00:00
Hey everyone, Mikki here. You're listening to Mikkipedia. This week on the podcast, I'm stoked to bring to you a conversation that I have with Dr. Sarah Hancock. Sarah is a public health researcher whose work sits at the powerful intersection of oral health and metabolic disease. In this conversation, Sarah unpacks for us the often overlooked links between what's happening in our mouths

00:30
and what's unfolding systemically in the body. And we explore how gum disease and blood sugar dysregulation are deeply entwined, why your dentist might be the first person to flag insulin resistance, and how the microbiome of the mouth plays a much bigger role in chronic disease than we've given credit for. Cera also challenges conventional public health approaches, which I think you'll find super interesting. And I've included some links to

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papers that Sarah and I discuss in the interview in the show notes. Dr. Sarah Hancock is a public health researcher. has a PhD in public health with her research interests focused on the role of nutrition in oral health and general health and how to design nutrition interventions to improve population health. Sarah is an advocate for dietary lifestyles, incorporating a whole food eating pattern that minimizes the intake of highly refined

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ultra processed foods for the prevention of chronic diet related disease. She currently works as an analyst at the School of Public Health at the University of Adelaide in South Australia. And as you'll hear, she's also undergoing or has just completed her studies on health coaching as well. So I really think you're going to love this interview that I have with Sarah and you can find her at drsarahancock.com. Again, that's in the show notes as well. And

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If you've never thought about your dental hygiene as being part of your overall sort of metabolic health, I think this will be really insightful for you. It makes sense, right? Because nothing in the body works in isolation. Before we crack on into the interview though, I would like to remind you that the best way to support this podcast is to hit the subscribe button on your favorite podcast listening platform and share it with a friend. That is the best way that a podcast like Mikapeedia gets in front of

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other people that can learn so much from the experts that I have on this show, particularly because there are thousands of other podcasts out there. So if you did that, that would be amazing. All right team, enjoy the conversation I have with Dr. Sarah Hancock. Sarah, so first of all, Dr. Sarah Hancock, I'm so pleased to have this opportunity to chat to you and you and I have mutual friends in obviously Dr. Cliff Harvey and Bella.

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as well, Bella Nutritionist. And Bella has said to me for years, she's like, Miki, you've got to speak to Sarah. And I'm like, I know. And for whatever reason, it has taken me this long to get you on. So thank you for taking this time. Well, it's an honor to be invited to be a guest on this podcast, Miki, because you know, it's a wonderful podcast. Listen to it every week. And it's just fantastic. have some really interesting guests. I have to say, I learn something every week from the people that you have on. And it's just a really

03:22
Yours is a really nice voice in this space of physical exercise, nutrition, how we improve our health and how we maintain our health through the lifespan. yeah, it's a great podcast and it's really nice to be invited to be a guest. Oh, lovely, Sarah. Thank you so much. And I think one of the reasons why you might enjoy it is because we're quite aligned in our approach of what constitutes health and

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the many different paths with which to get there. But of course, you've got a special interest in dental health. Yes. Can you just give us a little bit of your background? Yeah, little bit. I became really aware probably earlier than many people that food and diet has quite an impact on health. Because I have a younger sister who was diagnosed with type 1 diabetes when she was eight and I was about 10. And so there was this awareness of what she ate or didn't eat.

04:19
um, could have an impact on her health. You know, she could become very, very ill very quickly. Um, there'd be a bit of a lead in time for that. Um, then sort of, you know, grew up, went off and did a PE degree at Otago and sort of, you know, on the basis that physical exercise was going to be the cure all and the deal. And that was going to be how you're going to maintain your health through the life course. And, you know, so off we go. And then my,

04:44
parents' friends as I was getting older, know, having kids, moving through life as you do, more of them were getting diagnosed with type 2 diabetes. on the day that my sister was diagnosed, we know I had to go and stay with my grandparents and my grandmother had all these encyclopedias in the garage. And so we looked up diabetes because, know, what is it? I knew was that she was going have to inject herself every day of her life, multiple times a day for the rest of her life. And that seemed a bit unfair at the time. And I read about

05:14
a more rare form of diabetes because these encyclopedias were written in 1941. that, you know, there was a type of diabetes that you could control by your diet. You know, you just had to cut out cereals and bread out of your life and this is what you should eat instead. You know, it's things like bacon eggs, you know, no cakes. And I sort of decided that, you know, whatever way she had to eat to get on top of this, I was going to...

05:40
join her in it because it be mean to eat sweets in front of her, it just wouldn't be a nice thing to do. So I looked at that and I sort of if that's all you had to do, you know, it seemed really unfair that she got the type 1 version that required this level of care and attention and what we were soon to discover monitoring a certain amount of hypervigilance around her health. So it was a bit of a surprise when say 25 years later, there were more and more people of my parents' generation were getting diagnosed with type

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diabetes. Is that the rare type of diabetes that you were reading at the time in the encyclopedia? That was yeah at the time way back in 1984 you know in these very old encyclopedias and I can sort of stuck with me all the way through the actually you know you could control a you know if you couldn't you know deal with the sugar you're eating terribly well you could just take all those foods out of your diet and you would be okay and so

06:36
I thought that's a weird that people were just going straight to being prescribed with insulin and other medication rather than tackling diet. I just used to say to oh can control that one with diet. They were going, well my doctor's put me on this. I was like, well maybe things have changed. How does that go? Then my younger daughter was diagnosed with non-celiac gluten sensitivity when she was about

07:04
three, nearly four years old and so off we went down there. There are all these ideas of, we just substitute flour with these products and they were awful, Mickey, you're probably aware of how they just don't taste nice and there was tons of sugar in them and I just thought, oh, there has to be a better way. But I was aware for a while of the Atkins diet and when I was doing the honest-to-green phys ed back in the mid-90s in Otago,

07:31
Marianne Howe who's now a dietitian, I think she's working in England, lost contact with her. Well, she was working, her supervisor was Will Hopkins and they were looking at higher fat diets and endurance cyclists and Dave Rollins was doing some of that work as well too at the time. So I was aware of it and then the Atkins diet became a little bit more prominent and then I picked up North and South magazine and you were in it.

07:59
Discussing. We've just skipped, we've skipped maybe 20 years. believe that was 2014 or something. That's right, I Yeah, but then it was around about 2009 when my daughter Evie was diagnosed with the non-glutinous sensitivity. She's now 19 and living her best life and running marathons and all sorts of things. So that's all gone really well.

08:22
Yeah, and then became more aware of your work and the Fat Book came out and then, you know, there other things were happening as well too. We got a house, you know, we had a bit of a battle with an insurance company over our earthquake damaged house in Christchurch. Got that resolved and then still thought, okay, well, you know, entering my early 40s and, you know, rather than go and have a midlife crisis, I decided that actually some post-grad research.

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in something I cared about, like health of kids and how to prevent poor health in children was something I should probably invest some time and effort in. And then, I started looking at what put children in hospital. And the most common reason for children to be hospitalized in New Zealand is to have multiple teeth removed under general anesthetic. Who knew? Crazy. 8,500 kids per year. So, because, Sarah, I'm thinking...

09:16
There was that sugar film, if you remember that. I used it a lot in my teaching and stuff like that. I remember the children who had terrible dental health and they'd drink this Mountain Dew all day long. I bet you so many people would be watching that show going, gosh, that was awful. At least our kids here in New Zealand aren't faced with the same.

09:41
like complications to health because of that. But actually what you're saying is this is a huge issue. It's a massive issue. Regardless of the fact it's not mounted all day long, the same outcomes for a lot of our kids. It's the same outcomes. You know, there's a lot of the sweet drinks, but there's also, you know, we've got these ultra processed refined calf based foods that are implicated because of the effect of the processing of these wheat based products.

10:09
and that the more processed they are, like the more they've been mechanically agitated was termed, you know, with extrusion cooking, drum drawing, popping, all the rest of it. The more those foods lower the pH in the mouth and create a more acidic environment in there. And they also retain, the sugar is retained in the mouth for longer periods than say even sweets and lollies.

10:36
Yeah, so it actually holds the sugar in the mouth for longer. And so it's a longer period of time, which the oral cavity is acidic or cariogenic. That is a word. the same way carcinogenic is a word, cariogenic is a word as well too. Yeah. So likely for dental caries to be created under that environment. Yeah. Yeah. So interesting, Sarah.

11:03
Yeah, I mean it costs the country so much per day, you know, like in excess of $150,000 that the taxpayer will spend today in New Zealand on this single surgery and we'll get up and do it again tomorrow. It's crazy. the next day. Did you focus for your postgraduate research, which by the way, I did like the way you framed it that instead of having midlife crisis, I'm like...

11:26
Is this just like another version of a midlife crisis? Anyway, hey, no judgment. No judgment here. I could study forever if I had the opportunity. So I love it. Which is one of the reasons why I do this, right? Get to chat to people like you. It's all learning. So did you focus solely on children? And I just wonder, now what's the scope of the problem in adults? Do you have any idea? It's fine if you don't, because I mean.

11:52
You might not, but yeah. It's interesting in New Zealand. I mean, we're really lucky that we have the Dunedin multidisciplinary study because that's where the data on carers and adults, and actually most carers occurs in adults through the life course. You know, through, you know, they've studied all those people born in 1972, till, you know, they're all now in their early 50s.

12:16
And we know that more caries occurs in elderly people. But because of how the dental care system is organized in New Zealand, that it's essentially private, unless you have a community services card or you're a member of particular group that can get reduced price dental caries. It's all dealt with privately. Most I focused on kids in my postgraduate study because that's where the majority of the prevention and health promotion is focused.

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on the basis that if you can prevent it in kids, actually everyone's eating will improve and through the life course. that because how a child eats is a reasonably good proxy for how the rest of the family is eating, at the point in time when they're dependent on what is in their home or what they've been provided at a early learning center or early childhood educational facility.

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And so Sarah, just to clarify, the issue with the dental care is it isn't necessarily the sweet sugary foods. People will be listening to this thinking, but my kid doesn't eat sweets or even dried fruit. it's actually, is it the processed carbohydrate itself? It's the carbohydrates. Yeah, sorry. Yeah, it's the processed carbs that are implicated as well too. And part of the PhD was a systematic review looking at sugar and starch combinations.

13:41
And while we found that the total amount of starch wasn't the issue, because of course we consume starch containing foods at dinner time, like those starches and vegetables, but we're looking specifically at refined starches. But it's a between meal consumption of those foods, which is associated with greater caries burdens. Yeah, so it's a between meal snacking. Musi bars. Musi bars. Crackers. Muffins.

14:11
cakes, savory foods as well. know, things that are not regarded as necessarily sweets or, and they break down so quickly in the mouth. And I can remember fairly early in the piece having a discussion with a professor of pediatric dentistry called Bernadette Drummond, who's also a cousin of my mother's because New Zealand is really small. I know that name actually. Interesting. Yeah. And she,

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She said that what actually happens with very small children is they, you know, there's some pain early in the piece in the mouth. And so of course, eating is difficult. They don't have the language skills to tell anyone that eating is hard and painful. And so they go off food and so they're not eating the foods that you want them to eat at dinner time. Then people get worried that they're not, the parents get worried that they're not eating enough. So they'll feed them snacks between meals. And so they get into this grazing habits.

15:07
And of course that makes the problem worse because they might have crackers which break down very easily in the mouth and they're easily chewed and digested. And so of course these kids are not arriving at the meal times hungry and so they're even less likely to eat what they want to eat. And because they're a little bit full but not achieving satiety completely. It's interesting, isn't it? Like I think

15:34
I did my master's looking at childhood obesity. One of the things which I learned was that children are very good at regulating their appetite up until a young age, maybe five. I'm like, well, that makes sense to me now. I think about how sometimes the best thing to do in young children is to let them have food available. They will look after their own energy requirements. But of course, if that food available in

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outside of meal times are foods which may drive this sort cariogenic environment, then regardless of whether or not they're meeting their energy requirements, this is just not great for dental health. Well, it's not great for their overall bone health as well too, because the higher intake of those foods, the less you're consuming of what you really need to be eating, like your meat and some of your dairy product. And also, know, and it's interesting that you brought up obesity there.

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Because what we know is the kids, the very young kids with caries are often underweight because they're bit malnourished, they're bit skinny. And then by the time they enter early adolescence, the kids with caries, they're more likely to be overweight because there's been a dietary habit developed that is driving the caries, but it's also driving obesity as well too.

17:00
So with regards to say dental caries and metabolic syndrome, there's that inflammatory link between the two. Like if someone has some issues in with their sort of dental hygiene, systemically, is this an issue for their overall health? Well, the dental hygiene thing, we can get onto that a little bit. But if they've got dental caries, I think of it as a very early, sort of like a canary in the coal mine or

17:29
I was discussing with Cliff Harvey the other day, it was almost a harbinger of metabolic doom, which is, you know, because, and I only learned this relatively late, and it seems to be the most logical, plausible explanation linking dental caries and metabolic syndrome. But the tooth is, well, your teeth are internally nourished from inside out through the pulp by...

17:56
adentinal fluid and the control of the flow of that fluid into the tooth is mediated by the parotid hormone which is secreted by the parotid gland which is your largest library gland as well too. But with a high intake of refined carbs, I wonder if there's just a high and frequent intake because that's important as far as you know that the winded mouth response goes. We can get into that in a little bit. But systemically,

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that has an effect on the metabolism of the mitochondria in your hypothalamus. And so of course, once you get the reactive oxygen species produced there and the AGEs and what the impact that has on the parotid gland is it shuts off the production of parotid hormone. So you get that downregulated, which actually has an impact on the flow of dental fluid into the tooth.

18:54
Without that, tooth can become malnourished and then more vulnerable to what's happening within the mouth via the acid, you know, damaging the enamel. And then of course you get that dying of enamel. There's something I only found out, you know, as it is, you know, you get through the research and you have just different things that are sort of, you know, you're storing in your brain to read about. And so, was kind of like, for instance, can, acid can...

19:24
have an impact on the tooth enamel through a range of means, whether it's citrus drinks or often the eating disorder bulimia is diagnosed by a dentist because there's a certain pattern of erosion on the lingual surfaces of the tooth, which refers to the surface of the tooth which your tongue is in contact with. you know when you roll your tongue around here. And so of course most people, you haven't done it yet, but most people have.

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roll the tongue around the mouth like this. And so we sort of think, well, OK, well, we've got this pattern of erosion, but it's not associated with a decay where you've got the destruction of the dentin of the tooth, which is that layer underneath the enamel. yeah, so it's interesting. that's probably, but no one's really gone and tested this. And so it's been shown in animal studies that were conducted at, and you're going to love this, at Loma Linda University, which is run by the seventh-day Adventists, and who are

20:23
We're really into sanitarium and the visions and anti-meat and all the rest of it. But they are the people who did the animal experiments on this. So that's really interesting. I thought, that seems to be a logical pathway. And so if we look at that and that hormonal and metabolic responses to the high in refined sugars.

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and particularly with a very high and frequent consumption of those sugars that kind of links dental caries and metabolic syndrome. Whereas a lot of people would say, the first signs of your metabolic syndrome are the hyperinsulinemia and also non-alcoholic fatty liver disease, which we're seeing increasingly often in teenagers. But that's a pretty silent scream of the liver, whereas toothache is painful.

21:21
And it's presenting in really young children and at a really young age as well too. I often, people talk about inflammation of the gums, gingivitis, like, and that inflammation in the gums is linked to systemic inflammation. Is that your understanding, Sarah, if I got that right? Yeah, and there's some fairly plausible evidence of that. You know, gingivitis is kind of like a relatively mild inflammation.

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of the gums, but it's also an indicator of what might be going on under the surface of the gum. Because we know with, say for instance, complications of type 2 diabetes is that distal arthrosclerosis, which is why there's the poor wound healing, the poor kidney function, the poor eye function. But there's an impact on the cementum, which is the bony structure of the gum by which your teeth are held in place with a series of ligaments.

22:21
with the damage to blood vessels in the cementum, what actually means that the gums start receding away because of the death of that bone, or in the same way that you get problems with your toes, for instance, and type 2 diabetes. And then your gum starts receding, and that's where that expression, long in the tooth, comes from as well too. And that's a major cause of tooth loss. And so you can imagine for the people who have diabetes or type 2 diabetes,

22:51
and cardiovascular disease because those pathogens can enter through what's become a fairly damaged surface into the bloodstream. So that's all pretty much linked in. So we should probably be thinking of periodontal disease as one of those co-presenting conditions along with the poor kidney function, the cardiovascular issues, the distal arthrosclerosis that's in alongside the poor wound healing, poor eyesight.

23:21
So in people with the type 2 diabetes, they present with these conditions rather than someone has a toothache, someone has inflammation in the gums, they haven't yet been diagnosed with anything, but they shouldn't be thinking necessarily, okay, maybe I've got an issue with insulin resistance or metabolic syndrome. They probably should be thinking that.

23:42
There's probably, you know, a really, it's a really good justification to get things checked out a bit more systemically rather than just treating it as a within mouth thing. you know, the biggest problem is the sort of, um, fact that medicine operates in the silo and dentistry is over here and behavioral sciences over here and nutrition is over here and they don't speak to each other. was interviewing for the PhD, you know, some general practitioners and they never see anyone with.

24:12
an oral health issue. And as far as dental carriers go, one GP said that they'd only see somebody with that sort of problem if they needed antibiotics prescribed prior to surgery to remove their rotten teeth. Sarah, do we know? So I'm thinking that if the environment in the mouth is acidic, then the oral microbiome will be compromised.

24:38
Do we know much about the relationship between, say, the oral microbiome and blood sugar regulation, for example? Yeah, what we've got, it's a multi-way process really. mean, with our biome, a lot of the study is looking at the diversity of that biome. And we found through anthropological research that on the...

25:06
and they've looked at the teeth from Neolithic era skeletons, they've found that there's evidence of a reduced diversity of that biome and with a higher proportion of, or an overgrowth of, what they call cariogenic bacteria. And it used to be thought that there was just streptococcus mutans was associated with it, but there's a range of bacteria that actually, you know, if we are compromising the environment, so we've got...

25:34
you know, highly acidic environment, know, these bacteria proliferate, they produce more acid. But we know also not, also could be indicative of a vitamin deficiency because, um, you know, when you look at the tart, what we call the tartar buildup or solidified plaque, um, that's essentially calcified bacteria in the mouth. And so there's a potential that they may

26:04
be some dysregulation of calcium metabolism in the mouth because saliva has calcium, phosphate and a little bit of fluoride in it. And so that's been passed backwards and forwards between the saliva and the teeth by microbes. And so what happens when it's, we know we've got an acidic environment, mean, our oral environment is built to withstand quite a lot. And it has to because we want to have our teeth around for our whole lives. We shouldn't be losing our teeth during our lifetime.

26:32
apart from the deciduous ones that come out to make room for the others that need to get us through to age 100. yes, so it's interesting when we've got a greater preponderance of those sorts of bacteria in the mouth, then you've got a dysregulated oral environment. And the fact that that's calcifying might mean that there are some issues with, vitamin K2 deficiency, but that's not really been tested.

27:02
Because we know that vitamin K2 is responsible for enabling osteocalcin so that your calcium can get deposited where you want it in your heart tissues and getting it and activating the MgLA protein so that your calcium doesn't go where you don't want it to go. But we really don't want it working in the mouth to calcify bacteria. But it is possibly a useful sign that things are not going well in the mouth and also metabolically.

27:32
Yeah. You mentioned earlier about, I flippantly used dental hygiene and you were like, well, that's sort of a separate, no, you didn't say it was a separate issue, but you sort of didn't park it, but you thought, yes, this is something to discuss. Chat to me about dental hygiene, Sarah. So how much can dental hygiene, I suppose, and improving it, how much can that assist in?

27:58
Obviously I'm thinking about improving the oral microbiome, but just about generally speaking. like, there, I mean, we don't know, and this is probably another question, but if you can fix issues in your mouth, the way that you fix them is probably going to be helping you systemically as well, I'm thinking. Yeah. It's really weird that, you know, someone has vitamin C deficiency and that's, you know, resulting in gingivitis and

28:27
periodontal inflammation and the treatment that is prescribed is planning and getting rid of cleaning the mouth and that sort of thing. And that's hardly really a way to... But the oral hygiene story is really, really interesting. The history behind that is quite fascinating. And it sort of ties in with what was happening around about 100 years ago with the emergence of the germ theory, which Dr. Matthew Phillips has written about in his article.

28:56
And so, but in the 1920s, they're, you know, in the era of vitamin discovery, you know, it was fairly well established that a vitamin D rich diet, you know, so consumption of full fat dairy, grass-fed beef, they weren't calling grass-fed beef because it was all grass-fed beef. Eggs and fish were actually beneficial and there wasn't that much debate about that. But then during the, you know, the various public health triumphs with, and beating the microscope and there was

29:24
There was this idea that grew that tuberculosis was linked to poor oral health and having a dirty mouth was tied up with tuberculosis. And so then you've got this odd coalescence of the religious purity movement and the social hygiene movements and your health as a consequence of your behavior. Oh, God. Yeah, all that sort of thing.

29:54
So judgmental. I just think, how judgmental? judgmental. Yeah. Yeah. But basically, you know, they found that by, you know, there was some triumphs achieved with, you know, cleaning up the water supply, washing hands with surgery. So, you know, there was that whole idea where this sort of germ theory became the dominant paradigm by which we addressed health problems. But then there was some prominent dentists set up some oral hygiene schools. And then there were these organ businesses that

30:23
produced all these things to make your mouth feel nice. know, and mint became associated with your mouth feeling good and all the rest of it. And so you've got this, you know, this whole let's avoid tuberculosis by having a clean mouth. And you've got these movements and you've got these prominent dentists because then you don't have to get people to change behavior or anything like that. But there's, you know, increasing sugar production. And so then what happened is we've got the American

30:52
dental association, they had a council for deciding, you know, are these things therapeutic or not? And of course, they were getting a fair bit of advertising revenue in the American Dental Journal as well too. And so of course, they looked at the claims of therapeutic benefit and they actually used quite strong language for the time to describe that. was regardless quite fetish.

31:20
But then they started losing advertising revenue. And then there was this idea that actually the clean mouth and if you just started scraping your teeth clean often. So that was sort where the oral hygiene movement started. And then of course the sugar industry were really, really into this, particularly the Sugar Research Institute, because you basically could eat whatever you liked. you it off. And away you went.

31:50
And then of course, there was research on fluoride or that, you know, there were other people deciding that actually you could use community water fluoridation and make it work kind of like vaccinating whole communities and that you could actually, everyone could eat what they wanted and you could prevent problems or you'll prevent tooth decay just by fluoridating the water supply.

32:18
And then there were questions around about the safety of that because there's a relatively small gap between the safe dose and what could be harmful as far as neurosis of damage to the enamel and also whether it's a neurotoxin, whatever. But there was no new safety evidence, but the American Dental Association engaged in several reversals, one on oral hygiene thing, secondly on the safety of fluoride.

32:48
With all of that, the role of a vitamin D rich diet got downgraded and especially with the development of dietary advice that was revolving around reducing saturated fat intake. Okay, so those fat soluble vitamins, vitamin D, vitamin K, to reduced? Yeah, or the importance of a diet.

33:12
Comprising those things that have gotten downgraded, particularly with the development of guidelines that recommended increased grain consumption. And of course, that's, you've got an agricultural industry that are really into that being subsidized because mainly the, because the problem through human history for most of the time we've been on the planet is insufficient food. Yeah. So there's been a whole lot of factors that, you know, so of course dentists were sort of having to then deal with.

33:41
You know, we've got all these dietary guidelines that are promoting a diet that's implicated in dental caries and poor oral health. And so then you've got the rise and rise of your non dietary strategies, such as promoting fluoridation or water supply, application of various rinses, blasting, and then this idea that you could, it was a good idea to use mouthwashers to get rid of bacteria in your mouth.

34:09
I was so disappointed to discover that that was a terrible idea for your gut, for your oral microbiome. I used to love doing Listerine. It used to feel so good. And then I remember maybe it was five or six years ago when someone was like, you know what, that's actually terrible for your microbiome in your mouth. And I'm like, ah, and I'm like, I can't unknow that now. So I'm just going to give up bloody Listerine, which is a real shame because I loved it. Yeah. We had a half, you know, as soon as I found that out, will be...

34:39
we just had this half bottle and I used to take it along to talks because it was anti-microbial but here's what we're told to do and you see that when there are discussions in the news around dental decay that actually then the conversation turns into we just have to increase the number of dental visits that people do as if that in and of itself is going to fix the problem.

35:07
and the discussion on water fluoridation, which is something we'll actually, we'll probably, you know, I think that might've reached peak usefulness. There's a lot of people who think that, that's funny because issues like fluoridation, or sorry, fluoride in the water and in toothpaste, and I don't know, I don't know enough to make great informed opinions on it, albeit I follow the likes of Chris Masterjohn, I'm not sure if you do. And so very smart people have some,

35:36
have had some issues with, and I'm interested to know what you think Sarah on fluoride, or is it actually one of those contentious issues you can't really have a public opinion on? Like, because there are a lot of things that you can't. It's a really contentious issue. And if you want to be employed in public health, it's kind of a great source. I don't want to go and say too much about it that might be. But I think probably the more important point is that the discussions around caries prevention being

36:06
you know, and focusing on fluoride in the water supply, sort of takes the conversation away from what we really should be talking about as far as caries prevention goes. Yeah. Because I think what we know is that a latest oral health stats in New Zealand for under five or five year olds, it makes for pretty grim reading. And I just sort of thought, oh, just check the latest ones and see what we've got here.

36:35
In New Zealand, around 44 % of under fives in New Zealand have periods-free status, so that means that we've got 56 % of children... Yeah, no, sorry, sorry, it's 44 % of under fives in New Zealand have decayed missing or filled teeth before they start school. Good, wow, that is a crazy number. That's a crazy number, yeah. Yeah.

37:04
That's at four and they've been entirely dependent on what's been provided at home. They're not wandering off to the shops themselves and buying this. But also in the fluoridated areas, you've got 53 % of carriers free. So you've still got just under half of New Zealand children living in fluoridated areas who have dental decay. And it's actually in non-fluoridated areas fewer children have decay.

37:33
What do think that's to do with it? Has anyone made any assumptions there? Yeah, well, they've looked at the Maori children in fluoridated areas have worse health than non-Maori and non-fluoridated areas. And it's even more dire for Pacific kids that only 30 % of those children have no dental decay. So that means it's 70 % of all Pacific five-year-olds in New Zealand.

38:01
have decayed, missing, filled teeth. And the socioeconomic element of it is that the low socioeconomic status is associated with a threefold increase in caries burdens. So I think possibly we've reached peak usefulness, and we probably need to look upstream at the food environment as pathological and tooth decay, and maybe make that the starting point. But unfortunately, it's not.

38:31
No, much like a lot in public health. Do you know, it's interesting hearing those statistics because I'm taken back to watching on YouTube these clips with Western price. look, it was of its time. If anyone goes and has a look at the YouTube, they'll be like, oh my goodness, like it's so racist, et cetera. And it was in the 1930s. let's just acknowledge that. But it was striking to me that within a generation,

38:59
Children had their dental, the way that he was able to sort of determine health was looking, one of his markers here talked a lot more than just dental caries, but there was like, what, maybe 1 % of people had dental caries sort of before the 1930s or before populations were colonized. And then within a generation, everything changed with regards to dental caries, with regards to

39:28
the structure even of the jaw, their bones, fertility, with the influx of, and not sugar, and I think not just sugar, and I think this is something which you said before, which I think is really important for people to understand. You're not saying that it's parents are feeding their kids sugar, and this is what's happening. It's that the modern food supply of things that we think are, quote unquote, healthy, are actually undernourishing our kids and not providing them what they need, plus ruining it.

39:57
Yeah, and not only that, they're recommended snacks. Yes. New Zealand dietary guidelines. When you look at it, you're going, oh my goodness, this is terrible. The other tragedy about that, given that you've referenced the Weston A. Price work, is that he found that the best oral health in New Zealand does was around the East Cape area and in isolated New Zealand. But actually the stats have the worst oral health of New Zealand's children.

40:27
are in counties Manukau, Lakes, Northland, Tairawhiti, which is Gisborne, East Cape, and in the Bay of Plenty. And you know, so we're coming up a hundred years since he was in New Zealand doing that research. And in a century, they've got the worst oral health in the country. Yeah. And where they were, they were at, I remember him talking about them as warriors and being real amazing physical specimens.

40:56
Prior to. And one other interesting thing, which I know you'll know Sarah and maybe some of the listeners are aware as well, but he also found that when there were populations or families for whatever reason reversed back to a traditional way of doing things, health problems resolved in that next generation too. So he was able to follow a few generations. And if you look at the nutrients in the traditional Māori food, like you should, and I'm sure that you've seen this Sarah, in fact,

41:25
anyone else interested, I'll put a link actually to what I'm discussing so they can see. There is this huge list of all of these minerals and these vitamins which you're talking about that are now missing from our food supply that undoubtedly help support our dental health and just our physical structures, know, bones, et cetera. And our metabolic health as well too. And our metabolic health, yeah. Yeah, and I think, you know, what's a good diet for metabolic health is

41:55
guess what, a really good diet for our oral health as well. Crazy that. Crazy, I know. Yeah, but also in the fact that, you your bones are designed to heal. Like say you crack a bone or something like that, you know, you take some weight, know, stop bearing weight on it, it'll heal itself. And our teeth have the ability to do that as well too. And so even when you, if you say, because caries is a process that starts off as a little

42:24
white spot lesion on a tooth and then it will get a little bit more discolored as the enamel gets worn away. But you can actually reverse that and they found that in the 1920s and 1930s when May Malamby did those studies and her and her husband discovered that vitamin D prevented rickets in dogs, so that was the era of vitamin research. But they found out when they got these kids who had caries already, you know, those spot lesions, and they put them on an eating lifestyle that consisted of

42:54
got rid of the oatmeal porridge at breakfast time and the sweets and gave them things like cod liver oil, fish, beef, eggs, bacon. Actually those lesions healed up by themselves. That's interesting, isn't it? Which is really interesting. Whereas, you know, if it gets so bad, so bad, so bad, then you get this crater or this cavitated tooth or the big hole.

43:19
which requires filling. It's kind of like needing a screw put in your leg or something like that. If you break it that badly, know, some needs to go and actually fix it. But you can reverse that caries process in the same way that a cracked bone will heal if you nourish it well enough and possibly heal quicker, if you maintain your protein intake as well too. Well, it's interesting. I remember listening to Dr. Wanda Patrick some years ago before she had her son.

43:49
She went in to have a dental checkup when she was pregnant. They saw the beginnings of caries in her mouth. And so she chewed xylitol gum for the remainder of her pregnancy because she couldn't undergo the surgery required to help fix it. And then when she went to get it sorted out post pregnancy, there were no dental caries there anymore. Yeah. And that's where that can be quite useful as far as stimulating saliva flow as well too.

44:17
Because what we know is that actually the people who have issues with saliva reflux have been on antibiotics or they've got dry mouth and that's where the mouth sleeping can be an issue as well too. Is that the saliva reflux is quite important as far as the environment and the health goes and that's where, so if we think of what goes on in mouth when you eat say refined carbs and so there's some saliva amylase which you know,

44:46
carbs getting metabolized and so we've got these bacteria that metabolize carbohydrates and acids are produced as a result. But your saliva is like this natural cleaning mechanism for your teeth and it's know rich with phosphates calcium minerals and so X is a buffer. So your health of your saliva is really important you know for cleaning just getting rid of food waste.

45:12
but also it's calcium phosphate and little bit of fluoride. And so that remineralizes your teeth. So you've got this demineralization here, and you've got the remineralization here. But dietary behavior is absolutely crucial as to how well that process can work. So if you're continually eating and grazing, the demineralization is taking place faster than what you can remineralize it.

45:41
progression to that lesion is sort of say the net effect of the opposing demineralization remineralization cycle that's happening in your mouth all the time. So interesting and do you, and I've heard if I'm thinking about the chewing thing, so Sarah I used to be addicted to chewing gum like so bad that I had to go cold turkey and in fact decided to go cold turkey.

46:08
very easily once the penny had dropped for me that I was addicted to it. So I could never actually go back to chewing gum. I have thought over the years, God, what a pain, because that xylitol gum could probably be quite useful. So do we think that chewing gum is actually, from a dental hygiene or from an oral microbiome perspective, it would be a good thing for a lot of people or not? a short time. I mean, you wouldn't need to do it a lot.

46:37
But it may be quite useful for stimulating saliva flow into your mouth. And also the act of chewing in and of itself is good for your jaw development. that's an issue for kids with mouth breathing. There's issues with jaw development from there. But if they're eating soft foods all the time, there's just the mastication isn't taking place by which you build a strong jaw.

47:07
And you know, that does have an effect on your facial development as well too. Yeah, okay. I mean, I, for what it's worth, am not going to be chewing gum anytime. Like I have nightmares about accidentally saying yes to a piece of gum, then waking up in a cold sweat going, oh my God, I'm back there. But so, so I certainly, I won't be doing it. So Sarah, for people then who are, who this resonates with and they feel like they've just got some sort of questions or

47:36
next steps or best steps, what would be your recommendations based on what you understand the research and all of it? As far as the best thing to do for your mouth health dietary wise is to reduce or eliminate between meal snacking on ultra processed carb based foods. Yeah, that'd be the first thing and then you can make that sort of process so much more easily by

48:04
I'm joining Monday's matter. I think the focus on having protein rich meals is really important to drive society so that you shouldn't feel the need to do that in the first place. And that means that you're actually getting all those vitamins and minerals.

48:32
to data on meals because know, the of poor quality diet is that not only are you, is there damage caused by the ultra processed foods, but there's also all the things you're not having at the same time. And so if you have these nice meals that enable you to be satisfied, you won't need to go between meals snacking. And that will probably be the first recommendation.

49:02
for how you can eat to optimize your oral health. Yeah, nice one. And so Sarah, finishing up then, obviously, I this is a super interesting aspect of metabolic health, overall health that people don't really think about. Of course, they think about dental health, just, you know, the sort of connecting the two. So in your work now, are you looking at this area? I know that you're just finishing up health coaching.

49:32
certification on top of your midlife crisis PhD. So how can people sort of connect with you if they want to like work on these things or can they? Yeah, I've got a website called DrSaraHancock.com. Probably needs bit more updating. You can contact me on Twitter under SJ Hancock NZ or Instagram. It's a similar handle.

49:58
Yeah, looking at, I think the health coaching is going to be more and more important. And I think we've sort of looked at, you know, a pediatric dental visit is going to be important. I reckon this should actually happen before kids are born. Because we know that vitamin D deficiency in pregnant women has an impact on their kids' oral health. Has an impact on the formation of the tooth.

50:24
but also how a child eats might be a proxy to how parents are eating and they're engaging with the health system anyway, you know, not for probably one of the best reasons of all that you're about to have a child and you still think well so many people go and do things like get their financial stuff sorted, you know, by life insurance policies or whatever you do as far as life planning around this sort of big change in a family's life and so then we'll okay, should we then be looking at

50:54
your health, how you do know what to feed a child, what are your ideas about good health, how you're to maintain yours and your family's health particularly, is that becoming parents of a baby also might involve dropping down to one income for a while. And we've got a constant living crisis both here and in New Zealand. Food is where people will all

51:23
pull the belt in a little bit more on that. And people are under the misguided assumption that meat and dairy are well more expensive than grains and those processed foods, which on the face of it might appear to be the case, but you just end up eating less and to be the quality and nourishing yourself and actually you can end up spending less. Yeah, and I think Karen Zinn did a study on that looking at the cost of

51:51
a low-carb, healthy-fat diet. And for the benefits that you and your family might get from eating like that is going too far outweigh just the serious amount of junk. And there was also another study that they did in Brazil where they looked at the drivers of family expenditure on food were buying snacks and soft drinks. Yeah. So if you're having... don't think about the in-betweens. it's really hard to get people to consider that poor health

52:21
is costly for everyone in the long run. And that you finish up paying for it eventually. And you pay for it with your health. And that's a really awful way to pay for your food. Like that. Yeah. So I think, yeah, I'm interested in working in the, you know, whether it's work with midwives or oral health therapists and access to, yeah, because

52:49
Yeah, rather than just waiting for a problem to happen. You if we want to be into prevention, we should probably start prevention early and work in that space and look at what people's ideas of health are about to become. Because when I was interviewing parents as far as their ideas about healthy eating was, you know, for my PhD.

53:15
A number of them said, you know, I was doing great. And then I had kids and things just got really busy. And, you know, I had to take some time off work and even went back to work. It's also gone downhill. And they talked about, you know, still wanting to lose their pregnancy weight, but their youngest child was like 10, that sort of thing. And so I think, you know, that's a challenge for a lot of people. You know, there's a whole life change, but you know, the whole healthy eating does tend to go out the window. And

53:44
You know, there's been, I mean, I've lost friends in their forties to, you know, metabolically related issues. You know, that's really sad. Their parents have outlived them. That's a tragedy in anyone's book. Yeah, so you just sort of want, you know, so if we're looking at having families growing up, you know, kids growing up eating healthily, that's the thing we should probably be.

54:14
sort of engaging in discussions on health and metabolic well-being and dental well-being. And I think also, rather than, you know, we're still thinking about the feasibility of using pediatric checkups, yeah, absolutely to screen for metabolic health issues just seems to be a really, really good idea and probably is going to go down a little bit better than, you know, telling the parents of a...

54:41
robustly built four year old that their child's overweight, that never goes down well. That gets in the way of conversations. it part of, I mean, I often have this conversation about where the, not the duty of care lies, because obviously parents, I mean, that's huge. But I I think about like the curriculum of the dentists coming through and the dental hygienists, like did they get a good robust education and nutrition, or is it pretty similar maybe to what

55:11
the medical curriculum is like, which is next to none? It is next to none. There's very little nutrition education at all. There's very little on nutrition at dental conferences in New Zealand. All the stands are all these, know, scary things to toothpaste and big tools to drill into your mouth and...

55:38
do all this and that and next thing and they all just look too terrifying so I kind of gave them a of a sooth really. But also I went to a dental, a community dental forum and they provided jelly beans and moribars in the conference pack. Goodness. Yeah I know, that's kind of like disco balls or know, packless cigarettes for lung cancer supposing, you know.

56:03
muffins at a nutrition conference. I've seen that many of them in my day. And they've got fruit in them as well too. balance. Sarah, thank you so much. You I feel like it's like you sort of opened up this conversation by saying you learn, you almost learn something every time that you listen to Micropedia. And I don't doubt that people listening to you on Micropedia will certainly have, have their eyes and their sort of minds much more open to.

56:31
the impact of what our diet does to our teeth from an aspect that they wouldn't have thought of before. Because obviously people think sugar, dental caries, or lemon juice, et cetera. But fundamentally, this is actually a whole diet issue, not just one particular food. Yeah, I think just we need to start thinking of oral health and general health as one and the same thing. that just because you've got a tooth filled doesn't mean the problem's gone away. Yeah. But there's that tendency to go,

57:01
And especially with how dental care is organised in New Zealand, are often not getting their teeth checked until something is wrong and the whole treatment is all on remediation. There's no nutrition advice given at all. Yeah, interesting. Food for thought, Dr Sarah Hancock, thank you so much for your time this afternoon. You have mentioned where people can find you, so I will pop that in the show notes along with those YouTube clips to the Western Price.

57:30
I think people are semi interested in that, certainly found it super interesting and I look forward to seeing where you take your knowledge plus your health coaching in future. Thank you, it's been lovely being on the show and it's been a fun chat so thank you very much for inviting me on.

58:01
Alrighty, I found that super insightful and Sarah provided me with a few links to some of the information around dental caries and carbohydrates and fluorides and so I've popped them in the show notes too. And as I said, you can connect with Sarah over on her website at drsarahancock.com. So next week on the podcast team, I talk to Michelle Hearn and I'm super stoked to bring with you, bring to you that conversation.

58:29
She's just had a fantastic result at a recent ultramarathon and she has an unconventional approach to nutrition and we talk about that and her overall advocacy for better health outcomes for the population. That's next week. I would like to remind you as well that the registrations for Monday's Matter Accelerated are now open if you're listening to this when this episode drops on Wednesday New Zealand time.

58:56
and it will be open through till Sunday New Zealand time because we kick off next week, Monday 23rd of July. So if the idea of a full meal plan is overwhelming for you, but you really want to start somewhere and you like the idea of getting the nutrition coaching alongside the fat loss method we use in Mondays Matter, which is what Mondays Matter Accelerated is all about, then absolutely sign up. Really stoked to be able to coach a bunch of you through this.

59:24
as we go through the next 21 days. So that kicks off Monday, 23rd of June. There's a link in the show notes to that as well. All right, team, send me your DMs on this or anything. I'm over on Instagram, threads and X @mikkiwilliden, Facebook @mikkiwillidennutrition, or head to my website, mikkiwilliden.com and sign up for Monday's Matter Accelerator there on the banner on my website. All right, team, you have the best week.