Dental cavities: Preventable and curable?

The Quick Answer:  If you or a family member gets one cavity in three years, it’s not just an unnecessary expense that will lead to future pain and expense; it’s also a wake-up call to take preventative action.  Buy more fluoride?  No!  Eat less sugar (and more whole foods, including green salads).

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Here’s a fresh look at a common childhood disease: dental cavities (or caries).  The chronic diseases—type 2 diabetes, heart disease, cancer, autoimmune diseases, etc.—may take decades to develop, but cavities, which have a shared cause, can develop in baby teeth.  There’s a saving grace in the baby tooth cavity—if taken seriously, it’s an early warning that preventive change is needed to save the permanent teeth that follow.  Dental caries are highly preventable and curable, if caught early, by diet reform.

Dental cavity questions:

•  How big a problem is dental decay?   Cavities is the single most common chronic childhood disease (over 50% of children 5-9 years have at least one cavity; 78% of 17-year-olds do.  (How do 22% reach 17 with none?)

•  What causes cavities?  Sugar, mainly.  Bacteria that live in the plaque on your teeth use sugar to produce acid that can demineralize tooth enamel.  The body can repair this through remineralization but only if the plaque isn’t too acidic.

•  Can cavities be prevented?  Technically, yes, but you must move beyond the advice of the old dental establishment and the government.  If you Google “dental cavities, prevention” you will get official guidance on brushing & flossing, fluoridation, dental sealants, and regular visits to your dentists.  This is all good, it’s certainly a good business and does reduce decay, but history shows it won’t prevent or cure cavities.  Surprisingly, diet—the major factor—gets little mention.

•  So, can people actually prevent and even cure cavities?  Pretty much, but there are issues of family history, including genetics, and the fact that you’re starting well after your teeth were formed.

•  Is preventing and curing cavities a recent discovery?   No.  Important discoveries were made way back in the 1920s and 1930s and then forgotten.  So we should remember two pioneering women:  Dr. May Mellanby, and Mrs. Weston Price.

Dr. May Wellanby was the wife of Dr. Edward Wellanby who solved the problem of rickets (like caries, a bone disease) and contributed to the discovery of vitamin D.  His wife, a brilliant scientist in her own right, studied the epidemic of dental caries using dogs and then humans.  She found diet combinations that drastically reduced cavity formation and actually healed smaller cavities.  May Wellanby published her discoveries in 1924 (credit to Stephan Guyenet for this summary):

•  A diet with adequate minerals, particularly calcium and phosphorous (the ratio is important), is critical;

•  The diet must also include the fat-soluble vitamins, especially vitamin D which is also obtained from sunlight;

•  Dr. May Wellanby recommended a varied diet of whole foods, including dairy, and cautioned against excessive sugar and [refined] grain intake.

Mrs. Weston Price didn’t leave a record of her work; her contribution was to assist her husband during the ‘30s on expeditions around the world to the most primitive indigenous people they could find.  Their mission was to study the dental health of indigenous people who had not yet adopted the Western diet of refined foods, and compare them to their cousins who had moved to the city and converted to the modern diet.  Weston published his findings in the 1939 book Nutrition and Physical Degeneration:

•  Price found that for the same indigenous population, dental cavities were 35 times higher (that’s 3400% more) on the modern refined, sugary, diet, than on the traditional diet. 

•  Traditional diets were not only protective against cavities; they also resulted in well-formed dental arches in newborns.   Their cousins born in the city had the crowded malformed dental arches that delight the orthodontist.

•  Price visited tribal people all over the world who lived in varied climates and ate different diets.  What they had in common was an evolved food tradition based on natural foods and game at hand that sustained health. 

Preventive Dentistry:

Here we have a familiar story:  science has discovered a great deal about how caries develop, but we must turn to food traditions to learn how we can prevent them.  When scientists studied dental plaque—the coating on your teeth—they found a surprisingly complex community of bacteria that they gave a new name: biofilm.  Many of the bacteria in biofilm produce acid and when there is too much acid (the pH has to drop below 5.5) tooth enamel is demineralized, or eaten away.  When the pH is above 5.5 (less acidic) enamel can be remineralized, or repaired if given a healthy diet.  Your saliva is key to a healthy acid level.

The biofilm is constantly bathed in saliva.  Saliva, 98% water and sometimes called the blood supply for the mouth, is a rich broth that can buffer excess acid; it contains minerals, proteins, antibacterial agents, and enzymes needed for digestion of food.  The mouth produces about a liter of saliva each day, so drinking adequate water is as important as a healthy diet.  Prescription drugs present a special problem; there are around 3000 medications that have the side effect of “dry mouth,” which accelerates the formation of caries and gum disease.  If this warning is on the package insert of a drug you take, consult your dentist.

I had a phone interview with Dr. Cliff Sorensen, who practices preventive dentistry in Ogden, Utah.  I had read about Dr. Sorensen’s work so gave him a call, thinking that because he had once dated both my future Beautiful Wife and one of my charming sisters, he would talk with me.  We had a great conversation about saliva, biofilm, acid-producing bacteria, caries, and the difficulty of getting people to change self-destructive habits.  Dr. Sorensen gave up drill-and-fill dentistry, at considerable personal expense, when he became convinced that, for most, dental caries was preventable and curable.  As explained, he provides a cariogenic assessment and based on the outcome, provides guidance and support as appropriate.  (I like that word, cariogenic, meaning cavity or carie-producing.)

Dr. Sorensen doesn’t give nutrition advice, except to eat a healthy low-sugar diet.  I am not aware of any dentist who does; as you know, the subject is complex and the science incomplete.  But the guidance of science, tradition, and scripture combined can give us the best possible answer and that is the goal of this blog.  For example:

•  Cariogenic foods begin with sugar, but include refined and processed foods too.  Growth of the caries epidemic has paralleled our growing sugar appetite.  So sugary drinks and snack foods are a problem.  Research suggests eating less than 33-44 pounds of sugar a year will protect against dental caries.  This can be accomplished with the three sugar Healthy Changes (found here, here, and here), based on meeting the AHA’s maximum intake of six (women) to nine (larger men) daily teaspoons, which is about the proposed 33-44 pound maximum. 

•  Protective (non-cariogenic) dietary includes a variety of whole foods including dairy, plus adequate vitamin D (discussed here) as suggested by Dr. May Wellanby nearly 80 years ago.  Calcium and phosphorous are important minerals for bone health.  It's well-advertised that milk and dairy supply calcium; it's less well-known that plants are an essential source.  An important plant source is the leafy green vegetables used in salads.

Comment:  Share your favorite salad recipes, or your experience preventing cavities. 

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

the end of diets

We awoke this morning to a wonderland of white, from snow falling quietly in the night.  We live near the beach in California but traveled Saturday to the small town high in the Wasatch Mountains of Utah where my wife’s father, John Huber, grew up in the years between the World Wars.  This home has been in the family for over a century; we are its keeper now.  Built in the Victorian farmhouse style, its thick stone walls are a storehouse of family tradition.  The Hubers had been farmers for as long as anyone could remember.  John’s grandparents brought their farming traditions when they emigrated from Switzerland in the 1860s.  Here, they planted apple and pear orchards, and built a creamery cooled by water from a mountain spring.  The males of the family kept cows and planted wheat, oats, potatoes and onions.  The women tended a large kitchen garden, helped in the fields when needed, and baked bread twice a week using their own wheat (ground at the local mill).  This was the life of the traditional farming family.

You’ve heard of the roaring ‘20s?  Not so for the farmers—those were hard times.  In the post-WWI recession, crop prices were terribly low.  In the ‘30s, recession turned to Depression and prices fell even lower.  There was seldom any money in the Huber home; they raised what they ate or bartered with the person who made it.  The Johnson family kept the local mill for grinding wheat; Uncle Cooney across the way smoked their hams.  (My wife has a childhood memory of him yodeling as he called his cows from pasture.)

Did I say hard times?  I wrote John’s memoir just before his passing.  The childhood he recalled had a warm and golden glow.  His grandparents were founders of his town and his closest neighbors were all related.  Forty-three first cousins lived within shouting distance of his home.  At the end of his life, John still missed the breakfast groats his mother cooked (a hot cereal of oats and wheat with unpasteurized cream from their cow), the hearty homemade breads, and the fried trout that the boys caught in the creek by their farm.  He remembered the comforting sight of the root cellar packed full in the fall with the crops that would carry them through the winter.  They worked long days in the summer but in the winter they spent quiet evenings around the wood-burning stove that cooked their food, heated the water, and warmed the house.  It was a treat, he recalled, to get an apple out of the root cellar, dip it in the teakettle to warm it, and then remove the peel in a single piece with his pocketknife.    

John was the last in his line to grow up on a farm; when he came of age he sought his fortune in the city.  It was the modern thing to do; the world was changing and ambitious young men didn’t want to get left behind.  If there was one dish that marked the shift from traditional farm food to the modern diet, perhaps it was the Angel Food cake.   The Angel Food cake, in contrast to the whole-grain breads John had grown up on, was light, white, and ever so sweet.  The ingredients came from distant factories not the local mill, so had to be purchased.  The cake required equal amounts of powdered sugar, granulated sugar, white refined cake flour, plus an eggbeater to whip the egg whites.  Welcome to the modern diet.  

John, in his lifetime, saw all the phases of the modern diet: cheap sugar and refined flour; hydrogenated shortenings, margarines, and vegetable oils; processed foods easily prepared in your kitchen; and finally, take-out and fast foods that made your kitchen redundant.   Setting aside chronic disease, there is another result of modern food—we gain weight.  From weight gain, a new fad evolved—the diet.  The word now meant a temporary deprivation where you lost enough fat for your friends to notice, before returning to what you were eating before.  You could write a book about all the diets that have come and gone.  As noted in the post The Skinny on Being Overweight, eating less refined carbs lowers both blood glucose and insulin, which reduces stored fat.  From this concept came the Atkins Diet, which was a redo of England’s Banting Diet of the 1800s.

The French have a different approach to food.  Though they enjoy sweet buttery sauces and pastries, they are blessed with trim figures and a low rate of heart disease.  This is called the French paradox.  What was missed in our understanding of their diet was a strong discipline about food:  The French eat multiple courses but small servings; they don’t have the American disdain for whole foods like vegetables; and there is little between-meal snacking.  Well that has been changing—there is now a McDonald’s on the Champ-Elysees in Paris and the French are gaining weight and resorting to a most American mistake: le diet.

Last week the N.Y. Times wrote about the French take on the Atkins Diet—the Dukan Diet, the creation of the latest diet millionaire, Dr. Pierre Dukan.  The article was pimping a new book about Dukan’s diet.  What I found most fascinating about the story (“The French Diet You’ve Never Heard Of”) was the reader’s contempt, as shown in their comments.  The Times readers, at least the ones writing, are totally done with diets.  They recognize the absurdity of a temporary change to solve a long-term problem.  They were angry—with the N.Y. Times for recycling a discredited concept—and were calling, I thought, for a return to wiser food traditions. 

This brings us back to the Huber home, and their food tradition.  The table where I write is in the old parlor.  Before me (because of the thick walls) is a beautifully trimmed window.  Still standing in the distance, under a mantle of snow, are the sheds where they kept the milk cow and chickens.  In the foreground is the area where the kitchen garden once grew.  Close by is the root cellar.  Writing John Huber’s memoir was hard because it was my first book.  But there was a hidden blessing:  He shared with me all the charming details of how people ate before food was made in factories.  As noted, the source for Word of Wisdom Living is the three-legged stool of science, food tradition, and scripture.  Our quest is not a diet to lose weight, but each reader’s discovery of how to eat and be well.  This is a journey best made together, though our answers will vary as we do.

Please comment and share your best healthy food discoveries.

The Skinny on Overweight

I’m moved by the genuineness of our readers.  A bit overweight?  Well, it’s right out there in your comments.  Summer is coming—school will be out in about 100 days and swimming suit season follows.  Thinking about dieting?  Forget it.  Diets are temporary and Word of Wisdom Living is about permanent, healthful change.  Fortunately, a healthy lifestyle usually leads to a healthy body.  I say usually because we’re all different, but eating right is the place to start.   

A heavy guilt trip has been put on the overweight and obese in our society.  This is counterproductive; it just doesn’t work, as evidenced by the continuing national weight gain.  So lets do something smarter.  The common wisdom says weight gain occurs because we eat too much and move too little—excess calories become excess fat.  So, shame on the overweight?  Maybe not.   

W of W Living suggests a different theory:

This theory removes self-starvation—but not a little self-discipline—from the cure for overweight.  The hunger impulse is too strong to ignore for long, so we need a better strategy.  Here’s a new plan, based on the sugar-insulin theory of weight control: Simply eat a reasonable amount of healthy food and you’re on your way to a good weight.  Real food is rich in nutrients and filling fiber, but low in calories.  And don’t forget to exercise, get plenty of sleep, enjoy a little sunshine, and deal with whatever stress is making you snack.

Lest you credit me with too much genius, I must acknowledge the sugar-insulin theory has been around for a while.  Unfortunately, society tends to solutions that place guilt rather than enlighten—so the worn-out “eat less, move more” mantra persists in the media.  We’ll deal more thoroughly with being overweight in a later post, but here are a couple of suggestions from the Word of Wisdom on eating:

1. Lower your blood sugar and insulin levels by avoiding factory food.  Factory food is high in refined carbs (the white stuff—sugar, flour, white rice, plus HFCS) that raise your blood sugar and insulin levels.  Insulin moves the excess blood sugar into our fat cells and keeps it there.  If you don’t significantly reduce the refined carbs in your diet your waistline will keep growing.

2. Farm food has a low glycemic index (G.I.)—a measure of its ability to spike your blood sugar level.  A diet with a low G.I. lowers your insulin level and results in smaller fat cells.  Smaller fat cells mean a smaller waistline.  So enjoy some fruit and nuts along with lots of vegetables, whole grains, legumes, with a little meat and dairy.

3. If you buy factory food you’ll eat it.  So avoid the center aisles in the grocery store that offer sugary drinks, cookies, candy, chips, and bakery goods.  (Ever noticed that the baked goods in stores don't even taste that good?  If you're really craving apple pie, make your own!)

4. Life is to be enjoyed, but get your guilty pleasures in the smallest possible dose.  I like See’s candy, but I follow Healthy Change #8.  If I see a store in the mall I get my favorite piece.  But we don’t bring boxes or bags of candy into the house.  Sad experience has taught that if it’s in the house it’ll get eaten.

5. Besides sugary drinks, avoid diet drinks too.  They’re less healthy than water for a number of reasons, but there is another problem:  Studies show that diet drinks DO NOT result in you eating less sugar.  In fact, they seem to reinforce the infantile desire for sugar so you get extra sugar in other forms (more to come on this topic).  Per Healthy Change #6, drink lots of water.

Lifestyle change works best if your friends join in, so pass the word.  And please share your weight loss experience by adding a comment, so we can learn together.