Sugar Causes More Than Rotten Teeth

Alvin H. Danenberg, DDS Nutritional Periodontist
July 24, 2017 [printfriendly]



Sugar causes more than rotten teethI have written about soda and sugar’s effects on the mouth. Sugar alone is the major cause of tooth decay. However, sugar causes more than rotten teeth. It is the major cause of metabolic syndrome, which is the precursor to many chronic diseases like diabetes, cardiovascular disease (CVD), and non-alcoholic fatty liver disease (NAFLD).


Metabolic syndrome, as a precursor to many diseases, is the name for a group of risk factors. To be diagnosed with metabolic syndrome, you must have at least three of these risk factors:

  • Large waistline
  • High triglyceride level
  • Low HDL-Cholesterol level
  • High blood pressure
  • High fasting blood sugar


Unique Research

Robert Lustig, MD, and his co-researchers wrote two interesting papers, which were published in 2016. They studied 43 children with obesity and metabolic syndrome. The study lasted 10 days. At the start of the study, researchers recorded the children’s specific parameters for metabolic syndrome while on their normal diet. Over the course of the remaining nine days, the children were given meals to eat, which had all added-sugars removed. Basically, the children ate the same calories including the same protein and fat percentages as their normal diet. However, starchy foods replaced all added-sugar foods . The diet even included unhealthy processed foods, which did not include added-sugars. If the participants’ weight declined during the trial, the researchers increased the amount of food to sustain their weight without adding any sugars. At the end of ten days, the researchers again recorded the measureable markers of metabolic syndrome.


The results demonstrated that every aspect of their metabolic health improved, with no change in weight since weight was controlled. Blood pressure, triglycerides (TG), low-density lipoprotein (LDL), insulin sensitivity and glucose tolerance all improved. All this happened in only nine days by removing added-sugars.


In a further analysis and later publication of this study, there was an improvement in lipoprotein profiles, which indicated a reduction of risk factors for cardiovascular disease. Specifically, there was a reduction in TG, apoB, apoC-II, apoC-III, apoE, and LDL-C. In addition, LDL size increased, small-sized HDL decreased, and the TG/HDL ratio lowered. Once again, these improvements occurred after removing all added-sugars for only nine days!


This study shows that sugar is a major causative factor for metabolic syndrome and cardiovascular risk. The authors stated that this was the first human research project in obese children exhibiting metabolic syndrome that demonstrated that health detriments of sugar, and fructose specifically, were independent of sugar’s caloric value or effects on weight. The takeaway is that all of us can improve our overall health by just removing added-sugars from what we eat.


My Patients

I am concerned with oral health and overall health. Many of my patients want to change their nutrition and lifestyle to improve their overall health and their dental health. For those patients, I first suggest they fill out a 3-Day Food Journal. Their Journal will show them and me the foods they are eating that may be harmful to their bodies. Then, I isolate the most offending foods and suggest substitutions that may be healthier. Processed grains, all added and concentrated sugars, and unhealthy fats and oils are the most offending foods. That’s how I start my education program for all who want to be proactive with their health.


Primal societies eating their traditional diets rarely have dental decay, gum disease, or other chronic diseases. Here is a chart that speaks a thousand words, showing prevalence of dental decay for primal societies who eat their traditional diets compared to those who eat modern diets.



If you don’t want to miss out on new posts, sign up for my email alert list here.

The Connection is Impressive

evolution rPeriodontitis and Metabolic Syndrome are manifestations of chronic inflammation. Could there be a causal relationship between the chronic inflammation of gum disease and the chronic inflammation of metabolic syndrome? The answer lies in the fact that practically all chronic diseases start with inflammation on the cellular level. If chronic inflammation could be brought under control, cells might have the potential to heal.
Periodontitis is an advanced stage of gum disease where the gums are infected and the bone surrounding the teeth is breaking down leading to loss of teeth and spread of infection. Metabolic syndrome is a cluster of disorders including high blood pressure, increased belly fat, high blood triglyceride, low blood HDL cholesterol, and increased blood sugar. These disorders lead to type-2 diabetes and cardiovascular disease.
Current research has shown that there is a definite association between metabolic syndrome and periodontitis (Here and Here). A review paper published in April 2015 discussed the relationships between autoimmunity and various chronic diseases, and a paper published in May 2014 described the role of autoimmune responses in periodontal disease.
Possibly reducing the markers for metabolic syndrome will also reduce the prevalence of periodontitis.

  • In a paper published in 2009, a Paleo-type diet reduced gingival inflammation, virulent bacteria around the gum tissues, and the depth of gum pockets.
  • In 2012, Ian Spreadbury described how acellular carbohydrates (processed grains and sugars) as well as remnants of harmful bacteria (lipopolysaccharides or LPS) could pass through the intestinal lining to create chronic inflammation.
  • In 2014, a Paleo-type diet was shown to improve the markers of metabolic syndrome.

Skeptics, and those who strictly adhere to the proof of randomized clinical trials, will argue that currently there is not sufficient long-term evidence to unequivocally verify a causal relationship between a Paleo-type diet and health. There is much research to be done and to be published in peer-reviewed journals before defined causation could be proven.
I don’t know how many years it will take for the scientific community to pronounce, “Now it is proven!” Personally, the current published research is enough to convince me. I believe a Paleo-type diet is part of the lifestyle to choose if you want to become and stay the healthiest your genetic code has designed for you. Embracing a Paleo lifestyle will not only help promote a healthy mouth but also assist in maintaining a healthy body. Heal one cell at a time, and your body will thank you. The backdrop for my conviction is the two-and-a-half million years of our species’ evolution.

Your Dentist Could Save Your Life

evolution rA 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.

Science Gives Green Light to Low Carb

evolution rDiabetes is a huge problem in the US. The 2014 National Diabetes Statistics Report identified that this disease affects 29.1 million people in the US (9.3% of the population), and it is estimated that 86 million adults have prediabetes (1 out of every 3 adults). In contrast, today’s hunter-gatherer societies dispersed worldwide rarely experience degenerative diseases like type 2 diabetes.
Type 2 diabetes just doesn’t happen overnight. First, there are years of nutritional incongruities. Then there are years of progressive clinical manifestations of metabolic syndrome. Eventually, there is a diagnosis of type 2 diabetes and later possibly a diagnosis of cardiovascular disease.
The manifestations of metabolic syndrome, which are frequently precursors to type 2 diabetes, include:

  • High blood pressure
  • Increased triglycerides
  • Decreased HDL cholesterol
  • Increased visceral fat around the waist
  • Increased fasting blood glucose

Richard Feinman and 25 additional authors wrote a critical review citing evidence of the benefits of a low-carbohydrate diet on Type 2 diabetes and various metabolic syndrome markers. It was published in Nutrition on January 31, 2015. In this article, the authors summarized 12 points of evidence that strongly support the health benefits of a low carbohydrate diet.
The article points out that a low carbohydrate diet would consist of less than 130 grams of carbohydrates per day, which should translate to less than 26% of the total energy (calories) consumed in a day. In 2000, the average daily consumption of carbohydrates was 330 grams for men and 230 grams for women.
A primal or Paleo diet is a lifestyle of eating nutrient-dense foods. It could be a low-carbohydrate diet if fruits, nuts, and starchy vegetables were consumed in limited quantities.
Here is my summary of the article’s pertinent points that translates to an overall healthier body:

  • Reducing dietary carbohydrates is the best way to decrease blood glucose levels.
  • There has never been any other dietary intervention for weight loss that has been superior to reducing dietary carbohydrates.
  • Replacing carbohydrates with protein in a meal is generally helpful with the exception of those people with existing kidney disease.
  • Healthy fats that are consumed from food do not increase the risk of cardiovascular disease.
  • Plasma saturated fatty acids, which contribute to cardiovascular disease and insulin resistance, are increased with consumption of carbohydrates. Healthy fats in food consumed by humans do not contribute to unhealthy levels of saturated fatty acids in their plasma.
  • Reducing dietary carbohydrates will reduce serum levels of triglycerides, increase healthy levels of HDL cholesterol, and improve all factors of metabolic syndrome.
  • There have never been human studies that have shown that lowering carbohydrates will have significant negative side effects.

A lifestyle that incorporates a low-carb eating plan is not just for type 2 diabetics. It is a healthy plan for the entire family, for the entire body, and for the entire mouth. I encourage you to read this review paper where you also will find all the references for the various studies to support the authors’ statements.

The Connection:
This Is Huge

evolution rA newly published, peer-reviewed paper about the Paleo diet is very encouraging. Follow my thoughts on this as I make a case leading up to a discussion of this study:
Acellular carbohydrates, processed foods, and unhealthy fats damage the gut bacteria and cause intestinal permeability (or leaky gut). Then, proteins that should never enter the bloodstream begin invading. These invading proteins and bacteria set up chronic inflammation and immune responses. As a result, various characteristics of metabolic syndrome develop (such as increase in body weight, increase in waist circumference, increase in blood pressure, unhealthy levels of serum lipids, increase in fasting blood sugar).
Metabolic syndrome has been shown to create a high risk of progression to type-2 diabetes and cardiovascular disease.
Consider this: If the biological markers of metabolic syndrome could be reduced and brought back to healthy values, then other chronic diseases of the body might be able to heal or be prevented such as obesity, type-2 diabetes, cardiovascular disease, and insulin resistance.
Also, consider this: If a leaky gut could be healed by eliminating the “foods” that initiated intestinal permeability (like acellular carbohydrates, processed foods, and unhealthy fats), then other autoimmune diseases and chronic diseases also might be prevented or healed.
A recently published human study has identified that Paleo-type diets reduce the characteristics of metabolic syndrome.
The Paleo or Primal Diet is devoid of acellular carbohydrates, processed foods, and unhealthy fats and is loaded with the nutrients that each of our cells need to survive and thrive. Therefore, the Paleo Diet is conducive to preventing or healing many chronic diseases. This includes gum disease and tooth decay.
In October 2014, Inge Boers, et al, published the study I referenced above. These researchers evaluated 34 individuals who already were diagnosed with metabolic syndrome. Half of the group ate a Paleo-type diet and the other half ate a Dutch Healthy Diet (similar to the Mediterranean diet). The study lasted two weeks, and it controlled for changes in weight. The individuals in the study were eating foods that were prepared for them and delivered to them to make sure they ate exactly what they were supposed to eat. The group that ate the Paleo-type diet had improved most of their markers for metabolic syndrome while those on the Healthy Diet did not. Some of those in the Paleo diet group, who were previously diagnosed with metabolic syndrome, no longer had metabolic syndrome at the end of the study. And, all this happened in only two weeks.
This is huge!