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WholeHealth Connections: Nutritional Support for Sleep Apnea

liver detox pathways diagram
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By Felix K. Liao, DDS, MAGD, ABGD, MIABDM, and Lisa Jackson, RN, CHC, RYT-500, FDN-P, AFMC


This article takes the WholeHealth view of approach to sleep apnea treatment by integrating nutrition with oral appliance therapy to improve sleep. This paper is relevant for airway-minded dentists, nutritionists, and indeed all healthcare professionals and patients.

All diseases begin in the gut. – Hippocrates, 460 – 370 BCE

WholeHealth sees all parts of the body as inter-connected and seamlessly coordinated. In the WholeHealth view, chronic diseases such as cancers and sleep apnea are not just localized failures but late stages of a downhill slide. Similarly, sleep apnea is a form of systemic bankruptcy.

What starts that downhill slide? How can this be detected and reversed early on or prevented in the first place? The answers to these questions can help clinicians and patients better manage sleep apnea, which can in turn reduce risk of cancer (1), cardiovascular disease (2, 3, 4, 5), and brain degeneration (6, 7, 8, 9).

Science is very clear that obesity aggravates sleep apnea (10, 11, 12, 13), which in turn depletes adrenals and impairs memory (14). This growing body of evidence suggests that oral sleep appliances in combination with a functioning thyroid and weight loss, among other modalities, can improve sleep apnea.

Oxygen Deficiency

We can go for days without food and water, but less than 4 minutes without oxygen. Yet chronic oxygen deficiency is regularly overlooked in medical, dental, mental, and nutritional assessment in American healthcare in 2018.

  • Oxygen is the most essential ingredient in nutritional biochemistry, and oxygen deficiency is a grossly neglected source of chronic stress.
  • Oxygen deficiency is a source of acidosis; cancer cells thrive in an anaerobic environment. In 1931, Otto Heinrich Warburg won the Nobel Prize in Physiology and Medicine for his discovery that cancer cells are dependent on glucose in an anaerobic process called glycolysis. (15)
  • Well-developed jaws = wider airway; deficient jaws = choked airway. (16)

Savvy Nutritional Secrets

In the WholeHealth view, everything is interconnected, yet conventional medicine and dentistry training offers only a myopic/silo view that cries out for integration and coordination. Here are a few pointers linking nutritional insufficiency to either wellness or illness:

  • You are not what you eat; you are what you absorb. This includes what you ingest, digest, and absorb.
  • Digestion requires ingesting the appropriate vitamins, minerals, cofactors and enzymes.
  • Absorption requires a healthy microbiome, an intact gastrointestinal tract, optimal excretion of hydrochloric acid, and digestive enzymes.
  • Absorption blockers can include emotional stress, food sensitivities, common over the counter drugs like aspirin and NSAIDs, birth control pills, or excessive caffeine and alcohol. These are common contributors of inflammation in the gastrointestinal tract inhibiting digestion and absorption.
  • Absorption and digestion is further disrupted by gut dysbiosis, from addiction to sugar and empty carbohydrates. This bacterial overgrowth inhibits our “feel good hormones.” Neurotransmitters such as serotonin, dopamine, and melatonin, and B-vitamins, essential for energy production and detoxification, are all made in the gastrointestinal tract requiring a healthy microbiome.
  • Lack of melatonin, of course, exacerbates insomnia and interferes with gastrointestinal health.
  • Psychological dis-ease from attention deficit, autism, and Alzheimer’s to anxiety, depression, and schizophrenia are all influenced by the gut flora. (17) Researchers have coined Alzheimer’s to be “type 3 diabetes,” postulating elevated glucose in the brain as a cause of plaque. (18)
  • Intestinal permeability from high gluten diet. Gluten and gliadin stimulate the release of zonulin, an enzyme that increases intestinal permeability. This occurs whether one is celiac or not. This is a precursor to an ever increasing number of autoimmune diseases. (19)
  • We live in an increasingly toxic and pro-inflammatory world. Things such as glyphosate in rain water, antidepressants in municipal water, hormones in meats, and endocrine disruptors in personal care products contribute to our toxic soup.
  • Synergistic toxins drive obesity and adrenal fatigue. NR-Hg + Pb at 5% LD = 100% kill. This study shows that the no response level for mercury salt when added to just 1/20th of the no response level (LD1) of a lead salt killed all the animals. These toxins by themselves were below acceptable limits, but when combined, they had a synergistic effect that killed all of subjects. (20) Every year, the US adds thousands more toxic chemicals to our environment that have never been tested together for safety. These toxins are stored in fat to protect the internal organs. It is no wonder we have an epidemic of obesity, sleep issues, and adrenal fatigue.
  • Essential nutrients to quench toxins and inflammation: A diet rich in phytonutrients, healthy fats and neurotransmitters are needed to support both phase 1& 2 liver detoxification, as well as phase 3 elimination via the kidney and gastrointestinal tract. These include green leafy and cruciferous vegetables, healthy omega 3 balance, clean sources of proteins, fats, and complex carbohydrates, and clean filtered water.

liver detox pathways diagram

Nutritional Support to Improve Recovery from Adrenal Fatigue

Lisa Jackson was born in Washington DC where “we wear stress as a badge of honor. When someone asks, ‘How are you?’ the common response is, ‘Great, I’m sooo busy.’ We equate stress with success, so we become addicted to stress and its cortisol high.”

What can be done to support the adrenal fatigue that comes from life-long sleep apnea or deprivation? Food sensitivities are the most common cause of adrenal fatigue. A thorough review of eating and drinking habits accompanied by food sensitivity testing can be valuable.

The common advice from well-meaning professionals is to eat less and exercise more. Our clients with adrenal fatigue need just the opposite. They need to learn how to relax and repair, rest and digest, and/or mate and ovulate. (Yes, infertility is at an all-time high, exacerbated by endocrine disruptors, stress, and adrenal fatigue.)

Simply slowing down and practicing eating hygiene is essential to teach patients to flip the switch from “fight or flight” to the parasympathetic nervous system responsible for rest, repair, and digestion. Many people eat on the run or multitask, eating lunch at desks instead of sitting down and slowly chewing and savoring their food.

Below is a picture from Lisa’s book Savvy Secrets: Eat, Think & Thrive, depicting the whole-body effect of remaining stuck in “fight or flight” sympathetic system overdrive. The messages we are giving our bodies is that we are not safe and that we need to conserve fat for the marathon we are running. This is an innate survival tactic meant to protect us from danger. Today’s “danger” signals are triggered by stress, sugar, caffeine, and toxic thoughts and chemicals. This is a large contributor to our obesity epidemic effecting sleep apnea.

systemic effects of chronic stress diagram

The 5 R’s of Gut Health

A good functional medicine practitioner will enlist the 5 R’s of functional medicine for treatment of any chronic dis-ease:

  1. Remove inflammatory foods.
  2. Replete nutritional and digestive enzymes. Test to confirm.
  3. Reinoculate with appropriate probiotics and prebiotics. This can be ascertained with a comprehensive stool test.
  4. Repair the gastrointestinal lining with food and supplements.
  5. Rest for digestion, ovulating, and mating.

Let’s start with #1 weaning off off sugar and caffeine (inflammatory) foods, which goes hand-in-hand with #2 repleting nutrients and digestive enzymes.

Essential Minerals

  • Sugar, Caffeine and Stress deplete Magnesium. Two thirds of the US population is deficient in magnesium. Symptoms of magnesium deficiency include insomnia, constipation, hypertension and headaches. Magnesium controls over 300 biochemical reactions, but is depleted by stress and caffeine.
  • green smoothieWean off caffeine with this recipe from Dr. Liao: power greens + smoothie with arugula/mixed greens/sprouts (one-fistful), 4 Brazil nuts, 1/2 banana, 1/5 cup of coffee, and 4/5 of water. Blend until smooth and sip it slowly. Roll it around the mouth like wine over 20 minutes instead of one gulp. Try replacing coffee with raw cacao for less caffeine and super antioxidants.
  • Zinc mediates 200 enzymatic functions. It is required for healthy thyroid, key for prevention and recovery of intestinal permeability, and essential for healthy immune function to fight colds & flu, and for cancer prevention.
  • Good sources of zinc include lamb, pumpkin seeds, grass fed beef, and chickpeas. Many lozenges for colds/flu include zinc.
  • Calcium: Two-thirds of the population are lactose intolerant. Mass marketing has convinced us that we need dairy to get our calcium requirements. In reality, the calcium in green leafy vegetables is more readily absorbed. We need magnesium, vitamin D and K for absorption of calcium into the bones. Beware of supplementing with only calcium and ignoring the other essential nutrients. A whole food diet will ensure proper balance.
  • Fighting off colds and flu: A cocktail that we recommend to clients includes vitamins A and C, and zinc, as well as a good probiotic.

Phytonutrients protect against environmental toxins.

  • Variety and diversity is key. Choose a RAINBOW of colors: mostly vegetables and lesser in fruits.
  • Is seaweed in your diet regularly? It is high in a variety of minerals including iodine. Iodine is essential for healthy thyroid function as well as for optimal functioning of every cell in the body.
  • Cilantro, watercress, and spirulina (a type of algae) are all chelators of heavy metals. Lisa likes to start the day with a green energy smoothie that includes cilantro.
  • Eat seasonally and locally as Nature intends. Eat organic whenever possible for optimal nutrients and to avoid pesticides, fungicides, and GMOs.

Amino Acids

  • Power Breakfast: 20 grams of protein (from 3 organic eggs) or Amino Complex powder.
  • Green Energy Smoothie: sprouts, avocado, and plant-based protein (greens, quinoa, pea, chia, chlorella, rice), kelp, and green apple.

Essential Fatty Acids (EFAs): Fat does not make fat, sugar does!

  • Good fats build healthy brains: The human brain is nearly 60% fat (21).
  • Omega 3 essential fatty acids are anti-inflammatory. DHA is best for the brain, and EPA is best for lowering inflammation.
  • Omega 6 essential fatty acids are primarily pro-inflammatory. The Standard American Diet (SAD) includes too many inflammatory Omega 6 fatty acids. Conventionally raised beef, poultry, and farmed fish (fed grains), and the vegetable oil found in all processed foods have skewed this delicate balance.
  • Symptoms of EFA deficiency include:
    • Dry skin and hair, skin rashes.
    • Arthritis.
    • Memory issues, attention deficits, depression.
    • Poor absorption of essential fat soluble vitamins like A, D, E & K. These are critical for healthy immune function and prevention of cancer and autoimmune dis-ease.
  • Good sources of Omega 3s include seafood, grass-fed animals, walnuts, avocado, algae and supplementation. Avocados are anti-inflammatory and good sources of the antioxidants Vitamin C and Vitamin E. An avocado a day keeps the doctor away (22).
  • Cancer thrives via an anaerobic process called glycolosis. Sugar feeds this fermentation, as in turning grapes to wine.
  • Sugar is pro-inflammatory and pickles the brain, organs, and arteries. High sugar and high alcohol kills by slowly pickling and fermenting the body!

The good news is that we are not destined by our diagnosis or our genes. Diet and lifestyle attributes to 95% of both wellbeing or dis-ease. Chronic disease such as cancer and sleep apnea are preventable and treatable with whole health solutions (23).

Part II of this article will continue with Reinoculate, Repair, and Rest of the gut in support of sleep apnea patients. Please note that the points are to raise biological dentists’ awareness of mouth-gut-total health connections and are not meant to be prescriptions, and that each patient should consult with their own doctor(s).


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  2. Lattimore JL, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. Journal of the American College of Cardiology. 2003;41(9):1429–1437.
  3. Hoevenaar-Blom MP, Spijkerman AMW, Kromhout D, Verschuren WMM. Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: The MORGEN study. European Journal of Preventive Cardiology. 2014;21(11):1367-1375.
  4. Dement WC, Mitler MM. It’s time to wake up to the importance of sleep disorders. JAMA. 1993;269(12):1548–1550.
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  6. Yaffe K, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306(6):613-619.
  7. Collins LM. Treating sleep apnea may head off Alzheimer’s, other dementia. Deseret News. 2011;August 24. Accessed February 25, 2018.
  8. Ascoli-Israel S, et al. Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: A randomized controlled study. J Am Geriatr Soc. 2008;56(11):2076-2081.
  9. Raji CA, et al. Longitudinal relationships between caloric expenditure and gray matter in the Cardiovascular Health Study. Journal of Alzheimer’s Disease. 2016;52(2):719-729.
  10. Patel SR, et al. Relationship between obstructive sleep apnea and diurnal leptin rhythms. Sleep. 2004;27(2):235-239.
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  13. Pillar G, Shehadeh N. Abdominal fat and sleep apnea: The chicken or the egg? Diabetes Care. 2008;31(suppl 2):S303-s309.
  14. Huang CW, Lui CC, Chang WN, Lu CH, Wang YL. Elevated basal cortisol level predicts lower hippocampal volume and cognitive decline in Alzheimer’s disease. Journal of Clinical Neuroscience. 2009;16(10):1283-1286.
  15. Nutritional Oncology. Cancer cell metabolism. Accessed February 25, 2018.
  16. Liao F. Six-Foot Tiger, Three-Foot Cage: How to Take Charge of Your Health by Taking Charge of Your Mouth. Carlsbad, CA: Crescendo Publishing; LLC; 2017: chapters 4, 8, 15.
  17. Campbell-McBride N. Gut and Psychology Syndrome. Natasha Campbell-McBride; 2010: chapters 1-10.
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  22. Dreher ML, Davenport AJ. Haas avocado composition and potential health effects. Crit Rev Food Sci Nutr. 2013;53(7):738-750.
  23. Anand P, et al. Cancer is a preventable disease that requires major lifestyle changes. Pharm Res. 2008;25(9):2097-2116.

Felix LiaoFelix K. Liao, DDS, MAGD, ABGD, MIABDM has a Doctor of Dental Surgery degree from Case University of Dental Medicine and is a Holistic Mouth Doctor focusing on the dental contributions to medical symptoms and natural wellness. He blends leading edge technology with old-fashioned TLC for children and adults at Whole Health Dental Center in Falls Church, Virginia. He is the author of Six-Foot Tiger, Three-Foot Cage, connecting mouth structure with total health and showing how an impaired mouth is the start of a domino effect of patients’ persistent, escalating, and costly symptoms. His Holistic Mouth Solutions can effectively redevelop “ three-foot cages” by combining innovative Whole Health approaches with stem-cell-activating oral appliances to produce unexpected and even life-changing improvements.

Lisa JacksonLisa Jackson, RN, CHC, RYT-500, FDN-P, AFMC is an author, functional nutrition- and function medicine-trained health coach, yoga teacher, and retired registered nurse with the mission to “Inspire, Educate and Empower” individuals to heal from within. Her book Savvy Secrets: Eat, Think & Thrive is a self health book offering her Seven Steps to Optimal Health. When she is not coaching, speaking or advocating reform, you can find Lisa joyfully sharing Carpe Diem Dance or playing with her two grandchildren. She is the mother of four adult children and believes, “Optimal health should not be a secret.”

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