I vividly remember in grade school seeing a movie about the war that
goes on in our bodies between our immune system and bacteria. The white blood
cells were like
knights on their white horses and the invading bacteria were like insects. This
about the time Penicillin was first being widely used after WW II. The warfare
metaphor was not new—we have been looking for "magic bullets" to treat
syphilis ever since the germ theory was accepted. The concept of
antibacterial warfare has dominated our thinking in dealing with bacteria. We
now have bigger and better weapons, but the enemy bacteria are very adept at
learning how to cope with them; most of them are resistant to Penicillin. And,
thanks to earlier use in animals than in humans, many bacteria are resistant to
our new antibiotics by the time they are available to us. It is a very real arms race that brings us now
to the fear of bacteria resistant to all of our antibiotics. If we look at
the odds in this war we have further indication for concern. 95% of the bacteria
that existed 1.7 billion years ago, when the first cell appeared, are still
around, but 95% of the "higher" organisms, developed since that time,
are now extinct. We need other options in this warfare. For a further look at
some interesting parallels between our warfare with bacteria and with our fellow
men click here.
to consider a much broader perspective as we engage this enemy.
began around three-and-a-half billion years ago. They were the only
things on this earth for almost two billion years.
this period of time they learned to use the sun's energy, liberate
and use oxygen, and
ferment other bacteria.
reached a balance and learned to live in
co-operation with each other.
having much interest in intellectual property rights they even learned
how to share information with
each other by sharing genetic material.
do this and mutate much more actively when they are under stress,
like when we use antibiotics to kill
is the main reason we are always playing
catch-up with antibiotics.
We are also trying to use bacteria, the
unquestionable experts at slipping genes to others, to put corrected genes into
people with genetic
dying from the infection that we introduce.
biologists looking at the archeological record of these bacteria point out
that the first nucleated cell combined all of the abilities of the various
bacteria into one cell.
these biologists, is not "red in tooth and claw," as described by early
evolutionists, but a triumph of co-operation.
These biologist include scholars
like Lynn Marguilis, whose book, Early Life, portrays the developments of
our earth's history over a billion years ago.
Sahtouris, another of these
biologists, points out that the new concept of the evolutionary cycle is a
progression: from unity, to diversity, to conflict, to negotiation, to resolution,
to co-operation, and to a new and more highly developed unity.
this line of reasoning is not generally accepted by most biologists who
continue to look at random mutation and its environmental success as the
fundamental principle of evolution. It does provide a more friendly answer
to the questions
brought up by some about the complexity of some biologic processes, like blood
clotting, that rely on the cascade of processes that individually do
not seem to have any survival advantage. Without the whole
cascade each of the mutations leading to the individual steps would have been
meaningless and without advantage. If they can be seen as the result of
co-operation the end result makes more sense.
Ewald is a biologist
who has written on the subject of how bacteria evolve (Evolution of
Infectious Disease and Plague Time).
main argument is that when bacteria can move easily
one person to another they become more virulent—they cause more, as well as
more serious, infections.
Conversely when we clean
up our water, or use mosquito netting, or condoms—that block the spread of the
virus or bacteria—they become less virulent.
the section on glycobiology I wrote about how the sugar complexes on
the cells provide a means of
attachment for bacteria.
Using soluble sugars to prevent bacterial adherence inside
the body promotes the same evolutionary pressures as the barriers described by Ewald.
saw earlier how this happened with the women who drank the cranberry lingonberry
juice extract. They had less infections.
most likely reason is a change in the nature of their bacteria. Making
it harder for the bacteria to hold on
selects for bacteria that hold on by a different method and do not cause
Nathan Sharon, the pioneer of this aspect of infectious disease, points out
that the sugars on cell surfaces can change and that when they do they can provide
a means of communication: between our
cells, between our cells and bacteria, and between bacteria.
only do our body's cells talk to their neighbors and move in our bodies to
places where they are needed, but bacteria are able to
talk to the host cells in their environment and promote changes, either
helpful or harmful, in those cells.
when bacteria get together, they talk among themselves by releasing chemicals
in a process called quorum sensing.
more bacteria release these chemicals the bacteria reach a point where
they change their focus.
of the things some bacteria do when they have been allowed sufficient
time to grow is to make a biofilm.
are essentially houses in which the bacteria live that are sometimes
as elaborate on a bacterial scale
as the skyline of New York.
bacteria get to this stage it is difficult to get rid of them because
the antibiotics can't get into their
plaque is a biofilm and we have to go to the dentist to get this
biofilm scraped off.
exposure to xylitol also removes plaque.
Recent studies suggest that some cases of
recurrent ear infections occur because of biofilm formation.
we can't scrape off the biofilm in the back of the nose.
we need to interrupt this bacterial communication if we wish to stop the
problems. We have already seen how xylitol blocks adherence. And, following
Ewald's ideas we should see bacteria that are less virulent when repeatedly
exposed to xylitol.
Of course we can't ask
the bacteria if they understand and agree with what we want—we
have to see whether or not they are changed by looking at what they do.
And the changes need to be long-term, just as they were with the urinary
xylitol says to the bacteria.
the early 1990’s a study, performed by dentists at the University of
Michigan, was carried out in Belize to look at
the effect of xylitol on tooth decay in children at the time they lose their
study lasted for two years and used six different kinds of gum, including
mixes of xylitol, sorbitol, and maltitol as well as gums with only one
children chewed two sticks of this gum at regular intervals four
times a day and were given sufficient for the weekend on Friday.
the end of the two years they found that 100% xylitol was
the best of the six types of gum used in the study.
This did not surprise
anyone because that is what they found with all of the other studies with
five years later dental researchers from the
University of Washington returned and looked at the children again. They
found that if the children started the regular program of xylitol
gum-chewing one to two years before their permanent teeth erupted, then five
years after the end of the study, with no xylitol during the five years,
they had 90% fewer cavities than the control group.
Beside the spectacular benefit of this treatment the question it raises is
how this long-term benefit occurs. Bacterial indigestion and reduced adherence
are local and short-term effects of xylitol; they cannot explain this observed
long-term benefit. Like the study with the cranberry-lingonberry extract this long-term benefit is
only explained by changes in either the nature of the bacteria or the
type of bacteria.
Canadian researcher, had published his studies three years earlier showing
that the nature of S. mutans changed when exposed to
March 2000, Eva
the findings of her group that was looking at the effect of maternal xylitol
gum chewing on the S. Mutans carrier status of their children.
For the first
two years after giving birth these women either chewed xylitol gum, or had
treatments every six months with fluoride or chlorhexidine.
of the treatments changed the S. Mutans carriage in the mothers,
but less than 10%
of the children whose mothers chewed the xylitol gum carried S. Mutans at
They had other bacteria that did not cause tooth decay –
the type of bacteria changed.
numbers were three and five times less respectively than those treated
with chlorhexidine or fluoride varnish.
latest follow up on these children shows that at
five years they have 70% fewer cavities than the other groups.
correlation of the benefit seen in the Belize children with the loss of
their primary teeth also argues for a change in the type of bacteria.
recent study from the University of Washington Dental
School, that had done the follow-up study in Belize, looked at what
happens to the bacteria on our teeth in the presence of xylitol.
used adults, so they did not get the benefit of changing out your
teeth seen in
the Belize children, and found that their bacteria became tolerant of
xylitol in the manner Luc Trahan pointed out.
this tolerance was accompanied with not causing tooth decay.
decay causing bacteria are important we need to remember that all of the
studies comparing S. mutans, that cause tooth decay, and S.
cause most ear, sinus, and bronchial infections, show them equally effected
by xylitol. Obviously more studies need to be done, but they will not be
until enough people clean their noses regularly and show the government and
the health care industry just
how effective regularly cleaning the nose is at reducing associated
Don't hold your breath for this to happen because preventing
problems is not in the financial interest of the health care industry. More
about the roots of our health care problems is available at Common
We have been locked in the conflict stage too long and it is time to get on with
negotiating. The long-term effects of cranberry juice extract and xylitol—the
fact that xylitol changes the nature of the bacteria as described by Trahan and
reduces the carrier state in the community, without killing the bacteria—together
with the communicative function of these sugars opens the door to the
possibility of negotiation in this biological arms race. Ewald closes The
Evolution of Infectious Disease with the hope that we can "domesticate" the
bacteria and get out of
the arms race we are losing. I think this
possibility and the use of simple food sugars to facilitate it is one of the most exciting developments in infectious disease since
the discovery of antibiotics. It is, however, a lot easier to wage war than
it is to make peace. Making peace means talking, even when you are not sure the
other person is listening. Two years of gum chewing, and losing their primary
teeth where the plaque was home to the harmful bacteria, was necessary to convince
the bacteria in these children’s mouths to behave differently or just to not
make their home there. It is a lot more effort than just sending off a smart
bomb to blow them up, but smart bombs are just another challenge for bacteria. Again
feeding our enemies is an infrequently used option, but 35
generations, the time it takes to change a wolf to a dog, is a few days for
rapidly multiplying bacteria.
* * * *
* * * * * * * * *
summary, xylitol has two short-term actions, indigestion and decreased
adherence, on several bacteria—that live in the mouth and cause tooth decay,
and in the nose that cause upper respiratory infections. In addition xylitol has
long-term effects on S.Mutans that change it to being more friendly (less
virulent) and reduces the number of people in the community who have the
bacteria. And it does this without killing the bacteria, most likely by filling
the receptor sites on the bacteria whose function it is to communicate with the
environment, i.e. by negotiating. What it seems to say
to the bacteria is "shape up or ship out." Whether these long-term
effects will hold on the bacteria living in the nose will have to be determined
when enough people use it regularly in the nose. My own experience over the past
four years suggests it does.
- [The first three references pertain to mannose and bladder infections.]
Inhibitory activity of cranberry juice on adherence of
type 1 and type P fimbriated Escherichia coli to eucaryotic cells.
Zafriri D, Ofek I, Adar R, Pocino M, Sharon N
Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv
Inhibition of bacterial adherence to bladder cells has been assumed to
account for the beneficial action ascribed to cranberry juice and cranberry
juice cocktail in the prevention of urinary tract infections (A. E. Sobota,
J. Urol. 131:1013-1016, 1984). We have examined the effect of the cocktail
and juice on the adherence of Escherichia coli expressing surface lectins of
defined sugar specificity to yeasts, tissue culture cells, erythrocytes, and
mouse peritoneal macrophages. Cranberry juice cocktail inhibited the
adherence of urinary isolates expressing type 1 fimbriae (mannose specific)
and P fimbriae [specific for alpha-D-Gal(1----4)-beta-D-Gal] but had no
effect on a diarrheal isolate expressing a CFA/I adhesin. The cocktail also
inhibited yeast agglutination by purified type 1 fimbriae. The inhibitory
activity for type 1 fimbriated E. coli was dialyzable and could be ascribed
to the fructose present in the cocktail; this sugar was about 1/10 as active
as methyl alpha-D-mannoside in inhibiting the adherence of type 1 fimbriated
bacteria. The inhibitory activity for the P fimbriated bacteria was
nondialyzable and was detected only after preincubation of the bacteria with
the cocktail. Cranberry juice, orange juice, and pineapple juice also
inhibited adherence of type 1 fimbriated E. coli, most likely because of
their fructose content. However, the two latter juices did not inhibit the P
fimbriated bacteria. We conclude that cranberry juice contains at least two
inhibitors of lectin-mediated adherence of uropathogens to eucaryotic cells.
Further studies are required to establish whether these inhibitors play a
role in vivo.
Nippon Hinyokika Gakkai Zasshi 1989 Dec;80(12):1816-23
[Anti-bacterial defense mechanism of the urinary
bladder. Role of mannose in urine].
[Article in Japanese]
Toyota S, Fukushi Y, Katoh S, Orikasa S, Suzuki Y
Bacterial adherence to mucosa is thought to be an initial and important
stage to cause urinary tract infection. Among some mechanisms of bacterial
adherence, the role of fimbriae and its receptor is worthy of notice. In
particular, type 1 fimbriae, for which mannose is assumed as a receptor,
is reported as the most common type and called "common
fimbriae". Therefore if a certain amount of mannose is present in
urine, it will cover the fimbriae of bacteria and competitively block the
bacterial adherence to bladder mucosa. As the first step, we tried to
detect mannose in urine by high performance liquid chromatography (HPLC).
Sugar can be measured by detecting the fluorescence which is produced by a
sugar separated by ion exchange, reacting with arginine at high
temperature. The results using standard sugar samples should have highly
stable retention time and concentration curve with the minimum detectable
mannose concentration of 0.02 microgram. We investigated mannose in urine
from 186 cases. Since the mannose peak was often masked by near
unidentified peaks, the peak of mannose could be detected only in 80 cases
and its concentration could be measured only in 24 cases. Mannose
concentration in the urine of the 24 cases was between 2.6 and 108.7
micrograms/ml and in most of cases it was lower than 20 micrograms/ml.
Secondary, we examined the possibility of a mannose in urine to prevent
bacterial adherence to mucosa by the hemagglutination test using guinea
pig erythrocytes and type 1 fimbriated E. coli.(ABSTRACT TRUNCATED AT 250
PMID: 2576290, UI: 90172805
- [See also Dr. Jonathan Wright's
article on mannose and urinary tract infections online at http://www.tahoma-clinic.com/mannose.shtml ]
- Following two articles deal with biofilms:
Nippon Jibiinkoka Gakkai Kaiho 1998 Jan;101(1):25-36
JAMA 1998 Jan 28;279(4):296-9
[Inhibitory effect of macrolide antibiotics on biofilm
formation by Pseudomonas aeruginosa].
[Article in Japanese]
Kondoh K, Hashiba M
Department of Otorhinolaryngology, Nagoya City University Medical School.
In recent years, various medical indwelling devices have been developed and
used. Bacteria adhering to these devices often cause refractory infection. In
the field of otolaryngology, refractory infection accompanying these medical
indwelling devices such as middle ear ventilation tubes and artificial
auditory ossicles has been reported. The concept of bacterial biofilm
infection has been suggested as an explanation for the refractory infection.
Furthermore it has been reported that a bacterial biofilm is involved in
refractory infection unrelated to medical indwelling devices. Topical biofilm
formation was detected in patients with chronic sinusitis, chronic purulent
otitis media or habitual tonsillitis. In this study, we morphologically and
quantitatively examined the biofilm-forming capacity of a clinically isolated
strain of mucoid type Psecudomonas aeruginosa on Teflon to investigate the
effects of macrolide antibiotics on bacterial biofilm formation. In the
morphological examination, P.aeruginosa was cultured together with a Teflon
sheet in minimal medium containing various concentrations of the macrolide
antibiotics clarithromycin (CAM), erythromycin (EM) and midecamycin (MDM), at
37 degrees C for 7 days. The surfaces of the Teflon sheets were examined by
electron microscopy. The adherent bacteria and biofilm formation on Teflon
sheets soaked in minimal medium containing CAM or EM were found to be
decreased in a dose-dependent manner. However, in the Teflon sheets soaked in
minimal medium containing MDM, there was no decrease in biofilm formation
regardless of the MDM concentration. In the quantitative examination, P.
aeruginosa was cultured in minimal medium containing various concentrations of
the macrolide antibiotics at 37 degrees C for 7 days together with Teflon
beads. The levels of hexose, protein and alginate adhering to the Telfon beads
were quantified as an estimation of biofilm formation. On Teflon beads treated
with CAM or EM, there were dose-dependent decreases in hexose, protein and
alginate levels. In particular, marked decreases were noted when CAM and EM
concentrations were 10 micrograms/ml or more. Furthermore, there was no
significant difference between CAM and EM. However, in the presence of MDM,
there was no decrease in hexose, protein or alginate levels regardless of the
MDM concentration. The minimal inhibitory concentration (MIC100) of each
macrolide against P. aeruginosa used in this experiment was 100 micrograms/ml
or more. There may be no bactericidal effect on this strain at the macrolide
concentrations used in this experiment. However, this experiment used 7-day
treatment. The long-term bactericidal activity of macrolides was examined. In
the presence of CAM or MDM, bacterial levels after culture were similar to
preculture levels or slightly lower than the preculture levels. In the
presence of EM, bacterial levels were similar to the preculture levels. These
results demonstrated that CAM and EM, which are 14-membered macrolides
inhibited biofilm formation, while MDM which is 16-membered macrolide, did
not. These inhibitory effects of CAM and EM may be related to actions other
than bactericidal activity. In our experiment, CAM and EM inhibited biofilm
formation at 10 micrograms/ml or more. This concentration corresponded to 1/20
x MIC. This concentration can be achieved in tissues, nasal discharge and
sputum with actual clinical doses. Therefore, these agents may be effective
against biofilm disease caused by P. aeruginosa in the field of
- Evidence of bacterial metabolic activity in
culture-negative otitis media with effusion.
Rayner MG, Zhang Y, Gorry MC, Chen Y, Post JC, Ehrlich GD
Department of Pathology, University of Pittsburgh School of Medicine, Pa,
CONTEXT: Otitis media with effusion (OME) can lead to significant hearing
loss in children. Although previous studies have shown that bacterial DNA
is present in a significant percentage of effusions sterile by culture, whether
the DNA represents viable organisms or "fossilized remains" is
unknown. OBJECTIVE: To determine if bacterial messenger RNA (mRNA), as
detected by a reverse transcriptase-polymerase chain reaction (RT-PCR)-based
assay, is present in chronic pediatric middle ear effusions that contain
bacterial DNA but are sterile by standard cultural methods. Bacterial mRNAs
have a half-life measured in seconds to minutes; therefore, detection of
bacteria-specific mRNAs would be evidence that metabolically active
organisms are present. DESIGN: Blinded comparative study. PATIENTS: A total
of 93 effusions from pediatric outpatients seen for myringotomy and tube
placement for chronic (>3 months) OME (median age of children, 17
months). SETTING: Tertiary care pediatric hospital. MAIN OUTCOME MEASURES:
Percentage of positive test results for RT-PCR-based assays compared with
culture for Haemophilus influenzae and concordance between RT-PCR and PCR-based
findings for bacterial nucleic acids. RESULTS: Eleven (11.8%) of the 93
specimens tested positive by culture, PCR, and RT-PCR for H influenzae. A
total of 29 specimens (31.2%) were positive by PCR but negative by culture
for H influenzae. All 29 specimens were positive by RT-PCR for H influenzae-specific
mRNA. CONCLUSIONS: The RT-PCR-based assay system can detect the presence
of bacterial mRNA in a significant percentage of culturally sterile middle
effusions, establishing the presence of viable, metabolically active, intact
organisms in some culture-negative OME.
Polyol chewing gums and caries rates in primary dentition:
a 24-month cohort study.
Makinen KK, Hujoel PP, Bennett CA, Isotupa KP, Makinen PL, Allen P
Department of Biologic and Materials Sciences, School of Dentistry,
University of Michigan, Ann Arbor, USA.
The effect of 2-year chewing-gum use on the caries rates of primary teeth
was studied in a combined school and home program in a sample of 510
initially 6-year-old subjects with high caries experience, low availability
of fluoride, and difficult access to dental care. The gum, formed into
either sticks or pellets, comprised either xylitol, sorbitol, or mixtures
thereof. The gum was chewed for 5 min under supervision five times a day
during the school year, and for variable times during nonschool days. Seven
groups were studied. One group received no gum; two xylitol gum groups
received either pellet or stick gum as did, two sorbitol gum groups, and two
groups received either of two types of xylitol/sorbitol pellet gum. The
response variable was the development of a frank carious lesion detectable
by physical loss of enamel and probable extension to the dentin for those
surfaces of primary teeth that were not cavitated at baseline. Caries rates
associated with the use of each of the gum types were compared to the caries
rates in the no-gum group. The usage of all polyol gums resulted in a
significant decrease of the caries onset rate (p < 0.05). The caries
onset risk for a primary surface in the xylitol pellet and the sorbitol
pellet groups was 35 and 44% of that in the no-gum group (relative risk,
0.35; 95% confidence interval, 0.21-0.59; relative risk, 0.44; 95%
confidence interval, 0.30-0.63, respectively). The caries onset risk in the
xylitol stick gum group was 53% of that in the no-gum group (relative risk,
0.53; 95% confidence interval, 0.39-0.72), which was marginally (p = 0.1520)
lower than in the sorbitol stick gum group (relative risk, 0.70; 95%
confidence interval, 0.52-0.94). The usage of both xylitol/sorbitol mixtures
in pellet form was associated with a caries onset rate comparable with the
usage of the xylitol stick gum. The largest caries risk reduction was
observed in the group receiving xylitol pellet gum.
The optimum time to initiate habitual xylitol gum-chewing
for obtaining long-term caries prevention. Hujoel
PP, Makinen KK, Bennett CA, Isotupa KP, Isokangas PJ, Allen P, Makinen PL
Department of Dental Public Health Sciences, School of Dentistry, University
of Washington, Seattle 98195, USA.
Habitual xylitol gum-chewing may have a long-term preventive effect by
reducing the caries risk for several years after the habitual chewing has
ended. The goal of this report was (1) to determine if sorbitol and
sorbitol/xylitol mixtures provide a long-term benefit, and (2) to determine
which teeth benefit most from two-year habitual gum-chewing - those erupting
before, during, or after habitual gum-chewing. Children, on average 6 years
old, chewed gums sweetened with xylitol, sorbitol, or xylitol/sorbitol
mixtures. There was a "no-gum" control group. Five years after the
two-year program of habitual gum-chewing ended, 288 children were
re-examined. Compared with the no-gum group, sorbitol gums had no
significant long-term effect (relative risk [RR], 0.65; 95% confidence
interval [c.i.], 0.39 to 1.07; p < 0.18). Xylitol gum and, to a lesser
extent, xylitol/sorbitol gum had a long-term preventive effect. During the 5
years after habitual gum-chewing ended, xylitol gums reduced the caries risk
59% (RR, 0.41; 95% c.i., 0.23 to 0.75; p < 0.0034). Xylitol-sorbitol gums
reduced the caries risk 44% (RR, 0.56; 95% c.i., 0.36 to 0.89; p < 0.02).
The long-term caries risk reduction associated with xylitol strongly
depended on when teeth erupted (p < 0.02). Teeth that erupted after 1
year of gum-chewing or after the two-year habitual gum use ended had
long-term caries risk reductions of 93% (p < 0.0054) and 88% (p <
0.0004), respectively. Teeth that erupted before the gum-chewing started had
no significant long-term prevention (p < 0.30). We concluded that for
long-term caries-preventive effects to be maximized, habitual xylitol
gum-chewing should be started at least one year before permanent teeth
- Emergence of multiple xylitol-resistant (fructose PTS-) mutants from human
isolates of Mutans streptococci during growth on dietary sugars in the
presence of xylitol.
Trahan L, Bourgeau G, Breton R
Groupe de Recherche en Ecologie Buccale, Faculte de medecine dentaire,
Universite Laval, Quebec, Canada.
The growth inhibition of Mutans streptococci is one of the proposed mechanisms
of action of xylitol, a caries-preventive natural carbohydrate sweetener.
Xylitol is taken up and accumulated as non-metabolizable, toxic xylitol
phosphate via a constitutive fructose PTS, and selects, during in vitro growth
at the expense of glucose, for natural xylitol-resistant mutants that lack
constitutive fructose PTS activity. Since long-term xylitol consumption leads to
the emergence of xylitol-resistant Mutans populations in humans in an oral
environment containing sugars of dietary origin, we wanted to test the
hypothesis that xylitol-resistant cells could be selected from Mutans
streptococci strains during in vitro growth on fructose, sucrose, or lactose.
Three laboratory strains and three fresh Mutans streptococcal isolates were
repeatedly transferred in trypticase-yeast extract medium supplemented with
glucose, fructose, sucrose, or lactose in the presence and absence of xylitol.
Depending on the growth sugar, the presence of xylitol resulted in the selection
of xylitol-resistant populations for several of the six strains tested, but not
necessarily in the presence of all four sugars. All six strains rapidly became
xylitol-resistant when grown on glucose in the presence of xylitol. All three
fresh isolates became xylitol-resistant after 9 to 16 transfers in the presence
of fructose or sucrose plus xylitol, while none of the laboratory strains became
xylitol-resistant after 16 transfers in the presence of these sugars. The growth
rates of 12 xylitol-resistant mutants in the presence of eight sugars suggested
the existence of various types of xylitol-resistant mutants. The data partially
explain the occurrence of xylitol-resistant Mutans populations in long-term
xylitol consumers and suggest a mechanism consistent with a selection process.
Since various preliminary results suggest that xylitol-resistant natural mutants
may be less virulent and less cariogenic than their parent strains, this
selection process may alter, for the better, the Mutans streptococci population
of the plaque and play a role in the caries-preventive action of xylitol.
J Dent Res 2000 Mar;79(3):882-7
Influence of maternal xylitol consumption on acquisition of Mutans
streptococci by infants.
Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J
Institute of Dentistry, University of Turku, Finland. email@example.com
Xylitol is effective as a non-cariogenic sugar substitute.
Habitual xylitol consumption appears to select for Mutans streptococci (MS)
with impaired adhesion properties, i.e., they shed easily to saliva from
plaque. One hundred sixty-nine mother-child pairs participated in a two-year
study exploring whether the mothers' xylitol consumption could be used to
prevent mother-child transmission of Mutans streptococci. All mothers showed
high salivary levels of Mutans streptococci during pregnancy. The mothers in
the xylitol group (n = 106) were requested to chew xylitol-sweetened gum (65%
w/w) at least 2 or 3 times a day, starting three months after delivery. In the
two control groups, the mothers received either chlorhexidine (n = 30) or
fluoride (n = 33) varnish treatments at 6, 12, and 18 months after delivery.
The children did not chew gum or receive varnish treatments. MS were assessed
from the mothers' saliva at half-year intervals and from the children's plaque
at the one- and two-year examinations. The MS were cultured on Mitis
salivarius agars containing bacitracin. The salivary MS levels of the mothers
remained high and not significantly different among the three study groups
throughout the study. At two years of age, 9.7% of the children in the
xylitol, 28.6% in the chlorhexidine, and 48.5% in the fluoride varnish group
showed a detectable level of MS. In conclusion, therefore, habitual xylitol
consumption by mothers was associated with a statistically significant
reduction of the probability of mother-child transmission of MS assessed at
two years of age. The effect was superior to that obtained with either
chlorhexidine or fluoride varnish treatments performed as single applications
at six-month intervals.
Occurrence of dental decay in children after maternal
consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age.
Isokangas P, Soderling E, Pienihakkinen K, Alanen P
Ylivieska Health Care Center, University of Turku, Finland.
Studies have shown that prevention of mutans streptococci (MS) colonization
in early childhood can lead to prevention of dental decay. In the
microbiological part of the present study in Ylivieska, Finland, with 195
mothers with high salivary MS levels, regular maternal use of xylitol
chewing gum resulted in a statistically significant reduction in MS
colonization in their children's teeth at the age of 2 years compared with
teeth in children whose mothers received fluoride or chlorhexidine varnish
treatment. The children did not chew gum or receive varnish treatments. For
the present study, the children were examined annually for caries occurrence
by experienced clinicians who did not know whether the children were
colonized with MS. Regardless of the maternal prevention group, the presence
of MS colonization in children at the age of 2 years was significantly
related to each child's age at the first caries attack in the primary
dentition. In children at the age of 5 years, the dentinal caries (dmf) in
the xylitol group was reduced by about 70% as compared with that in the
fluoride or chlorhexidine group. We conclude that maternal use of xylitol
chewing gum can prevent dental caries in their children by prohibiting the
transmission of MS from mother to child.
Randomised trial of cranberry-lingonberry juice and
Lactobacillus GG drink for the prevention of urinary tract infections in
Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M.
Department of Pediatrics, University of Oulu, Oulu, Fin-90220, Finland.
Objective: To determine whether recurrences of urinary tract infection can
be prevented with cranberry-lingonberry juice or with Lactobacillus GG
drink. Design: Open, randomised controlled 12 month follow up trial.
Setting: Health centres for university students and staff of university
hospital. Participants: 150 women with urinary tract infection caused by
Escherichia coli randomly allocated into three groups. Interventions: 50 ml
of cranberry-lingonberry juice concentrate daily for six months or 100 ml of
lactobacillus drink five days a week for one year, or no intervention. Main
outcome measure: First recurrence of symptomatic urinary tract infection,
defined as bacterial growth >/=10(5 )colony forming units/ml in a clean
voided midstream urine specimen. Results: The cumulative rate of first
recurrence of urinary tract infection during the 12 month follow up differed
significantly between the groups (P=0.048). At six months, eight (16%) women
in the cranberry group, 19 (39%) in the lactobacillus group, and 18 (36%) in
the control group had had at least one recurrence. This is a 20% reduction
in absolute risk in the cranberry group compared with the control group (95%
confidence interval 3% to 36%, P=0.023, number needed to treat=5, 95%
confidence interval 3 to 34). Conclusion: Regular drinking of cranberry
juice but not lactobacillus seems to reduce the recurrence of urinary tract
Small talk. Cell-to-cell communication in bacteria.
Department of Molecular Biology, Princeton University, NJ 08544, USA.
In a process called quorum sensing, groups of bacteria communicate with one
another to coordinate their behavior and function like a multicellular
organism. A diverse array of secreted chemical signal molecules and signal
detection apparatuses facilitate highly productive intra- and interspecies
- Sci Am 1993 Mar;268(3):12
Carbohydrates in cell recognition.
Sharon N, Lis H.
Biophysics Department, Weizmann Institute of Science, Rehovot, Israel.
Telltale surface sugars enable cells to identify and interact with one
another. New drugs aimed at those carbohydrates could stop infection and
Anti-Escherichia coli adhesin activity of cranberry
and blueberry juices.
Ofek I, Goldhar J, Zafriri D, Lis H, Adar R, Sharon N.
How xylitol-containing products affect cariogenic
Roberts MC, Riedy CA, Coldwell SE, Nagahama S, Judge K, Lam M, Kaakko T,
Castillo JL, Milgrom P.
Department of Pathobiology, University of Washington, Seattle, USA.
BACKGROUND: The authors examined the effect of xylitol, a naturally
occurring sweetener, on levels of Streptococcus mutans and S. sobrinus. They
also investigated xylitol's mechanism of action. METHODS: The authors
compared cariogenic bacteria levels before and after exposure to xylitol
products in children and adults. In the first study, 187 children received
xylitol-containing snacks in school for four weeks. In the second study, two
adults received xylitol candy for four weeks. Unstimulated saliva samples
were taken from all subjects. Gingival samples also were taken from the
adults. The authors plated the samples on selective microbiological media.
Individual isolates were plated on media with varying concentrations of
xylitol, and were identified using specific DNA probes. Genetic relatedness
was determined via pulse-field gel electrophoresis. RESULTS: The children's
salivary S. mutans levels remained stable before and after xylitol exposure.
Further analysis of the S. mutans isolates was conducted for seven children.
Bacteria from five of these children grew with 10 percent or less xylitol at
baseline, while the bacteria from all seven children grew with 15 percent
xylitol after exposure to the xylitol-containing snacks, suggesting that the
S. mutans increased in tolerance to xylitol during exposure. Six children
had isolates with the same genotype at both time points. S. mutans and S.
sobrinus levels were reduced in one of the adults as a result of xylitol
exposure, and the bacterial isolates became more xylitol tolerant. In the
second adult, S. mutans and S. sobrinus levels increased, while the subject
maintained the same proportion of susceptible and tolerant strains as that
at baseline. CONCLUSIONS: Overall, consumption of xylitol-containing snacks
and candy did not reduce S. mutans levels. However, bacteria from five
children and one adult became more xylitol tolerant. CLINICAL IMPLICATIONS:
These results provide a basis on which xylitol-containing products can be
recommended and xylitol's mechanism of action can be explained to patients.
The spray described in these pages
is not a drug. This means that the people manufacturing this spray
cannot advertise what the spray does to prevent disease and illness.
The spray only helps to clean your nose. The benefits come from
a clean nose. The only way people will learn about this practical
and sensible way to help the immune system wash pollutants from
the back of the nose is by interested people, like you, sharing
If you have family or friends with any of these problems, they
may benefit greatly from your sharing this information with them.
Links in the other sections, referring to a person or study, will
take you to a Medline summary, from the National Library of Medicine,
of the article in question.
This spray is protected by United States and international patents.
While careful reading of these pages will tell you how to mix this
spray yourself we request that you do not sell such spray on the
open market. Such sales would be prohibited by the above mentioned
Disclaimer: All material provided in this web site is provided
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Dr. Jones specifically disclaims any liability, loss or risk, personal
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A. H. 'Lon' Jones D.O.
812 West 8th St. Suite 2A
Plainview, Texas 79072
Phone (806) 291-0700
Fax (806) 293-8229