Sleep Apnea with Dr. Joel Gould: Rational Wellness Podcast 125
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Dr. Joel Gould discusses Sleep Apnea with Dr. Ben Weitz.
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Podcast Highlights
3:25 Dr. Gould pointed out that rather than referring to it as obstructive sleep apnea, the new teminology is Sleep Disordered Breathing (SDB). Obstructive sleep apnea came out of looking at older, obese people who would choke in their sleep and generally all require a C-Pap machine. But now we are starting to see this in younger people, some with lesser versions of it, called Upper Air Resistance Syndrome (UARS). And sleep apnea has such a negative connotation that if you try to speak to patients about sleep apnea, they tend to feel like you are calling them a bad person and accusing them of being unhealthy. Sleep disordered breathing is a broad label that includes on one end, people with very severe apnea, and on the other end, people who are just having sleep issues for the first time, including children.
Dr. Gould explained that dentists can fabricate a device called a mandibular advancement device, and that’s a mouthpiece that will eliminate snoring and can greatly reduce the symptoms of apnea. This helps to hold the airway open and is a great allopathic treatment for the disease. This is how he first got involved in treating this condition.
6:32 The most common symptoms for patients with Sleep Disordered Breathing are daytime tiredness, insomnia, gastric acid reflux, headaches, and snoring. The signs that can be seen in the dental chair are bruxism, crunching and grinding, and something called scalloped tongue. That’s when the tongue thrusts against the lower teeth all night long, and the tongue gets indentations. Those indentations are a sign that the part of the brain that controls the airway isn’t functioning right. To diagnose this, the first step is to wear a pulse oximeter while sleeping, which can show if your oxygen level drops while you are sleeping. If that shows evidence, then a home sleep study will be recommended.
12:30 Dr. Gould explained that sleep apnea is a lifestyle disease that is multi-factorial. This disease came up in the ranks as a diagnosis for older men who stop breathing for 10 seconds or longer. This creates a series of arousals from our sleep. As we go down into deeper sleep, our body becomes more relaxed and we’re supposed to go into those deep stages of repair. But our modern lifestyle, like exposure to blue light, which suppresses the melatonin that helps you to fall asleep. And melatonin is also a very powerful antioxidant, so blue light exposure also increases your risk of cancer. When your airway becomes too relaxed, your airway may collapse and this sends a signal that the person is choking and it will arouse them. There is a spike in cortisol from the sympathetic nervous system and the person awakes from deep sleep.
15:45 This cortisol spike may raise blood sugar levels and could explain why a diabetic has a morning spike in blood sugar that has nothing to do with what they ate. This cortisol spike would not get picked up by conventional salivary cortisol tests, since it happens in the middle of sleeping. Dr. Gould describes sleep apnea as the disease of modern living. It is a disease of the autonomic nervous system, the part of the brain that regulates circulation, digestion, sleep, and all of the things that we don’t need to think about. Sleep apnea will result in premature aging, since your sleep is broken and you don’t get to get into that deep sleep that allows the body to regenerate and refurbish itself.
22:38 Snoring is a vibration of the soft palate and it is results from a primary vitamin D deficiency, followed by secondary B vitamin deficiency, specifically B5, pantothenic acid, which is the precursor to acetylcholine. Dr. Gould explained that in the brain stem you need to have a high enough vitamin D level to transcribe the enzyme choline acetyltransferase, which an enzyme that makes acetylcholine. Vitamin D it allows you to up-regulate the transcription of your genes to make the enzymes to stay healthy. If you lived in the wild, most people would have a vitamin D level of 50 or 60. When the D level goes down low enough, you no longer have enough energy from the sun to transcribe the most basic and important enzymes, the ones like glutathione, or superoxide dismutase, the enzymes that will detoxify free radicals, and that’s why vitamin D deficiency and health are so linked. Doctors aren’t really necessarily understanding that this one thing, just on its own the vitamin D is a massive issue that humans are literally solar powered animals, and we use that energy from the sun to power our reactions. Vitamin regulates our immune system and if that is shut down and it cannot kill bacteria, viruses, and fungus, it will change our gut bacteria and the good bacteria that promote B vitamin production will disappear. B vitamins are crucial for the electronic transport chain in mitochondrial energy production and for neurotransmitter production, like serotonin, our feel good chemical. B5 is needed to make acetylcholine.
28:43 Whether you breathe through your nose or your mouth is also important. Humans are designed to breathe through their nose and when you do, your nose filters and warms the air and provides nitric oxide, which causes a vasodilation. But a lot of us become mouth breathers when we can’t breathe through our nose due to allergies or deviated septum or some other issue that affects our airways. Buteyko breathing and mouth taping can be two strategies to help promote nose breathing. Dr. Gould said that he sees this mouth breathing a lot in kids–kids who suck their thumbs, kids who wet the bed, kids who have ADHD, these kids are all severely sleep deprived. Their airways are growing and developing and if they breathe through their mouth, this tends to narrow the palate. As kids are developing, if they don’t have enough vitamin D3 and K2, the airway won’t grow properly. With low vitamin D3 you tend to get increased colds, flus, allergies, and with low vitamin K2 you tend to get early calcification of the nasal septum and not enough calcium going into the jaw for proper, normal growth, and the airway’s being compromised. This was first discovered by Weston Price 80 years ago. They develop long face syndrome, which is where the palate becomes narrow from mouth breathing and the jaw becomes narrow as well.
34:40 Sleep apnea and disordered breathing increases your risk of heart disease. This is partially because sleep apnea is such a stressor for the body and you get an increase in the heart rate when you get woken up. It is also because of the vitamins D3, K2, and B deficencies that are the root cause of sleep apnea.
37:30 When you suspect a patient of having sleep apnea, the first step is to give them a pulse oximeter to wear while sleeping for one or two nights. If you stop breathing while sleeping, you will see a drop in their oxygen saturation, which is measured by the pulse oximeter. You will see the oxygen level drop 3-4%. After that, if they have severe health issues, then they should go to a medical sleep doctor and have a polysomnography done. If not, then Dr. Gould will have them do a home sleep study.
39:23 After the sleep study, Dr. Gould will often recommend an oral mandibular advancement device. This is a device in your mouth that brings the jaw forwards and increases the size of the airway and makes it harder for the tongue to fall back and block the airway. By bringing the tongue closer to the top of the palate, it may stimulate the vagus nerve, which may reverse apnea. Dr. Gould explained that most of the dental profession views it as a structural disease, but he sees it as more related to vagal nerve control of the musculature. If you can breath while you are awake, then you should be able to breath while you are asleep. This shows that there is no physical obstruction. But uncontrolled sleep apnea can lead to hypoxia and cause brain cell death, particularly in the cerebellum, which if it goes on long enough, can be permanent. We need to put the physical barrier in and add in the vitamin D3 and K2 to allow deep, restorative sleep, so the brain can heal. He may also supplement with a B complex and magnesium.
Dr. Joel Gould is a dentist with an interest in Functional Medicine. Dr. Gould graduated from the University of Western Ontario in Canada and practiced dentistry in rural Canada and in Vancouver for 10 years before relocating to Los Angeles. Dr. Gould’s practice is called Modern American Dentistry and he has practices in Manhattan Beach and in Woodland Hills. His website is https://www.modernamericandentistry.com/
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.
Podcast Transcript
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to DrWeitz.com. Let’s get started on your road to better health. Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, I would really appreciate it if you could to go Apple Podcast and give us a ratings and review. That will move us up on that list of alternative health podcasts, and more people will be able to find the Rational Wellness Podcast. Also, if you’d like to see a video version, please go to my YouTube page, and if you go to my website DrWeitz.com you can see detailed show notes and a complete transcript.
Our topic for today is obstructive sleep apnea and how to treat it, both with a functional medicine approach, along with traditional care. Sleep apnea is when a person has pauses in their breathing while sleeping, and each pause can last from a few seconds to a few minutes. Such pauses can happen many times per hour per night. It occurs in 1 to 6% of adults, and 2% of children, though I wonder if this number’s actually higher in adults who’ve never been diagnosed. Sleep apnea may be obstructive in which the airflow is blocked, or central in which breathing simply stops, or a combination of the two. Obstructive sleep apnea is overwhelmingly the most common form. With central sleep apnea accounting for less than 1% of cases. So we’re going to focus on the obstructive sleep apnea today. Patients with obstructive sleep apnea may not be aware that they have it. Common symptoms of sleep apnea include tiredness during the day, snoring, lack of energy, depression, ADHD and behavioral problems in children. Sleep apnea increases your risk of heart disease, stroke, diabetes, heart failure, arrhythmia, high blood pressure, non-alcoholic fatty liver disease, obesity, car accidents, cognitive impairment, and neurodegenerative diseases like Alzheimer’s.
Our guest for today is Dr. Joel Gould, who’s a dentist with an interest in functional medicine. Dr. Gould has a background in public health dentistry, and his practice is called Modern Health Dentistry. He has offices in both Manhattan Beach and in Woodland Hills. Dr. Gould is back for his second appearance on the Rational Wellness Podcast, first appearing on episode 17 over two years ago. Dr. Gould, thank you so much for joining us today.
Dr. Gould: Oh, great to be here. Thank you for having me again.
Dr. Weitz: So, as a dentist, how did you come to be interested in treating patients for sleep apnea?
Dr. Gould: Well, there’s definitely some background that I’d like to discuss with you. We’ve all heard about this syndrome obstructive sleep apnea. I know that your viewers are sort of a little ahead of the average person. I want to help everyone out by upgrading the terminology. We’ve sort of changed. We’ve gone away from OSA, obstructive sleep apnea to SDB, sleep-disordered breathing. The reason is that apnea was something that we looked at 20 years ago where older, obese people would choke in their sleep. That’s where you see them having a CPAP mask, but over time what we began to understand is that many people had a lesser version of this syndrome called UARS, upper-air resistance syndrome. This was basically, we’re starting to see this on younger, healthier people, and the obstructive sleep apnea name, first of all, it’s an accusation of poor health. Every time that I would question my patients, I’d say, “You know, have you heard of sleep apnea?” They’d say, “Oh, no, no. Not me. I don’t have that. I’m a good person. I eat healthy. I eat low fat. I exercise. I would never have that.” Or, “I sleep great.” And it’s really sad because so many people, their sleep has literally failed and they don’t really have any good options.
This sleep-disordered breathing is a much more broad label, and it can really bring into the tent everyone who has a sleep issue, because it’s a range. We have people at one end of the spectrum who have very severe apnea, and then we have people who at the other end of the spectrum are just for the first time having issues with their sleep, and this is happening a lot with children. This is something that we needed some more labels for, because apnea is literally Greek for, “Without breath.” This came from the past where we had this disease was initially discovered with basically Fat Joe, not the rapper, this was a character in Dickens’ writings hundreds of years ago where this character was falling asleep, and he was fat and he was eating all the time. This is our archetype for sleep apnea. It was called obesity hypoventilation syndrome. Basically it looked at fat people and said, “Well you choke and you snore, so that fat and that fat neck is causing this disease,” and it’s exactly the same as what we did with cholesterol and fat and obesity. We said, “Well, this greasy fat stuff must be making everyone fat.” It’s just basically non-scientific extrapolation.
So understanding that apnea is the term that we used to use, and it still fits, but this is a much more modern disease because this is happening to so many different people. Now, I got into this because dentists can help in the treatment of apnea by fabricating something called a mandibular advancement device, and that’s a mouthpiece that will eliminate snoring and can greatly reduce the symptoms of apnea. It’s a great allopathic medical treatment for this disease, is holding the airway open.
Dr. Weitz: Okay, so what are some of the most common symptoms that you might see in a patient coming in your office that would alert you to the fact that they might have this disorder. Would you call it disorder?
Dr. Gould: Sleep-disordered breathing, yeah.
Dr. Weitz: Sleep-disordered breathing.
Dr. Gould: Sleep-disordered breathing, right. Well, I think-
Dr. Weitz: We need a new acronym–SDB.
Dr. Gould: Well we have to update it. But you know, it’s a much better term because I think that what these guys… I got into this five years ago because dentistry was saying, “Hey, listen, your patients have this and you can see these signs much more easily than other doctors,” because we’re seeing patients lying flat. We’re seeing them with a bright light shining onto the airway. I can see the tonsils. I can see what the tongue looks like. The classic symptoms, the ones that people will notice are daytime tiredness. The ones that we see in the dentist chair are bruxism, crunching and grinding, and something called scalloped tongue. That’s when the tongue thrusts against the lower teeth all night long, and the tongue gets indentations. Those indentations are a sign that the part of the brain that controls the airway isn’t functioning right, so a scalloped tongue, bruxism, but we’ll see insomnia. Generally speaking, patients may complain of heartburn or gastric acid reflux, often headaches. And then there’s the snoring. Snoring is the most common complaint because you know, people will not sleep well, but they won’t really know what the issue is, but if their bed partner is making a lot of noise, that’s an immediate issue, so the snoring is often one of the first signs that we see.
Most people who don’t sleep well anymore, they know they don’t sleep right, but I don’t know if it’s an embarrassment, but we don’t have this great set of tools. If you have an issue with your sleep, what do you do? You and I talked about this, I’d asked you if you’d ever had a sleep study, and you kind of you know, you gave me the answer that I knew I was going to hear, and that is, “Well, I kind of don’t even want to know if I have it, because I probably have it, but I don’t want to be wearing the CPAP.” So what I want to do, is I want to change people’s perspective and let you know that you want to know if you have this. A diagnostic test, either a pulse oximetry or a home sleep study, this is just something that you want to know about. It kind of blows my mind that so many Functional Medicine doctors, they know sleep’s important, and they want to do some stuff, and so much of this stuff that you guys do will help with sleep, but the cool part about a sleep study is it gives you objective data.
My whole point and what I want to share with your viewers or a lot of Functional Medicine doctors, is that this is not something that you push aside and say, “Oh, well go see your regular doctor. Go see a sleep doctor.” There are no solutions. There isn’t anyone that’s being referred out to this wonderful doctor who looks at the whole person and says, “Let’s talk about your insomnia, and let’s work through the different stages to get your sleep back.” That doesn’t exist. What happens is then you know these patients will be sent to a sleep doctor. They’ll wait three months. They’ll go to a sleep facility, get all wired up for the polysomnography, which is the most intensive sleep study. They’ll come home with a diagnosis of apnea and a CPAP, and they’ll put it in their closet, and they’re like, “I’m good.” This is what’s happening around the country, and people aren’t really recognizing the dangers of apnea.
You mentioned to me today that you were reading about this, and this is linked to everything. Of course it is, because you spend one-third of your life sleeping. If your body isn’t doing it right, you can’t control that. You’re going to bed, and you’re hoping that you have… You know, the blinds are pulled, the room’s the right temperature. You’ve got a good pillow and you’ve got that great mattress, but now your brain has to go into a complex set of chemical reactions that is supposed to get you into sleep four to five cycles of deep sleep, REM sleep, and all that stuff, but you’re just putting your head down and hoping that it’s going to work. So we’re at this point where doctor don’t have the tools to fix this, and that’s what I want to do. I want to raise awareness of what this disease really is. This is not something that you get as a punishment. This is not something you get when you don’t take care of yourself.
I was diagnosed at age 48 by accident by doing a home sleep study for myself, and I eat well, I exercise five days a week. I take care of myself. Why would I have this disease? I’m a good person. And so it’s really quite different. For you, when you have a patient who has a sleep issue, do you see it on the intake forms that’s something you question them about, and what do you do?
Dr. Weitz: Oh, absolutely.
Dr. Gould: All right.
Dr. Weitz: Well, you know we use various sleep hygiene recommendations. I ask them about do they have a pre-sleep routine, what do they do in the evening? Are they looking at blue light? Are they looking at their computer screens? Are they watching TV? Are they talking about or reading emails related to work or finances? We go through a bunch of factors that would play a role in affecting their sleep. We’re looking at cortisol. We might do a salivary adrenal cortisol test throughout the day. Some patients have this spike in their evening cortisol, so that’s something we can address. Then I’ll give them a series of recommendations, you know, blue light-blocking glasses if they are doing some computer work, not looking at emails or talking about work or finances, you know, a whole series of things. Then we’ll consider what they’re eating. Are they eating in the evening? Then there’s nutritional supplements, you know, melatonin, 5-Htp, glycine, magnesium, et cetera, et cetera that may be of benefit as well. So that’s how I approach it.
Dr. Gould: Okay. Well, it’s great. You have to understand that sleep apnea as a syndrome is a lifestyle disease and it’s multi-factorial like almost everything. I want to go through and just define some things for your listeners so they can understand what apnea really is, and that the way this disease came up in the ranks and that this was a diagnosis for older men through Medicare who have to stop breathing for 10 seconds or more. How this all works, and why all those things you mentioned are a part of this, is that the sleep apnea syndrome itself is basically a series of arousals. Basically what I mean by that is what’s supposed to happen is that as we go down deeper into sleep, and our body becomes more relaxed, we’re supposed to be able to be paralyzed to go into those deep stages of repair, but still be able to breathe and swallow, okay? So our brains have this incredible system to coordinate this whole sleep and breathing thing. It all works great until we mess it up with all the things that we do in our modern life. Absolutely blue light is one of them.
The most simplest way to explain this is that melatonin starts to form in your brain after darkness, about two to three hours of darkness. Now if you keep on putting blue light in your eyes, then you’re basically destroying your melatonin. That’s doing two very bad things. Number one, you’re destroying the hormone that’s supposed to make you tired and put you into sleep mode, but melatonin is a powerful antioxidant, and by decreasing and destroying melatonin literally by the blue light going into your eyes, you’re decreasing your body’s ability to fight through radical damage, which will increase your chances for cancer. So too much blue light in your eyes, especially after the day’s over will increase inflammation and cancer. So it’s a pretty profound correlation. This isn’t something that we think about. We know this happens. So you definitely want to manage that, but the question is now, you have all the conditions right, and now you’re gearing down for sleep, but what happens is that people’s airways are becoming too relaxed, and the actual sleep program itself, the brain cells themselves are not functioning at optimal level. There’s a couple different reasons why.
So once that airway becomes a little too relaxed, in very healthy people it’ll send a signal that the person’s actually choking, and will arouse them. In people who are more sick, the airway itself will actually completely collapse. The tunnel will fall back and block the airway, and the oxygen level will drop until the key motor receptors of the carotid artery and your brain tell you, “Hey, wake up. There’s not enough oxygen,” and that’s when you get the spike or release of cortisol. This is a fight or flight reaction. This is the sympathetic nervous system going into high gear saying, “Hey, this is a threat,” and this is exactly as if someone’s putting a pillow over your face and trying to choke you, except that it’s your own tongue that’s clogging your airway. This spike in cortisol is called an arousal. It makes you come up out of that deeper sleep, and then you go back and relax and fall asleep again. This goes in cycles. This happens certain times per hour, and that’s how we grade the apnea. It’s normal to have some stoppage or slowing down of breathing in sleep, but we start to record them, then we get to the mild, moderate, or severe. So there’s a threshold of how many times-
Dr. Weitz: Why don’t we just stop here for a second. On this cortisol, that’s kind of interesting because I mentioned measuring salivary cortisol throughout the day, and we would take those readings four times during the day, the last reading in the evening. But with this scenario, the patient could have a low level of cortisol, but then because they awake in the middle of the night, that cortisol spikes, and we’re not actually able to record that. I can now see how this can play a role in the increased risk of diabetes because it’s well known that cortisol causes your blood sugar to spike, and a lot of times when I’m working with diabetics and we’re trying to manage their blood sugar levels, and they’re getting a spike in the morning, I’m thinking well, they must have an evening spike in cortisol, and it could be that they are, but it’s not being measured by that salivary cortisol test.
Dr. Gould: Yes, and that is correct. Again, so I like to sort of shrink these down to make them simple. This is basically an added stress on your body. However it happens, basically you’re being attacked all night long. This is a stress to your body. That’s why people get so sick when their sleep falls apart. You can be assured that if there’s somebody in your practice, if they’re over 45 or 50 and they have diabetes, or if they’ve had cancer, they already have sleep apnea. That’s a foregone conclusion, because these diseases are all related to the mitochondria and energy production. This has to do with the autonomic nervous system itself. Those are patients, this illness is… I like to consider this all one disease. This is the disease of modern living, because if we were hunter/gatherers, sleeping on the ground, living as the sun came up and down, eating these whole natural foods, our sleep wouldn’t get destroyed. There’s multiple things that come together to destroy our sleep.
This is literally the disease of modern living, but you have to understand that if the autonomic nervous system, the part of the brain that is regulating circulation, digestion, sleep, all of our housekeeping duties, all of the things that we don’t need to think about, if that system and control system is broken, then whatever it controls is a malfunction. So if the brainstem itself, and we’re looking at two separate parts here. I’m looking at the part of the brain that controls the bulbar muscles, or the muscles of the airway, it’s generally cranial nerve 7 through 12, but the 5th cranial nerve is in there. The muscles of mastication, the trigeminal, that’s my nerve as a dentist. So the brain stem itself as a controller of all these different things, if the neurons or the brain stem themselves are unhealthy, whatever message, whatever they’re trying to control and regulate, it’s a short circuit, and that’s what I see. So sleep apnea is only one expression of this syndrome, which is a disease of the autonomic nervous system. The reason that we focus on sleep is that your digestion is affected, your circulation is definitely affected, but the sleep becomes obvious right away because you can hear snoring. It’s loud. And you can feel tired. It’s obvious. Your circulation and digestion may not be ideal. You may have a little bit higher blood pressure, but this is what’s going wrong. It’s the controlling neurons of the autonomic nervous system that are supposed to be directing this very specific cascade of neurotransmitter release, and all this stuff that’s supposed to happen really elegantly starts to malfunction, and you can go right to one of the simplest things, and that is snoring. What is snoring, okay?
So let me ask you this, Ben: What causes snoring? What’s the root cause of snoring? Because that’s what we’re here for. We can put a piece of plastic in the mouth and eliminate snoring. That’s a great allopathic treatment, and we’ve basically hidden the signs of the diseases, but why is the snoring happening in the first place, and isn’t that the whole goal of Functional Medicine is to address the root cause and let the body restore itself? This is one of the biggest root causes because every day we stress our bodies and we break it down, and we’re supposed to go to sleep and regenerate and refurbish all the chemicals and really heal. If we are not getting into those deep stages of sleep, we’re going to break down prematurely, and that’s what this syndrome is. It’s literally premature aging. Our bodies are aging faster than our ancestors because we’re not able to repair in sleep, because almost everyone’s sleep is broken. I’ve seen thousands of sleep studies. You look like you have a question or thought on that. It’s a lot, but that’s what the syndrome is.
Dr. Weitz: Yeah. What percentage of people do you think have at least a mild version of this?
Dr. Gould: Well, so I have a little package I like to bring when I go to visit a Functional Medicine doctor, and show them a sleep study of a 23-year-old petite female whose Apnea–Hypopnea Index is high. It’s 27. That’s almost at CPAP. She’s a petite female.
Dr. Weitz: What does that mean?
Dr. Gould: So it means that there are people that you see on the street that look completely healthy that already have very bad apnea.
Dr. Weitz: What does 27 mean? How does that-
Dr. Gould: So the correlation we have, basically anything under a 5, and the score is how many times you stop breathing for 10 seconds or more. This is already well into apnea. This isn’t upper-air resistance syndrome where you have reduced breathing. This is somebody who’s stopping breathing. She has the same level of apnea that I had when I was diagnosed, and I was 48. She’s 23 years old and petite, eats healthy, goes to the gym, and she has terrible apnea. Based on seeing this over and over, these young people who come to me who can’t sleep and they all have terrible apnea, I would say that probably, it just depends on where you’re at, and how people are living, but almost everyone has this to some degree, and especially in kids.
Dr. Weitz: Ah, okay. That’s kind of what I was thinking.
Dr. Gould: Yeah. Almost everyone.
Dr. Weitz: Almost everyone has this to some degree.
Dr. Gould: Yes. To some degree, yeah. And you know, there’s all kinds of weird stuff that’s happened that doctors aren’t getting. When babies are delivered, they have apnea. They don’t breathe. And what do they do? They put them under a UV light. Okay, and what’s that UV light doing? Well, you and I know the UV light is doing multiple different things, but we’ll go back to the question, “What is snoring?” What do you believe that snoring is caused by, because I’m curious to your thoughts. You’re a well-traveled, educated person. What is the root cause of snoring, and can it be reversed instantly? Aside from putting a mouth piece in. There’s no wrong answer here, so I’m putting you on the spot.
Dr. Weitz: Yeah, you know, I never really thought about it too much. My own experience with it, it seems to occur sometimes. Sometimes it doesn’t.
Dr. Gould: Some people snore when they have a drink.
Dr. Weitz: I’m assuming the answer is because they’re not getting enough oxygen, right?
Dr. Gould: No, that’s not the case, which is interesting because it’s all related. So you have to think about what is snoring itself? Snoring is a vibration of the soft palate. That’s it. Okay? And so it doesn’t really matter, you know, everyone has this specific thought. There’s those commercials when they put the bed up and they stop snoring, and yes, there’s a positional component to snoring. If you’re lying on your back, that’s when your palate’s in the best position to flap when you breathe. If you turn on your side, maybe you won’t snore, but some people report they only snore when they drink. Well what does alcohol do? It’s a central nervous system depressant. So the answer to my question is: That snoring itself is a primary vitamin D deficiency, followed by a secondary B vitamin deficiency, specifically B5, which is the precursor to acetylcholine, which is one of the primary neurotransmitters of the autonomic nervous system.
Dr. Weitz: And B5 is pantothenic acid.
Dr. Gould: Pantothenic acid, correct. Okay. So there’s two parts to the reaction. One is that in the brain stem you need to have a high enough vitamin D level to transcribe the enzyme choline acetyltransferase. That’s just an enzyme that makes acetylcholine, okay? Now you know that vitamin D’s really important, and you know that it’s important in absorbing calcium, but no one asks the questions of, “Well how does vitamin D make you absorb calcium? Why is it related to all this other stuff?” It’s because it allows you to up-regulate transcription of your genes. So in a really simple way, when you add more vitamin D, you give your body the energy to allow for more copying of your own genes to allow you to make the enzymes to stay healthy.
Now, doctors are looking at vitamin D the wrong way, and you already know this, that most people should have a level of 50 or 60, that’s what we’d see if we lived out in the wild. So when we raise this level up, now we’re finally giving the body the fuel to be able to transcribe all the appropriate enzymes. When your vitamin D level’s low, I like to call it human power saving mode, or permanent winter, because throughout all of evolutionary history when your vitamin D level was low, it was winter. Your body’s smart. It has an adaption to winter, and when the D level comes down, your body no longer has enough energy to transcribe all the enzymes it wants to make, okay? I’m going to assume that natural selection over thousands of generations has decided as your D level drops, which enzymes am I not going to transcribe? Which ones are not so important? If you’re making $200,000 a year and you’re getting massages and all this fancy clothes, then you start having your salary cut over and over, you start to give up the esoteric things first, but after a certain point, when you’re starting to not have enough money to pay the rents, that’s what vitamin D is like. When the D level goes down low enough, you no longer have enough energy from the sun to transcribe the most basic and important enzymes, the ones like glutathione, or superoxide dismutase, the enzymes that will detoxify free radicals, and that’s why vitamin D deficiency and health are so linked. Doctors aren’t really necessarily understanding that this one thing, just on its own the vitamin D is a massive issue that humans are literally solar powered animals, and we use that energy from the sun to power our reactions.
You know that the vitamin D’s also tied to the immune system, so as soon as that level goes down, our immune cells, our macrophages, all of our blood cells, they no longer have enough energy in the form of vitamin D to transcribe the genes to make the antimicrobial proteins to be able to kill bacteria, fungus, and virus. Now, your immune system is shutting down because we don’t have enough energy to run that, and that changes the gut bacteria. Vitamin D regulates the type of gut bacteria that you’re going to have, and as that level goes down, the healthy gut bacteria that we like, the ones that promote all the B vitamin production, the ones that keep our muscles healthy and give us serotonin, all the really good chemical products that bacteria make, they disappear, and that’s why we’re really in the depths of power saving mode.
As our deal comes back up in the spring and we have those antimicrobial proteins that are bacteria, our colonocytes can now start to filter it and decide what bacteria we want to keep. We’re going to go back to those ones that make the B vitamins, because you know how important B vitamins are. They’re interjected into every single reaction, especially the production of energy, the mitochondria, especially the repair of DNA. These B vitamins are used by Mother Nature as neurotransmitters, or as the basis for neurotransmitters, as cofactors in enzymes, in electronic transport chain. These are Mother Nature’s helpers, those B vitamins. I think that… You know, you deal with a lot of people who are very sick who need that one-on-one help, but so many of the general public would benefit from just keeping that higher vitamin D level, because it would naturally provide more B vitamins. That’s kind of the equation.
So the second part is in the brain, having enough B5 to make acetylcholine is critical, and if you’re D level’s low, and your gut bacteria’s not making B5, you’re not going to have enough acetylcholine, and you’re going to lie in bed, and your brain is going to be racing, reaching thoughts, and you’re not going to be able to shut down for sleep because you don’t have one of the primary neurotransmitters for the sympathetic nervous system to go into the rest and repair phase, rest and digest, and that’s the equation. The vitamin D to make the enzymes, and the B vitamins to be the raw materials that are our transmitters. You can think about how all these different reactions to B vitamins are so important to cellular production of energy, that if you don’t have enough, everyone’s going to break it down differently. And so the snoring itself, we’ll see this in children, they can stop snoring in two days, three days, four days with vitamin B supplementation. In adults it can happen that quickly, but it depends how long they’ve been snoring for. Is the part of their brain damaged yet or is it just suffering temporary breakdown?
Dr. Weitz: Now isn’t the way you breathe also play a role in this? For example, whether you breathe primarily through your nose or through your mouth?
Dr. Gould: Yes. So humans were designed to breathe through their nose. When you breathe through your nose it filters and warms the air. It basically provides nitric oxide, which causes a vasodilation. The lungs can expand fully and bring in more oxygen. We have a whole system, and that system breaks down when we can’t breathe through our nose. And we can’t breathe through our nose primarily because we have some inflammation. It could be allergies, colds, flus. It could also be a deviated septum. These are all issues that happen primarily in our youth when we’re growing and developing, and can affect our airways, so we definitely want to breathe through our-
Dr. Weitz: And isn’t it very common that a lot of people end up being mouth breathers?
Dr. Gould: Absolutely. You know, it’s one of those things… You’ve probably heard of mouth taping. People are taping their mouth to force themself, so yeah, and that could be cured for some people who are having sleep and breathing issues itself. There’s also, you’ve heard of Buteyko breathing, and that’s where you basically-
Dr. Weitz: I took a bunch of lessons in that to try and improve my nose breathing.
Dr. Gould: Right, so the only issue is when you fall asleep. How’s that going for you? Can you control that? And so the answer is no, but if you tape your mouth, you’re going to wake up pretty fast if you can’t breathe through your nose. I think it’s kind of a cool technique, and I don’t think anyone’s really put the time and research in to figure out just how much that mouth breathing and nasal breathing effects us. Again, this is a multifactorial issue for some people that can’t breathe through their nose. It’s very, very important. We see this in kids a lot. Pediatric patients, the kids who suck their thumbs, kids who wet the bed, kids who have ADHD, these kids are all severely sleep deprived. The issue they’re having is now they’re going through their growth and formation of their airway, and they’re breathing through their mouth, which narrows the palate, and it really amplifies the issues that we see. This is a really terrifying syndrome where as children, as they start to grow and develop, if they don’t have the proper vitamins, and that’s a vitamin D3 and vitamin K2 combination, the airway itself won’t grow properly. With low D3, colds, flus, allergies, low K2 is you have early calcification of the nasal septum and not enough calcium going into the jaw for proper, normal growth, and the airway’s being compromised. That’s what I’m seeing in all the kids these days, is these tiny airways literally from a vitamin D3 and a vitamin K2 combination, this is something that Weston Price discovered 80 years ago and no one listened.
Dr. Weitz: And this is literally looking at someone’s face that if their jaw’s/face structure is narrow, that’s what we’re talking about, right?
Dr. Gould: Correct.
Dr. Weitz: Isn’t it called like long face syndrome?
Dr. Gould: Well yeah, so long face syndrome is basically when the palate is narrow, and it’s created from mouth breathing, so when you breathe all night long with your mouth open, it puts muscular pressure to narrow the palate, and the jaw itself, the lower jaw takes its growth cues from the upper jaw, and the development to the jaw itself is not pre-programed. When we start to grow as children, the size of our brain is pre-programed, so our cranial size is going to be already laid out. But the jaw growth itself is reliant on the conditions that we’re in. We see this really profoundly as a concept called epigenetics. Weston Price over 80 years ago discovered that when two substances were removed from the food chain, he saw dental decay, gum disease, a collapsing of the arches, lack of room for all 32 teeth, and illness in general. Those two substances that he defined back in those days turned out to be vitamin D3 and vitamin K2. It makes perfect sense because vitamin D is your calcium absorption hormone, and vitamin K2 is basically a cofactor that activates proteins that bind calcium in your blood, and take that calcium and put it into the matrix of bone and teeth. We’ll find those proteins in the mouth trying to bind to salivary calcium and put it into our teeth. This was a system, because we’re made so much of calcium, that in the summer when the sun is high in the sky, we’re getting a lot of vitamin D, and the grass is green, when we’re eating the meat and milk of animals that eat that green growing grass, that’s when we’re onboarding all this calcium. We’ll put it into our teeth and our bones.
In the winter when there’s no vitamin D, and there’s no green grass, our body’s going to say, “Hey, I don’t have enough calcium. I’m going to go into those bones and I’m going to pull that calcium out and utilize it,” so the D3/K2 was a system of managing our calcium to be able to allow us to be healthy throughout the year through winter. This was our winter… We basically have this whole other setting where we can… You know, in the northern hemisphere when we’re away from the zone of guaranteed sunlight and green vegetation, that we can live off of our storage of the meat of animals, and so the system is really effed up, because everyone as you know has descended into a vitamin D deficient state that I call permanent winter. Kids these days are all really suffering from the syndrome. It was something, again, defined 80 years ago by Weston Price. I didn’t learn about Price’s work in dental school 30 years ago when I was in school, and today he’s still not taught. It’s quite interesting as to why… You know, we could tear him apart with all of our new science, but unfortunately for the big institutions, his work has been clarified and defined by the new science, so this is all really obvious stuff. I’m trying to get the message out there that this is the root cause of pediatric sleep apnea, something that can be reversed in two, three, four days, and children having surgeries and wearing CPAPs. I’ve got eight year olds who’ve been wearing these. You know, this is destroying these kids lives. It’s just a simple vitamin and mineral deficiency. This is a D3/K2 combination.
Dr. Weitz: Interesting. Fascinating. Great information. Can you explain a little bit about the connection between this sleep apnea breathing problem and heart disease?
Dr. Gould: Sure. So there’s two different ways that this affects you. The first one is the actual whole sleep apnea syndrome where you’re choking in your sleep. Again, the stress on your body, if you’re a hunter-gatherer out in the wild and there’s a lion or a tiger or something scares you, and you have to run, that was probably relatively common, but this whole syndrome where your body’s having that full-on reaction fight or flight, is happening over and over. This is a terrible stressor on your body. For people who aren’t healthy to begin with, they don’t know that their basically running this marathon where they’re being chased by an animal all night long and being suffocated. They just wake up feeling terrible. The stress of the hypoxia, lack of oxygen, and the release of cortisol over and over again is very taxing on the body, number one.
Number two is these are people who already are not healthy. They already have completely inflamed vasculature, and the stoppage of breathing, and the increase of heart rate that happens after the arousal is signaled, you know after you’re woken up, many of your listeners may have had this where you wake up and you’re sweating and your heart is racing. That’s apnea, guys. If you’ve woken up several times in the night like that, you have some form of apnea. It’s reversible to a certain point. I think it’s reversible all the way, it just depends how much work you want to put into it.
The second part of the cardiovascular issue is that the root cause of sleep apnea is a primary vitamin D deficiency with a secondary B vitamin deficiency, and the cardiac cells, the endothelial cells themselves are suffering from an inflammatory process because those cells themselves cannot make enough of the anti-inflammatory enzymes. You can google any of your enzymes that eliminate free radicals, and you’ll see that supplementing vitamin D will increase their production and decrease the overall stress and inflammation of the cell in the body. It’s complex because the endothelial cells are involved, the cardiac cells are involved, and then we go back to the brain stem. It’s the part of the brain that’s regulating everything cardiac, has issues transmitting the right message in the right way because it doesn’t have the right neurotransmitter mix. The actual signal, the cardiac signal and how you’re whole body’s running, run by the autonomic nervous system isn’t functioning right. It’s coming at us from all different directions. It’s basically the overall poor health of a person, because it’s just so multifactoral, but when someone has apnea and it’s detectable like that, they’ve been sick for a long time and they have the other markers of inflammation as well.
Dr. Weitz: So, when you have a patient with sleep apnea or-
Dr. Gould: Disordered breathing.
Dr. Weitz: Disordered breathing, right.
Dr. Gould: Right, very good.
Dr. Weitz: How do you decide what’s the first step?
Dr. Gould: Okay. So I like objective data. Anyone who comes to me, I want to use two different types of monitoring devices. I like a pulse oximeter. We send the patient home with that, and it gives us an idea of the severity of their apnea. If the pulse oximeter shows them stopping breathing, I’m going to immediately recommend a home sleep study. Now, if this is someone who has serious health issues, they should go to a hospital facility and have a polysomnography done by a medical sleep doctor, because these are the people that have to be on CPAPs, and those are the people that probably aren’t even coming to you. They’re really sick, and they’re in that paradigm of allopathic medicine.
We can detect the apnea and do a sleep study that will show one night, two nights what’s going on, and will show whether this person’s getting REM sleep or they’re getting deep sleep, and are they choking? What’s going on? Are they having hypoxia? Because we’ll see the oxygen level drop 3 or 4%. You cannot hold your breath and do that. That’s in stoppage of breathing. All right, so this gives us an idea of who has this, and in my opinion, anyone who has had any health issues at all should have their sleep screened, especially if they complain. Some people will come in saying, “I don’t sleep right.” Some people, they’ll just be sick and they won’t know. I didn’t not know that I had apnea, and mine was pretty bad. It wasn’t on my radar just because I was thinking about an older, heavy person who didn’t take care of themself. Not me. Like why would I have it, right? So, this is something that you can only tell literally, I have children, I have adults. I recently had a 52-year-old woman who was a bit overweight, but she had the best sleep I’d ever seen. She’d been taking her vitamin D. She was relatively healthy. So you can’t tell by looking at anyone. You have to really do an objective study.
Dr. Weitz: So, you do this objective sleep study, this person comes out positive. What’s the next step? Do you test them for vitamin D? Do you measure vitamin B levels? Do you just try them on vitamins? What do you do first? Do you look at diet and other factors?
Dr. Gould: Right, so as you already know this, different people will have a varying degree of interest. At the most simple level, I’m going to provide all my patients with an oral device if they have a diagnosis of apnea. If they’re health-oriented-
Dr. Weitz: Is this oral device designed to move their upper jaw forwards to create more space, is that it?
Dr. Gould: It does a couple of different things. So the mandibular advancement device, lots of studies showing that it’s effective. Primarily it’s going to hold the lower jaw forward and open, and it increases the size of the airway and makes it harder for the tongue to actually fall back all the way. That’s one thing that it does. The other thing is that by holding the jaw further forward, in a lot of people it will put pressure on the palate where the vagus nerve runs across, and sometimes that tongue on the palate will actually stimulate the vagus nerve and will decrease the apnea syndrome. I know that this is a very big topic is vagus massage, all different things that will help stimulate that nerve.
I believe that there is a component, because I will see some patients who have a profound effect with the oral device maybe more than they should have just by making extra space. I literally see like a change in how their brain is sending out that sleep signal. I don’t think anyone really knows to be honest with you. Most of my profession is still stuck on, “This is a structural disease, that there’s not enough room in the airway.” I want to dispel that myth right now because if you can breathe while you’re awake, then you can breathe while you’re asleep. There’s no obstruction. This is not a physical obstruction. This is a relaxation of the musculature. I’m glad we got away from the obstructive sleep apnea because there’s no real obstruction. This is a problem with how your brain is regulating the musculature of the airway and the sleep program itself.
Dr. Weitz: I’ve had patients who’ve had surgery to grind down some of the bones in the back of the throat and create a bigger space.
Dr. Gould: Sure. Well, it’s sad because people are literally… Some people are going to need surgery, and there’s nothing wrong with that. Surgeons are great. They’re talented. So, this is my thought process: If someone’s willing to go along the ride with me, I will do a vitamin test on the spot. I’ll get their most recent level. I have a protocol that I want to get someone into the right zone, and then the issue really is that when someone comes to me, I don’t know how severe their apnea is, it depends on how long they’ve had it. Keep in mind that the part of the brain that’s regulating this, day after day of hypoxia causes brain cell death. You know that the cerebellum, in particular is very susceptible to hypoxia because the Purkinje fibers are really big, and they’re the first ones to die. Once this is going on, the system where you’re stopping breathing, you have hypoxia and damage starts. This goes on for many years until the brain itself, and the different parts of the brain, are damaged enough that no amount of vitamin supplementation is going to fix this. You need to put in a physical barrier to keep that airway open because the brain itself can’t heal. It’s not getting into good, deep restorative sleep. If we can change the vitamin mixture to provide health, and we can splint the airway open, only night after night of deep restorative sleep….
Dr. Weitz: Okay, so you’re measuring vitamin D. Are you measuring vitamin K? Are you measuring B vitamins?
Dr. Gould: No, so the K always comes along with vitamin D because you can never get vitamin D without K2. They always came together, should never be.
Dr. Weitz: And then you’re using the MK7 or the MK4 and how much?
Dr. Gould: So, MK7, everyone’s sticking to the 180 to 200 micrograms. No one’s really investigated this any further, but this was all from the Rotterdam Study. This is a very famous study that’s happened over the years that most doctors who haven’t heard about K2 should look at. I don’t know that we know the optimal level of K2. I just know that it’s currently known to be a cofactor on 17 different enzymes, and K2 is really… If it’s a cofactor on 17 enzymes and we got it from green growing grass, it’s really important. So there’s no upper limit on toxic dose, and I think that the more you can get the better, but I’d make everyone take 180 to 200 because I’d want to stay within the bounds of what’s accepted science at this stage. I supplement magnesium. I get the vitamin D levels to 60 to 80 range. K2 daily, and then I go to a B vitamin, and I want to use my B vitamin very judiciously depending on the person. And this is a personal…
Dr. Weitz: Do you measure B vitamins?
Dr. Gould: I don’t. This is the issue, is that if you measure B vitamin, what are you measuring? It’s a water-soluble vitamin. Are you measuring the current state where you’re getting your sample from? What does it look like one hour, two hour, 12 hours? How long do B vitamins last in our system?
Dr. Weitz: Well, I mean, there’s various things you can measure. Say, B12. You can look at a serum B12, but you’re right, probably not that representative of tissue levels, but then you can measure a homocysteine. You can measure a methylmalonic acid, so those are more functional measures of B12 status.
Dr. Gould: Right. Well, B12 is the only one that I can recommend supplementing on its own, otherwise I’ll always want a B complex.
Dr. Weitz: We also have genetic factors that affect whether or not you can metabolize B12 or folic acid, et cetera.
Dr. Gould: Right. And that’s what makes this such a confusing syndrome is that there’s all this genetics and epigenetics mixed in here. Medicine has really focused on the genetic components of all these diseases. You know, this is kind of one of the things I joke about is if you go to your traditional doctor and you’re obese and you have high blood pressure, they say, “Well, listen, you have high blood pressure. Cut your fats. Do some exercises. Lose some weight, and then we can maybe get you off medication,” but if you’re fit looking anyway and you go to the doctor and you have high blood pressure, they tell you it’s genetic, and then they give you medication because you’re going to have to take this the rest of your life, because you have this genetic issue. It’s all nonsense. Your genes are there, but it’s all the environment, so even the people who would have these genetic issues, a lot of them have the issue with B vitamins. They need more B vitamins, okay? But the B vitamins are fascinating because they are parallel to the bees, the insects in our environment. They’re literally under attack by modern living. You know that bees are affected by glyphosate, pesticides, heavy metal toxicity, radiation, all the same things that are destroying our B vitamins as well, kind of cool that Bs…
Dr. Weitz: How much B vitamins do you often recommend?
Dr. Gould: So, it’s going to be on a case-by-case basis, and this is people need to decide. Really what I see, it depends on how long someone’s been sick for, and how sick they’ve been. Most of the are diseases, these autoimmune diseases, they’re have a D deficiency followed by a B deficiency. I have patients who are healthy their whole lives, and one of my favorite patients is a fitness trainer. This guy was fit his whole life, and then he started to put on weight, didn’t know what was wrong, basically got completely unhealthy within six months to a year, and when I came across him, he had complete uncontrolled, untreated sleep apnea. This guy had a rapid recovery and he didn’t need a lot of B vitamins, where someone like myself who I’ve been sick my whole life, I need more B vitamins because apparently most of my illness was related to this having a chronic lower level of vitamin D, being stuck in permanent winter and not having the right amount of B vitamins. This really did a lot of damage in my life and my illness, so I tend to take more B vitamins, but you know that B vitamins are used up by being in the sun, drinking alcohol, and exercise and activity, so once this happens, once someone’s already become unhealthy, I really work with them on deciding how to take their B vitamins. Do they want to take them in the morning? Do they want to take them before bed? Too much can cause people to have insomnia as well, but for the most part, having a little more B vitamins later in the day can help you with your sleep. Simple as that.
Dr. Weitz: And I’m assuming you’re using methylated or activated forms rather than straight folic acid and…
Dr. Gould: Correct.
Dr. Weitz: B12 versus the cyanocobalamin.
Dr. Gould: Right. So I spent a lot of time researching B vitamins, and I don’t… I always try… My vitamin line, they’re methylated. There’s such a variety in the vitamins that we buy. There’s no one regulating this, and that’s why I always say, “Go to a reputable company that checks their own stuff.” You buy stuff off the internet and I don’t know what you’re getting. Some of it’s filler. Some of it’s real. But the real issue is that no one’s really spending the type of money, time, and energy looking into these things, because this is really what our health comes down to. Who has the money to do this? You know that all the research is driven by big pharma, and they’re not interested in these vitamins. This is an organic way to get healthy, and they’re not looking at that. They have not sworn an oath to do no harm. They’ve sworn an oath to their shareholders to make money, and they’re going to make this any way they can.
If you’ve seen some of the commercials, they have these new ones where they’re showing this woman and she’s in a hospital bed with dark circles under her eyes, and she’s missing her son’s wedding or something. They’re really playing on our fears of poor health. It’s really terrifying, so no one’s going to be looking into this, and there’s so much research that needs to happen on what these vitamins are doing. We’re coming to this in different ways. You know, people who are eating a ketogenic diet. We’re coming to all the right solutions, it’s just that this is the Wild West. You have your own system for how you treat people. How often do you test B vitamins? Do you ever supplement more than just, except for B12, do you ever give a single B?
Dr. Weitz: Sure, or we’ll use specific formulas, like for example, if I have a patient who has an elevated homocysteine level, which we know is an independent cardiovascular risk factor and inflammatory marker, we’ll use a certain combination of B vitamins and certain other nutrients that are specifically targeted to modulate the homocysteine.
Dr. Gould: Right. Do you worry about… Because those B vitamins are so inter-reliant on each other, do you worry about upsetting upstream or downstream results when you supplement one B vitamin like that?
Dr. Weitz: Yeah, for sure. Usually we’re using mixtures, you know, but I may use different combinations of mixtures. So like, for homocysteine we’re specifically looking at like a B3, B6, B12, B9 combo with certain other nutrients like trimethylglycine and maybe a few other things, specifically to try and modulate that one factor. We’re measuring it on a regular basis, so we’ve got targets. We intervene and then we retest to see if we’re accomplishing what we’re trying to do.
Dr. Gould: Great, great. And again, it’s really complex stuff. Now I, looking at this from… As a dentist, I’m looking at macro world here, and the message I want to share with you and your listeners is that sleep is something that’s well within your wheelhouse that you should be monitoring. This is something that you can use as a marker for the improvement of your patient’s health, because I have no doubt that almost every single thing that you’re doing is improving their sleep. I know your patients probably tell you, “Wow, I’m sleeping better,” when you’re doing all this other stuff. But I think that functional medicine doctors have this incredible opportunity to bring this into their practice. What I recommend is to find a local dentist. You’re going to have a hard time finding a local medical doctor to work with, but there are dentists in the community that want to work with you, that treat sleep apnea, that don’t feel comfortable with this vitamin D stuff.
This is recommending a partnership, a collaboration, because dentists have this unique ability to put things into the airway to help with sleep. We are doctors. We have a different perspective, but I think those relationships where you have a patient you suspect apnea, but what are you going to do with this person? If you send them back out into that cruel allopathic world, they will wait three months to go see that medical sleep doctor, and they’re all good people, but their solution is a CPAP for everyone. I have had patients who’ve had very mild apnea, a AHI score of 7 or 12 or something that’s low, that they have this massive CPAP thing and they’re not going to wear it. There’s a really cool opportunity with these people that are coming to you, they care about their health, is to give them that tool and allow them to have a mouthpiece that can save their marriage with snoring, but it can definitely make everything that you’re doing work better.
When you start to see your patients having stable sleep, and not having these arousals, you’re going to see all of their markers change. Their inflammatory markers are going to change. You’re even going to see their vitamin D levels change. There’s a study where they put a CPAP on people, and their vitamin D level came up. It made sense to me because if you’re running from a lion or tiger all night long, vitamin D’s a metabolic hormone, and you’re going to wear it out. You’re doing all these things. There was no time in evolutionary history where you should get more exercise running around and not be out in the sun. That never happened. So everything that you’re working on is affected by this, and you know, when it comes to your younger patients, you just don’t know why these people are so messed up. This is why a 23-year-old petite female and nothing you could test… The only thing that came up on her study was that she had a vitamin B level of 12. That’s why she had terrible apnea, because who knows how long she had that level for, and then choking in her sleep, it was just lowering it.
So there’s patients that you’re seeing that are suffering from this syndrome that you can greatly help by going to a dentist and having some sort of sleep screening. That’s what I’ve done in my neighborhood here. I have pulse oximeters. My local doctors will send a patient over. We’ll do a quick exam and they’ll log out a pulse oximeter, take it home for three nights, and we’ll see if they’re really a candidate, whether they should have a sleep study or not. So these are things that should be going on in your community with your local healthcare providers. I think that dentists are more open to this type of stuff than the average doctor.
Dr. Weitz: No, that sounds great. Great. By the way, if you know of any studies that you have ready access to that you can send me about the connections between vitamin D and vitamin K2 and B vitamins, I’ll throw them in the show notes.
Dr. Gould: Sure.
Dr. Weitz: I’d appreciate that.
Dr. Gould: You got it.
Dr. Weitz: Good. So I think that about wraps it for today, being that it’s almost 9:00, and I have a 9:00 patient.
Dr. Gould: All right.
Dr. Weitz: So how can listeners and practitioners get a hold of you to patients can either see you as a patient, or practitioners who want to work with you on sending patients to you for sleep studies?
Dr. Gould: Right, so you can reach us at ModernAmericanDentistry.com. We have a location in Woodland Hills. We have a location here in Manhattan Beach. If you have patients that you’re questioning whether they have sleep issues, basically you can email me, you can call, you can just refer people over. What we provide is copies of the pulse oximetry to give you an idea of what your patient’s doing in their sleep, a copy of the sleep study. Then we get a prescription from a medical sleep doctor to fabricate an oral device. We can work with you on the supplementations. What I’m trying to do is create a protocol and system for dentists to be able to work locally in the neighborhood. That’s what my main focus is. It’s not so much treating the one-on-one patients. I’ve been doing that for a while, but I want to share this information from preventive perspective for children, and for people who are literally struggling today with their sleep. There are some real tools here, and that most poor sleep is literally early apnea.
Dr. Weitz: Great. Awesome. Thank you, Dr. Gould.
Dr. Gould: All right. My pleasure. Thank you.
