blood pressure – Dr. Danenberg

Alvin H. Danenberg, DDS • Nutritional Periodontist
June 5, 2017

New research is revolutionizing the way physicians and dentists will appreciate the beneficial role of healthy mouth bacteria. There is a relationship between killing good bacteria in the mouth and increasing the risk of elevated blood pressure. Medical and dental professions should help educate their patients to the dangers of killing good bacteria in the mouth.

Good Mouth Bacteria

I wrote an article in 2016 about the balance of bacteria in the mouth. In early 2017, I posted a blog titled, Want Healthy Gums? In this article I explained the importance about good mouth bacteria and a critical biological process where these bacteria help create necessary nitric oxide for the body. New medical research is proving there are harmful consequences to our blood pressure and heart health if these healthy mouth bacteria are destroyed indiscriminately.

“Nitrate to Nitrite to Nitric-Oxide” Pathway

Specific and naturally occurring anaerobic bacteria on the top surface of your tongue play a necessary role in overall health. These bacteria eventually initiate the development of a large percentage of nitric oxide throughout the body.

Here’s how it happens:

After you eat leafy greens that contain natural nitrates, your body absorbs these nitrates through your upper GI tract. About 25% of these nitrates are concentrated into your saliva. The normal anaerobic bacteria on your tongue change the nitrates in the saliva into nitrites. Then, you swallow the nitrites. Nitrites then move throughout your body and are further changed into nitric oxide (NO). Nitric oxide is critical for overall health.

Some of the functions of nitric oxide are to reduce blood pressure, reduce the risk of cardiovascular disease, improve athletic performance, and improve gum health.

Review of Blood Pressure Research

In 2017, Nathan S. Bryan and coauthors reviewed the current research describing the importance of oral bacteria on the nitrate/nitrite/nitric-oxide pathway. The authors concluded,

With the loss of NO signaling and homeostasis being one of the earliest events in the onset and progression of cardiovascular disease, targeting microbial communities early in the process may lead to better preventative interventions in cardiovascular medicine.

The authors further stated at the end of their article:

Disruption of nitrite and NO production in the oral cavity may contribute to the oral-systemic link between oral hygiene and cardiovascular risk and disease.
It may be time to discourage the use of antiseptic mouthwash.
Therapeutically, then, perhaps an effective strategy to promote NO production and overcome conditions of NO insufficiency may “be targeted to” specific oral nitrate-reducing bacterial communities and increasing the consumption of nitrite and nitrate enriched foods and vegetables.
Because NO signaling affects all organ systems and almost all disease processes described to date, this novel approach to NO regulation has the potential to affect the study and treatment of many diseases across all organ systems.

Take Away Points

Don’t use antimicrobial mouthwashes on a regular basis.
Eat organic leafy greens daily that are high in naturally occurring nitrates (examples: Arugula, Spinach, Butter Leaf and Oak Leaf Lettuces, Swish Chard, and Beet Greens).

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A visit to your dentist may mean different things to different people. But, it could save your life.

Many dental offices take your blood pressure at the beginning of each appointment, which I do for all my patients. This may be the first time an abnormal reading is spotted. A high reading may be nothing more than a reading within the normal fluctuation range. However, if you do have undiagnosed high blood pressure, then this could be a wake up call for you to see your medical doctor for further tests and treatment.

Also be aware of the white-coat syndrome of hypertension. This frequently is caused by the stress or fear associated with a doctor or hospital visit. Most of the time, this is a transient occurrence because the elevation is due to being nervous. Sometimes it requires further evaluation. This article goes into more detail.

Personally, I have white-coat syndrome. Every time I see my MD, my pressure is elevated. Usually by the end of the appointment, it has stabilized. However, when I take my blood pressure at home in a relaxed state, it averages 121/72. If you suffer from this nervous situation, then take your blood pressure at home at various times when you are rested. Average these readings to get a baseline for your resting systolic and diastolic pressures. Here is a link that shows 24-hour ambulatory blood pressure monitoring (ABPM) for normal blood pressure fluctuations, for white coat syndrome, and for other anomalies.

Statistically, deaths due to hypertension have increased by 62% from 2000 to 2013 based on data from the Centers for Disease Control and Prevention. It is estimated that 70 million US adults have been diagnosed with high blood pressure, but only 52% of those with this disease have their blood pressures under control. In addition, approximately 1/3 of US adults has pre-hypertension, which means blood pressure is elevated and is a risk of progressing to full-blown hypertension.

If you have true high blood pressure (hypertension), then it is a significant medical concern because it increases your risk of heart disease, heart failure and stroke. It also can contribute to kidney failure, by weakening and narrowing blood vessels in your kidneys, and to problems with cognition. Here is a table summarizing average resting blood pressures.

One risk of increasing the chance of developing high blood pressure is carrying excess body weight. When fat is concentrated around your abdomen, it represents a more serious risk even if you are not overweight. A diet that includes processed sugars and foods is the primary cause for visceral fat around your waist. Research has shown that your waist-to-hip ratio may be an effective measure for assessing high blood pressure risk. In 2008, the World Health Organization wrote a paper on the waist-to-hip ratio.

Here is a way to measure your waist and hip circumferences and to calculate your Waist-to-Hip Ratio.

Interesting research published in 2014 has demonstrated that dietary sugars influence blood pressure and serum lipids independent of the effects of sugars on body weight.

In another article published in 2014, the authors reviewed the literature and concluded that the high consumption of added sugars in the US diet may be more strongly and directly associated with high blood pressure than the consumption of sodium. The abstract stated:

“Evidence from epidemiological studies and experimental trials in animals and humans suggests that added sugars, particularly fructose, may increase blood pressure and blood pressure variability, increase heart rate and myocardial oxygen demand, and contribute to inflammation, insulin resistance and broader metabolic dysfunction.

Thus, while there is no argument that recommendations to reduce consumption of processed foods are highly appropriate and advisable, the arguments in this review are that the benefits of such recommendations might have less to do with sodium—minimally related to blood pressure and perhaps even inversely related to cardiovascular risk—and more to do with highly-refined carbohydrates.”

Increased blood pressure and increased waist-to-hip ratio are two of the five markers for metabolic syndrome. Metabolic syndrome has been shown to lead to type-2 diabetes and cardiovascular disease. In 2014, a randomized controlled study reported that a Paleo-type diet improved the markers of Metabolic Syndrome. And, here is an article I wrote that goes into more detail about Paleo-type diets.

Bottom Line: If your blood pressure is questionable, you need to see your MD. Also, if you have high blood pressure, you already may have (or may be on the way to developing) metabolic syndrome. A Paleo-type diet might improve your blood pressure values as well as your overall health.