Monday, 21 October 2019

Oral Health

In previous Gut Matters we have looked at the gut microbiome (the complex mixture of beneficial and pathogenic species that reside within our gut) and the impact on the health of our whole physiology.  Now we need to examine the contribution of the oral cavity, as it is the gatekeeper to all that comes in from the outside, and the gateway to our health. I’m also going to highlight the strategies we can use to improve our oral health and consequently our overall health.

For centuries it has been suspected that our oral cavity has a wide ranging impact on the health of the whole body.  Now that work is beginning on mapping the oral microbiome – the collection of bacteria that occupy the oral cavity -  there are associations already being made with cardiovascular disease, pregnancy complications and auto-immunity.

There is so much more to oral health than having bright white teeth, and having healthy teeth and gums can be a predictor to overall health. The oral cavity contains a complex ecosystem that occupies all the niches and crannies, with over 600 species having been identified so far, with different species occupying different parts of our mouth, tongue, teeth and tonsils.  While a well balanced oral microbiome contributes to good oral health, a poorly  balanced oral microbiome is a major factor in the development of obvious dental problems like tooth decay, dental cavities, gingivitis and periodontal disease.

The interesting aspect of current research is the connection to other health issues.  There are connections being made with a poor oral microbiome and pregnancy complications such as pre-term birth, low birth weight , gestational diabetes and pre-eclampsia.  The placenta was long thought to a sterile environment but it is now understood that it contains it’s own complex ecosystem that is thought to replicate the oral microbiome.  Ideally good oral health would be part of any pre-pregnancy planning and offers a useful strategy for healthy pregnancy outcomes for mother and baby. Breastfeeding then begins the process of seeding the oral cavity of the baby.

The connection of poor oral health to cardiovascular disease is considered to be in part the disruption of the conversion of nitrate to nitrite from leafy greens in the diet, an important regulator of blood pressure and the health of our cardiovascular system.  Interestingly leafy greens promote the growth of the appropriate bacteria that carry out this conversion, so promoting healthy cardiovascular function.  Poor oral health increases the circulation of inflammatory molecules in the blood stream and research has shown that simply beginning a good oral health programme can reduce cardiac events.

Emerging research is showing the impact of poor oral health on rheumatoid arthritis and osteoarthritis, linking variations in the oral microbiota with variation in the disease states, and offering a potential route to intervention.

So how can we impact our oral microbiome, as much of damage in the mouth is reversible with good oral hygiene, in addition to the usual brushing and flossing.

Firstly, chewing is so important. Don’t eat in a rush.  Create saliva to start the process of breaking down food and getting the signals to the brain. 

Avoid antibacterial mouthwashes. Research has shown that they can destroy the healthy bacteria and disrupt the delicate balance of the ecosystem in the mouth.  In fact one study associated use of antibacterial mouthwashes with raised blood pressure. Use natural oral hygiene products that do not contain synthetic chemicals. Probiotic toothpastes are available. Aloe vera juice and green tea can be used as a mouthwash if necessary.  Specialised oral microbiome probiotics are available to support the health of your ecosystem.

Consider coconut oil pulling, a traditional practice in many cultures.  Start with one teaspoon of coconut oil, and build up to one tablespoon as you get used to the process.  Swish around the mouth for about twenty minutes and then discard.  Brush as normal afterwards.  This cleans the niches and a growing body of research associates it with good oral health outcomes.

Finally and most importantly, eat a healthy diet, avoiding sugar and simple carbohydrates, and focusing instead on good quality protein, healthy fats, and vegetables and fruit.  Snack on nuts and good quality artisan cheese instead of a sweet treat.  Finishing a meal with a good cheese can beneficially alter the ph of your mouth.

We also have a clinical tool called Oral EcolgiX to analyse and monitor the health of the oral microbiome.   It is a simple swab test and can be easily performed at home.  Results can be used to advise on treatment plans and lifestyle factors.

Sunday, 29 September 2019


Fasting in various forms has become very talked about recently, thanks in part to Dr Michael Mosley who 6 years ago popularised the idea of intermittent fasting with his 5:2 diet.  In reality fasting has been part of all the world’s major spiritual denominations for thousands of years, with designated periods throughout the year devoted to abstaining from foods.  It is a practice that is also rooted in our evolutionary biology. As humans evolved through periods of feast and famine, we evolved adaptive strategies to keep functioning in a fasting state, and these adaptations are of great interest to researchers today.

Compare the environment our ancestors lived in to the environment we inhabit today, with often highly inappropriate foods available constantly, snacking culture and sedentary occupations.  The cultural notion that we require three meals per day might have been appropriate when we engaged in largely physical work, but is less so now.  It takes a tremendous amount of energy to digest and process food and when you fast the body diverts that energy to repair and rebuilding. The modern epidemics of insulin resistance, type 2 diabetes, cardiovascular disease, and auto immunity  -  the degenerative diseases of society  - can be directly linked to our patterns of constant consumption.  But rather than looking at it as a diet, consider it to be a change in eating patterns for life, rather than short term punishment to achieve short term goals.

Intermittent fasting is simply a description of eating, and not eating, intermittently, and various forms of it are possible. Probably the easiest, healthiest and most accessible form of it is to eat within a window – such as eating within a 12 hour window and fasting overnight.  This means an early evening meal, and late breakfast the flowing day. It can be adapted to your lifestyle and working day, and if you have blood sugar control issues you can build up slowly. The ideal window to aim for as a daily practice is 16:8. Eat for 8 hours of the day and fast for 16 hours overnight. If you only eat within an 8 hour window you are releasing less insulin in to the blood stream.  Never forget that as well as a role in blood sugar control, insulin is the fat storage hormone and excess levels promote inflammation in the body, the root cause of all degenerative disease.

The numerous health benefits of fasting are well documented:

Firstly, when you fast, your body begins to consume damaged cells first, a process known as 
autophagy, or eating our self. Cells recycle waste material and repair themselves.  This has profound implications for our improving all aspects of our health and ageing. Fasting for more than 6 hours begins the cleaning phase, so eliminate snacking!

As insulin levels drop through fasting, blood sugar control improves and the body burns fat.

Fasting has the potential to improve autoimmune conditions.  In previous Gut Matters posts we looked at the importance of gut barrier integrity to prevent undigested food particles, toxins and microbes crossing the mucosal barrier, the potential trigger for autoimmunity.  Fasting can promote the proliferation of the gut bacteria Akkermansia, which is associated with all good health outcomes.  Akkermansia feeds on the mucosal layer of the gut, and the 16 hour window is considered ideal.  Fasting also increases the diversity of gut bacteria, which impacts on all positive health outcomes.
Fasting promotes the secretion of human growth hormone, important for the build up of muscle mass and muscle strength.
Somewhat counter intuitively, fasting can normalise grehlin, the hunger hormone.  You might struggle to adapt at the start due to habits, but fasting sensitises the body to when you are actually hungry, as opposed to eating routinely.  Eat only when you are genuinely hungry.

Fasting can normalise several markers of degenerative disease, such as triglycerides and oxidised LDL cholesterol. Fasting can stimulate stem cells which heal and repair your immune system.

When not to fast:

If you have poor blood sugar control, are taking medication, or have an eating disorder, discuss time restricted eating with your GP first. Do not fast if you are pregnant or breast feeding.

It goes without saying that when we eat we should avoid simple carbohydrates.  It is common to rely on simple carbohydrates as our source of fuel, and yet they are not an ideal energy source and generally nutritionally poor quality foods.  Eat healthy fats, good quality proteins, and complex low glycaemic load vegetables as the bulk of your diet.