Bite Point

138 Years of Caries Knowledge

"The researches of the late Professor W.D.Miller, published about 1880, finally gave to the world the true explanation of the process of tooth decay."

"Briefly stated, Miller, as the result of a long and exhaustive experimental study of the subject, found that the destruction of the hard structures of the tooth by dental caries was accomplished by the agency of a certain class of microorganisms which had the characteristic function of fermenting certain of the sugars and converting these sugars into lactic acid, which acid in its turn attacked the solid tooth structure wherever it came into contact with it, dissolving out its mineral matter which caused the structure to disintegrate, forming a cavity which gradually enlarged until it eventually included the entire crown; indeed, if unchecked, the whole tooth may in this manner become disintegrated and lost."

--Edward Cameron Kirk, DDS, UPenn Dean from 1895-1917, writing (with rather less periods than we would use today) in Alfred Fones' remarkable text Mouth Hygiene. This is my original 1916 edition.

Dr. Kirk goes on to say,

"Dental caries is a characteristic disease with a well-marked and definite group of symptoms and within certain limits it has a known causation, which is the localized destruction of the hard tissues of the tooth by the solvent action of lactic acid generated at the point of decay by the agency of bacteria acting upon carbohydrate foodstuff."

*

And so. Although Dr. Kirk and others had a little further to go in terms of understanding the dynamics of the frequency of refined sugars consumption, we had the answer to the total prevention of dental caries ***138*** years ago, with Dr. Miller's astonishing insightful research.

Why did, and does, caries remain such a widespread public health problem?

For one, the sugar lobby in the U.S. is extraordinarily powerful. Labeling foods and drinks for their cariogenicity potential will likely NEVER happen in the U.S. Which is a shame, because it really needn't decrease sales of high cariogenic foodstuffs. I positively love chocolate, more than I can put into words. I only eat it around meals, though, and usually only once a day. I dig raisins, sugary little beasties that stick in tooth grooves for hours, on cereal in the morning. But that's the only time I eat them, and I brush afterwards. Frequency matters with sugars, even natural ones. We can still safely enjoy cariogenic foods and drinks--just not via grazing.

The other reason that dental caries is still so widespread is that the industrialists who run things discovered long ago that foods high in sugar, fat and salt sell very well in the U.S. Across our nation, healthy foods are expensive and unhealthy foods are cheap--as well as designed to be maximally addictive via the enticements (powerful ones, that speak directly to our species' lean evolutionary past) of sugar, fat and salt. This makes me angry. You can't tell me that it costs more to ship a head of lettuce from California to Philadelphia than it does to make a pack of Twinkies, with all the processing and ink and packaging that a pack of Twinkies entails. And yet routinely, the vegetables cost more than the high-carb snack foods.

It's maddening.

Most maddening of all, though, is the inherent and rather unfair paradox that has been built into our foods, beverages and oral health care patterns in recent decades.

What I have noticed--and perhaps you have too--is that well-educated patients with a sound economic life often have few caries. (Most of the new patients we see between ages 21-40 have good educations, great jobs and no caries. Minimal existing restorations as well.) In contrast, less educated patients with less economic means, in my experience and perhaps in yours, tend to have more caries. Industrialists are more than happy to market and sell unhealthy foods to the most susceptible segments of our society. Hence the inherent unfairness--

Today, those who can least afford to treat dental caries generally have the most dental caries.

This is a markedly different situation than the one that existed from at least the 1920s to the 1980s, in which captains of industry, wealthy businesspeople and Hollywood celebrities often had mutilated dentitions. Nowadays, I doubt there's even one CEO of a Fortune 500 company who has posterior bite collapse due to the effects of severe dental caries. Or from periodontal disease, for that matter.

In my view, this epidemiological challenge--not the latest, greatest, costly means of restoring multiple implants, nor the finer nuances of "digital workflow"-- is the key challenge in American dentistry today.

And so a pair of vital questions arise.

How do we practice prevention in the face of what the industrialists of the food and beverage businesses are doing?

And how do we reach those many potential patients, those often at-risk patients who believe--mistakenly--that they cannot afford us, and therefore do not seek care?

Please Be Aware: Werther's Original Contain Sugar!

We have now seen our third patient in the past few months who has wrecked their dentition with one overwhelming specific cause--overuse of Werther's Original Hard Candies. Thus, I wish to post a warning about this product.

And that warning is: Werther's Original Hard Candies contain sugar! Lots of it. This would seem self-evident, but each patient was totally surprised by the fact, and their surprise may spring from Werther's marketing. "The Classic Candy made with Real Butter and Fresh Cream" is a fine tagline, but we never see the word "sugar," the main ingredient, in there at all.

While it's easy to find Werther's ingredients online, there's a sort of burying of this information in all their marketing messages. And of course nowhere is there any warning like, "This product contains straight sugar; overuse of sugar-containing food products leads to tooth decay."

But that's the truth. Of any food, liquid or solid, that contains refined carbohydrates.

Here are the ingredients in a Werther's Original Hard Candy:

Ingredients: Sugar, Glucose Syrup (from Wheat or Corn), Cream, Condensed Whey, Butter, Cane Sugar Syrup, Salt, Soy Lecithin Emulsifier, Artificial Flavor.

Translation: Sugar, sugar, milky sugar, more milky sugar, butter, sugar, salt, chemicals, chemicals and sugar.

I mean, damn. It's like the beloved old Monty Python Spam skit, only with sugar.

https://www.youtube.com/watch?v=anwy2MPT5RE

Please, please, folks, if you enjoy Werther's, or Life Savers, or hard candies of any kind, watch the frequency! Have them once a day. Each and every time you put a miniature hockey puck made of sugar into your mouth, you're bathing your teeth in sugars and acids for the entire time the thing takes to dissolve, plus about half an hour afterwards. Thus, the nightmare scenario for your teeth is to pop another one in every hour or so. Or right before you fall asleep. Your teeth never get a chance to recover from the acids. They WILL rot out of your head. It's only a matter of time.

This may sound like an odd warning to many, but each of these patients said the exact same thing once we identified that hard candies were the cause of the destruction in their mouths:

"Oh! I carry a bag of them around with me everywhere."

Words to send a shiver down every dentist's spine.

In the photos, the red arrows point to the serious cavities (darker areas on the images) that were caused, so far as I can tell, by interviewing each patient in detail about their diet, mainly by the overuse of one product--in these cases, Werther's Original Hard Candies.

Please, folks. Use any and all hard sugar candies sparingly and infrequently. Certainly never more than twice a day outside of mealtimes. And when it comes to cough drops--only use them while you actually suffer from a cough, not after it has passed.

Facts Versus Our Opinions and Beliefs

I am often astonished by the ability of human beings (myself included!) to form strong opinions and then, in the face of mountains of facts that directly contradict our opinions- to stubbornly maintain them.  Let's explore.

  

 

 

 

These images were created by Alicia Falco.  To me they illustrate the ideal- new facts altering and pushing out our existing opinions that have become outdated.  After the third image, we would go back to the first, with fresh new opinions about the matter in question.  Then, life being what it is:

Rinse and Repeat.

Yet we all see a daily parade of examples of people and groups of people and entire corporations and even, can you believe it, political parties wherein some madcap opinion got formed along the way and now it is unshakeable.  The trouble is, these opinions often stand in the way of good communication and progress in the world.  They are not harmless.

Diffusion of Innovations is a theory of how, why, and at what rate new ideas and technology spread through social systems; the chief architect of Diffusion theory is Everett Rogers.  Diffusion research often unveils surprising resistance to the spread of new ideas that, many years later in retrospect, seem so obviously beneficial that we would have expected almost instantaneous adoption.

Dentistry has a number of examples of surprisingly slow diffusion, and therefore opinions that were not shaken loose by new facts.  My favorite involves innovator Dr. Michael Buonocore.  He was the first dentist to bond or adhere a restoration to a tooth, in 1955.  This was enamel-only adhesion yet was still a major advance.  Adhesive restorations have spectacular advantages over any filling material that is only stuffed passively into a tooth.  Yet the widespread adoption of adhesive dental restorations took until the late 1970's.  Twenty years!  Imagine if Microsoft and Apple took this long with new product development and releases... 

With the advent of dental adhesion there were still technical hurdles to using bonded composite resin restorations in back teeth.  These hurdles involved wear resistance of the materials and also the strength of bond to the insides of teeth (dentin) in the high-stress back-tooth environment.  Once again however we find slow adoption of new ideas.  In 1985 excellent bonding techniques for dentin were independently developed by Takeo Fusiyama and John Gwinnett.  Around this time the wear resistance of the filling materials was dramatically improved as well.  Yes, the whole package of a bonded, tooth-colored restoration for use in molar areas was worked out back in the Reagan Era, and yet to this day many practitioners still stand by silver amalgam restorations, an innovation introduced during the presidency of Andrew Jackson.  Gack!

Take a minute and have a good, honest look at your own field.  See any innovations that took a long time to be adopted?   See any that should be introduced, already?  

What would cause us humans to be so stubborn about our opinions and beliefs once they are formed?  Some would say it's our ego, our dislike of being proved wrong.  Losing face; what a strange little expression that is!  Yet whenever something fundamental about ourselves needs examining, I turn to thoughts of our evolutionary past, to the forces that formed us.  There were likely supreme advantages to being either stubborn in adherence to choices made, or to being highly flexible when presented with new information about the world around us.  The middle ground, being wishy-washy, was a dangerous dead zone.

Imagine a tribe of early humans, with no modern knowledge of geography, no GPS, in fact "No phones, no lights, no motor cars", who are faced with a steadily cooling climate and the spectre of glaciers.  There would be an advantage to getting the idea in their head, expressed in the language of the times of course, of "Go south!  It's warmer there!"  Strict absolute adherence to this plan would save the tribe, especially when they saw contradictory evidence, like better weather temporarily behind their backs or a beautiful tempting valley lying off in the wrong direction.  Yet what if the tribe had set out to go north instead?  Then the advantage goes to the leader who first recognizes, "Hey, we're freezing our flintknappers off here, we gotta turn around RIGHT NOW!" and convinces his flock to turn around in spite of the wasted time and tacit admission of being wrong.

Do you see?  Either strategy has a decent chance of success, so we have ended up today with two groups in opposition: people who tend to hold tightly to their opinions no matter what and people who are mentally highly flexible.  It's the undecided folks, the ones who prevaricate, who go north, then south, then north by northwest, then camp in the same place for a time, then set out again in a random direction...  That's how we lose.

On balance I prefer to live in the mentally flexible category.  In today's complex world, great advantages reside there.  Put simply, it's oh so nice to be ahead of the curve, and maintaining outdated opinions often keeps us back.

My favorite story of all on this topic was relayed by Everett Rogers in his textbook.  The Royal Navy was the most important force that held the British Empire together for centuries; in fact the RN is chiefly responsible for English being the most widely spoken language of commerce and science in the world today.  You'd think that such a successful institution as the RN would be highly innovative, constantly tossing their outdated opinions aside like old chewing gum wrappers.  Think again...

From, then, Diffusion of Innovations, 5th Edition by Everett M. Rogers:

Scurvy control illustrates how slowly an obviously beneficial innovation spreads. In the early days of long sea voyages, scurvy killed more sailors than did warfare, accidents, and other causes. For instance, of Vasco da Gama’s crew of 160 men who sailed with him around the Cape of Good Hope in 1497, 100 died of scurvy. In 1601, an English sea captain, James Lancaster, conducted an experiment to evaluate the effectiveness of lemon juice in preventing scurvy. Captain Lancaster commanded four ships that sailed from England on a voyage to India. He served three teaspoonfuls of lemon juice every day to the sailors in one of his four ships. These men stayed healthy. The other three ships constituted Lancaster’s “control group,” as their sailors were not given any lemon juice. On the other three ships, by the halfway point in the journey, 110 out of 278 sailors had died from scurvy. So many of these sailors got scurvy that Lancaster had to transfer men from his “treatment” ship in order to staff the three other ships for the remainder of the voyage.

These results were so clear that one would have expected the British Navy to promptly adopt citrus juice for scurvy prevention on all ships. Not until 1747, about 150 years later, did James Lind, a British Navy physician who knew of Lancaster’s results, carry out another experiment on the HMS Salisbury. To each scurvy patient on this ship, Lind prescribed either two oranges and one lemon or one of five other supplements: a half pint of sea water, six spoonfuls of vinegar, a quart of cider, nutmeg, or seventy-five drops of vitriol elixir. The scurvy patients who got the citrus fruits were cured in a few days and were able to help Dr. Lind care for the other patients. Unfortunately, the supply of oranges and lemons was exhausted in six days.

 
Certainly, with this further solid evidence of the ability of citrus fruits to combat scurvy, one would expect the British Navy to have adopted this innovation for all ship’s crews on long sea voyages. In fact, it did so, but not until 1795, forty-eight years later, when scurvy was immediately wiped out. After only seventy more years, in 1865, the British Board of Trade adopted a similar policy and eradicated scurvy in the merchant marine.

Why were the authorities so slow to adopt the idea of citrus for scurvy prevention? Other, competing remedies for scurvy were also being proposed, and each such cure had its champions. For example, Captain Cook’s reports from his voyages in the Pacific did not provide support for curing scurvy with citrus fruits. Further, Dr. Lind was not a prominent figure in the field of naval medicine, and so his experimental findings did not get much attention. While scurvy prevention was generally resisted for years by the British Navy, other innovations, such as new ships and new guns, were readily accepted. So the Admiralty did not resist all innovations.

 

265 years to fully adopt a proven life-saving innovation.

 

And you know what the kicker is?  All the other navies and merchant fleets of the world took even longer...

  

 

 

 

The Allure of Sugar- Guest Post by Writer Tom Bentley

For a very long time in our past, our ancestors were hunter-gatherers: they would seek food, but they didn't grow or raise food.  With the advent of farming our forebears gained some measure of control over The Third Necessity, but famine was always lurking just around the corner, ready to pounce at the slightest dusturbance in the elements.  Every human in ancient times spent their lives living under the constant spectre of possible starvation.  This is not just ancient history- the forces of hunger have shaped us in deep and profound ways.  Modern America is, in spite of recent events, a land of abundance.  Today, when presented with foods containing concentrated sugars or fats- powerful energy sources that sustained our ancestors in the lean times- we often still react by giving in to temptation and eating more than we should of foods that we, well, shouldn't.

I asked my friend, writer extraordinaire Tom Bentley, to do a guest post here in which he delves into the mind of a sugar-chasing adolescent, namely himself.  Come along for the ride as Tom, in his inimitable way, gives a look into the window of: Ourselves.

 

You've probably seen a variant of this in some horror film: some trusted character's face, benign and loving, is suddenly revealed from a shocking new angle. Maybe horns sprout, there's a death's head skeleton seen shimmering within, a slight smile joins with brimstone eyes into a twisted evil thing. But then the character returns to the irresistible charmer you always knew her to be.

 

That (with the appropriate Tesla arcing of electricity) would be my happy child's face, paired with the alternating skin-stripped-away face that reveals, over time, my tormented teeth. Tormented? Aye, cap'n: these are the teeth of a man who was such a dedicated consumer of sugared objects—the more sugary the better—in his youth that it's miraculous that I still have any grinders left to grimace with.

 

I went from kid-hood to punk-hood from the late 50s to the late 60s, and that was a time when the processed foods industry was truly in its ascendance. Convenience foods, like packaged cereals, were, well, convenient. Corn syrup had yet to stab its nutrition-sucking needle in every product under the sun, but there were still many demons in the product aisles.  Candy bars were a nickel—five cents for a blast of sugared dynamite! I blasted, and enjoying the sensation, blasted again and again.  My brother and I would eat an entire box (and children, the boxes were bigger then) of Frosted Flakes at one sitting. Mmmm! I frequently ate an entire half-gallon of ice cream; a dozen doughnuts: no problem. My mother, the beleaguered shopper in this tawdry enterprise, began to despair of both my teeth and her wallet, and she began restricting our intake.

 

But by that point, around age 9 or 10, I was addicted; sugar was my soulmate. The neighborhood store personnel called me the Candy Man, because I would come in and buy 5, 7, 10 candy bars or other treats at a time, along with a giant RC Cola or two. Where was I getting the money? Well, if you're near my age, you might remember those square, folding coin-collecting books that had slots for the coins. My parents had given those to my siblings and me, and they'd let us go through their coins when they came home from work. We worked on those collections for years, books  of pennies, nickels, dimes, quarters and even half-dollars. We had nothing actually rare, but there were some nice old coins in those collections. 

 

"Were" is the word: my father had stored the more-full books in our attic, and I began taking them down and filching the coins to feed my sugar flame. Before it was discovered that Little Tommy was on the take, those books were about 1/4 their weight. Candy! Candy called to me, the sweet siren song, coin collections be damned.

 

I engaged one of my friends to be a sugar child with me, early co-dependency. We'd go to my Candy Man store, load up, and then go back to my room, close the door, and eat everything we'd brought back in our laden bags. I called them "Celebrations." Benders, essentially. Of course, I was so sugared-up that I hardly wanted to eat anything at dinner. Vegetables? Get thee behind me, Satan!  

 

There were consequences. My boyhood dentist drove a lovely Jaguar XKE; I had to have at least paid for its transmission. I once was diagnosed with seven cavities at one appointment. Many, many crowns adorn my non-regal enamels. Three root canals. One bridge. Some periodontal work. A hole where an implant should be. (Damn things are pricey.)

Of course I'm careful NOW. I floss, I pick, I brush religiously. But my candy-crazed mind didn't pay that much attention to my mother and father telling me to do those very things back then. I still love sugar, though; I just don't eat it in nearly the quantities that I did. I'm more choosy, going for the good chocolate, the high-end confections. I don't eat dessert after breakfast, lunch and dinner anymore. But sometimes, when I eat a small bowl of good ice cream, I can still feel the fever of my old self heating up—I KNOW I could eat a half-gallon again, delirious, inward-eyed, my soul glazed and syrupy.

 

I don't want to be one of those hovering protectors, preventing kids from having a nice dessert, an ice cream on a summer's day, but for some kids like me, man, that stuff should have come with a warning label.

 

-Tom Bentley

http://www.tombentley.com/wordpress/

  

What does "sweet" really mean, sugah?

Our "Caries Clock" is ready!  It's a graphic representation of how our daily eating and drinking habits can lead to cavities if we take in sugary foods and liquids too frequently.

It's here:

http://www.smilephiladelphian.com/Clock/Caries.html

 
"Caries" is the technical word for "cavities"; it just seemed to us that "Caries Clock" sounded snazzier than "Cavity Clock".

I would really like to review what types of foods are worse than others in terms of leading to tooth decay.  This is difficult though.  Supposedly there was work being done on a "Cariogenic Index" or cavity-causing rating system for common foods.  I cannot find any such thing at the moment.  I thought that some European countries had made that a part of their food labeling back in the 90's.  I'll keep looking and asking.

Essentially, if something (liquid or solid) tastes sweet, and if it has refined sugars as part of its substance, then it has a high potential for causing cavities.  So we're talking a range of foods all the way from candy to Twinkies to soda and sports drinks to tea with honey in it to ketchup to granola cereals to fruits of all kinds to raisins- it's a big range.  Many of the final foods that I listed are very healthy for us.  Yet as a separate issue they can cause cavities if eaten too often throughout the day on a regular basis. 

 

Fruit juices provide an excellent example with which we can learn some of the principles involved in thinking about sugars and our health.  Let's take a minute and examine them.  Fruit juices contain a number of simple sugars, especially fructose.  Fructose is a sugar found all over the place in nature.  (The most common sugars are fructose, sucrose (table sugar) and glucose.  There are many though.  These are different than high fructose corn syrup, which is controversial because the corn industry is powerful and has been responsible for putting it into everything.  And corn syrup has a lot of calories per gram.)

 

http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/Carbohydrates.html

 

So fruit juices contain many valuable nutrients and vitamins.  The negative aspects are that they do have calories, they do have these simple sugars that can cause cavities if taken with too much frequency, and if ingested quickly with no exercise following they might add to Type II Diabetes risk because they shock our insulin system.  So- my interpretation of the science is as follows:

 

-Fruit juices provide essential vitamins and nutrients;

-To avoid cavities they should not be sipped at over long periods of time;

-To avoid increasing diabetes risk they should not be ingested quickly too often without being followed by at least moderate exercise, and;

-To avoid weight gain their calories should be considered as balanced against exercise and overall calorie intake for the day.

 

Finally, the less high fructose corn syrup added, the better.

 

Keep these principles in mind for all foods that contain simple sugars and you will minimize your risk of diabetes, weight gain and tooth decay, and yet can still enjoy the wonderful range of fruits, vegetables, sauces and desserts which we have access to these days.

 

I mean, I love chocolate...

 

One Week's Worth

One 20 oz Coke or Pepsi has 69 grams of sugar and 250 calories.  As far as actual pure, refined sugar goes, this is all you should have in an entire week.

Another way of looking at this is that 250 calories is 1/8 of an entire day's 2000 calorie limit and 1/10 of a 2500 calorie daily limit. You often see 2000-2500 or so cited as some kind of reasonable average for non-athletes.

Then there's Insulin Shock and Awe- if we hit our pancreas with 69 grams of sugar in the span of 30 minutes and don't immediately enter the Iditarod race, we inexorably edge ourselves closer to Type II diabetes.  Which is a national epidemic.  Some folks who study these things estimate that one out of three Americans will be a Type II diabetic in coming years.

Then of course there are cavities.  The longer I'm in practice, the more I believe that, in America at least, more than half the reason for cavities is from liquid sugar sources. 

My medical advice is to avoid "regular" soda entirely, or to consume the most minimal amounts on occasion. 

(Doesn't the driver of this truck that we frequently see making deliveries understand the risks inherent in parking this product so close to a dentist's office?)

In any event, this is pretty interesting:

http://www.naturalnews.com/003228_Coca-Cola_soft_drinks.html

as is this:

http://www.msnbc.msn.com/id/36675390/ns/health-heart_health/

Also, so many news headlines contain phrases like "Soft Drink Consumption May Contribute to Childhood Obesity" and I have to wonder at that word "May".  "Does" is the truth of it.

We simply don't need an entire week's worth of sugar in an hour- at any age.

How Sweet It Is.

It seems worthwhile to run down a list of pros and cons of sugar and the most common artificial sweeteners.  So, here goes:

Sugar- table sugar is sucrose.  It tastes just like sugar because, well, that's what it is.  It can be a factor in obesity, diabetes and coronary artery disease.  Certainly it leads in a very direct way to tooth decay, and in that case it's all about the frequency of eating or drinking foods that are high in refined sugars. Yet it's natural and if used in moderation is something we gain a great deal of enjoyment from.  The moderation is the tricky part.

Saccharine- This is in the brand Sweet n Low.  It was first produced in 1878 at John's Hopkins University.  To many, it tastes sweet but not in an entirely pleasant way.  The health effects of saccharine have been controversial since the start.

USDA scientist Harvey Wiley, 1908, to President Theodore Roosevelt: "Everyone who ate that sweet corn was deceived. He thought he was eating sugar, when in point of fact he was eating a coal tar product totally devoid of food value and extremely injurious to health."

President Roosevelt's famed heated response: "Anybody who says saccharin is injurious to health is an idiot."

Since the 1960's many studies have attempted to link saccharin to cancer, particularly bladder cancer.  This has been demonstrated in rats yet the application of these findings to humans has been questionable.  It seems that no study has definitively linked saccharine to human cancer.

Since saccharin is not a sugar molecule, it has negligible calories, it does not predispose to diabetes and it does not cause cavities.

Aspartame- This is Equal and Nutrasweet.  Aspartame is an amino acid (one of the building blocks of proteins and certainly not anything related to a sugar) which just happens to taste astonishingly sweet.  Also steeped in controversy, everything from its rapid FDA approval in 1974 to the question of whether it, too, is implicated in cancer seem to be sources of ongoing debate.  (So far as I know, however, President Nixon never called anyone an idiot over the matter.)  Testing has been very thorough and over 90 countries approve its use.

(Still, in this author- and occasional user's- personal view, the fact that a protein tastes as sweet as a refined carbohydrate is pretty darn weird.)

Again, since aspartame is not a sugar molecule, it has negligible calories, it does not predispose to diabetes and it does not cause cavities.

Sucralose- This is Splenda.  Sucralose is simply the mirror-image molecule of sucrose, our old friend table sugar.  Here's how to think of this product:

Look at your right hand.  Let it represent natural sucrose or D-sucrose which is a "D" sugar.  "D" stands for "Dextro" or "right".  (Not in all contexts though.  No one says, "I'm dextro and you're wrong!")  Anyway your left hand then represents sucralose or L-sucrose which is an "L" sugar.  "L" stands for "Levo" or "left".

In 1981 my organic chemistry professor, the aptly named G.N.R. Smart PhD, explained to us that L-sugars could be made but the process was not cost-effective; he stated that if a company could make L-sucrose on a commercially viable scale it would be a highly profitable venture.  Brilliant!  This is precisely what Tate & Lyle accomplished in the early 1990's.

I hope that Dr. Smart had bought stock.

Differences from natural sugar?  Health concerns?  Natural sucrose dissolves in water to form a clear solution, sucralose looks cloudy.  Sucralose also does not attract water and so baked goods can seem a bit drier when made with it.  The taste of sucralose is percieved by many people to be closer to natural sugar than the other products mentioned above, but a percentage of people find its taste to be objectionable.  There are no known instances of President Clinton calling anyone an idiot over this substance either.  Sucralose is the only artificial sweetener ranked as "safe" by the consumer advocacy group Center for Science in the Public Interest.  The majority of sucralose ingested is not absorbed by the GI tract, so 70-80% is excreted unchanged in the feces and 20-30% is metabolized and passed in the urine.  Some concern has been raised about an immunological effect of sucralose on the thymus.  Once again many studies on this topic have been completed and to date no harmful effects have been found.

Since sucralose is a mirror-reversed sugar molecule, it has no calories (the body doesn't recognize it as food), it does not predispose to diabetes and it does not cause cavities.

Yet.

Now why would I make a meshuggeneh comment like that?  Yet?  What's with the yet?

Well, as many people use sucralose as a sweetener over many years, we're passing tons of a potential food source past the oral bacteria that crave sugar just as much as we do.  Sooner or later, it's entirely possible that a spontaneous mutation will allow the cavity-causing germs in our mouths to feast on L-sugars.  Once that happens cavities might come from sucralose just as readily as they do from sucrose and its kin.  For now, though, you're safe, dentally anyway.

So:

Of the four substances discussed above, all of which have significant (and varied) negative qualities when it comes to our health-

Which one do you think fills this container in my pantry?

I mean, you have to chose, and I always say, "When it comes to health and nutrition, there's no free lunch..."

 

Gatorade- Selling the Sizzle, not the Slake

(Joe Gibbs gets a Gatorade Bath from Clinton Portis and Rock Cartwright after the Redskins beat the Cowboys in Dallas on Sept. 19, 2005. Despite being down 13-0 with less than four minutes remaining, the Redskins came away with a 14-13 victory for the team's first win at Texas Stadium since 1995. Photo: Jonathan Newton, Washington Post.)

The "Gatorade Bath" has become a sports tradition more recognizable than each year's Indy 500 winner drinking that inexplicable bottle of milk.  Athletes everywhere of every age drink in the philosophy of Vitamin G- Gatorade- Is it in you? The website, www.gatorade.com is one thing; their auxilliary site http://www.missiong.com/ is on the verge of scary.

And yet this one fact is so often overlooked: Gatorade can cause cavities.  Just as much so as soda.

The big selling points for the "scientifically proven" claims about Gatorade are that it replaces electrolytes lost during athletic performance and also provides energy along with hydration.  Our first question should then be: how much of a concern is electrolyte loss during exercise?

During low- to moderate-intensity exercise of less than one hour, a person can lose from 1.0 to 2.0 liters of water through sweat.  In this example there are minimal electrolyte losses because the body can reabsorb most of the electrolytes from the sweat. As we get to high-intensity exercise of greater than one hour, the electrolyte loss in sweat becomes significant and the sweat rate is too fast for re-absorption of electrolytes. 

Even here, though, we must be careful.  In David Gordon Wilson's superb 3rd edition of Bicycling Science, he demonstrates that cycling creates such a significant airflow that heat is carried away from the athlete's body with far less sweat loss than, say for a runner, assuming equal power output over time.  It stands to reason that much the same effect occurs for competitive swimmers.  We could then say that activities like cycling and swimming cause less water and electrolyte loss than activities such as running and tennis, again assuming roughly the same time and power output.

If we decide that, in a given exercise event, we may still need to replace electrolytes due to the endurance and level of activity, what, specifically, needs replacement?  Let's compare a medical concoction to the commercial one.  Lactated Ringer's solution was designed to be administered by intravenous infusion for replacement of loss of fluid and electrolytes.  (That means it gets hung in IV bags because it's faster than having the patient drink it, and because it doesn't taste good!)  This is one of the mainstays in hospital ER's of treating dehydration and fluid loss due to trauma.

So here's the throwdown:

Lactated Ringer's ingredients, one liter: water, sodium chloride 600 mg, sodium lactate anhydrous 310 mg, potassium chloride 30 mg and calcium chloride dihydrate 20 mg.

Gatorade's ingredients, 8 oz. serving: water, sucrose (table sugar), glucose, fructose, high fructose corn syrup, electrolytes (110 mg sodium, 30 mg potassium, 93 mg chloride), sodium citrate, monopotassium phosphate, artificial colors.

There's quite a bit of sugar in there!  63 calories for the 8 oz. serving, 158 calories of you drink the entire standard 20 oz. bottle.  256 calories in the larger yet still oft-quaffed 32 oz. jug.

Sometimes, of course, fast calories are necessary during athletic performance, and in liquid form they get absorbed fast.  (Can any of you fellow cyclists out there say "bonk"?)  For sedentary people though, these drinks represent the same empty calories that soda has.  Then there's our dental concern- frequent, prolonged sipping of any sports drink containing sugars will lead to high potential for cavities.  "The Resurgence of Dental Caries" explains why in detail; it comes down to acid attack in the mouth driven by sugars where the body never has a chance to recover.

This is not a theoretical concern.  Many of our patients have experienced cavities that we could attribute to no other cause but liquids in their diet, and specifically sports drinks.  One patient had Gatorade standing by courtside during tennis practice- which was 7 days a week, all afternoon.

So- these drinks have their purpose, but this is a very specific purpose and as with anything that we eat or drink there are pros and cons.  Sugared sports drinks should be used at defined times during training and athletic events and our mouths need long periods of rest between episodes of sugar attack.  Cleaning between the teeth with floss or SoftPics is highly preventive.

Not to single out one particular brand, but the brand in question has deliberately and steadily created a mythos for itself that weaves through the entire sports world in the U.S., from grade school to the arena of professional $port$.

Use it carefully.