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Episode 47: Pediatric Wellness & Tongue Ties with Dr. Pejman Katiraei

, , , , , April 20, 2021

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Jacqueline Kincer  0:10

Welcome to the podcast, we have Dr. Pejman Katiraei with us, or we’re gonna call him Dr. K for short. That’s what his families call him. And he is a holistic pediatrician. And we’re going to have an awesome conversation today about lots of things. And I’ll really just kind of let him take the lead and introduce himself. You know, tell us what you’re up to in your practice and what you’re doing these days. And give us a little, you know, info about yourself?


Dr. Pejman Katiraei  1:07

Sure, first of all, thank you for having me on. really an honor to be here to share with your community, just a little bit of the information that I find valuable. So I graduated my residency in pediatrics in 2006. And it was around 2004 2005, that I started realizing like, gosh, there’s more, there has to be more to pediatrics and medicine and what I’ve been trained in and I love my residency, I did it at Loma Linda University, and they’re They’re a great group of people, brilliant doctors, we got to see a lot of really complex cases that, you know, very few other physicians would see. But in the midst of that court training, that there were just little holes, right, there were little things that just didn’t add up. And, you know, while my conventional my colleagues, my co residents were like, Yeah, you know, this guy has colitis. And this is what we do. You know, I was the weird oddball that was like, Wait a second, wait a second. Wait a second. Wait, what why is he have colitis. And I’ll give you like an example.


This was, I vividly remember one of the cases that had me really wake up and like stand and pause. And you know, I probably lost sleep over this guy. So it was a patient of mine, it was around 2005 is, I think eight to 10 year old guy adolescent came in because of horrible colitis where the intestines become super inflamed. And I remember he came into the hospital because his intestines were super inflamed. So we gave him some steroids, he got better, he went home. And then a week later, while I was still, you know, in the hospital, he came back and his intestines were even more inflamed. And they tried all the different medications. They tried all of these different things. And you know, then the team got together, all the senior doctors got together, we talked about him, they’re like, Well, we tried this, we tried this, we tried this steroids didn’t work. So now we need to call the surgery team to just have this Coleman taken. Literally, that was the next step in the progression of the discussion, because they taken out all the big guns, they had tried all the heavy duty medications and nothing worked. So obviously, clearly, the next option would be well, let’s cut out this 10 year olds colon because the medications aren’t working. And you know, I was the squeaky wheel. I’m like, wait a second, wait a second, like, What do you mean?


Like, Has anyone talked about the food he eats? Like, there has to be something else? Like, you can’t just say, well, we just need to cut out this 10 year old colon because the medications didn’t work. And they’re like, No, this is the standard of care. And I had a lot of these kinds of cases where it’s just you know, when you when you’re in medicine, and medicine is the system that is taught where you know, there’s a progression, you do this medication, if this medication doesn’t work, you do that medication. And if that doesn’t work, you do this. And that’s the standard of care. And I guess my brain is just wired differently to kind of stand back and say, Wait, a second type just doesn’t make sense. And it was a lot of these moments of it doesn’t make sense that had me stand back. And basically, fast forward now, what 1516 years since that, for 15 years, I’ve kept doing this thing of like, wait a second, that doesn’t make sense. And I think, you know, that leads us to this conversation of tongue ties and kids and all of the different issues and you know, up as as a I’m an integrative pediatrician, but a large part of what I do is also care for children who have intense behavioral issues. So the severe ADHD kids that can’t focus worth a darn and that you know, the parents that come to see me have already tried like three different medications. They’ve seen two different psychiatrist, you know, usually they’ve talked to a few therapists, the kid has had all kinds of testing and no one knows what to do. You know, I take care of the kids who have such severe anxiety that they can’t leave the house such severe OCD that you know, their eight year old is disabled because their thoughts are just constantly taking over them.


So a large part of what I do do is really to serve these kids. And part of why I’m drawn to these children is, you know, my childhood was not necessarily a very easy course in life, I had my fair share of anxiety, I experienced depression when I was an adolescent. So there’s a lot of things that when I see in these kids, I look at like Jesus, like I was kind of one of these children. A lot of the kids I take care of, sadly, are worse off than I was. But there’s a personal part of me that’s really invested in helping these kids because I see myself in some way in these children. And, you know, part of what has happened, and part of what has ultimately led me to a place where I’ve come out of my little box in private practice. And as I started having these more public discussions is that same thing like wait a second, wait a second, this doesn’t make sense. And as an example, you know, in our holist, so let’s step outside of conventional medicine, because conventional medicine says, Well, you know, this kid has ADHD, anxiety, whatever, let’s use this medication and this combination of medications to treat, you know, their thing. And in the holistic medicine world, we say, well, no, that’s not right.


You know, they may have a gut issue. In a lot of holistic, pediatricians rightfully focus on the gut. They focus on supplements to try to shift parts of the system. But those are the main areas that a lot of holistic, pediatricians focus on diet, gut, plus or minus some supplements. And that is the world that a lot of them know. Now, what occurred to me over, you know, a period of eight to 10 years is, you know, initially I was on the same bandwagon, and I would do these crazy elimination diets, you know, kid would come in with ADHD, anxiety, or whatever. And I would be like, well, let’s cut out gluten, dairy, corn, soy, bla, bla, bla, bla, bla, bla, you know, so the kid was eating like 10 foods, and then we would just blast them with like, huge doses of fish oil, or zinc, or whatever. And, you know, 25% of the time, like, things would get really better. But then that meant, like, two out of three times, like, things were still the same. And I would talk to my colleagues, and I’d be like, Wait, like, this isn’t working? What’s going on? They’re like, No, you just didn’t do it, right. I’m like, oh, wait a second, wait a second, you know, is that same thing like, wait a second, something isn’t adding up. And that that is what led me down, you know, a lot of different roads from looking at hormones and getting trained in the use of plants. And, you know, looking at exposures to mold and lime, and all of these things. And one of the things that also really came up was what happens in the mouth.


And it was about four years ago that I really woke up to this. And I vividly remember this little girl, she was about eight, highly, highly intelligent child, you know, super bright, super capable, but she had just off the charts, anxiety and ADHD. And we tried to elimination foods, we treated her gut, we supplemented up the wazoo, and nothing was getting better. And it was like the third or fourth time they came back to the office. And mom’s like, Yeah, I think they’re a little bit better. But nothing is really working. And I was like, well, let’s, let’s talk, let’s let’s talk about what else may be happening. And it was after like, 30 minutes of us talking literally, just as the session was about to end the mom was like, Yeah, and you know, what’s weird is that it takes her about 45 minutes to finish a meal.


And I’m like, well, that’s weird. Like, that’s not normal. And the mom didn’t even think anything of it, because that’s how this little girl has been the entire time. And fast forward, what ultimately came to light was that she actually had a tongue tie. And back then I wasn’t smart enough to put two and two together to see like, oh, geez, no, everything that this little girl is experiencing the anxiety, the ADHD, the sleep issues, fill in the blank, like she would wake up sometimes in the middle of night for no apparent reason. And all of that was her tongue. And, you know, one of the things that I tell our families and this is more your cup of tea than anyone elses is that, you know, if you have a broken eating mechanism, I’ve kind of simplified this term, you know, if your mouth doesn’t work, I gosh, well, that would be a whole big reason why a lot of other things would fall apart, right? Why these kids would have eating issues, why they would have trouble breathing, and I’m sure you’ve talked about this, you know, extensively, but that was the moment that I woke up. I’m like, Oh, my God, like, how many cases have I missed? Because I didn’t know what to look for it. And you know that that’s really my purpose to bring information out into the world, especially around some of these scenarios where we call the child Edd, or anxiety or whatever else, and it’s like, well, what does that mean, other than the fact that the kid has x anxious, we don’t know why they act anxious. So why don’t we explore all the different reasons and tongue ties and broken eating mechanisms and airway issues being one of them? So, in a nutshell, that’s me.


Jacqueline Kincer  9:59

You That’s That’s an awesome nutshell. By the way, I love it. And it’s Wow, just, you know, you’re, you’ve said so much. And I want to go back to something you said about how you realize that it was more than just, you know, diet and supplements. And you know that I see that a lot too. And I actually had a discussion with another ibclc colleague of mine yesterday about this exact issue, where especially like the breastfeeding moms we work with, maybe the baby’s showing signs of food intolerance, and these moms are taking all these things out of their diet. But now they’re very deficient, they’re not getting good nutrition.


And maybe the skin issues don’t clear up, sometimes they even get worse. And so what’s going on there? Well, we can’t just give them all, you know, like ton of supplements, like you said, and just have them take out all of these major foods, you know, maybe some of those are problematic or what have you. But if that was, if that was all that was necessary, then they should be getting better. And like you said, not 100% of the time, do people get better? Sometimes that’s what’s needed. But it’s not all the time. So there’s something else going on there. And there is a frustration with like, you know, me and some colleagues and probably yourself too, with the wellness community where there’s this, you know, kind of all you’re not doing it right? And you’re like, Okay, well, maybe there’s something else going on, just like you were frustrated in your residency, that we probably shouldn’t just surgically remove a colon, maybe there’s something else going on, you don’t just have to follow the protocol. So I love that you have that sort of big brain approach. And you’re really looking at, you know, multiple factors, because it is multiple things. And just what you shared about, you know, the way that things manifest, you know, anxiety and ADHD and ADHD in these labels. I love the show house, and I started rewatching it. So I’m on Season One again, I don’t know why I just really like it.


And there’s this episode, I want to say it’s episode four or five, and the patient has schizophrenia. And he takes on the case because of this. And ultimately, it turns out, she doesn’t have schizophrenia, she has copper toxicity. But so spoiler alert, if you haven’t seen season one of those, but like you’re saying, it’s it, you know, she she had been getting all these psych meds, whatever, you know, and her son’s like taking care of her and she’s not actually schizophrenic. So, you know, do these kids really have anxiety? Or is there something else going on? And I love that you’re discovering what’s really going on and helping them and finding that tongue tie actually ends up being the root cause of that. So maybe you could tell us, why does tongue tie, you know, contribute to these behavioral issues that you’re seeing in your patients that you’re working with?


Dr. Pejman Katiraei  12:37

Absolutely, yeah. I mean, let’s let’s stand way back, right. I think if parents can contextualize this, that that will be really helpful. So what starts the process of digestion? So, you know, with eating, first of all, where do we start the breakdown of our food in our mouth? Right? Right, the process of digestion starts in our mouth, we have to chew food, we have to break the food down, then swallow it. And then that food then goes into our intestines, and then the pancreas and bile and all of this stuff do the next part of digestion. If you don’t know how to chew your food, how does that affect your ability to digest? It throws it off, right? If if you’re basically biting off a chunk of food, and then essentially swallowing it, because your tongue doesn’t work, you don’t really know how to chew. Right? That That right there disrupts the process of digestion, because over time, what happens is Yeah, I mean, if that happened for a week or a month, not a big deal, if that is the case for your entire life, where you’ve never chewed your food, so you’re just swallowing big chunks of protein and fat and carbs. Ultimately, at a certain point, your pancreas and all of the other systems start really faltering because they’re, they have an a large task to do that, that isn’t really their job, right? The pancreas, his job is not to chew food, the pancreas job is to take food that has already been chewed and broken down and then finished the digestive process.


Dr. Pejman Katiraei  14:19

Now, if in addition to not being able to chew and kids who have tongue ties, for instance, because they can’t move their tongues, one of the things that they’re unable to do is really chew food well, and one of the tests that I do is kind of a litmus test before I even examined and as I asked parents a very simple question, like, when your kid was two to three years of age, or now, were they able to take a chunk of steak into it? And if presuming the family’s not vegetarian or vegan, and for vegan families I take I asked actually, like, can they chew a piece of portabella mushroom or a piece of Tempe? Something that’s kind of dense in the have to chew it a little bit. You know, you can’t just swallow a piece of steak. I mean, you can, but most people won’t won’t. And a lot of times, you know, parents whose kids have tongue ties, they’re like, Oh, my kid never, never wanted to, you know, chew steak, they would spit it.


Or yeah, mushrooms or 10 pe, or big pieces of chicken, we’re not talking shredded chicken, we’re not talking ground meat, we’re not talking, you know, tofu, for instance, we’re talking hard foods that actually require a lot of work. A lot of these parents are like, you know, my kid was, has never been able to do that. They don’t do it. Now, they were never able to do it. And that’s actually a big red flag for me. Like there’s something going on inside the mouth. The other thing that happens is, if you’re a little kid, and you have a tongue tie, so you have a broken eating mechanism, as I call it, right, your eating mechanism doesn’t work. And early on, you try to eat food, you’re interested in food, but you choke and you gag and the food either is too hard to chew, or every time you try to chew it something awful happens. And after a while, in your let’s say your year and a half, your year and a half-year-old, two-year-old brain tells you like well, these foods are dangerous, you shouldn’t eat them. And what happens? We get kids who become the most quote-unquote picky eaters, right? We call them the extremely picky eaters and a lot of families are like, Yeah, my kid has always been such a picky eater, and I’ve never understood why.


And they only eat mac and cheese. And it’s weird. It’s always the same foods, right? Mac and cheese, plus or minus peanut butter and jelly sandwiches on usually white bread, so nothing that’s too complicated. One type of chicken nugget, right, it’s like what has to be one kind of chicken nugget. It can’t be like the parents bread like a chicken breast, it has to be one kind of chicken nugget plus or minus like pizza, right? There’s always the same friggin foods, they don’t eat vegetables, they won’t touch most proteins, like most foods are completely eliminated out of their diet. What happens to the digestive tract immunological and bacterial level if for your entire life, you have basically swallowed big chunks of gluten, dairy, plus or minus fat and salt and sugar. So no vegetables, no fiber, no good proteins, very few minerals, what happens the gastrointestinal tract falls apart, the bacteria in the intestines need fiber to grow. And for the healthy bacteria to populate, they need lots and lots of diverse fiber.


If that fiber is non existent, for years upon years, what happens the bacteria in the intestines, the fungi in the intestine start changing and you get all kinds of the wrong strains in wrong types of micro flora growing fungus thrives with carbs in sugar, right? That that’s like fertilizer for fungus, the and the unproductive the bad bacteria, Clostridium gram negative bacteria, those kinds of things, they thrive in a low fiber diet, whereas the lactobacillus Bifidobacterium all the quote unquote good bacteria, the anti inflammatory bacteria, the probiotics that we take, they require tons and tons of diverse fiber. So if your kid has always been the picky eater, the foods they’re eating over time, over time, change the bacteria in the intestines. And we already know those bacteria change our brain chemistry for the worse. In addition to that constant exposure to just gluten and dairy, gluten and dairy gluten and dairy over time actually triggers an inflammatory response in the gut. Because the gut was never designed to only handle and digest that much gluten and dairy not not that those foods are necessarily evil in of themselves. But if all you eat are those foods, you actually start getting this sensitization this hyper immune reaction to these foods, because all day every day for as long as that kid has been alive, these proteins and fats have been showing up. So the immune system actually becomes activated to react to these foods. So you get the bacteria changing. You’ve got essentially what we call a leaky gut, you’ve got this immune activation at the gut level. And guess what? That combination is not favorable to the brain. The brain doesn’t like inflammation. If you inflamed the brain and how you would imagine that is imagine the time you had the flu. Did you feel fantastic?


Dr. Pejman Katiraei  19:39

Oh, no, no, no, we don’t. Yeah, yeah. But that’s that’s actually called sickness behavior. There’s actually a medical term for that, that that’s been described in the literature and they take these poor animals and inject them with these pro inflammatory chemicals and they watch to see what happens. These animals act anxious, they act scatterbrained So like the the tasks that they were easily able to do, like they run these mice through these little mazes, and these mice can usually get through the mazes really fast and get to their reward, you know, piece of cheese, whatever it is, they inject these mice with some kind of inflammatory chemical. And now like the mice are just totally lost, and they have no way of getting through the maze, same mice, like literally two minutes later did the maze, and then all of a sudden boom, like, they’re just totally scatterbrain. Wow, yes. What happens to the kids who have the leaky guts, the inflamed intestines, they’ve got those same chemicals floating around in their brains. And essentially, every day of their lives, they have what is the equivalent of a mild case of the flu. Wow,


Jacqueline Kincer  20:46

that really puts it into perspective.


Dr. Pejman Katiraei  20:49

And then, you know, it’s funny because we say, well, you know, Susie just doesn’t behave Susie’s irritable all the time. Oh, she must have an anxiety disorder, Susie, scattered brain, she just doesn’t pay attention. And she doesn’t learn well, she must have ADHD. No poor Suzy has sickness behavior, because her gut is a mess. And her gut is a mess, because this poor thing has never been able to eat foods. And this is where you know, the wellness community, as you talked about, like Doc’s will come in there. And I’ve had the cases that have been failed by other Doc’s, you know, where they come in there. They’re like, Oh, your kid has this and that, and we need to do probiotics. And we need to put them on these herbals. And we need to cut out gluten and dairy. And we need to cut out the chicken nuggets. And then what happens, the kid just completely falls apart because the four foods that they knew how to eat. Now this poor parent feeling guilty and trying to fix their kid is now like, well, you can’t eat this, you can eat this, you can eat this. So now it’s like the kid is left on this island with like, no foods that they know how to eat. And all along, we kind of miss the fact that like, oh gosh, no, this kid just doesn’t know how to eat. So let’s start with that. Wow.


Jacqueline Kincer  22:03

You’ve explained this. So so well, we’re I feel like, you know, everybody who’s listening can really follow along. And it’s it’s so important. Like you said, it’s food foods that are being eaten our component, but what’s driving which foods are being eaten. And then what’s happening once those foods are consumed, and there’s just so much communication going on. And like you said, it’s more than just throwing some probiotics at the situation. And, you know, I, I see so many people that just, you know, there’s this industry around it too, right? Like my patients will say, you know, which which baby probiotic do you recommend? And I’m like, well, first of all, why are you giving the baby a probiotic? And how are you choosing which one is best, like, you know, and then they’re just taking some random probiotics that they’ve been taking for years to and it’s like, we can’t just, you know, but like, that’s, that might be helpful, but let’s make sure, you know, it’s actually what’s needed, or it’s the right one and all of that. And, you know, like what you’re saying things manifest later on in life. Right. So, you know, like the colitis case that you mentioned, or, you know, by the way, now, I’m curious, were you able to save that kid from surgery? Or did you kind of have no say over it? And he had his colon removed?


Dr. Pejman Katiraei  23:15

No, but back then I had zero say over what was happening. So fortunately, I’ve had the pleasure of working with other colitis patients after that when I was actually in my own practice, but know that that poor guy went to surgery.


Jacqueline Kincer  23:28

Oh, my goodness, can you imagine living the rest of your life like that? I mean, that’s just horrible. And so sad. Oh, yeah. Well, I’m glad I got the answer. But it’s not the answer is moving for,


Dr. Pejman Katiraei  23:39

you know, along these lines, I think the value in this discussion we’re having is, you know, a lot of these poor kids. So let’s say we’ve got a little child, she’s six or eight, and she has a tongue tie. And she does know how to eat. And she has the inflammation, and she has other things that I’m sure we’ll touch on. And she’s acting anxious, and she can’t focus. And she she knows she, she’s scattered brained and she’s inattentive, and she’s constantly fidgeting. What happens to her? If, you know, they say, well, she has ADHD, we’ll put her on Ritalin or Adderall. You know, there’s now multiple medications out there. But we don’t address what is causing her to be that way. And little boys, even more so. And then they grow up to become the 15 year old, the 18 year old, the 20 year old, who has the same underlying issues that got messed up, the part that breaks my heart is it’s not just what happens to these kids early on. They start growing up to become these individuals that then identify themselves as well. I’m the ADHD kid, I’m the anxious kid. I’m the kid that you know, whatever. And it’s so I don’t know if you’ve encountered this, but you know, part of what got me to come out In my little bubble, like my private practice was very comfortable for me.


And it still is like, I love working with the families in the office. But part of what had me come out of my little bubble, I tend to be a very, you know, impressive introvert to a good extent. But I have to step out because I looked, I’m like, Holy Jesus, if we don’t have these discussions, these are the kids that then grow up to become the adults who have no self esteem, you know, like their, their appreciation of self, their value of self is destroyed, because they can’t function in life, they can’t learn, they can’t focus, they can’t function. So then they come to think of themselves as well. I’m just done. And I’ve had, you know, eight girls look at me and say, You think I’m stupid? Do you think I’m dumb? Do you think I’m bad? Like, do you think I’m evil? You know, can you imagine an eight year old that starting to think like, Am I an evil person? And, you know, it’s, it’s so sad to think that a child would ever get to a place where they would think that of themselves. And we don’t stand back, oftentimes enough to say, Why in God’s good Earth? Is this child feeling this way? What are the things happening to cause a child to dysfunction to this extent, where the eight year old is starting to question their own, you know, state of well being. And part of why I’m so grateful to be here is, you know, I hate to say this, but a tongue tie and issues with the mouse can certainly be one major factor of why your child will be falling apart.


Jacqueline Kincer  26:38

Wow. Yeah. And that’s, I mean, it’s just heartbreaking to hear, you know, because I’ve got kids, and you’ve got kids, and we work with kids, right, and you don’t ever want a child to isten, you know, nothing more than be a normal kid to feel this way about themselves. And to grow up as an adult to feel this way, you know, and what happens when they hit puberty and hormones are in the mix, and they’re already coming into it with this state of mind. And, you know, we know that there’s a huge, huge risk with children being put on psychiatric medications and blackbox warnings, and they’re, you know, just, we don’t want to go that route at all, if we can help it. And I feel like, you know, it’s interesting that you’re saying everything you are, because I feel like parents are kind of quick to look for diagnosis. These days, like, something’s wrong with my child. So let me get them evaluated, right. And they go to some, you know, occupational therapist, or, you know, neural neurodevelopmental person, or if they’re, you know, a mental health therapist, and they’re, they’re trying to get this diagnosis. And we can work on mindset, and we can work on parenting techniques and all these things. But if we’re missing this other bigger picture, you know, and like you said, you know, we can just start with maybe some simple questions, right? So if you’re, if you’re seeing a child for the first time, or meeting with a family for the first time, or if you want to give a family some guidance, what are some questions that this family, you know, should be asked to maybe start to screen for some of these things? You’ve mentioned some things about the picky foods or maybe waking up at night, but what are some warning signs that someone can look out for their child and say, Hmm, there might be something more going on here?


Dr. Pejman Katiraei  28:31

Yeah, so I’m sure a lot of this you’ve already talked about? So we’ll I don’t think


Jacqueline Kincer  28:37

everyone listens to every episode. And no, we always have different discussions. So yeah,


Dr. Pejman Katiraei  28:44

but you know, what’s going through my head is the writing is on the wall. If parents know what to look for. It will become bright as day as clear as this, you know, the sky. It’s like looking up and saying, Wow, know what the sky is really blue, except you’ve just never looked up to notice the sky. And there’s a very distinct pattern in the in these kids. It’s it’s really difficult to miss once you look for it. So I mean, first of all, these kids have difficulty with breastfeeding. Some of the kids do find for the first few months because mom has such an intense letdown. But then like at month 456, all of a sudden, they’re feeding issues. They’re not gaining weight appropriately, or it takes them forever to you know, nurse, it’s like 45 minutes per nursing session, which means they’re not transferring well, so something is off early on when the child is attempting to breastfeed or the mom just gives up and by month three or four, they’re like, Well, my kid couldn’t breastfeed, so I just put them on on the bottle. Then when the kids are a little bit older, and solids become introduced, somewhere around 12 months to let’s say, 24 months of age, just to give a broad spectrum of time. Other issues start coming up some of these kids start spitting out, you know, different textures of purees or other foods, or they do okay with purees. But then as more dense textures come in, that’s when they struggle. But usually there’s some other flags are early on, there’s the breastfeeding flags that go off.


Then later on, there’s some kind of eating issue that happens. And the parents like, oh, yeah, you know, and the pediatricians aren’t trained to look for this. It’s not that, you know, they’re being malicious. They, these poor folks just don’t know how to look for this. And I mean, to be honest with you, like, if, if you met me six years ago, I would be totally clueless about this. Because I had zero training, I’m just lucky enough to be surrounded by some really smart, gifted people that have really, like, helped me see this. But, you know, around a year to two, something happens. They have other food intolerances. And then by usually three to four years of age, these kiddos become very picky eaters. So they’ve, they’ve kind of gotten established in their certain, you know, dietary preferences. And when you look at it, all the foods that these kids want to eat, or what soft foods that basically don’t require any chewing, right, you can just bite, you can take a bite of chicken nugget, chew it once, swallow it, you can take a bite of mac and cheese, chew it once swallow it, you can take a bite of peanut butter and jelly sandwich. Bite it, swallow it. So these kids get drawn into eating foods that naturally don’t require a whole lot of chewing. They’re not foods that require a breakdown like a piece of steak. So that then goes that big that other flag goes off.


And then later on, they start having other issues. One thing I will add, is sometimes early on what these kids also have are is reflux or colic. So they’re colicky because a lot of times they have this clicking sound, right, they swallow air because their latches not very good. So because they swallow air that causes them to get very gassy and they tend to be very uncomfortable. It turns out that my osteopathic doctors, friends, who basically treat the the physical parts, you know, the physical connections in the body, one of the things that they have taught me and I’ve seen this now a lot is some of these kids reflux. Why? Because it turns out that there’s a piece of elastic tissue that connects the tongue all the way down to the esophagus. So if the tongue is tied, the tongue is constantly pulling on the esophagus and actually on the esophageal sphincter, the sphincter that’s supposed to keep the milk in the stomach. And that pooling actually causes we think we don’t know exactly, but it causes a strain or a pull on the sphincter.


So a lot of these kids will also reflux for no good reason. And it’s, it’s not that the mom is eating too much gluten or dairy or other foods. It’s simply a structural issue. And I’ve seen this so many times where the baby gets their tongue released, you know, everything is opened up, and suddenly colic and reflux are just gone. So there’s a very unique pattern that if parents look, they’re like, oh my gosh, yeah, my kid had trouble breastfeeding. Oh, my God. Yeah, they were kind of colicky, you know, some of these kids are difficult to put to sleep, because everything else is off. And then they grow up to be picky eater. So it’s that that pattern is very, very distinct in for me, like, these are things that I probe in every child I work with, because if I get a blip, that those things are there, you know, I’m not chasing down gluten dairy issues. I’m not going after the gut. First thing I’m doing is fixing the mouth.


Jacqueline Kincer  33:43

Yeah, I love I love that. And yeah, those are all things I absolutely see. And, you know, sometimes it’s difficult, especially with first time parents, they just, you know, really are new to this whole having a kid thing. And they’ll say, Well, you know, the baby is still breastfeeding, it’s doing fine. You know, what happens if I don’t get the tongue tie released? And I’m like, Well, you know, I don’t know how exactly it’s going to manifest in your child. But that list of things you just gave are some of the things I start to tell parents, like, you know, if breastfeed is not going, well, solid foods aren’t going to go well. And since the mouth is involved in speech, that’s probably not going to go well. Right, and breathing and all the things. So there is this cascade effect. And it’s like, do you want to be constantly addressing issues throughout your your, you know, Child’s childhood, and then they’re going to have to address those into adulthood as well? Or do we just want to try and tackle it as best as we can now, and avoid all of this, or especially for moms who are listening who, you know, maybe do have an older child and they’re about to have a second child or they do have a newborn or an infant now, and they’re wondering why didn’t breastfeeding go well, the first time and you maybe you can find some of these issues going on in your older child and that can help you put some pieces together for your younger one too. Because it It is it’s one thing leads to another. And I think a big question that you’re answering is from a lot of parents, will my child outgrow this? No, they will grow more into it. And the symptoms we see just tend to change over time or compound.


Dr. Pejman Katiraei  35:17

Yeah, I appreciate what you’re saying. And it’s really funny that you bring this up, because literally just yesterday, we had a family in the clinic that I was talking to. And the same exact conversation came up. And we actually knew in this case, we actually had the tongue tie diagnosed, but the mom came in, and she’s like, Hey, she’s doing fine. Right now. She’s not called a key. She’s not refluxing. She’s gaining weight. She’s growing. What do you think? And, you know, I think we should approach this conversation not from a place of fear. And certainly not from a place of doom and gloom, like, Oh, my God, you know, if you get as a tongue tied, like everything is going to fall apart, there are some kids that do fine, right? There are some kids that based on their genetics, and based on their constitution, and based on other factors, like they can have a tongue tie. And, yeah, they’re a little bit picky. But you know, with some hard work on the parents part, like they stay relatively healthy in their diet, and they grew up to be super healthy individuals that may have a list, or may have some subtle things going on, but not not a big deal.


And you know, what, I told this mom, we actually, it’s so funny that you bring this up, like literally, we just had this discussion, I told her, I’m like, Look, you know, I think how you approach this really depends on how preventative you want to be, you know, if if you were taking your kid into a major surgery that required anesthesia, and you know, as a four hour surgery in the hospital, different scenario, tongue tie and tongue procedures, our surgeries, are the the most intense surgery in the world. No. Do they usually, you know, some dentist charge money. So there’s the cost factor, there’s the discomfort to your child. And literally what I told them on is I, you need to decide for yourself, you know, the risk and cost of doing the procedure. What is that? And if we have the possibility of preventing things, possibly a picky eater, possibly speech issues, possibly some of these other things, what’s that worth?


And, you know, I try to really honor our parents, especially, you know, the ones that have babies early on, because parents are super overwhelmed, and they’re already kind of stressed out, you know, you’re already sleep deprived. And I certainly don’t want to be the person that adds more stress onto their plate, right? I’m not helping anything by doing that. So, you know, if the kid is failing to thrive, they’re not gaining weight, they’re super colicky. They’re super irritable, they’re not latching like they’re a hot mess, then it’s like, well, gosh, you probably should do this, because it can really help. If the parent is kind of in the middle, and like, you know what, my kid is actually doing pretty good, then it’s like, Sure, you can wait, you can wait. And you know, we’ll just track it. And you know, at some point, if it makes sense to you that the benefits of the procedure are now more than the risk and cost, then you go ahead and proceed in I think that this is where each family’s preferences, right?


Their perspective, their personal beliefs, I’ll come in, because there are some families that are like, you know, what I want to prevent every issue that can possibly happen, you know, even 20 years from now, and I’m willing to invest whatever cost money time, whatever, I’m willing to do it, you know, in those are the families. For them, it’s, it’s kind of like a no brainer, just go for it. And then there are other families that are like, look, I don’t want it subjected my kid to the pain, you know, this procedure may cost me 400 bucks, I don’t want to pay the 400 bucks or 800 bucks or whatever it is like that money is not something I want to spend right now or for whatever other reasons, they don’t want to do it. And it’s like cool. In, I think we should honor all families wherever they are. But the most important part is for there to be their awareness, right? For there to be their awareness that, you know, if you’ve got now the eight year old, who eats for foods is is having all kinds of weird behavioral neurocognitive issues, you know, plus or minus eczema or some kids that have eczema, there are some kids that have digestive issues, because they’re only eating for foods, and they can’t eat or digested right. So it’s not just the brain that gets hit, the entire body can get hit. But if parents start looking at this and say, oh my god, this is my kid, at least for us to have the awareness to say, well, this could be at play. And now it’s a matter of doing that cost benefit analysis. Yes.


Jacqueline Kincer  39:31

Oh, I couldn’t agree more. And I think there’s frustration from parents and on my side of things, working with them. When I hear that a pediatrician will say something like, well, your child’s gaining weight just fine. So you don’t need to treat the tongue tie. And they don’t really make it sound like the parent is getting to make the decision, right? They just say no, it’s not worth treating, but they don’t let the parents decide and they don’t really give them the full information. They just say well, things are good now. They don’t talk about the future. They don’t give them that opportunity to to say, you know, this is what could happen. So you’re aware, you know, but maybe maybe it isn’t the right time, you know, they just sort of direct them and say no, when recommend doing that baby’s baby’s doing fine. Like, okay, well it compared to what to write, because, you know, maybe you’re seeing a lot of babies that particular day that have a lot going on in this particular baby doesn’t it doesn’t mean that they shouldn’t be treated.


Maybe they shouldn’t, you know, but that’s not really, I’m a big fan of letting the parents decide, like you said, and I’ve seen cases to where I’ve had, you know, let’s say, a mom who’s really in the midst of, you know, postpartum issues, right, her anxiety is high, maybe she’s going back to work soon. Yes, the baby’s struggling to breastfeed, but, you know, throwing in doing a tongue type procedure and all the aftercare that’s involved with that, it’s just gonna push her over the edge, you know, is that is that going to make this mom now want to formula feed her baby and not even pumped anymore? So you have to be, you know, you have to take so much into consideration, right? It’s not just saying, Oh, this is what’s wrong, and we need to fix it. So I love that you have that perspective, and that you’re honoring where the families are at, because we are so individual, you know, I know that I might be less affected by something, because, you know, I have a pretty good genetic profile, whereas someone else who has a lot of mutations and whatnot, is going to be more severely impacted.


Dr. Pejman Katiraei  41:26

Yeah, yeah. And, you know, I think that that’s where parents being truly informed, right? Informed consent, like parents, really understanding all the different sides, and all the different parts of this discussion is really the most important thing. And through being really well informed that parents can make the best decision of what they think is best for their child. And, you know, I think is an extension of this, you briefly touched on airway. I think that that that’s actually a really important thing for us to talk about. Because


Dr. Pejman Katiraei  42:02

one of the things that, you know, I’ve definitely seen, and I know you touched on this, and I’m sure you’ve talked about this, is that it’s not just this kids, these kids don’t know how to eat, these kids also start having all kinds of weird, different types of airway issues, right? They have breathing problems, because what does the tongue do? In addition to help us chew our food, it helps push the teeth and palate out, right? It helps us develop our palate. And if you look in, you know, part of, I’m the pediatrician that lives in the world right in my eyes constantly scanning, and we were at the park probably a few months ago. And one of my friends, friends, his son, I looked at him and like my god, he has a tongue tie. And I kept looking at him and like, and how I nerves this face was totally flat, right. So there are some people out there that you look in like their upper jaw, their mouth is just completely flat.


It’s like they’ve got this horizontal face rather than you’ve got your forehead and then your upper jaw comes out. And for parents, you know, they can just have their kid turn to their site, and you could look at them. For the kids who have tongue ties, a lot of times you can see their upper jaw is actually not grown well, so they end up having grout crowding of their teeth. Sometimes the dentist orthodontist wants to pull the teeth because there’s just not enough room for them. Some orthodontist will use expanders to widen the palate. But ultimately, the the other part of the tongues job is to actually push the palate forward, which actually makes more room for us to breathe. Right. Then I’ve also one of the things that I’ve seen in a lot of these poor kids that have tongue ties later on is they have breathing problems. So they end up choking, gagging, storing having all kinds of different problems while they’re breathing. And guess what? If you’ve got the so we talked about the digestive issues, right? You got the leaky gut, you got the intestinal inflammation, you’ve got the bacterial changes, you’ve got the limited diet, which also limits the nutrients that you’re getting in, right. If you’re not eating vegetables, you’re not getting minerals, you’re not getting certain vitamins. If you don’t eat foods like fish, you don’t get omega fat, so their nutritional profile gets very limited.


And then you add to that sleep apnea of whatever sort and these kids may not have like a full fledged where they’re snoring like an old man and choking and gagging while they’re sleeping. But a lot of times what these parents say is what like oh, yeah, my kid wakes up at least once or twice, or sometimes three or four times in the middle of the night. They’re tired in the mornings when they wake up. And you kind of look at this cluster of issues and it’s just like, holy cow. When you add all of this together, you know, between the sleep apnea and poor sleep in low oxygenation while you’re sleeping, and this constant stress response, right? Every time you choking gag while you sleep, what does that do? It causes a big surge of cortisol that wakes you up. And for all you parents out there, you know if you can remember the time when you had the newborn that was waking you up three or four or five times in the middle of the night after, like, at least for me, after a few weeks, I thought I thought I was gonna just shoot myself like I was, I was such a hot mess, like, it was not even funny.


Now, imagine if that is your entire life’s experience, right? Imagine it for years, upon years, upon years, all you have known is disrupted sleep. So what we experienced, hopefully, you know, as parents for, you know, two, four, maybe six months, you know, heavens forbid, you know, and by the, by the six months, we’re like, oh my god, we’re gonna die. If you’re a kid, and you have the small palate, you’ve got the tongue issues, which then cause airway issues. So you’ve never slept well. And then you add to that, that flu like sickness behavior, like how in God’s good earth can you possibly function in life, right? Imagine having the flu and the sleep deprivation of when you had the baby. And now you have to be in school paying attention, who couldn’t pay attention? Who can learn who can focus? Like, how is that even possible, right? So all of a sudden, these weird, mysterious things of like, Oh, you’ll she has anxiety disorder, or oh, he has ADHD, or this or that? No, they’re just sleep deprived, and they have a mild case of the flu, you fix those things, you will get a completely different human being. And I think as we look at these things, and then we try to step into the shoes of the child, we’re like, Oh, my God, yes. There’s a reason why Susie can’t learn. There’s a reason why she can’t pay attention. There’s a reason why she’s crabby and having meltdowns and freaking out all the time. It’s because she just feels like hell. Yeah,


Jacqueline Kincer  47:02

yeah, I mean, I know, I’ve definitely had moments of where I don’t get enough sleep, and I’m a Krabby Patty, like, I’m blowing up at my kids or whatever, right. And then it affects the parents too. If you have a baby, who is going above and beyond with their night, wakings, and you’re not sleeping, well, you’re unhappy, your baby’s unhappy, this is affecting more people than just the child, you know, now you’re lashing out at your partner, maybe your other kids, you’re not performing at work, like there are so many ripple effects that happen from this and throwing something like sleep training at the situation, you know, when it’s not a behavioral problem to begin with, that’s really the result of something physiological going on, it’s so harmful to try to, you know, just put a damper on these things in those kinds of methods. So I’m really glad that you’re bringing that up. Because, yes, there is a normal amount of, you know, night wakings, you know, from infants and whatnot.


But there are also abnormal amounts. And I do think that sometimes there are parents who feel strongly that they don’t want to do really any interventions with their children, they want to have a really natural way of parenting, and they tolerate these night wakings and issues, but now you’ve got a three-year-old who’s waking up like a newborn. And, you know, they sort of end up blaming themselves, right? Oh, I should have sleep trained earlier on, or what have you. And, you know, there’s really a reason why, and I just saw a new study come out for it was about moms, and how that early sleep deprivation from having an infant really impacts you for the next six years, which is a very long time. So imagine your child starting off their life that way, like you’re saying, you know, how is that impacting them? And, gosh, we have an epidemic of problems going on with children who are suffering from these issues?


Dr. Pejman Katiraei  48:56

Yeah. You know, I think, along those lines, sadly, we have no idea why we’re having an epidemic of tongue ties. I mean, I can tell you that I’m certainly better at identifying them. But in some of the experts that I’ve talked to, and there’s a group out of Stanford that’s actually really trying to understand this, there’s, there’s definitely data to suggest that kids are having more tongue ties than we had years ago. And it’s not just because we’re better at identifying them. So this is, I think, sadly becoming an epidemic that I would say, you know, in the experts that I’ve talked to would also agree that you know, probably at least one in 10 if not one in four kids have some ties. And if we miss these, if we don’t know how to identify them, and we let this sit in the child, especially if they have genetic vulnerabilities. This can cause as we’ve kind of discussed a cascade of events a domino effect really But then can show up in all kinds of strange ways. So I think, you know, at least having this awareness that these things exist and for parents to be like, Oh, that’s my kid. And then from there to start having the discussion with different kinds of experts to then, you know, look at how to navigate it. And you know, thank God, there are people like you out there where you can help parents actually understand these things and identify them and guide them to find the right treatment. That’s how we make a change. That’s how we help these kids. Right?


Jacqueline Kincer  50:32

Oh, and thank God, we have you because I love that I’m able to give you a voice on this platform, no matter how few listeners I might have on the podcast. No, I have quite a few actually think so. Every time I checked the stats, it goes up. That’s great. So I want people to hear this information because you’re here to bring it to them. And I was just thinking, as you mentioned, those numbers one in 10, one and four. And just thinking about the past, you know, year now with the COVID, 19 pandemics. And imagine if we had a program where every elementary school, we were screening children, just like they get their hearing tests, just like we’re taking temperatures when they come to school, just like we’re doing random COVID test now for children who are in school? What if we checked every child for ties? What if we had a Presidential Task Force to tackle this epidemic? You know, not all epidemics are viruses. There are there are other causes behind them. And I hope I really, really hope one day that we get there that, you know, this is something that comes across the Surgeon General’s desk in the United States.


And they go you know what, this is a huge problem. Because, like you’re saying, if all these impacts are happening to someone’s health, the economic impacts the the the impact of the GDP, the productivity, I mean, employers should be very concerned about this, if you’ve got an employee who’s showing up tired every day and has to drink five cups of coffee to get themselves going and their brain craps out at 2pm. You know, what, what are we doing? Right? Like we can’t, or they’re taking sick time off, because, like you said, they’re there, they’ve got this sort of sick response going on in their bodies, you know, or they get sick more often, because their immune systems in overdrive, there’s so many things that I could think of, you know, and I, I’ve seen even studies about not just distracted driving, but people being too tired when they’re driving, and that’s causing fatal car accidents. I mean, probably so many things throughout society, it’s hard to get studies to do a direct link, right? There’s so many factors. But there’s a lot of impact from this, that’s negatively and, you know, affecting everybody around us. So I really, truly hope that by having you on here to talk so clearly about the issues and how you see it from your perspective, is going to just be another light at the end of the tunnel for us to get closer to you know, helping families fix these issues, and just bring awareness to it.


Dr. Pejman Katiraei  52:55

Oh, thank you for that. And it’s really a pleasure to be here. And, you know, at the end of the day, that’s how we bring change, right? We have conversations that bring awareness and, you know, through awareness, that’s that’s how we start changing things. And you know, whether it’s at a government level, at the educational school level, at the physician level, you know, of other doctors, pediatricians, holistic practitioner start really waking up and saying, like, gosh, this is really playing a big part. That’s how we start bringing change. And it all starts with just people saying, like, oh, yeah, these things are there, we kind of, you know, I try to lay these things out in very concrete terms. So it almost becomes inescapable, like it’s either there or it’s not. And when it’s there, it’s just like, we need to give credit where it’s due. And sadly, tongue ties require a lot of credit. They cause big problems and some children.


Jacqueline Kincer  53:52

Yeah, they really do. And we, you know, I think you’re like me, where we would love to not have to treat those problems, right? We don’t, we don’t want to see families suffering because of what’s going on. And, you know, wouldn’t it be nice to just treat a simple ear infection, but when you’re treating a tongue tie, it’s a lot more involved, and it is a big deal. So I one day really do hope that there’s some way that we’re identifying, you know, the cause, and we’re able to just prevent it, but until then we’ve got to just do the things we can to work with it and make things better for these families.


Dr. Pejman Katiraei  54:29

Yeah. You know, I think if we can leave families with one thing, it does require a lot of work. It is very involved. It is complicated, but my God, if something like this changes the entire trajectory of your child’s life for the rest of their life, and part of why I love doing what I do is, you know, my goal is not to give a simple fix and I tell all families like if you’re coming here for a simple fix, like go somewhere else, like I don’t work with, I don’t practice that way. But we What we do can change the child’s experience for the rest of their life. And my goal is, by the time I’m done working with the family, like they never have to see me or, frankly, any doctor, again, because we have addressed the core fundamental pillars of health in the child in their eating mechanism, and breathing and tongue are one of them. And by the time you address these things, it’s like you have a different human being with a different propensity and health in a different state of functioning. And once you achieve that, it’s like, you literally put that human being on a different trajectory in life for the rest of their life. So it’s not a simple fix, it’s not a fast fix, but the effects could be there for the rest of the person’s life. And that’s worth something


Jacqueline Kincer  55:47

that’s worth so much, I don’t think we can really put a price on it. And then those if we raise healthy children who go on to have their own children, it’s a huge effect, right. So it’s a big butterfly effect. And as you said, that I think about you know, parents that will spend, you know, whatever money right to put their kids in the best private school to have the best tutor to be in have the best athletic coach and whatever. But maybe the way we optimize performance and set our kids up for success is just something having to do with their health. You are amazing, amazing Dr. K, a Dr. K for President, you all, seriously, or at least had some sort of health task force, because what you do and what you have to say is so important. So I just want to thank you for your incredible contribution on the podcast and just everywhere, and what you’re doing in your practice in daily life. It’s been wonderful to talk to you and I just couldn’t have imagined a better conversation. So thank you


Dr. Pejman Katiraei  56:48

know, it’s my absolute pleasure. And you know, hopefully, this conversation gets into the, you know, ears and minds of some families and it helps parents feel better, it helps parents know what to do to help their children.


Jacqueline Kincer  57:02

Yes, that’s the hope for sure. Well, until next time, everyone, I will talk to you on another episode of The Breastfeeding Talk Podcast.



Families call him Dr. K., and on today’s episode we have Dr. Pejman Katiraei to talk about a holistic approach to pediatrics with a focus on tongue ties. Specifically, we’re discussing the domino effect they cause later in life–including failure to thrive, oral aversions/extreme picky eaters, sleep apnea, development of palate, and even what looks like ADHD and anxiety.

Dr. K graduated from his residency in 2006. From 2004-2005 he realized there has to be more to the story than what he was trained to do. He was fortunate to see a lot of complex cases, great training, but saw things that didn’t add up. One particular case was an 8-10 year old boy who had horrible colitis. Steroids didn’t work and doctors wanted to remove colon. Ultimately he knew there was more to the story than a major surgery.

Dr. K is an integrative pediatrician, with a focus on severe behavioral issues in children. He works with more than just diet, the gut, and supplements because his clinical experience has taught him that only 25% of kids got better with that approach. He was really awoken to what happens in the mouth 4 years ago.

Digestion begins in the mouth—chewing, breaking it down, swallow begins there. If you don’t know how to chew your food, how does the rest of digestion work? It’s not meant to work with unchewed food. The pancreas’ job isn’t to chew food—it’s to take already broken down food and further unpack that. Tongue tied children cannot chew food well (rotary chewing is lacking).

Can the child take a chunk of steak and chew it? If not, they have a “broken eating mechanism”. If eating is difficult or something isn’t happening properly, your brain learns those foods are dangerous. Then you have a picky eater.

Poor digestion and food intake means a lack of micronutrients, lack of fiber, changes in gut microbiome, lack of diversity. The immune system then becomes activated to these foods because they’re not more digested by the time they hit the gut. This ultimately causes a phenomenon known as “sickness behavior”—this is the brain’s response to immune activation—brain fogginess, feeling “sick”.

Once these kids are labelled with ADD, AHHD, depression, or anxiety, they lose their self-esteem and feel like they cannot function normally.

When parents know what to look for, it will become clear as day:

  • difficulty breastfeeding, sometimes shows up later once letdown calms
  • something is off early on
  • solid foods, from 12-24 months old other issues crop up—spitting out certain textures, higher density foods create struggles
  • 3-4 years old become very picky eaters, very established food preferences—soft foods that barely require chewing
  • colic/reflux—swallowing air, gassy—tissue pulling on esophageal sphincter causing reflux
  • difficult to put to sleep
  • speech problems

We shouldn’t approach this from fear or “doom and gloom”—tongue tie isn’t a damning diagnosis. How you approach this depends on how preventive you want to be. Tongue tie procedures are a surgery—risk/cost benefit.

What is it worth to prevent these issues? We must honor where the parents are at and supporting their choices and needs.

Lastly, the tongue helps us breathe—it pushes the palate and teeth out. Choking, gagging, snoring can all be related issues, and later in life we see sleep apnea or upper airway resistance syndrome.

Let’s do all we can to prevent these issues and bring awareness.