Welcome to the Get to the Root podcast where we uncover the real reasons behind everyday health challenges and give you hope for healing. Today, we're starting a special three-part series on ADHD.

In this first episode, Dr. K looks at something most people never connect to attention and behavior. The Airway. From mouth breathing and snoring to restless sleep, we explore how breathing at night can shape focus, mood, and learning during the day.

If ADD has ever felt like a puzzle you can't solve, this might be the missing piece you've never considered. This podcast is for education and encouragement.

Please consult your health provider for personalized medical advice. Now a note from Dr. K about our sponsor. At Hope for Healing, we believe knowledge is power, especially when it's in your DNA.

That's why we use the custom SNP panels developed in partnership with the BGRAHN to get to the root of our patients' health concerns. Today, we're highlighting the essential vitamins and minerals panel, abnormalities in copper and zinc balance, the need for vitamin C in the manufacture of dopamine, and the fat-soluble vitamins for cellular brain and nerve health is so important when we evaluate the potential causes of ADD and ADHD.

We're grateful for our partnership with Bagram and their sponsorship of this podcast, which allows us to personalize care from the inside out. To learn more, check out the link in our show notes.

Dr. Kate, thank you so much for taking the time to have this conversation. I think it's a conversation that people are really interested in because they all, and everybody does, just want to help their children or grandchildren to be able to support them in this way.

Let's just start from the beginning. What exactly is ADHD and how does it get diagnosed? Well, as the name implies, attention deficit hyperactivity disorder, but you can have inattentiveness without being hyperactive, so there's different labels for that.

And the diagnosis is made by completing a questionnaire, but it can also be someone's superpower. Because most great visionaries have a degree of ADD, ADHD, and their brain goes all over the place, but it's defining what it is and how to help it work for you.

So many of us were made uniquely. So we're just wanting to optimize what their superpower is right to be able to use it for for their benefit because it can be so hard to see like a child struggling through something where where you also see the brilliance and I think that's what I hear I love that you mentioned that I hear that from so many moms who whose kids do it's like I see the way that they can lock into something and learn something but then they can't always apply those skills to other things that they'd want them to learn.

So I really love that. How does functional medicine look at that diagnosis or that condition a little differently? Yeah, that's a great question because when we think about brain health and how the body shows up, you definitely have to peel the onion there because it's not a Ritalin deficiency or a Concerta or a Vivance deficiency.

So when we think about the brain, we have to look at how everyone's wired. So functional medicine will always look at the systems of the body. And so since we pull everything in from a genetic focus, we always look at inflammation.

Is the brain inflamed or not? And then we look at how is energy being delivered to the brain or to the cells? That's autophagy. And then how does the brain clean itself out?

How does the brain provide itself with fuel? And how does the body fuel itself overall? And then also genetically, what essential vitamins and minerals do you as a person lack?

The number of receptors to pull it in from your food. Because people will say, well, I eat a good balanced diet, but maybe you can't extract those nutrients from your diet and those may be missing.

So we look at the genetic symphony of a person's body. We look at modifiable lifestyle factors so, you know, every child or adult needs to have their airway evaluated and their mouth and how they can sleep and recover.

Before we get into all the specifics, when we were unpacking this episode, it was very clear that there are so many different ways to look at this, that there are so many different aspects, which I feel like at first I was like, man, that can be really overwhelming.

But what I was really concluding is that how hopeful is it that if you start to hear things and you're like, but I'm doing that and I'm still having struggles, hang tight.

There are going to be something in it for you to be able to glean, to unpack. And so we are going to dive into that. But before we dive into the brilliance of the airway, because I had no idea how important that was, can you talk a little bit about how ADHD can look different in boys versus girls?

Or can it look different? Yes, girls and boys are very different and typically little boys and this all goes back to how we learn. So we can learn auditorily, we can learn kinesthetically moving around, we can learn visually or a combination of all of them and typically we're a combination of most.

But if you take a little boy that needs to move his body and you put him into a classroom where he's told he has to be still and sit someplace, he's the first grader that's going to be pinging off the walls, moving, tapping the pencil or pen, moving around and getting called out.

And that does a number on who you are if you're being corrected all the time. It has no bearing on who the potential that that child has to learn. So it can be very demoralizing if you're being told to sit down, you're getting bad behavior ratings, that kind of a thing.

Little girls, on the other hand, tend to not move their bodies as much. and they will be very inattentive and their grades will slip and slip and slip and it won't be until they're in third or fourth grade and there's a crisis where they're struggling and then the diagnosis is made instead of the little typical first grader peeing off the walls can't be stilled little guy versus the compliant little girl sitting at the back of the classroom making mediocre grades.

This has nothing to do about intelligence, but it has everything to do about what's going on inside their brain, with their body, that kind of a thing.

Right. And so when ADHD presents itself in this way, I love that you mentioned that it can frequently be missed until they're older, where they could have had the support and they could have had the engagement and the tools that they need to succeed, and that's missed.

And so that's ultimately what we want to ensure through this episode is that people are getting the help that they need as soon as they can get it. What happens when it does get missed?

If it does get missed, is there still something that can be done? Is what we're about to be learning still going to be helpful for those people who have maybe teenagers?

Absolutely. As something that we try to instill, there's always hope to help the body function properly. But when you develop these ingrained habits, a lot of times you have to unlearn them.

You have to unlearn ways of interacting. And so many people have found little ways to help themselves, such as buying a timer and doing one thing, setting it for five minutes.

Okay, during this five minutes, I have to do this. Or having lists. You know, I think of parents as they work with children. Make your life as stressless as possible by taking a list, and if it's a pre-reading child, then make it pictures that you put together with your child.

It's like, okay, the night before, and especially if you have ADD yourself, you fly by the seat of your pants, you don't plan ahead, the world comes to a halting screech, and you realize, oh my gosh, I forgot the lunch, blah, blah, blah.

make a plan, keep it simple, keep it simple one thing at a time. And if you instill in your children there's an intelligence sequence, I lay my clothes out at night, this is my clothes, my shoes, my socks, my backpack, I make my lunch ahead of time.

You have this nice little simplistic list. But when you have older children or you're an adult and you've gone through The job roulette, you just keep going from one job to the next.

Yes, you can learn. Yes, you can change. But it's multifaceted and we're going to break it down. Absolutely. I love it. Okay. So now I really do want to get into like the lifestyle and what this looks like.

And so you mentioned it already and I'd really love you to dive into it. The airway. Like what does that have anything to do with ADHD and ADD? So if you cannot allow your brain to detoxify itself, clean itself out, and have good, healthy, restorative sleep at night, well then by golly, you're not going to be able to pay attention either if you're yawning all day.

So let's think about our children. So when you look at your child, How can you tell if they have airway problems? So when you look at them from the side, do they have a slightly receded chin?

Okay, that's number one. Okay. Number two, if you look at the distance or the space between the bottom of their nose to their top upper lip, First of all, does your child breathe with an open mouth a lot of the time?

If they're at rest, do they breathe with their mouth open? That's clue number one. Clue number two, do they have dark circles under their eyes? We call those allergic shiners.

are those present? Number three, the philtrum, which is that thin little indentation below your nose and to your top lip, is that very elongated and narrow, okay?

And does your child's face look very oval? And also, do they have a thin upper lip? If those things are present, their airway may be compromised. And also, do they smack when they eat?

Are you like, close your mouth when you chew? Is it hard for your child to chew without leaving their mouth open to get air? If that's the case, then their air may be impinged upon.

Now, that's the outside looking in and then your observations. My kid sounds like a little piggy. They're like smack, smack, smack. Well, they may not be able to breathe well.

Second is, do you hear them snoring softly at night? Okay. So, we've looked at the external appearance. Now, let's think about their sleep quality. Do you hear them snoring?

Do they wake up with drool on a pillow? Are they starfish? Are they moving all over their bed at night? Do they snort and move in their sleep? So those are clues, too, like if you find stains of drool or your kids, even if they're continuing to snore, and then prolonged bedwetting, that can be a sign that their airway is obstructed, and then also really bad breath.

Do they have bad breath all the time? That could be a sign of infection in their tonsils or their adenoid. So now, when you look in the mouth, In order to determine if your child has an airway problem that's causing the symptoms of ADD, ADHD, have them stick out their tongue.

And if you see their tongue and it looks like it has scalloped edges, like a scallop shell, just kind of like these little circled lines, that means that they're pushing their tongue into their teeth at night to make an airway.

So when they go to sleep, if they push their tongue forward into their teeth, now also, do your kids grind their teeth? That's another clue that their sleep could be interrupted leading to their ADD, ADHD, because we're going to tie all of this to inattentiveness or behavior that is less than optimal.

Ping, ping, ping, Roger Rabbit. Okay, now when you look in your child's mouth, this is your actual inspection. When you have your child open their mouth, have them say ah and stick their tongue out.

If the roof of their mouth is very high arched, that may mean that their airway could be potentially narrow. The other thing is if they stick their tongue out and the end of their tongue looks like a heart, okay, a little heart-shaped tongue, then they have a tongue tie.

And then lastly, have them lift their upper lip up. And do you see some webbing, some gum tissue come down right between the middle teeth, or is there a gap between the top two teeth?

So, all of that speaks to airway constriction. Now, there's other types of tongue ties, buckle ties on the sides, but that's where a pediatric dentist that has done airway training comes in.

if they start to see some of these things going on and they see either a few of them or several of them, what would be their first step? What would they do to either start supporting their child or who do they need to go see?

I would have them ask their dentist, hey, have you had specialized training in pediatric airway medicine? It is now becoming very, very, very common for pediatric dentists to have done airway training.

And if not, they need to search and try to find one, okay? Second, if their child is obviously snoring with respiratory pauses in the middle of the night or wetting their bed, especially after the age of six, they could ask their doctor to refer them to a pediatric ear, nose, and throat doctor.

And the ENT can order a sleep study or a pediatric sleep doctor, like we'll go ahead and give a referral to a pediatric sleep doctor, but also the pediatric dentist.

And I don't necessarily recommend ear, nose and throat to be the person who does the airway modifications. Why is that? Well, ear, nose and throat doctors understand and are outstanding at looking at that airway, but A pediatric dentist knows where and when and how much movement the tongue should make.

A child should be able to take their tongue and sweep at the back of their mouth to hit their back teeth. And an ENT may not be thinking of that. You know, they may be able to take out the tonsils and the adenoid, but you really want that pediatric dentist, airway specialist to be the one that does the laser procedures if necessary.

But they'll also determine if you need to go see someone who does what's called oral myofascial therapy, which is exercises to strengthen and stretch connective tissue before you do anything to release tissues that are impinging on the airway, causing the signs and symptoms of ADD and ADHD.

So as you can see, Airway, airway function is paramount to how you pay attention. So how is it paramount though? So what does that mean? Like what do those symptoms look like if my airway or if my child's airway?

And if you are part of all the people who whenever she did the tongue switching and all the things you should do and you did it, I'm with you. As she's talking, I'm like, can I do those things?

But you learn. So what exactly does that? So we went a lot into what to look for, but why do we look for those things? Why is it so important for my child's airway to be working functionally?

Yeah. So when your child goes to sleep and if they have tissues in their mouth that are too tight and they're clenching their teeth or they're grinding and pushing their tongue forward to try to make an airway, If your sleep is so interrupted over and over and over and over and over again all night long, then you're not able to clean your brain out of debris and you'll wake up fatigued and you won't be able to pay attention.

And so that will show up like ADD. So sleep in general is super important because ultimately you're talking about what is happening, but what does that mean?

Clear out their brain. What does it mean to clear out their brain? Yeah. So when you sleep, That is the only time that the patmen of the brain called microglia go in and they clean up the accumulated debris that has accumulated all day long.

So when you sleep, a couple of principles are this. You have the head of your child's bed. Instead of it being flat, go to Home Depot or Lowe's or someplace like that where you can buy those little quarter inch high little furniture moving devices and put them at the head of the bed, head of your child's bed.

Or you can even do this with a crib so that you elevate the head of the bed by about a quarter of an inch. Why is that? When you do fall asleep, the ability to clean the brain out needs gravity.

So you've all heard of the lymphatic system. You've got a sore throat and you've got these swollen little lymph nodes under your neck here or under your tonsils.

You can feel those. Or let's say you get a bug bite next to your groin and you get enlarged lymph nodes. So the lymph system cleans out the rest of the body, but we discovered in 2014 by special imaging of the brain that there's something called the glymphatic system of the brain, the glymphatic system.

So when we sleep, if you have the head of the bed elevated, the glymphatic system is draining by gravity all the debris and the leftover garbage from all the processes in your brain overnight.

So give it a little bit of help with gravity, okay? That's number one. So the brain can clean itself out. Then for sleep, just think about it when you haven't slept well, you're yawning the next day.

It's so hard. And I'm just thinking about it. Oh my gosh. That if you haven't recovered from the day before, you just don't have any juice in your brain to keep going and you're going to be sleepy.

So think about if your child has an airway where they finally fall asleep, they're still in pull-ups at seven years old because they're wetting the bed or they're not.

But they're waking, they're almost waking themselves up all night long because they They obstruct their airway and then they move. They don't have adequate recovery overnight.

And then their little brain, I couldn't pay attention if I was waking up all night either. Then you're expected to go and comply and follow instructions.

So sleep is so important. So that's the why. When we sleep, we clean the debris out of our brain. I've given you that tip to elevate the head of the bed.

I also like, there's what we call a liposomal melatonin, so if it's hard for your kid to fall asleep, we'll tack on that liposomal melatonin, and that means it's absorbed very rapidly through the fatty layer of the gut, the mouth, and it just gets in there rapidly and helps them sleep.

But that sleep is so important, because if you don't sleep, you can't pay attention, you're tired, and all those signs and symptoms of ADD, ADHD show up.

And just by addressing the airway, you may not have ADD, ADHD. You may not. That's amazing. Yeah, you may not. But it's really amazing. Okay, so I love everything you said there.

And really, in conclusion, you're really saying that they can see these things visually, and then they can get to a pediatric dentist that is trained in being able to support them.

And then if all else fails, like just actually getting sleep. So maybe the airway isn't that, but they're just not getting optimal sleep too, right? And so the drainage isn't happening.

And so getting your child the sleep that he needs, getting you the sleep that you need to be able to function as a parent too, is just so incredibly important.

So I really love that we dove into the complexities of sleep. That's it for part one of our ADHD series. We've seen how something as simple yet powerful as breathing can influence the brain, and our next episode will dive deeper into what's happening inside the body.

Inflammation, genetics, and nutrient deficiencies, and how they all can impact ADHD symptoms. Be sure to follow the show so you don't miss out on the next piece of the puzzle.

If any of this sparked an interest, make sure to share it with your friends. And as always, check out the links in the show notes. Until next time, remember, there's always hope for healing.

Is It ADHD—or a Breathing Problem? The Airway Connection Parents Miss

Paula Kruppstadt, MD, DABP, FAAP, IFMCP

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