Oral and Dental Problems in Diabetes

Unfortunately, diabetes is a disease that damages vital organs in the body, and it is also a major threat to gums and teeth. People with uncontrolled diabetes have a high chance of non-healing wounds, leading to infections after treatment. This issue is even more common in individuals who smoke and have diabetes. Oral and dental problems in diabetes include the following:

Oral Problems in Diabetes: Symptoms of oral issues in diabetic patients include:

• Cracks at the corners of the lips due to reduced saliva secretion and dry mouth
• Severe redness of the oral mucosa, burning sensation on the tongue and mucosa, and altered taste sensation
• Presence of fungal-like papillae on the tongue
• Development of grooves around the teeth near the tongue
• Enlargement of the tongue, thickening, and formation of grooves
• Tongue pain
• Change in the oral microbiome, such as an increase in Candida albicans, which causes lip corner cracks and thrush.

Dental Problems in Diabetes: Symptoms of dental issues in diabetic patients include:

• Increased sensitivity of teeth to pressure, especially in the gum-tooth junction
• Tooth pain without visible cavities
• Enamel destruction and increased tooth decay
• Sores caused by irritation from dentures in individuals with uncontrolled diabetes

Gum Problems in Diabetes: Symptoms of gum issues in diabetic patients include:

• Gum bleeding due to changes in gum blood vessels
• Gingival hypertrophy with severe redness and swelling
• Gingivitis and periodontitis, inflammatory diseases of the gum tissue. People with periodontitis eventually lose their supporting bone structure and teeth. Poor diabetes control is a very serious risk factor for periodontitis, and conversely, gingivitis and periodontitis are often the first signs of diabetes. Proper oral hygiene is crucial for diabetic patients, and regular dental check-ups can help detect oral problems early in these patients. In chronic gum inflammation, the supporting structures of the teeth (alveolar bone and periodontal fibers) are destroyed. This disease can be caused by various factors, including anaerobic bacteria and sometimes viruses, along with other risk factors such as smoking, diabetes, and depression, which make the individual more susceptible to gum inflammation. The body’s immune system’s inflammatory response to bacteria leads to tissue destruction, and this occurs in chronic gum inflammation.

Chronic Gingivitis Diagnosis in Diabetes: Chronic gingivitis is a very common inflammatory reaction that occurs in the gum tissue in response to dental plaque accumulation. If this condition persists, it can lead to periodontitis, though not necessarily. Clinical manifestations of gingivitis can change due to systemic factors, including poorly controlled diabetes, which further affects the gum tissue in response to dental plaque.

The Connection Between Diabetes and Gingivitis/Periodontitis in Dental Problems: Although periodontitis is a known complication of diabetes, individuals who effectively control their diabetes and maintain good oral hygiene are not at an increased risk of periodontitis. However, the risk of periodontitis clearly increases in people with poorly controlled diabetes, especially if they smoke. Recent epidemiological studies indicate that the prevalence of diabetes is twice as high in individuals with periodontitis compared to others.

Since diabetes can exist for years before being diagnosed, dentists are often the first professionals to detect warning clinical signs of diabetes in patients. Additionally, they can provide insight into how well a patient’s diabetes is being controlled based on oral symptoms.

These symptoms include:

• Resistant gum inflammation after standard periodontal treatment (scaling above and below the gums, oral hygiene practices)
• Severe gum inflammatory response to dental plaque and proliferation of gum tissue at the edges
• Continued alveolar bone loss despite periodontitis treatment
• Progressive and severe periodontitis in individuals aged 20 to 45 (deep periodontal pockets, increased tooth instability and movement, greater spacing between teeth, radiological evidence of advanced bone damage)
• Spontaneous formation of periodontal abscesses.

How Diabetes Increases the Risk of Periodontitis in Diabetic Patients: Glycosylation of end products and their deposition on tissues due to elevated blood glucose levels can alter the phenotype of macrophages and other cells via specific cell surface receptors. Macrophages are key cells in the development of periodontitis, as they cause the disease through the production of various cytokines. They also affect the inflammatory response, fibroblast and lymphocyte metabolism, and bone resorption via prostaglandin E2. Excessive glycosylation of end products seems to convert macrophages into destructive cells that uncontrollably produce pro-inflammatory cytokines.

The function of neutrophils, which are the first defense line in gum tissue and the bone surrounding teeth, is reduced in diabetic individuals. This may be another mechanism by which diabetes increases the risk of periodontitis.

Is There a Relationship Between Periodontitis and Diabetes Control? While periodontitis is a well-known complication of poorly controlled diabetes, it also creates metabolic disturbances that affect diabetes management. This process occurs due to the release of systemic mediators (inflammatory cytokines like TNF-α from gums affected by periodontitis) and exposure to gram-negative organisms.

What Steps Can Patients Take? People with diabetes must take special care of their oral health, including brushing and flossing. Using toothbrushes that reach between the teeth can help alleviate gingivitis. Using chlorhexidine mouthwashes or chlorhexidine gel twice daily (separately from toothpaste, as chlorhexidine is deactivated by toothpaste) can help manage many severe forms of gingivitis. Patients should consult their dentist to determine the appropriate duration for chlorhexidine use. Dental care, including checks and treatments every six months, is essential for diabetic patients to maintain gum health and prevent advanced treatments.

The diabetes care team should refer diabetic patients with gingivitis or periodontitis to a dentist for necessary treatments.

White Beans: Rich in protein and soluble fiber, which helps reduce cholesterol levels. Light legumes like white beans are very beneficial for slowing the rise in blood sugar levels. As part of a study conducted at the University of Toronto in 2012, 121 people with type 2 diabetes followed a healthy diet that included one cup of white beans or whole grains daily. After three months, it was observed that the group consuming beans had a significantly greater reduction in their hemoglobin A1C levels (a marker for average blood sugar control) compared to the group that consumed grains.

Spinach: Spinach is one of many leafy vegetables that are beneficial for treating diabetes. Research has shown that spinach can greatly reduce the risk of developing diabetes. Studies in the UK found that individuals who consumed more than one serving of spinach and other leafy greens daily had a 14% lower risk of diabetes compared to those who consumed less than half a serving daily. Spinach is particularly rich in vitamin K, along with minerals such as magnesium, folate, phosphorus, potassium, and zinc. It is also a good source of lutein, zeaxanthin, and various flavonoids.

Oxalic Acid in Spinach: Although spinach is a rich source of calcium, it also contains oxalic acid, which inhibits calcium absorption. To mitigate this issue, it is recommended to briefly boil spinach for one minute to reduce the effects of this chemical.

Sweet Potatoes: A study showed that sweet potatoes, a beneficial food for diabetics, can reduce fasting blood sugar levels by 10 to 15%. Sweet potatoes are also rich in anthocyanins, which contain natural pigments that give them their dark orange color and are high in antioxidants. Additionally, sweet potatoes are said to have anti-inflammatory, antiviral, and antimicrobial properties.

Walnuts: The walnut tree is the most widespread type of tree nut worldwide and is found in most regions. Walnuts contain an unsaturated fatty acid called alpha-linolenic acid, which has been shown to be very effective in reducing inflammation. L-arginine, omega-3s, fiber, vitamin E, and other plant chemicals found in walnuts and similar nut trees offer numerous health benefits due to their richness in essential vitamins and nutrients.

Benefits of Walnuts:

• Antioxidants
• Anti-cancer
• Antiviral
• Help prevent high cholesterol These properties can help slow down the progression of chronic diseases like diabetes and heart disease. The time spent cracking open walnuts also allows the body more time to absorb nutrients, and individuals will feel fuller with fewer calories.

Quinoa (Goosefoot Seeds): Quinoa tastes like grains but is more closely related to spinach. Unlike many grains, quinoa is a compact source of “complete” protein (14 grams per half-cup) and contains all nine essential amino acids. One of these amino acids, lysine, helps the body absorb fat-burning calcium and aids in the production of carnitine, which is responsible for converting fatty acids into energy, ultimately helping to lower cholesterol. Quinoa is also one of the most fiber-rich seed-like foods, containing 2.6 grams per 2.1 cups. This fiber helps balance blood sugar levels and keeps individuals fuller for longer.

Cinnamon: Numerous studies have shown that this delicious spice can help reduce blood sugar. In a journal dedicated to diabetes care, it was mentioned that individuals with type 2 diabetes who consumed one or more grams of cinnamon daily saw a 30% reduction in their fasting blood sugar. They also observed a reduction of more than 25% in their triglycerides, LDL cholesterol, and overall cholesterol levels. It is worth noting that cinnamon is rich in chromium, a mineral that enhances the effects of insulin. Additionally, cinnamon is rich in:

• Polyphenols
• Various antioxidants

What benefits does it offer?

• Collects all free radicals in the blood
• Protects the body from cancer
• Reduces inflammation in the body This ultimately boosts immunity against diabetes and heart disease.

Collard Greens: Leafy greens like collard greens, a type of cruciferous vegetable, are an excellent source of vitamin C, which helps reduce cortisol levels in the body and reduces inflammation. Collard greens (and other cruciferous vegetables like kale and Brussels sprouts) are also a good source of alpha-lipoic acid (ALA), which helps regulate stress in individuals. When scientists at the Linus Pauling Institute at Oregon State University injected aging mice with ALA, they found that the animals’ bodies were able to produce the necessary antioxidants, which helped them resist toxic environmental substances and also reduced inflammation. Good news for diabetics: ALA also helps reduce blood sugar and may help strengthen nerves damaged by diabetic neuropathy.

Turmeric: Turmeric has likely been a health protector for the entire Indian subcontinent for around 5,000 years. Turmeric is a part of the traditional Indian diet, including rice and white flour bread, and quickly aids in the digestion of carbohydrates that significantly increase blood sugar levels. The presence of turmeric – the yellow spice that gives many curry dishes their color – helps control its dramatic effect on blood sugar. Curcumin, the active compound in turmeric, works to regulate fat metabolism in the body. Curcumin directly affects fat cells, pancreas cells, kidney cells, and muscle cells by reducing inflammation and blocking the activity of tumor necrosis factors and IL-6, which are linked to cancer. Experts believe that the combined effects of all these factors enable curcumin to:

• Reduce insulin resistance
• Lower blood sugar
• Lower cholesterol
• Eliminate other obesity-related symptoms.

Chocolate:
Chocolate is rich in flavonoids, making it a beneficial food for treating diabetes. Research shows that these nutrients contribute to:

• Reducing insulin resistance
• Improving insulin sensitivity
• Lowering insulin levels
• Reducing insatiable cravings for food

However, it’s important to note that not all chocolates are the same. In a study conducted by the University of Copenhagen in 2008, it was reported that individuals who consumed dark chocolate, despite having a lower intake of beneficial flavonoids and often more sugar and excessive fat, were less likely to crave:

• Sweet foods
• Salty foods
• High-fat foods

Consuming dark chocolate resulted in:

• Participants rejecting 15% less pizza, which they were supposed to eat that day.

Benefits of Chocolate:
Research over the past five years has shown that the flavonoids in chocolate play a key role in:

• Reducing the risk of stroke
• Maintaining normal blood pressure
• Reducing the risk of heart attacks
• Contributing 2% towards these benefits.

Broccoli:
Broccoli is a superhero against diabetes. Like other cruciferous vegetables such as:

• Cabbage
• Cauliflower

Broccoli contains a compound called sulforaphane, which:

• Is effective in anti-inflammatory processes
• Improves blood sugar control
• Protects blood vessels
• Prevents cardiovascular damage

Cardiovascular disease is the leading cause of death for people with diabetes, so the properties of this food can be lifesaving. Sulforaphane also helps:

• Trigger the body’s natural detoxification mechanism.
• Safely eliminate dangerous cancer-causing enzymes.

Blueberries:
Blueberries stand out due to the following characteristics: They contain two types of fiber:

• Insoluble fiber, which is a “fat destroyer” for your system.
• Soluble fiber, which slows down the emptying process of the stomach, ultimately improving blood sugar control.

In a study conducted by the USDA, participants who consumed two and a half cups of blueberry juice daily for 12 weeks saw significant improvements in:

• Blood sugar levels
• Reduced depression
• Improved memory

Researchers believe these results are due to the anthocyanins found in berries.

Anthocyanins
Anthocyanins are a natural chemical that:

• Reduces fat cells
• Stimulates the release of adiponectin (the hormone that regulates blood sugar)

Increasing adiponectin levels can help:

• Keep blood sugar levels lower
• Increase insulin sensitivity.

Oats:
You might not envision oatmeal as a superfood, but oats are effective in reducing the risk of Type 2 diabetes. Oats are rich in magnesium, which:

• Helps the body utilize glucose.
• Improves insulin secretion.

Eight years of research has shown that:

• The risk of Type 2 diabetes in women with a magnesium-rich diet decreased by 19%, and in women who regularly consumed whole grains, the risk decreased by 31%.

Oats are quick and easy to prepare, and when consumed as whole grains, they contain:

• High fiber
• Nutrients
• Antioxidants

These help improve digestion and stabilize blood sugar levels.

Fish:
Fish is a weight loss legend. It’s packed with protein, which helps you feel satisfied. However, fish also contains a specific type of fat that:

• Causes low-level inflammation in the body.

Thousands of studies show that individuals with the highest levels of omega-3 fatty acids in their blood suffer less inflammation throughout the body. In fact, this inflammation contributes to:

• Weight gain
• Worsening diabetes symptoms

A diet rich in fish can also reduce the risk of health problems, especially stroke.

A study at Emory University in 2010 reported that:

• Those who consumed fish cooked, grilled, or steamed reduced their risk of stroke by 3%. However, fried fish like:

• Fast food

• Fish sandwiches

• Fried seafood in oil

Is very harmful and dangerous.

Olive Oil:
Recent findings in Spain suggest that following a Mediterranean diet rich in olive oil reduces the risk of Type 2 diabetes by 50% compared to a low-fat diabetes diet. Researchers at the Technical University of Munich (TUM) found that olive oil, compared to other oils like:

• Lard
• Butter
• Canola oil

Is much more beneficial and better meets the body’s fat needs. Additionally:

• Olive oil is a prominent source of unsaturated fats.
• It is rich in antioxidants, which protect cells from damage and prevent the progression of heart disease.

Psyllium Husk:
This fiber-rich supplement is used to relieve chronic constipation. It has also been shown to be highly effective for:

• Blood sugar control in diabetics.

A 2010 study at the University of California, San Diego, confirmed the significant impact of this plant from a pharmacological perspective. Participants who took psyllium before each meal showed:

• A 2% reduction in blood sugar levels after meals, compared to those not taking the supplement.

Note:
Researchers recommend waiting at least four hours after consuming psyllium before taking other medications because it may reduce the absorption speed of those medications.

“Eat This, Not That”

The idea behind “Eat This, Not That” comes from David Zinczenko (former editor of Men’s Health) and chef Matt Goulding. Throughout the book, the focus is on consuming fewer calories than the body burns each day.

You do this by swapping high-calorie foods with items that are lower in fat and calories.

What can you eat? Almost anything, including:

• Bread, coffee
• Desserts, steak

There is a lot of information about dining out and avoiding high-calorie meals at restaurants.

Substitute some restaurant main dishes:

• Burger: Double Stikin’ Shake with cheese (440 calories) instead of five small cheeseburgers with lettuce, tomato, onions, and mayo (673 calories)

• Salad: Santa Fe Chicken Salad (670 calories) instead of Fresh Max Choi’s Grilled Chicken Fajita Salad (1220 calories)

• Pizza: Domino’s Artisan – Italian sausage and three-pepper pizza (320 calories) instead of Italian sausage hot pizza and red onion pizza (540 calories)

Effort level: Low

There are no strict rules to remember, but you need to pay attention to the food you eat and figure out what the best choices are. Finding substitutes in your favorite restaurants is easy. It’s even easier to shop for food at grocery stores with a long list of approved foods.

Limitations:

• Cooking and Shopping: As you usually cook and shop.
• Packaged foods or meals: No.
• In-person sessions: No.
• Exercise: No specific recommendations, but the authors suggest you should engage in enough activity to burn off the calories consumed daily.

Is there room for different diets or preferences?

• Vegetarian or Vegan: While there are no specific instructions for vegetarian or vegan diets, this plan can be a source to help replace your eating style.
• Low-fat diet: Every substitute listed in the book includes calories, fat, sugar, and sodium.
• Gluten-free diet: No. Many of the substitutions are restaurant-related, where it can be hard to find gluten-free foods.

What else should you know?

• Cost: No extra fees.
• Support: This is a self-directed plan. You can sign up on the website for access to weight-loss tools and more.

What does Caitlin Zelman, MPH, from Reader’s Digest say? Does it work? “Eat This, Not That” is not really a diet, but a calorie-counting guide that helps you lose weight by making healthier choices. Don’t assume everything in the “Eat This” section of the book is healthy or recommended for weight loss.

This helpful guide can be taken to supermarkets and restaurants to help you make smarter decisions.

The weight-loss claims of the diet aren’t supported by any research, and some questionable recommendations, such as including some nutritious foods in the “Don’t Eat” sections, exist.

Is it good for specific conditions? If you’re trying to reduce sodium, fat, or calories in your diet, this guide can help steer you towards supermarket suggestions and restaurant menus. But it is not a nutritionally balanced diet. Don’t assume everything in the “Eat This” section of the book is a healthy suggestion for weight loss.

If you’re dealing with a medical condition, consult your doctor for dietary guidance.

Final thoughts: The analysis of restaurant menus and grocery store foods is eye-opening. Avoiding the 20 most fat- and calorie-heavy foods, while adding eight nutrient-dense options to your diet, is a good suggestion for anyone.

If you occasionally consume fast food or prepackaged meals, this guide is packed with useful information to help you make smarter choices.

It’s also a helpful guide for people who want to make better choices but don’t want to follow a strict diet. Weight loss won’t happen unless you control your daily calorie intake and exercise.

People who need structure and more weight loss should find another diet that works for them.

Here is the English translation for the text you provided:

“A low-carb diet is one that limits carbohydrates found in sweet foods, pasta, and bread. This diet is rich in proteins, fats, and healthy vegetables.

Low-carb diets come in various types, and studies show that they can all help you eat sweets, lose weight, and improve health effectively.

Here is a detailed meal plan for a low-carb diet along with a sample low-carb menu for one week.

A Simple Low-Carb Diet Plan The foods you should eat depend on a few factors, including your health status, the amount of exercise you do, and how much weight you need to lose.

Basic Principles:

Foods You Should Eat: Meat, fish, eggs, vegetables, fruit, nuts, seeds, full-fat dairy, healthy fats, and possibly some root vegetables and gluten-free grains.

Foods You Should Avoid: Sugar, HFCS, wheat, seed oils, trans fats, low-fat and “diet” products, and processed foods.

Foods You Should Avoid: You should avoid these 7 food items, in order of importance: sugar, soda, fruit juice, agave, candy, ice cream, and other sugary foods.

Gluten-containing grains: wheat, barley, and rye. This includes bread and pasta.

Trans fats: hydrogenated or partially hydrogenated oils.

High omega-6 vegetable and seed oils: flax, soy, sunflower, grape seed, corn, sunflower oil, and canola oil.

Artificial sweeteners: aspartame, saccharin, sucralose, cyclamates, and acesulfame potassium. Instead, use stevia.

“Diet” and “low-fat” products: many dairy products, cereals, crackers, and more.

Many processed foods: If a product was made in a factory, don’t eat it.

Even if a food is labeled “healthy,” read the ingredients before consuming it.

Low-Carb Food List – Foods to Eat You should base your diet on these low-carb and unprocessed foods.

Meat: beef, lamb, pork, chicken, etc. Preferably grass-fed meat.

Fish: salmon, trout, haddock, etc. Preferably wild-caught fish.

Eggs: Preferably omega-3 enriched, free-range eggs.

Vegetables: spinach, broccoli, cauliflower, carrots, etc.

Fruits: apples, oranges, pears, blueberries, strawberries.

Nuts and seeds: almonds, walnuts, sunflower seeds, etc.

Full-fat dairy: cheese, butter, heavy cream, and yogurt.

Fats and oils: coconut oil, butter, lard, olive oil, and fish oil.

If you want to lose weight, be careful not to consume too much cheese and nuts. Don’t eat more than one piece of fruit per day. Foods You Can Eat: Sweet potatoes

If you’re healthy and active and don’t need to lose weight, you can consume a bit more carbohydrates.

Roots: potatoes, sweet potatoes, etc.

Gluten-free grains: rice, oats, quinoa, etc.

Legumes: lentils, black beans, chickpeas, etc. (if you don’t have bloating issues).

If you like, you can also have organic dark chocolate with 70% or more cocoa in moderation.

Dark chocolate is high in antioxidants and can be beneficial for health if consumed in moderation. However, be careful not to overdo it, as it could hinder your progress on the diet.

Drinks Coffee Tea Water Sugar-free soda, such as sparkling water.

Sample Low-Carb Menu for One Week The following menu is a sample for a “eat sweets, lose weight” low-carb diet for one week.

The total carbohydrate intake in this meal plan is less than 50 grams per day, but as mentioned above, if you’re healthy and active, you can go beyond this.

Saturday: Breakfast: Omelette with various vegetables, fried in butter or coconut oil. Lunch: Yogurt with blueberries and a handful of almonds. Dinner: Cheeseburger with vegetables and salsa sauce.

Sunday: Breakfast: Bacon and eggs. Lunch: Leftover burger and vegetables from the night before. Dinner: Salmon with butter and vegetables.

Monday: Breakfast: Eggs and vegetables, fried in butter or coconut oil. Lunch: Shrimp salad with some olive oil. Dinner: Grilled chicken with vegetables.

Tuesday: Breakfast: Omelette with various vegetables, fried in butter or coconut oil. Lunch: Smoothie with coconut milk, various berries, almonds, and protein powder. Dinner: Steak with vegetables.

Wednesday: Breakfast: Bacon and eggs. Lunch: Chicken salad with some olive oil. Dinner: Pork with vegetables.

Thursday: Breakfast: Omelette with various vegetables. Lunch: Yogurt with various berries, coconut pieces, and a handful of walnuts. Dinner: Kebab with vegetables.

Friday: Breakfast: Bacon and eggs. Lunch: Smoothie with coconut milk, some heavy cream, chocolate-flavored protein powder, and various berries. Dinner: Grilled chicken wings with some raw spinach.

In your diet, consume plenty of low-carb vegetables. If you want to keep your carb intake under 50 grams per day, use large amounts of vegetables and one fruit per day.

Again, I repeat, if you’re healthy, active, and at a healthy weight, you can add some roots like potatoes and sweet potatoes and some grains like rice and oats to your diet.

Healthy and Low-Carb Snacks: It’s better not to eat more than 3 meals per day, but if you’re hungry between meals, you can use healthy and low-carb snacks that are quick and easy to prepare:

One piece of fruit Full-fat yogurt One or two hard-boiled eggs One small carrot Leftover food from the night before A handful of nuts Some cheese and meat

Eating at a Restaurant: In many restaurants, it’s often very easy to find low-carb meals.

Order a main dish based on fish or meat. Ask them to cook your food in butter. Instead of bread, potatoes, or rice, have extra vegetables.

Low-Carb Shopping List: As a general rule, it’s better to shop at stores that have all the ingredients you need.

Prioritize organic foods. But even if you don’t use organic foods, don’t worry, your diet will still be a thousand times better than the standard Western diet.

Try to select minimally processed foods that fit within your budget.

Meat (beef, lamb, chicken, bacon) Fish (fatty fish like salmon) Eggs (omega-3 enriched, free-range eggs) Butter Coconut oil Olive oil Cheese Heavy cream Sour cream Yogurt (full-fat, unsweetened) Blueberries (you can buy frozen) Nuts Olives Fresh vegetables: leafy greens, various peppers, onions, etc. Frozen vegetables: broccoli, carrots, various mixed vegetables. Salsa sauce Spices: sea salt, pepper, garlic, mustard, etc.

I recommend that, if possible, you clean your pantry of tempting unhealthy foods like chips, candy, ice cream, soda, fruit juice, bread, cereals, wheat flour, and sugar.”

Translation by Pararin Pars in Ordibehesht 1396 (April 2017). Sources: authoritynutrition”