And what wacko ideas they were!
In the first, 1997 edition of his landmark book, Dr. Bernstein's Diabetes Solution Dr. Bernstein told people with diabetes that the 7% A1c was too high to prevent complications. He insisted people with diabetes who maintained normal blood sugars would not get the complications most other doctors believed to be inevitable. He told us that the secret to living long and healthy lives with diabetes was to cut way, way down on carbohydrates and eat as much fat as we wanted, assuring us that fat did not cause heart disease even though every other health authority in the world insisted it did.
Wacky stuff indeed, though what is even wackier is that a decade later there is growingevidence that he was correct on all these points and thousands of people with diabetes have lived through the decade without complications thanks to following his advice.
But the point of this post is not to gloat, but to point to an even wackier Bernstein idea that has suddenly veered into the mainstream--one that few readers of Bernstein seem to have noticed and one rarely discussed on online discussion groups.
That point is this: Dr. Bernstein insists that gum infections are a major cause of elevated blood sugars and that treating these infections aggressively can dramatically lower blood sugars.
It has long been known that gum disease is more common among people with diabetes and that people with diabetes who have gum disease tend to have more severe cases of gum disease than people without diabetes diagnoses. But the conclusion most researchers drew from this finding was that gum disease was simply just another complication of diabetes.
New research is changing this, for several reasons. First of all, new research has shown that the physiological response to gum disease is a body-wide inflammatory response that raises TNF-alpha which in turn increases insulin resistance, a finding earlier seen in the diabetic Zucker rat.
Recent research into cardiovascular disease has also found that untreated gum disease raises CRP and that treating gum disease can lower carotid intima-media thickness which is the currently fashionable measure of whether heart disease is being reversed.
Other research has found a connection between gum disease and the development of gestational diabetes.
The presence of gum disease also seems connected to a person's likelihood of developing severe diabetic complications. A study of Pima Indians found that gum disease was a strong predictor of mortality in Pima with diabetes. However, until recently not much research has looked at whether treating gum disease can lower blood sugars and decrease the incidence of complications.
A study of 165 veterans found that over a period of four months those given periodontal care had slightly better blood sugars and were less likely to need higher insulin doses, though it is not clear how much periodontal treatment these veterans received or whether four months is enough time to draw conclusions about the treatment's efficacy.
Another study, reported today in Science News found that treating gum disease lowered the costs of treating diabetes. This was a larger study of 2,674 people with Blue Cross insurance who received at least a year's worth of periodontal treatment. The authors conclude,
The study showed that medical care costs decreased by an average of 11 percent per month for patients who received one or two periodontal treatment procedures annually compared to those who received none. For patients receiving three or four annual treatments, costs decreased nearly 12 percent.This suggests that treating gum disease may indeed improve the course of diabetes, though we will have to wait for this study to be published to see if there is actual data published about the impact of treating gum disease on the participants' blood sugars.
What all this new research means for you, if you have diabetes or prediabetes, is that, just as Dr. Bernstein states, it is essential that you take an aggressive approach to dental health with the emphasis on "aggressive".
The usual care dentists recommend may not be enough. Over the years, I have seen quite a few acquaintances lose all their teeth despite regular visits to the dentist. My impression is that this happens because dentists wait until gum disease is well established before recommending treatment and that they rarely use systemic antibiotics to treat it, relying instead on mechanical treatments like scaling.
Dr. Bernstein suggests that it may take many months of treatment with antibiotics to heal dental infections, a controversial position given that antibiotic over-use brings its own load of problems. However, he claims he has seen this approach work very well to help people with diabetes regain excellent blood sugar control. So if you have diabetes and periodontal disease that is progressing despite standard treatments, it might be worth investigating this approach further.
If you have diabetes or prediabetes and do not yet have significant gum disease, the single most helpful thing you can do is to floss your teeth every day. Brushing does not prevent gum disease, and, in fact, brushing with hard or even medium toothbrushes may cause gums to recede which promotes the development of gum disease.
Get into the habit of flossing at least once a day. If at first your gums bleed a lot or are painful, keep at it, over time they should toughen up and get healthier and bleeding will stop.
If you are told you have any pockets in the gums around your teeth, don't take a "watchful waiting" approach. Even low levels of gum infection will be calling forth an inflammatory response in your arteries and causing them to clog up. That same inflammatory response may increase damage to your nerves and kidneys. And of course, any infection will raise your blood sugars. So if you have any sign of gum disease, it is essential that you see a periodontist and do whatever you can to heal up your gums. If possible, look for a periodontist who supports your search for complete healing of your gum disease.
Eating a low carb diet may be helpful in preventing gum disease from starting. I cannot find any research to back this up, but over the years every hygienist who has cleaned my teeth has remarked on how little scale they have accumulated, even when I have gone longer than usual periods between cleanings. This has been true even when I have eaten closer to 100 grams a day of carbohydrate rather than a Bernstein-style much lower carbohydrate intake.
However, if you already have established bacterial colonies living deep within your gums, diet along may not be enough to solve the problem and you should visit a good periodontist.
The other major risk factor for gum disease is smoking. Smokers are much more likely to lose their teeth as they age and it may take years after you quit smoking to recover from the damage that smoking has done to your blood vessels. So if you have smoked in the past decade, assume you have early gum disease and ask your dentist to help you reverse it.
NOTE: Gum disease appears to be yet another of the unpleasant chronic diseases that attract vultures who prey on victims by promising miracle cures available only on the internet to those willing to pay a lot of money better spent on real dental help. Do not fall for these schemes!