The oral microbiome + fertility + chronic disease (and the red flags we should never ignore) – with functional dentist Dr Victoria Sampson

0:01Hi, I'm Sophie and this is Age Well with Dr Sophie Shotter, a space devoted to all things health, wellness and longevity. Because for me, ageing well is about looking and feeling like the best possible version of ourselves, inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing you conversations from a range of interesting women, and men finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

0:45Victoria, it's a real pleasure to finally meet you. Fee and I have been watching your career with a lot of interest. Can we start at the beginning with a very basic understanding of why so many people are now talking about oral health and specifically the oral microbiome? I know for example that there are links with everything from cancer and Alzheimer's to diabetes, heart disease, even erectile dysfunction. So if we start with serious disease, although just a caveat that I know there's more to it than that, but I know Fi has a question next about fertility. But can you perhaps do a quick whistle stop tour of where the latest data is and what we know from the research in relation to cancer, Alzheimer's and other chronic disease?

1:23I'm especially interested in the data around breast cancer for example because from what I understand the research here is pretty robust now yeah well I mean firstly thank you so much for having me I mean every time I'm on a podcast it's great to just be giving the opportunity to spread the awareness like you said I think in the past kind of maybe five years or so people are really starting to understand that oral health is part of general health or and their mouth is the gateway to the rest of their body. And really, I think that started in really in 2008, when the oral microbiome project came to fruition.

1:58And that was basically where the Forsyth Institute in the US, they went out to essentially map out the whole oral microbiome to so to see all the different bacteria inside the mouth. And they created this database, which is publicly available, you can go online and you can basically see all the bacteria that have ever really been found in a person's mouth. And from there, that gave a lot of companies, a lot of universities, the blueprint to do a lot more research and to understand like, okay, you know, if you have this bacteria in your mouth, and you have this systemic disease, you know, is there a connection?

2:34And so in the last five years or so, a lot of this research was kind of speculation previously. And it's been confirmed in the last five years that actually, no, there are a lot of correlations, there's a lot of connections. And now the next step is in a lot of these oral systemic connections, trying to find that causation element to it as well. So, so interesting. And as Sophie said, the oral microbiome is now being linked to many things. And we know that you are flying the flag for the link between fertility and oral health. We were amazed to hear you on Stephen Bartlett's show discuss some of the latest research coming out, which has found that 90 % of men unable to conceive were shown to have some form of oral disease.

3:15And with those who got treated, there was a 70 % improvement in their partner getting pregnant. That was nearly two years ago. What's the latest now on oral health and fertility? I think it's more, it just kind of keeps growing on top of what was previously found out. So that research that you just cited was in 2009. Since then, we're now starting to understand that men in particular, for example, if they do have periodontal disease, they have poor sperm quality, that systemic inflammation. So the inflammation that can spread from their gums elsewhere to the rest of their body can impact their testosterone levels.

3:50And from a female perspective, we're really starting to understand that actually there's a really strong correlation between periodontal disease or gum disease prior to birth. So when the mother is pregnant can really impact the child's life. It can impact preterm birth, preeclampsia, low birth weight and that's mainly to do with inflammation and also bacteria from the mouth travelling through and crossing the placenta and impacting the unborn baby. One thing we should say is that through your clinic the Health Society you offer extensive oral bacteria testing and Fi and I have both tested so we'll go through that shortly.

4:30But first when we talk about oral disease and dysbiosis are we talking about specific bad bacteria. For example, I think that a bacteria called P. gingivalis has been found in the majority of people with Alzheimer's. Could you maybe run through the main bacteria or bacterial strains that people need to be aware of? And did you test VNI for those? So yes, definitely. We tested you guys for, we test you for over 500 different bacteria. So we use a special technique called shotgun metagenomics, which means that we look at every single bacteria which is present in your microbiome. And then we zoom into the top 20 that we know are really strongly associated with oral diseases like gum disease, decay, bad breath.

5:11But going back to your question about, you know, are there specific bacteria? There are. And this has been mapped out from really like the mid-1900s. So I would probably say around 1960s or so, we started understanding that there are specific bacteria which are strongly associated with specific oral diseases. So for example, there's a bacteria called strep mutans and strep mutans really has been strongly connected to decay. So if you have strep mutans and you have sugar in your diet, then you are going to get decay. But if you have just sugar in your diet and no strep mutans, then you might not get decay.

5:48And the other way around, so if you have strep mutans and no sugar, then you also might not get decay. So you need all of it together to get that decay. And the same with gum disease. So we started to understand again in the late 1900s that there are specific bacteria that are really strongly associated to things like gum disease. So you're right. So one of them is Porphyromonas gingivalis. And a professor called Sokransky, he basically created what we call like the complex pathogens. And these are basically, he chose a couple of bacteria that he felt were most strongly associated with gum disease.

6:23and he kind of created like a hierarchy where the tip of the the pyramid is your bacteria which are really really strongly associated with gum disease and cause a lot of destruction and as you go down the pyramid they're less likely to cause problems until you get to the bottom of the pyramid where usually they're actually kind of good bacteria so we now understand that there are definitely some really really bad bacteria that can cause really bad things but now we're now understanding that but it's a lot more complicated than that, unfortunately. So it's not enough to say, okay, you've got P.

6:56gingivalis, therefore you have Alzheimer's, or P. gingivalis means you're going to get gum disease. We're now understanding that actually these bacteria are very unique and very special, and they will do bad things in certain environments. So there are multiple strains of the same bacteria. For example, Porphyromonas gingivalis has multiple strains. And some of these strains in specific environments can do very bad things. They can cause destruction. They can release toxic enzymes that break down collagen, which cause gum disease, which are associated with neurodegeneration. And other people might have another strain of P.

7:33gingivalis, which actually does nothing and is entirely fine. So when I was developing our oral microbiome test a couple of years ago, originally I had developed another microbiome test. And what we were finding was that two people would do the microbiome test and they would come out with pretty much identical results. And when you'd look in their mouth, one would have raging, terrible gum disease, really bad problems, and the other one was entirely fine. But their results were identical. And so that's when we realized it's not enough to just superficially look at absence or presence of these bad bacteria.

8:10You need to look at these bad bacteria, their strains, and how they're acting inside the body. So that's why we then redeveloped and created a new one, which you guys have taken. And this new test looks at not only if you have the bacteria, but also how that bacteria is acting inside your body, whether or not it's releasing those toxic enzymes, and therefore your risk of things like gum disease, and even the connections to Alzheimer's. So when you say the environment, I guess the terrain, that's the unique thing that would make two strains react differently in two different people's mouths. Is this to do with everyone's unique genetic environment, i.e.

8:49could we change the environment or not? I guess it's a question of, you know, nature versus nurture and it's with everything, right? It's like there are some people who smoke 40 cigarettes a day and, you know, don't brush their teeth and never have gum disease and have no problems. And then you have another patient who brushes six times a day, never touched a cigarette and has raging gum disease and can never keep it under control. And with those types of patients, there's a very strong genetic element, which will mean that they're more pro-inflammatory. So they're predisposed to destruction, to inflammation.

9:23So even the smallest amounts of bacteria, the smallest amount of stress in their body, they respond in a really aggressive and kind of destructive way. And the other person, even though they're doing pretty bad things to their body, their terrain, their environment, their habits are not good. Their genetics are actually kind of helping them and saving them. So it's, in my opinion, it's kind of a little bit of both. So the recipe for terrible gum disease would be someone who's got specific genetic mutations that mean that they're very pro-inflammatory. And then also they've got bad bacteria doing bad things and they've got bad habits.

10:02And I think it's also worth noting that, you know, your genetics, you can't change, right? But what you can do is you can work with them, not against them. So if you're someone who's got a genetic mutation, that means you release a lot more inflammatory markers than the average person, then why don't you try and reduce the production of inflammation from your body? So maybe that could be through supplementation, through nutrition. So we give a lot of that advice. And from the bad bacteria doing bad things, the really cool thing that we're now understanding and learning in the past couple of years is that it's not actually, we don't want to kill everything.

10:35We don't want to kill all the bacteria because actually that can cause more problems. What we want to do is switch off the bad bacteria from doing bad things. So if we're talking about P. gen duvalis, it's not that we have to wipe it out completely and make sure you have no P. gen duvalis in your oral microbiome. We just want to make the P. gen duvalis stop doing bad things. And there are a lot of products and recommendations and treatments that we can do to actually switch it off. Imagine it's just a switch that you turn on or off. gosh and we're going to get onto that this is also so fascinating onto our testing first I just want to say to listeners it was a really simple process of giving a saliva sample by post and as I understand it the test looks for people's oral bacterial profile including as you say specific strains but also genetic markers should we do Sophie's results first and by the time this goes live we can reveal that Sophie is pregnant and was pregnant at the time of the test I'm not sure yes so I'm not sure if this might have had any.

11:31I don't think I knew that. Oh gosh really oh gosh maybe this might have had an impact who knows but I'm sure that you could maybe tell us. Yeah okay so Sophie let's go through through your results too. Do you want me to go through them or do you want to just kind of ask questions or how do you want to do that? I think staying quite top line. I suspect pregnancy has impacted mine but it's quite interesting. All right so let's kind of go top line into your results. So at the top of the report it's kind of your cliff notes of like this is what we're finding. So essentially in your oral microbiome result, we found that you had pretty average levels of good bacteria.

12:08So you had good levels, which is actually quite rare, unfortunately. So we're finding that a lot of people are wiping out all their good bacteria. So they're using all these super strong antimicrobial mouthwashes. They're taking antibiotics. They're just wiping everything out because we've been trained from childhood adulthood that kills 99.99 % of bacteria. That's what we always think is a good thing. So you actually are pretty lucky. So you've actually got good levels of good bacteria. And then you did have high levels of a few bad bacteria that are associated with gum inflammation, with plaque accumulating around your gums, and potentially adverse pregnancy outcomes as well.

12:49So I guess I did know you were pregnant. So if we zoom into that a little bit more, what does that actually mean? we found that on average when we compared your results to our population of over a thousand patients on average most people would have 0.8 bad bacteria in their microbiome and in your case you had kind of three four times more of that it's worth noting that when you're pregnant your your oral microbiome goes absolutely crazy i mean i don't know sophie have you felt that your gums have been a lot more inflamed since you have been pregnant? I actually had my hygienist visit literally two weeks ago and there was like very little plaque accumulation, no sign of anything nasty going on.

13:35But I have got slightly more inflamed gums despite sticking to my normal routine. Nothing crazy, just a little bit. And of course, it's actually really normal in pregnancy. Most women get a degree of it. But yeah, I have a little bit of gum inflammation that I don't normally have. Yeah, so exactly. So most people who, let's say if you were to maintain your oral hygiene routine pre-pregnancy and during pregnancy, you might still get some gum inflammation during pregnancy and that's just hormonally related. So it's not to do with you're not brushing as well or anything like that. Most patients, I would say, I would say pretty much every patient who's pregnant that I've seen has some element of gum inflammation and some who actually start getting gum disease.

14:20And again, it's just that maybe the bacteria is there, it's the same, but their body is responding in a much more inflammatory way because they're pregnant and that's kind of being charged by their hormones. So when we look at kind of your bad bacteria, the pathogens, so we look at over 500 and then we zoom into the top 20, and you just had slightly high levels of a few bacteria which are associated with inflammation and with kind of plaque accumulating around your gums. so as you said it's not anything terrible we we didn't predict that you had gum disease we didn't think that there was anything terrible or or worrisome but it might be that just because you're pregnant these bacteria are elevated more than average and you're responding in a bit more of an inflammatory way yeah and and actually the recommendations that you've made I mean I don't take a specific dental probiotic but I do take a really good all-round probiotic every day I use a different mouthwash than the one you recommended but what I am changing is to do it extra times during the day and I take high dose omega-3s anyway I'm obviously not going to drink much green tea in pregnancy because I'm being careful with caffeine intake but I also thought the mints that you recommended are really interesting but despite all of that my overall microbiome score was 9.8 out of 10 which I thought was interesting yeah yeah so if we so we've also So we built an algorithm which looks at, it predicts your risk of gum disease, bad breath, decay, and general inflammation.

15:52And that looks at your levels of bacteria, strains of bacteria, activity of bacteria, your genetic mutations, your inflammation, age, medical history, absolutely everything. And despite me being pretty mean and saying you've got bad bacteria in your mouth, you scored low in every single one and you were still in the top 10 % of oral microbiomes. so what that shows is this is what I was saying about you know it's not necessarily that you have certain bad bacteria and therefore you're going to have disease or problems it's about those bacteria doing bad things and if your body is able to respond to those in a good or a bad way and that can be dictated by your genetics and in your case you had no genetic mutation so you were actually very good and healthy yeah and I think that's such an interesting example of exactly what you were saying that, you know, this is something for sure there are some small steps I can take to work on.

16:48I mean, I'm a big believer in the link between oral health and systemic health, but also probably something I'll look at retesting when I'm not pregnant anymore, at least when my hormones have had a chance to settle down post-pregnancy again. Yeah, exactly. So, and pregnancy does kind of skew things a little bit. The one thing that maybe would be mildly interesting in your situation is you had slightly elevated levels of Fusobacterium nucleotum. Yeah, yeah. So Fusobacterium nucleotum is a strange one. Again, there's multiple strains of this bacteria, but there has been shown to be a strong connection between low birth weight, preeclampsia, and preterm birth.

17:28So it's one of those bacteria that are able to cross the placenta and to just impact the development of any child. So that's why we recommended those mints for you. We recommended just kind of maintaining, even though you might feel that your gums are great, your hygienist is telling you everything's great. Just keep going to the hygienist every three, four months just to lower those bacteria. And I will go on to say that actually my baby is growing perfectly, at least at the moment, and my preeclampsia risk is low and normal. So everything is really, really healthy. So again, it's just something more to be mindful of.

18:05Exactly. Yeah, 100%. So and the beauty with this type of oral microbiome test is that it's not to say that if you have this, this is going to cause x, y, z. It's very easy, like you said, small things that you can just incorporate into your oral hygiene routine, which will just, you know, everything's about marginal impact. It's about just, you know, improving things, even if it's a couple of percent here and there. So this is one of those things. And knowledge is power. I mean, just to have this knowledge is a privilege for both of us. I'm not looking forward to my results, Victoria, because on my family line, there is a history of very, very bad teeth and bad gums.

18:41So I'm just, how did my results look? All right, let's bring up your one. So we said for your one, you had relatively low levels of good bacteria. So we do want to boost that up a little bit. And you had just high levels of one bad bacteria that's associated with a bit of gum inflammation and general inflammation. So if we go down to your actual results, again, your score is 9.6 out of 10 for the microbiome. So everything was pretty good. You had pretty much average levels of bad bacteria, but slightly lower levels of good bacteria than average. So that's why we just want to help boost those up a little bit.

19:22Then if we go onto your good bacteria, so these are your commensals. as I said you we do want to kind of boost that up a little bit so that's why in your recommendations we have recommended a oral probiotic which has been specifically recommended to you because of the specific strains of the commensals that you're lacking in your oral microbiome so we've designed that specifically for you and then when we look at pathogens again we zoom into the top 20 and you only had high levels of one which was pravotella intermedia and this is just kind of associated with a bit of inflammation, but it's nothing again too concerning or serious.

19:59When we look at your genetic mutations, so we look at 10 different genetic mutations and you actually didn't have any concerning ones. So one thing about our test report is that if you don't have something bad, we don't talk about it, which sometimes people are like, oh, there's nothing interesting about my report. Like you didn't look at anything. We're like, no, no, if you don't have it, we don't talk about it, you know. So in your case, you know, you didn't have any bad genetic mutations that we were concerned by, nothing that was going to cause, you know, a destructive or pro-inflammatory response.

20:30And I know you said you have a bit of a family history of that, but it might be that that was more of a habitual or an environmental thing as opposed to a genetic thing, which is good for you, basically. Yeah, yeah. Okay, that's good. So no crazy Alzheimer's genetic mutations on my, just another thing I was thinking about. No, no, exactly. And And so we're the only test actually on the market that looks for porphyromonus gingivalis. As I said, there's multiple strains and certain strains of porphyromonus gingivalis are able to release virulence factors. And these virulence factors are kind of toxic enzymes that can travel around through the body and break down tissues.

21:07And they have found in over 90 % of Alzheimer's sufferers that they have high levels of some of these toxic enzymes called gingipanes in their cerebral spinal fluid. This is only created by Porphyromonas gingivalis, which is in the mouth, and it's able to travel and cross the blood-brain barrier and impact neurons in the brain. So we're the only test that actually looks for those gingipanes and whether or not those toxic enzymes are being produced. And in your case, you didn't have that. Actually, one more quick ad hoc question. I had breast cancer three years ago. And as Sophie said, a lot of the data around oral health and breast cancer is now quite robust.

21:44And I've been reading a lot of stuff around that as well. Did I have that bad bacteria in my mouth? Sorry to put you on the spot. No. Oh, interesting. No, you didn't. Okay. Well, that's good. So yeah, everything was fine. What we said was, I think probably because of the treatment or everything that you've gone through, your microbiome is a little bit wiped out. So you just didn't have some of those good bacteria and your microbiome was slightly acidic as well. So that's why in your case, we've recommended that we put you on kind of an alkaline rinse for a couple of weeks just to help with the acidity and then to switch to a nice probiotic rinse afterwards and to really boost your nitrate rich vegetables and your good bacteria.

22:24So we want to really boost as much as possible. One thing I'm a strong believer in is that, you know, having probiotics is not kind of this solution and will solve everyone's problems. Yeah, exactly. It's more that, yes, it's great to maybe put good bacteria in your mouth or in your gut, but you need to also be creating the right environment for those good bacteria to survive, to thrive. And part of that is a lot through your diet. And even though some people are like, oh, but it's my mouth. Like, actually, no, if you have lots of beetroot and celery and rocket, those are really nice nitrate rich vegetables.

22:58And that will nourish the nitrate producing bacteria in your mouth. Thank you, Victoria. Thank you so much. So how can we best treat a dysregulated oral microbiome? You've mentioned a few things there. Are there any other products and brands that maybe you haven't mentioned that you would like to? So I would say if you want the like perfect kind of blueprint of what is best for you, you know, everyone's oral microbiome is different. Everyone's needs are different. Then yes, you kind of need to do an oral microbiome test to see what you're lacking or you have high levels of. But if I was to give kind of a, you know, I'm also very aware of the fact that oral microbiome testing is not up everyone's alley and also it is expensive sometimes.

23:37So if, you know, we were just going to take a few takeaway points, then the first would be don't kill, nourish as much as possible. So there's, like I said, this kind of idea that let's kill everything. Let's use these really strong antibacterial mouthwashes, but, you know, ones with alcohol in them. I'm not going to name any names, but there are some mouthwashes in, you know, the ones that you buy in boots or in the super drug or whatever. don't just go and grab a mouthwash and start using it because actually it wipes out all your good bacteria and there's actually now research to show that using some of these mouthwashes for a long amount of time can increase your blood pressure and that's because it is damaging and just it's killing those nitrate producing bacteria in your mouth and those nitrate producing bacteria are very important for the kind of endogenous production of nitrous oxide which helps with basodilation and basoconstriction of your blood vessels.

24:33So it's not so don't just go and grab it. It should be something that your hygienist or dentist recommends or prescribes to you for a certain amount of time for a certain or specific issue. So that would be my first one. My second would be keep things clean. So, you know, avoid alcohol in your oral care products, avoid things like sodium lauryl sulfate. So sodium lauryl sulfate is a foaming agent, which actually a lot of toothpastes have it makes your toothpaste nice and foamy and fun but it's actually not great for the microbiome it strips your microbiome and can be damaging same with essential oils so in low amounts and low concentrations it can be good but in high concentrations again it can be very damaging and strip the the microbiome as well third would be keep it simple so just like i think sometimes we like to overcomplicate things.

25:27If you just brush twice a day, you floss and you spit, don't rinse, like you're good. You know, like it's actually not, you don't need lots of fancy gadgets and, you know, water picks and this and that and the, you know, and like multiple toothbrushes and all of these mints and all of these, you know, like I sometimes patients come to me and they've got like a closet of like oral care products. They've got a mousse for this and of gel for that. And it's great. But honestly, if you have a good diet, you brush well, that's it. It's not that difficult. In terms of what negatively impacts people's oral microbiome, what are the main causation factors?

26:10Is it lifestyle or genetics? The other thing is, I know that our gums are made out of a certain type of collagen and that gum disease is also a form of collagen breakdown. But as you said in another interview, the problem with gum disease is that by the time we can see it in our mouth, it's kind of too late because the destruction has already occurred. So I'm also really interested in your oral collagen testing and to hear you say that on a biomolecular level, this test can identify collagen breakdown happening up to a year beforehand. I believe it's a certain enzyme that shows up in the saliva and that very often this is also linked to stress.

26:46So to return back to my earlier question, can you talk about the role of genetics and lifestyle and also stress all in terms of keeping our mouth healthy? Yeah so the test that you're talking about or the enzyme in particular is called activated matrix pitaloproteinase 8 so we call it AMMP8 and it is a enzyme which is found in your saliva and is relevant to collagen degradation specific to the the type of collagen that your gums are made out of. So a lot of people ask me like, oh, is this the same collagen that's going to be for my skin? And you know, can I test and see how my collagen breaks?