Your Mouthwash May Make You Diabetic

For many years, beginning with my book, Brain Maker, I have been discussing the symbiotic bond we share with our microbiome. This connection, while multifaceted, influences our health in ways we are only beginning to understand. Much of what I have written focused on the gut organisms and their relation to our health and risk for disease. But a fascinating new link has emerged that reveals a central role for our oral microbiome as it relates to our health. And this has come to light in part because of the discovery of the relationship between the routine use of mouthwash and risk of type-2 diabetes.

Our mouth is a bustling microcosm, hosting a diverse range of microorganisms that not only aid in digestion but also impact our overall health. Paradoxically, the commercial mouthwashes we use to maintain oral hygiene can disrupt this complex microbiota, rendering a significant blow to these helpful microbes.

Mouthwashes are antimicrobial, designed to kill oral bacteria in order to prevent dental issues. This is made clear but the multitude of television adds trying to convince us to “kill 99.9% of germs.” But let’s be clear. These mouthwashes are, in a sense, weapons of mass microbial destruction – they operate in an undiscriminating manner, indiscriminately decimating both harmful and beneficial bacteria alike. One particular group of beneficial bacteria produces nitric oxide, a molecule crucial for regulating insulin, the hormone responsible for controlling blood sugar levels.

By reducing the population of these nitric oxide-producing bacteria, mouthwash can indirectly impair our insulin sensitivity. Over time, this can contribute to the development of insulin resistance, a key feature of type 2 diabetes. As such, frequent mouthwash use may inadvertently enhance the risk of type 2 diabetes. One such group of bacteria that is implicated includes those involved in the nitrate-nitrite-nitric oxide pathway. Nitrate-reducing bacteria such as Veillonella and Neisseria are vital for this pathway. They convert dietary nitrate to nitrite, which in turn can be converted into nitric oxide in the body. Nitric oxide plays a key role in regulating insulin secretion and sensitivity, and thus influences blood glucose levels. Disturbances in nitric oxide production, such as that potentially caused by mouthwash use, can contribute to insulin resistance, a key feature of type 2 diabetes.

The potential link between mouthwash use and increased risk of type 2 diabetes has been examined in scientific studies. A study published in 2017 in the journal, Nitric Oxide, investigated the association between over-the-counter mouthwash use and the risk of pre-diabetes/diabetes. The researchers, led by Dr. Kaumudi Joshipura, found that among their study participants, frequent users of mouthwash (twice daily or more) had a significantly higher risk of developing pre-diabetes or diabetes over a three-year follow-up period compared to less frequent or non-users. Interestingly, this same researcher has demonstrated a similar link between mouthwash use and risk for hypertension. And this isn’t surprising given the role of nitric oxide in keeping blood pressure under control as we discussed in Drop Acid.

However, it’s important to note that these findings suggest an association, not causation, and further research is needed to fully understand this complex relationship. More studies are necessary to confirm these findings and to further elucidate the precise mechanisms involved.

As the global rates of type 2 diabetes continue to soar, it becomes increasingly crucial to investigate all potential influences, including those as seemingly benign as mouthwash use. Clearly, mouthwash use is just one factor among many. Diet, genetics, and lifestyle choices all play significant roles in diabetes development. However, the potential mouthwash-diabetes link underscores the importance of maintaining a balanced oral microbiome, reinforcing the interconnection between all parts of our bodies and our health. By developing a more comprehensive understanding of how our everyday habits impact our health, we can better tackle the mounting challenge of diabetes and work towards more effective prevention and treatment strategies.

You can learn more about the relationship between the oral microbiome and health by watching my interview with Dr. Mark Burhenne.