Episode 37: Dr. Cheng Ruan, MD On How Breath, Chewing & Body Structure Can Impact Brain Function

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SPEAKERS: Dr. Andrew Wong, Dr. Cheng Ruan

Dr. Ruan:

Humans have developed into organisms where we’re pretty much the only mammal that has impaired breathing. If we look at skull structures over the last 200 years, our skeletal structure has changed quite a bit, our sinuses and stuff like that, and it has to do with you know, more softer and processed foods and accessible to foods a lot easier you know, no one’s chewing the bicep off of a rhinoceros anymore, right, so our utility of our jaw structures and stuff like that is a whole lot less so the number one cause I think is looking at really the way we breathe and most people don’t have a concept of breathing “normally”. It’s because a lot of people are born not breathing, you know, correctly.

Dr. Wong:

So much of our lives and health is dependent on our brain health. Everything from our mood, memories, sleep, and daily activities relies on a healthy brain. What can we do to keep our brain in its best shape? Today, Dr. Cheng Ruan joins us to do a deep dive into how our breath, skull health, and lifestyle impact our brain health. I am Dr. Andrew Wong, co-founder of Capital Integrative Health. This is a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of disease and wellness. Dr. Ruan is a board-certified Internal Medicine physician, a Functional Medicine practitioner, and founder of the Texas Center for Lifestyle Medicine. He works with patients to find the root causes of their conditions using the best of lifestyle and nutrition and much more. Join us for a conversation about how our brains are impacted by breathwork, meditation, chewing, the health of the skull, and what actions we can take to support our brain health for the long term. Welcome Dr. Ruan to the podcast. Cheng, thanks so much for coming on today. We’re so excited to have you on to talk about brain health and a variety of other functional topics. Finally good to get together with you and have a podcast with you.

Dr. Ruan:

Yeah, thanks a lot. Thanks a lot for having me on, appreciate you.

Dr. Wong:

We’d like to talk first today about kind of your background or story. I think everyone’s kind of interested in that, our listeners are you know. You’ve been an Integrative and Functional leader for a number of years now, different companies, your own clinic as well, really shaping the narrative of landscape a lot of doctors too training other doctors on, you know, how to make this more accessible for, you know, the population at large. So, let’s just start first with kind of how you decided to become an integrative and functional doctor.

Dr. Ruan:

Yeah, sure. So, my origin I guess is my mother who is an acupuncturist and Chinese Medicine doctor for a number of years and my father is an MD, PhD so it’s been sort of Integrative like my whole life if you will and I think that there’s no other way to really look at Medicine, you know, other than this and I was never really big into labeling like the type of Medicine. I think Medicine really just should be Medicine. I’m trying to really change that within the actual landscape and be more inclusive in letting the patients really decide what their path really wants to be rather than, you know, us dictating health or companies dictating health and stuff like that so kind of a bit of a shift of power, you know, let the patients be their own heroes and kind of decide exactly what direction they want to go.

Dr. Wong:

We always say here that, you know, the patient is the CEO of their own health, right? Why

would we want to be the CEO of their own body, right? That doesn’t make a lot of sense.

Dr. Ruan:

Right, right. Absolutely and the one thing that I always grew up with, you know, I’m the sixth generation of doctors in the family and so the one thing I always grew up with when I was a little kid in China, I grew up in China, my grandfather who basically was the oldest, most senior doctor of the village always had a line of people kind of out the door because he’s one of the first people to incorporate more of the Western Medicine, you know, the aspirins and NSAIDs and stuff like that into like the eastern culture, right? And so, he was a really huge proponent of that in rural China and Southeast China and so, that’s what he was kind of known for. And so, I wanted to kind of fulfill that legacy by bringing a lot of the eastern concept into the western world and so, that was always my my vision ever since I was about three years old and so I guess I never really wanted to do anything else and then when I started training here and for medical school and residency and chief presidency, you know, I noticed that I was starting to kind of drift away from my origin because there was no incorporation of my origin into clinical training, right. And in fact, a lot of the things that are taught in Western Medicine are observation based so we observe a group of symptoms when a label is something that goes into a diagnostic code, right, which is sort of the opposite of what we generally do in Eastern Medicine as well, function is not right. So, instead of saying headache, abdominal pain, leg swelling and joint pain, we’re like, “Well, that’s one thing”, you know. In Eastern Medicine, that’s a pattern. And so, the collection of patterns and observations from a Western Medicine standpoint became really focused on I think coding and data collection and stuff like that and I think Medicine has really transformed from something that’s relatively holistic in the 1950s even the U.S to something that’s very focused on data collection and outcomes and stuff like that which has a good and bad point but I wanted to really refocus on exactly what Medicine should be.

Dr. Wong:

And there’s a few points there but certainly an Integrative Function of Medicine, we focus on the root cause, physiology, and like you said what’s kind of underneath the hood, what’s causing things rather than labeling for diagnostic purposes so instead of a diagnosis, we’ve come up with what’s functional or dysfunctional just like you said in Eastern and Western Medicine, it’s all just good Medicine depending where the patient is and where you know we are as practitioners like that’s what Mark Hyman said essentially that we should eventually just call this good Medicine.

Dr. Ruan:

Right, yeah. And I think that at the heart of every doctor in this country, every doctor is a heart of a Functional Medicine doctor and it’s because every doctor wants to get to the root cause but I’ll tell you and, you know, you probably notice as well is that through residency, we’re really trained to look at the root cause outside of the hospital system, you know? We’re really good at root cause analytics like if someone is an inpatient and we’ll figure out where the infection’s coming from and stuff like that. From an outpatient perspective, it almost became almost like a triage for inpatient so, you know, our emergency care is phenomenal in the US. It’s absolutely phenomenal. It’s crazy that we can’t apply a lot of the the same concepts into outpatient care but I think we’re really changing that since the pandemic started.

Dr. Wong:

Yeah, yeah. Well, actually, let’s get into that before we get into like what kind of conditions you want to work with so, how do you feel like the pandemic has sort of changed the landscape of how we, you know, look at outpatient medicine and chronic health conditions?

Dr. Ruan:

Well, first of all, bureaucracy and administrative patterns within the United States have changed pretty dramatically. If you look at what it takes for a doctor to get a credential with Medicare now compared to before the pandemic, all of a sudden everything’s electronic, things are so much faster, right? And then, all the red tapes, my gosh, there were so many red tapes into getting medical licensure before. It’s kind of gone now, you know, and there’s a lot of advancement in technology that’s able to do that so there was a forced hand. That’s the first part. The second part is a lot of the public is adaptive to technology, you know, whether it’s zoom or any other online platforms so you have a population who went from very little exposures like telemedicine to about half the population having had some sort of telemedicine in the last two years that you don’t see, you know, within a one-year change but we did with the pandemic and then another really good example is a QR code like everyone knows what a QR code is If they’ve ever went to a restaurant in the last two years because you scan your QR code, you go on the menu, right, and so, this concept of digitalizing whether it’s health or food or anything like that is a normal thing in a normal process, you know, these days so I think the adoption of what Medicine could be is really shifted and I can akin this too in the 1950s and I was on another podcast very recently interviewed by the physician who’s 81 years old and he akin this to when TV first came out it was a big deal and all of a sudden the doctors were having to combat against TV broadcast called commercials, right? And so, it was a huge issue at that time because they didn’t really know how to do it because the media was coming into play because TV started as government programs and it turned to media and commercials and now, we’re kind of seeing the same thing but on a very massive scale and pattern and that’s not going to change anytime soon so I think the evolution of Medicine is able to be accelerated should the right players be there. Now, you know as well as I do that not all doctors are going to be doing telemedicine or wanting to do group visits to share medical appointments and stuff like that which I think is really the wave of the future but this is where everything becomes accelerated because of the mass necessity, because of ease of access, because of the change between the bureaucracy reimbursement for telemedicine and stuff like that so I think it’s a good thing that we’re able to accelerate health in this way.

Dr. Wong:

I agree it is a firsthand but, you know, certainly telemedicine and, you know, group visits on telemedicine are ways to really accelerate the democratization of some of the access to the root cause of Medicine that both you and I practice so thank you for that and just in terms of going pivoting now to clinical, what kind of conditions do you see in your clinic that you most often like to work with?

Dr. Ruan:

Well, let me tell you how we kind of developed Texas Center for Lifestyle Medicine. That was developed in 2017 and the model was not what I imagined. So, we wanted to have Integrative Health within the insurance, in Medicare, Medicaid, and government insurance and marketplace insurance setting, and it was not the easiest thing in the world because it’s not really set up for that until we started with our health coaches and things kind of turned around a little bit. Clinically speaking, if you think about what we actually do, we take insurance and not only that. We try to get to the root cause of disease so we naturally get really complex people. All the rare disorders that I never thought I would see in clinical practice and med school, I’ve seen them. Every other patient is like this hereditary connective tissue, Ehlers-Danlos type patient, and that’s stuff that I never thought I would utter outside of medical boards and stuff like that. So now, it’s become really commonplace. And then, what we realized very quickly is that Medicine is lost, not necessarily because of the design but it’s really lost because there’s no incorporation of communication into how doctors really approach the patients and the families. And so, we just, you know, we’re not smarter than anybody else. We just communicate a whole lot more so we get more data points, right? And we utilize those data points to support everything that’s going on. And so, we really quickly realized that if we start with belief systems, then we can be extremely powerful and we’ve kind of evolved into that, which naturally took our entire attention into brain health, right? And because the brain holds the most number of amount of conjugate or the energy sub units in all of our bodies. So whenever something’s wrong, our brain is going to tell us first. The downside is most people are taught to ignore the brain, right? And so, what we do is we start leveraging brain technology. Instead of just just doing labs, we look at brain technology looking at patterns and started finding associated disease states, and then we were like, “Okay”, you know, we’re really going to shift the focus into what the brain is really telling us to let us know what’s going on in other parts of the bodies and that really turned into something that’s really magical because people are getting better faster, we’re looking at better outcomes and even through with the coronavirus pandemic, we can look at patterns of the brain after code infections of vaccines and stuff like that. That is very interesting and it simulates other things as well, so we’re better to able to categorize disease states by looking at brain patterns so that’s the main focus right now.

Dr. Wong:

Yeah, yeah. I think you actually introduced me to the EEGs and started to work a lot heavily with them too, so thank you for that. And we know that, like you said, it really can identify some of the root causes of maybe pathology or dysfunction in terms of the brain.

What would you say would be the top three causes of sort of brain dysfunction if there were top three of that?

Dr. Ruan:

There is, there is. Number one, is the way we breathe. Humans have developed into organisms where we’re pretty much the only mammal that has impaired breathing. If we look at skull structures over the last 200 years. Our skull structure has changed quite a bit, our sinuses and stuff like that, and it has to do with, you know, more more softer and processed foods and accessible foods a lot easier. You know, no one’s chewing the bicep off of a rhinoceros anymore, right? So, our utility of our jaw structures and stuff like that is a whole lot less, so the number one cause I think is looking at really the way we breathe and most people don’t have a concept of breathing “normally”. It’s because a lot of people are born not breathing, you know, correctly which is interesting because this completely ties back into my culture which is, you know, a lot of the tai chi, doing a lot of the breathing exercises, mindfulness, and meditative exercises which have a huge impact on brain pattern. I mean, if you think about it, that’s not surprising. If you go to a scary movie, you see a scary scene, you start holding your breath. When a scary scene comes on, your face goes white. Basically, your outside perception is shutting off blood flow to your face, right? So, it’s a physiologic mechanism in preparation for that fight or flight and that’s breath control versus if you get angry about something and then you get really ticked off and start hyperventilating, your face gets red which means there’s blood flow more directed in that direction, so there’s a lot of physiological mechanisms that happen with breath that we’re seeing. So, one is breath, two is light, and number three is the circadian rhythm which is affected by number one and two, so the circadian rhythm is our day-night cycle. It’s how we regenerate, it’s how we take away our damaged cells, a phase called autophagy, and the regeneration is from stem cells and upregulation and stuff like that, and so that mechanism is actually rooted in deep sleep. Now, one in three people do not have great deep sleep for a multitude of reasons. The stressor is a little bit different and, you know, we have the light coming in and we have impaired breathing mechanisms. You know, allergies is one of the main causes of issues, and so you have this sort of trifecta of air light and breath and the strike effect of airline breath really needs to be optimized so that disease states can really improve. And so, we didn’t really respect this process before because we kind of went around it. We started with gut health. We used to start looking at like environmental toxicity and stuff like that. None of that was very helpful because we don’t optimize breath, light and sleep. Then, all the other stuff that’s really out there is so variable and it’s really complex to get a hold on health but when we start focusing unapologetically on that, then people are getting better quicker and it’s fascinating. Actually, it doesn’t even matter what the disorder is. It’s fascinating how quickly they get better, so it’s been a journey.

Dr. Wong:

Well, BLS, I think that’s a good- You know, we all trained in BLS or ACLS, so BLS is a good healthcare.

Dr. Ruan:

Basic life support.

Dr. Wong:

Basic life support. Well, breath, light and sleep is basic life support really.

Dr. Ruan:

Absolutely.

Dr. Wong:

Right. So I have some sub questions based on that. Let’s kind of go back to breath for a second.

Dr. Ruan:

Yeah.

Dr. Wong:

So do you think it’s the chicken or the egg thing in terms of our skull and jaw, you know, anatomy and stuff has changed over the last 200 plus years, let’s say, or more. Has the changes been some of the root cause of why we don’t breathe as much now or is it just about the breath and we’re stuck in a fight-or-flight mode and we’re not breathing correctly? But is a structure also impairing that ability to breathe correctly?

Dr. Ruan:

I think it’s that. I think it’s actually our lives that have changed quite a bit. You know, if you look at human evolution, the frontal lobe of our brain is getting bigger, it’s crowding out the sinus spaces. The way we make balance in life is actually through nasal breathing, so right around next to the bridge of your nose, you have two structures and one on each side is called the paranasal sinus. The paranasal sinus is responsible for the up regulation and production of most of the nitric oxide within our body and systems. Nitric oxide is kind of an important thing because nitric oxide allows our body to balance, allows the brain to come into the calm state, allows the blood vessels to dilate so lack of nitric oxide is predisposed to diabetes and dementia and hypertension, etc. So, you know, that’s very common to look at from a pharmaceutical perspective because there are people that are making things that can improve the nitric oxide at one level or another, but then if you don’t take care of the breath part, it may not be very very useful. We take another set of animals, the baboon for example, who are actually born without perinasal sinuses. These animals have a smaller frontal lobe, higher aggression levels, higher blood pressures so we can see, you know, what happens from an evolutionary standpoint in that mammal, right? But for us and for all mammals, we need that, those sinuses, to be clear and working, for us not to develop a lot of chronic disease states. Now, this ties into gut health as well. It’s because our gut microbiome is purely dependent on the air that moves into your paranasal sinuses. So, if someone has chronic seasonal allergies, I expect them to have gut problems, right? If someone has been on a million different diets, right, and nothing seems to work, we look at nasal structures and breath and stuff like that, so that’s where we start working with ENTs and dentists and stuff like that to look at what we can optimize and we look at sleep disorders. One in four people have some level of obstructive sleep apnea, narcolepsy as well is really underdiagnosed. Most of those people also have structural abnormalities within the skull cavities and the way we know that is because there are people with hereditary disorders that can’t make good quality collagen and these are called ‘hypermobile people’. One class of it is called the Ehlers-Danlos Syndrome and they all, in my practice, they all have obstructive sleep apnea no matter how thin or how big they are. It’s because their soft tissue structures, the skull structure, have a very hard time accommodating to air and a lot of them have narcolepsy and dysautonomia and POT syndrome and stuff like that. So, all these different “rare disorders”, we’re seeing more frequently now and even Alzheimer’s dementia- is because our airways are constantly plugged up with stuff. You know, allergies, environmental toxins and stuff like that. And so, and after we deal with that, you can see people’s brain patterns change in honestly as little as a week and when we do that with the QEEG, measuring brain frequency waves, and we compare that to the normal population, so I think the evidence is there and this is a lot more easier to swallow if you will. It’s easier to understand than look at some other causes that may be a little more difficult to understand of brain degeneration.

Dr. Wong:

Yeah. You said a lot of really nuggets of wisdom there. I think the main thing that I got from the part about nitric oxide is that you need NO to help modulate a healthy gut microbiome, is that correct?

Dr. Ruan:

Yes.

Dr. Wong:

That’s a big part of it.

Dr. Ruan:

Right.

Dr. Wong:

And then also going to see a myofascial specialist or a biological dentist or someone that can, you know, use MFR, use some of the airway devices in addition to, you know, supplementing that with ENT care. I mean it sounds like sinuses are really important and the skull, you know, cavity and the anatomy is really important to have proper breathing.

Dr. Ruan:

Yeah.

Dr. Wong:

In addition to having mindfulness, etc.

Dr. Ruan:

Right. And that evidence is really apparent, right? So my mom is an acupuncturist and then one of the first things to do when it comes to someone with chronic disorders is we look at their posture. If someone comes in and their shoulder is kind of elevated towards the ears which a lot of people are and maybe they’re a little lopsided and they have like autoimmune disease and gut disorders and stuff like that, well the first thing would be like, “Whoa. What is causing that”, right? And if you go to acupuncturists or a cranial psychotherapist, the first thing to work on is fascia. And fascia is the outer covering muscle and the fascia is designed for us to protect ourselves, constant fight or flight, right? And so, if an acupuncture needle were to go on the top of the head, there’s an immediate release of fascial tension and this patient may actually fall asleep right after that goes in. We see that a lot in autoimmune disorders, right? And so, what we want to really respect is symmetry, so not just symmetry of the skull but symmetry of the spine, symmetry of our hips, in our knees and our ankles and of course, most of that is kind of rooted in the spine but without symmetry, very few things can be restored. I mean you can have severe scoliosis or hip issues where one leg may be a little shorter than another and then you have a gut disorder, you can go on any sort of elimination diets all you want but a lot of those are temporary because it’s not a dietary issue. There’s a symmetry issues that we really have to restore first. By restoring symmetry, you can increase your lymphatic drainage to different parts of the body, you can improve your detoxification mechanisms, and then you can start regenerating in deep sleep because symmetry also improves deep sleep. That’s why when people sleep on pillows that are not so great for them and they have neck pain, they don’t have great deep sleep. You wake up with brain fog the next day, right? And these are the things that we actually look at first from a structural standpoint, and then we kind of do the other more detailed stuff afterwards.

Dr. Wong:

I love that focus on structure function and diet. It sounds like they both need to be addressed by directions but certainly from a brain perspective, you know? It is almost like in some ways, we could almost argue that it’s top down mechanism. The brain is controlling or directing a lot of the other organ function, the tissue function, you know. Like you said, taking that point at the top of the head. I think maybe you’re talking about governor vessel 24. What was it? Not 24. The one at the top of the head. Right now, my medical acupuncture is getting rusty but right at the top of the head there is I think a really good point for depression as well too

Dr. Ruan:

Yeah, yeah. So, there’s another really high level of evidence type that can really explain our symmetry and breath and stuff like that is that those people who suffer from hormonal disorders- hypothyroidism, early onset menopause, they tend to have what’s called a high power to frequency ratio of the theta waves in the brain. The theta waves is supposed to be sleep waves, right, but we’re seeing a lot of the theta waves when they’re awake and this is done on our QEEG device called ‘Brainview’. And so, I’m able to kind of correlate major hormonal issues. In men, it could be low T as well. Two, there’s high power frequency ratio theta waves. Well, this is also the state of waves power that gets elevated when you have hypersomnia, basically sleepier during the daytime, and we’re able to correlate that with sleep apnea and we know that sleep apnea is one of the main root causes of hormonal imbalance. It doesn’t matter what hormone it is. And then, we can look at brain patterns of people with chronic pain, so most people have higher pain perception whenever they have airway diseases, sleep apnea , a lot of, you know, the light coming into the eyes especially doing a lot of computer work, so the perception of pain is quite high. And this is why when people get migraines, they get photophobic like it’s really hard for them to look at light. They have to be in a dark room because there’s just too much stimulus that’s going on. If we take that into a micro scale into what people are on a daily basis, then we can understand that over time, a lot of what we’re doing from a behavioral standpoint could be quite destructive to a process. And this is what I like to focus on because the behavioral changes don’t cost any money to breathe. It doesn’t cost any money to decrease light, right? And so, I think that by pulling the lever on the things that aren’t a huge inhibitor to the wallet and also can make the greatest outcomes, I think that’s where health really should head.

Dr. Wong:

Yeah, totally agree. That’s so great. Kind of going a little bit more into brain health now, what do you think about inflammation and brain health? I know that’s like a huge topic and certainly in Functional Medicine, a lot of experts and speakers say, you know, “Inflammation is the root cause of all chronic disease”. Is inflammation the primary root cause of brain dysfunction? I know you mentioned BLS, you know, overall meaning- breath, light sleep. Do all those BLS sub components essentially cause brain inflammation or what is your view of that?

Dr. Ruan:

Really good question. Well, first of all, we have to honor inflammation. We have to be thankful for it. Without inflammation, none of us will be alive.

Dr. Wong:

Yes.

Dr. Ruan:

So, it’s not about root causes inflammation. The root cause is something that the body necessitates inflammation for, so inflammation is great because we know something’s wrong and if you choose to ignore inflammation or cover it up with medications, then that’s our choice, right? We’re kind of suffering the consequences and that’s where we see a lot of chronic diseases go uncontrolled so I never like to use the ‘I’ word which is the inflammation word because it’s so general, right? And also, we don’t know what to do about it when it comes to this so it becomes very very taxing to anybody who is trying to like get a hold of things, you know. If patients come in and say, “I want to decrease my inflammation”, I’m like, “Well, okay”. That doesn’t necessarily mean anything because we have to look at your whole life, right? So, yes, a lot of the impaired airway mechanisms can increase inflammation more than what we should have and if we look at chronic disease states and brain health, I mean let’s just look at Alzheimer’s model for a second. We have people with Alzheimer’s develop sort of these plaques and tangles within their brain and thank God because if they weren’t there, we would have seizures we would die much earlier on, so we need those plaques to sequester whatever the hell is going on inside our noggin, right? So whether it’s infections or toxins and stuff like that. And so, the plaques themselves aren’t the pathological thing, right? It’s part of our immune response. Now, we just have to figure out what is causing that. Is it cigarette smoking? Is it because, you know, I live really close to interstate? It has a lot of pollution. Is it because I have mold in my house that’s causing blockages of my paranasal sinuses so I can’t make nitric oxide and therefore I can’t perfuse my temporal lobes of the brain? You see that shrinking on the MRI, right? Or is it because I’m using maybe some products that I’m allergic to or something like that, right? Or is it because I work three jobs to support a family and I only have four hours to sleep, so I have no time to regenerate which also increases inflammation, right? But that’s a good question though. You know, inflammation, I don’t think is the root cause of anything because it’s the system. In Chinese Medicine, it’s all about, you know, the imbalance between the yin and the yang. The yang, whenever you’re on the yang, the dominant side is inflammation and it’s there for a reason. Now, we have to figure out like what’s really going on.

Dr. Wong:

Let’s go back to Chinese Medicine for a second. I remember in my medical acupuncture course about the Hu Xi and the breathing and essentially in the West, we are taught to inhale first before exhale.

Dr. Ruan:

Yeah.

Dr. Wong:

But this idea of inhale before exhale, often people overemphasize that inhale and then that leads to a sympathetic nervous system dominant state. What do you think about, have you ever advised your patients for instance to like try to exhale before they inhale? And curious about that.

Dr. Ruan:

That’s a really good point and this whole thing between inhalation and exhalation comes from the fact that in the Western culture, our guts are always sucked in, alright, so when we’re out walking, we don’t want our guts to look very big. And so, we retain a lot of air that’s in there, right? And whenever people take a deep breath, everyone’s trying to increase their chest. No, you want to increase the width of your gut so you can draw all the air towards the bottom of the lungs and when you exhale, you want to squeeze your gut in for the exhalation process. But, you know, people are air retainers, I call them, right? And so, the actual concept of breathing should be soft belly breathing where your belly is really soft and not tensed up, right? And so, you know, why do Victorian women who wear corsets and stuff like that, they pass out, you know, if they stand up for too long. It’s because they have no air coming into the body, right? And why do people who, for example, go diving, their nose is covered but they’re getting oxygen through their mouth? Why is their blood pressure always elevated and they may feel this sort of sense of air hunger is because when you put air only through your mouth, you’re not able to also get that deep breath and oxygen can’t be delivered to the capillary, so divers can only stay in water for so long even though they may have a really long endless supply of oxygen, right? And so, our bringing mechanisms, you know, through the nose and out through the mouth or through the nose as well requires a lot of activation of muscles within our belly, so yes, I agree with you that when people start the exhalation process, the belly draws in. They actually have to let the belly to expand out again to draw all the air into the bottom part of the lungs and also activate systems within the body that balance the body as well.

Dr. Wong:

I love how we’re starting to talk about the comedy of some of these foundational, you know, fundamental basics that anyone could do, any of the listeners out there that wanted to promote their own brain health, bring out their loved ones just starting with breathing and some of these examples seem extreme like divers and Victorian women. Of course it is but the reality is, we’re probably all breathing that way a lot of the time.

Dr. Ruan:

Absolutely. Well, not only are we all breathing that way, we’re taught to breathe that way.

Dr. Wong:

It’s normal, right? It’s true the normal society way like we don’t want to have a big belly or, you know, a gut that’s sticking out. That’s not considered socially appropriate, otherwise It might be physiologically beneficial for us to breathe that way to have a big belly.

Dr. Ruan:

Yes. Absolutely.

Dr. Wong:

Going to food now, we know that food is medicine and we’ve kind of learned that throughout our training and all that. How does nutrition impact brain health and do you recommend any particular ways of eating for better brain health or is that kind of more individualized per person?

Dr. Ruan:

Yeah. Actually, brain health determines nutrition. And so, a lot of patients come in. I wanted to switch the topic a little bit on if you put too much emphasis on the food, the way of eating gets in the way. I’ll give you a really good example. So, right now, there’s a lot of phenomenon when it comes to like raw vegan diets and juicing and stuff like that. There’s an issue with that and the issue with that is that it’s not just the food going to the body, it’s how you’re actually consuming the food. If you’re juicing, there’s no active chewing. There’s not enough saliva to be produced.

Dr. Wong:

Exactly. Yeah, yeah.

Dr. Ruan:

And people are eating like in their cars on the go, sipping on the smoothie in traffic, so your body’s in fight or flight. When your body’s in fight or flight, you don’t have mechanisms in your gut to digest. It’s like trying to drink a smoothie when running away from a tiger, right? It’s just not it, like the body doesn’t compute. This is how food allergies occur, is that most people think it’s the food. It has nothing to do with the food. It has to do with the body is not ready to accept the food, right? And because you’re eating on the go, wolfing down things just to get to the next thing, so whenever you do that, you create food intolerances. This is why I don’t like doing food intolerance tests very much. It’s because if you eat one way one week, the other way the next week, your food intolerance test will completely change and it has to do with just slowing down, being mindful of what you’re eating. And so, we’ve seen this in studies looking at the speed to which people eat, the number of times they chew. Your body decreases the inflammation the more you actually chew the food because your brain is actually preparing your body for that digestive process and not only that, every time you chew, your brain frequency goes from super high frequency to a little calmer frequency. It’s called the alpha frequency and alpha frequency is when you can be more calm, the serotonin is upward regulated, you have more nitric oxide delivering blood flow to the gut, you have your digestive enzyme that’s made by the pancreas and the gut, and then when the food comes in, the gut’s ready for it, right? And so, the speed at which we eat is more important than the actual ingredients. Now, I’m not saying go out and eat four burgers at McDonald’s. I’m not saying that at all. It’s just that what we see is that even when people eat super healthy but they’re perpetually in the fight or flight state, then they’re going to develop reactions to food. They can have eczema, they can have asthma and all stuff like that and they can’t really tolerate a lot of the food very readily, so the brain still, you know, occurs first, right?

Dr. Wong:

That’s an excellent point you just made. It’s not only about what we eat but like you said, maybe even more important like how we eat and like how we’re digesting, the chewing of the food, you know, 25 to 30 bites per chew you would say, something like that?

Dr. Ruan:

Yes. Yeah, yeah.

Dr. Wong:

Now, how does brain dysfunction affect the person’s ability to chew and digest? I wonder if like brain dysfunction itself might actually impair someone’s ability to digest.

Dr. Ruan:

Yes, so it’s not just the brain. It’s essential nerves as well especially the vagus nerve, so the vagus nerve comes from the brainstem which is the bottom part of the brain and it’s called the vagus nerve because it’s like a vagabond which kind of wonders everywhere, so it’s called the wandering nerve and the vagus nerve innervates our heart, our gut, the outside portions of the lungs, our blood vessels, the tips of our fingers and stuff like that. And there’s different mechanisms in different sections to the actual vagus nerve, and so sometimes when there’s structural brain damage, either with concussions or just long-term, you know, chronic asthma, and not an ability to breathe very very well, you can actually impair the way that the the vagus system is created as well and not only that. You take someone like myself who’s had multiple concussions and cervical spine issues in the past, a lot of the modulation of the vagus nerve actually exists in your c-spine, in your neck spine right here. And so, there’s a lot of concussive and physical trauma that can really affect the way that vagus nerve works. It really affects our digestion and immune response and stuff like that, so it is definitely a two-way street. And then the last part about the vagus nerve is that guess what, if we don’t breathe correctly, our vagus nerve doesn’t get activated the way it should be and if we take 10 deep breaths, a lot of the regulation can actually come through but I’ll tell you. You know, we have a breath training group visit in my facility that’s run by Jenny Moreno, my Mind Body Medicine practitioner. That’s everyone’s favorite course, favorite group session. It’s because you realize no one’s really taught anyone how to breathe properly and then when they do, all of a sudden people who are constipated start having bowel movements, right? There’s this great story. We were doing a group tai chi one day and we just started with the breath training process and two people had to get up and eventually go to the bathroom and they weren’t able to have a bowel movement for like a week, you know? And they were very happy after that, and so that’s how important that breathing and that vagus nerve really comes in because the vagus nerve controls the squeezing you’ve got as well, so yeah. It’s definitely a two-way street.

Dr. Wong:

Like you said, it’s chronically suppressed by different issues- TBI concussion- like a lot of different things really that are causing that suppression. Speaking of that with breathing, this might get into a little bit of a general question about meditation but can meditation help with brains and if so, how much meditation do you recommend or what types of meditation I would say?

Dr. Ruan:

Yeah, so let’s define meditation for a second. I think there’s some preconceived notions there that meditation is sort of a religious thing. It’s not. It’s a mindfulness thing and meditation also doesn’t mean shut off your brain and do nothing. I think a lot of people are frustrated when they can’t meditate. No, meditation has to do with checking into your physical and spiritual body for a good five minutes and, you know, not even five. You can just do that for two minutes, you can as well, and it’s about redirecting focus to self and when we redirect our focus to self, we start noticing things about us and our body that we haven’t before and when you combine breath and meditation, I mean that time is for ourselves and meditation is one of the most powerful genetic triggers called ‘epigenetic triggers’, so genetics basically is the genes that you’re born with. Epigenetics are things that modulate those genes to do something. The meditation and breathwork is one of the quickest ways you can change your gene expression. I mean it’s fantastically fast and your brain starts liking it and it’s able to go into a lower frequency from a super high frequency like a stress state, and then eventually, when you get more in tune with yourself, your brain can exist in multiple frequencies and do multiple things and you kind of start understanding what your body and brain is really capable of. I think meditation is the crux of Medicine and we really have to view it as as important as, you know, going on a clean diet and taking your supplements and stuff like that, is because meditation is free. Anyone can do it in any situation that they’re in and the center for Mind-Body Medicine, you know, right now, their leader Dr. Gordon is in Ukraine right now teaching war-torn countries and a meditative state to get into that because it doesn’t require any more resource other than your brain,and so we have to view it as as improvement of primary function and we see a lot of great data coming out of meditation almost all disease states, and so I think this is exceptionally important and exceptionally essential.

Dr. Wong:

I agree. Meditation is huge. I believe it even comes from the same root word as Medicine to make pull on everything and like you said, a couple points there just to highlight what you said to listeners. A, it’s self care, it’s basic life support. You can only need it for two minutes at a time or more of course but, you know, you don’t need that much time. It’s free, it’s accessible. What do you say to someone that is like worried about Ukraine or some of the other world problems, COVID, we’re in the third year now in terms of like the worry and the anxiety and stuff and they can’t relive and do that. What would you say to that kind of person?

Dr. Ruan:

Yeah. You know, and I quote my mentor Tony Robbins on this one, “the quality of life depends on the quality of your focus”, so whatever you’re kind of focusing on can change your belief system and structures in a way where you can snap yourself out of a self-destructive state or a depressive state, right? And you know, there’s this video of Tony Robbins actually talking to someone that’s in the audience and he’s going on and on about how his life sucks and he’s really devalued, and then, you know, Tony says, “Hey, I love your red shoes”. He’s like, “Wait, what?”. It’s like, “Oh. I love your red shoes. They look fabulous”, and then you see this crack of a smile on his face of someone who’s talking about killing themselves, right? And then all of a sudden, the focus redirected. He’s able to snap people out of things, you know. One of the things that I recommend for people to do is that if you’re really bothered by a lot of stuff that’s going on out there, a lot of is outside of our control but there’s a lot of things that are within our control, right? I can say that, “Okay, I may be bothered by some of these events that are outside but what have I done to plan for my daughter’s birthday coming up?”, right? And get our own house at home organized first before we worry about someone else’s house, right? And there’s always room for improvement there and that is the quality of our focus and a lot of times and I’ll tell you this and people who are listening may even recognize this within themselves, we choose to focus on things that we have no control over because we feel like we have no control over some of the aspects of our lives that are creating a destructive process within our brains and this is natural, right? But just as much as you’re worried about wars and stuff like that, make a list and just shift your mindset from here to here, two millimeters left and say, “Okay. I’m gonna do something about this”, right? And so whatever you choose that to be, have an appreciation process for it and appreciate yourself for it and that actually is actually meditation. Not talking about you going in and sitting down in deep sleep but just changing your mindset for 30 seconds and playing this game called ‘what if the opposite was true?’. Say,“Okay. Well, what if the opposite is true of my belief system here? How would I feel about that?”, and then you change into, “Well, could the opposite be true? Well, how do I find out the opposite is true?”, and that gets rid of a lot of resentment. And this is how I actually build businesses as well. In team training, we try to get rid of resentment within people within the organization because there’s a lot of preconceived notions of people’s actions, so we kind of play this game ‘What if the opposite is true? Well, how do you find out?’ and it creates this wonderful family dynamic and culture within businesses and organizations but it’s something that we can do for ourselves on a daily basis, sort of play that game with ourselves.

Dr. Wong:

And I think that there’s a quote that we have 60,000 thoughts daily and a lot of those are repetitive, so if we can change our thoughts, change our mindset, we can change our lives. It’s like you said, your mentor said, Tony Robbins. It’s really huge and you know, even in situations that you know like you said we don’t have total control over or any control over, there’s still some actual steps you can start with yourself. You can start with some maybe actions to help others that are more measurable that are things we can control. At least we can, you know, kind of put a positive, you know, attitude in action on that. And I guess the other thing I wanted to mention about brain health as we kind of wrap up this part is how does connection or lack of connection impact our brain health?

Dr. Ruan:

What do you say connection? I guess you’re talking about-

Dr. Wong:

I think social connection, just the feeling of not being alone, you know, not being isolated because we know that a lot of people or at least I found it in our pack is a lot of people that have brain health issues, ultimately they also have maybe loneliness issues or purpose or joy issues and things like that which I think we all can have at some point but if you could comment on the importance of connection to our health.

Dr. Ruan:

So not too long ago, I posted this on my Instagram and Facebook and Linkedin. If you guys want to check that out it’s just my name c-h-e-n-g, last names is r-u-a-n-m-d, Cheng Ruan MD and I posted a story of how in 2014, a seven-minute conversation really changed my life, the way I view Medicine and the story is someone come in and she’s very diabetic and she’s seen a bazillion different doctors and dietitians and still very quite diabetic, and then she comes in and she’s like,” You know doc, I know what you’re going to tell me to do, you’re going toto tell me to stop eating sugar and I can’t. I’m just addicted. I don’t know how to do that but there’s got to be some other way. What can you prescribe for me?”. I’m like, “Okay”. I was like, “Well, before we get too far into the how, let’s talk about the why and the first thing I want you to do is I want you to pretend, we’ll play this game called ‘what if the opposite is true?’. So imagine for a second, just close your eyes. Imagine that sugar is like the most nutritious substance like on the face of the earth and the more you eat, the better you get. How does that feel for you?”. And then, you know, her lips quivered a little bit because it was an emotional thing and I thought, “Okay. We’re on to something here”, and she’s like, “Well, it feels great”, and we found out part of the reason is because she said that, you know, growing up in Poland, her mother had this cart that she rolled around and she’s a sugar artist if you will that and she creates the art on the little cart and it goes up in a stick. I think we have that in China as well, and so that’s how she supported her and her four siblings or five siblings. I can’t remember the number now and by the way, this lady is over eighty years old, a lot of great years under her belt, and so I’m like, “Okay”. Well then I asked her, “Could it possibly be that whenever doctors tell you to stop eating sugar or dietitians that you’re subconsciously forced to reject your mother’s love?”, and she started crying . She’s like, “I want to say no but but I’m crying, so maybe that’s right”. And so I’m like, “Okay. Well, great. So what if you look at this chair and next to you is your mother who’s already passed away. This is your mother and what if I tell your mother that, “Hey. You know, your daughter’s really diabetic and sugar can be quite destructive from a health standpoint”. What would your mother say to you right now?”. She’s like, “Well, she’d tell me to stop eating the sugar”, I’m like, “Awesome. So my role here is purely to respect the wishes of your mother”, and that was the end of the seven minute conversation. Three months later, her a1c dropped. I mean she was no longer diabetic out of all the medicines and really just took that conversation because she had the know-how but her identity was something that we wanted to really target, so her identity is someone who’s a caregiver. She gives care to her family, she honors her culture and her mother, and subconsciously she felt like she was forced to deny her culture, right? And then when we played for this game ‘what if the opposite was true?’ and kind of visualized that process, she had a massive behavioral change because I didn’t force her to change her identity. All I told her to do was have a conversation with her mother and honor her in her life, and so that flipped the script for her because this is what I like to call identity-based Medicine where we’re not talking about the outcomes, we’re not talking about the blood sugars. No, we’re just talking about the belief structures of belief systems and that is a connection, and so, you know, you ask about connections. That is the connection she’s had with her mom who’s already passed away for many decades for over a long period of time and that connection allows that behavioral change, you know? And then that was 201, so you know. Now, she’s not just got rid of diabetes, she’s doing running and stuff, you know, at the age of 80 something years old and I see her on her Instagram. She got Instagram after that conversation.

Dr. Wong:

Nice.

Dr. Ruan:

And really started like these elderly groups and stuff like that, so she’s really honored herself and her mother without sacrificing that honor by building a strong connection with her community, so I think connection is everything. I think connection should be the foundation of how we practice Medicine.

Dr. Wong:

Yeah. It’s an incredible story and I did check that on your feed @chengruanmd everyone. Please check that out. He has a great story. You have great stories on there, really getting to the true root I feel of health and wellness with a lot of your teachings and education, so yeah we can’t thank you enough for that and for being on today. Really appreciate it, Cheng. For yourself, I think maybe people want to know, what do you do every day to cultivate joy, yourself? We know that joy is so important for health. That’s a closing question we often ask our guests.

Dr. Ruan:

Yeah, so it’s a really good question and my wife’s gonna laugh when she hears this but every time we make a decision, my family, my kids, I have three young daughters and I live with my parents too, we’re a three generation Chinese household.

Dr. Wong:

Nice.

Dr. Ruan:

And whenever we make decisions and if there’s a disagreement about something, the easiest thing to do is, “Okay. What is the one decision we can do right now with absolutely zero regrets?”, right? And then we choose to do that, and then whenever I ask that question, it becomes simple of what we should actually do and the altercation just kind of stops, and so that was sort of the running joke is that, you know, if something comes up and there’s some sort of conflict, I’m always going to say, “Okay. What is the one decision with no regrets? Okay, let’s just do it unapologetic. Let’s just get it done right.”, and so there’s that. And then the second thing I do is I ask why a lot, you know. My daughter says why is my favorite letter in the alphabet. She’s like, “Why?”, so whenever someone is doing something and instead of just, you know, instead of just doing it, I always like to ask, “Why? Is there a bigger picture that’s there?”, and that also really forms our connection, our relationship, so those are two things I like to do.

Dr. Wong:

Yeah and speaking of your daughter, she’s super amazing and if she’s on the practice course that I’m taking that you’re there with your daughter.

Dr. Ruan:

Yeah.

Dr. Wong:

She’s so cute and smart. I could definitely see a lot of her with your wisdom as well, so yeah.

Dr. Ruan:

Thank you.

Dr. Wong:

So Dr. Ruan, thanks for coming on today. How can listeners learn more about you and, you know, this is really a very broad kind of podcast, you know. We have, you know, patients but also clinicians and everyone, so you might want to have different mechanisms or ways for people to reach you.

Dr. Ruan:

Yeah. So I’m all addressing the public out there, so if you want to follow me on social media, just search my name Cheng Ruan, MD, c-h-e-n-g-r-u-a-n-m-d. I’m on Youtube, Instagram, Facebook, Linkedin and someone tells me I’m on Pinterest and I just found out that to be true, so there’s a whole Pinterest pin of me. And then for the doctors out there, just go ahead and reach out to me on Linkedin. On Linkedin, I actually talk about more practice building and the perception of where Medicine should really lead post pandemic era and also the creator of Integrative Practice Builder, so go to integrativepracticebuilder.com. That’s me, actually teach how to practice Medicine with core values and tie it into insurances and Medicare, stuff like that, so we can serve a much larger audience for those Integrative Health practitioners and in January of 2023, I’m holding a very large summit with my partner Jason Prall who is the creator of the Human Longevity Project in 2018. It was on tv and we’re going to be focusing on something called Better Brain Health and it’s basically talking about a lot of things I talk about here with some celebrities and surprise guests, so if you follow me on Instagram and Facebook, I’ll be posting more events there as well, and so you guys can follow along there as well.

Dr. Wong:

Thank you so much, Cheng. Looking forward to the brain summit. I know that’ll be very epic and look forward to seeing what else that you do in the leadership space here of Integrative and Functional health but I would say even just like Medicine in general. I mean this is, you know, at this point in time, you know, we’re in 2022 now. I feel like Integrative Functional Medicine and all the different associated types of, you know, Medicine like that, it’s starting to branch out more. It’s becoming more accepted I think and I think there’s more people out there, whether it’s clinicians, whether it’s, you know, maybe insurance companies even, I don’t know, but certainly patients, you know, are kind of wanting to see more of a root cause approach to brain health and just health in general, so thank you for being a leader in the space.

Dr. Ruan:

Yeah. Thank you very much for having me on, appreciate you.

Dr. Wong:

Thank you for taking the time to listen to us today. If you enjoyed this conversation, please take a moment to leave this a review. It helps our podcasts to reach more listeners. Don’t forget to subscribe so you don’t miss our next episodes and conversations and thank you so much again for being with us.