anchor fully to that. So mindfulness doesn't have to be the breath. It could be, people who knit and they're really present to what the physical sensations of knitting are, the present to it. it could be walking meditation, it could be eating, actually eating and being present to the sensations of your food. It could be a mindfulness meditation as opposed to the way I usually eat. And I just take like one, two bites. And then I swallow the whole thing. I'm not very mindful at all. And so mindfulness helps train our mind and the benefit of it in the research is when we are attending to a sensation, whether it's the breath, whether it's something we're tasting, even the smell of something could be a mindfulness meditation.

Speaker 4: 27:49 Okay.

Dr. Brad: 27:50 The parts of the brain that fire are the parts that are involved in something called interoception. It's internal sensations, it's what we're feeling.

Speaker 4: 28:00 Okay.

Dr. Brad: 28:01 And the prefrontal Cortex, other parts of the brain that light up in those actually inhibit the Amygdala, which is considered an area where there's the fight or flight response to the fear based response. So attending to something really clearly helps deactivate our ruminating mind that's worrying about the future, worrying about the past and stuck in that fear response. So I, for that purpose alone, I think, wow, what a great reason to, to train that. And we can do this with the breath. Going back to the breath, we could just be aware of the breath, but another benefit of breath work is that breathing in a very slow way. Most of us don't do that. Breathing in the belly, learning to breathe in the diaphragm, you're using the diaphragm. Breathing in the belly and breathing slowly can actually regulate our nervous system as well. It can slow down our heart and it can activate our parasympathetic system. most people don't realize that it's on the exhale. When we exhale and we exhale slowly, the, it's the Vegas nerve, it's part of the parasympathetic system, stimulates our heart and slows it down. So whenever we're stressed or anxious and people go out, breathe, breathe, and they start taking in deeper breaths, you're actually activating the sympathetic nervous system. So we could do two different things at, as I'm just describing here. We could just focus on our breath, being mindful of our breath,

Dr. Brad: 29:39 and that can help deactivate the fear response. We can also slow down our breath and by slowing down our exhale specifically, we can slow down our heart rate and stimulate the parasympathetic system. So I mean, it's just like all these exciting ways we can do this.

Bryan: 29:57 It kind of reminds me of when you're really angry and someone tells you to take a deep breath and you take that big breath in. And if you hold it, it's kind of stressful. But the second you release it, the exhale like you talked about, then you're like, okay, I'm calmer. Okay, okay, I'll calm down. But yeah, I love it. That didn't hurt.

Dr. Brad: 30:18 And everybody can feel this. I mean, if you just put your fingers, if you feel your, your wrist, if you just feel your wrist, and feel your pulse at your wrist and you take a deep breath in and hold it, you can often feel your heart rate speeding up. And then when you take a really slow breath, you can feel your heart rate. Speed is speed down, slow down. You can feel your heart slow down. And most of us, when we're stressed or anxious, we breathe up in our chest. We take larger volumes of air, we take big breasts in and don't exhale. So, that, that's actually going to disrupt our nervous system. That's going to prevent us from sleep. I mean we can, we can work on sleep just by changing our breathing. So, one of the things I, as you mentioned the beginning, I, I work at best year at the best of your center for natural health. And I run our mind body medicine shifts. We see a lot of people with essential hypertension, meaning it's not due to other medical conditions. Teaching them to breathe slowly in a very specific way so they're not over-breathing so they're not breathing more air in, in the beginning. And then shore direct sales, but a nice slow breath. Maybe about six breaths per minute.

Speaker 4: 31:39 Yeah,

Dr. Brad: 31:40 we see a major reduction in their blood pressure. Almost every single person we worked with and they can get off. People can get off medications for hypertension just by learning to breathe. So I think it's really powerful.

Bryan: 31:56 So I'm, I'm curious because you're talking about getting the diaphragm to expand outward. So if you have patients coming in that have a lot of gut issues, a lot of inflammation in the gut, do you have to work on that simultaneously while you're working on the breath so that there they have room in there for the diaphragm to fully expand?

Dr. Brad: 32:18 Great question. Actually you could say, I'm going to give you one of those Papert answers. Yes and no because I work with a lot of people with IBS and, and colitis and many other digestive complaints, CBO, which everybody has cibo now, what I find is that learning to breathe can actually decrease inflammation. There is something called the anti-inflammatory colon energic pathway and this is regulated by our Vega nerve, our Vegas nerve. That's cranial nerve 10. And as I said a moment ago, breathing slowly activates the Vegas nerve and the Vegas nerve, it's called the wandering nerve. It's the largest nerve. It goes everywhere. Well it goes sub diaphragmatically, it goes into the organs of digestion. So many people know that when we're in sympathetic mode, when we're in fight or flight releasing cortisol or epinephrine and Norepinephrine, our gut shuts down. Cause like when I'm running from a tiger, I don't need to be thinking, oh, digest your food. We want a new needed for later. It's like no blood shunts away from my gut and goes to the periphery so I can run and fight the tiger.

Speaker 4: 33:40 Yeah,

Dr. Brad: 33:42 we have another system too that's parasympathetic, which is the freeze response. Many people have heard of that. That's parasympathetic as well. It's, it's another branch of our Vegas nerve. It's the reptilian branch. It's the branch that we still have that you know, a Guan is have or possums have. So when we see a poss it's frightened. It freezes well that Vegas goes down to the gut too, and it stops everything. So it stops digestion completely. So my point is, if we are stressed and I don't know who isn't, if we're walking around in the world and things trigger us and we freeze, and a lot of us do, you know, it's like when we can't mobilize, that's the term I use. When we can't sympathetically activate and mobilize, we freeze and the body just freezes. We go blank. We can't focus in both of those conditions. We're breathing in accurately. When we freeze, we don't breathe at all. We take in breaths and hold them for hours. Oh yeah, I should read that. And then when we're mobilizing, we're going, you know, we're breathing it radically. Both of those shot are shut down. Our Gut, so I'm getting back to your gut thing is when we start breathing slowly and let the diaphragm move,

Dr. Brad: 35:06 we actually get the blood flow back to the gut. We get the Bagel stimulation to the gut. We activate this anti-inflammatory colon energic pathway that helps with digestion. I've seen many people, many people built in private practice and at the best of your clinic who've been seeing their naturopath and doing their IBS or Cibo treatments. And when they start learning to breathe and they start learning to work on their posture cause we need to adjust her so we can breathe properly. Oh, I see. Their GI issues get better. Not necessarily go away completely because you know, you do need to look at food. I mean just breathing was not going to help me with my dairy allergy. So it, it's really powerful. So if there's too much distress in the gut, yes, you have to address that.

Speaker 5: 35:58 [inaudible]

Dr. Brad: 35:59 learning to breathe, divert magically and massage the gut. You know, the diaphragm goes down. So when it goes down into the abdominal cavity, it massages the organs. The other thing is the Vena Cava. The arteries run through the esophagus. I mean, I run through the diaphragm. The esophagus runs here, I'm sorry. and those get massaged. Our lymph tissue gets massaged because it goes through the diaphragm. And so we're increasing blood flow to the heart, increasing blood flow to the lower half of our body just by breathing. Diaphragmatically. And I've seen a number of people who are, who tell me, you know, in Yoga I was told, always hold, have your abs rock hard, tight. don't let your gut show. And I think that's a detriment to our health. When we breathe, we need to let our gut move. If you're doing squats, you can hold it tight, you know, and you can use it for exercise. But when we're sitting here breathing, you and I are just talking that belly can move and expand.

Bryan: 37:11 So since you mentioned massage and the Oregon's and also Michelle massaging some of the arteries through their, when you're exercising, you're breathing a lot harder. You're not necessarily breathing deeper but you're breathing harder. Would that still get you a lot of massage into those organs?

Dr. Brad: 37:30 He can. It's, it depends on what you're doing. When you're exercising. I, we tend to breathe more fully meaning, we breathe in with more of our lung capacity many times when we're exercising. So it's not just more volume of air, it's just

Speaker 5: 37:47 did the

Dr. Brad: 37:48 body often moves. We start using accessory muscles to expand the ribs and the diaphragm often does go down into the belly, depends on what we're doing with our exercise. but exercise is just going to help everything as well because just moving your body is going to massage all the tissues. It's going to help with blood flow through out the body. It's going to help with Paracelsus in the gut. So exercise is really helpful for gut issues as well. so I, I think exercise and movement is key in all of our exercise routines that we're doing to help.

Bryan: 38:29 And that's probably why yoga focuses so much on breath work as you're going through the flow because your moving in different ways, but you're still using the breath to not only keep you in more of that, parasympathetic state, but it can also massage in different ways as your body moves in different ways.

Dr. Brad: 38:48 Yeah. And you do certain poses and then they call attention to the breath rather than holding it, you massage different muscles in different areas and expand different parts of the rib cage. So I talk about diaphragmatic breathing, but that's just one thing to do at rest. Hopefully we're using our body the rest of the time so that we can increase the lung capacity in all fields.

Bryan: 39:10 And can you talk about different, methods for breathing cause you have some people, like a lot of, Pranayama, they have different box breathing and all sorts of stuff. is there benefit to these different types of breathing or do you just want people to breathe?

Dr. Brad: 39:29 Yeah, I get that question a lot. even from students, just like I said, there's exercise and there's different types of, just like I said, there's different sports and there's different meditations. There are different Pranayama or breath approaches. there's some very popular, now some people who are not connected to yoga, but who recommend over-breathing, you know, really rapid and that's going to increase your sympathetic nervous system anytime we hyperventilate like that. And we can do that in Yoga with Kapala Bati breathing and bus strike of breathing where it's really rapid. What happens is actually you decrease the cerebral blood flow, you decrease the blood flow and the oxygen saturation to the brain. So certain parts of the brain basically go off line. there are old psychotherapy techniques that would have people over-breathing hyperventilate like that for 40 minutes. There are techniques, the vim hof technique is one of them.

Dr. Brad: 40:35 Ah, Kapala Bati breathing in Yoga, there's Holotropic breathwork, that Stanislav Grof does, where it's all this hyperventilation. People use that for different reasons. And if you remember that Pranayama was developed in the yoga tradition as a spiritual practice, it wasn't an exercise. many people can have insight like when certain parts of the brain shut off, they have access to different parts of the brain. Now my biofeedback colleagues don't recommend any of those over aggressive types of breathing because we see what it does to blood flow and it can be difficult or even damaging for people with cardiovascular disease. So I wouldn't recommend it for people with cardiovascular disease the way I work with people. And I have done some of those hyperventilation approaches for people in specific times. But what I start with everyone is just teaching how to breathe into the lower abdomen. I think that is the most important skill for everyone to have.

Dr. Brad: 41:41 And from there we can branch out to different approaches. I think that learning how to regulate your diaphragm, allow the diaphragm to go into the abdominal cavity is important because you have to release muscle tension and when you can release muscle tension, you decreased sympathetic activation as well. I believe that slowing the breath rate down is helpful because it can regulate your nervous system. So that's what I believe that almost everyone needs to benefit from starting with that. And then we can go into these different types of box breathing. I don't do box breathing anymore. I used to teach that. I know Andrew Weil does a lot of four seconds in, seven seconds, hold eight seconds out. And that's beneficial for some people because it builds up the tension and increases your sympathetic nervous system and then your Alax what I'm more interested in just having a gentle approach to it where we don't have to increase tension. So I basically start with people and teach them to do about a ten second breath, like five seconds in, five seconds out in the diaphragm. sometimes we do four seconds in, six seconds out cause some people like the little bit longer, but never have the inhale be larger and bigger than the exit. So that's where I start with most people.

Bryan: 43:12 Awesome. What, do you have any final things you want to touch on about breath work, meditation and end of life care?

Speaker 4: 43:21 Yeah,

Dr. Brad: 43:22 let's see if I can connect that. What I was going to say is, to me it's all the same. You know, one of the meditations I do at my death cafes is I have people imagine their birth. I have them imagined. It's the moment they're born. And what's the very first independent act we do. We breathe on our own. That's when we say our life begins. Some people say it begins before that, but, and it's like our independent life begins when we take that breath on our own. And then I have them imagine their very last breath whenever it is. And it's interesting because when we think of their very first breath, they're very focused on it. And when they think of their last breath, they're clinging to it. They don't want the next, they want there to be a next one. And when I say with all of this is, how do you want to breathe each breath in between that first and that last breath.

Speaker 4: 44:13 Okay.

Dr. Brad: 44:14 And if we could give attention to that first at that, each breath, if we could really be present to each breath in our day to day life, then we'll really living. And so I encourage everyone to have some practice. If it doesn't, if somebody's teachings or approach doesn't work for you, find one that does something that helps you feel present to this moment regardless of what's going on. You might not have to like it. Like my patients in hospice, they didn't necessarily like that they were dying, but they could be present to it so they didn't react against it. So they could be fully present. I'd recommend everyone find something if it's the breath, it's walking, even if it's knitting. because I do believe that will change your nervous system more than taking a pill more than the food you eat. It's most important thing in my opinion.

Bryan: 45:14 Well, it's super insightful conversation. I loved every second of it. people can find [email protected]. Where else can people find you?

Dr. Brad: 45:23 that's my private practice. I actually have a youtube channel, which is the breath space. Dr Brad and I'm, some of my guided meditations which are on my website are also on insight timer. So I have some guided meditations on insight timer as well. and I also teach at the best year center for natural health so people could see me there for mind, body medicine, biofeedback and breathwork as well.

Bryan: 45:49 Awesome. Dr Brad, thank you so much for coming on. I appreciate it and we all appreciate it. Thank you very much. I have to say, Dr Brad has one of the most calming voices of any guest I've ever had on this show and I really liked how his work with hospice patients has translated into teaching the rest of us how to incorporate these breathing and meditation practices into our lives, especially since there are no specific ways to get started. You just have to start and you know where a great place to practice your breathing and meditation is in the Sauna Space. Sauna, if you heard the last episode I had Bryan Richards on to talk all about the health benefits of using a sauna, so now you can receive the benefits from the sauna while simultaneously getting benefits from breathing and meditation. That's like a three in one deal right there. So to learn more, go to the summit for wellness.com/sauna next episode we have Casey Polk Campbell who is a licensed esthetician and nutritional therapy practitioner. Let's go learn a little bit about Casey. I am here with Casey [inaudible] Campbell and a Casey. What is one unique thing about you that most people don't know?

Casey: 47:00 I have made my bed every day since high school. I had a golf coach that basically told me I would amount to nothing if I didn't make my bed. So I took that to heart. He said it much more eloquently, so I've made my bed every day.

Bryan: 47:12 You've never missed a single day?

Casey: 47:14 No. I mean, not like if I stay at a hotel, I'm not going to make that bad. But if it's my own personal bed, then yes, I have made it every single day.

Bryan: 47:22 That is super impressive.

Casey: 47:24 I don't have any throw pillows though. I think that helps too. Being able to make it every single day. And does that have to be perfect? It does. Or uses. It does now it's kind of become a flight obsession. Before it was just, man, I've, I've thrown the covers on and that's good enough. But now, yeah, it is a bit of an obsession. Even if I take a nap, I have to remake it.

Bryan: 47:49 Well, what will we be learning about in our interview together

Casey: 47:53 we are going to learn how to nourish our skin, which is our largest organ from the inside out.

Bryan: 48:01 And what are your favorite foods or nutrients that you think everyone should get more of in their diet?

Casey: 48:06 Collagen beets and asked Xanthan [inaudible].

Bryan: 48:11 And what is that last one?

Casey: 48:13 Oh yeah. You can either get it in supplement form or from salmon

Bryan: 48:18 from salmon. And then what are your top three health tips for anyone who wants to improve their overall wellness,

Casey: 48:25 drink more water, develop a meditation and gratitude practice and don't wear your shoes in the house because it brings in a ton of toxins and just gross stuff.

Bryan: 48:37 Thank you. That is like one of my biggest pet peeves and I can't believe people wear their shoes in the house.

Casey: 48:44 I know. I'm so judgy about it now.

Bryan: 48:49 I always enjoy talking to guests who focus on skin care because I know very little about the beauty industry. So every single time I learn something new, now take care and keep climbing to the peak of your health.