Surprising Health Risks of Poor Oral Airway Health

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hi everyone. Today I speak with Dr. Ted. Belfor about a number of issues regarding oral airway health and how this can affect breathing, sleep quality, and even autonomic nervous system tone. One of the things I really appreciate about Ted’s practice is he’s focusing on treating adult populations. This really resonates with me because some of the appliances I was attempting to use, I believe were a bit more for children and left me with a lisp, as you may remember me remarking about before. Thankfully for adults, and there’s likely many of us out there who either have forward head posture, snore mouth breathe, and or have had braces, There’s a fair chance that your breathing and therefore your sleep and therefore a major facet of your health may be suboptimal. Good news – improving that may provide substantial improvements to your health, energy, mental clarity. This can be uncovered by going through the process of improving the amount of room in your mouth for your tongue and the resting tone of your tongue.

DrMR:

So we delve deep into this topic today with more of a focus on therapeutics that are applicable for adults. So I very much hope that you will listen to this episode and take action because again, sleep is a massively important facet of health. If this is something that you’re not tending to, you have a massive potential area for improvement. It would be well worth any time and attention to pursue these avenues. He does list a resource for finding practitioners that he has trained in your area. So again, a very insightful conversation. I’d also like to reference Healthy Gut, Healthy You as a resource for better understanding how impactful sleep is on your overall health. There is a section on sleep in the lifestyle section where I outline how clear the data are that if there is anything that is interfering with your sleep, it could be putting you at increased risk for pretty much any disease that’s been studied. This could also thwart your health via an array of symptoms from mental clarity through digestion and of course energy.

DrMR:

So if you haven’t read Healthy Gut, Healthy You yet, that would be a good read to prime you and hopefully motivate you to take actions to optimize your breathing, your airway, and therefore your sleep. With that, we will go to the conversation with Dr. Ted.

DrMR:

Hi everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio today here with Dr. Ted Belfor. We’re going to be discussing this issue I’ve been chronicling about oral airway development and how, termed loosely, issues in your mouth may be impacting your sleep quality amongst other things. Certainly, anything that impacts sleep quality can have a very deleterious effect on one’s health. So Ted, it’s great to have you here today and I’m very excited to dig into this conversation more deeply.

DrTedBelfor:

Well, thank you. Thank you for your invitation.

Background

DrMR:

Can you tell us a bit about your background and kind of how you found your way here? Because I know this is kind of an emerging subset within orthodontics and dentistry. So how did you find your way into this niche?

DrTB:

Oh, it was purely an accident. About 20 years ago, I had a practice on the Upper East Side of Manhattan. I was treating a lot of performing artists and they would say to me, Hey doc, I’ve got this one crooked tooth and I need a new headshot. Do you think you could straighten it? You have to understand a performing artist can’t use wires and brackets and braces. So we needed to straighten those teeth using some kind of removable appliance. Fortunately in New York, you can find anything you want. I lucked out, located a retired orthodontist who had spent 60 years practicing without wires and brackets, and he was willing to come into my office. The deal was, teach me everything you know, but the accident was in the list of removable appliances that he had created to straighten teeth.

DrTB:

There was an appliance that had a unilateral bite block on the second bicuspid and first molar. The actors were coming back after treatment, even just a few months into treatment and they were saying their makeup artists is telling them that every time they do makeup, their face is changing. Singers were coming back and saying, Hey doc, since I’m wearing your appliance, I’m reaching higher notes. That’s what set me on this path. I mean it was such a motivating situation. Also when I spoke about it to my colleagues, nobody believed me. For all these years I’ve been using the appliance. Getting peer-reviewed papers written. Showing results and demonstrating and learning. Initially what I was doing was treating patients, giving them a wider smile and a younger face. Literally what the appliances it does, it stimulates the body, totally holistically, by switching on genes for development that we never switched on before.

DrTB:

Our mid face grows. The upper jaw is actually two bones. The maxilla. It’s actually two bones and those bones can grow separately and one can actually grow less than the other. The result is facial asymmetry. So if you look in the mirror and you have one eye lower or a deeper line between your nose and the corner of your mouth on one side, that will tell you right away that the upper jaw did not grow symmetrically. So the first thing that we can say about the appliance is that it activates the body. We understand how it works today. There’s a recent article, for example, in The Journal of Orthodontics and Dental Facial Orthopaedics in August of 2018, where they actually made a wearable appliance for a pig. It’s the first research that was done with a mammal.

DrTB:

Basically that appliance provided a cyclical signaling force for us to do cranial sutures. They only chose two sutures, the nasal frontal and midline sutures of the pig. Basically what they said when they sent force to those sutures was that literally every suture in the cranium was affected. The sutures grew wider and they had greater mineral deposits. Not to be too complicated. By putting a unilateral bit block on a dental appliance, we’re replacing the missing hard food in our diet. We’re generating strain, but we’re also generating a signal and a vibration into the bone. What they’re saying is just in this article alone, is that every time you swallow, for example, you bring the teeth together, but with this appliance, you’re going to hit in one spot, not both on both sides.

DrTB:

The concept is send a signal with strain. That strain actually helps to grow new bone. That’s just part of the story. But the concept in general is, the reason we have a pandemic of sleep and breathing disorder today is because our jaws are too small. When we have small jaws, particularly when our lower jaw is retruded, the mandible is set back, the tongue is in the airway. When the tongue gets in the airway, the head comes forward to breathe. When the head comes forward, you’ve got to lift your chin up to function, that drops your tongue the back of your tongue, further down into your throat. And now you’ve got a problem.

DrMR:

Okay. So, we could maybe restate that simply as the device, the Homeoblock, is providing almost akin to stress on a bone that we would use to prevent osteoporosis or stress on a muscle that we would use to prevent sarcopenia. This is being used to keep the bones healthy and in the appropriate formation, which has an impact positively on breathing and sleep, but also on aesthetics. Can you remind our audience of some of the context here. We’ve already hit a number of items, but we seem to be having this progressive under-development of areas of the face leading to teeth, crowding and braces, but also leading to sleep apnea and deformation of the of the smile. Is there anything else there you’d want to just kind of reiterate for people who maybe are somewhat new to this conversation and need a little bit of orientation?

Facial Development Over Time

DrTB:

Sure. I think you have to start at the beginning, looking at our first primate ancestors. As anthropologists track the cranial development, the facial development through the millennia, they see, as I was saying, big changes in our jaws. Within the last 300 to 400 years, we’ve had tremendous change. The reason is directly related to our diet. According to the US Department of Agriculture, the American diet today, 63% of our diet is processed food. This has added sugar and fats. The kind of processing that we have enough food today doesn’t allow us to put the correct force of chewing that the body responds to. We understand that it’s the DNA, it’s the genes that construct and operate the human body, but no gene ever turned itself on.

DrTB:

Now, you might have wonderful DNA. In your DNA is some of our ancient ancestors. Literally some of us walking around with genes that go back to Neanderthal man. The point is not what genes we have, but how they’re expressed. No gene ever switched itself on. It needs an input. To grow our face and our airway, what inputs and talks to the genes and switches them on is how we breathe, how we swallow and how we chew. So when I’m saying, is that our diet today, which is overly processed, does not give the correct signaling to switch on all the genes to reach a full genetic potential. When the face doesn’t grow properly, we don’t swallow correctly. Therefore the swallowing is not providing the correct signaling to grow our jaws. When jaws don’t grow enough, we don’t breathe properly.

DrTB:

So we have breathing, swallowing, and chewing that is compromised. The growth of our jaw is compromised. So therefore we need a protocol for an adult. Now there is a different protocol for children. What I do is strictly for so-called “non-growing” adults. I was taught in school that their cranial sutures fused in late adulthood. I knew it couldn’t be true and it isn’t, it’s been proven that it is not true. Many of the cranial sutures do not begin to fuse until the seventh and eighth decade of life. Basically a good portion of our growth comes from STEM cells. There are many sources of growth within the face. STEM cells can become anything. Therefore, if we provide the correct signaling, those STEM cells will become the cells that grow bone.

DrTB:

That’s one way of looking at it. That is for chewing. When we swallowed correctly as children, when we were growing up, to grow off face, our tongue went up against our palette and it said sent a cyclical light force signal to the teeth. Why is that important? Because around the roots of the teeth, something called a periodontal membrane has mechanical receptors that talk directly to the DNA. How do we know that is a fact? Well, when you’re a child, your teeth are in tooth buds, surrounded by this ligament. Somehow those teeth buds travel through the bone to exactly the correct position for the teeth to erupt into a beautiful smile. That’s because that periodontal ligament and the DNA are in communication. That continues. We understand epigenetics now. Epigenetics is when your environment affects the expression of our genes. We know today that the environment is constantly communicating to our DNA and we are forever changing. The concept of the Homeoblock appliance is we replace the missing hard food in the diet and signal that periodontal ligament around the roots of the teeth to get us to grow more. That’s what happens. In three to six months, you can see facial changes, due to that growth.

Breathing Disorders

DrMR:

There’s this confection of different breathing disorders. Can you help clarify to whatever extent you think is relevant, the difference between obstructive sleep apnea and upper airway resistance syndrome, or do they kind of boil down to the same handful of therapeutic interventions? Are they different in a way that that would be impactful?

DrTB:

That’s a wonderful question. I never claimed to treat obstructive sleep apnea. I treat upper airway resistance. Why? Number one: the American Association for Orthodontists in their white paper on the etiology, the cause of sleep apnea clearly state it’s due to the collapsibility of the airway. The modalities today for sleep apnea, none of them treat the collapsibility of the airway. When you put a C-PAP mask on and you blow air down your throat, that’s not treating the collapse. That’s not treating the cause of the problem. Mandibular advancement appliances, which are used by dentists to bring the tongue forward and out of the airway, once again, is not treating the collapsibility the airway. Now you mentioned muscles early on. Well, here’s where the muscles come in. There are several muscles that maintain our airway and those muscles that maintain our airway prevent the collapsibility of the airway.

DrTB:

So the system that I use, my Homeoblock and day time appliance, which was FDA cleared in July, 2019 called a POD (preventive oral device) are designed number one to tone the largest airway maintenance muscle, the genioglossus, which is the base of your tongue. So what happens is that muscle, when it contracts, it moves the base of the tongue away from the back of the airway. That muscle is designed for sticking your tongue out. So simply enough, the unilateral bite block technology, you bite on that block and contracts that muscle, it brings the base of the tongue away from the back of the airway. If you have a daytime appliance where you really can clench on that, we love when you clench on it, because you’re taking that muscle to the gym. However, the single most important muscle for maintaining the air is the muscle that attaches from your Adam’s Apple, your hyoid bone, to the inside of your mandible.

DrTB:

When you swallow that jumps up and down, doesn’t it? That’s your Adam’s Apple. One of the muscles that lifts your Adam’s Apple, when you swallow is called the geniohyoid muscle, this is the chief maintenance muscle of the airway. In order to tone that muscle, we use an appliance where when you swallow, your tongue has to travel twice as far, therefore you’re taking that muscle to the gym. So this is the basic concept. There are three things going on here. We’re actually stimulating the body to grow, but we’re also directing our energies to the cause, the literal cause of the breathing issue, the collapsibility of the airway. It is research that show that toning the airway, which is what we do through that muscle system, reduces upper airway resistance.

DrTB:

It reduces what we call cycling time. Cycling time is the amount of time that your body’s fighting for survival. Because when your airway even collapses a little bit, we’re not talking sleep apnea, sleep apnea is a particularly complex disease that should be handled by your physician. When we talk about upper airway resistance and mild apnea, I do treat mild apnea because our young folks today, because of that lack of development, many of them will sleep all night long, 10 hours and not feel rested. Why? Because what happens when an airway collapses, just a tiny bit, the hypothalamus in our brain thinks we’re going to suffocate. It sends a form of adrenaline into a blood, which speeds up a heart rate and this takes us from deep sleep to light sleep. We don’t even know this is happening. So that the slightly collapsible airway is causing us to feel tired in the morning. Feel terrible in the morning. That amount of tiredness is directly related to that cycling time. That’s exactly where the therapy is directed. Toning the airway, reducing the cycling time. That’s subjective. We could look at that. We have testing devices.

DrMR:

Just to kind of corroborate a few of the things that you said, and I want to thank, Dr. Nick Hedberg for making me aware of this study. There was one study on obstructive sleep apnea that associated playing of a woodwind instrument to reduce obstructive sleep apnea, which totally reinforces your posit, which is we need to be training the tongue so that you have not only enough room in the mouth, but also the right tonality of the tongue musculature.

DrTB:

That’s correct. A didgeridoo.

DrMR:

I just bought one of those actually.

DrMR:

Oh, you did. Research showed that using the didgeridoo, playing the didgeridoo, actually reduced sleep apnea. You’re a hundred percent correct. And it’s exactly what I’m talking about.

DrMR:

So, you know, for people who are maybe using some sort of device, that’s better than nothing. This is my opinion here, obviously.But there could be even better perspective on this, which would be correcting any insufficiencies in bone development so that you have enough room and then also retraining the musculature. I guess along those lines, as you’re doing this expansive work, I’m assuming you’re also having people do some tongue retraining and I’ve heard different protocols from frenular release snipping or other people having their patients work with a myofascial therapist afterward. Are you finding that your device, the tongue training device, is ample or is there another extent to which the tongue training needs to be done?

Everyone is Different

DrTB:

We start with an individual evaluation of the patient because every single one of us is terribly different. We’re so different, it’s incredible. Everything you’re saying are tremendous assets to improve, sleep and breathing. And yes, I use myofunctional therapy in certain instances. A perfect example are the folks that are mouth breathers all their life. They have long narrow faces because the mouth hung open. The tongue lived in the lower jaw and the upper jaw grew down. The lower jaw grew backwards. They have long narrow faces. To treat those patients, because they are mouth breathing, they weren’t breathing through their nose. They weren’t swallowing correctly because the tongue is living downstairs, not upstairs where it belongs. So primarily that patient needs to learn how to breathe through their nose and swallow correctly.

DrTB:

That’s the job for myofunctional therapy. That’s just one example of one type of patient. Now you talked about snipping the frenulum under the tongue. For a lot of us, the space between under our tongue and the tip of our chin, that space where our tongue lives. For some of us that’s very short. The reason it is short is because we never really swallow correctly because we have a tongue tie and that ligament under the tongue never allowed us to really use the tongue properly to swallow correctly. Now, remember from the beginning, I was saying that how we develop is related to how we breathe, how we swallow and how we chew. So those folks who have an attachment under the tongue, which doesn’t allow the tongue to send a proper signaling, that’s a perfect example of lack of development due to poor swallowing.

DrTB:

So each patient has to be evaluated individually to determine what is the cause of their problem. Was it poor swallowing? Was it a tongue tie? Are they a mouth breather? Did they inherit the issue? For example, we look at the heritable portion with the cranial base. In the womb we develop the brain, the cranium, the base of the cranium. That base of cranium measurement determines where our ideal facial growth should be. The face grows off of it. So we look at those measurements, we look at the angle of the cranial base that tells us where the lower jaw should be and what you inherited from your family. Some of our family profiles, and it’ll go back for generations, are very strong. That’s what they inherit. They inherit a strong jaw. Some family profiles, they inherit protruded, weaker jaws. That contributes. You can’t just take a person who has an inherited situation and mechanically throw them into a new situation and expect them to improve correctly. These are all a part of the evaluation and understanding, taking the correct measurements and deciding exactly the correct treatment protocol.

DrMR:

Yup. Certainly you have an advocate in me for personalization of therapeutics. In the realm of gut care, that is where we have the biggest success. A few things just to kind of rehash briefly for our audience, what are some of the factors that dictate risk? We’ve spoken before how if someone has had braces or headgear, if they’re snoring, these are all things that dictate risk. Is there anything you’d want to add to that just to help connect with our listeners and or readers to help them signify that they may want to look into this further?

DrTB:

I could go on and on about fixed orthodontics. Simply enough, we have an upper jaw and we have a lower jaw. The lower jaw is a victim of the upper jaw, generally speaking, but they grow entirely differently. Remember I was talking about that cranial base, well, the upper jaw grows off the anterior cranial fossa and the lower jaw and the airway grow off the medial crane. They’re two different animals entirely. So the folks that snore, I can generalize, their upper jaw has not grown forward enough. Therefore the soft palate, which basically is what you see when you open your mouth, hangs down and it rests on the tongue. Because the upper jaw is set back, the soft palate is too far in the airway.

DrTB:

At night, all you’ve got to do is open your mouth and that soft palate will start vibrating and you’re snoring. So the key critical cause for snoring is related to the upper jaw. The key critical cause for upper airway resistance is a different story. That’s related to the tongue and the lower jaw and the base of the tongue coming into the airway. When that happens, when you compromise the airway with the base of the tongue, the air speeds up and it sucks in the sidewalls of the airway, creating a negative pressure. Basically all this going on reduces the oxygen level by a tiny bit, just a 2% reduction for a young person. They have a hair trigger, just 2% of their oxygen becomes reduced and they go through that cycle I was telling you about where the body shoots the adrenaline into the blood, and they go from deep sleep to light sleep.

DrTB:

So they’re two different games, snoring related to the upper jaw, and very often upper airway resistance related to the lower jaw. We haven’t even talked about the nose. So we have to evaluate the nose as well, because, simply enough, all of at one time or another get stuffed noses. When we can’t breathe through our nose properly that definitely affects how we sleep at night. That’s the same story. We need the flow of air without resistance. That’s upper airway resistance, when we get a stuffy nose. I can go on and on and on about that. So there are three areas to look at the nose, the growth in position to the upper jaw and the growth in position of the lower jaw. All of these contribute, everybody’s different. They need to be evaluated each treatment protocol device around who they are.

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Common Findings in Practice

DrMR:

At the risk of asking another broad question that would kind of push you to generalize, are there common things that you’re seeing in your practice? For me, as an example, I see mostly IBS. I see some IBD, you’ll see some post-surgical maybe adhesion issues also, but there’s more of a kind of prevalent cohort. What is it that you’re seeing mostly? If you can generalize.

DrTB:

You hit the nail on the head. You can generalize because this is what’s happening to us. What we have now, as I mentioned earlier, is we have a lower jaw not developing forward. Our upper jaw, not developing forward. This backward lack of full forward development brings the tongue into the throat. In the human, when we breathe, the air goes through the nose and then it has to make a right angle to go back down behind the tongue to get into our lungs. If that tongue goes into the airway, that person inevitably has to bring their head forward to breathe. Just think about it. You can visualize that. If you’ve got to make a right turn to breathe and something interrupts that you’re going to have to bring your head forward to breathe properly. So today the classic patient we see has a head forward posture.

DrTB:

Furthermore, as soon as your head comes forward, if you just bring your head forward your eyes are looking down. You can’t function that way. So we bring our head forward and we rotate our chin upward to function. That becomes a problem. We now have posterior cranial rotation, a head forward posture. As soon as you lift that head up from posterior cranial rotation, the tongue goes further down to the airway. There is a link between posture and sleep and breathing. The best combination for treating that is a combination of a dentist who knows how to do Homeoblock treatment, for example, and a physical therapist, to work on posture. We also have thoracic breathing, breathing through our chest. This head forward posture affects our cervical spine. If we bring our head forward and we bring our chin up, we are definitely affecting our cervical spine.

DrTB:

Anything that affects our cervical spine affects our lumbar spine, which also affects our pelvis, which affects our diaphragm for breathing. Each thing is linked to the other. You need to see the complete picture. You need a team of professionals. It’s an interdisciplinary approach. Maybe it’s a myofunctional therapist. It could be a surgeon to release the tongue. It could be a physical therapist to get a patient to breathe correctly. Just understand this, controlled breathing helps our health enormously. Nature created in our chest, the perfect shape. Why? The average person out there has about 3000 square inches of body surface. Gravity puts 15 pounds per square inch onto each one of those square inches. So when we’re breathing in and expanding our lungs, we have resistance and we can control breathing in.

Breathing

DrTB:

The problem is when we breathe it out, all that pressure on us forces us to breathe out too rapidly. We need to control that breathing. So teaching the patient, how to control their breathing by generating resistance on the exhale. You do that simply. Breathe in through your nose, purse your lips when you breathe out, creating the resistance. Slow down your exhale till it is four times longer than your inhale. Pushing every ounce of air out of the lungs. When you breathe in, you have greater lung capacity, greater inhale, and I can go on and on and on. Somebody needs to teach your audience and everybody else out there, how to breathe correctly. Nobody has ever bothered.

DrMR:

On that topic. I know someone who wrote a quite a well done book on breathing. James Nestor wrote the book Breath. He is someone who really spoke highly of your work. While we’re on that topic really, really briefly here, anything else you want to expand upon regarding breathing. We will be having James on the podcast to kind of elaborate on his book, Breath. He also did an interview on Joe Rogan that I thought was excellent. For our audience, we’ve definitely discussed breathing in the past and all these things kind of link up. One other quick aside, if this is sounding on the patient end of things, a little bit overwhelming, it’s usually not that overwhelming, once you find a professional to lead the charge, because you’re not going to have to make all these decisions about who is on my team, who’s not on my team.

DrMR:

Usually you have a point person. From there they’ll dictate care and the people who will or will not be on the team. Also remember, and my personal experience also reinforces this, out of all the stuff that I’ve done, except for maybe treating an intestinal parasite, the one thing that has given me the most energy has been paying attention to sleep quality. Even though right now, I don’t have any diagnosed sleep condition. I know that if I can optimize further here, it will likely be more beneficial than any supplement, whatever. There is a lot of gain here to be had. On the topic of breathing anything, again there’s a lot there you can unpack, but anything else there that you think is really salient or any comments on the conversations that you’ve had with James?

DrTB:

Oh, sure. Well, let me start by defining the simplest possible understanding of how to improve your breathing. What we need is abdominal breathing. We need to breathe from our core. When we’re stressed, we use our chest and neck muscles. If you look in the mirror, you’re going to see your chest going up and down. Literally when we breathe, our chest does not move up and down at all. So simply enough, as the best advice I can possibly give to folks out there, take your hand down below your navel, move it over slightly to the side. When you breathe in through your nose, you should feel that hand being pushed out because you’re breathing downstairs with that core, not upstairs with the chest. There is no muscle for breathing. What we’re doing is by pushing that out, we’re dropping the diaphragm and creating negative pressure, and that’s how we breathe.

DrTB:

The first thing we can do is learn to breathe with our abdomen downstairs. The second thing we can do is learn to control it, slow it down, because we all breathe too rapidly and too shallow. So that’s number one. Number two, about conversations with James. I have to tell you, I first spoke with James. We realized we had a lot to talk about. He lives in California. I live in New York. So what did we do? We met in Paris. It was wonderful. We went down to the catacombs below Paris, where all the skulls were. That’s when we began our conversation in relation to the lack of cranial facial development known today as cranial facial dystrophy. That lack of cranial facial development, which causes breathing and jaw joint issues. In fact, I don’t want to go too far with it, but breathing is King.

DrTB:

Airway is King. If you don’t breathe through your nose properly, you don’t develop that airway. If you breathe through your mouth, you’re not developing that airway. For your audience, learning how to breathe properly and developing some good practices and exercises around breathing. Of course there are hundreds of different exercises involved with yoga. If you want to develop your airway and you want to have the best possible results for breathing exercise, you breathe in through your nose and out through your mouth with resistance. That doesn’t sound right because everything you are taught is you breathe in and out through your nose. But this is an exercise. We have to understand that the body is very complex system. There are three gases involved. So for you folks out there to want to do some investigating, look into the gas nitric oxide, which is created in our sinuses and goes back into our nose. That nitric oxide will kill the COVID virus. Hence breathe through your nose folks. If you breathe through your mouth, that virus will get right into your lungs and into your system. If you breathe through your nose, literally you can kill the COVID virus. I think that’s the most important thing I have to say today.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

DrMR:

Now coming to something you said earlier, that I wanted to cue in on because this is something that was personally impactful in my life. It’s also something I’m currently kind of grappling with and was actually the impetus behind us having this conversation today. I was working with Dr. Brian Hockel who’s out in Walnut Creek, California, and his practice is pretty fantastic. They’re doing a phenomenal job with pre/post measurement, publication, documentation, but I get the sense his practice is predominantly children. That’s evidenced by the photos on the wall and the fact that I’m the largest person in the waiting room by far. I think there was kind of a therapeutic mismatch where the Crozat that he uses, I have no doubt are effective, but I can’t have a lisp 24 seven for six months.

DrMR:

It’s just not something I can do. Shortly thereafter I read James’s book, came across your name and was excited at the prospect of a device that seemed to be, as you said, for professionals, working professionals, singers, musicians, actors, models, who also have some of those similar limitations. If I was working as an engineer, just in the computer and not sitting and talking to people, maybe I could have done that. But with speaking, being so prominent in what I do it was really hard to have a device that was leading to a lisp. So that’s where finding the right provider, who has a tool kit that’s attuned for your needs, for example treating adults versus children is pretty important. I thought the only option I had was the Crozat.

Devices in the Toolkit

DrMR:

So I guess there’s a lesson here of seeking out other opinions, just to make sure that the person who you’re working with, while they may have opinions in their toolkit, they might be rummaging in the child toolkit. So all of the opinions in that toolkit don’t really land for you fully, if you’re an adult. Your therapeutic options are more centered around not interfering with articulation and speech during the day, which again is really appealing to me. There’s the Homeoblock, there’s the POD. That’s what you’re wearing during the day. Will that cause any interference with articulation?

DrTB:

No, but first let me make it clear. The Homeoblock is only worn at nighttime, generally when you’re sleeping. So it doesn’t interfere with your life at all. The POD appliance is a daytime appliance, you wear it up to two hours, it doesn’t even interfere with articulation. When I tested it myself personally, I wore it 24/7 and I was treating and speaking to patients. So you actually can speak with it. You can have it in your mouth. It doesn’t interfere with anything during the day. Also I’d like to point out for practitioners that provide the services I’m talking about. I’ve trained quite a number of doctors. They can be accessed through my website. My website is https://drtheodorebelfor.com. Once you go on the website, you can email and set up a communication where you can find out where there is a practitioner near you that provides the same therapy that I’m talking about.

DrMR:

That will be helpful because we want to make sure people can access this support. Now, you also mentioned this tongue training device. What was the name of that? And how does that work?

DrTB:

Well, the tongue training is the POD. The reason it trains the tongue is if we don’t have enough room in our mouth, a lot of us are very short in there. So the tongue literally fills the whole mouth and it doesn’t get to do what it’s supposed to do. That is to move up, flat up against the palate with significant enough pressure to raise the soft palate, which blocks the airway. Then we swallow. So what the POD daytime appliance does since it has a block, when you bite on it, you now have all this room and when you bite on it and you swallow, the tongue has to travel so much further to swallow. That’s the tongue training device. In order to train correctly, we sometimes have patients go through an exercise. We tell them, stick your tongue out, take a piece of sugarless gum, put it in the middle of the tongue.

DrTB:

This is with the appliance in the mouth. Then they hold that piece of gum flat up against their pallet for a whole hour. That means they have to hold the gum without swallowing the gum. And, and they also have to learn how to get that tongue up into that position. Many folks don’t know how to do that. So what we do is we teach them how to suck their tongue. If you suck your tongue, you can get a flat up against your palate. So the point is, if you didn’t have the appliance in your mouth and somebody has no room in there anyway, tucking their tongue is easy. There is no strain on the tongue. We’re not training their tongue at all. As soon as we’d put the appliance in, which has a 5mm block, now when they bite down, the tongue has tons of room and has to move upward to generate that swallow. That’s where we’re starting to train the tongue.

DrMR:

This sounds to me like the Mewing exercises, where you’re kind of pushing the tongue up against the roof of your mouth with a kind of sucking motion. Is that what the Mewing exercises are?

DrTB:

That’s correct. That’s very similar. I met John Mew in 2004 in London. I went to his home and I do believe that his Bioblock appliance for children is the best there is. He generates forward growth and his son, Mike Mew is doing it. We have practitioners in the United States that are doing it. I met him so long ago and we were like, you know, a perfect match because the Bioblock is for children, the Homeoblock for adults. I remember in his perfect British accent, he said to me, “You have a marvelous appliance. You probably make a ton of money. Don’t let it go to your head”. That was 20 years ago. He said that to me and I still haven’t made a ton of money by the way.

DrMR:

At least for me, I think it’s going to be a game changer. One of the things I’m planning on doing is getting fitted for a Homeoblock, because I do want to move forward with this line of therapy. I just hit that roadblock of not being able to do the crozats during the day. I guess maybe also a good lesson for our audience that, you know, sometimes you have to rejigger the plan, but keep looking forward and keep your eye on the goal. Yes, you may hit a few speed bumps along the way, but the important thing is where you finish, not necessarily how many speed bumps you have to surmount on your way to your goal.

DrTB:

It’s not just the appliances. Just sticking the appliance in and it’s going to solve all your problems like magic or whatever. The Homeoblock treatment has four goals. We say the number one goal, pressurize the airway. What do we mean? Just wear mouth tape at night. You need to breathe through your nose 24 hours a day. So for all your audience out there that can be done tonight, go to any pharmacy and the medical tape division. They have plenty of selection. We like a 3m product, and you basically tape your mouth at night because all of us have a tendency to breathe through our mouth. Number two is that tongue work. You must have your tongue up against your palate. If you can’t do that properly, you’re not swallowing correctly. Number three is toning the airway.

The Autonomic Nervous System

DrTB:

That’s where the appliances come in. They tone the airway. Number four is one thing we haven’t discussed. The autonomic nervous system. The autonomic nervous system is what, when we’re not thinking about it, controls our breathing. It also controls our heart rate, temperature, on and on and on. The autonomic nervous system needs to function well for us to be healthy. The key to getting the autonomic nervous system to function is breathing. So like I said, when we start treating a patient, we start by teaching the patient how to breathe. And I want to emphasize that what happens when you breathe correctly, you enhance your autonomic nervous system function and enhance your digestion by the way, hand in hand with your microbiome. Your autonomic nervous system is running that digestive process. When we’re stressed out, there are two parts of the autonomic nervous system for you folks out there. I don’t want to make it too complicated. We have fight or flight and relax and digest. So it’s simple to understand when we control our breathing, we do our breathing correctly. We are in relax and digest. So you’re going to basically function better. So I’m sorry, I didn’t mean to interrupt, but I had to get that in.

DrMR:

No, please. It’s definitely important. I was actually just going to say something kind of in theme with what you were saying, which is, we can break some of these down into lifestyle interventions. Nasal breathing, tongue exercises, whether they’re the Mewing, or perhaps buying a didgeridoo and learning how to play that. Along those same lines, one thing I’ll offer people. Also, I believe it was Brian McKenzie, who was the initial voice championing this message of performing cardiovascular exercise, no matter how intense you go, always breathing through your nose. I found for me, this has made my ability to always feel comfortable breathing through the nose and having an appropriate toning of that airway much, much better. So something else for people to consider is breathing through your nose all the time.

DrMR:

Even during intense exercise. McKenzie is hypothesizing that it can also help with endurance performance. Then we have some appliances, potentially interfacing with a therapist of some sort, and all these things come together for the bottom line objective of you breathing better and sleeping better, and that having an effect on your autonomic tone. As I discussed in Healthy Gut, Healthy You, the data are so irrefutable regarding anything that interferes with your sleep. There are at least a couple of meta-analyses showing a deleterious effect on whatever the parameter is being measured, neurogenerative decline, cardiovascular disease, cancers. It was pretty shocking how incontrovertible the evidence there was. So this would be arguably one of the most important facets of health. Breathing, respiration and sleep. So definitely something well worth putting some time and effort into. Ted along those lines, are you using any kind of wearable device, perhaps something like an Oura Ring to get a sense for someone’s baseline and then how they improve post?

DrTB:

I do wear an Oura Ring. I like the Oura Ring. The issue is though I have not yet discovered how to sleep. My sleep is not consistent. I watch myself, I don’t know about everybody else. And I have to say, I don’t know how to improve deep sleep. For example, how to improve REM sleep. REM sleep is definitely related to upper airway resistance, but deep sleep is an issue. I’m an older person. The way that works is, the body generates sleep spindles in our prefrontal cortex. As we get older, we don’t get as many of those sleep spindles. We don’t get as much deep sleep and deep sleep is critical for our health. So I love the Oura Ring. I get up in the morning. I look and say “Oh my God, I didn’t get enough deep sleep” and I have yet to figure out how to improve that.

DrMR:

Okay. Now, outside of your own personal experience, is this something that you’re tracking anyone kind of pre-intervention and post-intervention and correlating to Oura scores?

DrTB:

No, I don’t use the Oura Ring for that. I use something called high-resolution pulse oximetry. I screen every patient with high-resolution pulse oximetry. The standard for looking at sleep and breathing is something called the apnea hypopnea index or the respiratory disturbance index. They were both developed by Christian Guilleminault who passed away recently at Stanford medical center. Before he died, he said he was so sorry he ever did that. How often do we find we have a person that feels terrible in the morning. They go in and have a test and the doctor looks at them and says “hey, you’re fine, go home, there’s nothing wrong with you”. That’s the trouble with the testing system we have today. It does not pick up the small desaturations of oxygen that we’re talking about that are due to upper airway resistance.

DrTB:

It’s those small desaturations that affect the quality of our life. Yes, by the standard that the medical profession has set we’re not sick, but we personally know better. The simplest way to determine what’s going on with your sleep is to look at your pulse at night. I use the high resolution pulse-ox symmetry, and I know the patients are not interested in the numbers. So I show them their heart rate. Their heart rate runs when you’re sleeping and you’re healthy 52 to 62 beats a minute on a steady level. Then all of a sudden you’re going 62 beats a minute. All of a sudden, you’re jumping up to 80, 90, a hundred beats a minute. You don’t need any sophisticated instrumentation to understand something happened there. That’s what we’re treating. That burst of adrenaline that goes into the blood that causes your heart rate to speed up. That takes you from deep sleep to light sleep. And when you wake up in the morning, you don’t feel so good.

DrMR:

Now, do you have a certain device you recommend? I just did a quick search here. It looks like these go from anywhere from around $50 to maybe $200, which is nice, it’s not too expensive. Is there a certain device there that you like?

DrTB:

Well, see, I’m a professional. Now, if it’s for somebody who just wants to track their heart rate, there’s all kinds of pulse oximetry. But the sleep sat pulse oximeter that I use is $500. Then again, I use it on a professional level.

DrMR:

So is this something that a patient will take it home for a night or two and then bring it back to the office? Is that how you’re using it?

DrTB:

Correct. It’s not for just a patient at home. You have to plug it into your computer and the data goes through the computer and then a report is generated. The software for that is another $500. So on a professional level I use the Sleep Sat High Resolution Pulse Oximetry, but I’m not recommending that your patients go out and buy one. It’s not a good idea.

DrMR:

Sure. Now, one of the things Hockel had me do was I believe it’s called OmniOne and it’s their home sleep test. Is that something that you have any familiarity with?

DrTB:

I don’t. The home sleep tests, generally speaking, they are all based on apnea hypopnea index. Really sophisticated home sleep tests will show you RERAs or respiratory effort related arousals. With high resolution pulse oximetry, we’re looking at the tiny desaturations and what they’re doing. That’s measured in what we call cycling time. If his assistant measures cycling time, I’m all for it. If it doesn’t, it’s not what I would use.

DrMR:

Gotcha. It seems to me like it may be a pulse ox paired with a microphone device that you clip on your chest.

DrTB:

Oh, for snoring. Yes. There are advantages to all these devices, just like there’s advantages to all kinds of breathing techniques. So I paired it down. I mean, I’ve been doing this for 20 years, so I’ve paired it down to what to me is the simplest and most efficient system. Each practitioner is going to do it their own way. So I’m sure that what he does is terrific. It’s just, we all have our own different systems.

Episode Wrap-Up

DrMR:

Sure. So this has been a very enlightening conversation, especially if I’m being totally honest and selfish for me personally, because I’ve been looking for a better path forward in a way to kind of get around that roadblock I mentioned earlier. So I want to give you a personal thank you. I’m sure our audience has also been quite informed from this and I’ll thank you on behalf of them as well. Are there any closing thoughts you want to leave people with and then please let them know again, your website and anywhere else you’d like to point them to.

DrTB:

Yes. It doesn’t matter which practitioner you choose, but I’m perfectly willing. If you get a cone beam, computerized, tomographic scan, that’s a three-dimensional cranial scan. If that scan is sent to me, I will personally do an evaluation and generate a PowerPoint presentation. That presentation goes to your treatment doctor, wherever you are. That treatment doctor then completely understands how to direct that treatment to the cause of your problem, because my evaluation is to determine the causes of your issue. So I highly recommend that you get a three-dimensional cranial scan done before any work is done. That’s the key to success. Understanding exactly what the cause is and treating the cause. Once again, my website is DrTheodoreBelfor.com. I hope you visit the site and I hope what I’ve said today has been helpful.

DrMR:

Yeah, it has been. Thank you again. I really appreciate it, Ted.

DrTB:

My pleasure.

OUTRO:

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