February Newsletter
In This Issue
Slow Down!
Brush Away Strokes
Stop Honking!
A Better Model of Medical Care
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. A short month of February always finds me scrambling at the last minute to get this newsletter out. I had a good trip to Arizona for physicals as the Brewers opened camp. I can definitely say is that this is going to be a fun season! I hope you had a chance to watch the Olympics. It was especially great for me to see our US Freeski and Snowboard athletes well represented on the podium. I can tell you, every year the tricks get bigger and more technical. Over the years I have worked with these athletes, I can't believe how far they have come. It's hard to imagine where these sports will be in another 4 years.  

The first article this month adds another recommendation to our best practices for eating. Over the past two months we have examined the relationship between dietary patterns and long-term survival as well as the timing of of our meals. This month we are looking at the speed of our food intake. Taking time to enjoy your meal and eating without distractions looks to be a way we can help to avoid metabolic syndrome. Continue reading for the details. 

There is evidence continuing to grow that dental hygiene may be crucial to our overall health and it isn't just that we may develop bad breath, Poor condition of our teeth and gums leads to inflammation throughout our bodies, which will affect our blood vessels. Previous research has shown that there is increased heart disease in people with poor dental conditions and the second study shows us that risk of stroke is increased as well. Looks like it's time to see the dentist! 

The study above shows us that the condition of our teeth and gums may affect heart disease, but what about our external environment? The third study looked at the effects of noise, specifically city noise and airplane noise on our cardiovascular system. Are city dwellers potentially more prone to heart disease, strokes and high blood pressure? 

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Slow Down!
Eating fast makes you fat
This five-year study from Japan was designed to see if eating speed was associated with metabolic syndrome, a cluster of symptoms including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels which occur together, increasing risk of heart disease, stroke and diabetes. The study was presented at the recent American Heart Association 
Sessions. The researchers found that the slowest eating group had a 2.3% incidence of development of metabolic syndrome versus 11.6% in the fastest eaters.
  • Introduction: Metabolic syndrome (Mets) is one of the cause of cardiovascular diseases. Several reports have showed associations between eating speed and incidence of weight gain. Limited information, however, is available concerning the relation between eating speed and the risk of prevalence of Mets.
  • Hypothesis: The aim of this study was to evaluate whether eating speed and future prevalence of Mets.
  • Methods: We evaluated 1083 subjects (642 male subjects, 441 female subjects; mean age 51.2 years) who underwent health examination programs in 2008 and 2013, who were free of Metabolic Syndrome in 2008. Mets was defined on the basis of criteria that was authorized by the Japanese Committee on the Criteria for Mets. We divided the participants into three eating-speed categories as follows: slow, normal and fast. Information on lifestyle factors, such as dietary behaviors, and physical activity, as well as medical history, were obtained by a self-administered questionnaire at the baseline. Weight gain was defined as gained over 10 kg from their weight at age 20.
  • Results: During the 5-year follow-up, 84 people were diagnosed with metabolic syndrome. The incidence rates of metabolic syndrome among slow, normal and fast-eating participants were 2.3, 6.5 and 11.6%, respectively. The multivariate-adjusted hazard ratio for incidence of metabolic syndrome in the fast-eating group compared to the normal and slow group was 1.89 (95% confidence interval [CI], 1.21-2.98, p<0.05), 5.49 (95% confidence interval [CI], 1.30-23.3, p<0.05). Eating speed was significantly correlated with weight gain, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) components of metabolic risk factors. Multivariable logistic analysis revealed that weight gain and TG and HDL-C was significantly associated with Mets cumulative incidence (OR 3.59: 95% CI: 2.12-6.09, p<0.001, OR 1.003: 95% CI: 1.001-1.004, p<0.001, OR 0.96: 95% CI:0.935-0.980, p<0.005).
  • Conclusions: Eating speed was associated with obesity and future prevalence of Metabolic syndrome. Eating slowly may therefore indicated to be a crucial lifestyle factor for preventing metabolic syndrome among the Japanese.  

"Stop eating so fast" is probably a term many of us heard from our mothers growing up (at least around our house it was). Well, it looks like mom was onto something. This Japanese study found that eating quickly resulted in a higher rate of metabolic syndrome, a cascade of symptoms associated with poor health which includes larger waist sizes. There may be multiple reasons for this including overeating (it takes around 20 minutes to realize we are full), acute glucose fluctuations resulting in increased insulin resistance, or impaired release of hormones which tell us we are full. What is the solution if you are a fast eater? Slow down, eat without distractions (put your phone away),  engage in conversation, chew more.  Other things to reduce your intake include drinking a glass of water before eating, waiting for 15-20 minutes before a second helping and leaving the second helping off the table. When it comes to dessert, you can indulge sometimes, but savor it. Take a bite, savor it, enjoy the flavor, and share it. Doing this may help prevent eating the whole thing and is a simple way to have your cake and eat it too!  

More information on metabolic syndrome. 

Brush Away Strokes!
Regular dental care may reduce risk of stroke

Periodontal disease has been associated with cardiovascular disease. This study of over 10,000 people, from the journal Stroke, found there is also an association between periodontal disease and ischemic stroke. People without regular dental care were up to 23% more likely to have an ischemic stroke. 


    Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk.
    In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs).
    In the ARIC study 10,362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (χ2 trend P<0.0001); the incidence rate for ischemic stroke/1000-person years was 1.29 for PPC-A (health), 2.82 for PPC-B, 4.80 for PPC-C, 3.81 for PPC-D, 3.50 for PPC-E, 4.78 for PPC-F, and 5.03 for PPC-G (severe periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95% confidence interval, 1.2-5.6) and thrombotic (hazard ratio, 2.2; 95% confidence interval, 1.3-3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95% confidence interval, 0.63-0.94).
    We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke.

While poor dental hygiene makes us think of bad breath and losing teeth, in reality, poor dental care is associated with systemic problems including strokes. This is likely due to overall body inflammation shown to be seen with gingivitis and periodontal disease which is likely the reason for the increased rate of heart attacks and strokes. An interesting point is that there wasn't a lot of difference between the highest disease group and the lowest disease group. This makes me think that any periodontal disease, thus any inflammation is a problem. People who had regular dental care had a 23% less risk of stroke compared to episodic care. We don't know how often the people in the study did self cares (brushing, flossing) which would be nice to know. At any rate, it seems to make sense to brush, floss, and see your dentist on a regular basis to help reduce our risk of both strokes and heart attacks. 
Stop Honking!
Environmental noise linked to increased risk of heart disease
An association between environmental noise from road traffic and aircraft may increase the risk for heart disease. This study proposes mechanisms for this finding which may include increased oxidative stress, vascular dysfunction, autonomic imbalance and metabolic abnormalities. These factors may all contribute to increased risk factors for cardiovascular disease including diabetes, hypertension, and progression of atherosclerosis. 

  • Noise has been found associated with annoyance, stress, sleep disturbance, and impaired cognitive performance. Furthermore, epidemiological studies have found that environmental noise is associated with an increased incidence of arterial hypertension, myocardial infarction, heart failure, and stroke. Observational and translational studies indicate that especially nighttime noise increases levels of stress hormones and vascular oxidative stress, which may lead to endothelial dysfunction and arterial hypertension. Novel experimental studies found aircraft noise to be associated with oxidative stress-induced vascular damage, mediated by activation of the NADPH oxidase, uncoupling of endothelial nitric oxide synthase, and vascular infiltration with inflammatory cells. Transcriptome analysis of aortic tissues from animals exposed to aircraft noise revealed changes in the expression of genes responsible for the regulation of vascular function, vascular remodeling, and cell death. This review focuses on the mechanisms and the epidemiology of noise-induced cardiovascular diseases and provides novel insight into the mechanisms underlying noise-induced vascular damage.
Chronic noise exposure, especially nighttime noise, may cause increased risk of coronary disease, stroke, and hypertension. People with known heart disease may be more susceptible to these adverse effects. Based on this and other studies, chronic noise exposure may be a significant risk factor for cardiovascular disease. Other studies have shown that this effect is independent of whether or not the noise was annoying to the individual, so just being exposed to the noise could cause the problem. At least one mechanism looks to be changes in  vascular resistance. Studies have show a lack of lowered blood pressure at night with noise exposure leading to chronically increased blood pressure. 

I think this study is interesting and it would be interesting to see a population-based study proving this hypothesis. This also likely backs up the idea that we need some quiet time periodically, especially for sleeping. 

Environmental Noise and the Cardiovascular System. Journal of the American College of Cardiology Feb 2018, 71 (6) 688-697; DOI: 10.1016/j.jacc.2017.12.015 .
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. Feel free to pass this on to anyone you think would benefit from this information. 

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As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email , phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.