Progressive Dental Nutrition? Relating the Lessons of the Past with the Present. Weston A. Price.
“We can now visualise our universe, its light, gravity and heat, its seasons, tides, and harvest, which prepare a habitation for the universe of vital forms, microscopic and majestic, which fill the oceans and the forests. We have a common denominator for universes within, and around each other, our world, our food and our life have potentials so vast that we can only observe directions, not goals. We sense human achievements or ignominious race self-destruction. Every creed today vaguely seeks a utopia; all have visualised a common controlling force or deity as the most potent force in all human affairs. Yes, man’s place is most exalted when he obeys Mother Nature’s laws.” Weston A. Price.
Have you ever heard of the name the Weston A. Price concerning your dental training or current practice? In all of my 30 plus years in dentistry, I must confess, until recently, I hadn’t. My first exposure to him occurred during a visit to a highly recommended Chiropractor. He was reasonably alternative, as was Price’s reputation, but respected highly by the person who recommended me to him, my Principal Dentist. Talking to and researching their website brought my attention to Price and their mistrust of fluoride. The warning bells were ringing loudly, but in conversation with him, I began to reappraise my position and reconcile the biases and controversy related to his work, and reflection on them. If you claim to be a holistic practitioner you, I hope, would be well versed with Weston A. Price’s work, just as, if you were a nutritionist, you’d be aware, as well, of the controversial academic and scientific work of one Ansel Keyes.
If you carefully delve into the dental literature and research, you will find it very difficult, if not almost impossible, to uncover anything related to Price. Ironically, the research and publications he undertook in the early decades of the 20th Century, a revolutionary and controversial book published in 1939 revealing his theories on subjects from root canal treatment, soil health, sacred foods to the development of the face and jaw can be found elsewhere. His work is seen by some as the forefather of the popular Palaeolithic dietary and Low Carb nutritional movements with echoes extending to progressive oral health approaches in the treatment and preventing dental diseases like caries and periodontal diseases. Interestingly, the New Zealand Dental Council includes the phrase “holistic” in approaching treatment in its guidance for professionals and encourages collaborative engagement with fellow healthcare professionals as part of our practice standards. It appears that the times are changing so let’s dig a little deeper into this subject.
“Life in all its fullness is Mother Nature”. Weston A. Price
Weston A. Price ( 1870 -1948 ) was born in Ontario, trained and graduated at the University of Michigan as a dentist in 1894. He set up his first practice in the same year but feel ill with Typhoid shortly after. His health was severely affected, and a period of convalescence brought him to the realisation of his future higher cause. He decided to direct his attention to the study of “healthy traditional cultures all over the world”. This may have also brought the birth pains of the focal theory of infection to his attention. This theory proposed that infected teeth should be treated by dental extraction rather than root canals, to limit the risk of more general illness. He spent 25 years working and researching with root treated teeth which lead to the publication in 1925 of Dental Infections and related Degenerative Diseases. Price’s next publication Dental Infections, Oral and Systemic, was used as a reference in textbooks and diagnosis guides published in the mid-1930s. Both contributed to the widespread acceptance of the practice of extracting, rather than root treating, infected teeth. By the mid-thirties his work was widely challenged and fell out of favour. Needless dental extractions were seen as too extreme when infected and diseased teeth could be restored and masticatory units maintained. Ironically, as we know now, the foods we eat need molars and other teeth to break down and allow not only passage through the digestive tract but also to gain maximum nutritional value from it. Without teeth, be they unrestored or not, we don’t fully, nutritionally benefit from what we eat. Efficient digestion requires the food to be well masticated. His focus soon aligned to the subject of traditional nutrition of communities uninfluenced by modernity by began a global learning journey to ascertain whether the “health of the body is reflected in the health of the teeth.”
“Tooth decay is a symptom, not a disease… it is evidence of faulty nutrition”. Weston A. Price
In 1939 Price published his now seminal book “Nutrition and Physical Degeneration” and claiming that “eating a nutritionally dense diet of whole foods, grown naturally in healthy soil and prepared in a traditional method” producing “nourishing and digestible foods enabling them to build strong and healthy bodies, sustainable over generations.’ His work led him to the conclusion of the power of “sacred foods”, such as “unpasteurised dairy foods, offal, pasture-fed animal, seafood, in particular fish eggs, cod liver oils, fermented foods like sauerkraut, kimchi, kefir and animal fats”. The lack of which, he believed, led to “dental caries and deformed arches, resulting in crowded, crooked teeth was a sign of physical degeneration as a result of suspected nutritional deficiencies”. This was due to his close observation and critical study of isolated communities around the world in that period. Price, it is noted, used chemical testing of soil, food quality and the prodigious use of photography in his work. He observed what he described as disease-free indigenous populations with “straight teeth”, “stalwart bodies”, “resistance to disease” and “fine” characteristics, associated with their traditional, nutritionally dense diets.
Interestingly too, Price also alluded to an unknown but healing component which he defines an “Activator X”, found in butter oil. Price concluded that butter, which was produced from rapidly growing grass in the spring, had higher “Activator X” levels than butter produced during the rest of the year. This “vitamin like activator” was to be better understood, after the Second World War, as Vitamin K1. He also deduced that modern processed foods lacked this and other essential vitamins and minerals due to modern food processing effects.
“For humanity to survive, it must eat better – foods must be whole, fresh and unprocessed.” Weston A. Price
Price’s detractors cite poor observational analysis, a simplistic scientific approach and confirmation bias. They claim, also, that he ignored native people who weren’t healthy, and that those who were in contact with European and modern civilisations were affected by diseases unfamiliar to them historically. They claim, with their own confirmation biases, that modern food is wholesome but native people “overconsumed” and didn’t balance their diets correctly.
“The most serious problem confronting the coming generations is the nearly insurmountable handicap of depletion of the quality of the foods because of the depletion of the minerals of the soil”. Weston A. Price
Let us look further back than Price’s influence on the nutritional debate, but perhaps something he may contend today is as essential, that of our very distant ancestors. Fossil records go back nearly 14 million years with Ramapithicus, found in Africa. Our cave-dwelling forefathers evolved over time in different habitats, with different foods, and began to migrate north living and eating seasonally. The lived and worked in communities to hunt and gather foods, designing tools and weapons, working in teams collaboratively to achieve their nutritional necessities. In the mid 20th Century, different hypotheses examined the changes in dietary cultures, meat-eating, seed-eating and, in particular, the Extensive Tissue Hypothesis which related brain and gut size in human evolution. The control of fire, the preparation of starches and meat led to increases in the energy gained from food in comparison to the raw form. The cooking process increased digestion, higher blood glucose, the energy gained through this process increased by nearly 30%. Interestingly too, the human microbiome, a mass of trillions of bacteria, is also responsible for 6-10% of daily energy supply, creating short-chained fatty acids, hormones than regulate hunger and satiety and vitamins, in particular, B6 and B12, passing via the gut lining into the blood supply. The microbiome has now become a subject of scientific research, and its presence into the oral cavity cannot be underestimated in its role in digestion and oral health. It is observed that the modern human microbiome in comparison to apes, monkeys and chimpanzees is far less diverse.
“Don’t eat anything your great-great-grandmother wouldn’t recognise as food”. Michael Pollan
What we know, as a consequence of the research, including the likes of Weston A. Price, is the importance of nutritional behaviour in the prevention and treatment of dental caries and periodontitis. The optimal function of the body’s host defence system is dependent upon an adequate supply of antioxidant micro-nutrients. Micro-nutrient antioxidants are essential for limiting tissue damage but also decreasing prolonged inflammation. Reducing periodontitis is associated with a reduction in HbA1c, a test measuring your average blood glucose over 2-3 months and gives an indication of your longer-term blood glucose control. Reducing blood sugar is also associated with reductions in death-related diabetes and myocardial complications.
“An adequate, well-balanced diet combined with regular physical activity“. World Health Organisation, Definition of Nutrition
Oxidative stress or oxidation is a damaging activity caused by an attack from free radicals. Nutrients called antioxidants help the body’s natural defence system combat this process. A variety of antioxidants including vitamins, A, C, E as well as minerals like Selenium and Zinc, are found in fruits, vegetables, nuts, seeds, oily fish and whole grains. Vitamins D2, from food sources and D3, from sunlight, are vital, along with Calcium, for bone health and repair. It is seen to benefit older age groups, beyond 50 years. Other studies indicate a 20% likelihood of less tooth lose with sufficient Vitamin D blood levels and 14% less likely to lose teeth over 5 years.
“Fermentable carbohydrates are the most relevant common dietary risk factor for caries and periodontal diseases” state Moynihan and Petersen (2004). Vitamin C depletion can lead to profuse gingival bleeding, known historically as Scurvy. Periodontal diseases demonstrate lower serum Magnesium and Calcium levels as well as lower antioxidant micronutrient levels. Using Vitamin D supplementation combined with Calcium has been shown to reduce risk in the elderly. The concentration and bioavailability of carbohydrates and starchy foods and the lack of Vitamin D, K and Calcium in the developmental growth of teeth increase the risk of dental caries.
“Let food be thy medicine”. Hippocrates
Upon reflection, it is advisable to create a guide for my clients regarding what will benefit healing and repair of dental diseases nutritionally. This I did in the light of an authentic learning project undertaken in 2017, but does it require updating? I would consider a deeper dental orientated nutritional discussion with all clients who have active periodontal disease, including bleeding on probing over 10% with no attachment loss. This would include supplementation of Vitamin D and Calcium with an additional emphasis on an antioxidant-rich diet and a significant reduction in fermentable carbohydrates. I’d consider, in severe cases, advising them to test for serum Vitamin D levels and advise exposure to a recommended level of sunlight too, depending upon the season. In the case of dental caries in the light of no new knowledge, I would continue with a reduction, cessation where possible, and regulation of fermentable carbohydrates. The onus on oral health improvement measures with both diseases are multifactorial, not just purely nutritional, but it does, however, play a significant role in both.
“Going against the principles of nature does nothing but harm for us, the animals and the environment”. Weston A. Price
Weston A. Price, I believe, was a principled and holistically minded individual worthy of study and attention. The mantle for his ancestrally linked nutritional improvement for better health has been handed over to many others, books are written, careers changed, lifestyles altered for the better and his legacy continues. I have learned to put his cannon of work into the context of time and his life experiences. I won’t judge him too harshly on what we know where he was incorrect but will maintain and protect the best intentions and knowledge gained from his work. He attracts and continues to influence those who associate good nutritional behaviour with better environmental practice and those who hold the values of our ancestral dietary legacy in line with their belief in nature.
Carmody N, Weinstraub G, & Wrangham R. (2011) Nat Academy of Science, USA.Energetic consequences of thermal and nonthermal food processing. Nat Academy of Science, USA.
Schmidt K. (1997) Interaction of antioxidative micronutrients with the host defence mechanisms. A critical review. Int J Vit Nutr Res.
Simpsom T, Needleman I, Wild S, Moles D, & Mills E. (2010) Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database.
Dietrich T, Joshipura K, Dawson-Hughes B, & Bischoff H. (2004) Association between serum concentrations of 25(OH)D3 and periodontal diseases in the US population. Am J Clin Nutr.
Jemenez M, Giovannucci E, Krall Kaye E, Joshipura J, Dietrich T. (2014) Predicted vitamin D status and incidence of tooth loss and periodontitis. Public Health Nutr.
Zahn Y, Samietz S, Holtfreter B et al. (2014) Prospective study of serum 25-hydroxy Vitamin D and tooth loss. J Dent Res.
Moynihan P, & Petersen P. (2004) Diet, nutrition and the prevention of dental diseases. Pub Med.
Leggott P, Robetson P, Rothman D, Murray P, & Jacob R. (1986) The effect of controlled ascorbic acid depletion and supplementation on periodontal health. Journal of Perio.
Van der Velden U, Kuzmanova D, & Chapple I. (2011) Micronutritional approach to periodontal therapy. Journal of Clinical Perio.
Krall E, Wehler C, Garcia R, Harris S, & Dawson-Hughes B. (2001) Calcium and vitamin D supplements reduce bone loss in the elderly. Am Journal of Medicine.
Miley D, et al. (2009) Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. Journal of Perio.
Chapple et al. (2017) Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases. Consensus report EFP/ORCA.
Eat well, keep gums healthy, live longer. Juliette Reeves RDH UK – https://www.nature.com/articles/bdjteam201940
Weston A. Price – Overview – https://youtu.be/OH1HSG9AOS8
CARTA: The Evolution of Human Nutrition – https://youtu.be/jGUsMYXdDDc
Weston A. Price’s appalling legacy-https://sciencebasedmedicine.org/sbm-weston-prices-appalling-legacy/
Weston Price – https://en.wikipedia.org/wiki/Weston_Price
The gang of five. Alternative approaches to dental disease prevention and celebrating the diversity of progressive opinions. Whole dental health and beyond.
When we critically look at scientific research (this assuming we do) our aims are to look at the type of research, the quality of the question, its methodology, their outcomes and results, subsequent conclusions and its relevance to our uniquely individual workplaces. The traditional face value approach featured heavily in the first half of my professional journey as a registered dental hygienist. To pass my certificate in dental hygiene back in 1988 it required of me a straightforward context. To believe everything I was shown or taught, reproduce it in writing and action, to a standard pass. My real learning began on my first day in clinic, post-graduation. My over sharpened and extremely thin sickle scaler fractured at the tip between the lower anterior teeth on my first client. I can remember my overconfidence, not born of experience but of the outcomes I magically and naively envisaged. I was the “master technician”, with all the data inputted, the on switch to go and the power selected for perfection.
I really had no expectation of a need to update on my own, I had been breastfed by the “gated” institutional culture of my learning, latching on at specific points of time and refuel with knowledge relayed from the institutional mothership. No thought of questioning my own practice every crossed my mind initially, to consider enquiring about anomalies observed in my everyday practice or connections between other healthcare practices and my own. The dentist was the one and only direct port of call, but the occasional trade or professional body publication revealed very little edifying additional new knowledge. The annual symposiums were the only real learning hubs available to me, the attending audience obediently and diligently offered applause to every keynote speaker and after each session fled sheeplike to the resident trade stand after which an orgy of sample taking unravelled.
My first experience of open critical thinking began at such an event a dozen or so years into practice, that long. A speaker, talking to a mass of hygienists, brutally and honestly stated that there was no research evidence to demonstrate that flossing was effective at reducing gingivitis, this would be a hot potato, many years later. I was horrified to hear this, I was an advocate to its efficacy and felt affronted by this preposterous charlatan. It challenged all I was wedded too and that was the point. I immediately put up my hand and challenged him back. He was probably waiting for this moment, well prepared and responsive in a friendly, calm and measured manner. The audience has silent, aware of the relevant context of the exchange. Afterwards, in the trade hall, he tracked me down, laptop and research in hand and explained in further detail, supporting his claim. He was, of course, right. I hadn’t a sound grounding in research, in fact very little at all until that point, thus began my contrarian journey into research, aided and abetted by this and many more fact-finding experiences to come.
I suppose the real rub of the green moment occurred after a year of study at the University of Kent where I studied part-time for a year in the mid-noughties. The first excursion into evidence-based practice learning, critical thinking and reflection were transformative. After that experience, I began blogging on topics close to my heart, getting to grips with new technologies of caries risk assessment and beginning self-directed learning journeys. This culminated in educational trips to New York, Key Opinion Leading and mentoring for Philips Sonicare and presenting to audiences at regional and national meetings. This lifelong learning worm had turned. The final flag-planting assent into learning enlightenment presented itself with O’Hehir University, and action research and reflective practise became active companions in my workplace.
Since then, I’ve taken a somewhat left-field approach to new knowledge creation for creative and curious is what it is to me, without exception. It provides a platform for the unorthodoxy of self-directed or independent person growth. It creates a playing field for new ideas to disseminate, to flow, challenge, and complement the landscape of my personal dental education. The independent researcher, the workplace learner, and reflective practitioner appear to be the future of education in dental health. The educational and regulatory establishments in several countries are now beginning to progressively embrace this new environment and are opening the gates to innovative practices. This also reflected to need to learn what was relevant in the unique workspace, required for the personal and professional development of the clinician.
In this alternative habitat of new learning brought about by modern technologies are a new breed of progressive, professional free thinkers. They are eloquent, motivational and provocative. The first exponent of this “dark dental” movement is Dr. Kim Kutsch. Kim has been active in the field of caries risk management for many years and must qualify, in my mind, as the Godfather of this genera. He is responsible for a significant resurgence into actively treating caries as a disease of imbalance, of pH and specific acidogenic, aciduric bacteria, as well as the more obvious importance of dietary fermentable carbohydrate. He also alludes to the significance of dry mouth, oral hygiene and our DNA. He advocates, as do many other like-minded thinkers the environmental and co-existing balanced approach to dental disease prevention. He has gone commercial one stage further. The creation of www.carifree.com provides a range of research and educational elements alongside a variety of products that can be used to identify at-risk individuals and solutions to pH and bacterial imbalances in caries cases. He has also worked with the research by Professor John Featherstone, a pioneer in caries research, to create caries risk assessment tools. Kim keeps his campaign to reduce disease in teeth up to date and relevant but also engages in active participation in educational topics, fronting presentations both online and in-person across the world and has a large following.
The xylitol prebiotic benefits are at the forefront of Kim’s approach after the destruction of the dysbiotic oral biofilm to help reseed the ecology of the mouth after, over time. This process is further supported by Dr. Mark Cannon, another American dentist and oral environmental activist. Mark is a proponent of the Neuro Arterial Gingival Simplex, positing the implication of a specific bacterial type, Porphyromonas Gingivalis. This alludes to this bacteria’s accountability in gingival diseases, atherosclerosis, and Alzheimer’s disease.
Mark has an intriguing divergent interest, growing amongst alternative and progressive healthcare professionals nowadays, in the evolutionary aspects of dentistry. He has studied and discusses with clarity the nutritional role in the development of the mouth, the evaluation of oral forms in the mouth, frenulum, tonsils and adenoids, the ecology of balanced play, processes that promote it and the benefits of our gateway oral microbiome to the rest of the body. These include, like Kim, the use of xylitol but also a similar sugar alcohol, erythritol. He also advocates the use of calcium phosphate-based toothpaste and Silver Diamine Fluoride in caries risk reduction and remineralisation strategies. You can find out more about the mark at www.drmarklcannon.com.
Dr. Steven Lin, a practising Australian dentist in Sydney in Australia is to me, living in New Zealand, a more local dental health legend. Steve began his journey into enlightening others with his activistic research in 2017. He then published his book, The Dental Diet, gaining a broad international audience. His participation in regional, national and international presentations further added kudos to his moral crusade. He starts by bringing back to the dental world the controversial figure of Weston A. Price, a long forget and conveniently ignored and published dentist with controversial environmental dental health research. The premise of Price with recent advocacy from Lin is not to ignore our ancestral dental past, in particular when compared to current dental issues of the arch under development, crowding of teeth and the nutrition of the body and the mouth with whole food. The importance of micronutrients like vitamins D, A and the recently discovered vitamin K2. He proposed that eating these and other micro and macronutrients are important for dental health. Steve also began the conversation and journey into oral myofacial function and epigenetics. Find out more about this progressive dentist at www.drstevelin.com.
Professor Philip Marsh, based at Leeds University in the UK, and the Health Protection Agency, is an world renown expert in bacterial behaviour in humans. He describes oral health is more than just the absence of disease but also crucial in boosting and promoting general health. He goes onto further propose that pathogenic bacteria grow in the mouth due to changes in the lifestyle of the individual. Beneficial bacteria produce natural benefits, regulating heart health and the immune system and gut health. Our human microbiome has co-evolved with us, living in structurally functionally organised communities communicating with themselves and our human cells. A great YouTube video can be viewed at https://youtu.be/zuxNMVR2nVM.
Last but by no means least is Dr. Bonnie Bassler, a Professor in Microbiology with interest in chemical signalling mechanisms of bacteria. Bonnie has been a keen observer in the growth and development of bacteria, their benefits and negative impacts on the body. She succinctly reveals the importance of bacteria to us, their scale and size comparatively in both cell and gene numbers but more importantly describes the incredible intricacy of their means of quorum sensing or communication. They create hormones to converse, talking and hearing, to neighbouring cells in multiple cellular languages, demonstrating collective behaviours. Her aim is to determine whether this community of communication can be disrupted or modified to produce human health benefits in the future. See more at https://youtu.be/KXWurAmtf78.
The world of dental health education continues to grow, the means to deliver it is evolving too. The age of the book continues with the likes of Dr. Steve Lin, await more publications from him both in paperback and eBook formats. Others will continue with online platforms like websites and video channels as well as podcasts. A special mention must go to Dr. Ryan Nolan for his series of podcasts that includes the likes of Steve, Kim, Mark, and many more besides. You’ll find these at www.thebiofilmfactor.com, ideal for company during a long walk with earphones in or at the gym when working out.
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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