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Is Chronic Mouthwash Use Endangering Your Beneficial Bacteria?

New study out of the journal Nitric Oxide links mouthwash use to diabetes.

It sounds like one of those spurious correlations that show up whenever you sift through large piles of data, such as the supposed link between cheese consumption and death from bedsheet strangulation.

But the results of a new epidemiological study linking mouthwash use and diabetes risk are – to all appearances, at least – a real effect, with fascinating implications for our understanding of the complex links between health, athletic performance and the trillions of bacterial cells that inhabit our bodies. A cleaner mouth, it turns out, isn’t always better.

The new study, which appears in the December issue of the journal Nitric Oxide, analyzes data from a longitudinal study of 945 adults in Puerto Rico who were followed over a period of three years. Just less than half of the participants reported using mouthwash regularly, and those who gargled at least twice a day were roughly 50-per-cent more likely to develop prediabetes or diabetes than those who used it less frequently or not at all.

“Most over-the-counter mouthwashes contain antibacterial ingredients,” explains Dr. Kaumudi Joshipura, an epidemiologist at the University of Puerto Rico and Harvard University who led the study, “which could destroy or inhibit oral microbes, some of which may be beneficial for metabolic health.”

This is an idea that’s already familiar to elite endurance athletes. Over the past decade, beet juice has emerged as a powerful and ubiquitous performance enhancer, because it enables muscles to consume less oxygen during exercise. The key component of beet juice is nitrate, which is converted by bacteria in the mouth to nitrite, which is in turn converted to nitric oxide, a powerful signalling molecule with wide-ranging beneficial effects in the body.

Earlier studies had already shown that mouthwash, by killing the bacteria that convert nitrate to nitrite, breaks this chain reaction and negates the immediate performance benefits of beet juice. It also wipes out acute gains in blood pressure and insulin sensitivity. But the new Puerto Rican study is the first to extend these findings to chronic health effects measured outside the laboratory. Since nitric oxide plays a role in determining how muscles use glucose, Joshipura hypothesizes that it is loss of oral bacteria that convert nitrate to nitrite that leads to higher diabetes risk in heavy mouthwash users.

It’s tempting, then, to wonder how we can nurture the “good” nitrate-converting bacteria while suppressing the “bad” oral bacteria that contribute to gum disease, bad breath and tooth decay. But it’s not that simple, says Dr. Anni Vanhatalo, an exercise physiology researcher at the University of Exeter in Britain who studies dietary nitrate but wasn’t involved in the new study.

“It’s about a balance,” she says. “We have around 700 species of bacteria in our mouths, most or all of which have the potential to be pathogenic in large numbers. In that sense there are no ‘good’ or ‘bad’ bacteria.”

That’s similar to our emerging understanding of the complexity of gut bacteria, where greater diversity, rather than any particular superbug, is associated with better health. And chronic mouthwash use, Vanhatalo says, can be likened to the effect of antibiotics on gut bacteria. “Few would contemplate going on antibiotics permanently,” she says, “while more than 20 per cent of Americans use mouthwash daily.”

Where is the ideal balance? Vanhatalo suggests that brushing your teeth with toothpaste twice a day is about right. Joshipura notes that the people in her study who reported using mouthwash just once a day didn’t have any elevated risk of prediabetes or diabetes, but adds that further evidence is needed to make recommendations.

“People with specific oral conditions may need to use mouthwash as prescribed, usually for short duration,” Joshipura says. “However, we are concerned that mouthwash is often used routinely long-term in the absence of specific oral needs, without awareness of potential long-term effects.”

Finally, if all this sounds a little gloomy, it’s worth concluding on a more positive note. The negative effects of blocking nitrate conversion are, in a way, a reminder of all the benefits you can get from nitrate-rich foods – in addition to beets, leafy greens like arugula and spinach are very high in nitrates, as are rhubarb and celery – if you don’t block them.


Alex Hutchinson’s new book, Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance, will be published in February. Follow him on Twitter @sweatscience.

ALEX HUTCHINSON        SPECIAL TO THE GLOBE AND MAIL       JANUARY 14, 2018
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Gum Disease Tied to Yet Another Deadly Illness

Add one more reason to why you should brush and floss regularly: Gum disease bacteria are now tied to higher odds of esophageal cancer.

The study tracked the oral health of 122,000 Americans for 10 years. It found that the presence of two types of bacteria linked with gum disease may hike the risk of the cancer.

The presence of one oral bacterium in particular, called Tannerella forsythia, was tied to a 21 percent increase in the odds of developing esophageal tumors, said a team led by Jiyoung Ahn. She is associate director for population science at NYU Langone Health in New York City.

Gum disease has already been linked in numerous studies to a heightened risk of the number one killer, heart disease. But an expert in esophageal cancer who reviewed the new findings stressed that researchers can’t yet prove a causal link to esophageal tumors.

“What is not clear is whether the presence of these bacteria or the resultant periodontal disease is primarily responsible for the development of cancer,” said Dr. Anthony Starpoli, associate director of esophageal endotherapy at Lenox Hill Hospital in New York City.
Still, Starpoli believes specialists should “consider a proper evaluation of the oral cavity as well as the remainder of the digestive tract in the hope of early diagnosis of esophageal cancer.”

Esophageal cancer is the eighth most common cancer and the sixth leading cause of cancer death worldwide, the study authors noted. Because it’s often only diagnosed at an advanced stage, five-year survival rates are between 15 to 25 percent.

Ahn said, “Esophageal cancer is a highly fatal cancer, and there is an urgent need for new avenues of prevention, risk stratification, and early detection.”

The news from the study wasn’t all bad: The investigators found that some types of mouth bacteria were associated with a lower risk of esophageal cancer.

Learning more about the bacteria communities living naturally in the mouth “may potentially lead to strategies to prevent esophageal cancer, or at least to identify it at earlier stages,” Ahn noted in a news release from the American Association for Cancer Research.

One other expert agreed.

“The study suggests that there are some oral bacteria that may contribute to the development of this highly deadly cancer but also, and very importantly, suggests that some bacteria may provide a protective effect,” said Dr. Robert Kelsch. He’s an oral pathologist at Northwell Health in New Hyde Park, N.Y.

“Knowing which bacteria are good and which are bad could lead to preventive treatments or serve as predictors of risk of development of this cancer,” Kelsch said.

Ahn added that good oral health – including regular tooth brushing and dental visits – may help protect against gum disease and health conditions associated with it.

The study findings were published Dec. 1 in the journal Cancer Research.=

By Robert Preidt   HealthDay Reporter      FRIDAY, Dec. 1, 2017    HealthDay News

SOURCES:  Robert D. Kelsch, DMD, oral pathologist, Northwell Health, New Hyde Park, N.Y.; Anthony Starpoli, M.D., associate director of esophageal endotherapy, Lenox Hill Hospital, New York City;  American Association for Cancer Research, news release, Dec. 1, 2017

source : www.webmd.com   WebMD News from HealthDay