Chew on This: Understanding the Link Between Oral Health and Heart Disease

As a writing member for an American College of Cardiology Workgroup, we are tasked with interesting and timely topics related to cardiovascular disease prevention. Our latest review “Oral Health and Atherosclerotic Cardiovascular Disease: A Review” was led by my colleague and fellow cardiologist, Dr. Eugenia Gianos.

Listed below are notable highlights from this review:

1. Periodontal disease (PD) is common in the U.S., (affecting 46% of adults) and is associated with a 3.5-fold increased risk of cardiovascular disease. Risk factors for PD include smoking, diabetes, obesity, emotional stress and poor oral hygiene.
2. Severe periodontitis is associated with impaired vascular health and a higher risk of heart attacks.
3. A specific bacteria isolated from dental plaque (Streptococcus sanguis) is associated with an increased risk of blood clots.
4. PD is associated with insulin resistance and worsening glycemic control whereas intensive periodontal treatment improves glucose control in diabetics.
5. Cigarette smoking is associated with a 20-fold increased risk of gingivitis and PD.
6. Fifteen or more cigarettes smoked daily raises the risk of tooth loss by 3-fold.
7. Poor oral hygiene may be an independent risk factor for hypertension.
8. If you have PD and are hypertensive, you are less likely to respond to blood pressure medications or achieve BP control!

The Bottom Line: Good oral hygiene is pivotal for maintaining a healthy heart!

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Make sure to check out his daily heart health tips on twitter (https://twitter.com/mmillermd1) or Facebook: (healyourheartbook).

The New Sleep Study that is Outrightly Nightmarish

Upon awakening (and before your caffeine fix), if you can say the title of this post three times perfectly in less than 10 seconds (go ahead, give it a shot…), odds are that you just slept like a baby!

In all seriousness, I was taken aback upon reading the newly published study that found men and women aged 50 and over who (on average), slept just 6 hours (or less) per night saw an  increased risk of dementia by 30% compared to those whose average sleep duration was at least 7 hours.    Other studies showed similar findings though most were conducted over a shorter follow-up period (generally less than 10 years).

We still don’t know whether sleep deprivation that begins at an earlier age has a similar effect.  Suffice it to say that during our medical or surgical residency training, we were chronically tired having been subjected to 36 hour shifts every 3^rd or 4^th night over multiple years.  Fortunately, today’s trainees are not afforded the rigorous sleep deprivation of previous generations.  As a result, the amount of time during medical training where 6 or fewer hours of sleep occurs is a lot lower than in years past.  Still, physicians are commonly assigned on-call overnight shifts where fewer than 6 hours slept has been the rule rather than exception.  Mechanisms proposed to account for the relationship between poor sleep and dementia include inflammation of the brain with buildup of cholesterol plaques in the lining of brain vessels as well as impaired processing of proteins (such as beta amyloid).

For my patients who have difficulty getting a good 7-8 hours of restful sleep not due to a medical condition (such as sleep apnea), I make the following recommendations.

1. Try to complete your dinner meal 4 hours prior to bedtime because a large part of digestion occurs during this period. Going to bed after a large meal is not conducive to a good night’s sleep if your body has to work overtime.
2. Take a 20-30 minute walk after dinner. Physical activity not only helps in digesting sugars and fat but also enables a more restful sleep.
3. Turn off the TV (or other stimulating activities) 1-2 hours before bedtime.
4. Try a cup of valerian tea or 2-4 ounces of tart cherry juice 1 hour before bedtime.
5. Engage in a relaxation activity (restorative yoga, meditation, lavender bath) 30 min-1 hour before bedtime.

Check out my heart health tips each day on twitter (https://twitter.com/mmillermd1) or Facebook: (healyourheartbook).

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.

What is the New “Normal” When it Comes to Blood Pressure & Optimal Heart Health?

“Back in the day…” is the way I like to regale stories of my medical school experience with current students.  In fact, just the other day I recalled that when I was a medical student, high blood pressure was defined by taking the age of the person and simply adding 100. In other words, a 60-year-old could have a systolic blood pressure up to 160 mmHg before many physicians would be concerned that it required treatment!

Fast forward a handful of decades later, and a systolic blood pressure of 160 mmHg is now considered very serious (Stage 2) and one that commonly requires multiple blood pressure medications in addition to a low sodium diet and healthier lifestyle. Yet many people with high blood pressure don’t appreciate the importance of following a low sodium diet. Back in the day, we permitted up to 4000 mg of sodium or ~1.5 teaspoons of salt daily (we called it a “no added salt” diet).

Today, if you are otherwise healthy, maintain a blood pressure of less than 120/80 and are younger than 50, it is reasonable to adjust your sodium intake ~2300 mg per day (1 teaspoon of salt).  However, if you are at least 50 years old or have a history of hypertension, diabetes or kidney disease, the recommendation is to consume less than 1500 mg of sodium (~2/3 teaspoon of salt) daily.

Listed below summarize 4 key findings related to blood pressure:

1. A normal blood pressure is less than 120 (systolic)/80 (diastolic) mmHg.
2. High blood pressure causes blood vessels to constrict/stiffen and leads to “premature vascular aging”.
3. For every 20 mmHg increase in systolic (or 10 mmHg increase in diastolic) blood pressure, the risk of a heart attack/stroke doubles!
4. In addition to heart attack and stroke, other feared complications of long-standing hypertension include kidney failure and heart failure.

Over the coming week, check out the “HeartHealth Tip of the Day” on Twitter: @mmillermd1 or Facebook: “healyourheartbook” for additional information on this topic.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  For many more tips on how to optimize your heart health, check out his book,  “Heal Your Heart…”: published by Penguin Random House.

5 Fiber-Enriched Foods that Lower Cholesterol Naturally

During my training, I had the good fortune to be mentored by the late Dr. Peter Kwiterovich Jr., a true pioneer in the cholesterol field.  In fact, “Dr. Pete” as he was affectionately referred to by his patients, (many of whom were children/teenagers since he was a pediatrician by training), started the Johns Hopkins Lipid Clinic in the early 1970s, years before “cholesterol” became a household word.  Needless to say, his 1989 book, “Beyond Cholesterol: The Johns Hopkins Complete Guide for Avoiding Heart Disease” has stood the test of time and remains a classic for anyone interested in learning why “it’s more than just cholesterol”.  Still, cholesterol remains an important predictor of heart disease (conferring up to 50% of heart attack risk) and lowering your levels of low-density lipoprotein (LDL) or “bad cholesterol” will reduce your overall risk of a cardiovascular event.  In this post, 5 foods are discussed that lower LDL cholesterol levels naturally.  If you incorporate each of these 5 foods daily, you can lower LDL upwards of 15-20%! Whether or not lowering LDL through diet/lifestyle alone is sufficient, depends upon your overall risk of a heart attack/stroke and should be discussed with your health care professional.

1. Oats: oats are good sources of soluble fiber that bind and eliminate cholesterol from the gut. Consuming 1 bowl of oatmeal daily may reduce LDL cholesterol levels ~5-7 mg/dL.
2. Pectin: pectin is contained in the inner white rind of citrus fruits (e.g., oranges, grapefruits). Eating 1-2 medium sized grapefruits daily lowers LDL cholesterol ~2-4 mg/dL.
3. Legumes: these seeds derived from pod plants (lentils, peas, chickpeas), contain the soluble fiber, guar gum. Consuming 1 cup of legumes daily in place of red meat can reduce LDL cholesterol levels by ~6-8 mg/dL.
4. Psyllium: another water-soluble fiber that is sold in husks, or as the laxative, Metamucil. Each packet of Metamucil reduces LDL cholesterol ~3-5 mg/dL and I commonly recommend 1 packet (or tablespoon of psyllium) mixed in at least 8 ounces of fluid (up to 3 times daily) for patients with high LDL cholesterol levels and ensuring that other medications are taken at least 45 minutes before Metamucil.
5. Beta-glucan: a type of viscous fiber, found in barley, mushrooms (e.g., shiitake, reishi) and seaweed, can have significant LDL lowering effects; each gram of beta-glucan consumed daily reduces LDL ~2 mg/dL. Try a hearty bowl of vegetable barley soup with shiitake mushrooms and lower your cholesterol naturally! Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  For many more tips on how to optimize your heart health, check out his book,  “Heal Your Heart…”: published by Penguin Random House.

How Can You Mend A Broken Heart? Try this Powerful Antioxidant

When the Bee Gees released their classic tune, “How Can You Mend a Broken Heart?”, I’m sure they didn’t have antioxidants in mind!  Yet, they were clearly onto something when they sang “Please help me mend my broken heart and let me live again”.  In fact, research that we and others have conducted show a direct link between emotional and vascular health.   When emotional turmoil/depression set in, chemicals are released that cause blood vessels to clamp down and blood pressure to rise.  Over, time chronic stress/depression sets the stage for other unwelcome/unexpected problems that can endanger your heart.

When the Bee Gees ask, “how can you stop the sun from shining?”, the answer is that gloom and doom will inevitably follow unless effective treatment is started. Fortunately and as described in “Heal Your Heart” many stress reducing tools are not only available but are also backed up with scientific evidence.  These tools may not only help to prevent a cardiovascular event but can also improve vascular health!

Along these lines, a new study has found that in addition to stress-reducing activities, consuming high levels of powerful antioxidants known as “flavanols” produce a similar effect. These plant-based micronutrients (or polyphenols) are among 6 subgroups derived from flavonoids (the other 5 are: anthocyanins, flavanones, flavan-3-ols, flavones and isoflavones).

In the new study, volunteers drank a cocoa beverage that contained a high content (680 mg) or low content (4 mg) of flavanols on 2 separate days.  Not only did the high flavanol drink lead to greater expansion of blood vessels (compared to the low flavanol drink) but it also reduced their blood vessels from clamping down after they were subjected to mental stress testing.

Bottom Line: This study supports incorporating plant-derived and powerful antioxidant flavanols as an important heart health strategy to protect your blood vessels from their daily stressors.

In addition to cocoa/cacao containing products that are high in flavanols, I recommend that my patients incorporate other sources of flavanols to enrich their heart and overall health: They include apples, apricots, beans, broccoli, cherry tomatoes, chives, cranberries, kale, leeks, pear, onions, red grapes, sweet cherries, and white currants.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland, USA.