"How Tongue Scraping Can Affect Heart Health"
The human mouth is an important habitat for microbes,
harboring up to ten billion bacteria, and no wonder.
It’s all warm and moist, providing a suitable environment
for bacterial growth, some of which are actually beneficial.
For example, it is widely recognized that dietary nitrate
aﬀords cardiovascular protection by turning into nitric oxide,
and guess what contributes to the generation of nitric oxide?
Our oral microbiome.
First we eat nitrate rich vegetables like dark green leafies and beets.
The nitrate is then absorbed into our blood stream
and our body then pulls it out of circulation
to be concentrated in our salivary glands
and secreted back into the oral cavity.
Why? Because our body knows
there are good bacteria on our tongue to tweak it,
eventually resulting in the synthesis
of the artery- protecting nitric oxide.
We’ve got more than a billion people with high blood pressure,
most of which is uncontrolled.
As such, it is critical to optimize daily behaviors to support
blood pressure regulation, and incorporating nitrate-rich foods
may be an optimal strategy as it supports opening of our arteries
via the enterosalivary pathway, the gut-saliva pathway,
thanks to the friendly flora in our mouth.
“Dietary Nitrate can Provide Sustained Blood Pressure Lowering
and that starts with eating our greens.
Leafy green vegetables contribute 80% of nitrate intake,
but it doesn’t matter how many greens we eat
if we have “oral dysbiosis,” if we don’t have
the right tongue bugs to take advantage of them.
How can you screw up your oral friendly flora?
By using an antiseptic mouthwash.
Yeah it can kill the bad bugs that cause plaque,
but it can indiscriminately kill the good bugs too,
and that can have systemic consequences.
For example, studies show an increase in blood pressure
following the use of antibacterial mouth rinses,
because they reduce the protective bacteria in your mouth
necessary for the nitric oxide pathway,
a pathway that's vital to blood pressure regulation
and overall cardiovascular health.
Just a single week of antibacterial mouthwash use can cause
a signiﬁcant increase in blood pressure.
And it’s not just one study.
All human studies done to date have revealed
deleterious effects of antibacterial mouthwash.
OK, so what about tongue cleaning, brushing your tongue
or using a tongue scraper?
Regular tongue cleaning is recommended by
the American Dental Association as a way to cut down
on the bacteria on your tongue that cause bad breath.
But if it wipes off those bacteria,
might it wipe out the good ones too?
It turns out, tongue cleaning may give you the best of both worlds.
Those who cleaned their tongue twice or more per day
as part of their normal oral hygiene were more likely
to have an increase in systolic blood pressure during use
of the antibacterial mouthwash, suggesting they had more
of the good bugs to kill. Here’s the graph.
The mouthwash was worse for those with better tongue hygiene.
So regular tongue cleaning may result in a baseline tongue microbiome
that has a greater ability to tweak nitrate,
and conversely, failure to clean the tongue daily may result in a
microbiome composition that is unfavorable to nitrate conversion.
Now but wait a second.
Maybe tongue cleaning just disrupts the surface bacteria,
making them easier for the mouthwash to pick off.
To see if tongue cleaning was actually associated
with a better oral microbiome, they did DNA analyses
to elucidate the dynamics of the tongue microbiome,
to compare diﬀerences between time points and tongue hygiene cohorts.
And… it turns out tongue- cleaning does appear to have
a signiﬁcant impact on the composition of the tongue microbiome,
specifically increasing the proportion of the good bacteria.
So based on this study, tongue cleaning assumes a new importance
from the perspective of blood pressure regulation,
as daily tongue cleaning appears to favor the increased abundance
and metabolic activity of the nitrate metabolizing species
like Neisseria,
whereas failure to clean the tongue daily
may result in a microbiome composition
that is less favorable to nitric oxide production.
Now you still have to eat your vegetables.
Regular tongue cleaning together with adequate dietary intake
of nitrate, since that has a two-fold benefit.
First, dietary nitrate improves artery function.
Eat some nitrate rich vegetables and within 3 hours
an improvement of artery function.
And the nitrate can also act as a prebiotic for the oral microbiome.
The most abundant best nitrate converter is Neisseria ﬂavescens.
And you can boost its abundance after feeding it with vegetables.
After 6 weeks of beet juice that’s had its nitrate removed,
not much change, but after 6 weeks of regular beet juice
and Neisseria jumps right up,
making your mouth a nitric oxide making machine.
And if you look at the association between nitrate-reducing
oral bacteria and cardiometabolic outcomes,
having more of this good bacteria in your mouth is linked
to all sorts of cardiometabolic benefits,
letting you take full advantage of the veggies you eat.
What if all you ate was plants?
The “Impact of a vegan diet on the human salivary microbiome”
and, a fully plant-based diet was association significantly with more
of the good Neisseria bugs that help you churn out nitric oxide.
So not only does eating plant-based boost
a beneficial bacteria at the end of your digestive tract,
but at the beginning too.
And eating nitrate-rich vegetables like greens doesn’t just boost
the good bacteria, but beats down the bad guys,
the bacteria that cause cavities, bad breath, and gum disease.
And indeed, if you feed people lettuce, or lettuce juice so you can do
a randomized, double-blinded, placebo-controlled trial
with a lettuce juice control that's had the nitrate removed,
you can significantly improve the health of your gums, with greens.
The researchers conclude that dietary nitrate consumption may be
a useful adjunct in the control of chronic gingivitis.
So when reviews suggest there’s no reason to clean your tongue
unless you have bad breath, and in the absence of a coating
on your tongue there’s no reason to clean it,
that was all before this new data, which suggests additional benefits.
The only caveat would be those with
heart valve problems or a pacemaker
or anything else that puts you at risk for endocarditis,
an infection within the heart, you may want to stay away
from tongue scraping, given this case report
tentatively tying the two together.
Just like you can get a heart infection after tongue piercing,
tongue scraping may introduce a few bacteria into your bloodstream
that could be hazardous for someone at risk.