From Mouth To Mortality: How Oral Health Shapes Your Future

Episode Transcript
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SPEAKER_00 (00:00):
Alright, everyone, welcome to a new episode of the
Daria Hamra Podcast, where wediscuss science and
science-based tools for everydaylife, longevity, and real-world
health span.
This is your host, Dr.
Daria Hamra.
Today I'm joined by a colleagueof mine out of Tufts University,

(00:23):
Dr.
Imran Asin, who is an oral andmaxillofacial surgeon and
pediatric craniofacial surgeonand researcher.
In this episode, we unpack howmouth reflects and drives whole
body health.
We cover what an oral andmaxillofacial surgeon actually

(00:43):
does, the bidirectional linksbetween oral health and systemic
disease, new evidence connectingoral bacteria to a
therosclerotic plaque,inflammation biology, and why
your high-sensitivity CRP, whichis HSCRP, matters, oral health
and glycemic control indiabetes, how losing teeth

(01:06):
shifts diet towardsultra-processed soft foods, and
population data, including aLancet analysis out of Tufts
University, linking number ofremaining teeth to all-cause
mortality.
That last topic is thecenterpiece of today's
conversation.
Why tooth count and periodontaldisease track with mortality

(01:29):
risk on the order of other majorrisk factors, and what practical
steps actually move those risks.
We also discuss health spantools, why Japan's 20-teeth
policy exists, for example, whatthe Swedish Twin Registry
suggests about oral care andlifespan, pediatric red flags

(01:53):
like snoring and mouthbreathing, airway anatomy,
orthodontic expansion, and whento intervene.
Sleep apnea options from CPAP tohypoglossal nerve stimulation,
breastfeeding, jaw growth andimmune development via the oral
gut microbiome, and theneuroscience of chewing,
hippocampal activation,cognition, and why keeping the

(02:16):
ability to chew may actuallyprotect brain health.
We close with a simplemicroprescription you can use

today (02:24):
dental cadence, daily hygiene, smart gum, xylitol use,
and replacing missing teeth.
By the end of this episode,you'll understand the
mechanisms, the studies, and thespecific actions that tie oral
health to cardiovascular risk,metabolic control, cognition,
quality of life, and ultimatelyto all-cause mortality.

(02:53):
We have similar passion, as itseems, and I'm really excited,
not just for our audience tohear what you have to say as far
as oral health, your teeth, andlongevity, but also personally I
have I'm very interested justbecause it's something, it's a
topic that's near and dear tome.

(03:16):
To combine specialty of oral andmaxulofacial surgery and oral
health with longevity issomething that you don't hear
influencers or podcasters talkmuch about.
It's almost like a side note,even in science.
There's a lot of lack of sciencefrom our specialty, but also in

(03:39):
other specialties likecardiology or longevity or
geroscience medicine, there isit's almost like an asterisk.
They mention it, but no onereally talks about it, really.
So I would love to hear what youhave to say.
You I know you do actively a lotof research, but before we get

(04:00):
into the nitty-gritty andnuances, I want you to introduce
yourself to the audience.
First of all, what the hell isan oral and maxillofacial
surgeon?

SPEAKER_01 (04:11):
Yeah, thank you so much, Daria.
I really appreciate you being onhaving me on the podcast.
It's something that I actuallyconsume on my own.
And to have the opportunity totalk to you and pick your brain
is really special.
So an oral and maxillofacialsurgeon is a surgeon that
operates everything from theneck up.

(04:31):
We have a background indentistry, we have a background
in medicine.
I personally have a dentaldoctorate and a medical
doctorate.
So we're going out there andwe're fixing people's jaws,
we're treating infections, we'retreating oral cancer.
And there's only 7,000 of us inthe entire US.
And so it's not as well known ofa specialty as things like
neurosurgery or orthodontics inthe respective medical and

(04:55):
dental fields.
But it's a very important field.
It's something that most peoplewill see an oral and
maxillofacial surgeon in theirlifetime.
If any of you guys have had atooth removed or have had an
implant placed or neededcorrective jaw surgery that are
out there in the in theaudience, you know exactly what
we're talking about, but manypeople don't.

(05:17):
It's something that they mightsee us very infrequently.
We fix the problem and they moveon to their next issue of in
their own prospective lives.
That being said, it's veryimportant that I think that we
highlight something that yousaid, Dario, which is that most
people out there are notconnecting the systemic health

(05:39):
with oral health.
And it's something that affectshearts, but cardiologists are
not talking about it.
It affects our brains, butneurosurgery and neurologists
are not talking about it.
And this is something that I seeevery day that you know many
oral and maximal facial surgeonsare seeing the worst-case
scenario of how your oral healthcan affect your systemic health.
And it goes both ways.

(06:00):
Not only can your systemichealth affect your oral health,
but your oral health can affectyour systemic health.
And that has effects on how youfeel, how long you live, how
much quality of life that youcan gain from every everyday
life.
And I'm so glad that we can talkabout this today, but
specifically I wanted to startout with longevity because I

(06:21):
feel like that's whateverybody's tuning in to Dr.
Hamra for.
And there's a lot of veryspecific studies that have been
done on the connection betweenoral health and longevity.
Specifically, out of our ownuniversity, out of Tufts
University, we have a doctor inthe periodontal department, Dr.
Yu, that has done a reallylandmark study that was printed,

(06:42):
it was printed in the Lancet,which is a very high-powered
journal that all of the surgeonsand medical professionals look
to for advice and guidance.
And they made a very clearanalysis that shows the number
of teeth that you have iscorrelated with the overall
all-cause mortality.

(07:03):
So if you have 20 to 10 teeth,that's a very different
experience than if you have 10to 0 teeth.
And obviously, you know, 32 to20 teeth.
So she she grouped it indiffering numbers of teeth.
And the more teeth that youhave, the longer that you live,
the more healthier that you are,the less teeth that you have,
the less healthier that you are.
And I I was I was, you know,you're in the community.

(07:25):
Like, is anybody else talkingabout this?
I I I haven't experienced that.
What have you?

SPEAKER_00 (07:29):
Yeah, I I actually have never heard our community
talk about it.
And I mean, again, there are alot of studies on all-cause
mortality.
Typically, the typical medicalcommunity talks about the
typical causes of mortality,which are smoking, diabetes,
cardiovascular disease,hypertension.

(07:51):
But there are also other factorsthat people don't talk about,
which are socioeconomic status.
Now, that might be also relatedto poor oral health.
You know, we all know thatpeople with poor socioeconomic
status have typically poorhealth.

(08:11):
They have a higher rate of allcause mortality, and it's it's
basically a downstream effect.
And so my question now is is itthe chicken or the egg?
In other words, is the cause ofpoor oral health the reason for
all-cause mortality?

(08:32):
Is there is this a correlationor is it a causation, or is it
due to the fact that there aretypically people in poor
socioeconomic status?

SPEAKER_01 (08:42):
Yeah, I'm so glad you asked that because that was
one of the things that I thoughtof when I initially went down
this pathway.
You know, surgeons were verymuch focused on treating the
immediate cause and thenbranching out from there.
So let me let me answer thatquestion in immediate causes of
death and branch out to theoverall causes of death, which
is I I think that you're you'realluding to.

(09:04):
So let's talk about the numberone killers that you talked
about heart disease, diabetes.
These are things that we knownow in 2025 that are causal.
And let me tell you why.
Heart disease, atherosclerosishas always been alluded to as
being correlated withinflammation in the mouth.

(09:25):
Most recently, again, 2025, aDanish paper came out that
actually biopsied heart plaques,and the overwhelming majority of
them had inflammatory biomarkersfor oral bacteria.
So to me, I feel like that's asmoking gun.
You know, I don't think thatit's very applicable to look at

(09:46):
a person and to detail everysingle molecule that goes down.
We have to divide the the waythat this happens from really
well-done studies.
And I think that this was one ofthose well-done studies.
So it's so you cut out a certaina certain person that has died
from athoscratic disease from aheart attack with the you know
ensuing death biopsy report.

(10:08):
You take the plaque that hascaused the problem, and that
plaque overwhelmingly is causedby oral bacteria.
So that's one thing that we knowthat is an immediate cause of
death, which if we can take thatoff the board, we've extended
the lifespan of millions ofpeople, right?
If we can absolutely fix that.
Let's talk about diabetes,right?
So there's no causalrelationship between diabetes,

(10:30):
but we know that if you treatsomeone's oral bacteria, their
diabetes gets better.
Why is that?
My suspicion is something thatyou've probably heard in the
longevity community, which isinflammaging, right?
So this systemic inflammation issomething that has caused
buildup of detritus in the body,it causes genetic mutations, it

(10:53):
causes an overabundance of badparticles that are out there
that everybody's trying todecrease, whether it comes from
you know, biomarkers likeC-reactive protein, IL6,
whatever.
But that's something that thatwe well we know that happens.
So if you if you treat a if youtreat the disease with oral
health care, that improves.
I'm sorry, you were about to saysomething.

SPEAKER_00 (11:15):
Yeah, I think you mentioned, I don't want that to
get lost because you mentionedHSCRP, which is high sensitive
EC reactive protein, just Ithink this month or even I think
it was yeah, in October or lastmonth, the American Academy of
Cardiology, they came out with arecommendation to check for the

(11:35):
biomarker HSCRP because theyfound that it's elevated, I
think, in an age group uh 50 andabove or 60 and above, up to 50%
in adults.
And that's a marker forcardiovascular disease and
all-cause mortality.
And now they have recommended uhto check for HSCRP.

(11:59):
And HSCRP is basically anonspecific inflammatory marker.
It's an enzyme that's producedin the liver in response to
inflammation, and it's a goodmarker to test for that.
So things like diabetes,smoking, poor lifestyle, poor
oral health, or general health,those increase the HSCRP level.

(12:19):
And so we can, you what youalluded to, the good news is we
can actually measure it.
We have a marker that we canmeasure inflammation, so we can
use as a proxy for inflammation.
And whenever we can measuresomething, that's when we're
better able to treat it.
So I want you to talk about therelationship a little bit more

(12:42):
of because that's fascinating,of oral health and diabetes.
If you hear it for the firsttime, it doesn't make sense.
Like, how does poor oral health,what what's the relationship of
poor oral health with diabetes?
How does that disable ourfunction to dispose of glucose?

SPEAKER_01 (12:59):
Yeah, so I I I think that the the I'd love to hear
more about how you treatC-reactive protein because
that's a biomarker that I'mlooking at myself.
Like I'm 42, I want to make surethat I live to be to be longer,
and I feel like I only know theoral health component.
So I'm gonna give you my take onthe oral health component, but I
want to hear, and it could beafter podcasts about like how

(13:22):
you're treating yourself.
Absolutely but the and I lovethis knowledge sharing, by the
way.
I feel like you know I'm gettingso much more out of this.
Usually I go on these podcastsand I I have to tell people, but
I feel like I'm learning as I'mas I'm talking to you.
Same, same here.
So the the the point that I'mtrying to say is that diabetes,
again, let's talk about the themicro factors and let's talk
about the macro factors.
And I'm gonna start with themacro factors, right?

(13:43):
Yeah, so macro factors, as youlose your teeth, as your teeth
become less functional, yourdiet changes very drastically.
And and you and you can probablyknow this if you've if you've
seen any of these people withwith dentures or that don't have
any posterior teeth to to do thegrinding that you know we we
need for salads, for for meat,for those kind of things.

(14:06):
And so the softer the diet is,the more likely it's gonna take
contain high dose ofcarbohydrates.
It's gonna be just worse overallfor glycemic control.

SPEAKER_00 (14:13):
It's gonna be processed, it's gonna be somehow
ultra processed so it's soft.

SPEAKER_01 (14:17):
Exactly.
Yeah.
So so that's something that wethat we know that is very
specifically correlated, notcorrelated.
That's that's causal, right?
So that is a causal factor.
But as you lose teeth, yourglycemic control gets worse.
And that's something that notonly the nutrition literature is
producing, but actually it's ledto policy.
If you if you go to Japan, youknow, they have this old old an

(14:40):
elder population.
They they have this policy whereover 20 teeth is their goal
because not only does it lead tobetter diabetes control, but it
leads to better overallfunction.
And so they've really done agreat job of investing in oral
health to prevent these kind oflocked downstream effects.
But but I feel like I'm gettinga little bit off topic.
Let me talk about the microcosm,right?

(15:02):
So we know also thatinflammation also is worse for
glycemic control, right?
So, again, if you treat the oralhealth, the diabetes tends to
get better.
And and I don't know whatpathway is is happening there,
but that has been proven throughthe periodontal literature as
well.
So we know that the micro issueis real, we know that the macro

(15:22):
issue is real.
I feel like the in-between, wedon't have good studies studies
to show us, we don't haverandomized clinical trials to
show us that this is without adoubt happening.
But I feel on the back end, wewe have the the information that
that leads to some sort ofhypothesis.
And I think that that's how allreally great theories happen.

(15:45):
You know, when Darwin put outthe origin of species, he just
looked at all of the differentbirds changing and he went
around and he talked about it.
And it wasn't until decadeslater that it was able to be
proven.
We have those building blocksfor diabetes.
I feel like the whole pathwayhas been elucidated in
cardiology and heart, butdiabetes is less so.
And so that's something that Ifeel like is a really open topic

(16:07):
for researchers to look into.

SPEAKER_00 (16:09):
Yeah, it's really fascinating.
I mean, I'm doing a lot ofresearch in this for the book
that I'm writing on this topicof anti-aging and what is the
root cause of aging, and all thesymptoms that we're treating,
they're basically the smoke andthe fire starts within each

(16:29):
cell.
And when we everything we do inmedicine is putting a patch onto
something that is caused insidethe cell by our through our
lifestyle habits and what theycall epigenetics, meaning the
factors that modify and decidewhich genes get transcribed into

(16:51):
proteins that then affect acertain cause and process within
our body.
In other words, which genes getturned on and which genes get
turned off, and based on that,the decision falls as to what
happens to us, whether we'regoing to come up with
cardiovascular disease or anyother metabolic disorder, which

(17:13):
then increases our all-causemortality.
So if you look upstream of allof these symptoms that we're
treating in medicine ordentistry, it's what you said
inflammaging, the inflammationin our body.
And so then the question is,okay, what causes, what are the
things that cause theinflammation?

(17:34):
And you alluded to a veryimportant neglected one, which
is oral health.
I don't think, and please, theaudience, chime in with your
comments.
If I'm wrong, please educate me,but I don't think dentists,
which are the gatekeepers oforal health, which are the first
contact to any patients that gofor to a practitioner for oral

(18:00):
health, as opposed to us as aspecialist, they're the ones
that have to start thatconversation.
They're the ones that uh shouldinitiate the conversation and
make the patients aware of it asopposed to just fixing broken
teeth or replacing missing teethjust for the sake of doing that.

(18:26):
I still have today patients comein thinking that nothing is
wrong with their mouth unlessthey are in pain.
This is a this is a publichealth issue where I don't think
we're doing a good enough jobeducating our patients as to the
bigger or the important aspectof oral health, which is your

(18:48):
life.
I mean, no one has connected, Ihaven't heard anyone other than
you ever connecting oral healthto death, to all cause
mortality, as much as we arehearing about all these diets
that are proposed byself-proclaimed nutritional

(19:11):
experts, all these lifestyle andfitness influencers.
No one, you don't see anything,at least I have, and maybe it's
my algorithm.
I don't know, maybe it's thepeople that I know.
I have never heard of it.
And you look at the data, thehazard ratio is pretty
significant.
It's equivalent to smoking, it'sequivalent to hypertension, it's

(19:34):
equivalent to diabetes.
I mean, we're talking abouthazard ratios close to 15-20
percent in cases of more than 10missing teeth, especially in
male patients, right?
I mean, a lot of the studiesshow more significant uh hazard
ratio in male, which I don'tunderstand.
Maybe.
Do you know why we are more, Iguess, uh vulnerable when it

(20:00):
comes to oral health than women?
Or did I get that wrong?

SPEAKER_01 (20:05):
Well, I think I can comment on the fact that men are
less likely to see the dentistin general.
That's something that is a veryreal thing.
It's something that goes throughto medicine also.
We're less likely to see adoctor.
We're more likely to undertakerisky things, like you know,
many of the more riskier jobs,like being a sailor on a one of

(20:29):
these boats that are out therecatching crabs that has like a
really high mortality rate.
It's all men, right?
And so I think that across theboard we have behavioral
predispositions that lead us topoor health, right?
And that's something that Idon't think that enough of us
are talking about.
It's definitely clear in whenwhen people come to see me, when

(20:51):
they're seeing me, that they'resaying the same thing, this
doesn't bother me, and it couldbe like infected out to this, uh
you know, it looks like a golfball in their face, right?
And just because pain is notpresent, that doesn't mean that
something isn't happening in thebackground that's affecting you.
And I just wanted to to commenton on one thing that you you you
say that like you know the thegeneral public doesn't

(21:12):
understand this, and and I Ifeel like that's true.
There are other people that aretalking about it, but I feel
like we have we don't haveenough voices that are saying
this stuff, and that hasn'ttrickled into the everyday life
of a general dentist just yet.
It hasn't trickled into theeveryday life of a cardiologist
just yet.
But if we continue to say thisstuff, if we get on podcasts

(21:33):
just like this one where peopleare very consciously focused,
it's gonna get out there.
And I and to those people thatare listening to this podcast,
you're obviously very healthfocused.
You want to live for a long timemore than supplements, more than
you know, any of these lifestylemodifications.
If you can go and see yourdentist on a regular basis, if

(21:56):
you have a healthy mouth, thatis going to confirm more
protection and lead to a longer,not only lifespan, but health
span for you.
So how am I saying that?
This is this is how I can saythat to you.
Of all of the studies that areout there, of all of like the
contributions to science, one ofmy favorite is the Swedish Twins

(22:18):
Registry.
You know, they have 87,000identical twins that are in this
registry and they do all sortsof analyses on them, right?
And we know that looking attwins, people who take care of
their health, their oral healthversus people who don't, confers
about a five to 10 year healthspan or longevity benefit.

(22:39):
What other other than exercise,which I know you're a huge
proponent of, and I I reallylove that.
Other than exercise, what elseis out there that can confer
that kind of benefit?
I don't think that there is.
And so I want to get this out tothe longevity community, but
also I want to get this out tothe general community.
I I feel like we're not doing agood job of talking about this
just like you said, but I I I dothink it's coming.
I think just like the wholelongevity movement started maybe

(23:03):
10 years ago, 20 years ago.
It did.
And and so it started withoverall health, and I think now
we're going into like which oneof these components are the most
effective.
And I think exercise is gettingits limelight right now, which I
really love because I do thinkthat that's kind of the the holy
grail for health span.
I don't think that oral healthhas really even been talked
about because for a large partthere wasn't enough connective

(23:26):
tissue between dentistry andmedicine, right?
There's there's there's justbeen this historic separation
between the two.
So so for a long time I feellike dentists just they just
weren't at the table.
And they, you know, it's it's upto people like like me and and
oral and maxillofacial surgeonsin general that have this dental
doctor and medical doctor thatcan hopefully serve as the

(23:46):
bridge to to bring thisinformation out to the public.

SPEAKER_00 (23:49):
Yeah, I think I think it's up to our profession
to scream about this.
I don't think other professionsare gonna listen if especially
we don't talk.
Because, you know, I mean, justin the September uh edition of
the Journal of American Collegeof Cardiology, where they

(24:12):
finally, thank God, talked aboutHSCRP, which uh and I tell you,
ask me how did I improve myHSCRP because my HSCRP was
elevated.
Mine too.
And all my downstream symptomslike joint ache, uh uh
fogginess, tiredness, some likeGI issues, everything, all of

(24:34):
these are downstream effects ofelevated uh HSCRP.
They were bothering me.
And then when I went to mydoctor, and this is a young
doctor, she was in her late 30s,early 40s, around 40.
So you could argue she is thenew generation.
Very great, a good doctor, uh,internist.
And so when I presented her withmy symptoms, she said, Yeah, all

(24:59):
your biomarkers look great, youknow, based on your family
history.
And I love when physicians talkabout family history, like uh we
just we just look at familyhistory almost as evidence for
what's gonna happen or what'snot gonna happen, and we don't
realize that genetics onlycontribute maybe 15% to what
happens to us and epigenetics,meaning our lifestyle that

(25:22):
affects our genes, which is thereason why we die or survive, is
dictated by our lifestyle andwhich is modifiable.
There's nothing to do withfamily history.
Yeah, 15% is family history,genetics, but you know, what
about the other 85% where we canmove the needle?
And so that conversation did nothappen, shockingly, now looking

(25:46):
back.
And so her response was, Well,you're this was I was 48, I
believe.
She's like, Well, you're nearingyour 50s and you're not 30
anymore, you're getting older,so you're probably working too
hard, just you know, relax alittle bit.
Nothing specific, just somethingI, of course, I knew.

(26:06):
But the problem in medicine iswe don't give specific lifestyle
instructions to patients thesame way we write a drug
prescription with dose frequencyand duration.
And so it goes into one year andgoes out the other year.
By the time we're sitting in ourcar driving home from our

(26:26):
doctor's office, it's just it'sjust, you know, something that
we were told and we already knewbefore we went in, so nothing is
gonna change.
We don't change our habits, wedon't change our lifestyle,
because we don't know how.
We haven't been given specificinstructions.
So the American College ofCardiology finally came out and

(26:46):
says, well, and they even have agraphic where they show all the
causes of elevated HSCRP, whichare smoking, increased visceral
fat, dyslipidemia, meaningelevated uh lipids,
hypertension, and they have apicture of the mouth with the
teeth, and above it it saysperiodontitis, which is gum

(27:08):
disease.
And then there is dysglycemia,which is diabetes, and then
infection.
Okay, so infection.
So two of the one, two, three,four, five, six, two of the
seven are related to the mouth,which is infection and
periodontitis, which isinflammation of your gums, and
then infection from bad teeth.
And all of those generate thepro-inflammatory cytokines,

(27:32):
which is your interleukins 1,TNFs, IL-18, CD40Ls, and so
forth.
And below that is then yourphysical activity, your diet,
are you eating enough fruits andvegetables?
Are you eating enough oily fish?
Are you increasing your omega-3fish oil?

(27:52):
Alcohol abuse, so limiting youralcohol, which all of that
eventually leads to youratherosclerosis, your plaque
buildup, and now we haveevidence that there is a
streptococcite within theplaque, which alludes to the uh
origin from the oral bacteria.

(28:13):
And and then ultimately thatleads to the downstream effects
of death.
You know, it's in I always sayaging is the accumul death is
the accumulation of the processof processes that cause aging in
our body, and then ultimatelythen they lead to death.
And there are so many studiesthat allude to the to the

(28:36):
solution of how can we reduce HStherapy, which is what I did.
You know, so I I just cleaned upmy diet.
That's the first thing I did.
I once I did that, a lot of myinflammation went down, so I
could be physically moreengaged, I could do my exercises
better, I had more stamina justthrough cleaning up my diet.
The other thing was chronicstress.

(28:57):
I worked on my mindfulness, so Idon't stress much about stuff.
The big one was sleep.
I thought sleeping six hours isgreat.
It was almost like a badge ofhonor.
I was wearing it in residency,we barely slept.
So we came from a history ofabusing our bodies for 10 years
or longer, and then into thestress of work.

(29:19):
So sleep was almost anafterthought.
You know, people say I uh I cansleep when I'm dead, but sleep
is one of the biggest drivers ofHLCRP.
So I made sure that I sleepeight hours a day, and then I
never really smoked or I neverwas a big alcohol drinker until
I realized if you have one drinka day, you're pretty much an

(29:40):
alcoholic.
And if you look in thecategories, so I would have like
a six ounce glass of wine.
I don't even have that anymore.
Maybe once a month I have it ata social event because I don't
want to be a party pooper.
And then that affected also, Imean, my A1C was 5.5.
I really it should be with mylevel of fitness.
It should be really lower.

(30:02):
My hormone panels were great.
My vitamin D was extremely low.
Also, not it's it's it's even inrecommendations, they say you
shouldn't routinely take vitaminD levels of patients that are
not in risk categories, whichare you know darker skin
patients or patients that don'tget much sunlight or older

(30:23):
patients above age, I think, 60.
Like, why wouldn't you take iton younger patients?
My vitamin D level was like 25.
That's like insufficient ordeficient.
I don't know which one it is,but so I now take the vitamin D
levels of all my patients, and80% are 30 and below.
Okay.
So and we all know theassociation of surgical side

(30:46):
infection with low vitamin Dlevels.
I mean, there are studies onthere.
So my point is this, and that'swhy I'm so excited to have you
here.
And sorry I'm hijacking thispodcast, but No, I don't I need
to know this stuff because my myCRP is too high.

SPEAKER_01 (31:02):
I know.

SPEAKER_00 (31:02):
So the only reason why I'm going on a rant here is
because you asked a question,and this was for me the upstream
cause of all the downstreamsymptoms that my doctor had no
answers for.
And all I had to do is correctthat biomarker, and then my
lipids fell into place, myglucose fell into place,
everything.
My my shoulder pain, my kneepain, my ankle pain.

(31:24):
I would wake up, my ankle wouldhurt.
I'm like, what did I do?
I just got out of bed.
And so I was 48 and thinking, soit's gonna start already.
So what's gonna happen in 20years?
I'll be in crutches.
And I just had a three-year-oldat that time.
I'm actually having another babyin in four weeks.
So I want to be able to go,thank you.

(31:46):
I want to go out and play withmy boys, you know, and and I
don't want to sit in a foldablechair at the porch and just
watch them and uh just tell themdaddy's ankle is hurting,
daddy's knee is hurting, I can'tcome and run with you, just play
by yourself.
I don't want to be that person.
So for me, that was themotivation.
I think for every person tofinally make a change, they have

(32:11):
to find some sort of motivation.
They have to look in the futurejust like they're planning their
business, just like they'replanning their day.
They have to plan for theirlives, they have to see what do
they want to do when they're 60,70, 80, and then reverse
engineer their health fromthere.
Okay, what do I need to do todayto be able to do those things in
the future?

(32:32):
And and that's something that Ithink our health advocates,
meaning doctors, should talk tothe patients about as opposed to
just treating the smoke.
So, but enough of me.

SPEAKER_01 (32:44):
I really can I just comment on that on that
engineering for the futurecomponent.
So there's two things that Iwant to talk to uh talk to you
about.
The first is longevity focused,which is the idea of engineering
your life for the future.
Yeah.
When you're a hundred and two,you might not be able to run

(33:06):
with your same zeal that you didwhen you were 52.
When you're 102, you might notbe able to swim the same way.
But you're gonna enjoy your foodthe same way.
And just from a quality of lifeperspective, when you are 102,
the the longevity benefit ofhaving things that you enjoy is

(33:30):
so important, whether that'sfriends, whether that's you
know, some sort of hobby thatyou do, like yoga or something
like that.
If you see the really superagers, you know, they always
have something in their lifethat they're just excited about.
You can pull every singledenture wearer in the entire US.
None of them enjoy their food,right?

(33:50):
It's something that is, it'sthey're eating because they have
to, not because they enjoy it.
So, in the same way that peoplecome in to see me and they're
like, oh, it's it's notbothering me, it's like not that
big of a deal.
I feel like there is thiscertain component here in the
US, and it's not like thateverywhere else, but here in the
US, that people don't valuetheir teeth or their mouth

(34:12):
enough.
And when they they're the ifit's not in the front, they they
just forget about it, you know,like they're they're like, oh,
just take it out.
You know, that's not a big dealto me.
And sometimes we have to dothat, but you should replace it.
In South Korea, it's not likethat.
They have overwhelmingly aphilosophy of if I have to
remove it, I'm gonna replace it.

(34:34):
And those people have much morequality of life in their older
years, they're still able toenjoy the same foods that that
they that they loved when theywere 40 years old.
And so, to the people that areout here that are on this
podcast, it's just as important,not only from a health longevity
perspective, but from a qualityof life perspective, that you
should really invest in yourselfthe same way that you're

(34:55):
investing in your health.
And the the other thing that Iwant to talk to you about is
that so much of what you saidwas lifestyle decisions, right?
Lifestyle choices that have ledto aging.
And I have young kids in thesame way that you do.
So much of from an oralcomponent of how we end up in

(35:15):
the situations that we are whenwe're in our 40s or 50s, is
because of how we treatedourselves from an oral component
when we were younger.
So, for whatever reason, in thesame way that you know, we don't
know why we're getting taller asa species.
You know, some people say it'snew to nutrition, some people
say it's whatever, our jaws areactually getting smaller.

(35:38):
And this is something that isnot evolution, but devolution.
We're going backwards, we'remaking ourselves sicker.

SPEAKER_00 (35:45):
Talk to us about that, because what is the
difference from betweenevolution and devolution uh for
the people that might not befamiliar with the technicality
of the two terminologies?
Because you know, biology tellsus with each generation we
should be improving and becausewe're adapting.
You know, that's basicDarwinism.

(36:06):
So, yeah, I'm really excited tohear about that.

SPEAKER_01 (36:08):
Yeah, so adapting can be adapting for fitness,
which is what Darwin proposed,that you put an animal in
certain environments, and overthe course of generations, the
genes will be selected to betteradapt to that environment.
The thing is, is that we'readapting for the modern
environment, which is arelatively new environment
considering our history as aspecies, right?

(36:29):
Like we've we've lived inair-conditioned, allergen-free
or allergen-promotingenvironments for maybe the last
hundred years, 200 years.
And so over the course of time,certain decisions that have been
made have led to worsening ofour healths to adapt to this
environment, right?
So, for example, the ability tobreathe through our nose versus

(36:52):
our mouth is completelydifferent now versus when we
were in more traditionalsocieties of hunter-gatherers.
And I say traditional becausefor the majority of our
lifespan, that's what we were.
As a species, we werehunter-gatherers that would be
out in the wild, that would be,you know, exposed to all of
these different allergens andthings.
And granted, these people had avery shortened lifespan because

(37:15):
of trauma, because of diseaseand all those things.
But we've wiped those things offthe table, and now we are
adapting to modern society.
And modern society means thatyou're not breastfeeding your
kids, your kids are having asoft diet.
So, you know, yourthree-year-old or four-year-old
that you know you alluded to,you know, look at the texture of
what they're eating incomparison to what those kids

(37:37):
were eating 200 years ago, orhow much they've been breastfed
as opposed to 200 years ago.
And it's completely different.
And the reason why we know thatthis is happening in modern
societies is because if you goto those hunter-gatherer
societies that still existtoday, like the Hadza tribe of
sub-Saharan Africa, they willtell you that they have a full
complement of teeth.

(37:58):
They have the ability to havetheir third molars in place and
they're perfectly up and down.
They have very little cavities,they have very little
periodontitis.
And so these are things that,you know, their oral health is
actually better than us thathave modern dentistry, that have
modern care, and it's it's allabout lifestyle decisions.
And do I have a prescription forthat?

(38:20):
No, I don't.
I don't know how I'm gonna beable to do that.

SPEAKER_00 (38:22):
Well, I think that's I think that's a public health
issue more than anything.
I think if we didn't in today'sage, let's say everything else
is the same.
Our diet is the same, you know,all these uh ultra-processed,
sugary foods, cigarettes,alcohol, all this stuff that

(38:42):
destroys our gums and our teeth.
Let's say that remains the same.
The only thing that chain wechange is getting rid of
antibiotics.
Let's say uh Flemings didn'texist, we didn't have
antibiotics.
Can you imagine the averagelifespan of humans with the

(39:03):
amount of dental infections thatis out there?
I mean, we would probably be theaverage life expectancy would
probably be 15 or 16 if we madeso I think the reason why we uh
survive infections is of coursebecause of antibiotics.
But back in the days you woulddie of an infection from a
splinter or some infection on onyour toes or something, but not

(39:28):
so much down teeth was acomponent.
But with today's processed foodsand diets, I would bet that more
people would have died fromdental infections.
And so to me, this is a publichealth issue.
We can scream all we want, wecan treat all we want, but we're
we're still downstream of the uhc causes of uh what leads to

(39:52):
oral uh health.

SPEAKER_01 (39:53):
Yeah, but you know, I think that people are talking
about it, you know.
I uh you know, for love them orhate them, this whole Make
America Healthy movement hasbeen able to take you know dyes
off the table for for who forall the foods that are out there
that have, you know, theseartificial dyes.
And and you know, I don't thinkthat that's something that we
would have even thought aboutlike 30 years ago.

(40:14):
It's just like you know, so Ithink that times are changing
and and it's up to people likeus that spread the message.
Here's what I can tell you aboutthe prescriptions that I do for
my own kids.
So number one is breastfeeding.
This is something that theAmerican College of Pediatrics
recommends for two years now.
They actually went from one yearto two years, exclusively
breastfed as a recommendation.

(40:34):
Very few people are doing that.
I mean, like if you look at theif you look at the numbers in
the US, like we're talking likeless than 20% of our
breastfeeding for two for twoyears, you know.
So that in and of itself moldsthe the jaws in such a way that
just like what you were sayingabout epigenetics, there's a
certain amount of geneticcomponent to things like how

(40:56):
height and and how we grow.
And there's also a certaincomponent of environmental
component, right?
So, like if you if you are ableto mold the jaws in such a way
through orthodontics, or youknow, my background is in cleft
lip and palate surgery, and sowe do this thing called
nisodobular molding, which kindof brings the the two the two
portions of the the clefttogether.

(41:17):
So you are able to mold the thejaws in such a way that promote
the full maximum growth thatthey can have.
That being said, there's alsothe idea of breathing through
your nose versus breathingthrough your mouth.
That's something that is asystemic issue.
You know, this is somethingthat, like when you have young
kids who are exposed toallergies, you know, a lot of

(41:38):
the theories behind allergies isthat it's mediated by a
component of our immune systemthat was made for parasites.
And because we're not exposed tothose parasites anymore, now
we're overemphasizing our immunesystem in regards to dust and
mold and all the stuff in modernlife, right?
So they they lose their abilityto breathe through their nose,
their tonsils and adenoids getreally big, and then they start

(42:00):
exclusively breathing throughtheir mouth, and then they end
up with these like very narrow,very skinny mouths.
So that's something that'shappening at a more common and
more frequent rate these days.
You know, the the the number ofkids who are in orthodontics is
at an all-time high.
Like it's almost like a rite ofpassage these days.
When I was growing up, it waslike you were kind of strange if
you if like they would make funof you if if you had braces, and

(42:23):
now like you're made like likethe kids want braces, you know.
You right, because all theirfriends have like I I exactly, I
I have braces.
Oh yes, I I can't wait to getbraces.
Yeah, so it's totally differentnow.
And and that is just reflectiveof the need for this stuff in in
modern society.
And so I think that if we wereto, you know, train kids how to

(42:44):
breathe through their noses moreoften, be a little bit more
diligent about removing some ofthis excess, you know, back
tonsillectomy tissue oradenoidectomy tissue.
I think that these are thingsthat can can help us get to the
point where we're not losing ourfitness, that we're actually
making our kids healthier ratherthan making them more sick and
leading to further problems.

(43:05):
You know, I can tell you that mycorrective jaw surgery practice
has exploded because so manykids have arches.
You know, it's it's somethingthat doesn't it doesn't happen
as much in in third worldcountries that that don't have
the same kind of diets that wedo in first world countries, you
know.
Just to give you an example,like both my parents are from
India, they had really tough,really rough diets, they had

(43:28):
full a full complement of teeth,and they had the ability to chew
with their third molars.
So their third molars arecompletely present.
Me and all of my siblings had tohave ours removed because our
jaws weren't big enough forthem, and that's just like one
indication.
Like we don't have enough roomin our jaws for this tooth, and
that has also become almost aright of path.

SPEAKER_00 (43:47):
Yeah, I think the evolution has even progressed
beyond that.
We see more and more patientswith lacking wisdom teeth, and
that's also the evolutionaryprocess, right?
So eventually evolution diddecides that, hey, I guess we
are not gonna, we don't need thewisdom teeth anymore because we
don't have big enough jawsanymore.
So I see more and more patientswith less wisdom teeth than

(44:11):
before.
So it will be good to look atyou know studies going back and
seeing if there is a trend.
But I want to go back tobreastfeeding because I think it
has a bigger health implicationtogether with oral health,
together with and I also wantyou to talk about before we

(44:31):
forget the uh neurological uhaspects of uh breastfeeding for
the brain development and ingeneral chewing, because there
are correlations when it comesto neurocognitive 100%.
So I want you to allude to that,but before we go there, there

(44:56):
are studies that have shown thecorrelation between
breastfeeding and the baby's andch later the child's development
when it comes to allergy,obesity, and autoimmune disease
risk.
And all of that has to do whenthe baby is breastfeeding, the
baby gets in touch with themicroflora or with the flora of

(45:19):
the mother's breast, and whichthen seeds the oral and the gut
microbiome.
And do you know anything in thatregard and how that affects
immunologically and also as faras obesity and allergy, the
future child's health?

SPEAKER_01 (45:36):
Absolutely.
So so just to give you a littlebit of background, so I I after
my oral and maxillofacialsurgery training, I did a
pediatric craniofacialfellowship, and I was super
lucky to be with this womansurgeon.
Her name is Pat Ricaldi.
She's uh just such a genius.
If you ever have an opportunityto meet her, she goes at length
about breastfeeding because sheshe she did she breastfed all of

(45:58):
her kids.
She's a true believer in it.
And so most recently, she cameout with a study about like the
pros and cons of phrenectomies,which is some a very common
procedure where you you trim alittle bit of the tissue
underneath the tongue to topromote better breastfeeding in
in neonates.
And and and so just like I I Iwant to say that because not

(46:20):
only was she a proponent of it,but she was promoting research.
And I feel like that's somethingthat's not only is she like a a
theoretical proponent of ofbreastfeeding, but she's also a
clinician that's trying toadvance the the idea, right?
And so what so during this wholeprocess of me being in
fellowship, I got married, Iended up, you know, having a

(46:43):
child with my my wife, and andso we were I was doing this
research independently of all ofthose things that you talked
about.
So, what I can tell you is thatthere it is such a complex
interplay of uh hormones andchemical messengers between the
child and the mom that we stilldon't understand it at the level
that we should.
And so, in the same way thatwe're trying to piece together

(47:06):
little bits of information, Idon't think that we have the
whole clinical picture, but thisis this is my theory, okay?
My theory is that the so firstoff, just to clarify, all of
those results are real that youtalked about.
It's better for the overallhealth of the baby, it's better
for neurocognitive development,it's better for mouth formation,

(47:27):
you know, all these things thatwe talked about, those things
are real.
We don't know why that's that'sthat's the case.
But when we're talking about whyI think it's the case, I think
it's a dose a dose-dependentresponse.
So, in the same way that youtreat an allergy by giving your
child a little bit of it so thatthey gain some sort of

(47:49):
acceptance of that.
So, like right now, I have aseven-month-old, we're giving
them peanut butter just to havea little bit of it so that they
don't have a peanut allergy inthe future, right?
I think that for babies, theyget a little bit of whatever it
is through the breast milk orthey get a little bit of it from

(48:10):
their environment and the breastmilk gives them the chemicals
necessary to withstand whateverit is that they're they're
exposed to.
So, for example, like if youhave a baby that's exposed to a
virus and the mom has had thatvirus and has the

(48:31):
immunoglobulins that cancounteract that virus, the
interaction between the salivaof the baby and the breast of
the mom will have some sort ofunderstanding that, oh, okay, we
need to make theseimmunoglobulins to send to the
baby so that they don't getoverwhelmed by this infection,
right?
We don't know why that happens.
I don't know why that happens,but it's so beautiful and it
tells me something that gives melike the real power of

(48:54):
breastfeeding.

SPEAKER_00 (48:55):
You know, well, there is there is actually you
you know what?
Intuitively, you're actuallycompletely correct.
They actually have studied it.
They they what there are studiesbecause I looked into it too,
because my son developedallergies to tree nuts.
And just the same way uh 20years ago, the American Academy

(49:16):
of Pediatrics was trying toeradicate peanut allergy by
telling parents not to givetheir kids peanuts, which is
completely the wrong approach,which it's it's mind-boggling
how they came up with it.
Makes no sense because nowherein history we tried to omit
foods from our infants, butthat's a different story.
But human milk hasoligosaccharides, which is in

(49:41):
breast milk, that selectivelypromote a certain bacteria.
I forgot what the name is, butthat bacteria is associated with
immune maturation and reducedrisk of disease.
So it it kind of matures our thechild's immune system.
And it's also associated withthe duration of breastfeeding,

(50:01):
which then also then shapes yournot only the oral microbiome and
in increases the IgA level ofthe of the baby, which also is
basically the first immunedefense that you know from the
initial portal, meaning themouth, when we eat food to

(50:22):
defend against pathogens, butalso it seeds then the gut
microbiome, which a lot of ourimmune system is controlled in
the gut.
So this has all downstreameffect from the mouth to the gut
and then eventually itinfluencing the immune system.
And there are studies on that,which I think not enough people

(50:45):
again.
This is another topic where notenough doctors are talking
about.

SPEAKER_01 (50:50):
Yeah, I mean, I I think that the American Academy
of Pediatrics put out thisrecommendation for a year of
breastfeeding a while ago.
You know, I and the adoptionrate has been abysmal because
we're up against the the marketforces, right?
Like how many, how many womencan realistically go out there

(51:12):
and breastfeed, you know?
Like if if my wife was asurgeon, like is she gonna stop
surgery to go breastfeed?
You know, and and just to tellyou how how strongly my my
fellowship director believed inthis, she had a room upstairs
where in between patients shewould go up and breastfeed, you
know.
So that's how strongly shebelieved in it.
But like she she created her ownlittle environment where she

(51:34):
could have this capability, andhow many people have access to
that, right?
So, so you know, I I think thatthere's a lot to be said about
different policy measures thatwe can make.
Like, you know, for example,Canada gives a year of maternal
leave, and that that would bevery easy to be able to
breastfeed if you had that timeoff.
But in the US, it's starklydifferent.

(51:56):
And so I think that we have tojust continue to talk about how
important this stuff is, andalso this like the downstream
components of it.
I think that there's there's notenough what we talk about, the
difference between it's justlike it's recommendation, and
it's just this most people don'trealize what they are are
subjecting their their baby to,like the choices that they're

(52:18):
making.
And in the same way that theydon't understand, they don't may
not realize like theirdifference in zip code might
affect their overall health, youknow.
So so these are things that likeI think are just coming to the
forefront, and I think it's it'simportant for us to talk about
it.

SPEAKER_00 (52:33):
So talk to us a little bit about we we initially
you mentioned it already aboutthe growth of the jaws that is
related to our dietary habits,especially in the developing
child, you know, the shrinkingjaw debate, et cetera.

SPEAKER_01 (52:51):
Yeah, yeah.

SPEAKER_00 (52:52):
And and so the question is how does that
affect, you know, as a pediatriccraniofacial surgeon, how does
that affect the airway when wehave smaller jaws?
You know, there are so manypatients now that have sleep
apnea or difficulties breathing,if even if they don't have sleep
apnea, like you said, they havetheir mouth breathers, which has
other health implications that Iwould like you to discuss.

(53:16):
Sure.
But tell us a little bit for thelayman how the shape of your jaw
affects the your ability tobreathe.

SPEAKER_01 (53:25):
Yeah, so if you can imagine the airway, the the way
that we get air from ourenvironment into our lungs as a
pipe.
The two restrictions on thatpipe are your posterior
oropharynx, which is just infront of your spine, and then
all of this anterior tissueright here, all the tissue in
the front.

(53:45):
So the back and front of yourthroat, for those of you who are
not watching this, exactly.
So the back and front of yourthroat are determined or
determine your airway, right?
And the back of your throat isfixed.
Well, let me let me rephrasethat.
The back of your throat is isfixed from a skeletal position.
Now, the back of your throat canget larger because you have

(54:07):
really big tonsils, you havereally big adenoids, and that's
that that kind of constricts thethe that pipe from the sides and
the back.
But the front of it, which is ahuge determinant, is based on
your your jaws.
All of this tissue attaches toyour jaws.
And so if you're not maximizingthe amount of growth that you

(54:29):
can get from your jaws, you'reminimizing the size of that
pipe.
And for every decrease in incircumference, it's a vastly
larger difference in volume.
You know, the the circumferenceis a square and the volume is a
cube in regards to theexponents, right?

(54:50):
And so when you when you squeezethat tube, even just a little
bit, you have a vastly differentexperience of breathing.
You know, it's the differencebetween breathing through a
straw versus breathing through ascuba mask.
And so when we're in thosesituations where we have to, you
know, advance somebody's jaw, wealways do an airway analysis

(55:11):
pre-operatively andpost-operatively.
And inevitably, it growsexponentially because these are
people that have really likerecessed jaws or they have a
really deep underbite, andthey're coming to me because
they don't like the way thatthey look, they don't like the
way that they chew, they don'tlike the way that they function.
But in addition to that, we do asleep analysis and they have
obstructive sleep apnea, they'rewaking up, they're constantly

(55:33):
tired throughout the day.
All of that gets better when youmove their jaw forward and
increase that airway.
You know, there's there's lotsof other ways of getting air
down there.
There's like the CPAP, whichpeople are not super compliant
with, which is basically thismachine that forces air down
your down your throat to keepyour airway open.
CPAP stands for continuouspositive airway pressure.

(55:54):
And then there's you know, allsorts of soft tissue maneuvers
to decrease the soft tissue thatcontributes to the constricting
of that airway.
And then now they have thingslike hypoglossal nerve
stimulators, which maintains acertain amount of stability of
the airway, even when you'reasleep, because when you're
asleep, everything relaxes andit collapses in on itself.
All of these are differentthings that are available for

(56:15):
people.

SPEAKER_00 (56:16):
For the audience, the hypoglossal nerve is the
nerve that you know is in chargeof controlling the muscles that
are associated with yourbreathing, and to stimulate that
would then improve yourbreathing.
Now, if you're a parent, you'relistening to this podcast, you
don't really know enough aboutthe stuff that we're talking,

(56:39):
you just overheard the factthat, oh my God, my child's jaw
size and shape will determinethe ability, his or her ability
to breathe.
What where do where do where doI start?
What age should I bring my childto the doctor or make because

(56:59):
maybe the pediatrician is notreally aware of these issues.
What can the parent do on theirown, being their child's
advocate?
What doctor should they bringto?
What should they do?
And when at what age should theylook into it and start?
What would you recommend?

SPEAKER_01 (57:15):
Yeah, this is a great topic.
So I I'm I'm gonna attack thisfrom two different pathways,
okay?
There's the tried and true,which is orthodontics, okay?
Orthodontists are very skilleddentists that have gone on to
complete training in how theface grows and how the teeth
move in relation to each other.

(57:36):
And really early anticipatoryguidance of the jaws can
counteract a lot of thesenegative aspects that that you
and I are talking about.
So, you know, the the growthplates fuse for the the upper
jaw that that determine a lot ofthe a lot of the growth at
different at different ages, butI would say the the earliest

(57:59):
that you know the the growthplates are fusing is around like
11 or 12 for the the maxillarypalatal suture, which can you
can widen with orthodontics verypredictably.

SPEAKER_00 (58:09):
So you're midline in your upper jaw and palate,
right?

SPEAKER_01 (58:14):
Exactly.
I apologize to the audience ifI'm if I'm using like a lot of
words that Dario's been so sokind to elucidate for me.
But the fact of the matter is isthat the 11 or 12 is like when
that thing closes.
So before it closes, you want tomaximize the growth that you can
get out of that.
And so you might have seen kidswith like these palatal
expanders that that they theythey slowly crank every day, and

(58:38):
it it actually gives enoughpressure to open their jaws up.
And that is something that isvery tried and true.
It's something that thatorthodontics are doing day in,
day out, and has a long historyof success.
I would say that there's anotherschool of thought that's out
there that has not beenvalidated by science, but is is

(58:58):
talked about a lot in thepediatric dentistry and
orthodontic community, which isorthotropics, which is the
ability to train a child tomaximize their jaw growth.
And and I don't I don't haveenough information to comment on
it.
I just know that it exists andyou know the the the there's a
there's been historically a lotof contentiousness between those

(59:18):
two communities, but they'veshown some success through that.
So those people are interveninglike as young as five, six,
seven, you know, and you'reyou're basically training your
kid to maximize their jaw growthby how you position the tongue,
how they they breathe.
You know, you want to maximizenasal growth, be or sorry, nasal

(59:38):
airway growth, because even justlike the the forces of breathing
in and out through your nose, itit allows your it allows your
nasal airway to grow andtherefore maximizes the ability
for your for your jaws to grow.
So so those are the two schoolsof thought that I would say.
I would say that go see apediatric dentist as early as
you can and have theseconversations with them.

(01:00:00):
Go see an orthodontistdefinitely if they feel like
there's crowding that'shappening anywhere from like the
seven to nine range, you know.

SPEAKER_00 (01:00:08):
And and then what are what are some red flags for
the parents to look out for?

SPEAKER_01 (01:00:12):
Yeah, yeah.
So the biggest red flag issnoring.
Like kids should not be snoring.
So even if like the kid is two,three, four years old, if your
kid is snoring, that's notnormal.
You know, that's gonna lead toobstructive sleep apnea, and
that is most often caused bylarge tonsils and adenoise,
which can be treated by yournose and throat physician.
So that's the biggest red flag.

(01:00:34):
If your kid is not sleepingappropriately, that can lead to
behavioral changes, it can leadto decreased brain growth, all
of these things that you want tomake sure that that is treated
as soon as you can.
I have uh a kid, was we we livein you know condo apartment
complex in in Boston, and wehave uh a lot of like kids who
are in the complex and they allplay together.
And this kid, like I even likewhen he was like running, I

(01:00:56):
could I could hear like he wasjust like struggling to keep up.
Yeah, exactly.
And and I taught his mom was apediatrician, and I talked to
her about it, and she was like,you know, like we're we've we've
we have noticed some some stuff,we're gonna take him.
He got a tatonxolectomy andabnoidectomy, not snoring
anymore, totally different kid.
Like, just wow, you know,beforehand, he was just like so

(01:01:19):
difficult to deal with, like hewas just you know, very
impulsive, like fighting all thetime, and now he's so well
behaved.
So I'm not saying that's gonnawork for everybody, but I'm just
saying I've seen it personally,really profound, really profound
difference in kids.

SPEAKER_00 (01:01:32):
Well, there's an association of lack of sleep and
elevation of cortisol, which isa stress hormone, uh, that has a
lot of hosts, other uh differenthosts of downstream, negative
downstream effects on ourhealth.
And children aren't immune tothat either.
So I think it goes back toimproving the quality of our
sleep, not just the length, butthe quality of our sleep is

(01:01:54):
really key for our health.
And it like you alluded to, itit starts very early on in life.

SPEAKER_01 (01:02:01):
Can I just comment?
I know we're we're getting tothe end of our time.
I love this conversation.

SPEAKER_00 (01:02:04):
No, we can we can we can continue as much as you you
you have time.
Um my podcasts are kind ofopen-ended.
There's no uh strict, my time,the time is based on my guest.

SPEAKER_01 (01:02:17):
I appreciate it.
No, I I would love to come onagain or or talk to you forever,
but but I unfortunately my mywife is gonna be texting me
about a birthday party that Ihave to take my kid to in just a
few minutes.
Of course.
But I did I don't want to leave.
One of the things that you hadtalked to about that I didn't
have the opportunity to expandon because we got we went in a
different direction, is just theneurocognitive effects of

(01:02:38):
getting.
Yes.
So thanks for reminding me.
No, no, no.
I I feel like this is somethingthat Because Yeah, it's just
people don't know about it,right?
And I want to make sure thatpeople know about it.
So University of Toronto did astudy where you took a hundred
kids that took a test totallynormally, and you took a hundred
kids that took a test and theychewed chewing gum, just regular

(01:03:01):
chewing gum beforehand.
The ones who chewed chewing gumoverperformed in comparison to
the control.
And this is something that weall have like kind of known
about for a long time.
Like they used to give GIschewing gum just to keep you
know happy in in these reallystressful environments.

(01:03:21):
Oftentimes, like when when youand I are in stressful
environments, we're grinding ourteeth, you know, grinding is
like a source of stress relief,and it's something that we all
kind of intuitively know, butthere hasn't been enough talk
about it.
And I think that we haveundersold just the ability to
chew for a long time.
And and that's one of the thingsthat I think contributes to a
lot of these downstream effects.

(01:03:43):
You know, we're not chewing thesame kind of stuff that we used
to when we were younger, youknow, like the the kids have
really soft stuff like chickennuggets and you know, really
soft cereals that that that'swhat they're chewing.
But it wasn't like thathistorically, you know.
If you were to look at even themost primitive civilizations,
all of them kind of chewedsomething just to pass the time.

(01:04:05):
You know, whether it was likethe beeswax of honey in some of
these ancient Greekcivilizations, mastic was also
very really commonly writtenabout in in in Greek
philosophers and and all the theexisting Greek literature.
Just so that you guys know,mastic is a tree sap that was
one of the initial inspirationsfor gum.
It's it's it's in some of thesebespoke chewing gums nowadays.

(01:04:28):
But the fact of the matter is,is that I don't think that we
treat chewing with the same kindof reverence that it deserves.
Uh or even just our oral cavityin general.
Just you know, if you were tomap out the brain of the
somatosensory component of ourbrain, like the amount of brain
cells that are given to acertain thing versus versus not,

(01:04:51):
overwhelmingly, the majority ofit is the head and neck, you
know.
The the sensation that we getfrom kissing our loved ones is
so powerful in comparison tolike shaking their hands, right?
Like it's it's just so much moreexciting and interesting, and it
just lights up all thesedifferent brain cells.

SPEAKER_00 (01:05:09):
And you know, I think that's talk to us about
the mapping so that the audienceunderstands, because it's that's
a key component of why that isimportant, of how different
parts of our body are mapped atdifferent sizes in our brain
cortices.

SPEAKER_01 (01:05:24):
Yeah, so so we have this somatosensory map of our
brain.
And so over the course of years,like because of you know,
multiple researchers, like weknow exactly the amount of
neurons that are devoted to thefeeling sensations of our hands
versus the feeling sensations ofour nose versus the feeling
sensations of every body part,right?
And it's mapped out in in ourbrain.

(01:05:47):
Uh, it's something that welearned about in medical school
called the somatosensory cortexmap of our brain.
And and you can actually, youknow, look it up, it's very it's
really, really straightforward.
But the the map, like if youwere to compare, like let's say
if it was like the map of theworld, the the amount of land
mass for the mouth, the lips,the tongue is huge.

(01:06:09):
It would be like North and SouthAmerica and Africa in comparison
to the rest of the body justbeing like you know, Asia.
Luxembourg and European exactlyLuxembourg, right?
So so it's it's vastlyovervalued in our brain.
And what I wanted to really talkabout is I think it's overvalued
in our evolution too.
I think that you know this issomething that is so integral to

(01:06:33):
being a human being, which istaste, right?
Taste is something that humanbeings have at a higher level
than almost any other you knowspecies that's on the planet,
right?
The ability to taste thedifference, the subtle
difference between sushi issomething that like you know,
not every animal can do, right?

(01:06:54):
Like you can't tell good sushifrom bad sushi for a dog.
Like they're just eating it, youknow.

SPEAKER_00 (01:06:58):
And and my dog doesn't, dogs don't have
Michelin star restaurants.

SPEAKER_01 (01:07:02):
Exactly, exactly.
And and and just just even that,like the idea of us learning to
cook our food, to tradedifferent recipes, to you know,
to to be gourmands over theyears, many people think that
that was what led to us beinghumans.
And and this is something thatlike I don't think that we talk

(01:07:24):
enough about.
And chewing is so integral tothat, right?
Like, like not everybody, likenot everybody has the same value
out of a meal because of theability to chew or not.
You know, if if you were to talkto somebody that has had had
neck cancer and has had half oftheir jaw removed, they're not
getting the same kind of valuethat you and I are getting when
we go into the restaurant, youknow?

SPEAKER_00 (01:07:46):
You know what this this brings me to a point about
neurocognitive decline inelderly.
You know, the study that youmentioned initially, the
association between all-causemortality and identify or loss
of teeth, you know, when youhave lost all your teeth, you're
very limited in the foods youcan eat.

(01:08:07):
You probably can't eat muchpalatable food, much nutritious
food.
So one is the nutritious aspect,like let's say the fiber, high
fiber containing food, you haveto chew a lot.
Well, you can't do that.
You know, most nutritious foodsyou have to chew a lot, you
can't do that anymore.
So one is the nutritionalaspect, but I think what you're
just talking about is also theneurocognitive effect of the

(01:08:31):
inability to chew, which we havestudies that it affects our
neurocognitive ability.
And perhaps that is anotherburden on the neurocognitive
decline in elderly because theytend to have less teeth, because
they can't enjoy that oral habitof eating and eating different

(01:08:52):
types of foods because they'revery limited.
And if you look at the bluezones, the number one thing they
have all in common, which isbasically the highest rate of
centenarians in the world, andspecific blue zones in the
world, which is, I think, uhsomewhere in Japan and Italy and
other places in the world, wherethe aspect of

(01:09:14):
interconnectedness, meaninghuman social connection, is has
one of the highest predictivevalues and is the most common
aspect of what all these bluezones have.
Of course, in addition toactivity level and good
Mediterranean style, diversediet, etc.

(01:09:34):
But the interconnectedness, theyactually interviewed them.
They asked those people and theysaid it's the human connection
being around people.
And food for human beings is asocial event more than anything.
It's not just to feed thestomach and feel satiated.
Yeah, that's one, that's anutritional aspect.
But the biggest aspect, I mean,look at when was the last time

(01:09:57):
we went out in a social event?
What did all of us do?
We were eating something, youknow, even if it wasn't
breakfast, lunch, or dinner,which most of the time it is,
there was some sort of snack,and and every time we have a
party, everybody just hangs outin a kitchen.
So when we built our house fiveyears ago, we said, okay, let's
look at the areas where we spentmost of our time and let's

(01:10:20):
invest in those areas and notworry about other areas.
And so we invested in ourkitchen and living room because
every time we have friends over,that's where everybody gathers.
So to me, eating is really asocial event, it's a habit, and
which goes really back to ourconversation.
Now, we don't look at it reallydirectly that way.

(01:10:42):
It's almost like, oh yeah,you're right.

SPEAKER_01 (01:10:45):
Yeah.
And let me back up some of thethings that we're mentioning
with science.
So so number one, the ability tochew is directly related to
hippocampal growth.
So you chew, you go into a afunctional MRI, and you see that
those parts light up in thebrain.

SPEAKER_00 (01:10:58):
For all for the for the audience, can you say what
the hippocampus is and where itis?

SPEAKER_01 (01:11:02):
Yeah, yeah.
Thank you so much.
I I I I really need that checkto remind me of what I go
through.
It's all right.

SPEAKER_00 (01:11:07):
That's what I'm here for.

SPEAKER_01 (01:11:08):
Yeah.
So so a hip the hippocampus is apart of the brain that's that's
really the the powerhouse formemory and and memory creation,
memory selection.
It's very underdeveloped and andpeople that uh you know are kind
of going away from uscognitively.
And it's something that has alot of of focus on when it comes
to the city.

SPEAKER_00 (01:11:27):
And you can you can actually grow it through exactly
you can you can grow that part,which affects it positively.

SPEAKER_01 (01:11:34):
That's one of the things that I wanted to say.
Like in the same way that wetalk about like growing muscles
and stuff, like keeping active,the same thing is true for the
brain, whether that's you know,through social interaction,
through games that you play, youknow, whatever it is, you want
to make sure that your brain isconstantly being used.
When you get into like states ofdepression or you know, stuff

(01:11:55):
that causes you to use yourbrain less, the brain kind of
shrinks away.
And so that's something thatthat's very clearly documented
in in the medical literature.
But the but the hippocampus hasbeen shown to be correlated to
the ability to chew.
And and one of the things that II know that we both follow Peter
Attia, he's talking aboutexercise as promoting the the

(01:12:17):
health span for an individualand and hopefully the lifespan
for an individual as well.
The things that he's looking atare things like grip strength
and you know the ability tobalance, right?
Like those are things that he'slooking at to promote so that he
makes sure that he's healthy forthe long term.
I think that we need somethinglike that for the ability to use

(01:12:37):
our mouths.
I don't think it's bitestrength.
I don't think that that'ssomething that's necessarily
correlated because I think it'ssome sort of chewing function.
And the number of teeth to me isis a direct correlate to that,
but I don't think it's beenbacked up by literature as yet.
But I want to have that samekind of metric.

SPEAKER_00 (01:12:55):
Maybe measure, maybe measure the VO2 max during
chewing activity.
Something like that.
Yeah.
How long can you chew gumwithout like a hubba without
without getting tired?

SPEAKER_01 (01:13:05):
Yeah, exactly.
I mean it's it's one of thesethings where I I I just know
that like there's something outthere.
I just haven't figured orhaven't seen somebody else
figure out.

SPEAKER_00 (01:13:15):
Well, I think I think I think metrics are great.
They're good as you know, forproof, as evidence for a
specific theory, and also goodto measure improvement and
target treatment.
But we have so many studies nowthat we know, I mean, we don't

(01:13:39):
have to argue anymore whetherhaving teeth and being able to
chew is good for you or bad foryou.
Yeah, we can get very technicalwith analytical data and
metrics, you know, more likeacademic or intellectual brain
massage.

(01:14:00):
But ultimately, I think one ofthe things that I've learned in
trying to get my patients tochoose healthier lifestyle to
improve their health, and it allstarted with me in order to
optimize them perioperatively toreduce the risk of infection,
uh, reduce the recovery time,and improve the outcome and
longevity of the treatment.
That's that was my motivation.

(01:14:21):
So when I started veryspecifically giving my patients
advice on how they can improvetoday through micro
prescriptions, not big changesbecause no one can do things
cold turkey or completely changeour lifestyle starting tomorrow.
You have to start microdose it.
I realized that those extrememetrics are maybe good for nerds

(01:14:47):
like me and you or the ATIAs inthe world, but the average Joe
can't even comprehend it,doesn't even care, actually
starts tuning off as soon as weget into the details.
It's it's too much going intothe weeds for them.
They just want simplerecommendations.
And if we keep it simple for ourpatients, I think it's more
likely for them to followthrough because number one, they

(01:15:09):
can understand better, and whenthey understand something
better, they they're motivateddifferently to apply it and to
start moving the needle towardsbetterment.
And chewing is one thing,exercise and another thing, you
know, in in terms of exercise.
You know, there's a lot ofstudies out of Britain that want
to see the effects of lifestyleon all-cause mortality, and they

(01:15:31):
realize it's not just one thing,it's really sleep, uh,
nutrition, and exercise.
It's three together.
If you isolate each one, let'ssay you just focus on one, you
don't really move the needlemuch.
And they showed, I think it was60,000 subjects over eight
years.
They followed them.
It's called the uh the spanstudy, which stands for sleep,

(01:15:55):
physical activity and nutrition,span.
And they wanted to see what's aminimum effective dose to
improve your all-causemortality, and what is the
maximum effect if let's say youimprove everything optimally,
which is the maximum level ofreduction of all-cause
mortality.
So the maximum level wasreduction of all-cause mortality
up to 64% in patients that slept75 minutes more per day,

(01:16:20):
increased their moderate tovigorous physical activity to uh
15 minutes per day, and addedvegetables and fruits to their
diet and eliminated allultra-processed foods.
So when they did that, overeight years it reduced their
all-cause mortality, which theytracked through the NHS records
of England by up to 64%.

(01:16:42):
The minimum effective dose,which was improvement of 10% of
reduction of all-causemortality, was all you had to do
is sleep uh 15 minutes, 35minutes longer per day.
Add 90 seconds of moderate tophysical activity per day, just
90 seconds, just to, I don'tknow, air squats or jumping

(01:17:03):
jacks, something where you starthuffing and puffing for 90
seconds, and just add a thirdcup of vegetable or fruit to the
diet that you're having withoutchanging anything else in your
diet.
That alone improves your alcosemortality by 10%.
We have no supplement that doesthat, we have no pill that does
that, we have nothing else thatmoves the needle that much with

(01:17:27):
just these minimal changes.
And all of these changes, theywill also reduce your HSCRP,
they will improve your glucosetolerance, your insulin levels,
your cortisol levels, I mean,everything.
You will just age more slowly,and that's why you're less
likely to die after eight years.
So if you look at these things,I always tell my patients before

(01:17:52):
you ask me about an NAD infusionor some supplement, have you we
have to check those boxes firstbecause those move those fill
90% of the bucket.
What they want is the other 10or 5% of the bucket with all
these longevity hacks, which wecall them today.
They're they're focused, hyperfocused on those hacks because

(01:18:14):
no one wants to put in the reps,do the work.
However, they don't know thatthey it's not even that hard,
you know, sleeping another 15minutes, adding 15 minutes to
your sleep, go and basically goto bed 15 minutes early earlier
every day.
Just do 90 seconds per day ofmoderate or vigorous physical

(01:18:35):
activity and just add, I don'tknow, three celeries or an apple
to your diet of whatever crappydiet you're already eating.
Go go to McDonald's.
I don't care what you do, justadd a little bit of fruits or a
little bit of vegetable, uh, notmuch, and you already reduce
your all-cause mortality by 10%.
What does that?
I mean, if you look at thehazard ratio, it falls into line

(01:18:56):
with quitting smoking andreducing your blood pressure.
It's insane.

SPEAKER_01 (01:19:00):
Yeah, no, I I totally agree, and I'm starting
this journey myself, and so I Iecho a lot of the same things
that that you're saying.
What I I I do have to leave injust a few minutes, but can I
give you my prescrip my microprescriptions for oral health?
Please.
Number one, everybody out there,go see your dentist on a regular

(01:19:20):
basis, at least twice a year,brushing, flossing twice a day,
and cleaning after every singlemeal.
Okay?
That's number one.
Number two, if you are can addsome small little life act to
your day, chew xylitol gum.
You know, I chew the neurogum,it's got a little bit of
caffeine, it's got a little bitof theanine in it, it gets me

(01:19:42):
going for podcasts like this.
It just makes sure that I'mhyper-focused and I can respond
to all the the interesting stuffthat the Dr.
Hammer's talked to me about.
And then number three, if youhave missing teeth, you should
replace them.
Okay.
This is something that I thinkthat if you can stick to those
three things, you're gonnamaximize your your oral health

(01:20:03):
from a longevity perspective.

SPEAKER_00 (01:20:06):
Very well said.
Thank you so much, Imran.
And I'm really happy that wewere connected because I think
this is a topic that I'm I'm aguilty as charge that I haven't
really, even though I shouldhave, but not uh dove into it
enough.

(01:20:26):
And I learned so much today fromyou.
So thanks for kind of opening myeyes to something that was right
in front of me.
I didn't really see the forestfor the trees.
And I think this is a bigger,has a bigger health implication,
not as far as general health,but also longevity and health
span than most understand, evenprofessionals.

(01:20:47):
I consider myself a professionaland I learned so much today.
I'm certainly going to integratethat even more aggressively into
my holistic approach in patientcare.
And we need advocates like youto talk about these and bring
awareness.
I think it's more important tobring awareness to our medical
colleagues because we asspecialists are always second or

(01:21:11):
third in line of the patient'sjourney.
I mean, the gatekeepers are theprimary cares and dentists that
I hope they're listening andtuning into this podcast.
And again, thank you so much.
How can someone get in touchwith you if they want to learn
more about what you do, whereyou are, what you're up to, or
just learn?

SPEAKER_01 (01:21:28):
Yeah, thanks so much for having me.
Honestly, I I I'm gonna hit youup after this for all of your
longevity recommendations.
I want to I want to know moreabout how I can get that.
And also, if you're ever in theBoston area, I'd love to work
out with you.
Like I I see on your Instagramand like you're always working
out with all these longevityinfluencers.
So you know, that'd be awesomeif you're ever in Boston.

(01:21:48):
That being said, I'm onInstagram.
My my Instagram is the Doctor isAwesome.
I also have a podcast called TheFuturist Society, and
specifically through Tufts, wehave a podcast called
Perspectives and Oral Health.
But also I'm on LinkedIn, justlook me up, Imron Awson, and uh
I'm always putting out contentthat I consider to be
revolutionary in regards toconnecting oral health and

(01:22:10):
systemic health.

SPEAKER_00 (01:22:11):
Love that.
And I'll put all those in theshow notes.
And if you have any questions,please comment.
And yeah, I would love to meetup with you.
My brother just left Tufts, hewas actually at Tufts Medical
School, the head of cornea andophthalmology, and he just moved
to Tampa, Florida, to FSU.
He took the chairmanship there,but he was for many years there.

(01:22:34):
I was myself, Boston was myfirst port that when I arrived
from Germany.
I went to Harvard, did oralpathology there.
That was 25 years ago.
So Boston is very near and dearto me.
It still feels like home sinceit was my first port of entry,
and I spend a lot of time there,and I have a lot of friends, and
definitely will come and visit.

(01:22:56):
And, you know, maybe we can dosomething together in the future
and uh love to connect with you.
Thank you.

SPEAKER_01 (01:23:01):
Thanks, man, and thanks to the audience.
You know, I I I reallyappreciate hearing Daria, but I
we wouldn't be here without youguys.
So thanks so much to everybody.
Have a great day, everybody.
Thank you, thank you, Iran.

SPEAKER_00 (01:23:16):
All right, guys, show's over.
Thanks for listening to theDaria Hammer Podcast, and thank
you to Dr.
Imran Asin for sharing hisexpertise.
If this helped you, pleasefollow the show and leave a
quick review and rating on ApplePodcast or Spotify.
It literally takes 15 secondsand makes a huge difference for

(01:23:39):
visibility so more people canbenefit from the knowledge my
guests bring.
Show notes and protocols are inthe description.
For deeper dives, subscribe tomy newsletter.
I'm Dr.
Daria Hamra.
Stay curious, take action, andI'll see you next time.
Bye bye.

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