Best Foods for Halitosis and Gingivitis

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Yeah, saturated fats produce an inflammatory response. Yeah, inflammation is “recognized as one of the key underlying [causal] factors in periodontal disease.” And so, that could explain why moderating people’s intake of meat and dairy could promote periodontal health. But plant-based diets don’t just offer lower levels of saturated fat, cholesterol, and animal protein, but also higher levels of complex carbohydrates, and dietary fiber, vitamins, minerals, antioxidants, phytochemicals. So, we don’t necessarily know what the mechanism is. Yes, saturated fat intake is associated with the progression of periodontal disease, but at the same time, dietary fiber intake may be protective. But you don’t know either way …until you put it to the test.

The effect of dietary intervention in a randomized, controlled trial. At seven months of age, more than a thousand infants were randomized, about half to a lower saturated fat and cholesterol intake to see if they get less heart disease when they grow up. They’re still just in their 20s, but as children and adolescents, those randomized to the healthier diets ended up with better saliva production. They had them chew on like wax cubes, and those randomized since infancy to the better diet produced more saliva. And “[s]aliva is essential for the maintenance of oral health;” for example, clearing out sugar and acid faster off the teeth. What they think happened is that “the greater increase of salivary flow was due to the greater intake of fibre-rich food”—whole grains, vegetables, fruit, and berries that require “more chewing which in turn is known to” boost saliva production. So, maybe their bodies were just used to putting out more? In other words, “in addition to general health benefits, dietary fibre may have benefits on oral health as well”—but not necessarily the fiber itself, but just the act of chewing itself.

That reminds of me of this study, in which a single high-fiber meal was able to reduce bad breath for hours. Bad breath is caused by these gaseous sulfur compounds produced by a certain type of bacteria that are concentrated on the back of your tongue.  And so, when we eat, the reason that bad breath gets better may be due to a kind of “’self-cleaning’ of the mouth while chewing food.” And so, it makes sense “that foods that need to be chewed more intensively have a stronger self-cleaning effect [on the back of your tongue] than foods that require less chewing.” But, you don’t know…until you put it to the test. Two very similar meals, but one had a whole grain roll, more fiber, more chewing, and a raw apple and jam, where the other was just white bread with jelly and cooked apples—less chewing. Then, they just measured the halitosis compounds in people’s breath at two hours after the meal, then eight hours. And, even after the low-fiber meal, bad breath levels dropped, but in the higher-fiber meal they dropped significantly more, and stayed way down even eight hours later.

So, the reason a high-fiber diet may improve periodontal disease may be from the fiber, the lower saturated fat intake, or just the chewing. But there’s another possibility. Maybe it’s the nitrate-containing vegetables. We know “the ingestion of dietary nitrate [in the form of greens and beets] has been proven to exert many beneficial and clinically relevant effects on general health,” including maintaining good blood flow and reducing inflammation in general. So, hey, might improved circulation to the gums and anti-inflammatory effects benefit periodontal patients? Let’s find out: a randomized, double-blinded, placebo-controlled clinical trial of repeated consumption of…lettuce juice? Why lettuce juice? That sounds so disgusting. Not to worry, though, “to improve patient acceptance,” the lettuce juice was seasoned by a “chamomile-honey flavour” and sweetened with Splenda. That just sounds worse!

But it worked. “This clinical intervention trial demonstrated an attenuating effect of dietary nitrate on gingival inflammation. Check it out. In the placebo group, most of their teeth had no gingivitis, about 60 percent. But 40 percent did have mild gingivitis with almost no moderate gingivitis. And after drinking two weeks of placebo lettuce juice—I don’t know if that sounds better or worse—no real change, as you would expect. In the lettuce group, they started out a bit worse. About half their teeth had mild or moderate gum disease. But then, after two weeks of actual lettuce juice, significant improvements. No more moderate disease, the mild disease rates were cut in half, and three-quarters of their teeth had no gingivitis at all.

“In conclusion, our findings suggest that the ingestion of [greens and beets] may be a clinically useful adjunct in the control of chronic gingivitis,” and all sorts of chronic disease. What’s good for the mouth—not smoking, a healthier diet—is good for the rest of our body. So, many dental professionals, who may see people more frequently than their doctors, should be counseling patients on living more healthfully. And, indeed, nearly all dental hygienists surveyed said they thought they have a role in helping patients improve their diets, yet that’s not what happens at all. Ask the patients. and less than one in ten said they got dietary advice from their dental professionals. Why? Because “although dentists were motivated to include nutrition in their clinical care, most felt unqualified to provide dietary guidance.” That never stopped doctors!

But, it’s true, nutrition is neglected in dental school, just like it is in medical school. And in most cases, all people got were like biochemistry of vitamins—the Krebs cycle all over again, as opposed to applied, clinical nutrition. I mean, it’s really not rocket science. Or is it? Get it? “[W]hy dietary nitrate is hard to ‘beet’.”

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• Iwasaki M, Manz MC, Moynihan P, et al. Relationship between saturated fatty acids and periodontal disease. J Dent Res. 2011;90(7):861-7.
• Kondo K, Ishikado A, Morino K, et al. A high-fiber, low-fat diet improves periodontal disease markers in high-risk subjects: a pilot study. Nutr Res. 2014;34(6):491-8.
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• Jockel-schneider Y, Goßner SK, Petersen N, et al. Stimulation of the nitrate-nitrite-NO-metabolism by repeated lettuce juice consumption decreases gingival inflammation in periodontal recall patients: a randomized, double-blinded, placebo-controlled clinical trial. J Clin Periodontol. 2016;43(7):603-8.
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Image credit: marilyn barbone via Adobe Stock Photos. Image has been modified.

Motion graphics by Avocado Video

• animal products
• animal protein
• antioxidants
• bad breath
• beets
• berries
• cardiovascular disease
• children
• cholesterol
• chronic diseases
• dairy
• dental health
• fat
• fiber
• fruit
• grains
• greens
• heart disease
• inflammation
• lettuce
• lifestyle medicine
• meat
• nitrates
• periodontal disease
• phytonutrients
• Plant-Based Diets
• saturated fat
• sugar
• vegans
• vegetables
• vegetarians
• vitamins