Periodontal Disease and Vitamin D - interview and transcript - GRH, Grant July 2023

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21 minute  Interview

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Diseases and Conditions Associated with Periodontal Disease

Coronary Heart Disease, Stroke. Atherosclerosis. Preterm Birth. Adverse Pregnancy Outcomes
Cardiovascular Disease. Pulmonary Disease. Respiratory Infections. Diabetes
Cancer. Systemic Inflammation. Metabolic Syndrome. Rheumatoid Arthritis, Obesity
Alzheimer's disease. Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease (COPD)
Obstructive Sleep Apnea. COVID-19 Complications
www.grassrootshealth.net

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Transcript

0:00:02.6 Jen Aliano: Alright. Welcome everyone to today's interview with the scientists. I'm Jen Aliano, Director of Grassroots Health. And today we'll be talking to two of our wonderful scientists about their latest publication titled "Periodontal Disease and Other Adverse Health Outcomes Share Risk Factors, including Dietary Factors and Vitamin D Status". Can you please introduce yourselves?

0:00:28.4 William Grant: I'm William Grant with a PhD. I'm the director of Sunlight Nutrition Health Research Center in San Francisco, California. I've been researching the effect of diet and UVB and Vitamin D on health outcomes since 1996. And I published several hundred publications on both Vitamin D and/or diet and risk of various diseases.

0:00:57.7 Aliano Great. Thank you. Barbara.

0:01:00.8 Barbara Van Amerongen: I'm Barbara van Amerongen. I live in Amsterdam. And I studied dentistry and I did a PhD. I worked at the dental faculty for many years, part-time combined with my part-time dental practice, and then I started doing vitamin D research at the medical faculty.

0:01:28.7 Aliano Great.

0:01:28.9 Amerongen So I'm a dentist, very interested in vitamin D.

0:01:33.8 Aliano Well, then I guess that gets us to our first question, perfect for you, Barbara. What is periodontal disease?

0:01:44.9 Amerongen Periodontal disease is a disease which is not very visible. Sometimes it shows when you have bleeding gums. But on the whole, it's a silent disease. But it's a destructive disease. It affects the supporting tissues around the teeth, the cementum, the periodontal ligament and the alveolar bone, and that results in bone loss around the root and loosening of the tooth, and you can even lose the tooth, which is not funny.

0:02:32.1 Amerongen You can't see periodontal disease. Periodontal disease has to be measured by probing in-between the gum and the tooth with a pocket probe. So you need a professional to do that. If the pocket is deeper than four millimeter and it bleeds, you are in trouble. So you can't see that yourself. You have to go to a professional to get the diagnosis of periodontal disease.

0:03:03.9 Aliano And about how common is periodontal disease?

0:03:07.2 Grant Very common, especially when people grow older.

0:03:14.7 Aliano Okay. And so, although periodontal disease is an oral health condition, is it correct that over 57 other systemic diseases or conditions have been associated with periodontal disease?

0:03:30.6 Grant That is correct. The association between periodontal disease and other diseases has been undertaken for about 100 years. And the general opinion among periodontists is that periodontal disease is a risk factor for other diseases because they always often find that periodontal disease comes first and the other diseases come later, and that the increased risk of other diseases may be 20% above average for the population. The diseases most commonly associated with periodontal disease are things like type two diabetes, cardiovascular disease and adverse pregnancy outcomes. But these are only primarily associations. There was a series of papers published by the Canadian Dental Hygienists Association, by Dr. Salme Lavigne around 2000, 2001, 2002, and she examined whether the link between periodontal disease and other diseases could be considered causal using the framework of Hill's criteria for causality in a biological system.

0:04:52.8 Grant Now, for causality, you have about eight or nine steps to go through, and association is just one of the steps. The more important step in terms of periodontal disease is whether treating periodontal disease with conventional dental approaches reduces the risk of other diseases. And the answer was, it may have limited effect over the short term, but it has not been shown to significantly reduce the risk of these adverse health outcomes. Anyway, the purpose of publishing our paper was to point out to periodontists and family physicians that you've got to now start considering, well, what does this mean? And we can discuss that next.

0:05:43.3 Aliano Right. So we've got an association between periodontal disease and all these other systemic diseases. And it's not that periodontal disease causes or leads to these other diseases. So how could periodontal disease indicate a higher risk of these other diseases?

0:06:05.8 Grant Okay. So what has the first look at the risk factors for periodontal disease? And of course, there are quite a few; obesity, smoking, poor dental care. But the two we discussed in great detail were dietary factors and vitamin D. So the western diet, which is heavy into meat and other animal products, ultra processed foods, sugars, bad oils and fats and low amounts of fresh fruits, vegetables, whole grains, beans, legumes, good fatty acids and so on, is a primary cause of periodontal disease. The other risk factor is vitamin D deficiency.

0:06:56.4 Grant It turns out that the bacteria in the mouth that promote periodontal disease and vitamin D through inducing production of cathelicidin and defenses can actually kill those periodontal toxic bacteria and make the mouth healthy again. Now, what the periodontists have said for years as well, the bacteria in the mouth that are causing periodontal disease and the increased inflammation in the mouth associated with periodontal disease probably have an impact on systemic diseases. No, that has not been proven. And so we're highlighting that you really want to address the risk factor. Well, it turns out that the bad diet, the western diet is a big risk factor for all sorts of diseases, including type two diabetes, cardiovascular disease, cancer, Alzheimer's, et cetera, et cetera.

0:08:06.6 Grant And in fact, I'm just finishing a manuscript now on the western diet versus a whole plant-based diet for affecting the risk of Alzheimer's. Western diet is the worst one for Alzheimer's, whereas a whole plant-based diet can practically eliminate the risk of Alzheimer's disease. And of course, vitamin D plays a role in many, many diseases. Turns out that every cell in the body has a vitamin D receptor, and as organs feel the need for extra help, they convert the circulating vitamin D metabolite,25-hydroxy-vitamin D, which is what is measured when you have your blood vitamin D level measured, and they convert that to 1,25-dihydroxyvitamin D or Calcitriol, which is a hormone. And when it goes to a vitamin D receptor, it can affect the expression of thousands of genes and thereby affect through many, many different mechanisms, the risk of many types of disease.

0:09:08.0 Grant So that's what we're trying to get periodontists and doctors to realize is that here is a sort of a warning sign, I'd like to call it the canary in the coal mine, that, hey, you've got a problem and you've gotta deal with it by dealing with the underlying factors, not just trying to correct the periodontal disease, which is still being caused by underlying factors.

0:09:32.3 Aliano And I think one of the things that I remember reading in your paper was that periodontal disease is often diagnosed at a younger age than many of the diseases it's associated with. Is that correct?

0:09:44.4 Grant Yes. And in my case, when I was a postdoc in Berlin in the early '70s, in my early 30s, I worked in a physics lab, was indoors all the time, did not know anything about sun exposure and vitamin D. After two and a half years, I returned to California, went to Menlo Park in Palo Alto, and found out I had very severe gingivitis. My gums were bleeding, there were deep pockets and I had to have the extra material removed surgically. Of course, being in Sunny California, that was more or less the end of the periodontal disease. But of course, at that point, I didn't have any other disease. But, I realized then that... Looking back, I can see that vitamin D deficiency was very likely the cause of my problem and that it was very early in life.

0:10:44.3 Aliano So some people, if they've been diagnosed with periodontal disease, might want to think about some of these risk factors that are not only associated with periodontal disease, but also these other diseases and start addressing them as soon as they learn about their diagnosis. And perhaps Barbara, you could talk about this a little more, how identifying and addressing some of these risk factors that might be playing a role in their periodontal disease, including low vitamin D levels and the fact that that might be just as important as brushing or flossing for periodontal disease. So what can be done to implement, for example, testing vitamin D levels or educating about diet into dental practice? Should dentists start testing vitamin D levels? And what can individuals do for themselves from home?

0:11:43.4 Amerongen Well, I think it's very important that patients start taking vitamin D, vitamin D3. And as written in our paper, people can easily take 2,000 international units a day or 4,000 international units (IU) (50 or 100 microgram (mcg)) a day. And of course, if you want to know if you are taking enough, you can have your vitamin D level tested. The recommendations by the National Dietary Reference Values for vitamin D are far too low in my country and in most countries. They are simply not healthy.

0:12:27.4 Aliano So you can't really rely on your doctor telling you that, if they measure your vitamin D level, you can't really rely on them saying, "Oh, you're fine." You wanna make sure you know what the number came back as so that you can determine if it's within an acceptable range?

0:12:45.9 Amerongen The acceptable range in my country is very, very low. So it's always fine and it's not. So you have to know... You have to educate yourself, and one way of educating yourself is by going to Grassroots Health website and study it. So you... The national advice is unhealthy, to be blunt. So it's... We need to take more to have an adequate vitamin D level. And if you have severe periodontitis, you better make sure that your vitamin D level is up-to-date. Up to... It's there where it should be.

0:13:40.2 Aliano And where do you both think that it should be? I know that Dr. Grant, you've written about how optimal vitamin D levels vary for certain diseases.

0:13:52.2 Grant Right.

0:13:53.8 Aliano If you guys could both make a suggestion of what you think the optimal vitamin D level should be, that would be great.

0:14:03.8 Grant So in the paper, we pointed out that most of the National Disease Agency or Health Agency recommendations call for 20 nanograms per milliliter (ng/ml) or 15 nanomoles per liter (nmol/L) as optimal or good. But most of the independent scientific researchers who have studied this recommend at least 75 nanomoles per liter or 30 nanograms per milliliter. The Grassroots Health and I think that optimal is really more like 40 nanograms per milliliter or 100 nanomoles per liter to really reduce the risk of all sorts of diseases like autoimmune diseases, cancers, diabetes, high blood pressure, et cetera, et cetera. And of course, as one gets older, the production rate in the sun goes down by about factor of two because there's less of the 7-dehydrocholesterol in the skin to convert the to make vitamin D. So as you get older, as your immune system sort of starts failing, you've got to really up your supplementation.

0:15:17.0 Aliano Okay. And Barbara, in your personal experiences, what do you believe the optimal vitamin D level is for...

0:15:26.8 Amerongen I follow Grassroots Health recommendations. And I think they are wonderful. And it's silly not to follow those recommendations.

0:15:41.5 Grant And those recommendations are?

[laughter]

0:15:42.8 Amerongen Yeah, 100 to... Well, it depends which measurement you take, 100-150 nanomoles per liter (nmol/L).

0:15:54.7 Grant Right.

0:15:55.8 Aliano So Barbara is in Amsterdam. And in the United States, we use nanograms per milliliter (ng/ml). So that range is 40-60(ng/ml).

0:16:05.9 Amerongen Yeah, 40-60 (ng/ml).

0:16:07.8 Aliano Okay. Alright, so...

0:16:11.5 Amerongen This is also very confusing for everybody and for patients, all the different notifications.

0:16:19.8 Aliano The different units, and then the different... The disagreement between what optimal or what's even defined as deficient. We can certainly talk about that topic another time because it's important to talk about.

0:16:33.1 Amerongen It's very important.

0:16:36.0 Aliano Yes. But I think for this talk, just knowing that you can't rely on taking a dose and not knowing what your vitamin D level is. Everybody responds differently to vitamin D intake. And so it really is important to measure your level and you can get that done through your doctor or you can order a home test through Grassroots Health, or there's lots of places that offer that now. But the most important thing is to make sure you're between that 40-60 nanogram per milliliter range, or 100-150 nanomole per liter.

0:17:10.7 Grant . . . that if you're taking 4,000-5,000 IU per day (100-125 mcg), you're probably very safe and you don't have any risk of adverse effects.

0:17:18.3 Aliano Yes.

0:17:19.1 Amerongen Yeah, that's very important. People have a wrong impression, get a wrong impression.

0:17:27.1 Aliano Because it's extremely difficult to become toxic from vitamin D, correct?

0:17:31.2 Grant Right.

0:17:32.3 Amerongen Yes.

0:17:32.5 Aliano You'd have to be taking about how much per day for how long?

0:17:38.9 Grant 50,000 IU per day for a month or two, or three, or four. And even then, you may not get hypercalcemia or other adverse effects.

0:17:48.2 Aliano So vitamin D at these levels that we're talking about, 2,000, 4,000, 5,000 IU per day (50, 100, 125 mcg) is very safe.

0:17:56.8 Amerongen Yes.

0:17:57.1 Grant Right.

0:17:57.9 Aliano Okay. So let's circle back to your paper. And I just wanna make sure that we nail the main point, which I think the main point is if you're diagnosed with periodontal disease, check your vitamin D level, check your diet, check your overall health, because it really can be an indication that you're on the path for developing some other systemic chronic disease. Is that correct? Or do you wanna add to that?

0:18:32.1 Grant Correct.

0:18:33.0 Amerongen But it takes a few years.

0:18:38.4 Aliano Right, but that's a few years that you could change your path and make different decisions in...

0:18:42.3 Amerongen Yes, exactly.

0:18:45.3 Grant Well, yeah. It turns out that one can reverse type two diabetes within a few weeks by going on a whole plant... High-quality, whole plant, low-fat diet. You don't need drugs when you have type two diabetes. You can get off your insulin, you can get much better health by changing your diet and it can happen very rapidly.

0:19:07.8 Aliano Right. And Barbara, do you have any last thoughts to share before we close?

0:19:12.5 Amerongen Well, I hope... Dentists are very prevention-orientated, and they are very caring. So I really hope that they will take this opportunity to improve their patients' health with vitamin D.

0:19:35.3 Aliano And on the Grassroots Health website, we're going to add a page specific for dentists with some information about how to utilize vitamin D testing and supplementation into practice and some other great resources for any type of practitioner, really. Well, I would love to thank you both for being here today and I really appreciate your hard work with the research that you do.

0:20:06.6 Grant Well, I'd like to thank Barbara too, for getting me involved with this project. I mean, she's been after me for years, I guess, to write a paper together on vitamin D and we finally got on this. And then all of a sudden, I guess, through the interaction, I realized that, well, hey, we should look at the underlying causes of periodontal disease, and first it's vitamin D, and then it was diet and vitamin D, and it just was a very nice organic growth, and probably took two or three months to complete the manuscript.

0:20:35.1 Amerongen Well, you worked so hard.

0:20:38.2 Grant Yeah, and it got Barbara Boucher involved as well. She added to it as well. Well, thanks very much for hosting this.

0:20:44.4 Aliano Yeah.

0:20:44.9 Amerongen Thank you very much.

0:20:46.2 Aliano Looking forward to doing it again. [laughter]

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The recent study by the two interviewees

More D less PD

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VitaminDWiki – Dental category contains:

116 Dental items

Some Dental studies

• Vitamin D cut dental caries in half 80 years ago – meta-analysis 2013 80 years ago
• Caries (tooth decay) and Vitamin D - 23+ studies
• Periodontitis reduced by Vitamin D - many studies
  • Periodontal Disease and Vitamin D - interview and transcript - GRH, Grant July 2023
  • Severe periodontitis is half as likely at 60 ng of vitamin D – Sept 2021
  • Vitamin D may provide the most peridontal benefits of all nutraceuticals – May 2018
• Risk of Oral Surgery reduced by Vitamin D – scoping review Nov 2021
• Some Dental Malocclusions 5X more likely if low vitamin D – June 2021
• Grinding teeth while sleeping (sleep bruxism) 6 X more likely if low vitamin D – Jan 2021
• Early tooth decay 1.9 X more likely if a poor Vitamin D receptor – July 2017
• 7 Intervention AND Dental studies
• 19 items listed in BOTH Dental and Infant or Child
• 7 listed in BOTH Dental and Vitamin D Receptor

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24+ VitaminDWiki pages with PERIODONT.. in the title

This list is automatically updated

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VitaminDWiki - 7 studies in both categories Dental and Vitamin D Receptor

This list is automatically updated

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17+ VitaminDWiki pages with Baggerly or GRH in title

This list is automatically updated

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VitaminDWiki pages with TRANSCRIPT in title (52 as of Aug 2023)

This list is automatically updated

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110,000 results for the Google Scholar search of (periodontal OR Dental) "vitamin d"

Google Scholar  ~ Examples:

• The role of vitamin D in periodontal health and disease - Dec 2022 PDF
  • talks about restriction of vitamin D by the Vitamin D Receptor
• Vitamin D and Vitamin D Receptor Polymorphisms Relationship to Risk Level of Dental Caries = May 2023 PDF
• Impact of serum vitamin D levels on periodontal healing outcomes: A preliminary cohort study - Sept 2022 https://doi.org/10.1111/idh.12619 PDF is behind paywall
  • "Vitamin D level was not associated with the percentage of sites of gingival bleeding on probing at the final evaluation (OR = 0.58, 95% CI = 0.17–1.99, p = 0.39)."

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ShortURL = https://is.gd/teethD