Worldwide Stroke Rates Are Up

November 12, 2013

You may think that stroke is something you only see in older people, but strokes can also be seen in younger adults and even in children. A recent study published in The Lancet revealed that from 1990 to 2010, rates of new onset stroke, stroke survivors, and deaths from stroke increased 68%, 84%, and 26%, respectively. There were bigger increases in low and middle-income countries, and in people younger than 75. 

There are lots of different reasons for stroke, including your genes, lifestyle habits, diet and exercise, but I wonder how much of an underlying sleep-breathing condition may be contributing, as more countries adopt Western style foods and habits. It’s remarkable how our younger generations have more dental crowding and smaller jaws, which lead to more narrow upper airways.

Which Comes First: Depression or Weight Gain?

June 3, 2013

Weight loss is probably now America’s pastime, surpassing baseball. Studies have suggested that if you are depressed and overweight, losing weight may help with depression. Other studies found that behavioral weight loss programs led to improvement in depression even without any weight loss. Here’s an article by a family physician who argues that undergoing a weight loss program in the midst of clinical depression is like running an entire marathon with a sprained ankle. 

While there may be some value in Dr. Freedhoff’s answer, I have a better suggestion: Get tested and treated for possible obstructive sleep apnea. There are now numerous studies that suggest that obstructive sleep apnea can predispose to both depression and weight gain. Having narrowed jaws and dental crowding prevents proper breathing at night while sleeping. Poor sleep in general has been found to lead to weight gain, which can narrow the throat even further. Not getting good sleep (especially deep sleep) can definitely cause symptoms of anxiety or depression. The rate of undiagnosed obstructive sleep apnea is so high in this country (~80%) that it should be a mandatory test for everyone, just like testing for high cholesterol or high blood pressure. 

I realize that some of you scientists are going to say that association does not imply causality. Show me the studies. Where’s the proof? 

Here’s my answer: For the next one year, sleep one hour less every night. Document your mood status and weight at the start and at the end of the year. Please post back the results of your experiment.


Culinary Practices And The Modern Human Bite

March 28, 2013

Dr. Weston Price showed that cultures that change from native to modern, Western diets produce jaws with more dental crowding, crooked teeth and more cavities. Others have shown that softer foods and even bottle-feeding can also promote dental crowding. Smaller jaws can lead to smaller airways, leading to a number of health problems due to poor sleep. Here’s an interesting perspective on how modern man’s bites have changed simply by eating in a more civilized manner: using table knives and forks. 

Staff writer for the New Yorker magazine Jane Kramer reviews a book by Bee Wilson, “Consider the Fork: A History of How We Cook And Eat.” On the third page of the online version, there a section where the author describes the work of American anthropologist Charles Loring Brace, who specialized in the evolution of hominid teeth. He dates the onset of the modern Western overbite at around 250 years. Prior to this human incisors lined up edge to edge, like a guillotine. Then all of a sudden, human jaws, especially in the more civilized areas (who used forks and knives to cut meat into bite-sized pieces), started to develop an overbite. This change happened too quickly to be as a result of evolution. Here’s an excerpt from Kramer’s article:

By the late eighteenth century in Europe, people were slicing their food into bite-size morsels and carrying them to their mouths with forks—those formerly weird things, Wilson calls them. And they hardly needed to chew such tiny pieces, which in most cases were already softened by pounding, overcooking, or long, gentle braisings. At the same time, the modern overbite began to appear prominently in upper-class Western European jaws. Do not confuse this with the seriously inconvenient condition known to the world as buck teeth (without which we would have no orthodontists, and no mortified adolescents with mouthfuls of rubber bands and wire braces). Wilson’s modern overbite refers to “the way our top layer of incisors hangs over the bottom layer, like a lid on a box,” as she nicely puts it, and is “the ideal human occlusion” for the way we now eat. Why this happened and how long it took to happen is open to some debate, but it’s clear that until it happened most humans had the bite of other primates—“where the top incisors clash against the bottom ones, like a guillotine blade.”

Wilson’s favorite theory comes from the American physical anthropologist Charles Loring Brace, a specialist in the evolution of hominid teeth. In 1977, Brace published an article that put the age of the Western overbite at no more than two hundred and fifty years—which is to say that flatware and, with it, a significant change in how we chewed were all it took for the edge-to-edge occlusion that we inherited from the Neanderthals to be replaced by the bite we now call normal. Brace was haunted by overbites. He had long assumed them to be an incremental and selective evolutionary change that began with agriculture and the consumption of grains. But the jaws he studied, on his way to building a database on the evolution of hominid teeth—apparently the biggest in the world—changed his mind. The transformation he’d seen in those eighteenth-century-gentlemen jaws was too abrupt, and too radical, to qualify as evolution, especially given the rapidity with which it then followed the spread of flatware into the middle classes, in the nineteenth century. In 1914, in the run-up to war with Germany, a stainless-steel alloy—developed to prevent corrosion in gun barrels—went on sale in Sheffield, England. Once stainless appeared on the country’s dinner tables, the guillotine bite all but disappeared. 

There have been further significant milestones in how to eat our food, what foods we eat, as well as how we feed our children. If you think about the implications of how quickly modern humans’ jaws have changed just in the past few hundred years, it’s a frightening thought. As our faces get smaller and our brains get bigger, what will we look like in 2000 years? Here’s a thought.

What do you think about Kramer’s article?

Does Slouching Make You Sad?

November 12, 2012

Here’s an article reporting on a study which suggests that slouching can make you sad. There’s no doubt that your body position and movements can affect the way you feel, but what about people who keep their heads pushed forward to be able to breathe properly? 

Which comes first, head-forward posture, leading to depression, or depression making you sad, leading to a head-forward posture?

Having smaller jaws and upper airways can definitely affect the way you sit, stand, and even walk. By not being able to get a good night’s sleep, it’s not surprising that you may feel sad or depressed.

How Finger Foods for Babies Can Prevent Obesity

February 10, 2012

Modern life leads to a number of unexpected consequences. Here’s an interesting study showing that infants that are weaned from liquid diets to finger foods rather than being spoon-fed pureé diets are much less likely to be obese later in life. In spite of the fact that infants in the spoon-fed group were offered more fruits, carbohydrates, vegetables and proteins, they wound up preferring  sweets more than the self-fed children. 

The most likely explanation is that early mechanical stimulation of the gums and teeth leads to more optimal dental and jaw development. This goes along with Dr. Corrucinni’s work showing that eating softer foods is associated with a higher risk of malocclusion and dental crowding. Dental crowding, by definition, increases your risk of obstructive sleep apnea by crowding your breathing passageways. Bottle-feeding can also aggravate dental crowding as well. 

Missing Teeth = Poor Health?

October 19, 2011

Ever since I began seeing patients in my new position at Montefiore medical center, I’ve been surprised by how many patients have missing teeth. In fact, many have no teeth at all, and often have to wear dentures, especially if they’re in the elderly years. Not too surprisingly, these same patients also have a number of chronic medical conditions, such as hypertension, diabetes, high cholesterol, heart disease, as well as numerous medications for these respective conditions. Many are obese.

Being in a major tertiary-care referral-based hospital, it’s expected that patients will have complex medical issues. But this observation only supports what dentists have been saying for years—that poor dental health equals poor general health. Not only do I see multiple missing teeth, there’s also significant jaw narrowing and crowding of the soft tissues of the mouth. Having smaller airways due to missing teeth and smaller jaws can aggravate significant medical problems, such as hypertension, diabetes, high cholesterol, and heart disease.

We’re seeing an epidemic of jaw underdevelopment these days, with dental crowding and numerous orthodontic and airway issues that arise as a result. The rise in premature babies, modern feeding habits, nutritional factors, and various toxins in our environment can prevent proper facial growth and development. It’s no wonder that we’re seeing increasing rates of ADHD, autism, and various other developmental delays. These are the same kids that will go on the develop high blood pressure, diabetes, obesity, high cholesterol, and heart disease later in adulthood.

You could argue that having bad teeth is a consequence of the particular population that we serve, but knowing what we know about the importance of proper jaw development and dental health, it’s likely that poor dental issues also predisposes people to chronic medical problems.


What do you think about my observations? 

How Breast Feeding Improves Children’s Behavior

May 10, 2011

There are numerous studies on the health benefits of breast feeding, and here’s another one that supports my sleep-breathing paradigm, that your overall state of health is directly proportional to how well formed your jaws are as you age (and subsequently your breathing passageways).

Researchers from Oxford University in the UK found that infants who were breast-fed for at least 4 months had a 33% less chance of having behavioral problems by age 5. They speculate that breast milk has higher amounts of healthy fatty acids, growth factors and hormones that contribute to healthier brain development.

The one thing that all these studies fail to address is that bottle-feeding can cause malocclusion and jaw narrowing. The smaller your jaws, the less room there is for your tongue, which can cause breathing problems when the infant is placed on his back. Add muscle relaxation from deep sleep, and you’re going to deprive infants of quality deep sleep which is vital for proper brain development. With the addition of back sleeping in infants to bottle-feeding, it’s likely that this combination is a major reason for the significant rise in pediatric developmental problems that are so rampant these days.

If you have obstructive sleep apnea, were you breast or bottle-fed as an infant?

Dog Sniffing, Sleep Apnea, & Facial Profiling

February 2, 2011

Someone just emailed me a link to an article showing that dogs can be trained to detect colon cancer in breath and stool samples, even in its’ early stages. He asked if this could be applied to sleep apnea. I though long and hard about this. There are so many metabolites in urine, stools, sweat, saliva, and even cerumen from untreated sleep apnea that could possibly be detected by dogs, but not any one of these substances would be specific, like cancer cells.

However, there’s an even easier way: Look at the person’s facial features. Look for narrow and/or recessed jaws, flat cheekbones, narrow nasal width, mouth breathing, or forward head lean. Inside the mouth, the classic findings would be multiple missing teeth, dental crowding, a high arched high palate, narrow and crowded dental arches, tongue scalloping, and a relatively large tongue that prevents you from seeing the uvula. Tongue scalloping alone has been found to predict apneas in 89%, oxygen desaturation in 89%, and abnormal AHI is 67%.

If you combine these exam findings which can take just a few minutes to observe, along with simple screening questionnaires such as the Epworth Sleepiness Scale or the STOP-BANG, you could probably screen for and pick out from 1/2 to 2/3 of all sleep apnea patients. Currently, it’s estimated that only about 10% of sleep apnea is diagnosed. Notice I didn’t mention being overweight, being male, or even the fact that you have to snore.

These days, I play an informal game with myself whenever I see patients. Just by looking at the medical history and external facial appearances, I try to guess who has sleep apnea versus who doesn’t. It’s scary, but I’m close to being about 95 to 98% accurate.

I know this may sound dangerously like facial profiling, but since I’m able to help many of these people breathe better and sleep better, I’ll continue to engage in this practice. Try it on yourself and then on your family members, and then on your friends. With some practice, you can be just a good as me.

Breast-Fed Boys Grow Up To Be Smarter

December 23, 2010

Here’s a study that showed that boys that were breast-fed as infants for at least 6 months do better in school compared with boys that were bottle-fed. Enhanced nutrients in breast mild and mother-infant bonding were thought to be reasons for this finding. Breast-fed girls also has mild increases in test scores, but the results were not statistically significant.

One major omission from the conclusion of this study is the fact that breast-feeding protects against developing obstructive sleep apnea. Dentists have long said that bottle-feeding promotes malocclusion and dental crowding. The smaller the jaws, the less room there is for the tongue, and the more often you’ll stop breathing at night.

Another important point is that pumped breast milk is not the same as breast-feeding. Unfortunately, our society and modern time don’t make it easy to exclusively breastfeed.

What are your thoughts on this? If you have sleep apnea, do you remember if you were breast or bottle-fed?

Good News For Breast-Feeding Moms

November 10, 2010

Here’s some good news for new moms: That women who breast-feed sleep the same amount as those who bottle-feed. This is an important issue since bottle-feeding has been shown to cause or aggravate dental crowding and malocclusions. Having smaller jaws (think smaller mouth) crowds the tongue and other soft tissues of the mouth and throat, aggravating or promoting obstructive sleep apnea.

This brings up a very sensitive issue, which implies that infants should be breast fed by using the natural breast, rather than pumping and using a bottle. Most modern women don’t have the luxury, time, or the resources to breast feed exclusively for 6 months or longer. Work schedules, caring for other children, and other demands of modern society makes breast-feeding difficult.

My feeling is that women (with spousal support) should do everything possible to breast feed, but shouldn’t feel guilty for not being able to do so. Everyone has unique circumstances, and ultimately, not everything we want to do is under our control.

What are your thoughts on this issue?

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