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 Allison Moss Johnson, MD, FACP

What is in a breath?

Just breathe. Most likely, we can think of a time that we have said this to ourselves. But why? Why do our minds tell our bodies to purposely do something that it does innately without any conscious contribution?

Well, our minds know. Minds know when bodies are in such sympathetic over drive that it becomes a hindrance versus a help. We need our sympathetic nervous system, the fight or flight mode, when our system is under acute stress to help us retreat from a dangerous situation. Whether that is an impending car crash, or as our ancestors outsmarted the saber tooth, the sympathetic nervous response is a healthy one. It heightens sensory awareness of our surroundings causing stress hormones to increase and heart rate to rise preparing the body to react in a moment’s notice.

Unfortunately, our lives today have brought us to a space where our bodies are suffering from being stuck in this mode: rushing with morning routines, multitasking through our work day so that we can race home and do it again the next day. How do we purposefully turn down that sympathetic tone? As simple as it sounds, one way is to breathe. Not the breathing that our bodies instinctively do to keep us alive, but breathing that can give our sympathetic nervous system a break. Decades of research about the power of conscious breathing are finally hitting mainstream healthcare and as many of my patients know, it is my favorite medicine to prescribe.

I attended the Integrative Mental Health Conference this past April. Dr. Andrew Weil opened one of the afternoon sessions with his 4/7/8 relaxation breath. I have witnessed Dr. Weil teach this technique multiple times through my last year of fellowship training. However, sitting in a room with hundreds of people practicing the same breathing technique was powerful. Collectively, the room shut down, allowing our systems to reboot. By resetting the system, it becomes open again. Through slowing our nervous system by the rhythm of breath, we receive new information more quickly, process it in more creative ways and are more present to that which surrounds us. All with just breathing! 

The research shows us that scheduled, conscious breathing twice daily significantly reduces our baseline stress hormone levels, helping us take things down a notch. This is good for all of us, even the picture-of-health patient! The benefits are even more dramatic when someone faces a chronic disease state. Whether it is excessive environmental stressors, personal anxiety or depression, elevated blood pressure, heart disease, diabetes, insomnia, heartburn, irritable bowel disorders or pain syndromes, all chronic disease is influenced by elevated stress hormone. Some of the most profound benefits I have seen with this breathing technique is its use to help with stopping smoking, alcohol cessation and disordered eating. I encourage patients to breathe before acting on habits that are really trying to satisfy our body’s need to reset!

So, how do you do it? Sit comfortably, preferably upright, with an expanded torso. Start by taking three easy breaths in and out. On the third breath, exhale everything out. Take a deep breath in for a count of 4, hold it for a count of 7, exhale for a count of 8. Repeat this cycle 4 times. Schedule twice daily and any time during the day your mind is telling your body it needs a break. Listen and take it! 4 cycles equate to about 90 seconds. 90 seconds friends, 90 seconds to reset your system. You can do 4/7/8 anywhere. Do it on your way to and from work, while cooking dinner, before bed, first thing in the morning, it doesn’t matter the time or place! Once this becomes habit, after about 4 weeks usually, see if you can increase to 8 cycles twice daily and as needed.

Try it, whatever your reason! All of us need that reset button pushed from time to time. Just breathe! Make it your medicine!

To health and happiness always,


February 26, 2020

In reading Caroline Myss’ work “The Anatomy of the Spirit”, on page 37, there is a break in the word disease to accommodate paragraph spacing. Dis-ease. As I sat there staring at this word that in large part defines my professional life, I began to think about its meaning in an entirely new way. A few months later, I found it again in “Coming to Our Senses” by Jon Kabat-Zinn. Dis-ease. This time, an entire chapter was dedicated to the root of this word. Spending the last 20 years in the study and practice of medicine, disease has been presented as a tangible ailment that has a physicality to it. Something that as a physician, I am charged with diagnosing and providing appropriate treatment. Dis-ease implies something different. Dis-ease: an absence of ease, a loss of harmony, a lack of synchrony across a system. 

Three years ago, preparing to recertify for the American Board for Internal Medicine, I became very frustrated by my training. I realized I had been molded into a thoughtful diagnostician, but all I had been given to treat patients was a proverbial prescription pad. The more I reviewed the mountain of material, I felt like a dispenser of Band-Aids in pill form: this is the diagnosis, here is the pill to treat it. For me, there is and, I am confident, always will be a beautiful art in discovering diagnoses, in hearing patient’s stories and in sitting with them in times of joy and sorrow, but I felt driven to find something more to offer patients. 

In my frustration I began to search for how to educate myself outside of conventional treatment. More importantly, how to reach beyond diagnosis to discover what has happened with patients from a physical, emotional and spiritual standpoint that has led them to the moment they sit with me. My search lead to Integrative Medicine which teaches providers to do just this. After a year of training in this expansive field, my practice and personal life have changed in ways that I would never have predicted. Reading the fragmented word “dis-ease”, I realized that it defines what I want to help patients discover and heal. 

How do we turn the tide of dis-ease back to a system at ease? What are we doing to cause our systems to be out of sync? Discovery of this answer takes a partnership. It is not about going to the doctor, receiving a diagnosis and leaving with a pill. It is tedious work on the part of both the physician and the patient. Work that can change the course of someone’s entire life if put to task in a manner that is focused and committed. It is more than a 10-minute visit. It is physicians taking back their profession, demanding time with patients to deliver personalized, quality care. It is more than saying a diet needs to change, exercise needs to happen, sleep needs to be prioritized, relationships need to heal. It is about focusing on ourselves and how we are living our lives. 

Caroline Myss describes this focus as not egocentric but purposeful for personal discovery and ultimate healing. As a society, we have become accustomed to looking outside ourselves for the answers. How do we help one another make the shift to look inside? We should know our bodies better than anyone else. We have the ability to care for ourselves in the most meaningful ways, but we have to dig deep to make the discoveries in order to start that process. By no means is this an easy or quick fix. Quite possibly, it is the most difficult work someone will do and if done right, it will be lifelong. So, let’s get to it! Patients and physicians alike, let us come together to put our systems back at ease.

With a grateful heart and mind,