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.
Pandemic rumors and information overload make separating fact from fancy difficult, putting people's health and lives at risk.
The dark side of the information age<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzU1NzYwMi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNjE3MzY3Nn0.0HveQP16MbMkj9HXE8miohSHXETOak7oFDtBdXtE7lM/img.jpg?width=1245&coordinates=0%2C400%2C0%2C256&height=700" id="60d48" class="rm-shortcode" data-rm-shortcode-id="9085c1a7d5b3f81344c3002acdf1df68" data-rm-shortcode-name="rebelmouse-image" />
A South Korean church became a viral hotspot after church officials sprayed a salt water "cure" in congregants mouths, without disinfecting the nozzle between uses.
The cure for bad information is good<div class="rm-shortcode" data-media_id="e0tfZ3YB" data-player_id="FvQKszTI" data-rm-shortcode-id="601aa46855087a4dfcf02a67a160e0c4"> <div id="botr_e0tfZ3YB_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/e0tfZ3YB-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/e0tfZ3YB-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/e0tfZ3YB-FvQKszTI.js"></script> </div> <p><strong></strong><strong></strong>That doesn't mean we are defenseless. The best cure for rumors, stigma, and conspiracy theories is good, evidence-based information. We just have to know how to recognize it when we find it. Unfortunately, that's difficult in the center of the infodemic vortex.</p><p>"Information overload is incredibly anxiety-provoking—which is true even when the information is accurate," Jaimie Meyer, a Yale Medicine infectious diseases specialist, <a href="https://www.yalemedicine.org/stories/covid-19-infodemic/" target="_blank">told <em>Yale Medicine</em></a>. "But here, if people get the wrong information from unreliable sources, we may have more trouble slowing the spread of the virus. And we can't afford to get this wrong."</p><p>In their study, the researchers concluded that governments and health agencies should study the patterns of pandemic rumors, track the misinformation, and develop communication strategies to circumvent these messages. </p><p>In the <em>Yale Medicine </em>article, Meyer provides advice for helping individuals deal with information overload. She recommends looking at data and graphs carefully, considering how individual studies connect with established facts, and considering the whole story (not just the eye-catching headline). </p><p>When it comes to garnering information from social media, proceed with caution.</p><p>"Everything looks the same on Twitter," Meyer said. "When you have a tweet from Anthony Fauci, MD, director of the National Association of Allergy and Infectious Diseases, next to a tweet that says the opposite thing from a celebrity or some random person—and they all appear similar, you have to weigh the credibility of your sources." </p><p>She recommends following health agencies like <a href="https://twitter.com/who?lang=en" target="_blank" rel="noopener noreferrer dofollow">the WHO</a>, <a href="https://twitter.com/CDCgov?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor" target="_blank" rel="noopener noreferrer dofollow">the Centers for Disease Control and Prevention</a>, and your local and state health agencies. When you come across a pandemic rumor or something that seems suspect, you can double-check it against these authoritative sources, such as the WHO's <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters" target="_blank" rel="noopener noreferrer dofollow">COVID-19 mythbusters page</a>. And if you find yourself stressing out over the news and your social media feed, <a href="https://bigthink.com/mind-brain/mental-health-activities-coronavirus-lockdown" target="_self" rel="dofollow">take a mental break</a>.</p><p>We all would like a return to some form of normalcy, but that return will not emanate from a miracle cure. It will be a slow, steady course of handwashing, social distancing, and learning to navigate the infodemic.</p>
Carbon locked in soils can be emitted by bacteria.Turning up the heat on them releases more carbon.
- A new study shows that an increase in temperature can increase the amount of carbon released by the soil.
- This is in line with previous studies, though this one demonstrates a larger increase than the older experiments.
- The risk is that increasing temperatures cause a positive feedback loop.
The dirty details of an aggravated carbon cycle<div class="rm-shortcode" data-media_id="CabkeAzx" data-player_id="FvQKszTI" data-rm-shortcode-id="169377c88f392a86f6c42180b74820a5"> <div id="botr_CabkeAzx_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/CabkeAzx-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/CabkeAzx-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/CabkeAzx-FvQKszTI.js"></script> </div> <p>There is a lot of carbon in the dirt. The world's soil contains more carbon than the atmosphere, all the plants, or all the animals<a href="https://blogs.ei.columbia.edu/2018/02/21/can-soil-help-combat-climate-change/" target="_blank"></a>. A third of this trove of carbon resides in the soils of the <a href="https://www.sciencetimes.com/articles/26866/20200813/tropical-soils-highly-sensitive-climate-change.htm" target="_blank">tropics</a>. Under normal circumstances, this works as a carbon <a href="https://earthobservatory.nasa.gov/features/CarbonCycle" target="_blank">sink</a>, keeping carbon in storage and out of the atmosphere. Some of this carbon is used by bacteria in the soil to provide the building blocks of new microbes. They expel surplus carbon into the atmosphere in the form of carbon dioxide. </p><p>Many of these microbes are known to be more active when exposed to higher temperatures. To determine what this could mean for carbon emissions, a team from The University of Edenborough and the Smithsonian Tropical Research Institute turned up the heat in tropical soils to see what would happen. </p><p>The researchers went to an undisturbed plot of forest on Barro Colorado Panama, the home of the Smithsonian's Tropical Research Institute. They placed heating rods just over a meter into the soil and turned up the heat, warming the earth by four degrees centigrade. They then measured the carbon emissions from the heated ground and another nearby patch left at ambient temperature. These measurements covered two years.</p><p>Their findings, published in <a href="https://www.nature.com/articles/s41586-020-2566-4" target="_blank">Nature</a>, show that the heated soil emitted 55% more carbon than the control plot<a href="https://www.sciencedaily.com/releases/2020/08/200812144102.htm" target="_blank" rel="noopener noreferrer dofollow"></a>. <br> <br> Study lead author Andrew Nottingham commented on these findings to the <a href="https://phys.org/news/2020-08-global-tropical-soils-leak-carbon.html" target="_blank" rel="noopener noreferrer dofollow">AFP</a>. "Carbon held in tropical soils is more sensitive to warming than previously recognized. Even a small increase in respiration from tropical forest soils could have a large effect on atmospheric CO<sub>2</sub> concentrations, with consequences for global climate."</p><p>You can probably also spot the potential feedback loop here: If the global temperature increases too much, more carbon will be released from tropical soils, which then increase the greenhouse effect, which causes global temperatures to rise. </p>
Once is happenstance, twice is a coincidence, thrice is evidence of a pattern.<div class="rm-shortcode" data-media_id="8PLWDgcM" data-player_id="FvQKszTI" data-rm-shortcode-id="378380d273bf4a1c9606370acea15e58"> <div id="botr_8PLWDgcM_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/8PLWDgcM-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/8PLWDgcM-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/8PLWDgcM-FvQKszTI.js"></script> </div> <p>Previous studies on this topic point in the same direction. Those studies and the models they inspired suggested that increased temperatures could increase soil-based carbon emissions, but they all underestimated how much carbon would be involved.</p><p>A 2016 study focusing on temperate soils also concluded that increasing soil temperatures would increase their carbon <a href="https://www.nature.com/articles/nature20150" target="_blank">emissions</a>. They predicted that, if left unchecked, these emissions would equal the amount produced by a country similar to the United States over the next few <a href="https://www.ucsusa.org/resources/each-countrys-share-co2-emissions" target="_blank" rel="noopener noreferrer dofollow">decades</a>. Another experiment in Colorado found similar <a href="https://science.sciencemag.org/content/355/6332/1420" target="_blank" rel="noopener noreferrer dofollow">results</a>. Both of these studies found lower increases in carbon emissions by percentage than the study on Barro Colorado. </p><p>However, these studies did not take place in the tropics, and the differences in the soils between temperate and tropical zones could explain the differences between the studies. Moreover, the dirt on Barro Colorado Island differs from the dirt in the Amazon and may be more inclined to produce more emissions when the heat is turned up. The same can be said of tropical soils <a href="https://www.nytimes.com/2020/08/12/climate/tropical-soils-climate-change.html?searchResultPosition=3&utm_campaign=Hot%20News&utm_medium=email&_hsmi=93170710&_hsenc=p2ANqtz-8McWKRhE8U9ChcWW2qkqNyp2Qndzr1aJmGlrMUwK_h1bM8RDQukWcM8r2OcBKW2Y0bWlRr9o4WUixKDzIo4HzKkVv19g&utm_content=93170710&utm_source=hs_email" target="_blank" rel="noopener noreferrer dofollow">elsewhere</a>. </p><p>Another <a href="https://www.forestwarming.org/" target="_blank" rel="noopener noreferrer dofollow">experiment</a>, very similar to the one in Panama, is currently underway in Puerto Rico. However, this experiment is taking the extra step of also heating the plants near the heated soil to see what the effect of warmer temperatures is on their ability to absorb carbon.</p><p>The current study also did not heat the soil past the one-meter mark and cannot provide us with predictions of what more comprehensive heating of the soil would do to emissions. It was also comparatively short, and the effect may be reduced in the long run as the nutrients in the soil are depleted by the increased activity of the microbes, which are using the carbon and other resources to <a href="https://www.nature.com/articles/d41586-020-02266-9" target="_blank" rel="noopener noreferrer dofollow">reproduce</a>. </p><p>The team behind the most recent study will continue their experiment to try and understand how tropical ecosystems respond to increased <a href="https://www.earth.com/news/billions-of-tons-of-co2-could-be-released-from-tropical-soils/" target="_blank" rel="noopener noreferrer dofollow">temperatures</a> over more extended periods of time. </p><p>As we increase our understanding of the planet and its various environmental systems, the potential consequences of climate change become clearer and more horrifying. This new study supports previous findings that suggest disrupting soils can increase carbon emissions. While it may be too soon to tell if the eye-popping increases found by this study are typical or an outlier, they do re-enforce the notion that a breakdown in the systems that keep the climate stable is possible if nothing changes. </p>
A study published Friday tested how well 14 commonly available face masks blocked the emission of respiratory droplets as people were speaking.
- The study tested the efficacy of popular types of face masks, including N95 respirators, bandanas, cotton-polypropylene masks, gaiters and others.
- The results showed that N95 respirators were most effective, while wearing a neck fleece (aka gaiter) actually produced more respiratory droplets than wearing no mask at all.
- Certain types of homemade masks seem to be effective at blocking the spread of COVID-19.
Fischer et al.<p>A smartphone camera recorded video of the participants, and a computer algorithm counted the number of droplets they emitted. To establish a control trial, the participants spoke into the box both with and without a mask. And to make sure that the droplets weren't in fact dust from the masks, the team conducted more tests by "repeatedly puffing air from a bulb through the masks."</p>
Fischer et al.<p>The results, published Friday in <a href="https://advances.sciencemag.org/content/early/2020/08/07/sciadv.abd3083" target="_blank">Science Advances</a>, showed that some masks are pretty much useless. In particular, neck fleeces (also called gaiters) actually produced more respiratory droplets compared to the control trial — likely because the fabric breaks down big droplets into smaller ones.</p><p>The top three most effective masks were N95 respirators, surgical masks and polypropylene-cotton masks. Bandanas performed the worst, but were slightly better than wearing no mask at all.</p>
Fischer et al.<p>Research on mask efficacy is still emerging. But the new results seem to generally align with <a href="https://newsroom.wakehealth.edu/News-Releases/2020/04/Testing-Shows-Type-of-Cloth-Used-in-Homemade-Masks-Makes-a-Difference" target="_blank" rel="noopener noreferrer dofollow">prior tests</a>. For example, a study from June published in <a href="https://aip.scitation.org/doi/10.1063/5.0016018" target="_blank" rel="noopener noreferrer dofollow">Physics of Fluid</a> found that bandanas (followed by folded handkerchiefs) were least effective at blocking respiratory droplets. That same study also found, as <a href="https://newsroom.wakehealth.edu/News-Releases/2020/04/Testing-Shows-Type-of-Cloth-Used-in-Homemade-Masks-Makes-a-Difference" target="_blank" rel="noopener noreferrer dofollow">others have</a>, that masks made from multiple layers of quilter's fabric were especially effective at blocking droplets.</p><p>The researchers hope other institutions will conduct similar experiments so the public can see how well different masks can block the spread of COVID-19.</p><p style="margin-left: 20px;">"This is a very powerful visual tool to raise awareness that a very simple masks, like these homemade cotton masks, do really well to stop the majority of these respiratory droplets," Fischer told CNN. "Companies and manufacturers can set this up and test their mask designs before producing them, which would also be very useful."</p>