Oral health and Systemic Disease
Five thousand years ago a man walked through the Austrian Alps. His name was Otzi. In the hard winter months, Otzi trudged through mountain passes wearing snow shoes he himself had made. They were waterproof, warm, and fit perfectly to his feet. His outer garment was tightly woven from marsh grass. It was lightweight, waterproof, windproof, and easy to repair. At night it became a tent-like shelter, under which Otzi slept. The inner was lined with deerskin and fur, that kept Otzi warm and dry. The outer had decorative fur, culled from smaller animals, giving Otzi a pleasing appearance. He carried about him a medicinal pouch containing birch bark and other antibacterial plants to ward off infection. He had a second pouch for repairs, allowing him to fix up his garments. Otzi was intelligent and self-sufficient. He was at one with his harsh environment. He knew how to build shelter, start fires, and make sophisticated waterproof clothes from natural materials. He could treat an injury and make weapons, while travelling vast distances, guided only by nature, the sun, and the stars.
We know this because in 1991 Otzi was discovered by two Alpine hikers. His body, skin, and clothing had been preserved by ice, frozen in time. Later, upon examination, his body was found to have been riddled with acupuncture markings, even though he lived in Europe many millennia ago. There was a good reason for these acupuncture marks. Otzi wasn’t just sick, he was very ill indeed.
He had arthritis in his ankles, knees, hips, and the lumbar of his back. He had intestinal worms that caused him considerable stomach pain, most likely caught from an infected water source. He was the first known carrier of Lyme disease. In 1999, a study in the British medical journal the Lancet showed that the acupuncture marks on his body corresponded to the meridian points needled for the very diseases Otzi had. This was a remarkable finding. That a Central European man, living over five thousand years ago, knew the points on his body to needle for the diseases that he carried. They were near identical to the points used today in Traditional Chinese Medicine.
It would be bad enough if Otzi had only Lyme disease, arthritis, intest- inal worms, and stomach pain. On its own, Lyme disease is debilitating and life changing. Even today it is challenging to treat. Yet Otzi had another problem, which came as a surprise to those dissecting his body. He had severe atherosclerosis. His arteries were blocked. Otzi was heading for a heart attack, several millennia before the birth of junk food. This was a puzzle de- manding to be solved.
The scientists examining Otzi’s body began by testing his genes. He carried a high genetic risk for coronary artery disease, but this alone was not enough to cause atherosclerosis. There had to be something else interacting with his genes. Otzi wasn’t alone among ancient peoples in having athero- sclerosis. It has also been found in ancient Egyptians, Peruvians, Aleutian Islanders, and female Inuit. Eventually, historians working alongside clinicians and scientists arrived at four causes of atherosclerosis in these ancient peoples. These were social stress, nutritional deficiency, infection, and inflammation.
Otzi was under some type of social stress, as it seems he was a loner, who died by axe blow to his head. Being chased by a man wielding an axe is pretty stressful. His stomach was infected by the intestinal worms that resided therein. Such infections in ancient people have been estimated to carry the same inflammatory burden as lupus and rheumatoid arthritis in our own time. This inflammatory burden leads to a 50% increased risk for atherosclerosis. The Lyme disease Otzi had caused systemic inflammation, height- ening his inflammatory state. When his stomach was examined it contained neolithic grains, such as wheat and barley. Yet there are indications that Otzi’s body hadn’t yet adapted to newly domesticated grains, further adding to his inflammation. Otzi was a veritable burning fire of inflammation, and where there is huge, systemic inflammation there is heart disease and arthrit- is—the very diseases Otzi had all those years ago.
This would all have been bad enough, but there was another important factor influencing Otzi’s diseased, inflammatory state. For this, we need to travel further back in time by another five thousand years, to the village of Cheddar in Somerset, England. In this village there lived another ancient man known only by the name of “Cheddar Man.”
Cheddar Man was very much a paleographic man of his time. Despite living in the village that would in the future give birth to Cheddar cheese, he was lactose intolerant. This is in keeping with all palaeographic peoples. He did not eat grains. He certainly did not eat vegetable oils or get a caffeine fix from Tim Hortons. As best as we can tell, he did not have inflammation. But there was another crucial difference between Cheddar Man and Otzi: Ched- dar Man had excellent teeth, while Otzi had inflamed gums, dental cavities, and tooth decay. A team at the University of Zurich found that Otzi had just about every possible disease of the mouth. The reason for this diseased mouth was twofold: he had poor oral hygiene and new, neolithic grains were altering the health of his teeth and mouth.
The first great dietary shift in human history was the domestication of cereal grains during the neolithic period. In that period, humans adopted a carbohydrate-rich diet for the first time. It was this dietary change that was causing Otzi’s teeth to decay and his gums to become inflamed. His genes and his body were not adapted to this new cereal food. The second great dietary change occurred about two hundred years ago, with the advent of industrialization. Industrial, refined white flour and sugar became easily available. Both tasted delicious, both provided calories. At the same time, capitalism was born, and there was a mercantile push to increase calories from carbohydrates. Flour, grains, and sugars could be gathered and transported all over the world, without fear of spoiling, making substantial profit for nascent corporations. These two dietary paradigm shifts did more than change eating habits. They did more than cause tooth decay. They altered the balance of bacteria in the mouth. These dietary shifts are of considerable importance as they changed the microbiome of the mouth to a diseased, inflammatory state.
Oral bacteria has been preserved in the dental calculus of ancient skeletons throughout Europe. In fact, the bacteria is preserved for millennia. The data from these skeletons reveals that as Europeans ate more new carbohydrates their oral microbiome changed to induce disease. These diseases were not limited to the mouth, such as cavities, inflamed gums, fillings, or root canals. When the oral microbiome changes for the worse, the risk for heart disease, some cancers, diabetes, autoimmune disease, and many other modern conditions of ill health starts to increase. Not brushing your teeth and eating the wrong food has consequences far beyond your mouth.
The mouth is one of the most heavily colonised parts of our body. It harbours a rich and diverse microflora. There are over two hundred different species of bacteria in this oral microbiome, while just one milligram of dental plaque contains ten billion bacteria. These bacteria found on the teeth, the gums, in the saliva, and upon the tongue have two important functions: they recognize and prevent disease-causing viruses and bacteria from entering the body, and they train the immune system to recognize both friend and foe. They guard an important entry point into the body.
In the nineteenth century, Charles Mayo, of Mayo Clinic fame, recommended the therapeutic removal of all teeth for many health conditions, from allergy, to arthritis, to schizophrenia. This is a pretty extreme tack, but he was on the right track. By the 1940s it had been recognized that the teeth were a source of systemic infections, that might cause a range of diseases, by showering bacteria from the mouth into the bloodstream. Scientists at that time found dental bacteria in distant blood vessels throughout the body, that had entered the bloodstream while eating or brushing the teeth. A few decades later, with new surgical techniques, systemic dental pathogens were found in deep tissue, from the joints to the pancreas. These pathogenic bacteria had found their way into the bloodstream to infect many organs, including the brain, spleen, liver, bone, and heart. There are now a large number of case studies documenting that oral bacteria can cause a variety of systemic infections.
Being infected would be bad enough, but these troublesome bacteria do not stop at causing infections. When there is infection there is inflammation; when there is systemic infection, there is systemic inflammation. This all body chronic or acute inflammatory state then starts to cause disease. As the gums become inflamed, pro-inflammatory cytokines are produced. They enter into blood circulation, hitching a ride to distant parts of the body. The body responds with inflammation to destroy these disease-causing bacteria. But there is a problem: the cytokines released during an inflammatory attack damage all and any biological material in the body, not just the bacteria that needs to be destroyed. At this point, there is an inevitable release of systemic cytokines, that attack endothelial cells lining the arteries. This leads to atherosclerosis. And that leads to either heart attack or stroke.
Remember that Ozti had Lyme disease, a stomach infection due to intestinal worms, and just about every form of oral decay imaginable. These conditions put his body into a state of immense systemic inflammation. Add this to his genetic predisposition to arterial disease, and the result was the severe atherosclerosis that scientists later found. His poor oral health contributed towards his diseased heart.
It is now well recognized that inflammation in the mouth and poor dental health can contribute towards atherosclerosis. Over the last twenty years, studies have shown that patients who had either a heart attack or stroke had worse oral health. A recent review of all the evidence, which controlled for other influences, such as smoking and age, found that cardiovascular disease is more likely in people with poor oral hygiene. In addition, people with inflamed gums are 400% more likely to have a stroke.
Atherosclerosis is not the only disease caused by poor oral health. The same oral inflammation that causes cardiovascular disease also influences the initiation and progression of type 2 diabetes. This increased systemic inflammation heightens the risk for insulin resistance, diabetes, and complications from both diseases.
Among other diseases linked to oral inflammation and infection are complications during pregnancy, Alzheimer’s disease, and dementia. Arthritis, which Otzi had, is more common. The risk for various cancers is increased. Cancers such as oesophageal cancer, pancreatic cancer, and colorectal cancer are more common in people with poor oral health. There are even differences between the oral microbiomes of obese and normal weight people. The type and diversity of bacteria, as well as the composition of the salivary microbiome, are different in obese people. All these conditions share the same link between oral health and a diseased state: oral bacteria entering the bloodstream induces local and systemic inflammation.
Generally, oral health is good in Canada, unless you are Inuit or are among the First Nations people. There is good access to dental care, but there are still problems. Around the world, nearly one hundred percent of adults have some form of tooth decay, which is now the number one global disease. It impacts quality of life. It impacts a person’s wallet. Having dental treatment for diseased gums or teeth is expensive. Over four million work days every single year are lost in Canada because of dental-related illnesses. For Canadian school children, over two million school days are lost every year for the same problem. One in five Canadian children under the age of five have tooth decay, and it accounts for one-third of all day surgeries in this age group. Around 85% have dental caries, which rises to 97% in teenagers
Part of this problem is sugar. It is true that sugar consumption is at last decreasing in Canada, but 20% of Canadian calories come from some type of sugar. On average, Canadian children eat thirty-three teaspoons of sugar per day, every day. The average Canadian teenager is drinking half a litre of sugary drink every single day, and obesity rates of Canadian children have tripled over the last thirty years. Compare these figures with those from preindustrial times, when people ate around three hundred grams of sugar per year. We might say that you are eating more sugar in two days than your distant ancestors ate in an entire year. Many of you here today will be of Pakistani heritage. That country has seen a massive rise in sugar consumption over the last twenty years, and is about to overtake America in the amount of sugar each person eats. The effects of this are plain to see: every- one knows a Pakistani uncle or aunty who had a heart attack.
Therefore, for the sake of your teeth, for the preservation of your oral microbiome, for dampening inflammation, for reducing the risk of diabetes, cardiovascular disease, and some cancers, the amount of sugar eaten and drunk has to be heavily reduced. Save it for special or festive occasions.
To prevent inflammatory oral disease and all the attendant diseases we have today mentioned, the first step is to follow the Sunna. That means, as any dentist will tell you, to regularly brush your teeth. The Prophet, peace and blessings be upon him, said, “This is my siwak and the siwak of the all the prophets before me.” He would use it before the obligatory prayers, say- ing, “A prayer with a siwak is better than seventy prayers without a siwak.” In another tradition, he continued, “Were I not afraid it would be hard on my followers, I would order them to use the siwak.” This prophetic wisdom of rubbing the teeth with the siwak tooth stick during the sacred rhythm of the day prevents the build-up of bad oral bacteria, reducing the inflammatory burden coming from your mouth. Cleaning your teeth morning and night is a given.
Judging the type and amount of carbohydrates that influence your oral microbiome and the inflammatory burden upon your body is much more difficult. Some intelligence and common sense is needed. Paleographic Cheddar Man did not have dental decay, but a paleo diet is not for everyone. Put an average Chinese person, who has good starch digestion, on a paleo or ketogenic diet, then watch their arterial health decline. Conversely, put a northern European on a higher starch diet, and see the detrimental effect upon their health. There is, however, agreement that industrial foods introduced into our diets over the last two hundred years are bad. These industrial foods include refined flours and foods made from them, processed food, junk food, and fruit juices. As for grains and starches, judge by your ancestry, and then only consume coarse, ancient strains of grain. Coarse, hard bread, for example, is much better for the bacteria of the mouth, than soft modern bread.
Dairy foods help. Yoghurt and cheese can restore the oral microbiome. The bacteria from dairy products struggles to colonize the gut and the mouth. However, yoghurt suppresses disease-causing, inflammatory bacteria in the mouth.
Finally, this month is national oral health month in Canada. All over your country dental clinics are opening up, encouraging people to have their teeth examined, or cleaned by a dental hygienist. Some will be offering their services free of charge. Don’t be shy, don’t wimp out, get your teeth checked and cleaned. The health of your body depends on it.