Comitting Suicide One Soda at a Time

As a dentist, I am on a permanent crusade against sugar because of its negative effect on teeth, but I’m beginning to think that tooth decay is the least of your worries if you are a big soda consumer. Here are some disturbing facts from a recent article in Bottom Line Personal.

The American Heart Association says that the safe upper limit for sugar consumption (above what is naturally present in foods) is six teaspoons for women and nine for men. Simple enough. But a 12 ounce can of cola contains 10 teaspoons of sugar. So do bottled iced teas and sports drinks. Even real fruit juices like orange, grape or apple contain about 10 teaspoons of sugar per 12 ounce glass. (It’s true that fruit sugar occurs naturally, but it creates the same disruption of body chemistry as added white sugar.)

So how many servings of these drinks do you consume in a year? If you are an average American, it’s 600 cans of soda and 125 12-ounce servings of juice. When you do the math, that’s about 7300 teaspoonfuls of sugar. American Heart Association guidelines are about 2000 teaspoons for women and 3000 for men. 

Without getting into the gory details, in addition to tooth decay, excess sugar consumption is associated with calcium depletion (as in osteoporosis), diabetes, autoimmune diseases, high blood pressure, pancreatic cancer, gout and asthma, just to name a few. These are all chronic diseases, meaning that they gradually diminish our quality of life. Said another way, we are killing ourselves a little bit at a time.

So what can you do? Switch to diet soda? I’m afraid not. In a study of 2500 people, those who drank diet soda daily were 61% more likely to have a heart attack or stroke than those who didn’t. On top of that, it’s hard to quit soft drinks because there are actual withdrawal symptoms, like headaches and cravings. Here are some strategies for quitting – switch from soda to fruit juice and water it down – about 25% juice and 75% water. If you like fizzy drinks, mix soda water with fruit juice or iced tea, about 50% of each. You can also add lemon slices or a little pureed fruit to good old water. There are a few commercially available beverages that are acceptable. Look for brands like Metromint or Hint. Be careful of so-called health drinks like Vitamin Water, however. Reading the label may reveal high sugar levels even though the name implies otherwise.

I have one more observation. Unless you have been living in a cave, you know that health care costs are one of the biggest economic challenges we face as a nation. The folks we have put in Washington don’t seem to have the slightest idea how to deal with it. What do you suppose the long-term economic benefit of reduced sugar consumption might be? Have you heard anyone in Washington talk about it in a serious manner? Neither have I.

Lifestyle Choices and Heart Disease

For over 25 years I have been a participant in the Healthcare Professionals Follow-Up Study (HPFS) sponsored by the Harvard School of Public Health. It is the world's largest, detailed long-term study of men's health. I fill out periodic, detailed questionnaires about my diet, exercise patterns, medical issues that develop and medications. The study has access to my medical records and occasionally even takes blood samples.What they seek to learn is the effect that dietary and lifestyle choices have on disease. 

In their recent newsletter, they reported on cardiovascular disease (CVD). While we all know the risk factors for CVD, I was astonished at what a large difference lifestyle makes. For example, men with a body mass index of 30 or higher (categorically obese) have more than DOUBLE the risk of skinny guys.

They also analyzed "low-risk lifestyle" choices which include prudent diet, regular exercise, weight management, moderate alcohol consumption and not smoking. Men who achieved all five of these factors had a whopping 87% lower risk for CVD than those who achieved none of the factors. Even men who were taking medications for high cholesterol or high blood pressure showed lower disease incidence if they maintained a low-risk lifestyle in addition to the medications.

I was pretty much blown away by these numbers. We all know that low risk behavior makes us healthier but I had no idea that the magnitude of the effect was so great. I guess I'll keep eating salads and working out at the Y.

VELscope and Oral Cancer

We have been using the VELscope in our oral cancer screenings for several weeks now. It's basically a high-tech, filtered, blue LED light that makes abnormal soft tissues in the mouth look different from normal tissue even before it changes enough to be seen with the naked eye. It's quick and painless and has met with overwhelmingly positive response from our patients. The idea is that the earlier we can find a problem, the better the chance of successful treatment.

Obviously, we can see more with the VELscope that we can without it. But using it has made me realize just how much we cannot see, no matter how carefully we look. We can't see down into the throat and in most cases, we can't really see the tonsils. Unfortunately,  these are areas where oral cancer is occurring more frequently in younger people. In a way, the VELscope is a metaphor for what happens in dentistry (and medicine, for that matter) every day. No matter how hard we try, it's impossible to find everything. High-tech stuff helps, but it is not a magic bullet. And we can't overcome the damage that occurs from harmful everyday habits. Treatments like filling a cavity or surgically removing a cancerous lesion are never as good as preventing the problem in the first place. I'm glad to have the VELscope, but I would be even happier if I didn't need it. Wouldn't it be great if no one smoked, or ate refined carbohydrates, or engaged in behaviors that encourage the spread of Human Papilloma Virus (HPV), a leading cause of oral cancer in young people? The VELscope is a cool thing to have and makes a big impression with many patients. Prevention, on the other hand, is not very dramatic but it is, by far, the best tool we have. 

Necessity is the Mother of Invention

On March 29, fresh from a trip to Viet Nam, I made a post about the difficulty of crossing the street in a small country with a lot of busy people and 25 million motor scooters. There's a lot more to the motor scooter story, however. If a motor scooter is your only means of transportation and an important part of your livelihood, you can use it for things that would never occur to those of us who have the luxury of having minivans and SUV's. In Viet Nam, the lowly motor scooter is family transportation, a commercial vehicle and a beast of burden among many other things, I saw scooters carrying dozens of live baby ducks, every conceivable fruit and vegetable, chickens, a side of beef, hundreds of eggs, hay and straw, flowers, stacks of cardboard for recycling, twenty foot long bamboo poles, giant bales of stuffing for furniture and the furniture itself. As long as the kids are little, it's no problem at all for a family of four to go on an outing with the sleeping baby wedged between Dad, who is driving, and Mom on the passenger seat while big brother sits in front of Dad. All kinds of things are sold from scooters. I saw basket vendors, brooms and brushes, pizza, a toy store and lots of mobile bakeries. I watched two guys weaving their way through traffic while carrying a full length mirror. But the most amazing thing of all is in one of the attached photos. Our guide in Hanoi, Huy, needed a new refrigerator. Rather than pay extra to have it delivered in a truck, he recruited one of his buddies who balanced it on the back of his scooter and made the delivery without incident.

Invisible High Tech

I recently took a CE course from Dr. Larry Emmott, who is regarded as the guru of high technology in dentistry. I was amazed to find that half of the offices attending the course did not use digital x-rays, did not have computers in the treatment rooms, and did not have a website. We have been using all these things for over ten years and it got me thinking about how, after being in place for a little while, technology sort of disappears into the infrastructure and gets taken for granted. For example, it's not obvious to our patients that computers in the treatment room mean that all their records are accessible from anywhere in the office without having to find a paper chart. Once an entry is made in a chart from anywhere in the office, it is accessible for front desk check-out, submission to insurance, for review by doctors, hygienists and assistants. Nothing gets lost. Nothing gets misfiled. We never find unidentifiable x-ray films on the floor because they have fallen out of someone's chart. (There are no films because the x-rays are digital.) Chances of a bad treatment outcome due to lack of information or, even worse, incorrect information are reduced dramatically.

When we moved into our present office over ten years ago, I remember how I almost choked on the amount of money needed to purchase and install the high tech systems. This course reminded me of what it used to be like in the olden days before we had them. Now I cannot imagine working without them.

Crossing the Street in Viet Nam

I'm traveling in Viet Nam and this is being written in Hanoi. The Viet Nam war was one of the defining events for my generation and I approached this trip with mixed feelings. But Viet Nam in 2011 is a far different place than it was in the sixties. The population is now about 90 million - more than double what it was when the war ended in 1973. Half are under age 35. There are also 25 million motor scooters. They are EVERYWHERE. Add millions more cars, trucks, bicycles and buses and you have a situation where taking a stroll is a big adventure. As best I can determine, here are the rules for getting across the street in one piece.

#1. Size matters. That means a bus is king of the road and pretty much goes wherever it wants. If a pedestrian, a motor scooter or even a car gets in its way, there is going to be trouble. As a courtesy, however, the driver will invariably honk the horn before he squashes you.

#2. Cars wish they were buses. They get frustrated because they are either cut off by the buses or boxed in by a swarm of motorbikes. The only thing left to intimidate is a pedestrian, particularly a bewildered tourist. It's best to try to avoid them at all costs. This, of course, is impossible.

#3. Motor scooters behave like people, except they have engines. Because their operators are out in the open, just like you, they are much more considerate than cars or buses and they will actually try to avoid you if you find yourself marooned in the middle of the street. However, they travel in large herds much like the Wildebeest in Africa. As an American-style pedestrian it is hard to get used to the idea that they they won't head straight for you when you step off the curb.

#4. Sidewalks are not safety zones. Trying to escape the stampeding herd of scooters by jumping back onto the sidewalk will not work. When things get too crowded on the street, the scooters use the sidewalk instead. They might also come out of an alley or even a storefront and sneak up on you.

#5. Traffic control measures such as stoplights and lane markers are regarded as amusing suggestions rather than rules to be obeyed. An open lane is regarded as an opportunity for a scooter to break away from the herd, even if the opening is on the wrong side of the street.

Given these rules, the question is - How do you get from one side of the street to the other without grievous bodily harm?  First, pay attention to everything around you. Being distracted from the task at hand by talking on your cell phone or to your traveling companion is a recipe for disaster. Second, keep your goal in mind. You want to get to the other side of the street. Move deliberately in that direction, even if it appears suicidal. Third, don't make any sudden moves. Don't chicken out and back up. Above all, don't try a quick sprint toward apparent safety. It's harder for someone to avoid you if they can't tell what you are going to do next. Fourth, have faith that everything is going to turn out okay. This is the toughest one of all. Believe it or not, the scooter drivers just want to get where they are going. Running over a pedestrian, especially a tourist with money to spend, would be bad for the local economy as well as inconvenient for you.

It turns out that Vietnamese motor scooter operators are incredibly skilled drivers who mean you no harm. They just play by an entirely different set of rules. The trick is to understand and respect those rules, then act  accordingly.

Come to think of it, life in general might be a little bit easier if we approached with the same level of attention and trust as crossing the street in Viet Nam.

Diet Soda, Heart Disease and Teeth

A study published in the July issue of the American Heart Association Journal has caught my attention. For years, we have been reluctantly recommending that soda drinkers switch from regular soda to diet soda because of the high sugar content in regular soda and its relationship to tooth decay. (We would much rather see no soda at all in your diet, but until now we thought that diet soda was more or less acceptable.) This study shows that people who consume significant quantities of diet soda have a 48% increased risk of heart disease. That’s a lot, and the more diet soda consumed, the greater the risk.

          This is not to say that diet soda necessarily CAUSES heart disease, but that it is ASSOCIATED with it. The current thinking is that people who consume lots of diet soda also tend to eat more fatty foods, more empty calories and exercise less. In other words, diet soda is part of an unhealthy lifestyle.  Apparently diet soda is one of the factors that leads to what is known as metabolic syndrome – a combination of high blood pressure, excess fat around the waist, high triglyceride levels, elevated insulin and low levels of HDL or “good” cholesterol. It’s metabolic syndrome that causes heart disease.

          The dental problem with diet soda is that it causes alarming levels of enamel erosion in kids who drink a lot of it. The enamel is gone within a year or two of the time the teeth erupt into the mouth. Diet soda contains phosphoric or citric acid and these acids can dissolve away the enamel in a very short time. Once it’s gone, there is no way to get it back. As a result, these kids often need crowns at a fairly young age to protect the underlying tooth structure. I have always thought that anything that eats the enamel off your teeth is probably not very good for the rest of your body and now there is a study to prove it.

          I think that maintaining a healthy lifestyle in our society is difficult for many reasons, but that’s a subject for a whole ‘nother blog. (Or several more, for that matter.) In the meantime, what to drink? The boring truth is that water looks like the healthiest choice.