“The roots of education are bitter but the fruit is sweet.” Aristotle
When I began the initial research phase for part 2 I pondered the possibility that the subject matter pertaining to the aims and goals of Whole Dental Health and the principles I want to pursue professionally here in Nelson had already been undertaken and, even, heaven forbid, published! I came up this nugget of theological gold courtesy of Joellen Coates, a thirty plus page of her Honours Capstone Project. This is undertaken in the final year of tertiary learning by some educational establishments. It is a unique and very personal and self-directed process by which the individual learner can develop a thesis, develop and establish new knowledge, test it and formulate a learning premise that ultimately goes towards the final grade and graduation. 1, 2
Her thesis looks closely at the human oral microbiome, its constituent parts, it’s history, present and potential future in regards to unlocking its potential to impact the direction of oral health in the future by understanding its very nature better. She begins by setting the historic scene, back to the hunter gatherer days, progressing into the Neolithic Period where Palaeolithic man moves from a seasonal and mobile dietary life into that of an agriculturally based one, land locked within the confines of the cereal sown and cattle raised nearly starting about ten thousand years ago. With this change in dietary life style comes a shift in dietary behavioural changes with eventual oral microbial changes and, following on from that, dysbiotic changes to oral floral and increasing archaeological evidence of dental diseases, namely caries and periodontitis.
“For the first half of geological time our ancestors were bacteria.” Richard Dawkins
The several hundred or so bacterial species of our oral microbiome combine with other microorganisms such as fungi, viruses, archaea and protozoa to construct our complex and diverse ecological communities, and have done so from days in memorial. In healthy subjects they display great diversity and health benefits. It begins before birth with some early pioneering bacterial species culturing the unborn mouth via the umbilical cord, amniotic fluid onward into the developing foetus. During birth further seeding is initiated by contact the mother’s vaginal microbiome and contact with the skin, being further reinforced through breast feeding and so on and so forth throughout life. The development of a functional and balanced oral microbiome has begun. How this community of diverse microorganisms can afford dental and general health benefits is the subject of modern research and, more so, how its disturbance can lead to a host of dental diseases is the subject of my interest.
“The important thing is not to stop questioning. Curiosity has its own reason for existence.” Albert Einstein
Within ancient dental calculus holds the clues and answers within highly preserved bacterial types, their cellular components and DNA. Careful analysis reveals that Neolithic farmers saw a significant increase in the consumption of fermentable carbohydrates as opposed to their cave dwelling ancestors, in this case the greater consumption of cereals, such as we do today. This has also seen the documented rise of dental diseases, both caries and periodontitis in archaeological evidence, but also comparatively to modern man. Studies have determined that the modern microbiome is “less diverse compared to ancient samples and could be composed of more opportunistic cariogenic bacteria”. Pre – Neolithic populations were rarely affected by dental diseases. 3
Baumgartner and co-workers in 2009 designed a simple study that took Swiss students from a modern Swiss diet and for a period of a month ate a Stone Age type diet to determine the effects of a lack of modern oral hygiene on the oral microbiome and presence of gingivitis. The results indicated a change and growth in the oral microbiome, less pathogenic bacteria and a significant decrease in the signs and symptoms of gingivitis. This simple and less rigorous research brings up many further questions as well as a need for more detail regarding its process. The next paragraph will look a little deeper into it.
The sample size was small, ten subjects, in one group and the study length was just four weeks. Microbiological samples were collected at the mesio-buccal aspects of all teeth and from the dorsum of the tongue. All ten subjects had no periodontitis. The results from samples gathered after four weeks demonstrated a mean bleeding on probing deceased from 34.8% to 12.6%, plaque scores increased from 0.68 to 1.47. Periodontal depths also showed changes which decreased at sites of sampling by 0.2mm. All three measured a P value of <0.001, indicating that the results have less than one in a thousand chance of being wrong. The bacterial profiles, had a higher growth count for 24 of 74 species despite the reduction of pathogenicity.
The elimination of refined sugars decreased the risk of gingivitis in the absence of traditional oral hygiene methods, despite the increase in plaque levels. This demonstrates that beneficial and symbiotic bacteria thrived in the oral microbiome in the subjects tested over a four week period without the benefit oral hygiene or the consumption of a modern style Swiss diet. 4
The oral microbiome is constantly exposed to the elements and pressures of the external environment and needs to treated, in the same way, as a precious ecosystem. The oral microbiome utilises nutrition supplied from the hosts diet, their saliva flow, enzymes and minerals. It is ecological disruption and dysbiosis can stem from poor saliva flow rates, quantity and quality, illness, stress, poor diets and even genetics.
“Is your diet really nutrient dense”? Dr. Weston A. Price
Importantly, dietary changes since hunter gatherers have dramatically changed. The simple food staples they once gathered have become processed, starting in Neolithic though to the modern, Industrial Periods. These have fundamentally altered seven crucial nutritional characteristics of our ancestral dietary habits. These include glycaemic load, fatty acid composition, macro nutrient composition and micronutrient density, acid balance, sodium-potassium ratio and fibre content. Glycaemic loading, fatty acids (Omega 3’s),acid balance and macro and micro nutrient contents will in particular prove important regarding the oral systemic interface of dental health and development. The controversial works and research of Weston A Price will need further examination in a quest for greater knowledge and connection to modern day alternative lifestyle and medical cultural ideology and practice. 5
The future of dentistry in relation to the oral microbiome, let along everything that appears to be happening in the world right now, is ripe for discovery. The benefits of a balanced, beneficial and healthy oral microbiome and, in turn, how we decide to directly or indirectly affect and influence it to our dental and general health benefit requires our attention. Poor nutritionally based diets with emphasis on the consumption of processed rich foods and in particular fermentable carbohydrates promote less diversity and imbalance of our oral ecology. This must become an innate message to our clients who suffer from dental diseases no matter how mild or severe they present.
“Natural ecosystems regulate themselves through diversity.” Big Little Farm
Finally, the materials we use to help control and manage oral health issues and the negative effects of poor oral flora may lie not solely in the realms of the mouthwashes which fill the pharmacy shelves or the cleverly marketed and boxed oral hygiene devices specifically but, more so, in the way we chose to live and eat. The stresses and pressures we put upon ourselves in our everyday lives, the type of nutrition we chose consume and the ability to manage not only our everyday oral hygiene habits effectively but how we sustain and maintain the diversity and symbiosis of our oral microbiome as a whole is vital.
1. Coates J, 2017. Got Teeth? How the Oral Microbiome and Diet Affects Our Oral Health and the Future of Dentistry.
2. Capstone Project. https://youtu.be/CWxwwLP2THU
3. Alder CJ et al, 2013. Sequencing ancient calcified dental plaque shows changes in oral microbiota with dietary shifts of the Neolithic and Industrial revolutions. Nat Genet 45: 450-455.
It is Monday, 6th April here in New Zealand, and the world has changed and is now different place. The roads are quieter, the streets are empty, less the occasional dog walker and jogger, and the lockdown is solidly in place. An peculiar sense of calm is reinforced by the bird song outside, the environment and habitat seemingly swelling to fill the void of lost modernity. Ironically it is exactly this at the moment that has switched, we’ve been role reversed and we huddle, like our forefathers did in the Second World War to catch each and every news item, hoping for the time to be encouraged to come out of isolation, our Anderson Shelters we call home. The natural world appears to be benefitting from this hiatus of human activity too, far fewer cars and planes travelling the streets and airlanes, less emissions and, thankfully, less pollution too. The deadly epicentres of the COVID 19 impact, Italy, Spain, Wuhan and New York are experiencing significant improvements of air quality and, strangely too, wild animals, in some places, are seen visiting empty neighbours, once teaming with people.
The COVID 19 experience, from my own particular professional perspective, as a Registered Dental Hygienist, has created an eerily ideal learning opportunity, the time to complete a project I began over a year ago, reflect upon it and consider my options and choices regarding whether the economic and financial fallout post COVID 19 allows me to return to my clinical normality.
The project, called Whole Dental Health, began as an idea to implement professional development as part of a nine week career break between jobs and places. The journey, I called it an odyssey, some might have classed it as a sabbatical, took me to France, the UK and the States and demonstrated my learning activities, commensurate with my professional and personal values, clinical headspace and self-guided development, all written and published in blog form weekly. These can be found on http://www.wholedentalhealth.com in the menu bar, under reflections. Over thirty thousand words written and several hundred global views, continuing recently form the first part of a written and published trilogy that will encompass three stages of my present and ongoing developmental journey. The first was more nutritional and behavioural based, the second will consider and explore a environmental and ecological approach to dental hygiene, guided by my interpretation of clinical oral health delivery in my new dental practice blended with a more natural philosophy and approach to oral health and orthodontics. Finally, the honing all of these experiences and learning into a post COVID 19 dental health environment and clinical approach. Ultimately my question is whether it will change me personally and professionally in a more meaningful way as a Dental Hygienist or will necessitate a career change in health care elsewhere?
The choice of a story telling approach to the project is anathematic of authentic learning and action research. It is particularly indicated with explaining a process or a journey reflectively, where you guide your own learning based upon where you feel you have a need to improve or create new knowledge in particular subjects or matters within your work place. You become the self-directed learner, you empower your quest for it through a guided process, it being authentic and genuine as it is specifically applicable to you. You research, critically appraise, create and design ways in which you can test its validity, reflect upon those outcomes, change, implement or reset the parameters or if unsuccessful, try again in a different way. Creating new knowledge, in an open ended and critical way maybe seem by others in written words, like this, published and disseminated through social media platforms or presented to a professional audience of some kind. Both are a form of peer review and can be, by our colleagues, challenged, adopted or adapted for their own practice to the benefit of their clients.
Ironically, in this time of great global upheaval and change, comes to the New Zealand Dental Healthcare profession change as wel. This brave new learning world has the potential to seriously test and challenge the will, intentions and adaptability of all concerned. Traditionally continuing professional development (CPD) was historically regulated, via The New Zealand Dental Council (NZDC), in verifiable and non-verifiable formats where specifically set numbers of hours had to be completed, demonstrated through a portfolio of evidence if required by the council as part of an audit. These audits, conducted on about ten percent of the re registering dental body every CPD cycle, I feel, made the need to meet the expected numbers greater than conduct appropriate learning, essentially detracting from the real need for authentic, individual learning. So I was to my great surprise and delight that several weeks ago the NZDC announced the intention to restructure its current CPD cycle. In will come, as from next March, the new paradigm incorporating the creation of a Professional Learning Plan (PDP), designed Professional Learning Activities (PDA) and a formal personal peer relationship with some you can nominate yourself. The most interesting part of the new direction, however, was the need to undertake written reflection on the learning outcomes from PDA’s you have proposed and undertaken through you PDP, and this in turn, discussed with your peer reviewer and validated as such via an online portal.
The thought that hundreds of dental healthcare professionals undertaking work related, personally guided and relevant learning with the intent to write it up and it be reviewed may sound quite revolutionary to some, complicated and unnecessary to others. However it needs to be borne in mind this process is already done by many, especially clinical nurses, midwives and other allied healthcare workers. What this does demonstrate, in my humble opinion however, is that the New Zealand dental profession is finally catching up with allied healthcare professionals too, and that the good old days of mathematical calculations for gaining re registration has gone. There is no need for the numbers game anymore, just, I hope, the intention to gain quality self-directed education, appropriate to one’s workplace and associated practise and the need to authentically apply it into practice, reflect upon its process, modify, adopt or adapt this new knowledge creation and justify its purpose through critical reflection and appraisal. The need for the dental trade industry to get its grubby pores into it will hopefully diminish and, if continued, be more relevant to the clinical spaces of practices and not for greater profit. I for one can’t wait.
So, finally, over the next few weeks expect posts related to authentic learning and action research, future professional development, oral health related to systemic and metabolic health, diet and nutrition related to dental caries and periodontal diseases, the oral microbiome, fluoridation, saliva and pH, alternative antimicrobials ( in particular honey ), sustainability and the creation of a philosophy related to those.
“Be the change that you wish to see in the world.” Mahatma Gandhi
It’s a curious thing, working in your past, that it be still part of your present, mixed confusingly with your clinical present and future. This paradoxical conundrum has unravelled as this unorthodox journey over the past six months is now coming to it’s end. We all need to earn money, I certainly do, having coming off a nine week break from zero earnings, a self imposed cessation of an income stream that pays rent, bills and creates a degree of financial security. July through to August of last year became a journey I feel everyone should undertake, at least once in their career, if the stars align and the opportunity and inspiration presents. This I will cover further on in this reflection to add context shortly as it really guides and sets the scene for these previous six months.
My learning odyssey was planned way back in October of 2018, when life events ensured that an intended single journey from New Zealand back to the UK went terribly South. My intention was to stay and re register in the UK and find work. I was disillusioned with clinical practice in Blenheim and life in general, the tank was empty and it seemed the only, but definitely not the easiest route, out of this dilemma was to do precisely that. This simplistic explanation of the circumstances leading to my learning odyssey back in Europe, the UK and the States belies a deeper need, a sense of entrapment in how my professional ideology at the time made me feel. I was outraged that the dental industry was slowly taking over and commercially influencing learning. Also I was frustrated that I was shackled by the lack of provision for new knowledge creation within New Zealand and felt stifled by regulations that govern my annual professional recertification. I was constantly wondering if I would realistically achieve the magical number of CPD points and hours of peer group contacts time to facilitate that and, deeper in my mind, the real fear that my name would be pulled of the 10 percent of re registrants who would need to present evidence of their learning journey. Picture the scene with all the right credentials for this but not a jot of real knowledge gained that would evolve and develop one’s practice, by just sitting and ticking the boxes to avoid negative scrutinisation. Maybe, just maybe, a more permanent learning journey back to the UK would make that easier, would make plain sailing of the frustration I felt. Alas it was not to be.
“It’s only after you’ve stepped outside your comfort zone that you begin to change, grow, and transform.” Roy T. Bennett
I had a canny sense that changes to re registration might be afoot when I wrote an email to the Dental Council regarding hours I worked creating a presentation to an addiction and behavioural change clinic in Blenheim I was asked to talked to. I got a somewhat mystical reply that demonstrated that they were starting to think outside the box and the journey into self directed learning and new knowledge creation had begun in earnest. I kept the email and re read it on occasion to be certain they were saying what I though they were saying was true. This was further back up by a local peer group/ mentoring event that reinforced my suspicions.
My real comfort zone is to be indifferent to established rules, to bend or break them would be ideal in my world, but not all of course, safety must always prevail, but those which prevent growth, exploration and evolution are my nemesis. I’ve been called a maverick and a contrarian, I’m comfortable with that, I’m not wanting to be followed, more to follow my innate curiosity and creative nature. Thus, with my life partner, Toni, the ground work for the odyssey was created and constructed. The event undertaken, lessons learned and behaviours changed. To catch up with these “real-time” week by week experiences go to the reflections page of wholedentalhealth.com. This reflection can now be seen in its context and I will move onto to September of 2019, when re returned to Nelson.
“Life is a series of natural and spontaneous changes. Don’t resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” Lao Tzu
The move from Blenheim to Nelson was on the cards from the beginning of the year, a professional and dear friend, Deb, had empathetically seen my need and advocated, on my behalf, to her boss at the time for me as a candidate when she moved to a bigger role in town. My interview was confirmation that my new clinical role was going to bring on many changes. These were welcomed but some uncertain, the move involved coming into contact with oral myofacial therapy (OMT), orthodontics, orthotropics and sleep apnea treatments. My role was to compliment most of these with oral hygiene support and additionally OMT once I attended a 4 day training course.
I was caught, however, in a situation where the new practice could only offer me 3 days and the additional clinical time I needed wasn’t available in Nelson, or so I thought. I called Blenheim to see if they had found my replacement. They hadn’t and needed support, I offered and spent the next six months, until now in fact, travelling to and from to help Blenheim and earn what I needed until work could be found in Nelson. The juxtaposition between the past, present and the future I felt profoundly, working back in my old practice, clinically in the past and the new work environment being one of dynamic change and challenges. I found the transition between the two testing and telling, the contradiction between the two at times felt profoundly uncomfortable, the tight and intense vertical learning curve of Nelson apposing the busy and comfortably numbing nature of Blenheim, the advanced equipment and technicality of one as opposed to the salubrious and simple nature of the other. The clients were also different, more children and questioning adults in one and a docile and accepting group in the other.
“Change the way you look at things and the things you look at change.” Wayne W. Dyer
The change also involved a move away from being self employed to being employed. One which had been of a self controlled professional environment, being able to say when, where and how I worked to being very much part of a team and embedded in the same boat as other colleagues. I also chose, deliberately, to have the same uniform colour as the Dental Assistants and Orthodontic Auxillaries. It turned out to be a wise move as within my adoption into the practice came the need to be affiliated to the behaviours, causes and beliefs on that clinical group, I had choices to make, processes to change and pride to put on the shelf. To say the first three months there were stressful, unsettling and confusing is an understatement. The nuanced clinical nature of my work also matched the nuanced nature of the practice personality as a whole. This is the same the clinical world over I suspect and experience has taught each and everyone of us in positive, neutral and negative ways how to steer the ship into the calmer waters and sandier shores. I needed every ounce of skill to get safely to port.
Clinically I was steady, happy and welcoming of new technology, an intra oral camera, high end airflow and ultrasonic systems and a highly organised and effective infection control regime. These were a contrast to the more laid back and laissez faire approach in my previous practice. More time was given too, initially I thought too much but as it transpired it was necessary to help build trust and create relationships with clients. It also helped me construct a new way of note writing on the Exact SOE software system which I had never done before, more really a check list of appropriate or non appropriate notes to write for my client centred and empathetic approach I was beginning to move more towards. Working within a team affords the individual the ability to feel what others feel, a shared experience, to sense the emotions both collectively and one on one. To be seperate from this is not to experience collaboration, be it clinical or social, or both. It is rich and rewarding, but can also be down right demoralising, especially to those of a more sensitive and vulnerable nature appear distressed or wounded by the turn of events. Sad too, when fortune doesn’t favour those you have emotional attachments too as they part waves and move on.
“Maturity is when you stop complaining and making excuses, and start making changes. Roy T. Bennett
The last three months have been as emotionally challenging, the uncertainty of enough work and income, the prospect of finishing in Blenheim and finally moving on from the past and plotting the future here in Nelson. Events finally came to a head when I decided the date of the Blenheim exit, a new Hygienist had been found and the prospect of travelling to and from over winter bore no benefit. The decision to leave also took into account the need to hand over to the new incumbent. I had never really thought this important before, my previous experiences were always cut a dry but the emotional loyalty I had to my clients and colleagues there really made me rightfully consider this necessary. Thinking about it we could all do with a handover period where the baton is passed slowly and deliberately to help a smoother transition. It’ll be something I undertake in Nelson but this time it’ll be more in the vein of shadowing my Hygienist colleague, Kelsey, who herself is well established, liked and respected. This will help me understand the nuances of her practice, be respectful of them, reflective of her particularly process and build commonality with it.
So, within the realm of work structure and the changes in my clinical process this is where I sign off to date. However, the direction of my approach, both personal and professional has also changed. This is mainly due to my nine week odyssey but also as a consequence of observational and empirical learning and through the post research process following on from that very sabbatical. The way I approach treatment is now more based upon changes in my beliefs and values. The essence of my practice has morphed into evidence guided, workplace learning based, sustainable and environmental practice. More on this very soon.
“Beliefs are basically assumptions that we make about the world and our values stem from those beliefs. Our values are things that we deem important and can include concepts like ‘“ equality, honesty, education, effort, perseverance, loyalty, faithfulness, conservation of the environment and many, many other concepts.” http://www.differencebetween.net/language/difference-between-values-and-beliefs/
A year ago I practiced in what I would in reality call now a limited and more conventional way, my experiences working in a semi rural practice, deep in the wine region of Marlborough had evolved my practice, The clientele were hardy folk, where the once poor agriculture region had benefitted from a vast Klondike in the proceeding three decades had brought a degree of wealth to some and a change in farming to grapes. The provision of hygiene care was itself burgeoning and the need, always there, was trying to be met by a few practices and clinicians, whereas once upon a time it was in the purview of dentists alone. I did find time to develop new ideas of practice, specific to Blenheim, for example, a wine makers protocol for effective management of erosion and wear resulting from the workplace environment was created. A protocol with Peter Yealands Wines was designed for the senior management and winemakers involving process and products.
The time in Marlborough allowed to further experiment and several research projects had helped me better understand my practice and how to evolve it, see my link in the menu bar to Action Research to discover more. I undertook them in progressive ways, to demonstrate to my Principal Dentist the commercial and well-being benefits of having my own nurse. Researching and presenting on dental health and general health nutrition also followed as well as developing a traffic light system to allow improved dental health in my clients to benefit from cheaper appointments and spend less clinical time on them. All were designed to be work based, creative, collaborative and changed my belief and value systems regarding learning towards being more action research/inquiry learning based. Significantly, the way I treated periodontal disease changed from a mainstream full mouth disinfection, two visit, half mouth approach to a more client centred and affordable individualised approach focusing initially on oral health improvement with additional follow-up and appropriate combination therapy use, if required.
“Those who do not move, do not notice their chains.” Rosa Luxemburg
It also became apparent to me that my practice was becoming one of being client centric rather than treatment outcome focused. I had found strict treatment approaches worked in a limited fashion, as I mentioned in the previous paragraph, it left out the heart of the matter, the human equation, what motivational tools beyond the floss or toothbrush demonstration were indicated to achieve dental health improvement. The connection to the individual seemed more fruitful in outcomes and my sphere of capturing that motivational trigger morphed into what I call patient/client centred practice, as opposed to what I deemed was my previous instrumental approach. But there seemed something missing, that link that adds energy to the client centred approach, listening was one thing, however I imagine what we as clinicians over time desire to develop, was empathy. We all need to, I firmly believe, to develop, constantly, the power of empathy that guides our advocacy in the oral health improvement message. What is an empath? Karla McLaren, author of The Art of Empathy describes “An empath is someone who is aware that they read emotions, nuances, subtexts, undercurrents, intentions, thoughts, social space, interactions, relational behaviour, body language, and gestural language to a greater degree than is deemed normal.”
“All advocacy is, at its core, an exercise in empathy.” Samantha Power
Also, complementary to this I had the good fortune to spend quality time, whilst in Blenheim during the last six months, with a close friend and spiritual healer. Although I don’t dare to claim that degree of energetic connection I have learned that when we engage with our audience, more often than not one on one, we create the opportunity, if grasped, to empower the space between each other with our human and clinical intuition. The silent spaces peppered between the idol chatter or gossip, the observation of the body and its reactive movements guide our conversation as well as our instrumentation. The conversations are carefully guided by estimations and calculations of where to use carefully chosen words and quantifying whether it’s too much or too little to make the all important impact. These are skills we learn along the way, refine and engage where we see fit. We are invested in people, their experiences and value systems and we in turn become the artisanal or clinical change agents. My way is one of empathy, humanism and environmentalism. The last I will discuss in the next paragraph but I will end this one in saying which ever way you chose to approach these fundamental truths of how we practice to use them albeit, wittingly or unwittingly, on almost every person we treat and we in turn learn too. How we do this, linked to the new recertification programme, with real active workplace investigation complimenting tradition learning, reflecting on our experiences, adapting and adopting new knowledge skilfully, and supported by our professional peers.
“A nation that destroys its soils destroys itself. Forests are the lungs of our land, purifying the air and giving fresh strength to our people.” Franklin D. Roosevelt
We are environmentalists, all hygienists are, whether they know it or not. We work around hard crystalline rock like structures and soft tissue surfaces forming land around them. Upon them form ecological life, benign, beneficial or potentially pathological. This delicate and dynamic environmental ecosystem provides important function to our bodies right from birth. Our own, unique ecology constantly evolves from seeding at birth being affected, altered and changed by how we behave, feel and nutrify ourselves over time. We also live in a time when the external environment around is is under pressure too. The surge in support for environmental change and protection resonates around us and nature teaches us the real truth through epidemics and geological events that we are not in total control of our world and don’t entirely control our and the planets destiny. We are lulled into a false sense of security that we are totally in control and instrumental in managing our mouths and that panaceas including fluoride toothpastes, mouthwashes and rinses and regular dental examinations and phrophys are indeed natural and completely normal.
Our conventional, instrumental and chemical approaches to oral health miss out the one component we seem to have missed with the world, that we are part of the world and the ecology of it, not far removed from the life in the oral cavity. Surely, an environment approach to balancing oral health working with the right ecology is the way forward, adapting better dental and health promoting behaviours and removing negative changes in nutritional and life style behaviours. These maybe lifestyle related, sleep deprivation or stress reduction, chemically orientated with smoking or drug use/abuse, nutritionally linked to free or processed sugars, frequent acidic events and a lack of well-being, the lack of meaningful connections or a higher calling or just plain exposure to sunlight and meaningful movement.
“You can’t fulfill your calling in your comfort zone!” Steven Furtick
How do I see an environmental approach evolving in my practice? Where do I start? The 2019 Odyssey has moved me greatly on from where I was in Blenheim and where I need and want to be in the next and final decade of clinical practice. The coming year will bring all my research and learning to the keyboard once more when I fully write up, with already published learning to date a thesis on environmentalism, humanism and empathy in hygiene practice.
With this the future changes to registration in New Zealand are a pearl in a shell. They will allow the Dental Healthcare Practitioner to follow their truth, their learning goals and aims, evolve their practice not through fear of persecution for not obtaining the satutory requirement of points. It also makes peer group contact potentially grow beyond dentistry itself and inter professional. The addition of a clinical peer to guide and critique our learning journeys is a forwarding thinking change too. To find an impartial and supportively knowledgeable peer will be a challenge though. There is a lack of knowledge and more overly, experience in this domain, but we have to start this process now and learn along the way how to get the best out of it. Finally, and more importantly, we all need to learn how to reflect upon our journey, write, publish, review and explain to others how we came to know knowledge, decided whether it was good or not, how we tested its validity in practice, it’s application into our workplace and ultimately where our journey will take us in the future.
To end this current reflection my ongoing journey involves adapting to a new practice in Nelson, creating Professional Development and Activity Plans (PDP’s and PDA’s), evolving my environmental and humanistic approach to practice, continuing my learning journey into OMT, and finally completing my odyssey journey with publication on a website, maybe even a presentation or two.
Bonjour tout le Monde.
Sitting on the deck of our cabin/caravan I’m listening to the second semi-final of the World Cup 1 Day International Cricket between England and Australia. The winners meet New Zealand this Sunday! How exciting, who to support if England beat the Aussies today?
The temperature is higher than anticipated, why ever I thought any different is a mystery to me and my readers I’m sure. Consequently it’s taken a while to adapt and become acclimatised. A “high” point was the 24 degrees on Monday night. I was oven ready by day break.
A thought on last weeks experiences was to perhaps look at some of the research I’ve done of late regarding Southern Europe’s nutritional research to add some sense to my ramblings. I have also got into the habit of looking at the various foods we consume detailing their nutritional and health benefits. I must confess being very surprised by the revelations and will post on this some. Veal liver looks amazing regarding Vitamin A!
Unsurprisingly too, we are eating differently. The 16:8 Fasting regime is working well. I thought it would be tricky but having a 2 day grace period to have European breakfasts is helpful. Sleep has been tricky, some good, some bad and moving has seriously slowed down but I’m beginning to understand (thank you Annette for your German frankness) that it is a holiday and places to visit like The Pont du Gard, Aix – en – Provence and Arles are destinations needing four wheels.
We are really enjoying the gentler pace of week 1, that was crazy intense considering the jet lag. The driving is easier, not so scary, helped massively by an unswerving navigator in Toni. I’m finding the tech on the car perplexing. I drive an old Volvo back in NZ, these new cars are a digital nightmare for the likes of old me. Come on driverless cars. NZ will probably be the last to have them, sadly as the driving standard there and “road toll” is crazy bad.
French markets have dominated our trips this week. I’m going to leave Toni, the culinary consultant on this journey to describe this, she’s passionate about this, more so than me. I just open my mouth and let all my senses go into overload. I’ll post this next so keep your eyes “peeled”. I’ll just poetically attempt to describe the people and place.
So as Toni and I watch a film called “Paris can wait” with Diane Lane, a road trip film heavy on French food, culture and national character from an American visitors perspective. I can’t help but wonder whether eating en France, in this case, the Mediterranean south has health benefits. There are many studies that have looked at these but the one’s detailed below show a little of higher end quality but also, in the case of PREDIMED how important the exacting science of them can be found to be less than accurate and detail is everything.
PREDIMED controversy @ https://www.medscape.com/viewarticle/898110#vp_3
Evidence From Clinical Trials @ www.medscape.com/viewarticle/504600_4
Reflections on Lambesc and Provence
Toni’s Diary Entry Thursday 11th, July
Apologies for the lack of entries since my arrival in France but I have been so involved with experiencing my environment that writing has taken a back seat.
First major distraction is food (naturally). I have finally eaten salad everyday in addition to veal liver, pork chop, cheese (goat/chevre, Comte) and saucisson/cured meat. I’m in tomato heaven, too. Provencale vegetables are packed with flavour and NOT packed in plastic. Even Supermarkets here seem more ” Market”. Where possible Mark and I are buying totally local and we can honestly say we have produced zero food waste. We have managed to forage herbs just outside the campsite: thyme and rosemary dried by nature in the hot Provencal sun.
Two days ago a visit to a local goat farm has supplied us with a variety of cheeses from frais (just three days old) to demi-sec (two weeks old). There were 33 goats, all named beginning with the letter N. I hugged and thanked the goats (my favourites were Naf Naf and Nounou. Mark liked Nebulues).
The wine, Rose, yummy….. difficult not to over indulge. On the plus side the 16 hour fasting continues, but not today because we went to market in Aix-en-Provence.
The weather has been hot, eased by the occasional thunderstorm and gentle breeze. With the sunshine and fresh local tasty food I really do feel healthier. A bit more sleep would be a bonus but at least now the mosquitoes are leaving me alone (many thanks to all my Facebook friends for their mosquito repellent tips)
Mark’s Dear Diary, En Provence Sunday, 7th July.
The road was straight and to the point. The point being the market at Pellisane. It was Sunday but no church bells could be heard. The mass of people moved slowly, like waves, to their centre of concentration, which ever stall caught their eye or the scribbled words on their hastily written shopping list. At first glance, from the eyes of an amateur in these affairs, the market looked a small affair, one long street zoned off with tightly packed stalls of every shape, size and variety. All seemed disorganised and jumbled, organizationless, but I’m certain all stall holders knew there patch and were accustomed to the area they flew their commercial flag having done so for many, many moons. Dogs, children, babies in prams or in the arms of their guardians swelled in the midst of human traffic. It was truly a sensory sceptical and event. The market grew as we saw over the heads of people around us alternative avenues of trade going left and right, east and west. We would remember and return to them, as was the difficulty in diverting and losing each other in the melee.
The human sounds blended with the intensity of the constant insect hum. Super market music could not compete. This was no supermarket, Artisans and stall holder spoke out to the crowd like a demanding Priest to a silent, sleepy congregation. Please, thank you, good day or good-bye was heard frequently at every turn, the slow momentum held us up every so often as a conversation became elaborate, no one moaned or complained, patience it seemed was in abundance. Food smells were met with occasional tasting to add, additionally, flavour and meaning to the sights before our eyes, to tempt us to purchase, not to gaze, but to part with real money. Only out of the corner of one’s eye, if you cared to carefully look, emblazoned up a wall nearby was a predictable sign of McDonalds and a direction to its operation in a nearby street. Modernity had to try a lure the blessed to the fiery hell of the ultra processed, commercial, and ultra predictable.
Fruit drinks and sugar sweetened beverages were the only semblance of that vast beast being consumed that hot Sunday. Far less by volume than what we saw a few days previously in Borough Market, London mercifully. We’ve avoided these things, on purpose. Why the need for that when nature and seasonality was so barely naked amidst us? Soft berry fruits, fresh from the less sun beaten north, super coloured, gnarled and misshapen peppers and tomatoes were present and incorrect but just as tasty, forgotten by the big food chains as imperfect. Even artisan bread, weighed and sliced to order, joint the throng of the nutritionally possible and plausible. Comte fromage, in huge wheels and chunks was cut to preference by its maker, cigarette in steady hand. The price was discussed after it was chopped, sealed and weighed, we just obliged. Pure theatre.
Lambesc is a great place to stay. We didn’t really have prior knowledge of Provence but Toni took a guess and got it perfect. Quality Extra Virgin Olive Oil, Rose wine, local markets, Lavender, Sunflowers, honey, foraged herbs and the pulsing hum of insects everywhere. There is a passion for the land, for community and provenance. History is within reach, the Cathars, Templars, Pilgrims and Romans. The French people still smoke more than I’m used too, still walk with the traditional baguette under their arm and look as if they are totally classless. We enjoyed many things, some too much, others a lot these than before. Would we come back again? Qui!
Captains Log – Supplementary 2
It’s our 33rd wedding anniversary today, the years seemed to have passed quickly. I’m still 20 years of age in my heart. I’m super happy to still be here with Toni in our collaborative journey with a bottle of wine that tastes like her and a glass that’s never empty.
Le Dordogne, the very name ironically evokes our past, be it hunter-gathering paleolithic’s, early farming neolithic’s, troglodyte medievalists or, of course, the present and we modernists. When you step into this vast area of central France you are wrapped, like a warm cloth, in a rich variety of culture, history, nutirtion, nature and more besides. We had made the long trip north by car via the Longuedoc and the Lot Valley to Salignac, approximately 5pm from the centre of Perigueux. The countryside was immense, the trees were mainly European Oak and a huge variety of nut trees too, Hazelnut, Walnut and Chestnut, either in orchards or randomly sown. This was probably the first indication of the food culture to come. The Dordogne is also the historic centre of the European hunter gatherer with caves displaying the art of our ancestral past, food, especially animals being centre stage. These are World heritage sites and are a welcome indication of what they hunted for and valued as food.
The little village of Salignac was a short 30 minute walk from the campsite and we took very little time in our pigeon French to ask the local natives directions. Through the wildwood we traversed and found it in no time. It is really a Bourg, not a village, something a little bigger. There were the cafe’s of course, the supermarket was on the fringes of the town, kept just out of sight but more in its gentle centre was the Grower’s market Shop, a treasure trove of what the region offers open everyday. The town centre, a small but significant affair was the venue to twice weekly markets, on Saturday morning and Thursday evenings. The later was also a time to commune, abide and take food cooked from the market and sit with the locals, or your neighbours, and eat what you smell and see cooking. A band played and the food and drink flowed.
We decided not to travel too far, we being unlikely tourists, we did need to feed, and consequently and earnestly we found the right places to shop for food in the local produce market in Sarlat – la – Caneda and the Grower’s Shop in Salignac. They displayed locally grown foods like nuts, nut oils, foie gras, pate, duck and truffles, of course. The additional staples like breads, vegetables and salad were also in seasonal abundance.
However, cooking ourselves was one thing and a total delight but getting a real food experience led us down the proverbial lane. We went to two places, one a Relais or Inn and a Ferme Auberge, a farm guesthouse come eatery. The later was the pick of the bunch and I’ll come back to that later. A bigger quest lurks in the shadows, and one that has spawned controversy and still does to this day. That being “Fat” and poor health outcomes, especially heart disease and weight gain. In the Dordogne the history surround fat, especially saturated fat is everywhere, but also other kinds of fat too, mono and polyunsaturated fats from locally caught fish and nuts pressed into oils or just plain raw. Saturated fats are an enigma it seems, a paradox even to some. Why are the French supposedly statistically healthier? As are the Swiss? The French go about their lives with a reverence for (quality) saturated fats, its in their blood culturally and physically. There is talk about a paradox, fat making them healthier in combination with wine, especially red, and living longer. This has been said to be similar overall to the UK in terms of mortality with a time line adjustment, reading the statistical data correcting and accounting for a difference in post-mortem reporting. I’m not so sure of that reading the report and references. I still think there is more to it than quantitative measuring, surely the lifestyle of the French, testing their sleep and movement history, stress levels, full dietary habits, community and value systems, especially in the rural areas accounts for some of the mismatch in data.
So what is the skinny on fat?
Week four of our learning journey continues as we head north from The Dordogne crossing the pilgrimage paths of Limogues and Perigueux. We pass wandering pelligrino’s near the Cathedral city of Bourges having sadly not, ourselves, being able to get to the pilgrimage centres and staging posts of Avallon and Valencay. We arrive at our destination, a small campsite next to the River Loire in sweltering heat and find a moment to get over yet another long drive. The Monday was set to be 38 degrees and we had made the unwittingly odd decision to kayak 25 kilometres downstream from La Charitie-sur-Loire, to the east to St.Satur (Saturday related I’m sure) along the River Loire. The recent heat waves in France had put pay to a conventional kayaking journey like we’ve done before, the shorter route from Pouilly-sur-Loire on the left bank of the river half way between our current route.
For those of you not hardcore wine buffs this is the area of France where the Sauvignon Blanc grape found it’s roots and later day fame. The Kiwi’s, Aussie’s, South African’s, American’s, both north and south, have made huge commercial enterprises from bringing this humble grape to the forefront of our vinous appetites. This is where the legend of the Sauvignon Blanc wine grape was born and continues to set the traditional standard of sunlight and water capturing the essence of the “terrior” and create a thing of liquid beauty.
The outward bound adventure team, conveniently positioned just outside the campsite, took us with kayak to the start point. We were advised to move very carefully from the get go. We thought the river, being very low, would be an issue and memories of grounding on previous trips made us initially cautious but to our surprise the guide pointed out several black stumps pointing out of the river. These were the wooden supports of a Roman bridge long disused and normally hidden by the water level. This was the first of three to traverse on our 4 hour journey. Arriving back at St. Satur we paddled through third ancient bridge and then under the current bridge, a vastly mored modern one, through the rapids and back to base. The 4 hour journey had been testing, Toni behind me navigating the shallows and rapids and the sun beating down. Thirsty doesn’t even come close but we made it and ticked off the bucket list.Kayak awaiting the journey from La Charitie-sur-Loire
The theme of week 4 determined itself. We started our wine journey in New Zealand, not when we lived there but after a bottle of pioneering, gooseberry cum blackcurrant leaf note driven Savvie in the UK in the mid 90’s. We visited Martinborough, to the east of Wellington and Hawkes Bay but never Blenheim. Ironically we ended up living there for 5 years for professional reasons and ever since our wine knowledge has grown but also our opinions and behaviours towards it. A lot of what we feel about it now stems from the environmental and ecological debates that rage regarding use of herbicides and pesticides locally and their toxicity not only to humans but also the good earth. It’s sustainability seems in question when talking with exponents and detractors of modern winemaking. Will the Marlborough plains of the Awatere, Wairau and Whaihope be destined to be a toxic waste land long-term? It’s a concern that has partially influenced our decision to move westward to Nelson.
Back to France and the heat the first night in St. Satur. We decided to call our local friends Lynne and Philippe, 12 kilometres from our riverside base to see if we could stay there and cope with the climate better. We were welcomed with the big wide open loving arms of the Raimbault’s of Sury-en-Vaux. The village name literally translates to the “Sound of the Moo”. Generations of Philippe’s family have tended the land and vines, his father, born in September 1940, was celebrated not only by his family but the occupying local German Army. Their cave in Sancerre, during the same war, was a safe haven for downed allied aircrew and special operation executive members. The rich vein of cultural winemaking heritage runs deeply in many families and communities of the region.
Raimbault Family Provenance
Sancerre sits south of the River Loire and covers approximately 3,000 hectares of vines with around 300 wine makers following the rigid Appelation Origine Controlle (AOC) guidelines that strictly determine the growing and production methods and processes of France at that quality level. Any deviation from that creed is closely scrutinized and punishment for even the smallest of misdemeanors can be severe. To that extent the art and craft of wine making and vine growing is culturally important and the has been so for many generations.
Philippe and Lynne are a unique, kind and affable couple. Lynne is a “hard case”, a “Legend”, to us, a kind and compassionate London lady who meet Philippe in a bar in Sancerre many moon’s ago and the rest, as they say, is history. Their vineyard is set in a little village on the fringes of Sancerre in a traditional small village called Sury-en-Vaux. Philippe’s vineyard spans the region from Sancerre to Pouilly sur Loire, with small parcels of land scattered throughout the region. We meet them some years ago when we stayed in Sancerre and keep in touch and meet up again from time to time.
This time I took the opportunity, despite the hot weather, to follow Philippe on a work place journey at his cave just for an afternoon. Philippe and I just about understood each other in his version of my language and vice versa. We both drove off from their house several kilometres away to Domaine Philippe Raimbault, the Cave and his workplace. Once there I got the guided tour, from the desteming and depipping machines of harvest to the huge hectolitre chrome wine tanks and the cool cave where the Burgundian barrels are stored for the fermentation and maturation of his red Pinot Noir. A lot of care goes into all of his processes of wine making, this day the red wine seemed to require more attention as sulphur tablets were added to each barrel after samples were sent to the local laboratory for analysis. I questioned Philippe regarding this “addition”. His answer drew focus to the need to get to optimal levels of tannins and balance before bottling, the chemical also gives and antioxidant and antibacterial benefit to the wine and ultimately the wine lover.
Red wine, more so than white wine (the skins are kept on during fermentation), has been proven to be beneficial to health in moderation, the flavonoids, of which there are 4 groups, catechins, flavonols, anthocyanins and tannins are the benefactors. Red wine also has 3 times the Riboflavin of white wine. Among the many benefits attributed to flavonoids are reduced risk of cancer, heart disease, dementia and stroke. More than 100 studies have shown that moderate alcohol consumption is linked to a 25-40% reduction in the risk of heart disease. They work by corralling cell-damaging free radicals and metallic ions. Resveratrol, another antioxidant, is found in the grape skins, is linked to fighting inflammation and blood clotting as well as reducing heart disease and cancer.Officialdom and Strict Guidance
We continued the day and travelled to Les Godons, the nearest vines to the centre of operation. He is a man of quiet passion, aware and alert to the health not only of his maturing wines and bottling production line, you’ll find his white Sancerre, Apud in Waitrose, but also of the land. A keen observer of the holistic and near organic approach to his art, Philippe with friends, have designed and built wooden dwellings for the local bat population. Bats, far from being an additional menace have many useful functions, looking at their droppings allows science to demonstrate the health of individual bat and colonies, as well as their insect food sources. They are positioned in a variety of areas, against trees that abut the vines and on nearby buildings as well. He also has a bat radar that measures the type, number and time they’re active. They play an important role in reducing the insect numbers, especially those which affect the grapes themselves. Also in use are insect pheromones at the end of the row of each vine and a smelly organic odour spray is being tested soon too.Home for bats
The whole theme continues with Philippe’s association with Terra Vitis, a growing organisation dedicated to promoting a whole approach to winemaking, not only is the health of the vine paramount but also the soil and, remarkably, the welfare of the staff too. Paperwork and compliance are other duties of the winemaker these days. Extra attention is also given to the choice of wooden barrels, not only the capacity, Bordeaux barrels store less the Burgundian, 225 liters to 228, but also the quality of the Oak. Philippe mindfully chooses them from specific areas of France where the porosity and permeability of the wood is less, allowing the wine to mature to its specified design and taste. This is used more so in red but also in white where the oaky, vanilla notes are desired. Corks are still in use too.Bat radar and pheromones
We both discussed each others work as we motor around the wine region, touching on the amount of sugar per litre of wine required for fermentation and achieving an ideal level of alcohol. Of the 200 grams per litre most, if not all, is consumed by the yeasts and left only is a residual amount of between 1 to 2 grams. From a dental perspective attention needs to be focused not only on the remaining mainly fructose monosaccharides but also, and perhaps more importantly regarding wine, its pH. Having working for several years in the Marlborough region of New Zealand I’ve noticed the effects of a poor, modern industrial diet on many a client regarding caries but specifically with the wine industry regarding acid erosion and tooth surface loss, whether through abrasion, attrition or abfraction. Tooth enamel demineralises in pH values below 5.75 and far less with exposed weaker root structure compose of dentine. Over time with increased regular exposure tooth structure can disease and be lost. Lower pH values intra orally also allow destructive bacteria to flourish and remove tooth mineral as well as reduce the numbers of beneficial germs that thrive in higher pH scenarios.
Relative pH of drinks
In New Zealand, the biggest wine making operation, Peter Yealands, recently approached me to create a protocol for their wine makers. Research was untaken, guidance produced and products purchased ranging from electric toothbrushes to calcium phosphate based toothpaste and sugar free gum for each individual. Whitening trays were also produced to allow the the remineralisation of teeth to be more effective as the product stayed in place longer. I discuss with Philippe, as he chomped merrily on sugar-free gum, the dental benefits of stimulated saliva flow with an increase in pH balance, an influx of minerals and ions from the saliva and the promotion in balanced or higher pH of beneficial calcium “building” bacteria to remineralise the affected tooth structure. The sugar alcohol debate regarding Xylitol wasn’t broached this time. Touched on too was the use of calcium phosphate toothpaste with stannous and other types of fluoride in adding their bioavailability to the teeth for further protection and strengthening.
My Remineralisation and Risk Reduction Protocol
Awaiting shipment, Les Godons Sancerre
Both dental health professional and wine maker have similar aims and goals, creating an end product that needs to be managed and maintained. We deal with bacteria, teeth, gums, bone and behaviours, they with weather, soil, fruit, yeasts, bacteria and the seasons. Both deal with envronmental pressures. We both see things environmentally and ecologically and play a game and a merry dance with similar external, internal, negative and positive pressures to achieve success. Philippe’s work environment is the weather, the soil and the vine married to the patient process of picking, gentle crushing of perfectly ripe grapes and fermenting wine, allowing nature, bacteria, yeasts and time to capture the essence of Sancerre. Ironically too, The Romans, had to deal with the land and the water, they carefully selected the right materials to support the bridges that allowed access over the wide French rivers they faced to control the environment, the natives and their empire, their environment. Those ancient wooden bridge supports stand testimony to the pressures of weather, water, sediment and the microbiome of the river, over nearly 2,000 years, preserving them.
Sources and further information
It was a hard drive in heat to Champagne after finals with Lynne and Philippe. We decided early in the week to not attempt the long trek north early in the morning to get to Charles De Gaulle International and risk missing the onward flight. Our attention turned to staying in Champagne with an old acquaintance in Mailly Champagne, a little village in the Grand Cru Blanc de Noir region south of the capital Reims. We’d visited it occasionally way back when and returning was a chance again, like in Sancerre, to catch up.
One of the previous “flying” visits saw Toni and I drive south from Weybridge to Mailly over a Friday afternoon in March 2009, on her birthday. We had booked into a local restaurant, Relais du Sillery, near to where we were staying. I had called ahead of time to Anni France Mailisart, the owner of the nearby bed and breakfast to ask her to confirm with the restaurant the time and that it was Toni’s birthday too.
Not only was the evening special but Anni France hauled us rapidly into her 2cv6 van and raced us to the destination after we arrived, just in the nick of time. The meal and wine, a Mailly Champagne Grand Cru, was outstanding but the total surprise came at dessert when unbeknownst to Toni, out came a birthday cake with fireworks exploding out of it. The whole restaurant stood up and burst into song. Happy birthday was sung with gusto in the way only the French can do. We felt touched and very honoured.
Anni France Mallisart is a kind, generous and hard working individual, looking after a brand new Chambres D’Hotes that sits on her champagne cellar and press. We found her new place eventually, parked up and welcomed renewed friendships.
We had booked, once again, into Relais de Sillery and prepared for an evening out. We had looked at the online menu and decided, mainly due to cost but also out of nutritional intrigue to select the Fricassée de Ris et Rognons de Veau aux Champignons. Pancreas we think and obviously Kidneys, Wild Mushrooms and New Potatoes in a jus.
Sweetbreads are in the offal (variety meats) group and so are meats coming from organs rather than muscle tissue. Sweetbreads come from two organs, the thymus (sometimes called the throat sweetbread) which is an organ from the immune system and the pancreas (sometimes called the stomach sweetbread) which is an organ from the digestive system. Usually sweetbreads come from veal or lamb or occasionally young pigs, but veal sweetbreads are the most popular. Sweetbreads are seen as the most prized offal meat due to their mild flavour and colour and their rich, velvety texture.
However, a bigger question, And one posed by our good friends Ralph and Hanna back at week 1, is not how it’s cooked and how much it costs but whether offal or organ meat is nutritious. In the past organ meat was valued more than it is now. Hunter-gatherer and native Peoples valued it above muscle tissue (meat) leaving it to their animals to consume. They also ate intestines, brain and testicles. Vitamin’s A and B12, folate, iron and protein are rich in offal, and anti-inflammatory Omega 3’s are found in brain. Liver is particularly nutritious.
Vitamin A comprises a group of organic compounds including retinol, retinal, retinoic acid and beta carotene. It plays a key role in eyesight, teeth and bone development, reproduction and the immune system. Plants and microorganisms make their own Vitamin A but we have to get it from our diet, animal food sources of the active form than plants. Cod liver oil is a particularly good source and has Vitamin D and various beneficial fatty acids too.
Source, The Dental Diet, Dr. Steve Lin. Pages 74-75, 174-175, 2017.
After recent discussions with aging parents and in-laws about their first food memories, during and after the War, a common tread was being ritually forced, at school, to consume fresh full fat milk, apples and, interestingly, cod or haddock liver oil. In my day we got just milk and apples.
A 3.5-ounce (100-gram) portion of cooked beef liver provides; RDI (Recommended Daily Intake)
Eating organ meats has several benefits:
The drawbacks of eating too much offal are minimal, but high levels of Vitamin A are not indicated for pregnant women and those suffering from gout don’t benefit from Purin, a dietary form of Uric Acid.
From the dental perspective Vitamin’s A, B6 and B12 have essential roles to play in preventing dental diseases and deficiencies can result in enamel hypoplasia, xerostomia, gingivitis, gum disease and its use as a nutrient in oral leukoplakia and submucous fibrosis. In children B12 deficiency is linked to increased caries and gum disease risk. Vitamin B6 is, again, associated with gum disease risk and anemia related sore tongue and burning sensations in the mouth.
It maybe appropriate from a dental health perspective to encourage moderate consumption of offal rich in A and B vitamins. Vitamin A may also be particularly important in early facial development too. Vitamins A with vitamin D essentially tell our cells to produce certain proteins—osteocalcin and MGP—that help build and repair teeth and bones by taking calcium where it needs to go, among other things. But for the body to use these proteins, it has to call on vitamin K2 to activate them.
Continuing Professional Development
Burgess Hill is on the rail line to Brighton, the venue for a Periocourses dental update I’d booked several months prior. The course leader is a former RAF Dental periodontitis of my acquaintance. We’d pasted each other going from and to Saxa Vord, a radar outpost in the very north of the British Isles in the mid to late 80’s. Phil Ower is a dental legend, gentle, softly spoken and very engaging. Recent changes to classification of gum disease and a mindful re interpretation of it by him and his colleagues that makes more practical sense to the coalface clinician.
Phil in action
The statistics for poor dental gum health are staggering. 98% of the UK have gingivitis, 10-15% of gum disease to the extent of losing their teeth. The primary culprit is the oral bacteria out of balance, causing inflammation and altering the host response as a consequence. The oral microbiome, the collection of microorganisms in the mouth, is complex, they communicate chemically and electrically, they are symbiotic, constructive, protective of themselves and collaborative. Factors that affect host response include;
80% of hard tissue damage(bone loss) is caused by how the body responds to the pathogenic oral flora. Interesting learning outcomes to the course indicate a developing nutritional and lifestyle bend to diagnosis and treatment. These include the need to test perio cases for prediabetes and diabetes, and a HBA1C glycated haemoglobin blood test is indicated. A 3 day diet sheet might be appropriate but I disagree with Phil regarding saturated fat, especially quality saturated fat. The culprit in my eyes is refined sugar and ultra and processed foods, less nutritional dense but more energy dense and glycating inflammatory foods. Something to chew over on another occasion me thinks.
Wells and our wonderful Whanua
Two journeys and two days later we arrived in Shepton Mallet, Somerset. We went via good friends Sue and Chris and Dave and Rachel once again. The later will feature on their own in a future post, their journey and influence on ours is immense.
Shepton Mallet was our staging post for a very special occasion. My step-mother Audrey, now living in Wells, Somerset was celebrating her 80th birthday. She’s been a widow for many years now and had recently moved from her home established with my late father to a retirement lodge. A big move at such an age.
Toni, Audrey and myself at the Halfmoon Inn, Melplash, Dorset.
I’ve not always been on her wave length but recent years have seen me in particular change my position. I’m only human and had issues that needed correcting. I’m a better man for it I feel. We discussed many things together, I was very interested to learn about her nutritional life journey, being an evacuee during the War, being trained down to Wool, Dorset, with her twin sister Shirley. It brought on many changes, dietary too. After the War and after the post rationing period Audrey become the secretary to the head of Coca Cola Europe, her stories regarding that and a stint as a rep for Birdseye span the nutritional changes that shape our current, unhealthy food environment. Little did we know or were allowed to know in those days. This story of Audrey’s will develop into further reading. We enjoyed her fellowship and were very pleased to see and be with her.
St. Cuthberts Church, Wells
Recently attended church sermons had taught lessons of atonement and redemption and the benefits of being forgiven, forgiveness and behaviour change. Not being religious but believing in our spiritual connection with nature, I find organised religion an ongoing challenge. Things that bring us together should be greater than that which divides us. My philosophy, if it is one, is to treat all the way I want to be treated, compassion before reaction, forgiveness before judgement and loving kindness that dispels fear and promotes a fellowship of peace and harmony.
That’s not to say the church doesn’t do good, it certainly does but the physical building is a just like Mother Nature from the canopy of the ancient elder forests. We aren’t separate, we are connected in physical fellowship with each other and everything around us. When we do things wrong we need the courage to accept it, make changes to ensure it doesn’t happen again, offer apologies and move on. Redemption and atonement can be found everywhere, be it on a Sunday at church with others, after offending someone at work or at home. Even offering something in return as a demonstration of atonement, perhaps your time, energy or a certain future behaviour change…..
Yew Tree and Cathedral
Wells Cathedral is immense, but at the same time simple. The Yew Tree in the centre of the land acts like a natural nucleus far from its pagan origins. The imposing building houses one the oldest clocks in the World, a stripped back interior in comparison to the less austere Winchester Cathedral. Outside in the nearby market square is a twice weekly market. Nothing comparatively to those of Provence and The Dordogne, Britain doesn’t embrace its deep food history cultural, have the days of Empire have turned the focus on conquered foods rather than that which sustained us before and during those times? Despite its paucity Wells Market presented some treasures. The Bagnell Farm stall had rare breed meat from their Ruby Red cattle, Jacob sheep and Iron age pigs, others had local cheeses, colourful vegetables and a variety of pies and pasties.
Cathedral thinking and Extinction Rebellion
On a completely different spiritual level and something that ultimately affects us all, young or old, even rich or poor is climate change. The deniers, the rich and powerful, those with scientific and critical minds or those blissfully unaware of the catastrophe that will befall us need to wake up. Let’s not deny, obfuscate or ignore any longer, we have a climate crisis. It’s torch has recently be taken up from the most obscure and determined of individuals and is virally spreading through global culture through deep activism.
Swedish environmental activist, Greta Thunberg, a 16-year-old young lady on the spectrum with ADHD and Autism is capturing the imagination and opinion of those who want to see climate change with a change in our behaviours. She subscribed to “Cathedral thinking”.
Thunberg said that “Notre Dame will be rebuilt, I hope its foundations are strong, I hope that our foundations are even stronger, but I fear they are not.” She points a finger at World leaders “If our house was falling apart, our leaders wouldn’t go on like the way they do today [in tackling climate change]. You would change everything you do.”
She listed how humans were causing “climate economical breakdown”, such as deforestation, air pollution, the extinction of animals and the acidification of oceans. Accusing world leaders of being too relaxed in tackling climate change, she said that she wants leaders to panic, evoking an image of a house on fire, comparing the Notre Dam event to the climate emergency.
Spiritual change maybe considered optional but environmentally, sustainably and climatically the situation is far from a lottery. That maybe the biggest challenge to us on our return to New Zealand. Extinct Rebellion might become the activism we find occurring in our everyday home and workplace environments. More to come on this subject is inevitable.
The Litton and Cousin Sally
On a less sombre note and one that I’m proud to say I have a certain degree of genetic association with is The Litton, a destination pub, a place people travel to and stay and use as a base for visiting local sites and attractions. The likes of certain 80’s pop heroes and International artists travelling to play at Glastonbury nearby are regularly visitors. It was once a ruin until a certain Sally Billington, my cousin, had a moment of madness and decided on a whim to act. It is a passion project like no other. Sally’s eye for originality and retaining its former glory is demonstrated in her mission statement, “Tradtionally Untraditional”. She has an indoor and outdoor restaurant, a bar selling local craft beers and a whiskey bar dating back pre Sally times and some. Renovation and resurrection leach out of every seam. Attention to tradition morphs into the food philosophy too, locally sourced and seasonal dishes are available to those wanting something homely and comforting. Audrey, Toni and I opted for Sunday Roasts, mine, Roast Beef was very hearty and generous. It filled me but not quite enough for a Sticky Toffee Pudding to top off the occasion. Sally afforded precious moments to catch up with many years of lost opportunities to be as we once were back in the early to mid seventies. A guided tour followed and parting was as the immortal bard put it “such sweet sorrow”.
Sally taught me a few things that day at her Litton. It has taken her years of dedicated effort, frustration and delight, moments of despair but also of great of joy and meaning. She manages dozens of staff, pays them well, has programmes that support their welfare and development and like Philippe in Sancerre, and has a hands on and very present approach at work. She is very honest and sincere, is aware of the need to continue to improve through feedback from customers and is super proactive and direct when need be. She’s modest too, not displaying her awards and gongs too obviously. I’d, for one, would love to work for her. Please call Toni and I whenever you want Sally, we’d be straight over.
I’m sitting aboard NZ1 bound for LA pondering this reflection. the changes we are witnessing environmentally are happening at 38,000 feet. Plastic cups are being used on the flight but the cabin crew have asked all to keep to using one cup. The problem still remains with them wearing disposable gloves as they take back the food trays. Interesting eh? We’ve gone one step further and are keeping the plastic cutlery too.
It’s not enough to write everything I feel at this moment and make it more meaningful. I’m creating a carbon footprint as I write, am I a hypocrite or just continuing a journey which is thoughtless and perhaps even a little touch of hedonism? What I am certain of is my future will be different, less unsustainable, more activistic, less consumptive and more aligned with what I’m learning about and with whom I’m learning from.
Week 6 will take us to Scotland, Royalty, natural splendour, family once more and intimacy with nature once again. Amen.
Some people don’t think walking counts as proper exercise. “This is a terrible mistake,” he says. “What we need to be is much more generally active over the course of the day than we are.” And often, an hour at the gym doesn’t cut it. “What you see if you get people to wear activity monitors is that because they engage in an hour of really intense activity, they engage in much less activity afterwards.”
A recent report by the Ramblers and Macmillian Cancer Support details the health benefits of the humble walk stating it could also lead to nearly 300,000 fewer cases of type 2 diabetes. In some cases walking can be more effective than running. Scientists at the Lawrence Berkeley National Laboratory in California, found that brisk walking reduces the risk of heart disease more effectively than running. They observed participants aged between 18 and 80 over a six-year period and found that walking reduced the risk of heart disease by 9.3%, while running reduced it by 4.5%.
Additionally 30 minutes of brisk walking over five days could help you sleep easy, according to research by Oregon State University. A study by the university showed that walking helped participants sleep better and feel more alert during the day.
The first rule of exercise is always engage your core muscles. This is particularly important in walking because you are upright the whole time and supporting your entire body weight. So tighten your stomach muscles. The best way to do this is to make sure you are not slouching when you walk. Spinal alignment is part of this core strength. You should stand up straight, trying not to lean too far forward or backward with your chin parallel to the ground.
Once you’ve mastered the 30 minutes of exercise per day, changing your walking route is a great way to keep motivated. Walk up hills for a great glute workout. Or if you are exercising in a gym, increase the incline for a similar effect. Walking uphill uses more energy than walking along flat surfaces.
Walking is a great way to connect with nature. Green Exercise, the Essex University research team that have been studying the benefits of walking in green spaces (PDF), found that it reduces stress levels, improves mood, enhances psychological wellbeing and improves attention and concentration.
Walking also helps the planet. By parking the car up and walking instead, you help to reduce air pollution. This is particularly important for short journeys. Taking the car for short journeys uses almost twice the CO2 per mile. So leaving the car keys at home, helps you and the environment. Recently the Woodland Trust suggested forest bathing – which doesn’t, despite its name, involve getting in water – should be among a range of non-medical therapies and activities recommended by GPs’ surgeries to boost patients’ boost wellbeing.
“Forest bathing is an opportunity for people to take time out, slow down and connect with nature. We think it could be part of the mix of activities for social prescription,” Stuart Dainton of the Woodland Trust. “Evidence about its benefits is building. So called “Social prescribing” is a growing movement in the NHS, can include volunteering, gardening, sports activities, cookery and befriending.
Gary Evans, who set up the Forest Bathing Institute in the UK last year, said: “People initially think they’ve been doing this all their lives: going for a walk in the woods. But it might be a brisk walk, or you might be worrying about where the dog has got to.
One UK study, carried out by King’s College London and published in January 2018, found that exposure to trees, the sky and birdsong in cities improved mental wellbeing. The benefits were still evident several hours after the exposure. “Even just 20 minutes can help, though 10 hours a month is even better,” said Dainton. “If you live in a city, you may not be able to get to a forest easily, but taking off your shoes in the park and feeling the grass will help you de-stress.” Healthcare professionals, politicians and charities alike should encourage these physical behaviour changes.
The bus journey from London Heathrow was a welcomed change, a lazy, laid back White National Express coach ride along the chocked up M25, onto the M40 and arriving at the A404 coach stop. We had arrived in High Wycombe. Our hosts, Mark and Rose, have been our families UK hosts for a number of years and we too, from time to time, have been theirs. We’ve know each other for over two decades and have seen each other’s families, and ourselves, grow up and older. Both Mark and Rose have a remarkable passion for their family, their children and grandchildren, of which there are quite a few.
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