EP. 31 | The Connection Between The Airway and ADD/ADHD, with Dr. Ruan.

Unlock the secrets behind your child's hyperactivity or inattention as we welcome Dr. Ruan, CEO of the Texas Center for Lifestyle Medicine, on this eye-opening episode of Brain Power with Dr. Eko. Could chronic mouth breathing or sleep apnea be masquerading as ADHD in your adolescent? Dr. Ruan sheds light on the skull-brain connection, revealing how sleep disorders might be at the root of behaviors often misdiagnosed as ADHD or ADD. He guides us through the "five whys" approach, encouraging parents to look beyond the symptoms and address the underlying causes that affect their child's brain function and overall well-being.

Do you know how crucial your oral health is to your brain function? According to Dr. Ruan, the trigeminal nerve plays a vital role in managing stress and emotional responses, and improper bite alignment can lead to cognitive impairments. We delve into the impact of COVID-19 on neurological and psychiatric symptoms, demonstrating the importance of seeking professionals knowledgeable in physiologic dental medicine and sleep education. Dr. Ruan recommends invaluable resources like the American Association of Physiologic Dental Medicine (AAPMD) and the Sleep Education Consortium (SEC) for those needing further guidance.

Finally, we explore the profound effects of diet and hydration on children's behavior and health. Dr. Ruan discusses how processed foods, sugars, and inadequate hydration can lead to increased mucus production and behavioral issues, offering practical tips to reduce processed food intake and ensure proper hydration. We wrap up the episode with a heartfelt message on parenting with grace, emphasizing that self-love and open communication are key to nurturing our children effectively. Tune in to uncover these vital insights and empower yourself with the knowledge to support your child's health and well-being.

Connect with Dr. Ruan!
Instagram: cheng_ruan_md / txlifemed
Website: www.texascenterforlifestylemedicine.org

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Transcript

Dr. Hokehe Eko: 0:25

Hello everyone. Welcome to another episode of Brain Power with Dr Eko, where today I have another amazing guest to bring on and we're going to have an amazing discussion today. So I'd like to introduce to you Dr Ruan, who is the CEO of Texas Center for Lifestyle Medicine and was the host of the Reverse Brain Disorder Summit on Dr Tok's platform. So welcome Dr Ruan to the show.

Dr. Cheng Ruan: 0:52

Hey, thanks for having me. I'm super excited to talk about what we're going to get into.

Dr. Hokehe Eko: 0:56

Yeah, thank you for coming on. So can you please introduce yourself even further, Because that was a really brief introduction and I know there's so much more that you do? Yeah, yeah.

Dr. Cheng Ruan: 1:08

So at Texas Center for Lifestyle Medicine, we create programs for people who really want to discover the root cause of disease, in groups and individual programs, and a big part of what we do is collaborative medicine, which means we want to collaborate with other people and other healthcare professionals on discovery for causes. In fact, that's where we're where I'm coming all of you today and also get it out there right. I think it's important to share the data and also, like I'm always learning and I mean the last three years, I've really learned a lot, especially about brain health, add, adhd, et cetera that I really want to share and bring to the world.

Dr. Hokehe Eko: 1:51

Wonderful, and I've been a recipient of your wonderful knowledge that you're gaining, so I am thankful for you as well. So let's dive into it. Today we're going to be talking about the connection between the airway and ADHD ADD specifically in adolescence. So, Dr Ruan, would you like to tell us what that connection is?

Dr. Cheng Ruan: 2:15

Yeah, I kind of coined this term skull-brain connection and it's sort of a new concept. That is not new, meaning that it was kind of lost. It looked like a loss ever since we really got into modernizing medicine. But we really have to talk about the concept of brain health. So let me just kind of bring this into existence real quick.

Dr. Cheng Ruan: 2:42

And the view, the way I view disease is not like disease. The way I view disease is that whatever's happening is a compensation of something else. We're always compensated for something else. In order for us to survive, that compensation mechanism has to kick in and that creates disease and that also creates disorder. And when we think about attention deficit disorder, activity disorder, we're looking at why is the brain compensating and what's it compensating for? And so and in fact the answer is quite simple, because if you actually look at the behavioral pattern in ADD and ADHD, our brain is actually trying to stay awake and attentive because perhaps it's having a hard time doing so.

Dr. Cheng Ruan: 3:31

So in the world of neurology we the concept in neurology of ADD and ADHD is that it could be potentially secondary to something else, and the most common is sleep disorders, such as sleep apnea, or in kids and adolescents, sometimes it is sleep apnea or sometimes it's sleep disorder breathing chronic mouth breathing that creates an ecosystem during sleep where we're not really able to get into deep sleep. So during the day our brain compensates by going to this mode called hypersomnia or hyposomalance, where the brain wants to take a little micro micro-naps, right? Well, in Kim's adolescence it becomes hyperactivity. In adults we call that fatigue or brain fog, right, memory issues, etc. So the nomenclature is a bit different depending on what stage.

Dr. Cheng Ruan: 4:33

And the question is well, why is it so common these days? And I think that's what we get into, because that's where we look at data, looking at human skull formations over the last couple hundred years, right, that's where we look at data of what else are we really seeing that's coexisting with ADD and ADHD. Why is there so much more allergies and chronic sinusitis? Why is there so much more dental issues, right? Why are there so much more wisdom teeth being removed these days, whereas before wisdom teeth coming in not an issue? So these are some aspects that I think have been lost for some time in understanding these disorders.

Dr. Hokehe Eko: 5:15

Okay, so thank you for that summary, but then that creates a whole host of questions. We need answers to Something I wanted to point out for parents listening Instead of asking the question like what's wrong with my child, right. Listening Instead of asking the question like what's wrong with my child, right? Dr Ruan just said your child's brain is trying to take naps during the day, and what it will manifest as is hyperactivity. So it's not that your child is willfully trying to misbehave and not listen to the teacher. Your child's brain is trying to compensate for what it's missing. So it's so important for us all to realize that and then start asking the right questions. Right? How can we help our children sleep better and so that their brain function better in the daytime, dr?

Dr. Cheng Ruan: 6:04

David Lamont Wilson-, absolutely, and there's an approach in root cause analysis and engineering called the five whys. Approach the five whys, the W-H, and engineering called the five whys. Approach the five whys, the W-H-Y. The five whys approach is simply asking why five times? So let's start. My child is having inattention, okay. Or a diagnosis of the energy deficit, right, the why is the brain compensating? That's the real first question. Why is the brain compensating by exhibiting inattention? And so the first answer is perhaps sleep quality is not very good the night before, okay. Second, why? Well, why wasn't sleep quality that was very good the night before? Well, perhaps maybe there's too much screen time last night late into the night, maybe there's too much roblox or or minecraft, whatever they're doing these days right. Or perhaps maybe they ate too late. Maybe they're in sports camp and they came home at 9 30. They ate too late and eating too late disrupts sleep, which can affect them within food. Perhaps is because the things that they actually eat right and you know, for the kids out there, I hate to hate on Chick-fil-A, but I'm going to for a second the amount of MSG in there creates a neuro-excitatory pathway that really inlays deep sleep, which is quite so, so addictive as well. If you eat that too late at the end, you know. Once again, I'm sorry parents, I have to hit on Chick-fil-A for just a second, and then another question is okay, are there other reasons that we don't know about that?

Dr. Cheng Ruan: 7:49

The sleep could be disrupted. Well, look at your child's sleep. Sometimes their neck could be hyper arched, meaning that their neck is kind of thrown backwards. Sometimes they're in different positions. Well, why is that? Cause they're trying to breathe at nighttime. Maybe they can't, maybe their palate aren't fully expanded, or maybe they have hereditary tibetaner issues. Right, perhaps in some parents a lot of children are born with like dystonia or torticollis. That could be its own mechanism to trying to get the airway to improve as well.

Dr. Cheng Ruan: 8:24

Right, and you hear your child grinding their teeth at night. Well, that's the case. That's a big issue, because grinding, the medical term is called bruxism. So bruxism is there to try to tent open the soft tissues in the mouth, to tent open the airway, to try to get enough bleeding as well. And, by the way, I'm intimately familiar with this with my three children, with my three daughters, so you're not alone. Perhaps, maybe there's some bedwetting, perhaps there are issues where the child has nightmares, product nightmares, sleepwalking, sleeptalking. Once again, I've been through all this as a parent, and so these are signs and hallmarks of something disrupting in the fleet right. And so the second why is after actually very broad, but we really have to ask all these questions.

Dr. Hokehe Eko: 9:21

Right.

Dr. Cheng Ruan: 9:22

And so let's say, for example, that we know there's something that's causing the child or the adolescent not to sleep very well. There's a third why? So let's play this game for a second. Let's say the second. Why is too much screen time? Okay, how many parents experience kids with too much screen time? Pretty much all of us, right, right? Well, why does the child even want to have so much screen time in the nighttime? Is it because they can form relationships online? Is it because that's Y and Z? Well, maybe, or perhaps the hyper-stimulation of pixelated light from the screen feeds the child's dopamine pathways, the addictive pathways in the brain that gets hyper-accepted to it. Because the night before they also didn't sleep very well either.

Dr. Cheng Ruan: 10:16

Okay, so, if you think about it, let's take it back into ancient civilization. If our brains were to come under stress, right, and we deal with it and we don't sleep throughout the night because maybe there's a war. This is part of our survival mechanism. The next night, our brains are actually triggered, so our eyes focus on objects and things that are moving, because there may be a war, right, and so over time, our brains really develop this response. But instead is no war, it's an iPad or some stuff there.

Dr. Cheng Ruan: 10:50

Hey so now, if your child also has issues with sleep and branding and stuff like that, then that's another war. The child is battling, is flea-reported, breathing, right, and that will also create dopamine mechanisms to occur within the brain. And when your brain is on dopamine and it can't activate that serotonin, serotonin will have a nice calm docus neurotransmitter right, and dopamine is sort of that go-go-go excitatory state, that hyperactivity that you see in kids, right, and so these are things to really think about. So that's the third why. And the fourth why is well, why is it? Why is it that a lot of people, a lot of kids, now have sleep disorder, breathing or airway impairments or grinding? It's because the human skulls have changed over time, the human anatomy has changed over time. So you know, we're in the eighth generation of humans right now. That started from industrialized world, you know, and our accessibility to softer foods and low processed foods are more and more and more and, epigenetically speaking, meaning that things that surround the human nature in terms of genetics, we're transferring a smaller jaw, we're transferring to these smaller palates as well. On top of that, what happened 60, 70 years ago is a fear. This fear is called the choking hazard, meaning that a lot of parents are introducing the child to solid foods way later in life than previously as well. So there's not much chance for the palate to really fully expand and grow and develop, which is why there's not enough real estate for the teeth to really grow in in the mastilla and the mandible, the top part or the jaw and the bottom part, and therefore there's routing, there's overlapping, there's something called crossbite right, and potentially overbite, and some underbites as well could be causing an issue where the brain is sensing that the teeth don't quite fully merge and meet together. Right, all right. And then here comes the fifth. Why the fifth? Why was okay? Well, now that we know that the brain are changing, because of the gall shape, that's changing. Well, why would it affect attention?

Dr. Cheng Ruan: 13:12

Going back into ADD, well, it's simple. So we have an amazing amount of neural networks within our brain and these neural networks go everywhere. One of them goes from the brainstem, which is the bottom part of the brain, past the jaw, right here next to the TMJ, and it sends multiple branches out and it's called the trigeminal nerve. And the trigeminal nerve sends a branch to the temples, sends a branch to the maxilla, the sinuses, but also sends branches to your teeth. So there's maxillary branches of these nerves and mandibular branches of these nerves. Well, believe it or not, there's so much sensory information that these nerves are actually going back to the brain, to the hypothalamus.

Dr. Cheng Ruan: 14:01

Now, what is it sensing? It's sensing bite force, okay, and so what happens is, well, what happens when something makes you angry, grit your teeth, right? Well, that's no accident, it's because it's sensing that the bite force right here, the grit of the teeth, allows the body to go into this fight or flight mechanism, you know, and I call it the roly-poly mode, where you, like your body, starts feeling really tense, right, and you kind of roll into a little ball of anger, or maybe even ball of excitement, because the brain can't tell the difference between excitement and anger. When that happens, it's only supposed to happen for a certain amount of time and for a certain amount of intensity, because if it happens for too long or too intense, our body naturally has a cognitive mechanism. Well, how does the body know that Through the teeth? So what happens is there is this reflexive body called the TCR, the trigeminal cardiac reflex. Where these branches to the teeth, the trigeminal cardiac reflex, where these branches to the teeth of the trigeminal nerve, okay, goes to the brain and says hey, we can either be calm or not be calm. And so if the teeth don't quite meet together, then the brain has a hard time calming down because it does not get that signal to hey, I'm safe, I'm safe, I'm safe it gets what happens.

Dr. Cheng Ruan: 15:22

Inattention happens, right, hyperactivity happens as well. So the parents listening to this Now we have a lot of teenagers like within our practice that a lot of times we ask the parents when did a lot of these behaviors start? And it usually starts when there's sort of a need for, like, orthodontic work. It's around them like the same time, right, and that's really no, no, acid, neither right. So, taking the five wise approach, we now just looked at um, a neurological pattern that's rooted to our, our teeth and other parts of our skull, our sinuses, that's trying to sense, to give our brain a sense of calm.

Dr. Cheng Ruan: 16:07

Okay, now here's another thing that I learned during COVID, because coronavirus, when you're exposed to coronavirus, a lot of people exhibit quote-unquote neurological symptoms and psychiatric symptoms Anxiety, insomnia, etc. Etc. Right, well, those same branches of the nerve goes back to the trigeminal nerve and feeds back to the brain and the sinus says the same thing. Hey, there's something going on here, don't create a con, okay, and the coronavirus has little different spikes on the outside, so that spike protein goes into the mucous membranes within the sinuses and it can relieve this giant inflammatory cascade. Well, that's also going on in the mouth when the teeth are able to bite together, but that also goes down in the mouth when your child also has periodontal disease, cavities, gingivitis, etc. So our sinus and our oral health is extraordinarily important for the brain. Right Now, in younger people we do call it ADD, add, add, add, and in older people we call it other things Brain fog, fatigue, mild cognitive impairment, which later on leads to dementia, right, and so we really have to put the big picture together for everyone listening to this.

Dr. Hokehe Eko: 17:32

Wow, that's amazing. It's so interesting how everything, every single thing in the body is connected Right. It's so interesting how everything, every single thing in the body is connected right, and so that's why it's so important to look at the root cause versus just the symptoms. No-transcript. Wow, this is amazing. So what would you recommend parents do? Okay, so they've heard this and so, yes, their child is grinding their teeth, their child has ADD, their child the dentist says take out the wisdom teeth. What should a parent do, or what kinds of questions should they be asking, or what kinds of professionals should they be looking for to take care of their child's symptoms?

Dr. Cheng Ruan: 18:18

Yeah, you know, I have an organization called the Physician Transformation Institute, so we actually teach dentists and doctors about stuff like this, and one of the webinars I had is the dentist's role in brain health right? Is the dentist role in brain health right? And what's really interesting is that most dentists don't understand a lot of the concepts I just talked about. Neither do most of the doctors out there, but there's some that do right. And there is an association called the AAPMD, the American Association of Physiologic Dental Medicine. The AAPMD is an extraordinary organization where they discuss these things. It's really the meeting between people who are stressful for oral health and dental health and everyone else right. And there's another organization called the SEC, the Sleep Education Consortium everyone else right. And there's another organization called the SEC, the Split Educational Consortium. That's founded by my friend, dr Gerald Simmons about 20 years ago and he is a triple-bore certified neurologist and, in fact, people listening to this. I did an entire podcast with him. You can find it on YouTube. If you just search on YouTube the skull brain connection, it's usually the first one that pops up. Between me and Dr Siggins, we really deep dive into this, and so I think it's important to talk to healthcare professionals who kind of understand it and talk to dentists who understand this, usually through the AAPMD's organization. There are other organizations that are out there as well. There's actually tons of education on this now, really over the last seven to eight years, that we can actually find, and there's a great book called Breath by James Nestor. It's a bright yellow book if you want to look on Amazon. But what about the medical professionals that you talked about? Right, I think it's important to work with dentists who are trained in airway dentistry, who do treat lead apnea, especially in pediatrics. There's also pediatric chiropractors who actually work on improving their airway for your kids and releasing a lot of the tension that's within the neck to help the child breed as well. So it's really an amazing consortium of professionals and all really have to collaborate together to do all this right.

Dr. Cheng Ruan: 20:48

And you know, and the thing is like we don't want to take away some of the other stuff that you can do at home, which is making sure the diet is good, making sure there's not too much processed foods, et cetera, et cetera. Those are all extraordinarily important things because they do affect your breathing and your airway and, if you think about it a lot of times children and adolescents eat things and then they get a little snotty, right, they start having, they start having mucus come out their nose, like literally snotty, a lot of snot coming out their nose Right and and the term snotty has the double meaning because snotty also means someone who's not behaving or aggressive or something like that right, but where did it came from? It came from the fact that the sinuses become so congested that they can activate the mechanisms within the brain that create that serotonin, the calm neuro-pansion, their dopamine dependent in their brain, and all of a sudden their behavior changes. So snotty in the nose equals snotty children, sometimes Right and snotty adults too.

Dr. Cheng Ruan: 21:54

You know, right now I'm a congester. If they got sick it's from daycare. But yeah, you don't feel good whenever your son is congested, and neither do children. So if they're eating foods and eating things that can create mucus, then those are things to really pay attention to. You know, and that's what I do with my kid, my two-year-old is becoming really like snotty. I have a lot of mucus in the nose and is coughing a bit. Well, I go to hey, what's going on. You know, what did my child eat, or what do we really do, and those are things to pay attention to as well. It all goes back into attention and patient death right.

Dr. Hokehe Eko: 22:38

So what are some examples of foods that parents can can watch out for that cause mucus?

Dr. Cheng Ruan: 22:45

oh gosh, yeah, so this is a good question. So what I want people to understand when I, when I list some of these things, is this is not universal. It's really. You really have to see how people respond. You know I don't do a whole lot of pediatric, I do mostly adult medicine, so but it's the same.

Dr. Cheng Ruan: 23:02

My same recommendation for for adults as well, is the first thing, that it's the most important, is processed food. I think processed food I'm looking at you Cheetos these actually were designed for an addictive response in the brain. There's also a lot of MSG and some other components that are in there and they can be getting your child to a bit different behaviors. Okay, and when sometimes your child is exhibiting these behaviors, they got a runny nose as well. That's a big indication. That's there. So processed foods, I think, is really important, and this actually goes into processed meats as well, by the way. So sometimes you'll notice that, let's say, the child's eating a hot dog or a sausage and they start having a big runny nose for a couple of days. Right, that's a big indication. But then if they eat non-processed meats whether it's beef or chicken, whatever it is right If you don't find that that's a huge indication as well. So don't think that processed meats are kind of outside of this category. So that's by far the biggest number one. Number two is actually a lack of water. That's by far the biggest number one. Number two is actually a lack of water. So dehydration is probably the most common trigger for behavioral issues and inattention in adults and in children. So when the kids want water, they'll tell you they want water and make sure you give them water. So what's not in the category of water is like sodas and stuff like that, because that can also trigger attention as well.

Dr. Cheng Ruan: 24:39

A lot of parents are what about juice? You know? So I would definitely. You know, my kids are good enough to know that whenever they get a juice, they, they, they enjoy it, but they dilute it like themselves, right, like daddy, bring me some waters, because this is juice, and so they've been kind of trying to do that. But they also don't like a lot of the overstimulating sweets and they're not necessarily used to it, and so you are having one out there and having juice and stuff like that which is diluted. Now there's some juices that come like not very sweet anyways, that are out there which you can get, but you gotta, you gotta pay attention to, to, to the reaction to the behaviors, what their body's doing, their study stuff like that, right.

Dr. Cheng Ruan: 25:25

And another category, and it's it's processed sugars, and when I say processed sugars I mean things that are, you know, beige in color and white and stuff like that, right. And so natural sugars, such as the things that are found in fruit, is actually quite amazing, because there's polyphenols, which are basically plant-based compounds that actually do help the brain, right. And so processed sugars we want to be really aware of. And then my last category is sugar substitutes.

Dr. Cheng Ruan: 25:53

I'm not a fan of sugar substitutes because there's huge behavioral implications in sugar substitutes as well, with the exception of natural sugar substitutes, such as stevia is okay, and I just forgot what the other one is Monk fruit is okay as well, and so these are more natural things that are out there, but a lot of the saccharides, a lot of the other major process sugar substitutes that are chemically made have a huge detrimental effect on brain function. In fact, it actually has been shown to accentuate pain, meaning a small amount of pain stimulus that the brain can actually say hey, this is more than what I'm used to was. The brain can actually say, hey, this is more than what I'm used to. So that's called pain sensitization. And we also know that sugar substitutes dramatically decrease sleep quality as well. So those are some of the things to pay attention to.

Dr. Hokehe Eko: 26:45

Yes, you're absolutely right. I had a little four-year-old. I found that was drinking chocolate milk in the middle of the night and I told him stop and voila, he sleeps now amazing, and his behavior improved the next day yeah, yeah, well, and that's that's the thing about milk too, because milk is not just sugars.

Dr. Cheng Ruan: 27:05

There's there's casein in there and some people you know they're not lactose intolerant but they react to casein. And there's a protein in milk called caseomorphone. It got its name from the word morphine because it has a very similar effect on the brain, and so for some people, drinking milk before bedtime has a morphine-like effect and so that's a genetic predisposition that's there. That is not great for the brain, and so you don't run into a bit more phenolic effects prior to bed, and so if your child is really wanting that glass of milk, that may be the actual issue. At that time it may be convenient, but over a long period of time it actually does some destruction. You just want to be careful.

Dr. Hokehe Eko: 27:58

Yes, absolutely. So what's your take on honey? What if it's raw honey?

Dr. Cheng Ruan: 28:06

Okay, I think it depends, because honey has really amazing medicinal benefits as well. It's the only thing that can make sure you live a jar out. It won't expire, right? Honey has its own natural antimicrobials. That actually fortifies the immune system. But you can overdo it with honey, just like anything else, I think. Right, you got to play around with it and see how your child reacts, right? Yep, I agree.

Dr. Hokehe Eko: 28:30

Wow, that's been so, so helpful how your child reacts, right. Yep, I agree. Wow, that's been so, so helpful to, even to me. I'm thinking I have a whole page of notes. Yes, and that's why we're always learning, because we want to keep expanding our knowledge base so we can help parents and children be the best version of themselves. So thank you so much, dr Ruan, for all you've shared version of themselves. So thank you so much, dr Ruan, for all you've shared. Can you tell our guests or our parents listening where they can find you and find out more about, and even the professionals that will be listening to this, where they can find out about the programs that you offer?

Dr. Cheng Ruan: 29:06

Yeah, so for the parents, you know I'm the CEO of Texas Center for Lifestyle Medicine. You can search for that on Google and Instagram and Facebook, et cetera. For me, I have my own personal social media as well. It's my name, so it's Chang Rung. First name is C-H-E-N-G. Last name is R-U-A-N-M-D. You'll find that on all my tag handles. For those professionals listening to me, send me a message on LinkedIn. I'm the executive director of the Physician Transformation Institute, where we get doctors to think differently and be curious about things that are outside of what we were taught in school. We also raise funds for Physician Burke. We're now in Physician Depression. We're at an all-time high right now in the history of the profession.

Dr. Hokehe Eko: 29:51

Thank you so much for what you do, so thankful you could come on here and forward to having another one with you.

Dr. Cheng Ruan: 29:59

Yes, thank you so much and you know I'm going to leave. One last message for the people that are listening into me today is it's not about being 100% perfect parents. It's really not, and I say that because my kids also eat some Chick-fil-A in there, all right. It's not about being a hundred percent perfect. It's about always be auditing, meaning that, observe what actually happens and talk about what actually happens. Right, um I that the more you communicate and educate um your children yourself, um your significant other, the family, grandparents especially, I think that's a big one, right? The more that we talk about this in an open fashion, the better. But it's not about being 100% perfection. So, parents, give yourself some grace, because I do.

Dr. Hokehe Eko: 30:49

Yes, me too, absolutely. Thank you so much for that last gem that you dropped. So, yes, parents, like Dr Rowan says, nobody's perfect. There's no manual for parenthood. We just keep doing what we can every day and showing ourselves love, so we can definitely love our children. So have an amazing day and thank you for listening.