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Report on “Diet and Nutrition in Oral Health and Disease”
Typed manuscript of a presentation for the Beechwold Clinic Food Education Department, March 27-28, 1965.
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One reason for this conference: in dental school a student sees a solitary case of scurvy and he is forever after imprinted with the idea that only this is scurvy. Also, he is taught disease is caused by a single factor–polio is caused by the polio virus. “We will attempt to prove a more realistic approach to health and disease. There are multiple causes of disease and are many shades of gray between the black and white health and disease.” It takes “two to tango” to produce disease and the capacity of the host is a factor. There must be an environmental challenge added to lack of resistance. Of these, this conference will single out nutrition by basing observations on animal experiments, the layman’s experience (“The man in the street may be crazy but he’s not stupid. He knows there is a difference in resistance if two men are caught in a chilling storm when out in a boat fishing, and only one catches pneumonia.”) and the experiences of doctors and dentists with their office patients.
Take a man on the verge of pellagra, a niacin deficiency disease. Apparently healthy, a good hard day in the field under strong sun makes him wake up the next morning–He’s sick, sick.. He has a rash wherever his skin was exposed to the sun.” There must be something wrong with the host for the environmental threat to cause the disease.
It’s absurd to change the gums alone. You can’t treat a person from the neck up because what affects the mouth is affecting all the system. Take the woman of 50 who comes in in tears. The dentist says, “Get your teeth out while you still have ridges to fit dentures.” She has a dry mouth, her tongue burns, her gums bleed. When she breathes in, her teeth move in, too. She’s a mild diabetic in the climacteric. If the dentist treats only her mouth, he sends her out with all her diseases; lots of little troubles, none very bad, add up to a very big disease.
“It’s not easy to prove a cure.” As DuBois said, “If I pour water on fire does this prove fire is due to a shortage of water?” We can, however, measure blood sugar, blood pressure, make arbitrary scores to evaluate gum tenderness, tooth mobility, caries, etc. to show effects of diet changes–restricting carbohydrates, adding protein and the like.
To begin with, the American diet is generally deficient. People choose poorly in the midst of plenty, their preferences interfere with good nutrition. Where food is grown makes a difference. In Central Am. where food is grown for quality it is better and healthier than in America where food is bred without regard to its nutritive qualities. The length of time from harvest is another factor in differences in nutrients along with refining, processing, storage and transportation, to say nothing of cooking techniques. Tests show dental students arrived with only two of them showing adequate intakes of vitamin C foods. After the second week in school, NONE had enough C in their diet. In unpublished data at Birmingham Medical Center, when their blood plasma levels of C were measured, 6.6% had zero levels of C, 24.2% had 0.21-0.40 and 20% had 0.41 C plasma levels. Translation: 30.8% of 861 people were deficient in vitamin C.
Combinations of foods eaten influences use of nutrients. If animals are made protein-deficient, huge amounts of vitamin A are required to prevent symptoms, whereas even minimum protein makes them require only normal amounts of A. Another intricate relationship: if an egg is eaten alone, 10% of iron is absorbed. If an egg is eaten with a glass of orange juice (85 mg. C) then 15% absorbed. But if one gram of ascorbic acid [is] given, then 75% iron [is] absorbed.
Diets of the mother can affect a child’s susceptibility to caries. During World War I when little sugar [was] available, children born then never had as many caries even though they ate the same diets as children born to mothers having ample sugars in their diets.
To show what happens when refined carbohydrates, white sugar and white flour, are restricted in a diet, gum tenderness scores are set up. Subjects were asked, “Do your gums hurt?” Some say “occasionally,” a few, “Always.” Scores of 0-4 are compared before and after change in diet.There were always higher numbers of those with tender gums when there was more carbohydrate concentration.
Besides the gum tenderness scores, blood sugar determinations were made and those with most trouble were found to have fluctuations more like a diabetic, both too high and too Iow. “The hypoglycemic of today is tomorrow’s diabetic.”
Eating much too much carbohydrate calls vitamins from elsewhere and needs go up. With tooth mobility (“How much the teeth move is like being asked ‘How’s your wife?’ ‘Well, compared, to what?”) They found they could get both beneficial and detrimental results by taking sugar away and adding it back. Also, since “You can’t glue calculus back on, nor can you treat just half a person with vitamins or diet, we devised a method of scaling half the teeth in a mouth and measured what happens.” Scaling was found to help, but the side unsealed improved with vitamins, and sugar restrictions. A person can have an absolutely clean mouth yet never have brushed his teeth, if his diet was excellent.
Protein was given in the form of a protein wafer made with tripe flour (“It was the cheapest form, but it tasted terrible.”) protein supplements and a placebo. 87% showed improvement of the gingival state.
Our diet is often deficient in the amino acid lysine because heating protein in the presence of reducing sugars, mannose, etc., forms a linkage so that the body can’t use amino acids. With animals, they found that by adding lysine to heat-treated milk, they could reduce caries. With milk, the effect of a temperature of 40° gave an available lysine of 3.29. If 90° temperature, amount of lysine reduced to 3.09. At 190°, lysine dropped to 1.98. Destruction of lysine in bread and cereals:
Survival biscuits baked by the army were supposed to have 3.1 available lysine by calculation. By analysis, only 1.0 was available and when fed to experimental animals, the biscuits would not support weight gain of any of the animals.
Other tests at Alabama showed that denture patients returned less often for re-fitting if they were given protein supplements. Also, less time was spent in the dental chair for adjustments.
Good protein supplements: brewers yeast, dessicated liver, or Sustagen. Metrecal is “terrible”. Only 2% is protein, 90% water. The supplements given had 70% protein.
There is no argument whatsoever that vitamins have something to do with the mouth. Tongue lesions were divided into categories: no observable lesions, mild involvement, marked and very severe. By improving the diet with respect to vitamin content, improvement in tongue condition was stepped up by half.
Bleeding, tenderness, redness, swelling and cavities have all been shown to be reduced by the addition of vitamin C. In testing natural versus synthetic vitamins, it was found that synthetic vitamin C plus bioflavonoids (all sources of which are natural as no-one has found a way to synthesize it) always gave better results. Citrus bioflavonoids were given to football players at San Jose in two doses, 450 mg, in the morning, 450 just before they went out to play. (“And these boys were healthy, trained to hurt each other.”) Compared with those who were given placebos, their total injuries, disabilities, and sprains were all reduced.
The mineral problem: sea salt with 40 p.p.m. fluorine inhibited caries after 5½ years of use. Cereal processors are now adding back the phosphorus which was taken out in refining because it has proved to reduce caries. Phosphorus is present in all unmilled foods.
Bone meal in amounts of 1% of diet, gave 60% reduction in caries, as good as fluorine.
In humans, the calcium-phosphorus ratio should be 0.55 (Equivalent: 0.8 grams of calcium in same meal with 1.6 grams phosphorus. To get ratio, divide phosphorus into calcium.)
Kelp has trace minerals in complete selection. “You can’t scoop up 50 minerals and put them in a supplement.” Kelp has been eaten by millions of peoples the world over. Kelp added to diets gave the best clinical improvement. Placebos alone gave 30-40% “psychological improvement.”
If a patient says “I bruise easily,” that means he bleeds. No blood should be out of a blood vessel wall. It is an indication of a vitamin C deficiency if he says “I can’t remember hitting myself but when I woke up there was a purple spot.” You can mask this deficiency by sewing up the vessel walls or putting in prothrombin, or by cold applications or injecting hormones.
“I shave, I go down to breakfast, that place I cut is still bleeding. My wife has to remind me to check when I go out the door.” He’s a bleeder, but no wonder when even 40.9% of Hollywood children eat any citrus fruits.
To know why someone bleeds, you can make direct microscopic observations of the capillary bed, make biopsies or make blood vitamin C determinations. We made scores like this; 0= no bleeding. 1= Bleeding on toothbrushing. 2= Gums bleed when eating a hard food like an apple. 3= Bleeding with soft foods like a sandwich. 4= Spontaneous bleeding–”I got up and there was blood on the pillow”–this is what brings mothers rushing their children to see the dentist when all other signs were ignored. Again, administration of vitamin C (for experimental purposes) improved the bleeding scores. In practice, they recommend change of diet, thus:
- Restrict intake of empty calories: sucrose, pastries, cookies, candies, soft drinks, cokes, cake, etc.
- Add more protein: fish, meat, eggs, cheese (we don’t mean a meat sandwich where the meat is merely “photographed” on)
- Take multiple vitamin and mineral supplements.
They ask patients to record a seven-day’s diet. Then they circle signs of multiple deficiencies: burning oral tissue, coated tongue, fissure and marks of teeth on tongue, cracks at corner of mouth, or dilated blood vessels in gums.
There are tests for vitamin C. One is done with the blood pressure cuff and the number of small red spots (petechiae) from break-down of capillary walls counted. Another was developed by Cheraskin and Ringsdorf and is done by dropping a dye on the tongue surface. A stop watch times how long it takes for the color to disappear. If it is around 16 seconds, [the] person is in good shape. If it takes longer, he is vitamin C-deficient.
“We don’t want to be known as a dandruff-cure clinic”. By changing diets and adding vitamins and minerals, people came in surprised at the “fringe benefits”–no dandruff, tough nails and nails that grew longer and absence of backaches. The girls in the office on working with IBM cards in a double blind test could foretell accurately who was getting the better treatment and not the placebos–only they thought it was because something was wrong with the machine!
“If we can crack the caries problem, we have the key to all disease, as caries always appears along with rheumatism, all degenerative diseases.”
Off the record, in post-session group informal discussions, we heard of future experiments underway: by feeding a patient a drink of glucose, they can make the electrocardiogram look like that “of a dead person.” Another: by making Pap smears on cancer patients, they find by changing the diet they can change the Pap smear results for the better.
Quote: “The philosophy of the health sciences of today is that you are guilty until proved innocent.” And “Today’s heresy is tomorrow’s orthodoxy.”