1

James F. Lichon RPh,DDS,NCCM

FIBROUS CAP

A PERFECT STORM

2

Most plaque ruptures do not

cause coronary events

CORONARY ARTERY SPASM

MAGNESIUM DEFICIENCY

COCAINE –AMPHETAMINES

HEART CATHETERIZATION

CIGARETTE SMOKING

COLD

STRESS

BALLOON ANGIOPLASTY

3

ADVERSE EFFECTS OF STENTS

(24-48 hours)

Acute access site pain with hypotension

Thrombus (blood clot)

Coronary artery spasm

Arrhythmias

Heart attack—4%

Cardiac mortality—1%

Bypass Surgery

ADVERSE EFFECTS OF BYPASS

SURGERY

Cognitive Impairment-short term memory

loss, depression

Stroke or MI—5%-6%

Death—3%

Insomnia

Flashbacks

Infection

1/300 second bypass

Neither coronary angioplasty,

stents, nor cardiac bypass surgery

is curative for coronary artery

disease. They do relieve symptoms

but do not treat the cause.

JAMA, NOV. 10, 2010-Vol 304, No.18

Dental Implications for Patients

with Stents and Bypass Surgery

INR < 3

Do Not Stop Taking Medication Without a

Cardiologist Approval

STENTS, OPEN HEART SURGERY, AND

VALVE REPLACEMENT:______________

No dental appointment for 3 months.

Appointment before 3 months- RX AB

Appointment after 3 months- no AB for

stents or OHS patients

Appointment after 3 months- Rx AB for

valve replacement patients

4

Patients who stop taking aspirin are at a

significantly increased risk of MI than

those who continue treatment.

British Medical Journal July 19, 2011

SUDDEN CARDIAC DEATH

SUDDEN CARDIAC DEATH IN

YOUNG ATHLETES

Dorian Dawkins Wes Leonard

Age 14 Age 16

SUDDEN CARDIAC DEATH IN

YOUNG ATHLETES Congenital Coronary Artery Anomaly

SUDDEN CARDIAC DEATH IN

YOUNG ATHLETES ISCHEMIC STROKE

5

CAROTID EXAM COROTID DOPPLER EXAM

ENDARTERECTOMY

PERIPHERAL VASCULAR DISEASE

Often Underdiagnosed

WHO IS AT RISK FOR PERIPHERAL

VASCULAR DISEASE

• SMOKERS

• DIABETIC

• OVERWEIGHT

• NOT EXERCISING

• OVER AGE OF 50

• HIGH CHOLESTEROL

• HIGH BLOOD PRESSURE

• THOSE WHO HAVE EXISTING CVD

• FAMILY HISTORY OF HEART DISEASE

6

LOWER EXTREMITY VASCULAR

DISEASE QUESTIONNAIRE Do your calves, thighs, or buttocks get

cramped, painful, heavy or tired when you

walk, and does the pain stop with rest?

Do you have leg pain mostly at rest or when

standing for long periods?

Do you have pain, numbness, or tingling in the

toes?

Do your toes ever become blue, black or red?

Do you have sores on your legs or feet that heal

slowly or do not heal?

Ankle-brachial index test for

peripheral vascular disease

Treatment with exercise (walking),

aspirin, statins, stents, or surgery

More women die from CVD then from all

cancers combined.

Women schedule mammograms but skip

lipid (cholesterol) profiles and blood-

pressure checks

HEART DISEASE SYMPTOMS IN WOMEN

Chest pain, but less severe then men

Neck, shoulder, upper back discomfort

Lightheadedness or dizziness

Shortness of breath

Unusual fatigue

Sweating

Nausea

2/3 of the deaths from heart attacks occur

among those women who have no

symptoms or don’t recognize the symptoms

Diagnostic tests in women not as accurate

as those in men

Women may have less blockage in main

arteries but more in small vessels called

“microvascular disease”

7

OUR IMMUNE /INFLAMMATORY SYSTEM

AND PERIODONTAL DISEASE

WHITE BLOOD CELLS

All white blood cells are known as LEUKOCYTES

Leukocytes are divided into 3 classes:

1. Granulocytes-Neutrophils, eosinophils, basophils

2. Monocytes-evolve into macrophages

3. Lymphocytes-2 kinds

A. B cells—produce antibodies

B. T cells—help destroy infected cells

Antigen (peanuts)

Antigen (ragweed)

Inflammatory Cells

Monocytes, Macrophages,

Lymphocytes

Cytokines—PRO-inflammatory

IL-1, IL-6, IL-8, TNF-1, Interferon

MMP(matrix metalloproteinase)

Cytokines-- ANTI-inflammatory

IL -4, IL-10, IL-11, IL 13,

TNF-2, MMP-1

SELF AND NON-SELF Periodontal disease initiation and

progression occurs as a response

of our immune/inflammatory

system to pathogens

Microbes?

Genetics?

8

CYTOKINES AND PERIODONTAL DISEASE

Anti Microbial

SRP

Peridex

I/I System

Periostat

NSAID

CYTOKINES AND RHEUMATOID ARTHRITIS

EMBREL, REMICADE, HUMIRA (TNF INHIBITOR)

Donated tissues and organs are

often attacked by a patient's

immune system

Cortisone

Cyclosporin

Sirolimus

EXAMPLES OF AUTOIMMUNE

DISORDERS Addison's disease

Celiac disease - sprue

Dermatomyositis

Graves disease

Hashimoto's thyroiditis

Multiple sclerosis

Myasthenia gravis

Pernicious anemia

Reactive arthritis

Rheumatoid arthritis

Sjogren syndrome

Type I diabetes

psoriasis

SJOGREN SYNDROME

A chronic autoimmune inflammatory connective tissue

disease

Majority of people with SS are middle-aged women

Dry eyes, dry mouth and lips, swallowing complaints,

fatigue, tongue changes, and overgrowth of Candida

Other causes of dry mouth

antidepressants

antipsychotics

antihypertensives

antihistamines

Venus Williams

9

CHOLESTEROL

ALWAYS in Animals

NEVER in Plants

Heredity/Immune System

Controls Both

Why is Cholesterol Good?

For normal structure, function and repair of cell membranes

For nerve conduction and brain function

Precursor for steroid hormones, e.g. testosterone, estrogens

Precursor for bile acid

Precursor for Vitamin D

Factors That Affect Your

Cholesterol Levels

Heredity

Sedentary lifestyle

Diet

Weight

Diabetes

Fewer than half the adults diagnosed with

high cholesterol knew whether they had

ever been tested for thyroid disease. American Association of Clinical Endocrinologists

January, 2011

Symptoms of Hypothyroidism

Weight gain

Fatigue

Depression

Dry skin

Feeling cold

Muscle cramps, joint pain

10

WHY IS LDL BAD? It Gets Under The Lining Of The

Artery And Forms Plaque

WHY IS HDL GOOD?

How to Lower Your

Triglycerides

Stop alcohol

Fat and simple sugars

Exercise

Obtain ideal weight

Fish Oil

Medication if needed

FAMILIAL HYPERCHOLESTEROLEMIA (FH)

Disorder of high LDL (bad) cholesterol that is

passed down through families. Can cause

heart attacks at an early age and premature

death.

Total cholesterol > 300mg/dl in adults

LDL levels > 220mg/dl in adults

Very common disorder: 1 in 300-500

(heterozygous)

IT’S IN THE GENES, NOT THE DIET

ONLY 15% DIAGNOSED

Stormie Jones • Age 6 diagnosed with HFH,

“homozygous familial hypercholesterolemia” –TC 1200 mg/dl (less then 160)

–TG 150 mg/dl

–LDL 1130 mg/dl (normal 120 g/dl)

–Progressive xanthomas

• Age 6 yr 6 mo. Angina and double coronary bypass

• Age 6 yr 8 mo. Second bypass

• Age 6 yr 9 mo. Heart failure

• Age 6 yr 9 mo. Combined heart and liver transplant

–TC dropped to about 250 mg/dl

11

GI Bleeding

Hemorrhagic Stroke

NEW REVISED GUIDELINES FOR

ASPIRIN –PRIMARY PREVENTION

Aspirin—uncertain value for primary

prevention except for high risk patients.

(HTN, smoking, diabetes*, heredity)

Always check with your doctor

NEW REVISED GUIDELINES FOR

ASPIRIN –SECONDARY PREVENTION

Patients with prior history of CVD, PVD, or

ischemic stroke should be

on aspirin

Always check with your doctor

NSAIDs Nonsteroidal Anti-Inflammatory Drugs

Aspirin—81mg, 325mg, 500mg, 650mg Ibuprofen (Motrin—Advil) 200mg OTC---400, 600, 800mg Rx Naproxen (Aleve) 220mg OTC---250, 375, 500mg Rx

*20-30% develop upper GI bleeding

Do not prescribe NSAIDs during the last 6 to 8 weeks of pregnancy

Prolonged gestation

Premature closure of ductus arteriosus

Cause maternal and fetal complications

Tylenol and Codeine is

safe during pregnancy

12

NSAIDs (not aspirin) Nonsteroidal anti-inflammatory drugs

1. Increase CV events and stroke September 8, 2010 – European Society of Cardiology

September 10, 2012--Circulation

2. Exacerbation of heart failure

3. Effect on kidneys and salt retention

4. Increase BP and worsen control of HTN

DENTAL IMPLICATIONS WHEN

PRESCRIBING NSAIDs

In patients with prior heart attack, most

(NSAIDs), not aspirin, even when taken

for as little as one week, are associated

with an increased risk of death and

recurrent heart attack. May 9, 2011 Circulation

Naproxen may be best choice

DENTAL IMPLICATIONS WHEN

PRESCRIBING NSAIDs

Caution when prescribing----

Patients taking ACE inhibitors (Vasotec, Zestril)

Patients taking ARB (Atacand, Cozaar)

Patients taking CCB (Norvasc, Cardizem)

Patients taking Diuril, Laxix (renal function)

Patients taking Digoxin (irregular heartbeat)

Patients taking Lithium ( tremors, confusion, muscle weakness)

DENTAL IMPLICATIONS WHEN

PRESCRIBING NSAIDs

Patients taking Methotrexate (kidney & bone

marrow toxicity, stomatitis, fatality)

Patients taking anticoagulants (Coumadin,Plavix) Rx—Tylenol with Codeine or Vicodin

Patients taking aspirin-- increased risk of GI

bleeding and decreases the cardio protection of

aspirin (naproxen does not interfere with aspirin)

Take aspirin two hours before ibuprofen

325mg 500mg 650mg

50% of all sudden (acute) liver failure in US

caused by Tylenol--ck pt for liver disease

Maximum adult dose = 3000 mg/day

13

New FDA Limits on Maximum dose of

Acetaminophen (Tylenol) The FDA announced limits on the dosage of

acetaminophen (Tylenol) because of serious liver

impairment. FDA limits drugs containing Tylenol to

325 mg in prescription medicine.

Issued February 9, 2011

Deadline January 2014

HEART-FRIENDLY MEDICINES

OMEGA 3 FATTY ACIDS Essential fatty acids

The 2 Active Components in

Omega 3 are DHA and EPA

•

1100mg

600mg

The 2 Active Components in Omega 3

are DHA and EPA

14

OJ—50mg/8oz

2752mg/teaspoonful

LOWERS TRIGLYCERIDES

HOMER

CARDIOVASCULAR HEALTH

SECONDARY PREVENTION

Systematic reviews of EPA + DHA found

that dietary supplementation reduced

the risk of cardiovascular deaths,

fibrillation, and non fatal cardiovascular

events.

*Check with your doctor Clin Cardiol. 2009 Jul:32(7)365-72

HFSA Scientific Meeting Sept20, 2010

Mayo Clin Proc.2011:86(7):626-632

CARDIOVASCULAR HEALTH

A review of 20 studies covering nearly

70,000 participants finds no statistically

significant evidence that omega-3

supplements, is linked to a lower risk of

heart attack, stroke, or premature death.

JAMA, Sept 12, 2012-Vol 308

The National Lipid Association continues

to believe that the totality of published

evidence supports the use of both fish

and fish oil supplementation to reduce

the risk for cardiovascular disease

NLA Oct. 2012

OMEGA-3 AND DEPRESSION

American Psychiatric Association concluded there is evidence for EPA-DHA based on DBRCT as an adjunctive therapy for major depressive and bipolar disordes.

Freeman MP et al J Clin Psychiatry Jan 2006

Archives of General Psychiatry Feb.2010

J No Am Menopause Society Vol 18:Mar.2011

Nutrition Journal Oct.2012

15

RHEUMATOID ARTHRITIS

Trials have demonstrated a range of

benefits in patients with RA that include

reducing joint pain when used as an

additive with NSAIDs (ibuprofen,

naproxen, aspirin).

Calder PC, Proc Nutr Soc. 2008 Nov:67

U of Maryland Medical Center 5/2011

John Hopkins Arthritis Center 11/2011

MACULAR DEGENERATION Studies (2500 patients – 7 years) shows

that omega-3 fatty acids slows the

progression of vision loss from age-

related early macular degeneration and

reverses the signs of dry eye syndrome.

SanGiovanni Arch Ophthalmol.2008Sep:16

Arch Ophthalmol. 2011 July, Vol 129, No. 7

Ophthalmol Vis Sci.2011, Jul 29,52(8)

OMEGA 3 AND PERIODONTAL DISEASE

The result of this clinical study suggest that

dietary supplementation with Omega 3 may

provide a sustainable, low-cost intervention

to augment periodontal therapy. Sharkawy H, J.Periodontol. 2010 Nov:81(11):1635-43

SIDE EFFECTS OF FISH OIL Increased risk of bleeding—minimal –ck coumadin

Heavy metals and other pollutants-China and India

Increase in LDL and total cholesterol

Stomach upset

After taste

Burping

Diarrhea

To minimize:

• Take with meals

• Start with low dose

• Keep in refrigerator or freezer

Heart Health: 1000mg-1200mg

High Triglycerides: 4000mg

Rheumatoid arthritis: 2500mg

Mental Health: 1-2000mg

Prenatal: 250-350mg

Vision: 800mg DHA or 1000mg

Periodontal disease: 1-2000mg

Potassium - 195 mg

Calcium - 11 mg

Phosphorus - 20 mg

Magnesium - 9 mg

Manganese - 0.064 mg

Iron - 0.22 mg

Sodium - 2 mg

Copper - 0.049 mg

Zinc - 0.07 mg

Vitamin A - 98 IU

Vitamin B1 (thiamine) - 0.031 mg

Vitamin B2 (riboflavin) - 0.047 mg

Niacin - 0.166 mg

Folate - 5 mcg

Pantothenic Acid - 0.111 mg

Vitamin B6 - 0.075 mg

Vitamin C - 8.4 mg

Vitamin E - 0.33 mg

Vitamin K - 4 mcg

16

MULTIVITAMINS

A 4 billion dollar business

Lots of Types

Lots of Confusion

Consumers Lab (June 2011)

10 of 38 multivitamins tested contained

either more or less of what the label

indicated

Vitamins E and C in the Prevention

of Cardiovascular Disease in Men

1997-2007, 15,000 physicians

Results— Vit.E and Vit.C no effect on

CVD, prostate or total cancer

November 12, 2008, Vol 300, No. 18

Multivitamins in the Prevention

of Cancer in Men

Conclusion In this prevention trial of

male physicians (15,000), daily

multivitamin supplementation modestly

but significantly reduced the risk of total

cancer.

November 14, 2012, Vol 308, No. 18

MULTIVITAMIN USE AND RISK OF

CANCER AND CARDIOVASCULAR

DISEASE IN WOMEN’S HEALTH

INITIATIVE COHORTS (1997-2005)

8 YEARS, 166,000 POSTMENOPAUSAL WOMEN

MULTIVITAMIN USE HAS LITTLE INFLUENCE

ON THE RISK OF COMMON CANCERS, CVD,

OR TOTAL MORTALITY.

ARCHIVE INTERNAL MEDICINE, 2009

$625 million NIH

Multivitamin use and breast cancer

incidence in a prospective cohort of

Swedish women (35,000)

Conclusions: These results suggest that

multivitamin use is associated with an

increased risk of breast cancer.

Am J Clin Nutr May 2010 vol. 91 no. 5 1268-1272

17

We did not find convincing evidence that

antioxidant supplements have beneficial

effects on mortality. Even more, beta

carotene, vitamin A, and vitamin E seem to

increase the risk of death.

• February 28, 2007, Vol 297, No. 8

• Oxford Journal Medicine:Oct 30,2008

• Journal of the National Cancer Institute

May 16, 2012

We found no evidence to support

antioxidant supplements for primary or

secondary prevention. Vitamin A, beta-

carotene, and vitamin E may increase

mortality.

January 20, 2010

Multiple Vitamins May Benefit

Those who have chronic gastrointestinal disorders

Those who fail to get the right amount and type of

food for proper nutrition

People with a chronic illness

Women who are pregnant

Alcoholism

PRENATAL VITAMINS

Folic acid (B9)

Prevention of neural tube or spinal

defects

Prevention of low birth weight

Reduce risk of autism

JAMA Feb 13, 2013

Vitamin B12

Prevention of infertility or

spontaneous abortion 400 mcg/day

DEFICIENCIES AS WE AGE

VITAMIN B12

Vitamin B12 (cobalamin) deficiency is

particularly common in elder adults

Aid in production of DNA and RNA

Aid in production of nerve cells

Development of RBC

Causes of vitamin

B12 deficiency

Chronic alcoholism

Abdominal,intestinal surgery

Atrophic gastritis, Celiac disease,

hypothyroidism, Metformin (Glucophage)

PPI (Nexium, Prilosec, Prevacid)--acid blocking

Elderly people (common deficiency 15-20%)

18

Symptoms of vitamin

B12 deficiency

Anemia, fatigue, tiredness

Neurologic (muscle weakness, unsteady gait,

numbness or tingling in fingers or toes—DM or

B12)

Psychiatric symptoms (dementia, cognitive

impairment, psychoses, depression)

Dental--bleeding gums, sore mouth/ tongue

ATROPHIC GLOSSITIS

(Smooth Tongue)

Nutritional deficiency

• Vit B12

• Folic Acid (B9)

• Riboflavin (B2)

• Niacin (B3)

• Iron

• Celiac Disease

ANGULAR CHEILOSIS

Nutritional deficiency

• Vit B12

• Folic Acid (B9)

• Riboflavin (B2)

• Niacin (B3)

• Iron

• Celiac Disease

RECURRENT APHTHOUS ULCERS

Nutritional deficiency

• Vit B12

• Folic Acid (B9)

• Riboflavin (B2)

• Niacin (B3)

• Iron

• Celiac Disease

BLEEDING GUMS-poor oral hygiene or…..

Vitamin B12

Vitamin K

CCB (Norvasc, Cardizem)

Pregnancy

Blood thinners (Coumadin)

Chemotherapy agents

Leukemia

Birth control pills

Immunosuppressant drugs (Cyclosporin)

Antidepressants (Zoloft, Celexa, Lexapro + NSAID)

VITAMIN D (?)

19

DEFICIENCY OF VITAMIN D

Liver or kidney problems

Aging-decrease provitamin D because of

thin skin (75%) .

GI disorders—Crohn disease, ulcerative

colitis, Celiac disease

Hyperthyroidism and hyperparathyroidism

No sun—Northern climate

Sunscreen (basal, squamous, melanoma)

If your shadow is longer than you are tall, you are not making any vitamin D

MUSCLE SORENESS Not Just Getting Old

Low vitamin D—muscle pain- fall rates

Statins (Zocor, Lipitor, etc--10%-15%)

Peripheral vascular disease

Vitamin B12 (low)

Magnesium (low)

Celiac Disease

Hypothyroidism

Bisphosphonates

Drug combinations

VITAMIN D and BALANCE Can present as severe bone pain, muscle

weakness (hard to get off chair or climb up

stairs), and increased body sway that can lead

to falls and hip fractures.

Mayo Clinic Sept 1, 2012

Vitamin D is now recognized as important

for cardiovascular health and its deficiency

as a potential risk factor for several

cardiovascular disease processes.

U of Wisc School Med and Public Heath Nov. 18, 2011 (No)

Am J Cardiology 2010; 106: 798-805

J Amer Col Cardiology July 2011;186-192

J Clin Endocrinol Metab. 2012, Nov 12

20

MACULAR DEGENERATION

High serum 25 (OH) D concentrations

may protect against early age-related

macular degeneration in women younger

than 75 years. Arch Ophthalmol. Apr 13,2011:129(4):481-489

VITAMIN D AND CANCER

16 year study, 88,000 women, found higher

intakes of vitamin D associated with lower

breast cancer risk in premenopausal women

Breast cancer--women with deficient

vitamin D levels (less then 20ng/ml) had a

increased risk of development of metastatic

disease

Journal Clinical Oncology, Vol 27, Page 3757-2009

Carcinogenesis. 2012 Jul;33(7):1319-26.

N Engl J Med. 2011; 365: 1396-1405

VITAMIN D AND COLORECTAL CANCER

The evidence for a protective effect of

vitamin D (and calcium) on colorectal

cancer risk is quite promising, with

25(OH)D concentrations of at least

32ng/ml being associated with lower risk.

Endocr Relat Cancer. 2012 May 3;19(3

Carcinogenesis 2009:30:88-92

Am J Clin Nutr. 2008:565-569

Mayo Clinic and Collaborators Find

Vitamin D Levels are Associated with

Survival in Lymphoma Patients

Patients with deficient vitamin D levels

had a 1.5-fold greater risk of disease

progression and a twofold greater risk of

dying, compared to patients with optimal

vitamin D levels

VITAMIN D AND PROSTRATE CANCER

Laboratory and population-based

research suggest that adequate levels of

vitamin D reduce the risk of developing

prostate cancer

CA Cancer J Clin. 2012;62:30-67

Johns Hopkins July 2009

Dr. Oz Recommends Vitamin D

for Colon, Prostate, Breast Cancer

21

VITAMIN D AND PERIODONTAL

DISEASE

“-found that patients in periodontal

maintenance programs taking vitamin D

and calcium supplementation had a trend

for better periodontal health.”

J Periodontol. 2011 Jan;82(1):25-32

VITAMIN D AND PERIODONTAL

DISEASE A study involving post-menopausal women

with osteoporosis found PD “is more common

in women with osteoporosis and is associated

with lower vitamin D and higher concentrations

of two cytokines, RANKL and MMP

J Periodontal Research. 2011 Feb

Do not take if have

Liver disease

Kidney disease

Hypoparathyrodism

Hyperparathyrodism

Sarcoidosis

*Always check with your doctor first

VITAMIN D VITAMIN D

Dose: 1000 to 4000 IU/day depending on lab

studies

Lab studies range (Mayo Clinic):

10 ng/mL—severe deficiency

10-30 ng/mL—mild to moderate

30-80 ng/mL—optimum

CALCIUM

Builds strong structure of bones and teeth

Muscle and blood vessel contraction

Secretion of hormones and enzymes

Transmit impulses thru the nervous system

CALCIUM

Found naturally in meat, dairy products,

leafy green vegetables, and beans.

May also need supplements since the

body cannot make calcium

22

CALCIUM SUPPLEMENTS

Calcium carbonate

Least expensive

Must be taken with food

Absorption is acid dependent

Calcium citrate

Acid independent

Take with or without food

Can take with PPI (Nexium, etc)

Calcium supplements can interact with many prescription medicines (AB, BP,Bisphosphates, etc)

CALCIUM SUPPLEMENTS Take with magnesium if blood test shows it is low

Do not take with thyroid, Dilantin, cortisone, bisphosphonates, thiazides, Vibramycin/Periostat

(take 4 hours before or 4 hours after taking Ca)

Those who have liver disease, kidney disease,

high or low parathyroid levels, talk with Dr. first

NEW DATA, MORE DEBATE

New studies linking calcium supplements to:

Increased risk for heart attack and stroke

Vascular calcification

Kidney stones BMJ APRIL 2010

JAMA Internal Medicine 05 Feb 2013

OhMyGosh!!!

I have been taking to much

CALCIUM SUPPLEMENTS MAY BE

BAD FOR YOUR HEART

Those who consumed 820mg/day had a 31%

lower risk of heart attacks then those who

consumed less from their diet.

Those who got calcium from

supplements were twice as

likely to have a heart attack as

those who took no supplements

24,000 people for 11 years

Heart: May 23, 2012

WOMAN’S HEALTH INITIATIVE

Women who took 1000mg of calcium daily

had 17% more kidney stones then those

who got a placebo

36,000 women/ 15 years

Caveat –women were allowed to

eat their usual diet, so calcium

intake was unknown

NURSES’ HEALTH STUDY

• -”those who consumed a high level of

calcium from food had fewer kidney

stones than those who consumed less”

23

CALCIUM INTAKE: MORE IS NOT BETTER

Calculate how much you are eating

through food and balance off the rest with

supplements so it equals 1,200 milligrams

of calcium a day for women older than 50.

*Food –Appx. 700mg/day

Calcium and vitamin D supplementation

had a modest positive effect on periodontal

health on those subjects receiving

periodontal maintenance therapy.

J Periodont 2011:82:25-32

Physical activity and eating a proper diet can

mitigate progression of chronic disease and in fact

reverse existing disease

Whole grains contain the

germ, bran, and

endosperm.

Refined grains retain only

the endosperm

Gluten* is the protein part

of the endosperm

(83% of the kernel)

*cause of celiac disease

CELIAC DISEASE an

AUTO IMMUNE DISEASE Symptoms:

Stomach pain

Diarrhea

Weight loss

Depression

Fatigue

Osteoporosis

Mouth sores

Muscle cramps

Arthritis

80% not diagnosed 1 out of 133 people

24

IF YOU HAVE AN AUTOIMMUNE

DISEASE THERE IS A 15-25% CHANCE

THAT YOU HAVE CELIAC DISEASE

ORAL MANIFESTATIONS OF

CELIAC DISEASE

• Recurrent aphthous ulcers

• Atrophic glossitis

• Oral lichen planus

• Cheilosis

ORAL MANIFESTATIONS OF

CELIAC DISEASE

Enamel Defects in Children

HYBRIDIZATION OF WHEAT HYPER-CLEANLINESS Let Them Eat Dirt: How Clean Environments

May Set Up Kids for Immune Problems

25

WHITE / WHEAT FLOUR

BRAN AND GERM OUT

THIAMIN (B1), RIBOFLAVIN (B2), NIACIN (B3)

ZINC, FOLIC ACID, MANGESIUM, COPPER

PHOSPHORUS, IRON, CALCIUM,SODIUM,

AMINO ACIDS, ANTIOXIDANTS, FIBER, PLUS

15 MORE

INTO THE BREAD

VITAMIN B1, B2 , B3, IRON, FOLIC ACID

(Molasses or Carmel)

WHOLE GRAINS

• Rolled oats

• Whole wheat flour

• Whole rye

• Brown rice

• Wild rice

• Whole cornmeal

• Popcorn

• Barley

• Quinoa

• Spelt

• Couscous

• Amaranth

• Wheat berries

WHOLE GRAINS REDUCE

HEART DISEASE

STROKE

CANCER

DIABETES

OBESITY

Wheat flour Durum wheat

Unbleached flour Enriched flour

Semolina Multigrain

Cracked wheat

DON’T BE TRICKED THESE ARE NOT THE SAME AS

“WHOLE WHEAT” or “MULTI-GRAIN WHOLE GRAIN”

•

•

26

Exercise

IF YOU WANT TO BE FUNCTIONAL

AT 80

YOU NEED TO START AT 50

See a physical therapist first if you

have joint problems

Don’t compare yourself with others

Keep track of your progress

Be realistic. Set goals loosely

Forget the past

Check with your Dr.

Beta Blockers (BP)

Diabetes

Statins

Women who walk 2 or more hours a

week, especially at a brisk pace, are

significantly less likely to experience

any type of stroke than women who do

not walk.

Woman’s Health Study 4-13-2010

39,315 women, 45 years or older

Reduce risk of colon, breast,

prostate, and other cancers

Harvard’s Nurses’Health Study

February 26, 2013

Journal Clinical Oncology

2013: 31:876-885

Walking Improves Cancer Outcomes

Primary and secondary prevention

of hormone driven cancers

Exercise

Vitamin D

Good diet

Lose weight

27

Exercise does not have to be a workout at the gym

Health clubs provides instruction, supervision, equipment, and motivation

The key is doing some type of moderate exercise routinely--time of day

9 MONTHS!!!!!

By the age of 65, many seniors have

lost 30-40% of their muscle mass

Benefits of Exercise

Improves

• Mood

• Self confidence

• Sense of well-being

• Have a better sex life!

Reduces

• Stress

• Depression

• Anxiety

• Blood pressure

• Blood sugar

• Bone mineral

loss

Decreases

• CHD by 30%

• Stroke by 30%

• Type II Diabetes by 30%

• Medication dosage

• Post surgical

recovery is faster

• Increases weight

loss

• Emphysema

• Increases joint

function-arthritis

Aging

Progressive weight gain

Decreased metabolism

Loss of muscle mass

Decrease in pancreatic beta-cell function

Adverse distensibility of the arterial tree

Exercise is Medicine

With No Side Effects

PROCRASTINATION

28

PERSEVERANCE

jclichon@aol.com