In this episode of Functional Medicine Research, I interview Dr. Theodore Belfor in a discussion on cranial facial development and airway resistance. If you have read James Nestor’s new book “Breath” then you are aware of Dr. Belfor’s work.
We talked about the causes of abnormal cranial development and how this causes airway resistance and a number of health problems including sleep apnea, insomnia, IBS, bruxism, and more.
Our cranial bones don’t form properly when we aren’t breastfed and eat a modern diet of processed foods. Dr. Belfor’s oral appliances help to correct these abnormal developments to restore proper facial bone structure and improve the airway.
Full Transcript with Dr. Theodore Belfor
Dr. Hedberg: Well, welcome everyone to “Functional Medicine Research.” I’m Dr. Hedberg, very, very excited today to have Dr. Theodore Belfor on the podcast. I first heard about Dr. Belfor in James Nestor’s new book called “Breath.” And we’re gonna be talking about all of that today on the show.
And Dr. Belfor, he’s a graduate of New York University College of Dentistry, and a senior certified instructor for the International Association for orthodontics. In the 1960s, Dr. Belfor was sent to Vietnam to work as the sole brigade dentist for 4000 soldiers of the 196 Light Infantry from the jungles of Vietnam to Park Avenue in Manhattan. Upon his return, he opened his own private dental office in New York City, and has been in private practice for more than 40 years. And Dr. Belfor specializes in the treatment of the cranial facial system, and that’s what we’re going to be diving into today. So, Dr. Belfor, welcome to the show.
Dr. Belfor: Well, thank you for having me. It’s my pleasure.
Dr. Hedberg: Excellent. So, why don’t we start by talking about how this all began, and go back to, you know, what happened that changed the cranial bones, the cranial structure, our skulls, that led to this epidemic of airway issues, breathing issues, and all of the health issues that come with that?
Dr. Belfor: Well, how we develop, how we grow and develop is based on how we breathe, how we swallow, and how we chew. So, just looking at how we chew, according to the U.S. Department of Agriculture today, in the U.S., 63% of our diet is processed and refined foods. So, without the proper stimulation to the body, we are not fully expressing our genes, we’re not developing to our full potential. Because of that, particularly when our jaws do not grow forward enough, the retrusion of those jaws helps to push the tongue backwards into the airway and down the throat, so now we have compromised sleep and breathing.
Dr. Hedberg: So, it’s a combination of things. I know Dr. Nestor talks about it in his…or James Nestor talks about in his book, the changes in diet, soft food, not enough hard foods, not breastfeeding. Can you talk a little bit more about these changes in our society and some of these predisposing factors that can cause an abnormal airway?
Dr. Belfor: Well, for me, the enlightenment came, when almost 20 years ago, I was treating performing artists who couldn’t wear braces and they wanted straighter teeth, and I used an appliance and had a unilateral bite block, which basically, in essence replaces the missing hard food in our diet. And guess what? The actors, performers were coming in, and their makeup artist was telling them that their faces are changing, and the singers were coming in and saying they were reaching higher notes. So, that’s what set me on the path.
You see, the concept in dentistry is to balance the bite all the time. And it’s kind of an anathema to have, when you bite down, to hit on one side. However, if I give you a stick of gum to chew, nobody on the planet is going to chew on both sides at the same time. We chew on one side then we chew on the other. And apparently from the research, many articles that have been written, the latest one in August 2018, the Journal of Orthodontics and Dentofacial Orthopedics the concept, they used a mammal, a pig, and they sent cyclical signaling to just two cranial sutures.
And the result was that that changed…it reached all the cranial sutures, it created strain on the sutures, and that’s the key word, because we chew on one side, we create strain at the suture level. And the result was a widening and mineralization of the sutures. So, in other words, there’s your direct example of how we’re chewing works. And, by the way, chewing is basically a communication that the body uses for development. The body works this way. There’s only certain things the body understands. So, chewing is really a reciprocal pressure, alternating pressure. And that reciprocal, alternating pressure and strain is what helps to generate the growth.
So, our breathing is reciprocal, cyclical, alternating pressure. And from a lot of articles which are written, when we breathe correctly, as we’re developing, that air goes into all of the spaces in our skull, and that helps to stimulate the growth. So, the body is responding to alternating pressure. And for swallowing, when we swallow, we create a volume pressure change. So, all of this is how we develop.
So, the concept is, let’s take an oral appliance and let’s duplicate what the body expects. And as a result of that, what we get, literally, is we get expression of genes that have not been expressed before. We get cranial facial growth and development. We get the upper jaw growing bigger. But the key element is the central bone of the skull where the jaw hangs off. That’s known as the sphenoid. And what we want is balance in the neurocranium, which is the eight bones, including the sphenoid, which are central to the skull.
And I can go on and on about this, but we just had a conversation you and I, what I believe is, when this is an imbalance, your jaw is misaligned, for example, then your head is crooked, your neck, the shoulders, your back, everything is crooked, your body is in stress 24 hours a day. That’s high allostatic load, according to the U.S. government. That basically reduces the body’s resilience. Reduction in resilience can lead to all kinds of issues and problems.
So, I believe by aligning, by developing the cranial suture, by getting a jaw balance, by getting the jaw to grow bigger so you breathe better, for example, all of this is a key, central factor for improving your health.
Dr. Hedberg: So, we have a lack of breastfeeding and then we have increased consumption of processed foods that don’t put enough strain on the chewing mechanism that would normally create healthy bones in the cranium. It sounds like that’s one of the real main issues here and the drivers of this.
Dr. Belfor: [inaudible 00:07:26].
Dr. Hedberg: And so, I just think back when I was a kid, I mean, I was raised on breakfast cereal, and the rest of the day didn’t really entail much consumption of foods that were difficult to chew. And what we’re seeing now…and you have a list of conditions that you like to see and things that you can help. So, can you talk a little bit about some specific conditions that you see a lot of?
Dr. Belfor: Well, I start with an evaluation. I do a very, very comprehensive evaluation. What we do is we have the patient…We send them for a cone beam scan, or we take a cone beam scan, it’s three-dimensional cranial scan and also a facial photo. Now understand this, even if you look in the mirror, you can tell whether you have a facial asymmetry. So, for example, one eye is lower, or you have a deeper depression on one side between your nose and the corner of your mouth. What’s this all about?
Well, our midface, our midface, the way it grows, it’s two separate bones. It’s called one bone, it’s called the maxilla, the upper jaw, but that is actually two bones. And it literally grows downward and forward as we grow. Now, if one of those two bones does not grow as downward and forward as much as the other, then that bone is set back, your face ages more rapidly on that side. And by the way, your jaw is up and back on that side, so your jaw is crooked. So, literally, my first evaluation I can help to diagnose a patient’s problem by just looking at their face.
Then we also are interested in the head posture. Where we look at the cervical spine, the head posture, forward head posture. Let me explain forward head posture. Today, it’s a disaster. Everybody’s on their computer, their cell phone, their tablet, they have forward head posture. Dentists, for example, they’re working all day long in a forward head posture. So, what’s the story with the forward head posture? Well, if you have your head forward and then you lift your chin to look around, what happens is literally your…the back to your tongue drops down your airway.
So, you have either folks who start out using their computer too much, cell phones, etc., with forward head posture, and they end up with a tongue in the airway, or it is the reverse. That is the folks that don’t develop their jaw forward, they have retruded mandible and the tongue is in the airway. And when the tongue is in the airway, since the air has to go through our nose and make a right turn to go down behind our tongue, because our tongue is in the airway, our head must come forward for us to breathe properly.
So, in the end, either way, we end up with forward head posture, and the forward head posture makes things worse when the back of the tongue drops down the throat. So, this is part of my diagnosis, first the face, then the posture.
Then, we actually look at your development. Now, the whole cranial system, the development of the face, for example, is based on, in our womb, in our womb, when we’re growing, the first thing that grows is the brain, the cranium, and the basicranium, the base of the brain that supports the brain. That basicranium, those dimensions are what determine or should determine the dimensions of your face. So, we compare the dimensions of that cranial base to the face, we know exactly where you’re lacking.
Now, for example, if you have a short face, well, it’s we use…basically, we can make more room for the tongue with the appliance that we use. If you have a long face, chances are, you’ve been breathing through your mouth, been a mouth breather with poor swallow. So, then the next thing we’re gonna look is at your tongue posture, how do you use your tongue? How you use your tongue is directly related to how your face develops.
So, I think you’re starting to get the idea. We evaluate the cranial facial development of each individual, we see where they’re lacking. Does their jaw need to come forward? Does their upper jaw, which we can only do surgically is that’s so far back that that needs to come forward through surgery. But the point is, our protocol has five goals. And if we stick to those five goals, we can help every single patient we treat.
The first goal in the protocol, we call it pressurizing the airway to depressurize the airway. That’s breathing through your nose 24 hours a day. So, we want you to wear or to use mouth tape at night to ensure that you breathe through your nose.
The second goal is to improve tongue posture and swallowing, to make sure, for example, that you don’t have a tongue tie. That would be part of it. The third goal is to tone the airway. Now this is critical. The American Association for Orthodontists in their white paper on the etiology, the cause of sleep apnea, they clearly state it’s the collapsibility of the airway. However, none of the treatment protocol are directed towards the collapsibility of the airway.
And basically, the appliances that I developed, that’s exactly what they do, they tone the airway. The airway is a muscle. You can actually take those muscles that support the airway, the muscles that lift the tongue, the styloglossus, the muscles that maintain the tongue, the genioglossus. We can take those muscles and tone them to maintain your airway. That’s the third factor.
The fourth factor is called the autonomic nervous system. The autonomic nervous system runs so many factors of your body. And that’s directly related to how you breathe. So even yogis knew for 2000 years or whatever, how important it is to control your breathing, so we do that. We provide breathing exercises. We show you how to breathe correctly so you can fall asleep, for example. We show you how to breathe to lower your cortisol and raise your melatonin, which is how you sleep. And, of course, and the fifth goal is to improve your head posture.
So, if we take a patient, and we pursue those five goals, every single patient is going to improve one way or the other.
Dr. Hedberg: Yeah, and we’ve all seen those, you know, we see people with really thin, long faces and different abnormalities like that. And so you can tell somewhat by looking at them and then you do the scan and treatment. And so do you believe that an adult, say, in their 40s, 50s, and up can actually change these bones even though they’ve completely formed?
Dr. Belfor: Yeah, the answer is absolutely. I’ve been doing that for 20 years. We can stimulate the body. First of all, all physiologic systems have built-in mechanisms, the self-correction. It’s just a matter of stimulating the body and the body will generate self-correction. So, we can grow bone and we can reposition bone in so-called non-growing adult patients. And we don’t do it with palatal expansion. We do it, literally, by providing the correct signaling mechanism to the body. And that correct signaling mechanism kicks in genes, expression of genes that have never been expressed before.
The first research on that was done, actually, around 2003 at the University of Illinois, where they took adult male rats and they put a unilateral bite block behind one central incisor. So, when the rat was chewing, it was creating strain within the cranial system. Then they looked at the cranial system after they dissected the rat. And what they found was cranial changes that took place that can only be attributed to the upregulation or switching on of genes in the body. That’s what told me exactly what I was doing with my unilateral bite block system. So, yes, the answer is we can grow bone, we can reposition bone. We remodel the bone, and it’s not palatal expansion. It’s something called morphogenesis, which is a physiologic size and shape change. It’s growth.
Dr. Hedberg: And you mentioned sleep apnea, which is really, I mean, I think it’s at least half of Americans have sleep apnea, probably more undiagnosed. That’s clearly an airway issue. And you mentioned the collapse of the tongue and the muscles in the airway and the blocks while people sleep. And so have you seen with your work improvements or elimination of sleep apnea? Can you talk a little bit about…more about that issue?
Dr. Belfor: Yes, I actually don’t address my treatment directly to sleep apnea. What I address my treatment to, is what you might call pre-sleep apnea because sleep apnea is a complex and dangerous problem and should be in the hands of a medical professional, a physician. So if somebody has, for example, moderate to severe sleep apnea, I believe they should be treated by this physician. However, our young folks today, they’re all suffering. And when I say young, I mean, anywhere from, let’s say, 17 to 50. What’s happening there is, you’re getting a much smaller collapse of the airway. It’s not sleep apnea, it’s something called upper airway resistance.
However, the way the body works, if you have a tiny collapse in your airway, and you’re young and healthy, your brain thinks you’re gonna suffocate. And what does it do? It sends signals to the body, the result is a form of adrenaline in your blood, which takes you from deep sleep to light sleep, raises your heart rate, and your blood pressure, by the way, and you go through this cycle, called a desaturation cycle. Some of the old folks, when we look at their cycling, kind of percentage of their sleep during a cycling event, it can be 50%. I mean, I’m not kidding you, 25% to 50% of their sleep, they’re fighting for survival. And if you send them for an overnight study for sleep apnea, they’d say, “Oh, you’re fine. You have no sleep apnea.” That’s weird. That’s absolutely insane.
So, by the way, toning the airway and the cycling time are directly related. If you tone the airway, you reduce the cycling time, the amount of time that you’re in a desaturation event, so you can take… And it can happen in three to six months when you’re young. By toning the musculature, we can take somebody who has 20%, 25% of their sleep, fighting for survival, and in 6 months, they’re fine, and they have 3%, which is in a normal range.
So, that’s what I’m directed towards. I think that the concept of this sleep apnea business is highly overplayed, tremendously overplayed. Because sleep apnea is so complex, the idea of curing it is far-fetched. I mean, you can improve it. You can improve quality of life when you direct yourself towards treating sleep apnea. But curing sleep apnea is a whole other ballgame, which I don’t really believe exists. So, what I do is I try to help those folks to improve their breathing so they don’t end up with sleep apnea, for God’s sakes.
Just try this, think about your airway as tube, which it is. And when you breathe through your nose…you can try it. Just breathe into your nose, you can feel the pressure on that tube. So, that pressure is working that musculature. But then try breathing in through your mouth. There’s none, there’s zero pressure on the airway. So, you can imagine, if you’re not breathing through your nose all the time, you’re not working, taking that muscle, that airway muscle to the gym. That’s not a good story.
So, there is a number of ways, a number of ways to help people breathe better, which are natural, physiologic, which is the body fixing the body, which is what we really should be doing in the 21st century. So, that’s where I’m headed. That’s where I go with this.
Dr. Hedberg: And you list some really interesting conditions that would make someone a candidate for this kind of work, so headaches, bruxism, which is teeth grinding and clenching, insomnia, irritable bowel syndrome, lack of alpha-delta sleep. So, it’s interesting that you list irritable bowel. I know a lot of the listeners have gut issues. Is there anything you wanted to add to that, how you would connect irritable bowel?
Dr. Belfor: Definitely. What you need to do is look at Adam Gold’s publication of an article in 2003 in “Chest” I believe it was. He did the research comparing, for example, upper airway resistance to sleep apnea. Now, let’s start with sleep onset insomnia. There was absolutely no contest upper airway resistance contributes to the morbidity of sleep onset insomnia may be five times more than sleep apnea. Irritable bowel syndrome, irritable bowel syndrome, upper airway resistance, is at least three to four times more significant than sleep apnea. Alpha-delta sleep, sleep apnea doesn’t even fit into the program if you want to improve delta sleep. And on and on and on. In other words, upper airway resistance has been neglected and ignored.
I was…published an editorial in “Cranial Magazine” in 2010 on this. And 2010, it’s now 2021, and nobody is paying attention. The whole deal is let’s treat sleep apnea. Let’s treat sleep apnea. That’s ridiculous. If you wanna fix irritable bowel syndrome with sleep onset insomnia, you treat upper airway resistance.
Dr. Hedberg: And the device that you use, it’s called the Homeoblock. And so can you just talk a little bit about that? Is that just an oral appliance? Tell people what to expect with that treatment.
Dr. Belfor: Sure. So the Homeoblock is completely designed to be an epigenetic appliance. I mean, epigenetics is understood all around the world today. I mean, everything is related to epigenetics. Why? In the Human Genome Project, by the time they were done in 2003, what they understood was how significant the environment plays in our gene expression. In other words, it’s…we all have the genes that we inherited, but the key is the expression of those genes. And the environmental input is what causes the proper expression of the genes.
So the appliance, the Homeoblock, is designed to provide the correct signaling to the body. It has a unilateral bite block, which replaces the missing hard food non-diet, but it’s also designed when you swallow…and by the way, with that appliance you can only swallow correctly by pressing your tongue flat up against your palate, up against the acrylic of the appliance. And when you do that, that…there are little springs that are specifically designed. So, when you swallow, those little springs send a slight cyclical signal, a cyclical light force signal to the teeth, to the periodontal ligament around the teeth.
Now, the periodontal ligament, which sits around our root roots, has a direct red phone to the DNA. There are mechanoreceptors in that ligament that talk directly to the DNA. How do we know that, by the way? Well, just think about it, when you’re born and you have teeth buds, they’re in the bone of your jaw. And somehow, they’re surrounded by that ligament that’s in direct communication with the DNA. As a result, as your jaw grows, if everything is right, all those tooth buds move exactly into the right position, then the teeth erupt into a gorgeous smile. How’d that happen? That’s because the periodontal ligament and the DNA were in direct communication.
While the appliance is designed to signal the periodontal ligament, the mechanoreceptors, to upregulate the genes that we haven’t expressed.
As a result…there are no genes for asymmetry, so, as a result, we got a symmetrical growth in the maxilla, in the upper jaw, which helps to align the eight bones that I was talking about, the neurocranium, which improves us posturally. And, by the way, what do I treat? I’m not only treating headache, I’m treating neck pain, I’m treating lower back pain, because your head position is directly related. And with forward head posture today, we lose the cervical curvature, it’s called cervical lordosis. Our forward head posture straightens our neck.
When we straighten our neck, our pelvis rotates, our lower back flattens, that takes the pelvic diaphragm and the thoracic diaphragm out of sync, they need to work together, so that affects breathing. Your head position affects your breathing in so many ways. So, yes, we need to understand the big picture, the bigger picture about how the body functions. And that’s what I call quantum. It’s not mechanical. Unfortunately, today, most of the therapies that are provided are purely mechanical. I like to go into the world of quantum, how does the body function? And that’s what we’re doing.
Dr. Hedberg: Right. The mandibular advancement devices, which are becoming very popular for sleep apnea, that seems like it just essentially drives the jaw forward, hoping to move the tongue out of position of the airway, but that just seems like it would be addressing the symptom and not the cause. What do you think?
Dr. Belfor: That’s exactly right. Also, once you step into that world…and we’re talking about the young people now. Young people have breathing issues. And if we give them a mandibular advancement appliance, they have to wear that the rest of their life. And, by the way, there’s another consideration. Just a little up there, but you’re a physician and, of course, you’ll understand it. How our cranial base…remember, that’s the brain, the cranium, the base of the cranium, how that develops is genetic. And we inherited that from our parents 98%.
Now, there is an angle of that base, which affects the position of our jaw. That angle is something we inherited. And in some of the folks, that’s an obtuse angle and our mandible is supposed to be back. Unfortunately, that’s what we inherited. And now the dentist grabs ahold of you, uses the formula, which says we’re going to advance your jaw 70% of the…how far you can extend it. That may not be the position that your body wants to be in. There needs to be an overall evaluation to determine how much you can bring the jaw forward. Mandibular advancement can be extremely effective and extremely helpful if you understand the amount of vertical height you need and the amount of jaw extension you need before you make the appliance, and there’s ways to do that.
Dr. Hedberg: So, could you talk to us about what it’s like working with you? So, you’re in Manhattan. And how can someone work with you? And then, are there other options? How would they find a practitioner that’s been trained by you so they get the same level of care?
Dr. Belfor: So, actually, my website, drtheodorebelfor.com, if you email that website, we will definitely get back to you. And depending on where you are, we’ll locate a Homeoblock certified dentist to treat you. And that’s pretty much the easiest way to do that.
Dr. Hedberg: So the website is drtheodorebelfor.com. And Dr. Belfor, I appreciate you coming on. Any last words you wanted to say to the audience?
Dr. Belfor: Well, I’m wishing everybody well out there. And I hope that some of the things that I had to say tonight got you thinking. The issue is it’s a pandemic. Just about every single one of us today are compromised some way in our cranial facial development. And I think the awareness of that is something that we need to be…to understand and to try to do something about it going forward.
Dr. Hedberg: Excellent. Well, again, thank you for coming on. And to all the listeners, go to drhedberg.com and search for Dr. Belfor. And I’ll have links to his website and any other resources that we talked about. So, thank you for tuning in, everyone. This is Dr. Hedberg. Take care, and I will talk to you soon.