Episode 94 – Mouthwash, Proton Pump Inhibitors (PPIs), and Hypertension
Speaker 1: 00:00 This is Dr Chad Edwards and you’re listening to podcast number 94 of against the grain on Mouthwash, PPIs, and hypertension.
Speaker 2: 00:05 Welcome back. This is Diana Edwards, your host on our amazing journey. We’re going against the grain. I’m here with Dr Chad Edwards today, whose focus? Oh yeah, is to identify the underlying causes for your disease and illness so that we can get to that root cause. We’re continuing our cardiovascular disease journey discussion today. Um, before today we’ve actually talked about endothelial dysfunction. We’ve talked about the ED. We’ve talked about nitric oxide. We’ve talked about how they play well together or how we can make them play well together. We’ve also talked about vascular health in general. Mouthwash, PPIs, and hypertension. Now this podcast, you’re actually telling me we can’t use mouthwash and you’re taking away my medicine for my burning heart, my heartburn.
Speaker 1: 00:58 You’re achy, Breaky burning.
Speaker 2: 01:00 There we go. Now tell me why? Because I like, I like the thought of having a nice clean breath with mouthwash. So why can’t I use it?
Speaker 1: 01:08 Yeah. Because it’s bad for you. Believe it or not, it’s actually bad for you. So there are a lot of people that use mouthwash. They think it’s a good thing we’re killing bacteria, which in theory is a bad thing, but I’m going to show you today why you’re actually doing your heart harm by doing that. So let’s get into it. Alright, so we talked about nitric oxide. That’s important for your overall cardiovascular health. Very, very important. If you want to have good heart health, blood vessel health, you need good nitric oxide. It counteracts all the bad crap that you get in your standard American Diet with inflammation, with oxidative stress and all kinds of those things. And so you want good nitric oxide to counteract a lot of that and honestly you really can’t get too much in theory you can, but the reality is is that there’s so much damage and so much insult that you need really as much nitric oxide as you can get. And we talked about the two pathways that make nitric oxide. So we have the L-arginine, and if you haven’t listened to our podcasts about those, go back and listen to those.
Speaker 2: 02:08 Yeah, because at a certain age it’s gonna Kinda shut down on you and you got to go another route.
Speaker 1: 02:12 You got it, which is part two, or, or the alternate pathway, which we call the nitrate nitrite nitric oxide pathway. So over the age of 30, 35, you’re probably making more of your nitric oxide through the nitrate nitrite and nitric oxide pathway than through the L-arginine. And there’s this whole mix about howL-arginine may not be takingL-arginine, may not really help you and could actually do some more harm called the Argentine paradox. So, uh, it’s important to, um, to keep those things in mind. So to the two pathways and what we’re talking about today with the mouthwash and the PPIs has to do with the nitrate nitrite and nitric oxide pathway.
Speaker 2: 02:53 So what exactly does mouthwash and our PPIs have to do with, with all of this, these
Speaker 1: 03:00 pathways and, and, um, nitric oxide. So we’ve got this, this pathway, this nitrate and nitrite a nitric oxide pathway where we consume nitrites and nitrates. And we get most of those, like 85 percent of them come from vegetables in our diet. So if you’re not eating a lot of vegetables, you’re probably not getting a lot of nitrates. And so that’s, you know, another piece. Makes sure you are getting good leafy green leafy Greens, a lot of your, a multicolored vegetables. Fruits. Yeah. What, what, um, so if you like the office, uh, the TV show, the office dwight beet farmer. Oh yeah, Yep. There was, he was, he was ahead of his time. Yup, exactly. So, uh, make sure that you’re getting a good amount of those vegetables. And we talked about a neo 40. It’s a supplement that we have in the office developed by Nathan Brian, probably one of the, um, one of the world’s experts in nitric oxide has beet root, has Hawthorne, vitamin C, Methyl Cobalamin.
Speaker 1: 04:04 Several things. Ours that we have is the professional formula on his website. You can get the regular formula and you can get just beet root powder and things like that. None of those are a bad idea. The professional version is gonna be a little bit stronger. I take it twice a day, every day myself, Dr Houston, my mentor for cardiovascular stuff, I’m also takes it twice a day, uh, and it actually tastes really good. Kind of like a sweet tart. It’s like a little piece of candy, a little bit of heaven right there. It’s awesome. Uh, okay. So we eat fruits and vegetables, have nitrates, and that part’s very important. Now 25 percent of these dietary nitrates are going to be converted to nitrites. And that’s an important step and that’s done by the symbiotic salivary and oral bacteria in your mouth. So when you, when you consume mouthwash, you’re killing those bacteria that convert nitrates to nitrites.
Speaker 1: 04:57 So the, uh, our body doesn’t really do this on its own. You have to have these symbiotic bacteria that reside in your mouth to convert nitrates to nitrites. Very, very important. Don’t kill those guys. Um, so then you make these nitrites and nitrates are also a breakdown product of nitric oxide. And, uh, the nitrites are converted to nitric oxide in your stomach by hydrochloric acid that resides in your stomach. So if you are taking a PPI or a proton pump inhibitor to lower your stomach acid and so you’re trying to decrease your stomach Ph and not have as much acid in there to treat the symptoms of heartburn. And I have done a podcast about this in the past, go back and listen to that on a, on reflux and some of these medicines, they are not good. In fact, there is an FDA label that says that you should limit those medications to no more than three months because we don’t have longterm studies showing positive outcomes and in fact we’ll get into a little bit of data on how they’re harmful and that there’s evidence for harm.
Speaker 1: 06:09 Uh, so then the night trites are also, they update those nitrites, you know, generally what happens is the nitrates convert to nitrites which converts to nitric oxide. And we talked in our nitric oxide podcast about nitrites. I’m going biochemical. So bear with me just for a minute. Bear with me just for a minute. The nitrite or the nitric oxide activates a chemical called SGC are soluble Guanylate cyclase, which causes an increase in Cyclic GMP, which ultimately causes the increase in cyclic amp, which causes vasodilation and a whole host of other cardiac protective effects. You’re going to say something?
Speaker 2: 06:47 Well, I’m just thinking about the fact that the pbms and the lowering of the stomach acid, now we have reduced our ability to convert into nitric oxide, but now not only that, but we have less than like acid. Nitric oxide with less stomach acid were also unable to break down any other food that we’re putting in there to have proper nutrient absorption even if we are taking in nitrates.
Speaker 1: 07:10 Oh yeah. Without question. So we’re getting off topic for cardiovascular sort of. But yes, I mean there’s, there’s clearly, you know, the, the PPIs, there is risk for osteoporosis longterm because you can’t absorb minerals. Um, allergies go up because you don’t sterilize your foods because the acid is not there to break down all these other things. It can cause or contribute to an overgrowth in small intestinal bacterial overgrowth or what we call a SIBO, which can contribute to leaky gut and like there’s a whole host of problems that go along with these medications. Now if you have reflux, that absolutely has to be treated, but it in some cases you may have to take a PPI short term. That’s the key part was that there, there are some patients that have a condition called Barrett’s esophagitis and they may need to take a PPI, but you have to understand that those are increasing risk of cardiovascular disease period. So it’s about balance and if you have something like a Barrett’s esophagus or just have to shore up the other side. Right, exactly. Anyway, you can’t. Exactly, but for those of you that have the, you know, your weekend warriors that have reflux because you ate too much or your diet sucks, then fix your diet, fix your gut, quit taking PPIs because they’re causing you harm.
Speaker 2: 08:23 Well, is the. Tell me the proof though. I need to know to prove that these are actually harmful.
Speaker 1: 08:28 Yeah, so you want to make sure that I’m not just speaking out the list, give me the data. Got It. Okay. So there’s actually four studies that show some of these things that we’re talking about. There was a study published in July of 2013 and in a journal called MPR, uh, may of 2016 and Circulation Research May of 2016 in the American Heart Association and June of 15 and plus one. All of those studies together show that PPIs, Proton pump inhibitors elevate a chemical called again, a little bit of biochemistry, an elevate a chemical called Adma, asymmetric dimethylarginine. And again, we, we measure that in our functional medicine clinic in Tulsa Revolution, health and wellness, uh, where we measure a dma in most of our patients. And these PPIs increase ADMA by about 30 percent. And we did talk about this and our nitric oxide endothelial function podcasts. And so when you increase ADMA, it competes with L-arginine to go in and make nitric oxide through the NOS enzyme.
Speaker 1: 09:26 So when adma comes in there, you’re decreasing at a and m adma when it goes through, it does not make nitric oxide to be clear. So functionally what you’re doing is decreasing nitric oxide, which means that you’re decreasing your cardiovascular health, you’re decreasing your vasodilation, and allowing the vasoconstrictive side of that pathway dominates. And this of course, induces endothelial dysfunction, was going to ask you what the Ed was, if it was endothelial dysfunction or erectile dysfunction. Well, but remember that erectile dysfunction comes about because of endothelial dysfunction. So Ed is Ed for walking through that door. There you go. Alright, so the next piece is that PPIs also inhibit DDAH. So this is kind of a double whammy. Um, and so DDAH is another biochemical term. Again, asymmetric dimethyl Argentine, dimethyl Amino hydraulic hydrolase, a big word DDAH works.
Speaker 1: 10:24 So PPIs inhibit DDAH agent. That’s actually how they, they elevate a, uh, ADMA So DDAH is the enzyme that breaks down ADMA I think like 80, 85 percent of ADMA is broken down by DDAH. and so when your brake, when you’re inhibiting that enzyme, you can’t break down ADMA, so you’re losing a balance and everything is contributing to the vasoconstrictive lack of nitric oxide, cardiovascular, that bad side, uh, so ultimately it also showed directly, so we know that mechanistically, this would in theory, increased risk of cardiovascular disease, but these studies that I mentioned or referenced up above also increase the risk for congestive heart disease. I’m sorry, a cardiovascular or heart disease. And for chronic kidney disease specifically, those two things, so constructed exactly what you’re not able to send it to the Mariella route and you got it filtered. So we have direct evidence for studies that are referenced right there that show that PPIs a increased risk for cardiovascular disease and chronic kidney disease in the show notes so they can actually read the whole thing for themselves and say, we’d like, you bet.
Speaker 1: 11:38 Then there was another study that was published by Nathan Bryan. He’s of course, the expert in nitric oxide and he’s a PhD out of Baylor. Uh, so he’s written several books, and he’s, he does a lot of research in regards to nitric oxide and its effect on our overall health and things like that. So he’s published a study in plus one in 2014 where they showed that the bacteria in the mouth a fix these nitrates. And when you don’t have those bacteria, you can’t fix the nitrates. Well. So we know that this mechanism occurs and so now we’re kind of talking about the oral part instead of the PPI part a, then another study by him, they, they did this study where they got dental students and they started evaluating, uh, their, their oral hygiene, their oral health and their blood pressures. And they noted that if you are a tongue scraper, so you scrape your tongue, then on average you’re starting blood pressure was lower.
Speaker 1: 12:40 However, if you scrape your tongue and use mouthwash, then there was a significant increase in your blood pressure and they think it’s because you open up the crypts and your tongue and the mouthwash is able to get in there and kill those bacteria better. And so, uh, you can’t, um, you can’t then convert the nitrates to nitrites, which means you can’t go on and make nitric oxide nitric oxide. So in, in one particular example, there was a 21 year old dental student, normotensive and well trained athletes. They gave him chlorhexadine, which they gave in, in this study. Chlorhexidine is, is a, an antibacterial agent. We use it for skin prep and surgery. We use it in a clinic for a same thing. Um, and uh, so they had them wash their mouth with chlorhexadine and after just one week, one week, he had a 26 mmHg, a 26 point increase in the systolic blood pressure and made him clinically hypertensive.
Speaker 1: 13:36 So if he was 80, he would have been 106. Exactly. Good grief in one week, exactly one week. Um, so this, there’s really interesting stuff. They did further data to be able to link the fact that this was indeed due to the bacteria not being able to fix nitrates and nitrites and make nitric oxide. So they, they linked those two things a thoroughly in this study. And then, um, in, in other studies, he also demonstrated that you can actually predict, and he was very excited about this, hearing him talk about it was kind of cool. You can actually predict blood pressure, not like you can, you can not like you’re going to be high or like you can predict blood pressure by the presence or absence of, for bacteria in your mouth. And the bacteria are leapt a trickier, a nice area, him awfulness and Prevotella. So if you have those four bacteria, than that predicts blood pressure and those were actually a good thing. How do we find those? What do you sign the test? Yeah. Um, so I’m not exactly sure how he did the whole study. I thought that was very interesting though, that for these four bacteria were, were predictive. So very interesting. Mouthwash, PPIs, and Hypertension. want to make sure that you have good oral hygiene and oral health and don’t use mouthwash.
Speaker 2: 14:59 Okay. So basically at this point, if you want to be healthy, you have to get enough nitric oxide because we talked about it having a very, very, very short half life. So you gotTa make sure you’ve got a lot of this going through your system. So how, give us the short version. Give me some bullet points. How am I going to do this?
Speaker 1: 15:18 Yeah, well, first of all, go back and listen to our podcast on nitric oxide because I go into much more detail about what to do, but here’s specifically, make sure you eat enough foods that contain nitrates, leafy Greens, Leafy Greens, beet roots, go Dwight Dwight, Dwight Schrute, shirt, farms, and then you have to be able to convert your nitrates and nitrites. So don’t use mouthwash. Don’t use PPIs. They’ve been shown that you can scrape your tongue, but don’t use those things. Okay? So they have been shown to increase cardiovascular disease, to reduce nitric oxide, a proven in the medical literature that it does those things. And then the last thing is make sure that you do everything you can to reduce oxidative stress. So introduce antioxidants and you got it. So that’s all of our podcast for today. Tune in for more on cardiovascular health and how all kinds of Weirdo things to increase your overall health as well as your cardiovascular health. Make sure you go on to Itunes, leave us a review. Please go give us a review on Google. Thank you guys for listening and we will talk to you next time.
Mouthwash, PPIs, and hypertension
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