Seth's Blog

A few months ago, Joyce Cohen, who writes The Hunt column for the NY Times Real Estate section, started drinking 2 tablespoons of flaxseed oil every day. She began after talking with me and because of stuff posted here. Yesterday she went to the dentist for the first time since she started drinking it.

“Jane the hygienist said my gums were in great shape — better than ever,” she wrote me. Meaning the best they’d ever been.

“What’s funny is you can’t FEEL good gums from inside your mouth, but I take her word for it.” The hygienist said that although she was scraping and scraping, there was no bleeding.

Joyce started with Spectrum Organic flaxseed oil without lignans but later switched to the oil with lignans. She despises the taste but finds it is most palatable mixed with yogurt.

My dental story. Tyler Cowen’s story.

People who have heart disease are more likely to have gum problems. Why? According to an online health magazine from the University of Texas,

Medical researchers have two main theories to explain the link between gum disease and heart disease . . . One theory is that the bacteria from periodontal disease enter the blood stream and stick to the blood vessels, creating a thickening of the walls, which may end up clogging these vessels. The second theory is that the chemical by-products from gum disease cause the same clogging effect. The chemicals may come from the by-products of the bacteria or from the chemicals produced by the body’s own immune system.

A third possibility, not mentioned in the article, is that both gum disease and heart disease are caused by too much inflammation.

The three cases I described yesterday, in which high-omega-3 oils rapidly eliminated gum disease, convince me that the third possibility is correct. When you take 2 tablespoons/day flaxseed oil or 1 teaspoon/day fish oil, you are not killing the bacteria in your mouth. The bacteria remain as plentiful as ever. The difference is that your body is no longer overreacting to them. Plenty of evidence suggests that heart disease is caused by too much inflammation. This correlation is more evidence.

Why omega-3s reduce inflammation is known. The body requires omega-3 to build an anti-inflammatory signaling molecule. Not enough omega-3, not enough of this molecule, too much inflammation.

The gum improvements produced by omega-3 fats can be easy to see:

1. About six months ago, my dentist noticed that my gums were in excellent shape (a healthy pink, not red), for the first time in memory. I had started taking 3-4 Tablespoons/day flaxseed oil a few months earlier. I hadn’t made other dietary changes nor had I started brushing or flossing my teeth more. I have slacked off the usual dental care (I floss less often) but my gums have remained in excellent shape, according to my dentist.

2. When Tyler Cowen (author of Discover Your Inner Economist) starting taking 2 Tablespoons/day flaxseed oil, his gums got much better within weeks. They improved so much surgery was canceled.

3. Catherine Shaffer, a Michigan writer, had the same experience with fish oil:

I bought a bottle of Carlson Laboratories [fish oil] and began taking the recommended dosage [1 teaspoon/day] . . . My gums have been chronically inflamed for as long as I can remember. They were reddish in color, had a tendency to bleed when poked, and have earned me many lectures on flossing from my dental hygenist. I have had to brush three times a day and floss twice to keep the inflammation down. However, as soon as I started taking the fish oil, my gums turned a pale pink, and I even though I have been very lazy about flossing, they have not been bleeding.

Maybe I should have called gingivitis (inflamed gums) the new scurvy. (Vitamin C cures scurvy in a few weeks.) Such fast big lasting improvements imply the flaxseed or fish oil supplied something important that was missing. Too much inflammation is a body-wide problem — many conditions end in -itis (e.g., arthritis) — so it is likely that the flaxseed or fish oil is having other benefits. Consistent with this idea, gum disease is correlated with several other health problems, including stroke, heart disease, and low-weight babies.

According to an online health-info source, echoing conventional wisdom:

Gingivitis is the most common and mildest form of oral/dental disease. According to the Food and Drug Administration, approximately 15 percent of adults between 21 and 50 years old, and 30 percent of adults over 50, have gum disease . . . The main cause of gingivitis is plaque . . . The best defense against gingivitis is brushing and flossing after meals, as well as professional cleaning by a dental hygienist every three to four months.

How fragile the conventional wisdom (“The main cause of gingivitis is plaque . . . The best defense . . . is brushing and flossing”) turns out to be. Eighty years ago, Weston Price, a Cleveland dentist, had the same doubts I do. In travels around the world, he saw many people with excellent teeth who never brushed them. They ate ancient diets, with far more omega-3 than modern food.

I started writing a follow-up to this Marginal Revolution post by Tyler Cowen before I knew of its existence:

January [2007] entodontist [= gum specialist]: “You’ll need surgery either right now, or within a few months. We cut open the gum, clean out the inflammation, and sew your mouth right back up. Only sometimes do we have to eliminate the tooth.”

July 5 [2007] entodontic surgeon, 10:31 a.m.: “We can cancel this morning’s surgery, it seems OK for now, just keep an eye on it.”

In June, Tyler posted about the benefits he derived from flaxseed oil (2 Tablespoons/day): “Very good for my heart, my brain, and my gums.” I asked him what was better. “Much better gums, for sure,” he replied. “The rest is harder to measure.” On July 4 I got around to asking for details. Tyler said that he had had bad gums for most of his life and that he noticed they were much better within a week or two of starting the flaxseed oil. He added

I have crooked wisdom teeth, never wore braces, and my mouth naturally produces lots of plaque. Put all together that means a significant problem with gum disease. I get cleanings every three months or so but still my gums have been much worse than average.

I too have crooked teeth and more plaque than average and I too found that flaxseed oil improved my gums; my dentist was the first to notice.

A recent experiment about omega-3 and dental health. A 1997 experiment. An amazing bowling video.

I looked at my gums this morning. I had never seen them so pink (that is, non-red). They looked just like the picture of healthy gums at the dentist. As I explained yesterday, my gums are in good shape because I am drinking 4 tablespoons/day of flaxseed oil, which contains a lot of omega-3.

Meta-analyses of the effects of omega-3 have had trouble finding an effect. A meta-analysis about mood found a barely-reliable effect and concluded “the evidence available provides little support for the use of n–3 PUFAs to improve depressed mood.” (They should have said “a little support.”) A meta-analysis about heart disease concluded “Long chain and shorter chain omega 3 fats do not have a clear effect on total mortality, combined cardiovascular events, or cancer.” The effect on total mortality was close to significant and there was evidence of heterogeneity (i.e., studies varied) so their results were not completely negative, as the authors noted in response to comments. The effect is just weak, apparently.

In other words, after combining many experiments, each experiment with dozens or hundreds of subjects, meta-analyses can barely see an effect of omega-3. Yet I found a perfectly clear effect with one subject? An effect I wasn’t even looking for? That seems discrepant, and worth trying to explain.

My explanation is this: What I had in my favor and all those other studies did not were the benefits of self-experimentation. In particular,

1. The effect on balance was so clear that I used it to find the best dose. I found that 3 tablespoons/day was better than 2 tablespoons/day and even at 3 T/day there was an effect of time of day. So I went to 4 T/day. It seemed no better than 3/T day, so I stopped there. Conventional studies have not been able to do anything like this.

2. The effect on balance was so clear that I could use it for quality control. If I happened to buy a bad bottle of flaxseed oil I would have noticed — the results would not have been consistent, starting from when I started the new bottle. (I have gone through about six bottles.) Previous studies have had little or no quality control. If half their omega-3 went bad, they would have had no way of knowing.

3. I was strongly motivated to take the flaxseed oil. I know it is beneficial. This is not the case in any double-blind experiment when treatment is compared to placebo. In such experiments, every subject has reason to doubt that taking the pill will make a difference.

4. Dosage in nutrition, as in these mood and heart disease studies, has been built around avoiding failure — for example, what dose will avoid heart disease? Whereas I was looking for the optimum. My brain does not fail in any obvious way if I don’t have enough omega-3; it just functions worse. The amounts needed to avoid obvious failure are probably (a) different for different parts of the body and (b) less than optimal. For example, the amount of omega-3 needed to avoid dementia may be 1 T/day whereas the amount needed to avoid heart disease may be 2 T/day. The optimal amount, the amount needed for best performance, is likely to be greater than all of these failure thresholds. It is a better target.

Something else in my favor, not related to self-experimentation is that I studied the effect of omega-3 on my balance — how long before I lost my balance, a measure that can have many values. In contrast, most omega-3 research has involved binary measures like mortality or heart attacks. Someone either dies or does not die, for example. Binary measures tell you less than many-valued measures.

Given these advantages, it makes sense that I could find a much clearer effect.

Today I had my teeth cleaned and was told my gums were in excellent shape, better than ever before. They were less inflamed than usual. “What causes inflammation?” I asked. “Tartar,” I was told. I haven’t changed my cleaning habits. The only thing I have deliberately changed since my last cleaning is how much flaxseed oil I drink. At the time of my previous cleaning I was drinking about 1 tablespoon/day; now I drink 4 tablespoons/day. The person who commented about my gums doesn’t know about my omega-3 intake.

Omega-3 is believed to be anti-inflammatory, so it is quite plausible that the change in my omega-3 intake is what improved my gums. There have been a few studies of omega-3 and gum inflammation but none found impressive results. Weston Price emphasized that dental health and overall health go together. Lots of research connects gum disease and heart disease. The importance of omega-3s was first realized because of their effect on heart disease.

This research means better gums is very good news — for which I thank SLD-forum posters, who sparked my interest in omega-3.