 So several years ago when I was first diving into why humans are the worst breathers in the animal kingdom I Found some research that showed that in just a few hundred years our skulls have Dramatically changed our mouths have grown smaller our faces have grown backwards So this countered what I had understood about evolution Which was that evolution was this straight line of progress, but it's not because there are no Real benefits to having a mouth that's too small for your face So your teeth growing crooked having a smaller airway so you choke on yourself and to have terrible posture so We're gonna hear from some experts in this field and we're gonna hear about how this all happened Why it happened and what we can do To fix it and this is sort of a sampler from Various people who are gonna be giving some very quick talks into each of these specific areas and the first one We're gonna hear from calling in remotely is dr. Shabon cook She's an assistant professor in the center of functional anatomy and evolution at the Johns Hopkins University School of Medicine and she's here to introduce why our Ancestors had straight teeth and wide mouths and why we don't today sure, well Thank you for having me today. I Just finished teaching it is the first day of our Anatomy course for the first year medical students and I course direct that so that's why I am here in Baltimore Rather than out there in LA with you all Okay, so this is a little bit about Myself and as he said I James said in the introduction I'm in this an assistant professor in the center for functional anatomy and evolution at Johns Hopkins University School of Medicine and I am trained as an anatomist paleontologist and a biological Anthropologist and my research primarily focuses on dental functional morphology and mastocritory anatomy So the anatomy associated with chewing and food processing. I Also have a specialization in primate evolution and to better understand how evolutionary Anatomy changes through time. I do lots of shape analysis of crania of teeth of mandibles So that we can understand what these anatomical shapes look like at certain points in evolutionary history And then I also have a portion of my research that correlates natural normal anatomical variation with pathologic conditions. So for example, if you have a specific Anatomical form to your TMJ that's different from someone else Are those is one of those forms more likely to result stay in osteoarthritis over the lifetime of Your use of that joint. So that's another part of my research Next slide, please So humans and all non-human primates as well chew and process food with their teeth and across our group the primates Animals eat lots of different things in the upper corner there You can see a very distantly related relative the tarsier munching on an insect Next over is a gorilla eating some leaves. We have a spider monkey there eating some Fruit some palm fruit and then in the lower panels There's a squirrel monkey eating some fruit and one of our closer relatives the chimpanzee also eating some fruit And a nice human being eating some salad as well These diets correlate with dental morphology and dental form next slide, please and what we see across primates are Different dental shapes associated with how they process food So for example this leaf eating monkey this howler monkey has these really large teeth with big pointy cusps or tips on them Lots of crests for grinding up those leaves And if you compare that with a closely related spider monkey, which eats primarily fruit they overall have smaller teeth If you look in closely, you'll see that the crests aren't as long the cusps aren't as high and as pointy And overall the teeth are smaller all together Next slide, please So humans that have teeth that look more like that spider monkey We have smaller teeth relative to body size than primates that have very difficult to process food items like leaves or food that has lots of tough carbohydrates But one of the things about human beings is we have an incredibly variable diet The source of calories across human beings in hunter gatherer populations Can range from 10 to 90 percent meat From 10 to 80 percent fruits and seeds So one of the things that we should remember about human beings is we're omnivorous we eat all different kinds of things And all of these different Types of diets are successful. They keep us alive. They keep us healthy And i've still in an image here from an article in scientific american Which was distilling some of the long term studies on hunter gatherer populations world over And this compares three different hunter gatherer groups In different parts of the world. So we have the Inuit and the polar regions the iwi in northern south america and then two different hunter gatherer populations in africa the kong who are in the Kalahari desert and the hadsa who are in eastern africa there and you can see there's a lot of variation in that diet But one of the things that all of these diets have in common is they're largely undomesticated food items They are Usually tough to process Require a lot of chewing a lot of mastication Next slide, please And if we compare the foods that we from an industrialized agricultural population eat to what those foods look like Historically, you can see there's a big difference. So on the bottom Left slide here. You can see a wild avocado versus an domestic domesticated avocado There's not much to that wild avocado other than seed. There's a little bit of of food out there And then here's a wild banana versus a domestic banana lots of seed not a lot of squishy bits So these Domesticated foods are actually much easier to process compared to wild foods. You don't have to chew them as long They have a higher sugar content. They're easier to process overall. So you're just kind of mushing them up and swallowing them Next slide, please Now what we've found and it's not just me, but lots of researchers have Contributed to this line of of work is that these masticatory influences will influence mandibular shape over time So if you from a young age are eating lots of things that are really tough to process and are chewing for extended periods During the day, you will develop somewhat large mandibles And that's in response to the pulling forces that muscles make on the mandible There also might be some differences that develop in palate shape. So that's the top part of the jaw As a result of breastfeeding for a very extended period of time some hunter gather populations minimally to age two sometimes to four or so versus bottle feeding and these Changes in feeding have resulted in agricultural and eventually industrial populations and these changes in jaw shape Now we should say that if you as an industrial person in the audience Were to go back to eating like a person who Is from a hunter gatherer society Probably your mandible would if you you know, we're born there dropped in there as a young child Your mandible would look like theirs over development So we're talking about a relationship between the underlying Genes that code. This is how you make a mandible in a person With how that person is using that anatomy over the course of their lifetime Next slide, please One thing I do want to note though Is that we shouldn't romanticize the deep past of where everybody was a hunter gather Or wild populations of primates too They are not without dental and Other problems pathologies that develop so Even though this howler monkey up in This the top corner a Eight leaves her whole life. She developed a crooked face for some reason. I don't exactly know why but that's the specimen from a museum collection Specimen B up there is a human being from an archaeological Hunter gatherer population You can see they've lost a lot of teeth their teeth are really ground down. They do have a nice white palate And they did have room for m3 the wisdom tooth in there Some individuals might develop things like osteoarthritis. You can see that kind of Bumpy bone along the mandibular condyle and picturesy and that in picture d Here's an example of a baboon that lost a tooth has some dental abscesses. They're they're When they met that collector for the museum, they were they were not in good shape dentally So I think that there's a lot to learn from a wild populations of primates And then also from humans that are living in hunter gatherer societies about how Dentition and palette shape and mandibles form As a response between the environment and the underlying genetics So I will stop for there and pass it on to one of the next presenters Thank you, shabon We're next going to hear from dr. Kevin Boyd. He's a pediatric dentist and visiting scholar at the university of pennsylvania And he's here to discuss how the deformations in our faces and airways can occur In the first few years of life. Maybe maybe even before before born Um, am I going to advance my slides or can I you could do that? Would you I I like that aspect of it? You know With pleasure plus I like standing next to why don't you stand over here and I'll just be your little work boy over here. Okay You ready? Yeah, here he goes. Okay. I'm not wearing the tie for formality Hold on Okay, sorry the the tie is to honor the Beatles and a friend of mine Misha peskay's husband steve who gave me this and I I don't even pack at my suitcase because I'm afraid of losing it Like the span, you know the the gap between health span and lifespan you can figure out what that is I mean lifespan is expectancy at birth And how healthy do you stay as you age into your older age? Are you healthy or not? And You know the goal is to increase life expectancy, but also staying healthier longer So Generally ontogenetic ontogeny Just means what happens in one single generation. We used to say cradle to grave next slide or no click it Because I've got animations there So but now we say no, you know, it's it's maybe uh in utero till till death or how about preconception and and uh You know even before that a woman's eggs start to form when she's inside her mother So grandma actually can impact that be genetically You know men's gametes. They shouldn't be left out of it. I just made a ton of them while I was talking to you So, you know, we we we have it a little bit differently But you know women have to take care of their eggs and they get all the Criticism. Oh, you can't drink or smoke and you shouldn't but men have to take care of their sperm too. Okay So I'll just leave that alone. I have two daughters and that's how we uh told them about that next, please I'm going to talk about the Dunedin study 1037 kids followed in Dunedin, New Zealand for Still going on started in 1972 Uh, I'll talk to more about that of how it affects next, please So cool. Thanks, james Obstructive apnea adverse pregnancy risk now, you know, what's going on here Most of you have heard of the barker hypothesis and that has to do with Programming in the womb to anticipate starvation Calories, all right. That's a starvation. There's also oxygen starvation and we've Developed our own modification of the barker hypothesis for respiration respiratory substrate if a woman isn't breathing right next next next click And and and that means snoring something called gestational apnea. You've all heard of gestational diabetes hypertension gestational apnea Okay, and the natural experiment that was done over years was smoking And they ever go ahead next one, please james They used to advertise cigarettes as women want to have smaller babies. So smoke, right? So we got to change that thinking And and i'll develop that uh, the importance of changing thinking not just therapeutic techniques next, please So when does this start? Perhaps in utero and we're proposing a study to compare Midgestational ultrasound profiles to and and christian geemano was interested in this To to what happens in orthodontic clinics like and so that more more about that later, too Not enough time next, please Click so that's my patient four and a half years old That's that same kid and and the mom was a dental hygienist brought her kids to me from milwaukee Five of them and she goes i got another one brewing in here and she showed me that and it was her hypothesis Laura and her name is the end hypothesis next please So this is in the literature Smaller faces retroposition jaws This is the barker hypothesis, okay, is that uh apnea of prematurity preterm birth is a problem with interuterine growth restriction and that is something that is That that correlates with a woman not having good respiration during pregnancy Okay, so there it is, but it doesn't say it is such But you you can speculate from there. I love it That that the first speaker that was talking about the ancestral population of that island said let's speculate back and he did a great job With those questions next please So here it is. This is an amazing study. It's still going on. They thought it would go 10 years our NIH actually invested in this in new zealand Uh, so next please So here we go a gradient of self-control. You've all heard of the marshmallow test, right? Now that means that a kid and they had validated metrics And that's why i asked brett pottinger about that sit and reach thing Is that they had validated metrics to show that if a kid exhibits good self-control before the age of 11 They live a lot. They will live longer speculating. They will stay healthier longer They know that now because they looked at them at 35 years old and next please here's what happens Okay, that we they're projecting that they will live longer hit it again. Please james You're doing a great job my friend So we want life expectancy to increase But we want the time that you stay healthy into your extended lifespan to last longer too It'd be nice to live to 98 Then get sick and drop dead at 99 or 100, you know, and that's really where it's going We can actually um with with really good Not scientific certainty, but but optimism that the kids that we treat that we help sleep and breathe better in early life That they're gonna have a better quality of life short term long term They're gonna live longer and they're gonna stay healthier longer watch this next please Okay, so hit it again, please The the looks they the faces age more slowly, okay These are babies that were born in the 70s Next please Lower chronic non communicable diseases next Lower criminal behavior next Addiction how about that brett pottinger is that these kids if they sleep and breathe better And we're saying because we widened their jaws when they're very young and You know the this morning they were saying that my kid, you know at 13 had a life threatening orthodontic need If that was an orthodontic candidate at 13 That could have been addressed when that kid was two or three or four when they had 20 baby teeth usually by two and a half years old next And increased wealth management Um, I can say everything is referenced here. I can send it next please So look at that I mean even if you just want to look better How is that elasticity of skin if kids are sleeping and breathing better you demand from your dentist Look if you're telling me to save up my money for braces because my four-year-old doesn't have any space between his teeth and a deep narrow palette And his chinless Why can't you do something about it now at least widen the jaw if nothing else that's the easiest dimension To optimize age appropriately Vertical and you know forwardness that's different you can control that young but Widening a kid and making room for the tongue is what you should insist your dentist if they don't want to do it Send me to somebody who will next And look at that. I mean that's not one individual that's a composite of several people within the study that they've been following They're still following these people next So childhood sleep problem they did this in the dean's study, but they didn't connect it And i'm working with dr. Moffitt and she you know, we're working on that We want to know is the age the aging process gets slowed down Based upon self-control. There's other metrics that they looked at before the age of 11 Next please That's it. Thank you Okay, next up is dr. Scott solomons. He's a dentist and specialist in functional medicine He's here to discuss why small modern mouths can lead to severe Health problems. Would you like me to click your slides for you? Okay Where's the uh, where's the thingy? All right, um, let's figure this out There we go, uh So you don't have to bother taking pictures of my slides there live right now on on my blog right there Okay, so i'm a general dentist in a multi-specialty practice what that means is i mean i just kind of do the basic stuff I'm sort of the ringleader the coach I diagnose i see things and then we have a bunch of specialists that will come in as needed Functional medicine is something i learned about years ago Um, i think most of you are familiar with chris crescer. Sorry to not to see him here But uh, he he started the adapt program And uh, it had it has an emphasis on evolutionary medicine. So, uh, I think that should be Critical no matter what, um Part of health care you you're in I think we really need to keep in mind Our our genetics and what we're optimized for Um And of course we all just treat patients. Okay people think of dentists is you know, you treat teeth Yeah, I mean that's part of it, but what goes wrong with the mouth as you'll see today Has huge ramifications with the rest of the body And then of course, uh, this is not news to anybody here, but hopefully when this goes on on youtube We need to really be Believing that the best medicine is to teach how not to need it Not to say that medicine is all bad. Um, I like to say Western medicine is great when body parts fail. Yay western medicine, you know as in teeth um And then of course That last statement speaks for itself. So when we look at the left here this beautiful ancestral face They didn't know anything about vitamin b12 or vitamin d But look at that face That's a perfect face Not to throw this other gentleman under the bus who shall remain nameless, but um You know, if you if you look at that face, he doesn't really look unusual But if he walked into this person's village over here, they might think an alien landed Um, and you know, there's certain things that that we can see that you know that we're trained to look at this stuff Um, we can all see it looks like he's angry. You see his chin So he can't keep his lips over his teeth without forcing it. So that's that's lip incompetency Um, he probably never spent a good day breathing through his nose whatsoever, which made him a great swimmer Um, and then you know that bottom thing that's that's kind of the big takeaway because as much as we're concentrating on teeth and jaws and breathing Um, all these things come together in a constellation and luckily The answer to all of these problems is generally some sort of Ancestral approach to life. Um, so Kevin alluded to it. We can straighten teeth But if they're on a crooked body, it's really a bad idea Okay, um, let's see. I guess I can look at this So i'm not going to get too much into this. Um, basically, uh, the consequences of a A small face A small jaws or apnea, but you don't have to have apnea. You can have restricted breathing There are swallowing problems speech problems. It's all related. But when you look at that list, I could go I just ran out of room. We we we have limited slides Um, Kevin talk about self control. I'm going to take my five minutes um Couple of studies, okay Um, the the person on the bottom right there That's kind of an obvious thing. I think everybody would would recognize that At the gentleman above Uh, clearly has apnea. We we can pretty much assume that and and so a lot of people associate apnea with being overweight or being obese Um, and that that is true So when we look at patients quickly, uh, the most important things there the malam potty score is Like how much room you could see Behind the tongue it goes from one to four. I don't have too much time to get into that But bmi is a big thing waste hips or conference Necks or conference maleness being over 50. You can almost assume that that person's going to have apnea. Okay but in in the absence of, uh Being overweight, there are certain other parameters that we look at Uh, and it would relate more to the size and shape of the jaw Okay, so this is me And this is a much more subtle case So can everybody see the tracing, uh, in front of my face there? Is that obvious? So that's a bolt in tracing That's a composite that they did at Case Western Reserve University 6,000 kids Paul Newman was one of them and they have a tracing from zero one two three four five years of age all the way up to 18 So that's an 18 year old But the face is generally done developing kevin water around 10 Mostly it varies 10 11 wait wait, okay So that's an 18 year old and you can clearly see that my upper and lower jaws are too far back Okay, and then on the left there. I mean, I'm two and a half days out from uh finishing invisibility So on the left there, you can see my teeth were overlapping too much and uh That causes the jaw to go even further back So we're correcting that and then a big thing that I look at is intermole distance 37 millimeters is actually not bad for a modern person But we're getting my tongue. We'll talk about this more later, but getting my tongue more room So that it comes out of my throat because I have apnea And this is my patient lexie. He's she's not actually my dental patients. She was referred to me She couldn't tolerate a CPAP machine. You know those machines that help you breathe at night um, and her heart was enlarged and you know, what could she do and She didn't have a lot of time or money So we made her that little appliance that's called the avond and it just repositions her jaw forward And her heart's normal a dentist did this So, you know, I'm not superman, but we treat patients. We we don't just treat teeth. I think that's the end of that. Yep Next All right, this is starting to feel a bit like the oscars We've got a superstar coming up right now None other than dr. Mike mu he's an orthodontist from london and an expert in oral posture and rehabilitation He's here to discuss how the way in which we hold our mouths affects how our faces will grow How we'll breathe and more Dr. Mike you want me to I'd like you because I want to do um, I want to get the slide at the right moment Where am I going? You're going this way. Yeah There you go. You got me. Okay. So, thank you very much. I'm trying to For me, I was listening So my father came out with some of the ideas some of the core concepts The behind what you've just heard so I was hearing this stuff 20 30 years ago And I've been thinking about how it all comes together. So I wanted a broad brush stroke overview Of a process a pathological process that connects together everything you've just heard Because otherwise if you work without a central philosophy you're a bit lost Things don't all tie together to make sense And so I came up with this concept of craniofacial dystrophy saying that our faces aren't growing forwards and upwards they're growing down and backwards they're down swinging and the two most important factors here are this soft modern diet gaining a nasal obstruction So our ancestors went from having this really tough diet to this really soft diet You've gone from having you know, I've got a strong jaw. I've got strong jaw muscles But you know, you could these days at a cup You could have a third of your daily calorepic intake With no masticatory effort, you know, the mastication we're doing has gone down massively, you know, some people say our ancestors reading for a third of the physical waking hours and of course that's changed greatly and then of course we're getting nasal obstructions and we Clearly it's important to keep your mouth closed The tongue-to-palate contact is a vitally important almost like I think of it as a reflex that tongue-to-palate contact Lip seal is you know, it's one of the body's fictors. You know, don't lose any of your fictors. They're really important but As much of the importance of your oral sphincter tongue-to-palate breathing is possibly the most important thing you do So to breathe you lose those two vitally important reflexes So you then hang your mouth open And you've got weak muscles You've seen insomnia has that stroke the face just lengthens the whole face lengthens reducing the cross sectional area And as that drops down you get why the long face now So I've tried to put together 3d model of this now Okay, so the thing I think we're not seeing this is because everyone today is affected You're all affected. You're all deformed And it's very difficult, you know It's really a hard thing to get around your head this and the reason why you don't get around your head is just because We've forgotten where we used to be because ancestral material had this really good facial form This has gone from the ancestral perspective where scott showed that really good facial growth Here's the really good facial grower Okay that you can see how it drops down So everyone's dropped down to about there Then some individuals carry on down. So that's now the adenoidal face type But we have to eat sleep. Do we have to talk eat? breathe So as the face drops down depending on your individual way of resting your tongue and your Mouth So that you can still breathing you then go you follow one of these different patterns of behavior. So if You decide that dropping your tongue in your mouth holding your mandible forwards Is a good method to keeping your airway open You'll develop with this class three If you simply hang your mouth down like this Recount classical anglo-saxon thing to do You end up with this type of pattern and if you rest with your tongue in the middle you end up with this pattern so you have one overall general schematic of change With modifications depending on your individual pattern of modification and that's what gets the various different types of malocclusion But put simply if a face is not the correct shape, then it does not function correctly So you have all the patterns of pathological symptoms From different in different areas that comes from a face not growing well And my objective not only to gain a good overview my other perspective my other Goal has been to try and gain change to try and physically reverse this pattern of behavior pattern of pathological development now This is life changing This is making someone healthy But it's also incredibly difficult and it's not very financially cost effective You know Whereas I think the value I've added to his life is just extreme, you know, he's going to have a completely different life I would like to feel we're gaining the best facial changes ever achieved by anyone ever on the planet But I don't know because no one will compare the results with me And that would be nice because then I'd get some tangible result, but no one will But I think there's we've gotten pandemic Going on no one's even noticing this is occurring and It's it's really affecting people's lives. This is the biggest disease you've all got that you don't know about Because it's in your face. It is your face You know, you don't want to admit This it's uncomfortable to admit it And that's why we haven't really looked at this before Okay, so thank you very much indeed Thank you Mike The next speaker doesn't need an intro, but I'm going to give you one. Anyway, uh, it's dr. Robert Lustig He's the emeritus professor of pediatrics in the division of endocrinology He's also a member of the institute of health policy studies At ucsf. He's an expert in obesity and diabetes and he's here to discuss How modern changes in our faces have impacted our metabolism Thank thank you, james So you've heard about the structural aspects of this now the question is what are the functional aspects of this? How does this ultimately contribute to disease? So we're going to start with this concept that ultimately allies dentistry and medicine oxygen Okay, the airway is the conductor of oxygen and the airway is under assault That means oxygen is under assault and how does changes in oxygenation Ultimately impact on changes in disease. That's what this is all about So this is what I want you to think about we all start out as one cell a zygote We end up growing into an adult Okay, how many doublings? Did that take to go from one cell to 10 trillion cells The answer is 41 doublings How many of those doublings occur before birth and how many of those doublings occur after birth? 36 doublings before birth five doublings after birth and I can prove that to you later on with some math The point is that every cell in our body has to grow at one point in its life And has to burn at another point in its life, but it never does both at the same time It does one or it does the other and there are switches For whether it should grow or whether it should burn. What is that switch? Well, one of the components of the switch is oxygen so Otto Warburg Won the Nobel Prize in 1931 for figuring out that cancer cells do not need oxygen They actually grow without oxygen. They grow by anaerobic glycolysis. They grow by fermentation So the oxygen tension inside a breast cancer is 44 millimeters of mercury. That's pretty low Right when you think about the oxygen tension in our blood being 100 millimeters of mercury The oxygen tension at the top of mount everest is 53 millimeters of mercury yet the oxygen tension inside the umbilical artery Is somewhere between six and 31 millimeters of mercury thus mount everest in utero The fact of the matter is the fetus grows the fastest of any Organism in the entire world is what's going on before you're even born all this growth is occurring And it's being done without oxygen on purpose Because in fact growth Doesn't need oxygen. In fact growth actually gets in the way I'm sorry oxygen gets in the way of growth This is if the phenomenon Known as the warburg effect. So on the left side, you have a cell that's burning And you'll notice the pyruvate goes into the mitochondria and oxygen is a cofactor for being able to generate all that ATP through oxidative phosphorylation On the right side, you have proliferative tissue either fetal tissue or cancer tissue That is trying to grow. It's not trying to burn And so what's happening is that the glucose becomes pyruvate But the pyruvate's not going into the mitochondria because there's no oxygen But the pyruvate is still being utilized. What's it being utilized for? It's being utilized for structural components to grow So you're getting ATP, but you're getting it through glycolysis. You're not getting it through oxidative phosphorylation You need the pyruvate in order to generate ribose or deoxyribose in order to make DNA in order to grow You need the pyruvate to make fat through de novo lipogenesis that was mentioned by One of the speakers earlier By dr. Bustos, okay for membranes in order to be able to grow in other words Take this analogy. Okay, you have a house full of firewood Okay, and that firewood on top it can do one of two things. You can either build furniture with it Or you can light a fire with it, but you can't do both Each piece of firewood can be used for one or the other but not both Each molecule of glucose can be used to grow or to burn but not both And the question is how does the fetus Decide when to grow and when to stop and when to burn we actually now use this phenomenon of blood of Hapoxia of getting Oxygen tension down in order to grow muscles This is now being used to treat sarcopenia called blood flow restriction And you can see the bands on these people's arms for exactly this reason is to be able to increase muscle mass because lack of oxygen increases growth Presence of oxygen increases burning Now there are three Enzymes in every cell in your body that ultimately dictate the switch Those three enzymes are in this slide First one p i3 kinase phosphatidyl anastol 3 kinase This is the spigot that opens the cell to Increasing the amount of glucose being imported from the bloodstream into the cell This is the enzyme that lucanthly a cornell Demonstrated is absolutely essential to cancer growth Because you need all that glucose because you're not making it with you're not burning it with mitochondria Therefore the ATP have to come off the Off glycolysis in order to power the cell so you need 400 times The amount of glucose being imported In order to do that because you're not burning it The second enzyme amp kinase that's the fuel gauge on the liver cell That's the enzyme that tells the mitochondria to work or not to work And then finally the last one is called mTOR mammalian target of rapamycin And that's the enzyme that basically tells the cell to either divide or not Okay, these three enzymes work in concert To tell your cell whether it's supposed to be growing or whether it's supposed to be burning So we have three enzymes. We have two states on or off So in the first column Okay, that was by the way that that since three enzymes two states that's eight permutations right two to the three So here are the eight permutations in the first permutation You can see pi three kinase on amp kinase off mTOR on that's growth Well growth also increases the risk for cancer. So that's also the cancer pathway as well The second path Permutation it's the exact opposite and that's the burning one. That's the burning pathway But what you will notice is that you can have Disynchrony of those three enzymes in those other six permutations Where they're not lined up in one direction or the other and every one of those leads to chronic disease as demonstrated by various transgenic models Where one of those has been knocked out where the and the others haven't in other words Growth and burning are essential to all life But at different times and these three enzymes which are dependent on oxygen Are telling yourselves when they should grow and when they should burn and all of our chronic diseases are dysfunctions Of that phenomenon. Well When we're not oxygenating We're not burning. We're growing when we shouldn't be and that unfortunately is The basis for how dentistry and medicine ultimately Combined to impact on this phenomenon of chronic disease We have to improve oxygenation in order to stop these other processes from occurring and the question of course is How that is coming up next all right We had this set up that each speaker was going to do about three minute slide presentation That didn't happen because these slide presentations were way too good to cut off. So We're going to have a very truncated Short version of the panel discussion right now in which I will be able To ask each of these people some questions and then at the end We're going to tell you what you can do to fix all of these very depressing problems that we're just addressed here So if the speakers could please come up here And shabon is still on the call. Okay. Good. Good So, um, the first question that I have for shabon is I thought was very interesting That she mentioned that paleolithic cultures had Problems with their teeth and I had heard that that the very first farming cultures 12 000 years ago was the very first incidents of widespread crooked teeth and I went to the University of Pennsylvania to the Morton collection on kevin's recommendation here looked at thousands and thousands of Of skulls and I met a researcher there who had been looking at these skulls for years and years and had never seen a hunter gather With with crooked teeth ever. That's what she said. So I guess the question is Shabon, do you know what percentage of the population of our ancestors and paleolithic ancestors Had crooked teeth was this widespread in certain Areas or was it widespread for certain individuals? I wasn't crooked so much as having dental pathologies most hunter-gatherers have very straight teeth and Usually room in the mouth for the The wisdom tooth or the m3 as well but they certainly were susceptible to the things like dental abscesses dental decay If you're eating a diet that has a lot of grit in it wearing the teeth down To the point where you enter the pulp chamber that can occur as well in advanced ages of wear and age But you're yeah, the in terms of crookedness. No the image that I showed the person would have had pretty nice teeth but many of them were missing as a result of Dental abscesses primarily they had some loss Some bone resorption at the alveolus that kind of thing So no, I'll agree with your assessment. Absolutely that the vast majority of hunter-gatherers have very straight teeth Excellent um and one other question for you. I'm sure you're familiar with the work of western price He was convinced that one of the reasons That we modern people had crooked teeth was caused by vitamin and mineral deficiencies specifically k2 and d And I was wondering if you have any Comments on that if that fits and it seemed like you were talking mostly about mastication Not so much vitamin and mineral deficiencies and if that plays into The health of our teeth and jaws Certainly it does any vitamin or mineral deficiency can result during dental development in having a tooth Have structural problems. So for example Not adequate mineralization of the tissue now that would happen in Well starting in utero, but also in juvenility and early childhood as well as the adult dentitioner for is forming in terms of crooked teeth if you had A Mineral deficiencies to the point where it was affecting bone health certainly it could result in In crooked teeth or misplacement of teeth dental loss those kind of things Primarily having crooked teeth has to do with having enough room in your mouth for your teeth And if you have as the other presenters have very nicely laid out a smaller face and a less Prognastic face or a face that doesn't stick out quite as much you won't have as much space in your mouth for your teeth And since the space is limited, they start to overlap They, you know, we'll turn a little bit sideways or you might have dental impactions at the Back of the dental row as well if you're talking about molars second third molars in that area So that's mostly about space dental crowding is mostly about space Thank you Dr. Boyd Let's talk about a mother's breathing and how that might affect Fetal development this concept of gestational apnea. Would you call this a hypothesis? Is this a theory? Is it None of those things it's a pretty well supported hypothesis and getting stronger Um, and again, it's a modification. I think of the barker hypothesis this uh barker Said that in starvation Uh of calories is that the baby's anticipating being born in starvation And they get something called a thrifty phenotype and they preserve calories they hold on to them well If oxygen is a substrate a respiratory substrate not an energy substrate that's deficient then there's oxygen starvation in utero and I feel that a good analogy would just be that the baby's anticipating being Born on top of a mountain and mountain people and the indigenous cultures that are mountain people like on You know the indies. They're very small Um, the the largest reservoir of mitochondria are the musculoskeletal system So it behooves them to be smaller proportional Allometrically scaled in proportion But they're still I mean, you know, they're smaller, but their jaws their tongues fit in their mouths They're they're not until they get westernized food in living. They don't get crooked teeth They don't get malocclusion. So um I'm the other thing that I would like to say is that Uh a tongue is responsible for building itself a home to live in For the rest of its life and it starts in utero Of you know mid gestation when they're chewing amniotic fluid and then when they're born if they don't develop A palette that's conducive to nose breathing in the first, you know, a couple years of life. Guess what they died That's why we don't see malocclusion in ancestral populations because Antisedence to malocclusion they died before they could even develop malocclusion. So that's just a hypothesis And we don't die We're here Fair enough Scott you mentioned something in your slide that you said we know how to fix crooked teeth But we don't know how to fix a crooked body. Could you elaborate on that a bit more? Yeah, we we do know how to fix crooked bodies and part of it is fixing crooked teeth So the overarching reason we're here is because of an ancestral Approach to health So I don't want to get too far afield because we're talking about the formation of the jaw But all these other things you saw on that list come with it So in the past we would treat each one, you know, obesity gets treated like this Unfortunately, usually with some kind of pill or something that doesn't work and high blood pressure gets treated like this and On and on and on We really need to kind of see the big picture And tie all of these things together. So when I see somebody come in with small jaws I also see the obesity that they bring in with them and then I do a careful review of their medical history and I see that they have hypertension And we have to treat all of these things holistically um, and and again, that's getting back to the the functional medicine approach because uh, there's This thing called the exposome It's it's kind of a fancy word for saying everything The size are genetics That affects our health And our longevity So in other words nine out of ten elements that we have are from our environment, whether it's toxic relationships Poor movement too much sunshine not enough sunshine So there's a recipe for a happy healthy vibrant human being that I have it requires maybe six or seven things Done correctly all together um Will result in a fully functional healthy human being um, and and any uh excess or lack thereof Can manifest itself in many ways small jaws just happens to be one of them. But typically we see a multiple of things Dr. Mew let's talk about craniofacial dystrophy I can understand how the shape of our faces and our mouths can affect our breathing that seems pretty obvious But you also had a list of other things that our poor posture would affect including our hearing How does that work? Well as So as I said A face that's not the right shape doesn't work particularly well It doesn't also function particularly well. So as your face downswings the cross sectional area is reducing You're going to struggle to place your tongue fully on the roof of the mouth when you swallow The architecture and the muscles around the top of the tongue won't contract correctly Now, you know, there's a eustachian tube runs from the middle ear and it runs through to the top of the nasopharynx And the idea is that whenever you do a correct swallow You open the eustachian tube. This allows aeration of the middle ear and That keeps everything healthy If you can't swallow correctly and you can't even get your tongue into the correct position because your face is already distorted You don't open the eustachian tube You don't get this aeration of the middle ear and of course then you tend to get otitis media and if This needs to be corrected as we call it a grommet in the uk But you just put a I don't know what you call it. You put a bypass tube through the eardrum to allow aeration to the middle ear So effectively you bypass the eustachian tube and It's because you're not getting the correct functional Physiology you're getting a pathological situation. That doesn't open and that's one of the many features of craniofacial dystrophy It's you know, everyone's at the moment very correctly Highlighting this the sleep apnea and the lack of space and the fact that generally you've got this broad reduction in cross-sectional area You know the structure's got longer There's less space for the tongue the teeth and the airway. So you've got malocclusion You've got sleep apnea. Yeah, this is a really good observation But there are other effects of a face that doesn't grow correctly as you say like middle-ear infections and hearing problems Thank you Dr. Lustig so I had talked to somebody about six months ago about the warburg Hypothesis and they reminded me that it was a hypothesis. I was totally bought into it And so I wonder if you can Elaborate on if it's cancer that creates an acidic environment or if it's the acidic environment That lends itself to cancer So the warburg effect is not a hypothesis the warburg effect is an effect What we've that what I put up on the screen is a hypothesis Okay, we haven't proven that although the Supplementary data the empiric data that exist both in terms of Correlation and also in terms of mechanistic studies done in animals Support this but it is still a hypothesis no argument there, but the effect is it is the effect Without question the cancer cell makes the lactate and the reason is because the cancer cell Is not burning all the way to carbon dioxide So it makes pyruvate that pyruvate is either turned into Structural components or it will be released from the cancer cell as lactate and that's why lactic acid builds up now There are only three count them three States where your lactate is high your serum lactate is high One is post exercise for obvious reasons because you didn't get enough oxygen to your muscles to be able to You know burn all of that in your mitochondria The second one is cancer And the third one is mitochondrial encephalomyopathy like curnsayer syndrome mela syndrome Murph ragged red fiber syndrome so basically In each case it's because your mitochondria Didn't do their job Okay, and so anything that affects your mitochondria will lead to lactate Well cancer cells don't have mitochondria. They can't build mitochondria fast enough for as fast as they are growing In fact, if you look at cancer cells, they are devoid They're practically they're they're almost like no mitochondria there on purpose because they don't need them So in fact, this is you know, how cells grow Don't do mitochondria because mitochondria are superfluous to growth because their job is burning So that you know The the the lactate is definitely a function of the cancer cell, but it's also a function of the fetal cell So the warburg hypothesis has been around for like a hundred years, right? Okay, no, no, I understand what you're saying the difference, but the idea that An acidic environment can lend itself to can't that has that concept has been around for a hundred years Will it ever be proven right or wrong? Okay? I don't know any data that says an acidic State can lend lend itself to cancer. I've never heard that And I know a lot about this field and I've never heard that Cancers definitely make an acidic environment. No argument there, but I've never heard of it going the other way There are a lot of states of acidosis and they don't have an increased risk for cancer Thank you Now we're going to get into the how do we fix it? What do we do about all of this section? And we're going to start with shabon Dental cavities this seems pretty obvious how to fix it But if you could elaborate a little bit on if we have these problems, what can we do right now to help decrease our chances of having them in the future Well, I think it's unrealistic to assume that everyone is going to go back to an ancestral diet so to speak We have an industrialized diet and many people live in industrialized society, but limiting Super processed foods certainly would help I also will toss it back to the clinicians in the group and say that having a clinical perspective that is holistic and takes into account as many of the the folks have brought up what a Normal and I'm using normal in the evolutionary sense a normal face would look like when treating aspects of dental malocclusion palette formation jaw shape and so forth Is important and some of the benchmarks for creating an ideal face orthodontically are based on agricultural populations and modern industrialized populations and taking a look at those benchmarks as I know some people are doing and reevaluating those in the treatment of many of these Diseases and anatomical variants would go a long way towards helping people breathe better Thank you Kevin What can we do about gestational apnea? Well for one thing when we talk about pregnancy wellness, it's more than yoga. It's more than folic acid or folate It is sleep and breathing and it isn't just amount of sleep when a woman is pregnant She needs to oxygenate optimally and that is through her nose So this is not talked about even I have obi guiney parents That bring kids to me and I'll ask them. Have you heard of this disease entity called and in really I think Unlike warburg. This is a hypothesis that gestational apnea hypothesis, but it does have a lot of support So assuring that it it made mean just giving a mom something called a boiling bite You know an oral appliance that helps them keep their jaw forward Their lips closed myofunctional therapy. We have myofunctional therapists here joy molars famous Samantha that there there's pregnancy myofunctional therapy myo muscle function and With little kids we do it But we need to optimize that when women are pregnant or pre pregnant and that's when it should start and that means every woman Needs because someday she might be pregnant or pregnant and doesn't know it We talk about no alcohol. That's good. But how about nasally breathe there Scott how about for adults if kevin is suggesting this when we're younger? What can we specifically do? When we're younger When we're older when I'm sorry when we're older. Well, it's a little bit difficult But that means most of us in this room as you saw by my little bolt in tracing So it means more of an interventional approach, doesn't it? Mewing works wonderfully well, but not so much in the 65 year old. Sorry That's so good So there are any number of interventions. It really depends on How far somebody wants to go? Um So we go so far as to do a combination of orthodontics Which can even include expanders on adults and there's a variety of them fixed with little mini implants removable Um, so a course of orthodontics and then surgery to actually advance both jaws and then a finish up Stage of orthodontics that would sort of maybe be the extreme, but it would still include Uh And densists are very capable of looking at how big the tonsils are We kind of can't see the adenoids. So we would need to get an e and t involved Potentially if that was the situation, but if you don't want to go that far A Simple appliance that I showed before that lexie was wearing just to bring the jaw forward and take the tongue out of the throat When we sleep is really what apnea is is A situation When we have REM sleep Our brains are actually very very active and as a result we we paralyze ourselves So when we're in REM sleep, we're paralyzed and and if the tongue Is closer to the back of the throat as in my case Okay, because you saw my jaws were too small. It's going to include breathing And so if we can do something to bring the jaw forward that sometimes is enough And Mike how about for craniofacial dystrophy? What can we do right now? What can everyone in this room do right now to help reverse this stand up straight and shut your mouth? You know, this isn't a new idea You know that what I've said could be summed up with that phrase The wind will change shut your mouth or the wind will change in your face will set like that You know these ideas aren't new, you know what ester go clay was saying yesterday It's you know myophontal therapy is you know, it's it's a it's a science behind such a simple statement To stand up straight shut your mouth eat your eat your food with your lip mouth closed Um, don't speak when you're eating You know, it's there's nothing new in what we're saying If you're young and I think we've got to be trying to get prevention that doesn't totally answer what you're saying because just ask me what can we do now and A lot of people the problem is that the if the your Oral posture and function has created your craniofacial form Then the most comfortable Oral posture and function for you to exhibit Is the one that you already have because that is comfortable in the form that you've created So change is really difficult and I don't need you have the muscle memory You've sort of got this structural memory preventing you from moving forwards And sometimes that's where I would intervene as an orthodontist But a lot of people with severe sleep apnea I think are going to have to have bimaxillary surgery and more involved methods Training it will only go so far Thank you. Dr. Lustig anything we can do right now to help improve our breathing improve our health So, um, I have a question for all of you How did mothers feed their babies before there was baby food? Exactly Just like birds they pre-masticated and dropped it into the little baby's mouth That's how it was done in 1901 Netherlands company made the very first baby food. Okay, and it's been basically All hell's broken loose since The bottom line is we used to feed our kids very differently But we have been told by the food industry. Oh, you don't want to give Solid foods to babies because they'll choke They didn't choke Okay, none of them choked Okay, but You know, we bought it with lion's anchor. And so now we have baby food and pouches And that is, you know, sort of part of the problem. So As, uh, you know, kevin, you know explained to me sucking on a mother's nipple is very different from sucking on an artificial nipple In terms of the negative pressure put by the tongue on to the incisive suture in order to grow the palatal vault Mastication the four muscles of mastication the masseter the temporalis the medial and lateral pteragoids Are basically pulling the jaw forward in order to increase that palatal vault But we're not doing either of those because we're basically giving kids artificial nipples and Um, uh, pureed, uh, baby foods Did anybody see the new york times yesterday? There was an article about a study that just came out I can't remember where it was, but they actually measured where was it? Manchester, Manchester, England Which uh, uh, measured the amount of energy expended in chewing and it turns out that it's about Five to ten percent of total energy expenditure. Well, if you're not chewing guess what you're gonna get obese No matter what you eat So, um, you know the fact of the matter is our processed food environment Both at the neonatal level at the toddler level at the child level and now we know at the adult level Has if not been the sole cause has absolutely been a cause Of this phenomenon both anatomic and also functional in terms of chronic disease So we got to rethink our food Speaking of chewing and obesity. It's lunchtime everybody. So thank you very much for coming. Thank you to the entire panel