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Health Sciences Institute e-Alert 

February 5, 2003 


Dear Reader, 

Dental hygiene is its own reward, of course, but did you know that the health of your gums may have a direct correlation to the health of your heart? This isn't really news - since the late 90's we've seen growing evidence that periodontal disease (an advanced form of gum inflammation) may be linked to an increased risk of heart disease. In fact, later this year the final results are due from a major National Institutes of Health study about the connection between these two disorders. 

In the meantime, I recently came across a study that shows how in addition to diligent brushing and flossing, there may be another important way to help keep your gums (and, consequently, your heart) healthy - a method that relies on what we've come to know as one of the primary mainstays of good health: antioxidants. 

Deep below the gum line 

This study from the University of Birmingham in the UK is small, but I think it's important in that it specifically singles out what could be an effective prevention and treatment of periodontal disease. 

The study examined 20 subjects - 10 with healthy gums, and 10 with advanced gum disease. From each subject, researchers took samples of gingival crevicular fluid (GCF), a fluid within the gums that is routinely released from the crevices under the teeth. All of the subjects with healthy gums were shown to have high levels of the antioxidant glutathione, while the subjects with periodontal disease had substantially lower levels of glutathione. When blood serum levels were tested for glutathione, the same disparity was recorded for the two groups. 

The fact that this study tested for glutathione (as opposed to any number of other antioxidants) is significant. Last month I sent you an e-Alert ("The Workhorse" 1/9/03) with an in-depth look at glutathione - an enormously effective antioxidant found in every cell of the body, most notably in immune system cells. Glutathione has not only been shown to protect against disease, but may also protect other antioxidants (such as vitamins C and E) from oxidizing, prolonging and enhancing their effectiveness. 

Chicken or egg? 

But while the UK study results would indicate that boosting glutathione levels might help prevent and control periodontal disease, other questions remain. The researchers wondered, for instance, if lower levels of glutathione directly contribute to gum disease, or if free radicals, produced by gum disease inflammation, depletes the stores of glutathione. The answer may very likely be "yes" on both counts, but we'll have to wait for further research before we have definitive answers. 

To me, the word that jumps out here is, "inflammation." A 
1997 study from the University of North Carolina at Chapel Hill revealed that patients with advanced gum disease, who had also suffered heart attacks, all showed significantly higher levels of C-reactive protein (CRP) than heart attack survivors who did not have gum disease. 

This isn't a surprise, inasmuch as I've explained before that elevated CRP is a key marker for inflammation. But it does establish further evidence linking periodontal disease and heart disease. In an e-Alert I sent you last November ("Burst of Inflammation" 11/21/02), I told you about a new study that showed how the levels of C-reactive protein have been recognized as an important marker indicating a risk of heart disease. 

Taken together, these studies add further circumstantial evidence to a cycle of cause and effect that goes like this: A low level of the antioxidant glutathione may be associated with periodontal disease - periodontal disease is characterized by inflammation - inflammation brings up CRP levels - elevated CRP levels may indicate a risk of heart disease - a risk of heart disease may be reduced by an increased intake of antioxidants - elevated levels of the antioxidant glutathione may help prevent periodontal disease. 

Protection & prevention 

The upcoming results of more extensive studies (such as the NIH periodontal/heart disease study) will be needed to further define the gray areas of this cycle. But for the time being the UK study offers promising evidence that antioxidants (and specifically glutathione) may prove to be an important defense against periodontal disease. 

So, what's the best way to raise glutathione levels? One way NOT to do it is by oral supplement. Taking glutathione orally is regarded as ineffective because the molecules are too big to pass through the intestinal walls to the blood stream. There is, however, an important amino acid I've told you about in previous e-Alerts, called N-acetylcysteine (NAC) that gives a powerful boost to your body's natural production of glutathione. 

The food sources that deliver glutathione precursors are meats and fresh fruits and vegetables. But even with a diet high in the proteins that supply glutathione amino acids, one of those amino acids - cysteine - is more difficult than the others to come by. A natural food component with high concentrations of glutathione precursors (including cysteine) is milk-serum-protein concentrate - more simply known as whey. 

If you've been diagnosed with periodontal disease, or if you're currently undergoing treatment for it, share this information with all of your health care providers - physician, dentist, periodontist - knowing that an important key to both gum and heart health may be as simple as enhancing your production of glutathione and increasing your intake of other antioxidants. 

...and another thing 

And as long as we're discussing the wide-ranging benefits of antioxidants, this would be an ideal opportunity to answer this question sent in by an HSI member who identifies himself as "EA": 

"In your Dec 10 e-Alert ("Over The Wave") you wrote about the benefits of selenium and recommended an intake of around 200 mcg per day. In your Dec 18 e-Alert ("Mineral With Muscle") you wrote about the synergistic effect between selenium and vitamin E. What daily dosage would you recommend for vitamin E for this synergistic effect to be optimal?" 

As with most matters concerning nutrition and vitamins, I called on HSI Panelist Allan Spreen, M.D., and here's the good doctor's response to EA: 

"The 'standard' is usually 400 iu (international units) of vitamin E and 200 mcg (micrograms) of selenium for general antioxidant protection. In athletes or in the presence of heart disease I'd take people higher than that. You can get too much selenium, and I'd always stay under 1,000 mcg 
(personally I never went above 400 mcg). 

"Now that vitamin E can be obtained as 'mixed tocopherols' 
(alpha, beta, gamma, delta), that's the only way it should be taken (and adding the newer 'tocotrienols' helps even more). Synthetic vitamin E (dl-alpha) should never be used other than topically, and natural d-alpha is now inferior to the mixed form. Vitamin E is so non-toxic that the dose is difficult to determine...heart disease patients can go up to 
2,400 iu or higher (though technically 'iu' only exists relative to the alpha form, not the other forms). 

"Finally, those starting out with vitamin E should start with small amounts and work up. Occasionally the nutrient can be so stimulating to heart muscle that there can be a transient increase in blood pressure, so your health care practitioner should monitor." 

My thanks to Dr. Spreen for taking care of the heavy lifting on this one, and for rounding out our mini seminar on antioxidants. 

To Your Good Health, 

Jenny Thompson Health Sciences Institute

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