The Health Fix and the Vagus nerve - with GP & bestselling author Dr Ayan Panja

For this World Voice Day Special edition of our This Is A Voice podcast we're delving into the Vagus Nerve and health diagnostics with one of the most influential GPs in the UK (Pulse Magazine), Dr Ayan Panja. Dr Panja is a GP (family doctor), podcaster, presenter on BBC World News and the bestselling author of "The Health Fix"

Voice experts Dr Gillyanne Kayes & Jeremy Fisher share thoughts, stories and advice with Dr Ayan and bust some of the myths about singing, breathing and the vagus nerve.

00:00 A great start!
01:36 The Health Fix and how we diagnose
04:35 What is a symptom?
07:03 Pattern Recognition
10:55 Systems + pattern interrupts
12:47 Lifestyle and the monkey brain
19:21 The vagus nerve and humming
23:13 Dr Ayan's One Minute Recharge
26:33 Singing and changing the way you breathe
29:01 Singing and COPD
34:19 Four stages of pitch matching
36:27 Finding your truth as a singer
37:47 Singing and style envelopes
40:15 Jeremy gets contentious

Get Dr Ayan Panja's book (highly recommended) The Health Fix here https://amzn.to/49xGTUL

Transcript

This is a voice a podcast with Dr. Gillyanne Kayes and Jeremy Fisher.

Hello and welcome to this is a voice series 9 episode 3. Oh god, I am so sorry. Oh we'll keep that in. Should we drop it in? Yes. Brilliant, lovely. I love that little jingle with lots of sevenths and ninths, very jazzy. Isn't it cool? It was written for us by one of our students. Are we going to listen to it again or should I just say?

Just, I'll do it, I'll do it. Hello and welcome to This is a Voice, Series 9, Episode 3. The podcast where we get vocal about voice. I'm Jeremy Fisher. And I'm Dr. Gillyanne Kayes. And we're doing our special World Voice Day episode for 2024.

And we are very pleased to have the guest, Dr. Ayan Panja, who is a medical doctor. In fact, he's a career GP with an NHS practice in St. Albans. He's a lifestyle medicine pioneer. He's author of the book, The Health Fix, and he is creator of the Saving Lives in Slow Motion podcast. And Dr. Rupi Aujla has said, A true pioneer in the lifestyle medicine space, Ayan is the quintessential GP that everyone wished they had.

I love that quote. Welcome to the podcast. 

Thank you so much for having me. It's an honor. Well, it's going to be a pleasure for us. We should, we should talk about this, The Health Fix, which is your book. Um, I devoured it last night. Uh, what I thought was really interesting, first of all, how clear the route through the information is, which is congratulations because that's a skill.

And I know you were saying off camera that you wrote it quite fast. But what's so fascinating is that the way that you've structured the book is very, very good. It's really great read and it makes sense as you read through it and it builds together. The thing that I really want to talk about is diagnosis because when we are doing singing lessons or we're doing, we're training our singing teachers, we teach them to diagnose.

Now this is in a similar way in that it's much more holistic than, uh, your voice is doing this and your diction is this and your, you know, your sound is this. We actually have, we, I looked it up, we have 15 different, um, diagnosis points in the way that we listen to a voice and go, how does that work? And is that voice working for that person?

You're doing something very similar in the and you don't just do disease, you do life as well, and stress factors and all that. So that was really interesting. Tell us about the way that you built that diagnosis. Yeah, you've got your health loop, and you've got your systems and how it's how those interact.

That seems to be the core concept of the book. And it's very clear, I think. You know, thank you. I didn't know that about voice, you know, and it's, it goes to show there's so much more to anything than you think, you know, um, and, um, you know, I'd love to know more about that, but it's, it's, um, it's interesting.

It was, it's a mixture of my own personal experience as a patient and also what I was seeing in practice. So although there are, you know, evidence based medicine collects big data, most GPs in particular, because the volume of people that we see is. much higher than any other type of doctor because we spend less time in a way, but you're much, you get very good at pattern recognition.

Sort of, you know, so you might, a silly example might be, hang on a minute, this guy's got joint pains as well, and his vitamin D is really low. Hmm, wonder whether vitamin D's got anything to do, you know, in terms of one piece of the puzzle. Or, one of the things I noticed in Haringey, when I used to work there, was people who were displaced, who were, who were, you know, coming from places like Azerbaijan, or particularly, you know, victims of torture or refugees, they would arrive in England, and their health would just get worse.

disintegrate within two years. They'd suddenly develop allergies, rheumatoid arthritis, you know, and I didn't quite, I just sort of got this model, but I didn't really understand it back then. And I would sort of think, God, what is wrong with you? Why, why do you keep getting ill? And of course, now I completely understand that it's, it's interconnected.

And it was, it's a case of just building that up over many years, spotting patterns. And Reading, you know, I've got so many books on lifestyle medicine and other models of medicine, and I try to sort of look at all the commonalities, and in a way I've tried to sort of encapsulate that in the book, but in a way that you can use it as a framework for yourself, and it's very simple, you know, our biological systems, lead to symptoms, you know, systems going wrong lead to a symptom.

So a symptom is usually an early warning sign that there's something wrong with your, one of your systems or more. And in the, in the book, I talk about the, the water leak upstairs, you know, in the bathroom. That is exactly what happens to us in, in. in our systems biology. I think the difficulty with this, and you know, I had to do a tutorial the other day for two of our GP registrars, so they've just finished their exams and they're going to be fully fledged GPs from about summertime onwards, and um, they're both really bright and very clever, and um, so I took them through In a very short way, parts of what I teach them to doctors on the course, which is a whole day and then some online stuff.

Um, and they got it, but one of their worries was, yeah, you know, how do you do it in, in such a short time? And I go, look, it's, it's not, it's not that you have to do all of it in 10 or 15 minutes. You can see the person again, because they're, they're going to come back. You know, and one of the cases in the book is this.

this chap called Gary who, you know, he's had normal endoscopies. He doesn't have this bug called H. pylori and he's on maximum medication for reflux. And normally to a GP that makes their heart sink when you see their name again on the list thinking, what can I do with him now? Do I send him back to gastro?

No, they'll just reject the referral because they've just seen him last year and they'll just, You know, we've tried them on every combination of drugs, you know, and it's one of those ones, and that happens a lot, this kind of, you know, before the patients come in, the doctor's already thinking, I don't know what to do with this, and that happens a lot more in primary care than in secondary care, because everything comes back to us, and so part of this method is to help doctors look look at things slightly differently.

So it's part experience and part, you know, and also I forgot to say we did lots of extra learning, you know, in America on courses for weeks here and there and just sort of, as I said, learning as much as possible, you know, and that's the only way that you can come up with this sort of thing. So it's, it's ongoing professional development, either in a formal or informal sense, which is something we talk about a lot in our profession.

A couple of things I want to pick up on, actually. First of all, I loved that you talked about pattern recognition. Yes. As it happens, it's something that we look at in music, and with Jeremy as undiagnosed ADHD, it's one of his big skills as a, as a music sight reader. He doesn't read all the music, he just looks for the bits that don't fit the pattern, and then sits down and plays it.

Amazing. But where I wanted to go for our listeners was. I know that for me as a singing teacher, uh, the way that I learned to teach singing well was I was in a situation in a college where I had three people at once for 25 minutes and I had that throughout the day and of course these young actors they're absolutely either screaming terrified of singing or desperate to learn how to sing and I learned to teach By sitting in that situation, I would hate to do it now.

It's exhausting, but you start to be able to pull out that one thing that's going to make a difference and you start to see these patterns. Yeah, I want to talk about pattern recognition as well because I have this. Have you done? No, I haven't. Okay, carry on. Um, just, just for our listeners, because you referred to the systems and our listeners who have not yet read your book, what are the six systems that you as a medic look at?

Sure. So, so they're very basic in a way in terms of biology. So these are things that we've all read at school, but your cardiovascular system, your musculoskeletal system, your gut, your immune system, most of which is, is in the gut, your endocrine system, which is, um, hormones, and, oh gosh, is there another one?

I've forgotten now. Let me have a look. Just let's read your book and see what it's like. And, uh. Happens to me all the time. What was the other one? Gut, cardiovascular, neurological, brain, brain, obviously, brain. Yep, we've got them all. We've ticked them all. Briefly, yes. So, um, and the thing, I guess the thing that people don't realize, doctors often don't realize, and they get really annoyed because once you say it to them, they're sort of embarrassed they didn't think it.

They go, well, that's obvious, isn't it? I mean, we know that, but it's that they're all interconnected and they're all constantly talking to each other all the time. And the example I give to, you know, on the course and in the book, I think is also that, you know, if you, if you've ever sort of stayed up all night revising for an exam and drank ten cups of coffee, and you think about what your gut and your brain and your heart are doing. That's a very extreme sort of acute example, but in the longer term that's exactly what happens depending on your habits and depending on what you're doing. Things start to go wrong, so that one fixes itself because once you get some sleep and you've done the exam.

You're okay. But, um, but it doesn't, it doesn't, you know, these things happen in slow motion over many years. And, um, so, you know, it's, it's, it's, yeah, that's part of why it's important to understand that there are biological systems and anything you do. At the moment, I'm drinking coffee. So that's going to affect.

but actually that water, when it enters several of my systems, it will sort of increase the speed of things going through my gut, because that's one of the things it does. It will increase acid secretion in my stomach, it will, you know, detoxify my liver, because it does that very well, black coffee particularly, but it also raised my heart rate temporarily, so, you know actively think these things, but you know, trying to dissect a symptom, um, it's worth look, when you sort of think, hang on, let me just think about what I'm doing, you know, those things do come into play.

There's something about systems that I think is really interesting. When you put systems and pattern recognition together, one of the things that you're looking for when you are checking a symptom is, is it long term? Is it, it's, is it just a one off? Like, is this happening today or does this happen over a period of time?

And it's the longer term pattern interrupts that I think are really fascinating and that's where you go. And that's sort of what I picked up from HealthFix. You're looking for longer term pattern interrupts. So that those health loop habits, and you've got eight of those, which, I mean, you even say in the book, you know, some of them are pretty obvious, like, you know, good sleep patterns and exercise and what do you eat, et cetera.

Um, it's that those are actually interacting with how the systems respond. That's what you're saying, isn't it? That's exactly it. And, and, you know, the, the, you know, stress, sleep, diet, exercise, you know, historic infections, which you can't do anything about, genetics that you can't do anything about, sunlight, which is a euphemism for vitamin D, um, your environment, you know, which you can sometimes change, um, those things.

are the things in all of our lives that give rise to how you feel effectively. So they also give rise to symptoms and they're the tools that you've got to make yourself, you know, feel better. It's not always possible because some people come in, they go, I just can't, you know, Times are tough at the moment, so people are like, I'm in a job that I hate, my boss is a bully, but I need the money and I can't get another job.

And I really feel for those people, so there's nothing you can do about their stress or their environment. So you have to work with the other bits, and all of those inputs, in a way, affect us in terms of our body's responses, and part of it is how we deal with it, um, which I didn't sort of do enough of in the, in a way, in the book.

The book is almost like a sort of, as you know, the middle section is sort of real world cases where Their lifestyle prescription sort of shows how they got better, but a lot of it, and one of the golden threads in the book is What's going on here? That is the most important thing, because you know what, and I, you know, this sits above everything else.

So yes, diet and exercise and vitamin D and all that stuff's important, but it's sort of really Second level stuff, like, above all that, and I'm sure you all know this from your students and people that you know socially or whatever, but people who've got this sorted tend to stay quite well, you know, and that sounds so woo, me saying that, but, you know, I'm not saying it from a point of view as a, some sort of academic scientist, but as someone who's worked for 25 years and listened to lots of people's stories and seen what happens.

By and large, that's true. Just for those who aren't watching, um, Ayan, you're popping your hand on the top of your head. Yeah, sorry, sorry. Are you talking about mindset, mind? Um, you're talking about the monkey brain that you mentioned quite a lot in the book. Tell us a bit more about that and how you see that aspect.

Yes, yes, monkey brain is really interesting and it's, it's, to do with, um, impulse control and how you feel. And so it's so Professor Steve Peters who I'm sure lots of people have heard of who wrote this Chimp Paradox has written a whole book On this type of work, so it's not an original concept, but it's very useful because I struggle with it myself and anyone who has ADHD for example will struggle with it, you know, in terms of impulse control.

So you sort of have one biscuit out of a pack and the next thing you know the whole, the whole pack's gone because you're, you're, you're in a monkey who's basically dopamine driven. If you ever seen monkeys in real life, like we went on um, honeymoon to India for, we took six months out of medicine when we got married.

This was 20, almost 25 years ago now, 25th anniversary is next year, but, and uh, we landed in Mumbai and went to Elephanta Island and uh, which is full of monkeys, and we're sort of sitting there quietly, sort of, you know, innocently, sort of, with a couple of samosas and a cup of tea, and before you know it, these monkeys sort of dive down, steal the food, you know, throw some of it at you and stuff, you know, and that's what monkeys are like, they don't care about, you know, long term consequences.

They just want what they want now. And all of us have that in us, and it comes out when we're tired, or frustrated, or hungover, or, you know, it's very childlike, you know, teenagers tend to be a bit like this, and toddlers tend to be a bit like this. But if you're aware that it's there, and you just check yourself, and take the extra second, and think no I'm no I'm not going to drink tonight because it's a weeknight because you sort of know that one glass of wine might lead to another but you've got to just be able to do that but that that's again second level really and I guess what I'm talking about in terms of higher level um brain function.

The higher level thinking is adult thinking, so it's not monkey brain, and it it requires, you know, when you're a child you think of someone as being a proper grown up, and then you realize when you're 50 yourself that you're never going to grow up, because because no one ever really does, and you think, well actually, you know, maybe most 50 year olds are walking around my town aren't as grown up as I thought, you know, but some people are just more sensible and more responsible and you think, yeah, he's like a proper grown up, you know, compared to me. Um, and, um, but, but that, that, what I'm, I get, what I'm getting at is about how you process things like grief, like disappointment, and Gabor Maté, who's this amazing man who I went to an event with, um, such an amazing thing just meeting him. And I remember when I met him, I thought he's going to be able to tell what I'm like just by looking in my eyes. He can see into my soul. He's like a mixture of Columbo and Yoda. It's so, so clever and sort of, it's quite dismantling actually, because when he, when he interviews people on stage, within three or four questions, he's like, got to the, the nub of why they became ill.

And it, and actually it made me realize that there's nothing to do with diet and exercise. It's sort of, it's to do with not saying no when you mean no. It's to do with boundaries. It's to do with, um, some, some sort of traumatic event that was never processed and people just powered through, which we all do because life's busy.

And those things. I think are very, very important. Very difficult to prove in scientific papers, and a lot of people criticize his work, but, um, the more I mature and the more I get, the more patients I meet, the more I can sort of see that is, is important. It's, you know, the other end of it is, you know, I, I, I got slightly, ill myself and often the people that end up in this world.

I can't speak for Rangan or Rupi or anyone else, but you know, we've all got our stories. Um, the other direction people go is where they become absolutely obsessive about diet and nutrition and exercise and all that sort of stuff. And I, I, I, I didn't ever go down that route because it's not, For me, it's not real life.

Um, and some, some of my patients, particularly where I live, love that. And they, they come to me going, um, oh, I just wanted to come and say thanks because I feel a lot better. But actually, have you heard of this? And it's something that I've not even heard of. And I'm like, no, I haven't. But you crack on with, with that if it's, if it's helped you.

Um, uh, because they've just, they, it's opened another door for them. And that, suits them, you know what I mean? And I'm sure you've, again, you've met people who the golden thread in their life is exercise or turmeric or, you know, everything in their life seems to revolve around one thing, you know, and they become evangelical about it.

And that's, that's great if it works for them. I think that's a good thing. So, it's kind of whatever works. I think that's very interesting, actually, because I can say for myself when I hit a health condition, particularly as it coincided with the pandemic. I became very, very obsessive, about all the things that I was supposed to do, and I think it takes a while to help people, because something like that is really just another manifestation of whatever made you feel bad in the first place, I think.

and then you have to learn gradually how to manage that, so that it becomes part of you, if it's a chronic condition, and then how you live with that, you accept it, and you, you find a way to live your best life.

Hey, should we talk a little bit about the vagus nerve and humming. Um, when you were, I think you were having an interview with, uh, Rangan Chatterjee and you said you were feeling a bit nervous, so you started humming.

It's talked about a lot in the singing world. I think often without a a good understanding of what's going on. But I will say for listeners who know a bit about me that I grabbed this idea and I thought, okay, next time my heart kicks off, I'm going to hum. And that's exactly what I did. And I hummed loudly along with a very slow paced track. And you know what? On that particular day, bye bye heart arrhythmia. 

Amazing. 

So interesting, doesn't work every time, many other listeners who suffer from heart arrhythmia, but it certainly helped, has helped on several occasions. Tell us why humming affects the para, I presume it's the parasympathetic or 

That's right, yes, yeah, I think people may have heard of the vagus nerve and particularly singers will, probably will have done, but it runs essentially from the brain to the gut. And so it's, it's a sort of, um, the nerve that essentially relaxes us and inhibits things. So it's the opposite. It does the opposite of fight or flight. So if someone sort of says boo, you know, quickly, your heart starts racing and you feel really anxious.

The vagus nerve does the opposite. One of the things that I'm not sure. Non-med medics will be fully aware of is that it's not just one nerve, it has lots of branches, so it has branches that go to the heart. It has several branches that goes, go to the head and neck, you know, like the glossopharyngeal nerve or the recurrent laryngeal nerve, you know, which is often one that gets, occasionally, sometimes gets severed when you're having sort of thyroid surgery or something.

Mm-Hmm. . It's a very important nerve, it's the 10th cranial nerve and it comes out of a part of the brain called the medulla oblongata, and it, it, why humming works, there's a lot of reasons actually, so when you're humming, because you're actually breathing out very slowly, it doesn't feel like you are, obviously I'm talking to singers, so I know you know this.

It's better than anyone but, you know, if you kept humming, eventually you'd have to stop because your lungs would run out of air and just that, for people who aren't singers and want to sort of a lay explanation, my understanding is that actually just by doing that you are activating your vagus nerve but also because you're using um, something that is connected to the vagus through those nerves, I said, that go to the voice box, you're going to be stimulating that, it's the wrong word in a way, you're stimulating that relaxation response, and the vagus nerve, you know, It has effects on heart rate, it has effects on mood, it has sort of these beneficial effects, you know, it's the nerve that gets activated when you meditate, when you're still and quiet.

And there's been a lot of research on it in terms of, you know, a really good hack, by the way, if you ever want to find. medical papers online, on anything, rather than sort of sticking it just into a search engine like Google, if you type the letters NCBI after it in Google, it will come up with lots of things from Medline.

Now some of them will be absolute, you know, rubbish, but, you know, from just, just opinion pieces by someone that doesn't really, you know. But a lot of them will generate studies and actually, if you want to, you can have a look at the studies on the vagus nerve. And again, big pharma and pharmaceutical companies have tried to sort of target things like this.

And actually, it's very difficult to because it's a nerve and it's something that you can, um, You know, if you hummed every day and, and, or if you, if you, you know, in terms of daily routine, if you want to set yourself up, which is another thing that I talk about in the book in the, in terms of in the morning, how to get yourself going, um, and you did some sort of practice.

And so I do this every day. I do this thing called a one minute recharge. So I, in the car, when I park at work, I'm activating my vagus nerve. Literally, I sit there quietly and breathe slowly and close my eyes. Almost to the point where I don't want the minutes to run out. And I do the same when I get home.

And the reason is, it's sort of time transitioning really, because if I rush into work, because I know I'm going to be hit with problems as soon as I walk in, that's just the nature of a GP partner's job. job you know the roof's leaking or we've got a grievance from someone or a patient's made a complaint and has spoken to our local MP it's that sort of but you're getting 20 of those things a day on top of everything else um you You need to be in a sort of a good space to receive those things without jumping down someone's throat, you know, and actually if I, if I don't do that, I'm much worse, you know, um, I, you know, especially when you walk in at home, you know, the boiler's broken or whatever, there's something, there's something going on or someone's got into trouble at school or whatever, um, and so you're, it's, it's, so it's very common sense in a way, but so that's where the vagus nerve's very important, I think, for singers.

You know, my singing teacher years ago, she, she's very classically sort of trained, and I, I remember we were, you know, and I wasn't really singing the sort of stuff I wanted to sing, it was all arias, and there was this lovely sort of song called Oh Sleep. I don't know whether you know it, but I'm sure you do, sorry.

It's a bit like asking me whether I know penicillin, I guess, but anyway. And, um, and I was sort of singing it, and she goes, she, and she goes, well, look, you can sing it really well, and I don't know whether it was for a grade in singing, I sort of, I went straight in at grade six, I think, and then to grade eight, but it was a, but no, it was before that, it was when I started, and she goes, but what, what's this song about?

And I just didn't care, because I was sort of 13 or 14, and I go, Well, it's about sleep, isn't it? And she goes, yes, but what happens when you wake up in the morning? It's like, oh, I'm just so tired. Yes, exactly. You're sort of, you're, you're upset that you're, you're, you know, sleep has left you. But she made me really sort of understand the, the words, you know, and, um, and that was when I realized this sort of mind body connection.

There's also something much more personal about singing. You know, if you're, um, kind of going to, I don't know, a concert or something, and someone's playing the clarinet or the piano or whatever, it's just not, it's not a Part of you, like your voice. And actually, Jeanette Ives, my singing teacher, said to me, she goes, you know, actually the first thing you notice when someone's ill, one of the first things that goes wrong is their voice, the sound of their voice.

It's always stuck with me. This was, you know, 20 years before I went to med school sort of thing. And I was like, Hmm, that's interesting, and it's so true, you know, and that's again, not directly linked to the vagus nerve, but there's an element of that, if your vagus isn't sort of functioning very well, and you're stressed, and you're not feeling well, or if you've, you know, anyone who's been bereaved, and you haven't seen them in a while, you sort of think, wow, God, they're really not themselves, and they don't sound like themselves, you know, so, There's a lot to it, but I'm not, I'm no expert. I'm not neuroscientist, so I, you know, but that's my sort of take on it. 

Yeah, it's really interesting. I love that. Really you are using humming as a, as a pattern reset. Yes. Okay. Yes. I'm calming down before I go into the surgery. Now I'm going to, I'm calm down so that I can go into my home life.

There's something very interesting and I know you touch on it, um, but there's something very interesting about singing and it almost doesn't matter what style you sing in, what you're doing is changing the way that you breathe. And that's an, that is an absolute direct outcome of singing because essentially, whatever style you're singing in, it's a fast in breath and a slow out breath.

Yes. And when you think about normal tidal breathing, like when we're, we're relaxed, it's approximately 50 50, approximately, uh, so it's 50 in, 50 out with, with pauses. Either at one end or at both ends, depending on how you normally breathe. But the moment you start to speak, you're normally doing a faster in breath and a slower out breath.

And then when you sing, that's exaggerated. Yes. So it's a even faster in breath, usually, and a much slower out breath. And, When you're changing music style, so if you're singing pop, it's very rare that you sing long phrases, so the breathing pattern is closer to speaking. When you're singing musical theatre, it's sort of half and half.

You do some conversational phrases and you do some extended phrases. The moment you go into classical, it's pretty much all extended phrases. And this is the thing, is that you have to change your breathing pattern in order to be able to accommodate the music. Sorry, I'm on my hobby horse now. There is no one breathing pattern for singing that works.

Yes. Again, it's context. It depends what you're doing, but the whole point is that you're changing your breathing patterns from normal. Yes. That in itself can be useful if you're in a stressed state. You're actually quite a fan of singing though, aren't you? You did your own podcast on it. Yes. And you see it as, you described it as a healthy habit. Do you want to tell us more about your thoughts on that as a GP?

There are lots of, it's funny, I've got to mention someone Who I used to work with, who's an amazing man. He's called Julian Godley. And Julian is my retired ex senior partner. He's a brilliant singer, and he's a very well known baritone. No, he's a bass, actually.

Um, and actually, had he sort of not done medicine, would have probably done that. And all he does in retirement now is put on concerts. They're wonderful, like, you know, carols at candlelight and things. And, um, and he, he takes singing very seriously. And one of the things that we talk, we used to talk quite a lot about all sorts of things and, and, um, you know, I don't know where to start really, but you know, if you're, if you're talking about principles that even in my book, like I talk about something about behavior change called community spirit, joining a choir is just one of the, I've seen it with my friends, and I'm embarrassed to say I'm not.

a member of one, you know, but actually I'm sort of thinking, you know what, I'd love to do that again. It's just, it's just doing that in itself has so many benefits. But, and, and on the other end, in terms of physiological benefits, um, years ago, and you can still find this online, I, when I used to work for the BBC, I went down to Kent to a group of patients who had COPD, chronic obstructive pulmonary disease, and they joined a choir and actually, The respiratory nurse that was coming to do their measurements, they were, they were improving their tidal volume and their respiratory reserve had improved.

And one of the reasons is exactly as you say, Jeremy, you know, the, the breathing is controlled, you know, um, and you sort of, especially in COPD, it's, it's a horrible feeling. You feel like you can't fill your lungs up. So you do this sort of, as they describe in the, as the professor doing the study describes this sort of breathy breathing, whereas actually when you're singing phrases you, you, you get control, but you have to have control, and so You know, that's another benefit, but there are, there are so many, you know, blood pressure, you know, cognitive, um, benefits as well.

It's, it's, it, and I don't know whether you can put them all down to the vagus nerve. A lot of them will be, but it's, it's bigger than that. You know, there's something very primal about using your voice, I think, which, again, is difficult to study. But, um, you know, it's like Walt Whitman's Great Barbaric Yawp, you know, you're actually sort of you know, putting yourself out there.

So yeah, I don't want to sort of bore people with it, the benefits are just, you know, there are so many, I mean, so many really, it's just a wonderful thing. It's one of those things where I wish everyone would do it. And I've got, I know people, I won't name any names but who, who, want to sing, but they're just, they're kind of embarrassed or they don't know where to start.

And, um, you know what I mean? I'm sure you see that quite, uh, you may not, but I mean, cause you, you sort of coach professionals as well, but, it's something I miss quite a lot. You know, I don't do enough of it myself now. The only time I think it's become much more accessible because, because of things like karaoke and, um, you know, you know, I guess a sort of a proper singer would think of that as a sort of a, um, you know, a dumbing down of singing, but it's actually getting people to do 

Absolutely. 

Something I think that's fun and participatory and done in a group. You know, I'm going to, this year I've got so many 50th birthdays 'cause I'm in that sort of year of my life. And, um, we're going to one of the weekend and, and. The person who's 50th it is, her, her dad was a sort of a pop star in another country. So music is a massive part of their life.

And so she's got karaoke set up like really proper sort of, you know, and I'm really looking forward to it. But I'm sort of thinking, God, what am I going to sing? You know, cause there'll be sort of a minor expectation for me to sing something. Cause I used to be the guy that used to sing at parties. my friend's weddings.

And like, they sort of go, one of my friends, Jeremy, I remember, he got married in 2007. You know when people come up to you at their weddings and they ask you to sing with the band? How would you feel if I asked you that now? He was very clever.

You can't just do it without practice. And so songs I think I can sing, I sort of think, Oh my God, I can't, can't get to that note. And it's just because it's an instrument like anything else, and it takes practice. And so, um, yeah, but it's a great thing. And so that's another element, discipline, practice, you know, it sort of, it teaches you so much, I think, doesn't it?

And by the way, are we allowed to say you have a gorgeous voice? Oh, thank you. That's really kind of you. No, it's something that, you know, obviously, as a voice trainer, you listen to, I don't just listen to how people sing, and no, we're not going to ask you to sing today. Well, not yet, anyway. But I listen to what, you know, I listen to the timbre, kind of the pitch and the clarity.

Um, and actually yours is really warm and gorgeous. I don't know if it's a microphone or if it's just your voice. Um, but it's, that's like you were saying that singing is very visceral. That I think we do respond to. those signals, those subtle signals in someone's voice. And it's why our voice, whether it's our speaking voice or singing voice is so personal to us.

I think it's really interesting because you are, singing is by default extended. You know, you are holding a note long enough that people can recognize it. And that means that you're holding it longer than you would normally do when you speak. Um, and I think anytime that you do. any type of extended sound, it's almost like we hear more of you.

And the goal for so many professional singers certainly is that we, that they tap into that, that we actually hear them as the performer. It's also the fear. I think it's why people just are so afraid of singing because you get more of a handle on who you are when you hear someone singing. Yes, of course is for solo singers.

And I mean, we work with a lot of choir trainers and they tell us. over and over again that they get these people coming to them that you've just talked about. I was told to shut up at school, I don't believe I can sing, and you get them in a group and suddenly they realise, actually I can. Oh, and can we just talk about four stages of pitch matching?

So many people do not know about this and it, to me, I loved this because it made so much sense of why somebody would have been told at school that they shouldn't be singing because they're droning in the background. So for non musical listeners, this is about people who maybe have been told they're tone deaf or that, oh, you're not singing in tune.

Yep. So I'm not going to demonstrate them because I actually do a demonstration on video, and which I'll put in the show notes, uh, on YouTube. But there are four stages of pitch matching, and the first one is basically droning. And everyone goes through this, but they go through it at different ages. So, uh, number one is droning, where the rhythm And the words are normally accurate, but the notes are nowhere.

So you're chanting happy birthday in time with the words? Absolutely. Uh, then you get one where the approximate shape of the melody is right, but then still not hitting the notes. Then you get one where the phrases, each phrase is about right. You know, it's like you sing the melody, but then every time you go on to the next sentence, you've changed key.

Everybody changes key when you get to the top note in Happy Birthday. Oh, I've got to, I know, I've got to do the demonstration for that one, because you hear this in restaurants a lot. Happy birthday to you, happy birthday to you, happy birthday, happy birthday, happy birthday to you. Every one of those phrases is accurate, but they just do not lock together.

Yes, yes, yes, that's true, that's so interesting. And then stage four is where you're pretty much, you're on, you're accurate. Everything is right. I think when people find out that there are literally stages that you go through to learn to pitch, it gives them so much relief, actually, because it's like, oh, I'm normal.

Yeah, yeah. I also just, just while we're on voice, and I mentioned And this not in the singing episode, but there's something about speaking and singing voices and whether it's your true voice, you know, and one of the things I think, you know, I've interested is people finding their truths. And, again, you must see this where you've got someone who's a very capable singer, and technically they're excellent, but actually it's because they're actually a good impressionist.

And, actually, I'm partly that, I think, you know, and I have been because of lots of reasons, really, from childhood. I've moved around schools quite a lot, so I had to fit in very quickly. So I lived in Wales and Liverpool and, you know, if you, and if you turn up to Brighton where, you know, I finished my schooling days with a Welsh accent, you very quickly lose it.

So, um, and I, in one of, and I sometimes think, is this my real voice or how I want people to hear me? And I think this is my real voice because I've sort of, over the years, my accent has subtly changed as I've sort of, you know, found my truths, if you like. I mean, does that ring true to you? Oh, totally. I mean, the thing is, There's nothing wrong with learning by imitation because it's how we learn to speak.

Mm-Hmm. , you know, we've got those mirror neurons that do the job for us. Yeah. Um, you know, once upon a time in sort of singing training, we would sort of hoo the idea that people would imitate in order to learn to sing. They weren't doing it properly. Now that we've learned more about the brain, uh, we realize this is actually, uh, it, it's just not correct.

Um, but I think it's more about finding the authentic message that that particular person wants to give through that song, through, we talk about the song being an envelope, you know, what's the style envelope. You're not going to sing a rock song in the style of, oh, sleep. You possibly could, you know, it would be interesting, you know, Barbra Streisand would have made it work.

Um, but, uh, you know, some people will come at you, uh, if, if you do that, and then you have to go, Hang on, this is, this is how I see it, you know. Okay, we've got two things here. One is the style envelope, and I love this, that whole envelope thing which is a song has an envelope and within the envelope you can do all sorts you can.

move in any direction. And that immediately says there is not one right way to sing this song. There's a whole load of right ways to sing this song. When it, if you like, it goes wrong is when you are singing that song not in the envelope that it's in. So you're singing from a style from a different envelope and trying to bring it in.

Having said that, some people are extremely successful at bringing the style features from a one envelope. into another so that they change the style that they sing the song in, that also works. I think when it doesn't work is when you don't realize you're doing it and then it's this sort of weird hybrid.

So that's, that's the, that's the song. The singer, I think this is really interesting, what you're, because my sister does this by the way, she's a chameleon, she will, adopt elements of speech patterns of the people that she's talking to. Right. And I think that's a societal thing. I think that's a, uh, I want to connect with you.

I want to be friendly. It can also be, I don't want to stand out, but it's very much about connecting with the people around you. And if you like, okay, again, this is about music and style and genre. When you're in a pop world, if you, if you are a pop star. Then you have a whole load of audience expectations, they expect you to sound a certain way, and then you are as real as you can be within that style.

When you are a classical singer, there's a certain sound expectation. We don't care if you're an 85 year old singing a 17 year old role, we don't care as long as it sounds right. Okay, exaggeration. I know all the opera singers will come at me, but I don't care. I think they'll be come back on that show.

Jolly good. There are sound expectations and you basically, you morph yourself to again, do the, the realist version of you within that sound. Yeah. Where it gets really interesting is musical theatre, because the whole thing is you have to sing in character. And if your character is in Oklahoma, you sing in an Oklahoma accent and you have to make it real even though Oklahoma accent is not your thing.

And then, you know, you can be doing that during the day and then at night you're rehearsing Phantom of the Opera which is basically classical. So you have to find the realistic part of you that matches that envelope but you then switch envelopes. It's why we love working in musical theatre because there's so much variety and variation.

As a singer you have to be incredibly flexible but also real. Yeah, that's so interesting. I love all that. Yeah, I love musical theatre. A lot of my friends and family don't, but it's just, it really, it really captivates me. It's just the perfect sort of Medium for me. But yeah, no, amazing. I love that. That's really, really interesting and kind of fits with, you know, that thing we've been talking about earlier on about, you know, the brain sitting above everything else.

And it's all interlinked, isn't it? That's such an important part of self, I think. We have to stop there. There is so much that we can talk about, so much more we can talk about. And, uh, again, we're going to recommend that people get the book The Health Fix. Absolutely, and do listen to Dr Ayan's podcast, which is called Saving Lives in Slow Motion. we are going to invite you back for another episode next time. We'll see you then. Fantastic, looking forward to it. Thank you.

This is A Voice, a podcast with Dr. Gillyanne Kayes and Jeremy Fisher.