February 26, 2025 • 50 mins
Our guest today is Dr. David McIntosh, a Pediatric ENT Specialist with a particular interest in airway obstruction, facial and dental development, and its relationship to ENT airway problems, and middle ear disease. He is also passionate about Indigenous Health. He has undertaken advanced surgical training in ENT and Head and Neck Surgery and Pediatric training at Starship Children’s Hospital in Auckland, New Zealand.
Dr. McIntosh has been published in peer-reviewed ENT Journals worldwide, has presented on ENT topics throughout Australia and overseas, and is a Fellow of the Royal Australasian College of Surgeons. During his career, Dr. McIntosh has held memberships with the Australian and New Zealand Society of Pediatric Otolaryngology, the Australasian Rhinological Society, and the Australasian Sleep Association.
He is also the author of “Snored to Death: Are You Dying in Your Sleep?”, "A Parent's Guide to Sleep Disordered Breathing," and "Mental Health: Exploring How Problems of the Ear, Nose, and TYhroat May Affect Your Mental Health."
You can find out more about Dr. McIntosh at https://entspecialists.com.au/.
Show Notes:
- Airway obstruction and brain dysfunction in children - CAFF Blog
- Facebook for Dr. McIntosh
- Study of Sleep Apnea and Motor Vehicle Crashes - NCBI Article
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi everyone, and welcome to another video.
(00:29):
Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James.
Today we're going to jump into part two of our conversation with pediatric ENT, David Macintosh.
So let's pick up with where we left off in our conversation yesterday with epigenetics, and let's talk to Dr. David Macintosh.
(00:58):
So, but the thing, you know, look at all the things that we could mention that that that can feed into the trigger top of the list is having an airway problem leading to a sleep problem.
That is, you know, because across the board, we're talking in the range of somewhere around about 20% of children having this. And if we look at go back to the ADHD, you know, in that research study and the ones that have come, we have seen ADHD systems
(01:27):
that have gone from 25 to 50% of children after they've had surgery to relieve their airway obstruction.
Now, you go into the math on that. That's just one condition and one treatment that has been given to these children with an ADHD diagnosis, and up to half of them are then off the list.
Half of them. That's nuts. What else are we missing? What else are we missing?
(01:53):
And, you know, and they'll be, I'm sure there'll be some specialist out there in some other medical field who's probably doing the same thing with someone crying out, you know, for people to listen to them saying, hey, you know, your child with ADHD, it's not that it's dot dot dot.
And you and I don't know about it because, you know, we're not in that right. We're not just not right. And that just proves the point again, if we have to understand parents can't know about it.
(02:21):
Because if there's some specialist out there that's cotton on to, you know, some, I don't know, let's just make something up some gut problem that all you got to do is just eat this, you know, whatever from wherever.
And 20% of kids will have a transformational event. Every parent would want to know about that. Well, we're talking about breathing and sleep. We're not talking about a gut problem.
(02:45):
We're not talking about some magic super food. We're talking about the basic of breathing and sleep. I'm not talking about 20% of kids with ADHD. We're talking up to 50% of kids with ADHD.
So, you know, in terms of the elephant in the room, we are front and center in terms of where we're at. But the problem is we're just not, you know, there and, you know, as I happily do these things, you know, I just emphasise this to the parents that listen is that whenever you've come across something like this,
(03:14):
and you learned something, you just, you didn't know what you didn't know. I guarantee you, I guarantee you five of your friends don't know it either. And you know what you need to do.
You need to get them to listen to this. Okay, and then if you're already in that sort of circle of parents that have children that you know, neurodivergent neurodevelopmental management of the same.
(03:38):
And you didn't know about breathing or sleep. Well, make sure you have the whole group knows. Okay, this is this has to be a collective heavy lift where you pass it forwards.
And you give the next person the benefit of this knowledge as well. Because at the end of the day what we want is we want children to reach their full potential.
(04:01):
And we've got intrinsic potentials. You know, we're not all going to be doctors. We're not all going to be lawyers. And trust me, it's not as glamorous as it sounds.
It would be so boring if we all were right. Everybody's different. But if your child is creative and they can't sleep, they're not going to become a writer or an artist or whatever when they're older.
(04:23):
It's just not going to happen.
Yep, if we're if we're all doctors, then I guarantee you would all be walking because no one would know how to fix a car.
That's true.
And so on and so forth. So we all need to be different. You know, again, we are divergent. We need it's essential that we're divergent and so forth.
(04:45):
And in that context, we all have our interests and so forth and potential and, you know, and interests, you know, you talk about, you know, you can have examples, you know, high ranking level people, you know, could have been doctors or lawyers or business people,
and they just walk away from it all and they just go and paint.
(05:08):
And it makes them happy.
It's like, huh, all right, go listen to that little inner child that's yelling out, you know, and express that.
So yeah, so so from from that point of view, I think moving forwards.
(05:29):
We need to the those that involved with the ADHD, ASD communities to have even more awareness, even more emphasis on breathing and sleep issues and and if I talk in eyes and throat, I'm going to throw ear infections into the mix there as well.
Because the problem that particularly with these neurodivergence issues is that it makes it worse in terms of the impact. So for a child that has an ear infection, well, for a child that gets an ear infection, they get some fluid behind the eardrum that sits around for a while.
(06:10):
And they have a period of time where they can't quite hear properly. Because of the divergences and the functioning that impact is magnified extraordinarily.
So it's kind of one of those things where the rules don't apply. You know, normally say all the ear, ear infects, they got ear infections, but they're not that bad.
(06:32):
But hang on a sec. You're telling me that your child has speech and language development issues. So anything that feeds that beast, and it all gets put down to the, the, you know, the autism or gets put down to the ADHD.
It's like it becomes the excuse.
But in a natural, let's go to what the root could be. Yeah, I'm a natural fact. Having those things means that what would in the context of things be an ear infection that maybe isn't that bad is actually really quite significant for that child.
(07:07):
And that's where we take away the generalizations and we get to the specifics. And if by doing the specifics, we then, you know, focusing on the individual, then we actually have a more proactive scenario in play, because an ear infection that, you know, the parent goes,
look, every time they get an ear infection, their speech goes backwards a bit. That's significant. That's every time they get an ear infection, their behavior gets so much worse. That's significant. Okay. So that's that's that's where we just need to be mindful of things again, sort of being normalized with, you know,
(07:44):
say, stop normalizing. Yeah. Yeah. And so hang on a sec. So when your child gets an ear infection, does it really make a big difference to who they are for a while? Oh yeah. Okay. That's a big deal. Okay.
So that that's, you know, that that's where we sort of I think we need to focus and emphasize the importance of, you know, getting these things right. And there's a huge knock on effects that happened so that, you know, for example, you know, the fussy eating.
(08:19):
Well, if you can't chew properly, and you have to breathe through your mouth, which leads to it getting dry. And you want to be and you need to sort of come up for breath in between food items.
You're not going to hoe down on a big chunky juicy steak. You want to you're going to want soft, mushy processed foods. There's a problem with feeding the beast against.
(08:45):
Okay, these circle back. And they go, Oh, the child's sensory, you go, Yeah, they're sensory because they've realized they can't eat you and swallow properly. They're surviving is what they're doing, because they've worked out what's easy, they've worked out what's hard.
You know, they're going to go the easy option, they're going to go the easy route. So they're going to live off of smoothies and yogurt and anything that's been processed because it's all basically been, you know, pre chewed and pre digested by the machine for them anyway.
(09:20):
So, so there's that gravitation there. Plus, you know, it affects their sense of taste, it affects their sense of smell. So things taste weird, things smell weird to them. So that leads into it as well.
So there's all these things that start to play into it that, you know, you, you again, you just blame the ADHD, you blame the ASD for an actual fact it's a manifestation potentially, again, of some of those ear, nose and throat problems that we really want to emphasize being my bias to just say,
(10:01):
hang on a sec, have a look at the back of their throat, have they got really big tonsils, because if they do, that's going to make it really hard to swallow. And they're going to notice that it's hard to swallow and if they've got sensory tendencies, they're going to notice that way before anybody else does.
Okay, because that's going to be to them is a big deal. Right. And then it's going to become more obvious. And then it's going to be part of what gets labeled part of their spectrum of symptoms is fussy eating and, you know, oral sensitivities and the like.
(10:36):
So, you know, in fact, it could be that the tongue is not in the roof of their mouth so they're not regulating and here we go again we're back to the airway.
We're back, you know, it's a conspiracy of people are on to me everything leads to the airway. I'll call it out now.
That's what we are to say conspiracy. All right, yeah, yeah, yeah, yeah, yeah, yeah, yeah, we'll go to our secret meeting and handshakes later.
(10:59):
So, so, you know, so there's just, you know, the reason that we're so front and center with airway is because of its interplay with sleep. And, you know, that that we've got to make sleep an important topic of health.
And it is if we look at, like, your big sporting teams so you like your NFL teams are you got players there with tens of millions of dollars, you know, these are big investments that these people are, you know, representing.
(11:28):
Right. On your professional teams. Okay. So these are the teams that have got access to enormous amounts of money or enormous amounts of technology and wellness and health and, you know, just next level.
They have sleep doctors on on their on their list now, you know, used to be the team doctors were like the orthopedic surgeons and stuff. And now they have the sports psychologist because I know that's important.
(11:55):
Now they have the now they have the nutritionists, because they know that's important.
And of course now they have the sleep doctors on there as well as consultants, and they have the sleep trackers, and they're making sure that these players know because it's in their contracts.
You don't stay up until one o'clock in the morning on your phone anymore.
(12:16):
We are, we know when you are going to sleep, and we know if you are getting good sleep. Why, because good sleep is part of your overall performance on the field and that's what we're paying for you for.
And for the time that you're going to do that we own you, we own your time, and not just on the field but we you know we basically regulate a lot of what you get to do, and how you get to do it, and sleep is now on that list.
(12:43):
And that's not done in a dictatorial way or anything. It's, you know, it's in the benefit of that athlete.
And they're protecting their investment is what they're doing.
They're protecting their investment but it's good for the player as well because the player has, you know, like most of us is like, you know, I'll sleep just one of those things I get around to it's not that important to then it's like, oh, you, oh well you mean like I can perform better.
(13:06):
Hey, if I can perform better I'm going to be worth more money right.
Right. Two and two is four. I'm going to do everything I can to optimize what I can do, and so forth.
You know, so these things all, again, sort of just to emphasize if you know you want to look at you know what are the top people with you know, effectively unlimited resources doing their investing in their wellness they're investing in their sleep, they're investing in their breathing.
(13:36):
There's got to be a reason for that. You know, it's not a fad. There's got to be a reason for that. You know, so that whole you know I'll sleep when I die. Well to be honest you'll die if you don't sleep.
And it's actually been proven. So, from that point of view, we want to get you know breathing and sleep.
And just the same conversation that it needs to be about food and exercise. You know, they all need to be those level playing fields of understanding and awareness. That's just the basic thread of you know, starting at the parent level that's that's the time to catch it at its best is catch it in the child.
(14:13):
If your child's got it well, get on and we fix it whatever that is it is what it is.
At the end of the day, keep going to a provider that says and this is what we tell you don't have to say it will say it. You keep going to a provider and their responses.
Let's just watch it. No, we're not going to watch it. Or it's all poppycock. Perhaps find a new provider.
(14:35):
Be this is where advocacy comes into place because they may not know about it. But if they're open to it.
Yeah, yeah. So and again, it's I think it's helpful for the parents to have something in their back pocket. So the paper that I think is the top of the tree for this one is one that was done by a researcher called Karen Bonnock that was out of the Einstein University.
(14:58):
And that research paper was published in 2012. And it is was actually done in the United Kingdom. But what they did just so that people can understand so they they monitored 11,000 children for the first seven years of their life.
And the parents had a simple job. Does your kids snore mouth open or stop breathing at night. And these were surveys questions that were done every couple of months.
(15:26):
And that was sort of their screening process to then see what the kids breathing through the night was. And where the child had the parent observed on a consistent basis for six months from one time point to the next that the answer was yes to any of those three things.
Mouth breathing snoring stopping breathing any of those three things that child was put into the sleep disorder breathing category. And they ended up through that with about 2000 odd children, which again highlights my point that's 20% of children right there.
(15:58):
You know 2011 1000 ish at 20% of kids right there. What they did though is they did exactly what we just alluded to. They watched and waited. Okay, because that was one of the paradigms, you know, 10 years ago.
Yeah, and it was literally don't worry they'll outgrow it. And what did they find. Well, they found those 2000 kids that 20% that got the sleep disorder breathing.
(16:29):
And they did find some kids down the track that did outgrow it. But that wasn't their prime interest. Their prime interest was to look at it from a behavioral and education point of view.
And that was their outcome. So they've got the kids basically then fell into three groups. Kids, you know, it's actually broader than this but I'm going to break it down even more kids that never got sleep disorder breathing.
(16:52):
Kids have got sleep disorder breathing that hung around throughout the whole time once they got it and kids that got it where it went away.
Now let's focus on the kids that got it that went away because they're the interesting group to my mind.
They got it and then it went away. When they looked at these kids at the age of four and seven. These kids were more hyperactive.
(17:16):
Had problems with their concentration. We're prone to being aggressive had trouble relating to other kids and had troubles just in general with you know emotional regulation and behavior.
And hyperactivity was way at the top of the list. What's part of the ADHD. What's the H in ADHD. It's hyperactivity.
(17:40):
So what they found is that in the group of kids that outgrew the airway problem. They did not outgrow the consequences of brain development that came with that.
So that was the first big wake up calls like you know what we found a problem we let the kid outgrow the problem but they were left with a consequence.
(18:03):
So that's the that's the big one there and I'll come to another research element in a sec.
But within that research paper. The second thing that they found that I think is really important is the timing of things and the younger.
The child was when they first started in particular under 18 months of age that was a stand out. Okay.
(18:27):
The next stand out was two and a half the next stand out was four but the big one was 18 months of age. Okay.
The big stand out though was that the younger it started.
The more likely those problems were going to sit around and still be there regardless of whether child out or not.
The more likely they were going to have those problems show up at the age of seven. So think about that.
(18:49):
The breathing and sleep problem in a 14 month old shows up as ADHD symptoms in at seven years of age.
So the second thing is first of all they are not too young to have the problem and they are certainly not too young to get it fixed.
Okay. It is possible to happen very early on in the piece and if it does you want to get it fixed.
(19:16):
And this is the third string to the bow in terms of the papers to highlight in that context.
Can we prove has it been proven the difference between early versus delayed intervention and the answer is yes.
And that's in the chat study that's the childhood add no time select to be studied.
And there's a US study and what they did is they found grid kids with sleep disorder breathing and then they broke them up into two groups.
(19:46):
They broke them up into the groups of we're going to fix you now versus we're going to give it six months before we fix you.
And now in that we're going to get six months before we fix you those kids fell into two groups those that got better those that didn't.
And what they wanted to do is look at those that got better by themselves versus those that had surgery six months prior.
(20:08):
Okay. So we've had surgery, you know, say what group of kids that had surgery now a group is it didn't we're looking at six months later.
And the kids that we've selected out are the kids that had surgery that made them better versus the kids that just got better by themselves.
And we're going to look at how does that then compared to the behavior outcomes. Long story short, the kids that had surgery did better than the kids that got better by themselves.
(20:35):
So even in that six months that it took for these kids to declare themselves as having got better.
They had a worse health outcome than the ones that had surgery.
So that's all it takes. And that's again, exactly what the Karen Bonoch study did.
Six months. It's a recurring thing that's come up in the Canadian research in the trial study again, six months, six months.
(21:01):
It's all it takes.
And I'll put the links to all of this in the show notes but you know I've read that the Karen Bonoch study and I will tell you.
Reading that along with everything else that I've read and I highly recommend our reading lists to parents if they haven't read it yet but
reading it in the back of my mind all I could hear over and over is something I used to say all the time.
(21:25):
I'm not raising children. I'm raising adults. They're children now but I'm raising adults.
And if you from my perspective, if you think about it like that.
Let's get the airway fix. Let's have them sleep because guess what?
When they don't, the brain's not developing health issues are starting and we're seeing kids with high blood pressure.
(21:49):
Anxiety, depression.
Yep.
And we could have stopped it back here.
Yep. So what you just touched on, I think is another great rabbit hole to go down because we've just been brain brain brain and brain.
Let's just pull back from that one for the moment. Let's talk about another body system. Let's talk about the cardiovascular system.
Okay.
So the cardiovascular system means heart and blood vessels.
(22:12):
Okay.
So in children with sleep disorder breathing, they are more likely to have irregular heart rhythms.
Okay.
So you know those TV shows where they come in with the paddles and they shock the heart.
Oh yeah.
Yeah. Right. Well, that's all related to the heart has stopped.
And one of the reasons that the heart stops is because it's got into an irregular rhythm.
(22:36):
Again, amazing part piece of biological engineering as to how the heart works.
We won't go into the weeds on that one.
But so children can get irregular heart rhythm from having sleep disorder breathing.
So can adults, but we go on of, you know, everything I say in kids is adults are pretty much the same too, but it's more significant in children.
(22:57):
They get high blood pressure is particularly at night time.
So their blood pressure can be normal during the day, but it gets high during the night.
Why?
Because during the night when they're not breathing properly to go into stress mode, what does that do?
It pushes out that stress hormone.
We call it adrenaline.
You call it epinephrine, tomato, tomato.
They're just in fight or flight all night.
Yeah.
(23:18):
It's their fight or flight.
And that leads to the blood pressure going up, but it also does something really, really pernicious and it sensitizes the blood vessels and makes them stiffer, which is a contributing factor then to getting high blood pressure later on in life.
And when we look at this sort of thing, there was an Israeli study where they looked at cardiovascular disease in young adults and what they found with early cardiovascular disease.
(23:48):
A lot of it was related to poor sleep.
They didn't specify an airway but poor sleep before the age of 30.
So wake up call again right there.
Yeah.
I'm going to have a, you know, I keep hearing all these podcasts like if anybody, you know, this is, this is shameless now. If anybody can link me in with someone like Andrew Huberman, you know, or Peter it's here.
(24:12):
Very prominent podcasters in the health scape.
They are talking about health and wellness, health and wellness blood pressure.
And they've had world experts on about blood pressure and not a single one of their talks in their whole spectrum has ever been about any childhood condition, any childhood condition.
And we're talking about optimizing wellness when we can be doing this in childhood.
(24:35):
And what I want to shout to them for is to have this chat.
And we'll talk about cardiovascular disease. And we'll talk about how, you know, we have, you know, what we call, you know, it's called essential hypertension.
It means high blood pressure and you just got it because you just got it. There's no underlying medical reason.
And I would just say pause for a sec. Let's do a retrospective analysis on what was that child's breathing and sleep like, because we know prospectively now.
(25:03):
And that came from Australian research in about 2015 that the sleep disorder breathing things are translating into high blood pressure in early childhood adolescents and then bouncing forwards into adulthood.
Like this setup for failure right there from a blood pressure point of view right there.
We also know in this sleep disorder breathing spectrum of things that it also marks up the blood lipids and we have simplified blood lipids into good and bad cholesterol.
(25:36):
That's what we're talking about. Well, the bad cholesterol is elevated in children with sleep disorder breathing.
So we have high blood pressure. We have high cholesterol. We have what's called arterial stiffness. This is all hardest-hackard stroke material right here when you go to read the adult literature.
We also in children have demonstrated plaque buildup. Okay, so plaque buildup is what we call atherogenesis.
(26:03):
It's the thing that leads to heart attacks and strokes of certain type. Again, there's your problem right there. Okay, in kids demonstrated proven.
And then, you know, just sort of just keep layering and layering upon this. One of the other sort of, you know, risk factors for heart attack and stroke is diabetes.
(26:26):
Okay, high blood sugar. Well, we touched on the diet part, but the thing that protects us, you know, we need sugar, but in a certain level, sugar is toxic to us.
So we have a system that regulates our blood sugar to keep it under control. That regulatory system is not working properly in kids and adults in kids that have sleep disorder breathing.
(26:49):
So their whole body hormone system that regulates sugar control doesn't work properly. So they're prone to their blood sugars creeping up a bit, not to the diabetes point, but it's high normal.
Okay. Okay. And then it also then affects the gut. And we're starting to learn a lot about the brain gut axis or something that was talked about at university when I was there, but not understood in terms of this thing called the microbiome.
(27:18):
You know, everyone's like about, oh, gut health, gut health, gut health. Well, hang on. Let me interject you yet again. Sleep disorder breathing and we've known about this for about 10 to 15 years, at least.
Because the reason I know that because in my first book that came out in 2016, I was making reference to research that I was reading that was already out there then.
(27:41):
So I know that it's at least 10 years. And it was in animal models. What they were doing is they were exposing mice to low oxygen levels.
So deliberately making a slight low oxygen environment and then looking at what does it do to their gut microbiome and it changed.
(28:03):
And again, we've simplified this to good bacteria, bad bacteria, the bad bacteria to start to take over. And what we've also learned is that with this brain gut axis is that there's an interplay there and communication that then basically, you know, as clever as we want to think we are with the
(28:24):
the gut and the bacteria are somewhat driving the bus at times because that actually affects our food seeking behaviors. And in what way, it makes us crave the high sugar foods. Why? Because that particular type of bacteria wants it.
So in a way, we've kind of been taken over, you know, by these little bacteria are actually telling us what to do without us realizing it.
(28:51):
But interestingly, if we resist that temptation and do the, you know, the gut health protocol, the good ones start to make a comeback.
But the comeback is limited if you have a breathing and sleep problem because you basically you're swimming against the tide there in that low oxygen effect.
And what do we also know that the brain gut axis mental health. We know understanding those links. And back to what you said before with sleep assorted breathing.
(29:19):
So let's just give you some very simple, you know, take homes in terms of mental health now.
I'm going to lift some mental health conditions. Depression, anxiety, schizophrenia, psychosis, PTSD, ADHD, ASD, bipolar, effective disorder, personality disorder.
(29:43):
And everything I mentioned goes up if you've got sleep disorder breathing every single one of them. Okay, some of them by a factor of three.
Okay, now let's take that out of the equation for the moment. Let's look at something completely different, but not entirely. Let's look at hay fever.
Okay, let's look at a fever. So this is nasal allergies. All right.
(30:07):
So this is another soapbox that I get on. It's not just allergies. It really isn't. Okay.
So now nasal allergies causes nasal congestion and that can lead to a breathing in a sleep problem, which is everything we've just already spoken about.
But just ignore that for the moment. They don't always cause a breathing in a sleep problem.
So just having nasal allergies by themselves in a child that child is 30% more likely to suffer from clinical anxiety.
(30:39):
30% more likely because they've got nasal allergies. Why? Because nasal allergies are really annoying.
And what is anxiety when you're annoyed? Two and two is four.
Okay. And we talked about brain growth and brain development in the context of that prefrontal cortex and so forth.
(31:00):
Well, that's not the only part of the brain that gets mucked up and sleep disorder breathing. The memory part does. That's called the hippocampus.
Right. And then the learning part, sort of the anxiety part, it's called the amygdala.
You know what happens in the kids that have got allergies, you know what happens in kids with sleep disorder breathing?
(31:22):
Well, when you use a part of the brain more, it gets bigger. It gets bigger.
So their brains, their amygdala is bigger. Why? Because it was conditioned to be so.
By what? Not breathing properly. By getting bothered and irritated by allergies.
So we're basically promoting a type of brain function that is actually counterproductive to sensible function because of these underlying pathologies.
(31:56):
So when we look at this whole big, big picture, you know, everything's connected, you know, healthcare is segregated, but the person is the big picture.
You know, the things that we have touched on here, this, you know, again, somebody, please, Andrew Huberman, Peter Tears, someone's got to know someone, you know, the world's not that small.
(32:17):
We need to get these childhood issues as part of these wellness conversations because of exactly what you said.
We're raising adults, you know, we're nurturing a child to be the adult that we want or need them to become. And we know that's an important thing to do.
We know that, you know, nurture and nature, you know, intertwined. It really does make a big difference in terms of opportunities and experiences and outcomes.
(32:45):
And, you know, this is the things that we need to work on equality for, you know, because we don't, you know, not everyone has equal ability, but we do want equal opportunity to reach your potential.
In terms of, you know, there are literally, you know, neurosurgeons and, and the like living, unfortunately, in the worst of conditions that will never see the lighter day to be the same.
(33:10):
But they are there, it's just purely that opportunity. So let's work together on pulling that up.
And, but, you know, at the grassroots level, we really need all these health and wellness things that people are focusing on an adult to realize, you know what, could have done it with your could have been done as a kid.
(33:32):
Yeah, yeah, yeah, hit the rewind button, you know, all those Twinkie bars that you would challenge down on.
Well, guess what, your body remembers that, you know, and it's not too late to change, you know, you know, but you've got to make those changes.
And those cigarettes, you know, they're good that alcohol, it ain't good. All right, you know, you're not trying to be, you know, 1920s 1930s, you know, prohibition and tea total areas but you know, let's just, let's just be honest with the conversation pieces.
(34:06):
And then when it comes to breathing and sleep, let's be honest about it. You know, and I got a lot of pushback when I started making this noise but you know, the science papers have come around, you know, you know, when I started this conversation piece way way back over 10 years ago, I was pretty blunt and to the point and kind of
I was like, I'm gonna get it right that way. And I was saying, I was saying, these children with sleep disorder breathing are getting brain damage. You know, it's like, oh, you can't say brain damage. Period. But that's it. Period.
(34:36):
Like stop there, that's it. But that's it. That is it. And again, that's why we don't have children drink alcohol. It's why we don't let them play with mercury. It's why we're worried about chemical exposure, heavy metal exposure.
That's why, because it causes brain damage. But if I say snoring at night causes brain damage is like, oh, you can't say that. But you know what, now the science papers are even saying it like it's actually in the titles of the paper they are saying brain damage and I think it's
(35:06):
like, it's got nothing to do with me. They're following my lead. I think it's the frustration. We have these scientists, they're not clinical people. Okay. But they're at the grassroots, they're doing all the science, they're doing the research, they're seeing these kids, you know, in their working capacity.
And they're going, why are not why doctors not listening to us. Damn it. We're going to call it brain damage. All right. They're going to start to make.
(35:30):
We're right back where we started where I said, I don't understand why we don't have red flags, sirens going off and everyone just a 10% lower, 10 point lower IQ. It's there. It's factual.
Look, look at how much money parents put into like accessory education like school tutors. Okay. For a child that's struggling at math, struggling at reading, struggling with whatever.
(35:58):
Well, let's go back to sleep disorder breathing. We have looked at those things. Your math skills are decreased. If you have sleep disorder breathing. Okay.
So, if you're basically trying to optimize your child, make sure that they're breathing and sleep is optimal first, because you need that foundation to build upon, you know, you can have the best architect design and the best builder
(36:27):
but unless the foundation, the thing that you're putting it on is rock solid. It is not going to hold.
It might be good for a bit, but it's going to start falling apart. And that's what these children are doing. They are falling apart because their foundation is not there.
They have, you know, like I said, the whole biology started biology. It's an amazing thing. It's ridiculous. It doesn't make sense.
(36:52):
It's mind blowing. It's extraordinary when you get into the weeds. I mean, we take it for granted, but when you get into the weeds, it's just extraordinary.
And but it's also doesn't take much to really upset the apple cart. Like it's really, really fragile. You know, you know, again, if you don't mind me saying, you know, you made it public knowledge about your cancer.
(37:15):
That was one genetic mishap that slipped through the door that then everything just knocked on from there one.
Now, your body has this amazing protective system against it. What do we know about adults?
Adults with sleep disorder breathing, certain types of cancers are more likely to slip through the door.
(37:36):
So breast cancer is an example. In my country, we wave the flag again for the highest rate of skin cancer known as melanoma.
Melanoma is worse if you've got obstructive sleep apnea in that awkward, you know, bowel cancer, prostate.
The list goes on. Why? Because part of our defense system against cancer is our immune system.
(37:59):
And when does your immune system, you know, people talk about, I want to boost my immune system and then they go and buy some green powder and make a green smoothie thinking that's the that's the biohack to it all.
Right.
Your immune system is replenished and rejuvenated when you sleep as long as you sleep well.
(38:20):
So sleep isn't just about the brain. It's also about your immune system.
So your veggies, not not the pretend ones like eat the real good veggies.
Yeah, and sleep.
Yeah, and breathe.
And breathe. Yeah.
Yeah. So, you know, that's the sort of the spin around and knock on effect is, you know, like you said, you know, we start at one point and then we just do this full circle and then so forth.
(38:48):
And yeah, look, you and I know these red flags there.
The problem is that they're just behind a wall. We just need someone to speak around that wall and go, guys, I think we've come out. Let's talk about it. Yeah.
Yeah. And let's be honest about it. And let's not weaponize words. Let's not weaponize brain damage. Okay.
(39:09):
And make it say that I find that upsetting. So well, you should find it upsetting because it is upsetting. And it needs to then be motivating to resolving it.
Okay.
Exactly.
All right. That's the thing that you've got to sort of then pivot towards is that, you know, we need to raise the awareness and we need to raise the level at which we are proactive about addressing these things.
(39:35):
It's time to stop, you know, kicking the can down the road, because we know the how that story ends. You just got to get a look to circle back look at your process food industry in the United States.
Look how that story is playing out now. You have a 50% overweight and obesity rate. For the first time in your country's history, your life expectancy of your current generation is less has gone down one that has come from your life
(40:04):
expectancy has gone down. You spend more money on healthcare per GDP than any country in the world. And your outcomes are getting worse.
Because the basics are not there.
(40:48):
You can find out more about the Children's Airway First Foundation and our mission to fix before six on our website at Children's Airway First dot org.
The CAF website offers tons of great resources for both parents and medical professionals. Visit our parents portal clinicians corner resource center and video library to see for yourself.
(41:17):
We also encourage parents to join the Airway Huddle, our Facebook support group, which was created for parents of children with airway and sleep related issues.
You can access the airway huddle support group at Facebook dot com backslash groups backslash airway huddle.
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child might have an airway issue, contact your pediatric airway dentist or pediatrician.
(41:46):
And now let's jump back into today's episode.
(42:16):
You know, you so so again, I'm back to that three legged stool.
Let's just call it what it is and exactly right, you know, for those that don't know the analogy. If you can sit on a three legged stool, you can't sit on a two legged one.
Exactly.
So you need nutrition, you need nutrition and you need air, you take a really, yeah, and then you things start to fall apart.
(42:40):
So, yeah, so, you know, I think, as you know, I can sort of talk and rabbit on for hours on this. It's one of the things about just knowing it so well.
And I think importantly, knowing that the interplay and the links, you know, being able to bring mental health and all these sorts of things into into the mix.
But you know, I should be mindful it's your show, not mine.
(43:02):
Did you know before we go, I want to, I want to talk a little bit about your book for parents that don't that don't know about it and want to check it out.
Yeah, for sure. So I'm up to book number six, which, you know, is just a reflection of, you know, my passion for this.
(43:24):
I think for parents, this is two that I would flag. One is a general book, and it is called sleep disorder breathing, a parent's guide.
And what I do in that book is I try and give them a roadmap because one thing I've realized is that when parents stumble across this problem, depending on, you know, who their first touch point is really dictates what then can be the
(43:51):
paradigm that can play out.
And if they see an ENT, they might just get the ENT version if they see a dental practitioner that might just get the dental version.
If they see a breathing practitioner, they might just see a breathing rehabilitation scenario.
But the problem is that again, that's a segregated system in something where it is actually a multi disciplinary team approach to a multi factorial problem.
(44:21):
So what I did in that book is I sort of did my best to spell out all of the things, all the Enos and throat problems, all the dental problems, etc.
So you know what, if you've got this problem or you need this for it, and if you've got this problem, you need this for it. And if your child has got both, hey, they need both.
And you know, and in terms of having a sequence and so forth, these are things to do. And whilst we're at it, you need to look to see if there's nasal allergies, you need to check their metabolic profile, in particular, their iron.
(44:51):
Because this thing, like I said, it mucks up the gut in certain ways. One of the ways it mucks it up is it limits iron absorption.
If the iron is low, you're tired. This kid is tired already. So this compounds the problem. And iron is a really important thing, not just from an energy point of view, it's really important for a whole lot of brain function and development too.
So there's all these knock on effects. So that's the sort of that's to me that's kind of like your roadmap.
(45:17):
And then the other one that I've put out recently is going really, really deep into the weeds of the links between ear, nose and throat, and the ADHD and ASD.
And it's called the ABC of ENT, ADHD and ASD. So it's basically it's the alphabet book.
And, and the reason I've done that is that I see a lot of children. Okay. And in particular, I seem to have a knack and attraction that then follows on from word of mouth to seeing the children that have the neurodivergent neurodevelopmental issues,
(45:55):
and have a good understanding about how, like I said, you know, before these little things are not little things in these kids, and how we can miss so many things by being complacent, and how, you know, it's pushing these kids further off course than they need to be in the spectrum of their potential
(46:16):
outcomes of the same. So from that point of view, what I've done there is just given a huge overview of genetics, developmental brain development pathways of, you know, nutrition feeding ear infections breathing sleep tonsillitis nasal allergies, etc.
(46:39):
And how these things are all related to brain development, which is not what people think about intrinsically, you know, think about how tonsillitis affects the brain but it does.
You don't think about how an ear infection affects the brain, but it does. And, and I just throw a big spotlight on this.
And again, at the end of the day, the parents can have the knowledge and be proactive. And as I say in the tail end of that book is, you know, don't take no for an answer you know your child best, you know, and you know, it certainly if someone says it's not that bad.
(47:13):
It could be right. But for goodness sake, go and ask someone else just in case they're not because it could make a huge difference to your child as to what their landing point can be. As you know, as you said, as a time plays out to become an adult.
Yep.
I love that and I'll leave that as our final work as usually asked for a last word to me.
(47:36):
That's perfect.
Okay.
I love that. So thank you again so, so, so much for coming on. I really I always enjoy it when you're here. And I appreciate you, you know, attacking some of these questions our parents had.
Oh, it's always a pleasure, you know, and like I said, it really is a privilege as well.
You know, and this is so much more than you and I know that we could talk about. But given that it's been two hours, I'm pretty sure that that just became two episodes for you again.
(48:08):
Yes, I don't envy you for trying to work out where the split in the middle is but I'm sure you're clever enough to do that. And anyone that's listening to this that has their own podcasts that want to sort of, you know, jump on board they can find me through the social
networks. So I've got the Facebook Dr David Macintosh and the the Insta Dr David Macintosh ENT and they can probably reach out to you if they're having trouble finding me can sort of bounce in my direction.
(48:33):
All this in our show notes as well.
Yeah, absolutely. And, you know, I'm more than happy to do these things.
I've got another one tomorrow and I've got another one next weekend and I did for, you know, in the past fortnight, but I will put the time aside and make the effort to just know that at the end of the day there's there's a very good chance I've just helped one child from
(48:56):
doing this. That's all it takes to be worth it.
And that's kind of our motto every day. Like, if we say one child, or 400 million ago, but we've got one.
Yes, exactly.
Thank you. Real pleasure as always.
You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn and YouTube.
(49:20):
Don't forget to subscribe to the Airway First podcast on your favorite podcasting platform so you won't miss an upcoming episode.
If you'd like to be a guest or have an idea for an upcoming show, shoot us a note via the contact page on our website or send us an email directly at infoatchildrensairwayfirst.org.
(49:41):
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Draughan and guest outreach by Kristy Bojikian.
And finally, thanks to all the parents and medical professionals out there that are working hard to help make the lives of kids around the globe just a little bit better.
Take care, stay safe, and happy breathing, everyone.
(50:31):
Bye.
Hi everyone, and welcome to another video.
(00:29):
Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First Foundation.
I'm your host, Rebecca St. James.
Today we're going to jump into part two of our conversation with pediatric ENT, David Macintosh.
So let's pick up with where we left off in our conversation yesterday with epigenetics, and let's talk to Dr. David Macintosh.
(00:58):
So, but the thing, you know, look at all the things that we could mention that that that can feed into the trigger top of the list is having an airway problem leading to a sleep problem.
That is, you know, because across the board, we're talking in the range of somewhere around about 20% of children having this. And if we look at go back to the ADHD, you know, in that research study and the ones that have come, we have seen ADHD systems
(01:27):
that have gone from 25 to 50% of children after they've had surgery to relieve their airway obstruction.
Now, you go into the math on that. That's just one condition and one treatment that has been given to these children with an ADHD diagnosis, and up to half of them are then off the list.
Half of them. That's nuts. What else are we missing? What else are we missing?
(01:53):
And, you know, and they'll be, I'm sure there'll be some specialist out there in some other medical field who's probably doing the same thing with someone crying out, you know, for people to listen to them saying, hey, you know, your child with ADHD, it's not that it's dot dot dot.
And you and I don't know about it because, you know, we're not in that right. We're not just not right. And that just proves the point again, if we have to understand parents can't know about it.
(02:21):
Because if there's some specialist out there that's cotton on to, you know, some, I don't know, let's just make something up some gut problem that all you got to do is just eat this, you know, whatever from wherever.
And 20% of kids will have a transformational event. Every parent would want to know about that. Well, we're talking about breathing and sleep. We're not talking about a gut problem.
(02:45):
We're not talking about some magic super food. We're talking about the basic of breathing and sleep. I'm not talking about 20% of kids with ADHD. We're talking up to 50% of kids with ADHD.
So, you know, in terms of the elephant in the room, we are front and center in terms of where we're at. But the problem is we're just not, you know, there and, you know, as I happily do these things, you know, I just emphasise this to the parents that listen is that whenever you've come across something like this,
(03:14):
and you learned something, you just, you didn't know what you didn't know. I guarantee you, I guarantee you five of your friends don't know it either. And you know what you need to do.
You need to get them to listen to this. Okay, and then if you're already in that sort of circle of parents that have children that you know, neurodivergent neurodevelopmental management of the same.
(03:38):
And you didn't know about breathing or sleep. Well, make sure you have the whole group knows. Okay, this is this has to be a collective heavy lift where you pass it forwards.
And you give the next person the benefit of this knowledge as well. Because at the end of the day what we want is we want children to reach their full potential.
(04:01):
And we've got intrinsic potentials. You know, we're not all going to be doctors. We're not all going to be lawyers. And trust me, it's not as glamorous as it sounds.
It would be so boring if we all were right. Everybody's different. But if your child is creative and they can't sleep, they're not going to become a writer or an artist or whatever when they're older.
(04:23):
It's just not going to happen.
Yep, if we're if we're all doctors, then I guarantee you would all be walking because no one would know how to fix a car.
That's true.
And so on and so forth. So we all need to be different. You know, again, we are divergent. We need it's essential that we're divergent and so forth.
(04:45):
And in that context, we all have our interests and so forth and potential and, you know, and interests, you know, you talk about, you know, you can have examples, you know, high ranking level people, you know, could have been doctors or lawyers or business people,
and they just walk away from it all and they just go and paint.
(05:08):
And it makes them happy.
It's like, huh, all right, go listen to that little inner child that's yelling out, you know, and express that.
So yeah, so so from from that point of view, I think moving forwards.
(05:29):
We need to the those that involved with the ADHD, ASD communities to have even more awareness, even more emphasis on breathing and sleep issues and and if I talk in eyes and throat, I'm going to throw ear infections into the mix there as well.
Because the problem that particularly with these neurodivergence issues is that it makes it worse in terms of the impact. So for a child that has an ear infection, well, for a child that gets an ear infection, they get some fluid behind the eardrum that sits around for a while.
(06:10):
And they have a period of time where they can't quite hear properly. Because of the divergences and the functioning that impact is magnified extraordinarily.
So it's kind of one of those things where the rules don't apply. You know, normally say all the ear, ear infects, they got ear infections, but they're not that bad.
(06:32):
But hang on a sec. You're telling me that your child has speech and language development issues. So anything that feeds that beast, and it all gets put down to the, the, you know, the autism or gets put down to the ADHD.
It's like it becomes the excuse.
But in a natural, let's go to what the root could be. Yeah, I'm a natural fact. Having those things means that what would in the context of things be an ear infection that maybe isn't that bad is actually really quite significant for that child.
(07:07):
And that's where we take away the generalizations and we get to the specifics. And if by doing the specifics, we then, you know, focusing on the individual, then we actually have a more proactive scenario in play, because an ear infection that, you know, the parent goes,
look, every time they get an ear infection, their speech goes backwards a bit. That's significant. That's every time they get an ear infection, their behavior gets so much worse. That's significant. Okay. So that's that's that's where we just need to be mindful of things again, sort of being normalized with, you know,
(07:44):
say, stop normalizing. Yeah. Yeah. And so hang on a sec. So when your child gets an ear infection, does it really make a big difference to who they are for a while? Oh yeah. Okay. That's a big deal. Okay.
So that that's, you know, that that's where we sort of I think we need to focus and emphasize the importance of, you know, getting these things right. And there's a huge knock on effects that happened so that, you know, for example, you know, the fussy eating.
(08:19):
Well, if you can't chew properly, and you have to breathe through your mouth, which leads to it getting dry. And you want to be and you need to sort of come up for breath in between food items.
You're not going to hoe down on a big chunky juicy steak. You want to you're going to want soft, mushy processed foods. There's a problem with feeding the beast against.
(08:45):
Okay, these circle back. And they go, Oh, the child's sensory, you go, Yeah, they're sensory because they've realized they can't eat you and swallow properly. They're surviving is what they're doing, because they've worked out what's easy, they've worked out what's hard.
You know, they're going to go the easy option, they're going to go the easy route. So they're going to live off of smoothies and yogurt and anything that's been processed because it's all basically been, you know, pre chewed and pre digested by the machine for them anyway.
(09:20):
So, so there's that gravitation there. Plus, you know, it affects their sense of taste, it affects their sense of smell. So things taste weird, things smell weird to them. So that leads into it as well.
So there's all these things that start to play into it that, you know, you, you again, you just blame the ADHD, you blame the ASD for an actual fact it's a manifestation potentially, again, of some of those ear, nose and throat problems that we really want to emphasize being my bias to just say,
(10:01):
hang on a sec, have a look at the back of their throat, have they got really big tonsils, because if they do, that's going to make it really hard to swallow. And they're going to notice that it's hard to swallow and if they've got sensory tendencies, they're going to notice that way before anybody else does.
Okay, because that's going to be to them is a big deal. Right. And then it's going to become more obvious. And then it's going to be part of what gets labeled part of their spectrum of symptoms is fussy eating and, you know, oral sensitivities and the like.
(10:36):
So, you know, in fact, it could be that the tongue is not in the roof of their mouth so they're not regulating and here we go again we're back to the airway.
We're back, you know, it's a conspiracy of people are on to me everything leads to the airway. I'll call it out now.
That's what we are to say conspiracy. All right, yeah, yeah, yeah, yeah, yeah, yeah, yeah, we'll go to our secret meeting and handshakes later.
(10:59):
So, so, you know, so there's just, you know, the reason that we're so front and center with airway is because of its interplay with sleep. And, you know, that that we've got to make sleep an important topic of health.
And it is if we look at, like, your big sporting teams so you like your NFL teams are you got players there with tens of millions of dollars, you know, these are big investments that these people are, you know, representing.
(11:28):
Right. On your professional teams. Okay. So these are the teams that have got access to enormous amounts of money or enormous amounts of technology and wellness and health and, you know, just next level.
They have sleep doctors on on their on their list now, you know, used to be the team doctors were like the orthopedic surgeons and stuff. And now they have the sports psychologist because I know that's important.
(11:55):
Now they have the now they have the nutritionists, because they know that's important.
And of course now they have the sleep doctors on there as well as consultants, and they have the sleep trackers, and they're making sure that these players know because it's in their contracts.
You don't stay up until one o'clock in the morning on your phone anymore.
(12:16):
We are, we know when you are going to sleep, and we know if you are getting good sleep. Why, because good sleep is part of your overall performance on the field and that's what we're paying for you for.
And for the time that you're going to do that we own you, we own your time, and not just on the field but we you know we basically regulate a lot of what you get to do, and how you get to do it, and sleep is now on that list.
(12:43):
And that's not done in a dictatorial way or anything. It's, you know, it's in the benefit of that athlete.
And they're protecting their investment is what they're doing.
They're protecting their investment but it's good for the player as well because the player has, you know, like most of us is like, you know, I'll sleep just one of those things I get around to it's not that important to then it's like, oh, you, oh well you mean like I can perform better.
(13:06):
Hey, if I can perform better I'm going to be worth more money right.
Right. Two and two is four. I'm going to do everything I can to optimize what I can do, and so forth.
You know, so these things all, again, sort of just to emphasize if you know you want to look at you know what are the top people with you know, effectively unlimited resources doing their investing in their wellness they're investing in their sleep, they're investing in their breathing.
(13:36):
There's got to be a reason for that. You know, it's not a fad. There's got to be a reason for that. You know, so that whole you know I'll sleep when I die. Well to be honest you'll die if you don't sleep.
And it's actually been proven. So, from that point of view, we want to get you know breathing and sleep.
And just the same conversation that it needs to be about food and exercise. You know, they all need to be those level playing fields of understanding and awareness. That's just the basic thread of you know, starting at the parent level that's that's the time to catch it at its best is catch it in the child.
(14:13):
If your child's got it well, get on and we fix it whatever that is it is what it is.
At the end of the day, keep going to a provider that says and this is what we tell you don't have to say it will say it. You keep going to a provider and their responses.
Let's just watch it. No, we're not going to watch it. Or it's all poppycock. Perhaps find a new provider.
(14:35):
Be this is where advocacy comes into place because they may not know about it. But if they're open to it.
Yeah, yeah. So and again, it's I think it's helpful for the parents to have something in their back pocket. So the paper that I think is the top of the tree for this one is one that was done by a researcher called Karen Bonnock that was out of the Einstein University.
(14:58):
And that research paper was published in 2012. And it is was actually done in the United Kingdom. But what they did just so that people can understand so they they monitored 11,000 children for the first seven years of their life.
And the parents had a simple job. Does your kids snore mouth open or stop breathing at night. And these were surveys questions that were done every couple of months.
(15:26):
And that was sort of their screening process to then see what the kids breathing through the night was. And where the child had the parent observed on a consistent basis for six months from one time point to the next that the answer was yes to any of those three things.
Mouth breathing snoring stopping breathing any of those three things that child was put into the sleep disorder breathing category. And they ended up through that with about 2000 odd children, which again highlights my point that's 20% of children right there.
(15:58):
You know 2011 1000 ish at 20% of kids right there. What they did though is they did exactly what we just alluded to. They watched and waited. Okay, because that was one of the paradigms, you know, 10 years ago.
Yeah, and it was literally don't worry they'll outgrow it. And what did they find. Well, they found those 2000 kids that 20% that got the sleep disorder breathing.
(16:29):
And they did find some kids down the track that did outgrow it. But that wasn't their prime interest. Their prime interest was to look at it from a behavioral and education point of view.
And that was their outcome. So they've got the kids basically then fell into three groups. Kids, you know, it's actually broader than this but I'm going to break it down even more kids that never got sleep disorder breathing.
(16:52):
Kids have got sleep disorder breathing that hung around throughout the whole time once they got it and kids that got it where it went away.
Now let's focus on the kids that got it that went away because they're the interesting group to my mind.
They got it and then it went away. When they looked at these kids at the age of four and seven. These kids were more hyperactive.
(17:16):
Had problems with their concentration. We're prone to being aggressive had trouble relating to other kids and had troubles just in general with you know emotional regulation and behavior.
And hyperactivity was way at the top of the list. What's part of the ADHD. What's the H in ADHD. It's hyperactivity.
(17:40):
So what they found is that in the group of kids that outgrew the airway problem. They did not outgrow the consequences of brain development that came with that.
So that was the first big wake up calls like you know what we found a problem we let the kid outgrow the problem but they were left with a consequence.
(18:03):
So that's the that's the big one there and I'll come to another research element in a sec.
But within that research paper. The second thing that they found that I think is really important is the timing of things and the younger.
The child was when they first started in particular under 18 months of age that was a stand out. Okay.
(18:27):
The next stand out was two and a half the next stand out was four but the big one was 18 months of age. Okay.
The big stand out though was that the younger it started.
The more likely those problems were going to sit around and still be there regardless of whether child out or not.
The more likely they were going to have those problems show up at the age of seven. So think about that.
(18:49):
The breathing and sleep problem in a 14 month old shows up as ADHD symptoms in at seven years of age.
So the second thing is first of all they are not too young to have the problem and they are certainly not too young to get it fixed.
Okay. It is possible to happen very early on in the piece and if it does you want to get it fixed.
(19:16):
And this is the third string to the bow in terms of the papers to highlight in that context.
Can we prove has it been proven the difference between early versus delayed intervention and the answer is yes.
And that's in the chat study that's the childhood add no time select to be studied.
And there's a US study and what they did is they found grid kids with sleep disorder breathing and then they broke them up into two groups.
(19:46):
They broke them up into the groups of we're going to fix you now versus we're going to give it six months before we fix you.
And now in that we're going to get six months before we fix you those kids fell into two groups those that got better those that didn't.
And what they wanted to do is look at those that got better by themselves versus those that had surgery six months prior.
(20:08):
Okay. So we've had surgery, you know, say what group of kids that had surgery now a group is it didn't we're looking at six months later.
And the kids that we've selected out are the kids that had surgery that made them better versus the kids that just got better by themselves.
And we're going to look at how does that then compared to the behavior outcomes. Long story short, the kids that had surgery did better than the kids that got better by themselves.
(20:35):
So even in that six months that it took for these kids to declare themselves as having got better.
They had a worse health outcome than the ones that had surgery.
So that's all it takes. And that's again, exactly what the Karen Bonoch study did.
Six months. It's a recurring thing that's come up in the Canadian research in the trial study again, six months, six months.
(21:01):
It's all it takes.
And I'll put the links to all of this in the show notes but you know I've read that the Karen Bonoch study and I will tell you.
Reading that along with everything else that I've read and I highly recommend our reading lists to parents if they haven't read it yet but
reading it in the back of my mind all I could hear over and over is something I used to say all the time.
(21:25):
I'm not raising children. I'm raising adults. They're children now but I'm raising adults.
And if you from my perspective, if you think about it like that.
Let's get the airway fix. Let's have them sleep because guess what?
When they don't, the brain's not developing health issues are starting and we're seeing kids with high blood pressure.
(21:49):
Anxiety, depression.
Yep.
And we could have stopped it back here.
Yep. So what you just touched on, I think is another great rabbit hole to go down because we've just been brain brain brain and brain.
Let's just pull back from that one for the moment. Let's talk about another body system. Let's talk about the cardiovascular system.
Okay.
So the cardiovascular system means heart and blood vessels.
(22:12):
Okay.
So in children with sleep disorder breathing, they are more likely to have irregular heart rhythms.
Okay.
So you know those TV shows where they come in with the paddles and they shock the heart.
Oh yeah.
Yeah. Right. Well, that's all related to the heart has stopped.
And one of the reasons that the heart stops is because it's got into an irregular rhythm.
(22:36):
Again, amazing part piece of biological engineering as to how the heart works.
We won't go into the weeds on that one.
But so children can get irregular heart rhythm from having sleep disorder breathing.
So can adults, but we go on of, you know, everything I say in kids is adults are pretty much the same too, but it's more significant in children.
(22:57):
They get high blood pressure is particularly at night time.
So their blood pressure can be normal during the day, but it gets high during the night.
Why?
Because during the night when they're not breathing properly to go into stress mode, what does that do?
It pushes out that stress hormone.
We call it adrenaline.
You call it epinephrine, tomato, tomato.
They're just in fight or flight all night.
Yeah.
(23:18):
It's their fight or flight.
And that leads to the blood pressure going up, but it also does something really, really pernicious and it sensitizes the blood vessels and makes them stiffer, which is a contributing factor then to getting high blood pressure later on in life.
And when we look at this sort of thing, there was an Israeli study where they looked at cardiovascular disease in young adults and what they found with early cardiovascular disease.
(23:48):
A lot of it was related to poor sleep.
They didn't specify an airway but poor sleep before the age of 30.
So wake up call again right there.
Yeah.
I'm going to have a, you know, I keep hearing all these podcasts like if anybody, you know, this is, this is shameless now. If anybody can link me in with someone like Andrew Huberman, you know, or Peter it's here.
(24:12):
Very prominent podcasters in the health scape.
They are talking about health and wellness, health and wellness blood pressure.
And they've had world experts on about blood pressure and not a single one of their talks in their whole spectrum has ever been about any childhood condition, any childhood condition.
And we're talking about optimizing wellness when we can be doing this in childhood.
(24:35):
And what I want to shout to them for is to have this chat.
And we'll talk about cardiovascular disease. And we'll talk about how, you know, we have, you know, what we call, you know, it's called essential hypertension.
It means high blood pressure and you just got it because you just got it. There's no underlying medical reason.
And I would just say pause for a sec. Let's do a retrospective analysis on what was that child's breathing and sleep like, because we know prospectively now.
(25:03):
And that came from Australian research in about 2015 that the sleep disorder breathing things are translating into high blood pressure in early childhood adolescents and then bouncing forwards into adulthood.
Like this setup for failure right there from a blood pressure point of view right there.
We also know in this sleep disorder breathing spectrum of things that it also marks up the blood lipids and we have simplified blood lipids into good and bad cholesterol.
(25:36):
That's what we're talking about. Well, the bad cholesterol is elevated in children with sleep disorder breathing.
So we have high blood pressure. We have high cholesterol. We have what's called arterial stiffness. This is all hardest-hackard stroke material right here when you go to read the adult literature.
We also in children have demonstrated plaque buildup. Okay, so plaque buildup is what we call atherogenesis.
(26:03):
It's the thing that leads to heart attacks and strokes of certain type. Again, there's your problem right there. Okay, in kids demonstrated proven.
And then, you know, just sort of just keep layering and layering upon this. One of the other sort of, you know, risk factors for heart attack and stroke is diabetes.
(26:26):
Okay, high blood sugar. Well, we touched on the diet part, but the thing that protects us, you know, we need sugar, but in a certain level, sugar is toxic to us.
So we have a system that regulates our blood sugar to keep it under control. That regulatory system is not working properly in kids and adults in kids that have sleep disorder breathing.
(26:49):
So their whole body hormone system that regulates sugar control doesn't work properly. So they're prone to their blood sugars creeping up a bit, not to the diabetes point, but it's high normal.
Okay. Okay. And then it also then affects the gut. And we're starting to learn a lot about the brain gut axis or something that was talked about at university when I was there, but not understood in terms of this thing called the microbiome.
(27:18):
You know, everyone's like about, oh, gut health, gut health, gut health. Well, hang on. Let me interject you yet again. Sleep disorder breathing and we've known about this for about 10 to 15 years, at least.
Because the reason I know that because in my first book that came out in 2016, I was making reference to research that I was reading that was already out there then.
(27:41):
So I know that it's at least 10 years. And it was in animal models. What they were doing is they were exposing mice to low oxygen levels.
So deliberately making a slight low oxygen environment and then looking at what does it do to their gut microbiome and it changed.
(28:03):
And again, we've simplified this to good bacteria, bad bacteria, the bad bacteria to start to take over. And what we've also learned is that with this brain gut axis is that there's an interplay there and communication that then basically, you know, as clever as we want to think we are with the
(28:24):
the gut and the bacteria are somewhat driving the bus at times because that actually affects our food seeking behaviors. And in what way, it makes us crave the high sugar foods. Why? Because that particular type of bacteria wants it.
So in a way, we've kind of been taken over, you know, by these little bacteria are actually telling us what to do without us realizing it.
(28:51):
But interestingly, if we resist that temptation and do the, you know, the gut health protocol, the good ones start to make a comeback.
But the comeback is limited if you have a breathing and sleep problem because you basically you're swimming against the tide there in that low oxygen effect.
And what do we also know that the brain gut axis mental health. We know understanding those links. And back to what you said before with sleep assorted breathing.
(29:19):
So let's just give you some very simple, you know, take homes in terms of mental health now.
I'm going to lift some mental health conditions. Depression, anxiety, schizophrenia, psychosis, PTSD, ADHD, ASD, bipolar, effective disorder, personality disorder.
(29:43):
And everything I mentioned goes up if you've got sleep disorder breathing every single one of them. Okay, some of them by a factor of three.
Okay, now let's take that out of the equation for the moment. Let's look at something completely different, but not entirely. Let's look at hay fever.
Okay, let's look at a fever. So this is nasal allergies. All right.
(30:07):
So this is another soapbox that I get on. It's not just allergies. It really isn't. Okay.
So now nasal allergies causes nasal congestion and that can lead to a breathing in a sleep problem, which is everything we've just already spoken about.
But just ignore that for the moment. They don't always cause a breathing in a sleep problem.
So just having nasal allergies by themselves in a child that child is 30% more likely to suffer from clinical anxiety.
(30:39):
30% more likely because they've got nasal allergies. Why? Because nasal allergies are really annoying.
And what is anxiety when you're annoyed? Two and two is four.
Okay. And we talked about brain growth and brain development in the context of that prefrontal cortex and so forth.
(31:00):
Well, that's not the only part of the brain that gets mucked up and sleep disorder breathing. The memory part does. That's called the hippocampus.
Right. And then the learning part, sort of the anxiety part, it's called the amygdala.
You know what happens in the kids that have got allergies, you know what happens in kids with sleep disorder breathing?
(31:22):
Well, when you use a part of the brain more, it gets bigger. It gets bigger.
So their brains, their amygdala is bigger. Why? Because it was conditioned to be so.
By what? Not breathing properly. By getting bothered and irritated by allergies.
So we're basically promoting a type of brain function that is actually counterproductive to sensible function because of these underlying pathologies.
(31:56):
So when we look at this whole big, big picture, you know, everything's connected, you know, healthcare is segregated, but the person is the big picture.
You know, the things that we have touched on here, this, you know, again, somebody, please, Andrew Huberman, Peter Tears, someone's got to know someone, you know, the world's not that small.
(32:17):
We need to get these childhood issues as part of these wellness conversations because of exactly what you said.
We're raising adults, you know, we're nurturing a child to be the adult that we want or need them to become. And we know that's an important thing to do.
We know that, you know, nurture and nature, you know, intertwined. It really does make a big difference in terms of opportunities and experiences and outcomes.
(32:45):
And, you know, this is the things that we need to work on equality for, you know, because we don't, you know, not everyone has equal ability, but we do want equal opportunity to reach your potential.
In terms of, you know, there are literally, you know, neurosurgeons and, and the like living, unfortunately, in the worst of conditions that will never see the lighter day to be the same.
(33:10):
But they are there, it's just purely that opportunity. So let's work together on pulling that up.
And, but, you know, at the grassroots level, we really need all these health and wellness things that people are focusing on an adult to realize, you know what, could have done it with your could have been done as a kid.
(33:32):
Yeah, yeah, yeah, hit the rewind button, you know, all those Twinkie bars that you would challenge down on.
Well, guess what, your body remembers that, you know, and it's not too late to change, you know, you know, but you've got to make those changes.
And those cigarettes, you know, they're good that alcohol, it ain't good. All right, you know, you're not trying to be, you know, 1920s 1930s, you know, prohibition and tea total areas but you know, let's just, let's just be honest with the conversation pieces.
(34:06):
And then when it comes to breathing and sleep, let's be honest about it. You know, and I got a lot of pushback when I started making this noise but you know, the science papers have come around, you know, you know, when I started this conversation piece way way back over 10 years ago, I was pretty blunt and to the point and kind of
I was like, I'm gonna get it right that way. And I was saying, I was saying, these children with sleep disorder breathing are getting brain damage. You know, it's like, oh, you can't say brain damage. Period. But that's it. Period.
(34:36):
Like stop there, that's it. But that's it. That is it. And again, that's why we don't have children drink alcohol. It's why we don't let them play with mercury. It's why we're worried about chemical exposure, heavy metal exposure.
That's why, because it causes brain damage. But if I say snoring at night causes brain damage is like, oh, you can't say that. But you know what, now the science papers are even saying it like it's actually in the titles of the paper they are saying brain damage and I think it's
(35:06):
like, it's got nothing to do with me. They're following my lead. I think it's the frustration. We have these scientists, they're not clinical people. Okay. But they're at the grassroots, they're doing all the science, they're doing the research, they're seeing these kids, you know, in their working capacity.
And they're going, why are not why doctors not listening to us. Damn it. We're going to call it brain damage. All right. They're going to start to make.
(35:30):
We're right back where we started where I said, I don't understand why we don't have red flags, sirens going off and everyone just a 10% lower, 10 point lower IQ. It's there. It's factual.
Look, look at how much money parents put into like accessory education like school tutors. Okay. For a child that's struggling at math, struggling at reading, struggling with whatever.
(35:58):
Well, let's go back to sleep disorder breathing. We have looked at those things. Your math skills are decreased. If you have sleep disorder breathing. Okay.
So, if you're basically trying to optimize your child, make sure that they're breathing and sleep is optimal first, because you need that foundation to build upon, you know, you can have the best architect design and the best builder
(36:27):
but unless the foundation, the thing that you're putting it on is rock solid. It is not going to hold.
It might be good for a bit, but it's going to start falling apart. And that's what these children are doing. They are falling apart because their foundation is not there.
They have, you know, like I said, the whole biology started biology. It's an amazing thing. It's ridiculous. It doesn't make sense.
(36:52):
It's mind blowing. It's extraordinary when you get into the weeds. I mean, we take it for granted, but when you get into the weeds, it's just extraordinary.
And but it's also doesn't take much to really upset the apple cart. Like it's really, really fragile. You know, you know, again, if you don't mind me saying, you know, you made it public knowledge about your cancer.
(37:15):
That was one genetic mishap that slipped through the door that then everything just knocked on from there one.
Now, your body has this amazing protective system against it. What do we know about adults?
Adults with sleep disorder breathing, certain types of cancers are more likely to slip through the door.
(37:36):
So breast cancer is an example. In my country, we wave the flag again for the highest rate of skin cancer known as melanoma.
Melanoma is worse if you've got obstructive sleep apnea in that awkward, you know, bowel cancer, prostate.
The list goes on. Why? Because part of our defense system against cancer is our immune system.
(37:59):
And when does your immune system, you know, people talk about, I want to boost my immune system and then they go and buy some green powder and make a green smoothie thinking that's the that's the biohack to it all.
Right.
Your immune system is replenished and rejuvenated when you sleep as long as you sleep well.
(38:20):
So sleep isn't just about the brain. It's also about your immune system.
So your veggies, not not the pretend ones like eat the real good veggies.
Yeah, and sleep.
Yeah, and breathe.
And breathe. Yeah.
Yeah. So, you know, that's the sort of the spin around and knock on effect is, you know, like you said, you know, we start at one point and then we just do this full circle and then so forth.
(38:48):
And yeah, look, you and I know these red flags there.
The problem is that they're just behind a wall. We just need someone to speak around that wall and go, guys, I think we've come out. Let's talk about it. Yeah.
Yeah. And let's be honest about it. And let's not weaponize words. Let's not weaponize brain damage. Okay.
(39:09):
And make it say that I find that upsetting. So well, you should find it upsetting because it is upsetting. And it needs to then be motivating to resolving it.
Okay.
Exactly.
All right. That's the thing that you've got to sort of then pivot towards is that, you know, we need to raise the awareness and we need to raise the level at which we are proactive about addressing these things.
(39:35):
It's time to stop, you know, kicking the can down the road, because we know the how that story ends. You just got to get a look to circle back look at your process food industry in the United States.
Look how that story is playing out now. You have a 50% overweight and obesity rate. For the first time in your country's history, your life expectancy of your current generation is less has gone down one that has come from your life
(40:04):
expectancy has gone down. You spend more money on healthcare per GDP than any country in the world. And your outcomes are getting worse.
Because the basics are not there.
(40:48):
You can find out more about the Children's Airway First Foundation and our mission to fix before six on our website at Children's Airway First dot org.
The CAF website offers tons of great resources for both parents and medical professionals. Visit our parents portal clinicians corner resource center and video library to see for yourself.
(41:17):
We also encourage parents to join the Airway Huddle, our Facebook support group, which was created for parents of children with airway and sleep related issues.
You can access the airway huddle support group at Facebook dot com backslash groups backslash airway huddle.
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child might have an airway issue, contact your pediatric airway dentist or pediatrician.
(41:46):
And now let's jump back into today's episode.
(42:16):
You know, you so so again, I'm back to that three legged stool.
Let's just call it what it is and exactly right, you know, for those that don't know the analogy. If you can sit on a three legged stool, you can't sit on a two legged one.
Exactly.
So you need nutrition, you need nutrition and you need air, you take a really, yeah, and then you things start to fall apart.
(42:40):
So, yeah, so, you know, I think, as you know, I can sort of talk and rabbit on for hours on this. It's one of the things about just knowing it so well.
And I think importantly, knowing that the interplay and the links, you know, being able to bring mental health and all these sorts of things into into the mix.
But you know, I should be mindful it's your show, not mine.
(43:02):
Did you know before we go, I want to, I want to talk a little bit about your book for parents that don't that don't know about it and want to check it out.
Yeah, for sure. So I'm up to book number six, which, you know, is just a reflection of, you know, my passion for this.
(43:24):
I think for parents, this is two that I would flag. One is a general book, and it is called sleep disorder breathing, a parent's guide.
And what I do in that book is I try and give them a roadmap because one thing I've realized is that when parents stumble across this problem, depending on, you know, who their first touch point is really dictates what then can be the
(43:51):
paradigm that can play out.
And if they see an ENT, they might just get the ENT version if they see a dental practitioner that might just get the dental version.
If they see a breathing practitioner, they might just see a breathing rehabilitation scenario.
But the problem is that again, that's a segregated system in something where it is actually a multi disciplinary team approach to a multi factorial problem.
(44:21):
So what I did in that book is I sort of did my best to spell out all of the things, all the Enos and throat problems, all the dental problems, etc.
So you know what, if you've got this problem or you need this for it, and if you've got this problem, you need this for it. And if your child has got both, hey, they need both.
And you know, and in terms of having a sequence and so forth, these are things to do. And whilst we're at it, you need to look to see if there's nasal allergies, you need to check their metabolic profile, in particular, their iron.
(44:51):
Because this thing, like I said, it mucks up the gut in certain ways. One of the ways it mucks it up is it limits iron absorption.
If the iron is low, you're tired. This kid is tired already. So this compounds the problem. And iron is a really important thing, not just from an energy point of view, it's really important for a whole lot of brain function and development too.
So there's all these knock on effects. So that's the sort of that's to me that's kind of like your roadmap.
(45:17):
And then the other one that I've put out recently is going really, really deep into the weeds of the links between ear, nose and throat, and the ADHD and ASD.
And it's called the ABC of ENT, ADHD and ASD. So it's basically it's the alphabet book.
And, and the reason I've done that is that I see a lot of children. Okay. And in particular, I seem to have a knack and attraction that then follows on from word of mouth to seeing the children that have the neurodivergent neurodevelopmental issues,
(45:55):
and have a good understanding about how, like I said, you know, before these little things are not little things in these kids, and how we can miss so many things by being complacent, and how, you know, it's pushing these kids further off course than they need to be in the spectrum of their potential
(46:16):
outcomes of the same. So from that point of view, what I've done there is just given a huge overview of genetics, developmental brain development pathways of, you know, nutrition feeding ear infections breathing sleep tonsillitis nasal allergies, etc.
(46:39):
And how these things are all related to brain development, which is not what people think about intrinsically, you know, think about how tonsillitis affects the brain but it does.
You don't think about how an ear infection affects the brain, but it does. And, and I just throw a big spotlight on this.
And again, at the end of the day, the parents can have the knowledge and be proactive. And as I say in the tail end of that book is, you know, don't take no for an answer you know your child best, you know, and you know, it certainly if someone says it's not that bad.
(47:13):
It could be right. But for goodness sake, go and ask someone else just in case they're not because it could make a huge difference to your child as to what their landing point can be. As you know, as you said, as a time plays out to become an adult.
Yep.
I love that and I'll leave that as our final work as usually asked for a last word to me.
(47:36):
That's perfect.
Okay.
I love that. So thank you again so, so, so much for coming on. I really I always enjoy it when you're here. And I appreciate you, you know, attacking some of these questions our parents had.
Oh, it's always a pleasure, you know, and like I said, it really is a privilege as well.
You know, and this is so much more than you and I know that we could talk about. But given that it's been two hours, I'm pretty sure that that just became two episodes for you again.
(48:08):
Yes, I don't envy you for trying to work out where the split in the middle is but I'm sure you're clever enough to do that. And anyone that's listening to this that has their own podcasts that want to sort of, you know, jump on board they can find me through the social
networks. So I've got the Facebook Dr David Macintosh and the the Insta Dr David Macintosh ENT and they can probably reach out to you if they're having trouble finding me can sort of bounce in my direction.
(48:33):
All this in our show notes as well.
Yeah, absolutely. And, you know, I'm more than happy to do these things.
I've got another one tomorrow and I've got another one next weekend and I did for, you know, in the past fortnight, but I will put the time aside and make the effort to just know that at the end of the day there's there's a very good chance I've just helped one child from
(48:56):
doing this. That's all it takes to be worth it.
And that's kind of our motto every day. Like, if we say one child, or 400 million ago, but we've got one.
Yes, exactly.
Thank you. Real pleasure as always.
You can stay connected with the Children's Airway First Foundation by following us on Instagram, Facebook, X, LinkedIn and YouTube.
(49:20):
Don't forget to subscribe to the Airway First podcast on your favorite podcasting platform so you won't miss an upcoming episode.
If you'd like to be a guest or have an idea for an upcoming show, shoot us a note via the contact page on our website or send us an email directly at infoatchildrensairwayfirst.org.
(49:41):
Today's episode was written and directed by Rebecca St. James, video editing and promotion by Ryan Draughan and guest outreach by Kristy Bojikian.
And finally, thanks to all the parents and medical professionals out there that are working hard to help make the lives of kids around the globe just a little bit better.
Take care, stay safe, and happy breathing, everyone.
(50:31):
Bye.
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