Metabolic Breath Analysis in Dentistry

Hi, everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. As we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Years ago, I decided I'm going to clean up my cupboards and stop using chemical toothpaste, chemical mouthwashes. And I started different brands of natural toothpaste and I found that some of them didn't taste very good. They were very medicinal because of the herbs that were in there. But the biggest problem is that they were not good cleaners. And I really wanted a toothpaste that actually cleans my teeth. It brings up the white and strengthens my teeth. Because I didn't find what I wanted, I actually went and created the Orasana probiotic tooth powder and I sourced the best nano calcium hydroxy appetite that actually had studies to show that it can whiten your teeth. And I started brushing with this and I wanted to add also the probiotics for gum support and gum health. And I noticed that my teeth are whiter, brighter, and it cleans the plaque so well. So that's why I created the Orasana natural probiotic mineralizing tooth powder to give you that nice clean. The benefits from the probiotics, the calcium hydroxyapatite to keep your teeth strong and bright.

Hi, everyone.

Welcome to today's show. I'm your host, Dr. Sanda, and I'm very excited to talk to you about today metabolic breath analysis. And a lot of you might be thinking, what the heck is breath analysis? And it was new for me. I learned about it at the Institute for Anti Aging Medicine this past December, and I'm excited to have with me Panos papa diamantes. Did I say that right?

Very, very nicely. Very nicely done.

And I'm super excited because I typically don't get to talk to know engineers and inventors of the product. So thank you, Panas, for being with us.

Absolutely. Thank you so much for having me.

How did this journey start for you into this, you know, nutrition and exercise?

So, yeah, it started about, I want to say, like six, seven years ago when my co founder, Apostolos and I were both Greek, as you can tell from the name, decided to explore the realm of breath analysis, which is truly a fascinating space. Both of us are engineers, so we didn't really identify a specific need and tried to build a product or service to address this need. We kind of started by building a technology because we thought it was very cool. And specifically what happened is that Apostolos, by the way, we go back almost 25 years, so.

Yes, yes, yes.

Yeah, yeah, yeah. So we've been friends since the age of six, so he was my first friend in life. We went through elementary school, middle school, and high school together. Also same undergrad, I was doing mechanical engineering, he was doing applied physics and math. And then right after Greece, I moved to Stanford to do my graduate degree. And then I got a job in tech. I was working as a product manager and enterprise data centers. He went to Cambridge, UK to do his PhD on sensing technologies. And as part of his research there, he became involved in breath analysis. Because breath analysis is a very evolving field in the. In the space of diagnostics, medical diagnostics and cardio metabolic analysis, which is what Pinoy does today, is probably the most well established application of breath analysis. But. But before we came along, breath analysis was something that was only available in highly sophisticated and very few clinics. And that was a factor of the devices, meaning that the actual hardware available before we came along was bulky, expensive, very difficult to operate, but also it was a factor of the rigor and the time required to analyze all the data coming out of these devices effectively. And so what. What would happen is some clinics would invest the money to buy a device. The device was clunky, big, difficult to operate, they wouldn't run many tests. But then the biggest thing is that most people who would get their VUE to max test done, or they would get their metabolic rate test assessed, they would pretty much get a report that had one or two numbers. So here's your VO2 max. You have V2 max of 47, and these are your training zones, or your resting metabolic rate is 1200 calories, 1400 calories. Whatever the case may be, the reality is that cardiometabolic testing, or VO2 max testing or metabolic analysis is one of the most rich assessments in clinical diagnostics. And because people hadn't really looked into fully analyzing the spectrum of information coming out of that test, they would hand out reports that were only scratching the surface of what this assessment has to offer us. And so, as a company, what we focused on is initially to build a hardware that is scalable and something that the average health professional can utilize in their practice. Today, we have people ranging the entire gamut of health businesses using us, from physical therapy clinics, chiropractic clinics, primary care doctors, fitness centers, weight Loss centers, resorts. Everyone who deals with health and wellness can benefit tremendously from breath analysis because it's arguably one of the best first line screening tools for anyone starting their health and wellness journey. And so we made hardware that all of these folks can very easily use. But then also we built the entire service and software stack in order to be able to give reports to end consumers that A they can read and B, they can find useful for their lives. In other words, okay, you gave me a little bit of information or a lot of information about my body. How do I change my nutrition accordingly, how do I change my training accordingly, how do I change my breath work or whatever the case may be. So we focused a lot, I would say we focused the past like three, four years of product development in covering the entire spectrum of lifestyle, nutrition and training recommendations so that people can find this assessment useful. We've talked to countless health professionals that have bought into other devices, predicate devices and the number one feedback they would give us is that yeah, we bought it, we put it in the closet because people would come, spend $200, get their view to max value and not really know how they can use this information in order to optimize our performance, optimize their training, nutrition, etc. More or less. Both Apostolos and I came from purely engineering backgrounds and we kind of became health professionals on the job. We ultimately had to read a lot upon scientific articles and learn how endocrinologists, cardiologists and pulmonologists actually utilize information coming out of the device. And to this day, obviously we've worked with many kols to develop our algorithm and our service stack. And yeah, it's been about six, seven years that we've been added at this point.

Yeah, so, so basically this clunky device and you from an engineering perspective kind of looked at it and say how can I make this less clunky and more user friendly? And started changing the technology.

Smaller, portable, easier to use and cheaper. These were many of the problems that health professionals were facing before we came along. And that's, you know, that's what we were selling for the first like one or two years of the company. And as we started to successfully enter more general population health centers is when we realized that there's this additional need for a comprehensive solution that doesn't just offer a more scalable hardware, but also complements it with a service that answers, you know, bridges the gap between here is the insights and here are the actual things you need to change in your diet, exercise, et Cetera.

Yeah. And I want to step it back a little, because a lot of people listening, just like me when I first ran into this, don't have no clue what we're measuring via breath. They're like breath. I thought you just measure if it's bad or good.

Yeah, well, that's one thing. It's not the only thing that's pretty.

Much easy to recognize. Good breath on that.

Yes.

And there's breath tests that look at the amount of bacteria, but this is not what we're talking about here. How would you. I'll let you explain what knowing the bike does and what. What are we quantifying when we talk about a breath test?

Sure, sure. So cardiometabolic testing, or Vue to Max testing, or metabolic testing, basically analyzes three signals at a fundamental level. You're measuring oxygen concentration, CO2 concentration and flow volume. Flow volume is the amount of air you're exchanging with the environment in every breathing cycle. So what you're basically doing is you're wearing this mask and continuously in every breathing cycle, you are measuring oxygen concentration, CO2 concentration, and how much air you're exchanging with the environment. From these three fundamental signals, you can then compute 23 biomarkers. These 23 biomarkers, some of them are famous, like VO2 max or metabolic rate, how many calories our body is burning. If you think about it at a fundamental level, what is happening down to our cells is they are pulling in oxygen. They're using it to oxidize fats and carbohydrates, and that process generates CO2. And because we know from molecular biology how much oxygen the oxidation of a carbohydrate molecule requires, and we know the same for fats, we can derive from measuring O2 and CO2, the number of carbohydrates and the number of fats that have been oxidized through our metabolism in a particular time window. By analyzing how much oxygen has been consumed and how much carbon dioxide has been produced. This is why we also refer to this assessment as indirect calorimetry. You're effectively measuring indirectly the amount of fats, carbohydrates, and therefore calories your body has expended. Now, in addition to these metrics, however, there's several other metrics that look into other systems of our biology. For instance, you're looking into metrics like O2 pulse. O2 pulse is the amount of oxygen your heart pumps into your body per heartbeat. You're looking into things like ventilation over VCO2, which is an indicator of how Efficiently our lungs discharge CO2 as we are exhaling. And in totality you have about 23 biomarkers. And by grouping these biomarkers into different categories, you can start to delineate the health of four major systems in the human body. Cells being one of the most important ones. Lungs, heart and blood circulation, and then lastly, nervous system. Now, the trifecta of lungs, heart and cells is what we refer to as the oxygen chain, which is effectively what is powering our aerobic metabolism, which is basically what is keeping us alive at any given point in time. Because this is the process through which we take oxygen and we push it down to the cells in order to generate energy. If that thing stops like we die in minutes. And then this chain also discharges the CO2 that is produced through that process. And it's extremely important to think about this chain as the most fundamental element in our biology. Because if you think about it, nearly every chronic condition that is likely to kill you or reduce your quality of life has to do in some way through either the disruption of oxygen supply in one of these systems or one or more of these systems. For instance, if you look at heart disease, it is manifested through some sort of disruption in oxygen supply of the heart. If you look at lungs, it's kind of the same. If you look at metabolic dysfunction, it's a inability of our cells to effectively pull oxygen in and utilize it to burn fats and carbohydrates. So by analyzing these 23 biomarkers, we're effectively scanning the health concurrently of our lungs, heart and cells. And we're not just looking at them in unison, but also individually. That's why this type of assessment is used by cardiologists, it's used by pulmonologists, is also used endocrinologists, and now rapidly expanding in the integrative medicine space where you know, as you know, the, the, the, the name alludes to it's field of medicine that looks into things in a holistic level. And breath analysis obviously has a very big role to play in the space because of its holistic nature.

Yeah, absolutely. And I love the way you explain that. You know, I'm a nutritionist as well as, you know, owning Beverly Hills Dental Health and Wellness. We do holistic dentistry. And for me as nutritionist, the challenge was always personalizing the experience. How can we personalize their nutrition? So I don't give everybody one size fits all plan. And one thing that I love about adept Nelly program is yes, now you know, it's such an easy test. That you developed. And you know, by the way, it's so easy to use for my assistant to Capture all this, 23 biomarkers in 10 minutes, really. And based on that, we can create this personalized nutrition plan, a three month plan that you offer based on their goals, whether they want to lose weight, whether they want to gain muscle. And this is really groundbreaking for me and hugely helpful and a busy practice to actually have you do this in a, in a scientific way way versus just like, okay, well, you want to use weight, here's some general recommendations.

100%. And you know, personalization truly works when it comes to nutrition because each person burns a different level of calories. You know, a lot of people show up and have slow metabolisms and they don't really know about it. And the only way of figuring it out is doing a metabolic test like the one PNOE offers. But then it's not just about calories, it's also about macronutrients. Like, how effectively your body metabolizes fats and carbohydrates is massively important when it comes to determining the right macronutrient balance for your diet. How many fats, carbs, and protein you need to be consuming. Right. And so again, going back to what I said before, which is, okay, this is the insight, but how do we translate that into something actionable for the patient? That's where our service comes in and fills the time gap that would be required to be filled by your practice if we didn't have the service, which is, okay, now we have this information. How do we put together a nutrition program that is personalized to someone's biology, but also personalized to their lifestyle? You know, in addition to the test, we hand out a very comprehensive questionnaire that clients can fill out where we understand things about their preferences, medical conditions, risk restrictions, etc, and merging all of this lifestyle and biological information into a personalized nutrition plan is something that takes time. And in order to make it something that can be provided at scale, we've actually built a lot of code and a lot of technology in order to power that. Right. And so, yeah, that's ultimately why we lay claim to the fact that we don't just sell metabolic testing, we offer an A to Z solution for an integrative medicine practitioner to bring in personalized wellness into their practice.

Yeah, I really feel like this testing, cardiometabolic testing, should be the standard of care in addition to the blood testing that's being done. Because right now, you know, even for us, we do salivary Diagnostic. We do this, but, you know, it's part of healthy lifestyle, and we're talking about lifestyle medicine. This, to me, is a test that's an absolute must for everybody, and so.

Does the American Heart Association. So according to. Yeah.

Go ahead.

Yes. According to their 2016 scientific statement, assessing Carter's piratory fitness, ie VO2 max, is something that should be done at least annually. Why? Because it gives us probably the best indicator of how long and well someone is going to live. Obviously, the statement doesn't go into the details of, hey, you can also use that to prescribe nutrition, or you can also use that to prescribe training, or you can also use that to detect disease. But, you know, just the fact that this test can give you the gold standard for understanding how healthy this person is and how likely this person is to die and develop some sort of chronic condition is alone enough to cause a major scientific organization like the American Heart association to openly state that, hey, this is something that everyone should be doing at least once a year.

Oh, absolutely. So, you know, somebody. I actually had a patient said, oh, my God, I'm afraid to do this. I don't want to predict, you know, my death. But the good news about it is, like, we can make changes if we know. Correct?

Yeah, 100%. And, you know, knowing is half the battle, as, you know, as we like to say. Right. You know, you cannot change what you can't measure.

So talking about the customer journey, let's say, you know, somebody comes in, for those of you listening that want to know, how is this testing done? Basically, you know, you come in the office, there's actually a mask that's being put on that you breathe through. And one of the questions we get is, like, is it claustrophobic? We didn't find that to be the case. Even people that had that, you basically, you know, sit in a chair, you put the mask on, you just sit and breathe like you normally would for 10 minutes. And then we get results pretty quickly, I want to say, you know, within a few days. And we always want to know what your goals are. Is it longevity? Is it weight loss? Or is it building muscle performance? And then one of your specialists would go over the test results and kind of interpret them. And the recommendation is always based on nutrition and exercise. Those are the two main things here that we're focusing.

And sometimes a little bit of breath work. But, yeah, typically it's nutrition and exercise. Yeah.

Yes. And breath.

Yeah.

It's so important to actually be able to breathe. Well, three months later, we do another test to see where you're at and what changes are you seeing. Have you look at the data yet from.

From 100?

Yeah, yeah.

We've done more than 150,000 metabolic tests at this point. And we actually have quite a bit of information on, you know, how things change over time for people following specific regimens. But in general, you know, the way we structure the customer experiences in a way to help the practitioner provide justification and support for their program. So what we typically do is when an affiliate signs up with pnoe, they will take the services they provide, which may be simple things like personal training or more advanced things like red light therapy, other bio optimization services like cryotherapy or pmf. We also have the ability to integrate IV compounds or supplements into the recommendations that we provide. And that creates a very holistic plan that doesn't just talk about nutrition and exercise, but also brings in the totality of available services within the walls of the practice. Now, the reason why this is extremely important for the affiliate is that when someone comes back and retests, and in most cases the retest is actually going to yield some sort of improvement. Typically we see improvements in either V2 max or resting metabolic rate, or fat oxidation versus carbohydrate oxidation. In other words, seeing that the person is more reliant on fat oxidation after going through a three month program, which is a very strong indicator of improved cellular and mitochondrial fitness, these are typically the areas where we see improvements. For those who focus a lot on breath, work and lung fitness. We also see improvements in breathing frequency, which has a profound effect on sympathovagal balance, balance between sympathetic and parasympathetic activation. But whatever the case may be, it's way more likely than not to actually see an improvement. And that immediately creates retention for the affiliate and the business because the person can actually see and paper, not just feel, but actually see in paper that whatever I did over the past few months actually produced some sort of measurable health result. And ultimately, this is the biggest gift that we can provide to the affiliate. Better retention, more happy clients, more predictable revenue streams, and ultimately business growth.

Yeah, absolutely. In a healthier world, which is the best. Yeah. You're also doing some retreats that you mentioned about. So, you know, I mean, in the beautiful Greece, which, you know, I love to visit, I don't get enough time usually there, but tell us a little bit about that. I'm sure somebody listening might be interested in a wellness retreat. It's just so hard in the United States. To actually take the time to, to get well. Sometimes a retreat is just what's needed to kick start somebody's wellness 100%.

And this is actually the motivation behind that. So it was, the mental journey for us was kind of the following. We sell quite a bit into the hospitality industry and we've seen how powerful personalization and wellness can be as part of someone's vacation. Right. Because a lot of people now travel and go on vacation with wellness being an extremely important part of their schedule and their intention for traveling. But then we've also seen with a lot of friends of ours or a lot of people we know or, you know, things we hear from the industry that, as you said, people jumpstart their health journey or people begin a health journey because they actually get, go into a retreat and define themselves in an environment that, you know, lasts for about seven to 10 days, where people, you know, surround themselves with wellness and, and, and, and, and good habits. And so we thought, what if we actually help people organize these retreats, right. We provide them with the infrastructure they need to provide personalized wellness. And we're starting with our first retreat in Greece, which is going to take place sometime in September of this year. Signs up will be live in a few months from now. And it's going to be a retreat that includes nutrition, nutrition training, workout programming by optimization services, all in one package. And it's going to be in the beautiful island of Paros is. Yeah, yeah, Paros is right across Mykonos and Santorini. So there's going to be some day cruises that people will have the opportunity to do while they're there. And it's going to be about seven to eight days and yeah, we'll see how that goes. We're actually quite excited about it. We're confident it will do quite well if it does. So I mean, we're obviously looking to do more of that.

Yeah, we're going to post the link with that information in the show notes for anybody who's interested. Let's go. I would love to chat a little bit about dentistry and breathing and how that's related. We have a few dentists actually listening to our podcast, Hygienists. And for me, in holistic dentistry, we check the airway and breathing all the time. But I would love to hear your thoughts about that.

100. I was actually going to bring it up, so thank you for the segue. So breathing and dentistry is one more like, you know, area that, you know, people have neglected when they looked into metabolic analysis for all these years. And the thing is that the way we breathe like massively impacts oral health. First of all, people who are bad breathers, mouth breathers, they hyperventilate, suppress the amount of saliva they produce. Saliva is a neutralizing factor for many bacteria and toxins that can cause, you know, many negative externalities in our, or in, in our mouth and negatively impact oral health, from simple things like cavities to more serious things like periodontal disease or pathological inflammation of our gum. So being a mouth breather can, you know, severely and almost, you know, immediately impact negatively your oral health. Bad breathing can also be a factor that negatively impacts the way your face evolves. So there's a lot of studies and there's a lot of literature out there showing how mouth breathing can shape our jaws and also our airways. So typically people who are mouth breathers and they hyperventilate, they create the so called long face syndrome, which is basically this concept of describing someone's face that is being elongated, right? You get narrowing of the upper jaws and that creates a series of problems like narrowing of the nozzle, cavities, the nostrils and the nasal airway that has several other externalities that we can talk about later on. But overall that is going to negatively impact how your face looks. And that ultimately can give rise to several breathing conditions that can be debilitating, like obstructive sleep apnea. That's why a lot of orthodontists today actually employ their interventions as treatment for osa, obstructive sleep apnea. And many of them actually are able to cure people just by changing, right. The anatomical formation of their patients mouths. Right. So something else that is very important to highlight here for our listeners is that people tend to think of mouth breathing as something that we develop later on in life. As a matter of fact, however, pediatric mouth breathing occurs at an incident of roughly 10 to 15%. That means that many of us are about, are bad breathers, mouth breathers. From early on in life, we don't know it like our parents don't know it. And so we go about living our lives and we subliminally create this habit, this horrendous habit of bad breathing that you know, is going to wreak havoc in our oral health, but then can is certainly wrecking havoc in so many other areas of our physiology. And as I said earlier, there's certainly a bi directional connection between breathing and oral health. Bad breathing can impact negatively oral health and the formation of our mouth, but vice versa, poor anatomical evolution of our mouth can also yield to, can also yield things like obstructive sleep apnea, sleep problems, snoring at night. And obviously that has a day to day impact that, you know, is pretty significant for many people out there. And I think what's very important for people to understand is that because oral health is probably one of the first things that will be impacted when people start to breathe abnormally and when people start to have these kinds of problems, oral health professionals are probably one of the best suited professionals out there to be the first line of attack in terms of identifying the presence of these problems and intervening earlier. Compared to other things that we have in our arsenal down the road. Making a few changes in our, you know, mouth, doing some orthodontist work or like maybe just changing the way we breathe is extremely less costly than, you know, fighting a chronic condition down the road. Right. Doesn't even compare when it comes to like, you know, the, the cost at the end of the road.

Oh yeah, I agree with you 100%. Yeah, I'm glad you brought up this topic because we're in dentistry, we don't talk about this enough. I think more in the recent years. But when I was in school, it wasn't a topic of conversation. And I do think, you know, even in terms of breath testing is something so easy to do and incorporate. And it goes hand in hand with sleep apnea, which is something that now I am treating in the dental office via, let's say, laser therapy. We actually have some really cool modalities outside of orthodontist to help to open up the airway space. And in conjunction with a personalized nutrition plan from Noe, Having those two things together I feel is really a game changer in treating patients with sleep apnea and weight 100%.

And you know, irrespectively of where bad breathing is coming from, it may be a consequence of poor oral health or anatomical formation of our mouth, but it may also be a factor of something completely different. Right. But poor breathing is going to immediately create a cascade of negative effects, including deregulation of our sympath balance, which then becomes like a cluster bomb. Right. You know, our CNS PNS balance goes out of whack, we immediately start to burn less fat and we burn more carbs because when we are in a fight or flight mode, our body is primed to utilize carbohydrates because it is the fuel source we use. When we are in a condition where we have to react to things, it yields digestive problems, we metabolize things a lot less effectively. It also impacts oxygenation of our active tissue through two separate pathways. A is the Bohr effect, and B is the vasoconstriction, the constriction of the arteries. So all of these things happen just because we breathe badly. So if you simply change the way you breathe, you can bet that there's a very high degree chance that all of these issues can be rectified. And so, yeah, identifying whether someone is breathing incorrectly is extremely important. And, yes, a dentist could very well put a mask on for a few minutes and give their patients tremendous value.

Yes. And this is, you know, with the airway evaluation. It's something that, you know, I was just reading an article in a registered dental hygiene magazine because this article was encouraging hygienists, because a lot of people go in for their dental cleanings, and it was encouraging hygienists to look at the airway and kind of identify, hey, are you a poor breather? And encourage the patients to do something about it. So I think, as you said, in dentistry, we have such a great opportunity to observe someone breathing and really change their life by doing simple testing.

Exactly.

Great topic. So for those of you listening, where can dentists and hygienists find out more information about Noe?

We should add the www.pnoe.com, that is pnoe.com. or follow us on Instagram. We are there as Pinoy. Pnoe analytics in Greek means breath.

Okay, perfect. Easy term.

Very. Yeah, exactly. Pinoy.

Well, this has been hugely informative. Panos. Any. Any last words of wisdom in relationship to breath?

I think we covered pretty much everything. The number one thing that I would like people to take away from this discussion is that, you know, metabolic testing is so much more than just measuring how many calories your body's burning. It's about understanding the mechanics of your breathing, which can impact so many different things in your life and your health. It's about evaluating your heart function, lung function, nervous system function. And that's why bringing this information to people through a very, very simple test is something that we are very, very passionate about in our company, and we're very excited to have people like you bringing this integrative test in their integrative, you know, clinic. And thank you so much for having me.

Yeah, it's my pleasure. Thank you, everyone, for listening to this show. If you have any comments, please go to my YouTube channel, ask Dr. Sanda where you can actually leave comments in there or any questions you might have so we can address them. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me at on Instagram. Doctorsanda, this is Dr. Sandha. And remember, your mouth is the gateway to your health. So take care of it in the most natural and best way possible.