With all the modern advancements of the world, we might assume people feel more socially connected than they did generations ago. Afterall, with texting, videoconferencing and social media, we’re all connected all the time. Yet, in 2023 the U.S. Surgeon General declared loneliness a public health epidemic and the American Medical Association concurred the following year.
 
How, in this Age of Communication, is loneliness a public health crisis?
 
 “Loneliness” is a subjective experience in which the individual feels a level of unease because their need for connection does not meet their reality. A lonely individual may be surrounded by people but still does not feel connected and supported. The depth of their relationships is too shallow.
 
“Social isolation” is the objective reality of lacking social bonds. For some, that may be just fine, as they do not experience a need for something deeper. But for others, loneliness comes as a consequence of social isolation.
 
Studies illustrate loneliness as a major risk factor for morbidity and mortality, on par with diseases and lifestyle factors such as obesity, sedentary behavior and even smoking. Evidence links loneliness to premature death and several adverse health outcomes including but not limited to an increased risk of dementia, stroke, heart disease, hypertension, depression, diabetes, and arthritis.
 
How can loneliness undermine one’s health in such profound ways? Varying studies show physical, psychosocial and behavioral impacts, and other studies result in an interplay of all three.
 
Here are some ways loneliness can impact our health:
 

• Stress. Having an unmet need for deeper social connections is suspected to sustain a physiological stress response leading to immune suppression, hypertension, systemic inflammation and impaired metabolism.
  
  
• Lifestyle behaviors. Lonely individuals might be more likely to have a sedentary lifestyle, poor diet, and engage in activities known to undermine health, such as smoking, alcohol consumption or recreational drug use.
  
  
• Sleep. It is well-documented that lonely individuals demonstrate poor sleep quality. This may be the result of depression or stress and lifestyle behaviors, all of which are deleterious to sleep quality.
  
  
• Depression. In some cases, loneliness may drive depression where an unmet need for deeper social connections leaves the individual feeling unsupported and ill at ease. In other cases, depression may lead to self-isolation. Depression can activate a physiological stress response, disrupt sleep and encourage poor lifestyle behaviors.

 
If you are lonely, please schedule time to speak with me. Together we can discuss your feelings and explore options for resolution.
 
If you are satisfied with the depth of your social connections, it is still possible you know someone who is suffering. Perhaps someone who recently lost a pet or spouse, someone new to your community, a neighbor who lives alone, or a quiet coworker. Could you take the time to extend yourself to that person? Perhaps you could invite them for a walk or a cup of coffee, drop off a home-cooked meal and have a chat with them, invite them for a game of cards—or something else that piques your interest, and theirs?
 
Extending yourself in this way can be good for you, too. A 2024 study analyzing 90 workplace well-being interventions found only one intervention resulting in a positive association across all measurable well-being outcomes: charitable work/volunteering. In other words, being of service to others.
 
With the holidays rapidly approaching, perhaps you can find the opportunity to improve your sense of well-being by extending yourself to someone in need?

UPFs, or ultra-processed foods—like packaged snacks, sugary drinks, instant meals and fast food—are often renowned for their convenience, low cost and pleasant taste, but they could be taking a major toll on our health, even more than we once thought. Today, I am sharing an interesting study I came across, supported by the Intramural Research Program of the National Institutes of Health, National Institute of Diabetes & Digestive & Kidney Diseases, which demonstrated the negative effects of UPFs on our health.
 
I was particularly intrigued when this nutrition-based RCT (randomized controlled trial) surfaced within the current discussion around UPFs. Nutrition research is rarely conducted as an RCT, resulting in a mountain of conflicting observational studies where associations between variables are identified but causation cannot be drawn. The lack of RCT makes nutrition research particularly confusing and is often compounded by publication bias, media interpretation, reductionist thinking and self-interest.
 
Note that the generalizability of this study is limited due to the lack of consumer choice and the in-patient nature of the study design. Further, the sample size was small, the time in each study group was short and a washout period between groups was absent. But the implications remain interesting and something to consider when we make choices about what we’re consuming.
 
(Keep in mind, this study is from 2019, so its discussion around UPFs precedes the current political climate.)
 
Let’s take a close look at this study and the findings:
 
THE VARIABLES:
The study examined 20 weight-stable participants: 10 males and 10 females aged 18-50, all who were admitted to the NIH Clinical Center for a continuous 28-day period. For a two-week period, participants were randomly assigned a UPF diet (as defined by NOVA) or an unprocessed diet. After two weeks, without a washout period, they switched diets. All 20 participants completed the study.
 
Each participant was provided with three meals a day. The weekly per-person costs of these diets were estimated to be $106 for the UPF diet and $151 for the unprocessed diet. The foods presented among the two diet groups were matched for calories from sugar, fat, sodium, fiber and macronutrients. Participants were instructed to eat as much as they wanted within a one-hour window for each meal. Snacks were also made available for each diet group.
 
MEASURING THE VARIABLES:
Participants wore continuous glucose monitors (CGMs) to track glucose, accelerometers to track energy expenditure (calculated as METs), and spent one day a week in a respiratory chamber to track energy components. Fasting blood was drawn at baseline and on the final days in each diet group.
 
Participants also responded to surveys assessing appetites, sensory experience and palatability.
 
To offset deconditioning from sedentary behavior, participants performed three, 20-minute cycle sessions at a controlled intensity.
 
THE OUTCOMES:
While on the UPF diet, participants consumed 500 more daily calories per day than when on the unprocessed diet, which correlated with an increase in calories consumed per minute in the UPF diet group. The extra calories consumed were from carbohydrates and fat (notably, not from protein).
 
Not surprisingly, participants showed increases in weight and body fat mass when on the UPF diet and reductions in weight and body fat mass when on the unprocessed diet. While on the UPF diet, fat oxidation was reduced, while insulin secretion and blood glucose increased.
 
While on the unprocessed diet, appetite-suppressing hormone PYY levels increased, along with free fatty acids and free T4, while hunger hormone ghrelin, adiponectin, total cholesterol, hsCRP and Total T3 levels decreased.
 
UPFs AND BRAIN HEALTH
Last month, in Concierge Choice Physicians members’ only wellness program, Motivated Mondays, CCP closely examined the role of UPFs on cognitive health. UPFs have been associated with a number of health concerns, including cardiovascular disease, diabetes, and mental health disorders. In this study, a well-controlled RCT, we see it corresponding in a linear, stepwise fashion with weight gain via increased calorie consumption. In addition, even in the short term, the biomarkers hint at the potential for additional inflammatory and metabolic health concerns.
 
WHAT ALL OF THIS MEANS FOR US:
With all this in mind, strongly I encourage you to eat and identify real, unprocessed food.
 
To help, you can ask yourself the following three questions we should ask ourselves before adding a food item to our grocery baskets:
 

1. Did my grandmother eat this food?
2. Could I recreate this food at home in my kitchen?
3. Are the ingredients on this label available right here in the grocery store?

 
If your answer is no to any of the above questions, try to avoid it.
 
As your concierge physician, I am always available to you, especially when it comes to helping you make healthier choices. Feel free to reach out with your individual questions. 

Well, we’ve made it halfway through what has been an undeniably challenging decade. Hopefully, the second half compensates with some relative peace and quiet. I know many of my members report developing or slipping back into some less health-promoting habits and are looking to make some changes in the New Year. That’s right, the often-joked-about New Year’s resolutions.
 
Rather than rehashing the trite SMART goals, let’s talk about some statistics and the more unusual approaches to succeeding at your resolutions, which can help put things into perspective for you.
 
Resolution Stats

• Those that make resolutions are ten times more likely to change their behavior than people who do not—so make one!
  
  
• Resolutions that incorporate a new behavior are more likely to succeed than those which avoid an old behavior.
  
  
• People who choose one resolution are more likely to succeed than those who set multiple goals.
  
  
• Those who anticipate and plan for obstacles are more likely to succeed than those who do not.

 
Approaches

• For built-in motivation, align your resolutions with your values. For example, if your resolution is to sleep more, tie your resolution to the pitfalls of excessive social media consumption or TV use. If you watch less TV and spend less time scrolling at night, you are more likely to hit the hay earlier.
  
  
• There is no reason to swallow the elephant whole. Take smaller bites! In other words, break the resolution down into smaller resolutions. For example, one study found that those who resolved to volunteer 200 hours a year were more likely to reach and even exceed that goal if they broke down that resolution into volunteering 4 hours a week, instead.
  
  
• Tie the resolution to a reward so it’s associated with pleasure and not seen as a chore. If you resolve to hit the gym 5 days a week, plan a small donation to your favorite charity if you successfully hit your goal.
  
  
• On the flip side, tie a “punishment” to a backslide, so it’s associated with pain. Using the example above, if you miss your weekly gym goal, make a donation to a charity not aligned with your belief system—ouch!
  
  
• Some say misery loves company. Hold yourself accountable to another person by setting the resolution with a friend or a group (can be virtual). You will be less likely to backslide if you know you are there to support others. Camaraderie is a great motivator!
  
  
• Think like a Marine – Improvise, Adapt and Overcome. Life rarely goes as planned, so pivot when challenged, as there is usually more than one path to victory. Using our gym example, what happens if your car is in the shop, and you cannot drive to the gym? Go walking for the time you would spend at the gym so that you’re still getting exercise, just in a different environment.
  
  
• Moreover, if you journal your progress, you will be able to reflect upon and learn from past successes or challenges.
  
  
• Seek professional guidance-there is no harm in hiring a coach! Consider the cost your financial accountability partner!

 
And, of course, I will use this opportunity to remind you of the Motivated Mondays program available to you via my partnership with Concierge Choice Physicians. If you were enrolled last year, you will be auto enrolled for 2025. If you are a new member or have not previously participated in Motivated Mondays, then you’ll soon receive an email inviting you to participate.
 
Good luck and, as always, feel free to comment below or reach out directly with any personal questions or concerns.

With Thanksgiving approaching, our hearts are filled with immense gratitude and warmth. We want to take a moment to express just how thankful we are for each and every one of our concierge members. Your decision to join our concierge program and prioritize your health is something we deeply appreciate.
 
In an era where healthcare often feels like a series of rushed appointments and impersonal interactions, we knew we needed to forge a new approach to patient support and enhance the service we provide. Our concierge program became the solution, helping us build a more personalized patient environment and fostering a mutual dedication to improving health outcomes.
 
This journey has been incredibly rewarding for us, not just as healthcare providers, but as partners in your health. We’ve seen firsthand the positive changes and improvements that come from a more engaged and proactive approach to healthcare. It’s been inspiring to witness your progress and to work with you to maintain and improve your health over time, with greater continuity and understanding.
 
Together, we are not just managing health. We are thriving.
 
The opportunity to make a real difference in people’s lives is truly fulfilling, and we thank you for making that possible.
 
Practicing Gratitude for Your Health
 
“The heart that gives thanks is a happy one, for we cannot feel thankful and unhappy at the same time.” -Douglas Wood
 
In the spirit of Thanksgiving, we encourage you to identify all that you are thankful for and to develop a regular practice of gratitude. Gratitude is like a personal trainer for your mindset—just a few reps a day can boost your mood and strengthen your outlook!
 
Your practice doesn’t have to be hokey or complicated. It can be as simple as writing one line in a journal each day or keeping a note in your phone to share something that happened that day for which you are grateful.
 
For example, you can start by writing a note that states, “Good things always happen to me.” Then, throughout the day, look for positive things that occur and write them down.
 
When we regularly acknowledge and appreciate the positive aspects of our lives, we shift our focus away from stress and negativity, which can help lower levels of the stress hormone, cortisol. This shift not only improves emotional resilience but also supports better mental health by reducing symptoms of depression and anxiety. Furthermore, gratitude can enhance physical health by encouraging healthier lifestyle choices, such as improved sleep quality and more consistent exercise, which contribute to a stronger immune system and better cardiovascular health.
 
A Final Note
 
Thank you once again for reminding us why we chose this profession, and for being major contributors to our gratitude practice each day.
 
As we move forward, we remain dedicated to ensuring your membership exceeds your expectations. Your feedback and experiences are invaluable, and we encourage you to share them with us so that we can continue to improve and adapt to better serve your needs.
 
We wish you and your loved ones a wonderful Thanksgiving.

As the primary fat in the Mediterranean Diet, olive oil has been studied extensively for its health-promoting benefits. Regular consumption, defined as 1.5 - 4 tablespoons a day, has been observed to reduce the risk of total and cause-specific mortality. But not all olive oils are created the same. Thus, a study comparing the health benefits of EVOO to OO recently caught my eye.
 
Extra virgin olive oil (EVOO) is distinguished from olive oil (OO) by the extraction process. OO is produced via chemical extraction and processing, whereas EVOO is produced by crushing the olive thereby retaining and preserving the phenol content of the fruit (yes, olives are classified as a fruit!). It is the phenol content of the EVOO which is thought to impart the health-promoting benefits, not the fatty acid content (aka MUFAs).
 
The study participants
 
In the study comparing the two, 12,161 participants were assessed for variables such as sociodemographic factors, self-reported health conditions and medications, and diet, specifically their adherence to the Mediterranean Diet and type of olive oil consumed each day. Participants were followed for a mean 10.7 years.
 
The findings
 
Researchers found the risk of all-cause mortality and cardiovascular mortality was lower in those with the highest reported daily EVOO consumption, and this association was not replicated in those reporting OO consumption.
 
When total daily olive oil consumption was combined (i.e. adding together both OO and EVOO consumption), the risk of mortality was also reduced—but not as low for those with higher daily EVOO consumption (not combined with OO).
 
Interestingly, deeper reductions in all-cause mortality were noted in those reporting both higher EVOO consumption and physical activity, indicating a synergistic effect between the two, the mechanism of action for which is not fully understood.
 
How do we interpret this study?
 
We can start by noting it is not a randomized clinical trial (RCT). Instead, this study is strictly observational, meaning we can observe the results, but we cannot draw conclusions. Had the researchers randomly assigned half the participants to EVOO consumption and half to OO, we would have more conclusive results. So, I dug a little more into the research in PubMed. A review article of 34 studies in which EVOO was compared to other fats found EVOO superior in a variety of biomarkers and health outcomes—this was again believed to be imparted by the phenol content.
 
Where does this leave us?
 
It would seem that EVOO might have benefits above and beyond that of other fats, including plain old olive oil. Specifically, a serving of 2 tablespoons of EVOO a day appears to be beneficial. It’s important to also remember the statistically observed synergy between EVOO and physical activity—so keep moving!
 
Buying EVOO
 
When purchasing, remember to read the label to make sure it says EXTRA VIRGIN olive oil and if you can find it unfiltered that’s even better! Check the expiration date, as phenol content wanes with time. Pesticide residue studies of European olive oils do not indicate contamination above threshold levels, thus if purchasing European olive oils, it may not be important to choose an organic version. And be sure to keep your EVOO away from heat (not next to or above the stove or oven) and away from light.
 
There exists both controversy and contradictory research results regarding the degradation of phenols with cooking. It seems prudent to save the pricey EVOO variety for salad dressings and for finishing/topping soups and vegetables for flavor and mouthfeel.
 
If you have questions about your specific EVOO recommendations in relation to your personal health, please reach out for a chat. You may also feel free to share this blog with your friends and family.

​ 
 

SOURCES:
 
​Ambra R, Lucchetti S, Pastore G. A Review of the Effects of Olive Oil-Cooking on Phenolic Compounds. Molecules. 2022 Jan 20;27(3):661. doi: 10.3390/molecules27030661. PMID: 35163926; PMCID: PMC8838846.
 
Donat-Vargas, C., Lopez-Garcia, E., Banegas, J.R. et al. Only virgin type of olive oil consumption reduces the risk of mortality. Results from a Mediterranean population-based cohort. Eur J Clin Nutr 77, 226–234 (2023). https://doi.org/10.1038/s41430-022-01221-3
 
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Fitó M, Gea A, Hernán MA, Martínez-González MA; PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13. PMID: 29897866.
 
Flynn MM, Tierney A, Itsiopoulos C. Is Extra Virgin Olive Oil the Critical Ingredient Driving the Health Benefits of a Mediterranean Diet? A Narrative Review. Nutrients. 2023 Jun 27;15(13):2916. doi: 10.3390/nu15132916. PMID: 37447242; PMCID: PMC10346407.
 
Gaforio JJ, Visioli F, Alarcón-de-la-Lastra C, Castañer O, Delgado-Rodríguez M, Fitó M, Hernández AF, Huertas JR, Martínez-González MA, Menendez JA, Osada J, Papadaki A, Parrón T, Pereira JE, Rosillo MA, Sánchez-Quesada C, Schwingshackl L, Toledo E, Tsatsakis AM. Virgin Olive Oil and Health: Summary of the III International Conference on Virgin Olive Oil and Health Consensus Report, JAEN (Spain) 2018. Nutrients. 2019 Sep 1;11(9):2039. doi: 10.3390/nu11092039. PMID: 31480506; PMCID: PMC6770785.
 
Guasch-Ferré M, Li Y, Willett WC, Sun Q, Sampson L, Salas-Salvadó J, Martínez-González MA, Stampfer MJ, Hu FB. Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults. J Am Coll Cardiol. 2022 Jan 18;79(2):101-112. doi: 10.1016/j.jacc.2021.10.041. PMID: 35027106; PMCID: PMC8851878.
 
Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean die t, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 2004 Oct;80(4):1012-8. doi: 10.1093/ajcn/80.4.1012. Erratum in: Am J Clin Nutr. 2005 May;81(5):1181. PMID: 15447913.

Background
 
Over the past 20 years, medicine has made incredible advances, and those of us in practice can attest to the incredible ways in which we can extend the life of our patients, beyond what we could have ever anticipated in medical school. But with longer lives comes the spectrum of cognitive decline and neurodegenerative diseases, namely dementia—an umbrella term for a number of neurodegenerative diseases, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD). In early June, a rare, albeit small (n=51), randomized clinical trial was published in Alzheimer’s Research & Therapy that determined the effectiveness of lifestyle changes on the progression of MCI and AD, and I am inspired by the findings.
 
It is estimated that 40% of global dementia cases are related to 12 modifiable risk factors. (Many of which also impact heart disease. Remember, what affects the heart affects the brain!). Several previous, small studies have shown the effectiveness of intensive lifestyle changes on the progression of MCI and early AD, but none had a control group nor were they randomized. That is what sets this study apart.
 
What did the study address?
 
Over the course of 20 weeks, participants and their spouses or study partners adapted the following lifestyle changes:

• A diet of minimally processed, plant-based, whole foods (no Beyond Meat here—remember, some plant-based foods can still be highly processed!), low in added sugar, refined carbs and harmful fats. Calories were unrestricted.
  
  
• Taking select* supplements. *Please consult me before divesting yourself of hard-earned money prior to taking something that may not be appropriate for your biochemistry or that interacts with medications prescribed for you.
  
  
• Moderate daily exercise, such as 30 minutes of walking or other cardio exercise, and mild strength training three times per week. Specific exercise guidelines were based on age and fitness level.
  
  
• Stress management via an hour of meditation, gentle yoga or breathwork daily.
  
  
• Support groups for participants and their spouses or study partners, 3 days a week.

 
In the study, all interventions were supported via 4-hour Zoom sessions three times a week for the participant and spouse or study partner.
 
The study aimed to determine if:
 

• these specific multi-modal intensive lifestyle interventions could affect MCI or cognitive function in cases of early dementia
  
  
• there was a correlation between the degree in lifestyle changes and the change in cognitive function
  
  
• the degree in lifestyle change affected the degree of biomarkers

 
What did they find?
 

• There were significant differences between the study group and control with regard to all four cognition and function tests, either by improvement over the control group, or less deterioration than the control group.
  
  
• There was significant correlation between the degree of lifestyle change (how closely participants adhered to the protocol, i.e. a dose response) and clinically relevant biomarkers for AD/MCI and cognition and function tests.
  
  
• Only the study group experienced positive microbiome changes.

 
Interestingly, in one of the biomarkers, the degree of change was similar to that affected by the clinical trials for new intravenous medications!
 
My takeaway
 
This study provides yet another reason for us to eat real food, move more, breathe better and connect more—all of which have multiple benefits to our health and wellbeing.
 
Let’s continue to work together on the path toward better health and wellness. Don’t forget, my concierge members also have access to the Concierge Choice Physicians Motivated Mondays program which provides a year’s worth of mini-resolutions focused on the prevention of cognitive decline through lifestyle changes. To sign up for the weekly emails, please contact CCP’s Erica Rios: [email protected]
 
Click here to visit past editions of Motivated Mondays.
 
Study source:
Ornish, D., Madison, C., Kivipelto, M. et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alz Res Therapy 16, 122 (2024). https://doi.org/10.1186/s13195-024-01482-z
​

I hope you enjoyed the holidays and have had a fresh start to the new year.
 
Now that it is nearly the end of January, I wonder: have you set wellness resolutions and health goals for 2024? Are you struggling to achieve those health goals or stick to those wellness resolutions? Are you surfing the internet for help? Are you falling down the rabbit hole in your search for a leg up in reaching your goals and resolutions? If so, you are not alone.
 
The internet has created a shift in patient care. Consumers can now gather health-related information for themselves and come primed to the healthcare encounter with a level of knowledge not seen by previous generations of physicians. In some ways, this is healthy empowerment for patients who have long felt a lack of control over their care. And it is indeed helpful when patients have a general understanding of their condition/s as it can facilitate the conversation and encourage compliance with the plan of care.
 
Yet, in other ways, access to online health information has undermined the doctor-patient relationship. Patients now come to the encounter prepared to lead their care in a direction that may not be in their best interest according to science. This is partly because the information on the internet is not monitored for accuracy. This is especially evident in the “blogosphere,” where influencers shell out health advice without a background, education or training in their subject matter.
 
There are several ways to determine if the medical advice you’re reading is sound. One of the greatest tip-offs to inaccurate or misleading information relates to your wallet. If the sale of supplements, services, subscriptions—or anything—comes along with the purported medical advice, think twice.
 
Here are a few additional questions to ask yourself before believing what you read:

• Does the sponsor of the information have relevant credentials in that topic?
• Do they provide references to back up their claims?
• What do they have to gain with your buy in?

 
There was a time when we could say traditional media sources (newspaper, radio, TV) were OK. That is rapidly shifting in an era of “advertorials” and “infomercials.” Two health-related sites that are conservatively OK are the NIH and WebMD. However, even that content can be taken out of context, misconstrued or simply not applicable to you, as the context of your whole health history is not considered in those articles.
 
Instead of consulting Dr. Google, I urge you to consult me, your actual doctor, instead. One of the wonderful benefits of concierge medicine is the time we can spend together which is often not available in other settings. Send me an email with your health goals and wellness resolutions. If you have already combed the internet and have found information you would like me to vet, include it in the email.  Then schedule an appointment. I will come to our encounter prepared to understand what you need during that visit, and we can have a dialogue about your questions or interest.
You may also wish to consider participating in Motivated Mondays, which is a reputable source of information for many of your typical wellness resolutions. Contact your Motivated Mondays coach, Michele McCambridge, MPH, to participate.
 
Cheers to your best health in 2024.

​Dear Concierge Members:
 
I trust this email finds you in good health and spirits ahead of the Thanksgiving holiday. As your dedicated healthcare provider, I wanted to take a moment to express my sincerest gratitude for the privilege of being a part of your wellness journey.
 
Throughout our interactions, whether for routine check-ups or times when you've sought my guidance, I have been continually impressed by your commitment to your health and honored by the trust you have placed in me. Your dedication to making positive changes has not only reflected on your own well-being, but has also inspired me in my profession.
 
It's patients like you who remind me why I chose to be a physician—to make a positive impact on lives, to provide care, and to be a source of support. Your openness in sharing your concerns and your active participation in healthcare decisions have truly made our doctor/patient relationship a remarkable one.
 
Please remember that your health and well-being remain my top priority. If you ever have questions, need guidance, or simply want to discuss an aspect of your health, please don't hesitate to reach out. I am here to provide you with the best service possible.
 
As we continue this journey together, I am excited to witness your progress and support you in achieving your health goals. Thank you once again for allowing me to be a part of your healthcare team.
 
Wishing you a Happy Thanksgiving.
 
Warm regards,
 
Dr. Gina Brar

​This month I would like to address a topic we may not always discuss: oral health and its relationship to systemic health. It has been 40 years since a relationship was observed between atherosclerosis and alveolar bone loss (in the tooth sockets). At the time, little was known about the nature of the relationship, but now this is an area of increasing interest among researchers and clinicians. Let’s take a closer look.
 
Systemic conditions associated with poor oral health include diabetes, cardiovascular disease, bacteremia/endocarditis, pneumonia, gastritis, rheumatic arthritis, cancer, liver and kidney disease and dementia. A person with poor oral health may exhibit tooth loss, gingivitis (swollen bleeding gums), halitosis (bad breath) and periodontitis (bone loss in the tooth socket). Beyond a lack of oral hygiene, culprits contributing to poor oral health include genetic factors, xerostomia (dry mouth), bruxism (jaw clenching), diet (excessive sugar consumption), gut dysbiosis and smoking.
 
What is the mechanism by which the relationship between oral hygiene and systemic health exists?
 
In general, inflammation that is allowed to fester (advances from acute to chronic) doesn’t remain contained, regardless of where it occurs. Meaning the oral inflammatory mediators and pathogenic bacteria can translocate systemically via the damaged periodontium to damage other organs and systems.
 
In addition, the same inflammatory burden and bacteria may be absorbed extra-orally via inhalation or ingestion. This is the case when bacteria associated with gingivitis or periodontitis is aspirated leading to pneumonia, a common nosocomial infection. If ingested, it may lead to endocarditis or gastritis. In some cases, specific oral bacteria have been linked to specific diseases, such as atherosclerosis. With diabetes, a bi-directional relationship exists. Periodontal disease is a complication of poorly managed blood sugar and acute inflammation (such as that in gingivitis and periodontitis) reduces the uptake of glucose and reduces the efficiency of insulin. Thus, diabetes can cause periodontal disease and periodontal disease can exacerbate diabetes.
 
A final consideration is the relationship between the gut microbiome (GMB) and overall health. Dysbiosis in the GMB is a culprit in numerous conditions and disease states, because the digestive system initiates with the oral cavity.
 
There is much we are still learning about the relationship between oral health and systemic conditions/diseases. We do know that maintaining oral health includes:
 

• Daily brushing and flossing. A soft brush is your go-to on this one. A hard toothbrush is not a friend to your gums and enamel. Add a water pick if you have the counterspace for it.
• Tongue scraping
• Replacing your toothbrush every three months or if you have been sick
• Visiting your dental hygienist at least twice a year, more often if indicated or recommended
• Replacing missing teeth or broken filings
• Addressing bruxism either with a mouthguard created by your dentist or by injecting Botox into the masseter muscles
• Identifying xerostomia, which is a common side effect of many medications
• Quitting smoking if you are a smoker

 
It has been said that the oral cavity is the mirror reflection to one’s overall health. If you have concerns, please schedule a visit with me for a discussion. I am happy to collaborate with you and your dental team to shine that mirror.