The Health Effects of Oil Pulling

Health!  Wealth!  Happiness!  I’m Dr. Michael Greger and you’re listening to the Nutrition Facts podcast.  And while I can’t promise you all of those things, if you take a listen to the evidence-based nutrition found in this podcast, chances are you’ll learn something that you can use to make a positive change in your diet and in your health.  My job here is to bring you the information you need to make that reality possible.

On today’s show we go where the Nutrition Facts podcast has never gone before – to the ancient Ayurvedic practice of oil pulling, which is the act of swishing oil in your mouth.  And, yes, this is actually a thing. 

Have you heard there is evidence to suggest oil pulling can effectively treat serious diseases such as paralysis, meningitis, cancer, and AIDS?  Let’s find out if it’s true. 

I’ve done videos on how coconut oil is safe to put on your hair or on your skin, but you certainly don’t want to eat the stuff. You may not even want to be in the same kitchen when it’s being cooked with. I don’t know where people get the idea it’s safe to cook with. It’s got one of the lowest smoke points. At typical frying temperatures, it can release a variety of toxic compounds—in fact, even below the smoke point. So, you want there to be good ventilation.

You also don’t want to inject it into your privates, and even standing under a coconut tree is not completely without risk. But, what about swishing coconut oil around in your mouth? So-called “oil pulling” is evidently “a time-honored…folk remedy that involves swishing…oil in [your] mouth”—“pulling” it back and forth between your teeth “for [purported] oral and systemic health benefits.” You put a spoonful of oil in your mouth, swishing for up to 20 minutes. If that’s too much, you can go 5 or 10 minutes. Then, you spit it out, rinse out your mouth, and then, brush your teeth.

I could see how it might dislodge dental plaque or something, and have oral health benefits, but what’s this about systemic effects? Not only is it supposedly “absolutely harmless,” but “it effectively treats the most varied diseases, in some cases enabling one to avoid [drugs and surgery].” There is one source cited by oil-pulling proponents that seems legit, published in the British Dental Journal, but it’s just a letter from some guy saying that the literature has reported that oil pulling can “effectively treat” things like “paralysis,…meningitis,…and chronic diseases like [oh] cancer, AIDS etc.” But, absolutely no references are given. So, this literature of which he speaks is presumably the fairy-tale literature. The bottom line is that there is simply no scientific proof. Okay, but what about the “oral health” claims?

If you look at the list of purported “benefits,” they go from blood clots to “stop[ping] the growth of malignant tumors.” And, you look at those citations purported to back such wild statements up, and you won’t be surprised at this point to see they have absolutely nothing to do with blood clots, cancer, or any of those other diseases, but instead are references to studies done on dental health. Okay, well, let’s not spit the baby out with the bathwater; let’s see what they say.

The studies started out: add oil pulling to some people’s regular oral hygiene regimens, and stand back and watch gingivitis get better, week after week, as the amount of plaque gets less and less. Conclusion: “Oil pulling [has] dental benefits.” This was with sunflower oil; same thing with coconut oil. Gingivitis; gum inflammation started to get better within a week, as the dental plaque goes down. Looks pretty good, right? So, same conclusion: “Oil pulling…could be an effective [addition to one’s oral hygiene habits].”

Okay, so what’s wrong with these studies? Right, “no control group.” But, why am I always going on and on about needing control groups? I mean, didn’t they each act as their own control? Look, we know where they were at baseline: week after week, bam, bam, bam, bam, down to less than half the plaque, half the gingivitis. What? Are we supposed to imagine it’s all just one big coincidence that they all just happened to start getting better right after they started the coconut oil? Come on!

Let me tell you about the Hawthorne effect. “Patients frequently appear to improve merely from the effects of being placed in a clinical trial.” Why? “[B]ecause patients may improve oral hygiene…as a result of the special attention [or] frequent examinations” they get. That’s the Hawthorne effect, and why it’s so important to do controlled trials.

Think about it. You know how you may brush really good the morning of your dentist appointment? Well, imagine knowing you’re going to be going back to the dentist for an exam every single week to see how your plaque and gingivitis is going? I mean, don’t you think you’d brush a little extra well, floss a few more times that month? And, that alone could get you these kinds of results. So, the only way to tell if the oil pulling had anything to do with it is to have a control group that didn’t do the oil pulling, but also knew they would be getting these weekly checkups. But, there was never any compilation of controlled studies—until now, which we’ll cover next.

In our next story, oil pulling is put to the test head-to-head against chlorhexidine mouthwash for oral and dental health.

What are the potential risks and benefits of the “ancient practice” of oil pulling, in which oil is swished or pulled between the teeth for like 15 minutes, and then spit out? There are wild, unsubstantiated claims online, and even in the medical literature. I can believe it’s “good exercise” for your tongue and cheek muscles, but “heal[ing]…all organs simultaneously”? That statement seems a bit of a tongue-in-cheek exercise right there!

Respondents in the British Medical Journal expressed surprise reading that swishing some oil around in the mouth could “effectively treat [diseases like] meningitis [and heart/kidney/hormone] disorders.” Oh, did I mention “cancer, AIDS, etc.”?

Look, it may help in some way, but for things to enter into evidence-based medicine, we actually need a little something called evidence, “without being distracted by illusory effects ascribed…by their advocates,” especially when another set of respondents shared their experience of a case of “severe inflammatory” gingivitis that worsened after oil pulling. She stopped, and it got better. They were thinking maybe some of the oil got like stuck under her gums. Regardless, maybe people should hold off until we actually have some evidence.

Thankfully, there’s a Centre for Evidence-Based Medicine at Oxford that recently compiled all the controlled trials. Why is it so important there’s a control group? Because maybe the reported declines in gingivitis and plaques with oil pulling are just because, in the study, they had dentists looking over their shoulders, with constant check-ups. So, maybe the study subjects just upped their brushing-and-flossing game.

When you test a new drug, it’s not enough to show it works better than nothing—better than a sugar pill. What you ideally want to know is does the new drug work better than the current best drug out there, for the same condition? Otherwise, what’s the point of a new therapy? That’s why drug companies are often forced to use so-called active controls; comparing their drug not just compared to nothing, a placebo, but head-to-head against the leading drug. How about oil pulling compared to chlorhexidine, an antiseptic chemical used in medicated mouthwash, which is considered to be “a gold standard” in the fight against plaque, cavities, and gingivitis?

So, here we go. Ladies and gentlemen—in one corner, we have oil pulling. In the other, chlorhexidine, measuring their ability to lower the number of cavity-producing bacteria on people’s teeth. And…chlorhexidine worked faster, a significant drop within just 24 hours, whereas, it took a week for the oil pulling to really start working. But, by two weeks, the oil pulling may end up just as efficacious as the gold standard. In fact, they appeared to work so similarly, skeptical me is critically thinking, “Wait a second, maybe it’s just the physical act of swishing that disrupts the plaque?” It would have been cool if they included a third group that just swished with water. And they did! And, swishing with water had…no effect.

Now, it wasn’t exactly fair; they had the oil-pulling group swishing for 10 minutes, whereas the other two groups only swished for one. So, for all we know, swishing with water for 10 minutes might be as good as the oil.

And, one could look at this and argue that chlorhexidine actually worked 10 times better, since it got the same effect swishing for one-tenth the time. But, chlorhexidine has side-effects—potentially serious side-effects—like painful desquamation, meaning peeling of the mucous membranes in your mouth, as well as discoloration of the teeth or tongue.

So, “oil…has certain benefits over commercially available mouth rinses.” It’s “non-chemical, non-alcoholic, low cost, and non-staining, yet the effectiveness…[is] unclear.” But wait, oil pulling has been shown to significantly drop the number of cavity-causing bacteria on the teeth.

Yeah, but does that translate out into actual fewer cavities? That’s what we really care about, but it hasn’t been studied. They did pair up oil pulling versus chlorhexidine against plaque and gingivitis, and did find they were both able to help to a similar degree. And, plaque-induced gingivitis is a reasonable predictor of future dental health, thereby explaining the Oxford Center’s conclusion that “oil pulling may [indeed] have beneficial effects on [oral and] dental health.”

Oil pulling may help with tooth sensitivity, but the risk of inducing lipoid pneumonia outweighs the benefits. Here’s the research. 

So far, we learned that oil pulling may be no more effective than swishing with water for plaque and gingivitis, doesn’t whiten your teeth, and may even make dental erosion worse.

What about oil pulling as a treatment for tooth sensitivity? About a quarter of people have sensitive teeth—like experiencing aching sensations when drinking ice water. So, researchers split people up into three groups: oil pulling vs. a desensitizing toothpaste vs. placebo (just rinsing with salt water), and then they blasted people’s teeth with cold air. The placebo didn’t help much; the before-and-after sensitivity scores were the same for nine out of the ten in the placebo group. But, the desensitizing toothpaste seemed to help in most of the patients, and so did the oil pulling. Okay, so, there is some benefit to oil pulling. If you have sensitive teeth, why not give it a try? Unless, of course, there’s some downside—some risks associated with oil pulling.

Typically, the only concerns you see expressed are for clogging your sink drain or something. But, the reason it’s warned against in young children is fear of “aspiration”—that you might accidentally choke on it, and some oil may go down the wrong pipe into your lungs. And, this could potentially happen at any age. But, is that just a theoretical concern? No, there are cases of “lipoid pneumonia [attributed to] oil pulling”—which is when you get an oily substance stuck down in your lungs.

First described in 1925, when it was customary to use like mentholated Vaseline in the nostrils of kids—until they died of pneumonia. And, on autopsy, areas of their lungs were clogged with oily fluid. Glad we don’t use mentholated Vaseline anymore. But we do—that’s what Vicks VapoRub® is. And, if you stick it in your nostrils, you can end up filling up part of your lung with it. That’s why you should never put Vaseline in your nose before bedtime; it “lique[fies] at body temperature,” and creeps down into your lungs as you sleep. And so, people “need to be aware.” I did my part by posting a video about it ages ago, but it’s not just Vaseline—anything oily or greasy can do it. You can give your kid pneumonia with “intranasal butter application”—evidently a folk remedy for a stuffy nose, which can end you up with a stuffy lung.

Same thing with olive oil. Less common causes include inhaling too much “vaporized” candle wax, because you “spen[d] most of [your] time in a shrine [surrounded by] burning candles.” Lipoid pneumonia isn’t nicknamed “fire-eater’s lung” for nothing, as performers place themselves at risk for aspirating that tiki torch oil in their act.

A thankfully really uncommon cause is self-injection with oil. Why would anyone do that? “[T]o increase the size of [their] genitals,” of course—until they accidentally hit a vein, and squirt oil into their bloodstream.

But, this is what concerns me more. Cases like this poor woman: four admissions to the hospital with pneumonia within just six months. During her fourth admission, her doctors “meticulously inquired about every possible cause of her recurrent pneumonia, and she revealed that she had [started] oil pulling 2 weeks [before] her first admission.” And then, when she was discharged from the hospital, she did it even more to try to “detoxify” from all the drugs they had given her, which led to three more hospital admissions. They told her to stop the oil pulling. And, no more pneumonia.

That’s one of the reasons the American Dental Association recommends against the practice. In fact, remember that tooth-whitening experiment? There’s a reason they used extracted teeth, instead of just having people do it. They didn’t think it would be ethical “to conduct a human trial” of oil pulling “with the knowledge that there was a chance of inducing lipoid pneumonia in study volunteers.”

To see any graphs, charts, graphics, images or studies mentioned here, please go to the Nutrition Facts podcast landing page.  There, you’ll find all the detailed information you need – plus links to all the sources we cite for each of these topics.

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Thanks for listening to Nutrition Facts. I’m Dr. Michael Greger.

This is just an approximation of the audio content, contributed by Allyson Burnett.