Heart attacks and canker sores: why we need to take oral health seriously
Your microbiome begins in your mouth. Why don't we look there more often?
- Eighty percent of patients who've had heart attacks have gum disease, says Dr. Shahrzad Fattahi.
- Oral health is also implicated in forms of cancer, dementia, canker sores, and more.
- Fattahi says the future of medicine must also focus on saliva, as a whole new field of salivary diagnostics is emerging.
Over the summer, I was sitting in the dentist's chair, waiting for a cap to be placed over a cracked tooth. While dentist offices rarely inspire joy, I always enjoy visiting Shahzrad Fattahi. Leaving my doctors in New York City was one of the hardest aspects of moving. Thankfully, a mutual friend recommended me to Dr. Fattahi. I gladly travel the extra distance to get to her Playa Vista office—we sometimes forget how much a good doctor matters until we find one.
Part of the reason I enjoy our visits is that we end up spending half the time talking about a variety of topics related to health. On this occasion, I mention the microbiome; it's something I've been writing about lately. Dr. Fattahi mentions that the mouth has its own microbiome: Oral health affects a variety of autoimmune disorders, cancers, heart problems, and cognitive issues.
It makes sense. The entryway into our gut microbiome is the mouth. Yet I'd never made the connection about just how important food is from this particular perspective. Gut health begins with salivation. In fact, as you'll read below, saliva contains nearly as many molecules as blood, making chair-side salivary diagnostics an important part of the future of medicine.
During our wide-ranging discussion (much of which I couldn't fit into this article), we talk about why dental insurance is separate from medical insurance—one of those givens in America we rarely question—as well as the connection between gut and mouth health, how to promote good bacteria and reduce bad bacteria, why dentistry misses so much by focusing on cosmetics instead of functional health, how oral health affects your breathing, and the best way to help your child develop a strong, healthy jaw for life: breastfeeding.
One thing became clear while I talked to Dr. Fattahi: Holistic health needs to include oral health. Insurance companies need to figure that out, too.
Dr. Shahzrad Fattahi
Derek: In your office, you pointed out the connection between dental health and the microbiome, which is something I had never thought about.
Shahrzad: It's a great place to start, but maybe we can back up to how dental health affects your whole being and overall health. There is a missing link between what happens in the mouth and what happens in the rest of the body. With our distaste for dental checkups and focus on treatment versus prevention, we really fail to see how dental disease is a warning sign of so many other diseases. We should take a cue from our medical colleagues, who have made a shift toward more functional medicine and looking at root causes of diseases. When you come in for a dental visit now, we are only doing a cleaning, checking for cavities, recommending whitening, and sending you on your way.
We need to move toward functional dentistry. We have so much more information that we can pass on to our patients in terms of their overall health, like salivary testing for your pH levels and your airway assessment. We can do a simple chair-side salivary test to tell you if your bacterial levels are off.
In terms of your microbiome, we all hear so much about gut health, which is really your digestive system. Your gut is now responsible for 80 percent of your immune system and your gut starts in the mouth. If you think of the gut as a long tube, sort of like a conveyor belt, you put the food in your mouth first. Any diet that you follow—keto, paleo, vegan—you're actually first coating the food with your saliva. If there's an imbalance, you're passing that down into the ecosystem along the way. That's the main way swallowing bacteria is going to further affect your immune system downstream.
Derek: And you start salivating before you even begin eating. Sometimes a trigger, such as thinking about food, can make you salivate.
Shahrzad: Absolutely. The first part of your digestive system is the salivary enzymes that are exuded from your salivary glands. You activate your vagus nerve the first time you swallow, which activates the rest of your digestion. What's important to understand is that we're not saying "antibacterial." We are saying you should have a balance of bacteria. Imbalance causes the dysbiosis between the good and bad bacteria.
Interview with Dr. David Wong on Salivary Diagnostics
Derek: What causes bad bacteria in your mouth?
Shahrzad: Good and bad bacteria is divided into two groups: the slow eaters and the fast eaters. The fast eaters feed on simple carbohydrates like sugars. When we eat sugary, white flour foods, we send these back bacteria into a frenzy. Then they metabolize acids. The slow eaters are actually the ones that are designed to digest longer, more complex molecules. They feed more on fibrous fruits.
Derek: Good and bad in this sense are based on the foods you're eating. When you say slow, it's not necessarily the amount of times you chew, but the actual foods you're consuming?
Shahzrad: In part, yes, definitely the foods that you're consuming. Processed foods, white sugars, and grains tend to see the faster-metabolizing bacteria. The more fibrous foods tend to affect the more slow-growing bacteria. If you eat too much sugar, the fast-metabolizing strains multiply too rapidly and spew out too much acid. That starts a chain reaction that leaches too much calcium from the enamel. The fastest-growing bacteria grow at the expense of the slower-growing bacteria.
If you have an imbalance, for example, if you have a lot of stress, we know that cortisol tends to secrete from the fluid around your teeth. That leads to the growth of gingivalis, which is the main bug that causes all the problems that we are seeing with GI.
Derek: What is it psychologically that people don't like to or are afraid to go to the dentist?
Shahzrad: We have to talk about the fear and trauma around dentistry. I was a kid in the seventies. We didn't grow up in a very kind, nurturing environment. Usually they would kick your mother out, tell you to be quiet and just suck it up, and you would be sitting helpless on the chair. More than anything, I hear every day, "Doc, I don't want to be here. I'm so afraid." The dentist appointment is the last phone call anyone makes. You're not thinking of your dental appointment as part of your health.
Most of the calls I get are pain calls. You tend to only go when you're in pain. Organized dentistry is now making a more concerted effort to create nurturing environments.
A dentist treating a soldier, Trench Mortars School, Nervesa della Battaglia, World War I, Italy, 20th century.
Derek: How do we get people to understand that oral health affects overall health?
Shahzrad: We have so many studies linking all kinds of periodontal disease and gum disease. There are links between gum disease and heart disease. In fact, 80 percent—this is a staggering number—80 percent of patients who've had heart attacks have gum disease, yet there's no discussion between dentists and cardiologists. We now have evidence of Alzheimer's being linked to gum disease. We now show increments of the same bacterial colonies in the intestine of patients with HIV, colon cancer, GI, and pancreatic cancer. The science is there.
Derek: We're really just learning how important gut health is. You're adding another layer here. The "tongue microbiota" is a new term to me.
Shahzrad: Yes. And we need to have more of these discussions. We need to make a paradigm shift to thinking about oral health as valuable and a part of our overall health. As our food got softer and less nutrient-dense, not only did we stop eating less roughage, we stopped using the muscles of our faces. We also started to eat a more grain-based diet, which is lacking in fat-soluble vitamins like A, D, and K. We also see in our patients a higher incidence of canker sores. If you're low in Omega 3s, you may be having periodontitis.
Derek: Cooking, however, made foods more nutritionally bioavailable. Richard Wrangham wrote an excellent book on that topic. The trade-off, of course, was that our jaws got much weaker.
Shahzrad: It's like going to the gym and exercising your muscles. The more you exercise, the better muscle strength and overall bone bone density improves. It's the same with the jaw. You want to eat more fibrous foods, but also foods that are nutrient-dense, that have K2 and vitamin D.
Derek: I used to have regular outbreaks of four to six canker sores at a time. When I went from a longtime, grain-heavy vegetarian diet to eating meat again, my canker sores disappeared. I haven't had one in four years now; I know there is a link there. This is just one example of the importance of food and your mouth. Overall, what is the future of oral health?
Shahzrad: The field of salivary diagnostics has come so far. Saliva markers can be used to detect all kinds of diseases, oral cancer, breast cancer, all kinds of autoimmune diseases. Chair-side salivary testing, which we offer in our practice now, will be the new paradigm, not only in the dental field but in the whole medical field. Dr. David Wong at UCLA is doing some very exciting research. He published 165 million genetic sequences and found that saliva contains many of the same molecules contained in blood. In the future, if you're not looking at saliva, you're going to be missing indicators of disease.
A socially minded franchise model makes money while improving society.
- A social enterprise in California makes their franchises affordable with low interest loans and guaranteed salaries.
- The loans are backed by charitable foundations.
- If scaled up, the model could support tens of thousands of entrepreneurs who are currently financially incapable of entering franchise agreements.
The underdog challenging McDonald’s & Wall Street | Hard Reset by Freethink www.youtube.com
Social responsibility is becoming a major focus of many businesses. While turning a profit is always the ultimate goal — nobody can eat good intentions, after all — having a positive impact on society is becoming an equally important goal.
A restaurant chain in California, already focused on providing healthy food at a competitive cost, is testing a new way to create more entrepreneurs. Specifically, it is working with charitable foundations to provide business opportunities to those who normally would not have access.
When a company wants to expand without paying all of the upfront costs itself or taking on the entire risk of operating in a new market, it can enter into a franchise agreement with an entrepreneur. In exchange for a share of the profits (as well as some fees and adherence to certain quality standards), the entrepreneur — now a franchisee — can open their own branch of a larger brand. The entrepreneur enjoys the benefits of owning a business, while the brand owner can cash in on intellectual property.
This model is wildly successful. There is a reason you can find fast food joints like McDonald's everywhere from Times Square to Prague (next to the Museum of Communism, no less). According to the International Franchise Association, there were more than 733,000 franchised business establishments in the United States in 2018, accounting for nearly 3 percent of GDP.
The franchise model — in which a local agent keeps some earnings while handing over a portion to a central authority — isn't new. Indeed, variations have been around since the Middle Ages, though it only took off after WWII. Franchising is now a recognized system in many countries and is used in all manner of industries, including restaurants, pet supply stores, automotive repair shops, hotels, and even senior care.
The Catch-22: you have to spend money to make money
The biggest problem with franchising is the high cost of becoming a franchisee.
While the costs vary, opening a restaurant as a franchisee can easily cost $500,000. A franchise car repair shop can require $250,000, and opening a hotel under a franchise's banner can set a person back millions. In some cases, the franchiser also will set a minimum net worth requirement or insist that the money that pays their fees not be borrowed. Even if a person can find a way around that, most new businesses do not turn a profit for quite some time after opening. These limitations essentially rule out all but the wealthy from becoming a franchisee.
As a result, there are some social enterprises that are looking to make franchising more accessible to the less affluent.
As a business that hopes to rapidly expand, they looked to franchising. However, the idea of seeking out a bunch of rich people to support a business like theirs struck CEO Sam Polk as out of step with its vision. So, the company came up with a better idea.
Their Social Equity Franchise Program helps tenured Everytable employees open their own franchise locations through free training and assistance in securing low interest loans to finance the store. To help the entrepreneurs survive the difficult early years, participants in the program are assured an income of $40,000 in their first three years of operations. Repayments on the loans do not begin until after the business is turning a profit.
The capital for all these low interest loans comes from a number of foundations such as the California Wellness Foundation (Cal Wellness). Foundations like these are required to give away a small portion of their endowments every year on causes aligned with their missions. However, most of the rest of it is simply invested in the stock market to assure the endowment continues to exist.
People like Cal Wellness CEO Judy Belk have begun to invest that money elsewhere, like in loans to provide the money needed to open an Everytable franchise. As she explained to FreeThink:
"Cal Wellness and many other foundations are saying, 'I think we can do a little better with that [money]. Why not use that capital to invest in the communities that we're supposed to serve?'"
In the end, Everytable gets a new restaurant that expands the brand, foundations get returns on their investment, and the franchisee gets an opportunity that they likely never would have had without the program.
Expanding the Everytable model
If even a small share of the $2 trillion foundations in the U.S. have are invested into this sort of social cause, tens of thousands of loans could be given to those less affluent people who are looking to start a business. While this model likely would lower returns to institutional investors like charities, they could enjoy more tangible results in the communities they exist to serve. According to a report published by the Federal Reserve Bank of Atlanta, local entrepreneurship increases income and employment and decreases poverty.
At the individual level, this would help a lot of people who otherwise never would be able to seriously consider going into business for themselves. By a number of measures, business owners make more than wage workers and can also claim ownership of the assets that comprise the business. Beyond that, many small business owners enjoy the non-financial benefits of their position as well, including the independence and autonomy that often come with business ownership.
When working optimally, good business is good for society.
Fintech companies are using elements of video games to make personal finance more fun. But does it work, and what are the risks?
- Gamification is the process of incorporating elements of video games into a business, organization, or system, with the goal of boosting engagement or performance.
- Gamified personal finance apps aim to help people make better financial decisions, often by redirecting destructive financial behaviors (like playing the lottery) toward positive outcomes.
- Still, gamification has its risks, and scientists are still working to understand how gamification affects our financial behavior.
- YouTube www.youtube.com
The human brain is a pretty lazy organ. Although it's capable of remarkable ingenuity, it's also responsible for nudging us into bad behavioral patterns, such as being impulsive or avoiding difficult but important decisions. These kinds of short-sighted behaviors can hurt our finances.
However, they don't hurt the video game industry. In 2020, video games generated more than $179 billion in revenue, making the industry more valuable than sports and movies combined. A 2021 report from Limelight Network found that gamers worldwide spend an average of 8 hours and 27 minutes per week playing video games.
Good at gaming, bad at saving
It's not necessarily bad that Americans spend millions of dollars and hours on video games. But consider another set of statistics: 25 percent of Americans have no retirement savings at all, while roughly half are either living "on the edge" or "paycheck to paycheck," according to a recent report on the Financial Resilience of Americans from the FINRA Education Foundation. Meanwhile, experts predict that Social Security funds could dry up by 2035.
So, why don't people save more? After all, the benefits of compounding interest aren't exactly a secret: Investing a few hundred bucks every month would make most people millionaires by retirement if they start in their twenties. However, the recent FINRA report found that many Americans have alarmingly low levels of financial literacy, a topic that's not taught in most public schools.
Even for the financially literate, saving money is psychologically difficult
But what if we could infuse the instant gratification of video games into our long-term financial habits? In other words, what if finance looked less like an Excel spreadsheet and more like your favorite video game?
A growing number of finance applications are making that a reality. By using the same strategies video game designers have been optimizing for decades, gamifying personal finance could be one of the most efficient ways to help people save for the future while reaping instant psychological rewards. But it doesn't come without risks.
What is gamification?
In simple terms, gamification takes the motivating power of video games and applies it to other areas of life. The global research company Gartner offers a slightly more technical definition of gamification: "the use of game mechanics and experience design to digitally engage and motivate people to achieve their goals."
The odds are you have encountered gamification already. It's utilized by many popular apps, websites, and devices. For example, LinkedIn displays progress bars representing how much profile information you have filled out. The Apple Watch has a "Close Your Rings" feature that shows how many steps you need to walk to meet your daily goal.
Brands have used gamification to boost customer engagement for decades. For example, McDonald's launched its Monopoly game in 1987, which essentially attached lottery tickets to menu items, while M&M's gained consumer attention with Eye-Spy Pretzel, an online scavenger hunt game that went viral in 2010.
In addition to marketing, gamification is used in social media, fitness, education, crowdfunding, military recruitment, and employee training, just to name a few applications. The Chinese government has even gamified aspects of its Social Credit System, in which citizens perform or refrain from various activities to earn points that represent trustworthiness.
Finance is arguably one of the best-suited fields for gamification. One reason is that financial data can be easily measured and graphed. Perhaps more importantly, financial decisions occur in the background of almost everything we do in modern life, from deciding what we eat for lunch to where we are going to spend our lives.
Gamification doesn't just make boring stuff fun; it's also an effective way to change our behavior. Used properly, it can also disrupt our habits.
The nature of habits
It's tempting to think that we make our way through life by thoughtfully considering the information before us and making sensible choices. That's not really the case. Research suggests that about 40 percent of our daily activities are performed out of habit, a term the American Journal of Psychology defines as a "more or less fixed way of thinking, willing, or feeling acquired through previous repetition of a mental experience."
In other words, we spend much of our lives on autopilot. From an evolutionary perspective, it makes sense that we rely on habits: our brains require a lot of energy, especially when we're faced with tough decisions and complex problems, like financial planning. It's relatively easy to rely on learned behavioral patterns that provide a quick, reliable solution. However, those patterns don't always serve our long-term interests.
Saving money is a good example. Imagine you have $500 with which to do whatever you want. You could invest it. Or you could go on a shopping spree. Unfortunately, the brain doesn't process these two options the same way; in fact, it actually processes the investing option as something like a pain stimulus.
Why gamification works
Saving is painful. But can't people simply choose to be more financially responsible? In short: Yes, but it takes a lot of effort. After all, when it comes to changing behavior, willpower is only part of the equation.
Some psychologists think willpower is a finite resource, or that it's like an emotion whose motivational power ebbs and flows based on what's happening around us. For example, you might establish a monthly budget and stick to it for a couple weeks. But then you get stressed. The next time you're out shopping, you might find it harder to resist making an impulsive purchase in your stressed-out state.
Pixel Art Lootvlasdv via Adobe Stock
"A growing body of research shows that resisting repeated temptations takes a mental toll," the American Psychological Association writes. "Some experts liken willpower to a muscle that can get fatigued from overuse." In the terminology of psychology, this is called ego depletion.
Gamification offers a way to outsource your willpower. That's because games offer psychological rewards that can motivate us to perform certain actions that might otherwise have seemed too boring, taxing, or emotionally draining. What's more, gamifying parts of your life is less of a change of mind and more of a change of environment.
A 2017 study published in Computers in Human Behavior noted that "enriching the environment with game design elements, as gamification does by definition, directly modifies that environment, thereby potentially affecting motivational and psychological user experiences."
The study argued that games are most motivational when they address three key psychological needs: competence, autonomy, and social relatedness. It's easy to imagine how games can tap into these categories. For competence, games can feature badges and performance graphs. For autonomy, games can offer customizable avatars. And for social relatedness, games can feature compelling storylines and multiplayer gameplay.
Gamification and the brain
Games can motivate us by satisfying our psychological needs and giving us a sense of reward. From a neurological perspective, this occurs through the release of "feel-good" neurotransmitters, namely dopamine and oxytocin.
"Two core things have to happen in the brain to influence your decision-making," Paul Zak, a neuroscientist and professor of economic sciences at Claremont Graduate University, told Big Think. "The first is you have to attend to that information. That's driven by the brain's production of dopamine. The second thing, you've got to get my lazy brain to care about the outcomes. And that caring is driven by emotional resonance. And that's associated with the brain's production of oxytocin."
Cheerful Father And Son Competing In Video Games At HomeProstock-studio via Adobe Stock
When released simultaneously, these neurotransmitters can put us into a state that Zak calls "neurologic immersion." In this state, our everyday habits have less control over our behavior, and we're better able to take deliberate action. It's an idea Zak and his colleagues developed over two decades of using brain-imaging technology to study the nature of extraordinary experiences.
As he wrote in an article published by the World Experience Organization, neurologic immersion can occur when experiences, including video games, are unexpected, emotionally charged, narrowing one's focus to the experience itself, easy to remember, and provoking actions.
"The components of the extraordinary come as a package, not in isolation from each other," Zak wrote. "It's the 'action' part that is key to finding immersion. Extraordinary experiences cause people to take an action, whether it's donating to charity, buying a product, posting on social media, or returning to enjoy an experience again."
Games can invoke these types of immersive experiences.. But how exactly are financial organizations using gamification to help people "level up" their financial futures?
Gamifying personal finance
Banks and financial companies have been using gamification for years. What started with simple concepts, like PNC Bank's "Punch the Pig" savings feature, has evolved into a diverse field of games that are helping people stick to budgets, save money, and pay off debt.
What's surprising about the gamification of personal finance is that some of the most successful apps are redirecting destructive financial behaviors, like buying lottery tickets, toward positive outcomes. One example is an app called Long Game, which uses an approach called "lottery savings."
"People actually really love the lottery," Lindsay Holden, co-founder and CEO of Long Game, told Big Think. "The lottery today is a $70-billion-dollar industry in the U.S., and the people that are buying lotto tickets are the people that least should be buying lotto tickets. And so how can we redirect that spend into something that's helping them in their lives?"
Long Game's answer is to encourage users to make automatic or one-time investments into a prize-linked savings account. As users make investments, they earn coins that can be used to play games, some of which offer cash prizes. But unlike the real lottery, the prize money comes from banks that are partnered with Long Game, meaning users can't lose their principal investment.
Blast is a savings app aimed at traditional gamers. The platform lets users connect a savings account to their video game accounts. Users then set performance goals in the video games, such as killing a certain number of enemies. Accomplishing these goals triggers a pre-selected investment into the savings accounts. In addition to earning interest, users can also win prize money by accomplishing certain missions or placing high on public leaderboards.
"Gamers tell us they feel better with the time they spend gaming when they know they are micro-saving or micro-earning in the background," Blast co-founder and CEO Walter Cruttenden said in a statement.
Young gamer playing a video game wearing headphones.sezer66 via Adobe Stock
Fortune City takes a different approach to gamified finance. The app encourages users to track their spending habits, which are represented by visually appealing graphs. As users log expenses, they're able to build buildings in their own virtual city. The expense categories match the types of buildings users can construct; for example, buying food lets users construct a restaurant. It's like "SimCity" meets certified public accountant.
The risks of gamification
Gamifying your finances might help you save money, but it doesn't come without risks. After all, receiving extrinsic rewards when we perform a behavior can affect our intrinsic motivation to repeat that behavior both positively and negatively. It's a phenomenon called the overjustification effect.
In addition, gamified finance apps can also be addictive and encourage risky financial behavior. Robinhood, for example, uses visually appealing performance metrics and lottery-like game elements to incentivize the trading of stocks and cryptocurrencies. But while investing in these assets might be a good financial decision for some people, Robinhood arguably encourages its users to be "players" in the difficult world of trading, not necessarily rational investors.
What's more, gamification doesn't seem to work for everyone.
"From social psychology and behavioural economics, we know that the most likely [result of] gamification [is that you] will motivate some people, will demotivate other people, and for a third group there'll be no effect at all," noted a 2017 study on gamification and mobile banking published in Internet Research.
But given that 14.1 million Americans are unbanked, and millions more struggle with financial literacy, it's reasonable to think that gamified finance apps could help many people work toward financial independence.
"One of the most interesting things we've found is that people want help when it comes to making difficult decisions," Zak told Big Think. "In my view, any app that helps you be a more effective saver is probably a good app. But I think we have to do a lot more work to really understand the underlying neuroscience of gamification. And so we need to continue to design games that teach you more about how to 'level up in life,' not just level up in the game."
Playing video games could help you make better decisions about money.
- The word is out on gaming—it's not just something that children do for fun anymore. Games are tools that can be used to teach new skills, reduce stress, and even change behaviors by triggering chemical reactions in the brain.
- These benefits and more have provided scientists and developers with a promising path forward. "Games reduce the stress of making decisions," says neuroscientist and professor Paul Zak. "App designers have now used game structures to help people learn new information, make new decisions; and one of the most exciting applications is in financial decision making."
- But simply turning something into a game isn't enough to see meaningful changes in habits. Developers of gamified apps like Long Game have found ways to combine the engaging and fun experience we expect from video games, with something that has traditionally not been very fun: saving money.