Health & Fitness

In an exclusive interview with Body+Soul, Pia Miller (née Loyola) reveals why it's OK to be an imperfect working mum, how sageing keeps her mental health in check and what she does to stay physically fit all year round.

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You're probably aware that the bacteria in your gut play an integral role in your health, affecting everything from heart health to brain function. It's not only gut bacteria that matter, however, as bacteria elsewhere on and in your body are also important, including those in your mouth.

Unfortunately, people have long been advised by well-meaning dentists to use mouthwash to kill oral bacteria and freshen breath. But just as is the case in your gut, if you kill off bacteria in your mouth, you're wiping out both good and bad varieties, which puts your health at risk.

Antiseptic compounds in mouthwash may even destroy beneficial oral bacteria that are important for maintaining blood pressure, thereby contributing to high blood pressure levels.

Oral Bacteria Affect Blood Pressure Via Nitric Oxide

The bacteria in your mouth are thought to play a role in blood pressure via nitric oxide (NO), a soluble gas stored in the lining of your blood vessels, called the endothelium. NO is produced inside your endothelial cells from the amino acid L-arginine, where it acts as an important signaling molecule throughout your body.

Along with promoting healthy endothelial function and heart health, NO supports healthy blood flow by helping your veins and arteries dilate. This, in turn, allows vital oxygen and nutrients to flow freely throughout your body. NO also plays a protective role in your mitochondrial health, the energy storehouse of your cells, responsible for the utilization of energy for all metabolic functions.

Dietary nitrates, which are found in foods like beets and leafy greens, are converted into nitrites by oral bacteria during chewing. Writing in Frontiers in Cellular and Infection Microbiology, researchers led by Nathan Bryan, Ph.D., from the department of molecular and human genetics at Baylor College of Medicine in Texas, explained the details of how a healthy, balanced oral microbiome assists the conversion of dietary nitrate into NO:^1,2

"The oral microbiome has the potential to provide an important symbiotic function in human blood pressure physiology by contributing to the generation of nitric oxide (NO), an essential cardiovascular signaling molecule. NO is produced by the human body via conversion of arginine to NO by endogenous nitric oxide synthase (eNOS) but eNOS activity varies by subject.

Oral microbial communities are proposed to supplement host NO production by reducing dietary nitrate to nitrite via bacterial nitrate reductases. Unreduced dietary nitrate is delivered to the oral cavity in saliva, a physiological process termed the enterosalivary circulation of nitrate."

How Mouthwash May Raise Blood Pressure Levels

The problem with mouthwash is that most contain antiseptics like chlorhexidine, which has been used in dental practice since 1970 and has broad-spectrum antibacterial activity.³ The antiseptic has been found to reduce bacteria associated with periodontal disease and dental caries, as well as reducing bad breath,⁴ leading many dentists to recommend their patients swish with mouthwashes containing it once or twice a day.

Chlorhexidine (CHX) does not act in a bubble, affecting only "bad" bacteria, however. It also affects the bacteria your mouth needs for a healthy microbiome. For their study, Bryan and colleagues used 16 S rRNA gene sequencing and analysis to determine how the use of chlorhexidine-containing mouthwash twice a day for one week affected oral bacteria and blood pressure in 26 study participants.⁵

The use of the mouthwash twice daily was associated with a significant increase in systolic blood pressure after one week, while once the mouthwash was stopped, "recovery from use resulted in an enrichment in nitrate-reducing bacteria on the tongue."⁶

Differences in more than 10 species of bacteria living on the tongue were noted after mouthwash use, including lower microbial diversity after one week of use,⁷ while those with relatively high levels of bacterial nitrite reductases had lower systolic blood pressure when at rest.

"The demonstration that the presence of NO-producing bacteria in the oral cavity can help maintain normal blood pressure gives us another target to help the more than 100 million Americans living with high blood pressure," Bryan said in a news release, adding:⁸

"We know one cannot be well without an adequate amount of NO circulating throughout the body. Yet, the very first thing over 200 million Americans do each day is use an antiseptic mouthwash, which destroys the 'good bacteria' that helps to create the NO. These once thought good habits may be doing more harm than good."

Other research, including a study that followed 1,028 people over a period of three years, revealed similar mouthwash risks. Those who used mouthwash twice a day or more were more likely to develop high blood pressure than those who used it less often or not at all.⁹ Writing in Scientific Reports, another team of researchers noted:

"Additionally, we and others have recently shown that the use of CHX in healthy subjects can attenuate the nitrate-reducing activity of oral bacteria by at least 80%. This in turn leads to lower nitrite availability and an increase of blood pressure, suggesting that the oral microbiome can regulate cardiovascular health in healthy individuals and hypertensive patient."¹⁰

Mouthwash Disturbs Your Oral Microbiome

As you might suspect, the indiscriminate killing of bacteria in your mouth via harsh antiseptics like chlorhexidine has far-reaching implications, even beyond your blood pressure levels. Twice-daily use of mouthwash has been linked to an increased risk of prediabetes and Type 2 diabetes, for instance, again by affecting oral bacteria critical for the formation of nitric oxide, which predisposes individuals to metabolic disorders like diabetes.¹¹

As it's becoming more apparent that regularly exposing your oral microbiome to antiseptics in mouthwash is problematic, researchers have taken on increased interest in the topic, including a team that investigated multiple effects of chlorhexidine mouthwash after seven days of twice-daily use.

Thirty-six individuals used a placebo mouthwash for one minute, twice a day for one week, followed by a CHX mouthwash using the same protocol for another week.

A "major shift" in the salivary microbiome was noted after the chlorhexidine mouthwash usage, triggering more acidic conditions, which favor increased dental caries, and lower nitrite availability and oral nitrate-reducing bacteria, which affect heart health. Specifically, the study noted:

"CHX significantly increased the abundance of Firmicutes and Proteobacteria, and reduced the content of Bacteroidetes, TM7, SR1 and Fusobacteria.

This shift was associated with a significant decrease in saliva pH and buffering capacity, accompanied by an increase in saliva lactate and glucose levels. Lower saliva and plasma nitrite concentrations were found after using CHX, followed by a trend of increased systolic blood pressure."¹²

Oral care products containing chlorhexidine are also widely used in hospitalized patients, including those who are critically ill, in order to maintain oral health. But when researchers compared patients exposed to low levels of chlorhexidine oral care (300 milligrams or less) with those not exposed, those receiving chlorhexidine products had an increased risk of death.¹³

"These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations," they concluded.¹⁴

Avoid Mouthwash for Optimal Health

In my interview with Dr. Gerry Curatola, founder of Rejuvenation Dentistry who has over 30 years' experience in biological dentistry, he discusses that achieving oral health is really about promoting balance among the bacteria in your mouth.

Probiotics do not work in the oral cavity the way they do in your gut, so it's not as simple as adding beneficial bacteria to your mouth. Rather, as an initial step, you need to cease killing microbes in your mouth, and a key way to do this is by not using antimicrobial mouthwashes and by avoiding fluoridated toothpaste.

"In the mouth, you don't want to have a 'scorched earth policy,' nuking all bacteria and hoping the good bugs come back," he says. "[G]ood bugs basically have a harder chance of setting up a healthy-balanced microbiome when you disturb them, denature them, or dehydrate them with alcohol-based products."

A natural alternative to mouthwash would be oil pulling with coconut oil, which has a lipophilic effect, helping to eliminate unhealthy biofilm from your teeth. While it does have a natural detergent effect, it doesn't do the damage chemical detergents do. Coconut oil also contains a number of valuable nutrients helping promote oral health. "If you don't have a good nutritional that promotes oral microbiome homeostasis, coconut oil pulling is great," Curatola says.

Another tip: If you want a healthy oral care rinse, Curatola suggests rinsing with some Himalayan salt dissolved in water, as it contains more than 85 different microminerals. Additional nutrients that support gum and oral health are vitamin C and coenzyme Q10 (CoQ10), as bleeding gums is often a sign of CoQ10 deficiency.

Your Lifestyle Can Lead to Healthier Teeth

Proper oral hygiene, including regular brushing and flossing, and getting regular cleanings with a mercury-free biological dentist, will go a long way toward keeping your teeth and gums healthy, but your lifestyle, including your diet, is also important.

Your risk of cavities increases the more sugar you eat, for instance. One study found that, in order to minimize your risk of cavities, sugar should make up no more than 3% of your total energy intake (with 5% noted as a "pragmatic" or more realistic goal).¹⁵

Mineral deficiencies, like magnesium, can also weaken bones and teeth,¹⁶ while vitamin K2 is crucial for bone mineralization; unless you have a regular source of healthy nonpasteurized fermented foods in your diet, there is a good chance you will be deficient in this important nutrient.

Dr. Dominik Nischwitz, author of "It's All in Your Mouth: Biological Dentistry and the Surprising Impact of Oral Health on Whole Body Wellness," is another expert who firmly believes cavities and resulting problems can be avoided altogether by following an optimized lifestyle program for oral health including ideal levels of sun exposure and nutrition, and avoiding toxins and certain dietary culprits such as gluten and dairy.

Unfortunately, dentistry remains distinctly separated from the field of medicine, even though it's widely known that your oral health is intricately connected to your overall health. For best results, choose a biological dentist who understands the connection and can advise you on steps that will not only support your oral health but your health as a whole as well.

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Dr. Chris Knobbe, an ophthalmologist, is the founder and president of the Cure AMD Foundation, a nonprofit dedicated to the prevention of age-related macular degeneration (AMD).

AMD, a leading cause of blindness in the U.S. — and the third leading cause of blindness globally (after cataracts and glaucoma)¹ — is said to be a disease associated with aging, but, in the presentation above, Knobbe asks, “Could age-related macular degeneration be a disease of processed food consumption?”

Nine years of research and investigation have led Knobbe to conclude that AMD is, indeed, being driven by nutrient deficiencies and toxicity caused by processed foods. This common denominator isn’t linked only to AMD, however — it’s also linked to chronic diseases of all kinds, including Type 2 diabetes, heart disease and cancer.

The root of the problem lies in mitochondrial dysfunction, which is caused by the excessive consumption of a Westernized diet, including toxic industrially processed seed oils (incorrectly called “vegetable oils”), refined flour, refined added sugars and trans fats.

Chronic Metabolic and Degenerative Disease ‘Didn't Exist’

According to Knobbe, chronic metabolic and degenerative disease “clearly didn’t exist 125 years ago,” at least not nearly to the extent they do today, citing a study by Dr. David Jones and colleagues, published in the New England Journal of Medicine in 2012.² The study looked at the history of disease over the past 200 years, comparing the top 10 causes of death in the U.S. from 1900 to 2010.

In 1900, the top four causes of death were infectious in nature: pneumonia/influenza, tuberculosis, gastrointestinal infections and cardiac valvular disease. The latter is classified as heart disease, but, Knobbe says, “This wasn’t coronary artery type heart disease. This was cardiac valvular disease driven by syphilis, endocarditis and rheumatic fever … It was infectious still.”

By 2010, this had all changed, with chronic diseases replacing infectious diseases as the top killers. “Today, heart disease, cancer, stroke, COPD, Alzheimer's disease, Type 2 diabetes, kidney disease, all chronic diseases account for seven of the top 10 causes of death.” In reviewing the data, Knobbe found that diabetes of any type was rare in the 19th century, but it increased 25-fold in a period of 80 years.

He also cites data that found the obesity rate in the 19th century was 1.2%. By 1960, it had already risen to 13% — an 11-fold increase — and continued to climb steadily to this day. “Obesity is on target to be 50% of adults obese in the United States by 2030, half obese,” Knobbe says. “So the increase looks something like … a 33-fold increase already in 115 years.” He continues:

“Again, you have to ask, you know, what accounts for this … All right, well, let's go back to the dietary history now. So you're going to see Westernized disease correlate to modernized diets. That's the theme of this, essentially …

And I will submit to you that this has really been a global human experiment that began in 1866, it didn’t begin in 1980, you know, with our low-fat, low saturated-fat dietary guidelines, it began in the 19th century and nobody gave informed consent of us. Not one of us knew what we were getting into and most of us still don't.”

Four Primary Processed Food Culprits

The four primary components that make up processed foods that are, in turn, contributing to chronic diseases like AMD are sugar, industrially processed seed oils, refined flour and trans fats. Knobbe says:

“ … Sugar has been in the food supply for hundreds of years, but between 1822 and 1999 sugar increased 17-fold … Cotton seed oil, the world's first, highly polyunsaturated vegetable oil introduced right here in the good old US of A in 1866, the entire world, or at least 99.9-plus% of it had never seen a polyunsaturated vegetable oil, ever. All right, 1880 roller mill technology was introduced.

And in the United States, it was introduced in Minneapolis … roller mill gives us refined white, wheat flour, which is a nutrient deficient food. And then fourth, 1911, Proctor and gamble introduced Crisco. That's trans fats, they're hydrogenated and partially hydrogenated vegetable oils … by 2009, our own USDA reports that those four foods make up 63% of the American diet, 63%. That's the recipe for disaster.”

As the consumption of processed foods rose, so too did chronic diseases. According to Knobbe, AMD was rare from 1851 to about 1930, but had reached epidemic proportions by the 1970s. As of 2020, 196 million people worldwide suffer from AMD.

“And what we always see is that the processed foods come first and then the AMD hits later,” Knobbe says.

“It's always this way. There's a temporal relationship. It's at least 30 years of this consumption, probably closer to 50. You know, these are chronic … diseases that take a long time to develop, right? There's a dose response relationship … I believe if you look at all of our data, this becomes nearly a mathematical certainty that this relationship between food and macular degeneration exists.”

Knobbe also cites the work of Weston A. Price, the dentist who wrote the classic book “Nutrition and Physical Degeneration.” In the 1900s, Price did extensive research on the link between oral health and physical diseases.

He was one of the major nutritional pioneers of all time, and his research revealed native tribes that still ate their traditional diet had nearly perfect teeth and were almost 100% free of tooth decay. But when these tribal populations were introduced to refined sugar and white flour, their health, and their perfect teeth, rapidly deteriorated. In many ways, Knobbe is the 21st century equivalent of Price.

Diet-Related Macular Degeneration

Knobbe believes “age-related” macular degeneration should be called diet-related macular degeneration instead, and states that out of all the components in processed foods, polyunsaturated vegetable oils are the greatest contributor. Comparing them to “biological poisons,” Knobbe notes that industrially processed seed oils are not only nutrient deficient but also pro-oxidative and proinflammatory:

“ … When vegetable oils are produced … oil seeds are crushed, heated, pressed. They go through about four or five heatings … then they go to a petroleum drive, hexane, solvent bath, right? And then it's steamed, degummed … then they go through a chemical process of being alkalinized, bleached and deodorized before they go into this bottle and we think they're healthy.

They're extraordinarily oxidized. They’re toxic. Aldehydes in these, these are literally poison. These are extremely noxious agents, and … vegetable oils replaced animal fats.”

He cites the work of nutrition pioneer Elmer V. McCollum, who, in the early 20th century, fed rats diets enriched with either 5% cotton seed oil or 1.5% butterfat — “this is good butter,” Knobbe points out. “It's coming from pasture-raised cattle grazing on grass, right? That's all they had back then.”

Stark differences were observed among the rats, with the cottonseed oil group experiencing stunted growth, illness and shorter survival. The rats fed butterfat fared much better, growing to about twice the size of the other rats and living about twice as long. The fat-soluble vitamins A, D and K2 in the pastured butterfat were a likely factor in the marked health differences.

“We need them to maintain our health and prevent degenerative disease,” Knobbe says. “There’s absolutely no question in my mind — all the data supports this — that macular degeneration patients are vitamin A-, D- and K2-deficient.”

Knobbe cites data from native populations around the globe, including the Maasai tribe in Eastern Africa, inhabitants of Papua New Guinea and Tokelau in the South Pacific, which had very different diets with one major similarity: “In general … they have no refined sugar, no refined wheat, no processed foods, no vegetable oils.” They also have little or no macular degeneration.

Vegetable Oils Cause Mitochondrial Failure, Insulin Resistance

AMD is ultimately a disease process rooted in mitochondrial dysfunction and insulin resistance, and the catastrophic cascade of health declines are triggered by the long-term consumption of vegetable oils (omega-6) and other processed foods, Knobbe explains the complex process in his presentation:

“Here's what excess omega-6 does in a Westernized diet: induces nutrient deficiencies, causes a catastrophic lipid peroxidation cascade, is what this does … This damages … a phospholipid called cardio lipid in the mitochondrial membranes. And this leads to electron transport chain failure … which causes mitochondrial failure and dysfunction.

And this leads first to reactive oxygen species, which feeds back into this peroxidation cascades. So, you're filling up your fat cells and your mitochondrial membranes with omega-6, and these are going to peroxidize because of the fact that they are polyunsaturated.

All right, the next thing that happens is insulin resistance, which leads to metabolic syndrome, Type 2 diabetes, nonalcoholic fatty liver disease. When the mitochondria fail, you get reduced fatty acid, beta oxidation, meaning you can't burn these fats properly for fuel.

So now you’re … carb dependent and you're heading for obesity. So, you're feeling tired. You're gaining weight. Your mitochondria are failing to burn fat for fuel … this is a powerful mechanism for obesity.

So, the energy failure at the cellular level leads to nuclear mitochondrial DNA mutations, and this leads to cancers. Three weeks on a high-PUFA diet causes heart failure in rats — three weeks. And this also leads to apoptosis and necrosis. And of course, that's how you get disorders like AMD and Alzheimer's.”

Knobbe has also been studying the toxic aldehydes that result from omega-6 fats. When you consume an omega-6 fat, it first reacts with a hydroxyl radical or peroxide radical, producing a lipid hydroperoxide.

This lipid hydroperoxide then rapidly degenerates into toxic aldehydes, of which there are hundreds, which in turn lead to cytotoxicity, genotoxicity, mutagenicity carcinogenicity and more, along with being obesogenic, at very low doses.

Ancestral Diet Key to AMD Prevention

According to Knobbe, there were only 50 cases of dietary blindness described across the globe between 1851 and 1930, some of which were likely other diseases. This skyrocketed to an estimated 196 million cases in 2020.³ Knobbe believes that by following an ancestral diet, rich in grass fed meat and poultry, pastured dairy, wild-caught fish, vegetables, nuts and seeds, the majority of AMD cases would disappear.

“Could modernized processed foods drive this disease? That's the question. I mean, is it as simple as this, you know, could this difference be due to diet and diet alone?” Knobbe asked. “I will submit to you that everything I have found so far indicates that it is, and I can't find anything that doesn't support this concept.”

For more details, Knobbe discusses more of this eye-opening information in his book, “Ancestral Dietary Strategy to Prevent and Treat Macular Degeneration,” as well as via his website, on CureAMD.org. As Knobbe says:

“Today, about 534 people will go blind due to AMD. They've already lost vision in their first eye. They'll lose vision in their second eye. And I think this is a travesty because I believe it's all preventable. So, our mission at Cure AMD foundation is to prevent and treat AMD through ancestral dietary strategy advocacy. And we need more scientific research in order to convince all of us and our peers.”

Single Most Important Strategy You Can Implement

It is vital that you reduce your intake of industrially processed seed oils as much as you can. This means eliminating all of the following oils:

Soy	Corn
Canola	Safflower
Sunflower	Peanut

Olive and avocado oil should also be on the list as over 80% of these are adulterated. But even if they weren’t it simply isn’t worth it to have high levels of olive oil as it is loaded with the omega-6 fat called linoleic acid.

It will also be important to avoid nearly all processed foods as it is the rare processed food that does not include these toxic oils. Nearly every fast food restaurant is also guilty of using high levels of these toxic fats. This is why it is so important to prepare as much of your food as you can in your home so you can know what you are eating.

Most health “experts,” including many I have previously interviewed, simply do not understand how much more dangerous these oils are than sugar. These fats become embedded in your cell membranes and stay there for years wreaking havoc on your health.

This is one of the reasons why a high fat diet can be harmful. If it is loaded with these dangerous omega-6 fats it will make you metabolically unhealthy and radically increase your risk for nearly every chronic degenerative disease, like heart disease, cancer, diabetes and blindness.

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