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August 10, 2024 28 mins

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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Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
William Davis, MD (00:07):
The oral microbiome is second only to the
colon in the density ofmicrobes living in that location
.
The mouth is really acollection of varied ecosystems
that differ in composition.
For instance, the microbiome ofthe teeth is different from
that of the tongue.
That is, in turn, differentfrom the microbiome of the teeth
is different from that of thetongue.
That is, in turn, differentfrom the microbiome of the gum
line.
The oral cavity is thereforeteeming with hundreds, perhaps

(00:31):
thousands of species of bacteria, fungi, archaea and viruses.
It's a virtual tropical jungleof life.
But what is especiallyremarkable is that the oral
microbiome is an ecosystem oflife that plays a role not just
in dental health that is,cavities, tooth loss, abscess,

(00:53):
gingivitis, periodontitis andbreath odor but it also
contributes to causing diseasesin other parts of the body,
including cardiovascular disease, colon cancer and reproductive
and cognitive health.
So in this episode of theDefiant Health podcast, let's
consider how the oral microbiomecontributes to all sorts of

(01:14):
health issues.
While solutions are still beingsorted out, let's discuss at
least some of what we know thatcan be effective in improving
the condition of the oralmicrobiome and thereby hope to
have a favorable impact onhealth elsewhere in the body.
And later in the podcast, let'stalk about Defiant Health's
sponsors Paleo Valley, ourpreferred provider for many

(01:38):
excellent organic and grass-fedfood products, and BioDequest,
my number one choice forprobiotics that are
scientifically formulated,unlike most of the other
commercial probiotic productsavailable today.
So the mouth is rich inmicrobial life, from healthy

(01:59):
microbial species likeVillanella or Neisseria, rothia
or Carinobacterium to pathogensthat lead to tooth decay and
increased risk for heart disease, dementia, adverse outcomes in
pregnancy and other healthproblems.
This is especially true forpeople who experience gingivitis
or periodontitis, in which themouth microbiome tends to be

(02:23):
dominated by potentiallydangerous species such as
Porphyromonas Prevotella andFusobacterium.
We'll discuss these.
This can be an especiallytroublesome problem for people
with hypochlorohydria or lack ofstomach acid, as hydrochloric
acid in the stomach kills mostmicrobes.
Loss of stomach acid means thatoral microbes can colonize the

(02:47):
stomach while also, by the way,allow a scent of fecal microbes
from the colon.
That is, sibo, or smallintestinal bacterial overgrowth.
So the mouth can serve as arepository for unhealthy
microbial species that can reachthe stomach in someone with
hyperchlorhydria, reach thelower reaches of the

(03:08):
gastrointestinal tract, thesmall bowel and colon in the
absence of stomach acid.
But even with stomach acidintact and an intact immune
system.
Oral microbes can also colonizethe brain, uterus, sinuses and
other body parts and can therebybe responsible for health

(03:28):
problems in those locationsoutside the mouth.
Let's therefore consider some ofthese microbes and the
potential effects they exert onyour body.
So let's take some microbes oneby one Now.
I know these names aresometimes tongue twisters and
hard to remember, but you'llfind.
Once you hear what thesemicrobes do, it'll make a bigger
impression on you and you'll beable to remember some of these

(03:49):
names.
So the first microbe toconsider is Fusobacterium
nucleatum.
Well, this is a microbe thatmost of us have already, even in
a healthy mouth.
But if you have any bleedinggums or gingivitis or
periodontitis, fusobacteriumoddly proliferates out of

(04:09):
control when that happens, andthen it enters the bloodstream
with any kind of microtraumalike just flossing or brushing
your teeth, and theFusobacterium enters the
bloodstream.
Some is also swallowed and canreach the gastrointestinal tract
that way.
But it also enters thebloodstream and oddly colonizes
the colon, where the evidence isquite strong that it is a major

(04:33):
cause of colon cancer.
So think about that.
Your gastroenterologist urgesyou to have occasional
colonoscopies to look for polyps.
Look for it to prevent futurecancer.
But now we have pretty goodevidence that Fusobacterium in
the mouth can be the start ofcolon cancer.
Along with dysbiosis, adisrupted composition of bowel

(04:54):
flora in the colon, that's alsoa clear-cut cause of colon
cancer.
So what they should be doing Ithink what they will do in
future is pay attention to theoral microbiome and the colonic
microbiome and introduce factorsto improve it and prevent
cancer, so that microbe, thoughFusobacterium nucleotide, gets

(05:15):
its start in the mouth andthereby causes colon cancer.
That microbe also has beenassociated with eclampsia and
premature delivery.
Premature labor when a woman ispregnant, that can be
catastrophic.
Eclampsia can lead to seizuresand death of the mom and the
baby.
Premature delivery of a childcan be catastrophic.

(05:37):
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 preventor to reduce the likelihood of
premature labor.
And Fusobacterium nucleotideappears to colonize the amniotic
fluid and provoke inflammationin the amniotic fluid and the

(05:59):
uterus and that's why thesethings may happen.
At least that's the currentthinking.
And that's why these things mayhappen.
At least that's the currentthinking.
Fusobacterium can also be foundin the brain.
It can be one of a number ofmicrobes that infest the brain
and it's been shown that peoplewho have fusobacterium in the
mouth have more rapiddeterioration in their dementia,
in their Alzheimer's dementia.

(06:20):
So it's hard, it's verydifficult to prove cause and
effect, because it would takesomething like this I'm going to
give you fusobacterium or aplacebo 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 thatkind of awful clinical trial.
So we have to rely on this kindof indirect evidence that
people with fusobacteriumidentified in the mouth and then

(06:41):
had their cognitive abilitytracked.
Formally, people withFusobacterium deteriorate more
rapidly.
Fusobacterium has also beenassociated with inflammatory
bowel disease, in this caseprobably via swallowing, but
perhaps via blood-bornecolonization also.
But ulcerative colitis has beenassociated with the presence of
Fusobacterium nucleotide.

(07:03):
So that one microbe in the mouthhas broad and widespread
implications for health in anumber of areas.
Another very important microbein the mouth that gets its start
in the mouth is Porphyromonasgingivalis Like Fusobacterium.
You'll see more Porphyromonasin someone who's got some

(07:24):
problems with their dentalhealth and Porphyromonas like
Fusobacterium can be found athigh numbers in the brain.
In fact, people with dementiawho die and then allow their
brains to be examined tend tohave polymicrobial infestation.
So Fusobacterium is a commonmicrobe in the brain of people
with dementia.

(07:44):
So Fusobacterium is a commonmicrobe in the brain of people
with dementia.
Porphyromonas gingivalis andfungal species are also various
candida and other fungal speciesLike Fusobacterium.

(08:07):
If someone has Porphyromonasgingivalis also appears to be a
factor that facilitates thedevelopment of stomach cancer.
A lot of stomach cancer iscaused by Helicobacter pylori,
but Porphyromonas gingivalissomehow amplifies that risk.
Another important microbe isStreptococcus sanguinis, and
this is an odd one in that whenyou have this microbe in your
mouth it can lead to clumping ofplatelets, that is, blood clot

(08:30):
formation, and that's a factorin such issues as heart attack
and stroke or carotid disease,where if you have platelets that
are trying to clump, it canclose off that artery and cause
heart attack or stroke.
That same microbe artery andcause heart attack or stroke.
That same microbe,streptococcus sanguinus, can
also increase inflammation.
That increases your risk forcardiovascular events like heart

(08:50):
attacks, but also risk forweight gain, abdominal fat
expansion, insulin resistance,type 2 diabetes and even cancer.
So streptococcus sanguinus, itsmain adverse effect is
amplifying both blood clottingand body-wide inflammation.
There are two other speciesthat are relatives of fecal or

(09:13):
stool microbes, klebsiella andEnterobacter, but they can be
found in the mouth and when theyare found in the mouth they've
been associated with increasedrisk for ulcerative colitis.
It's an odd situation, isn't it?
And there are species ofPrevotella, also cousins of
fecal microbes, that have beenassociated with coronary
atherosclerosis, that is, thedevelopment of coronary plaque

(09:36):
in your heart's arteries, thatit puts you at risk for heart
attack, sudden cardiac death orhaving need for procedures like
stent implantation or bypasssurgery.
Now, poor oral health that leadsto bleeding gums, gingivitis,
periodontitis, cavities, toothloss can also cause inflammation
that is body-wide.

(09:57):
So there's inflammation in themouth, but it can export those
inflammatory phenomena to otherparts of the body.
But it can export thoseinflammatory phenomena to other
parts of the body and you canmeasure this as increased levels
of inflammatory mediators orcytokines like
interleukin-1-beta orinterleukin-6 or tumor necrosis
factor alpha.
All originate from the mouthand that has broad implications

(10:20):
for health, including increasedrisk for carotid disease and
stroke.
For health, including increasedrisk for carotid disease and
stroke, coronary disease andheart attack, type 2 diabetes,
obesity, fatty liver and otherdiseases.
Many cancers are also driven bybody-wide inflammation.
So study of the microbes of themouth is still a work in

(10:40):
progress.
There's still much to belearned, but I think you can
begin to appreciate that theoral microbiome plays a profound
role in numerous locations inthe body outside the mouth as
well as the mouth.
Now, before we continue and wetalk about how to correct some
of the situation, at least givencurrent knowledge, let's talk
for just a moment aboutmicrobiome.

(11:00):
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(13:33):
Now let's get back to ourdiscussion.
You can see that this isclearly a work in progress.
Lots more needs to be learnedbefore we can come to firm
conclusions, but one thing isclear that it's a disrupted oral
microbiome that puts us at risk.
So what kinds of factors can weidentify that has disrupted the

(13:54):
oral microbiome and causedproliferation of some of those
unhealthy pathogenic specieslike Fusobacterium porphyromonus
?
Another thing to keep in mindis that we need to get away from
this idea that came from theantibiotic age, and that is,
when you have a microbe youdon't like, you kill it with an
antibiotic.
There's a time and place forthat, but more often than not,

(14:16):
when we're managing themicrobiome, we don't just kill
things, because most of themethods used to kill these
microbes are indiscriminate orthey're not specific for just
that one microbe.
They tend to kill good microbesalso.
So while this is not always truein general, think about
changing the context, theenvironment that is.

(14:37):
So imagine you have a garden inyour backyard.
If you weed that garden, let'ssay in late May, does that mean
you've eliminated all weeds forthe rest of the growing season?
Of course not.
You're going to have weeds allthrough the growing season.
Weeding is something you doperiodically, right?
So just by weeding it once theycome back.
Same thing here a microbe youdon't like, there's a good

(15:03):
chance it comes back because youhave not changed or improved
the background, the other plantsin your garden or, in this case
, the microbes in the mouth.
So a smarter approach in generalis to re-establish a favorable
and healthy oral microbiome thatoften takes care of those
pathogens for you.

(15:24):
That's how we do it in SIBO inthe GI tract, right?
We don't eradicate those fecalmicrobes with antibiotics, right
?
If you have an overgrowth of Ecoli and salmonella in your
small intestine, we don't giveyou lots of antibiotics to kill
those microbes.
What we do is we restorehealthy, beneficial microbes

(15:44):
like lactobacillus roteri,lactobacillus gasseri, that take
care of it for you.
So we are rebuilding a healthybackground microbiome.
Same thing here in a disruptedoral microbiome.
Let's try to work to restore ahealthier oral microbiome,
accepting that not all lessonshave been learned yet.

(16:05):
One big issue is wheat, grainsand sugars.
So it's clear as day in therecord in the anthropological
record that when humans firstturned to consumption of wild
wheat einkorn wheat about 10,000years ago, there was an
explosion in tooth decay.
Prior to consuming wheat andgrains.

(16:25):
Tooth decay was uncommon.
About one to three percent ofall teeth recovered prior to the
age of wheat and grainconsumption showed decay,
abscess formation, cavities,misalignment, tooth loss.
Now think about that.
So only one to three percent inadults of teeth showed decay or
other diseases.

(16:46):
Yet there was no fluoridatedtoothpaste, there's no
fluoridated drinking water,there's no dental floss, there's
no dentists, yet there was verylittle tooth decay.
When humans first turned toeinkorn wheat in the Fertile
Crescent, what is now Syria andIsrael, or millet in sub-Saharan
Africa, or maize in CentralAmerica, there was an explosion

(17:10):
in tooth decay, from very littletooth decay to 16 to 49% of all
teeth recovered, showingcavities, tooth loss, abscess,
misalignment, etc.
And of course that has been thehuman condition all throughout
history, middle Ages and onward,tooth decay was rampant, it was
everywhere and the solution isvery poor.

(17:30):
So people suffered.
It was not uncommon to have noteeth or have a very few
remaining teeth in your 20s.
So this has been a problem.
We've solved at least part ofit with our efforts at oral
hygiene right Dental floss,fluoridated toothpaste, dental
cleanings, all that kind ofthing.
But it's not uncommon, by theway, for Americans and other
people in the Western world tolose a lot of their teeth over a

(17:52):
lifetime, and this is becauseof the consumption of wheat and
grains and the reason for thatis the amylopectin A
carbohydrate, unique to wheatand grains, is extremely
digestible.
There are many indigestiblecomponents in wheat and grains
but there happens to be a highlydigestible carbohydrate because
we have the enzyme amylase inour saliva and in our stomach.

(18:13):
That is very effective, veryefficient at consuming
amylopectin A.
And amylopectin A is brokendown promptly, within seconds,
into sugars that in turn areconsumed by microbes that turn
into acidic byproducts that rotteeth, cause tooth decay.
And we also know that at thattime when humans first began

(18:37):
consuming wild einkorn wheat andother grains that there was a
shift in the composition of theoral microbiome.
It went from a healthymicrobiome to a cavity-causing
microbiome in the mouth,including proliferation of a
species called Streptococcusmutans.
That's the primary microbe thatcauses tooth decay because it

(18:58):
creates those acidic byproductsthat cause tooth decay.
So the incorporation of wheatand grains was a turning point
where tooth decay, dentaldiseases and the oral microbiome
underwent dramatic changes.
It got even worse in the 19thcentury when sugar became
available widespread because ofsugarcane and so people consumed

(19:21):
a lot of sugar and that addedfurther to tooth decay and to
deterioration of the oralmicrobiome.
It got even worse.
Those changes in the microbiomegot worse.
There was more streptococcus,nutans and other decay causing
microbes.
So diet is a major factor.
Well, you can return to thediet that was associated with
healthy teeth, that is, no wheat, no grains, no sugars, as we do

(19:47):
in my wheat belly programs andother programs.
Another thing you want to beaware of is mouthwash is not a
solution.
So mouthwash is like abroad-spectrum antibiotic.
It kills everything goodmicrobes and bad microbes.
And that's why the observationhas been made that when people
swish with mouthwash, theirblood pressure goes up for a

(20:09):
while, because they've killedoff nitrate-producing microbes,
because nitrates and nitritesbecome nitric oxide, which is a
vasodilator and maintainshealthy 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 riskfor heart disease.

(20:30):
Now there may be times where amouthwash is necessary as part
of a treatment program, say forperiodontitis, where somebody's
at risk for losing their teeth.
So in that very specificsituation, advised by a dentist
or a periodontist, there may bea role for that.
But as a general rule, just fordaily oral hygiene, mouthwashes
have no role.

(20:51):
Another thing to bear in mind isthat the best way to tell this
part of the story is to share astory that Dr Debbie Osmond, a
functional dentist in OklahomaCity, shared with me.
A functional dentist inOklahoma City shared with me.
She told me how, every year,she would volunteer her time for
free in the Peruvian highlandsin South America.
She would offer her dentalservices to the inhabitants of

(21:12):
this mountainous area and shesaid that some people would ride
as long as two days to get tothe American dentist for their
free dental care.
And she saw that these peoplehad mouths of rotten teeth
because they chewed sugar cane.
And she would spend her dayspulling teeth all day long, left
and right.
But she said that occasionallysomeone would show up with a

(21:34):
full mouth of intact, healthyteeth and she'd ask them do you
chew sugar cane?
And they say yes, I do.
Then she'd ask what do you dodifferently sugarcane and they
say yes, I do.
Then she'd ask what do you dodifferently?
And she said every last one ofthem would say well, after I
chew sugarcane, I take a twigand I run it between my teeth
and clean out the debris.
So what she interpreted this asand this has been borne out also

(21:56):
by the science is that they'rebreaking the biofilm.
That is unhealthy.
Microbes produce a protectivefilm, a so-called biofilm, to
protect themselves againstantibodies and other
antimicrobial factors in saliva,and so breaking the biofilm
appears to be essential topreventing tooth decay, cavities

(22:19):
, tooth abscess, tooth loss.
Now you can accomplish that, ofcourse, with a twig, but it's
probably better in a modernworld to use dental floss or a
pick those plastic picks you canbuy, or even just a plain old
toothpick, and make a habit ofthis at least once a day to
break the biofilm and keep thosepathogenic organisms from

(22:40):
collecting and producing acidicbyproducts.
Another thing you can do isaddress your vitamin D, as we do
in all my programs.
So vitamin D is essential fortwo reasons One, it strengthens
your teeth and two, it changesthe microbiome.
It changes the microbiomethroughout the body.
It changes it in thegastrointestinal tract, it
changes it in the vagina, itchanges it in the mouth.

(23:02):
So vitamin D exerts positiveeffects on teeth and on the oral
microbiome and also amplifiesyour immune response.
So vitamin D essential.
It's part of your dentalprogram.
Now let's talk about fluoride.
So there's two ways most willget fluoride.
About 70% of Americans drinkdrinking water that has fluoride

(23:24):
in it.
So fluoridated drinking waterand the other is fluoride
toothpaste.
Well, the evidence hasaccumulated over the years that
fluoridated drinking water doesnot prevent cavities, does not
prevent dental decay.
It's still done and there arepeople trying to fight it and
have the state governments stopadding fluoride to water.
But the science is pretty clear.

(23:44):
Fluoridated drinking water doesnot reduce dental problems.
Now that's different thanfluoride toothpaste.
We don't want to conflate orconfuse the two.
Just because fluoridateddrinking water does not provide
any benefit, it may even beharmful it does not mean that
fluoride toothpaste isineffective.
The evidence is very good thatfluoride toothpaste does prevent

(24:06):
some tooth decay.
It's not real powerful, it'sonly a few percent, but it does
help and it also helps toremineralize your teeth and keep
them a little stronger.
One mistake people make is theyuse too much fluoride
toothpaste.
Fluoride toothpaste ismanufactured such that only a
pea size of toothpaste isnecessary.

(24:27):
You don't need the entiretoothbrush covered with
toothpaste.
I see people doing that.
You just need a pea sizebecause that's just a little bit
of fluoride.
You don't want a big balls offluoride, but fluoridated
toothpaste the evidence is quitegood does help somewhat.
Probiotics this is a toughquestion.
It's not quite worked out whatmicrobes we should replace.

(24:48):
So when we replace some of themicrobes we play with, such as
those in fermented foods likeleuconostoc or pediacoccus, or
how about the keystone specieswe replace as yogurt or other
fermented foods likelactobacillus roteri,
lactobacillus gasseri, do thoseplay a role?
So it's not entirely clear.

(25:10):
The best evidence is for astrain or two strains of
lactobacillus roteri, 17938 and5289 strains.
There is some evidence.
You get this as a commercialproduct called ProDentis and
there is some evidence that itdoes shift the oral microbiome a
little bit into a more positivecomposition, and you do this as
a lozenge, but that's about allwe know.
There's not a whole lot moreknown.
Maybe lactobacillus salivariusmay have some potential, but the

(25:34):
evidence is very preliminary.
So I predict that sometime soonit may be in the next year or
three years, but sometime soonwe're going to have some
powerful insights on how tobetter manage the oral
microbiome using probiotics andrelated things.
But right now we don't have alot of information outside of
those two microbes, butespecially lactobacillus roteri,

(25:54):
those two strains which aredifferent than the strains we
use for other purposes, right,the strains that produce ox,
that cause oxytocin to bereleased from the brain and
colonize the upper GI tract.
We don't know if there'soverlap in the capacities of
these several different strainsof rhodorite, so unclear.
Lastly, the sweetener, xylitol.
That is found naturally in somefruit in small quantities, but

(26:16):
you can use it as a sweeteneralso and it has mild
antibacterial effects againstthese species that cause
cavities, dental decay, likeStreptococcus mutans.
It also, interestingly, hasmild antifungal properties.
Not xylitol itself, but itsmetabolites have mild antifungal
properties.

(26:37):
So if you're going to use asweetener and you're going to
make whatever cheesecake or somecookies you bake them, say,
with almond flour or almond mealand you're going to choose a
sweetener, you could choose monkfruit, you could choose
allulose, you could choose thevarious forms of stevia, but
think about using xylitol.
There's also xylitol chewinggum and xylitol-containing

(26:57):
toothpaste and that can help.
The evidence is uneven.
There's some evidence in favorof xylitol as an antimicrobial.
There's some that say it's notso helpful.
But it's so harmless, it's soinexpensive, so easy to
incorporate into your toothpasteor into your baking that it's
at least something worth knowingabout and maybe incorporating
on occasion.
Now, clearly, we need to updateas the science unfolds, because

(27:20):
right now you can see we stillneed a lot better answers, but
know that our focus here is totry to identify what goes wrong
in an oral microbiome and whatcan you do about it so that it
does not contribute to your riskfor dementia, heart disease,
depression and all those otherconditions that could be blamed

(27:41):
on, at least in part, on adisrupted oral microbiome.
Now, if you've learnedsomething from this episode of
Defiant Health, please post areview, post a comment,
subscribe through your favoritepodcast directory and join the
conversation.
Thanks for listening.
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On Purpose with Jay Shetty

I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!

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