Reflections – Robert Lustig’s Metabolical Chapter 5 and O’Hehir University’s recent interview with me.

It’s been quite a while since I’ve had the opportunity to put finger to key pad, a combination of employment changes and a hip operation ( not mine I hasten to add ) has seen little to no time to reflect, until now. Many things have happened of late, most inconsequential, but reading Robert Lustig’s new book, Metabolical, and being interviewed by O’Hehir University’s Tim Ives are both events that have prompted professional thought. I am continuing to dwell on my mycological and apicultural (shrooms and bees) journeys as well, intending to put them into the next post, both are related directed to the original odyssey, as it this, learning undertaken way back in 2019. That will have wait for another day.

Dr. Robert Lustig has always been on my radar as a free thinker, a man of great conviction, an exemplar of new knowledge, honestly correcting himself late in his career, from face value and establishment thinking. His championing of the dark horse that continues to challenge the all-pervading destructive metabolic dietary dogma and holding extreme scepticism regarding the party line of the carbohydrate verse fat argument. The messages woven into his many YouTube presentations and best-selling books barely flinch as he puts his proverbial head over the parapet to face and provoke his entrenched mainstream detractors.

This his latest offering comes with the threat of professional misconduct removed, having recently retired, removing the constraints born of late by the likes of Tim Noakes and Gary Fettke, both restrained and framed for their so-called “fringe” but evidence-based beliefs, both noble lambs to the establishment slaughter, Tim after a long drawn out legal battle was admonished, Gary, sadly not so fortunate. He continues his fight against those in power, he believes influenced by darker forces than just the medical regulatory body. His fight is worth investigation, cancellation of his opinions and beliefs haven’t been successful despite their best efforts. I urge you to follow Gary and appraise yourself of his genuine and ethical ongoing struggle.

As a Dental Hygienist and, I hope a critical free thinker, I’m now acutely aware of the lack of training I received back in the late 80’s. The times I do a simple scale and polish nowadays, similar to those early days are a rare event and when I do I feel strangely nostalgic, not for some golden time but my naivety and ideological conditioning. It wasn’t until recently that I began to think less reductively about dental health and metabolic and systemic health, beyond what was beginning to be revealed by research and wider, more joined up thinking, for example the link and inverse/reverse assocition between Diabetes, a metabolic disease and periodontal (gum) diseases, beie/ng now considered an auto-immune disease.

The internet has played an important role in this curiosity, especially YouTube, the residence of many a maverick podcast downloaded by a cluster of expert proponents of an alternative narrative to the established line. One of these brave souls is Dr. Robert Lustig, MD, MSL. An author of several books, an expert orator on the subject of endocrinology and metabolic health. However, it was not until the release of his latest book, Metabolical, a few months ago, had he attempted to speak truth to authority regarding dental health, a key component of metabolic health, still unbeknownst to many practising clinicians.

Chapter 5, page 77, is the place where Lustig vents his spleen regarding the myths and the established dogma of contemporary dental health. He begins at what he believes is the beginning, way back in 1947, when the science of nutrition was taken off the academic syllabus for dental students, becoming an “inconvenient truth”, “getting in the way” of modern dentistry. This blotted out to inconvient truth of our ancestral dental heritage where dental diseases weren’t common place and, in fact, relatively rare. Our forefathers and mothers didn’t brush their teeth the way we know of today, if at all, and consequentially didn’t have appreciable decay, unlike the modern world where decay rates with intervention are still high.

What Are Hunter-Gatherers? - WorldAtlas
Hunter Gatherer Cave Art

Fossil records, dating back to the paleolithic era demonstrate some sub-par tooth mineralisation and infrequent poor tooth alignment, and the start of recorded history demonstrating tooth disease in 1-5% of the then population. This stayed that way until the mid-industrial revolution seeing a huge jump up to 25% in a short space of time. The culprits, unknown to hunter gatherers, being refined floor and sugar. The controversy appears to have become more evident after the 1920’s when dentists like Weston A. Price endeavoured to find answers to these alarming, growing and continuing trends. Price began an expedition visiting primitive and industrial countries. He wrote of his investigations and findings associating modern foods with this denigration of arch size and dental decay, traditional diets being a natural antidote to it. In March 1934 a meeting in New York tried to determine the cause of disease increase, in one corner where those who determined that clean teeth don’t decay, AKA Team Bacteria, and those who asserted that countries with traditional diets with unclean teeth had little or no disease, AKA Team Nutrition.

The flaw appears in the Team Bacterial position, who had no idea of the evolution of oral bacteria, being mediated by lifestyle and dietary changes, from ancestral to modern day microbiomes. Bacterial migration, determined from investigation of fossilised calculus has seen a shift in those bacteria from the mouth to the upper gut. The changes indicate a reduction in diversity, introducing bacteria that thrive in modern oral environments nowadays.

The irony is that “Our  foraging/gathering ancestors ate tons of carbohydrates and didn’t develop caries” and that traditional flora weren’t dominated by modern bacteria species, specifically the Streptococcus Mutan strains, being acidogenic, aciduric, with potential to produce lactic acid and demineralise. This bacterium is uniquely designed, possessing an enzyme called Fructanase, able to cleave the glucose/fructose bond of sucrose in a nanosecond. It is highly efficient in oral environments where sucrose is frequently available, not only in acid production but dominating the local and regional bacterial flora.

“Would people prefer some decay rather than the elimination of sweets (sucrose)?” William Davis, then researcher and dentist, continues “Let us hope our research workers discover more practical means of controlling or preventing dental decay.” Dr. McCollum, a co-worker of Weston A. Price, conversely proposed “It seems that were we to turn to a low sugar, high fat type diet, such as prescribed for diabetic patients, we might expect a prompt and marked reduction in caries susceptibility. This type of diet is practicable in many countries, but fats are in many countries considerably more expensive to produce than starches or sugars”. This is the devil in the detail it seems, “food” that is cheaper to produce, and in greater quantities, far more readily available, irrespective of its potential negative attributes wins the day.

Was there a modern day solution to this dental health dilemma? Step forward 1945 and the discovery that Sodium Fluoride, at 1 part per million (PPM) that could inhibit dental caries formation. It had the ability to bound into the Calcium Hydroxyapatite crystals of the tooth, hardening the tooths external crystalline structure. It was noted that that decay rates dropped by more than 60% in children when added to the water in that specific concentration. Up to this point fluoride was considered to be toxic, a waste product of the aluminium and phosphate mining industries and a chief contributor to environmental pollution. Between 1971 and 1988 caries rates began to level off, from 25% to 19% in toddlers, 55% to 24% in 6-9 year old’s but never got lower than that. Toothpastes with 1500 PPM saw a reduction in adult dental decay by up to 30%. Increased amounts, up to 5000 PPM saw that rise to 40% never breaking beyond that figure.

The reduction in these disease rates led to dentists having less active disease to treat, fluoride it seemed had become an arbiter for the sugar lobby to encourage people to consume more sugar without getting cavities, dentists became less inclined to offer nutritional advice, and officials afraid to stop fluoridation. Evidence of fluorides negative effects, initially isolated to developmental discolouration of teeth soon moved onto small but significant correlations between fluoride exposure and reduction in child IQ, exacerbated when mixed into infant milk formula. How is this risk seen in New Zealand?

“Typical fluoride intakes from formula feeding using fluoridated water at the levels of fluoridation used in New Zealand are safe, and there is no evidence of any adverse effects on infant health or child development.” NZ Ministry of Health

“The Australia New Zealand Food Standards Code also specifies that powdered or concentrated infant formulae containing naturally higher levels of fluoride must indicate on the label that consumption may cause dental fluorosis and should be discussed with a medical practitioner or other health professionals. That is, those containing more than 17μg of fluoride per 100 kilojoules (prior to reconstitution), or ‘ready to drink’ formulae containing more than 0.15mg fluoride per 100mL.” That’s about 1.5 PPM, higher than water fluoridation recommendations (Author). NZ Ministry of Health

1 ppm is equivalent to 1 milligram of something per litre of water (mg/l) or 1 milligram of something per kilogram soil (mg/kg).

The NZ Ministry of health continues “The workshop concluded that, while there had historically been some infant formula powders with high fluoride content, infant formula products now have very low levels of fluoride, and that infant formula is safe for consumption by infants whether reconstituted with fluoridated or non-fluoridated water.”

It is interesting how they deem low levels of fluoride in formula being higher than population water fluoridation recommendations. Are they assuming that no infant toothpaste formula is being used, remembering first teeth erupt after 6 months of age? Or, are they factoring this into the calculation? Is there a risk of fluorosis to the developing secondary dentition? Are the water fluoridation detractors right?

This has left me feeling slightly uneasy. I was unaware that fluoride was put into some formula, as did my Practising Midwife partner. I don’t see usually see many babies or very young children as clients but I am asked frequently my opinions and position on fluoride. I will reflect more on this particular part of Lustig’s revelations and consider my position more fully. First of all I will look in the local shops and see for myself what is on the shelves and at what strength. Some more calculations will follow.

A final word on this contentious subject comes from the late Aubrey Sheiham, an Emeritus Professor in Dental Public Health. This UK epidemiologist recommended the reduction of dietary sugar to less than 5% of calorific intake, reducing the risk of dental decay to their lowest possible levels with minimal sugar consumption continuing. In this case, I wonder, would fluoride still be needed? Fluoride has not been a magic bullet, hasn’t seen the end of dental caries, has subtly enabled us to take our eyes of the prime driver of cavities, frequent exposure to fermentable carbohydrates, and frequent oral pH imbalance, over time. The dental profession hasn’t, in my opinion, followed the evidence, and has relied on these toothpastes and water fluoridation for the answer, and still does to this day.

Dental Hygienists and Therapists see the evidence of decades of poor advice, reliance on this interpretation of the science and continue to hope those sitting in their dental chair, despite brushing their teeth as they were told too, using the toothpastes recommended, still need the Dental Plan, the need for radiographs and intervention. Why are they not asking the real question, why in the hell am I sitting here despite this? The answer would be, in my opinion, simple and direct, read Chapter 5 of Metabolical, by Dr. Robert Lustig.

Moving swiftly on, I had a peculiar experience recently too, not of the book reading variety but of the online interview kind. This is a novel and fairly contemporary occasion, potentiated by the presence and everyday use of social media. I myself watch many a podcast in the week, preferring it to reading nowadays. I’m guessing COVID lockdowns and time on our hands has led to the growth and acceptance of such platforms and presentations, however, those involved are normally famous people. That leads me to the amusing thought of just who is famous in the dental world nowadays? My guess is those who challenge authority and established doctrine, Dr. Steve Lin, in Australia being the most notable presently. I say World purely because we are all now connected globally and O’Hehir University must be one of the pioneers and forbearers of this communication revolution in learning for dental healthcare professionals today.

Tim, O’Hehir tutor and co-creator, has a good knowledge of my professional journey, the theme of transiting from working in the UK to New Zealand, the cultural differences and how my practice has evolved and where I see it going. Having viewed some of the other interviews there is a rich vein of nuance, making every cast interesting and personal, humanistic in a sense. I liked the flow of the interview, it always appears strange viewing what you say at the time, in the moment. I would have liked, in hindsight, to have given consideration before the event, to the questions Tim posed. I would have liked to have put more meat to some of the responses, they lacked depth I feel. I liked the idea that the conversation could take an unlikely turn but kept loosely to the script. In a future scenario it would be good to focus on one particular aspect of personal and professional development, I’ve seen this in other interviews, and for example, how go about learning in an alternative context, in New Zealand, where courses are limited and sometimes not relevant to your particular workplace would be pertinent in the current climate.

Tim and Trish, the minds and drivers of O’Hehir University find themselves at a peculiar juncture in the evolution of the learning “child” and as it grows how to nurture it. Thankfully, both a keen advocates of alternative styles of professional, and indeed, personal development. I’m intrigued as to the direction they take, the many opportunities that will subsequently arise and the folk that lean on them to make their professional journey as wholesome as mine has been and continues to be so.

Finally, my head is telling me to consider a modern hunter gatherer dietary challenge, consider eliminating breakfast, a modern construct, and this I will give some thought to, along with a bit of bio-hacking to draw metabolic context. Watch this space.

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