Hi Friends!
In this issue: Focus on the front end of the gut and the “oral-gut-brain” axis.
For anyone new—this is a monthly newsletter where we address new, or older but relevant, research findings, as well as summarize recent findings or gut-related news. Here, “gut-related” is broadly interpreted, so we will be covering anything that might affect the gut, both “top down” and “bottom up.” This means brain/mind things (“top down”), such as psychology of stress, resilience, and emotion regulation, as well as body-based things (“bottom up”), including inflammation and typical comorbidities of gut disorders, such as pain conditions and autoimmunity.
Dr. Lisa Goehler
Table of Contents
Introduction
The mouth is different than the rest of the alimentary canal (aka “gut”). We use it to express emotions when we smile or grimace with it. We express our thoughts and feelings with words that come out of it. And we put food into it. We experience the sensory features of what we eat thanks to the taste receptors on our tongues and elsewhere in our mouth. This is the first place in the gut where food influences brain functions (such as mood), and where digestion of food begins. Chewing food prepares it for the stomach, which breaks food down so that it can be absorbed in the small intestine. The more we chew our food, the easier things are for the stomach. Enzymes in saliva begin digestion of carbohydrates.
So, the alimentary canal, aka “gut,” begins with the mouth, but even people who study the “oral cavity” may not think of it as part of the gut. But the mouth is directly connected to the rest, and it can have marked effects on it.
As a dentist once pointed out, the mouth is the gateway to the inside of the body. What is happening in the mouth can directly influence the rest of the gut, and as new research is showing, oral health influences a wide variety of other bodily functioning, from the cardiovascular system to the nervous system (Sedghi 2021, Kunath 2024, Xi 2024, Adil 2025). Immune cells in the mouth, as in the rest of the gut, can influence local and systemic immune function. The link between oral health and conditions in the rest of the body is now considered to be carried out via inflammation and oral microbial dysbiosis (Kunath 2024, Senel 2021).
Historically, factors recognized to influence periodontal inflammation and oral dysbiosis have centered on oral hygiene. But now it is clear that other environmental factors, in particular psychological stress and diet, are interacting in several ways to improve or exacerbate oral health (Sedghi 2021).
Oral microbes in health and disease (gingivitis, periodontitis)
Each section of the gut (mouth, esophagus, stomach, small and large intestines, rectum, and anus) has a unique set of microbial species. These populations make up whole ecosystems, in which each species inhabits specific habitats or niches. In the mouth, these include the tongue, mucosa (part of the gums), or plaque.
As in other parts of the gut, the populations of these microbes need to be balanced so that none overgrow and cause dysbiosis. Indeed, dysbiosis underlies the main dental conditions: dental caries, periodontal disease, and oral candidiasis (Sedghi 2021, Senel 2021).
What are the key factors that influence oral microbe populations? Diet is important, unsurprisingly (Sedghi 2021). In general, diets high in sugar and starchy carbohydrates, and low in fiber and antioxidants (such as those found in vegetables and fruits), contribute to both periodontal disease and caries (tooth decay). Other factors include environmental exposures, gender, age, and lifestyle habits (Zhu 2025). Some authors have reported genetic contributions as well, but these are not well understood and may be expressed as genetic variation of immune responses to the microbes.
Perhaps more surprisingly, psychological stress is associated with oral dysbiosis and dental problems (Sedghi 2021). One way this happens is that stress dysregulates hormones, including cortisol, leading to increased growth and virulence of pathogenic bacteria. Chronic stress, especially psychological stress, also dysregulates the immune system, leading to inflammation (e.g., Sedghi 2021; there’s lots on this effect). All of this causes and exacerbates dysbiosis and its oral and systemic consequences.
Implications for the rest of the gut: IBD and cancer
Oral dysbiosis can also contribute to disease conditions farther along in the gut (Lam 2023, Zheng 2025), particularly inflammatory bowel disease (IBD) and gastrointestinal (especially colorectal) cancer. How can this happen? Microbes from the mouth can move farther along the gut, carried by saliva or food (Xi 2024). The idea is that overgrown “pathobionts,” which are microbes that are not known to be beneficial but that don’t cause disease unless they overgrow, end up in the rest of the gut where, as in the mouth, they induce inflammation. This inflammation can be chronic, driving further inflammation in IBD, and can cause DNA damage to gut cells that leads to cancer (Lam 2023, Wang 2025).
Oral dysbiosis and inflammation can influence the brain
Poor oral health can influence brain health and function both directly, via systemic inflammation or malnutrition, or indirectly as a function of personal and social experiences such as pain, difficulty eating, and embarrassment over missing teeth or wearing dentures (Zhang 2025).
Depression (in particular) and poor oral health (such as periodontitis and tooth loss) seem to be common companions. Dental disorders can drive systemic inflammation, which is now a well-known contributor to depression. But difficulty chewing, for instance because of tooth loss or pain, can reduce “diet diversity” (especially harder-to-chew fibers), which can lead to malnutrition (also associated with depression) and gut bacterial dysbiosis (Huang 2025, Zhang 2025), as well as constipation. Gut bacterial dysbiosis is also associated with depression, most likely due to gut barrier disruption and increased systemic inflammation that goes along with dysbiosis. But this relationship likely goes both ways. Self-care practices, such as tooth brushing and flossing, can be neglected during mood disorders, further driving oral health problems.
Oral dysbiosis may also contribute to neurodegenerative diseases, particularly Alzheimer’s disease (Adil 2025, Mo 2025, Rozenblum 2025, Sedghi 2021, Shawkaßtova 2025). I find this possibility intriguing, so Journal Club this month will feature the Rozenblum paper.
What impacts your oral health?
Now that we realize how important oral health is, what can we do?
Let’s just say this has not been my favorite literature to review. The importance of oral health for overall health is still dawning for much of the general public (and many scientists). There are plenty of good papers validating the links of oral dysbiosis to many different and seemingly unrelated organ systems, but the quality of studies that address just what needs to be done to improve or maintain oral health is rather variable. But I have been able to glean some themes. They are not surprising, probably, but I add them here for anyone who may need more motivation to stay on top of oral hygiene, or who has patients or clients with conditions that might be affected by the consequences of oral dysbiosis and may need tips.
Teeth need to be brushed twice a day, and some kind of “interdental” cleaning should be done at least once a day (Bertelsen 2022, Worthington 2019).
“Interdental cleaning” means flossing or using an “oral irrigating” device such as a Waterpik. I did not find reliable differences in efficacy between the two; both are effective for cleaning (Bertelsen 2022, Worthington 2019).
Among toothbrush types, electric toothbrushes are more effective at cleaning teeth without causing damage to the tooth enamel or gums (Kumar 2025).
Toothpicks are not as effective for “interdental cleaning” for preventing gum bleeding (gingivitis) (Bertelsen 2022). Mouthwash did not make much of a difference either (Bertelsen 2022), although James et al. (2017), in a meta-analysis, found a slight benefit when mouthwash is used along with brushing.
High-carbohydrate diets (especially refined carbohydrates) have long been linked to poor oral health, as have low-fat diets. High-protein diets are also listed as bad for oral health. It seems that the best strategy is the boring old balanced diet. Overall, the Mediterranean diet strategy, as for the rest of the gut, seems best for overall oral health (Popovac 2025).
What about alternative oral hygiene practices, such as brushing with “activated charcoal” toothpaste? Apparently, these toothpastes are not more abrasive than regular toothpastes, so they seem safe, but there are concerns that these toothpastes don’t contain fluoride and therefore will not improve or maintain tooth enamel hardness (Zoller 2023).
What about “oil pulling” (an ancient Ayurvedic practice of gargling with oil) with coconut oil? Although there are many claims of benefits for clean teeth and controlling bacteria, a recent meta-analysis found no effects on plaque or gum health (Peng 2022).
Fluoride in public water supplies is dangerous
In 1944, the cities of Newburgh and Kingston in New York State agreed to participate in an experiment whereby one city, Newburgh, added sodium fluoride to the public drinking water while the other city did not (Ast 1950). Why did they do this? Extensive epidemiological studies from all over the world had indicated that regions with naturally higher levels of fluoride in the environment (from rocks or soil) had children with remarkably fewer cases of dental decay (dental caries). So it was decided that, to determine whether this effect was in fact due to fluoride, a real-world experiment needed to be done using towns that were otherwise very comparable.
The initial findings, after only three years, showed a marked reduction in tooth decay in children exposed to fluoride during the eruption of permanent teeth (ages 6–9) (Ast 1950). These findings spurred many communities in the United States, Canada, and other countries to add fluoride to their public water supplies (McLaren 2021). Since then, fluoridated water has been considered an important tool for preventing tooth decay and promoting remineralization in teeth (Monjaras-Avila 2025).
How does fluoride help prevent decay?
Tooth enamel is mostly made of calcium crystallized with phosphate and hydroxide. Fluorine replaces the hydroxide, forming stronger crystals (Armfield 2007, Wikipedia) that are more resistant to acid attack. It also appears to be one of the most effective agents for remineralizing areas of teeth at risk for caries (Monjarás-Ávila 2025).
In recent years, however, some communities have stopped adding fluoride to their water, including the entire state of Utah and some communities in Canada, including the city of Calgary. Why are they doing this?
How dangerous is fluoride in drinking water?
That fluoridation prevents tooth decay is not controversial among legitimate scientists and practitioners. More than 30 countries fluoridate their water and have done so for decades (Armfield). Many studies, including recent ones, support a consistently positive effect of fluoridated water (Wang 2004, Armfield 2007). When cities stop fluoridating water, there is a corresponding increase in tooth decay in children (Yazdanbakhsh 2025, McLaren 2022). Because of this, a city in Canada—Windsor—that had stopped fluoridating its water eventually reinstated it due to concerns about rising tooth decay (Canadian Broadcasting Company 2018).
That said, fluoride levels several times higher than those used in municipal water supplies have been associated with neurological harm, typically demonstrated in “preclinical studies” (e.g., laboratory animal studies rather than real-world human studies). In addition, higher levels of fluoride can lead to “mottled teeth.” But again, these levels are well above what is added to public water. In fact, a carefully conducted study from Australia found no effect of early childhood exposure to low levels of fluoride on cognition (Do 2024).
So, as with many (most?) things, more is not better. Another example of this effect is that low levels of fluoride appear to encourage colonies of beneficial gut microbes, while higher levels seem to be detrimental to beneficial microbes and may encourage potentially pathogenic ones (Yasin 2025).
What are the stakes?
Dental decay is not trivial for anyone, but it is particularly damaging for children, whose teeth are still developing. Dental decay causes pain, and when left untreated—such as in under-resourced communities or in those that avoid modern medical care—it can lead to sepsis (McLaren 2022) and even death. I remember a few years ago when a teenage boy in the District of Columbia died of sepsis caused by a decayed tooth that his family could not afford to have treated.
Who is behind the anti-fluoride movement?
Unsurprisingly, many allegations against fluoride come from entities that have something to gain by scaring people about the public water supply, such as bottled water companies, sellers of water filtration systems, and “purveyors of alternative medicines and therapies” (Armfield 2007), including supplement vendors. More recently, there has been a dramatic increase in fear-mongering on social and other media, presumably for commercial or political advantage.
It is also interesting that, historically, objections to water fluoridation have tended to mirror the dominant anxieties of the time. In the 1950s, for example, fluoridation was claimed to be a Communist plot (Armfield 2007), or alternatively a German or Russian drug designed to cause schizophrenia and make people easier to control. Today, conspiracy theories are more likely to blame domestic governments rather than foreign adversaries.
Every month, we pick a published (and peer reviewed) article to highlight and discuss.
This month’s selected article
Title
Unraveling the oral microbiome’s role in Alzheimer’s disease: From pathophysiology to therapeutic potential
Authors
Gilliana Rozenblum, Karima Ait-Aissa, Gadeer Zahran, Mahdieh Alipour, Amal M. Sahyoun, Undral Munkhsaikhan, Adam Kassan, Tauheed Ishrat, Qi Wang, Ammaar H. Abidi, Modar Kassan
Publication
Alzheimer's & Dementia. 2025
I think this paper is worth a read! Check it out →
For many decades, there have been intense research efforts aimed at understanding and treating Alzheimer’s disease (AD). The results have been disappointing. I think that if anyone had told me back in the 1980s that well into the 2020s we would still not have an effective treatment for the disease—or even really understand what is causing it—I probably would not have believed them. But here we are. The good news is that the search for contributing factors driving AD has broadened beyond “plaques and tangles,” and some of the factors identified might be a bit surprising to the old guard.
The paper by Rozenblum et al. details the evidence that microbes from the mouth likely contribute to the pathophysiology of Alzheimer’s disease, what the mechanisms of their roles might be, and how we can use this knowledge to screen for people at risk for AD. Key highlights include:
Oral dysbiosis and overgrowth of pro-inflammatory bacteria are reliably associated with AD.
Several studies have found evidence for the presence of “oral pathobionts” (microbes that are not inherently beneficial but do not cause disease unless they overgrow) in both oral and brain tissue of people who had AD.
One pathobiont that is receiving a lot of attention in relation to AD is Porphyromonas gingivalis. P. gingivalis is a “keystone periodontitis pathogen” that produces enzymes called gingipains, which can break down proteins. Gingipains can promote neuroinflammation and other pathophysiological hallmarks of AD, including plaques and tangles. P. gingivalis is consistently found in the brains of individuals with AD. There are several other bacterial species associated with both periodontitis and AD as well.
In addition to the overgrowth of pathogenic oral bacteria in AD, there is a concomitant decrease in “beneficial” species found among the oral microbiota of people with AD. This may facilitate the overgrowth and “dominance of pro-inflammatory pathogens” that could drive “systemic inflammation linked to neurodegeneration.”
Oral dysbiosis is also seen in other disorders, including diabetes, hypertension, and kidney disease, which are themselves risk factors for AD.
The authors point out that “lifestyle interventions remain a cornerstone of oral microbiota modulation, with improved oral hygiene practices and dietary modifications showing systemic benefits. Regular professional dental care, proper brushing techniques, and the use of antimicrobial mouthwashes can significantly reduce pathogenic bacterial loads. Dietary interventions rich in polyphenols, omega-3 fatty acids, and fiber may also foster a healthier oral microbiota while concurrently reducing inflammation, a strategy that aligns with emerging research on the gut–brain axis.” Couldn’t have said it better myself!
Bottom line?
Anyone concerned about their risk for developing Alzheimer’s disease should prioritize their own—and their loved ones’—oral health.
Tips for keeping your mouth healthy
I went to the dentist this month, and while I was there, I asked my hygienist if she had any pro tips for me. She did, and here they are:
There really is no substitute for brushing twice a day and flossing at least once.(I have also heard from other hygienists that water picks work well for people who have real difficulty flossing, but you do have to make an effort to keep the machine clean.)
Regular, good oral hygiene is especially important for people who cannot make it to the dentist twice a year (as recommended).
In between meals, refrain from sipping on beverages for long periods of time such as coffee, energy drinks, and soda that contain sugar, as they can contribute to tooth decay and oral dysbiosis.
She emphasized the importance of saliva, which helps wash away sugary or starchy residues. So, in general, sweet beverages or those with acids should be consumed with meals, because meals stimulate saliva production.
Soft, starchy snacks are the worst, as they tend to stick to teeth. Without enough saliva or other food particles to scrape or wash them away, starchy residues on and between teeth can trigger microbial overgrowth and acid production. It’s a feast for them!
I would say that this last point is a good argument for a “high-residue diet” of intact and minimally processed foods.
Don’t rinse the toothpaste out of your mouth after brushing your teeth! The fluoride in the toothpaste needs about 20 minutes uninterrupted by water or food to help repair your enamel.
When reading through the literature, it seemed that many of the studies—especially earlier ones—were a bit simplistic, for instance asking people whether they flossed or brushed. What if you do both? For best results, I brush my teeth to remove large particles, floss, and then brush again to remove any plaque or debris dislodged by flossing.
Do you have a tip for us? Let us know!
Every month we will highlight an easy to make, gut-healthy dish that we are eating now!
Mini Dutch Babies (Muffin Tin Version)
We are eating Dutch Babies.
Little ones.
Usually, Dutch babies are made as one large pancake, similar to a Yorkshire pudding. I found a recipe for individual Dutch Babies in Sunset Magazine (January 2019 issue), baked in muffin pans.
They are very easy to throw together for breakfast or lunch. They’re made from eggs, milk, flour, and whatever else you want to add. You can make them sweet with fruit or savory. We like ours with cheese and apples, with a little poultry seasoning added to the batter.
This recipe makes about 12 Dutch babies (big family!).
Ingredients
4 large eggs
1 cup milk
1 cup flour
¼ cup butter, diced (goes in the muffin pans first)
Optional fillings:
Fruit: raspberries, strawberry chunks, blueberries
Savory: cheese, ham
Chopped apples
For savory versions:
⅛ to ¼ teaspoon poultry seasoning (added to the batter)
Instructions
Preheat the oven to 425°F.
In a bowl or blender, mix the eggs and milk.
Add the flour and mix until smooth.
(If using a bowl, it helps to sift the flour in to avoid lumps.)Divide the butter among 12 muffin cups (⅓-cup size).
Place the muffin pan in the oven and heat until the butter melts and begins to brown, about 2–3 minutes.
This step is key for getting the Dutch Babies to “poof.”Carefully remove the pan from the oven and divide the batter evenly among the muffin cups.
Sprinkle with your chosen filling.
Return the pan to the oven, placing a baking sheet underneath to catch any drips.
Bake until puffed and well browned, about 18–20 minutes.
Loosen the Dutch Babies with a knife or spoon and serve immediately.
Enjoy!
About the Author
Lisa E. Goehler, Ph.D. is a neuroscientist and expert in the science and treatment of psychological stress, chronic inflammation, and gut-related disorders. She pioneered the study of how GI-tract related bacteria can interact with the brain to lower mood and increase anxiety. Throughout her career, she authored over fifty publications and contributed to peer review for scientific journals and funding agencies, including the National Institute for Health.
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