The human body is constantly generating free radicals via oxidative reactions which if unchecked can contribute to immune and inflammatory stress. Anti-oxidants that serve to neutralize these reactive oxygen species do so by donating electrons. The earth’s surface has a net negative electrical charge characterized by an excess of electrons. Therefore, the earth is a natural repository of electrons to supply our bodies with anti-oxidants thus mitigating oxidative stress. However, this ultimately requires direct contact of our skin to the earth or the use of conductive sheets/pads/wrist bands (Earthing products) that are connected to the grounded component of an outlet.

Modern living subscribes to a plethora of toxins that we ingest and are exposed to through our foods and environment requiring significant anti-oxidant retaliation. Consider this relative to how the natural human electrical discharge mechanism between the ground and our bodies has become mostly obsolete. Until recently, throughout much of our human existence we walked barefoot and slept on the ground. Our shoes, particularly rubber soled, pose a barrier for this electrical conductance pathway. Furthermore, most of us are walking on artificial surfaces. There are many individuals who never or rarely experience barefoot contact on real earth. This is one of the reasons why walking barefoot on the beach is so enjoyable and relaxing for people. Not only are you experiencing wide open space (in contrast to the typical close-up, indoor, focal work we do on screens) and the natural multi-sensory rhythms of the ocean (as opposed to the artificial dissonance created by modern technological devices) but you are also absorbing electrons from the ground to neutralize free radicals in your body.

In the Journal of Environmental and Public Health, Chevalier et al (2012) describe in “Earthing: Health Implications of Reconnecting the Human Body to the Earth’s Surface Electrons” the numerous health benefits of this phenomena. Such effects of “earthing” that have been demonstrated include beneficial changes related to sleep, pain, cortisol level, autonomic nervous system activity, immune function, osteoporosis, heart rate variability, hypercoagulable blood, and glucose regulation. In addition to personally sleeping on an earthing sheet, as a Physical Therapist I commonly recommend them to my patients, particularly those who are experiencing pain, inflammation, and have difficulty sleeping. Thus far, in addition to myself, my family, friends, and patients have reported significant improvements in these areas since incorporating earthing practices.

From a postural perspective, “being grounded” means your body is authentically aware of where the ground is and its positional and gravitational relationship to it. This is the responsibility of our postural system which is primarily comprised of our visual, auditory, vestibular, and sensory-motor systems. Our postural system and essentially all of the systems in our body, work in the realm of patterns. Our brain-body is a dynamic habit centered organism. Furthermore, our neuromuscular system works in patterned “chains.” This means that groups of linked muscles fire together in synergized mechanisms to accomplish our functional needs to be upright against gravity and move. Our primal human essence of movement is walking which is comprised of two polar phases-being on the left leg and being on the right leg. This has an accompanying predictable neuromuscular firing pattern from the foot all the way up to the head including the visual and vestibular systems.  Each side is essentially a conjugate of the other with opposite patterns occurring simultaneously.  When the left leg is on the ground it is in the “grounded” phase when the right leg is in mid-air, and thus ungrounded. The opposite occurs for the right stance phase of gait.

Our postural system is intimately linked with our breathing (respiratory) system. Just like our alternating left/right walking, breathing also exhibits an oscillatory essence characterized by inhalation and exhalation. When we inhale the front of our rib cage elevates into external rotation as the diaphragm contracts and lowers. This is in contrast to exhalation where the front of the rib cage lowers. During exhalation the diaphragm relaxes as it returns to a upward domed position in apposition to the internal surface of the rib cage (referred to as the “zone of apposition”). Authentic and efficient breathing is characterized by being able to alternate between a full inhale when the diaphragm lowers and a full exhale where the diaphragm rises up into apposition with rib cage. This requires synchronized activity between the abdominal and pelvic floor musculature to control pressure and positional relationships throughout the trunk. These same muscular patterns are also involved in managing the process of walking. Therefore, how we breathe effects how we posture and move. Likewise, how we posture and move effects how we breathe.

Let’s take this a “step” further. When we walk our pelvis and rib cage rotate in opposite directions. This means when the pelvis is rotating to the right the rib cage is rotating to the left and vice versa. When the rib cage is rotating to one side it exhibits a twist in which the left and right sides are in opposite phases. For example, when we are on the left leg our rib cage is concurrently rotating to the right. This means that the front right side of the ribs are in an open, elevated, inhaled state while the left front ribs are in a closed, lowered, exhaled state. The best way to understand this is to place your hands on the front of your ribs and feel this opposing motion when you turn your torso to one side or the other. Likewise, when we are on the right leg our thorax is concurrently rotating to the left in conjunction with the left ribs being in a state of inhalation while the right is in exhalation.  This comprises a pattern of whatever leg is “grounded” the corresponding side of the rib cage is in an exhalation state.  This means that exhalation correlates to the postural phase of being “grounded.”

The current trend of postural and breathing dysfunction amongst our modern living society is characterized by being in a chronic state of inhalation. Many of us are functioning in a stressed out mode characterized by excessive sympathetic nervous system activity and holding our breath. Consider what we do when we are startled or experiencing fear-we gasp! This is in contrast to “a sigh of relief” when we exhale into a calm and relaxed state of being. Unfortunately, this inhalation pattern has become a chronic breathing behavioral habit vs an acute transient one (such as if we were startled by a predator as was the case in our paleo times). This means the rib cage is excessively elevated and open in the front, closed in the back, with the diaphragm locked down in a perpetual contracted state, preventing a full exhalation and thus relaxation to occur. This means poor breathing excursion and airflow. It also translates into excessive tension in the psoas, hip flexors, back extensors, and neck musculature as the diaphragm is fascially and functionally connected to these muscle chains. Positionally, this pattern is typically accompanied by an excessive anterior pelvic tilt, lumbar lordosis, protracted scapula, and forward head posture. This is ultimately an “ungrounded” posture.

Now it’s time to connect our emotional system to breathing and posture. A study done out of Northwestern University lead by Dr. Christina Zelano demonstrated that during inhalation people are more likely to learn fear based memories compared to the exhalation phase of breathing. Inhalation was shown to facilitate the amygdala and hippocampus in the brain (involved with emotional processing and memory) to encode and retain stressful events significantly more than during exhalation. This relationship can also work in reverse where emotional patterns incorporating fear and anxiety can impact how we breathe, our posture, and thus our “grounding.” Individuals who experience anxiety related disorders tend to function in an inhaled state of breathing and its correlational postural pattern. Therefore, anxiety and stress states are typically “ungrounded.”

In order to potentiate one’s ability to be “grounded,” one must consider the behavioral, postural, breathing, and emotional dimensions that ultimately create it. Behaviorally, we can increase our electrical contact with the ground either naturally and/or through the use of Earthing products. We can also attempt to reduce our free radical production in that we have some degree of control over the amount of toxins we ingest and are exposed to.  By restoring appropriate postural and breathing patterns one can improve their ability to authentically “ground.” The method of the Postural Restoration Institute (PRI) is heavily focused on creating these grounded relationships. An important component to this is to establish a full exhalation to allow the diaphragm to achieve a relaxed domed position in contact with the internal rib cage. Furthermore, because the diaphragm is part of a continuous chain of synergistic muscles from the foot all the way up through the head, a portion of or all of these chains may need to be re-educated to ultimately create this grounded pattern. This typically requires practicing specific postural restoration techniques so that the brain-body can learn a “grounded” pattern. Finally, by addressing fear based emotional patterns one can also influence their breathing, posture, and thus ability to “ground.” Likewise, one can positively influence anxiety and stress via better postural and breathing function. It’s all connected!

Chevalier G, Sinatra ST, Oschman JL, Sokal K, Sokal P. Earthing: Health Implications of Reconnecting the Human Body to the Earth’s Surface Electrons. Journal of Environmental and Public Health. 2012;2012:291541. doi:10.1155/2012/291541.

Postural Restoration Institute: https://www.posturalrestoration.com/

Earthing Products: https://www.earthing.com

Before we get into the specifics of these relationships, I am going to go off on a bit of tangent. The purpose of which is to create a framework and context for which to hang OMT and PRI and how to integrate them into clinical practice.

A couple months ago I was answering an email question regarding the connection between occlusion and neck pain. It was a challenging email to write out in a linear text fashion. There are so many factors involved in this relationship and they are all interrelated in terms of cause and effect. When I looked at my response I realized that I had explained my answer in an integrated circular manner.

This then got me thinking about the non-linear nature of time and reality and I thought about the movie “Arrival.” The premise of this film is that aliens, Heptapods to be more specific, unexpectedly visit our planet which puts humans in a tizzy because we are unsure of the true intention of their arrival. The main character, played by Amy Adams, is a linguist who has been assigned to learn how to communicate with the Heptapods and thus determine the true purpose of their visit. What she ultimately learns about their language is that their sentence structure is nonlinear because they ultimately perceive time as nonlinear in nature. Their reality is an interlacing circle of the past, present, and future perceived all at once.

I remember that as I watched this scene it occurred to me that this is how the mind of Ron Hruska (founder of PRI) operates and thus is a reflection of the PRI approach. For those who know Ron, he has a pattern of writing and speaking using complex sentences that take more time than usual to decode. For example, it took me 3 years to decode this particular sentence:

“Right occipital rotation on a left oriented atlas with left mandibular orientation, during left grounded stance reduces re-occurrence of right occipital rotation in left OA lateral flexion (L TMCC pattern) and right O on A and A on A rotation. “

(p. 38 2016 Cervical Revolution Manual/Postural Restoration Institute).

The purpose of putting this sentence up is not to discuss the specifics of these interrelated variables. That requires an understanding of multiple integrated three-dimensional spatial relationships of R vs L grounded stance patterns of the temporal cervical cranial mandibular system, which ones are pathological, and which ones are normal. There is an entire 2 day course that does this called Cervical Revolution. What I do want to do with this sentence is to look at it from the perspective of a Heptapod. This statement is ultimately depicting two different potential realities of L grounded stance, one with L occipital rotation and another with R occipital rotation based on the independent variable of L mandibular rotation.

For those that have taken Cervical Revolution, isn’t this a bit easier to understand if written out this way?

After I saw Arrival I notified Ron that I had discovered his secret. I knew where he came from and who “his people” were. The truth is now out, Ron is a heptapod masquerading as a human. Just take a look at all these domed diaphragms and crura! I wonder where that obsession came from?

The reason I just used all this text and imagery to discuss the concept of circles is not only was it fun but because it is important to lay the context for which I am going to sew orofacial myofunctional therapy into a PRI perspective.  It is but a sliver of the entire sphere where our intention is to ultimately create craniofacial resonance.

We typically refer to “reciprocal alternating motion” as the goal of PRI. This could also be regarded as resonance, a coherent vibration of shifting the body side to side. A resonating whole is predicated on the integration and sum of its resonating parts. The more systems you involve the more likely you can implement a change, create a new pattern, and thus resonate in tune. Our systems do not work in isolation but as an orchestrated symphony. As you can see above, OMT is but one component of the gestalt but personally and clinically it is perceived as a potentially potent one.

OMT may be defined as the neuromuscular re-education or repatterning of the oral and facial muscles to achieve proper tongue posture, breathing, chewing, and swallowing.  In other words, it is about creating appropriate functional patterns of resonance via specifically training the orofacial system.

In the craniofacial world of PRI, the goal is to create alternating hemi-cranial extension and flexion patterns that correspond to the lateralized oscillations of gait. In PRI lingo this means authentic shifting of right and left TMCC (temporal mandibular cervical cranial chain) and thus resonance. This phenomenon is linked to the ability of one to achieve a “cranial zone of apposition” (ZOA), “facial hole control” (lip seal with nasal breathing), and a “upward and backward” swallow pattern. If any of these components are missing, it will be difficult to functionally resonate (chew, swallow, breathe, and also walk).

In “Connecting Postural Dysfunction, Craniofacial Development, and Nutritional Deficiencies”, the concept of a cranial ZOA is discussed in detail as well as potential causes of not having one. To briefly review these here, it is perceived that a cranial ZOA is the habitual posture of the tongue in full contact with the palate with the tip of the tongue against the alveolar ridge (not against the front teeth). This is analogous to the concept of a diaphragmatic ZOA where the thoracic diaphragm achieves a domed position in apposition (in contact) to the internal rib cage. We can take these comparisons another step further and relate how the pelvic floor diaphragm also maintains an elevated habitual position in states of functional balance.

The benefits of a cranial ZOA include:

• Facilitates forward and lateral development of the face during growth
• Maintains the shape of the dental arch
• Supports the head
• Promotes nasal breathing
• Enables proper speech production
• Serves as a brake to cranial torque driven by an asymmetrically powered diaphragm, visual system, and brain lateralization.
• Enables a swallow pattern that ultimately “pumps” the cranium facilitating CSF and lymphatic flow.

Potential interrelated factors that can limit a cranial ZOA are:

How does one assess a cranial ZOA? This is an integration point between PRI and OMT. Before you begin going down the cranial ZOA pathway you must first establish where your client/patient is with regards to their PRI tests. It is very important that they be aware of how they feel and what they see during their tests so that they have a reference point of comparison between pre and post-testing. For example, humeroglenoid internal rotation, abduction, and flexion can typically be both perceived and seen and thus easier to demonstrate a change. Cervical axial rotation, sidebending, and OA sidebending cannot typically be seen but felt. Straight leg raise is also a good test to use as cranial ZOA restoration typically influences this motion. Of course you may do any tests you choose and desire to make and demonstrate a change.

After you have established your PRI measurements and allowed your patient/client to sense where they are at, it is time to determine the habitual rest position of their tongue.  Through this questioning, explain to your patient/client the different components of their palate. Anteriorly, this includes the alveolar ridge (above inner front incisors angling up and back until it meets the hard palate. From here, conceptually break up the hard palate into an anterior ½ and posterior ½. Posteriorly, there is the downward sloping soft palate. After explaining the concept of these “parts” have the patient/client determine where they habitually posture. The ideal position is to have complete contact against the entire hard palate, anterior soft palate, with the tip against the alveolar ridge. If they are already there then great! They have a cranial ZOA! If they aren’t then you need to determine the amount of contact they can achieve. How far back can they sense and make contact with their tongue with the tip of the tongue on the alveolar ridge?

If they are limited in posterior contact points the following manual technique (I refer to this as the cranial ZOA Restoration Technique) may be applied to achieve full tongue/palate apposition. This technique accomplishes both a fascial stretch as well as neuromuscular inhibition to the muscles that prevent the tongue from elevating. The Institute for Physical Art has a version of this technique which I learned about through fellow Physical Therapist, Brad Gilden.

Wrap a napkin or paper towel (something with relative thickness and texture) around the tongue, close to the anterior base of the tongue. You may feel a fibrous, central, tendonous, tissue here (frenulum). Grip around the tongue with the thumbs at the frenulum and gently pull the tongue up towards the hard and posterior soft palate (wherever the apposition is limited) until a stretch is felt. Direct the amount of force by opening and closing the jaw. One may also open and move the jaw side to side to get different fibers to stretch. Perform for 1-2 minutes and repeat frequently throughout the day.  Laying supine is typically the easiest position to perform this but it can also be done in the sitting and standing positions. I typically perform this technique on my patient and then teach them for self-application.

After performing the technique, have the patient/client reassess how much contact they have. Usually, they should feel more apposition posteriorly. Once this is established then take them through their PRI tests to determine the extent that their cranial ZOA is having on the rest of the postural system. Now its time for the “wow” factor as they typically are blown away by how this can create such significant changes. If it does, then it is appropriate to proceed with further intervention to establish a consistent cranial ZOA. If it doesn’t, then its time to move on to another variable as this one has proven to not be significant for their system.

If after a few weeks of diligent performance of the manual and non-manual techniques (to be described later in this article) and there is no significant improvement, consideration of a frenectomy would be appropriate. If a frenectomy is going to be performed the success of this procedure is dependent on immediate performance of orofacial myofunctional therapy techniques afterwards (same day) to prevent scarring. A positive outcome is also facilitated by performing the techniques prior to the frenectomy so that the tongue can begin to develop some sensori-motor awareness and function that is often limited in cases involving tongue ties. To learn more about tongue ties you may reference “Connecting Postural Dysfunction, Craniofacial Development, and Nutritional Deficiencies.”

We are now in a position to begin training the tongue and orofacial complex for the goal of adopting a habitual cranial ZOA. Like acquiring any other new skill, this process requires a period of significant cognitive effort. The individual will have to consciously work at training this new behavioral pattern. One of the ways to do this is to place a small rubber band (such as those used in orthodontia) on the top of the tongue to serve as a sensory reminder to keep it in contact with the palate. This can be done in circumstances where the individual does not have to talk such as when working on a computer, driving, or watching TV. I give credit to Joy Moeller for teaching this to me. Joy is also credited with getting orofacial myofunctional therapy on the map, establishing the Academy of Orofacial Myofunctional Therapy, and taught me the majority of the techniques I am going to discuss through her 4 day course titled, “AOMT Comprehensive Introduction to Orofacial Myofunctional Therapy.”  I encourage you to check out AOMT’s website (https://aomtinfo.org/) to learn more about OMT and opportunities for learning more about it.

In situations regarding a tongue tie, techniques that incorporate multi-directional movement of the tongue serve not only to promote flexibility but sensorimotor education as well. For individuals who have had restricted motion capability of their tongue all their life, they will now be able to move their tongue in ways they have NEVER experienced before. In a way, you are taking them back in time through the developmental processes that should have occurred in the womb and early life.

The “Monkey” and “Monkey Circles” help to accomplish continued tongue flexibility as well as provide a sensorimotor experience. Simply place your tongue between your front teeth and lips and either hold this for ~30 seconds and/or make circles (clockwise and counterclockwise) between the lips and front teeth. It’s amazing how tiring this can be for the tongue!

Side Note: Special thanks for my handsome husband, Jan, for agreeing to be my face model for the following, not always flattering, pictures:)

The “Snake” coupled with multi-directional tongue slides is another option. Point the tongue straight out, hold for ~ 5 sec, then slide the tongue posteriorly attempting to make contact with the posterior tongue on the soft palate. You can also do side to side (frontal plane) sweeps where the tongue moves between the outer teeth and cheeks, over the molars, the palate, over the molars on the other side, and between the outer teeth and cheeks. You can also “waggle” the “snake” and move the tongue side to side outside the mouth.

Once one has the ability to achieve a cranial ZOA they need to learn how to shift the rest of their cranium in this new relationship. This involves moving the jaw, face, and eyes in different directions while maintaining a cranial ZOA. This also brings us to another integration point between PRI and OMT. If the TMCC is not neutral please take caution with performing these activities. If you perform them on a non-neutral cranium, more specifically temporal bones that are not neutral, you could potentially be irritating the TMJ and/or other cranial relationships. For example, if one experiences any clicking, popping, or pain in their jaw/face/head they likely are not neutral and thus require specific PRI TMCC intervention before integrating these shifting activities. In the PRI world, this is analogous to establishing neutrality and authentic L and R stance positions at the pelvis and thorax before teaching alternating movements.

Another point to reinforce regarding integrating OMT and PRI is that it will be easier to establish a cranial ZOA when one is neutral. The neuromuscular patterns that facilitate the tongue resting on the palate are paired with neutrality of the AIC, BC, and TMCC patterns. If you question your patient/client about the ease with which they can keep their tongue up when neutral vs not neutral you likely will see this pattern.

Intimately paired with establishing a cranial ZOA is what I refer to as “facial hole control.” For those in the PRI world, “hole control” is typically associated with the pelvis. From a craniofacial perspective, we want our lips sealed so that airflow is only going through the two holes in the nasal cavity vs a hole in the mouth such as with mouth breathing.

Nasal breathing is a big deal for multiple reasons. Nasal breathing warms and humidifies air for improved gas exchange vs mouth breathing which can be very dehydrating. It is via airflow through the nasal cavity which promotes nitric oxide (NO) production. NO is a powerful anti-microbial agent and serves to sanitize the air we breathe. This can also impact the type of microbiome colonies in the oral cavity and gut. NO is a vasodilator which has implications for improving gas exchange in the lungs as well as influencing blood pressure. Finally, there is a significant difference between airflow volume when comparing nasal vs oral breathing. Mouth breathing is characterized by ~12-15 L/Min vs ~6L/min with nasal breathing. This is significant for two reasons. One, increased ventilation volumes promote hyperventilation patterns with decreased CO2 concentrations. This can impact O2 exhange as the presence of CO2 is required for O2 to be released from hemoglobin and utilized by the body. One of the triggers of central sleep apnea can be altered blood gas levels. Therefore, if CO2/O2 levels are shifted due to excessive ventilation the body may stop breathing in order to attempt to increase CO2.  Increased airflow volume can also facilitate obstruction in the airway. A higher volume of air moving through the airway will create a higher negative pressure in its wake thus leading to an increased likelihood of collapse. For more information on these concepts I recommend looking into the Buteyko Breathing method (http://www.buteyko.co.uk/).

Before attempting to teach someone how to breathe through their nose, please ensure that they have the ability to do so. An easy test is to see if they can comfortable breathe for 1 minute with their mouth closed. If not, I recently learned a great “nasal clearing method” from Patrick Mckeown, one the premier Buteyko instructors. When one is habitually mouth breathing this can promote “swelling” of the tissues in the nasal cavity as well as tonsils and adenoids. To perform:

1. After a normal exhale pinch off your nose and close your mouth (hold your breath).

2. Keep holding your breath until you feel the urge to breathe in.

3. While doing so move your head forward/backward, side to side, tilt to tilt. This motion helps to flush any excessive fluids out of the nasal cavity.

4. Repeat 4-5 times

5. Determine if helps enable one to breathe through their nasal cavity with lip seal.

If this works then great! You can recommend this technique in conjunction with other techniques that will help promote nasal breathing/lip seal.  If there is still congestion, one may need to consider allergies which are common co-morbidities with mouth breathing. Dairy allergies in particular seem to be very mucous producing in the sinus area. To rule this out, I recommend a 3 week elimination of dairy to test whether this is influencing sinus congestion. However, there can be a host of many other possible allergens and thus getting tested for these can be helpful.

If after the above has been considered and there is still an incapability of breathing freely through the nose a referral to an ENT and/or a Dentist with experience in sleep medicine is recommended. ENTs can offer surgical options for increasing space in the nasal cavity. Dentists doing palatal expansion can influence the structural architecture of the nasal cavity (the palate is the floor of the nasal cavity) and create more physical space for air to flow. Palatal expansion can change mandibular/maxillary relationships which can also promote improved airway patency. Finally, palatal expansion can influence the neuromuscular relationships of the orofacial/pharyngeal complex in such a way as to create improved breathing patterns. There are different types of palatal expansion options available such as “Orthotropics”, “DNA Appliance,” and the “ALF.” This process can be implemented on both children and adults with the overall theme, “the younger you start the better.” One of the world’s leading experts in the ALF, Dr. James Bronson, prefers to start this process as soon as the deciduous molar teeth are in which is typically around age 2-3.

Once an affirmative establishment of nasal breathing has occurred it is time to train habitual “hole control.” It is common for chronic mouth breathers to have an over-active mentalis activity (chin muscle that brings the lower lip up) in attempt close their mouth. If this is the case, a great technique I learned from a myofunctional therapy giant, Kathy Winslow, RDH, COM, is to physically pinch the mentalis during the techniques to help inhibit it. Otherwise, a big focus on obtaining lip seal is to facilitate the obicularis oris, particularly the upper fibers. There are many ways to accomplish this goal. Variety can be helpful in keeping the techniques novel and thus more likely to be complied with. It also provides more sensorimotor opportunities to ultimately learn this important pattern.

Just like how the tongue may need to be fascially mobilized, the lips may need to be stretched due to fascial restrictions. This can be done by stretching and massaging the lips:

Placing cotton balls inside the upper and lower lips and maintaining lip closure is one option to reinforce this pattern:

Using a tongue depressor, index card, or any other object between the lips is another option for facial teaching habitual “hole control.”

Puckering the lips to create a “pop” or a “doe” sound can be performed:

Using air or water, and maintaining a cranial ZOA, sequentially puff the upper lip, lower lip, and each cheek holding for about 5 seconds each, 5 x each.

This brings us to another integration point between PRI and OMT, which is balloon blowing. The mainstream PRI perspective of doing progressive balloon blowing with a ~4 sec pause after exhale is to restore the diaphragmatic zone of apposition. This means facilitating the diaphragm (particularly the left leaflet) to become more “domed” and in apposition to the rib cage thus allowing improved inhalation/exhalation function. To see the specifics of the PRI balloon blowing sequencing please refer to this video where Ron Hruska, the originator, is instructing it. What is not typically considered with PRI balloon blowing though is that Ron also designed this technique to impact the orofacial neuromuscular system. PRI balloon blowing also facilitates a cranial ZOA as the tongue attempts to seal off the oral cavity to prevent air from escaping the balloon during the pause and inhalation phases as well as “hole control” due to the need to maintain lip seal around the balloon. In fact, in this study by Guillaraes et al (2009), balloon blowing was one of a group of five orofacial exercises proven to significantly reduce sleep apnea episodes. There was also another study  by Puhan et al (2006) that demonstrated how didgeridoo playing had a moderate to large effect on reducing components of obstructive sleep apnea. The authors concluded that the didgeridoo playing was effective in its ability to improve function of the upper airway dilators. However, what the authors did not consider as another possible benefit of didgeridoo playing was the impact it had on influencing diaphragmatic and abdominal position and function.

As mentioned previously, nocturnal mouth breathing and its corresponding excessive ventilatory volume can lend itself to both central and/or obstructive sleep apnea disorders due to the potential for hyperventilation and airway collapse.  It can be very difficult for habitual mouth breathers to maintain a lip seal during sleep. For some individuals, their anatomy lends itself to an increased vertical facial dimension creating an extra challenge for lip closure. In these cases, it is highly recommended that these individuals tape their lips together at night. It can take a little time to get used to, but can be very effective in improving sleep quality and accompany subjective sensation of feeling more rested upon waking in the morning.

We can now move onto the “upward and backward” swallow pattern vs an anterior tongue thrust pattern. A normal swallow pattern involves the tip of the tongue moving up and fulcruming against the palate while the body of the tongue moves posteriorly in a wave-like motion against the roof of the mouth. The facial muscles are relaxed and light occlusal contact occurs. This is opposed to an anterior tongue thrust pattern where the tongue pushes forward and the cheeks suck inward (may see facial grimacing) to create the seal and pressure gradient required for the swallow. Anterior tongue thrusts are typically associated with malocclusion and anterior open bites as demonstrated below (http://www.speechbuddy.com/blog/wp-content/uploads/2012/02/speech10.jpg).

If an individual has a cranial ZOA and lip seal issues it is likely that they also are not swallowing properly as these three patterns tend to co-occur. However, before training correct swallowing, one must be able to have an authentic cranial ZOA. Once that has been established, techniques may be considered to help reinforce an “up and back” swallow pattern. Initially, swallow training is characterized by keeping the lips apart. This is to help reduce the facial grimacing. There is also a gentle “bite” component with the techniques. This topic is beyond what is to be covered in this article  but it is worth mentioning the importance of proper occlusion with regards to swallow patterns. There may be some individuals who avoid the bite due to malocclusion while there may be other situations where the maloccluded bite can be creating undesirable temporal cranial cervical mandibular neuromuscular relationships. In the PRI world, this is typically associated with the TMCC patterning. Therefore, it may be necessary to have the bite addressed through dental integration.

The first technique to be discussed is the “K” Swallow. Practice saying “K” or “Kaw” ~5 times (facilitates posterior tongue/palate contact), gently bite, keep lips open, and swallow. Next there is the “Water Trap Swallow” where one takes a small sip of water, traps it up against the palate (may need to tilt the head), gently bite, keep lips open, and swallow. Another technique is the “Pencil or Chopstick Swallow” where one gently bites down on either a pencil or chopstick which makes it difficult for the tongue to posture anywhere but up during the swallow.

After the mastery of these swallow techniques, one must begin to functionally integrate the “up and back” swallow pattern during meals. Just like how achieving a habitual cranial ZOA initially requires significant cognitive effort, implementing a new swallow pattern can as well. Therefore, eating and drinking takes on a certain type of mindfulness as one is attempting to reinforce the new habit. Since we have reached the topic of eating it is also worth pointing out the importance of being able to alternate chewing on each side. This is another integration point with PRI. With the typical R TMCC pattern, an individual is more inclined to chew on their right side vs their left. Chewing is analogous walking as it represents an alternating lateralized behavior or we may refer to as “resonance.”

Finally, as one establishes mastery of their cranial ZOA, facial hole control, and up and back swallow, integration with the rest of the postural system may be warranted to be able to achieve not only craniofacial but entire body resonance. Therefore, depending on the specific needs of the individual, any OMT technique may in combined with any PRI technique. Below are some examples where lip seal techniques are being integrated with upright reciprocal PRI techniques. There are so many potential ways to integrate. Be creative and channel your inner Heptapod!

The ability to achieve a cervical-cranial-facial postural system that allows one to move and breathe in all three planes with balanced neuromuscular function and position can be significantly influenced by certain anatomical and physiological characteristics within it.  One of these factors involves how one postures with their tongue in relationship to their palate and its correlation to craniofacial system development. This includes such variables as the size of different parts of the cranium (particularly the maxilla), the anatomical relationships between them, and the interrelated sensory-motor behavior that learns from its anatomy as well as directs its inhabited structure. Furthermore, a major factor driving craniofacial growth and function is nutritional in nature that interacts at the epigenetic level.  This article aims to connect these postural, developmental, and nutritional variables together as well as demonstrate potential points of intervention along the continuum. Such treatment opportunities serve to both prevent as well as restore structural and functional relationships of the cervical-cranial-facial postural system.

Connecting Postural Dysfunction and Craniofacial Development 

The behavior of habitually posturing with the tongue on the palate has a number of important benefits to the postural system. First, provided one has enough nasopharyngeal space, it facilitates nasal vs. mouth breathing. Nasal breathing serves to warm, humidify, and filter the air for sanitization and maximizing gas exchange capacity. It also facilitates nitric oxide production in the sinuses which stimulates vasodilation in the lungs for efficient gas diffusion as well as act as a potent anti-bacterial and anti-viral agent. On the other hand, posturing with the mouth open lowers and retrudes the tongue, mandible, and hyoid. This can occlude the oropharyngeal airway space resulting in compensatory posterior cranial rotation to further open the airway. As a result of this re-posturing, in order to level the ocular plane due to the upper cervical and cranial extension, the neck assumes a more forward and reduced cervical lordotic posture. (Solow, Ovesen, Nielsen, Wildschiodtz, & Tallgren, 1993) The mandibular and tongue retrusion that occurs with a mouth breathing posture are associated with the hyoid moving posteriorly and inferiorly which can further occlude the airway. Forward head posture helps to restore the hyoid position and further increase airway patency. (Meiyappan, Tamizharasi, Senthilkumar, & Janardhanan, 2015) Mouth breathing also facilitates increased accessory muscle breathing use and is associated with shoulder and pelvic asymmetries. It is correlated to decreased nocturnal genioglossus, tensor palatine, upper airway dilator, and intercostal activity which can facilitate airway obstruction. (Uhlig, Marchesi, Duarte, & Araújo, 2015) Furthermore, forward head posture lengthens and narrows the airway making it more prone to collapse during inspiration thus encouraging apnea behaviors. (Yeol et al., 2013)

There appears to be a functional parallel between the diaphragm and the tongue. The diaphragm serves to pump air as well as lymphatic fluids throughout the body via its oscillatory downward contraction during inhalation and upward elevation during exhalation coupled with the subsequent pause before the next breath. When the diaphragm is at its highest point it is also maximally in apposition to the rib cage. This is referred to as the zone of apposition and is taught in detail via the Postural Restoration Institute (“Postural Restoration Institute,” 2013) as a crucial element to restoring breathing and postural function of the body. Essentially, if an individual does not possess an appropriate zone of apposition the diaphragm will not be able to fully relax to allow adequate inhalation and exhalation function. It can often get stuck in a contracted, downward, and poorly opposed position against the rib cage that will tend to leave the individual in more of an inhaled state of function. Due to the diaphragm’s anatomical connection with the psoas, the increased tension in a poorly apposed diaphragm may extend into the psoas as well. This can contribute to increased lordosis in the lumbar spine, elevation of the anterior inferior aspect of the rib cage (external rotation), and a myriad of other postural compensations throughout the entire body.

Respiratory and Pelvic Diaphragms

Cranial Diaphragm  (Figure adapted from the Postural Restoration Institute)

The rest position of the tongue against the palate is analogous to the pause after exhalation during breathing. Swallowing is comparable to the active inhalation and exhalation phases of respiration. Every time one swallows the tongue should move like a wave going anterior to posterior against the entire palate. There is significant variability in the literature as to the amount of times a human swallows per day and seems to be dependent upon salivary flow rate and volume whereas a higher flow rate/smaller volume correlates with more frequent swallowing and a slower flow rate/higher volume correlates with less frequent swallowing patterns. One study found a range between 18-400 times per hour (Rudney, Ji, & Larson, 1995).  The Academy of Orofacial Myofunctional Therapy cites that humans swallow 500-1000 times per day. According to Orofacialmyology.com, citing the works of Flanagan and colleagues, adults swallow about 585 times per day and children 800-1000. Swallowing creates a force directed up against the palate. One study, (Mcglone & Proffit, 1973), found tongue to canine and molar contact ranged from around 150-200 g/cm² which is around 1 lb/in². This is in contrast to other sources such as Wikipedia (Tongue Thrust) claiming 4 pounds of pressure is created during a swallow. However, whether the force is 1 or 4 lbs there is still a rhythmical pressure directed against the maxilla and sphenoid facilitating cranial flexion and extension movement which can potentially assist with cerebrospinal fluid motility. Therefore, the tongue may be referred to as “the cranial diaphragm” and serves to “pump” the cranium.

Posturing with the tongue on the palate provides a “brake” to the cranial system against asymmetrical neuromuscular torque. Because the right respiratory diaphragm is thicker, has broader spinal attachments, and is thus more powerful than the left, there is a tendency for these spinal attachments (~T8-L3) to orient to the right. In order to restore a forward facing position,the segments above T8 will attempt to compensatorily re-orient to a forward facing direction by moving left. This creates an increased anterior lower left rib flare (external rotation) relative to the right. Furthermore, the torsion imparted to the postural system by the asymmetrical diaphragm imposes ascending forces throughout the chain potentially facilitating craniofacial asymmetry. It has been shown in the normal population that almost 75% of cranial strain patterns exist with a propensity for the sphenoid to be elevated on the right. (Timoshkin & Sandhouse, 2008). As a result of the diaphragm’s torque, the left diaphragm leaflet’s zone of apposition is reduced relative to the right. By restoring the left diaphragm leaflet’s zone of apposition there will be a reduction in torsion going through the postural system. Similarly, just as restoring more symmetrical apposition of the diaphragm against the rib cage will reduce postural torque, the tongue in apposition to the palate serves to anchor the maxilla against torsional forces around it. Without this opposing force, craniofacial asymmetry and potential dysfunction may be more likely to occur.

Braking effect of the tongue against maxilla torque. Adapted from https://commons.wikimedia.org/wiki/File:Maxilla_close-up_posterior.png

A cranial zone of apposition of the tongue against the palate provides a steady expansion force against the maxilla to maintain the size of the dental arch and prevent malocclusion. Without this consistent pressure, the arch can be overpowered by the opposing constricting forces imparted by the orbicularis oris, buccinator, and mentalis.

Dynamic neuromuscular balance between the expanding tongue and arch constrictors

The orbicularis oris, buccinators, and superior pharyngeal constrictor form a neuromuscular sling around not only the arch but also the airway. Descending from the superior pharyngeal constrictor, the sling continues around the airway via the middle and inferior pharyngeal constrictor. Therefore, over facilitation within this neuromuscular chain can not only constrict the dental arch but also the airway.

https://o.quizlet.com/.BqlDQTRc3JuK9JWnJo.lw_m.jpg

A narrow arch may not allow enough room for the teeth and can thus facilitate crowding and malocclusion problems. This will be particularly problematic if there is a reverse swallow pattern characterized by thrusting the tongue forward into the front teeth and sucking the cheeks and/or lips inward via buccinator, obicularis oris, and/or mentalis hyperactivity. This type of swallow pattern occurs during infancy as a primitive reflex to facilitate breastfeeding behavior but could potentially not become integrated during development to allow an adult physiologic swallow. During normal swallowing the facial muscles should be relaxed with the tongue moving upward against the palate. If breastfeeding is ceased too early and soft foods introduced too soon it can possibly maintain a tongue thrust pattern.  Anterior tongue thrusting can also lead to an anterior open bite due to the repetitive forces against the front teeth coupled with the tongue habitually resting against the incisors which typically accompanies this motor pattern. It is also common for the tongue to be resting on the mandibular teeth and in between the arches with a reverse swallow behavior impacting proper eruption and occlusal relationships of the teeth. Malocclusion is associated with imbalanced cervical-cranial-facial posture such as TMJ dysfunction, neck pain, and headaches.  After every swallow the teeth should lightly come into occlusion. If a malocclusion exists with interferences, this can further contribute to postural problems. (Adhikari, Kapoor, Prakash, & Srivastava, 2011)

An habitual tongue and palate interface helps direct growth and development of the craniofacial system. The tongue in apposition to the palate provides a mechanical stimulus that is interpreted at the cellular level to promote osseous growth. (Singh, G. D. and Krumholtz, 2009). The force of the tongue against the floor of the maxilla guides its growth in a forward, upward and outward direction. Without this mechanical stimulus, the maxilla may have reduced spatial dimensions in these directions setting up a template for a narrow and elongated facial structure.

Oromotor activity facilitates craniofacial development. In utero, the embryo begins to establish craniofacial sensory-motor relationships in conjunction with embryological growth and differentiation. Postnatally, the latch and suck functions during breastfeeding promote the coupling of tongue-on-palate posture and oromotor function with concurrent nasally breathing. The tongue in apposition to the palate provides a neurosensory stimulus for orofacial motor learning. Furthermore, due to the anatomical brainstem proximity of the vagus nerve nuclei positioned next to the afferent and efferent craniofacial nerve nuclei there is cross-talk between craniofacial and autonomic nervous system processing. The vagus nerve even innervates the palatoglossus muscle, which functions to elevate the tongue towards the posterior soft palate. Activity in one nuclei can stimulate the other and vice versa. Likewise, reduced signaling in afferent and efferent craniofacial nuclei can impact vagal tone and the reverse. Stephen Porges discusses in The Polyvagal Theory (Porges, 2011) the integrated nature of craniofacial motor-sensory function and autonomic nervous system regulation which ultimately allows for higher level cortical-directed behavior such as social engagement, executive functioning, and advanced motor-sensory integration to occur and develop. In other words, without a solid foundation of brainstem cranial nerve networks, patterns, and regulation it will be challenging for the cortex to integrate primitive reflex patterns and allow more complex sensory-motor skill acquisition.

Inadequate osseous development of the cranium and face has a number of potential consequences. The maxilla houses the floor of the nasal sinus cavities and if not developed adequately from an anterior and/or lateral perspective has the potential to restrict nasal airflow. A lack of nasal cavity space can also lead to deviated septums as the septum may collapse in on itself due to inadequate room. Turbinates and adenoids may become enlarged due to the increased turbulent airflow that occurs with a reduced size nasal cavity which only serves to further occlude the nasopharygeal space. Due to these restrictions in nasal breathing, mouth breathing may become the preferred route. As was previously discussed, mouth breathing is associated with a number of negative postural repercussions.

A lack of adequate anterior and/or lateral maxillary growth will not allow enough room for the dentition. Narrowed and retruded maxillae are prone to crowding and malocclusion. An underdeveloped maxilla has the potential to create either a Class III or II malocclusion relationship with the mandibular teeth as well. As was previously discussed, malocclusion correlates to postural dysfunction.

There is a paucity of research regarding “ideal” and “normal” resting position of the tongue. This may be due in part to the challenges of imaging it in real time situations without providing altered sensory input that would bias the results. One study compared tongue position between non-cleft palate, unilateral cleft palate, and bilateral cleft palate individuals (McKee, 1956). It found that the apex of the tongue tended to rest on the lingual surface of the mandibular incisors and not on the palate while the posterior dorsum of the tongue rested against the uvula and posterior soft palate. It was also determined that there was increased convexity and higher static and dynamic tongue posture of the non-cleft subjects while the bilateral cleft subjects demonstrated the lowest position.  In another study on edentulous (without teeth) (Kotsiomiti, Farmakis, & Kapari, 2005) individuals, it was determined that in the majority of the edentulous cases the tongue rested in the lower aspect of the mouth. Lee et al (Lee, Chen, Lee, & Chang, 2009) noted that improved denture retention occurred with improved tongue posture. The International Association of Facial Growth Guidance (Orthotropics) led by Drs. John and Mike Mew advocate that the tongue is meant to rest in full contact against the entire palate which includes the hard and posterior soft palate. This clinician supports this position and finds that the best postural outcomes are associated with the ability to achieve this tongue and palatal relationship.

The most common pattern this clinician sees in practice is individuals with either no habitual contact with their tongue on their palate with the tongue resting between the upper and lower arches or only contact the anterior 1/3 with or without pressure against the front teeth. In agreement with Dr. Mew, (Mew, 2013) the tongue exerts its most beneficial physiologic function when resting against the entire palate which can be divided into thirds. The first 1/3 (alveolar ridge) is immediately behind the upper front teeth, angles upward, and sometimes has texture. The next 1/3 is the topmost and hardest part of the palate followed by the soft downward sloping posterior 1/3^rd.  Individuals who have never habitually postured in this manner may have trouble sensing and knowing proprioceptively where their tongue is in relation to their palate. Some may have never felt this before in their life. The reason behind this lack of tongue/palate contact in many cases is due to a lack of flexibility of the tongue to adequately contact the entire palate. This is usually due to a tongue tie, formally referred to as ankyloglossia.

https://en.wikipedia.org/wiki/Ankyloglossia

Ankyloglossia is an abnormal frenulum restricting tongue movement. The frenulum may be excessively short, thick, and/or tight displaying varying degrees of anatomy. Normally during development the frenulum helps to facilitate forward growth of the tongue but should undergo apoptosis and disappear to allow full mobility of the tongue at birth. Tongue ties are usually also associated with lip ties (frenulum restriction between the upper and/or lower lip and gum). During development either of these ties can negatively impact breastfeeding and speech production. Tongue and lip ties have genetic and environmental etiologies to be discussed in the latter part of this article. The current incidence is estimated to be 4-10% of newborns but it is thought that this is an under-representation due to lack of awareness of the condition and a consistent established criteria in diagnosis. (Rowan-legg & Society, 2015) They are more common in males than females (~4/1 ratio). (Tow et al., 2014)

If a tongue tie exists and is restricting full palatal contact, then tongue “stretching” or inhibition of the tongue retruders and depressors is recommended. This can be easily instructed for “self application” by the patient as follows:

“Wrap a napkin or paper towel (something with relative thickness and texture) around the tongue, close to the front base of the tongue. You may feel a fibrous, central, tendonous, tissue here called your frenulum. Grip your fingers around your tongue with the thumbs at the frenulum and gently pull the tongue up towards your hard and posterior soft palate (wherever your are restricted from contacting) so you feel a stretch. You can then direct the amount of force by opening and closing your jaw. You may also open and move the jaw side to side to get different fibers to stretch. Perform for 1-2 minutes and repeat frequently throughout the day.  Laying on your back is typically the easiest position but it can also be done in sitting and standing positions. As you gradually begin to gain improved tongue to palatal contact you need to develop the habit of keeping it there at all times except for eating, drinking, or talking. It can take weeks to develop the habit of keeping your tongue positioned on the palate. It is recommended to leave reminders out to cue you as your brain learns this new postural pattern. “

Tongue Stretching Exercise

As an individual learns to achieve a tongue/palatal zone of apposition at rest, it is also beneficial to retrain other dynamic craniofacial neurosensory functions. These include the ability to move the jaw in all directions while maintaining tongue/palatal contact, proper swallowing, and lip seal. It can also involve moving the eyes in conjunction with the jaw in different directions which can further be superimposed on various postural patterns of the rest of the body. As previously described, enhancing the brainstem cranial nerve pathways will promote higher level cortical sensory-motor integration and learning.

If one is still not able to achieve a proper tongue/palate relationship after diligent stretching then consideration of getting the tongue tie “clipped” to free up the tongue may be appropriate. This is usually done via laser but can also be accomplished with liquid nitrogen or scalpel surgical intervention. Dentists and ENTs typically perform the procedure. Clinically, this clinician finds that stretching is effective in most cases and this procedure does not need to be done very often. Tongue tie is particularly important for identification in newborns as the tongue restriction may serve as a barrier for breastfeeding (Rowan-legg & Society, 2015). It is encouraged that each newborn be screened for tongue tie at birth to ensure successful breastfeeding capability which is essential to spark the craniofacial osseous and sensory-motor developmental cascade.

After restoration of proper tongue-on-palate posture an individual may still have persistent breathing and postural dysfunction, oromotor problems (i.e., lip seal, tongue thrusting, and bruxism), and/or malocclusion that is contributing to pain and functional limitations. In such cases, consideration of a maxillary expansion appliance such as an ALF (Alternative Lightwire Functional Appliance) (Bronson, Bronson, & Holway, 2015) or Orthotropics (Mew, 2013) coupled with orthodontia and orofacial myofunctional training may be appropriate. Nasal surgery could be indicated as well. These appliances create a neurosensory expansion stimulus across the palate, similar to what the tongue would apply, but at a stronger force. The result is all of the above benefits that were previously described for posturing the tongue on the palate and initiation of a process called palatal and circumaxillary osteogenesis. Even in adults, it is possible to stimulate growth of the stem cells along the sutures of the cranium and expand not only the palate but the circumaxillary sutures as well thus opening up the craniofacial complex. Epigenetic Orthodontics­ by Dr. Dave Singh explains and provides evidence for this mechanism. The end result of this facial expansion is increased space throughout the cranium including the nasal cavity and sinuses to allow improved airflow, maxilla to mandibular relationships, increased dental arch space to accommodate the teeth, address overcrowding issues, and increased room for the tongue on the palate. In addition to the spatial improvements, the craniofacial sensory-motor system may be facilitated to reorganize and integrate primitive reflex patterns such as tongue thrusting to allow higher level cortical-directed oromotor function. All of these factors can facilitate improved breathing and neuromuscular capacity of the cervical and craniofacial system.

Dietary Links to Craniofacial Development

Why is there an increasing prevalence of tongue ties, tongue thrusting, narrow and restricted dental arches with associated malocclusion, and/or occluded nasal and oropharyngeal airways? The reasons are widespread in addition to interacting with one another. First, there have been dramatic changes in our diet over the past few hundred years with regards to nutritional content and consistency yet our genetic blueprint has not significantly changed. Studies show that starting around 10,000 years ago during the agricultural revolution deterioration began within the craniomandibular system.(Boyd, 2011, 2012) Epigenetic and microbiome changes are also a prominent component of these findings as are environmental factors. In addition, feeding (bottle vs breastfeeding) and birthing changes (vaginal vs. cesarean which influences an infant’s developing microbiome) have also had an impact on craniofacial development and function. (Tow et al., 2014) Jennifer Tow is a holistic lactation specialist and provides numerous webinars on these topics which can be accessed here: http://holisticibclc.blogspot.com/. The remainder of this article will focus on some of these dietary and interacting epigenetic factors.

Since the introduction of refined sugar about 400 years ago, the onset of the industrial revolution in the 1800s, increased food processing technologies further facilitated by World War II, and the creation of massive food production giants during the 20^th century there has been a dramatic change in the human diet within a very short time period relative to our existence. The most significant aspects of these dietary shifts are extreme increased consumption of sugar, processed foods, pasteurized dairy, GMOs, pesticide-laden and nitrogen-fertilized fixed produce, and animal meat that had been fed a grain-based diet while being injected with anti-biotics and hormones. This is contrast to the hunter-gatherer diet we consumed for ~95% of our modern human existence.

Weston Price was a dentist who noticed a decline in his patients’ dental health over his years of practice during the early part of the 20^th century. He particularly saw an increase in tooth decay coupled with changes in facial structure such as narrower palates and malocclusion. His retirement consisted of traveling around the world and investigating the craniofacial structure, health, and nutrition of cultures who were still consuming their indigenous diets. He wrote about his findings in Nutrition and Physical Degeneration (Price, 2009). Among all of the cultures he studied still eating a diet unaltered by commercialized modern foods he found that cavities, malocclusion, and craniofacial deficiencies were virtually non-existent. Whenever any members of these societies were exposed to modern processed and sugar laden diets they quickly began to deteriorate physically. The first generation in these cultures exposed to the modern diet displayed tooth and gum decay. Later generations displayed malocclusion and reduced development of the craniofacial system. The following pictures are from Price’s Nutrition and Physical Degeneration.

Native Alaskan Eskimos not exposed to modern diet. The woman on the top left has a broken tooth and has born 26 children. Note the broad faces, straight teeth, and lack of decay.	Native Alaskan Eskimos born to parents eating a modern diet. Note the crowding and malocclusion.
New Zealand Maori prior to the introduction of modern food. Very low incidence of tooth caries with a preponderance of wide dental arches and good occlusion.	Maori generation born from parents consuming modern food with underdeveloped facial structure and sinus cavities, teeth crowding, and narrow arches.

Dr. Price’s analysis of the diets of these indigenous cultures around the world showed variety with regards to macronutrient content as well as the amount of plant and animal food consumed. There was not a single culture that did not eat some sort of animal product (including insects). Furthermore, four times more calcium and 10 times more fat soluble (A, D, E, and K) vitamins were consumed compared to the standard American diet at the time (1930-40s). He also discusses the negative consequences of soil depletion of nutrients as a factor in the deficiencies.

In Nutrition and Physical Degeneration Price describes an association of mental retardation with underdevelopment of the middle 1/3 of the face and how this can compress the pituitary gland with correlating clinical effects. Price describes one of his patients (16 years old) with mental retardation and significant underdevelopment of the maxilla, an entirely occluded L nostril, and reduced opening on the right. He slept supine with his coat rolled under his neck and head maximally posteriorly rotated to facilitate mouth and airway opening. If he wasn’t in this position, he would awaken due to apnea type episodes. When this individual’s palate was surgically widened and then supported with a palatal expansion appliance (increased 1/2 inch over 30 days with radiographic evidence of new bone growth within the palate) there was a significant change in physical development and behavior. Price reports he began to grow facial hair; grew 3 inches within 4 months; his genitals grew from child to adult size within 12 weeks; and there was marked improvement in his cognitive and social behaviors. Furthermore, if he didn’t wear the appliance to maintain the widened cranial position he would revert back to his former behavior. Reinstating the appliance would once again result in improved function. This case supports a connection between pituitary function and craniofacial space.

Price describes how Dr. Hector Mortimer at McGill University looked at 3000 human retrospective cases and concluded there to be a direct link between facial and dental arch formation with pituitary function. As part of his research, Mortimer surgically removed the pituitary gland in young rats which then produced skull defects including a lack of forward face development, narrow nose, and arch. Furthermore, by giving them pituitary extracts he was then able to prevent these defects. He also correlated a vitamin E deficiency with these presentations. This provides support to the connection between pituitary function and craniofacial space and that improved pituitary function can lead to craniofacial development during growth years. This was in contrast to the former described case where it appeared that the reduced size of the cranium negatively impacted pituitary function and that a reversal of pituitary function was achieved via an expansion of the cranium. It seems likely that both can influence the other and that there are other potential nutritional factors involved such as fat soluble vitamin and/or mineral deficiencies.

In addition to a reduced size of the middle 1/3 of the face, Price discusses how an overall lengthening and narrowing of the skeletal structure tends to coincide with this craniofacial and physical degeneration phenomenon. A narrower pelvis has significant negative implications for the ability to give birth while a narrower rib cage has negative respiratory implications. Price describes a correlation between TB susceptibility and the structure of the rib cage stating that a chest that was narrow and deep was more prevalent in children who were lighter, had narrower nostrils, and more prone to TB.

Francis Pottenger, MD conducted nutrition studies on over 900 cats during the 1930-40s. (Pottenger, 1945, 2012) He fed the experimental group 2/3 cooked meat, 1/3 raw milk, and cod liver oil (vitamin A source) while the control group ate 2/3 raw meat, 1/3 raw milk, and cod liver oil. The results showed that the cats who ate raw meat weighed more, had a healthier coat, were not vulnerable to disease, and showed uniformity in structure and size. Meanwhile, the cats who ate cooked meat were lethargic, had cases of arthritis, decreased coordination, and dental degeneration. The offspring of the experimental group had smaller and flatter heads, narrower zygomatic arches, and nasal cavities. Furthermore, later generations fed a cooked-meat diet displayed even more pronounced developmental and health problems. These commonly included allergies, asthma, pronounced exhaustion, impaired coordination, gum abscesses, aggressiveness, nearsightedness, farsightedness, reproduction problems, increased rate of infection, leg bones that tended to increase in length, trabeculae becoming courser with less calcium present, thyroid problems (underactive or inflammatory), inflammation of the nervous system (paralysis, meningitis), heart and lung problems, and decreased visceral volume and size of the thoracic and abdominal cavities. These patterns of deterioration represent a multi-system impact such as immune, endocrine, visual, neuromuscular, behavioral, skeletal, respiratory, and cardiac. Furthermore, females displayed reduced fertility with increasing rates of miscarriage and death during labor, as well as decreased ability to lactate. In fact, the 3rd generation of cats who ate cooked meat were unable to reproduce as it was not possible to create a 4^th generation.

Pottenger tried to regenerate the cats who ate cooked meat by switching them over to a completely raw food diet. When a female cat was subjected to a cooked meat diet for 12-18 months and then returned to a normal diet (3-4 years) her reproductive ability was significantly impacted to the point that she was unable to give birth to normal kittens. He ultimately found that it took 4 generations to reverse the problems and even then it wasn’t consistent amongst an entire litter.

Pottenger also compared pasteurized, condensed, and sweetened condensed milk (2/3 of total diet) in conjunction with 1/3 raw meat and cod liver oil. The results showed deterioration and dental problems with all experimental conditions compared to raw milk which progressively worsened from pasteurized, condensed, to sweetened condensed milk. In other words, the more sugar in the milk the poorer the outcomes.

The specific food selections in the Pottenger experiments may not necessarily be directly applicable to humans in that humans and cats have different nutritional requirements. For example, human vs cat consumption of cooked meat may not be as detrimental since cooking will destroy an enzyme essential to the development of cats, while this is not the case for humans. Nonetheless, these findings do show similar results (impaired craniofacial development and physical degeneration) to what Price found in humans undergoing dramatic dietary changes towards processed and sugar laden foods.

What the Price and Pottenger studies demonstrate is a correlation between nutritional intake, craniofacial development, as well as endocrine health. The generational propagation and exacerbation of the structural and physiological changes also indicate epigenetic mechanisms at work. This means that nutritional behaviors and their structural and physiological consequences in one generation can be passed on and actually exacerbated in subsequent generations. Furthermore, the findings of these investigations parallel what is happening in today’s modern society of which malocclusion and decreased development of the face, particularly the maxilla and mandible are common.  There is also a parallel between the inflammatory and endocrine dysfunction found in Price’s and Pottenger’s work and these problem’s increasing prevalence in our society today.

Another significant dietary factor over the past century or so is the change in the consistency of our foods. Our modern diets mainly consist of soft foods while our evolutionary ancestors typically ate tougher foods which could facilitate more facial muscle strength. There is an association between increased vertical facial growth and facial muscle weakness. (Mew, 2013) However, it is unlikely that facial weakness associated with a lack of chewing challenge is the sole reason behind increased vertical facial growth. First, in Pottenger’s studies on raw vs. pasteurized/fortified milk there was no difference between the consistency of foods between groups yet the outcomes demonstrated the same patterns in craniofacial structure as the raw vs cooked meat groups. Second, it is questionable as to how much of a difference there was in masticatory challenge between the raw vs cooked meat groups. Third, Pottenger’s human studies comparing different milk products exhibited no differences in food consistency and still showed the same craniofacial developmental patterns. It is possible that the inherent nutritional differences between ancestral diets that happen to contain tougher foods vs less nutritional modern foods that are also softer in consistency may be influencing these developmental patterns. Furthermore, one must also consider that modern babies are typically weaned from breastfeeding and introduced to soft foods earlier than primitive infants.

Connecting Nutritional Deficiencies with Genetic Expression of Craniofacial Development

There are genetic correlations related to tongue ties and cleft palate such as the TBX22 gene mutation (Andreou et al., 2007). Cleft palate and tongue tie are also associated with the MTHFR (methylenetetrahydrofolate reductase) enzyme mutation. This type of mutation is called a SNP (single nucleotide polymorphism) and involves a single nucleotide swap in the DNA sequence (example-thymine is used instead of cytosine). Dr. Benjamin Lynch is a leading expert on the MTHFR mutation and has provided many of the references below for this information. His website MTHFR.net is an excellent source of the latest information on this topic.

There are over a million different potential SNPs which have been around for much of humanity with some more significant than others related to health. The MTHFR SNP has specific implications for craniofacial development. This enzyme is a key component to metabolizing folate which is a crucial element of the methylation process. Methylation is the process of adding methyl groups (carbon attached to 3 hydrogens) to various compounds (including DNA) which are needed for proper function of: turning on and off genes (gene regulation-epigenetics); processing chemicals including endogenous and xenobiotic compounds (detoxification); building and metabolizing neurotransmitters; processing hormones; building immune cells; DNA and histone synthesis; producing energy; myelination; and building and maintaining cell membranes. These functions are vital to human regulation.

There are two variants of the MTHFR mutation: MTHFR C677T and MTHFR A1298C with different potential combinations. For example, each individual has 2 alleles of the gene (one from each parent). It is therefore possible to have two normal genes,  one normal gene in combination with either the C677T or the A1298C gene, two C677T genes, two 1298C genes, or one C677T and one A1298C gene. Depending on the combination present, this will tend to correlate with different levels of reduced enzyme function ranging from a 20% -75% reduction. (van der Put et al., 1998)

Folic acid deficiency is associated with midline developmental problems such as neural tube defects, cleft palate, and tongue tie. (Rooij et al., 2003) The MTHFR SNP has a significant impact on the utilization of folic acid. The MTHFR enzyme is needed to convert folic acid into its bioavailable form, 5-Methyltetrahydrofolate (5-methyl-THF). Synthetic folic acid, which is what is typically given in supplements (particularly pre-natal) and in fortified foods, is not a readily useable form of folic acid and is difficult to convert into the bioavailable form. (Mitchell, Murray, Brien, & Christensen, 2003). If the MTHFR mutation exists one can be further challenged with this conversion. Furthermore, it has been shown that high levels of synthetic folic acid compete with the bioavailable form at receptor sites further inhibiting bioavailable folate uptake. (Rooij et al., 2003) Elevated levels of synthetic folic acid may also desensitize folate receptors downregulating them and making it even more difficult to metabolize folate. (Henderson, 1990; Houghton, Yang, & O’Connor, 2009) Therefore, it is important (especially in cases of the MTHFR mutation) to supplement with the bioavailable forms of folate which include: L-5-MTHF = L-5-Methyltetrahydrofolate = 6(S)-L-MTHF = 6(S)-L-Methyltetrahydrofolate or L-Methylfolate Calcium = Metafolin = Levomefolic Acid. Seeking Health, Biotics Research Laboratories, and Orthomolecular are examples of supplement companies that carry these types of bioavailable folate. One may take caution with labels such as: 5-MTHF; 5-Methylfolate; and 5-Methyltetrahydrofolate. These forms may not be the L or 6(S) forms which are the biologically active forms. (Lynch, 2012) It is best to contact the maker of the supplement to verify the forms.

Another SNP, BCMO1, is associated with a 60% reduced ability to convert beta carotene to retinol, the bioactive form of vitamin A. “Higher levels of vitamin A intake from multivitamins and liver sources also seemed to protect against cleft palate indicating that adequate levels of vitamin A may be required for normal development of the primary palate.” (Mitchell et al., 2003) Dr. Price also found an association of vitamin A deficiency with cleft palate.

It is important to note that folate metabolism and the methylation cycle are dependent on other nutrients that are important to obtain via diet and/or bioavailable supplementation such as B12 (methylcobalamin); B6 (Pyridoxine); B2 (Riboflavin); Betaine; Choline; and Cysteine. Furthermore, there are many other interrelated metabolic pathways requiring their own plethora of nutrients that are integrated with the methylation cycle and gene expression regulation. Other types of SNPs within the methylation cycle may also potentially effect these processes requiring specific nutrient supplementation. Therefore, when considering dietary and nutritional needs these must all be considered. Other variables of significance include digestion (which can further be broken down into stomach, pancreatic, gallbladder, small intestine, and large intestine function); blood sugar regulation; endocrine and immune function; ANS and CNS regulation; toxicity levels and detoxification capacity; and any number of potential environmental stressors.

Despite the millions of potential SNPs that may be present in one’s genome and thus potentially be expressed, we still have the capability to influence their full expression and thus impact on our system’s physiologic regulation and developmental patterns. It has been shown that genetics account for 20-50% of cleft palate with “the remainder associated with a wide variety of environmental factors during early pregnancy, such as smoking, use of alcohol and chemotherapeutic drugs, lack of maternal nutritional supplements such as folic acid or other vitamins, viral infection, and exposure to agricultural chemicals or other teratogens. More complex factors have also been implicated, including maternal age, low socioeconomic status, psychological stress in the mother, altitude, and conditions of hypoxia, in some cases with good supporting evidence provided by animal models.” (Andreou et al., 2007) An example of this genetic-environmental interaction can be demonstrated in Italy where there is a high prevalence of the MTHFR mutation yet a low incidence of neural tube defects likely due to dietary and environmental factors. This is in contract to Mexico and China where there is a high rate of the MTHFR mutation as well as neural tube defects which is likely explained by environmental and/or dietary challenges. (Yang et al., 2013) (Wilcken et al., 2003)

In conclusion, cervical-cranial-facial postural function is integrated with various structural and sensory-motor aspects of the craniofacial system, in particular the relationship between the tongue and palate. Restrictions of the tongue (ankyloglossia) can have a detrimental effect on craniofacial growth and thus the postural system. Ankyloglossia and craniofacial development have correlations to nutritional deficiencies interacting with genetic factors as well as other environmental and behavior variables. Prevention of tongue tie and craniofacial deficiency can be addressed via nutritional optimization which includes genetic and environmental interactions. Preconception, in-utero, and post-natal nutritional support is ideal to establish a foundation for optimal growth and development. Intervention of an already established tongue tie with accompanying craniofacial and postural dysfunction should be addressed as early as possible but can also be treated as an adult. Adults can significantly benefit from orofacial postural retraining interventions as well as have the ability to expand and modulate the craniofacial structural and sensory-motor system.

References

Adhikari, H. D., Kapoor, A. K., Prakash, U., & Srivastava, A. B. (2011). Electromyographic Pattern of Masticatory Muscles in Altered Dention Part II. Journal of Conservative Denstistry, 14(2), 120–127.

Andreou, A. M., Pauws, E., Jones, M. C., Singh, M. K., Bussen, M., Doudney, K., … Stanier, P. (2007). TBX22 Missense Mutations Found in Patients with X-Linked Cleft Palate Affect DNA Binding , Sumoylation , and Transcriptional Repression. The American Journal of Human Genetics, 81(October), 700–712. http://doi.org/10.1086/521033

Boyd, K. L. (2011). Darwinian Dentistry. Journal of American Orthodontic Society, 34–40.

Boyd, K. L. (2012). Darwinian Dentistry Part 2. Journal of American Orthodontic Society, 28–33.

Bronson, J. M., Bronson, J. A., & Holway, C. (2015). Introducing the Advanced Light Force ( ALF ) Appliance. Oral Health, 10–17.

Henderson, G. B. (1990). FOLATE-BINDING PROTEINS. Annual Review of Nutrition, 10, 319–335.

Houghton, L. A., Yang, J., & O’Connor, D. L. (2009). Unmetabolized folic acid and total folate concentrations in breast milk are unaffected by low-dose folate supplements. American Journal of Clinical Nutrition, 89(1), 216–220. http://doi.org/10.3945/ajcn.2008.26564

Kotsiomiti, E., Farmakis, N., & Kapari, D. (2005). Factors related to the resting tongue position among partially and completely edentulous subjects. Journal of Oral Rehabilitation, 32, 397–402.

Lee, J., Chen, J., Lee, H., & Chang, H. (2009). Improved denture retention in patients with retracted tongues. The Journal of the American Dental Association, 140(8), 987–991. http://doi.org/10.14219/jada.archive.2009.0308

Lynch, B. (2012). L-Methylfolate, Methylfolate, 5-MTHF, L-5-MTHF. What is the Difference!? Retrieved from http://mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/

Mcglone, R. E., & Proffit, W. R. (1973). Patterns of Tongue Contact in Normal and Lisping Speakers. Journal of Speech and Hearing Research, 16, 456–473.

McKee, T. L. (1956). A cephalometric radiographic study of tongue position in individuals with cleft palate deformity.pdf.

Meiyappan, N., Tamizharasi, S., Senthilkumar, K. P., & Janardhanan, K. (2015). Natural Head Position: An Overview. Journal of Pharmacy and BioAllied Sciences, August(Suppl 2), S424–S427.

Mew, J. (2013). The Cause of Malocclusion. Broadfield.

Mitchell, L. E., Murray, J. C., Brien, S. O., & Christensen, K. (2003). Retinoic Acid Receptor Alpha Gene Variants , Multivitamin Use , and Liver Intake as Risk Factors for Oral Clefts : A Population-based Case-Control Study in Denmark , 1991 – 1994. American Journal of Epidemiology, 158(1), 69–76. http://doi.org/10.1093/aje/kwg102

Porges, S. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation.

Postural Restoration Institute. (2013). Retrieved from https://www.posturalrestoration.com/

Pottenger, F. (1945). Effect of Heat-Processed Foods and Metabolized Vitamin D Milk.

Pottenger, F. (2012). Pottenger’s Cats.

Price, W. A. (2009). Nutrition and Physical Degeneration.

Rooij, I. A. L. M. Van, Vermeij-keers, C., Kluijtmans, L. A. J., Ocké, M. C., Zielhuis, G. A., Goorhuis-brouwer, S. M., … Steegers-theunissen, R. P. M. (2003). Does the Interaction between Maternal Folate Intake and the Methylenetetrahydrofolate Reductase Polymorphisms Affect the Risk of Cleft Lip with or without Cleft Palate ? American Journal of Epidemiology, 157(7), 583–591. http://doi.org/10.1093/aje/kwg005

Rowan-legg, A., & Society, C. P. (2015). Ankyloglossia and breastfeeding. Canadian Paediatric Society, 20(4), 209–213.

Rudney, J. D., Ji, Z., & Larson, C. J. (1995). The prediction of saliva swallowing frequency in humans from estimates of salivary flow rate and the volume of saliva swallowed. Archives of Oral Biology, 40(6), 4–6.

Singh, G. D. and Krumholtz, J. (2009). Epigenetic Orthodontics.

Solow, B., Ovesen, J., Nielsen, P. W., Wildschiodtz, G., & Tallgren, A. (1993). Head posture in obstructive sleep apnoea. European Orthodontic Society, 15, 107–114.

Timoshkin, E. M., & Sandhouse, M. (2008). Retrospective study of cranial strain pattern prevalence in a healthy population. The Journal of the American Osteopathic Association, 108(January), 652–656.

Tow, J., Boyd, K., Lynch, B., Jacobson, H., Buckley, S., Jaminet, P., & Masterjohn, C. (2014). Tongue-tie, Epigenetics, and the Microbiome.

Uhlig, S. E., Marchesi, L. M., Duarte, H., & Araújo, M. T. M. (2015). Association between respiratory and postural adaptations and self-perception of school-aged children with mouth breathing in relation to their quality of life. Brazilian Journal of Physical Therapy, 19(3), 201–210.

van der Put, N. M. J., Gabreëls, F., Stevens, E. M. B., Smeitink, J. A. M., Trijbels, F. J. M., Eskes, T. K. A. B., … Blom, H. J. (1998). A Second Common Mutation in the Methylenetetrahydrofolate Reductase Gene: An Additional Risk Factor for Neural-Tube Defects? The American Journal of Human Genetics, 62(5), 1044–1051. http://doi.org/10.1086/301825

Wilcken, B., Bamforth, F., Li, Z., Zhu, H., Ritvanen, A., Redlund, M., … Botto, L. D. (2003). Geographical and ethnic variation of the 677C>T allele of 5,10 methylenetetrahydrofolate reductase (MTHFR): findings from over 7000 newborns from 16 areas world wide. Journal of Medical Genetics, 40, 619–625.

Yang, B., Liu, Y., Li, Y., Fan, S., Zhi, X., Lu, X., … Sun, G. (2013). Geographical Distribution of MTHFR C677T, A1298C and MTRR A66G Gene Polymorphisms in China: Findings from 15357 Adults of Han Nationality. PLoS ONE, 8(3). http://doi.org/10.1371/journal.pone.0057917

Yeol, H., Jong, K., Jeong, I., Jung, H. D., Sohn, H., Duk, S., … Yun, S. (2013). Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing. Clinical and Experimental Otohinolaryngology, 6(4), 226–230.

What are grains?

Grains are small, hard, dry seeds harvested for human or animal consumption. The two main types of commercial grain crops are cereals such as wheat and rye, and legumes such as beans and soybeans. Cereal grains may be either in whole form where the entire grain (bran, germ, and endosperm) is preserved or in refined form where the bran and germ have been removed.

What is gluten?

Gluten is a type of protein found in most cereal grains such as wheat, rye, spelt, kamut, semolina, and barley. It is typically found in pasta, bread, cereals, cakes, cookies, crackers, beer, and even salad dressings. Most foods that are processed and come out of box will contain it. Compared with other types of cereal grains, gluten is the most difficult for humans to digest.

Why are grains not good for us?

For 97% of our human existence, we did not consume grains. Our bodies are not inherently designed to digest and metabolize them and haven’t made much progress towards doing so either. However, some individuals are genetically able to tolerate grains better than others. Furthermore, when grains were first introduced to the human diet (about 10,000 years ago), they were prepared and consumed in a manner that made them easier for humans to digest and metabolize.  Pre-industrialized societies fermented grains so that they were more easily digested and their vitamins and minerals could be better absorbed. Today, grains are typically sprayed with pesticides while they are growing and then  milled at high temperatures which causes their fatty acids to spoil and become rancid. If the milled flour is stored for long periods of time it becomes even more rancid. Preservatives, stabilizers, and additives are often added to flour further making it less beneficial and even harmful to our health.

If grains are not properly prepared, meaning if they are not soaked (aka fermented or sprouted) then they contain substances called anti-nutrients. Anti-nutrients can cause damage and inflammation to the lining of our gut as well as prevent the body from absorbing nutrients from food. This doesn’t mean only the nutrients in the grains won’t be absorbed but also any other food that you are consuming along with the grains. One example could be vegetables which are full of beneficial vitamins and nutrients and thus would not be readily absorbed if they are paired with anti-nutrient containing grains.

Phytic acid in an anti-nutrient found in all grains which combines with magnesium, iron, copper, calcium, and zinc in the intestinal tract thus preventing the body from being able to absorb these specific nutrients. Therefore, consuming large amounts of our modernly prepared whole grains can cause the body to become mineral deficient. Some believe that this is a driving cause of high cases of osteoporosis in our society.

Another anti-nutrient found in grains are enzyme inhibitors which don’t allow the body to properly break down sugars and proteins. This can further irritate the pancreas and digestive system contributing to allergies and other digestive and autoimmune disorders, such as celiac disease, Chron’s disease and irritable bowel syndrome. In Leaky Gut Syndrome, chronic irritation of the lining of the gut creates excessive permeability thus allowing incompletely digested food particles to cross over into our blood stream. Our bodies will subsequently recognize these particles as foreign material and mount an immune response to them. This is the pathway to creating various food allergies.

Even though only a small percentage of the population has celiac disease (which means they have a true gluten allergy) it has been found that about 30% of the population has noticeable amounts of anti-giadin in their stools. Anti-giadin are antibodies secreted when the body encounters giadin, one of gluten’s constituents, as an intruder. Having the antibody in your stools means that your body is actively fighting an intruder and that you are exhibiting signs of chronic inflammation.

The structure of gluten resembles the protein portion of the thyroid gland. If gluten has made it into your bloodstream and has created an immune response against it, the body may likely also begin to attack the thyroid gland. This can be a contributing factor to autoimmune based thyroid disease. This process also occurs in Crohn’s disease where the body has been producing antibodies against giadin and mistakenly recognizes the intestinal tract as foreign material and thus mounts an immune attack against it.

If you have developed an immune response to gluten, it can last up to 6 months each time you consume it. That is why in these cases it is critical to completely remove it from your diet. Even a small amount can create a significant immune response in some people.

Chronically elevated insulin levels and diabetes are huge problems in our society. Grains are inherently high in carbohydrates which can easily spike blood sugar (glucose) levels. If you consider the large amounts of grains we typically consume this is a big problem. High sugar and carbohydrate consumption puts increased pressure on the pancreas to release a lot of insulin to lower elevated blood glucose levels. Furthermore, this excessive glucose gets converted into fat contributing to weight gain. With chronically elevated insulin levels our bodies begin to become resistant to it leading to Type 2 Diabetes. Elevated insulin levels can also lead to systemic inflammation throughout the body. Systemic inflammation can cause a variety of other health problems such as atherosclerosis, arthritis, dementia and Alzheimer’s disease.

Dysbiosis is defined as an imbalance of beneficial and pathogenic bacteria and yeasts in the gut. It is associated with depression, anxiety, autoimmune disorders, systemic inflammation, ADHD, autism, obesity, and pretty much most of the major diseases in our society. One of the causes associated with this problem is consumption of grains. The excessive amounts of carbohydrates in grains in addition to the pesticides and toxic chemicals usually associated with them contribute to dysbiosis. For individuals with significant gut flora imbalances sometimes just eliminating grains is not enough. They must also spend some time eliminating most sources of carbohydrates and sugars from their diets as they rebalance their system. The growing popularity of the FODMAPS diet encompasses this approach.

Our food system currently values grains, especially whole grains as healthy and nutritious being at the bottom of the USDA food pyramid with a recommended 6 to 11 servings per day. Based on the points made in this article, this is obviously not regarded as nutritious. A reason why our government initially pushed grains was economical. They are cheap to produce (although not without environmental costs), they can be stored for much longer, and they can easily be sold overseas which doesn’t lend much incentive to promote them as being unhealthy.

The bottom line is that depending on the state of your gut and susceptibility to inflammation you likely should not be consuming any grains or if you do in small amounts. If you are able to tolerate grains then opting for ones that are organic (free from toxic chemicals) and sprouted (pre-digested that gets rid of the anti-nutrients and enzyme inhibitors) are the way to go.  The best sources of carbohydrates and fiber are from vegetables!

References

Diet, the gut microbiome, and epigenetics.  Hullar MA, Fu BC.  Cancer J. 2014 May-Jun; 20(3):170-5.

Physiology and immunology of the cholinergic antiinflammatory pathway.  Kevin J. Tracey. Clin Invest. Feb 1, 2007; 117(2): 289–296.

The vagus nerve and the inflammatory reflex: wandering on a new treatment paradigm for systemic inflammation and sepsis.

Huston JM. Surg Infect (Larchmt). 2012 Aug;13(4):187-93. doi: 10.1089/sur.2012.126. Epub 2012 Aug 22.

The clinical importance of the anti-inflammatory vagovagal reflex. Boeckxstaens G. Handb Clin Neurol. 2013;117:119-34.

Neurobehavioural effects of developmental toxicity. Philippe Grandjean, Philip J Landrigan. Lancet Neurol 2014; 13: 330–38

Normal gut microbiota modulates brain development and behavior. Proceedings of the National Academy of Sciences

Rochellys Diaz Heijtz et al. February 15, 2011 vol. 108 no. 7

Proceedings of the 2014 A.S.P.E.N. Research Workshop: The Interface Between Nutrition and the Gut Microbiome:

Implications and Applications for Human Health. John Alverdy, MD, FACS; Jack Gilbert, PhD; Jennifer R. DeFazio, MD;Michael J. Sadowsky, PhD; Eugene B. Chang, MD; Michael J. Morowitz, MD; and Daniel H. Teitelbaum, MD. Journal of Parenteral and Enteral Nutrition. Volume 38 Number 2. February 2014 167–178c 2013 American Societyfor Parenteral and Enteral Nutrition

Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption. Miriam Goebel-Stengel, Andreas Stengel, Marco Schmidtmann, Ivo van der Voort, Peter Kobelt and Hubert Mönnikes. J Neurogastroenterol Motil, Vol. 20 No. 2 April, 2014

The Microbiota–Gut–Brain axis in gastrointestinal disorders: Stressed bugs, stressed brain or both? Giada De Palma, Stephen M. Collins, Premysl Bercik and Elena F. Verdu. Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada

Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. Manfred Lamprecht, Simon Bogner, Gert Schippinger, Kurt Steinbauer, Florian Fankhauser, Seth Hallstroem, Burkhard Schuetz and Joachim F Greilberger1

Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance

Anthony SAMSEL and Stephanie SENEFF . Interdiscip Toxicol. 2013; Vol. 6(4): 159–184.

Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases  . Anthony Samsel and Stephanie Seneff. Entropy 2013, 15, 1416-1463.

Books

Autoimmune: the Cause and the Cure by Uridales and Brockley

Gut and Psychology Syndrome by Natasha Campbell-McBride

Clean Gut by Alejandro Junger

Why Stomach Acid is Good for You by Jonathan Wright and Lane Lenard

You’re Not Sick you’re Thirsty F. Batmanghelidj

The Candida Cure by Ann Boroch

The Complete Candida Guidebook by  Jeanne Marie Martin and Zoltan P. Rona, MD

Web Based Articles

http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-up-your-microbiome.html?pagewanted=all&_r=3&

 http://www.naturalnews.com/024508_grains_gluten_WHO.html

http://sustainablepulse.com/2014/02/19/roundup-linked-global-boom-celiac-disease-gluten-intolerance/#.UwzQpIUhtcp

http://chriskresser.com/the-gluten-thyroid-connection

http://paleoleap.com/what-is-wrong-with-grains/

http://www.naturalnews.com/039690_grains_dangerous_gluten.html#

http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/gluten-free-diet/art-20048530

There are three layers within the adrenal cortex with the outermost being where the mineralcorticoid, aldosterone, is secreted. This hormone regulates electrolyte and fluid concentrations by retaining sodium (Na) and water and facilitating potassium (K) urinary excretion in an attempt to keep up blood pressure. Hydrogen ions are also excreted more via urine to decrease metabolic acidosis. With increased facilitation such as with chronic stressors, aldosterone will exaggerate these effects. In cases of adrenal and or HPA hypofunction there will be a reduction in aldosterone production resulting in sodium depletion, excessive potassium, increased water loss via urination, and low blood pressure.

The next layer of the adrenal cortex produces cortisol which has a huge impact on glucose regulation. Cortisol is normally synthesized as a result of low blood sugar such as in the morning upon waking from sleep. Cortisol stimulates the liver to break down glycogen (glycogenolysis) as well as form glucose from amino acids and fatty acids (gluconeogenesis). Muscle tissue will respond to cortisol by breaking down into amino acids for gluconeogenesis while adipose tissue will metabolize triglycerides. Cortisol also has anti-inflammatory effects and inhibits white blood cells. In chronic stress states excessive cortisol production will enhance these processes and higher reactive blood sugar levels putting increased pressure on insulin to counteract the blood sugar surge. This may create a reactive hypoglycemia depending on whether there is still cellular insulin sensitivity and pancreatic secretion. Over time, insulin resistance may eventually occur which would maintain elevated blood glucose levels. This blood sugar dysregulation may simultaneously be compounded by a diet that is heavily laden with sugar and carbohydrates and/or low in nourishing fats and protein. Please refer to this article: http://heathercarrdpt.com/uncategorized/blood-sugar-dysregulation/ for more information on these processes.

With adrenal hypofunction, individuals will present with reduced cortisol levels. In this situation, hypoglycemia will typically occur due to decreased gluconeogenesis and lipolysis (breakdown of adipose tissue). If insulin levels are high and there is still cellular sensitivity this will further contribute to hypoglycemia as glucose will be transported intracellularly for storage.

The 3^rd layer of the cortex secretes the androgens, the sex hormones and their precursors (DHEA, pregnenolone, androstenedione, estrone, testosterone, estradiol) for both sexes. Proper function of this layer is important for post-menopausal women as well as assisting with endocrine regulation. The androgens balance the effects of cortisol and are anti-oxidants. Decreased androgen production is associated with adrenal hypofunction which can create symptoms of decreased libido, acne, hair loss, and endocrine imbalances. Decreased progesterone production in men can leave the prostate vulnerable.

The inner layer of the adrenal glands consists of the medulla which secretes norepinephrine and epinephrine serving to enhance sympathetic nervous system activity and parallel the blood sugar effects that cortisol and glucagon have, namely elevating blood glucose levels. Norepinephrine redirects blood flow to the lungs, muscles, and heart and away from the digestive and reproductive systems.

There are different patterns of hypo and hyper adrenal function which may also show cyclical relationships. Based on an individual’s physiological and psychological susceptibility to perceiving stress coupled with the dosage of stress they experience will determine their pattern. For example, it has been shown that certain behavioral coping styles in animals can result in different HPA and SA reactions. A proactive and more aggressive behavior pattern when faced with a challenge was associated with more SA but less HPA activity while a typical reactive less aggressive response correlated to more HPA, less SA activity, and more parasympathetic activity (the parasympathetic activity may be from the more primitive dorsal motor nucleus creating more of a freezing response. Refer to this article for more details on parasympathetic nervous system activity related to the vagus nerve. (http://heathercarrdpt.com/uncategorized/the-polyvagal-theory-and-the-pri-approach/). The bottom line is that it is one’s ultimate appraisal of a stressor that will determine how they process it.  This appraisal process is a complex conglomeration of excitatory and inhibitory input from all different parts of the brain, neuroendocrine, and immune systems further influenced by environmental, genetic, and epigenetic factors.

The hypothalamus is the primary regulator of cortisol production with receptors for circulating cortisol levels to determine whether further production is needed. When cortisol levels become low the HPA axis is stimulated. If the brain is receiving chronic stress signals (in various psychological and/or physical forms and combinations) then there will be increased production of cortisol as well as aldosterone and androgens which can feature the symptoms described above. However, if there are prolonged elevated cortisol levels in the body, the hypothalamus and/or the pituitary may compensatorily downregulate and become less sensitive to cortisol resulting in decreased production of it. Glucocorticoid receptors on the hypothalamus may also become destroyed via chronic systemic inflammatory processes. It appears that a significant factor that facilitates the decreased HPA response is increased cytokine levels, in particular interleukin-6 (IL-6) in which the midbrain has a high number of receptors for. If the body has chronic levels of systemic inflammation such as through autoimmune processes and/or chronic infections the subsequent increased cytokine production can inhibit the effects of CRH and ACTH and thus decreased cortisol production will ensue. It is also worth noting that this may also impact other endocrine pathways such as with the thyroid and reproductive glands.

In addition to the hypothalamus and pituitary, the hippocampus and pineal gland are important regulators of cortisol’s release patterns. Dysfunction in these important parts of the brain may potentially impair cortisol regulation.  Cortisol and melatonin (synthesized by the pineal) have an inverse relationship with one another and dysregulation of one will impact the other. Prolonged elevated systemic cortisol levels due to chronic stress have been shown to reduce the size of the hippocampus. Chronically high insulin levels and glycation related to excessive sugar and carbohydrate consumption can also damage the hippocampus. The pineal gland can become calcified due to excessive fluoride exposure or nutrient deficiencies impacting calcium levels such as magnesium, vitamin D and cofactors, and/or vitamin K-2. Lastly, anything that interferes with melatonin synthesis such as deficiencies of Vit B6, L-Tryptophan, serotonin, and/or systemic inflammation can also indirectly impact cortisol regulation.

Other possible nutrient deficiencies can also influence cortisol levels.  Examples include vitamin B12, iron, omega 3s, arachidonic acid, CoQ10, methyl donors, choline, magnesium, vitamin D and cofactors, and cholesterol. Insufficient neurotransmitter levels may also be a part of the problem. Epigenetic issues could be involved such as the expression of the enzyme methylenetetrahydrofolate reductase which helps with creating L methyl folate (utilized for converting homocysteine into methionine).  Without proper functioning of this metabolic pathway there may be increased homocysteine levels which are associated with neurodegeneration and inflammation. Other potential causes are free radical processes, cancer, use of stimulants, blood sugar dysregulation, chronic use of synthetic steroids, and hypothyroidism. Finally, adrenal autoimmunity may be a mechanism behind decreased adrenal hormone secretion.

In reality, there are likely numerous factors and interrelated pathological processes going on during cortisol dysregulation. It seems that a key element involved with the switch from elevated to depressed levels is the increased levels of cytokines as their presence has the ability to downregulate the HPA axis and/or destroy its receptors. This naturally brings up the question as to why there are elevated cytokines in the first place. One answer could to be related to systemic inflammation likely caused by gut dysfunction such as dysbiosis, leaky gut, and the subsequent autoimmune processes connected to them. Blood sugar dysregulation can also facilitate systemic inflammation. The autoimmune mechanisms that often accompany gut problems may manifest in autoimmune adrenal gland issues further impacting cortisol regulation. Finally, chronic stress and/or a brain that is highly sensitive to stress (as a result of chronic stress signaling) is associated with increased sympathetic nervous system tone and reduced parasympathetic nervous system activity. The vagus nerve is the primary parasympathetic regulator in addition to connecting the gut and the brain. If this nerve becomes inhibited via dysbiotic gut environments and/or excessive sympathetic activity it will also not be able fulfill its other primary role which is to dampen systemic inflammation via the cholinergic anti-inflammatory pathway. This will ultimately create elevated cytokine levels and thus a prime environment for cortisol downregulation processes to occur.

Clinical Implications for Healthcare Providers

• Whether an individual is in a hyper or hypoadrenal functional state may influence intervention strategies. Physical Therapists commonly encounter individuals who present with chronic inflammatory musculoskeletal issues. A typical treatment approach would be to address postural and mechanical issues related to the neuromuscular system. However, such a condition is likely associated with underlying decreased cortisol and increased systemic inflammatory processes occurring. As outlined above, there may be a variety of factors that can influence such a state. Common major ones that are typically related include gut dysfunction (maldigestion, malabsorption, and/or dysbiosis), nutritional deficiencies (from lack of intake and/or gut dysfunction) autoimmune issues, reduced vagal tone/elevated sympathetic tone, a sensitized limbic system (particularly the amygdala), blood sugar dysregulation, and environmental toxins. Breathing dysfunction as well as airway insufficiency may also be involved as well. An integrative approach to managing such an individual would consider all of these potential variables and their interactions with one another. For example, I am currently treating a woman in her 50s who presented with medial elbow pain for the past year. She had two cortisone injections that resulted in temporary relief. Upon assessment, I concluded that she was likely in a hypoadrenal state (the fact that she improved with cortisol supports this) coupled with blood sugar dysregulation, impaired digestion, breathing, and postural dysfunction that was mechanically straining her ulnar nerve. Therefore, my treatment intervention included addressing all of these issues via both dietary recommendations, breathing, and postural retraining. Within 1 month she has made excellent progress and is virtually symptom free.
• Healthcare providers are encouraged to seek out other like-minded integrative referral sources as specialists working in other systems of the body are frequently needed to fully support our patients and clients. One of the most challenging referrals to make is one that addresses underlying psychological maladaptive patterns.

References

The Clinical Importance of the Anti-Inflammatory VagoVagal Reflex.pdf. In R. M. Buijis and D.F. Swaab (Ed.), Handbook of Clinical Neurology. Elsevier B.V.

De Jonge, W. J. (2013). The Gut’s Little Brain in Control of Intestinal Immunity. ISRN Gastroenterology, 2013, 630159. doi:10.1155/2013/630159

De Palma, G., Collins, S. M., Bercik, P., & Verdu, E. F. (2014). The Microbiota-Gut-Brain axis in gastrointestinal disorders: Stressed bugs, stressed brain or both? The Journal of Physiology, 00, 1–9. doi:10.1113/jphysiol.2014.273995

Gedgaudas, N. (2014). Rethinking Fatigue: What Your Adrenals Are Really Telling You And What You Can Do About It.

Gedgaudas, N. (2011). Primal Body Primal Mind: Beyond the Paleo Diet for Total Health and Longer Life.

Hannibal, K. E., & Bishop, M. D. (2014). Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy, 1816–1825. doi:10.2522/ptj.20130597

Koolhaas, J. M., Korte, S. M., De Boer, S. F., Van Der Vegt, B. J., Van Reenen, C. G., Hopster, H., … Blokhuis, H. J. (1999). Coping styles in animals: current in behavior and stress-physiology. Neuroscience and Biobehavioral Reviews, 23(99), 925–935.

Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers.

Wilson, James, Wright, J. (2001). Adrenal Fatigue: The 21st Century Stress Syndrome.

In Paleolithic times (which encompass the majority of human existence and what shaped our current genome), humans consumed macronutrient ratios between 19-35% protein, 22-44% carbohydrate, and 28-58% fat with no trans fats. Today, these ratios have shifted to 15% protein, 52% carbohydrate, and 33% fat of which 2-3% are trans fats. This means we are consuming less protein, more carbohydrates, and eating on the lower end of the proportion of fats coupled with toxic trans fats. Furthermore, sugar consumption has dramatically increased from 10 lbs per person per year in 1821 compared to 199 lbs in 2005 (USDA statistics).

Excessive sugar and carbohydrate consumption coupled with a lower fat and protein intake can result in an unstable and rapid glucose metabolism that typically requires frequent replenishing and compensatory stimulants.  Carbohydrate digestion creates a quicker blood glucose elevation (high glycemic load) compared to fats and proteins which slow down the digestive process resulting in a steadier blood glucose state. The problem with rapid and large blood glucose surges (hyperglycemia) is that they ultimately create a stress response in the body. As blood glucose levels surge from either too much sugar/carbohydrate consumption and/or not enough protein and fat paired with it to slow the processing, the body reacts by releasing excessive insulin. This pancreatic hormone works to facilitate blood glucose transfer into liver and muscle cells for energy production and conversion into glycogen thereby lowering blood glucose levels. Any excessive amount that is not needed by the liver and muscle will then be converted into adipose tissue.

As a response to hyperglycemia, the body typically over reacts and shifts into a state of reactive hypoglycemia (too low blood sugar). Symptoms of hypoglycemia include fatigue, irritability, cravings for sweets, more carbohydrates, and stimulants in order to facilitate bringing blood glucose levels up again. The body then responds by releasing the hormones glucagon (from the pancreas), cortisol, norepinephrine, and epinephrine (from the adrenal glands) which all act to elevate blood glucose levels.  Stimulant cravings (particularly caffeine) are present in this reactive hypoglycemic state as the body desires increased sympathetic nervous system activity to help elevate blood sugar levels.  People will typically crave caffeine at times when their blood sugar is low such as in the morning or in the middle of the afternoon.  Stimulants may also be desired in cases of adrenal dysregulation where the adrenal glands are not producing adequate amounts of cortisol, epinephrine, or norepinephrine. The body’s response to a reactive hypoglycemic state will usually once again create a reactive hyperglycemic state and thus a vicious repetitive cycle is born characterized by a roller coaster blood glucose ride. Eventually, dysregulation may further occur where the cells are no longer sensitive to insulin either due to receptor downregulation and/or receptors being destroyed through glycation. Glycation occurs with elevated glucose levels which adhere to proteins (AGEs-associated glycation end-products) including tissue membranes, joints, neurons, and/or red blood cells thus creating inflammation and degeneration. When cells no longer can take in glucose, the body’s ability to produce energy is impaired. The excessive glucose is then converted into fat. Furthermore, insulin resistance impairs the body’s ability to break down adipose tissue. Therefore, obesity is even more encouraged.

Foods that are high in sugar also typically contain high amounts of the sugar fructose. Fructose is processed differently than glucose in that the liver has to completely metabolize it vs 20% in glucose processing creating stress on the liver. Furthermore, fructose does not trigger the release of the hormone ghrelin as glucose does which suppresses appetite. Therefore, one is more likely to overeat. Also, for every 120 calories of fructose, 40 of them end up being stored as fat. Finally, the free fatty acids created via fructose metabolism are eventually converted into very-low-density lipoproteins (VLDL) (harmful to the body) and triglycerides which promote more fat storage in the liver and muscle. This can also facilitate insulin resistance.

It is evident how weight gain and blood sugar dysregulation are associated with increased consumption of carbohydrates and sugar (particularly fructose), under consumption of fat and protein, and/or over consumption of food period (too much healthy fat and protein can also lead to weight gain). However, it is also important to realize that chronic stress can also contribute to obesity and endocrine dysregulation. The stress response involves the release of cortisol and epinephrine which, as just explained, results in increased blood glucose levels. Therefore, a stress stimulus by itself can also facilitate a roller coaster blood sugar ride, glycation, and eventually insulin resistance. Furthermore, increased activation of the stress response pathways can also impact the thyroid gland which is a primary regulator of metabolism. Hypothyroidism, which is becoming more common in today’s society, will contribute to weight gain as well. The unfortunate result from chronic stress can manifest in obesity, diabetes, and any variety of chronic systemic inflammatory disease process.

Based on this discussion thus far it is clear that one should attempt to limit their sugar and carbohydrate consumption while being mindful of adequate and nutritious fat and protein intake. The use of stimulants are also not recommended. Stress management and coping strategies with today’s societal, work, and family demands is also crucial. Everyone’s physiology and genealogy is different and therefore there is typically not a single formula that will work for all. However, below are some general food choice recommendations:

• Breakfast
  • Eliminate or significantly reduce cereals, toast, bagels, muffins, pastries, and any other sugary/carbohydrate laden food. Breakfast bars are usually high in sugar and include a lot of processed ingredients.
    • Smoothie: Unsweetened coconut milk (preferred over almond milk) (do not use “light”), the least amount of berries needed to make it taste good, and protein powder.
      • Recommend: NOW unsweetened pure pea powder or Designs for Health pure pea powder.  Sold online at: www.naturalhealthyconcepts.com
      • Optional:  fresh ginger, greens (spinach, chard, kale (alternate them)), mint
  • Eggs with veggies/greens and/or meat (non-processed, organic, grass fed preferred). Yes to the yolk! Some individuals may have a sensitivity to eggs and thus need to be avoided.
  • A typical meal you would eat for lunch or dinner (see below)
• Lunch and Dinner
  • Avoid/significantly reduce grains, sandwiches, pasta, rice, potatoes. Some individuals will be able to tolerate grains better than others.  Grains are best tolerated if they have been soaked (sprouted) before consuming.
  • Avoid processed foods
  • Consume lots of vegetables and greens coupled with high quality protein and fat. One’s bio-individuality will determine the type and amount of meat, seafood, and or grain sources of protein that will best nourish them and may require experimentation. If one is to obtain protein through grains then it is recommended they are sprouted. It is difficult to obtain a full protein profile via vegetarianism and thus supplemental support is likely required.
  • About 25-30% of your calories should come from protein. Athletes and a high level of physical training will require more while less active individuals will need less. If your daily calorie needs are 2000 calories, 30% of this is 600 calories which equals 150 grams of protein.
    • Good protein sources will be from:
      • Meat (preferably organic, grass fed)
      • Seafood
        • Wild is best, low mercury levels.
        • Sardines, anchovies, and salmon have high beneficial omega 3 levels
  • Depending on your bio-individual metabolic needs and qualities, your need for fat can range from 30%-~65% of your macronutrient needs.
  • Good sources of fat include:
    • Meat (preferably organic, grass fed)
    • Seafood
      • Wild, low mercury levels.
    • Oils
      • Preferably cold pressed and organic.
      • Avoid canola  and vegetable oil.
      • Many polyunsaturated oils sold are rancid and oxidized.Tropical oils such as coconut and palm provide the best fat energy source and are most stable under high heat. They should be used for cooking instead of polyunsaturated oils. Lard and butter (or ghee (clarified butter) are also good for cooking.
  • • Avocados.
    • Be liberal with the butter (provided you don’t have any dairy issues)! Use on your vegetables. Butter is an excellent source of good quality fat for energy and nutrients provided it is from organic grass fed cows. If you have a dairy sensitivity then use clarified butter which is called ghee.
  • Provided you don’t have any issues with dairy, raw is recommended. Fermented milk (kefir) and raw cheese have a lot of beneficial bacteria and enzymes coupled with fat and protein macronutrients.
• Snacks
  • When someone has switched over to a more efficient fat burning metabolism they will typically be able to go for longer periods of time without the need for frequent meals, snacks, and stimulants. However, in situations where a snack is required some suggestions are:
    • Coconut Butter (sometimes referred to as Manna Butter):
      • https://store.nutiva.com/coconut-manna/
      • http://www.artisanaorganics.com/coconut/coconut-butter/
    • Nut butter (preferably organic and sprouted) Almond is typically best. Peanut butter tends to have high levels of mold and best avoided.
      • http://www.mannaorganicbakery.com/)
      • http://www.maranathafoods.com/category/almond-butters
    • Sprouted nuts (Recommend: http://www.livingnutz.com/)
    • Sprouted Crackers
      • http://www.goraw.com/c/20/sprouted-flax-snax
    • Avocado-guacamole or slicing up with olive oil + lemon juice + sea salt on some sprouted crackers
    • Smoothie (see above)
    • Raw cheese (provided no problems with dairy) and sprouted raw crackers
• Fluids
  • Drink ½ your body weight in water ounces per day. More may be required depending on your activity level.
  • Green tea may be appropriate for some.
  • For every diuretic (caffeinated) beverage, you must have additional equal amounts of water.
• Dessert
  • Chocolate Fudge
    • Combine 1 cup almond butter, 1/3 cup softened coconut oil, 1/2 cup cacao powder, 2-3 TB raw honey or 20 drops liquid stevia
    • Spread onto parchment lined dish
    • Freeze or refrigerate for 45 minutes
    • Cut into 1 inch squares and serve
    • Keep in freezer or refrigerator

Caveats

• Consuming a balanced macro and micronutrient diet that fits your bio-individual needs is important but being able to properly digest and absorb it is even more important. If you still have problems after making these changes you may need further work up to determine if your digestive system is functioning correctly. One of the most common culprits with poor digestion and absorption are not effectively chewing, producing enough stomach acid, and/or pancreatic enzymes. Please refer to this article (http://heathercarrdpt.com/uncategorized/the-importance-of-stomach-acid/) to learn more about this.
• Being on a low fat diet for awhile can result in a sluggish gallbladder. Therefore, one may have to gradually introduce fat into their diet as their gallbladder accommodates to the new bile production demands. Additional supplemental support may also be needed.
• It can take some time for your body to adjust to a reduced carbohydrate/sugar/stimulant and increased fat/protein load. Some individuals may experience “withdrawal” reactions as they undergo this process. Cravings, irritability, and mood swings may reflect this. Another potential reason is systemic candida/yeast overgrowth and/or pathogenic bacterial overgrowth. Sugar feeds this condition and as you starve the yeast and/or bacteria toxins may be produced as they die off.
• Malabsorption, increased gut permeability, food allergies, and autoimmune disorders can significantly complicate things and may require professional support.

References

The Clinical Importance of the Anti-Inflammatory VagoVagal Reflex.pdf. In R. M. Buijis and D.F. Swaab (Ed.), Handbook of Clinical Neurology. Elsevier B.V.

De Jonge, W. J. (2013). The Gut’s Little Brain in Control of Intestinal Immunity. ISRN Gastroenterology, 2013, 630159. doi:10.1155/2013/630159

De Palma, G., Collins, S. M., Bercik, P., & Verdu, E. F. (2014). The Microbiota-Gut-Brain axis in gastrointestinal disorders: Stressed bugs, stressed brain or both? The Journal of Physiology, 00, 1–9. doi:10.1113/jphysiol.2014.273995

Gedgaudas, N. (2014). Rethinking Fatigue: What Your Adrenals Are Really Telling You And What You Can Do About It.

Hannibal, K. E., & Bishop, M. D. (2014). Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy, 1816–1825. doi:10.2522/ptj.20130597

Koolhaas, J. M., Korte, S. M., De Boer, S. F., Van Der Vegt, B. J., Van Reenen, C. G., Hopster, H., … Blokhuis, H. J. (1999). Coping styles in animals: current in behavior and stress-physiology. Neuroscience and Biobehavioral Reviews, 23(99), 925–935.

Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers.

Wilson, James, Wright, J. (2001). Adrenal Fatigue: The 21st Century Stress Syndrome.

To read Part 1: The Prevalence of Human Asymmetry and Lateralization click HERE

To read Part 2: What Does Asymmetry Provide for a Human Being? click HERE

To read Part 3: How Did Humans Become Asymmetric? click HERE

To read Part 4: How Does One Reconcile an Asymmetrical Neuromuscular System?

The following piece is primarily based off David Shannahoff-Khalsa’s article “Lateralized rhythms of the central and autonomic nervous systems.”  (Shannahoff-Khalsa, 1991)

In addition to the need for the neuromuscular system to be able to laterally shift amidst an inherently asymmetrical system, the autonomic nervous system (ANS) and central nervous system (CNS) have evolved to coupling in lateralized rhythmical patterns, referred to as ultradian rhythms. This represents further specialization of each side of the body for increased adaptive and evolutionary potential. More specifically, the ability of the ANS and CNS to lateralize can facilitate the conservation and production of energy whereas one side functions in an ergotrophic state (energy production) while the other is simultaneously in a trophotropic state (energy conservation). This may be referred to as a basic rest activity cycle (BRAC). It has been proposed that ultradian rhythms serve as a neural matrix for coupling mind and metabolism manifesting as a pendulum of ANS-CNS activity to help maintain allostasis of two polar states. This dynamic alternation allows for increased specialization in congruence with energy efficiency.

The first example of an ultradian rhythm in the body is the nasal cycle as defined by an alternation of vasoconstriction in one nostril and vasodilation in the other that tends to average 3-4 hours per cycle with ranges anywhere from 2-8 hours. Nasal tissue is highly innervated by the sympathetic nervous system where increased activity is associated with increased vasoconstriction and less congestion. Nasal shifting is also coupled to lung inflation. Forced inhalation through one nostril is paired with increased ipsilateral lung inflation referred to as the pulmonary reflex mechanism.  There is a sympathetic coupling mechanism where vasoconstriction in one nostril is associated with vasodilation of the ipsilateral lung.

The nasal cycle is also coupled with contralateral hemispheric function. Increased performance of verbal (L hemisphere dominant) tasks is associated with R nasal breathing while better spatial (R hemisphere dominant) task ability is associated with the left nasal cycle. Strength of verbal and spatial performance has been shown to correspond to 90 minute cycles. The nasal cycle is associated with REM (rapid eye movement) and NREM (non-rapid eye movement) stages during sleep where the right nostril dominates with REM and the left with NREM stages. Insomnia has shown to be associated with unilateral nasal obstruction. There are hemispheric dominance EEG patterns during REM (left) and NREM (right). Waking during either stage can reflect differences in spatial and verbal performance. Furthermore, spiral aftereffect (an illusion in visual perception) exhibits an ultradian rhythm coupled with the nasal cycle and sleep state.

There are coordinated rhythms between hemispheric dominance, sleep stages, autonomic, digestive, and endocrine systems. Hemispheric cerebral metabolic rates are consistent with these patterns. There are lateralized alternations of peripheral concentrations of norepinephrine, epinephrine, and dopamine in the body. Generally, as concentrations rise on one side they fall on the other side. The nasal cycle is also paired with these patterns. Extracellular hippocampal norepinephrine and serotonin concentrations measured in rats have demonstrated substantial fluctuations which correlate with activity level as well as 8 cycles over a 24 hour period. Measurement of adrenal blood flow in dogs showed no times where there was not a significant difference between sides in conjunction with a 90 minute cycle. It was also observed that the right adrenal gland weighed more than the left. Corticotrophin-releasing hormone from the hypothalamus directed to the pituitary to signal adrenocorticotropic hormone (ACTH) release has shown to have a lateralized alternating ultradian rhythm during the day as well as being coupled to REM and NREM sleep. During R sympathetic/L parasympathetic states there is a stronger hunger drive that is associated with increased salivary flow, stomach contractions, and gastric acid production. Gastric pH has been shown to fluctuate between 1.07-5.5 hour periods with cycles averaging around 2-3 hours. Increased gastric acidity is coupled with decreased motility while increased motility is enhanced during the REM stage. During sleep, 100 minute gastric cycles have been found to be loosely related to REM stages.

Growth hormone (GH) secretion is paired with NREM sleep while lutenizing hormone (LH) is coupled to the REM stage. It has been shown that an injection of lutenizing releasing hormone in men (but not women) prevents improvement in a spatial orientation task but enhanced performance in a verbal fluency task further deducing that LH is correlated with left hemisphere function.  Testosterone production via the pituitary-gonadal axis is linked to cortisol secretion thus coupling with the pituitary-adrenal axis. Testosterone secretion is also associated with penile tumescent cycles, and REM sleep. Parathyroid hormone, elevated calcium levels, and endorphins are paired with REM sleep. Prolactin production is correlated with NREM cycles.

Other examples of ultradian cycles and lateralization are:

• Oxygen consumption in a resting state demonstrates cyclic patterns of about 90 minutes.
• Body temperature has an ultradian rhythm where a rise is associated with increased grip strength and thus left hemisphere dominance.
• Cerebral rhythms impact immune function. It has been shown that lateralized neocortical lesions affect spleen weight, thymus weight, number of T cells, percent of helper T cells, percent of cytotoxic/suppressive T cells, and antibody production, T and B lymphocyte proliferation, and natural killer cell activity.
• A case of a woman with multiple personality disorder revealed significant hemi differences depending on which personality (aggressive vs. timid) state she was in. In the aggressive state, there was a pattern of hypersensitivity to touch, smell, vision, on the right coupled with increased right nasal clarity. Salivation and abdominal reflexes were also reduced, pupils were constricted, and there was absent sweating on the sole and palm. When she switched over to the timid personality, these lateral findings shifted over to the left side of the body.
• The right adrenal gland averages 1.8 g vs the left at 1.3 g.
• When babies are born they can exhibit unilateral harlequin color changes.
• Perspiration can occur laterally on one side of the body. Lying on a side can cause increased perspiration of the superior side. This effect can be mimicked by manual pressure to the axillary point near the 5^th intercostal space which can result in contralateral increased sympathetic tone.

The hypothalamus couples the BRAC, nasal cycle, sleep stages, eating-oral-gastric activity, pituitary cycles, and cerebral rhythms. It is the main regulator responding to the needs of the individual and environmental stressors. More specifically, the suprachiasmic nucleus, a part of the hypothalamus sitting above the optic chiasm seems to regulate these rhythms. It is hypothesized that stress may be induced if rhythms become out of sync, demonstrate altered temporal characteristics, or cease to alternate. In other words, if a pattern becomes locked in an ergotrophic state of increased left brain and right sympathetic dominance, patterns of stress sequelae may ensue. The “Integrative Systems Model of Stress and its Potential Clinical Patterns” (Carr, 2014) may explain some of the possible manifestations of a stressed system.

It is a logical correlation to connect the prevalent asymmetrical right body neuromuscular dominance controlled by the left hemisphere with the dominant right sympathetic nervous system, right nasal cycle, and ergotrophic state. This common pattern of existence is quite prevalent in modern society. Many individuals are functioning in a narrowly focused, egocentric, objective reality characterized by left hemisphere dominance. This dominance is being fueled by both the natural physiological evolutionary development of our powerful language, reasoning, and motor control skills in addition to a culture that prizes rewards thus further reinforcing these traits.

In order for the asymmetrical body to exist in a healthy and balanced state, it is essential for it to be able to fully shift between both the left and right sides. This is imperative for not only the neuromuscular system but the autonomic, central nervous, endocrine, and gastrointestinal systems as well. There needs to be an appropriate balance between lateralized ergotrophic and trophotropic states for efficient energy conservation, production, and system restoration. Furthermore, health care practitioners utilizing an approach focusing primarily on movement with the goal of achieving proper left to right neuromuscular shifting may also consider the impact they are having on other systems in the body and vice versa. It is possible that as one gains better neuromuscular ability to ground through their left leg they are also facilitating their nondominant right cerebral cortex, left sympathetic nervous system, right parasympathetic nervous system, and trophotropic state.

How can one facilitate alternating rhythms within an asymmetrical system?

1. Learn how to breathe properly. Most R sympathetic/L hemisphere dominant individuals are predominantly in a respiratory state of inhalation (L>R), not properly exhaling, nor properly using their diaphragm which is associated with increased neck tension. The neck muscles then attempt to compensate for reduced diaphragm function. This is coupled to inefficient postural patterns putting additional stress and strain on the body. Be aware of your breathing pattern. If you tend to hold your breath and breathe shallowly and rapidly then you are not breathing correctly and need to focus on longer exhalation periods. A great breathing technique to help decrease R sympathetic/L hemisphere dominance is to inhale gently through the nose (with your tongue resting on the roof of your mouth) over the course of a few seconds, purse your lips (teeth apart) and slowly exhale for 7-8 seconds, followed by a 4 second pause. This can be repeated 4-5 times. Yoga techniques associated with alternating nostril breathing can potentially facilitate better ultradian rhythms. Alternating nostril breathing has been shown to impact angina pectoris. Forced right nostril breathing has shown to increase blood glucose while left lowers. Finally, deviated septums and other factors negatively impacting the ability to primarily nasally breathe can potentially affect ultradian rhythms. If you are unable to breathe through your nose it is in your best interest to address this problem. Finally, your tongue should normally rest on the roof of your mouth (palate) during all activity except eating, drinking, and talking. This provides a beneficial expansion force to the palate, helps decrease excessive muscle tension in the body, and facilitate nasal breathing.

2. Learn how to properly shift and synchronize your body between right and left stance phases of walking. Typically, the human body needs to be better able to shift into left stance phase. The following is an activity to help facilitate this ability. If you are unable to perform this exercise or it creates pain you likely need the assistance of a professional to guide you for proper training and neuromuscular re-education.

Left Stance Phase Training

1. Place the majority of your weight through your left leg. Your right foot will be placed in front of the right as if you were walking.
2. Feel the center of your left heel pushing down into the floor. Imagine your tailbone anchoring down to your heel.
3. Left knee should be unlocked and slightly bent.
4. You should be able to feel the front of your left thigh (quad), inner thigh (hamstrings and adductors), and buttocks (gluts) engage.
5. Pelvis should be slightly rotated to the left. Your zipper should be aligned with your left big toe.
6. Engage your left abdominals by reaching down to the ground with the left arm 1-2 inches. This will slightly sidebend your trunk to the left. Your left shoulder will be slightly lower than your right shoulder.
7. Reach forward with your left arm and backwards with your right arm.
8. Fully exhale and allow your ribs to drop down into your belly.
9. Gently bite down with your left teeth (biscuspids/molars) only. Try to not have any teeth touching on the right.
10. Keep head straight or turned to the right. Look to the left with your eyes only.
11. Keeping your tongue on your palate, inhale and exhale through nose. Pause 4 seconds after each exhale. Allow your ribs to drop down as you exhale.
12. Repeat for 4-5 breaths. Perform periodically throughout the day.

3. Learn how to manage your stress levels and experience a relaxed and regenerative state of being at least during some parts of your day. This will help engage the typically nondominant R parasympathetic/L sympathetic state. The following articles ((“The Flow of Open Focus” and “Rediscovering our Rhythmical Connection to Nature”) (Carr, 2015a) (Carr, 2015b)) discuss how being in natural environments as well as modulating the way you focus can help facilitate this.

4. Engage in enjoyable rhythmical activities. Because our systems are entrained to be alternating, participation in one type of rhythmical activity such as walking can potentially help the other systems shift. Other examples are listening to music, being in nature, dancing, and Thai Chi. Even our primal procreation method is based on rhythm!

References

Arun, C. P. (2004). The importance of being asymmetric: The physiology of digesta propulsion and earth and in space. Annals New York Academy of Sciences. doi:10.1097/JAC.0b013e3181e62bf3

De Theije, C. G. M., Wu, J., Da Silva, S. L., Kamphuis, P. J., Garssen, J., Korte, S. M., & Kraneveld, A. D. (2011). Pathways underlying the gut-to-brain connection in autism spectrum disorders as future targets for disease management. European Journal of Pharmacology, 668. doi:10.1016/j.ejphar.2011.07.013

Domellöf, E. (2006). Development of functional asymmetries in young infants: A sensory-motor approach. Umeå University, Sweden. Retrieved from http://www.diva-portal.org/smash/get/diva2:144424/FULLTEXT01.pdf

Fehmi, L. (2008). The Open Focus Brain.

Horvath, K., & Perman, J. a. (2002). Autism and gastrointestinal symptoms. Current Gastroenterology Reports, 4, 251–258. doi:10.1007/s11894-002-0071-6

Joganic, J. L., Lynch, J. M., Littlefield, T. R., & Verrelli, B. C. (2009). Risk factors associated with deformational plagiocephaly.Pediatrics, 124, e1126–e1133. doi:10.1542/peds.2008-2969

Joseph B. Hellige. (1996). “Hemispheric asymmetry for visual information processing.” Acta Neurobiol. Exp., 56, 485–497.

McManus, C. (2003). Right Hand Left Hand: The Origins of Asymmetry in Brains, Bodies, Atoms, and Cultures.

Nichols, W. J. (2014). Blue Mind: The Surprising Science That Shows How Being Near, In, On, or Under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do.

Pottenger, F. (1945). Effect of Heat-Processed Foods and Metabolized Vitamin D Milk.

Price, W. A. (2009). Nutrition and Physical Degeneration.

Rönnqvist, L., Hopkins, B., Van Emmerik, R., & De Groot, L. (1998). Lateral biases in head turning and the Moro response in the human newborn: Are they both vestibular in origin? Developmental Psychobiology, 33, 339–349. doi:10.1002/(SICI)1098-2302(199812)33:4<339::AID-DEV5>3.0.CO;2-R

Shannahoff-Khalsa, D. S. (1991). Lateralized rhythms of the central and autonomic nervous systems: Implications for stress, adaptation and psychopathology. International Journal of Psychophysiology, 11, 76. doi:10.1016/0167-8760(91)90317-Q

Vallortigara, G., & Rogers, L. J. (2005). Survival with an asymmetrical brain: advantages and disadvantages of cerebral lateralization. The Behavioral and Brain Sciences. doi:10.1017/S0140525X05000105

Wolpert, L. (2005). Development of the asymmetric human. doi:10.1017/S1062798705000682

Zaidi, Z. F. (2011). Body Asymmetries : Incidence , Etiology and Clinical Implications. Australian Journal of Basic and Applied Sciences, 5(9), 2157–2191.

Postural Restoration Institute. https://www.posturalrestoration.com/

Wikipedia. Suprachiasmic Nucleus. http://en.wikipedia.org/wiki/Suprachiasmatic_nucleus

Carr, H. (2014). The Integrative Systems Model of Stress and Its Potential Clinical Patterns. http://heathercarrdpt.com/integrative-systems-model/

Carr, H. (2015a). Rediscovering our Rhythmical Connection to Nature. http://heathercarrdpt.com/uncategorized/rediscovering-our-rhythmical-connection-to-nature/

Carr, H. (2015b). The Flow of Open Focus. http://heathercarrdpt.com/uncategorized/the-flow-of-open-focus/

In a healthy gastrointestinal tract, hunger signals from the brain initiate the digestive process by stimulating the secretion of saliva and gastric juices in preparation for food consumption. Upon entry into the mouth, mastication further stimulates digestive enzymes and gastric acid production in addition to mechanically breaking down food. Proper swallowing allows the bolus (chewed food) to pass into the esophagus, through the lower esophageal (cardiac) sphincter, and into the stomach.

Normal stomach acidity is between 1.5-3 pH and maintained via the production of HCL (hydrochloric acid) from the parietal cells of the stomach lining which are coated with a protective layer of mucous. The hormone gastrin (released in the antrum of the stomach), the neurotransmitter acetylcholine, and histamine (released from enterochromaffin-like (ECL) cells) are all involved in stimulating the parietal cells. Parietal cells are also responsible for creating intrinsic factor which is required for proper Vitamin B12 absorption.  Chief cells in the stomach secrete enzymes that digest proteins (pepsin) which are only activated in the presence of adequate HCL levels. It is the acidity levels in the stomach that allow nutrients such as calcium, zinc, magnesium, iron, vitamin B12, and folic acid to be properly prepared for bioabsorption.

Muscular contractions of the stomach also help to mechanically digest the bolus eventually creating chyme which passes through the pyloric sphincter into the first part of the small intestine, the duodenum. It is the level of acidity of the chyme (which gets less acidic as it reaches the lower sections of the stomach due to the release of the somatostatin which slows gastric acid secretion) that triggers the next level of digestive events to properly occur. The acidic pH of the chyme stimulates the production of secretin which results in the release of pancreatic enzymes to further aid in digestion as well as the hormone cholecystokinin to facilitate the gallbladder to release bile for fat emulsification. The pancreas also responds to the acidity levels by producing bicarbonate to raise the pH of the chyme for continued transit along the small intestine. Without bicarbonate being triggered, the duodenum may be subject to developing ulcers.

In a normal system, once the mass has passed through the small intestine, much of the nutrients have been absorbed at this point. It now enters the large intestine via the iliocecal valve for further processing. The large intestine is the home to numerous colonies of beneficial (probiotic) bacteria which act in a symbiotic relationship with us. They help to further extract nutrients such as Vitamin K and B1, 2, and 12 and produce butyric acid which serves to nourish the colon. In a dysfunctional system where maldigested and malabsorbed food is being passed into the large intestine, dysbiosis may occur with pathogenic yeast and bacterial colonies outcompeting the probiotic ones. This can create inflammation, further nutrient deficiencies, and constipation further feeding the cycle.

In addition to enabling proper digestion of nutrients, a properly acidic stomach also prevents the overgrowth and invasion of pathogenic bacteria and yeasts. This includes H pylori bacterial overgrowth in the stomach which is associated with cancer and further dysregulated stomach acid production. When stomach acid is deficient, the undigested carbohydrates, fats, and proteins ferment, rancidify, putrify, and do not move forward into the small intestine propagating more dysbiosis. Pathogenic bacteria in the stomach and small intestine may further impair digestion by inhibiting bile salts and carbohydrate metabolism, facilitate water loss via diarrhea, and steal vital nutrients such as amino acids, vitamin B12, and folic acid producing toxins in the process. Without proper protein digestion due to inadequate acidity levels coupled with pathogenic bacterial consumption of essential amino acids there will be reduced production capability of vital neurotransmitters such as serotonin and norepinephrine. Deficiency of these neurotransmitters is associated with depression and chronic fatigue.  Finally, the stasis of this rotting mass and resulting gases can build up and create reflux through the cardiac sphincter and irritate the esophageal tissue which is not designed to handle acidity. Therefore, it is ultimately a lack of acidity in the stomach that leads to gastroesophageal reflux disease (GERD).

As the toxic mass of improperly digested food eventually gets pushed into the small intestine it can create further damage to the villi and microvilli lining it. This will significantly impact the small intestine’s ability to absorb nutrients. If degradation of the small intestine’s lining continues these improperly digested food particles will leak out of the GI tract and into the bloodstream. The immune system reacts to these foreign particles as a pathogen and thus mounts an inflammatory response against them. This is how food sensitivities and allergies can develop. The immune system then starts to mistake similar chemical protein structures in the body such as the thyroid and other endocrine glands, connective tissues, nerve cells, and/or joints as pathogenic and autoimmune dysfunction can occur.

The concept of low stomach acidity as the real issue with digestive problems is in direct conflict with the current standard medical perspective that it is too much acid that creates the symptoms of heartburn and GERD. When the putrefied contents of the stomach leak out of the lower esophageal sphincter they are still relatively acidic and thus will damage the esophageal cells. However, the problem is that the mass is not acidic enough to allow the rest of the digestive cascade to properly occur. The practice of prescribing acid inhibitors (antacids, histamine (H2) blockers, and proton pump inhibitors) for managing reflux symptoms may temporarily relieve symptoms but is inherently exacerbating the problem.

There are a number or reasons why the medical community continues to epidemically prescribe acid blocking medications for GERD and indigestion problems. Probably the biggest one is the powerful influence the pharmaceutical industry has over doctors in addition to the general public through advertising. John Oliver recently did a story on “Big Pharma” (https://www.youtube.com/watch?v=YQZ2UeOTO3I) which gives further insight into this problem in a humorous manner. Furthermore, since drug companies are primarily driven by financial profits they will create products and patents that enable this. Many of the remedies that are suggested for stomach acid deficiency are inexpensive, natural, and thus not lucrative. Therefore, such treatments are unlikely to be promoted over profit inducing options. Furthermore, the process of getting approved by the FDA is very expensive and time consuming which further discourages small companies from producing herbal and homeopathic remedies and gaining traction in the medical community.

This leaves consideration of what natural treatment options are available to properly restore stomach acidity levels and thus improve digestive function further down the gastrointestinal tract. Below is a list of the “top 10” suggestions:

1. Eliminate/reduce processed foods, grains (in particular gluten and non-sprouted), soda, sugar, caffeine, and alcohol. These types of food choices create additional strain on the stomach and esophageal sphincter.
2. Consume smaller sized portions.
3. Get parasympathetic. Proper digestion requires the autonomic nervous system to shift into a “rest and digest” phase. Eat meals in a relaxed manner and environment. Appreciate and truly enjoy what you are eating.
4. Thorough chewing is essential to properly initiate the digestive process. Spend time chewing on each side of your mouth taking about 30 seconds per bite of food.
5. Re-evaluate your current medications as they may be impeding your digestion. Bronchodilators, NSAIDS, certain calcium channel blockers and beta-blockers, Valium, Demerol, and Nitroglycerine can weaken the lower esophageal sphincter and muscles of the GI tract. Aspirin, NSAIDS (ibuprofen, naproxen), and some antibiotics (tetracycline) can directly irritate the stomach lining.
6. Do not eat within 3-4 hours of going to bed. Use the force of gravity by being upright after eating to facilitate digestive transit.
7. Consider doing an elimination diet of potential food allergies and sensitivities. The most common culprits are pasteurized dairy, grains (particularly gluten), soy, corn, and sugar. It is also possible to use your heartrate as a measure of food sensitivities. Take a 1 minute heartrate to establish a baseline in the seated position. Place the suspected food on your tongue for 30 seconds to establish the taste of it. While keeping it on your tongue retake your pulse. An increase of 6 or more beats per minute is indicative that the food is a stress to your system. You may spit out the food and test another in the same manner.
8. If the esophagus and stomach are currently in a state of inflammation care must initially be directed at healing these tissues. Therefore, avoiding acidic foods (citrus, coffee) may be necessary initially. Professional assistance may likely be needed to guide one through this process of regeneration.
9. The use of bitters, lemon water, or vinegar may help facilitate HCL production in the stomach. HCL and/or enzyme supplementation as well as numerous other nutritional and herbal remedies may be needed. Examples include wormwood, milk thistle, deglycyrrhizinated licorice (DGL), vitamin B12 (injection or oral), vitamin C, vitamin A, L-glutamine, zinc, turmeric, ginger, chamomile, probiotics, and many other options exist. Professional guidance is likely needed to help with the use of these treatment options.
10. Last but certainly not least: Learn how to breathe and move properly. Efficient diaphragmatic excursion coupled with three dimensional rib cage deformation that should naturally occur during walking is necessary to facilitate gastrointestinal transit in addition to peristaltic contractions. The forces imparted by the thoracic respiratory cavity via gait and diaphragmatic breathing are transferred to the abdominal cavity in a pumping fashion to help propel intestinal contents. Good diaphragmatic function serves to constantly massage the stomach also contributing to stomach acid production. Furthermore, nasal breathing is desired over mouth breathing. Chronic mouth breathing is associated with orofacial dysfunction which can impact swallowing ability. Poor swallowing can result in the ingestion of air into the stomach and gut further degrading the digestive process. Furthermore, mouth breathing also impacts proper gas exchange and is associated with increased sympathetic tone (stress response). This can perpetuate food sensitivities and autoimmune reactions. The assistance from a professional with expertise in breathing, movement, and orofacial therapy may be needed.

References

Arun, C. P. (2004). The importance of being asymmetric: The physiology of digesta propulsion and earth and in space. Annals New York Academy of Sciences. doi:10.1097/JAC.0b013e3181e62bf3

Matteoli, G., & Boeckxstaens, G. E. (2012). The vagal innervation of the gut and immune homeostasis. Gut, 62(8), 1214–1222. doi:10.1136/gutjnl-2012-302550

Boeckxstaens, G. E. (2013). The Clinical Importance of the Anti-Inflammatory VagoVagal Reflex.pdf. In R. M. Buijis and D.F. Swaab (Ed.), Handbook of Clinical Neurology. Elsevier B.V.

De Jonge, W. J. (2013). The Gut’s Little Brain in Control of Intestinal Immunity. ISRN Gastroenterology, 2013, 630159. doi:10.1155/2013/630159

Wright, J and Lane, L. (2001). Why Stomach Acid is Good for You.

To read Part 1: The Prevalence of Human Asymmetry and Lateralization click HERE

To read Part 2: What Does Asymmetry Provide for a Human Being? click HERE

To read Part 3: How Did Humans Become Asymmetric? click HERE

Perhaps as a consequence of our asymmetry there are some subsequent negative aspects? Zaidi states that “symmetry in bilateral traits are highly correlated with the amount of stress experienced during development. Adaptive development requires the organism to resist genetic and environmental stresses that disrupt the genetic plan for growth, a buffering capacity termed developmental stability. Individuals are presumably buffered against such developmental insults by employing homeostatic mechanisms to produce the ideal phenotype. Developmental instability is revealed by fluctuating asymmetry, thus fluctuating asymmetry is often used as a proxy to quantify developmental stressors and explore the effects of these developmental perturbations on an organism’s health, fitness, and behavior. The effect of developmental perturbations on an organism’s functional asymmetry level appears to be trait-, sex-, and stressor-specific and dependent on the developmental stage of the individual.” (Zaidi, 2011) It is argued that more symmetric people tend to be more intelligent, have a better memory, and are less impaired by drugs. They also tend to have a higher basis for sexual attraction. From a biomechanical perspective, it is reasonable to assume that mechanical asymmetry can create inefficient distributions of stress and strain in a system of paired parts.

What is not typically accepted amongst the healthcare community is that the neuromuscular postural system is asymmetrical. It is normal and common for individuals to favor standing on their right extremity in addition to using their right hand. This is due to a number of influences. The first being brain lateralization where a dominant left hemisphere for motor tasks favors right body dominance. The next driver, and probably the most significant, is asymmetrical organ arrangement. Because of the right sided liver positioning underneath the right diaphragm, there is a cephalic directed pressure up against the diaphragm. This actually helps maintain a proper functional domed position of the diaphragm on the right with apposition against the basal internal rib cage called the zone of apposition. Maintaining a proper zone of apposition is crucial for efficient respiratory function. On the other hand, the left diaphragm does not have as big of a piston (stomach) underneath it driving it superiorly and thus is not able to maintain as good of a zone of apposition. Furthermore, the girth and power of the diaphragm differs side to side. The right hemidiaphragm (perhaps in evolutionary developmental response to the force of the liver) is thicker and stronger than the left. As a result of the biomechanical and power disparity between the two sides, the right hemidiaphragm attachments to the spine (~T8-L3) will rotate the spine to the right. Due to this anatomical finding amongst all human beings (except in cases of situs inversus where the organs are reversed to the other side) this will be the prevalent asymmetrical postural pattern regardless of handedness. Furthermore, due to a higher population frequency of right handedness, our society reinforces this asymmetry via environmental adaptations geared for the right handed individual who prefers to stand on their right leg. However, even in a left handed individual, the torsion imparted through the body due to the asymmetrical diaphragm will also propel them to favor standing on their right leg. This is not to completely discount situations where people may prefer to stand on their left leg or both legs. In these cases, it is maintained that these behaviors are typically a result of compensation and adaptation that has occurred in response to the right leg dominance. In other words, individuals who habitually stand on both legs or the left are attempting to find more of their left leg. The question then becomes “Are they properly accomplishing this with synchronized integration throughout the rest of their body?”

Due to the right T8-L3 spinal torque driven by the asymmetrically powered and positioned diaphragm there is a resultant pattern of compensation throughout the body in an effort for the limbs to be oriented in a forward progression state parallel with the face and eyes. The result of this force creates a domino effect of three dimensional compensation occurring superiorly all the way up to the craniomandibular and visual systems and inferiorly down to the feet. Essentially, every human being has some degree of three dimensional curvature in their spines and body. The ultimate result of this tri-planar postural torsion is that we have a pattern of primarily functioning in the right stance phase of gait. Another particularly significant consequence of this spinal torque is the effect it has on rib cage positioning and subsequent respiratory mechanics. Essentially, the left side of the rib cage is relatively externally rotated (over-inflated) compared to the internally rotated (under-inflated) right. This respiratory pattern induces additional compensatory mechanisms in the body, particularly in the cervico-cranio-mandibular system.

This abundantly prevalent state of asymmetry amongst humans has huge implications for any healthcare professional dealing with the neuromuscular system. Essentially, because the left and right sides of the body are positioned differently, there are resultant differences is muscle length influencing force production capabilities. Muscles that are shorter and stronger on one side of the body tend to be longer and weaker on the other. Therefore, they must be treated differently. Ron Hruska, the founder of The Postural Restoration Institute (PRI) is the pioneer of this concept amongst the healthcare community. This institute’s core philosophy is grounded in the tenet that the neuromuscular postural system is asymmetrical and thus treats the left and right sides of the body very differently depending on the possible predictable patterns present.

The Postural Restoration Institute also maintains that there is a neuromuscular coupling amongst chains of muscles that correspond to being either in right stance (dominant) or left stance (nondominant) of the gait cycle. Essentially, the body has two functional neuromuscular phases and within each phase there must be a 3 dimensional synchrony of movement and coordination from the foot up through the entire body including the jaw, cranium, vestibular, and visual systems. Any glitch in the chain can impact the rest of it. However, due to the inherent predictable pattern of asymmetry previously explained, there are common patterns of dysfunction that can be reliably tested and treated using the PRI approach.

There is another important consideration when interacting with a 3 dimensional asymmetrically torqued body which involves a paradigm shift from traditional manual therapy approaches. When the body is in an asymmetrical position there will be a change in orientation amongst all the involved joints. For example, because the pelvis and lumbar spine are typically oriented to the right, the femurs will compensatorily rotate (externally on the left and internally on the right) to maintain an aligned forward facing position. The resulting changed femoral acetabular relationships will also reflect ROM discrepancies. For example, in an intact left femoral acetabular joint (meaning secure joint capsule and ligamentous support) because the femur is already rotated externally it will display decreased excursion going in that direction and increased range of motion going into internal rotation. In the traditional manual therapy world, this would be interpreted as a left hip joint restriction and range of motion limitation for external rotation when in reality it is the malposition that is dictating this presentation. Therefore, to mobilize for external rotation would actually perpetuate the problem and potentially create ligament and joint capsule hypermobility.

The principles explained in the example at the hip can be applied to any other joint in the body. It can be a bit overwhelming to consider the impact this concept has on how manual therapists assess and treat. It is therefore imperative to consider the relative orientation and compensatory position of the entire body when deciding if a particular segment or region is truly restricted from a connective tissue “tightness” or due to malposition. The only true way to know if a segment is restricted is to restore a neutral rest position of the suspected segments and then test for restriction. The Postural Restoration Institute teaches how to successfully negotiate these issues.

In conclusion, the bottom line challenge of dealing with an asymmetrical postural system is that it biases the body to function on the right more than the left. This has major implications for the primary human function of walking which requires a rhythmical shifting between the right and left sides of the body. If the body becomes excessively grounded on the right side they will not properly alternate over to the left. This can set the system up for biomechanical and respiratory imbalance. Furthermore, there are additional systems in the body that also display asymmetrical tendencies with side to side rhythm that may become stuck.  Part 5 of “Asymmetry, Lateralization, and Alternating Rhythms of the Human Body” will expound on this.

References

Arun, C. P. (2004). The importance of being asymmetric: The physiology of digesta propulsion and earth and in space. Annals New York Academy of Sciences. doi:10.1097/JAC.0b013e3181e62bf3

De Theije, C. G. M., Wu, J., Da Silva, S. L., Kamphuis, P. J., Garssen, J., Korte, S. M., & Kraneveld, A. D. (2011). Pathways underlying the gut-to-brain connection in autism spectrum disorders as future targets for disease management. European Journal of Pharmacology, 668. doi:10.1016/j.ejphar.2011.07.013

Domellöf, E. (2006). Development of functional asymmetries in young infants: A sensory-motor approach. Umeå University, Sweden. Retrieved from http://www.diva-portal.org/smash/get/diva2:144424/FULLTEXT01.pdf

Fehmi, L. (2008). The Open Focus Brain.

Horvath, K., & Perman, J. a. (2002). Autism and gastrointestinal symptoms. Current Gastroenterology Reports, 4, 251–258. doi:10.1007/s11894-002-0071-6

Joganic, J. L., Lynch, J. M., Littlefield, T. R., & Verrelli, B. C. (2009). Risk factors associated with deformational plagiocephaly.Pediatrics, 124, e1126–e1133. doi:10.1542/peds.2008-2969

Joseph B. Hellige. (1996). “Hemispheric asymmetry for visual information processing.” Acta Neurobiol. Exp., 56, 485–497.

McManus, C. (2003). Right Hand Left Hand: The Origins of Asymmetry in Brains, Bodies, Atoms, and Cultures.

Nichols, W. J. (2014). Blue Mind: The Surprising Science That Shows How Being Near, In, On, or Under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do.

Pottenger, F. (1945). Effect of Heat-Processed Foods and Metabolized Vitamin D Milk.

Price, W. A. (2009). Nutrition and Physical Degeneration.

Rönnqvist, L., Hopkins, B., Van Emmerik, R., & De Groot, L. (1998). Lateral biases in head turning and the Moro response in the human newborn: Are they both vestibular in origin? Developmental Psychobiology, 33, 339–349. doi:10.1002/(SICI)1098-2302(199812)33:4<339::AID-DEV5>3.0.CO;2-R

Shannahoff-Khalsa, D. S. (1991). Lateralized rhythms of the central and autonomic nervous systems: Implications for stress, adaptation and psychopathology. International Journal of Psychophysiology, 11, 76. doi:10.1016/0167-8760(91)90317-Q

Vallortigara, G., & Rogers, L. J. (2005). Survival with an asymmetrical brain: advantages and disadvantages of cerebral lateralization. The Behavioral and Brain Sciences. doi:10.1017/S0140525X05000105

Wolpert, L. (2005). Development of the asymmetric human. doi:10.1017/S1062798705000682

Zaidi, Z. F. (2011). Body Asymmetries : Incidence , Etiology and Clinical Implications. Australian Journal of Basic and Applied Sciences, 5(9), 2157–2191.

Postural Restoration Institute. https://www.posturalrestoration.com/

Wikipedia. Suprachiasmic Nucleus. http://en.wikipedia.org/wiki/Suprachiasmatic_nucleus

Triglycerides provide the most concentrated source of energy for the body. They are composed of glycerol and 3 fatty acid molecules. The body and brain can efficiently use fat as the primary source of fuel in the form of ketones and free fatty acids instead of glucose derived from carbohydrates. Once broken down into its constituents, glycerol may be converted into glyceraldehyde 3-phosphate that may then be formed into either glucose to be used directly by the body or pyruvic acid for ATP production via the Krebs cycle. These catabolic reactions may also be reversed and triglycerides may be created via anabolism.

The fatty acids that are attached to the glycerol backbone may be classified as either saturated, monounsaturated, or polyunsaturated which will dictate what functions they fulfill in the body as well as their inherent chemical stability.  The saturation level of fat is determined by the number of carbon bonds occupied by a hydrogen atom. If 2 hydrogen atoms are missing then a double bond between two carbon atoms ensues (monounsaturated) creating a kink in the chain of molecules. Polyunsaturated fats have two or more pairs of double bonded carbon atoms creating more than one kink in the molecular chain. Saturated fat’s carbon atoms are completely filled with hydrogen atoms making them the most solid and stable fat. The more unsaturated (polyunsaturated) a fat becomes the more unstable it is. These types of fat will be liquid at room temperature and be more susceptible to becoming rancid.  Animal fats are highest in concentration (40-60%) of saturated fats. Saturated fats exist in the body because they are stable and resist oxidation. However, the body needs all types of fat. Examples of polyunsaturated fats that are essential (can only be obtained via diet) to the human body are linoleic (omega-6) and linolenic (omega-3). The current government dietary recommendations are to receive up to 30% of calories from polyunsaturated fats whereas some sources (Fallon, 2003) believe a better value of polyunsaturated fats is ~4% with the majority of the total fat coming from quality saturated and monounsaturated fats. Of this 4% of polyunsaturated fats, Ms. Fallon recommends ~1.5% from omega 3 and ~2.5% from omega 6. Typically, the American diet is particularly lacking in omega-3 linolenic acid which is important for cellular respiration, metabolizing sulphur amino acids, and balancing prostaglandins.

Fats can be further classified according to the number of carbon atoms. Short chain (4-6 carbon atoms) are always saturated, have anti-microbial properties, and assist with immune function. Examples include butyric acid (butterfat) and capric acid (goat butterfat). Bile salts are not needed for their metabolism as they are directly absorbed into the bloodstream providing energy. These types of fats are less likely to cause weight gain. Medium chain (8-12 carbon atoms) have similar properties to short chain and include tropical oils. Long chain fatty acids (14-18 carbon atoms) can be saturated, monounsaturated, or polyunsaturated. Examples include stearic acid (beef), oleic acid (olive oil), palmitoleic acid (animal fats including antimicrobial properties), and gamma-linolenic acid (GLA) (comprises prostaglandins and hormones).  Very long chain fatty acids (20-24 carbon atoms) tend to be highly unstable yet are still a necessity for the human body. Some individuals have the ability to synthesize these better than others. If one’s ancestors ate a lot of fish they typically do not have the ability to make these types of fatty acids on their own requiring increased dietary intake (meats, yolks, butter, fish oil). The most important ones are dihomo-gamma-linoleic acid (DGLA), arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic (DHA). These all have important roles with regards to optimal nervous system function.

Fat is absolutely essential for the human body to thrive. In particular, we need saturated fats and cholesterol which are primarily obtained through animal fats. In addition to providing energy, fat and cholesterol are necessary for the following in our system:

• Comprise hormones
  • Cholesterol is involved in the synthesis and regulation of adrenal and steroid hormones (estrogen, progesterone, testosterone, adrenaline, cortisol, DHEA, vitamin D, pregnenolone)
• Make up cell membranes (phospholipids)
• Protect the liver from alcohol
• Essential for developing children. Breast milk has 50% fat, mostly saturated.
• Enhances immune function
• Supplies the heart with energy
• Balances the microbiota in our gut
• Vital nutrients come from fat and cholesterol and are regulated by them.
  • Convert carotene to true vitamin A (retinol)
  • Assist with absorption of calcium and play a role in bone metabolism
  • Examples of fat derived nutrients include coenzyme Q10, taurine, EPA, conjugated linoleic acid, linolenic acid, glutathione, L-carnitine, vitamin A, E, D, K, anti-homocysteine vitamins B6, 12, folic acid, lipoic acid, magnesium, zinc, and sulphur
  • Needed for proper use of dietary protein.

Cholesterol is derived from fat and is absolutely essential for proper cellular, organ, and system regulation.  90% of dietary cholesterol we consume is reabsorbed by the gut so it can be used again. Every cell can manufacture its own supply but this process is not efficient and puts stress on the liver. Reduction of cholesterol consumption signals crisis and famine to the body facilitating the liver enzyme HMG-CoA reductase to produce cholesterol from carbohydrates which can strain the liver under chronic demand. Therefore, it is best to consume cholesterol vs. rely on liver production via carbohydrates. It is of significance that statin pharmaceuticals inhibit HMG-CoA reductase at the cost of depleting the nutrient CoQ10 (important for heart function) and overburdening the liver. Such demand on the liver may ensue damage which will render the liver not able to produce C-reactive protein, a marker of inflammation. Therefore, in cases where the use of statins is associated with a reduction in C-reactive protein may actually be due to the statins’ negative impact on liver function vs a true inflammatory reduction.

Our medical culture is fixated on LDL (low-density lipoproteins) and HDL (high-density lipoproteins) ratios. Typically, it is recommended to have an LDL level lower than 130 mg/dL and HDL higher than 46 mg/dL with total levels no more than 200. Levels of HDL/LDL reflect transport mechanisms for cholesterol and not actual cholesterol levels. LDL takes cholesterol away from the liver to the extremities, organs, and makes hormones. HDL cholesterol removes excess cholesterol from the body tissues to the liver for elimination. Cholesterol travels to areas of inflammatory damage to patch up lesions.  A high level is an indicator that an inflammatory process may be occurring that the body is attempting to compensate for. Some sources (Gedgaudas, 2011) suggest that HDL levels greater than 70-75 may indicate underlying inflammatory and autoimmune issues and that an activated inflammatory peroxidase system can increase HDL levels. Very low levels of LDL may indicate low inflammation but also an inability to compensate from inflammatory reactions. This is another reason why statin drugs may not be of benefit as they will restrict the body’s natural repair systems using cholesterol. Furthermore, low levels of cholesterol are associated with increased risk of cancer, hormonal imbalance, depression, sexual dysfunction, memory loss, Parkinson’s Disease, and stroke.

Our society demonizes cholesterol and yet, as just described, it is crucial for system function. The real problem is consumption of oxidized cholesterol through highly processed foods and rancid polyunsaturated oils. Increased polyunsaturated fat intake is associated with cancer, heart disease, and immune dysfunction. Polyunsaturated fats are typically oxidized and rancid when consumed due to high temperature and chemical processing creating free-radicals. When consumed, the body incorporates these altered fats into cell membranes with negative effects on cellular metabolism.  Such chemicals can damage nuclear material and body tissues including the facilitation of atherosclerosis.

Between endothelial arterial cells are spaces that allow nutrients to pass and flow through. Lipoproteins can lodge in there, block flow, and cause an inflammatory response. Statins do not effect lipoproteins, only diet can. (Choi et al., 2010) (Gedgaudas, 2011). 80% of arterial plaque is not cholesterol or saturated fat but oxidized rancid unsaturated fats. More importantly, chronic systemic inflammation in the body can oxidize cholesterol leading to arterial plaque build-up.

Modern processing methods destroy practically all the nutritional value of food in addition to creating increased stress on the body to metabolize them. Hydrogenation turns liquid fats into solid fats at room temperature usually using cheap and already spoiled oils such as soy, corn, cottonseed, and canola. This process uses high pressure, hexane gas, metal (usually nickel oxide), and bleach. Consumption of hydrogenated oils blocks the utilization of beneficial fatty acids. They are also associated with cancer. Homogenization involves using high pressure to strain the fat particles of cream through tiny pores creating very small particles making them more susceptible to becoming rancid and oxidizing.

One must be cautious with fat consumption today because of the ease that fat soluble and water soluble poisons can accumulate in our standard sources of animal fat and water fraction of milk and meats. This includes antibiotics and growth hormones that are typically injected into most of our meat sources. It is therefore recommended to consume animal sources of fat that have been raised on organic pastures (grass fed) without the use of pharmaceutical treatments. It is also suggested to store high quality monounsaturated and polyunsaturated oils in cool dark places to minimize oxidation.  A good quality oil is typically cold pressed and minimally processed.

In conclusion, the idea that “fat, particularly saturated animal fat, and cholesterol are bad for us” is simply not true. As described above, it is essential for humans to consume fat and cholesterol for proper cellular and thus system regulation. What is important is we choose the correct types, of good quality, and in balanced ratios. Bring on the butter and throw out the margarine!

References

Choi, C. U., Seo, H. S., Lee, E. M., Shin, S. Y., Choi, U.-J., Na, J. O., … Oh, D. J. (2010). Statins do not decrease small, dense low-density lipoprotein. Texas Heart Institute Journal / from the Texas Heart Institute of St. Luke’s Episcopal Hospital, Texas Children’s Hospital, 37, 421–428.

Fallon, S. (2003). Nourishing Traditions.

Gedgaudas, N. (2011). Primal Body Primal Mind.