January 8, 2009

Gum Disease Worsens Diabetes: Another Crazy Bernstein Idea Validated

Back when I first was diagnosed, a lot of people warned me not to pay any attention to that crazy Dr. Bernstein and his wacko fringe-science ideas.

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!


ItsTheWooo said...

Very interesting, however I'm not sure how this is evidence that gum infections are more diabetes-causing than any other type of infection. It's well established that any stressor on the body (such as an infection) is going to cause insulin resistance and raise blood sugar. Also as you said it's really very cyclical... infections make diabetes worse by causing high blood sugar and insulin resistance, but then again the state of being diabetic makes infections more likely and chronic (poor immune system, poor healing, high sugar for bacteria to exploit).

I guess I'm just not sure how GUM infections are worse on blood sugar and insulin sensitivity than, say, a candidiasis infection or a low grade UTI or an URI.

TedHutchinson said...

Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population.
Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation
A couple of links to research showing how low levels of vitamin d3, the natural anti inflammatory anti biotic agent may result in gum disease.
I'm sure I don't have to remind readers here that Dr Davis of the Heartscanblog finds in Wisconsin Latitude 42ish it takes on average 5000iu for women and 6000iu/d for men to achieve the kind of level our bodies evolved to function best at.

Berny3 said...

This might be one of those chicken versus the egg situations. People who eat a lot of starches and sugars have to be more diligent in dental hygiene than other people, and it could be that the starches and sugars aggravate BOTH gum disease and bad blood sugars. Gum disease might "cause" diabetes, but diabetes affects blood circulation in the arteries, tiny or otherwise, that nourish the gums. I think it's a circular reinforcement.

Jenny said...

I don't think debating cause vs result is all that useful here.

What is useful is the takeaway message that people who have diabetes should be checked for gum disease and if they have it, no matter how "mild" they should treat it aggressively and eradicate it if possible.

Dietary changes and Vitamin D supplementation will not get rid of an existing infection whatever the original cause might have been.

TedHutchinson said...

Our Innate immune function works by the activation of toll like receptors (TLRs) in certain cells, including those of the epidermis, gingiva, intestine, vagina, bladder, and lungs.

TLRs recognise pathogens from infectious agents and that triggers the innate immune response

Activation of TLRs leads to the induction of antimicrobial pep-
tides and reactive oxygen species, that kills the organism.

The paper

Explains in greater detail. My attention to the anti biotic properties of Vitamin D3 arose after I read
Antimicrobial Peptides, Innate Immunity, and the Normally Sterile Urinary Tract
http://jasn.asnjournals.org/cgi/content/full/18/11/2810 and found that by increasing my D3 intake to 5000iu/daily I cleared up my urinary tract infection and haven't now for the past 2yrs needed an antibiotic.

Jenny said...


Thanks for the references. The Endocrine Journal requires a subscription but the other article did not and was of great interest to me.

Alan said...

G'day Jenny

I hope you continue to be well.

I also have pertiodontal disease, diagnosed twenty years before my diabetes dx so it's a subject I have taken an interest in.

Thanks for the extra references. I think I can add to your list in the cites to these:


and earlier

Cheers, Alan

Jenny said...


Great posts.

Folks who are interested in this subject should click on Alan's links.

Mike Hussey said...

Diabetic retinopathy could be associated with poorer memory and diminished brain power in people with Type 2 diabetes, according to a new research.

Trystan Don De Los Reyes said...

This is a very clever post; you have given me more information about periodontal treatment. Another thing that made me hooked up with this post is that I have an uncle with diabetes and tried laser periodontal treatment due to his gum disease and after that treatment the doctor told us that his sugar level decreases, so I guess there is really a connection with periodontal treatment and diabetes.