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
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