Xylitol: In the dock and in the surgery
In the Dock
Dental caries can be defined as a carbohydrate modified transmissible local infection with saliva as a critical regulator1 and is a disease with a high prevalence in the European Union (EU) 2. In November 2008 the European Food Safety Authority (EFSA) formed a scientific panel to substantiate a claim made by a sugar free confectionary company who presented evidence that xylitol chewing gum and pastilles can lead to the reduction in the risk of tooth decay in the general population pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA is the organization that collaborates closely with national authorities and is tasked with providing independent scientific advice and clear communication on existing and emerging risks in food products and safety 2.
Article 14 of Regulation (EC) No 1924/2006 establishes the rules which govern health claims made by individuals or companies. Health claims are prohibited unless they comply with the general and specific requirements of this regulation. Article 14 is part of the regulation that lays down the provisions for the authorization and subsequent inclusion of reduction of disease risk claims. The Panel on Dietetic products, Nutrition and Allergies evaluated the evidence provided comprising over 31 publications including human intervention and observational studies, systemic reviews and other publications. The evaluation considered the effects of chewing gum sweetened with 100% xylitol and pastilles sweetened with at least 56% xylitol as compared to non-treatment 2.
Results of the Evaluation
The panel concluded that despite some studies demonstrating evidence limitations i.e. not being fully randomized for practical reasons that the higher number of studies, subjects and observation years presented, the consistency of the results and the magnitude of the effect that the cause and effect relationship established between the consumption of 100% xylitol chewing gum lead to the reduction of the risk of tooth decay in children. The basis of this evidence is related to the consumption of 2-3grams of chewing gum sweetened with 100% xylitol at least 3 times for 5 minutes a day after meals. They also recommended that children under the age of 3years avoid chewing gum due to choking hazards.
However, the panel could not sanction the claim regarding the sweetened pastilles as the cause and effect relationship could not be clearly established conclusively from the evidence provided 2.
What is Xylitol?
Xylitol is not an artificial sweetener but a sweet crystalline carbohydrate that occurs naturally in virtually all vegetables and fruits. It is produced commercially from birch bark, corn husks and stone fruit. The average adult consumes several hundred milligrams of xylitol from fruit and vegetables daily and the body makes between 5 and 10 grams of xylitol every day in addition. Xylitol is significantly different to sorbitol, another well-known polyol, in its chemical make-up. Sugar alcohols like sorbitol have a 6 carbon structure whereas xylitol has 5 carbon atoms. This makes it unique and useful in treating a number of health related conditions including dental caries 3.
The History of Xylitol – Sweet Surrender.
Xylitol has been known to science for over a century after being discovered
by Fischer and Stahel in Germany and Bertram in France prior to the outbreak of the Great War. During the Second World War sugar shortages compelled some countries to produce alternative sweeteners with the Finnish developing a limited xylitol production facility. After the war when shortages diminished xylitol production ceased until its resurrection in the 1960’s and 70’s when scientists started to apply it to dental products. The first xylitol gum was launched in Finland and The United Sates in 1975 3.
Important Related Research
The Turku Sugar Studies (1972-5) undertaken at the University of Turku Dental School in Finland involved 125 volunteer adults who substituted the Sucrose in their diets with Xylitol. Special non sucrose based xylitol sweetened foods were manufactured for the study period of 2 years. The second test group consumed fructose sweetened food using the same protocol and the third group acted as a control with the Sucrose containing diet. During the study period the Xylitol group developed almost no new caries lesions, while more than 7 developed with the sucrose group and 4 among the Fructose group 3, 4.
The Belize Trials in Central America (1989-97), one of several submitted to the EFSA, demonstrated the benefits of xylitol over the other more the extensively used polyol, sorbitol, as a caries preventive agent. One of the trials compared groups of subjects who chewed xylitol sweetened, sorbitol sweetened and a mixed xylitol-sorbitol gum with a “no gum” control group as well as a group who chewed sucrose sweetened gum during a period of 40 months(ethically, this was questioned by some because children were subjected to an unhealthy product during this trial). The results demonstrated the 100% xylitol sweetened gum was the most effective followed by the xylitol-Sorbitol mixture. The trial determined the superiority of xylitol as compared to sorbitol. Children chewing xylitol gum developed 73 percent less tooth decay than those chewing the sorbitol 2, 3, 5.
The Mother-Child Studies (2000-2001) undertaken in Finland demonstrated that the mother or care givers use of xylitol prevented dental caries in their children. The 195 mothers were all determined to have high S. Mutans levels at the start of the study were treated with either Chlorhexidine varnish, fluoride varnish or 100% xylitol gum chewed 2 or 3 times a day for 18 to 21 months. The children of mothers treated with xylitol had the lowest levels of S. Mutans during the intervention period and follow up compared to the children whose mothers received fluoride and Chlorhexidine varnish treatments. Additionally, the children received no preventive treatment and where examined annually for caries until the age of 5. The caries rate for children aged 5 was 70% lower in the xylitol group than the other two 6. A second significant finding was that children whose mothers consumed xylitol had fewer caries incidents over a three year period compared to those who used non xylitol measures. This lead to the conclusion that the mothers and caregivers long term use of xylitol during tooth eruption successfully delays and reduces the transmission of harmful bacteria by reducing the bacteria in their mothers and caregivers mouths 7, 8.
In the Surgery
The benefits of Xylitol
The evidence for xylitol health benefits is very compelling and difficult to dismiss. It cannot be metabolized by disease causing bacteria, it reduces the accumulation of plaque on non-shedding (tooth) surfaces, it enhances remineralisation when chewed in gum by not decreasing the pH and it inhibits the growth of s.mutans in the mouth with suggestions of a permanent reduction in s.mutans levels. Chewing gum also stimulates the flow of saliva, enhancing the beneficial buffering effect in plaque. It also has two thirds the calorific value of sucrose and has a sweetness ratio similar to ordinary commercial sugar and a low glycaemic index (GI) 3.The body absorbs carbohydrates differently thus raising blood sugars at varying rates. GI is a scientific index that ranks the effects of various carbohydrates on blood sugar levels from a value of 100 and determines the rate at which 50 grams of sugar raises these levels in 2 hours, the higher the number the faster the blood sugars are raised. Xylitol has a value of 7, sucrose is 68.
Promotion of xylitol
Xylitol is still relatively difficult to source commercially in a 100% form. However, new chewing gum ranges are becoming more accessible from the internet and smaller dental and health product companies. Granulated xylitol is also available in some super markets, online and from the dental trade industry. With time and increased demand it is anticipated that more choice and better availability will result in an enhanced interest from the dental profession and public, cheaper products and better awareness of the benefits thus leading to greater improvements in dental and general health.
The author, as part of a smile campaign at a dental practice, recently demonstrated the dental and health benefits to the public with a xylitol taste challenge. 24 muffins were made at home using the same recipe and were either xylitol or sucrose based being cooked under the same conditions and recipe. The participants who attended the practice open day or were approached on the high street and in local shops were asked to determine the difference between the two in terms of taste, texture and look. They were also challenged about their knowledge of xylitol, its dental and general health benefits. Bespoke handouts were produced and much debate followed. The results demonstrated that nearly all participants couldn’t tell the difference and knew nothing of xylitol and its benefits before being challenged. The participants also felt both looked similar and more considered the texture of the xylitol muffin better.
Xylitol is currently being used by the author and other dental professionals in caries, fresh breath, dry mouth and remineralisation management protocols
Oral health has been described as being “central to our general well-being” and with the rapid changes in the field of oral health there is a “great deal to learn”10. Tickle and Milson in 2008 declared a “need to take prevention serious” and not see it a just “something to which we pay lip service”11. Indeed, In 2005 Cockcroft stated that “Oral health should be considered part of general health, addressed through evidence based interventions focusing on the underlying factors that put people at risk of disease” 12.
Xylitol has now demonstrated its health benefits internationally. Will we now promote its dental and general health benefits within our clinical environments, local and national dental health promotion strategies to the benefit of our patients and population? As xylitol becomes more accessible within the market place will the dental profession embrace this safe and EFSA endorsed natural product that has demonstrated its efficacy beyond doubt as being able to help reduce the risk of caries, one of greatest chronic diseases in the country and in other dental and health related fields?
1. Role of microorganisms in caries aetiology, van Houte, J Dent Res, 73: 672-81, 1994.
2. Xylitol chewing gum/pastilles and reduction of the risk of tooth decay, EFSA Scientific Opinion, The EFSA Journal 852, 1-15, 2008.
3. Xylitol, an amazing discovery for health, Makinen et al, Woodland Publishing, P 9, 2007.
4. The use of sorbitol – and xylitol – sweetened chewing gum in caries control, Burt. B, JADA, Vol. 137, Feb 2006.
5. The rocky road of xylitol to its clinical application, Makinen K, Journal of Dental Research 79 (6): 1352-1355, 2000.
6. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age, Isokangas, P, et al, Journal of Dental Research 79(11): 1885-1889, 2000.
7. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6 year follow up, Isokangas, P, et al, Caries Res 35:173-7, 2001.
8. Natural and healthy sweeteners, Allen D, Woodland Publishing 9-11, 2009.
9. Influence of xylitol consumption on mutans streptococci by infants, Isokangas, P, et al, J Dent Res 79(3):882-7, 2000.
10. Basic guide to oral health education and promotion, Felton, A et al, Wiley-Blackwell, Preface, 2009.
11. The whole population approach to caries prevention in general dental practice, Tickle, M & Milson, K. BDJ, Vol 205, No. 10 Nov 2008.
12. Choosing better oral health, Department of health Publications, 2005. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4123251>
LEAF International http://www.xylitol.com/eng/index.php?page=7f310aef768c9579689ee8a2c38ce1f
The University of Turku, Finland. http://www.utu.fi/en/research/areas/xylitol_tooth_friendly_sugar.html
The European Food Safety Authority. http://www.efsa.europa.eu/cs/BlobServer/Scientific_Opinion/nda_op_ej852_art14_0158_xylitol_tooth_decay_en.pdf?ssbinary=true
Fluid Food for Thought – Health Benefits of Red Wine, Beer, Green Tea, and Extra Virgin Olive Oil and Recommended Dosages. A Whole Dental Health Reflective Perspective.
While on our 2019 learning odyssey in France, we had the privilege to eat whole, real food from local markets and restaurants. It was a contrast to see how the French approached nutrition regionally, from Provence to the Dordogne, the Loire northward to Champagne. One theme ran through the whole adventure, a variety for food staples, solid and liquid, that cropped up time and time again, that of tradition and nature. These products are also grown, produced, and imported into New Zealand. I’m particularly interested in red wine, extra virgin olive oil, green tea, and beer. These featured in my journey then and continue to do so to varying degrees today. It would be of interest to travel through the literature, focusing on their health benefits and recommended intakes to achieve health benefits.
If we sip the wine, we find dreams coming upon us out of the imminent night. D. H. Lawrence
I have a penchant for red wine, in particular, Pinot Noir orientated red Burgundy. I have tried others with a varying degree of favour, perhaps Syrah and Merlot come close as runner-ups. I’ve been intrigued as to what benefits a glass of red wine might afford, as there seems so much negative health labelling, true or false, about their use, overuse or abuse. Associated with this is the controversy of the French Paradox, where the French statistically demonstrate improved health and longevity despite regular consumption of wine with the additional and confounding debate regarding saturated fat. My curiosity is not to justify my own behaviour but to know what, if the literature indicates, are the benefits and the safe and most beneficial amounts to consume would be. Would it change my behaviour and attitude if new knowledge was revealed?
Moderate wine consumption, in particular red, is a characteristic of the Mediterranean Diet, has been studied intensively for the health benefits it affords to those who have been brought up in its midst traditionally or they that modify their diet and lifestyle towards it. Red wine is composed of mainly water, carbohydrates, organic acids, minerals, alcohol, polyphenols, and aromatics. Specific substances within wine have been found to have significant positive effects on modern non-chronic communicable diseases. There are particular interests in its antioxidant effects for;
Bioactive polyphenolic compounds appear to be the predominant player, in particular resveratrol, anthocyanins, catechins, and tannins. Additional research indicates improvements in cognitive decline, depression, metabolic syndrome, osteoporosis, and gut bacteria.
Antioxidants, such as these, are found in abundance in red and purple berry fruits, the amount dependent on the variety, geographical location, time of harvest, maturity, and health of their growth. The richest red wine grapes are Pinot Noir and St. Laurent red wines. Resveratrol is a sirtuin activator, importantly benefitting and regulating nitric oxide, blood pressure, oxidative stress, and reactive oxygen species. Other antioxidants found in red wine are Flavonoids, rhamnetin, and malvidin, abundant in grape extract which elicits cardio protection.
Moderate red wine consumption appears to positively impact human health compared to abstainers. Beneficial amounts vary between 5 to 15 grams a day being associated with a 26 per cent lower risk of cardiovascular disease (CVD). There is also a 35 per cent risk reduction in total mortality, and a 51 per cent less risk of CVD mortality, assuming intake was mostly red wine. Healthy intake is cause for much debate still. Sinkiewicz et al. indicate that drinking three glasses of red wine every day had the lowest risk of cardiac events and mortality, also decreasing high blood pressure and myocardial infarction in men over the age of 65 significantly. Vilahor and Badimon looked at the Mediterranean Diet and red wine in association with cardio-protectivity suggesting daily red wine consumption of 0.15 litres for women and 0.45 litres for men, aiding reduction in inflammation, lipid metabolism, antioxidation, and endothelial function.
“Wine is sunlight, held together by water”. Galileo Galilei
An interesting point for consideration is that is highly likely that red wine alone doesn’t solely contribute to health improvements, many confounding factors need to be considered, in particular with dietary and other lifestyle behaviours that positively and negatively contribute to health. It would be prudent to associate other beneficial foodstuffs like extra virgin olive oil to improved health outcomes. I had the opportunity to taste many gold medal samples in Lambesc, Provence, and was so impressed with the light, flavoursome taste and texture. Despite their price, I bought three sample bottles and stewarded them carefully back to New Zealand.
Olives also possess bioactive polyphenolic compounds of various chemical structures, sourced from fruit, vegetables, nuts and seeds, roots, bark, leaves of different plants, herbs, whole grains, dark chocolate ( processed/fermented foods), as well as tea, and coffee. The health-promoting properties in olive oil, are antioxidant, anti-inflammatory, anti-allergenic, anti-atherogenic, anti-thrombotic, and anti-mutagenic properties. They are natural, synthetic, semi-synthetic organic compounds with over 8000 different polyphenolic structures known, several hundred isolated from edible plants. Unlike vitamins and minerals, polyphenols are not essential elements of primary plant metabolism but are the products of secondary plant metabolism that play critical metabolic roles in the human organism. The polyphenols of olive oil, however, are especially interesting for their well-established beneficial effects on human health and metabolism. The oils are obtained through mechanical and chemical extraction and then are purified for additional refinement. Extra virgin olive oil (EVOO) is a more expensive, low yielding form, having a delicate flavour, aroma, and light colour, with a higher polyphenolic structure. It consists mainly of the fatty acid triacylglycerols (98-99 per cent) with monounsaturated oleic acid making up to 83 per cent of weight to weight. Other components include palmitic, linoleic, stearic, and palmitoleic acids.
“The olive tree is surely the richest gift of heaven, I can scarcely expect bread”. Thomas Jefferson
Consumption of EVOO rich in phenolic acid compounds has been linked to the promotion of antioxidant and anti-inflammatory responses. A minimal dose of 5mg/kg/day, the equivalent of 23gms of EVOO, has been claimed to be protective by the European Food Safety Authority (EFSA), protecting against lipid oxidation. Polyphenolic compounds bind to low-density lipoproteins (LDL) and protect them against oxidation, higher levels of which are considered a strong predictor of CVD, widely associated with metabolic disease, obesity, type 2 diabetes, and metabolic syndrome. Schwingshackl & Hoffman also report from systematic and meta-analysis of cohort studies an overall risk reduction of all-cause mortality of 11 per cent, cardiovascular mortality 12 per cent, cardiovascular events 9 per cent, and stroke 77 per cent.
Linked to the Mediterranean Diet, the importance of olive oil consumption impacts blood glucose, triglycerides, increases in high-density lipoproteins (HDL), and the amelioration of the antioxidant and inflammatory status of subjects, with decreases in C-reactive protein (CRP), as well as risk reduction of metabolic syndrome and lower levels of inflammatory markers related to atherosclerosis.
I have always been a big fan of tea, being English it was part of my introduction to hot beverages as a child, slowing sipping it, and when too hot carefully blowing on it to cool it down. Until recently, I haven’t been as keen, a significant health event has changed how my body reacts to milk, its caffeine sending me on an unpleasant high and a rapid journey to the toilet. Coffee does me a similar disservice. A gentle evolutionary journey into green tea, in particular high-grade Jasmine, has however grown on me, be it hot, tepid, or plain cold it is now welcomed. My body also seems to tolerate it more too.
Green tea is made from the leaf of the plant Camellia sinensis. It is a species of evergreen shrubs or small trees in the flowering plant family Theaceae whose leaves and leaf buds are used to produce the tea. The chemical composition of green tea is a complex of proteins, amino acids, carbohydrates like glucose, fructose, and sucrose with trace elements of calcium, selenium, fluorine, aluminium, and lipids, vitamins, B, C and E with additional sterols, caffeine, and pigmentation. Green tea contains polyphenols, flavanols, flavonoids, and phenolic acids. Beneficial effects come reportedly from 3 cups a day, that being 8 ounces a cup.
“A woman is a teabag – you can’t tell how strong she is until you put her in hot water”. Eleanor Roosevelt
It is said to possess anti-cancer, anti-obesity, anti-atherosclerotic, anti-diabetic, anti-bacterial, and anti-viral effects. These are related to the activity of epigallocatechin gallate, a major component of green tea catechins. Its natural caffeine stimulates wakefulness, decreases fatigue, and has diuretic effects. Theanine and y-aminobutyric acid act to lower blood pressure and regulate brain and nerve function. Ongoing research is looking into hepatoprotective and anti-diabetic effects and anti-metastatic and anti-cancer, anti-obesity, and anti-atherosclerotic effects.
Epidemiological evidence demonstrates that populations with a high intake of green tea catechin benefit from regulated and reduced body weight and fat, glucose homeostasis, and cardiovascular health. Human intervention studies have demonstrated improved glucose homeostasis gained from green tea catechins. In particular, in-vitro and in vivo research indicates better endothelial function and increased antioxidant activities and improved pressure control.
Beer is a “tasty beverage”, as a famous Hollywood meme would purport. I have a fondness for hazy beer, but in comparison to red wine, olive oil, and green tea, the evidence might suggest it to be the poorer cousin in terms of health benefits. The cliched image of the average beer drinker being overweight, and relatively unhealthy is one that needs to be challenged. I will try and advocate for a reappraisal of that perception.
Beer may bring some nutritional and medical health advantages. These include protein, B vitamins, and minerals like selenium and high potassium with low sodium, fibre and have antioxidants values equivalent to that of wine but categorically different in variety. Its antioxidant capacity is also related to its polyphenolic components with the benefit of blocking free radicals, decreasing significantly cholesterol and triglycerides in lager specifically, as well as improved lipid metabolism and increased antioxidant and anticoagulant activity. Further research suggests beer has the potential to aid stress alleviation with the additional effect of the hop derived bittering agent providing sedative and hypnotic benefits.
“Beer, if drunk in moderation, softens the temper, cheers the spirit and promotes health”. Thomas Jefferson
Further research by a panel of international experts showed in a sizeable evidence-based review the effects of moderate beer consumption of beer on human health. It indicated non-bingeing behaviour reduces the risk of CVD, that being 1 drink per women and 2 drinks per men, per day, similar to that of wine at comparable alcohols levels. Some observational studies have also demonstrated low to moderate consumption associated with a reduced risk of neurodegenerative diseases. In general, the research alludes to the benefits to human health coming from light to normal use, originating from antioxidant, mineral, vitamin, and fibre components of beer, specifically in low or non-alcohol form.
The benefits of red wine, olive oil, green tea, and beer seem significantly associated with their effect regarding anti-oxidative and anti-inflammatory activities metabolically. Admittedly just looking purely at the health benefits and recommended intake is simplistic. It doesn’t take into consideration the adverse health outcomes of alcohol overconsumption. However, I do feel it was an appropriate approach to get a comparative snapshot of them all as beneficial fluid ingredients related to health. I would have considered both olive oil and green tea as a given but have learned more about the benefits that red wine and beer afford. It has also made me think about the relative health benefits of them all and amounts required for a health impact. I will continue to enjoy them all to varying degrees, and when in the mood, but am also more aware that they are a small part of a greater whole, in the improvement of our long term systemic and metabolic health.
Contribution of red wine consumption to human health protection. Snopek et at 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099584/
Alcohol, coronary heart disease and stroke: an examination of the J-shaped curve. Wannamethee & Shaper, 1998. https://www.ncbi.nlm.nih.gov/pubmed/9778595
Network meta-analysis of metabolic effects of olive-oil in humans shows the importance of olive oil consumption with moderate polyphenol levels as part of the Mediterranean Diet. Evangelia Tsartsou et al., 2019. https://www.frontiersin.org/articles/10.3389/fnut.2019.00006/full
Potential Health Benefits of Olive Oil and Plant Polyphenols. Monika Gorzynik-Debicka, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877547/
The safety of green tea and green tea extract consumption in adults – Results of a systematic review. Hu et al., 2018. https://www.sciencedirect.com/science/article/pii/S0273230018300928
The Potential Role of Green Tea Catechins in the Prevention of the Metabolic Syndrome – A Review. Thielecke & Boschmann, 2009. https://pubmed.ncbi.nlm.nih.gov/19147161/
Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in the prevention of stroke, age-related cognitive decline, and Alzheimer disease. Roman et al., 2019. https://www.ncbi.nlm.nih.gov/pubmed/31521398
Effects of moderate beer consumption on health and disease: A consensus document. De Gaetano, 2016. https://www.ncbi.nlm.nih.gov/pubmed/27118108
Wine: An Aspiring Agent in Promoting Longevity and Preventing Chronic Diseases. Pavlidou et al., 2018. https://www.ncbi.nlm.nih.gov/pubmed/30096779
Mediterranean Way of Drinking and Longevity. Giacosa et al., 2016. https://www.tandfonline.com/doi/abs/10.1080/10408398.2012.747484?src=recsys&journalCode=bfsn20
Potential Health Benefits of Olive Oil and Plant Polyphenols. Gorzynik-Debicka et al., 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877547/
Extra Virgin Olive Oil: Lesson from Nutrigenomics. De Santis et al., 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770023/
Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies. Schwingshackl & Hoffman, 2014. https://www.ncbi.nlm.nih.gov/pubmed/25274026
Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. Guasch-Ferre et al., 2014. https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-12-78
Health-promoting effects of green tea. Suzuki et al., 2012. https://www.ncbi.nlm.nih.gov/pubmed/22450537
Beneficial effects of green tea: A literature review. Chacko et al., 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855614/
Health-Related Aspects of Beer: A Review. Sohrabvandi et al., 2009. https://www.tandfonline.com/doi/full/10.1080/10942912.2010.487627
The Fluid Aspect of the Mediterranean Diet in the Prevention and Management of Cardiovascular Disease and Diabetes: The Role of Polyphenol Content in Moderate Consumption of Wine and Olive Oil. Ditano-Vazquez et al., 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893438/
Honey, Propolis, Fungi and Mushrooms, Uncommon Allies in Dental Healthcare and Humanity? A Reflective Personal and Professional Journey
I can remember the moment that I discovered the beautiful truth of mushrooms. Upon a mound of grassed earth, about 5 metres square was a huge ancient oak tree, perched next to a minor road that led from the railway station to the leafy suburbs of the wealthy, and well-healed. This was a relatively innocent spot when every late-Spring to mid-Autumn when the environmental conditions lend themselves, the fruiting bodies of the Boletus Edulis mushroom appeared. This they do with grateful regularity, along with other less gastronomic varieties, being ignored by all and sundry, ignorant of the identity these fungi fruiting bodies, and the free gift from nature herself. Dear friends of ours, David and Rachel, had the same epiphany, but of the honey bee kind. They have found common purpose, collaboration, well-being, and began to care bees and their production of honey. They had both found peace and greater common interest, teaching and motivating others to the cause. Bees, however, are in crisis and for many reasons.
“Bees do have a smell, you know, and if they don’t they should, for their feet are dusted with spices from a million flowers”. Ray Bradbury
The Woodland Trust, a tree planting, and ancient woodland protecting UK organisation, is acutely aware of the necessity of the bee. They state “bees have been around for millions of years, pollinating our plants and producing the sweet, golden syrup we call honey.” The trees and woods are essential to filter our air, but bees are vital for pollinating about a third of our food and 80 per cent of the trees and flowers of our wildlife habitat.
New Zealand has 28 native species of bees and 13 introduced species. As the native bees don’t make non-native honey species do the job in their absence collecting pollen from 224 native plant species. Despite this obvious benefit, the native bees are under threat by the honey-producing bees as they take their food sources, possibly threatening indigenous biodiversity.
However, bees are globally declining in numbers due to many threats, and saving them goes hand in hand with protecting the trees and ancient woodlands. Habitat loss, caused by urban development, intensive farming methods alongside pesticides are the greatest threats to them. Climate changes, altering seasonal timings affect the flowering calendar, and extremes of weather contribute too, disrupted bee nesting behaviour. Parasites and diseases are another significant threat, the Varroa mite clings to the back of the honey bee, passing diseases and viruses to it, thus draining its strength. These and other invasive species cause havoc to native species.
The recently released documentary film Fantastic Fungi, a “time-lapse journey into the mysterious and magical world”, details the power of fungi to heal, sustain and contribute to the regeneration of life on earth beginning some 1.5 billion years ago. Fungi feature actively in foods as diverse as beer, wine, and cheese. Fungi is neither animal nor vegetable, there are over 1.5 million species, 6 times more than plants. They can break down complicated organic matter and are responsible for the generation of soil. Fungi extend in vast networks that span hundreds of miles underfoot. They use electrolytes and electric pulses to communicate through mycelial networks, more extensive than our own brain neural networks. Trees use these incredibly complex natural communication pathways recognising, protecting, and nurturing their own kind and kin. My hero, Paul Stamets, a mycologist with a mission, has an uncanny knack and passion powered presence regarding all things fungal. Hearing his podcasts with famous talking head Joe Rogan has three dimensionalised my mushroom learning journey. Initially, I was emotionally recruited into being mycophile because of its alternative and historical context. I liked the notion that critical knowledge could surpass that of the power of danger. Still, Paul’s pervading and persuasive sermons bring cruciality to the messages that a variety of medicines, conventional and alternative, can be created from fungi to ultimately saving the plant and humans by protecting the bees.
“A day without a friend is like a pot without a single drop of honey left inside.” Winnie the Pooh
Honey is composed of many things, primary Fructose (38%) then Glucose (31%) followed by water (17%). Other components include minerals, amino acids, proteins, and acids. Sugar composes about 95% of honey dry weight. The acidity and pH of honey are lesser than the balanced level of 7, blossom honey is lower ranging between 3.3 to 4.6. Honeydew honey, due to its higher mineral content, has a higher pH value varying between 4.5 to 6.5. Honey, having a very concentrated sugar solution, has a high osmotic pressure which makes it impossible for the growth of any microorganisms.
The oldest civilisation known, the Sumerians, from Mesopotamia, historically renowned for their innovations in language, governance, and architecture were also well acquainted with bee-keeping and honey. They worshipped a honey bee goddess and fashioned pottery, was making unique jars for honey. There are biblical references to honey and are mentioned in scrolls from the Talmud and the Koran. The Egyptians and the Romans applied honey to wounds, and English Kings and Queens fermented it into drinkable mead.
Honey has both therapeutic and pharmacological properties. It also possesses osmolarity, acidity, hydrogen peroxide system (inhibin), phytochemicals, and methylglyoxal. Expectorants, containing honey, are found in the anti-cough and anti-constipation medications. Also beneficial in alleviating digestive disorders like peptic ulcers, honey is also considered both a probiotic and prebiotic and can be classed, as a result as a symbiotic, being contained in one product.
Honey and its associated products have also been researched in the oral health context. Honey, having a high fructose and glucose content, would be expected to be very cariogenic, additionally presenting a lower pH too. Various studies (George et al. 1978, Shumon et al. 1979 and Nizel 1973) have determined it to be equal, or worse (Kong 1967) than sucrose, with one, by Decaix, (1976) surprising finding it less so! The diversity of outcomes demonstrates a degree of confusion, perhaps detailed observations of the differing methodologies, funding, and biases of the research, and researchers might add clarity. It may also be that selected honey having higher antibacterial activity and better-balanced pH, like honeydew, are less harmful to teeth by inhibiting cariogenic bacteria. Further research, if deemed necessary, may reveal more beneficial evidence.
Propolis, a resinous (55-60%), lipophilic material is waxy (30-45%), sticky, yellow-brown to dark brown, with aromatic oil and pollen (5-10%). It is collected from tree buds, sap flows, shrubs or other botanical sources is used to protect and seal unwanted open spaces in the hive. Propolis is rich in chemicals like flavonoids, phenolics, and aromatic compounds being antioxidant and anti-inflammatory to name but a few. The main benefits come from two propolis products, the first is the Ethanolic Extract of Propolis (EEP). It is a rich source of phenolic acids and flavonoids. EEP and its phenolic compounds have been known for various biological activities including immunopotentiation, chemopreventive, and antitumor effects. It is highly effective against strains of Bacteroides and Pepto streptococcus.
Secondly, propolis contains Caffeic Acid Phenethyl Ester (CAPE), a versatile therapeutically active polyphenol, and an effective adjuvant of chemotherapy for enhancing therapeutic efficacy and diminishing chemotherapy-induced toxicities. It is acquired from propolis obtained through extraction from honeybee hives. This bioactive compound displays anti-inflammatory and anti-oxidative properties, improving the production of cytokines IL4 and IL10 and decreasing the infiltration of monocytes and neutrophils.
Propolis has been shown to inhibit cariogenic microorganisms, as well as slowing down the synthesis of insoluble glucans. It can hinder glucosyltransferase enzymes, essential for Streptococcus mutans to become sticky and adherent. Cariostatic effect of propolis is assisted by its fatty acids, slowing down the production of acids by Streptococcus mutans, and decrease the tolerance of microorganisms to acid pH. Also, A study assessed, in vitro, the antibacterial effect of Iranian propolis on oral microorganisms concluded that ethanol extract of propolis is useful in the control of oral biofilms and dental caries development.
“Mushrooms were the roses in the garden of that unseen world because the real mushroom plant was underground. The parts you could see – what most people called a mushroom – was just a brief apparition. A cloud flower.” Margaret Atwood, The Year of the Flood
A large variety of mushrooms have been utilised traditionally in many cultures for health purposes, prevention, and treatment of diseases. Over 100 medical functions have been found in mushrooms and fungi. They range from antioxidant, anticancer, antiparasitic, antifungal, detoxification and hepatoprotective. The bioactive properties are located in fruiting bodies, cultured mycelium, and broths which contain polysaccharides (most important in modern medicines), proteins, fats, minerals, phenolics, flavonoids, carotenoids, folates, lectins, and enzymes. Beta-glucan is the next most versatile metabolite from the mushroom kingdom. It has a broad spectrum of biological activity, related to the immune system, especially regarding antitumor benefits.
A critical review on health-promoting benefits of edible mushrooms was undertaken by Jayachandran et al. in 2017. They looked into the role of fungi as prebiotics in improving the host’s health. They have substances that induce the growth of or the action of microorganisms that contribute to the host’s well-being. Importantly they play a vital role in immune regulating pneumococcal pneumonia and antitumor activities. In particular button mushrooms increase microbial diversity in gut flora. Other mushroom types have been reported to reduce obesity, gut dysbiosis, improve antioxidant status via microbial alterations.
Specific cultivated and wild mushroom species have been researched for their potential application in human health. The Shiitake mushroom, Lentinula edodes, cultivated since the Sung dynasty in 1100 AD, is one of the most popular mushrooms worldwide, prized for their rich, savoury taste. It has a variety of biologically active compounds like erythritol. It is suggested Shiitake possess anti-oxidative and anti-atherosclerotic potential, with regular consumption improving human immunity. A study was undertaken in 2015 (Dai et al.) looking at 52 subjects between the ages of 21 – 41 consuming 5g -10g daily. Their blood pictures after 4 weeks revealed reductions in C reactive protein (CRP) and an increase in IgA immune function activity. The cytokine pattern also differed before and after indicating immune improvement also, demonstrating less inflammation than that which existed before. A culinary favourite, the Cep or Penny Bun (Boletus edulis) has a polysaccharide profile. When tested in laboratory mice, it demonstrated reduced pro-inflammatory and increased anti-inflammatory responses.
Erythritol is responsible for antimicrobial activity in dental health, being seen to detach cariogenic bacteria from tooth structure, altering the cell surface hydrophobicity, and disrupting signals transmitted in Streptococcus mutans. Studies into Shiitake extract mouthwash was compared to a chlorhexidine rinse in an artificial mouth model. Eight key taxa of the oral health community were investigated over time. The results indicated the Shiitake extract lowered pathogenic bacterial numbers without affecting the taxa associated with health, whereas the commercial rinse changed all.
The symbiotic healing relationship between bees and fungi is becoming more understood. Mushrooms have an essential role as providers of powerful medicine in fighting honey bee viruses. There have been waves of highly infectious viruses contributing to a massive decline in honey bee health. However, it has been recently noted that bees forage on mushroom mycelium. This suggests that they may be deriving medicinal as well as nutritional value from fungi. The wide range of chemicals that mushrooms possess include some that may benefit, antimicrobially, honey bees. They are particularly affected by two viruses, Lake Sinai Virus (LSV) and Deformed Wing Virus (DWV). Research undertaken by Stamets et al. (2018), determined that extracts of Omadou and Reishi mushrooms reduced DWV 79 fold and LSV 45,000 fold compared to control colonies and they, understatedly, may gain health benefits from fungi and their antimicrobial contents. Besides the continuing work of Stamets and co-workers beyond fungi, where they are disseminating three-dimensional printing diagrams for the greater public to produce bee feeder platforms. These are simple measures we can all immediately do to meaningful help in real-time. This includes filling your garden with bee-friendly flowers, stopping the use of pesticides, and using 1 tablespoon of water with 2 tablespoons of white granulated sugar to make an energy drink, placing it nearby busy bees.
To conclude, I am pleased that a passion project of mine, mycology, can be researched in my clinical field, albeit unorthodox but very relevant in my social context. I am aware that honey, propolis, and fungi will probably never see the mainstream light of day in my practice but will be able to engage, with knowledge, clients who are interested or associated with them. I am more the wiser and sympathetic towards those who have tried through research to bring their benefits to the fore, their work is worthy of examination. Furthermore, the future of the human race is aligned with the future of bees and the environment. Greater attention to them and their habitat, be they fungi or bees should be invested in. It is time for man to provide more action and resources to protect them and understand our mutual environmental and sustainable needs.
A critical review of health-promoting benefits of edible mushrooms through gut microbiota Jayachandran et al., 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618583/
Propolis in Dentistry and Oral Cancer Management. Kumar, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083525/
Propolis: A natural biomaterial for dental and oral healthcare. Khurshid et al., 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768961/
Extracts of polypore mushroom mycelia reduce viruses in honey bees. Stamets et al., 2018. https://www.nature.com/articles/s41598-018-32194-8
In vitro assessment of Shiitake mushroom (Lentinula edodes) Extract for its anti-gingivitis activity. Ciric et al., 2011. https://www.hindawi.com/journals/bmri/2011/507908/
Apitherapy – A sweet approach to dental diseases – Part I: Honey. Ahuja & Ahuja https://static.webshopapp.com/shops/035143/files/056059908/2012-a-sweet-approach-to-dental-diseases-part-i-ho.pdf
Apitherapy – A sweet approach to dental diseases. Part II: Propolis. Ahuja & Ahuja, https://journals.sagepub.com/doi/pdf/10.1177/2229411220110201
Does Propolis Help to Maintain Oral Health? Włodzimierz et al., 2013. https://www.hindawi.com/journals/ecam/2013/351062/
Health from the Hive: Potential Uses of Propolis in General Health. Eshwar, Shruthi, & Suma, 2012. https://www.scirp.org/html/1-2100265_19381.htm
Propolis: A natural biomaterial for dental and oral healthcare. Khurshid et al., 2017.
Effectiveness of Propolis on Oral Health: A Meta-Analysis. Hwu et al., 2014.
Honey for Nutrition and Health: A Review. Bogdanov et al., 2008.
Novel Insights into the Health Importance of Natural Honey. Ajibola, 2015.
Anti-inflammatory effects of Boletus edulis polysaccharide on asthma pathology. Wu et al., 2016. https://www.ncbi.nlm.nih.gov/pubmed/27830033
Edible Mushrooms: Improving Human Health and Promoting Quality Life. Valverde, 2014. https://www.hindawi.com/journals/ijmicro/2015/376387/
Lentinula edodes (shiitake mushroom): An assessment of in vitro anti-atherosclerotic bio-functionality. Rahman et al., 2018.
Consuming Lentinula edodes (Shiitake) Mushrooms Daily Improves Human Immunity: A Randomised Dietary Intervention in Healthy Young Adults. Dai et al., 2014.
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