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Healthy mouth, healthy you – Dentistry Online

by adminjay


Jackie Tarling considers the links between diet, lifestyle and oral health by adapting and updating commissioned articles by Paul Clayton PhD.

Oral health is something that far too many people overlook. This shouldn’t be the case as it’s a very important aspect of health.

There are many established links between diet, lifestyle and oral health.

Consider excessive sugar (and poor oral hygiene); inherent acids and sugars in soft drinks, which both have acidogenic and cariogenic potential, resulting in dental caries and potential enamel erosion; the increased oral cancers risk of using of tobacco and high octane alcoholic beverages, especially when combined; the link between smoking and tooth loss – the list goes on.

As the evidence base for these links has accumulated, various nutritional strategies have come on board. They have done a great deal to improve oral health. However, there is a good deal more to come.

Risk factors for periodontal disease

If we review the risk factors for periodontal disease, they include (apart from xerostomia and poor oral hygiene), age, smoking and the use of immuno-suppressant medications such as steroids, HIV, diabetes, DNA mutations, malnutrition or dysnutrition. 

It seems likely that malnutrition is the most common of these risk factors. For example, studies show that around 70-80% of malnourished patients currently enter and leave hospital without taking action to treat their malnutrition. Also, without the diagnosis appearing on their discharge summary.

One might reasonably speculate that malnutrition related to the many hospitalised patients. Also, that hospital patients are therefore unrepresentative of those still in the community.

Here too, however, a significant proportion of middle-aged and elderly subjects have been found to be malnourished, and immuno-compromised to the point where their immune function is improved by supplementation.

Two types of malnutrition

A deficiency of a single micronutrient characterises type A malnutrition (often the water-soluble vitamins C, B1 and B3). It’s often combined with calorific deficit.

This is uncommon in the developed nations. Instead, what we see is a pattern of multiple micronutrient and phytonutrient depletion, generally combined with calorific balance or excess. This is termed Type B malnutrition, or dysnutrition. It is emerging as a likely common cause of the majority of the degenerative diseases. Also it’s a cause of much of the process of ageing as we know it.

The reasons for this prevalent pattern of multiple micronutrient depletion are structural and well established.

Perhaps the single most important cause of Type B malnutrition is that we don’t eat enough. This sounds paradoxical, given that we are getting fatter, but we actually eat far less than we used to.

Looked at through a longer lens, humans were designed to live active lives. Humans need to consume between 3,000 and 4,000 calories per day. No longer hunter-gatherers, we live sedentary lives. We work sat down during the day and basking in the glow of the television screen at night.

The result is that we burn, on average, slightly fewer than 2,000 calories a day. Our appetites have indeed shrunk, but not quite to match; leaving most of us in a slight but persistent state of calorie excess, which explains, over time, the weight gain.

Food intake

By cutting our food intakes in half, we have at a stroke halved our intakes of many essential micronutrients. To make matters worse, our dietary habits are out of joint. We no longer eat many unprocessed foods. Instead we increasingly rely on pre-processed, pre-cooked and ready-to-eat meals and snacks. In many cases, these are significantly less nutritious than the original ingredients would have been.

These, and other factors, have dramatically reduced our intakes of valuable micronutrients and phytonutrients such as flavonoids, sterols, phospholipids, methyl groups, selenium and resistant starch – resulting in the widespread problem of Type B malnutrition we see today.

This matters because it causes trouble for a person depleted in anabolic co-factors and the anti-catabolic agents. Tissue renewal is down, tissue decay and breakdown are up; they are now catabolically dominant, accumulating tissue damage, and heading towards clinical illness.

What’s more, Type B malnutrition generally worsens as we age. This is due to such factors as dental problems, difficulties with swallowing. Also, a deteriorating sense of taste and appetite, and often reduced finances.

This neatly explains why we become progressively more catabolically dominant. Furthermore, we are ever more likely to become diseased, as the years and decades pass. It also explains why, as we age, our immune functions tend to become ever more compromised.

The immune system

You can divide the immune system into two distinct but overlapping sub-systems: the innate and the adaptive (or acquired).

The adaptive immune system is the one with the memory function, and is involved in immunisation, allergy and auto-immunity. Once the adaptive immune system has learned to recognise an enemy (after an initial infection or after vaccination), it remembers the enemy’s characteristics.

On second exposure to the threat, the memory cells recognise it. They generate an immune response involving highly specific weapons such as antibodies.

This is a powerful, sophisticated and highly specific system. However, it is complex and slow to mount. It’s often insufficient to protect the host against the first onslaught of a virulent bacterium or virus.

Unlike the adaptive immune system, the innate immune system springs into action the moment it recognises the presence of a pathogen. The innate immune system protects us from the many non-specific pathogenic threats that exist in the world. It is our first line of defence, while the adaptive immune system is the second.

Potential pathogens cover us every second of our lives. We inhale and ingest them with every breath and mouthful we take. However we rarely develop clinical infections.

The innate immune system protects us for more than 99% of the time. It confines pathogenic bacteria, viruses and moulds to safe and generally surface areas of the body and, self-evidently, prevents the vast majority of them from gaining access to deeper tissues, where they could cause problems.

The very complexity of the adaptive immune system can cause problems. In autoimmune disease, the adaptive immune system confuses an element in the body with a pathogen that it partly resembles, and attacks the host’s own tissues (as in rheumatoid arthritis, multiple sclerosis, systemic lupus, Hashimoto’s thyroiditis etc).

Allergy

In allergy, the adaptive immune system overreacts to a stimulus such as animal dander or a species of pollen, and causes the well-known symptoms of allergic conjunctivitis, rhinitis or asthma.

The innate immune system combines physical and chemical barriers (such as the skin, the mucociliary escalator, which continually cleans the respiratory tract, and the acid bath of the stomach), biochemical elements such as certain fatty acids and antibacterial peptides, and immune cells such as macrophages and granulocytes.

It has long been thought that this system of defences merely existed, but one of the biggest breakthroughs in immunology has been the recent discovery that the effectiveness of these cellular components has been compromised by our modern lifestyle, and that it can be restored with one of a limited number of immuno-primer compounds that the innate immune cells recognise.

The innate immune system is rather more basic. In evolutionary terms, it is much older than the more sophisticated acquired immune system. It is less specific, and its key components are macrophages and natural killer (NK) cells. Broadly, these patrol the body and look out for anything that doesn’t belong there. If macrophages spot a bacterium, they swallow it whole and try to digest it. If NK cells recognise a virally-infected cell or a cancer cell in the body, they will kill it so that it cannot produce more viruses or replicate.

It is now widely understood that it is the innate immune system that keeps us healthy most of the time.

Immune cells

Immune cells in the innate immune system have no memory, but they have receptors that recognise a small number of compounds presenting in the cell walls of most pathogens. These include lipopolysaccharides (gram negative bacteria), lipotechoic acids (gram positive bacteria), peptidoglycans (gram + and – bacteria), flagellin and the 1-3, 1-6 beta glucan present in the cell walls of moulds and yeast. These receptors enable the innate immune cells to recognise the vast majority of potential pathogens, and respond rapidly and effectively to them.

In fact, work at Brown University, the universities of Louisville and Berlin, and at the Mayo Clinics has shown that constant stimulation of these receptors is actually necessary to keep the innate immune cells in a fully functional mode; and that the beta glucan in moulds and yeasts are the most effective of all the immuno-primers, acting via the CR3 receptor that occurs on all innate immune cells.

These compounds are called immuno-primers rather than the older term immuno-stimulants, which is inaccurate and misleading. They do not stimulate the immune cells at all, but merely prepare them for action.

For innate immune effector cells (such as a macrophages or neutrophil granulocytes) to phagocytose and kill pathogens most effectively, the CR3 receptor must be occupied; supplying beta glucan in pure form to occupy this receptor is simply getting the immune cells ready to act as and when it is appropriate for them to do so.

Environment

Humans and other animals evolved in an environment without soap, antibiotics or food sterilisation technology; in short, a highly microbiologically contaminated environment. In such an environment, this constantly challenged our innate immune systems, to stay on high alert. However, in the last century, we have progressively sanitised our environment.

The food chain in particular, in which formerly every item would have been at least borderline contaminated with yeast/mould, has been sanitised to near sterility thanks to the agricultural use of fungicides, and modern food technology. This in turn has left our immune systems unbalanced (the so-called ‘hygiene hypothesis’), resulting in reduced immune function and, paradoxically, a hugely increased incidence of allergy.

Some clinical scientists have speculated that allowing people to acquire infections more frequently would be helpful, but this is a crude and potentially dangerous approach. Far simpler to re-engineer 1-3, 1-6 beta glucan back into our diet, via supplements; a strategy already shown to dramatically enhance immune function and reduce the risk of disease in many species, including our own.

Improving a patient’s general nutritional status, therefore, will often lead to an improvement in immune function.

Nutrition for the immune systems

As the numbers of antibiotic-resistant bacteria in our environment continue to increase, it makes good sense to ensure that your immune systems are working as effectively as possible. But, as with the adaptive immune system (acquired immune system), there is persuasive evidence that the innate immune system is too often in disrepair, due again to malnutrition.

Therefore, a comprehensive micronutrient support programme is a good foundation. Onto that foundation you can add a second layer of very specific innate immune support agents. They include vitamin D, the trace element selenium, and the 1-3, 1-6 beta glucan derived from yeast.

Beta glucan in particular has a very critical role to play. It actively primes innate immune cells via the CR3 receptor as mentioned above; one of a small group of so-called toll-like receptors that must be occupied if the overall innate immune system is to respond appropriately to the presence in the body of a pathogen.

Selenium is important too. It is critical to NK cell function, as well as having a positive influence on inflammation and immune responses. Selenium depletion is particularly prevalent in the UK. It impairs immune responses to viral infection.

Like selenium, vitamin D is also essential to innate immune cell functions, and also like selenium, depletion is very common.

To conclude, when combined with broad-spectrum nutritional support, this approach leads to rapid improvements in oral health.

Key takeaways

  • There are established links between diet, lifestyle and oral health
  • Risk factors for periodontal disease include age, smoking, use of immuno-suppressant medications such as steroids, HIV, diabetes, DNA mutations and malnutrition
  • Type A malnutrition is characterised by a deficiency of a single micronutrient (often the water-soluble vitamins C, B1 and B3) and often combined with calorific deficiency
  • Type B malnutrition typically is a pattern of multiple micronutrient and phytonutrient depletion, generally combined with calorific balance or excess
  • There has been a dramatic reduction in intake of valuable micronutrients and phytonutrients such as flavonoids, sterols, phospholipids, methyl groups, selenium and resistant starch – resulting in the widespread problem of Type B malnutrition
  • The immune system can be divided into two distinct but overlapping sub-systems: the innate and the adaptive (or acquired) immune systems
  • The adaptive immune system is the one with the memory function, and is involved in immunisation, allergy and auto-immunity
  • The innate immune system springs into action the moment it recognises the presence of a pathogen
  • Many micronutrients play an essential role in immune function
  • Improving a patient’s general nutritional status will often lead to an improvement in immune function and a comprehensive micronutrient support programme is a good foundation.

References

For the references that accompany this article, please email [email protected].

This article first appeared in Oral Health magazine. You can read the latest issue here.

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