The Daria Hamrah Podcast
Welcome to The Daria Hamrah Podcast—where world-leading minds translate science into real-life tools for healthspan, performance, and aesthetics.
I’m Dr. Daria Hamrah. By day I’m a facial cosmetic and reconstructive surgeon and wellness enthusiast; the rest of the time I’m a teacher and relentless student of longevity. After years of speaking with colleagues and hearing your questions on social media, I launched this show to go deeper than headlines and quick takes.
Here’s what’s different. We’ll often take a single theme and stay with it—sometimes for an entire month—so you actually master it. That could be metabolic and mitochondrial health, sleep architecture, brain performance, strength and protein strategy, hormones across the lifespan, the microbiome and gut, skin longevity, oncology prevention, mental fitness, relationships, and purpose. Some episodes are solo—clear frameworks and clinic-tested protocols. Many feature world leaders in their fields: scientists, physicians, and founders pushing the frontier of health and wellness.
We’ll talk tools in plain language:
- Behavioral practices (what to do—and what to stop doing)
- Nutrition strategies and supplementation
- Business and Entrepreneurship in Healthcare
- How to navigate current trends and hypes withoug gimmicks
And this is a two-way conversation. Your comments, reviews, and upvotes guide what we cover next. Tell us what you want more of, and we’ll build it.
No hype. No one-note protocols. Just evidence, nuance, and practical steps you can start this week—whether you’re a clinician guiding patients or a motivated listener optimizing your own life.
Thanks for being here. Let’s redefine aging—and living—from the inside out.
The Daria Hamrah Podcast
From Mouth To Mortality: How Oral Health Shapes Your Future
Tweet me @realdrhamrah
IG @drhamrah
Alright, everyone, welcome to a new episode of the Daria Hamra Podcast, where we discuss science and science-based tools for everyday life, longevity, and real-world health span. This is your host, Dr. Daria Hamra. Today I'm joined by a colleague of mine out of Tufts University, Dr. Imran Asin, who is an oral and maxillofacial surgeon and pediatric craniofacial surgeon and researcher. In this episode, we unpack how mouth reflects and drives whole body health. We cover what an oral and maxillofacial surgeon actually does, the bidirectional links between oral health and systemic disease, new evidence connecting oral bacteria to a therosclerotic plaque, inflammation biology, and why your high-sensitivity CRP, which is HSCRP, matters, oral health and glycemic control in diabetes, how losing teeth shifts diet towards ultra-processed soft foods, and population data, including a Lancet analysis out of Tufts University, linking number of remaining teeth to all-cause mortality. That last topic is the centerpiece of today's conversation. Why tooth count and periodontal disease track with mortality risk on the order of other major risk factors, and what practical steps actually move those risks. We also discuss health span tools, why Japan's 20-teeth policy exists, for example, what the Swedish Twin Registry suggests about oral care and lifespan, pediatric red flags like snoring and mouth breathing, airway anatomy, orthodontic expansion, and when to intervene. Sleep apnea options from CPAP to hypoglossal nerve stimulation, breastfeeding, jaw growth and immune development via the oral gut microbiome, and the neuroscience of chewing, hippocampal activation, cognition, and why keeping the ability to chew may actually protect brain health. We close with a simple microprescription you can use today: 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 the specific actions that tie oral health to cardiovascular risk, metabolic control, cognition, quality of life, and ultimately to all-cause mortality. We have similar passion, as it seems, and I'm really excited, not just for our audience to hear what you have to say as far as oral health, your teeth, and longevity, but also personally I have I'm very interested just because it's something, it's a topic that's near and dear to me. To combine specialty of oral and maxulofacial surgery and oral health with longevity is something that you don't hear influencers or podcasters talk much about. It's almost like a side note, even in science. There's a lot of lack of science from our specialty, but also in other specialties like cardiology or longevity or geroscience medicine, there is it's almost like an asterisk. They mention it, but no one really talks about it, really. So I would love to hear what you have to say. You I know you do actively a lot of research, but before we get into the nitty-gritty and nuances, I want you to introduce yourself to the audience. First of all, what the hell is an oral and maxillofacial surgeon?
SPEAKER_01:Yeah, thank you so much, Daria. I really appreciate you being on having me on the podcast. It's something that I actually consume on my own. And to have the opportunity to talk to you and pick your brain is really special. So an oral and maxillofacial surgeon is a surgeon that operates everything from the neck up. We have a background in dentistry, we have a background in medicine. I personally have a dental doctorate and a medical doctorate. So we're going out there and we're fixing people's jaws, we're treating infections, we're treating oral cancer. And there's only 7,000 of us in the entire US. And so it's not as well known of a specialty as things like neurosurgery or orthodontics in the respective medical and dental fields. But it's a very important field. It's something that most people will see an oral and maxillofacial surgeon in their lifetime. If any of you guys have had a tooth removed or have had an implant placed or needed corrective jaw surgery that are out there in the in the audience, you know exactly what we're talking about, but many people don't. It's something that they might see us very infrequently. We fix the problem and they move on to their next issue of in their own prospective lives. That being said, it's very important that I think that we highlight something that you said, Dario, which is that most people out there are not connecting the systemic health with oral health. And it's something that affects hearts, but cardiologists are not talking about it. It affects our brains, but neurosurgery and neurologists are not talking about it. And this is something that I see every day that you know many oral and maximal facial surgeons are seeing the worst-case scenario of how your oral health can affect your systemic health. And it goes both ways. Not only can your systemic health affect your oral health, but your oral health can affect your systemic health. And that has effects on how you feel, how long you live, how much quality of life that you can gain from every everyday life. And I'm so glad that we can talk about this today, but specifically I wanted to start out with longevity because I feel like that's what everybody's tuning in to Dr. Hamra for. And there's a lot of very specific studies that have been done on the connection between oral health and longevity. Specifically, out of our own university, out of Tufts University, we have a doctor in the periodontal department, Dr. Yu, that has done a really landmark study that was printed, it was printed in the Lancet, which is a very high-powered journal that all of the surgeons and medical professionals look to for advice and guidance. And they made a very clear analysis that shows the number of teeth that you have is correlated with the overall all-cause mortality. So if you have 20 to 10 teeth, that's a very different experience than if you have 10 to 0 teeth. And obviously, you know, 32 to 20 teeth. So she she grouped it in differing numbers of teeth. And the more teeth that you have, 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. Like, is anybody else talking about this? I I I haven't experienced that. What have you?
SPEAKER_00:Yeah, I I actually have never heard our community talk about it. And I mean, again, there are a lot of studies on all-cause mortality. Typically, the typical medical community talks about the typical causes of mortality, which are smoking, diabetes, cardiovascular disease, hypertension. But there are also other factors that people don't talk about, which are socioeconomic status. Now, that might be also related to poor oral health. You know, we all know that people with poor socioeconomic status have typically poor health. They have a higher rate of all cause mortality, and it's it's basically a downstream effect. And so my question now is is it the chicken or the egg? In other words, is the cause of poor oral health the reason for all-cause mortality? Is there is this a correlation or is it a causation, or is it due to the fact that there are typically people in poor socioeconomic status?
SPEAKER_01:Yeah, I'm so glad you asked that because that was one of the things that I thought of when I initially went down this pathway. You know, surgeons were very much focused on treating the immediate cause and then branching out from there. So let me let me answer that question in immediate causes of death and branch out to the overall causes of death, which is I I think that you're you're alluding to. So let's talk about the number one killers that you talked about heart disease, diabetes. These are things that we know now in 2025 that are causal. And let me tell you why. Heart disease, atherosclerosis has always been alluded to as being correlated with inflammation in the mouth. Most recently, again, 2025, a Danish paper came out that actually biopsied heart plaques, and the overwhelming majority of them had inflammatory biomarkers for oral bacteria. So to me, I feel like that's a smoking gun. You know, I don't think that it's very applicable to look at a person and to detail every single molecule that goes down. We have to divide the the way that this happens from really well-done studies. And I think that this was one of those well-done studies. So it's so you cut out a certain a certain person that has died from athoscratic disease from a heart attack with the you know ensuing death biopsy report. You take the plaque that has caused the problem, and that plaque overwhelmingly is caused by oral bacteria. So that's one thing that we know that is an immediate cause of death, which if we can take that off the board, we've extended the lifespan of millions of people, right? If we can absolutely fix that. Let's talk about diabetes, right? So there's no causal relationship between diabetes, but we know that if you treat someone's oral bacteria, their diabetes gets better. Why is that? My suspicion is something that you've probably heard in the longevity community, which is inflammaging, right? So this systemic inflammation is something that has caused buildup of detritus in the body, it causes genetic mutations, it causes an overabundance of bad particles that are out there that everybody's trying to decrease, whether it comes from you know, biomarkers like C-reactive protein, IL6, whatever. But that's something that that we well we know that happens. So if you if you treat a if you treat the disease with oral health care, that improves. I'm sorry, you were about to say something.
SPEAKER_00:Yeah, I think you mentioned, I don't want that to get lost because you mentioned HSCRP, which is high sensitive EC reactive protein, just I think this month or even I think it was yeah, in October or last month, the American Academy of Cardiology, they came out with a recommendation to check for the biomarker HSCRP because they found that it's elevated, I think, in an age group uh 50 and above or 60 and above, up to 50% in adults. And that's a marker for cardiovascular disease and all-cause mortality. And now they have recommended uh to check for HSCRP. And HSCRP is basically a nonspecific inflammatory marker. It's an enzyme that's produced in the liver in response to inflammation, and it's a good marker to test for that. So things like diabetes, smoking, poor lifestyle, poor oral health, or general health, those increase the HSCRP level. And so we can, you what you alluded to, the good news is we can actually measure it. We have a marker that we can measure inflammation, so we can use as a proxy for inflammation. And whenever we can measure something, that's when we're better able to treat it. So I want you to talk about the relationship a little bit more of because that's fascinating, of oral health and diabetes. If you hear it for the first time, 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 our function to dispose of glucose?
SPEAKER_01:Yeah, so I I I think that the the I'd love to hear more about how you treat C-reactive protein because that's a biomarker that I'm looking at myself. Like I'm 42, I want to make sure that I live to be to be longer, and I feel like I only know the oral health component. So I'm gonna give you my take on the oral health component, but I want to hear, and it could be after podcasts about like how you're treating yourself. Absolutely but the and I love this knowledge sharing, by the way. I feel like you know I'm getting so much more out of this. Usually I go on these podcasts and I I have to tell people, but I feel like I'm learning as I'm as I'm talking to you. Same, same here. So the the the point that I'm trying to say is that diabetes, again, let's talk about the the micro factors and let's talk about the macro factors. And I'm gonna start with the macro factors, right? Yeah, so macro factors, as you lose your teeth, as your teeth become less functional, your diet changes very drastically. And and you and you can probably know this if you've if you've seen any of these people with with dentures or that don't have any posterior teeth to to do the grinding that you know we we need for salads, for for meat, for those kind of things. And so the softer the diet is, the more likely it's gonna take contain high dose of carbohydrates. It's gonna be just worse overall for glycemic control.
SPEAKER_00:It's gonna be processed, it's gonna be somehow ultra processed so it's soft.
SPEAKER_01:Exactly. Yeah. So so that's something that we that we know that is very specifically correlated, not correlated. That's that's causal, right? So that is a causal factor. But as you lose teeth, your glycemic control gets worse. And that's something that not only the nutrition literature is producing, but actually it's led to policy. If you if you go to Japan, you know, they have this old old an elder population. They they have this policy where over 20 teeth is their goal because not only does it lead to better diabetes control, but it leads to better overall function. And so they've really done a great job of investing in oral health to prevent these kind of locked downstream effects. But but I feel like I'm getting a little bit off topic. Let me talk about the microcosm, right? So we know also that inflammation also is worse for glycemic control, right? So, again, if you treat the oral health, the diabetes tends to get better. And and I don't know what pathway is is happening there, but that has been proven through the periodontal literature as well. So we know that the micro issue is real, we know that the macro issue is real. I feel like the in-between, we don't have good studies studies to show us, we don't have randomized clinical trials to show us that this is without a doubt happening. But I feel on the back end, we we have the the information that that leads to some sort of hypothesis. And I think that that's how all really great theories happen. You know, when Darwin put out the origin of species, he just looked at all of the different birds changing and he went around and he talked about it. And it wasn't until decades later that it was able to be proven. We have those building blocks for diabetes. I feel like the whole pathway has been elucidated in cardiology and heart, but diabetes is less so. And so that's something that I feel like is a really open topic for researchers to look into.
SPEAKER_00:Yeah, it's really fascinating. I mean, I'm doing a lot of research in this for the book that I'm writing on this topic of anti-aging and what is the root cause of aging, and all the symptoms that we're treating, they're basically the smoke and the fire starts within each cell. And when we everything we do in medicine is putting a patch onto something that is caused inside the cell by our through our lifestyle habits and what they call epigenetics, meaning the factors that modify and decide which genes get transcribed into proteins that then affect a certain cause and process within our body. In other words, which genes get turned on and which genes get turned off, and based on that, the decision falls as to what happens to us, whether we're going to come up with cardiovascular disease or any other metabolic disorder, which then increases our all-cause mortality. So if you look upstream of all of these symptoms that we're treating in medicine or dentistry, it's what you said inflammaging, the inflammation in our body. And so then the question is, okay, what causes, what are the things that cause the inflammation? And you alluded to a very important neglected one, which is oral health. I don't think, and please, the audience, chime in with your comments. If I'm wrong, please educate me, but I don't think dentists, which are the gatekeepers of oral health, which are the first contact to any patients that go for to a practitioner for oral health, as opposed to us as a specialist, they're the ones that have to start that conversation. They're the ones that uh should initiate the conversation and make the patients aware of it as opposed to just fixing broken teeth or replacing missing teeth just for the sake of doing that. I still have today patients come in thinking that nothing is wrong with their mouth unless they are in pain. This is a this is a public health issue where I don't think we're doing a good enough job educating our patients as to the bigger or the important aspect of oral health, which is your life. I mean, no one has connected, I haven't heard anyone other than you ever connecting oral health to death, to all cause mortality, as much as we are hearing about all these diets that are proposed by self-proclaimed nutritional experts, all these lifestyle and fitness 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 the people that I know. I have never heard of it. And you look at the data, the hazard ratio is pretty significant. It's equivalent to smoking, it's equivalent to hypertension, it's equivalent to diabetes. I mean, we're talking about hazard ratios close to 15-20 percent in cases of more than 10 missing teeth, especially in male patients, right? I mean, a lot of the studies show more significant uh hazard ratio in male, which I don't understand. Maybe. Do you know why we are more, I guess, uh vulnerable when it comes to oral health than women? Or did I get that wrong?
SPEAKER_01:Well, I think I can comment on the fact that men are less likely to see the dentist in general. That's something that is a very real thing. It's something that goes through to medicine also. We're less likely to see a doctor. We're more likely to undertake risky things, like you know, many of the more riskier jobs, like being a sailor on a one of these boats that are out there catching crabs that has like a really high mortality rate. It's all men, right? And so I think that across the board we have behavioral predispositions that lead us to poor health, right? And that's something that I don't think that enough of us are talking about. It's definitely clear in when when people come to see me, when they're seeing me, that they're saying the same thing, this doesn't bother me, and it could be like infected out to this, uh you know, it looks like a golf ball in their face, right? And just because pain is not present, that doesn't mean that something isn't happening in the background that's affecting you. And I just wanted to to comment on on one thing that you you you say that like you know the the general public doesn't understand this, and and I I feel like that's true. There are other people that are talking about it, but I feel like we have we don't have enough voices that are saying this stuff, and that hasn't trickled into the everyday life of a general dentist just yet. It hasn't trickled into the everyday life of a cardiologist just yet. But if we continue to say this stuff, if we get on podcasts just like this one where people are very consciously focused, it's gonna get out there. And I and to those people that are listening to this podcast, you're obviously very health focused. You want to live for a long time more than supplements, more than you know, any of these lifestyle modifications. If you can go and see your dentist on a regular basis, if you have a healthy mouth, that is 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 say that to you. Of all of the studies that are out there, of all of like the contributions to science, one of my favorite is the Swedish Twins Registry. You know, they have 87,000 identical twins that are in this registry and they do all sorts of analyses on them, right? And we know that looking at twins, people who take care of their health, their oral health versus people who don't, confers about a five to 10 year health span or longevity benefit. What other other than exercise, which I know you're a huge proponent of, and I I really love that. Other than exercise, what else is out there that can confer that kind of benefit? I don't think that there is. And so I want to get this out to the longevity community, but also I want to get this out to the general community. I I feel like we're not doing a good job of talking about this just like you said, but I I I do think it's coming. I think just like the whole longevity movement started maybe 10 years ago, 20 years ago. It did. And and so it started with overall health, and I think now we're going into like which one of these components are the most effective. And I think exercise is getting its limelight right now, which I really love because I do think that that's kind of the the holy grail for health span. I don't think that oral health has really even been talked about because for a large part there wasn't enough connective tissue between dentistry and medicine, right? There's there's there's just been this historic separation between the two. So so for a long time I feel like dentists just they just weren't at the table. And they, you know, it's it's up to people like like me and and oral and maxillofacial surgeons in general that have this dental doctor and medical doctor that can hopefully serve as the bridge to to bring this information out to the public.
SPEAKER_00:Yeah, I think I think it's up to our profession to scream about this. I don't think other professions are gonna listen if especially we don't talk. Because, you know, I mean, just in the September uh edition of the Journal of American College of Cardiology, where they finally, thank God, talked about HSCRP, which uh and I tell you, ask me how did I improve my HSCRP because my HSCRP was elevated. Mine too. And all my downstream symptoms like joint ache, uh uh fogginess, tiredness, some like GI issues, everything, all of these are downstream effects of elevated uh HSCRP. They were bothering me. And then when I went to my doctor, and this is a young doctor, she was in her late 30s, early 40s, around 40. So you could argue she is the new generation. Very great, a good doctor, uh, internist. And so when I presented her with my symptoms, she said, Yeah, all your biomarkers look great, you know, based on your family history. And I love when physicians talk about family history, like uh we just we just look at family history almost as evidence for what's gonna happen or what's not gonna happen, and we don't realize that genetics only contribute maybe 15% to what happens to us and epigenetics, meaning our lifestyle that affects our genes, which is the reason why we die or survive, is dictated by our lifestyle and which is modifiable. There's nothing to do with family history. Yeah, 15% is family history, genetics, but you know, what about the other 85% where we can move the needle? And so that conversation did not happen, shockingly, now looking back. And so her response was, Well, you're this was I was 48, I believe. She's like, Well, you're nearing your 50s and you're not 30 anymore, you're getting older, so you're probably working too hard, just you know, relax a little bit. Nothing specific, just something I, of course, I knew. But the problem in medicine is we don't give specific lifestyle instructions to patients the same way we write a drug prescription with dose frequency and duration. And so it goes into one year and goes out the other year. By the time we're sitting in our car driving home from our doctor's office, it's just it's just, you know, something that we were told and we already knew before we went in, so nothing is gonna change. We don't change our habits, we don't change our lifestyle, because we don't know how. We haven't been given specific instructions. So the American College of Cardiology finally came out and says, well, and they even have a graphic where they show all the causes of elevated HSCRP, which are smoking, increased visceral fat, dyslipidemia, meaning elevated uh lipids, hypertension, and they have a picture of the mouth with the teeth, and above it it says periodontitis, which is gum 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 is inflammation of your gums, and then infection from bad teeth. And all of those generate the pro-inflammatory cytokines, which is your interleukins 1, TNFs, IL-18, CD40Ls, and so forth. And below that is then your physical activity, your diet, are you eating enough fruits and vegetables? Are you eating enough oily fish? Are you increasing your omega-3 fish oil? Alcohol abuse, so limiting your alcohol, which all of that eventually leads to your atherosclerosis, your plaque buildup, and now we have evidence that there is a streptococcite within the plaque, which alludes to the uh origin from the oral bacteria. And and then ultimately that leads to the downstream effects of death. You know, it's in I always say aging is the accumul death is the accumulation of the process of processes that cause aging in our body, and then ultimately then they lead to death. And there are so many studies that allude to the to the solution of how can we reduce HS therapy, which is what I did. You know, so I I just cleaned up my diet. That's the first thing I did. I once I did that, a lot of my inflammation went down, so I could be physically more engaged, I could do my exercises better, I had more stamina just through cleaning up my diet. The other thing was chronic stress. I worked on my mindfulness, so I don't stress much about stuff. The big one was sleep. I thought sleeping six hours is great. It was almost like a badge of honor. I was wearing it in residency, we barely slept. So we came from a history of abusing our bodies for 10 years or longer, and then into the stress of work. So sleep was almost an afterthought. You know, people say I uh I can sleep when I'm dead, but sleep is one of the biggest drivers of HLCRP. So I made sure that I sleep eight hours a day, and then I never really smoked or I never was a big alcohol drinker until I realized if you have one drink a day, you're pretty much an alcoholic. And if you look in the categories, 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 at a social event because I don't want to be a party pooper. And then that affected also, I mean, my A1C was 5.5. I really it should be with my level of fitness. It should be really lower. My hormone panels were great. My vitamin D was extremely low. Also, not it's it's it's even in recommendations, they say you shouldn't routinely take vitamin D levels of patients that are not in risk categories, which are you know darker skin patients or patients that don't get much sunlight or older patients above age, I think, 60. Like, why wouldn't you take it on younger patients? My vitamin D level was like 25. That's like insufficient or deficient. I don't know which one it is, but so I now take the vitamin D levels of all my patients, and 80% are 30 and below. Okay. So and we all know the association of surgical side infection with low vitamin D levels. I mean, there are studies on there. So my point is this, and that's why I'm so excited to have you here. And sorry I'm hijacking this podcast, but No, I don't I need to know this stuff because my my CRP is too high.
SPEAKER_01:I know.
SPEAKER_00: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 downstream symptoms that my doctor had no answers for. And all I had to do is correct that biomarker, and then my lipids fell into place, my glucose fell into place, everything. My my shoulder pain, my knee pain, my ankle pain. I would wake up, my ankle would hurt. I'm like, what did I do? I just got out of bed. And so I was 48 and thinking, so it's gonna start already. So what's gonna happen in 20 years? I'll be in crutches. And I just had a three-year-old at that time. I'm actually having another baby in in four weeks. So I want to be able to go, thank you. I want to go out and play with my boys, you know, and and I don't want to sit in a foldable chair at the porch and just watch them and uh just tell them daddy's ankle is hurting, daddy's knee is hurting, I can't come and run with you, just play by yourself. I don't want to be that person. So for me, that was the motivation. I think for every person to finally make a change, they have to find some sort of motivation. They have to look in the future just like they're planning their business, just like they're planning their day. They have to plan for their lives, they have to see what do they want to do when they're 60, 70, 80, and then reverse engineer their health from there. Okay, what do I need to do today to be able to do those things in the future? And and that's something that I think our health advocates, meaning doctors, should talk to the patients about as opposed to just treating the smoke. So, but enough of me.
SPEAKER_01:I really can I just comment on that on that engineering for the future component. So there's two things that I want 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 with your same zeal that you did when you were 52. When you're 102, you might not be able to swim the same way. But you're gonna enjoy your food the same way. And just from a quality of life perspective, when you are 102, the the longevity benefit of having things that you enjoy is so important, whether that's friends, whether that's you know, some sort of hobby that you do, like yoga or something like that. If you see the really super agers, you know, they always have something in their life that they're just excited about. You can pull every single denture wearer in the entire US. None of them enjoy their food, right? It's something that is, it's they're eating because they have to, not because they enjoy it. So, in the same way that people come in to see me and they're like, oh, it's it's not bothering me, it's like not that big of a deal. I feel like there is this certain component here in the US, and it's not like that everywhere else, but here in the US, that people don't value their teeth or their mouth enough. And when they they're the if it'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 deal to me. And sometimes we have to do that, but you should replace it. In South Korea, it's not like that. They have overwhelmingly a philosophy of if I have to remove it, I'm gonna replace it. And those people have much more quality of life in their older years, they're still able to enjoy the same foods that that they that they loved when they were 40 years old. And so, to the people that are out here that are on this podcast, it's just as important, not only from a health longevity perspective, but from a quality of life perspective, that you should really invest in yourself the same way that you're investing in your health. And the the other thing that I want to talk to you about is that so much of what you said was lifestyle decisions, right? Lifestyle choices that have led to aging. And I have young kids in the same way that you do. So much of from an oral component of how we end up in the situations that we are when we're in our 40s or 50s, is because of how we treated ourselves from an oral component when we were younger. So, for whatever reason, in the same way that you know, we don't know why we're getting taller as a species. You know, some people say it's new to nutrition, some people say it's whatever, our jaws are actually getting smaller. And this is something that is not evolution, but devolution. We're going backwards, we're making ourselves sicker.
SPEAKER_00:Talk to us about that, because what is the difference from between evolution and devolution uh for the people that might not be familiar with the technicality of the two terminologies? Because you know, biology tells us with each generation we should be improving and because we're adapting. You know, that's basic Darwinism. So, yeah, I'm really excited to hear about that.
SPEAKER_01:Yeah, so adapting can be adapting for fitness, which is what Darwin proposed, that you put an animal in certain environments, and over the course of generations, the genes will be selected to better adapt to that environment. The thing is, is that we're adapting for the modern environment, which is a relatively new environment considering our history as a species, right? Like we've we've lived in air-conditioned, allergen-free or allergen-promoting environments 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 of our healths to adapt to this environment, right? So, for example, the ability to breathe through our nose versus our mouth is completely different now versus when we were in more traditional societies of hunter-gatherers. And I say traditional because for the majority of our lifespan, that's what we were. As a species, we were hunter-gatherers that would be out in the wild, that would be, you know, exposed to all of these different allergens and things. And granted, these people had a very shortened lifespan because of trauma, because of disease and all those things. But we've wiped those things off the table, and now we are adapting to modern society. And modern society means that you're not breastfeeding your kids, your kids are having a soft diet. So, you know, your three-year-old or four-year-old that you know you alluded to, you know, look at the texture of what they're eating in comparison to what those kids were eating 200 years ago, or how much they've been breastfed as opposed to 200 years ago. And it's completely different. And the reason why we know that this is happening in modern societies is because if you go to those hunter-gatherer societies that still exist today, like the Hadza tribe of sub-Saharan Africa, they will tell you that they have a full complement of teeth. They have the ability to have their 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 that have modern dentistry, that have modern care, and it's it's all about lifestyle decisions. And do I have a prescription for that? No, I don't. I don't know how I'm gonna be able to do that.
SPEAKER_00:Well, I think that's I think that's a public health issue more than anything. I think if we didn't in today's age, 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 destroys our gums and our teeth. Let's say that remains the same. The only thing that chain we change is getting rid of antibiotics. Let's say uh Flemings didn't exist, we didn't have antibiotics. Can you imagine the average lifespan of humans with the amount of dental infections that is out there? I mean, we would probably be the average life expectancy would probably be 15 or 16 if we made so I think the reason why we uh survive infections is of course because of antibiotics. But back in the days you would die of an infection from a splinter or some infection on on your toes or something, but not so much down teeth was a component. But with today's processed foods and diets, I would bet that more people would have died from dental infections. And so to me, this is a public health issue. We can scream all we want, we can treat all we want, but we're we're still downstream of the uh c causes of uh what leads to oral uh health.
SPEAKER_01:Yeah, but you know, I think that people are talking about it, you know. I uh you know, for love them or hate them, this whole Make America Healthy movement has been able to take you know dyes off the table for for who for all the foods that are out there that have, you know, these artificial dyes. And and you know, I don't think that that's something that we would have even thought about like 30 years ago. It's just like you know, so I think that times are changing and and it's up to people like us that spread the message. Here's what I can tell you about the prescriptions that I do for my own kids. So number one is breastfeeding. This is something that the American College of Pediatrics recommends for two years now. They actually went from one year to two years, exclusively breastfed as a recommendation. Very few people are doing that. I mean, like if you look at the if you look at the numbers in the US, like we're talking like less than 20% of our breastfeeding for two for two years, you know. So that in and of itself molds the the jaws in such a way that just like what you were saying about epigenetics, there's a certain amount of genetic component to things like how height and and how we grow. And there's also a certain component of environmental component, right? So, like if you if you are able to mold the jaws in such a way through orthodontics, or you know, my background is in cleft lip and palate surgery, and so we do this thing called nisodobular molding, which kind of brings the the two the two portions of the the cleft together. So you are able to mold the the jaws in such a way that promote the full maximum growth that they can have. That being said, there's also the idea of breathing through your nose versus breathing through your mouth. That's something that is a systemic issue. You know, this is something that, like when you have young kids who are exposed to allergies, you know, a lot of the theories behind allergies is that it's mediated by a component of our immune system that was made for parasites. And because we're not exposed to those parasites anymore, now we're overemphasizing our immune system in regards to dust and mold and all the stuff in modern life, right? So they they lose their ability to breathe through their nose, their tonsils and adenoids get really big, and then they start exclusively breathing through their mouth, and then they end up with these like very narrow, very skinny mouths. So that's something that's happening at a more common and more frequent rate these days. You know, the the the number of kids who are in orthodontics is at an all-time high. Like it's almost like a rite of passage these days. When I was growing up, it was like you were kind of strange if you if like they would make fun of you if if you had braces, and now like you're made like like the kids want braces, you know. You right, because all their friends have like I I exactly, I I have braces. Oh yes, I I can't wait to get braces. Yeah, so it's totally different now. And and that is just reflective of the need for this stuff in in modern society. And so I think that if we were to, you know, train kids how to breathe through their noses more often, be a little bit more diligent about removing some of this excess, you know, back tonsillectomy tissue or adenoidectomy tissue. I think that these are things that can can help us get to the point where we're not losing our fitness, that we're actually making our kids healthier rather than making them more sick and leading to further problems. You know, I can tell you that my corrective jaw surgery practice has exploded because so many kids have arches. You know, it's it's something that doesn't it doesn't happen as much in in third world countries that that don't have the same kind of diets that we do 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 full a full complement of teeth, and they had the ability to chew with their third molars. So their third molars are completely present. Me and all of my siblings had to have ours removed because our jaws weren't big enough for them, and that's just like one indication. Like we don't have enough room in our jaws for this tooth, and that has also become almost a right of path.
SPEAKER_00:Yeah, I think the evolution has even progressed beyond that. We see more and more patients with lacking wisdom teeth, and that's also the evolutionary process, right? So eventually evolution did decides that, hey, I guess we are not gonna, we don't need the wisdom teeth anymore because we don't have big enough jaws anymore. So I see more and more patients with less wisdom teeth than before. So it will be good to look at you know studies going back and seeing if there is a trend. But I want to go back to breastfeeding because I think it has a bigger health implication together with oral health, together with and I also want you to talk about before we forget the uh neurological uh aspects of uh breastfeeding for the brain development and in general chewing, because there are correlations when it comes to neurocognitive 100%. So I want you to allude to that, but before we go there, there are studies that have shown the correlation between breastfeeding and the baby's and ch later the child's development when it comes to allergy, obesity, and autoimmune disease risk. And all of that has to do when the baby is breastfeeding, the baby gets in touch with the microflora or with the flora of the mother's breast, and which then seeds the oral and the gut microbiome. And do you know anything in that regard and how that affects immunologically and also as far as obesity and allergy, the future child's health?
SPEAKER_01:Absolutely. So so just to give you a little bit of background, so I I after my oral and maxillofacial surgery training, I did a pediatric craniofacial fellowship, and I was super lucky to be with this woman surgeon. Her name is Pat Ricaldi. She's uh just such a genius. If you ever have an opportunity to meet her, she goes at length about breastfeeding because she she she did she breastfed all of her kids. She's a true believer in it. And so most recently, she came out with a study about like the pros and cons of phrenectomies, which is some a very common procedure where you you trim a little bit of the tissue underneath the tongue to to promote better breastfeeding in in neonates. And and and so just like I I I want to say that because not only was she a proponent of it, but she was promoting research. And I feel like that's something that's not only is she like a a theoretical proponent of of breastfeeding, but she's also a clinician that's trying to advance the the idea, right? And so what so during this whole process of me being in fellowship, I got married, I ended up, you know, having a child with my my wife, and and so we were I was doing this research independently of all of those things that you talked about. So, what I can tell you is that there it is such a complex interplay of uh hormones and chemical messengers between the child and the mom that we still don't understand it at the level that we should. And so, in the same way that we're trying to piece together little bits of information, I don't think that we have the whole clinical picture, but this is this is my theory, okay? My theory is that the so first off, just to clarify, all of those results are real that you talked about. It's better for the overall health of the baby, it's better for neurocognitive development, it's better for mouth formation, you know, all these things that we talked about, those things are real. We don't know why that's that's that's the case. But when we're talking about why I think it's the case, I think it's a dose a dose-dependent response. So, in the same way that you treat an allergy by giving your child a little bit of it so that they gain some sort of acceptance of that. So, like right now, I have a seven-month-old, we're giving them peanut butter just to have a little bit of it so that they don't have a peanut allergy in the future, right? I think that for babies, they get a little bit of whatever it is through the breast milk or they get a little bit of it from their environment and the breast milk gives them the chemicals necessary to withstand whatever it is that they're they're exposed to. So, for example, like if you have a baby that's exposed to a virus and the mom has had that virus and has the immunoglobulins that can counteract that virus, the interaction between the saliva of the baby and the breast of the mom will have some sort of understanding that, oh, okay, we need to make these immunoglobulins to send to the baby so that they don't get overwhelmed 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 me like the real power of breastfeeding.
SPEAKER_00:You know, well, there is there is actually you you know what? Intuitively, you're actually completely correct. They actually have studied it. They they what there are studies because I looked into it too, because my son developed allergies to tree nuts. And just the same way uh 20 years ago, the American Academy of Pediatrics was trying to eradicate peanut allergy by telling parents not to give their 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 nowhere in history we tried to omit foods from our infants, but that's a different story. But human milk has oligosaccharides, which is in breast milk, that selectively promote a certain bacteria. I forgot what the name is, but that bacteria is associated with immune maturation and reduced risk of disease. So it it kind of matures our the child's immune system. And it's also associated with the duration of breastfeeding, which then also then shapes your not only the oral microbiome and in increases the IgA level of the of the baby, which also is basically the first immune defense that you know from the initial portal, meaning the mouth, when we eat food to defend against pathogens, but also it seeds then the gut microbiome, which a lot of our immune system is controlled in the gut. So this has all downstream effect from the mouth to the gut and then eventually it influencing the immune system. And there are studies on that, which I think not enough people again. This is another topic where not enough doctors are talking about.
SPEAKER_01:Yeah, I mean, I I think that the American Academy of Pediatrics put out this recommendation for a year of breastfeeding a while ago. You know, I and the adoption rate has been abysmal because we're up against the the market forces, right? Like how many, how many women can realistically go out there and breastfeed, you know? Like if if my wife was a surgeon, like is she gonna stop surgery to go breastfeed? You know, and and just to tell you how how strongly my my fellowship director believed in this, she had a room upstairs where in between patients she would go up and breastfeed, you know. So that's how strongly she believed in it. But like she she created her own little environment where she could have this capability, and how many people have access to that, right? So, so you know, I I think that there's a lot to be said about different policy measures that we can make. Like, you know, for example, Canada gives a year of maternal leave, and that that would be very easy to be able to breastfeed if you had that time off. But in the US, it's starkly different. And so I think that we have to just continue to talk about how important this stuff is, and also this like the downstream components of it. I think that there's there's not enough what we talk about, the difference between it's just like it's recommendation, and it's just this most people don't realize what they are are subjecting their their baby to, like the choices that they're making. And in the same way that they don't understand, they don't may not realize like their difference in zip code might affect their overall health, you know. So so these are things that like I think are just coming to the forefront, and I think it's it's important for us to talk about it.
SPEAKER_00:So talk to us a little bit about we we initially you mentioned it already about the growth of the jaws that is related to our dietary habits, especially in the developing child, you know, the shrinking jaw debate, et cetera.
SPEAKER_01:Yeah, yeah.
SPEAKER_00:And and so the question is how does that affect, you know, as a pediatric craniofacial surgeon, how does that affect the airway when we have smaller jaws? You know, there are so many patients now that have sleep apnea or difficulties breathing, if even if they don't have sleep apnea, like you said, they have their mouth breathers, which has other health implications that I would like you to discuss. Sure. But tell us a little bit for the layman how the shape of your jaw affects the your ability to breathe.
SPEAKER_01:Yeah, so if you can imagine the airway, the the way that we get air from our environment into our lungs as a pipe. The two restrictions on that pipe are your posterior oropharynx, which is just in front of your spine, and then all of this anterior tissue right here, all the tissue in the front. So the back and front of your throat, for those of you who are not watching this, exactly. So the back and front of your throat are determined or determine your airway, right? And the back of your throat is fixed. Well, let me let me rephrase that. The back of your throat is is fixed from a skeletal position. Now, the back of your throat can get larger because you have really big tonsils, you have really big adenoids, and that's that that kind of constricts the the that pipe from the sides and the back. But the front of it, which is a huge determinant, is based on your your jaws. All of this tissue attaches to your jaws. And so if you're not maximizing the amount of growth that you can get from your jaws, you're minimizing the size of that pipe. And for every decrease in in circumference, it's a vastly larger difference in volume. You know, the the circumference is a square and the volume is a cube in regards to the exponents, right? And so when you when you squeeze that tube, even just a little bit, you have a vastly different experience of breathing. You know, it's the difference between breathing through a straw versus breathing through a scuba mask. And so when we're in those situations where we have to, you know, advance somebody's jaw, we always do an airway analysis pre-operatively and post-operatively. And inevitably, it grows exponentially because these are people that have really like recessed jaws or they have a really deep underbite, and they're coming to me because they don't like the way that they look, they don't like the way that they chew, they don't like the way that they function. But in addition to that, we do a sleep analysis and they have obstructive sleep apnea, they're waking up, they're constantly tired throughout the day. All of that gets better when you move their jaw forward and increase that airway. You know, there's there's lots of other ways of getting air down there. There's like the CPAP, which people are not super compliant with, which is basically this machine that forces air down your down your throat to keep your airway open. CPAP stands for continuous positive airway pressure. And then there's you know, all sorts of soft tissue maneuvers to decrease the soft tissue that contributes to the constricting of that airway. And then now they have things like hypoglossal nerve stimulators, which maintains a certain amount of stability of the airway, even when you're asleep, because when you're asleep, everything relaxes and it collapses in on itself. All of these are different things that are available for people.
SPEAKER_00:For the audience, the hypoglossal nerve is the nerve that you know is in charge of controlling the muscles that are associated with your breathing, and to stimulate that would then improve your breathing. Now, if you're a parent, you're listening to this podcast, you don't really know enough about the stuff that we're talking, you just overheard the fact that, oh my God, my child's jaw size and shape will determine the ability, his or her ability to breathe. What where do where do where do I start? What age should I bring my child to the doctor or make because maybe the pediatrician is not really aware of these issues. What can the parent do on their own, being their child's advocate? What doctor should they bring to? What should they do? And when at what age should they look into it and start? What would you recommend?
SPEAKER_01:Yeah, this is a great topic. So I I'm I'm gonna attack this from two different pathways, okay? There's the tried and true, which is orthodontics, okay? Orthodontists are very skilled dentists that have gone on to complete training in how the face grows and how the teeth move in relation to each other. And really early anticipatory guidance of the jaws can counteract a lot of these negative aspects that that you and I are talking about. So, you know, the the growth plates fuse for the the upper jaw that that determine a lot of the a lot of the growth at different at different ages, but I would say the the earliest that you know the the growth plates are fusing is around like 11 or 12 for the the maxillary palatal suture, which can you can widen with orthodontics very predictably.
SPEAKER_00:So you're midline in your upper jaw and palate, right?
SPEAKER_01:Exactly. I apologize to the audience if I'm if I'm using like a lot of words that Dario's been so so kind to elucidate for me. But the fact of the matter is is that the 11 or 12 is like when that thing closes. So before it closes, you want to maximize the growth that you can get out of that. And so you might have seen kids with like these palatal expanders that that they they they slowly crank every day, and it it actually gives enough pressure to open their jaws up. And that is something that is very tried and true. It's something that that orthodontics are doing day in, day out, and has a long history of success. I would say that there's another school of thought that's out there that has not been validated by science, but is is talked about a lot in the pediatric dentistry and orthodontic community, which is orthotropics, which is the ability to train a child to maximize their jaw growth. And and I don't I don't have enough information to comment on it. I just know that it exists and you know the the the there's a there's been historically a lot of contentiousness between those two communities, but they've shown some success through that. So those people are intervening like as young as five, six, seven, you know, and you're you're basically training your kid to maximize their jaw growth by how you position the tongue, how they they breathe. You know, you want to maximize nasal growth, be or sorry, nasal airway growth, because even just like the the forces of breathing in and out through your nose, it it allows your it allows your nasal airway to grow and therefore maximizes the ability for your for your jaws to grow. So so those are the two schools of thought that I would say. I would say that go see a pediatric dentist as early as you can and have these conversations with them. Go see an orthodontist definitely if they feel like there's crowding that's happening anywhere from like the seven to nine range, you know.
SPEAKER_00:And and then what are what are some red flags for the parents to look out for?
SPEAKER_01:Yeah, yeah. So the biggest red flag is snoring. 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 not normal. You know, that's gonna lead to obstructive sleep apnea, and that is most often caused by large tonsils and adenoise, which can be treated by your nose and throat physician. So that's the biggest red flag. If your kid is not sleeping appropriately, that can lead to behavioral changes, it can lead to decreased brain growth, all of these things that you want to make sure that that is treated as soon as you can. I have uh a kid, was we we live in you know condo apartment complex in in Boston, and we have uh a lot of like kids who are in the complex and they all play together. And this kid, like I even like when he was like running, I could I could hear like he was just like struggling to keep up. Yeah, exactly. And and I taught his mom was a pediatrician, 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 and abnoidectomy, not snoring anymore, totally different kid. Like, just wow, you know, beforehand, he was just like so difficult to deal with, like he was just you know, very impulsive, like fighting all the time, and now he's so well behaved. So I'm not saying that's gonna work for everybody, but I'm just saying I've seen it personally, really profound, really profound difference in kids.
SPEAKER_00:Well, there's an association of lack of sleep and elevation of cortisol, which is a stress hormone, uh, that has a lot of hosts, other uh different hosts of downstream, negative downstream effects on our health. And children aren't immune to that either. So I think it goes back to improving the quality of our sleep, not just the length, but the quality of our sleep is really key for our health. And it like you alluded to, it it starts very early on in life.
SPEAKER_01:Can I just comment? I know we're we're getting to the end of our time. I love this conversation.
SPEAKER_00:No, we can we can we can continue as much as you you you have time. Um my podcasts are kind of open-ended. There's no uh strict, my time, the time is based on my guest.
SPEAKER_01:I appreciate it. No, I I would love to come on again or or talk to you forever, but but I unfortunately my my wife is gonna be texting me about a birthday party that I have 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 had talked to about that I didn't have the opportunity to expand on because we got we went in a different direction, is just the neurocognitive effects of getting. Yes. So thanks for reminding me. No, no, no. I I feel like this is something that Because Yeah, it's just people don't know about it, right? And I want to make sure that people know about it. So University of Toronto did a study where you took a hundred kids that took a test totally normally, and you took a hundred kids that took a test and they chewed chewing gum, just regular chewing gum beforehand. The ones who chewed chewing gum overperformed in comparison to the control. And this is something that we all have like kind of known about for a long time. Like they used to give GIs chewing gum just to keep you know happy in in these really stressful environments. Oftentimes, like when when you and I are in stressful environments, we're grinding our teeth, you know, grinding is like a source of stress relief, and it's something that we all kind of intuitively know, but there hasn't been enough talk about it. And I think that we have undersold just the ability to chew for a long time. And and that's one of the things that I think contributes to a lot of these downstream effects. You know, we're not chewing the same kind of stuff that we used to when we were younger, you know, like the the kids have really soft stuff like chicken nuggets and you know, really soft cereals that that that's what they're chewing. But it wasn't like that historically, you know. If you were to look at even the most primitive civilizations, all of them kind of chewed something just to pass the time. You know, whether it was like the beeswax of honey in some of these ancient Greek civilizations, mastic was also very really commonly written about in in in Greek philosophers and and all the the existing Greek literature. Just so that you guys know, mastic is a tree sap that was one of the initial inspirations for gum. It's it's it's in some of these bespoke chewing gums nowadays. But the fact of the matter is, is that I don't think that we treat chewing with the same kind of reverence that it deserves. Uh or even just our oral cavity in general. Just you know, if you were to map out the brain of the somatosensory component of our brain, like the amount of brain cells that are given to a certain thing versus versus not, overwhelmingly, the majority of it is the head and neck, you know. The the sensation that we get from kissing our loved ones is so powerful in comparison to like shaking their hands, right? Like it's it's just so much more exciting and interesting, and it just lights up all these different brain cells.
SPEAKER_00:And you know, I think that's talk to us about the mapping so that the audience understands, because it's that's a key component of why that is important, of how different parts of our body are mapped at different sizes in our brain cortices.
SPEAKER_01: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 we know exactly the amount of neurons that are devoted to the feeling sensations of our hands versus the feeling sensations of our nose versus the feeling sensations of every body part, right? And it's mapped out in in our brain. Uh, it's something that we learned about in medical school called the somatosensory cortex map of our brain. And and you can actually, you know, look it up, it's very it's really, really straightforward. But the the map, like if you were to compare, like let's say if it was like the map of the world, the the amount of land mass for the mouth, the lips, the tongue is huge. It would be like North and South America and Africa in comparison to the rest of the body just being like you know, Asia. Luxembourg and European exactly Luxembourg, right? So so it's it's vastly overvalued in our brain. And what I wanted to really talk about is I think it's overvalued in our evolution too. I think that you know this is something that is so integral to being a human being, which is taste, right? Taste is something that human beings have at a higher level than almost any other you know species that's on the planet, right? The ability to taste the difference, the subtle difference between sushi is something that like you know, not every animal can do, right? Like you can't tell good sushi from bad sushi for a dog. Like they're just eating it, you know.
SPEAKER_00:And and my dog doesn't, dogs don't have Michelin star restaurants.
SPEAKER_01:Exactly, exactly. And and and just just even that, like the idea of us learning to cook our food, to trade different recipes, to you know, to to be gourmands over the years, many people think that that was what led to us being humans. And and this is something that like I don't think that we talk enough about. And chewing is so integral to that, right? Like, like not everybody, like not everybody has the same value out of a meal because of the ability to chew or not. You know, if if you were to talk to somebody that has had had neck cancer and has had half of their jaw removed, they're not getting the same kind of value that you and I are getting when we go into the restaurant, you know?
SPEAKER_00:You know what this this brings me to a point about neurocognitive decline in elderly. You know, the study that you mentioned initially, the association between all-cause mortality and identify or loss of teeth, you know, when you have lost all your teeth, you're very limited in the foods you can eat. You probably can't eat much palatable food, much nutritious food. So one is the nutritious aspect, like let's say the fiber, high fiber containing food, you have to chew a lot. Well, you can't do that. You know, most nutritious foods you have to chew a lot, you can't do that anymore. So one is the nutritional aspect, but I think what you're just talking about is also the neurocognitive effect of the inability to chew, which we have studies that it affects our neurocognitive ability. And perhaps that is another burden on the neurocognitive decline in elderly because they tend to have less teeth, because they can't enjoy that oral habit of eating and eating different types of foods because they're very limited. And if you look at the blue zones, the number one thing they have all in common, which is basically the highest rate of centenarians in the world, and specific blue zones in the world, which is, I think, uh somewhere in Japan and Italy and other places in the world, where the aspect of interconnectedness, meaning human social connection, is has one of the highest predictive values and is the most common aspect of what all these blue zones have. Of course, in addition to activity level and good Mediterranean style, diverse diet, etc. But the interconnectedness, they actually interviewed them. They asked those people and they said it's the human connection being around people. And food for human beings is a social event more than anything. It's not just to feed the stomach and feel satiated. Yeah, that's one, that's a nutritional aspect. But the biggest aspect, I mean, look at when was the last time we went out in a social event? What did all of us do? We were eating something, you know, 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 out in a kitchen. So when we built our house five years ago, we said, okay, let's look at the areas where we spent most of our time and let's invest in those areas and not worry about other areas. And so we invested in our kitchen and living room because every time we have friends over, that's where everybody gathers. So to me, eating is really a social event, it's a habit, and which goes really back to our conversation. Now, we don't look at it really directly that way. It's almost like, oh yeah, you're right.
SPEAKER_01:Yeah. And let me back up some of the things that we're mentioning with science. So so number one, the ability to chew is directly related to hippocampal growth. So you chew, you go into a a functional MRI, and you see that those parts light up in the brain.
SPEAKER_00:For all for the for the audience, can you say what the hippocampus is and where it is?
SPEAKER_01:Yeah, yeah. Thank you so much. I I I I really need that check to remind me of what I go through. It's all right.
SPEAKER_00:That's what I'm here for.
SPEAKER_01:Yeah. So so a hip the hippocampus is a part of the brain that's that's really the the powerhouse for memory and and memory creation, memory selection. It's very underdeveloped and and people that uh you know are kind of going away from us cognitively. And it's something that has a lot of of focus on when it comes to the city.
SPEAKER_00:And you can you can actually grow it through exactly you can you can grow that part, which affects it positively.
SPEAKER_01:That's one of the things that I wanted to say. Like in the same way that we talk 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, you know, whatever it is, you want to make sure that your brain is constantly being used. When you get into like states of depression or you know, stuff that causes you to use your brain less, the brain kind of shrinks away. And so that's something that that's very clearly documented in in the medical literature. But the but the hippocampus has been shown to be correlated to the ability to chew. And and one of the things that I I know that we both follow Peter Attia, he's talking about exercise as promoting the the health span for an individual and and hopefully the lifespan for an individual as well. The things that he's looking at are things like grip strength and you know the ability to balance, right? Like those are things that he's looking at to promote so that he makes sure that he's healthy for the long term. I think that we need something like that for the ability to use our mouths. I don't think it's bite strength. I don't think that that's something that's necessarily correlated because I think it's some sort of chewing function. And the number of teeth to me is is a direct correlate to that, but I don't think it's been backed up by literature as yet. But I want to have that same kind of metric.
SPEAKER_00:Maybe measure, maybe measure the VO2 max during chewing activity. Something like that. Yeah. How long can you chew gum without like a hubba without without getting tired?
SPEAKER_01:Yeah, exactly. I mean it's it's one of these things where I I I just know that like there's something out there. I just haven't figured or haven't seen somebody else figure out.
SPEAKER_00:Well, I think I think I think metrics are great. They're good as you know, for proof, as evidence for a specific theory, and also good to measure improvement and target treatment. But we have so many studies now that we know, I mean, we don't have to argue anymore whether having teeth and being able to chew is good for you or bad for you. Yeah, we can get very technical with analytical data and metrics, you know, more like academic or intellectual brain massage. But ultimately, I think one of the things that I've learned in trying to get my patients to choose healthier lifestyle to improve their health, and it all started with me in order to optimize them perioperatively to reduce the risk of infection, uh, reduce the recovery time, and improve the outcome and longevity of the treatment. That's that was my motivation. So when I started very specifically giving my patients advice on how they can improve today through micro prescriptions, not big changes because no one can do things cold turkey or completely change our lifestyle starting tomorrow. You have to start microdose it. I realized that those extreme metrics are maybe good for nerds like me and you or the ATIAs in the world, but the average Joe can't even comprehend it, doesn't even care, actually starts tuning off as soon as we get into the details. It's it's too much going into the weeds for them. They just want simple recommendations. And if we keep it simple for our patients, I think it's more likely for them to follow through because number one, they can understand better, and when they understand something better, they they're motivated differently to apply it and to start moving the needle towards betterment. And chewing is one thing, exercise and another thing, you know, in in terms of exercise. You know, there's a lot of studies out of Britain that want to see the effects of lifestyle on all-cause mortality, and they 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's say you just focus on one, you don't really move the needle much. And they showed, I think it was 60,000 subjects over eight years. They followed them. It's called the uh the span study, which stands for sleep, physical activity and nutrition, span. And they wanted to see what's a minimum effective dose to improve your all-cause mortality, and what is the maximum effect if let's say you improve everything optimally, which is the maximum level of reduction of all-cause mortality. So the maximum level was reduction of all-cause mortality up to 64% in patients that slept 75 minutes more per day, increased their moderate to vigorous physical activity to uh 15 minutes per day, and added vegetables and fruits to their diet and eliminated all ultra-processed foods. So when they did that, over eight years it reduced their all-cause mortality, which they tracked through the NHS records of England by up to 64%. The minimum effective dose, which was improvement of 10% of reduction of all-cause mortality, was all you had to do is sleep uh 15 minutes, 35 minutes longer per day. Add 90 seconds of moderate to physical activity per day, just 90 seconds, just to, I don't know, air squats or jumping jacks, something where you start huffing and puffing for 90 seconds, and just add a third cup of vegetable or fruit to the diet that you're having without changing anything else in your diet. That alone improves your alcose mortality by 10%. We have no supplement that does that, we have no pill that does that, we have nothing else that moves the needle that much with just these minimal changes. And all of these changes, they will also reduce your HSCRP, they will improve your glucose tolerance, 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 you ask me about an NAD infusion or some supplement, have you we have to check those boxes first because those move those fill 90% of the bucket. What they want is the other 10 or 5% of the bucket with all these longevity hacks, which we call them today. They're they're focused, hyper focused on those hacks because no one wants to put in the reps, do the work. However, they don't know that they it's not even that hard, you know, sleeping another 15 minutes, adding 15 minutes to your sleep, go and basically go to bed 15 minutes early earlier every day. Just do 90 seconds per day of moderate or vigorous physical activity and just add, I don't know, three celeries or an apple to your diet of whatever crappy diet you're already eating. Go go to McDonald's. I don't care what you do, just add a little bit of fruits or a little bit of vegetable, uh, not much, and you already reduce your all-cause mortality by 10%. What does that? I mean, if you look at the hazard ratio, it falls into line with quitting smoking and reducing your blood pressure. It's insane.
SPEAKER_01:Yeah, no, I I totally agree, and I'm starting this journey myself, and so I I echo a lot of the same things that that you're saying. What I I I do have to leave in just a few minutes, but can I give you my prescrip my micro prescriptions for oral health? Please. Number one, everybody out there, go see your dentist on a regular basis, at least twice a year, brushing, flossing twice a day, and cleaning after every single meal. Okay? That's number one. Number two, if you are can add some 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 bit of theanine in it, it gets me going for podcasts like this. It just makes sure that I'm hyper-focused and I can respond to all the the interesting stuff that the Dr. Hammer's talked to me about. And then number three, if you have missing teeth, you should replace them. Okay. This is something that I think that if you can stick to those three things, you're gonna maximize your your oral health from a longevity perspective.
SPEAKER_00:Very well said. Thank you so much, Imran. And I'm really happy that we were connected because I think this is a topic that I'm I'm a guilty as charge that I haven't really, even though I should have, but not uh dove into it enough. And I learned so much today from you. So thanks for kind of opening my eyes to something that was right in front of me. I didn't really see the forest for 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, even professionals. I consider myself a professional and I learned so much today. I'm certainly going to integrate that even more aggressively into my holistic approach in patient care. And we need advocates like you to talk about these and bring awareness. I think it's more important to bring awareness to our medical colleagues because we as specialists are always second or third in line of the patient's journey. I mean, the gatekeepers are the primary cares and dentists that I hope they're listening and tuning into this podcast. And again, thank you so much. How can someone get in touch with you if they want to learn more about what you do, where you are, what you're up to, or just learn?
SPEAKER_01:Yeah, thanks so much for having me. Honestly, I I I'm gonna hit you up after this for all of your longevity recommendations. I want to I want to know more about how I can get that. And also, if you're ever in the Boston area, I'd love to work out with you. Like I I see on your Instagram and like you're always working out with all these longevity influencers. So you know, that'd be awesome if you're ever in Boston. That being said, I'm on Instagram. My my Instagram is the Doctor is Awesome. I also have a podcast called The Futurist Society, and specifically through Tufts, we have a podcast called Perspectives and Oral Health. But also I'm on LinkedIn, just look me up, Imron Awson, and uh I'm always putting out content that I consider to be revolutionary in regards to connecting oral health and systemic health.
SPEAKER_00:Love that. And I'll put all those in the show notes. And if you have any questions, please comment. And yeah, I would love to meet up with you. My brother just left Tufts, he was actually at Tufts Medical School, the head of cornea and ophthalmology, and he just moved to Tampa, Florida, to FSU. He took the chairmanship there, but he was for many years there. I was myself, Boston was my first port that when I arrived from Germany. I went to Harvard, did oral pathology there. That was 25 years ago. So Boston is very near and dear to me. It still feels like home since it 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. And, you know, maybe we can do something together in the future and uh love to connect with you. Thank you.
SPEAKER_01:Thanks, man, and thanks to the audience. You know, I I I really appreciate hearing Daria, but I we wouldn't be here without you guys. So thanks so much to everybody. Have a great day, everybody. Thank you, thank you, Iran.
SPEAKER_00:All right, guys, show's over. Thanks for listening to the Daria Hammer Podcast, and thank you to Dr. Imran Asin for sharing his expertise. If this helped you, please follow the show and leave a quick review and rating on Apple Podcast or Spotify. It literally takes 15 seconds and makes a huge difference for visibility so more people can benefit from the knowledge my guests bring. Show notes and protocols are in the description. For deeper dives, subscribe to my newsletter. I'm Dr. Daria Hamra. Stay curious, take action, and I'll see you next time. Bye bye.