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the modern high sugar high carbohydrate diets that are very common and widespread in our western civilization have always been the worst enemy of the dental community. This diet is the direct cause of ordinary tooth decay and much of the acid erosion that destroys the enamel of our teeth. The high carbohydrate low fat diet can also be an indirect cause of periodontal disease, sleep disorders, and orthodontic problems.

A DARK DAY FOR DENTISTRY

Back in the early 1970's a poorly equipped and seriously undermanned dental community was struggling to get control of dental diseases that were poorly understood and and completely out of control. At the same time some very well meaning people at the American Heart Association jumped to an erroneous conclusion that heart disease was the result of too much fat in the American diet. This led them to promote low fat diets and an increase in the consumption of what the labeled "Healthy Whole Grains". Forty years later we have epidemics of type two diabetes, obesity, dementia, orthodontic problems, sleep apnea, acid erosion of teeth, and heart disease is worse than ever so what went wrong?

ANOTHER DARK DAY

About the same time as the American Heart Association started its war on fats the agriculture community was enjoying an increase in demand for "Healthy Whole Grains" and was looking for ways to increase their yields. Dr. Norman Borlaug is credited with creating a high yield dwarf wheat for which he later won the Nobel Peace Prize. While this wheat produced twice the yield of its predecessors it had one flaw. The carbohydrate component of the grain was unstable. The Amylopectin A molecule which is a string of glucose molecules that are supposed to release its glucose slowly. Instead the Amylopectin A molecule breaks down way too quickly leading to a fast release of insulin which ushers the glucose to our fat cells. This has led to a type two diabetes epidemic and obesity epidemic. One researcher has stated that a slice of white, whole grain, or multi grain bread increase blood sugar as much as a tablespoon of regular sugar. As well the hybridization process used to produce the dwarf wheat has produced considerable structural changes to gluten proteins which has cause another whole set of issues.

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THE PENDULUM SWINGS

Thankfully today the American Heart Association is coming to the realization that saturated fats and cholesterol were not the main cause of heart disease. In fact sometime in the near future the whole cholesterol theory may be disproven to most people's satisfaction and perhaps eventually entirely abandoned.

Fats and cholesterol are important for the production of many hormones and for the overall health of the central nervous system. The fat soluble vitamins are essential for the maintenance of strong bones and proper skeletal growth. In children this is important for the prevention of orthodontic problems and sleep disorder issues.

Healthy whole grains are in no way essential to complete nutrition. They do have the benefit of some B vitamins, minerals, and some protein but also come with a lot of empty calories. Healthy whole grains have also been shown to interfere with absorption of iron, zinc, vitamin D, and folate thereby contributing to deficiencies in these nutrients. To make matter worse many high carbohydrate beverages and snack foods are high in empty calories and contain almost no nutritional merit whatsoever.

A lot of sedentary adults do not require a lot of calories to meet their daily energy needs. Still they do require a certain amount of fat soluble vitamins and essential fatty acids which are both found in the fat portion of our diet. There are also nine essential amino acids which have to come from the protein portion of our diet. These essential nutritional needs have to be addressed first and there are a certain amount of carbohydrates that can come along with the foods that supply these essential nutrients. If a person's daily energy requirements is met by this point consumption of additional carbohydrates should be avoided.

A SURPRISE WARNING FROM THE CDA

A recent alert sent to the dental community by the Canadian Dental Association (CDA) raised a concern about a rapidly growing rate of Non-Alcoholic Fatty Liver Disease (NAFLD) in the American population in general and children in particular. They stated a rate of occurrence in the general 

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American population at 33% and went on to quote a study of autopsy cases that showed NAFLD in 13% of children studied and 38% in obese children. NAFLD is generally caused by excess fructose a simple sugar found in fruits, fruit juices, common table sugar, and the ubiquitous high fructose corn syrup. This sugar, when present in the mouth, is metabolized by the mouth bacteria into lactic acid which demineralizes the tooth causing tooth decay. The obvious inference of this warning by the CDA is that when dentists see children with tooth decay they should not just fix the teeth and move on but instead they should realize that tooth decay is the least of the child's problems and that the child is at high risk of developing NAFLD.

AN ETHICAL CONUNDRUM

During the last half century the dental community has worked tirelessly to try and prevent dental disease by encouraging and teaching patients to practice very thorough oral hygiene. The results of this has been very rewarding in that we almost never see very serious tooth decay problems any more. However annual per capita sugar consumption still continues to rise. If the final result of improved dental hygiene is now patients are able to consume more refined carbohydrates than ever without getting tooth decay but then go on to have worse problems like Non-Alcoholic Fatty Liver Disease then we have failed to done our patients a great service at all. And this is a troubling development.