1. C214
TREATING PATIENTS WITH CARDIOVASCULAR
DISEASE
JAMES LICHON, RPH, DDS, CCL
FRIDAY, FEBRUARY 22
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3. James F. Lichon RPh,DDS,NCCM
Risk Factors That Weaken
The Endothelium and the Fibrous Cap
Diabetes High Toxic Mechanical Food Sedentary
Cholesterol (nicotine) (hypertension) choices lifestyle
RUPTURE OF PLAQUE
The more risk factors, the faster the
development of the plaque
What Increases the Strength of the CORONARY ARTERY SPASM
Endothelium and the Fibrous Cap
MAGNESIUM DEFICIENCY
COCAINE –AMPHETAMINES
Cholesterol, diabetes, and blood HEART CATHETERIZATION
pressure medicine CIGARETTE SMOKING
COLD
No smoking
STRESS
Exercise
Good diet
1

4. ADVERSE EFFECTS OF STENTS
(24-48 hours)
Acute access site pain with hypotension
Thrombus (blood clot)
Coronary artery spasm
Arrhythmias
Heart attack—4%
Cardiac mortality—1%
Bypass Surgery ADVERSE EFFECTS OF BYPASS
SURGERY
Cognitive Impairment-short term memory
loss, depression
Stroke or MI—5%-6%
Death—3%
Insomnia
Flashbacks
Infection
Neither coronary angioplasty, Dental Implications for Patients
stents, nor cardiac bypass surgery with Stents and Bypass Surgery
is curative for coronary artery
disease. They do relieve symptoms
but do not treat the cause.
JAMA, NOV. 10, 2010-Vol 304, No.18
INR < 3
Do Not Stop Taking Medication Without a
Cardiologist Approval
2

5. Valve replacement—no appointment for
Patients who stop taking aspirin are at a
6-12 months
significantly increased risk of MI than
those who continue treatment.
Stents and open heart surgery—no British Medical Journal July 19, 2011
appointment for 6 months
Contact cardiologist
for an update
Depression SUDDEN CARDIAC DEATH
15% to 20% of post heart attack, stent, bypass
patients have major depression
65% have one symptom of depression
Under diagnosed--only 20-30% diagnosed
Depression and heart disease
are a lethal combination
Dental Implications
Excess plaque
Tardive Dyskinesia
SUDDEN CARDIAC DEATH IN SUDDEN CARDIAC DEATH IN
YOUNG ATHLETES YOUNG ATHLETES
Congenital Coronary Artery Anomaly
3

6. ISCHEMIC STROKE CAROTID EXAM
COROTID DOPPLER EXAM PERIPHERAL VASCULAR DISEASE
Often Underdiagnosed
WHO IS AT RISK FOR PERIPHERAL LOWER EXTREMITY VASCULAR
VASCULAR DISEASE DISEASE QUESTIONNAIRE
• SMOKERS Do your calves, thighs, or buttocks get
• DIABETIC cramped, painful, heavy or tired when you
• OVERWEIGHT walk, and does the pain stop with rest?
• NOT EXERCISING Do you have leg pain mostly at rest or when
• OVER AGE OF 50 standing for long periods?
• HIGH CHOLESTEROL Do you have pain, numbness, or tingling in the
• HIGH BLOOD PRESSURE toes?
• THOSE WHO HAVE EXISTING CVD Do your toes ever become blue, black or red?
• FAMILY HISTORY OF HEART DISEASE Do you have sores on your legs or feet that heal
slowly or do not heal?
4

7. Ankle-brachial index test for More women die from CVD then from all
cancers combined.
peripheral vascular disease
Women schedule mammograms but skip
lipid (cholesterol) profiles and blood-
pressure checks
Treatment with exercise (walking),
aspirin, statins, stents, or surgery
HEART DISEASE SYMPTOMS IN WOMEN 2/3 of the deaths from heart attacks occur
among those women who have no
symptoms or don’t recognize the symptoms
Chest pain, but less severe then men
Neck, shoulder, upper back discomfort Diagnostic tests in women not as accurate
Lightheadedness or dizziness as those in men
Shortness of breath
Unusual fatigue
Sweating
Nausea
Women may have less blockage in main WHITE BLOOD CELLS
arteries but more in small vessels called All white blood cells are known as LEUKOCYTES
“microvascular disease”
Shortness of breath Leukocytes are divided into 3 classes:
1. Granulocytes-Neutrophils, eosinophils, basophils
Unusual fatigue 2. Monocytes-evolve into macrophages
3. Lymphocytes-2 kinds
Lack of energy A. B cells—produce antibodies
B. T cells—help destroy infected cells
Neck, shoulder,
back discomfort
5

8. Inflammatory Cells
Monocytes, Macrophages,
Lymphocytes
Cytokines-- pro inflammatory
IL-1, IL-6, IL-8, TNF-1, Interferon
CYTOKINES
MMP(matrix metalloproteinase)
Cytokines-- anti-inflammatory
IL -4, IL-10, IL-11, IL 13,
TNF-2, MMP-1
SELF AND NON-SELF CYTOKINES AND PERIODONTAL DISEASE
CYTOKINES AND RHEUMATOID ARTHRITIS EXAMPLES OF AUTOIMMUNE
DISORDERS
Addison's disease
Celiac disease - sprue
Dermatomyositis
Graves disease
Hashimoto's thyroiditis
Multiple sclerosis
Myasthenia gravis
Pernicious anemia
Reactive arthritis
Rheumatoid arthritis
Sjogren syndrome
Type I diabetes
EMBREL, REMICADE, HUMIRA , ACTEMRA
6

9. IS PERIODONTAL DISEASE Rheumatoid Arthritis and the
AN AUTOIMMUNE DISEASE? Temporomandibular Joint
SJOGREN SYNDROME
CHOLESTEROL
• A chronic autoimmune inflammatory connective tissue
disease
• Majority of people with SS are middle-aged women
ALWAYS in Animals
• Dry eyes, dry mouth and lips, swallowing complaints,
fatigue, tongue changes, and overgrowth of Candida
NEVER in Plants
Other causes of dry mouth
antidepressants
antipsychotics
antihypertensives
antihistamines
Venus Williams
Why is Cholesterol Good?
For normal structure, function and repair
of cell membranes
For nerve conduction and brain function
Precursor for steroid hormones, e.g.
testosterone, estrogens
Precursor for bile acid
Precursor for Vitamin D
Heredity
7

10. Factors That Affect Your Fewer than half the adults diagnosed with high
Cholesterol Levels cholesterol knew whether they had ever been
tested for thyroid disease, despite the well-
Sedentary lifestyle documented connection between the two
conditions
Diet
American Association of Clinical Endocrinologists January, 2011
Weight Symptoms of Hypothyroidism
Diabetes Weight gain
Fatigue
Heredity
Depression
Dry skin
Feeling cold
Muscle cramps, joint pain
FAMILIAL HYPERCHOLESTEROLEMIA
Disorder of high LDL (bad) cholesterol that is passed down
through families. Can cause heart attacks at an early age
and premature death.
Blood tests may show:
Total cholesterol > 300mg/dl in adults
LDL levels > 220mg/dl in adults
IT’S IN THE GENES, NOT THE DIET
Very common disorder: 1 in 300-500
(heterozygous) ONLY 15% DIAGNOSED
Stormie Jones
• Age 6 diagnosed with HFH,
“homozygous familial
hypercholesterolemia”
–TC 1200 mg/dl (less then 160)
–TG 150 mg/dl
–LDL 1130 mg/dl (normal 120 g/dl)
–Progressive xanthomas
• Age 6 yr 6 mo. Angina and double
coronary bypass
• Age 6 yr 8 mo. Second bypass
• Age 6 yr 9 mo. Heart failure
• Age 6 yr 9 mo. Combined heart
and liver transplant
–TC dropped to about 250 mg/dl
8

11. “All substances are poisons, there is none
which is not a poison. The right dose
differentiates a poison from remedy.”
Paracelsus, 1493-1541
“the precursor of chemical pharmacology and therapeutics”
www.scientificamerican.com
DRUG INTERACTIONS WITH BELOW PRODUCTS
STATIN SIDE EFFECTS WHEN TAKING ZOCOR, LIPITOR AND MEVACOR
*CRESTOR, FLUVASTATIN, PRAVASTATIN, AND
• Muscle pain or damage LIVALO OK
• Liver damage
• Low testosterone levels
• Increased blood sugar or type 2 diabetes
• Neurological side effects
Headaches
GI distress
Myopathy
Rhabdomyolysis
DRUG INTERACTION WITH BELOW PRODUCTS WHEN
TAKING ANTIARRHYTHMIC MEDICATIONS
(AMIODARONE, DIGOXIN, BETAPACE, ETC)
P450 3A4
Ventricular arrhythmia
Sudden death
Cytochrome P450 3A4
9

12. Caution with Calcium Channel Blockers (3A4) What Can I Prescribe When Taking Zocor,
(Diltiazem, Verapamil, Felodipine, Nifedipine) Lipitor, Mevacor, antiarrhythmic medications
when prescribing or CCB?
Biaxin, Ketek
Amoxil--amoxicillin
Keflex--cephalexin
Ventricular arrhythmias Cleocin--clindamycin
Sudden death Vibramycin--doxycycline
Edema Flagyl--metronidazole
YEAST (FUNGAL) INFECTIONS OF MUCUS MEMBRANE
• Amoxicillin (Coumadin)
Drug interactions of Diflucan, Sporanox, or Nizoral (3A4)
• Keflex--Cephalexin when taking Zocor, Lipitor, Mevacor, CCB
• Cleocin—Clindamycin or antiarrhythmic medications
• Erythromycin (Coumadin) (Crestor, Lescol, Pravachol OK)
• Z-Pak—Azithromycin (Coumadin)
• Biaxin—Clarithromycin (Coumadin)
• Vibramycin-Doxycycline (Digoxin, Sun,
Vit A, Amoxicillin, Methotrexate, Coumadin)
• Periostat (low dose doxycycline-20mg)
• Flagyl--metronidazole (Coumadin, alcohol) ----------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------
Mycelex troche (clotrimazole-4-5x/d)
Nystatin S&S
Factors Predisposing To Candida albicans ORAL SIDE EFFECTS-STATINS
(KNOW THE CAUSE) Angioedema—Crestor, Lipitor, Zocor,
Dentures Lescol, Mevacor
Also from antibiotics, BP medicines (Ace
Antibiotics inhibitors & renin inhibiting agents), insect
Steroids bites, food (shellfish, nuts)
Smoking
Diabetes
Xerostomia
Dysfunction of certain cranial nerves
Radiation
Alteration of taste, impairment of extraocular
HIV-AIDS movement, facial paresis
Nutritional deficiencies (iron, folate, B12)
10

13. Drug-Induced Gingival Hyperplasia
NEW REVISED GUIDELINES FOR
Calcium Channel Blockers
Amlodipine (Norvasc)
ASPIRIN –PRIMARY PREVENTION
Nifedipine (Procardia)
Verapamil (Calan)
Aspirin—uncertain value for primary
prevention except for high risk patients.
Antiseizure Drugs (HTN, smoking, diabetes)
Phenytoin (Dilantin)
Carbamazepine (Tegretol) Always check with your doctor
Immunosuppressive Agents
Cyclosporine (Neoral)
NEW REVISED GUIDELINES FOR NARCOTICS
ASPIRIN –SECONDARY PREVENTION
Vicodin —Hydrocodone/Tylenol—5/500
Patients with prior history of CVD, or Vicodin ES—Hydrocodone/Tylenol7—7.5/500
ischemic stroke should be Vicoprofen—Hydrocodone/Ibuprofen—7.5/200
on aspirin Tylenol with Codeine—#3 and #4 (300mg Tylenol)
Fiorinal with Codeine-(butabarbital, aspirin 325mg,
caffeine, codeine 30mg)
Always check with your doctor
Percodan—Oxycodone/Aspirin—5/325
Percocet—Oxycodone/Tylenol—2.5/325, 5/325, etc
Physicians’ Health Study showed that Demerol—Meperidine 50,100mg
taking aspirin every other day also works
CAUTION--NARCOTIC SIDE NSAIDs
Nonsteroidal Anti-Inflammatory Drugs
EFFECTS WITH:
Aspirin—81mg, 325mg, 500mg, 650mg
Antidepressants: Elavil, Wellbutrin, Celexa,
Lexapro, Zoloft, Serzone, Effexor, Prozac, etc. Ibuprofen (Motrin—Advil) 200mg OTC--400, 600,
800mg Rx
Antipsychotics: Clozaril, Holdol, Lithium,
Abilify, Seroquel, Zyprexa, Thorazine, etc. Naproxen (Aleve) 220mg OTC--250, 375, 500mg Rx
*20-30% develop upper GI bleeding
Symptoms: slow heart rate, confusion,
respiratory depression, etc.
11

14. Do not prescribe NSAIDs during the NSAIDs (not aspirin)
last 6 to 8 weeks of pregnancy Nonsteroidal anti-inflammatory drugs
1. Increase CV events and stroke
September 8, 2010 – European Society of Cardiology
Prolonged gestation
2. Exacerbation of heart failure
Premature closure of ductus arteriosus
3. Effect on kidneys and salt retention
Cause maternal and fetal complications
4. Increase BP and worsen control of HTN
Miscarriage
Tylenol and Codeine is
safe during pregnancy
BLACK BOX WARNING DENTAL IMPLICATIONS WHEN
PRESCRIBING NSAIDs
Cardiovascular Risk
NSAIDs may cause an increased risk of serious
cardiovascular thrombotic events, myocardial
In patients with prior heart attack, most
infarction, and stroke, which can be fatal. This risk may (NSAIDs), not aspirin, even when taken
increase with duration of use. for as little as one week, are associated
with an increased risk of death and
Gastrointestinal Risk
recurrent heart attack.
NSAIDs cause an increased risk of serious
May 9, 2011 Circulation
gastrointestinal adverse events including bleeding,
ulceration, and perforation of the stomach or
intestines, which can be fatal. Naproxen may be best choice
Elderly patients are at greater risk for serious
gastrointestinal events.
DENTAL IMPLICATIONS WHEN DENTAL IMPLICATIONS WHEN
PRESCRIBING NSAIDs PRESCRIBING NSAIDs
Caution when prescribing---- Caution when prescribing----
Patients taking Methotrexate (kidney & bone
• Patients taking ACE inhibitors (Vasotec, Zestril) marrow toxicity, stomatitis, fatality)
• Patients taking ARB (Atacand, Cozaar)
• Patients taking CCB (Norvasc, Cardizem) Patients taking anticoagulants (Coumadin,Plavix)
• Patients taking Diuril, Laxix (renal function) Rx—Tylenol with Codeine or Vicodin
• Patients taking Digoxin (irregular heartbeat)
Patients taking aspirin-- increased risk of GI
• Patients taking Lithium ( tremors, confusion, bleeding and decreases the cardio protection of
muscle weakness)
aspirin (naproxen does not interfere with aspirin)
12

15. 325mg 500mg 650mg
50% of all sudden (acute) liver failure in US
caused by Tylenol--ck pt for liver disease
Maximum adult dose = 3000 mg/day
New FDA Limits on Maximum dose of Study: Tylenol and Ibuprofen May
Acetaminophen Cause Hearing Loss in Women
The FDA announced new limits on the dosage of
Taking ibuprofen or acetaminophen regularly
acetaminophen (Tylenol) because of serious liver
impairment. FDA limits drugs containing Tylenol to was associated with increased risk of
limit dosage to 325 mg in prescription medicine. hearing loss in women, and the risk generally
increased with the frequency of use
J of EpidemiologyVolume 176 Issue 6 September 15, 2012
Issued February 9, 2011
Deadline January 2014
HEART-FRIENDLY MEDICINES
TYLENOL (ACETAMINOPHEN) 500MG
MOTRIN OR ADVIL (IBUPROFEN) 200MG
13

16. No drug produces reliable NEW ANTICOAGULATION DRUGS
pain relief in every patient TO REPLACE COUMADIN
Rivaroxaban—Xarelto (3A4)
Apixaban—Eliquis (3A4)
Dabigatran—Pradaxa (renal)
*Check with physician
Caution with aspirin, ibuprofen, naproxen, Z-Pak
Ketek, Biaxin, itaconazole, ketoconazole (3A4)
OMEGA 3 FATTY ACIDS
Essential fatty acids
Mayoclinic.com
Epocrates
(downloadable app)
The 2 Active Components in The 2 Active Components in Omega 3
Omega 3 are DHA and EPA are DHA and EPA
•
•
• 1300mg 600mg
•
•
14

17. LOWERS TRIGLYCERIDES
HOMER
2752 mg
CARDIOVASCULAR HEALTH OMEGA-3 AND DEPRESSION
SECONDARY PREVENTION
American Psychiatric Association
Systematic reviews of EPA + DHA found concluded there is evidence for EPA-
that dietary supplementation reduced DHA based on DBRCT as an adjunctive
the risk of cardiovascular deaths, therapy for major depressive and bipolar
fibrillation, and non fatal cardiovascular disordes.
events.
*Check with your doctor Freeman MP et al J Clin Psychiatry 2006
Archives of General Psychiatry Feb.2010
Clin Cardiol. 2009 Jul:32(7)365-72
HFSA Scientific Meeting Sept20, 2010
Mayo Clin Proc.2011:86(7):626-632
RHEUMATOID ARTHRITIS MACULAR DEGENERATION
Studies (2500 patients – 7 years) shows
Trials have demonstrated a range of that omega-3 fatty acids slows the
benefits in patients with RA that progression of vision loss from age-
include reducing joint pain when used related early macular degeneration and
as an additive with NSAIDs (ibuprofen, reverses the signs of dry eye syndrome.
naproxen, aspirin). SanGiovanni JP Arch Ophthalmol. 2008 Sep:16
Arch Ophthalmol. 2011 July, Vol 129, No. 7
Calder PC, Proc Nutr Soc. 2008 Nov:67
15

18. OMEGA 3 AND PERIODONTAL DISEASE OMEGA 3 AND PERIODONTAL DISEASE
9182 adults aged 20 years or older The result of this clinical study suggest that
Conclusion: higher intakes of DHA/EPA dietary supplementation with Omega 3 may
were associated with lower prevalence of provide a sustainable, low-cost intervention
periodontal disease. to augment periodontal therapy.
Sharkawy H, J.Periodontol. 2010 Nov:81(11):1635-43
Kaye, E. J Am Diet Assco. 2010 Nov:110 (11) 1650-52
SIDE EFFECTS OF FISH OIL Heart Health: 1000mg-1200mg DHA+EPA
Increased risk of bleeding—minimal –ck coumadin
High Triglycerides: 4000mg DHA+EPA
Heavy metals and other pollutants-China and India
Increase in LDL and total cholesterol Rheumatoid arthritis: 2500mg DHA+EPA
Stomach upset Children (1-5 yrs): 300mg-400mg DHA
After taste Mental Health: 1-2000mg EPA or EPA+DHA
Burping
Prenatal: 250-350mg DHA
Diarrhea
Vision: 800mg DHA or 1000mg DHA+EPA
To minimize: Periodontal disease: 1-2000mg EPA+DHA
• Take with meals
• Start with low dose
• Keep in refrigerator
MULTIVITAMINS
A 4 billion dollar business
Lots of Types
Consumers Lab (June 2011)
Lots of Confusion 10 of 38 multivitamins tested contained
either more or less of what the label
indicated
16

19. PHYSICIAN HEALTH STUDY-2 MULTIVITAMIN USE AND RISK OF
PRIMARY PREVENTION CANCER AND CARDIOVASCULAR
DISEASE IN WOMEN’S HEALTH
1997-2007, 15,000 physicians
INITIATIVE COHORTS (1997-2005)
Results— Vit.E and Vit.C no effect on 8 YEARS, 66,000 POSTMENOPAUSAL WOMEN
CVD, prostate or total cancer MULTIVITAMIN USE HAS LITTLE INFLUENCE
ON THE RISK OF COMMON CANCERS, CVD,
The multivitamin component will OR TOTAL MORTALITY.
continue for a few more years. ARCHIVE INTERNAL MEDICINE, 2009
$625 million NIH
Multiple Vitamins (may benefit)
Those who have chronic gastrointestinal disorders
Those who fail to get the right amount and type of
We found no evidence to support food for proper nutrition
antioxidant supplements for primary or People with a chronic illness
secondary prevention. Vitamin A, beta- Women who are pregnant
carotene, and vitamin E may increase Alcoholism
mortality.
January 20, 2010
PRENATAL VITAMINS DEFICIENCIES AS WE AGE
VITAMIN B12
Folic acid (B9)in prevention of
neural tube or spinal defects
Vitamin B12 (cobalamin) deficiency is
particularly common in elder adults
Prevention of low birth weight
Development of RBC
Development of nerve cells
Helps support growth of placenta
Aid in production of DNA and RNA
Vitamin B12 deficiency may be Aid in production of
cause of infertility or neurotransmitters
spontaneous abortion 400mcg/day
17

20. Causes of vitamin
B12 deficiency Symptoms of vitamin
B12 deficiency
• Abdominal or intestinal surgery
• A diet low in vitamin B12 (a strict vegetarian diet) Anemia, fatigue, tiredness
• Chronic alcoholism Neurologic (muscle weakness, unsteady gait,
• Crohn’s disease, atrophic gastritis, Celiac disease, numbness or tingling in fingers or toes—DM or B12)
hypothyroidism (40%), Metformin (Glucophage) for type
Psychiatric symptoms (dementia, cognitive
2 diabetes
impairment, psychoses, depression)
• PPI (Nexium, Prilosec, Prevacid) acid blocking
medication Dental (bleeding gums, sore mouth and tongue)
• Elderly people (common deficiency 15-20%) Lab test—methyl malonic acid
ATROPHIC GLOSSITIS
(Smooth Tongue) ANGULAR CHEILOSIS
Nutritional deficiency
Nutritional deficiency • Vit B12
• Vit B12 • Folic Acid (B9)
• Folic Acid (B9) • Riboflavin (B2)
• Riboflavin (B2) • Niacin (B3)
• Niacin (B3) • Iron
• Iron • Celiac Disease
• Celiac Disease--1 in 133
(gluten intolerance)
BLEEDING GUMS-poor oral hygiene or…..
RECURRENT APHTHOUS ULCERS
 Vitamin B12
 Vitamin K
Nutritional deficiency  CCB (Norvasc, Cardizem)
• Vit B12  Pregnancy
• Folic Acid (B9)  Blood thinners (Coumadin)
• Riboflavin (B2)  Chemotherapy agents
• Niacin (B3)  Leukemia
 Birth control pills
• Iron
 Immunosuppressant drugs (Cyclosporin)
• Celiac Disease  Antidepressants (Zoloft, Celexa, Lexapro + NSAID)
18

21. BURNING MOUTH SYNDROME
VITAMIN D
 Iron
 Zinc
 B vitamins—B1, 2, 6, 9, 12
 ACE inhibitors---Lisinopril
 Diabetes
 Allergies
 Hypothyroidism
 Hormonal imbalance---menopause
Check “mayoclinic.com”
DEFICIENCY OF VITAMIN D
Use of sunscreen
Liver or kidney problems
Aging-decrease provitamin D because of
thin skin (75%) .
GI disorders—Crohn disease, ulcerative
colitis, Celiac disease (gluten induced)
Hyperthyroidism and hyperparathyroidism
No sun—Northern climate
MUSCLE SORENESS*
Low vitamin D—muscle pain- fall rates
Statins (Zocor, Lipitor, etc--10%-15%)
Peripheral vascular disease
Vitamin B12 (low)
Magnesium (low)
Celiac Disease
Hypothyroidism
If your shadow is longer than you are Bisphosphonates
tall, you are not making any vitamin D Drug combinations
19

22. VITAMIN D and BALANCE Vitamin D is now recognized as important
for cardiovascular health and its deficiency
.Can present as severe bone pain, muscle
as a potential risk factor for several
weakness (hard to get off chair or climb up
stairs), and increased body sway that can lead cardiovascular disease processes.
Am J Cardiology 2010; 106: 798-805
to falls and hip fractures.
J Amer Col Cardiology July 2011; 58: 186-192
MACULAR DEGENERATION
High serum 25 (OH) D concentrations
may protect against early age-related
macular degeneration in women younger Vitamin D in the form of vitamin D3
than 75 years. seems to decrease mortality in
Arch Ophthalmol. Apr 13,2011:129(4):481-489 predominantly elderly women (mean age-
74 years).
Cochrane Database Syst Rev 2011 Jul 6; CD007470
VITAMIN D AND CANCER Mayo Clinic and Collaborators Find
16 year study, 88,000 women, found higher Vitamin D Levels are Associated with
intakes of vitamin D associated with lower Survival in Lymphoma Patients
breast cancer risk in premenopausal women Patients with deficient vitamin D levels
had a 1.5-fold greater risk of disease
Breast cancer--women with deficient progression and a twofold greater risk of
vitamin D levels (less then 20ng/ml) had a dying, compared to patients with optimal
60% increased risk of development of vitamin D levels
metastatic disease
Dec. 5, 2009
Journal Clinical Oncology, Vol 27, Page 3757-2009
20

23. PROSTATE CANCER AND
ANDROGEN DEPRIVATION THERAPY
VITAMIN D AND PROSTRATE CANCER
To reduce levels of male hormones (testosterone) which
stimulate the growth of prostate cells and fuels the growth of
cancer
Laboratory and population-based
Within 4 years of starting androgen therapy, 50% of men will
research suggest that adequate levels of have osteoporosis
vitamin D reduce the risk of developing More likely to have periodontal disease and osteoporosis
prostate cancer J Urology-2007 Mar, 177(3): 921-4
Johns Hopkins July 2009 Need to change lifestyle
- Smoking cessation
- Alcohol consumption
- Resistance exercise
- Calcium and vitamin D supplements
*Depends on lab test of Calcium and Vitamin D
VITAMIN D AND PERIODONTAL DISEASE VITAMIN D AND PERIODONTAL
“a low vitamin D concentration was DISEASE
independently associated with periodontal An observational study in the U.K. involving post-
disease.” menopausal women with osteoporosis found PD
Cleveland Clinic Journal of Medicine Aug 2009 “is more common in women with osteoporosis and
is associated with lower vitamin D and higher
concentrations of two cytokines, RANKL and MMP
J Periodontal Research. 2011 Feb
VITAMIN D VITAMIN D
Dose: 1000 to 2000 IU/day depending on lab
Do not take if have
studies
Liver disease
Kidney disease
Lab studies range (Mayo Clinic):
Hypoparathyrodism
10 ng/mL—severe deficiency
Hyperparathyrodism
10-30 ng/mL—mild to moderate
Sarcoidosis
30-80 ng/mL—optimum
*Always check with your doctor first
21

24. CALCIUM CALCIUM
Found naturally in dairy products, leafy
Builds strong structure of bones and teeth green vegetables, beans, and meat.
Muscle and blood vessel contraction
Secretion of hormones and enzymes May also need supplements since the
Transmit impulses thru the nervous system body cannot make calcium
CALCIUM SUPPLEMENTS CALCIUM SUPPLEMENTS
Take with magnesium if blood test shows it is low
Calcium carbonate
Least expensive Do not take with thyroid, Dilantin, cortisone,
Must be taken with food bisphosphonates, thiazides, Vibramycin/Periostat
(take 4hours before or 4 hours after taking Ca)
Calcium citrate
Best if have low gastric acid Those who have liver disease, kidney disease,
production and those taking high or low parathyroid levels, talk with Dr. first
Nexium, Prevacid, Prilosec, to
block stomach acid
Do not need to take with food
NEW DATA, MORE DEBATE CALCIUM SUPPLEMENTS MAY BE
BAD FOR YOUR HEART
New studies linking calcium supplements to:
Those who consumed 820mg/day had a 31%
• Increased risk for heart attack and stroke
lower risk of heart attacks then those who
• Vascular calcification consumed less from their diet.
• Kidney stones
Those who got calcium from
BMJ APRIL 2010
supplements were twice as
likely to have a heart attack as
OhMyGosh those who took no supplements
I have been taking to much 24,000 people for 11 years
Heart: May 23, 2012
22

25. WOMAN’S HEALTH INITIATIVE CALCIUM INTAKE: MORE IS NOT BETTER
Calculate how much you are eating
Women who took 1000mg of calcium daily through food and balance off the rest with
had 17% more kidney stones then those supplements so it equals 1,200 milligrams
who got a placebo of calcium a day for women older than 50.
36,000 women/ 15 years
Caveat –women were allowed to
eat their usual diet, so calcium
intake was unknown
RISK FACTORS FOR OSTEOPOROSIS DRUGS ASSOCIATED WITH LOW
BONE MINERAL DENSITY
• Aging and estrogen deficiency Steroids
• Smoking, alcohol Antiepileptic drugs (Dilantin, Tegretol, Neurotin)
• Sedentary lifestyle Nexium, Prilosec, Pepcid, Zantac
• Low vitamin D Coumadin
Actos or Avandia
• Gastric bypass
• Type 1 diabetes
ACTONEL, BONIVA, FOSAMAX
Calcium and vitamin D supplementation
had a modest positive effect on periodontal Arthritis of the joints (primarily in the
health on those subjects receiving jaw) has been reported in patients taking
periodontal maintenance therapy. bisphosphonates.
J Periodont 2011:82:25-32
Bisphosphonates may
cause bone, joint, and
muscle pain.
23

26. A Manual of Physical activity and eating a proper diet can
Laboratory and mitigate progression of chronic disease and in fact
Diagnostic Tests reverse existing disease
by
Frances Fischbach
Lab Tests
• Vitamin B12
• Vitamin D
• Calcium
• HgA1c
• Iron
• tTGA
Whole grains contain the
germ, bran, and
endosperm.
Refined grains retain only
the endosperm
Gluten is the protein part
of the endosperm
(83% of the kernel)
*cause of celiac disease
CELIAC DISEASE an
ORAL MANIFESTATIONS OF
AUTO IMMUNE DISEASE
Symptoms CELIAC DISEASE
• Stomach pain • Recurrent aphthous ulcers
• Diarrhea • Atrophic glossitis
• Depression • Oral lichen planus
• Fatigue • Cheilosis
• Weight loss
• Osteoporosis
• Mouth sores
• Muscle cramps
• No symptoms
80% not diagnosed 1 out of 133 people
24

27. ORAL MANIFESTATIONS OF Let Them Eat Dirt: How Clean Environments
May Set Up Kids for Immune Problems
CELIAC DISEASE
Enamel Defects in Children
WHOLE GRAINS
WHITE OR WHEAT FLOUR
• Rolled oats
• Whole wheat flour
BRAN AND GERM OUT • Whole rye
THIAMIN (B1), RIBOFLAVIN (B2), NIACIN (B3) • Brown rice
ZINC, FOLIC ACID, MANGESIUM, COPPER • Wild rice
• Whole cornmeal
PHOSPHORUS, IRON, CALCIUM,SODIUM,
• Popcorn
AMINO ACIDS, ANTIOXIDANTS, FIBER, PLUS • Barley
15 MORE • Quinoa
• Spelt
INTO THE BREAD • Couscous
• Amaranth
VITAMIN B1, B2 , B3, IRON, FOLIC ACID
• Wheat berries
(Molasses or Carmel)
WHOLE GRAINS REDUCE
HEART DISEASE
STROKE
CANCER Wheat flour Durum wheat
DIABETES Unbleached flour Enriched flour
Semolina Multigrain
OBESITY Cracked wheat
DON’T BE TRICKED
THESE ARE NOT THE SAME AS
“WHOLE WHEAT” or “MULTI-GRAIN WHOLE GRAIN”
25

28. Cold Cereals Hot Cereals
Mostly refined Mostly refined
Whole grain Whole grain
grain grain
Cheerios Basic 4 Oat bran Cream of rice
Granola or muesli Corn flakes Oatmeal Cream of wheat
Grape-Nuts Frosted Flakes Quaker Multigrain Grits
Nutri-Grain Just Right
Ralston High •
Fiber
Raisin bran Kix, Corn Pops Roman Meal •
Shredded wheat Product 19 Wheatena
Total Puffed wheat
Wheat germ Rice Krispies
Wheaties Special K
• 51
51 Gm Sugar=17 packets
IF YOU WANT TO BE FUNCTIONAL See a physical therapist first if you
AT 80 have joint problems
YOU NEED TO START AT 50 Don’t compare yourself with others
Keep track of your progress
Be realistic. Set goals loosely
Forget the past
Check with your Dr.
26

29. Benefits of Exercise Women who walk 2 or more hours a
week, especially at a brisk pace, are
Improves
• Mood
significantly less likely to experience
• Self confidence any type of stroke than women who do
• Sense of well-being
• Have a better sex life!
• Post surgical not walk.
recovery is faster
• Increases weight
loss Woman’s Health Study 4-13-2010
• Emphysema
Reduces 39,315 women, 45 years or older
• Increases joint
• Stress
function-arthritis
• Depression
• Anxiety
Decreases
• Blood pressure
• CHD by 30%
• Blood sugar
• Stroke by 30%
• Bone mineral
• Type II Diabetes by 30%
loss
• Medication dosage
Pedometer Benefits of using Pedometers
Helps you realize just how active you are
(or are not) in your everyday life
Gives you a visible cue to see how far you
are walking
Acts as a motivator
Inspiration on a
daily basis
Impact of Physical Activity on Cancer EXERCISE AND BREAST CANCER
PRIMARY PREVENTION
Accelerates movement of
food through intestine, Increasing physical activity, even if
reducing time bowel lining is
exposed to mutagens. started later in life, reduces overall
risk of developing breast cancer by
20%.
Reduce risk of colon, breast,
C Brown et at M.C. Anderson Cancer Center 2009
prostate, and other cancers
27

30. Primary and secondary prevention Exercise does not have to be a workout at the gym
of hormone driven cancers Health clubs provides instruction, supervision,
equipment, and motivation
Exercise
The key is doing some type of moderate exercise
Vitamin D routinely--time of day
Good diet
Lose weight
9 MONTHS!!!!!
A Dip in the Pool Does an Aging
By the age of 65, many seniors have Body Good
lost 30-40% of their muscle mass Swimming reduces blood pressure, improves
artery health and boosts endurance in COPD in
elderly adults American Journal of Cardiology July, 2011
Aging Exercise is Medicine
Progressive weight gain
Decreased metabolism
Loss of muscle mass
Decrease in pancreatic beta-cell function
Adverse distensibility of the arterial tree
With No Side Effects
28

31. PROCRASTINATION PERSEVERANCE
jclichon@aol.com
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