Dr. Nammy Patel explores the A in the AGES protocol: airway. She explains why nasal breathing, nitric oxide, tongue position, snoring, and sleep apnea matter to whole-body health and how biological dentistry can evaluate and support airway function.
John Maher: Hi, I’m John Maher and I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health, and the author of the bestselling books, Age With Style: Guide to a Youthful Smile on Healthy Living and Total Wellness: Understanding the Link Between Your Teeth and Your Health. Today, our topic is the Airway is Everything. Welcome, Dr. Nammy.
Dr. Nammy Patel: Thank you for having me, John. I am so excited to talk about one of my favorite topics.
Why Airway Health Matters for Aging
John: Absolutely. So we’re talking about your AGES protocol, A-G-E-S. And today we’re talking about the A of that, which is airway. You say that the airway is really the foundation of how we age. Why is breathing, which is obviously something that we all do without even thinking about it. Such a driver of issues like inflammation and sleep quality and long-term disease.
Nammy: Well, the airway is really important because guess what’s the one thing you can’t live without? It’s called air.
If we stop breathing, we have eight minutes and that’s it. And then our cellular function start deteriorating. So one of the most important things when it comes to the airway that’s really important is that your dentist can help you. And that’s what most medical doctors miss. Most dentist miss is that we can actually help our patients breathe better. The reason we start with the airway is because it is the foundational. You cannot live without air, and that’s why we start there as the most important point. When we look at the airway, we want to have functional breathing, which means breathe in through the nose, back of the throat, and down. And that is critical because we create this molecule called nitric oxide. And nitric oxide is made through the nose. When we breathe, our nose hairs with a nitric oxide oxidase. It helps us take that oxygen and convert to nitric oxide.
And that nitric oxide is the molecule that our body actually uses. Our body actually uses nitric oxide for so many functions. It uses vasodilation so we can get better blood flow. It uses to repair cancer cells. It’s part of so many different pathways. And that nitric oxide molecule is the key that we really want. Now, when I talk about the airway, I talk about nitric oxide. The reason I talk about the nitric oxide is because if you are breathing through your mouth, you are not creating nitric oxide. And because you can get air two ways in through the nose or in through the mouth. Those are only two options for airway. So when we breathe through the nose, we want to make sure that that is the proper format of breathing so that we can have maximum nitric oxide so that our cellular functions can work properly without a pill, without a person, just you.
And yogis have been doing this for thousands of years. In India, people actually have been doing this for 5,000 years. Yoga and breathwork is very important. When breathing through the nose is what’s really helping them live so long. And now science has actually proved it. People have been doing it Ayurveda for thousands of years, but now science is really sharing with us that this is actually true. And the mechanism by which it works is nitric oxide, which is what I’m sharing with you. So we start with oxygen first. It’s the one thing that we can’t live without.
Snoring as an Airway Warning Sign
John: Snoring is something that people talk about a lot too. But when people talk about snoring, it’s often in a funny way. We say, “Oh, my husband or my wife snores. Isn’t that funny?” Or, “Oh, I got woken up last night because my husband was snoring.” But it’s more used as kind of a joke, but what is snoring really telling us about the body and when does it become dangerous?
Nammy: Snoring is an alarm bell that your body is ringing. Now, that alarm bell can be very, very low grade, can be very loud. So the alarm bells are really critical to pay attention to. One would think because it’s not loud, I shouldn’t worry about it. Or it’s normal. It’s part of aging. We’ve seen it on TV. We’ve seen our parents do it. And it’s just a normal thing. And actually, it is one of the biggest predictor of disease. Now, snoring is very problematic because if you’re snoring, you’re breathing through the mouth
John: And
Nammy: That is not what we want. We want the airway to go through the nose. When we breathe through the nose, we’re making that nitric oxide. Now, when we’re breathing, not only are we breathing through the mouth, not getting the nitric oxide, the quantity of air that we’re getting is very small. So our windpipe that’s normally this big, when we are snoring, gets compressed. That’s why you hear the sound. And when that happens, you are not getting the amount of air that you really need. So your body is under stress. Your body is producing cortisol. It is stressed out when you are sleeping, and that is not what we want. If I measured somebody’s heart rate while they’re sleeping and snoring, what I find is that their heart rate is like 100, 110, 115. Now, that’s like you going for a really nice walk or being on the treadmill.
Your resting heart rate should not be 115. It should not be a hundred. Your resting heart rate needs to be in the 60s and the 70s, even lower because you’re sleeping. So when we see the heart pumping really fast, and it’s like you are sleeping consciously, but unconsciously, your body is on the treadmill. It’s like, “Whoa, this is what’s going on. ” And over time, what it does is releases stress
When there’s stress in your system and there’s that cortisol that’s built up. Now, that is the number one way our bodies are going to be very unhappy. And I said the predictor of disease because it really messes up our HPA axis. And the reason we’re looking at the HPA axis is your hypothalamus is the control, the gatekeeper of all your other hormones. So if we have too much cortisol, it’s not going to allow all the other hormones to work properly. A lot of times we’ll hear patients who are snoring or not sleeping well are just really exhausted or low libido is a perfect example because you’re just exhausted and drained. It’s because their HPA access is not working. That testosterone, that estrogen is not working properly because the hormones are not released in a proper way. When that cortisol is increased, the hypothalamus is sending different signals.
It’s not saying go produce more estrogen. It’s not saying go produce more androgens or testosterone. It’s focusing on bringing that cortisol down, and that is a really big concern. And what it does is it puts our body under a lot of stress. We’re unhappy. We don’t like life. And so I go back to the airway as the foundational and the functional source that we must fix first.
What a Dental Airway Evaluation Includes
John: You mentioned before that doctors don’t often think of dentistry as a way to fix your airway, but what does an airway evaluation look like from your perspective?
Nammy: So when I have a patient come in for an airway evaluation, we’re just not doing a sleep study because when you go to your medical doctor, they will do a sleep study and like, “Oh, you don’t have apnea or it’s no problem.” But see, the apnea is the highest form of a problem. The thing is, if it was me, I know I would want to know before it got to that level, because once sleep apnea occurs, you’ve got diabetes, you’ve got high blood pressure, you’ve got all these different diseases. Again, chronic inflammatory diseases, diseases that take a long time to develop. So I, if it was me, would want myself to do it in the beginning. So I would want to check not only for sleep apnea, if I hear a little bit of snoring, I know that’s called upper airway resistance because natural breathing should be through the nose.
I’ve got it through the mouth. So I would want to number one, do a sleep study. Number two, most importantly, do a CT scan. What the CT scan tells me is why is that snoring happening? Why is that airway constricted? Is it because the sinus is congested? Is there maybe mold in the sinuses that we need to look at? Is it the tongue position? Is the tongue not in the right space? Or is it physiological where the windpipe is just really small because I’m petite? Or is it because I’ve gained 20 pounds and all of a sudden my airway has shrunk? So we want to know exactly where the problem is so that we can fix it because there are multiple ways to fix it. Now, CPAP is a nice band-aid. There’s also devices that move your jaw forward, which are also, again, bandaids in my opinion.
And the reason I say those is if there’s a problem in the nose and you put a CPAP on, you’re going to breathe through the mouth. You’re never going to breathe through the nose. It’s just impossible if your nose is congested. So unless we really figure out the root via CT scan, where the problem is, we can’t really fix it at the root. We can provide band-aids, but we want to fix things at a root. And that is how I operate. I want to get to the root of it so that it’s resolved forever.
Expanding 3D Nasal Volume With Oral Appliances
John: So you do work with products like a vivos and homeoblock. Tell us a little bit about what those are for somebody who might not have heard of those before and how can they change somebody’s life?
Nammy: The products that I use are life-changing. And the reason for that is because with 3D expanding your nasocranial volume. So earlier I mentioned to you that if you are on a CPAP but you can’t breathe through your nose, what good does it do? You’re still mouth breathing. The quality of the air you’re getting is not so great. Or if your tongue doesn’t have enough space, what does it matter because you’re still mouth breathing? And so what we want to do is really make enough space for that tongue so that it can rest at the roots of the palate and you can get that functional airway and nose breathing. There are products and there’s materials that I use in my practice in a specific way. We work with products like homeoblock and vivos, but they have to be designed and worked in a specific way to give you the results.
Now, what we do is use these products in a way that activates the bone making cells of your upper and your lower jaw. When we activate these cells to make more bone, what we’re doing is expanding your upper jaw, which expands your nasal volume, expanding the lower jaw, which expands the windpipe and makes more space for that tongue. The other things that we do is that as we’re doing this process, we are doing different techniques to open up your sinuses. We’re doing different techniques to be able to train your tongue to be strong. Just like we go to the gym, we get the tongue to become strong because we want that tongue to be very, very, very strong and at the roof of the palate. We also use products that are activating the bone like lasers that will help get the bone to expand quicker, faster, and make sure it stays.
Those are some things that we do in the practice to be able to help increase that functional airway. Now, the reason I like these products rather than a device that moves your jaw forward is because if you have a device that moves your jaw forward, it will cause TMJ problems. It’ll cause ring in the ear. It’ll cause jaw joint problems. It will be helpful for a period of three to six, nine months or so, but after your body adapts and you’re still not getting that nose breathing, which we want. So in order to really bio-optimize you or if you have chronic ill conditions, if we want our body to work better, whether it’s arthritis, Alzheimer’s, cancer, whatever it is, we want to get that functional airway really open and maximize. And the only way we can do that is by breathing through the nose, making more space for the sinuses, making more space for the tongue, really expanding the wind pipe so that it can do it as passive, unconscious path of least resistance, because that’s how our body works.
Our body likes to do things unconsciously, things we don’t have to think about. Breathing is one of them. So if we have the proper form in place, our body will function properly. It’s when there’s not enough space for the tongue that the person will be, even when they’re talking to you, a lot of times your mouths will be open. If they can’t breathe through their nose, the same thing, their mouth will be open unconsciously because that body is trying to stay alive unconsciously, autonomically, and is going to do it in the path of least resistance where it doesn’t have to actively work hard to breathe. So what we do is put the structures in place so that your body can really breathe really well through the nose. The mouth is always closed and you’re getting maximum volume. And that’s what people miss is maximum volume.
We’ve all heard about DO2. Now, you can get VO2, you put a mask on, you go on the treadmill, but that’s you being conscious. Let’s work on the unconscious so that you’re doing it all the time. So maybe when you’re not on your desk or when you are at your desk, not on the treadmill and working with a VO2 machine, let’s do it so that your body is actually having that 3D nasal volume, so getting the amount of air that it needs and unconsciously so that it works really well on its own. And that is the best way to help with any sort of chronic condition to biohack, to bio-optimize, to prevent diseases, and to even have more energy. When we have more air, we have more energy, we have less brain fog. We’re able to function at just a higher level, and that’s what we really want.
Tongue Ties and Functional Breathing
John: You mentioned the tongue and how important that is. I’ve heard of something called tongue tie. Is that something related to what you’re speaking about and how do you treat that if a patient comes to you?
Nammy: Yes. A tongue tie is necessary for some patients. So we evaluate the patient to see if we need to do a tongue tie. We find that many patients have a restriction in their tongue. So if you open your mouth all the way, and what we want to do is we want to put that tongue to the roof of the palate. See how far back it goes? Yeah. A lot of times, a lot of patients, what happens is they open their mouth. The tongue is not able to get to the roof of the pallet. And so when it doesn’t get to the roof of the pallet, what that tells me is if this is the palate, the tongue’s not resting on it. We want this. If this was your airway, we want the tongue to be like this, but their tongue isn’t able to do that and it’s restricted.
The reason why that’s a problem is because when there is a tongue tie, the tongue is not able to have its mobility. We want the tongue to have its mobility. When it has the proper mobility, it stays at the roof of the pallet even when you lay down. So that snoring that we talked about, one of the reasons somebody could be storing is if there’s a tongue tie. If we release the tongue tie, we get the tongue to the roof of the palate and we’re in good shape. That’s the easiest fix. Sometimes people need expansion. Sometimes we just need to train the tongue to become stronger because there is no tongue tie, but because we’re in our 70s, our tongue has just gone a few wrinkles and they just need to be tightened up. So that would be something else that we would do. Each of the procedures that we do are highly customized, personalized, and results driven.
So we really are wanting things that are least invasive, but give you maximum output.
CPAP, Oral Appliances, and Nasal Breathing
John: A lot of people, I think, who suffer from sleep apnea and related issues are on a CPAP or are being asked to use a CPAP, but they’ve tried it and they hate it. Is an oral appliance always a better alternative to a CPAP?
Nammy: According to science, the CPAP is the best alternative because it keeps you alive, but that’s also the lowest standard because you will be alive, but it’s not biooptimizing you. The way to biooptimize is get that nose breathing. So any dental appliance that moves the jaw forward, it’s not able to close the mouth all the way. It’s not something that we’re wanting. We’re really wanting something that works to close a mouth and breathe through the nose. And the easiest way to start is really tape. You can get this. You don’t even have to go to the drugstore and buy anything fancy. Just go look in your office. There’s scotch tape. Try it out for a few days. We just want to take scotch tape, put it vertically right here, and try it out for a few days and you realize your sleeping a lot deeper.
You’ll feel much better. There’s more energy. You kind of don’t really realize, what did I change? Because it is something that is unconscious and it works really, really, really, really well.
Patient Stories: Airway Treatment and Quality of Life
John: Finally, can you just give us an example of a patient whose life was changed because their airway was addressed? What were they dealing with and what did they look like different after treatment was finished?
Nammy: Absolutely. I’ll actually talk about two people. And I have one patient, I’m going to talk about somebody who’s younger and has the same kind of issues, and she wanted to bioptimize. And I’ll talk about somebody who wanted to get off a CPAP. So we’ll talk about both. So I have one patient, lovely, lovely, lovely, lovely young girl in her 30s, and let’s name her Janie. And so Janie is amazing. She’s very smart, go- getter, very research. She found me a few years ago, and she’s like, “I keep going to the dentist and I keep breaking teeth and I’m tired of it. I’m 30. I’m going to have no teeth by the time I’m 40 if I keep going down this path. I’ve already had fillings done and redone maybe 10 times at this point.” And so she came in, we looked, we looked at her functional airway, turned out her tongue didn’t have enough space.
So we expanded her upper jaw and her lower jaw and used and exercised her tongue. And now it’s been about seven years since we’ve been working together. She now tells me, Dr. Patel, I am running marathons. I am feeling so good. I haven’t had to have a feeling redone. I am a loving life. The anxiety that I had is gone because she used to be so anxious. She should shake her leg so much because she’d be so nervous. That leg shaking is completely gone. She is on the top of the world. She’s super happy and has referred me 25 patients throughout our seven years together, which is amazing and so grateful for that. And so many lives I can help. And that’s my purpose is how can I help the world? This is my mark, this is my purpose. So that’s Janie. And then I’m going to talk about Joe.
58 years old, has been on a CPAP, actually found me because he was doing some research. He’s an analyst, so he’s in the stock market. And so he was looking at stocks and he discovered the vivo stock and he said, “This doc is doing really well.” So he found me. He’s like, “I wonder who’s doing this in this area.” And so he found me, I think it’s been about five years now, came to my office and said, “I really want to get off the CPAP. I’ve been using it, but I just snore. It doesn’t feel good. I’m not feeling a difference. I’m 58, but I still have kids in 20s. I want to live long and I don’t want to worry about a heart attack because that runs in my family and I have high cholesterol.” So I said, “Okay, no worries. Come on in.
” We did his analysis, we did expansion, we did a tongue tie release, we did myofunctional therapy and we’re happy, happy, happy to report his medical history. He was shocked because we always do a medical history before we start and then in the middle and then when we end. So even just one year, I remember the story specifically because it was one year in and we did his medical history and we’re reviewing it. And I was like, “John, do you realize everything that you listed is completely gone? Your sleep study is way better. Your CT scan is way better and your anxiety is gone. Your fatigue is brain fog is gone. You have more energy. Again, you’re exercising, you’re traveling more, you’re going camping because one of the things he really wanted to do is go camping.” He’s like, “I couldn’t go camping because I had to take the CPAP everywhere.” He’s like, “I can go camping with my kids.
I am beyond delighted.” And that was just one year in. And then I was like, “Well, if you’re feeling good, we could stop.” And he’s like, “No way. I want to keep going. I want to maximize my 3D nasal volume. I really want to get the maximum amount of error because I really feel really good because of this. ” And so Joe was really happy and we’ve been working together. It’s been, like I said, five years and it’s just been really wonderful. And again, we see his kids, we see the family, we see the wife, we see the relatives because we’re checking everyone for the airway. We’re really making sure that we’re optimizing everyone so that they can have a wonderful, beautiful life. And again, these are things that traditional dentistry misses. Medicine already misses the mouth as a missing link. Secondarily, dentistry is so … It’s because it’s easy to put an appliance that moves your jaw forward.
I can get that done in two visits. But when we’re talking about expanding your 3D nasal volume, it’s taking time. It’s going to take a year. It’s going to take two years. It may even take three years, but we’re really maximizing you. That’s why we do these protocols in a way that is very part of your daily lifestyle and easy and predictable. And we like that because they’re personalized and customized. That’s how we know we always get results and we have patients who are delighted and happy now.
John: All right. Well, that’s really great information, Dr. Nammy. Thanks again for speaking with me today.
Nammy: Absolutely.
John: And for more information about Green Dentistry, you can visit the website at sfgreendentist.com or call 415-433-0119.
