We explore in depth the connection between Rheumatoid Arthritis and Oral Bacteria. Our guest, Emily Stein, PhD, is one of the world’s leading experts in the connection between oral health, p.gingivalis, gum disease and Rheumatoid Arthritis.

We discuss in this interview:

  • The role of the oral microbiome in triggering flares within autoimmune diseases
  • The relationship between autoimmune diseases and periodontal disease
  • Gut dysbiosis, oral dysbiosis and microbiota imbalance
  • Pregnancy and the microbiome
  • Anti-CCP anti-bodies
  • p-gingivalis bacteria and its interaction with amino acids
  • Reducing p-gingivalis through diet modulation
  • The impact on the microbiome from being disconnected with the environment
  • Daily Dental Care lozenges
  • Leafy greens, acidity and inflammation
  • Drinking clean water

Clint – What if by improving the oral bacteria in your mouth, you could potentially reduce inflammatory arthritis symptoms? It is a real possibility. And today’s guest is one of the world’s experts on this topic. We’re going to talk about p gingivalis, which is a specific bacteria in the mouth which could be implicated in worsening rheumatoid arthritis symptoms. And all the things that we can do about minimizing p gingivalis and potentially other pathogenic bacteria and have less symptoms. It’s going to be a fun and detailed chat on this topic. My guest today, she has a unique scientific background that spans molecular biology, microbiology and molecular and cellular immunology with emphasis in chronic infections and chronic inflammatory diseases. She completed her postdoc fellowship in the Department of Immunology and Rheumatology at Stanford University, where she studied the role of the neuroendocrine immune axis in the in rheumatoid arthritis and other autoimmune diseases. Now she’s the chief executive officer and director of Primal Therapies and she has an affordable product that she’s developed to reduce p gingivalis that we’re going to learn about as well. Emily Stein, PhD, thank you for joining us.

Emily – Thank you. It’s great to be here.

Clint – All right, let’s get into this. One of my favorite topics, The mouth and inflammatory arthritis. We’re well aware of it, but not many people understand the connection. What should we know if we have inflammatory arthritis about the importance of our oral health?

Emily – Um, I’m going to take it back even one more step if you have an autoimmune disease, the oral microbiome seems to be a big player in triggering flares, exacerbating flares or mitigating flares.

Clint – Okay. Please expand.

Emily – Yeah. So we’ve known that for quite a few years now, the co-occurrence and this is like metadata from numerous clinical studies, epidemiologic studies around the globe, right? That there tends to be if you have rheumatoid arthritis or an inflammatory arthritis of an autoimmune nature, your risk of developing periodontal disease is significantly higher than the average human being. And concomitantly, if you have periodontal disease, you have an increased risk of developing inflammatory arthritis and or reactive arthritis. And so there seems to be this intimate relationship between the two disease states, because if you think about inflammatory joints, right, whether it be your phalanges, like your fingers, Or your toes or feet or your joint, like bigger joint spaces, like your knees, shoulders, hips. You have a joint in the jaw, right? And then you have ligaments that hold your teeth in place in your jawbone. And those are often forgotten on the medical side of the equation. They are realized by the dental side of the equation, but the two don’t correspond often times. And I got into this game not game, but like trying to solve this puzzle. When my grandmother actually had she had rheumatoid arthritis and Sjogren’s syndrome and she was having significant dental problems, she had periodontal disease and she had to have a tooth extracted. Then the next day she threw a clot in her brain and she had a stroke. Retrograde analysis of hundreds and hundreds of Medicaid cases in the United States have led to this realization that if you have a dental implant or if you have a tooth extracted, your increased risk for a stroke or a heart attack is 50% higher for four weeks after that procedure.

Emily – And I feel strongly that if you have an autoimmune disease, your risks are even higher than that average. Right, because it’s just a global average. And so I think my grandmother was absolutely a statistic and that’s what got me into the game. My doctorate was in microbiology, so studying autoimmune diseases, particularly rheumatoid arthritis, and she had that. So I was really, I guess I was at the right time to kind of really dive in deeply and to bio hack my grandmother’s oral microbiome and tell it to stop causing inflammatory processes that would cause significant disease process to occur in her mouth. Right. Because microbes don’t just stay put, they go everywhere. We’re like walking petri dishes. I mean, we would get people’s joints from the or they would get a joint replacement and they’d had highly erosive osteoarthritis or something, and we’d get their knee joint or their shoulder joint. And I mean, they would have a ton of microbial biofilm right in that erosive lesion in the joint space and come to find out where its origin is most often from the mouth.

Clint – Oh, my gosh. You’re blowing my mind. So you got the actual leftover knees from the surgical room to experiment on and to study. Oh, my gosh. Okay. And then you were testing those microbes inside the capsule of the synovial fluid or the synovium itself and finding that the bacteria in them, the biofilm from the bacteria comes from the mouth.

Emily – And we’re finding post mortem and Alzheimer’s patients there. You know, those there’s oral microbes and people’s brains. And in patients with pancreatic cancer, there’s oral microbes in the pancreas. So the question is chicken or egg. Right. And now a lot of studies in animals have really highly suggested that the microbes are present at the time are nearly the time of that inflammatory event. And most recently there have been to several amazing publications that actually one of them came out of my old lab in collaboration with Rockefeller Institute. But they’re showing that microbes escape from the mouth leads to a flare, especially if the microbes happen to be citrullinated. So there is this thing called anti-citrulline autoimmunity, right?

Clint – Sorry, can I just pause there because we’re about to launch into some more really, really valuable. But first of all, just backing up a little bit before we get into the most valuable information around Citrullination, but how do you like did your laboratory find that the microbes that had an oral origin, were there also microbes that had a bowel origin in a classic leaky gut of the classic source of microbes which is causing the colon. So were you seeing a combination of both?

Emily – What we see in people’s and dogs mouths with arthritis. Is gut bacteria in their mouth.

Clint – From the gut?

Emily – So we have a tube with two ends, right? And think of it almost as a continuum. And what we know now through 13 years of our research at Primal is that if someone has oral dysbiosis, which usually co-occurs with all sorts of patients with neurodegenerative diseases, chronic pain syndromes, autoimmune diseases, cancers, you have a fundamental imbalance in the microbiota that inhabit that cavity. In the case of the mouth, it’s too many anaerobes that are really pro-inflammatory, namely porphyromonas species, but not all of them have to be porphyromonas. Gingivalis happens to be one of the biggest troublemakers in the mouth. But also you see, you know, gut dysbiosis develop in patients with oral dysbiosis and you’ll see in patients now with gut dysbiosis, they will develop oral dysbiosis over time. So it seems to be kind of a linked thing, whether it’s happening more at the downstream end or the upstream end is dependent upon that person, mainly diet driven or inheritability you inherit your just like you inherit your parents genetics, you actually inherit your mom’s microbiome. Or if you’re a C-section, you inherit that delivery rooms microbiome.

Clint – Roger that. Yeah. Yeah. In fact, there’s theories or so forth that the reason that the baby comes out with its face towards the mum’s anus is essentially to pick up as much of mum’s bacteria down there as possible to act as the pilot or the seed of the microbiome. And I see you nodding, for those who are listening.

Emily – That’s definitely one of the leading theories. What’s interesting is more recent animal studies of pregnant animals have shown when they pre-label, let’s just call it e coli for simplicity. And there was actually a study with E coli. So they labeled it red or they labeled it green and they delivered it either through the bloodstream by IV injection or just dripped it into the mouth or they introduced it Intravaginally. The leading route of transmission into that theoretically protected area right where the fetus grows and develops was actually through the mouth. It beat the bloodstream. So there is some magic highway that we don’t understand yet that is not anatomical. The understood but Maya, like microbes from the mouth, gain access to the placenta. During development. So we’re actually developing with the microbes from our mom.

Clint – Obviously this means Mum’s consumption of whatever microbes she’s ingesting end up into the placenta of the growing baby.

Emily – Yeah. So if mom has gingivitis, the risk of preterm birth skyrockets.

Clint – Wow. Okay. So I think we’ve firmly established the importance of the oral microbiome. Let’s take it now a little bit further from the science and go into a very specific area of your knowledge, which is this relationship between the oral microbiome and inflammatory arthritis via this concept of citrullination. Now, just to bring everyone up to speed here, because if we’re on our treadmill listening to this or we’re driving our car, this isn’t something that’s at the front of our mind. But when we are diagnosed with what’s called seropositive, rheumatoid arthritis, normally there are two blood markers that go along with that. One is rheumatoid factor and the other is anti CCP antibodies. Now, a lot of us don’t know what that means when we’re first diagnosed, we’re overwhelmed, we Never think about it. And the doctors rarely test for it again because quite frankly, they say those markers never come down. They’re a diagnostic tool, often expensive to run. Let’s just check your CRP and said, Right, that’s enough to keep an eye on how you’re going. However, on this channel, we’ve witnessed people who are following our program and seeing both rheumatoid factor and anti CCP antibodies normalized. It’s not common, it’s rare. However, we have seen it happen, but the anti CCP antibodies is where we’re going to dive straight into now. Emily, you’re going to explain what does it mean, how is it created? And what in your view of what you know from the science is influencing it?

Emily – Ooh, yeah. So taking a really top level and then we’ll dive down. So we as mammals make antibodies against foreign and I’ll call it domestic self and non-self proteins, right? We are trained, we go through our immune system, goes through a training session when we’re growing up where it becomes, quote unquote tolerance, where it learns what self looks like. Right? That includes your own microbes that we’re born with. Okay. So we have floating around in our bodies at all times memory cells that recognize our own tissue, but they don’t react to our own tissue because they were taught to go into like an energetic state, which energy is like a non-reactive phase of the immune response. So they’re like, Oh, that’s me. I’m not going to kill it. Right. Um. And then everything else that’s not self it starts it sees is different and it will react against that. And then that’s your first initial phase of the reactivity. So the more of the innate side of the immune system is self, non self, just inherent fundamental. And that’s where a lot of the microbiome and recognition is involved is in this first innate side self non self sensing. And then where these anti-ccp antibodies come in are more on the adaptive side where B cells, which are the antibody producing well, B cells turn into plasma cells, which plasma cells are the mature, like little factories of just antibody and all their job is, is just to spew out antibody. They make antibody against one particular thing. So in your body you have if you’re positive, you have plasma cells that are secreting rheumatoid factor, right? Or if your CCP positive, you have antibodies secreting antibodies that recognize citrulline indiscriminately or discriminately based on context. And so I don’t want to go super in the weeds, but it’s complicated. But you have if you’re positive for any of these, you’ve got B cells floating around and plasma cells floating around in your bloodstream that are spewing out these things whenever they see it, Right? And so or whenever the innate system activates them, like in the case of a flare, if you get an infection or whatever, that has nothing to do with your disease state, you’re going to upregulate and get a flare of your or your CCP just because of the fact that they’re triggered by these upstream systems.

Emily – Now, where periodontal disease comes in is, you know, there are microbes in the mouth that actually citrullinate your own tissue and create foreign tissue. So they’re changing fundamentally changing your gum tissue. And we have evidence internally that they’re doing it not just in the mouth, they’re doing it in women’s general urinary cavities, and they’re doing it downstream in the gut and creating these foreign epitopes because you swallow every time you swallow, you’re swallowing a more than a million microbes. And believe it or not, it’s a false assumption that they are killed by the stomach acid, they make it through. And then they’re affecting downstream processes and the community downstream. And so long story short, they happen to be porphyromonas species. There’s at least three species that we know of that secrete a enzymes called pad, which is peptidyl, arginine, deiminase. So they take an amino acid called arginine alternated into citrulline. Right. And that on your own protein and they also the enzymes also modify the surrounding bacteria and themselves. So they’re modifying not only your own tissue and taking it from self to non self, but they’re modifying the microbiome you inherited and taking it from self to non self. And that’s an extra double whammy of inflammatory activation, we think, at this point in time.

Clint – Okay, let me repeat back what you’ve said in the context of what I’m aware of in the past and having to try to explain this myself in the past and also what I’ve just learned that’s different. Okay. So, um, I’ve explained in the past that arginine is an amino acid that, um. Uh, is it a peptide? Arginine?

Emily – It’s an amino acid. Basic amino acid. Sorry. Fundamental. You require it. It actually is anti cavity. In the mouth.

Clint – It’s. Sorry. Sorry. Yes. I said the wrong thing. So Arginine’s an amino acid and we have to remember that amino acids make up our proteins, which make up the structure of most of our tissue right? And so what you’re saying is that arginine is an anti cavity especially important, um, amino acid making up proteins in the mouth.

Emily – Yes.

Clint – And then along comes these bacteria that thrive in the mouth, of which only one of them that can do this is called p gingivalis, a specific bacteria. That can then go and mess up arginine, basically change its structure so that instead of it being recognized as self and healthy and a healthy part of our proteins. The bacteria comes along and it basically the citrullinated I think of as basically sort of chopping up part of its structure so that it doesn’t look the same anymore. Would that be fair to say? In simple terms, yeah.

Emily – So imagine I stuck A the letter F capital F on the surface of a protein, and then an enzyme came along and turned it into a Y. There’s still two sticks, but they’re differently oriented. That is totally different that could change the function of that protein definitely changes the shape and changes the charge a little bit.

Clint – Right, which makes it foreign. And the body says, that doesn’t look like my body, and therefore I’m going to develop antibodies against it to destroy it.

Emily – Yeah, but what we know about autoimmune disease is you can see a foreign molecule and not react. What is required is coactivation. So you have to have a foreign sense, and then you also have to sense the presence of an overabundance of what your immune system sees as a hazardous microbe. So activation of toll like receptor pathways plus antigen recognition through this Anti-ccp Autoantibody is super flare triggering?

Clint – Right. Okay. And this is the second part where you said that it modifies the microbiome around. Is it local to the area that gets modified or is it a systemic microbiome modification?

Emily – Yeah, we don’t know yet. The best data show definitely the mouth is modified, the oral microbiota are modified. Um, and they’re detectable in the bloodstream.

Clint – Right. Okay.

Emily – You gain access because, you know, porphyromonas Gingivalis needs heme to survive. It not only has enzymes that change our amino acids in citrullinated them, but it also literally causes wounds in our tissue so that we bleed because it feeds off the heme. And yeah, it needs to, to survive. So that’s why you don’t want a lot of microbe in your mouth.

Clint – I’m going to repeat that back and say so so that it creates bleeding, and the heme it’s iron, isn’t it? The heme is the iron source. So it wants to almost, you know, cut a hole in the in the wheat bag. So the wheat comes out so that it can, it can chew on it and live. But in this case it wants the heme iron.

Emily – Yeah, it needs the heme to survive. And it also feeds off of guess what? Protein.

Clint – Degrading structures.

Emily – So it literally has enzymes. Imagine little tiny enzymes that it secretes that are lawn mowers that mow down the surface of our tissue. And chop, chop, chop, chop, chop. Chew chew chew chew chew chew. Modify, modify, modify.

Clint – Right. So what we’re hearing here is this is like the absolute nemesis bacteria of inflammatory arthritis. Would you say that it’s our guy?

Emily – It’s a girl? Why is it genderless? Right. I’ll just say guy for didn’t mean to gentrify this.

Clint – Yeah, yeah, yeah. Maybe it’s transgender. Things have changed in the world these days. So it’s at the absolute top of the baddie’s list of bacteria.

Emily – And, and and it’s like the bully on the school ground. Because clinical studies have shown if you have even 1% of the total bioburden in your mouth is porphyromonas gingivalis. It literally there’s enough of it to functionally influence how the rest of the microbes in your mouth behave.

Clint – Wow. Wow. What a fascinating area of research that you’ve become involved with. This is another aside, but like maybe we can finish on that is your passion and where you’re going with your research on this after we finish on all of the science and what we can do about it, I’d love to hear your personal journey at the end here. So how does the p gingivalis end up in our mouth? Is it a commensal bacteria? And inasmuch that is it in everyone’s mouth? And I mean, how have we evolved to have such a destructive bacteria living right here in our in our gums?

Emily – Well, you’re asking $1 million questions, but I can tell you that there are people that don’t have porphyromonas gingivalis in their mouth. They also tend not to have gingivitis and gum disease. Um, but four out of ten at least Americans have porphyromonas gingivalis in the mouth and have various degrees of gum disease. Because the earliest stages are just like the bleeding. Right. And inflammation tissue, you know, immune system gets recruited to that site. Right. Where the wounds are. And then over time with the anti CCP and all of that and you know, you get massive degradation of the periodontal ligament which holds your tooth in in place, which is why tooth loss is the outcome. So with every tooth loss, you lose some life span.

Clint – My gosh. Okay. All right. So with four out of ten with P Gingivalis and we know from the literature that p gingivalis elevation is associated with this as you, as you say, the periodontal disease or gum inflammation. And we know this coexistence between rheumatoid arthritis or let’s say inflammatory arthritis and the periodontal condition. Um, so with all this going on, what now do we do about it? What are the sort of the headlines of the topics of, of areas that we need to do to reduce p gingivalis and, and hopefully get rid of it altogether.

Emily – Yeah. Well, there are some folks that have or companies that are a couple of failed and one is currently trying to develop a vaccine against it. And it came out years ago in the canine world and it did not stop gum disease because you can still have periodontal dental disease or gingivitis and not have one single cell of Porphyromonas Gingivalis. So it’s not just that bad player, it seems to be a polymicrobial infection that leads to this state. And there are several porphyromonas species that can actually make the enzymes we’re finding that constituent.

Clint – Wow, so poly meaning multiple. So what you’re saying is there is a collection of microbes of which pe gingivalis is most heavily associated, but not always involved in that collection.

Emily – Correct.

Clint – But they all tend to be in the porphyromonas right in that category?

Emily – Yes. So far that we know we’re working on a couple of never been characterized organisms that seem to be bad players as well, and they might be doing something slightly differently. So TBD, we’re still at the early days of our work, but as far as non porphyromonas players, but I can also tell you fungus is playing a role. I mean, how many autoimmune patients have mold allergies? That’s a question to ask. But getting back to what you know, we’re so we’re not developing a vaccine. We’re not trying to throw another antibiotic in the next because microbes just design around that. Like, you know, they’re really used to getting hit with antibiotics these days. So they’re like, what do you got next, buddy? You know, I’m going to design around that, too. So what we’re doing is actually changing the ecosystem of the mouth through modulation of the diet. So a human can eat whatever they want, but we’re going to block uptake of sugar by the microbes. Because part of what porphyromonas species grow really well off of, is the waste products of sugar fermentation. Which is why you see Porphyromonas hones to the mouth, which is the first site of sugar breakdown. Points to the brain, which neurons eat sugar all day long and spew out organic acids that, you know, there’s tons of amino acids out there to the pancreas. So you’re seeing where there’s inflammation, you know, all these different chronic disease states, pancreatic cancer, Alzheimer’s, dementias, periodontal disease. You’re seeing this microbe being a common link because it lives in places where sugar gets fermented. It doesn’t eat sugar itself, but it loves amino acids, and it needs those organic acids that are results of sugar fermentation to survive.

Clint – Ah.

Emily – So we’re blocking that whole process.

Clint – Okay. It just dropped for me that what you’re saying is that the fermentation or the breakdown or consumption of the sugar by microbes creates a metabolite or a byproduct of that that are amino acids. And that’s where the p gingivalis wants to be to get this outcome of the sugar fermentation to consume itself.

Emily – Yeah, it’s not a primary feeder, it’s a secondary feeder.

Clint – Gotcha. That’s it.

Emily – So it’s highly dependent on the 80% of strep species that live in the mouth that break down sugar first when you drink a glass of milk or when you eat a cracker or, you know, eat some rice or a candy, they’re there. By the time I don’t know you swallow microbes are they’re already starting to break down the simplest of sugars. And so if porphyromonas is there we don’t know how it’s coming into our mouth. It could be through our water, it could be through our food. I don’t know if it’s a commensal. It could it definitely can be inherited. Right. Because you can share it in a family, we know this now. We’ve been following dogs, cats and people, and it seems to be a transferable microbe. Um, and so that’s the best we know so far. But if you eat carbohydrates and you’re cohabitating with someone that has it in their mouth, more than likely you might get it in your mouth. And so we’re just blocking global sugar fermentation in the mouth only. So we’re starving that downstream waste product from being developed. And then at the same time, get this, we are asking the whole microbiome instead to switch to a keto diet, to break down amino acids. So they’re out competing naturally for porphyromonas because porphyromonas is a slower grower, slower metabolizer than a lot of the global good bacteria that live in the mouth. And by just telling them no sugar, eat amino acids, instead they’re stealing the amino acids away from the porphyromonas. So we’re just applying nutrient pressure to starve out a fair amount of and we’re having amazing results. In the mouth and downstream, if that makes sense.

Clint – Yes. Yes. Let me just clarify. First of all, let’s imagine pre industrial revolution or pre kind of western diet where lots of processed foods, lots of sugars and stuff. Let’s imagine we were just eating foods that had grown from the soil and so on. And if, for example, that included lots of root vegetables and non-starchy vegetables and so on, where let’s say there’s not a lot. Imagine a scenario where there’s not a lot of sugar production in the mouth, it would be conceivable that there wasn’t a lot of gingivalis in our history, and we’ve probably exacerbated our situation and the likelihood of autoimmune diseases through the changing of the oral microbiome, through bad eating.

Emily – Fundamentally, I mean what we know is you’re increasing your risk factors like a lot of people with RA have either had major bouts of antibiotic treatment in their childhood.

Clint – That was me. Yep.

Emily – Which eradicated the good bacteria. And then they inherited their environmental microbes and then they fed them or facilitated their expansion through their diet. Right. So how many of us eat things that are processed with preservatives? So preservatives are not good for beneficial microbes. How many of us no longer eat a lot of fermented foods? Right. So that’s how we used to preserve things. Historically, we used to use either farm to table or you preserve or smoke or dehydrate, right? And we no longer eat that way on a daily basis or for a sustained period of time, like historically, because, you know, when you’re thinking about autoimmune diseases, there were very few recorded cases historically in a century ago. And yes, it wasn’t as well documented or as well characterized, but you cannot explain the epidemiologic rates now with occurrence any other way?

Clint – Totally. And if you look at like regional, very primitive cultures in Africa, Papua New Guinea, there’s almost no incidence. In fact, there’s I forget the exact country, but it’s in. It’s in Africa that I have a study, Tanzania or something, where there’s been no recorded case ever. Do you know what I mean?

Emily – I mean, in the Amazon the Yanomami don’t get dental disease, they don’t get skin cancer and they’re out in the sun all day long. Their microbiome is so thick and diverse compared to our week. We’re just so far removed from our environment.

Clint – That’s right. That’s right. Hand sanitizers. No fermented foods. Washing the hands every time we go to instead of going out and touching the the leaves, the soil. Gardening, even. Or just like, preparing crops, whatever, with our hands and then eating. No, it’s like everything’s sanitized. Removing. Yeah.

Emily – Yeah. If you don’t live with a pet, you’re. Kids are going to wind up, You know, the odds are they’re going to wind up with a inflammatory respiratory disease with an autoimmune nature. And if you wash your hands too much or you’re too clean, you’re going to probably have gut issues or high anxiety because they’re correlated with gut brain axis and the microbiome. Right. So. Yeah, the microbes, we are fundamental aspects of our human biology, they help keep our immune system in check. So what we’re seeing is by putting microbes on the keto diet in the mouth, respective of whatever the host is consuming, we’re able to completely knock down the immune response tissue health improves the diversity of the microbiome goes back up. You get an increase in the lactobacillus and the beneficial microbes that you need to have because they help quiet down the immune system and help regulate it and keep it normal and they help with tissue homeostasis. So you have healthy barrier functions in the mouth, aka and the gut downstream.

Clint – So you do this. Is this all done via your product, which is called daily Dental Care lozenges?

Emily – I know sexy, isn’t it? I named it so sexy. I know. Ask a scientist to do. Marketing is like, impossible. Yeah, that’s what they’re called. Yeah. I built the lozenges for my grandmother.

Clint – Okay. And so when we put those in our mouth, what we are then doing is we are suppressing that sugar uptake in the mouth, thereby providing less of the secondary feeder opportunity for p gingivalis, therefore having it down regulated or the healthy microbes in the mouth can start to thrive once more and diversity will increase in the mouth.

Emily – Yeah. And we’re doing that by asking them instead, please eat amino acids at the same time.

Clint – Let’s get into this topic because there is a little bit of a contraindication here with a high fat animal diet with rheumatoid arthritis. So all the meta analysis over the past sort of 4 or 5 years all suggest that because of the gut microbiome links to inflammatory arthritis, things like translocating Lipopolysaccharides, whole bacteria components in joints as you’ve talked about so interestingly, before seeing off the surgery table. All this stuff is related to dysbiosis as you of course are the expert on. And we see the microbiome improve with plant diversity with 30 plus plants per week and so on. So we know and we recommend and see results for a plant rich diet for people with inflammatory arthritis. So how can we get that second part of the benefit of the daily dental care lozenges in the mouth without wanting to shift to sort of an animal emphasis.

Emily – Oh, you know what’s funny is a lot of folks think that animals are the only the only makers of protein, but plants make a ton of protein. They’re just smaller quantities per plant, and they’re in a little bit more simpler format, which is great for our mechanism of action. But yeah, they’re there. I mean, you eat legumes, you’re eating a ton of protein, you know what I mean? You eat peanuts or you eat I mean, even like spinach, it’s got high calcium, which is great for anti cavities, but it also has this rich in iron folate. You know, it’s great. It’s great. You need all that stuff. You need B vitamins to give, which is one of our cofactors that we’re providing in the activist and most active form to the microbes so that they are ready to break down because enzymes that break down protein require vitamin B6.

Clint – Okay, I’m coming up to speed, so we don’t need to shift the source of protein like I do. I eat tons of legumes, beans, beans and so on, like just like you said. So if they are being masticated in the mouth and those amino acids are present, alongside the manipulation through the lozenges, we then have that double barreled approach that you believe is most effective.

Emily – Yes. Yes. And in our memory care and Alzheimer’s and in animals, because we also have a product for dogs and cats because they don’t get their teeth brushed at all, that they needed an extra help. So we’re giving them l-arginine actually in the formulation to start that process. So they’re breaking down right away and creating more of an amine friendly environment with a nitric oxide burst, which then you know, because porphyromonas is an obligate anaerobe, it hates nitric oxide. So it’s even more of a let’s call it a disruptor. So we’re taking away its nutrient sources in two different ways, and we’re hitting it with a bit of nitric oxide that microbes are making themselves. And that’s just like a triple whammy, you know?

Clint – Okay. Now, you’ve touched upon something that Dr. Caldwell Esselstyn, who’s one of the most famous plant based cardiologists who helped to develop alongside Dr. Dean Ornish, strategies that are dietary related to reduce and reverse heart disease. And he is just on the podium for decades talking about nitric oxide, which gets released when we chew our leafy greens. So he’s like more greens, more greens, more greens and a little bit of balsamic vinegar with greens apparently helps to even up the increase of nitric oxide.

Emily – But if you have gum disease you already have plenty of vinegar in the form of acid in your gum tissue. So no more acid, you don’t need it. So if you’re inflamed, acid is bad. Acid is the fastest way to upset your immune system and create leakiness in your gums.

Clint – So leafy greens though. On their own.

Emily – Leafy greens on their own. Chew chew chew. If you have disease. But if you’re healthy, maybe a little bit of balsamic vinegar.

Clint – Gotcha. Wait. High fiving on that one. Okay, good, good, good. Okay, Now you’ve almost set yourself your own trap here. What about something like traditionally made well prepared sauerkraut, which to the taste is very acidic. And yet I find from the studies they show their anti-inflammatory and also improved the microbiome of folks. So the acidity that we’re getting from something like sauerkraut. Does that still fit with the same cautionary warning label?

Emily – I know, I know. Um, so the souring effect is the one of the waste products from sugar degradation, right? So it does have some bad ramifications in the mouth if you have porphyromonas gingivalis. However, the abundance and active activity or activeness of what’s called postbiotics that are generated by the ferments. Very likely may outweigh. Yeah. And so I, you know, as a scientist, I always came in ha. But the data on a fermented foods is so strong and its benefit and immune modulation and health and gut health and that I if we could just eradicate the acid part, you know that would be the best of all worlds from a dental health perspective.

Clint – Yeah. And what I do, practically, without knowing the science behind the acid that you’ve introduced me to, is I just eat the food alongside a regular meal. It’s not like you’re eating just the sauerkraut, of course. And so eating it without it’s sort of like you can cheat it down the throat without it actually feeling like the acids hitting your teeth. If you only do little samples at a time. I don’t know if that’s a way.

Emily – What’s interesting is, you know, there’s this mouse model for inducing autoimmune arthritis and it requires a foreign collagen. So bovine collagen injected into a mouse is seen as a foreign, you know, protein, but it’s prepped in acid. And then you have to add in the microbial component, usually heat killed Mycobacterium tuberculosis, inject that and boom. Without the acid, you don’t get immune stimulation either. So acid chain, it basically proteins lose shape in the presence of acid, which is why when you preserve something like eggs, right? You we all have done that study where we take an egg and we put it in a jar of vinegar. Right. So you decalcify and you fund or you pick a quick pickle of anything, right? Or ceviche. You hit it with acid to kill and denature protein. So it creates all these foreign epitopes, which is also bad if you’re immune reactive. So acid is not a good thing if you’re autoimmune, period. You know what I mean? That’d be that’s why maybe hit it with some. I don’t know. Let’s find out what some basic substances are like. No one likes the taste of ammonia, but you know, that kind of like the counterbalance of that, you know, would be ideal.

Clint – Yeah, and going back to studies on actual synovial tissue and synovial fluid, those of rheumatoid arthritis, it is more acidic. The synovial fluid which matches with what you’re saying.

Emily – So where you have inflammation, you have acid, where you have acid, you have inflammation, you it’s, it’s reciprocally causal.

Clint – Okay. So downstream, outcomes of acid forming foods, which of course amino acids make up proteins. So if we’re eating like a very, very high or excessive protein intake without offsetting that with things that are alkaline forming like again, leafy greens, then we could be shifting ourselves to metabolic acidosis, which may not help.

Emily – Yeah. And you definitely don’t want too much carnitine. We know that now. So carnitine l-carnitine is a is a special amino acid, very present in red meats, and it’s linked to massive gut inflammatory diseases and neuro issues. So it’s it feeds the wrong kind of bacteria.

Clint – Okay, good. Well, we’re our channel, our audience are not eating much if any of the red meats and so we’re on the right track. How can we get some daily dental care lozenges?

Emily – So we are in the process of massively expanding and we’re going to be also introducing water, adding it to water.

Clint – Into people’s drinking water in their house?

Emily – Right now we’re just offering it as sachets you can add to your own drinking water, but eventually, yeah.

Clint – Okay. Well, first of all, how can our community, everyone who’s watched this, get their hands on it? Because I went to your website and I submitted like just your average punter through your contact form. Hello, I’m in Australia, can I get some of these? But I’m wondering, is it available globally? Because I don’t know the answer to it yet and how can we get them out to people? And I even want to give a shout-out to Spencer, who’s a doctor was Yeah, um, you might speak of him in just a moment, but as a dentist, he has seen some great results in treating people with inflammatory arthritis. And we’ll talk about his clinic in just a moment. We’ll just go ahead. Where is Spencer, this dentist he’s based in? Is it Houston, Texas.

Emily – Texas, Yes. Houston? Yeah.

Clint – What’s the name of his clinic?

Emily – That’s a really good question. If you just Google Spencer Woods, Houston, Texas, you will find it. I haven’t read this clinic’s name, I’m sure we can put it in the show notes. He’s phenomenal, he’s been working with us now for about a year, and he’s seen some really impressive results.

Clint – Yeah, I found it. Now it’s smileBelair.com is his website. So go to Smilebelair.com. And he has shared with me privately an email here some results of p gingivalis reduction that has been done using your lozenges and including the saliva bacterial microbiome analysis is to support that. So he’s doing some great work and he’s very interested in having people reach out to him with inflammatory arthritis. So we’ve got Spencer in our court ready to help on a actually in a clinic level. And you’ve got this product, though. Tell us where how can we get it?

Emily – So Spencer’s clinic is one of the places you can get it. And we are you can get off our website. Um, if you just search PrimalHealthllc.com you will find it and it will be we’re launching our second formulation next month that oral systemic it’s called it’s an international meeting actually next week in Florida so called protect. And so we have it in on the market and that’s gone through clinical studies successfully reducing porphyromonas in people’s mouths in as little as six weeks with gingivitis. Um, and then the protected formulation is an even stronger formulation for people that need more help, such as Alzheimer’s patients, dementia patients, people with autoimmune diseases or people on antidepressants.

Clint – Okay. Well, that website then will be super helpful for everyone. Now can you just clarify, let’s say the average person with inflammatory arthritis with mid range symptoms, which product should they buy to get started?

Emily – To get started, our current product on the market, the lozenges with Fawcett formula is apropos, especially if you have bleeding gums and you have mild to moderate joint pain, not highly erosive and you have a moderate titer of Anti-ccp or RF.

Clint – Right. Okay. Interesting. Thank you. And then if people are what would be exceptions? If someone’s more severe, would you recommend a different product?

Emily – Yeah. Right now, since we haven’t launched our protecting formulation on the market yet, I would just you can quadruple the the dose easily. We just finished a clinical study in fact in chronically inflamed older adults and showed that a 4X dose so they’re taking four times our recommended amount. There were no side effects and they got even faster results.

Clint – That’s fantastic. Would I be able to get a copy of those results as well? Because I can do different shorts videos on this separate to our podcast. I might even link to them on the show notes as well. I know that you had a study that was up on your website that I looked for and I wasn’t able to access. Could you send me any studies that you have? Because I love this topic and I like to sort of trail along the research myself. So yeah. Okay. What should people expect if they start the lozenges? Would you expect that based on the studies that you’ve put through clinical trials, in 2 or 3 weeks they start to notice some symptom improvement?

Emily – Yeah. So definitely you’ll notice pay attention to the look and feel of your gum tissue before and after. So you’re actually you know, they say the gums are actually the gateway to hell as far as your health. Like optometrists can look into your eyes and tell you how healthy you are. Dentints actually can tell just by or hygienist can tell just by looking at your gum tissue, how healthy you are as an individual and so puffy orangie. You know, bleeding, that is inflammation. Just imagine what’s going on in your joints, right? So the quieter, calmer, healthier gingival tissue, you’re going to get healthier because this mucosa. Right. Mucosal immunity right in your mouth and mucosal immunity in your lower gut and fibroblasts are everywhere in your mouth and your joints. You know your synovial fibroblasts cause so much problems in RA and having those quieter because there’s less microbes escaping from the mouth going into those protected joint spaces causing problems you know that’s that’s going to reduce pain, it’s going to reduce swelling. It’s going to slow down the erosion process and the joint deterioration process. It keeps it quieter.

Clint – I love it. So. And then I just need to bug you again about the international shipment of your product. Are we able to get this product in?

Emily – We ship internationally. Yes.

Clint – Okay, great. All right. Well, people should just hit the contact us little form if they.

Emily – Yeah, absolutely.

Clint – Okay, great. Is there anything else that we can do to improve our oral microbiome other than taking these specially designed lozenges in high dose up to four times a dose if necessary, as you said, and make sure that we’re consuming some protein-rich foods on a daily basis, which can be plant based like beans and legumes and so on? As you say, lots of leafy greens for nitric oxide production, what else can we do? I mean, there’s therapies out there like ozone therapy for the mouth consuming ozonated water. There’s like. I mean, I’m talking. We’ll do anything. The rheumatoid committee. We’ll sit and we’ll keep our mouth open in direct sunlight if that’s going to kill bacteria. What can we do? What else?

Emily – Okay, so right now, don’t waste your money on any probiotics. Uh, I would instead spend your money on drinking as clean of water as you can, most frequently throughout the day. Because the more hydrated you are, the more waste you’re going to remove. Because these microbes are secreting waste products that are inflammatory. Um, I would minimize, you’re going to hate to hear this fruit, high sugar, and high acid. I would exercise even clinical data, even on yoga or stretching. If you have severe RA is so good you have to move those joints. Again it’s like a flushing mechanism when you move your joints, you’re actually forcing fluid exchange and new fluid into your joint space and old fluid out. And so you really need to remove a lot of those inflammatory mediators that are in that joint space hydration movement. And then I mean, the simplest of stuff. What worked in all of our animal models was resveratrol, and curcumin. Anything that’s highly pigmented is an antioxidant. Right? So, um, any of the olive oil is awesome. Anti-inflammatory, uh, fish is great. Limit that though, because there’s a downside to too much fish from a protein perspective. But the omega is great. And that so so from a dietary perspective, you can influence your immune system and modulate it quite a bit just by what you take in.

Clint – I love it. I’ve underlined so many things here. Exercise is basically the whole message of our program and everything, right?

Emily – So I know people don’t want to do if they’re in pain, but it’so important.

Clint – We haven’t spoken about that, you and I, but you’ve basically underlined the core principle there. Clean water is a good reminder, something that not as many messages we’ve put out as possibly we need to and something I can certainly look at more. Um, the olive oil is an interesting one. I actually my mixture of omega three you mentioned the the fish. I get my omega 3’s via a supplement form, an algae omega three and it’s co-packaged with very high quality olive oil. And I can tell you this, this is fascinating, Emily. I have noticed my gums improve and I have only low grade, low grade periodontal disease. I went to see a periodontal dentist to explore this in detail and he kind of classified me as low grade periodontal. Okay. Now what I noticed is that this formula of the olive oil mixed with the omega three seemed to make my my gums healthier. So there must be might be the polyphenols in the olive oil or something, but it made me.

Emily – Omega six and omega three are what are anti-inflammatory.

Clint – For the, periodontal?

Emily – Any mucosa tissue. Mucosal immune system. So that’s, you know, it’s like, you know, the whole tube that runs through us is a mucosal immune system. And that is what does the primary sensing.

Clint – And so these long chain fatty acids, omega three and in that case, specifically in for this, the omega sixes as well, can be an inflammatory.

Emily – Yeah.

Clint – Just to confuse everyone who’s worried about the omega 6 to 3 ratio for their cell membranes. It gets a little confusing, doesn’t it?

Emily – Oh, yeah, but that’s like in the weeds. I mean, I’ve had people that had, like, autoimmune alopecia with growing their hair back in spots just by putting olive oil on their head. It’s calming, it really is. There’s something I don’t understand the mechanism. I don’t think we understand really the mechanism, which is why there’s all these, like little nuanced stories of like ratios and things like that, is because we really don’t understand it yet, you know? But anecdotally it’s it’s there, clinically. It’s there.

Clint – Well, thank you so, so much. I hope that you are able to see a lot of people uptake your lozenges, not because of profit margins or anything, but purely because this should help people. And I said this to Spencer, but if Spencer gets enough people coming into his clinic and people want to work with him and take your lozenges and he can measure the salival microbiome, I would love it if there’s a collaboration, even if it was just the two of you. But I could help recruit people and do a clinical trial and show here’s a bunch of people with rheumatoid arthritis. Here was their saliva before, here’s their saliva. Six weeks later, you can see the reduction in the gingivalis on a group of, you know, this, these folks with rheumatoid arthritis. And I don’t know if you’ve already done that study, but that would be one that would be really interesting to do.

Emily – Yeah, I know we’re very eager to start to migrate. We’ve we’ve stayed more in the oral dementia side of the spectrum but we’re very interested in migrating to the oral autoimmune side. We definitely have cases that our MDs are reaching out to us because their patients are on daily dental care and they haven’t had a flare. And I’m just like and they’re like, Can we do a study? And I’m like, Oh wow, yeah, let’s do it. We got to write a grant though. So then it takes two years to get that going. But yeah, there’s a there there. We just I would love to investigate it.

Clint – Well, this is something we can talk about offline. We don’t need to make it too complicated. I don’t know how much money is needed to basically say, Hey, show up to this dental clinic. Get your supply of these natural lozenges, pay for your own microbiome analysis of your saliva. See you in six weeks, pay for your own again. And then tick the box that you’ve agreed that your data only can be included in the study.

Emily – That’d be awesome.

Clint – Yeah. I mean, I may be missing some of the crucial elements of what’s needed legally, but surely we can do it something without the complications.

Emily – It’s doable. We just have to get the right appropriate approvals.

Clint – Okay, well, I can help drive people your way if it’s something that you would like to lead. And I’d love to see, the results because I’m sure that they’re going to be really exciting.

Emily – Yeah, thank you. Yeah, that’d be great. That’d be great.

Clint – Thank you, Emily. I have loved this. You’ve jumped me out of my seat several times with excitement. Um, I thoroughly appreciate it and I know that it was a little bit of a timing thing, getting this interview set up, but I’m so glad that we got it done. Oh, yeah. And thank you for all the work that you’ve done and for sharing with us today. Oh, and I wanted to ask you just to close off. Surely this must be one of the most exciting and and most interesting areas that any researcher such as yourself could be involved with. I mean, you’re you’re at the cutting edge of addressing root cause that could affect not just rheumatoid but so many other like of the big, big detrimental diseases in Western society.

Emily – Yes. The top three linked to gum disease are cardiovascular, diabetes, and preterm birth.

Clint – So it gets you out of bed each morning with a lot of excitement. Thank you. Let’s leave it there. I’ll. I’ll share this widely. And let’s hope that we can get, including myself, a lot of people onto your lozenges and and see how we go. So thanks very much.


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  1. Hi
    Just listened to podcast really interesting.
    I have RA having most awful pain in my gums. On 2nd antibiotic first didn't work.
    Going to dentist today.


  2. Hi, the smilebelair website doesn't work. Can we buy this product and have it shipped to Australia? the Primal health website says no . Thanks,

  3. Just wow ! What an informitive read!
    Finally , makes sense – answers iv been looking for to do with my RA & mouth , antibiotic use in childhood & beyond ..
    Really want / need these lozenzes !!
    Thank you Clint

    Sherrie Hill

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