How to Improve Your Teeth & Oral Microbiome for Brain & Body Health | Dr. Staci Whitman

Andrew Huberman:
Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Stacy Wittman. Dr. Stacy Wittman is a functional dentist with expertise treating both adult and pediatric patients. She focuses on oral health as a key feature of overall gut health and a powerful modulator of brain longevity, heart health, hormones, and fertility in both men and in women. Today, we discuss many of the common myths about tooth and gum care, and how to use specific nutrition, breathing, and cleaning methods to repair cavities, whiten teeth, and freshen breath, while at the same time improving the oral microbiome. This is very important because, as Dr. Wittman explains, most of the things that people do in pursuit of better tooth health and appearance and fresh breath actually damage their oral microbiome and indeed can lead to serious cardiovascular issues. So today we discuss how to brush, how to floss. I know we've all heard that we need to brush and floss, but Dr. Wittman explains exactly how to do those so that they are of the maximum benefit for our tooth health, gum health, and oral health generally. We also discuss the science and benefits of things like tongue scraping and oil pulling. And we discuss fluoride, which of course is a very controversial and timely topic nowadays. It's a very interesting conversation that I believe everyone, young, old, parents, and kids need to be aware of. We also discuss treating things like tongue ties, deviated septums, canker sores, and more. By the end of today's episode, you'll have the most up-to-date knowledge about how to take care of your oral health, both for aesthetic reasons and, of course, to reduce cavities and gum disease, and in doing so, how to support your brain and heart longevity. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, this episode does include sponsors. And now for my discussion with Dr. Stacy Wittman. Dr. Stacy Wittman, welcome.

Dr. Staci Whitman:
Thank you, Andrew.

Andrew Huberman:
I'm super excited to talk about oral health from all perspectives. Your public-facing content, especially on Instagram, has completely transformed the way I think about this thing that I call my mouth, that people think of as their teeth and their mouth and their breath and their tongue and all this stuff, as a key site for evaluating and maintaining health of my brain, my body, and today you'll make it clear as to why that's the case. I'd like to just start by looking at this oral health thing through the lens of what I think most people think of when they hear the words oral health, which is people want, it seems, whitish or very white teeth, depending on their preference. They want fresh breath, or at least to not have bad-smelling breath. And they want their mouth to sort of feel good, right? The question I have is what are some of the things that many, many people do in trying to have white teeth, fresh breath, that actually are very destructive for our teeth and our oral microbiome? And if we go through that entry point into this conversation, then we can get into some of the specifics of why that is. So what's something that you see many people doing in terms of trying to have bright white teeth that actually is harming their teeth?

Dr. Staci Whitman:
Sure. Great question. Great way to start off. So I first want to commend you and thank you for including the oral microbiome and oral health as one of the pillars of health. That means a great deal, and it has a lot to do with this answer. So unfortunately, we have been taught that we need to carpet bomb the mouth. We need to add astringents and alcohols and foaming agents and really strong essential oils to clean, disinfect, and to freshen the breath. But what we're doing with these products is damaging our delicate microbiome, which can make things far worse. So much of oral health is a less is more approach, and it's not so product heavy. It should be more focused on diet and lifestyle, like anything with health. Unfortunately, dentistry's been separated and compartmentalized out of the body, like much of medicine. We're so specialized and sub-specialized, and dentistry is included in that, and we need to remember it's all interconnected. And what we're doing to the mouth, whether it be strong toothpaste, mouthwashes, certain gums, and even what we're eating, and how we're breathing can really do a number on our oral health. And so it's taking a different perspective, and it's a bit of a mindset shift to really get us back to optimization.

Andrew Huberman:
So do you think that most of the common over-the-counter toothpastes, while they smell minty or pepperminty and taste minty and pepperminty, are they effectively cleaning teeth? And are they causing any damage to teeth by virtue of what they have in them?

Dr. Staci Whitman:
It really depends on the ingredients. So I'd like people to start looking at their oral healthcare products like they're starting to look at food labels. We should be reading the ingredients and understanding why they're there and what they're doing. Where are they sourced from? But certainly, I think so many of us feel it has to burn and foam to be effective. What is toothbrushing? What is it really doing? You're disrupting the biofilm, which is really the plaque or the bacteria that are adhered to your teeth. And so all these extra bells and whistles, it's sort of extra credit, but if you're perfectly imbalanced, we shouldn't need all these stripping agents and strong mints and things. So, for example, sodium lauryl sulfate is a foaming agent, but it also can be really disruptive to the oral mucosa and can lead to oral ulceration. So that's a common ingredient that causes foaming that I would argue we do not need. Your toothpaste shouldn't foam, nor should it burn. Essential oils, we think, oh, that those are ... natural, they're healthy, right? Well, many are very antimicrobial, and so they could be damaging the healthy bacteria in your mouth. So that's where that strong burn after many toothpastes, you really don't need that. And if your breath is so bad or you have halitosis that you feel the need for that, then I would argue, well, let's dig deeper. Why is your breath so imbalanced? There's probably something else going on. So I really encourage people to start learning about their products. I think we just give dentistry and teeth, we push it to the side. It's kind of an afterthought many times, and just like we're prioritizing skincare, shampoo, things that we're putting on our bodies, we need to be focused on the ingredients in our oral healthcare products, too.

Andrew Huberman:
Especially since we're literally putting it into our body-

Dr. Staci Whitman:
Sure

Andrew Huberman:
... not just on the surface of our body. What was the foaming agent again?

Dr. Staci Whitman:
Sodium lauryl sulfate.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
And the problem is there's derivatives. So some cleaner versions might have coconut-derived SLS derivatives, and many people will do okay with those, but a common complaint I see in my office are oral ulcerations, and the first thing I think of is what's in your toothpaste. Does it have SLS or a derivative? Because we're all different and some people have more sensitivities, and will react more to those.

Andrew Huberman:
Are oral ulcerations canker sores?

Dr. Staci Whitman:
Mm-hmm. Yeah.

Andrew Huberman:
Or are canker sores-

Dr. Staci Whitman:
Aphthous ulcers or yes.

Andrew Huberman:
Mm-hmm. So if one gets a canker sore, what does that reflect typically? Let's assume the toothpaste doesn't have anything to do with it. Is that a disruption in the microbiome? Is it from a physical injury, like a bite to the gum?

Dr. Staci Whitman:
Could be all.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
So it could be secondary to trauma, certainly. It can be viral related, so the herpes virus often will result in oral ulcerations.

Andrew Huberman:
HSV-1.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
But also, and this is not on many people's radars, the mouth is the gateway into the body, and the mouth is the gut. I want people to start thinking of it that way. So what happens in the mouth can be a reflection of what's happening in the gut. And so a lot of times when I have patients that come in with recurrent aphthous ulcers or ulcerations, that can be a sign of Crohn's or celiac, IBS, something going on deeper within that we need to be evaluating, food sensitivities, et cetera.

Andrew Huberman:
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Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... and demineralization of teeth?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Because I find this so interesting, and later I'll share a little bit. Full disclosure, I have a very complicated oral health history, and had I known what you're about to tell us, I think I would've spared myself a ton of pain.

Dr. Staci Whitman:
Potentially. I'm sorry to hear that, but we'll unpack that.

Andrew Huberman:
You weren't my dentist, unfortunately.

Dr. Staci Whitman:
No.

Andrew Huberman:
So.

Dr. Staci Whitman:
I have stories to share, too, we'll get to as well. I think many people do, and that's the problem. So I wasn't taught this in dental school, interestingly enough. So this is something I learned later out in practice, and it's the concept that your teeth can naturally remineralize if you have a small cavity. But let's start further back. So your teeth are constantly going through demineralization and remineralization, and this is very natural, and any time we put anything into our mouth besides arguably neutral water, and this has to do with pH. So any time we eat, our mouth is the beginning of the digestive system. So we release amylase, which is an enzyme that helps break down our food, and in doing that, the pH drops. This is how we start digestion. When that happens, we lose minerals in our teeth. The acid will leach out calcium, phosphorus, and minerals from our teeth. But the concern is we don't want it to stay in that acidic state for too long, in that demineralized state for too long, because if we allow our body to do its thing, our saliva will naturally remineralize our teeth. This is all part of a healthy, balanced system. So our saliva is this golden elixir of our body, and it contains immune cells and enzymes, but also the minerals that we should need, if balanced, to create that remineralization. So there's something called the Stefan curve, and essentially it's showing us how our mouth will become acidic and neutral, and acidic and neutral throughout the day as we eat. The problem is, in modern society, we tend to be snacking and grazing and sipping all of the time. So we're not giving our mouths enough of a break, enough of an opportunity to remineralize. So many of us are staying in the state of constant acidity and demineralization. But what's interesting is, so if you have a small cavity or lesion that hasn't yet truly cavitated, and a cavity means a hole. So if you look on an X-ray and I see a shadow on your tooth, it's called an incipient lesion. Those, if they're still in the enamel, those can quote unquote "heal" or remineralize, and this is where you would need to work with, let's say, a functional or biological dentist to understand how deep your cavity is. Once it becomes a hole, generally you do need some sort of treatment, but our body is meant for stability. It knows what to do, but how you eat, how frequently you're eating, and then we can get into this, but how you're breathing and certainly the products you're using and your hygiene practices all factor in as well.

Andrew Huberman:
So my understanding is that the minerals that make up teeth are not the same materials that are put into a lot of common toothcare products. So without getting into a discussion right now about fluoride in water, we will get to that conversation a little bit later, but in order to frame that properly when we arrive there, could you explain why it is that fluoride is in most toothpastes when basically we don't have fluoride in our teeth at birth-

Dr. Staci Whitman:
That's right

Andrew Huberman:
... but there are other minerals in our teeth that certain toothpastes have.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
And so why would we give an artificial substance to our teeth? Maybe you could explain demineralization, remineralization in the context of fluoride and-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... these other minerals.

Dr. Staci Whitman:
So we have hydroxyapatite, which is essentially calcium and phosphorus, in our teeth. Our enamel is about 90% hydroxyapatite. The dentin, which is the layer below the enamel, through the enamel, is about 60, and our bone has hydroxyapatite, too, about 60%.

Andrew Huberman:
Our limb bones?

Dr. Staci Whitman:
Mm-hmm. All bones.

Andrew Huberman:
60% hydroxyapatite.

Dr. Staci Whitman:
Yes, which is calcium and phosphorus. Our saliva will also have calcium and phosphorus floating around, too. So what fluoride does is it throws off the hydroxyl group in hydroxyapatite, and so it changes it from hydroxyapatite to fluorapatite. So it restructures it a bit. When it does this, the bonds generally are considered stronger, and the dental crystalline structure is more densely packed, so it's known to be more acid-resistant. And so we can get into the history of how they discovered this, but essentially, fluoride was put into toothpaste in about the 1960s. It became very popularized. So that is why many dentists love fluoride, is that you're using it, and it makes your teeth more acid-resistant, and also it has some antimicrobial effects, too. The issue I have, and we can unpack this more later, is that it's not super selective. So it's not only selecting anaerobes or pathogenic bacteria, but it potentially could be damaging beneficial bacteria, too. So that's why toothpaste has fluoride in it. It also will lower the critical pH. So the critical pH is the pH of which your enamel will start to demineralize or degrade, and for enamel, it's 5.5, and then for dentin, it's closer to 6.5. So what fluoride does is it raises the pH resistance.

Andrew Huberman:
I see. So for people that aren't familiar with pH, it's a measure of how alkaline or acidic a given environment or something is. And so what you're telling me is that fluoride makes teeth ultra strong.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
It's not a mineral that teeth normally see. Like if a child never used fluoridated toothpaste or drank fluoridated water, they basically, unless they happen to drink from a stream with fluoride in it Their teeth would rely on hydroxyapatite to remineralize. But we put fluoride into toothpaste and into water, and that allows teeth to become even stronger and even more acid-resistant.

Dr. Staci Whitman:
Yes. Some out there argue the enamel structure actually is weaker. This is very nuanced, but generally, the dental community believes it's a stronger version of enamel. Some will argue when you look under scanning electron microscopy, the crystalline structure can be more wave-like, and potentially the bonds could break more easily. But generally, topical fluoride does work. However, it is no match for a poor diet. So all of this really comes back to what you're eating.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So it will make you less at risk for cavities, but it's not a shoo-in. It's not for sure going to prevent decay.

Andrew Huberman:
What are the times in each 24-hour cycle when our teeth are repairing themselves? So, like in the middle of the night, provided somebody's asleep, they're not eating.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
They're not drinking unless they get up for a moment and have a sip of water or something. In between meals, they're not eating. If I just sort of naturally intermittent fast, I generally eat my first bite of food somewhere around 11:00 a.m., sometimes a little earlier. But that's just habit. It sort of falls under this intermittent fasting kind of thing. So I and many people have stretches of time of anywhere from three to 14 hours when we're not ingesting any food or caloric beverages. Is that when remineralization occurs?

Dr. Staci Whitman:
It's a tough one.

Andrew Huberman:
Tricky word.

Dr. Staci Whitman:
It's a tough one.

Andrew Huberman:
Remineralization. We'll have to do it as a-

Dr. Staci Whitman:
Remineralization.

Andrew Huberman:
Right. Oh, that's right. You've got to put the accent. Remineralization.

Dr. Staci Whitman:
Uh-huh.

Andrew Huberman:
Thank you. That helps. You said that before.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Thank you. Is that when our teeth repair themselves?

Dr. Staci Whitman:
Yeah. This is great. This is important. So generally, after you eat, as I mentioned, your mouth will become more acidic. After about 20 to 30 minutes, your saliva will naturally start to buffer. So it will start to rise and raise the pH up. I like to see us eating more on a schedule. So generally, every two hours or so is when we'll get full optimal remineralization. The issue is we are a society on the go, and we're grabbing crackers and chips and granola bars, and we're eating and nibbling and sipping on Frappuccinos, so we never allow that remineralization to take its full effect. So yes, when you're not putting food or drink, in theory, in your mouth, your saliva, if it's optimized, and we should talk about that as well, will be remineralizing. But unfortunately, I do feel so many of us are just not in balance. We're dehydrated, we're mineral deficient, we're calcium deficient, we're phosphorus deficient, and we're mouth breathing, so the pH is changing. Just from mouth breathing can make the mouth more acidic. And so there's a lot of factors at play. But in theory, if I can make one suggestion to someone out there who might be struggling with cavities, I want to know not only what are you eating, but how frequently are you eating it? And this is a great reason why, from a dental standpoint, fasting, intermittent fasting, or time-restricted eating is a great way to combat dental decay. It's also better on gut health as well. The migrating complex, the cleansability, just giving things a break and a rest is really important.

Andrew Huberman:
I grew up hearing that sugar causes cavities. Does sugar cause cavities? And when we say sugar, of course, all the biologists and people with a nutrition background roll their eyes because sugar is a very broad statement.

Dr. Staci Whitman:
Sure.

Andrew Huberman:
There are simple sugars, there's fructose, there's sucrose, there's glucose, there's all sorts of variation within the simple and complex carbohydrates. But when I'm saying sugar, I'm thinking about foods that taste sweet-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... or that contain sugar that's masked by other flavors, for sake of simplicity.

Dr. Staci Whitman:
Like added sugar.

Andrew Huberman:
Like added sugar.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Now if you buy a cracker, typically, if you look at the package, there's some sugar in there, which is ridiculous, but that's a whole-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... other discussion.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Or we could just even say starchy carbohydrates.

Dr. Staci Whitman:
Fermentable carbohydrates is what I like to say.

Andrew Huberman:
Fermentable carbohydrates.

Dr. Staci Whitman:
But that gets kind of nerdy. So not directly. It's really acid that causes cavities. So what sugar does, and I like everyone to think of flour like sugar. This is also very important. Because the bacteria in our mouth, they thrive, the pathogenic bacteria, they thrive on sugar. But flour will act like sugar in the mouth, so they'll also thrive on flours. So the crackers-

Andrew Huberman:
Bread

Dr. Staci Whitman:
... the bread. Yeah.

Andrew Huberman:
Even a good sourdough bread?

Dr. Staci Whitman:
Well, the issue-

Andrew Huberman:
Do I have to give up sourdough bread?

Dr. Staci Whitman:
I like sourdough, too. The issue is more contact time. So things that are really sticky and dried, I would argue, so crackers or toast.

Andrew Huberman:
Chips.

Dr. Staci Whitman:
Chips.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Think about if you take a handful of Goldfish crackers. I haven't done that in a long time, but imagine that. It's all throughout your teeth, in between the teeth, down in the grooves. It's sticky. It's just a smorgasbord for the bacteria. And so what do the bacteria do when they metabolize the sugar or the flour? They release acid. And so if that food substrate is stuck against the tooth for a long period of time, and these foods are also hyperpalatable, so we're meant to be just snacking and grazing, hitting the bliss point. Grab a handful, go do something, come back, grab another handful. You're just constantly feeding that bacteria, so your mouth is staying constantly acidic. So it's truly the acid that causes cavities, but I would argue that sugar or flour is kind of the catalyst that feeds the bacteria to create that imbalance.

Andrew Huberman:
Is it fair to say, I know you prefer the term fermented carbohydrates or trying to, for most people who don't think in terms of starches versus fiber or simple, although nowadays people are more versed in that sort of thing. Think of carbohydrates or foods, for that matter, that if you put them in your mouth and you just kind of kept them there for a little bit, that they would dissolve. Like a cracker.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Like a chip, like rice.

Dr. Staci Whitman:
Pasta.

Andrew Huberman:
Like a piece of pasta, as opposed to a piece of broccoli, which would get soggy, but it's got a lot of fibrous-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... material, so it doesn't dissolve in the mouth.

Dr. Staci Whitman:
And interestingly, broccoli or prebiotic fiber is what feeds the good bacteria. So I work mostly with children now, and we can talk about why that transition happened. I used to work with adults. But I teach them eat the rainbow. Feed the good guys. Okay? So we want to feed our healthy bacteria more than we want to feed the bad bacteria. And that's not to say you can't ever have fun and enjoy some fun foods, but it's all about balance. And so I think people don't realize the true root cause issue with dental disease is primarily diet. We're so hyper-focused on fluoride, and what's in your toothpaste, and the mouthwash, and all these products, but all of those things are really just masking the underlying issue, which is how are these bacteria behaving? What types of bacteria and in what ratios do we have them in the mouth? And how often are we feeding them?

Andrew Huberman:
So I'm hearing this as a repeating theme, that diet and lifestyle are going to be more important than drugs or products for keeping the mouth looking good and healthy.

Dr. Staci Whitman:
Yes. For example, I personally haven't used fluoride for many, many years, and neither have my children, just because I know there are other ways to prevent disease. And I have many of my patients that choose not to use fluoride or these products also. I think so many people have been taught you have to have this product, fluoride, et cetera, to stay cavity and disease free. But if you eat a clean diet, focus on just some of the pillars of health, that will translate into the mouth as well.

Andrew Huberman:
Perhaps it's worth mentioning just what some of the facets of a clean diet are through your lens of-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... what you consider a clean diet.

Dr. Staci Whitman:
Sure. So I'm not advocating for any one diet, and I do believe we're all different, so what works for some people may not work for others. But generally what I suggest is really high-quality protein sources, a wide array of vegetables, fruit. I would argue you should limit fruit, potentially, especially if you're a high decay risk, just because there is sugar, fructose. But I don't want to villainize fruit, as there's so many healthy benefits, the polyphenols and everything in it. So nuts, seeds, olives, pickles. I love fermented foods for gut health, and then oral microbiome support, too. So essentially, a whole food diet. Things that come from the earth and more from farms and less from factories, less things out of bags. Arguably, ultra-processed foods should be avoided as much as possible or minimized, and then trying to stick to minimally processed or unprocessed foods.

Andrew Huberman:
Is it fair to say that if one does that, either a child or an adult, that their oral microbiome will not only get healthier, but that their teeth will get whiter? And the reason I keep bringing this up is I think a lot of people want white teeth, or at least not yellow teeth.

Dr. Staci Whitman:
Sure.

Andrew Huberman:
Having been involved in the public-facing health education business for a little while now, I realize that nothing that is encouraged to be good for us that takes away from the way that people want to look-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... and feel about how they look gets much traction. So what I like about what you're telling us is that all the things of eating mostly unprocessed or minimally processed foods, those are going to be good for our entire body. Great that it's great for our oral microbiome. Probably is good for our whole body because of its effects on the microbiome, at least in part. But what makes teeth white, and will supporting the oral microbiome make our teeth whiter?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
And by the way, there are some folks out there whose teeth need to be less white, in my opinion.

Dr. Staci Whitman:
Agree. Totally agree.

Andrew Huberman:
Now we're being somewhat facetious, but not really. But I think most people would like to have teeth that would be characterized as mostly white.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
We want to look good. I appreciate and respect that. I do think we've moved a little away from reality with some of that, so I agree with you. I think there are teeth out there that could not be quite so bright, but you do you. I think everyone should do what makes them happy. So what makes teeth white? So interestingly, if you look at a baby tooth next to an adult tooth, and I get this call all of the time from parents. So the child loses their first baby tooth, the adult tooth starts to come in, and adult teeth are quite a bit darker than baby teeth, which are very white and bright. And they're worried. "What's wrong with my child's teeth? They're so yellow." That's actually a very natural shade of enamel. And why is that? It all has to do with that crystalline structure and the mineralization. So baby teeth are less mineralized, and the crystalline structure is a little more haphazardly arranged. It's not quite as organized. So instead of Lincoln Logs lined up, it's more like pickup sticks to some degree. Why is that? Baby teeth are meant to resorb, dissolve, and fall out. Okay? So this is why baby teeth are also much more susceptible to decay. So the whiteness is coming how the light reflects and refracts off the teeth, which is a lot of times why you'll hear if you use hydroxyapatite or even coconut oil is changing the surface, surface modification. So it's changing the way light reflects and refracts off that tooth to make it seem whiter and brighter. Now, certainly with adult teeth, if you're using bleaching agents, hydrogen peroxide or carbamide peroxide, some of the stronger bleachings, that's actually penetrating into the tooth and changing the structure, pulling out stain.

Andrew Huberman:
Do people do that? They gargle with hydrogen peroxide?

Dr. Staci Whitman:
Well, they do bleaching trays, essentially.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
Well, people will rinse with hydrogen peroxide, yes. And it will make your teeth brighter and whiter, but I'm telling you, it's going to do a number on your oral microbiome. So I suggest it in a very limited fashion.

Andrew Huberman:
The only time I ever had a bad canker sore- ... was because I gargled with 50% water, 50% hydrogen-

Dr. Staci Whitman:
Oh, interesting

Andrew Huberman:
... peroxide because an acupuncturist recommended it.

Dr. Staci Whitman:
Hmm.

Andrew Huberman:
He looked at my tongue and then he said, "You should do that." And then I did that, and then four or five days later, I had this nickel-sized canker sore on the roof of my mouth.

Dr. Staci Whitman:
Too much.

Andrew Huberman:
And I was like, "Ugh." And I will say, and I have no product affiliation whatsoever to any specific products, but by switching to hydroxyapatite-containing toothpaste, my teeth definitely have gotten whiter.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
I drink a lot of-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... yerba mate and coffee. And I brush, but it was sort of a progressive issue of my teeth dimming. So that's been great. I also used to get cavities fairly often when I was a kid. I'll talk about that a little bit later. But since switching to hydroxyapatite toothpaste, I've had stellar-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... dental reviews, assuming my dentist is looking carefully.

Dr. Staci Whitman:
Great.

Andrew Huberman:
I believe he is, but we'll see. And to me, it just makes so much more sense. Give teeth the mineral that they normally use to remineralize. It just makes sense.

Dr. Staci Whitman:
It's biomimetic. It depends on how you look at life, I think. I prefer biomimetic materials personally. Again, it's a personal choice, but I agree with you. My patients who have switched to hydroxyapatite, and I'd like to point out not all hydroxyapatite toothpastes are the same. It depends on sourcing and the other ingredients that are in there.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
But generally speaking, their teeth look healthier, stronger, whiter and brighter. They just look more nourished, more hydrated. Their microbiomes look more balanced too.

Andrew Huberman:
Mm-hmm. You're talking about kids and the fact that sometimes if their teeth are a little bit yellow, that's normal. One thing that I've been really struck by as the discussion around longevity seems more and more prominent these days is occasionally I'll run into somebody who's in their 70s or 80s, even 90s, and it's very rare to encounter somebody in their 80s or 90s whose teeth are not the color of this tea.

Dr. Staci Whitman:
Mm.

Andrew Huberman:
And for those that are listening, it's a very dark brown.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
I've never seen somebody, unless they're doing something highly artificial with bleaching, I've never seen somebody 75 or older whose teeth aren't basically yellow to brown.

Dr. Staci Whitman:
Darker.

Andrew Huberman:
And when you look at people when they're very close to death, their teeth often look very opaque.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
What is that? Is that a blood flow issue? What's going on there?

Dr. Staci Whitman:
Yeah. It can be xerostomia or dry mouth, so we definitely lose salivary capabilities as we age. Very likely more mouth breathing, so mouth breathers will tend to have darker teeth because the teeth desiccate, they dry out, and over time you will experience mineral loss. Decades and decades of coffee, tea, wine will do it too.

Andrew Huberman:
Well, I don't drink the wine, but I've definitely had-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... coffee, tea since I was a-

Dr. Staci Whitman:
They will stain

Andrew Huberman:
... little kid.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
I've been drinking lattes since I was five.

Dr. Staci Whitman:
It's good.

Andrew Huberman:
Yeah. It's delicious.

Dr. Staci Whitman:
Yeah. Got to live life.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
But yeah. And they're losing minerals too over time. Your teeth take a beating. We're living to be 100 now. That's a long time to maintain this non-shedding surface in our body. And then it depends on the generation too, but some generations, especially as you mentioned, 70s, 80s, I'd wonder about tetracycline exposures when there's certain antibiotics that we don't use anymore that were known to darken the teeth, which is why they pulled them-

Andrew Huberman:
Hmm

Dr. Staci Whitman:
... from common prescription.

Andrew Huberman:
That raises a question I'd never thought about before. So if one takes a course of antibiotics, typically the advice is to ingest low-sugar kombucha, to have some-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... Bulgarian or Greek yogurt, repopulate the gut with the substrates for healthy microbiota. We now know, because you've told us, that the mouth is the gut-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... which makes perfect sense. We are but a series of tubes. That's what I always-

Dr. Staci Whitman:
Yes

Andrew Huberman:
... teach in my developmental neurobiology class, but it's true.

Dr. Staci Whitman:
It's true.

Andrew Huberman:
In embryology, you learn that we're basically born of a bunch of tubes that kind of do their thing in development.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
But the digestive tract obviously starts with the mouth. So is it the case therefore that we should be repopulating the oral microbiome if we take a course of antibiotics?

Dr. Staci Whitman:
Yes. Very commonly, patients, parents will report, "Gosh, my child just finished this course of antibiotics and now their teeth are stained," or their gums are inflamed or they just seem off, and it usually is because they've wiped out a lot of the healthy bacteria, too. It's all connected. So I do suggest my patients, if I have to write antibiotics, which I try to avoid, but sometimes we have to, that they do take a high-quality probiotic and increase their probiotic-rich fermented foods as well.

Andrew Huberman:
So a high-quality probiotic pill, yeah.

Dr. Staci Whitman:
Generally, yeah, because it's hard to get in enough, especially in kids, I would argue. Kids aren't usually eating a lot of sauerkraut and kimchi and-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... natto and... But you could do kefir, yogurt, as you mentioned, low-sugar kombucha, et cetera. But usually a high-quality gut probiotic will have some benefit to the oral microbiome, but they also do have oral probiotics, too, focused on the bacteria of the mouth.

Andrew Huberman:
What about mouthwashes?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
I've never liked them. They burn-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... for one, and then I learned some years ago, and this is just kind of fun to cue to. Years ago, it must've been eight, 10 years ago, I heard, I think on the Tim Ferriss podcast, somebody said, "Oh, mouthwashes will nuke certain chemicals that are essential for cardiovascular function, and so don't use them. Don't use mint mouth strips. Don't use any of that stuff." And at that time, that was considered clear, quote-unquote, "pseudoscience."

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Nobody really-- Like-

Dr. Staci Whitman:
Outrageous

Andrew Huberman:
... alternative science, outrageous.

Dr. Staci Whitman:
Sure.

Andrew Huberman:
Now we know-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... this is actually true.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
This always delights me and scares me at the same time that many of the things that right now people go, "Ugh, that's pseudoscience." Like creatine seems to be a big thing right now. 10 years ago it was only the-

Dr. Staci Whitman:
Sure

Andrew Huberman:
... gym rats that were talking about it. Now everyone's like, "Creatine, creatine."

Dr. Staci Whitman:
Everybody needs it.

Andrew Huberman:
So, what's the story on mouthwashes and mouth strips and-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... mints and things of that sort?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
That again, like people just want to have fresh breath or at least they don't want to be the person with the bad breath.

Dr. Staci Whitman:
Sure.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
So Listerine and those stronger rinses in particular, they generally contain alcohol, astringents, really strong antimicrobials. It says kills 99.9% of germs. Well, I think we've learned we're over-disinfecting. This is why asthma is up, eczema, allergies are up in our children. We now are saying get into the dirt, get exposed to microbes and things. So we're carpet bombing the mouth. What we've learned through the data, and you're right, there are studies to show that chronic habitual use of these mouthwashes, including prescription-strength mouthwash, like chlorhexidine is a common one, it can damage the nitrate-reducing bacteria. So we have bacteria in the dorsum of our tongue specifically, that is essentially your tongue, that reduces nitrate to nitrite, which is a precursor to nitric oxide. Nitric oxide is a molecule that is really important for cardiovascular health and vasodilation and immune health. So if we're indiscriminately carpet bombing the mouth with these really strong astringents and rinses, we can be affecting our cardiovascular health, and there are studies to show it can increase blood pressure and potentially cause cardiovascular issues. So when I hear someone say, "But my breath is so bad, I have to use this multiple times a day," I immediately think, "Well, gosh, why is your breath so bad?" It's normal to have bad breath after you eat garlic hummus or have a cup of coffee. But if it's chronic halitosis or bad breath, I'm curious, do you have periodontal disease, which is a chronic inflammatory issue in the mouth, which can have a slew of downstream effects, which we should discuss in a bit. Or do you have an infection? It could be a sinus infection, postnasal drip. Do you have tonsil stones or tonsillar infection? Like what else is going on in your mouth where you feel you need this multiple times a day to even feel like you can present yourself in public? Really strong essential oils and mints, again, I'd be cautious with that. Every once in a while, throwing in a piece of gum or a mint, of course. It's really the habitual use of these things that can be damaging.

Andrew Huberman:
I'd like to take a quick break and thank our sponsor, AG1. AG1 is an all-in-one vitamin mineral probiotic drink with adaptogens. I've been taking AG1 daily since 2012, so I'm delighted that they're sponsoring this podcast. The reason I started taking AG1, and the reason I still take AG1, is because it is the highest quality and most complete foundational nutritional supplement. What that means is that AG1 ensures that you're getting all the necessary vitamins, minerals, and other micronutrients to form a strong foundation for your daily health. AG1 also has probiotics and prebiotics that support a healthy gut microbiome. Your gut microbiome consists of trillions of microorganisms that line your digestive tract and impact things such as your immune system status, your metabolic health, your hormone health, and much more. So I've consistently found that when I take AG1 daily, my digestion is improved, my immune system is more robust, and my mood and mental focus are at their best. In fact, if I could take just one supplement, that supplement would be AG1. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. They'll give you five free travel packs, plus a year's supply of vitamin D3 K2 with your order of AG1. Again, go to drinkag1.com/huberman to claim this special offer. Today's episode is also brought to us by Joovv. Joovv makes medical-grade red light therapy devices. Now, if there's one thing that I have consistently emphasized on this podcast, it is the incredible impact that light can have on our biology. Now, in addition to sunlight, red light and near-infrared light sources have been shown to have positive effects on improving numerous aspects of cellar and organ health, including faster muscle recovery, improved skin health and wound healing, improvements in acne, reduced pain and inflammation, even mitochondrial function, and improving vision itself. What sets Joovv lights apart, and why they're my preferred red light therapy device, is that they use clinically proven wavelengths, meaning specific wavelengths of red light and near-infrared light in combination to trigger the optimal cellar adaptations. Personally, I use the Joovv whole body panel about three to four times a week, and I use the Joovv handheld light both at home and when I travel. If you'd like to try Joovv, you can go to Joovv, spelled J-O-O-V-V, .com/huberman. Joovv is offering an exclusive discount to all Huberman Lab listeners with up to $400 off Joovv products. Again, that's Joovv, spelled J-O-O-V-V, .com/huberman to get up to $400 off. Okay, so those are some don'ts. What are some things that we can do to improve the chemistry of our saliva and our mouth? And, just in full disclosure here, won't be the disclosure most people are anticipating. What I'm trying to get at here is all the chemical aspects, the chemistry of the mouth.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Because when I think about biology, just because of my training, I think you've got chemical forces and you have mechanical forces.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Like there's stuff that literally like moves or you could chip a tooth or things that you shouldn't do to protect your teeth, and then there's how to create the right chemistry environment.

Dr. Staci Whitman:
Yep.

Andrew Huberman:
So that's really what we're talking about here, and I'm trying to figure out how could I have The best possible saliva.

Dr. Staci Whitman:
Yeah. Love it.

Andrew Huberman:
I want to be the person with the best possible saliva.

Dr. Staci Whitman:
Good spit.

Andrew Huberman:
Yeah. Good spit.

Dr. Staci Whitman:
Don't underestimate your spit. It's true. It's the golden elixir of your body.

Andrew Huberman:
So if I were to put spit under the microscope, and then also take some of my spit and put it in mass spec and separate out all the goodies that are in there, just give us a sense of the kinds of goodies that are in spit.

Dr. Staci Whitman:
What's in there?

Andrew Huberman:
Because it just looks like a bunch of clear liquid to people, but-

Dr. Staci Whitman:
Sure

Andrew Huberman:
... blood looks like just a bunch of red liquid, and there's a lot of stuff in there. So-

Dr. Staci Whitman:
There's so much in it, and it's so important. So it has bacteria-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... viruses, fungi, protozoa, hopefully in the right ratios. So we want beneficial bacteria. We all have about 5% pathological bacteria. However, at that ratio, those may not be pathological. They're symbiotic at that point. We are still unpacking and learning more about the oral microbiome. But essentially, you'll have bacteria.

Andrew Huberman:
There's hormones. There's free cortisol.

Dr. Staci Whitman:
There's hormones. There's-

Andrew Huberman:
Cortisol's in our spit, folks.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
Absolutely.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
There are enzymes to aid in digestion, there are immune cells, and there are minerals floating around, too. So, think about how important saliva is to chew. If you have dry mouth or you're sick, you can't chew and swallow your food, and this is why a lot of elderly people have a very hard time eating certain foods or if you've undergone cancer therapies and things. Once you get xerostomia, dry mouth, your teeth can degrade so quickly. So your saliva is so important. And so how do we keep it healthy? Hydration. So many of us are dehydrated. I would argue we aren't getting enough minerals either, so I suggest to some kids, I can tell in a child's mouth if they're hydrated or not by the way their saliva looks. If it looks more thick and ropy and mucousy, they're dehydrated. If it looks like water, it's healthy. This is without any tests. So put a pinch of salt in your water or some electrolytes. That can really help with bioavailability and absorption. How you're breathing is incredibly important, too, for your salivary health. So if you're mouth breathing, you will have less saliva. Your mouth's going to dry out. The pH will drop, and you're going to be in trouble. Dry mouth leads to cavities. Dry mouth leads to gum disease.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And then the foods we eat, of course, too, we want to have a mineral-rich diet. So many of us are mineral deficient. We're magnesium deficient. We're fat-soluble vitamin deficient, particularly vitamin D3, K2. So I think it is good-- I like the idea of test, don't guess. If you have the capability to work with a doctor to see where you are with some of these things to know if you need to supplement or not or how you can change your diet.

Andrew Huberman:
Sorry to interrupt, but-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... would I test my saliva specifically? Is there a good saliva test out there?

Dr. Staci Whitman:
That would be a different test, so this would be more of a blood test.

Andrew Huberman:
Like a standard blood test or-

Dr. Staci Whitman:
A standard blood test, but there is salivary analysis, and we should discuss the importance of testing your oral microbiome. I think just like so many of us test our gut microbiomes now, GI mapping, stool tests to understand what's happening in the gut, there's salivary analysis now, and this is what a lot of functional dentists are working toward. I do salivary analysis and biomarker analysis in my practice. We can tell a lot through a patient's saliva and what ratio and types of bacteria are there, as well as fungus and viruses and things as well. So if you have the capability, if you really want to optimize your health, I suggest testing your oral microbiome because there are certain keystone pathogens that you may have that you're unaware of that can lead to many downstream issues. And we can jump into this now, but the oral-systemic connection is really blowing up now in how oral bacteria, specifically pathogens, can contribute to Alzheimer's and dementia, infertility issues, pregnancy issues, cardiovascular issues, autoimmune disease, rheumatoid arthritis, diabetes, obesity, mood disorders, cancers. It goes on and on.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
All coming back to the bacteria in our mouth.

Andrew Huberman:
Amazing. I really want to not just double-click, but really dive into that, no pun intended. I do want to just ask because a subset of listeners will be interested in how they could get their saliva tested.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
I've never had my saliva tested. I will say that based on your teachings online, I've made an effort to drink more water in addition to massive amounts of yerba mate- ... and small amounts of coffee. I've made an effort to-- Well, I switched to a hydroxyapatite-containing toothpaste, which has been terrific for all sorts of reasons. I've really emphasized nasal breathing. That's something I was into before through the sports performance world because my friend Brian McKenzie, who's a human performance expert, was really big on this a while ago. And the healthiest my breathing and cardiovascular function ever was for me was when something I don't suggest people do unless it's their profession, I was boxing for about a five-year span, and I had a fitted mouthpiece, and I would do my running, my road work, with my mouthpiece in breathing through my nose.

Dr. Staci Whitman:
Mm.

Andrew Huberman:
And that taught me really how to breathe correctly through my nose, and it translated to switching to nasal breathing when I slept. I didn't sleep with a mouthguard in. But I think that breathing through the nose is just so important for the reasons you're describing, James Nestor's described. And I will share this little factoid, and then I'll shut up and nasal breathe. A friend of mine who is a physician at UCSF, he told me that the methamphetamine addicts that come in have terrible teeth. Everyone knows this. Meth addicts have terrible teeth. But do you know why it is? He works with the School of Dentistry.

Dr. Staci Whitman:
I do.

Andrew Huberman:
It's because they're mouth breathing.

Dr. Staci Whitman:
I've worked with that population before.

Andrew Huberman:
Meth doesn't actually deteriorate the teeth. It's the fact that they're mouth breathers. And so I find this fascinating. And then, of course, the book "Jaws" which was published by-

Dr. Staci Whitman:
Yes

Andrew Huberman:
... Paul Ehrlich and Sandra Kahn-

Dr. Staci Whitman:
Absolutely

Andrew Huberman:
... my amazing colleagues at Stanford-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... years ago. And by the way, when they published that book, people said, "Oh, this is pseudoscience. This is crazy."

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
"You're saying nasal breathing, epidemic of fear-mongering." Well-

Dr. Staci Whitman:
It is

Andrew Huberman:
... we now know this is a real thing.

Dr. Staci Whitman:
It's an epidemic.

Andrew Huberman:
So-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... so how do you encourage kids and adults to switch from mouth breathing to nasal breathing?

Dr. Staci Whitman:
Yes. This is a big part of my practice. So we need to understand the why, just like anything. Why are you a mouth breather? So humans are obligate nasal breathers. We are meant to be breathing through our nose. Unfortunately, so many of us are mouth breathers. They estimate up to 50% of the population now breathes through their mouth. I personally think that's an underestimate with what I'm seeing at my practice. So why is this? So the theory is that ancestrally we used to chew and masticate up to four hours a day. This act of chewing, it pushes, forces out... It was actually what grows the face, the lateralization of the tongue, the tongue elevating. It would grow the jaws wide, the sinuses wide, including breastfeeding, okay? We now flash forward 10, 12,000 years, okay? So we had the agricultural revolution where we went from hunter, gatherer society to agrarian. Then the Industrial Revolution, we started milling and processing everything. Everything's soft and mushy now. We used to chew four hours a day. We now chew four minutes a day. So there's atrophy, essentially.

Andrew Huberman:
We slurp our food.

Dr. Staci Whitman:
We slurp our food.

Andrew Huberman:
It's like that movie. What was that futuristic movie with the little robot?

Dr. Staci Whitman:
"WALL-E"?

Andrew Huberman:
I hated that movie.

Dr. Staci Whitman:
Oh, I cried during that movie.

Andrew Huberman:
I hated that movie.

Dr. Staci Whitman:
I was so worried that it was true, and here we are.

Andrew Huberman:
Yeah, they're just slurping their food-

Dr. Staci Whitman:
Yes

Andrew Huberman:
... lying on recliners.

Dr. Staci Whitman:
Here we are.

Andrew Huberman:
They've outsourced pretty much everything.

Dr. Staci Whitman:
Yes. Yes. So this is many generations of this happening. We're essentially shrinking. James Nestor phrases it, we're de-evolving, okay? So faces are shrinking, jaws are shrinking. This is why we see so much crowding in teeth. If you go to the Natural History Museum in New York, Washington, DC, look at the ancestral skulls. The teeth are pristine. There's no decay, and all 32 teeth, including the wisdom teeth, fit perfectly into the dental arches. So that was not that long ago in our trajectory. So what has happened? It's our food. It's how we're chewing. It's how we're breathing, and so if this structure shrinks, the nasal volume shrinks, the sinuses shrink, the airway shrinks. Our tongue has no room in our mouth anymore, so it either sticks out, tongue thrust, or it falls back, and it's obstructing us. So there's so much sleep disordered breathing, dysregulated breathing, and sleep apnea now that's not getting diagnosed. So if we look at children early, and they come into me, and I can see it as they walk in, they generally will have forward head posture because they're trying to open their airway, okay? Forward head posture. They have dark circles. That's called venous pooling. That's a sign of inflammation secondary to mouth breathing. You can see more of the whites of their eyes, so it has to do with their visual plane. So forward head posture, the droopy eyes from inflammation. You see more of the sclera, the white of the eye. They just look congested and sick, and their mouth's open, and those kids have major airway issues, and we need to understand why. So it is generally either a hard tissue issue or a soft tissue issue. So what would the hard tissue issues be? That would be the size and shape of the jaws, the size and shape of the palate, the position of the jaws. Is your jaw set back? Is it forward like a bulldog? And do you have a deviated septum? They estimate 75% of humans can have some sort of deviated septum, and people think that's ridiculous. It's not just from getting in a fight and getting your nose broken. So think of it this way: if your palate is narrow and I smoosh your face like this, the septum has to go somewhere, and so it can't, okay? So that's what creates the deviated septum. And so if we expand a face, and this is what early functional orthodontists, and this is what I'm doing at my practice, are doing in these younger kids. You put in a little retainer that can help expand the face, and the septum straightens, and now we can breathe better. So that's hard tissue. Soft tissues could be enlarged adenoids, enlarged tonsils, oral motor dysfunction, low tongue tone, low tongue positioning, too.

Andrew Huberman:
How much plasticity is there of the sinuses? So let's say somebody has a partially or severely deviated septum, and they could get surgery, and I want to talk about some of the different surgeries. There's a balloon-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... expansion thing that online it looks really cool. I want to try this.

Dr. Staci Whitman:
I really want this to happen to myself.

Andrew Huberman:
Yeah, they put the balloon up there.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
They inflate the balloon.

Dr. Staci Whitman:
And it's guided.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
They do one that's guided.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
That's really cool.

Andrew Huberman:
They numb it, and then they take it out, and the this kind of thing.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Well, is actually the appropriate way to do it, both in and out through the nose. But if somebody makes the effort to nasal breathe, so maybe they mouth tape at night-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... or I'm a big fan of shifting from any mouth breathing to nasal breathing by insisting that I nasal breathe while I do any cardio, unless I'm pushing really hard, and then I need to bring mouth breathing into it. But I've noticed just because I can measure snoring through-- I sleep on an Eight Sleep, I can measure snoring that way, but even if you don't do that, there are other ways you can measure snoring with an app-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... or someone can tell you you're snoring. So this isn't about a product per se. But if I force myself to nasal breathe during cardio workouts, especially kind of zone two, zone three stuff, translates to less mouth breathing and snoring in sleep. So the question is, do the sinuses actually dilate, or if you have a deviated septum, do you need it surgically or somehow otherwise repaired?

Dr. Staci Whitman:
It depends on your age.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So most facial development is done around the age of 10. So the issue I would say with traditional orthodontics, which is when you wait for all the baby teeth to fall out, and then you put braces on, you can't control the modeling of the face, the midface, the jaws. Which is why we now are starting with functional therapies as young as three or four years old with retainers. So in the middle of our palate is a suture filled with cartilage, and so with kids, it's really easy to manipulate and change facial development. If you make the jaws wider, not only is it improving airway, but the teeth will come in straight. Now they have room. The reason they come in crooked is there's not enough room for them to come in. It's important to note the floor of the mouth's the roof-- Sorry, the roof of the mouth is the floor of the nose. So if you expand the palate, the sinuses will get wider. The septum's going to upright. Everything's connected. Now, as an adult, it's really hard to manipulate bone structure just through posturing and habit. There are myofunctional therapists. They're the best, and they're really important in this conversation. Think of them like physical therapists for breathing, teaching you to keep your lips closed, your tongue up. All of this musculature is really important, toning it. If you don't use it, you lose it. So if you're a mouth breather, your tongue will lay low. Your tongue's a muscle. It will get weak. It will get flaccid. So we want to strengthen these muscles to help with lip seal and nasal breathing. But as an adult, if you do have a skeletal discrepancy, usually you need some sort of intervention. You're not going to just be changing it through lip taping or how you're training or myofunctional therapy. And there are more conservative ways now besides true jaw surgery. There's an appliance called the Homeoblock, which I know is what James Nestor used. You can read about it in his book. That will actually start to change facial structure. There's less invasive treatments. There's an MSC appliance. It's a maxillary skeletal expansion device. It does put these little mini screws in your palate, but it will pop the suture in adults. And this is-

Andrew Huberman:
Yikes

Dr. Staci Whitman:
... you really would have to want this because you're struggling so much.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And people who aren't breathing well-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... they're struggling. I think it's the most important thing for health is how you're breathing and how you're sleeping. And with children, if they're not breathing appropriately, and they're waking up a lot, which is why it would be interesting to get some sort of product on you. I'm just curious, do you get into deep sleep? Do you get into REM sleep?

Andrew Huberman:
I do.

Dr. Staci Whitman:
Great.

Andrew Huberman:
Yeah. I'm measuring deep sleep and REM sleep-

Dr. Staci Whitman:
From the Eight Sleep

Andrew Huberman:
... through the Eight Sleeper loop-

Dr. Staci Whitman:
Great

Andrew Huberman:
... or both. My deep sleep is great, provided I get to sleep by about 10:00, 10:30-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... because that's when I capture the deep sleep window. If I go to sleep around 11:00 or midnight-

Dr. Staci Whitman:
For sure

Andrew Huberman:
... I lose out on some deep sleep-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... even if I sleep longer.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
And my REM sleep's really solid these days.

Dr. Staci Whitman:
Great.

Andrew Huberman:
Yeah, I'm struck by how convincing the data are about nasal breathing improving brain function. There were a couple studies that showed that if people either mouth breathe or nasal breathe in a laboratory study, the nasal breathers have better memory recall. But those were of odors, so everyone said, "Well, okay, of course, it's of odors, and you're breathing through your nose, and so you can remember those odors." So they've now run these studies with other types of memory and brain function, and it's just very clear that you oxygenate your brain better, and you think better. Your cognition's better. Your memory's better for everything, not just odors.

Dr. Staci Whitman:
So you get 20% more oxygen when you nasal breathe, and this is really important for children in these formative years of brain development. And this is why we're seeing studies showing that children who mouth breathe have sleep-disordered breathing. They have behavioral issues, and many are getting diagnosed with ADHD and arguably potentially put on medications when really if we'd screened them for airway issues, potentially we could've avoided some of this. And it also has to do, we're not getting into deep sleep. The glymphatic system's not kicking in. Hormone function's not kicking in, so a lot of these children, growth hormone is impaired. Antidiuretic hormone is impaired if they're not getting into deep restorative sleep, so that is why we see bedwetting. Some signs to look for in your partner or your children is tossing and turning, clenching, grinding, snoring, or noisy breathing, sleeping in really odd positions like craning the neck because they're trying to open their airway, spinning around the bed. The child's legs are in and the body's out of the bed. The bedsheets are everywhere. And then certainly waking up unrested, and then noticing behavioral issues, too.

Andrew Huberman:
Well, all you have to do to convince the male half of the audience to-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... focus more on nasal breathing and to not use mouthwashes is to tell them that being a mouth breather will give them sexual dysfunction.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Or will predispose them to sexual dysfunction, and they'll start working on their nasal breathing.

Dr. Staci Whitman:
Because of nitric oxide.

Andrew Huberman:
Because of nitric oxide.

Dr. Staci Whitman:
So the paranasal sinuses is what will help produce nitric oxide too. So if you're breathing through your mouth, not your nose, you're not getting enough nitric oxide, which is very important in sexual health. But also, we know men who have gum disease are 2.85 times more likely to have erectile dysfunction as well.

Andrew Huberman:
Wow.

Dr. Staci Whitman:
So no bleeding gums. We do not want inflamed, bleeding gums. Flossing is something we haven't touched upon yet, but it's incredibly important, not only for cavity prevention, but gum health. And pink in the sink, any amount of bleeding is a sign of inflammation, and it doesn't just stay in the body. It can impact the entire system. So, please take your gum health seriously, if for nothing else than for your sexual health.

Andrew Huberman:
Great message. So to shift over to nasal breathing, if somebody's really struggling with this, are you a fan of mouth taping?

Dr. Staci Whitman:
Yeah. You want to make sure you can do so safely.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So with kids, I always suggest they get screened by an airway-focused dentist, or potentially an otolaryngologist or an ENT. For adults, there is a test that you can do. It's the three-minute test. Can you breathe through your nose without panicking or feeling sympathetically challenged for three minutes? So you can either put water in your mouth, put a piece of paper, tape your lips, and literally time yourself. And if you can breathe through your nose successfully, then you, in theory, can safely lip tape. There are different tapes that you can do that are open in the middle, so you can still off-gas, or it feels less invasive. And what I suggest if people are interested in it is just start five minutes while you're chopping vegetables for dinner, and then move up to 30 minutes while you're watching a show, and then watch a whole movie for two hours. And then if you've been able to tape that long, you can do so at night as well. I will tell you, it is one of the top things that I have done to improve my health, and I do see it with my wearables and my sleep data.

Andrew Huberman:
Recently, I had the privilege of giving a talk at Stanford with Renée Fleming, who's one of the world's greatest opera singers alive today. And I said, "Well, what are some things that you do for your breathing?"

Dr. Staci Whitman:
Mm.

Andrew Huberman:
Because I end up talking a lot for the podcast. And she gave me some lung and diaphragm-strengthening exercises.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
But then the one that she suggested for emphasizing nasal breathing, because there's a lot of nasal breathing that's done quickly and subtly in order to maintain air pressure in the lungs, and for her craft, which I know very little about. But is instead of doing weight training for the neck, this is kind of a fun one. It doesn't make the neck big, so people who don't want a larger neck will appreciate that. But to exercise the internal muscles of the neck, and the way you do this is something called kiss the sky. The boxers will actually know this, the old-school boxers. It looks ridiculous, but I'll do it because I look ridiculous on this podcast all the time intentionally. So you look up at the sky and you pucker like you were a pufferfish-

Dr. Staci Whitman:
Oh

Andrew Huberman:
... for 15 seconds per side.

Dr. Staci Whitman:
Interesting.

Andrew Huberman:
And she said it builds the strength and the neural control over the internal muscles of the neck. So again, no widening or thickening of the neck, but on the inside, and it makes it much easier to take deep breaths through your nose. It probably increases the amount of resistance-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... so that you can fill your lungs more easily.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
So I've been doing a little bit of kiss the sky, and it looks completely ridiculous.

Dr. Staci Whitman:
It's kind of a yoga move, too.

Andrew Huberman:
Yeah. And you just really lip smack as if you were going to kiss the sky from side to side, 15 seconds per side a couple times per day-

Dr. Staci Whitman:
Love it

Andrew Huberman:
... or just whenever you remember it. And her voice is amazing, her speaking voice-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... and her posture and everything. So, I borrowed that one from her.

Dr. Staci Whitman:
You can do a lot to improve your airway health through breathing rehabilitation. So I think that is a big part that's missing in these conversations with airway health. We talk about, well, you need to see the airway-trained dentist. You need to see the myofunctional therapist, the orthodontist, the ENT.

Andrew Huberman:
Yeah, that's a lot. Just the scheduling of that alone-

Dr. Staci Whitman:
It's-

Andrew Huberman:
... makes me want to take a nap.

Dr. Staci Whitman:
But it is. It's a lot to unpack airway issues. If parents are out there, there's two books, three, I'd recommend if you're very interested in this, since it impacts so many people. Certainly "Breath" by James Nestor, "Jaws," as you mentioned, by Sander Kahn, and "Sleep Wrecked Kids" by Sharon Moore, if you're a parent.

Andrew Huberman:
What's the title again?

Dr. Staci Whitman:
"Sleep Wrecked Kids."

Andrew Huberman:
Sleep Wrecked. W-R-

Dr. Staci Whitman:
Yes

Andrew Huberman:
... E-C-K.

Dr. Staci Whitman:
By-

Andrew Huberman:
Right

Dr. Staci Whitman:
... Sharon Moore. So it will just help you screen and understand why we're worried about these things more. But yeah, we can't overemphasize airway health, especially in our children. And catching it early and intervening early is really important.

Andrew Huberman:
Great. In trying to maintain airway health and healthy saliva, and now I'm obsessed with saliva.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
I was like, cool, it's got all this stuff in it. I was thinking, it's just like if we know blood has all these goodies in it, we test blood.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
We know skin microbiome. We know that women go to an OBGYN. They get Pap smears. We know if you've ever raised a kid or changed diapers, you can tell a lot about somebody's health by the fluids-

Dr. Staci Whitman:
Yes

Andrew Huberman:
... that they emit and that they have within them.

Dr. Staci Whitman:
Absolutely.

Andrew Huberman:
I'd like to place saliva on the list of critical things to pay attention to. But chewing gum, is this good for our breathing and for our saliva or not?

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
I'm not a big gum chewer.

Dr. Staci Whitman:
I'm not either.

Andrew Huberman:
But is it good, bad, neutral?

Dr. Staci Whitman:
Yeah. I think its time and place can be very beneficial. So where I like it is if-- Because I will say, "Hey, parents, you really need to avoid crackers and chips and granola bars." And they say, "What do I feed my kid?" So if we've missed the window of how to introduce food to children or they just favor those type of foods, what's a good strategy if you're out on the go to minimize decay risk and increase salivary health? Chew some gum, particularly xylitol gum, because xylitol will inhibit bacterial proliferation- It will reduce Strep mutans, which is the bacteria that causes cavities. Big fan of xylitol. So offering a piece of xylitol gum after an exposure to some of these snack foods, these fermentable carbohydrates, is great. It will loosen the food. It will increase salivary health. Some people like it to strengthen, mastic gum, I always get asked about that. You can overdo it. I worry about temporomandibular dysfunction.

Andrew Huberman:
I had a bad experience with mastic gum. I was buying it. I love the kind of primordial aspect of it.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
It's like a tree sap that you chew on.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
It comes in this beautiful paper package and no plastics or anything. You get it going in there, and you feel like you're really working it the same way my bulldog Costello would work. He used to teeth on bricks and he was just...

Dr. Staci Whitman:
Uh-huh.

Andrew Huberman:
And you feel great, and then all of a sudden you'd go

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... and your jaw would kind of stick. And then later, you're like-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... "Whoa, my jaw really hurts." And-

Dr. Staci Whitman:
Or you feel something pop up in your joint

Andrew Huberman:
... feel something pop.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
And yeah, it'll give you that, these days, the young influencers are so obsessed by this, it'll give you a little bit of a golf ball-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... hypertrophy of your jaw. That's not why I was doing it, but, boy, does it make your jaw feel sore.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
I'm not a big fan. I like to just explain it, think of a baseball pitcher. I mean, how many of them go on the disabled list because they're overusing their shoulder? It's a similar joint rotation. We're only meant to chew really for sustenance. That's how we were evolved. So if you're chewing gum all day, it's very likely wearing down the cartilage in your joint. So I'm not a huge fan of it. I just personally don't love gum chewing, but I think time and place, too. So especially from a cavity standpoint or hydration, increasing salivary flow. But I would just chew it for a couple of minutes, throw it out. You don't need to be chewing it for an extended period of time.

Andrew Huberman:
But chewing food is good.

Dr. Staci Whitman:
Yes. Thank you. So the issue, as we mentioned is, we are slurping and smushing our food.

Andrew Huberman:
Oh, gross. To me, almond butter has never existed in nature.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
The idea that you would take, almonds are so delicious, right? But that you would grind them up and put them into a paste. To me, the texture is so aversive.

Dr. Staci Whitman:
Well, you do that in your mouth.

Andrew Huberman:
Oh, I know.

Dr. Staci Whitman:
You're supposed to do that through chewing.

Andrew Huberman:
Just the fact of it, peanut butter, to me these things make no sense whatsoever.

Dr. Staci Whitman:
It's yogurts and apple sauces and fruit snacks and-

Andrew Huberman:
Baby food

Dr. Staci Whitman:
... baby food. Exactly.

Andrew Huberman:
Or it's for animals and people without teeth.

Dr. Staci Whitman:
Exactly. So I'm not advocating one camp or the other. There can be a mix, but there's blended food that's offered, or you can do more of a baby-led weaning, which is eating more real foods. Obviously, please be smart about this. Don't give choking hazards to your children. There's a lot of information out there that you can look on how to safely prepare food for your child, but chewing is incredibly important for facial development. And-

Andrew Huberman:
Well, I was thinking for adults. I was kind of making fun-

Dr. Staci Whitman:
Yes

Andrew Huberman:
... of the fact that adults are eating like kids.

Dr. Staci Whitman:
Well.

Andrew Huberman:
They're slurping their food and then like it's-

Dr. Staci Whitman:
Chicken nuggets and french fries and yeah, we need to chew. When really asked what's gone on with the airway, why does everyone, why are faces shrinking? It's chewing. We've lost chewing. And then arguably breastfeeding, too. We've moved away from exclusively breastfeeding, too.

Andrew Huberman:
What are the numbers on that? I don't know the numbers on that.

Dr. Staci Whitman:
How many people bro-

Andrew Huberman:
Yeah. I-

Dr. Staci Whitman:
I don't know either.

Andrew Huberman:
No.

Dr. Staci Whitman:
I don't know, but it's certainly down. I think it's making a resurgence, and a lot of people, though, are doing a blend. We do what we need to do.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
I mean, it's a lot of women are working, and so it's important to know if you're not able to breastfeed or it doesn't resonate with you or you are working and having to pump, that there are fixes, okay? So this isn't dire, but just working with someone to catch these issues early. And also, unfortunately, even if we're doing all the things correctly, introducing hard foods, our child's chewing and they're nasal breathing and we're breastfeeding, it's hard to combat generations and generations of disevolution, essentially. So a lot of humans are needing intervention now.

Andrew Huberman:
I'd like to take a quick break and acknowledge one of our sponsors, Function. Last year, I became a Function member after searching for the most comprehensive approach to lab testing. Function provides over 100 advanced lab tests that give you a key snapshot of your entire bodily health. This snapshot offers you with insights on your heart health, hormone health, immune functioning, nutrient levels, and much more. They've also recently added tests for toxins, such as BPA exposure from harmful plastics, and tests for PFAS, or forever chemicals. Function not only provides testing of over 100 biomarkers key to your physical and mental health, but it also analyzes these results and provides insights from top doctors who are expert in the relevant areas. For example, in one of my first tests with Function, I learned that I had elevated levels of mercury in my blood. Function not only helped me detect that but offered insights into how best to reduce my mercury levels, which included limiting my tuna consumption, I'd been eating a lot of tuna, while also making an effort to eat more leafy greens and supplementing with NAC, N-acetylcysteine, both of which can support glutathione production and detoxification. And I should say, by taking a second Function test, that approach worked. Comprehensive blood testing is vitally important. There are so many things related to your mental and physical health that can only be detected in a blood test. The problem is blood testing has always been very expensive and complicated. In contrast, I've been super impressed by Function's simplicity and at the level of cost. It is very affordable. As a consequence, I decided to join their scientific advisory board, and I'm thrilled that they're sponsoring the podcast. If you'd like to try Function, you can go to functionhealth.com/huberman. Function currently has a wait list of over 250,000 people. But they're offering early access to Huberman Podcast listeners. Again, that's functionhealth.com/huberman to get early access to Function. Earlier you mentioned ... the many different systems and diseases of the body that the oral microbiome has been directly linked to. I would say in science and medicine, there are direct effects, like this mediates that, and then there are indirect effects. Like if a fire alarm goes off in the middle of the night, your sleep isn't good, but fire alarms don't regulate sleep. They just can modulate your sleep.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
But my understanding, and I'm not deep in this literature, but my understanding is that we now have fairly conclusive evidence that certain bacteria from the mouth make its way to the brain or heart or other tissues and directly increase either the occurrence or the susceptibility of dementia, cardiovascular disease. That this isn't just a, oh, you broke your ankle, so you move less. You move less, your heart gets less healthy. Your heart gets less healthy, your brain gets less healthy. This is the kind of point I'm trying to make.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
But that the bacteria in our mouth, bad bacteria, can cause real problems for the brain and heart.

Dr. Staci Whitman:
Yes, and many other systems too. So much research. So they're finding 57 diseases are linked back to oral dysbiosis or oral pathogens, which is quite a lot. And different species can affect different parts of the body. So what does this all come down to? It comes down to gum disease. So it's important to note about 80% of the global population suffers from some sort of gum disease. That's huge. And about 10% of the population will have severe periodontal disease, which is chronic bone loss, tissue loss, and this is where we get tooth loss, too. So it's sort of a continuum, but these all have one thing in common. It's the type of bacterial species that live in our mouths and when they get out of balance. So there's something called the red complex. These are the five bacteria that most influence gum disease and dysbiosis that can affect the heart and other organ systems. The big contenders, P. gingivalis, F. nucleatum, T. denticola, there's AA, and then Strep mutans too can affect the heart as well. But why do these bugs, how do they get where these other organ systems are, and what are they doing? So I like to term this leaky gums. So we've all heard leaky guts.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So let's say we're just in dysbiosis and probably because maybe our oral hygiene isn't the best as well as some other things, so we're not flossing, let's say, and our gums bleed. Okay? That's a sign of inflammation, but you now have created a vector, an opening in the skin, in the mucosa, where bacteria can get into the circulatory system, catch a free ride, and end up in places they shouldn't be. And that creates an immune response, so an inflammation. Okay? And then also these bacteria release endotoxins. Okay? They can create cytokine storms, all kinds of things. So the body doesn't like these bacteria to end up where they shouldn't. So heart disease, for example, if you have gum disease, you're twice as likely, two times as likely, to have cardiovascular issues. If you have gum disease, you're three times more likely to have stroke. A lot of this is correlative, not quite causal yet, but some of these are looking to have more influence than others, and there's more research that's needed. Fertility's a big one that I like to speak about. So women who have gum disease can take two months longer to get pregnant and to conceive. And there are studies that show in couples that can't conceive, that 90% of the men show some sign of gum disease, and once they go in and get it treated, then their fertility, conception improves by 70%. That's significant.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
And it's not only gum disease, but just any oral infection. P. gingivalis is being linked to Alzheimer's and dementia. These bacteria end up in the brain. They cross the blood-brain barrier, and they create amyloid plaques and inflammation in the brain. And so there have been studies, many studies now, one big one was out of Harvard, where they sampled the cerebral spinal fluid in the brains and saw that in these plaques, they had P. gingivalis of almost 100% of the patients. And when they tested them against other patients who had passed away without dementia or Alzheimer's, they didn't see any P. gingivalis. So there's a lot of association and links right now that we need more research on. The other to be aware of is cancer, and this is why I love people to consider oral microbiome testing. I personally have a friend who we tested her oral microbiome, and she was through the roof with F. nucleatum. Pretty asymptomatic otherwise, but F. nucleatum is linked to increased risk of pancreatic cancer, breast cancer, and colorectal cancer. We swallow 2,000 times a day, and we know some of these bugs, these bacteria, they can live through the stomach acid and make their way down into the gut. So I-

Andrew Huberman:
Pancreatic cancer is... Sorry to interrupt.

Dr. Staci Whitman:
No.

Andrew Huberman:
I must say, I've had a couple friends die of pancreatic cancer, and while I wouldn't want any cancer, that's the one that I really wouldn't want.

Dr. Staci Whitman:
I have-

Andrew Huberman:
Because so many of them are deadly.

Dr. Staci Whitman:
I have someone really close to me dealing with it right now. He actually just had his pancreas removed prophylactically because it was pre-cancerous.

Andrew Huberman:
Did the Whipple procedure?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
And so he's healing.

Andrew Huberman:
Yeah, if they catch it early enough, it goes anterior to posterior.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
And if you catch it early enough, they can lop off the anterior portion, the Whipple procedure as it's called. But even a colleague of mine, a brilliant bioengineer, a few years ago who had the Whipple done and he was progressing well, and then he passed away about a year and a half ago. Yeah, pancreatic cancer is-

Dr. Staci Whitman:
Don't want it

Andrew Huberman:
... joke. And-

Dr. Staci Whitman:
So if you could just test your spit.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
It's a simple test. And I can give some of the tests that I like in the show notes, but you just spit into this little vial and mail it off, and then they send back your results with you. That's pretty amazing. You do need to find a dentist who can then guide you, what do you do with this information? A lot of these pathogens, they do need antibiotics. They're very virulent. They're spirochetes, so they're corkscrew shaped, and they can just impregnate and wedge into tissue. And so sometimes we really do need to be pretty heavy-hitting with how we treat them, so antibiotics.

Andrew Huberman:
What kind of antibiotics are used to treat these things?

Dr. Staci Whitman:
It's usually an amoxicillin type of blend that they'll use. Yeah.

Andrew Huberman:
Okay, radical idea that's going to get me in trouble with my more natural health audience, but I speak to those that are more-

Dr. Staci Whitman:
Everyone

Andrew Huberman:
... pharmaceutical, more nothing, don't take anything. What is the argument against once every three years as a healthy adult doing a round of antibiotics to kill off unhealthy bacteria, replenishing the microbiome in various tissues?

Dr. Staci Whitman:
Just preventatively?

Andrew Huberman:
Yeah, just preventative, like kill off what might be living in the mouth, might kill off what might be living in the prostate. I learned recently that the prostate doesn't have the same sort of immune system protection.

Dr. Staci Whitman:
Mm-hmm. Yeah.

Andrew Huberman:
And so a lot of men, while they don't have UTIs, they have a prostatitis, and they basically just need to do a 21-day or 31-day round of antibiotics.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
And everyone will be like, "Oh, you're-

Dr. Staci Whitman:
Yeah, yeah

Andrew Huberman:
... you're spreading MRSA with that or something."

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
No, but it can protect against a number of different cancers related to the prostate and things like that. Why don't we do this as a regular practice? Like every three years or so, you hit the system hard for about a week, kill off a bunch of bad stuff and a bunch of good stuff, and then replenish the good stuff.

Dr. Staci Whitman:
Yeah. It's a good question. I think it's harder to repopulate the gut and the oral microbiome than one might think.

Andrew Huberman:
Mm.

Dr. Staci Whitman:
I like a less is more approach. I think there's better ways to kill off bad things, like ozone therapy is being used a lot. I use ozone in my office.

Andrew Huberman:
Tell me more about ozone.

Dr. Staci Whitman:
So ozone, it's O3. Okay, so it's a very unstable molecule. I use it in gas form or water. You can use it as an oil. It's carried usually in olive oil or hemp oil or flax oil. And so it's antimicrobial, it's antiviral, it's antifungal. And so what I'd use it for is to treat gum disease, and periodontal pathogens, but then also under fillings or under sealants or if I'm doing a pulpotomy or kind of a root canal procedure. Because otherwise we're just blasting water everywhere.

Andrew Huberman:
Wait, so is this oil pulling? This is the basis of-

Dr. Staci Whitman:
I use it as a gas.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
It comes out of a machine, and I use it in a wand as a gas.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
Very localized.

Andrew Huberman:
I got to try this. But what's the deal with people swishing olive oil and oil pulling? I know this is big in some of the... I don't even know what to call it anymore. What used to be alternative, and it's now mainstream.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
It sounds like music in the '90s, right? Indie medicine is now mainstream.

Dr. Staci Whitman:
I love that.

Andrew Huberman:
They sold out, right?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
I'm just joking, folks, but not really. There's so many mimics between the health-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... arena and kind of music and art.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
What used to be niche becomes trendy-

Dr. Staci Whitman:
Sure

Andrew Huberman:
... and then becomes mainstream. Everyone's cool with it now.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yoga breathwork, resistance training used to be niche. Swishing olive oil, spitting it out. Acupuncturists love this.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Alternative medicine types like this. Is there any truth to it, or does it relate to ozone?

Dr. Staci Whitman:
It can. So you can find ozonated oils on the market for oil pulling. So this is an ancient Ayurvedic practice.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Going back to ozone, though, just killing off mycotoxins and bacteria, this can get kind of controversial, but a lot of naturopaths will use gas ozone either rectally or they'll use it IV, too. You have to go to someone who knows what they're doing.

Andrew Huberman:
Rectal ozone?

Dr. Staci Whitman:
Yes.

Andrew Huberman:
To get all the way up to the oral microbiome?

Dr. Staci Whitman:
No, it would affect more like the gut area-

Andrew Huberman:
Okay

Dr. Staci Whitman:
... the pancreas, the liver, et cetera. It's used-

Andrew Huberman:
Nothing shocks me anymore

Dr. Staci Whitman:
... it's used a lot with mold elimination, mycotoxin elimination.

Andrew Huberman:
I get a lot of questions nowadays about mold toxicity-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... especially people in Austin. I don't know if you know this, but it's either theory or real that lots of people who live in Austin or used to live in Austin think they have mold toxicity.

Dr. Staci Whitman:
Is it because of a lot of new building architecture?

Andrew Huberman:
I don't know.

Dr. Staci Whitman:
They say a lot of new buildings are too-

Andrew Huberman:
I've honestly, the heat, cold, or the heat-cold variation-

Dr. Staci Whitman:
Mm

Andrew Huberman:
... and the moisture. I don't know. I don't know if this is true or not, but the last thing you ever want to do is tell somebody who thinks they have something-

Dr. Staci Whitman:
Sure

Andrew Huberman:
... that they don't.

Dr. Staci Whitman:
Sure.

Andrew Huberman:
And I'm not saying they don't, I hear this a lot. I've known a number of people that have left the city of Austin-

Dr. Staci Whitman:
Because of the mold?

Andrew Huberman:
... because they couldn't deal with the mold.

Dr. Staci Whitman:
Interesting. Mold, it can be scary. We see it affect the teeth. The teeth will just start degrading, too, in some of the kids who have tested really high in mycotoxins.

Andrew Huberman:
So rectal ozone.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Wild. Well, hey, listen, it's the digestive tract.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
We're a health science podcast.

Dr. Staci Whitman:
So everyone can look it up on their own, but there are providers out there doing it.

Andrew Huberman:
Oh.

Dr. Staci Whitman:
So ozone can be great as an antimicrobial instead of an antibiotic. Now, going back to oil pulling, oil pulling is an ancient Ayurvedic practice. It used to be with sesame oil. More people do it with coconut oil now. I oil pull a couple times a week occasionally.

Andrew Huberman:
So what does that practice look like?

Dr. Staci Whitman:
So I put a spoonful of organic raw coconut oil in my mouth, let it melt, and just swish it around as I'm dawdling around in the morning.

Andrew Huberman:
Nasal breathing.

Dr. Staci Whitman:
Nasal breathing.

Andrew Huberman:
Yep.

Dr. Staci Whitman:
Yeah. Don't spit it into your sink. It will clog your sink. Spit into the trash can. So what is it doing? Well, it's dislodging the biofilm as you're swishing, okay? Lauric acid, which is in coconut oil, is antimicrobial It can help with lymphatic stimulation, and it has some anti-inflammatory properties too, and a lot of people report it makes their teeth look brighter and whiter, which is nice.

Andrew Huberman:
I mean, you do have great teeth.

Dr. Staci Whitman:
Well, I'll tell you the story why.

Andrew Huberman:
I mean, it's in your profession to have great teeth, but I walked in and I met you for the first time in person.

Dr. Staci Whitman:
Ah.

Andrew Huberman:
I was like, "Wow, you have really, really nice teeth."

Dr. Staci Whitman:
They're not real.

Andrew Huberman:
They're not real?

Dr. Staci Whitman:
I had facial trauma. Should we get into that?

Andrew Huberman:
Yeah, let's get into that.

Dr. Staci Whitman:
So when I was 10, it's why I became a dentist. When I was 10, I was trying to gain the attention of my older brother's friends, who were very into dirt biking and BMX biking, and we had just watched the movie "Rad," and I thought I would impress them, and they were all doing tricks out in the neighborhood. And long story short, I fell off my bike and landed on the asphalt in a vault and knocked out my teeth, and I broke my premaxilla, and you can see the scar still. But this is part of my story, and it's why I became a dentist, because I was in and out of dental offices and oral surgeons and orthodontists. And at the time, I was an art theater kid. I loved working with my hands. But as time went on, I thought, "Well, gosh, I don't want to be sleeping on couches in New York City. I need to make sure I make a living. What am I going to do?" And I really love science, and I thought, "Well, how do I work with my hands?" And it was dentistry, and dentistry can be a little creative and artistic, too. So these are not real, but thank you.

Andrew Huberman:
No. Well, you're welcome, and thanks for the full disclosure.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
They look very natural.

Dr. Staci Whitman:
Yeah, they did a great job.

Andrew Huberman:
Unlike some people's falsies-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... or whatever. What do you call them? I call them falsies because I've got a tooth that was kind of chipped in half from getting hit, honestly. Dumb. If you're going to box, make sure you're getting paid a lot of money.

Dr. Staci Whitman:
And you wear a mouth guard.

Andrew Huberman:
Yeah, and wear a mouth guard. There are better martial arts where you can go full blast, like Brazilian jujitsu, where you stand less of a chance of brain injury, let's just say. So as a neuroscientist, I can't support boxing. But I remember the movie "Rad."

Dr. Staci Whitman:
It's so good.

Andrew Huberman:
I remember the back flip at the end.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
I remember the whole thing that-

Dr. Staci Whitman:
I think I was trying to do that. I don't know what I was doing.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
Anyway.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
Didn't land it.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
Didn't land it.

Andrew Huberman:
Well, you landed it, but on the wrong-

Dr. Staci Whitman:
So this is a bridge

Andrew Huberman:
... on your face, yeah.

Dr. Staci Whitman:
You could get implants.

Andrew Huberman:
Oof.

Dr. Staci Whitman:
People have flippers. We were talking about hockey players earlier. You'll see them flipping their flippers around with their fake teeth. So a flipper's a retainer with fake teeth on it. There's a lot of different things you can do.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
But what's interesting, I was part of making my teeth. I sat in the lab and helped, so-

Andrew Huberman:
That's cool

Dr. Staci Whitman:
... I wanted them to look not quite as contrived, I suppose.

Andrew Huberman:
Well, they look very natural.

Dr. Staci Whitman:
Yeah. Thanks.

Andrew Huberman:
And today we're learning all the ways in which teeth are just part of this whole ecosystem that's so critical. I have to ask, and we will come back to some things related to avoiding really horrible diseases by way of taking better care of one's oral health. Nicotine. These days, everyone knows or should know that smoking, vaping, dipping, and snuffing, and yes, I did say vaping, are all terrible for your health. The vapers will say it's not carcinogenic, cancer-causing, and I'll say remains to be made really clear, but the whole popcorn lung thing is clearly problematic. But nicotine doesn't cause cancer. It's the delivery mechanism.

Dr. Staci Whitman:
Mm-hmm. Yes.

Andrew Huberman:
But these days, a lot of people, realizing the cognitive enhancement, if you will, I don't even like the phrase, the stimulant effect of nicotine, are using nicotine pouches in particular, gums, let's set patches aside for the moment, and mints and things of that sort for the stimulant effect. It's an unusual stimulant because it also relaxes oneself a little bit at the same time, so it's kind of that sweet spot. And I confess, I will occasionally take one or two milligrams, very low dose. Most pouches are anywhere from three to eight pouches, milligrams rather. I'll take one to two milligrams of nicotine in the form of a gum. I'll just chew it, and then take it out. Nicotine is a vasoconstrictor. What does nicotine do to the oral microbiome? Are you going to make me quit nicotine? I don't feel addicted, but every addict says that, so yeah.

Dr. Staci Whitman:
The first step is admitting the issue. So I don't want to villainize anything.

Andrew Huberman:
No, you can villainize it.

Dr. Staci Whitman:
So I agree with you. I don't think it's the nicotine itself, but the pouches, for example, are becoming very popular. So what else is in those? And there's a really interesting case study that maybe we can link it for people to look at.

Andrew Huberman:
Sure.

Dr. Staci Whitman:
And I'll share it with you later. And then I have colleagues who are reporting this all throughout the globe, but one brand in particular, it will have mannitol and maltodextrin in it, which are sugar alcohols and a different carbohydrate, and they market them as sugar-free. Well, products are allowed to have trace amounts of sugar still in the product, very small amount, and still be called sugar-free. And the issue with these products is the duration of action, the contact time, and you're supposed to leave them in for 20 to 30 minutes. Am I correct?

Andrew Huberman:
That's right.

Dr. Staci Whitman:
So it's quite a long time to have that up in the mucosa, along the bone, and along your teeth that potentially has some sugar in it, okay? So it's like if you're sucking on a hard candy. But also we're seeing changes to the cellular structure up in that area. So you can see leukoplakia, which is like white patching, which can be pre-cancerous. So this is why I just like everyone to get checked out. And we are seeing bone loss and gum recession. Again, any time you put anything into the mouth, it's going to change and shift the microbiome, and that could be a filling, that could be a piece of gum, that could be-

Andrew Huberman:
Toothpick

Dr. Staci Whitman:
... a toothpick, anything, arguably besides neutral pH water. And so this case study This gentleman was going in, I believe he was in his mid-50s. He started using these pouches and had always had very wonderful dental checkups with X-rays, and went in regularly, and maybe he missed one appointment. And after 15 months of use, the X-rays are outrageous. He just has rampant decay along the side where he had the pouch, very likely from potentially that trace amount of sugar, the microbiome changes. It looked like mothball chunks taken out of his teeth, and he lost some teeth.

Andrew Huberman:
Wow.

Dr. Staci Whitman:
So this isn't to scare people, but if you're going to choose to use these, I just say know the risks and make sure you're getting checked regularly at your dentist. Don't just ghost your dentist.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Because if they're starting to see cellular changes, recession, or early decay, then you may say, "Gosh, I should really cut back on this."

Andrew Huberman:
Or maybe if somebody is really adamant about taking nicotine, they should just take a milligram or two milligram pill of nicotine.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Or a patch.

Dr. Staci Whitman:
Right.

Andrew Huberman:
You scared me with leukoplakia. Yeah, because growing up we were all told no one really dips in Northern California, but don't dip. And then I saw these pictures of leukoplakia-

Dr. Staci Whitman:
Jaw recession

Andrew Huberman:
... jaw recession, and it's pretty vile. And so they're designed to scare you. It scared me sufficiently. I never wanted to chew tobacco anyway. But good to know. Coffee, do I need to stop drinking coffee? Okay, thank you.

Dr. Staci Whitman:
It's amazing.

Andrew Huberman:
You're from Portland, after all.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Or near Portland.

Dr. Staci Whitman:
How could I possibly say that?

Andrew Huberman:
Okay. Yeah.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
You wouldn't be able to return home.

Dr. Staci Whitman:
Coffee's great. It will dry out the mouth a bit. Just counteract it with hydration, and it will stain your teeth, so go in regularly for cleanings, and you may want to-- If that bothers you, there are ways to bleach your teeth or lighten your teeth. Hydroxyapatite's a wonderful way to improve the brightness and whiteness of your teeth, and oil pulling as well. Or you can use heavy hitter bleaches, too. Just don't overdo it. Everybody's overdoing everything now.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And bleaching too much can damage your teeth. It can cause chemical harm to the pulp or the nerve over time, and some people will get spontaneous abscessing or need root canals. These are people who are really bleaching all the time, the people who you need sunglasses to look at their teeth, and it's just not really a natural aesthetic. But some people are into that, but just know what the risks are.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
That's what I would say.

Andrew Huberman:
The two things I've done in the last couple of years that have completely transformed my oral health, says my dentist, and how I feel are, first of all, I switched a few years ago, I would say really about 14 months ago, I just said, "That's it. I'm not eating processed foods again. I'm just not going to do it." So I eat meat, fish, eggs, fruits, vegetables, and I eat some rice, oatmeal, and a good sourdough bread.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Butter, olive oil. Which is not to say that I won't have a slice of pizza someday, but I was like, that's it. I'm kind of over it.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
49 years old, I've eaten enough of that stuff. I'm kind of bored with it anyway.

Dr. Staci Whitman:
I hear you.

Andrew Huberman:
And what was interesting is I used to get a lot of tartar buildup, a lot, despite brushing and flossing on the-- what are the lower front teeth called?

Dr. Staci Whitman:
Incisors.

Andrew Huberman:
Yeah, and they'd scrape it away. It's a non-issue now.

Dr. Staci Whitman:
Interesting.

Andrew Huberman:
It's completely gone.

Dr. Staci Whitman:
Yeah. So we have minor salivary glands on the floor of our mouth, and that is a common place people will see calculus or tartar is those lower teeth.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
That's where you'll feel your hygienist scraping a lot. But I wonder if it's because you increased your K2 in your diet, which helps with calcium metabolism.

Andrew Huberman:
And I supplement K2.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
But I was doing that before.

Dr. Staci Whitman:
Mm.

Andrew Huberman:
And then I switched, and I have just full disclosure, because there's nothing to disclose, I have no financial relationship to the toothpaste that you make or the toothpaste that Gator Dentist makes. I actually know his real name, but he hides as Gator Dentist.

Dr. Staci Whitman:
I love Gator.

Andrew Huberman:
Gator Dentist. But I switched from fluoride-containing toothpaste, not because of fear of fluoride, but excitement about hydroxyapatite.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
So I switched to using your toothpaste, and I occasionally-- well, I routinely switch back and forth with NOBS, or I think it stands for No BS

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Which is Gator Dentist's tooth tablet product.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
So I use them, and neither of them pay me. I pay full price. They don't send it to me. I purchase it like anyone else. And that's made a tremendous difference, says my dentist. I have no cavities whatsoever. I was constantly battling this. When I was a kid, I had a bunch of oral health issues. And I don't want to waste our time talking about those right now. Maybe we'll return to them a little bit later. But my teeth and oral microbiome never felt better. It's just remarkable.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
It's just remarkable. And I have a family member who has some gut issues, just digestion issues, and it's unclear what's going on there, and I'm inspired to try and help them address that through the oral microbiome-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... by switching to hydroxyapatite.

Dr. Staci Whitman:
Yeah. And test their oral microbiome. That'd be very interesting to know what's going on in there, because think, you're swallowing-

Andrew Huberman:
Is there a best test? Sorry. Is there a best test? Because a lot of listeners are going to say, okay, I want to-- If they have the disposable income, they're going to want to test their oral microbiome.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Is there one that your office uses or that-

Dr. Staci Whitman:
I use either the SILLHA test, which is more just biomarkers. So it's a-

Andrew Huberman:
How do you spell that?

Dr. Staci Whitman:
S-I-L-L-H-A.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
This is done in an office.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
It's just testing basic biomarkers, so I use it a lot as an educational tool. It will show the pH, the acidity, if there's leukocytes, if there's red blood cells, inflammatory markers. So a lot of parents, this is so new to them when I'm talking about this. But it prints out in a graph form for them.

Andrew Huberman:
It's a cheek swab?

Dr. Staci Whitman:
Spit.

Andrew Huberman:
Spit. So kid or adult will spit in that little-

Dr. Staci Whitman:
Yeah. Kids usually won't spit till about four, just physically. It's hard.

Andrew Huberman:
Kids can't spit until they're four?

Dr. Staci Whitman:
Yeah. It's hard.

Andrew Huberman:
Huh. Okay.

Dr. Staci Whitman:
Anyway, but I really like tests that use shotgun metagenomics because you're looking for the whole array of bacterial DNA. And so my favorite is Bristl, like a toothbrush bristle.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And it's direct to consumer. Because the issue is I can talk about all of these things, but sometimes it's hard to find providers that are offering them. So I really love people to be able to get the tools in their home.

Andrew Huberman:
So Bristl is a company that people can-

Dr. Staci Whitman:
It's an oral microbiome test. Yes.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
And it's really user-friendly. Their interface is wonderful, and they will give guidance and protocols.

Andrew Huberman:
Are you affiliated with them? I should probably ask, because some of the audience will ask.

Dr. Staci Whitman:
I am actually.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
Yes, I am.

Andrew Huberman:
Okay. That's fine. As long as the people know.

Dr. Staci Whitman:
Their oral probiotic, we have a collaboration with their oral probiotic.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
But regardless if it's Bristl or not, you look for a test that's using shotgun metagenomics.

Andrew Huberman:
Shotgun metagenomics.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
There's PCR testing too, and a lot of biological dentists will offer something, like oral DNA is the most popular. The issue with that is it's really only looking at the top 12 pathogens, periodontal pathogens, which is important, but there can be a lot of other information that you're missing. So it's a great place to start, and your dentist may offer that. Again, it's Oral DNA, and I have no affiliation with Oral DNA.

Andrew Huberman:
Great. Thank you for that. I think some people want to test their oral microbiome, and other things in their mouth.

Dr. Staci Whitman:
And there's more and more popping up. The oral microbiome is really blowing up. So for those who are looking for investment opportunities, I'd say look toward the oral microbiome. It's kind of what the gut microbiome was doing a decade plus ago.

Andrew Huberman:
Yeah. I feel like oral microbiome is so much more tractable. Switch to nasal breathing, get away from alcohol-containing mouthwashes, consider a hydroxyapatite-containing toothpaste instead of fluoride, which brings us to fluoride.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Let's talk about fluoride. I've already been accused of being a sunscreen denier. No, I actually believe that sunscreen exists. I do occasionally use zinc oxide sunscreen a little bit. I prefer a physical barrier-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... because I'll wear a hat or something if I-- I don't tend to burn very easily, but if I feel like I might burn, I use a physical barrier. I'm being somewhat facetious here because people will say all sorts of things. But, I did an episode about water, a little bit about oral health, certainly not the depth or expertise that you're providing today, so thank you. And I said, yeah, fluoride does a bunch of things. My question was and remains, why are we drinking fluoride? But this relates to... Okay, I'll tell this story briefly. It's not as cool as your story. I was taken to a dentist when I was a kid, and they put these-

Dr. Staci Whitman:
Oh

Andrew Huberman:
... like a mouthpiece with fluoride gel in it-

Dr. Staci Whitman:
The fluoride tray

Andrew Huberman:
... on the top and bottom, and they sat me in a little wicker chair in front of a TV with cartoons.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
And I hated it. It tasted awful, and it kind of had this sour thing. So I was probably six or seven, so I drank it. I just sucked it up, drank it down, turned around, barfed all over the wicker chair.

Dr. Staci Whitman:
Oh my gosh.

Andrew Huberman:
Fluoride's a poison.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
But everything is a poison at high concentrations.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Most everything is a poison, excuse me, at high concentrations. So I don't have anything against fluoride, but it is a poison. Then the question becomes, if something is not dangerous in a small dose or concentration, what are its cumulative effects? This is what I have issues with. A lot of people say, "Oh, going through the X-ray machine, no big deal." But what if you fly 150 times a year?

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Is it cumulative? And so, the logic of the sort of pushback from the traditional, if I will, community sucks. They're just not logical. These are my colleagues sometimes, too. You go to the dentist to get an X-ray, they're running behind the next wall.

Dr. Staci Whitman:
With a lead wall.

Andrew Huberman:
Put you in a lead shield.

Dr. Staci Whitman:
I know.

Andrew Huberman:
And then they're like, "Oh, no, it's no big deal."

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Well, how many?

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
How many times a year can you do this before it becomes a deal?

Dr. Staci Whitman:
Sure.

Andrew Huberman:
So my question is, what is the rationale for putting fluoride in drinking water, given that the contact time in the mouth is so short?

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
And then what's the cumulative effect of bringing fluoride into the gut over and over? And then earlier you said something, and I've never thought about this. The bones contain hydroxyapatite, 60% I think you said?

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
60% of your bone minerals are made from hydroxyapatite. Fluoride infiltrates-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... the minerals of the teeth and replaces it. So is fluoride going into our bones?

Dr. Staci Whitman:
Skeletal fluorosis.

Andrew Huberman:
Okay, so I'm not trying to paint a scary picture here.

Dr. Staci Whitman:
Sure.

Andrew Huberman:
But frankly, and people can probably tell, my blood pressure goes up a little bit when people say, "Oh, you're anti-fluoride." I'm not anti-fluoride, but I just don't get the logic. It doesn't make sense.

Dr. Staci Whitman:
You're thinking critically about it.

Andrew Huberman:
Why would I continually bombard my system with fluoride-

Dr. Staci Whitman:
Yes

Andrew Huberman:
... at the level of the gut, at the level of my bones? If it's good for me, tell me it's good for me. But they're saying, "Oh, it's so that poor populations don't have decaying teeth." Sounds like a good argument. I'm not even counter-arguing it, but I can't piece together the logic. And like most public health arguments, I feel like neither side is explicitly clear-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... about what exactly they're arguing about. And that's part of why I have this podcast, to try and get clarity on things.

Dr. Staci Whitman:
Okay. I'll do my best.

Andrew Huberman:
Yeah. And please don't worry that you're going to offend anyone, because I'll offend everybody. And they've already said everything they possibly could. And they'll say more, so I'm not afraid to open up these topics anymore.

Dr. Staci Whitman:
Okay. Well, I appreciate that.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
And I-

Andrew Huberman:
And I'll take the heat.

Dr. Staci Whitman:
Well, I will get it, too. Don't worry. I have thick skin at this point.

Andrew Huberman:
But you have great teeth, and they don't.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
So...

Dr. Staci Whitman:
And I haven't had a cavity for multiple decades and haven't used fluoride. And Portland isn't fluoridated.

Andrew Huberman:
Portland is not fluoridated?

Dr. Staci Whitman:
It is not. So let's talk about that.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
Fun story. Back in 2011, 2012, I was working on the pro-water fluoridation campaign, volunteering in Portland, picketing and handing out educational flyers, because I thought we needed it in our water. And this is because that's how I was trained, and I just never questioned it. I never picked up a journal to look at the other side. I thought anyone speaking out against water fluoridation, that's the Tin Hat Brigade, that's the Woo Woo Caucus, all the things. I was that person.

Andrew Huberman:
The Woo Woo Caucus?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
That's pretty funny.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
I like that.

Dr. Staci Whitman:
So I went to a debate in Portland, pro versus against. I don't like those terms, but it's just the easiest way to describe it. And I was sitting kind of on the pro side and just waiting to see these pseudo-scientists come out to speak. And I was so profoundly impressed with what they said and also had no idea that there were any concerns with fluoride. I had never been taught that in dental school, the endocrine disruption, the neurotoxicity, the skeletal fluorosis. I knew about dental fluorosis, but I, at that point, was of the mindset, well, it's just aesthetic, but your teeth are stronger. And the microbiome issues, too. So it didn't take long. I just started rabbit holing, and there's so much literature. And this, again, this was quite a while ago. And more and more data and literature is coming out to question the practice. So it's important to go back to the history of water fluoridation. I'll try to be brief, but in the early 1900s, there was a dentist in Colorado Springs, Frederick McKay, who noticed his patients had mottled, brown-spotted teeth, but they were really strong. They weren't getting decay. And so this kind of spread, and they started kind of trying to understand the why, and they realized there was a really high concentration of fluoride in the natural water supply that this community was drinking. And this just kind of spread like wildfire with very little evidence-based medicine to back it, because this was in the early 1900s. Now it was like the 1930s. So no long-term safety studies or efficacy studies, and it was put in as an experiment in Grand Rapids, Michigan, in the mid-40s. After about a decade or so, they noticed that caries rates, cavity rates were going down. And so based on this observation, it just went like wildfire throughout the United States, and I believe about 80% of the United States is fluoridated. So the pro advocates, if you will, say it's the greatest public health movement of the century because decay was such an issue. It's important to know dental decay is the top chronic disease globally in children and adults. It's almost entirely preventable. I think we've just normalized it. You just get cavities, but I'd like to point out we're one of the only species to get dental decay. Wild animals don't get decay. Our domesticated animals do because of what we're feeding them, the kibble, processed animal food. So here we are. So it's been controversial from the beginning. Epidemiologists, endocrinologists, neuroscientists have always challenged it, saying this is a bad idea. It's a highly reactive element. The fluoride ion can interfere with iodine uptake and again, skeletal fluorosis, neurotoxicity, et cetera. So about seven years ago, there was a federal trial in Northern California, but it was federal. The people versus the EPA. It was a TSCA trial, and this has been ongoing for the past seven years, and basically, they were saying, "Where is your safety data, EPA, on the long-term effects of water fluoridation?" So the idea was that if we put it in the water, it's not a very efficient way to get fluoride to people, but eventually it will make itself into the saliva and have a topical effect coming out through the saliva. They used to think systemically it was actually incorporating into the developing teeth in children, making the enamel stronger that way, but that's been debunked. So now it's most likely still a topical benefit, maybe a little bit of a systemic benefit, touching the teeth. And we do know fluoride really needs to work topically. We don't need to be ingesting it, and that is all through the data, and they're teaching that in dental schools now, too. Okay?

Andrew Huberman:
Okay.

Dr. Staci Whitman:
But this is the easiest way to get fluoride to the masses because caries or cavities are such an issue. Now, my first comment on this is we're not addressing the root cause of dental decay, which is our food. It's all the ultra-processed foods. Again, we didn't really see dental decay in humans until the agricultural revolution, the Industrial Revolution, and now the ultra-processed food craze that's been happening the past many decades. Okay?

Andrew Huberman:
Is that right? So if we look at skeletons from dead people, obviously.

Dr. Staci Whitman:
Okay.

Andrew Huberman:
Well, you can look at skeletons of live people. Skeletons in dead people from dead people that died prior to 1900. How are their teeth?

Dr. Staci Whitman:
1900, they would have decay. But if you looked at about 10,000 years ago, very little. Unless they lived in an area with a lot of fruit abundance or honey, like where are you getting your sugar from? And you go pick some berries on a bush, you're competing with the animals and the birds. You didn't have much opportunity to over-consume sugar.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
But there was the sugar trade, and then sugar was a sign of wealth and royalty, and people's teeth just rotted out, and it was because of our diet. So that's the root cause issue that no one's talking about. We're just saying, "Let's slap fluoride on it." How about we educate and teach people what is really causing cavities? But anyway. Okay, so the Tasker trial was going on, and Judge Edward Chen was waiting for this National Toxicology Program's report, which was under the Department of Health and Human Services. And it reads like a soap opera, to be honest with you. And it kept getting delayed and postponed, and they wouldn't release it. And finally, under the Freedom of Information Act, he said, "This needs to be released." And it said, "There is a strong correlation between increased fluoride consumption and IQ issues in children." And so with that, he took this information, and he made his ruling. Now, this was after years of expert testimonies as well, okay, saying there's an unreasonable risk to current water fluoridation practices in the United States. This was his ruling that just happened late last year. This is very new. And EPA, you now need to fix this. You need to regulate this better. What people will argue is a lot of the studies they were looking at that are showing lowered IQ in children or neurocognitive issues, it was at 1.2 or 1.5 milligrams per liter. That was the concentration. The United States, we now do 0.7 milligrams per liter. But that's per liter. Okay? So how many liters of water do you drink a day? This is the controversy. So for example, the American Academy of Pediatrics generally recommends pregnant women drink two to three liters a day. You might be cooking with fluoridated water, making your pasta, making your soup. How do we really know how much someone's getting exposed to? What's their body composition? How much do they weigh? What are the other outside sources of fluoride? Are they swallowing their toothpaste? Fluoride is in many pharmaceuticals because it helps increase bioavailability, especially SSRIs and Prilosec. A lot of these have fluoride in them.

Andrew Huberman:
Really?

Dr. Staci Whitman:
Yes. Ultra-processed foods will have fluoride. So the factory that's making your Rockstar energy drink or your Hi-C or whatever you're consuming, they're not using reverse osmosis to filter the water, so you're getting fluoride that way. It's naturally found in green tea and black tea, and this is not to make people worried about green and black tea. I still consume them. It's more to say, how are we really understanding how much is exposed to? And so they were finding that pregnant women, they follow... There's many studies now. A famous one was a Rivka Green study out of Canada, and they followed about 520 mother-child pairs. They tested urinary fluoride in the mother per trimester, averaged it, and then followed these children to the age of three or four and did IQ tests and found that mothers who had higher concentrations of urinary fluoride, the children tested lower on their IQ tests up to five to seven points, and that's on par with lead. Okay?

Andrew Huberman:
On par with lead?

Dr. Staci Whitman:
On par with lead, yes. And so that was in 2019. There's been so many more studies now. So the judge ruled, "EPA, you need to regulate this better." In that amount of time, there was a meta-analysis that came out that further supported the NTP report by JAMA Pediatrics, okay. And this is very controversial for these editors to be putting out, by the way, so I commend them. And also a Cochrane report came out, Cochrane Collaborative, which has said, this again was very recent, looking at all the data from water fluoridation, water fluoridation isn't reducing decay like we thought it was. It's only reducing decay by about one-quarter a cavity per person. One quarter of a cavity per person. So that's not statistically significant. So people will say, "Well, what gives? Why were cavity rates going down when we added fluoride to the water?" Well, it's hard to say. Maybe they were already just going down due to education, more access to dental hygiene, and toothbrushing, flossing. But also, we now have fluoride everywhere in our toothpaste. So fluoride was put in the water in the 1940s. It wasn't added to our toothpaste until the 1960s, and now it's everywhere. We get fluoride everywhere. Rinses, the varnishes that made you vomit at the office. And by the way, that's very common. That's very common, and it's because a lot of those fluoride varnishes, number one, fluoride, it does have a poison control label on it. You're not supposed to swallow it. But these varnishes also have polyurethane and hexane derivatives in them. It's what makes them so sticky.

Andrew Huberman:
Yeah. I still loathe going to the dentist.

Dr. Staci Whitman:
I know that.

Andrew Huberman:
And I think it's because of that early association.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
So it's very controversial, and unfortunately, we've lost sight of the science. It's getting buried in politics right now, and it really upsets me because it's not a political issue. We just need to look at the data, and I feel like we're losing sight of the scientific method. The American Dental Association, the American Academy of Pediatrics is doubling down on saying we have to put fluoride in the water. And for nothing else, I think it's important to know 97% of the world does not fluoridate their water. This is a very United States controversy. Many countries removed it and found, I think it was Denmark, Germany, Japan, they have very low decay rates. And why is this? Well, they educated their population on what's really causing decay and also made fluoride toothpaste accessible.

Andrew Huberman:
And I have Danish relatives. They have very nice teeth. If you told me that there's no fluoride in the drinking water in England I might be like, well, sorry, my English friends, but that's the stereotype, right? That their teeth are bad. I don't think that that's true any longer. I think that that was true at one point.

Dr. Staci Whitman:
I think they're crowded and crooked, too, and a lot of that has to do, I think, with facial development as well. I think we see a lot of Western European, they do have that kind of dysmorphic face, if you will, probably from nasal breathing. Who knows why? Industrial revolution, allergies, mouth breathing, et cetera. Why does it seem more prevalent there? So that's the quick take on it. And so I just think it should be a personal choice. If you want to use fluoride, you can go out to the store. You can get fluoride toothpaste at the dollar store now. They give it out for free at many clinics. To me, I just think it's a medical ethical issue. We're mass-medicating a population without their consent.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And then the even bigger issue for me is no one's talking about this, nor can I find any literature on it. What is it doing to the gut microbiome?

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Because it is an antimicrobial. So that would be a wonderful study, NIH, if you're listening. Can we test people that live in fluoridated areas versus those that don't? Could we follow them? Maybe it's a prospective cohort study to just see how their microbiomes are different. Because it just doesn't make sense to me. And why would we ingest something systemically with all these potential risks when we could just use it topically or actually talk about what's really causing decay? If fluoridation worked, cavities wouldn't be the top disease in our country, in our children. And many worry, well, if we take it from the water, decay may go up. And it may. They did this in Calgary, Canada, where decay rates went up. But then if you actually look at the data, the decay rates were already going up when they removed it, but they only show you the data that they kind of want to show you for that. But again, it's a risk-benefit analysis. I think dentists tend to be too focused on teeth. And so you mentioned, if they say it's good for me, I'll do it. Well, good for what? Good for your teeth or good for your whole body, or good for your brain? And I think that should be an individual choice. As a parent, do I want to choose one-quarter less cavity in my child, or do I want to preserve their optimal brain development?

Andrew Huberman:
The data that show deficits on par with what one sees with lead exposure, that's the most striking-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... thing to me.

Dr. Staci Whitman:
Yeah. And I'm a dentist. I was trained to fix teeth. I can fix a one-quarter cavity in a tooth. I can't fix a developing brain. We have one shot to develop a brain. We have one shot to grow a face. It's really important.

Andrew Huberman:
Well, I really appreciate you taking us through the full arc of the history of it. I think it's extremely important that people take that in so they can start to form their own opinions. And you pointed out a number of logical flaws in just the way the whole system is arranged right now, which is this mass treatment of everybody with a potent chemical, especially given the amount of water that people drink and cook with, et cetera, without their consent. And-

Dr. Staci Whitman:
And without a risk assessment. So your low decay rate, I might be a really high decay rate. You don't need anything extra. Your diet, your balance, your microbiome's great. I'm not eating well. My hygiene's terrible. We can't just blanketly be treating everyone the same. We're supposed to be doing risk assessments.

Andrew Huberman:
I'd like to take a quick break and acknowledge one of our sponsors, LMNT. LMNT is an electrolyte drink that has everything you need but nothing you don't. That means the electrolytes, sodium, magnesium, and potassium, all in the correct ratios, but no sugar. Proper hydration is critical for optimal brain and body function. Even a slight degree of dehydration can diminish cognitive and physical performance. It's also important that you get adequate electrolytes. The electrolytes, sodium, magnesium, and potassium, are vital for the functioning of all the cells in your body, especially your neurons or your nerve cells. Drinking LMNT dissolved in water makes it extremely easy to ensure that you're getting adequate hydration and adequate electrolytes. To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of LMNT in about 16 to 32 ounces of water when I wake up in the morning, and I drink that basically first thing in the morning. I also drink LMNT dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and therefore losing a lot of water and electrolytes. They have a bunch of different great-tasting flavors of LMNT. They have watermelon, citrus, et cetera. Frankly, I love them all. If you'd like to try LMNT, you can go to drinklmnt.com/huberman to claim a free LMNT sample pack with the purchase of any LMNT drink mix. Again, that's drinklmnt.com/huberman to claim a free sample pack. Okay, so I think that pretty much puts fluoride in a, not in a box, let's say on the shelf for all of us to look at. I think this is going to be a very important aspect of public health in the year to three years to come with this new administration and Bobby Kennedy paying a lot of attention to fluoride. And I really like what you said about trying to remove the political aspects of this. If this becomes a blue versus red, left versus right thing, we're never going to get to the heart of the matter.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
And that would be really sad, and the ones that would really suffer would be kids.

Dr. Staci Whitman:
Kids. The children, yeah.

Andrew Huberman:
So a nonpartisan look at this, which is how I heard everything that you said, just seems really critical. Where are they getting the fluoride?

Dr. Staci Whitman:
So water fluoridation, the fluoride that they get is a byproduct of the phosphate fertilizer industry, and it's called hydrofluorosilicic acid. So as a byproduct of the phosphate fertilizer industry, it's considered a hazardous waste, and it's very expensive to dispose of. But they have found that if diluted, in theory, it's an acid, first of all, so if it's put into our water system, it is so diluted that it becomes safe. But I will say everyone can go research this and look at it themselves, but it does come in cement bags with skull and crossbones on the front, and they do have to wear hazmat suits to put it into our water. They're supposed to titrate it. And I think what's interesting, we're supposed to target 0.7 milligrams per liter. I've been involved in some educational campaigns and have tested communities surrounding Portland. It's very hard to keep it in range. And so there are some communities testing as high, we've seen, as 2.2 milligrams per liter, which definitely falls into, based on the science and literature, a more concerning zone for neurocognitive issues and other health issues. So if you're concerned, you can call your local water bureau, municipality. I will say, I don't think the federal government's going to have much control over this. It would be nice if the EPA stepped in. They have appealed, by the way. But it will come down to more on the state level and local level, and we're already seeing states like Florida and Utah have run it through and initially done a "we're going to ban this as a mandatory thing in our state." And I think it's North Dakota, Kentucky. There's other states picking this up, too, and other communities that are removing it or not adding it to their water. So it's an interesting time to observe all of this.

Andrew Huberman:
Super interesting. I will resist the temptation to ask questions about why it sounds like mostly red states are the ones doing this as opposed to blue states, although Portland is in a blue state. Portland's traditionally-

Dr. Staci Whitman:
Blue city, for sure

Andrew Huberman:
... blue city.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yeah. Right. Blue city in a-

Dr. Staci Whitman:
Red state.

Andrew Huberman:
Oregon went red this last election?

Dr. Staci Whitman:
The city's makeup, it's kind of like many states. So Eugene, Portland-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... Bend tend to be pretty blue.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And I think the surrounding is more conservative. But no, it's shifted a bit, but not enough to shift out of voting-

Andrew Huberman:
Okay

Dr. Staci Whitman:
... liberal.

Andrew Huberman:
All right. Well, we'll do another episode in 2090 about politics. Meanwhile, back to the oral microbiome and otherwise. I'm very interested in the relationship between oral health and what you described as fertility, pregnancy, and hormones. And obviously, hormones can be about men or women, but let's talk about oral health and fertility.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
What, if any, knowledge is there about how the oral microbiome or oral health would be impacting egg health, fertility, ovulation, ovarian reserve? Is that the sort of the level that the regulation of fertility is thought to occur? What's known about the link?

Dr. Staci Whitman:
Yeah. So again, it ties back to that translocation and creating an immune response and inflammation, as well as the endotoxins that are released. With men particularly, they're seeing increased challenges with sperm motility and sperm mobility as gum disease and periodontal pathogens increase, and again, probably it has to do with the inflammation. And with women, we can show that women take about two months longer to become pregnant. It does affect ovulation, egg quality, but also we know it can lead to miscarriages and low term birth, low weight birth, preterm birth, and just pregnancy complications as well. And so we are finding oral bacteria in the placenta. We're finding there's different microbiomes everywhere now. The breast has a microbiome. The placenta has a microbiome. And so oral bacteria can end up in many of these places and just create that cascade of inflammatory events. And so certainly it's an exciting time to be alive because of all the research happening, and right now it's, again, not causal. There's a lot of correlation, but I would love to see fertility clinics focusing more on oral health. How amazing would it be if they started testing the microbiome of patients, and if they realize they're really high in P. gingivalis or F. nucleatum and they eradicated or lessened that bacteria? It'd be interesting to see how pregnancy and fertility outcomes would change and possibly improve.

Andrew Huberman:
Great. What are some of the mechanical as opposed to chemical things that we can do to improve our oral health?

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
So we were all taught brush and floss twice a day. I even have a colleague who can be caught in the bathroom brushing his teeth after lunch.

Dr. Staci Whitman:
Great. I should try it.

Andrew Huberman:
So he's brushing three times a day. I don't know what motivated that.

Dr. Staci Whitman:
I do that, too.

Andrew Huberman:
Do you?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Okay. Great. So what's the deal with brushing? Let's say kind of like exercise. Let's say if someone were going to only brush once-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... a day, better to brush in the morning or at night? Obviously, people should brush twice a day or more. But if one could only brush once a day, would it be morning or night?

Dr. Staci Whitman:
Yeah. I guide parents on this a lot because brushing a child's teeth can be challenging. Nighttime is always the most important. One, you're removing the food particulate matter from the day away. You're disrupting that biofilm so that you're not sitting, sleeping all night, eight, 10, 12 hours if you're a child, with that sticky Potentially dysbiotic biofilm on your teeth, and then you add in maybe your mouth breathing, that's going to shift the microbiome and drop the pH more. So it's really nice to go to bed with clean teeth. So I suggest focusing on the nighttime. What does drive me a little bonkers is the fact that we tend to focus so much on brushing, but we leave out flossing a lot of the conversation, so thank you for mentioning that. If you read children's books, you'll see they all say, "Go brush your teeth," but never floss.

Andrew Huberman:
Mm.

Dr. Staci Whitman:
So we need a revamp there. But most cavities that I see in children, and this translates to the adult population as well, are in between the teeth, or interproximally in the molars. And it's really common. So a lot of parents will bring their kids in, they think they've been doing everything correctly. They haven't been flossing quite yet. And we take X-rays for the first time, and the children have eight cavities, which sounds like so many, but it's really common because we have eight molars. And so it happens between the teeth where you're eating those Goldfish crackers, those pretzels, those chips. They get stuck in between the teeth, the bacteria come to feed, the acid gets released, and it just sits there hour after hour, day after day, arguably week after week if you're never flossing. So I really like flossing to be part of the routine, too. Again, if you can only do it once a day, that's great. That's fine. Do it at night. I like to floss first, then brush.

Andrew Huberman:
Mm.

Dr. Staci Whitman:
You're dislodging the food in between and kind of brushing it away. There's actually studies to support this, too, that order. However, beggars can't be choosers. Just do it. Some people get a suction cup mirror. They'll do it in the shower. Some people do it in their commute in the car. I'm not going to be picky about it. I will also say, as we age, flossing doesn't always cut it by itself. So think about a little string of floss. We want to put it between the teeth, and they suggest you do a C and a backward C. You're scraping the sides of the teeth to disrupt that biofilm. But as we age, we all lose a little bone, so you get this little pocket where that string isn't cleaning the bacteria out of, and that's where a waterpik can come in. And so if you really want to be an overachiever, I do love a little waterpiking, too. I personally will alternate. So one night I might floss, the next night I might waterpik. This works really well in patients that can't put their hands in the mouth. Maybe they have an aversion to that. Sensory children often will struggle with flossing, so waterpiks can be fun. You can do it in the bathtub so it doesn't get totally messy, or in the shower. They make cordless versions. But I can't overemphasize how important flossing is. That interproximal cleaning, it stimulates the gum tissue, and you're less likely to have gum disease as a result.

Andrew Huberman:
What about those little toothpicks with the little sling of floss-

Dr. Staci Whitman:
The trees?

Andrew Huberman:
... across?

Dr. Staci Whitman:
Oh.

Andrew Huberman:
The hard picks that-

Dr. Staci Whitman:
Yeah. Floss picks.

Andrew Huberman:
Floss picks.

Dr. Staci Whitman:
They're great, especially in kids. It's the only way to floss a child's teeth, first of all. So I want parents, as soon as teeth touch, they should be flossing. That could be the anterior teeth. Our jaws are shrinking. Our teeth are crowded. It's rare for me to see a child with space in their front teeth. That is how we should be developing because adult teeth are wider than baby teeth. They need more room to come in. But very often we're crowded. So anywhere teeth touch, we should be flossing. But usually around the age of two and a half, the molars are in touching, and parents look at me like I'm crazy, but we really should be flossing. And so if you start some of these behaviors early, it becomes easier and easier. We know kids that floss become adults who floss. But also floss picks are fine for adults, too. Some people have big hands. It's hard to get floss in or-

Andrew Huberman:
Yeah, I have to use them. I can't get into my-

Dr. Staci Whitman:
The dexterity. Yeah

Andrew Huberman:
... I can't get my hands into-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... my mouth.

Dr. Staci Whitman:
They're fine.

Andrew Huberman:
Yeah. Okay.

Dr. Staci Whitman:
You just want to try not to just go straight up and down, just kind of angle if you can.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
And then maybe a waterpik, too.

Andrew Huberman:
And I was told by my dentist, soft toothbrush.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Because I tend to get in there and like-

Dr. Staci Whitman:
Oh, you're an aggressor

Andrew Huberman:
... I'm hearing all this stuff about how the oral health is so important for the brain, and that could lead some people, including me, to get in there and just start scrubbing and scrubbing and trying to get everything out of there, and that's not the right approach, right?

Dr. Staci Whitman:
Paintbrush stroke, very gentle. So you want to do gentle, circular movements. You don't want to wear away your enamel. This is also important. Many people will eat and then run to the bathroom and brush their teeth. Every time we eat, our teeth demineralize a little bit, right? Remember I mentioned it-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... takes about 20 or 30 minutes for that remineralization to begin. So if you're immediately going to brush, your bristles could be damaging your enamel and just wearing it away and creating little marks, and it could lead to sensitivity, recession. So if you can, try to wait 20 or 30 minutes after you eat or drink to brush. This includes with vomiting.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
The same thing. So we all want to brush our teeth after we maybe get sick. Try to just maybe rinse your mouth, maybe with a little baking soda. A lot of this is perfect world, okay?

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And I get it, but just I like people to have the information.

Andrew Huberman:
You said marking, and I meant to ask something earlier, not to return us to the fluoride conversation, but you said that the person who initially had the idea to include fluoride-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... in treatment of tooth decay noticed that kids' teeth had dark spots on them.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Does fluoride cause darkening of the teeth?

Dr. Staci Whitman:
It can. So I believe it was his pediatric and adult patients. It was just this whole community had these spotted teeth. So that is something called dental fluorosis. Spots and markings on the teeth can mean many different things. One is fluorosis. One could be hypoplastic enamel. I think we should touch on that. So fluorosis can be mild, moderate, or severe. When it gets more severe, that is where it can be dark, spotted, orangey brown.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Mild fluorosis usually is more brighter white. You often see it on the-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... incisal tips or on the cusp tips of the molars.

Andrew Huberman:
It's not a very attractive feature.

Dr. Staci Whitman:
It's not, and it is a sign that you've had excessive fluoride. And I will say 40% of teenagers now have dental fluorosis. That very likely means they also have some degree of skeletal fluorosis as well.

Andrew Huberman:
So for all the challenges that the debate around fluoridization of water has, I am willing to bet a significant amount of my savings that this issue will end up being the linchpin issue. It might seem crazy. Here's this substance that may or may not be safe that we're ingesting for various reasons, and there's a history there, which you beautifully described. But having been in this public-facing health education game for a little while now, for the typical person who's like, "Yeah, whatever. I've been drinking water and I feel fine," or, "My kids feels fine," or, "There's nothing I can do about it now. They're 15. Maybe they're 10 IQ points down from where they would be." This is what I find so interesting about human psychology. If you tell people, "Did you know that fluoride not only might have some neurodevelopmental impact, it's probably getting into your bones just like it's getting into your teeth. But you know those spots on your teeth, those white spots or dark spots that are really unattractive? That's because of fluoride." Now you've got everybody.

Dr. Staci Whitman:
Yes. Aesthetics.

Andrew Huberman:
Aesthetics. And it's either a shame or whatever that this is the way that people are. But the moment that people realize that something that either is good for them or was intended to be good for them might be bad for their long-term health, you sort of got them hooked. But these long-term correlations are very hard to motivate human behavior. But those white spots, nobody wants those.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Dark spots on the teeth, nobody wants those. And I'd be willing to bet that that becomes one of the key issues. And if people go, "Oh, listen, it's actually making my teeth uglier."

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
"Maybe stronger, but uglier," I bet you this becomes a wedge in the conversation.

Dr. Staci Whitman:
That will come from the public. But I will tell you, I have dentists, when I speak as I do about water fluoridation and fluorosis specifically, say, "Well, it's just aesthetics. At least their teeth are strong." They're making the decision for the patient. And I think that's not our right as providers to make that decision for someone. But it's really common.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Fluorosis is very common. I've even seen more recent data saying as high as 60%, but 40 is kind of the standard number that we go with of teenagers with fluorosis. There is something called hypoplastic enamel, and this is something I'm very passionate about. This is undermineralized enamel, and I believe it's a silent epidemic in children. I see more and more children whose teeth erupt, and they're mottled and chalky, and some are so severe they're crumbling. And I've seen a big uptick in this in my 20-year career, and the data is starting to show this as well. And so unfortunately, so many parents, their kids will get decay. It's really common, and they get shamed and blamed like, "What are you feeding them? You're not brushing and flossing their teeth. You're neglecting them." Or they're told to stop breastfeeding because that's what's causing the issue. But it's really that the teeth, the enamel didn't form properly, and it's not as acid-resistant. It's more fragile. It's more pickup sticks than the Lincoln Logs, okay? And I believe, and colleagues globally agree, that it's very likely due to all the mineral deficiencies that we're seeing globally and the vitamin D deficiency that we're seeing globally. We're inside all the time. We're not outside. All the junk light that we're getting, the blue light. It can also be from environmental toxins, high fevers, viruses. But it's a real concern, and so many children are having to undergo general anesthesia now to get their teeth fixed. The study I read said about 100,000 to 150,000 a year for a preventable issue. There's risks to general anesthesia, and this is where I do love to consider a more conservative approach, like can we remineralize these teeth? Are there strategies that we can do to even just kick the can so the child's older so they could sit for treatment so that we're not putting so many children under anesthesia? Because I don't think we have the data for all the long-term potential cumulative effects. And we talked about this earlier. It's not just one exposure. It's not just one exposure from an X-ray or one exposure from fluoride or one anesthesia exposure necessarily, but it's that cumulative effect that we don't have enough data on.

Andrew Huberman:
Going back to this relationship between the oral microbiome, oral health, and hormones, and focusing specifically on female hormones, the menstrual/ovulatory cycle that occurs each month, as well as perimenopause, menopause. About half of our listeners are women. I'm curious Are there certain phases of the menstrual cycle or certain phases of perimenopause, menopause, or prior to it, in which women should pay particular attention to their oral health? Is there a known association with when estrogen is rising or falling-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... that the oral microbiome tends to be more vulnerable, and they perhaps should spend a bit more attention on their oral health?

Dr. Staci Whitman:
Yes. So we see it both ways, rising and falling. So around puberty, we'll see changes to gum health, so a lot of young girls will have more gingivitis or gum inflammation and certainly, if they're on oral contraception, that can change things, too. And they'll go into the dentist and be accused of maybe not brushing and flossing appropriately, but it's really a hormonal issue, so it's important to know that. As well as women who are pregnant. Pregnancy gingivitis affects 50 to 70% of women.

Andrew Huberman:
50 to 70?

Dr. Staci Whitman:
It's a lot.

Andrew Huberman:
Wow.

Dr. Staci Whitman:
Yeah. And it usually-

Andrew Huberman:
Most

Dr. Staci Whitman:
... goes away once you have the baby, and you've gotten through some breastfeeding and hormones regulate. But it's important to know that. You can also have relaxin, it helps us prepare for childbirth, but it can shift teeth. We have a ligament around our teeth, much like we have ligaments in our pelvis, and that periodontal ligament is impacted by relaxin, so you can see teeth shift and move, and women may sometimes say, "My bite is different now. My gum health is different." So it's very important preconception, and certainly during pregnancy, to be really on top of your oral hygiene as best as possible and see a dentist regularly. And then perimenopause and menopause, there's a whole slew of issues that happen to women, and from an oral health perspective with hormonal shifts, decreases in estrogen and progesterone can impact collagen synthesis, so more TMD, more headaches. Certainly gum inflammation, dry mouth, burning mouth syndrome, more bad breath, taste changes, too. And so it's just so powerful to be able to have these conversations with women rather than just say, "Well, just use this product. Brush and floss more." Maybe we could talk, speaking of it from a hormonal lens, like is hormone replacement therapy appropriate for you, or how can we help support you in other ways? Maybe you should see the dentist every two or three months instead of every six months. And also just the mental health component to say, "Hey, this isn't something you're neglecting. This is a change your body's going through, and so how can we support you from a dental community?"

Andrew Huberman:
Yeah. Thanks for that. More and more, I'm getting asked questions on social media and elsewhere about how is this different for women versus men, and in particular, different phases of the cycle and perimenopause, menopause, and essentially the entire lifespan. So appreciate that.

Dr. Staci Whitman:
Yeah. I get burning mouth question a lot, too, from my community.

Andrew Huberman:
What's burning mouth? Sounds awful.

Dr. Staci Whitman:
So your mouth feels metallic, and it truly feels burning, almost like itchy, I think. I haven't experienced it, but that's how it's described to me, or kind of like a dry mouth. It can be a sign of zinc deficiency or vitamin B deficiencies, and we can see changes in those with perimenopause and menopause. I think it's important to know the mouth is the gateway into the body, and we can see nutritional deficiencies in the mouth as well. So cracks in the corner of the lips can be a zinc deficiency. It's the same with white striations on your fingernails. That can be a zinc deficiency. B vitamins can be burning mouth or geographic tongue is something people experience.

Andrew Huberman:
What is geographic tongue caused by? I have a family member who has it, and it's permanent-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... because they're quite far along in their life now and still have it-

Dr. Staci Whitman:
Sure

Andrew Huberman:
... from childhood.

Dr. Staci Whitman:
We're told in dental school, it maybe has changed, but it's benign, and just tell patients to avoid citrus and acidic foods. It is cross-linked to latex allergy and psoriasis.

Andrew Huberman:
Mm.

Dr. Staci Whitman:
So it's a autoimmune issue. It can be a sign of nutritional deficiencies, usually zinc, B, or iron.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
And also, it can be a sign of celiac, Crohn's, or a gut issue. Again, it's all connected. And so a lot of times when kids see me, I will send them to a functional medicine doctor or a naturopath to rule that out. And there's genetic predispositions, too.

Andrew Huberman:
As we progress further along in this conversation, these ideas pop to my mind that I'd never thought of before, because I don't tend to use them, like lip balms, lipstick. I don't use lipstick. I don't use lip balm. I suppose I've put one of those sunscreens when I went skiing or snowboarding years ago-

Dr. Staci Whitman:
Same

Andrew Huberman:
... on my-- And now I'm wondering, was that just a terrible idea?

Dr. Staci Whitman:
It's better not to burn.

Andrew Huberman:
But more often, people are going to use, but I suppose specifically lipsticks, are they safe for the oral microbiome?

Dr. Staci Whitman:
Well, I don't think it's getting into your-- Hopefully you're not eating it that much, but we need to be mindful of our products. There's petroleum-based products. A lot of lipsticks, lip balms, they have nasty ingredients in them. We're learning more and more, and they're not necessarily as regulated here from a cosmetic standpoint as they might be in the EU. So read your ingredients. But a lot of petroleum-based products will actually cause more dryness, and it has a reverse effect, which is why people get addicted to ChapStick, I think. Their lips dry out more. But when I see chronic dry lips, I'm thinking dehydration, and are you mouth breathing? Because when you mouth breathe, all the tissues dry out. So if a kid comes in with chronically dried lips, I do wonder if they're a mouth breather.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Another way to assess if you have a mouth breather on hand is, are you always asking someone in your life to chew with their mouth closed, especially kids? So when we're chewing, we have to breathe. So you should chew, lips closed, breathe through your nose. But if you can't because of an obstruction, deviated septum, inflamed nasal turbinates, you'll have that kid, his mouth's always open, and they tend not to chew enough. They kind of mash food and swallow it, because they f- They're worried about oxygenation. They feel like they're going to choke. These kids tend to get picky eaters because they stay away from meat, carrots, apples, things you have to chew a lot, and they eat more chicken nuggets, mac and cheese, because you can just mash it and swallow it. That can be a sign of oral motor dysfunction in adults and kids. So if you have a hard time chewing with your mouth closed, that's something you can explore and get help with.

Andrew Huberman:
Should we be able to chew equally on both sides of our mouth?

Dr. Staci Whitman:
You should chew equally on both sides of your mouth. So if you're chewing just on one side, not only will you get hypertrophy of the muscle on that side, but it can cause a shift, especially in kids, of the way you're growing. But I would want to know why. Why are you chewing that way? Is your occlusion or your bite off? Are you avoiding a tooth because you're in pain? It can be a bad habit. There's ways to retrain, but everything should be symmetrical. So you should kind of chew, chew. Your tongue should move the bolus of food to the other side, chew, chew. So if you can't do that, it can be a sign of oral motor dysfunction, too. Maybe your tongue doesn't have good range of motion or mobility. Maybe you have a tongue tie or low tone. So there's a lot that can go into that, and this is where seeing a myofunctional therapist could really help.

Andrew Huberman:
You said it, so I'll have to ask. Tongue tie, a few years ago, this was a controversial area. Tongue tie being the stretch of skin between the bottom of the tongue and the bottom of the, what is it? Bottom of the-

Dr. Staci Whitman:
Floor of the mouth

Andrew Huberman:
... floor of the mouth.

Dr. Staci Whitman:
Uh-huh.

Andrew Huberman:
Thank you. And this idea that in babies it should be cut. Other people say it shouldn't be cut.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
And then everyone starts looking at it, or did they cut it? I think mine just seems to have naturally torn back some distance, but-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... what's the deal with tongue tie?

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
And should it be cut?

Dr. Staci Whitman:
We're going into all the controversial conversations here.

Andrew Huberman:
I'll take the heat for it.

Dr. Staci Whitman:
So, that's called your frenum, okay? So we all have a frenum. It's the band of tissue that attaches our tongue to the floor of the mouth. We also have a labial frenum, and sometimes you have little buccal frenums up here in the vestibule, okay?

Andrew Huberman:
Near the cheek?

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
If you put your finger up in your mouth-

Andrew Huberman:
Oh, yeah

Dr. Staci Whitman:
... you'll feel.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
You may have them, you may not.

Andrew Huberman:
And they dried my teeth out for something once.

Dr. Staci Whitman:
Yeah, you see it stretches.

Andrew Huberman:
You pull it back and you see it's... Yeah.

Dr. Staci Whitman:
It's, like, webbed.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
So the whole thing with this conversation is all about function, okay?

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So does your tongue and do the oral structures function appropriately? In which case, you're good. What's hard is, something to be mindful of, you can't diagnose anyone from a photo on social media. So I see a lot of parent blogs who are saying, "My child has a tongue tie. My child has a lip tie." You can't tell. We have to look at function.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So is it impairing or impacting breastfeeding? Can the tongue not lift appropriately? It's all about lifting, elevating, and lateralizing.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So many think tongue tie impacts you sticking your tongue out. We don't care as much about that. What grows the face and the palate in utero and then beyond is that tongue lifting, elevating, and spreading that palate, almost like an expander.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Like an orthodontic expander. And so if it can't lift, that's the first sign, and that means it can't pull in the breast tissue and breastfeed appropriately. Babies might have a lot of reflux. Women will have pain. Okay? So that's one of the first things we look at. But then as children get older, we look, well, is there a tongue tie that is potentially leading to mouth breathing? So when your lips are closed and you're breathing through your nose, your tongue should be up at the palate, and it should have enough tone to stay there, ideally while we sleep, too. But if your tongue is tethered, it can't lift up. Your tongue's going to lay low, and you're going to have more of the Napoleon Dynamite look, okay? So that open mouth, forward head posture. That's just because the tongue can't lift. Many times when people have tongue tie, their palates are narrow, too, because in utero, the tongue wasn't up to grow the face optimally. And this runs genetically in families as well, the predisposition. So then the next thing we look at is speech, and is it impacting speech, or is it impacting chewing and swallowing? So if all of those things are fine, if it looks like there's a tongue tie but you're thriving, you're doing great, assuming you're not compensating and using other muscles and now having other downstream effects like shoulder pain, headaches, postural issues, you're great. But if a child is having issues and you've gone through the right screening and had the risk-benefit discussion with the parents, I do think a frenectomy is indicated. And I myself have had one, and it benefited me a lot. My issues were neck strain and a lot of shoulder tension that really, there's a lot of fascial tissue that's impacted with a tongue tie, or can be, and so it helped me a tremendous amount. But nothing's one size fits all, and we're all different. So this is where you do want to work with someone with additional training to see if you have a tongue tie, how are they assessing that, and then is it impairing function, and then do you actually need a procedure done? Sometimes just working with a myofunctional therapist or different body workers, a chiropractor, a craniosacral therapist, an osteopath, can be enough to create balance again. So it's not always a surgical intervention.

Andrew Huberman:
In your case, was it a general anesthesia or a local anesthesia?

Dr. Staci Whitman:
I had my tonsils out also very recently, just a few years ago, because I had chronic tonsillitis. And so I knew I had a posterior tongue tie, and I just told the surgeon, "Just go ahead and do it. I'm already getting my tonsils out."

Andrew Huberman:
Sure. You're already in there.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
Already in there.

Andrew Huberman:
But for most people, it would be a general anesthesia.

Dr. Staci Whitman:
Usually no. Usually it is local It's really not bad, especially they're using lasers now for the procedure.

Andrew Huberman:
Oh, okay.

Dr. Staci Whitman:
It's pretty straightforward, yeah.

Andrew Huberman:
Yeah, that can cauterize-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... as you make the cut.

Dr. Staci Whitman:
Exactly.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
You do want to generally suture, and you want to make sure you're working with a myofunctional therapist before and after for optimal outcomes. It's like, think about if I went in for a knee replacement, I wouldn't just walk into the operating room, "Here's my knee." Usually, there's physical therapy before and after to make sure you're optimized, and so it's the same with the tongue release.

Andrew Huberman:
Peptides and red light therapy. Now we're in the sort of specialized-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... next sort of cutting edge of health and self-directed health, or self-directed/working with a professional like yourself, oral healthcare. So can red light therapy, like shining red light-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... and near-infrared light, so long wavelength light into the mouth, provide any benefits for a person that doesn't have any other issues, like they just want to maximize their oral health? Is that something that can be helpful? What else is it potentially helpful for?

Dr. Staci Whitman:
Yeah. It certainly couldn't hurt. I haven't seen any solid data on that, but-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... it would reduce inflammation, improve blood flow. So I'm not opposed to it. It's wonderful post-surgery. So if you have wisdom teeth out or periodontal surgery, a lot of dentists and specialists are using red light therapy extra-orally or intra-orally to help expedite healing, collagen synthesis, et cetera. Peptides are newer, and exosomes as well, that are being used particularly in root canal therapies and maybe cavitation surgeries and things.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
Again, just to help with inflammation, healing, collagen synthesis. It's pretty cool. It's very cutting edge, and it's very new, and there's very few out there doing it right now. There's a couple in LA that I know are, so I can share names. But the idea is to regenerate tissues. Specifically with peptides, when put down in the pulpal chamber, potentially can help build up the dentin within the tooth, and maybe help increase vascularization, get some more vitality back to the tooth, too.

Andrew Huberman:
Hmm.

Dr. Staci Whitman:
So it's pretty cool.

Andrew Huberman:
Interesting.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
All right, so we'll stand by on that.

Dr. Staci Whitman:
Yeah, stand by.

Andrew Huberman:
Should we be concerned about metal fillings? I don't know what material they use for the other fillings, and sometimes they'll use, quote-unquote, "sealants." Like they'll see a pit, and they'll put some sealant in there. And retainers are made from plastic. Now everyone's worried about plastic. So what gives?

Dr. Staci Whitman:
So the best dentistry is no dentistry. I will always say that, so that's why we always want to take a preventative lens as best we can, but that's not the reality since 90% of us have suffered from some sort of dental disease in our life. So mercury fillings, this can get controversial. I think the first thing to do-- I don't love mercury amalgam fillings, and they were recently banned in Europe. I think if you're getting a new filling, I would try not to have mercury placed. That would be my recommendation. Try to use a composite, ideally a ceramic-based biomimetic material. But if you have existing mercury fillings, amalgam fillings, and you're concerned, the first thing to do is get a test. Get a blood test to see what are your mercury levels. If they're within normal, I wouldn't worry too much. If you have mercury toxicity or mercury through the roof, then you probably should have that conversation with your dental team and your medical team to see, could this be coming from my fillings? And certainly if a filling is breaking, damaged, it needs to be replaced, maybe considering not doing an amalgam metal filling. So that's kind of my stance on that. Composite fillings, they are plastics, essentially. Most are BPA-free, but that is a bit of a marketing idea. There's still other plasticizers in there, BisGMA, et cetera. So I do really like ceramic-based materials if you can find them. Nothing is perfect. This is the best available that we have. Regarding retainers, I get this question a lot, too. Acrylic retainers, those are the pink retainers.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
What's interesting about those, methyl methacrylate can have gluten in it, so if you are celiac. There have been case reports of teens especially who they keep having GI distress or rashes because celiac often can come out in the skin, and they can't figure out why, and it ties back to the retainer. So just be aware of that.

Andrew Huberman:
Interesting.

Dr. Staci Whitman:
And then people will ask, well, about Invisalign, and again, nothing's perfect. Usually, most of these retainers and things you're only wearing for a short period as you're trying to correct your airway issue. So lesser of two evils. I'm a big airway advocate. I want people breathing optimally. That is the most important thing for your health, in my opinion, is optimized oxygenation and breathing, and rest and recovery. So I am an advocate for expansion in some of these materials and products for short durations if necessary, so we can't take all the risk out of everything, right?

Andrew Huberman:
Right.

Dr. Staci Whitman:
And this is why the host, making sure your immune response is optimized, your detox pathways are open, your phase two liver detox is optimized, that's ideal.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So yeah.

Andrew Huberman:
Cruciferous vegetables.

Dr. Staci Whitman:
Yep.

Andrew Huberman:
Sulforaphane supplementation, maybe.

Dr. Staci Whitman:
Bitters. Mm-hmm. Dandelion.

Andrew Huberman:
The same things that were recommended in the microplastics episode that I did that other people have touched on. So things like sauna, sulforaphane-

Dr. Staci Whitman:
Yes. binders

Andrew Huberman:
... cruciferous vegetable intake should help binding to some of the-

Dr. Staci Whitman:
Yeah

Andrew Huberman:
... microplastics that surely we are ingesting.

Dr. Staci Whitman:
Everyone has them.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
So you just try to minimize your exposure. And then sealants, I am an advocate of sealants. They really do reduce cavity risk. They're usually put on the molars in the grooves and the fissures of the back teeth. But again, so I use spectrometry to make sure I'm not sealing in bacteria, so it's an image that shows me if there's carries or cavity there. I'm using ozone to make sure I'm killing the bacteria. Sometimes I'll use my laser, which helps disinfect too, to open the groove up, and then I'm using ceramic-based materials, too. So I think it depends on your risk as well. If you're low risk, you're not eating a lot of these ultra-processed foods, you're probably okay. But a lot of kids, we have control over our children's diets only to a certain point, and then they go off to middle school and start eating the Takis and the Doritos, and they make maybe some bad choices. And so if you want their teeth as protected as possible, I'd suggest sealants.

Andrew Huberman:
A somewhat unpleasant topic, but something that I've heard repeatedly, and I don't know if it's true, is that dentists, more than people in any other profession, commit suicide at very high rates. And then there's this very dark joke that people make. Well, their hands are always in other people's mouths, so they don't have anyone to talk to.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
And then I always think, well, the logic's wrong there. They actually could talk as much as they want. It's the patients that can't talk. So, setting aside that kind of gallows humor-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... which it's not my style of humor.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Do dentists kill themselves more than people in other professions?

Dr. Staci Whitman:
Yeah. Thank you for bringing this up. I think it's important to talk about. Dentists do have a really high rate of depression, anxiety, and yeah, suicide, too. I always heard this, too, even before I became a dentist, and it's a really hard profession. And so we tend to be the brunt of the joke. We're in the song, there's songs like "I'm Afraid of Dentists in the Dark" by Vance Joy, and like Steve Martin playing the eccentric dentist in multiple different movies, I think.

Andrew Huberman:
Little Shop of Horrors.

Dr. Staci Whitman:
Little Shop of Horrors. Horrible Bosses, there's like a crazy dentist. Horror movies have dentists. We are the brunt of the joke a little bit. And so that's hard. And unfortunately, there are just so many negative childhood experiences at the dentist. And this is partly why I went into pediatrics, is that I was an adult dentist for many years. I felt very dissatisfied with my career because I just felt like I wasn't making a difference. Dental disease is so prevalent, and unless we're talking about it from this root cause lens, we're not going to move the needle. But it's very hard when you get in the system to get out of it. The way our appointment times are set up, and the overhead is crazy, and the student debt now, and the pressures. And the things with dentists is we are the clinicians, but we're also kind of the CEOs of our businesses. Many of us have private practices. So you're wearing two hats. So when you're done with treatment all day and seeing patients all day, then you're sitting in front of the computer, and you have people to help you, but you're trying to manage the business. And we didn't go into school for that, looking at spreadsheets, HR issues, et cetera. And many of us are in solo practices, so it can be very lonely. But also, we tend to be more Type A personalities, perfectionists, and dentistry's hard. There's a lot of unknowns. There's a lot of variables. I can put a filling in your mouth, but I can't guarantee that you're going to brush, floss, follow my rules, not eat ultra-processed foods. You're breathing through your nose. What's your microbiome like? So then you're doing all of these things that I've instructed you not to do, and then you come back because the filling fails, and we're the ones to blame for that. And don't get me wrong, there's all variations of providers out there, and there's people doing excellent work and people doing not so excellent work. But I do think it's important for everyone to know that many dentists are having a hard time with work, especially post-COVID, I would say. There's a lot of pressures. Dental insurance is very challenging. It's not truly insurance like medical insurance. It's really a benefit package. And so you tend to only get $1,000 or $1,200 a year, and then everything else is out of pocket. And so people kind of look at us like that's kind of a scam. It's so expensive. But what they don't realize is many of these dental supply companies, they have essentially monopolies on us. Our equipment is outrageously expensive. And prices keep going up and up and up, but what isn't changing are insurance reimbursements, okay? So where does that delta come in? And usually it's coming out of the dentist's pocket, too. So it's why corporate dentistry's taking over. In a lot of ways, kind of what happened to medicine. But I would just say be kind to your dentist. Just recently, this is very timely, but I don't know where this came from. Maybe it was like a TikTok thing, but there were letters being mailed. Specifically, I saw in the Pacific Northwest, Oregon, and Portland that dentists were receiving these hate letters saying dentists are scumbags, and they should all kill themselves. So I think it's important for people to know what we kind of deal with behind the scenes, and to just be kind to your dentist. And I would say if someone doesn't resonate with you, if their personality doesn't resonate with you Just go find a different dentist. And I do want to understand there is a lot of post-traumatic stress disorder from patients who truly fear the dentist. It's usually from experiences in childhood, and that's what I wanted to change, too. I just said it doesn't have to be this way. We can make dentistry a very positive place, a safe place, so that children grow into adults without dental disease, but also that find the dentist to be a safe, comfortable place to go. So I mean, some people, if you're really that fearful, maybe considering therapy or some sort of anxiolytic. Do you need something to help you feel calmer at the dentist? But I encourage everyone to go to the dentist. Don't avoid the dentist. But also trying to understand, it is a challenging profession. It really is. And there's a lot of unknowns, and there are some mental health challenges out there, too.

Andrew Huberman:
Well, thank you for being an incredible ambassador for dentistry, and no small part of that comes from your obvious kindness and goodness and also the rigor with which you approach it.

Dr. Staci Whitman:
Thank you.

Andrew Huberman:
The two are certainly not incompatible. You're proof of that.

Dr. Staci Whitman:
Thank you.

Andrew Huberman:
I wonder if now would be a good time for us to just sort of summarize the top 10 or top 12 things. There are a bunch of don'ts.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Maybe we can leave those out, like avoid sugary, starchy, floury foods that get stuck between teeth, that kind of thing. But maybe I'll fire off a few, and you can tell me what I'm missing.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Be a nose breather, not a mouth breather. Unless you're eating or speaking, keep your mouth shut, basically.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Right?

Dr. Staci Whitman:
Absolutely.

Andrew Huberman:
Or you're exercising really hard and you need to suck for some air, or you're scuba diving and you would drown otherwise. Eat non-processed, minimally processed foods. We're hearing that over and over again these days. Brush twice a day. Floss twice a day. Waterpik if you can.

Dr. Staci Whitman:
Yeah. That's loading a lot onto people. I would say floss at least once a day.

Andrew Huberman:
Okay.

Dr. Staci Whitman:
Flossing twice a day is extra credit.

Andrew Huberman:
Great.

Dr. Staci Whitman:
Yeah. Because a lot of people don't floss, so we want to start out reasonable.

Andrew Huberman:
Yeah. Before sleep.

Dr. Staci Whitman:
Yes, ideally. Mm-hmm.

Andrew Huberman:
So it's brush, then floss.

Dr. Staci Whitman:
Floss, then brush.

Andrew Huberman:
Floss, then brush.

Dr. Staci Whitman:
But however you can do it.

Andrew Huberman:
No, I didn't get it wrong on purpose. I knew you would correct us-

Dr. Staci Whitman:
I also like tongue scraping

Andrew Huberman:
... I got it wrong.

Dr. Staci Whitman:
We forgot to talk about tongue scraping.

Andrew Huberman:
Yeah. So I want to add in these things. So maybe oil pull three times a week. Put some coconut oil in there, swish it around, practice your nasal breathing while you're doing it.

Dr. Staci Whitman:
That's right.

Andrew Huberman:
Spit it out. But not in the sink.

Dr. Staci Whitman:
Not in the sink.

Andrew Huberman:
Right.

Dr. Staci Whitman:
And why just a few times a week? I don't know if I was clear on that. It's because coconut oil is antimicrobial, so I'm erring on the side of caution, because it will target more anaerobic pathological bacteria, but less is more. We don't want to disrupt the oral microbiome too much. So just a couple times a week. You don't need to do it daily.

Andrew Huberman:
Great. Soft toothbrush.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Be gentle. Avoid alcohol-containing mouthwashes for all sorts of reasons.

Dr. Staci Whitman:
Mm-hmm.

Andrew Huberman:
Pay attention to the fluoride debate.

Dr. Staci Whitman:
Yes. Consider hydroxyapatite if you're concerned.

Andrew Huberman:
Great. I love these hydroxyapatite toothpastes.

Dr. Staci Whitman:
I do too.

Andrew Huberman:
Yours and Gator Dentist's one.

Dr. Staci Whitman:
Me.

Andrew Huberman:
Love them. I don't get paid a dime for it. I pay my own money for them. I really love them. My teeth are so much healthier now. I just like them, too. They taste good. I don't actually rinse afterwards.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
We didn't talk about that, but ideally, you don't rinse after you brush.

Dr. Staci Whitman:
Correct. So think about if you were a big advocate for sunscreen or a lotion, you put it on, you immediately jump in the shower. You're washing it all off. So it's the same with your toothpaste. There is a duration of action that it takes for maximum efficacy. So if you're brushing for two minutes and spit and rinse, all that goodness is getting rinsed down the drain. So you can still spit. People get confused by this. You can still spit, but try not to vigorously rinse everything off. You do want it trying to sit on the teeth and in your saliva a little bit.

Andrew Huberman:
Avoid nicotine.

Dr. Staci Whitman:
And alcohol.

Andrew Huberman:
And alcohol. Hydrate well.

Dr. Staci Whitman:
Yes. Electrolytes.

Andrew Huberman:
Electrolytes. Keep your saliva abundant.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Especially for older people.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
The nasal breathing during sleep, we can double-click on that one because-

Dr. Staci Whitman:
Yeah, absolutely

Andrew Huberman:
... that's going to get your sleep right.

Dr. Staci Whitman:
Because that just checks so many boxes. I'd say optimize minerals and fat-soluble vitamins.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
This is kind of Weston Price stuff.

Andrew Huberman:
I'm trying to think here if there's anything I missed.

Dr. Staci Whitman:
Well, we could say tongue scraping.

Andrew Huberman:
Tongue scraping. Excuse me.

Dr. Staci Whitman:
I do like tongue scraping. So again, Ayurvedic, Chinese medicine will look at the tongue from a health standpoint. If you have a white coating on your tongue, that's a sign of dysbiosis. You could have candida. This is important to touch upon. Strep mutans gets blamed for cavities so much, with kids especially, but with children, we really need to be focusing on fungus, too. So candida is really prevalent in early decay in children. No one's screening for this or treating it. Candida loves sugar. And this is also with diabetics. We're seeing a bidirectional relationship with gum disease, periodontal disease, and insulin resistance, and blood sugar imbalances, too. So tongue scraping, and it will do a better job than your toothbrush. People always ask because it is removing the biofilm, as the toothbrush is kind of moving it around. So it's taking off that film of bacteria. I know, it's kind of gross, but they tend to be anaerobic. And that can help with nitric oxide production too, because the good bacteria on the tongue tend to live down more in the crypts. So you don't want to scrape too hard, but just get that film off. You'll also notice improvement in your taste perception too-

Andrew Huberman:
Mm-hmm

Dr. Staci Whitman:
... because you're getting food remnants and things off as well.

Andrew Huberman:
You wouldn't want that.

Dr. Staci Whitman:
Yeah.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
Oh, I love it. Once you start tongue scraping, you usually-- Most everyone's a big advocate for it.

Andrew Huberman:
Thank you so much for this-

Dr. Staci Whitman:
Thank you, Andrew

Andrew Huberman:
... really extensive and exceptionally clear voyage through oral health. I am sure that people are going to take away many, many things that are actionable, and I really appreciate that you've been such a strong advocate for pointing out that oral health is not just about teeth, it's not just about breath, it's about that, but it's also about your whole digestive tract and about brain health and about heart health. And we have a lot of control over this particular-

Dr. Staci Whitman:
Mm-hmm

Andrew Huberman:
... aspect of our body as opposed to heart health, which we have to get to indirectly unless we're a heart surgeon.

Dr. Staci Whitman:
Yes.

Andrew Huberman:
Or gut health, which we have to get to indirectly unless we're a-

Dr. Staci Whitman:
Exactly

Andrew Huberman:
... gastroenterologist, right? So-

Dr. Staci Whitman:
What other biofilm do you have access to? It really is a window into the body.

Andrew Huberman:
Mm-hmm.

Dr. Staci Whitman:
So if you have gum disease or cavities, that is a sign of a metabolic imbalance in your body. So not to make you panic, but I just want people to take it seriously, that it is a window into other things that could be happening deeper within the system.

Andrew Huberman:
Yeah. Well, I absolutely love the work that you're doing. I couldn't think of a better person to bring on here to-

Dr. Staci Whitman:
Thank you

Andrew Huberman:
... educate us all. And like I said, you've given us so many valuable tools, and we will provide links to all the incredible resources that you continue to put out into the world. So thank you for doing that. Thank you for coming here. It's clear that this is a labor of love for you. It's not just about cleaning teeth or something. So yeah, people probably can't see-- Well, certainly if they're listening, they can't see the incredible extensive notes that Dr. Whitman brought with her, and her incredible handwriting. Goodness gracious, what beautiful handwriting.

Dr. Staci Whitman:
Thank you.

Andrew Huberman:
Yeah.

Dr. Staci Whitman:
So I could read it later. Not all doctors have bad handwriting, I suppose.

Andrew Huberman:
No, they notoriously have bad handwriting, but yours is- ... you certainly could offset whatever failures of handwriting the other physicians have. So-

Dr. Staci Whitman:
This was really fun. Thank you so much.

Andrew Huberman:
Thanks. Well, we'll do it again.

Dr. Staci Whitman:
Appreciate it.

Andrew Huberman:
And I'm really grateful for you coming on here today. Thank you.

Dr. Staci Whitman:
Yes. Thank you.

Andrew Huberman:
Thank you for joining me today for my discussion with Dr. Stacy Whitman. I hope you found it to be as interesting and useful as I did. To find links to Dr. Whitman's work and the various resources we discussed, please see the show note captions. If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero-cost way to support us. In addition, please follow the podcast by clicking the follow button on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a five-star review. And you can now leave us comments at both Spotify and Apple. Please also check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. If you have questions for me or comments about the podcast or guests or topics that you'd like me to consider for the Huberman Lab podcast, please put those in the comments section on YouTube. I do read all the comments. For those of you that haven't heard, I have a new book coming out. It's my very first book. It's entitled "Protocols: An Operating Manual for the Human Body." This is a book that I've been working on for more than five years, and that's based on more than 30 years of research and experience, and it covers protocols for everything from sleep to exercise to stress control, protocols related to focus and motivation, and of course, I provide the scientific substantiation for the protocols that are included. The book is now available by presale at protocolsbook.com. There you can find links to various vendors. You can pick the one that you like best. Again, the book is called "Protocols: An Operating Manual for the Human Body." And if you're not already following me on social media, I am hubermanlab on all social media platforms. So that's Instagram, X, Threads, Facebook, and LinkedIn. And on all those platforms, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the information on the Huberman Lab podcast. Again, it's hubermanlab on all social media platforms. And if you haven't already subscribed to our Neural Network Newsletter, the Neural Network Newsletter is a zero-cost monthly newsletter that includes podcast summaries as well as what we call protocols in the form of one to three-page PDFs that cover everything from how to optimize your sleep, how to optimize dopamine, deliberate cold exposure. We have a foundational fitness protocol that covers cardiovascular training and resistance training. All of that is available completely zero cost. You simply go to hubermanlab.com, go to the menu tab in the top right corner, scroll down to Newsletter, and enter your email. And I should emphasize that we do not share your email with anybody. Thank you once again for joining me for today's discussion with Dr. Stacy Whitman. And last but certainly not least, thank you for your interest in science.