Defiant Health Radio with Dr. William Davis
Defiant Health Radio with Dr. William Davis
How much of your personal health begins in the mouth?
The oral microbiome is second only to the colon in the density of microbes living there. The mouth is really a collection of varied ecosystems that differ in composition. For instance, the microbiome of the teeth is different from that of the tongue that is, in turn, different from the microbiome of the gumline. The oral cavity is therefore teeming with hundreds, perhaps thousands, of species of bacteria, fungi, Archaea, and viruses. It is a virtual tropical jungle of life.
But what is especially remarkable is that the oral microbiome is an ecosystem of life that plays a role not just in dental health (cavities, tooth loss, gingivitis, periodontitis, breath odor) but also in contributing to causing diseases in other parts of the body such as cardiovascular disease, colon cancer, reproductive and cognitive health.
So, in this episode of the Defiant Health podcast, let’s consider how the oral microbiome contributes to all sorts of health issues. While solutions are still being sorted out, let’s discuss at least some of what we know that can be effective in improving the condition of the oral microbiome and thereby hope to have a favorable impact on health elsewhere in the body.
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The oral microbiome is second only to the colon in the density of microbes living in that location. The mouth is really a collection of varied ecosystems that differ in composition. For instance, the microbiome of the teeth is different from that of the tongue. That is, in turn, different from the microbiome of the teeth is different from that of the tongue. That is, in turn, different from the microbiome of the gum line. The oral cavity is therefore teeming with hundreds, perhaps thousands of species of bacteria, fungi, archaea and viruses. It's a virtual tropical jungle of life. But what is especially remarkable is that the oral microbiome is an ecosystem of life that plays a role not just in dental health that is, cavities, tooth loss, abscess, gingivitis, periodontitis and breath odor but it also contributes to causing diseases in other parts of the body, including cardiovascular disease, colon cancer and reproductive and cognitive health. So in this episode of the Defiant Health podcast, let's consider how the oral microbiome contributes to all sorts of health issues. While solutions are still being sorted out, let's discuss at least some of what we know that can be effective in improving the condition of the oral microbiome and thereby hope to have a favorable impact on health elsewhere in the body. And later in the podcast, let's talk about Defiant Health's sponsors Paleo Valley, our preferred provider for many excellent organic and grass-fed food products, and BioDequest, my number one choice for probiotics that are scientifically formulated, unlike most of the other commercial probiotic products available today. So the mouth is rich in microbial life, from healthy microbial species like Villanella or Neisseria, rothia or Carinobacterium to pathogens that lead to tooth decay and increased risk for heart disease, dementia, adverse outcomes in pregnancy and other health problems. This is especially true for people who experience gingivitis or periodontitis, in which the mouth microbiome tends to be dominated by potentially dangerous species such as Porphyromonas Prevotella and Fusobacterium. We'll discuss these. This can be an especially troublesome problem for people with hypochlorohydria or lack of stomach acid, as hydrochloric acid in the stomach kills most microbes. Loss of stomach acid means that oral microbes can colonize the stomach while also, by the way, allow a scent of fecal microbes from the colon. That is, sibo, or small intestinal bacterial overgrowth. So the mouth can serve as a repository for unhealthy microbial species that can reach the stomach in someone with hyperchlorhydria, reach the lower reaches of the gastrointestinal tract, the small bowel and colon in the absence of stomach acid. But even with stomach acid intact and an intact immune system. Oral microbes can also colonize the brain, uterus, sinuses and other body parts and can thereby be responsible for health problems in those locations outside the mouth.
William Davis, MD:Let's therefore consider some of these microbes and the potential effects they exert on your body. So let's take some microbes one by one Now. I know these names are sometimes tongue twisters and hard to remember, but you'll find. Once you hear what these microbes do, it'll make a bigger impression on you and you'll be able to remember some of these names. So the first microbe to consider is Fusobacterium nucleatum. Well, this is a microbe that most of us have already, even in a healthy mouth. But if you have any bleeding gums or gingivitis or periodontitis, fusobacterium oddly proliferates out of control when that happens, and then it enters the bloodstream with any kind of microtrauma like just flossing or brushing your teeth, and the Fusobacterium enters the bloodstream.
William Davis, MD:Some is also swallowed and can reach the gastrointestinal tract that way. But it also enters the bloodstream and oddly colonizes the colon, where the evidence is quite strong that it is a major cause of colon cancer. So think about that. Your gastroenterologist urges you to have occasional colonoscopies to look for polyps. Look for it to prevent future cancer. But now we have pretty good evidence that Fusobacterium in the mouth can be the start of colon cancer. Along with dysbiosis, a disrupted composition of bowel flora in the colon, that's also a clear-cut cause of colon cancer. So what they should be doing I think what they will do in future is pay attention to the oral microbiome and the colonic microbiome and introduce factors to improve it and prevent cancer, so that microbe, though Fusobacterium nucleotide, gets its start in the mouth and thereby causes colon cancer.
William Davis, MD:That microbe also has been associated with eclampsia and premature delivery. Premature labor when a woman is pregnant, that can be catastrophic. Eclampsia can lead to seizures and death of the mom and the baby. Premature delivery of a child can be catastrophic. If a child is delivered, say, at 28 weeks, that child's going to have lifelong problems, psychological, immune problems and neurological problems. So it's a big deal to prevent or to reduce the likelihood of premature labor. And Fusobacterium nucleotide appears to colonize the amniotic fluid and provoke inflammation in the amniotic fluid and the uterus and that's why these things may happen. At least that's the current thinking. And that's why these things may happen. At least that's the current thinking.
William Davis, MD:Fusobacterium can also be found in the brain. It can be one of a number of microbes that infest the brain and it's been shown that people who have fusobacterium in the mouth have more rapid deterioration in their dementia, in their Alzheimer's dementia. So it's hard, it's very difficult to prove cause and effect, because it would take something like this I'm going to give you fusobacterium or a placebo and I want to see who gets more dementia. Well, no one's going to do that. It's unethical, right? No one would submit to that kind of awful clinical trial. So we have to rely on this kind of indirect evidence that people with fusobacterium identified in the mouth and then had their cognitive ability tracked. Formally, people with Fusobacterium deteriorate more rapidly. Fusobacterium has also been associated with inflammatory bowel disease, in this case probably via swallowing, but perhaps via blood-borne colonization also. But ulcerative colitis has been associated with the presence of Fusobacterium nucleotide.
William Davis, MD:So that one microbe in the mouth has broad and widespread implications for health in a number of areas. Another very important microbe in the mouth that gets its start in the mouth is Porphyromonas gingivalis Like Fusobacterium. You'll see more Porphyromonas in someone who's got some problems with their dental health and Porphyromonas like Fusobacterium can be found at high numbers in the brain. In fact, people with dementia who die and then allow their brains to be examined tend to have polymicrobial infestation. So Fusobacterium is a common microbe in the brain of people with dementia. So Fusobacterium is a common microbe in the brain of people with dementia. Porphyromonas gingivalis and fungal species are also various candida and other fungal species Like Fusobacterium.
William Davis, MD:If someone has Porphyromonas gingivalis also appears to be a factor that facilitates the development of stomach cancer. A lot of stomach cancer is caused by Helicobacter pylori, but Porphyromonas gingivalis somehow amplifies that risk. Another important microbe is Streptococcus sanguinis, and this is an odd one in that when you have this microbe in your mouth it can lead to clumping of platelets, that is, blood clot formation, and that's a factor in such issues as heart attack and stroke or carotid disease, where if you have platelets that are trying to clump, it can close off that artery and cause heart attack or stroke. That same microbe artery and cause heart attack or stroke. That same microbe, streptococcus sanguinus, can also increase inflammation. That increases your risk for cardiovascular events like heart attacks, but also risk for weight gain, abdominal fat expansion, insulin resistance, type 2 diabetes and even cancer. So streptococcus sanguinus, its main adverse effect is amplifying both blood clotting and body-wide inflammation. There are two other species that are relatives of fecal or stool microbes, klebsiella and Enterobacter, but they can be found in the mouth and when they are found in the mouth they've been associated with increased risk for ulcerative colitis. It's an odd situation, isn't it? And there are species of Prevotella, also cousins of fecal microbes, that have been associated with coronary atherosclerosis, that is, the development of coronary plaque in your heart's arteries, that it puts you at risk for heart attack, sudden cardiac death or having need for procedures like stent implantation or bypass surgery.
William Davis, MD:Now, poor oral health that leads to bleeding gums, gingivitis, periodontitis, cavities, tooth loss can also cause inflammation that is body-wide. So there's inflammation in the mouth, but it can export those inflammatory phenomena to other parts of the body. But it can export those inflammatory phenomena to other parts of the body and you can measure this as increased levels of inflammatory mediators or cytokines like interleukin-1-beta or interleukin-6 or tumor necrosis factor alpha. All originate from the mouth and that has broad implications for health, including increased risk for carotid disease and stroke. For health, including increased risk for carotid disease and stroke, coronary disease and heart attack, type 2 diabetes, obesity, fatty liver and other diseases. Many cancers are also driven by body-wide inflammation. So study of the microbes of the mouth is still a work in progress. There's still much to be learned, but I think you can begin to appreciate that the oral microbiome plays a profound role in numerous locations in the body outside the mouth as well as the mouth. Now, before we continue and we talk about how to correct some of the situation, at least given current knowledge, let's talk for just a moment about microbiome.
William Davis, MD:Defiant Health's sponsors. The Defiant Health podcast is sponsored by Paleo Valley makers of delicious grass-fed beef sticks, healthy snack bars and other products. We're very picky around here and insist that any product we consider contains no junk ingredients like carrageenan, carboxymethylcellulose, sucralose or added sugars and, of course, no gluten nor grains. One of the habits I urge everyone to get into is to include several servings of fermented foods every day in your diet, part of an effort to cultivate a healthy gastrointestinal microbiome. Unlike nearly all other meat sticks available, paleo Valley grass-fed beef, pork and chicken sticks are naturally fermented, meaning they contain probiotic bacterial species. Paleo Valley has also launched a number of interesting new products, including extra virgin olive oil, spice mixes, organic coffee, strawberry lemonade, super greens and essential electrolytes in a variety of flavors, and if you haven't already tried it. You've got to try their chocolate flavored bone broth protein that makes delicious hot chocolate and brownies. See the recipes for the brownies in my drdavisinfinitehealthcom blog. Listeners to the Defiant Health podcast receive a 15% discount by going to paleovalleycom.
William Davis, MD:Backward slash defiant health. And, in case you haven't yet heard, B? Biodequest probiotics are my first choice for intelligently, purposefully crafted probiotics. I've had numerous conversations with BioDeQuest founders Martha Carlin and academic microbiologist Dr Raul Cano. They have formulated unique probiotic products that incorporate what are called collaborative or guild effects, that is, groups of microbes that collaborate with each other via sharing of specific metabolites, potentially providing synergistic benefits. They have designed their sugar shift probiotic to support healthy blood sugars. Simple slumber to support sleep. Ideal immunity to support a healthy immune response. Heart-centered that supports several aspects of heart health. And antibiotic antidote designed to support recovery of the gastrointestinal microbiome after a course of antibiotics. The biodequest probiotics are, I believe, among the most effective of all probiotic choices. You have enter the discount code undoc1515, that is, u-n-d-o-c all caps 15, for a 15% discount for Defiant Health listeners.
William Davis, MD:Now let's get back to our discussion. You can see that this is clearly a work in progress. Lots more needs to be learned before we can come to firm conclusions, but one thing is clear that it's a disrupted oral microbiome that puts us at risk. So what kinds of factors can we identify that has disrupted the oral microbiome and caused proliferation of some of those unhealthy pathogenic species like Fusobacterium porphyromonus? Another thing to keep in mind is that we need to get away from this idea that came from the antibiotic age, and that is, when you have a microbe you don't like, you kill it with an antibiotic. There's a time and place for that, but more often than not, when we're managing the microbiome, we don't just kill things, because most of the methods used to kill these microbes are indiscriminate or they're not specific for just that one microbe. They tend to kill good microbes also.
William Davis, MD:So while this is not always true in general, think about changing the context, the environment that is. So imagine you have a garden in your backyard. If you weed that garden, let's say in late May, does that mean you've eliminated all weeds for the rest of the growing season? Of course not. You're going to have weeds all through the growing season. Weeding is something you do periodically, right? So just by weeding it once they come back. Same thing here a microbe you don't like, there's a good chance it comes back because you have not changed or improved the background, the other plants in your garden or, in this case, the microbes in the mouth.
William Davis, MD:So a smarter approach in general is to re-establish a favorable and healthy oral microbiome that often takes care of those pathogens for you. That's how we do it in SIBO in the GI tract, right? We don't eradicate those fecal microbes with antibiotics, right? If you have an overgrowth of E coli and salmonella in your small intestine, we don't give you lots of antibiotics to kill those microbes. What we do is we restore healthy, beneficial microbes like lactobacillus roteri, lactobacillus gasseri, that take care of it for you. So we are rebuilding a healthy background microbiome. Same thing here in a disrupted oral microbiome. Let's try to work to restore a healthier oral microbiome, accepting that not all lessons have been learned yet.
William Davis, MD:One big issue is wheat, grains and sugars. So it's clear as day in the record in the anthropological record that when humans first turned to consumption of wild wheat einkorn wheat about 10,000 years ago, there was an explosion in tooth decay. Prior to consuming wheat and grains. Tooth decay was uncommon. About one to three percent of all teeth recovered prior to the age of wheat and grain consumption showed decay, abscess formation, cavities, misalignment, tooth loss. Now think about that. So only one to three percent in adults of teeth showed decay or other diseases. Yet there was no fluoridated toothpaste, there's no fluoridated drinking water, there's no dental floss, there's no dentists, yet there was very little tooth decay.
William Davis, MD:When humans first turned to einkorn wheat in the Fertile Crescent, what is now Syria and Israel, or millet in sub-Saharan Africa, or maize in Central America, there was an explosion in tooth decay, from very little tooth decay to 16 to 49% of all teeth recovered, showing cavities, tooth loss, abscess, misalignment, etc. And of course that has been the human condition all throughout history, middle Ages and onward, tooth decay was rampant, it was everywhere and the solution is very poor. So people suffered. It was not uncommon to have no teeth or have a very few remaining teeth in your 20s. So this has been a problem. We've solved at least part of it with our efforts at oral hygiene right Dental floss, fluoridated toothpaste, dental cleanings, all that kind of thing.
William Davis, MD:But it's not uncommon, by the way, for Americans and other people in the Western world to lose a lot of their teeth over a lifetime, and this is because of the consumption of wheat and grains and the reason for that is the amylopectin A carbohydrate, unique to wheat and grains, is extremely digestible. There are many indigestible components in wheat and grains but there happens to be a highly digestible carbohydrate because we have the enzyme amylase in our saliva and in our stomach. That is very effective, very efficient at consuming amylopectin A. And amylopectin A is broken down promptly, within seconds, into sugars that in turn are consumed by microbes that turn into acidic byproducts that rot teeth, cause tooth decay. And we also know that at that time when humans first began consuming wild einkorn wheat and other grains that there was a shift in the composition of the oral microbiome. It went from a healthy microbiome to a cavity-causing microbiome in the mouth, including proliferation of a species called Streptococcus mutans. That's the primary microbe that causes tooth decay because it creates those acidic byproducts that cause tooth decay.
William Davis, MD:So the incorporation of wheat and grains was a turning point where tooth decay, dental diseases and the oral microbiome underwent dramatic changes. It got even worse in the 19th century when sugar became available widespread because of sugarcane and so people consumed a lot of sugar and that added further to tooth decay and to deterioration of the oral microbiome. It got even worse. Those changes in the microbiome got worse. There was more streptococcus, nutans and other decay causing microbes. So diet is a major factor. Well, you can return to the diet that was associated with healthy teeth, that is, no wheat, no grains, no sugars, as we do in my wheat belly programs and other programs.
William Davis, MD:Another thing you want to be aware of is mouthwash is not a solution. So mouthwash is like a broad-spectrum antibiotic. It kills everything good microbes and bad microbes. And that's why the observation has been made that when people swish with mouthwash, their blood pressure goes up for a while, because they've killed off nitrate-producing microbes, because nitrates and nitrites become nitric oxide, which is a vasodilator and maintains healthy arteries. When you swish with mouthwash, you kill all those microbes. You don't have nitric oxide, your blood pressure goes up and you put yourself at greater risk for heart disease. Now there may be times where a mouthwash is necessary as part of a treatment program, say for periodontitis, where somebody's at risk for losing their teeth. So in that very specific situation, advised by a dentist or a periodontist, there may be a role for that. But as a general rule, just for daily oral hygiene, mouthwashes have no role.
William Davis, MD:Another thing to bear in mind is that the best way to tell this part of the story is to share a story that Dr Debbie Osmond, a functional dentist in Oklahoma City, shared with me. A functional dentist in Oklahoma City shared with me. She told me how, every year, she would volunteer her time for free in the Peruvian highlands in South America. She would offer her dental services to the inhabitants of this mountainous area and she said that some people would ride as long as two days to get to the American dentist for their free dental care. And she saw that these people had mouths of rotten teeth because they chewed sugar cane. And she would spend her days pulling teeth all day long, left and right.
William Davis, MD:But she said that occasionally someone would show up with a full mouth of intact, healthy teeth and she'd ask them do you chew sugar cane? And they say yes, I do. Then she'd ask what do you do differently sugarcane and they say yes, I do. Then she'd ask what do you do differently? And she said every last one of them would say well, after I chew sugarcane, I take a twig and I run it between my teeth and clean out the debris.
William Davis, MD:So what she interpreted this as and this has been borne out also by the science is that they're breaking the biofilm. That is unhealthy. Microbes produce a protective film, a so-called biofilm, to protect themselves against antibodies and other antimicrobial factors in saliva, and so breaking the biofilm appears to be essential to preventing tooth decay, cavities, tooth abscess, tooth loss. Now you can accomplish that, of course, with a twig, but it's probably better in a modern world to use dental floss or a pick those plastic picks you can buy, or even just a plain old toothpick, and make a habit of this at least once a day to break the biofilm and keep those pathogenic organisms from collecting and producing acidic byproducts.
William Davis, MD:Another thing you can do is address your vitamin D, as we do in all my programs. So vitamin D is essential for two reasons One, it strengthens your teeth and two, it changes the microbiome. It changes the microbiome throughout the body. It changes it in the gastrointestinal tract, it changes it in the vagina, it changes it in the mouth. So vitamin D exerts positive effects on teeth and on the oral microbiome and also amplifies your immune response. So vitamin D essential. It's part of your dental program.
William Davis, MD:Now let's talk about fluoride. So there's two ways most will get fluoride. About 70% of Americans drink drinking water that has fluoride in it. So fluoridated drinking water and the other is fluoride toothpaste. Well, the evidence has accumulated over the years that fluoridated drinking water does not prevent cavities, does not prevent dental decay. It's still done and there are people trying to fight it and have the state governments stop adding fluoride to water. But the science is pretty clear. Fluoridated drinking water does not reduce dental problems. Now that's different than fluoride toothpaste. We don't want to conflate or confuse the two. Just because fluoridated drinking water does not provide any benefit, it may even be harmful it does not mean that fluoride toothpaste is ineffective.
William Davis, MD:The evidence is very good that fluoride toothpaste does prevent some tooth decay. It's not real powerful, it's only a few percent, but it does help and it also helps to remineralize your teeth and keep them a little stronger. One mistake people make is they use too much fluoride toothpaste. Fluoride toothpaste is manufactured such that only a pea size of toothpaste is necessary. You don't need the entire toothbrush covered with toothpaste. I see people doing that. You just need a pea size because that's just a little bit of fluoride. You don't want a big balls of fluoride, but fluoridated toothpaste the evidence is quite good does help somewhat.
William Davis, MD:Probiotics this is a tough question. It's not quite worked out what microbes we should replace. So when we replace some of the microbes we play with, such as those in fermented foods like leuconostoc or pediacoccus, or how about the keystone species we replace as yogurt or other fermented foods like lactobacillus roteri, lactobacillus gasseri, do those play a role? So it's not entirely clear. The best evidence is for a strain or two strains of lactobacillus roteri, 17938 and 5289 strains. There is some evidence. You get this as a commercial product called ProDentis and there is some evidence that it does shift the oral microbiome a little bit into a more positive composition, and you do this as a lozenge, but that's about all we know. There's not a whole lot more known. Maybe lactobacillus salivarius may have some potential, but the evidence is very preliminary. So I predict that sometime soon it may be in the next year or three years, but sometime soon we're going to have some powerful insights on how to better manage the oral microbiome using probiotics and related things. But right now we don't have a lot of information outside of those two microbes, but especially lactobacillus roteri, those two strains which are different than the strains we use for other purposes, right, the strains that produce ox, that cause oxytocin to be released from the brain and colonize the upper GI tract. We don't know if there's overlap in the capacities of these several different strains of rhodorite, so unclear.
William Davis, MD:Lastly, the sweetener, xylitol. That is found naturally in some fruit in small quantities, but you can use it as a sweetener also and it has mild antibacterial effects against these species that cause cavities, dental decay, like Streptococcus mutans. It also, interestingly, has mild antifungal properties. Not xylitol itself, but its metabolites have mild antifungal properties. So if you're going to use a sweetener and you're going to make whatever cheesecake or some cookies you bake them, say, with almond flour or almond meal and you're going to choose a sweetener, you could choose monk fruit, you could choose allulose, you could choose the various forms of stevia, but think about using xylitol. There's also xylitol chewing gum and xylitol-containing toothpaste and that can help.
William Davis, MD:The evidence is uneven. There's some evidence in favor of xylitol as an antimicrobial. There's some that say it's not so helpful. But it's so harmless, it's so inexpensive, so easy to incorporate into your toothpaste or into your baking that it's at least something worth knowing about and maybe incorporating on occasion. Now, clearly, we need to update as the science unfolds, because right now you can see we still need a lot better answers, but know that our focus here is to try to identify what goes wrong in an oral microbiome and what can you do about it so that it does not contribute to your risk for dementia, heart disease, depression and all those other conditions that could be blamed on, at least in part, on a disrupted oral microbiome. Now, if you've learned something from this episode of Defiant Health, please post a review, post a comment, subscribe through your favorite podcast directory and join the conversation. Thanks for listening.
