Plus, the reason I stopped getting botox and the best thing you can do for your metabolic health.
Did you know that you have a signature breathing pattern akin to your fingerprint that can be used to identify you with 96.8% accuracy? We are how we breathe, according to a study published this month in Current Biology. Your signature nasal airflow pattern—your “breath print”—can also be used to predict your body mass index, anxiety level, and cognitive traits.
I’ve been fascinated with airway medicine since James Nestor came out with his book Breath: The New Science of a Lost Art in 2020. An estimated 50% of us are mouth breathers. It’s an evolutionary change due to:
🍪 The shift from tough, fibrous foods to processed, soft diets, which has led to underdeveloped facial bones, and smaller mouths and jaws.
👃 Chronic nasal blockages due to allergens and pollution.
🫁 Narrowing of the airway due to chronic inflammation from food and environmental allergens, high-sugar diets, and chronic stress; being in a heightened state of sympathetic tone all the time can constrict your airway without you even realizing it.
😴 Habitual mouth breathing during sleep, which also decreases airway tone.
Mouth breathing has huge consequences for our health. It leads to:
❌ Sleep disorders including sleep apnea. Mouth breathing exacerbates airway collapse; a 2024 study among patients with obstructive sleep apnea found that simply closing the mouth increased airflow by 28% overall.
❌ Reduced cognitive function. FMRI studies show reduced activation in key brain regions, including the frontal lobe, cerebellum and parietal lobe. (In my practice, I’ve had patients with adult ADHD experience significant improvement in symptoms after seeing an airway medicine specialist to treat breathing issues.)
❌ Chronic fatigue and brain fog: Reduced oxygen efficiency overnight can can cause frequent micro-arousals that fragment deep sleep so you wake up feeling unrefreshed and foggy.
❌ Higher blood pressure: Studies show nasal breathing has a modest but impactful effect on lowering diastolic blood pressure and improving sympathetic nerve tone.
❌ Poor metabolic health outcomes: Snoring and sleep-disordered breathing in early childhood increases the risk of obesity and metabolic syndrome in adulthood.
❌ Cavities, gum disease, and halitosis: Mouth breathing alters the oral microbiota, which can lead to gum disease and plaque.
❌ Altered craniofacial development in kids: This can lead to increased risk of TMJ, breathing problems, and sleep apnea in adulthood.
Breathing through your nose, meanwhile, promotes health by:
✅ Filtering, humidifying, and warming air to help maintain healthier lungs. And helps prevent allergies and illness.
✅ Producing nitric oxide in the sinuses. Nitric oxide dilates blood vessels and helps oxygen travel more efficiently through the bloodstream, meaning better oxygen delivery to tissues.
✅ Improving HRV and lowering cortisol. Slow nasal breathing helps shift the body into a “rest and digest” parasympathetic state.
✅ Improving sleep quality so you feel more rested.
✅ Supporting greater brain activity in the prefrontal cortex, which improves memory, focus, and emotional regulation.
This topic came into focus last year when I was struggling to figure out why my son was chronically congested and mouth breathing at night. As a gluten-free, dairy-free house, I couldn’t figure out what was causing his constant post-nasal drip.
In addition to working with a functional medicine pediatrician (it’s hard to be your own kid’s doctor and I didn’t want to miss anything) who helped me identify an egg allergy, I dove into why he was mouth breathing with a visit to The Gelb Center, a team of dentists specializing in various aspects of airway medicine, in NYC. This revealed his mouth breathing was also the result of a high arched palate and crossbite. We are now on the palate expander journey and have seen an improvement in his mouth breathing and congestion symptoms already in only a couple of months of using it (and being egg-free).
It turns out that the majority of us are mouth breathers, especially during sleep—including me.
I went 40 years without realizing this! I don’t breathe through my mouth during the day and I don’t snore (so says my husband) so I’d never flagged nocturnal mouth breathing as a personal health risk. But as my son was going through all of this, I realized I often wake up with a dry mouth—especially If I drink alcohol—which is a sign you’re breathing through your mouth at night. In a self-experiment, I tried using mouth tape for a week and, sure enough, the problem is so much better. (Now I’m a convert.)
A CT scan at Gelb revealed I too have a high arched palate (probably from sucking my thumb as a kid) and slight airway narrowing that impacts the way I breathe.
So, what can you do?
I see people with constricted airways and breathing issues a lot in my practice. The good news is that mouth breathing and airway issues are often solvable. Sometimes, the habit is the result of an anatomical issue and medical or surgical intervention is needed, but for most of us, behavioral retraining, airway support, and resolving the root cause of congestion and nasal inflammation, are what it takes.
👃 Address nasal congestion.
The first step is working with a functional medicine provider to figure out what’s causing your mouth breathing—for most of us, it’s chronic inflammation. A functional doctor can help you get to the root cause, whether it’s food sensitivity, environmental allergen, chronic stress, or a microbiome imbalance.
🧘 Nasal breathing exercises.
Pranayama (aka alternate nostril) breathing helps strengthen nasal airways and promote parasympathetic balance. A similar exercise called the Buteyko Method involves breathing through the nose with slow, shallow breaths to build CO₂ tolerance.
🍸 Avoid alcohol.
Alcohol is a muscle relaxant. Even one drink a couple of hours before bed can make your airway more likely to narrow or collapse (i.e. obstructive sleep apnea) while you sleep.
👄 Mouth tape.
If your nasal passages are clear, using mouth tape can retrain you to breathe through your nose while you sleep. I like the one from Skinny Confidential but you can also just use medical tape. If you notice a change (e.g. you feel more rested, less foggy) after a week, you were probably mouth breathing.
🛌 Do an at-home sleep study.
There are great at-home sleep studies now. The one we prescribe at Parsley is AccuSom, which uses a portable battery-powered unit to record breathing patterns and oxygen levels.
🦷 Find an airway literate dentist for your kids.
Once we develop habits, we tend to stay in them. Given mouth breathing is so common among kids (especially those who suck their thumbs) I wish I’d done this sooner. I’ve also learned a lot from Hillary Fritsch, DMD, a dentist in Montana who specializes in airway issues.
What’s In My Group Chat
#1 Microneedling for optimal skin health
I recently came across this article on at-home microneedling. My long-term esthetician Lisa Shannon completely changed my approach to skincare in my 40s. She has me on a program to help me build up my skin’s natural resilience through enhancing my own elastin and collagen production.
Through my work with her, I stopped getting botox two years ago.
I started to question the long-term impact of botox and whether there was a better way to support my skin’s aging. Botox gives you “botox face” over time—it paralyzes certain muscles in your face, so other muscles have to overcompensate. Long-term, those paralyzed muscles atrophy while the ones picking up the slack become hypertrophied. I don’t love how it changes facial architecture.
I also think I’m subconsciously hoping there is a better way—that science will deliver something better soon. I mean, if Kris Jenner’s facelift is any indication of where aesthetic medicine is heading, all I can say is…wow. I’m holding out as long as I can for the science to keep improving!
For now, I’m focusing on promoting my skin’s production of elastin and collagen through high dose vitamin A based products (NOT retinoids) and with microneedling, which is backed by a body of high-quality research. Microneedling has been shown to:
- Stimulate collagen and elastin production. Controlled micro-injuries trigger the body’s wound-healing response, boosting type I and III collagen and elastin.
- Reduce acne scars. Over time, that process helps reduce scarring by rebuilding the dermal matrix.
- Improve fine lines and wrinkles. Especially around the eyes, mouth and forehead.
- Reduce hyperpigmentation. Facilitates deeper penetration of skin care products containing ingredients like tranexamic acid, vitamin C, and kojic acid.
At-home dermarolling results aren’t quite as impactful as the microneedling treatments you can get in-office (which are often paired with radiofrequency) but they do work; used regularly, they take the penetration of your skincare products from 5% to close to 80%, so you see better results. (Reminder: most of what you’re putting on your face just sits there. The skin is an organ of digestion—demarollers help products get into the skin to be used.)
I’ll dive more into skin health in another post, but for now my favorite home dermaroller is below!
#2 Type 2 diabetes is reversible
I’ll never forget years ago reading that the American Diabetes Association was promoting bariatric surgery as a method to reverse diabetes and thinking, Wow, we would rather cut out part of our stomachs than change how we eat. My head spun.
More of us are in the metabolic danger zone than we realize—recent estimates say nearly 40% of adults in the US have prediabetes but only about 20% of them know it. The fact is that type 2 diabetes is a lifestyle driven disease far more than it is caused by our genetics, which only dictate about 10% of our health. Yet the medical system at the time (and still in many cases to this day) was more interested in prescribing a drug or a major surgery than addressing the root cause.
So not to be like, I told you so, but…it was gratifying and a huge “DUH” moment to read this recent study published in BMC Medicine, which found evidence that diabetes is a mostly reversible disease.
People with newly diagnosed type 2 diabetes or prediabetes were put on a treatment plan that included medications for diabetes and weight loss. A test group was also put on a lifestyle program including:
- A high-protein diet (25% of daily calories)
- 30 minutes of exercise 5x per week
After 12 months, 87% of people in the lifestyle program were declared in remission, compared to 17% of those receiving standard care.
For those with prediabetes, 73% of participants returned to normal blood glucose levels, compared to just 8% in the standard care group. That’s a major difference!
For those of us paying attention to root cause medicine, this is a “duh” finding. But it’s also a really important one that underscores how much lifestyle choices matter! Getting 150 minutes of moderate-intensity exercise per week, maintaining a healthy weight, and eating enough protein can literally add years to your life!
How to Be Healthier Than Ever
🍯 Immune boosting honey: I don’t like adding sugar to things but if I’m going to, I use honey, which has some immune-boosting and anti-inflammatory benefits. I recently got into Manukora honey, which has prebiotics and a high concentration of antibacterial methylglyoxal.
💉 My favorite dermaroller: I use the Cosmetic Roll-CIT! If you want a fancier version, the Gold Roll-CIT is plated in 14k gold and has twice the number of microneedles.
🧬 Check your biometrics: I just shared the 7 biometrics every woman should be tracking on my Instagram and the post is getting a lot of traction. Look out for an in-depth guide coming soon..