Periodontal disease and pancreatic cancer


An intriguing article appeared in the Journal of the National Cancer Institute showing a correlation between periodontal disease and the development of pancreatic cancer. There have been a couple of studies correlating tooth loss with pancreatic cancer, but this is the first study I’ve seen that looks at periodontal disease and cancer of the pancreas.

You don’t want to get any kind of cancer if you can help it, but you really don’t want to get cancer in your pancreas. The virulence of cancers are usually defined by their 5-year survival rates, meaning what percentage of people who are diagnosed with a particular cancer are still alive 5 years later. The lower the 5-year survival rate, the deadlier the cancer. According to the latest statistics from the American Cancer Society (ACS), breast cancer has a 5-year survival rate of 88.5 percent, which means that out of 100 patients who are diagnosed with breast cancer, 88.5 of them will still be alive 5 years later. For lung cancer, a pretty deadly cancer, the 5-year survival rate is 15 percent. The 5-year survival rate for pancreatic cancer is 5 percent, making it the most deadly of all the cancers listed in the ACS list. Pancreatic cancer is a good one to avoid.

According to most papers I’ve read the only established modifiable risk factor for pancreatic cancer is smoking. There is evidence is starting to accumulate suggesting that diabetes, obesity and insulin resistance are also associated with increased risk. Recently a number of papers have been published showing that sugar, sugar-sweetened beverages, and high-glycemic-load diets are associated with an increased risk for this deadly cancer.

Now comes this paper showing that male health professionals with periodontal disease have significantly higher rates of pancreatic cancer. And the more severe the periodontal disease, the higher the correlation. Why should periodontal disease predispose to pancreatic cancer? I think the reason is pretty obvious, but the authors of the paper dance all around the issue.

According to the authors

Several mechanisms could potentially explain the observations from this study. Inflammation appears to play an important role in pancreatic cancer pathogenesis, although the inflammatory mediators that lead to the development of pancreatic cancer remain poorly defined. An association between periodontal disease and systemic inflammation has been observed using biomarkers. In the HPFS [Health Professionals Follow-Up Study, the study from which the database for this analysis was drawn], plasma C-reactive protein levels were 30% higher in individuals with a history of periodontal disease than in those with no history. We hypothesize that periodontal disease may promote pancreatic carcinogenesis through inflammation.

Alternatively, periodontal disease could influence pancreatic carcinogenesis through increased generation of carcinogens, namely nitrosamines. Individuals with periodontal disease and poor oral hygiene have elevated levels of oral bacteria and have much higher nitrosamine levels in their oral cavity due to nitrate-reducing bacteria. Nitrosamines and gastric acidity have been hypothesized to have an important role in pancreatic cancer; numerous studies support this hypothesis [I found only one].

To summarize, the authors hypothesize that the inflammation caused by the infection in the gums causes the pancreatic cancer and/or the increased gastric acidity from the nitrosamines produced by action of the infectious bacteria.

I suppose that inflammation and increased gastric acidity could cause it, but I don’t believe those are the most likely causes. Remember, we’ve got a number of studies showing that the consumption of sweets and a high-glycemic diet appears to increase the risk for pancreatic cancer. There is evidence that obesity, diabetes and insulin resistance are correlated with increased rates of pancreatic cancer. And now we’ve got periodontal disease to add to the mix.

What causes periodontal disease? I’ll give you a clue. Just as with dental caries (cavities), periodontal disease doesn’t appear in the remains of pre-agricultural man. Periodontal disease is easily recognizable from skeletal remains, and it just ain’t there in our meat-eating ancestors. Once agriculture took root (no pun intended), dental caries and periodontal disease became common. It’s hard to find an ancient Egyptian mummy without severe dental disease. And remember, ancient Egyptians lived in the days before sugar, so we can’t blame sugar for their dental disease. They ate a huge amount of grain and mummy-jpeg.JPGgrain-based foods, a fari amount of fruits and vegetables, and very little meat. In fact they ate pretty much the kind of diet that today’s nutritionists would have us all eat to prevent disease. It didn’t do the Egyptians a whole lot of good. The calculus (tartar) deposits on their teeth were often so extensive that they held the teeth in place after death for 2,000 years. The result of these deposits is early bone loss, loose teeth, infection, and tooth loss. In addition, the ancient Egyptians had arteriosclerosis, obesity, rampant tooth decay, and a host of diseases that we consider ‘modern’ diseases.

Sticky, high-carb foods cause periodontal disease. The obesity, diabetes, and insulin resistance mentioned above are probably caused by high-carb diets. The papers mentioned above show that high-carb diets are associated with pancreatic cancer. So, despite the authors speculating about inflammation and increased gastric secretions, I think the periodontal disease data further confirms the hypothesis that excess carbohydrate consumption is more than likely the driving force behind pancreatic cancer.

As if you needed more, this is just another reason to follow a whole-food low-carbohydrate diet.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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15 thoughts on “Periodontal disease and pancreatic cancer

  1. Thanks for another informative post, Dr. Eades. My dad died of pancreatic cancer in 1983 at the age of 56. He had terrible teeth and had had bridge work and several false teeth put in. I wouldn’t have called him a sugar junkie or obese. He WAS overweight in the five years before his cancer was diagnosed, but not what I’d call obese.

    What he did do, though, that you didn’t mention as a possible factor, is drink. In fact, he was probably an alcoholic, though not the stereotypical type who gets abusive and loses work time. No, he was a responsible leader of the community. But every day he’d come home and have a nice tall screwdriver (very high carb drink) and several drinks made with Coke or Pepsi. You can bet those soft drinks were not the diet variety. He drank lots of beer and wine as well.

    He also smoked, way more than I suspected at the time. My mom served us a standard American diet of the time — mostly good home-cooked food, dessert occasionally but not every day — though there was always ice cream around and he loved that. Naturally, it’s difficult to reconstruct this many years later. But we had the standard meat-starch-veggie combo for every meal, and he did dearly love the starchy foods.

    That, and his smoking and his drinking, probably did it for him.

    Good reason for me to stick to my low-carb eating habits, my general avoidance of alcohol (except as an occasional accompaniment to dinner), and my commitment to not smoking. –Anne

    Hi Anne–

    Sorry to hear about your dad.  Smoking is the one modifiable risk for pancreatic cancer that no one argues with. Combining that with a high carb diet is deadly.



  2. Your point about a high-carb diet being a major contributor to this disease makes a lot of sense. Of course the mainstream disagrees… A quickie web search reveals that Mayo clinic, oncology channel, Sloan-Kettering and WebMD all claim “a diet high in meat and animal fat” is a risk factor. No surprise there considering the sources.

    I suspect they have misinterpreted, or misrepresented, the results of some study (sorry, no reference) that showed smoked/cured/charred meats increase cancer risk. I could maybe buy that argument, but I need to see the study.

    Anyway, keep up the great blog. I love your easy-to-understand style of presenting highly technical info.

    Hi Tamara–

    Michael Hill, a British epidemiologist, has written and lectured extensively on the subject of meat and cancer.  In hundreds of thousands of subjects, he has found no evidence that fresh meat causes cancer.  In fact, it may be protective.  According to Dr. Hill there is some evidence that a large consumption of cured meats might cause a slight increase in cancer risk.



  3. Excellent post Dr. Eades! I will be sure to email this to my Mom who would find this information useful. (She is a Type 1 diabetic with periodontal.)



  4. I think you’re right with this, Mike. About 30 days after starting Protein Power way back when, my previously ‘intractable’ perio disease dramatically disappeared. My periodontist actually took photos of my mouth for a talk he was giving. He said it ‘wasn’t likely’ that carb restriction helped. Phooey. (I wish I had known that before enduring my first round of gum surgery.)

    I also think high-carb eating is the link between perio disease and heart disease, which I’ve heard about many times. High-carb diet, high insulin, high CRP, and you’re heading for CHD.

    Hi Walt–

    I can’t tell you how many patients I’ve had who have told me the same thing–they say that since starting low-carb, their dentists are remarking on how good their gums look.

    Sugar feeds the bacteria that cause periodontal disease and dental caries.  Carbohydrates are basically sugars.  Therefore carbohydrates cause periodontal disease and cavities.  In fact, starches are probably worse than sugars because they are sticky and end up stuck between the teeth and in the gum line.



  5. It’s about 9 am on the east coast and I am checking in with Dr. Mike’s blog to find out how little I actually know about economics. I have a hot mug of heart healthy coffee as I click on the link from “My Favorites.” As the page loads I am treated to the close up picture of bloody gums. Good morning to you too Dr. Mike, excuse while I go brush my teeth.
    Keep up the good work, I am learning lots!

    Hi Dave–

    Believe it or not, I’m learning lots too.  Thanks for keeping after me; it forces me to refine my own thinking.



  6. I always suspected that the link between oral health and other diseases was not a cause-effect reaction. It always seemed naive to me to think that it was, instead of thinking of them both as symptoms of an underlying problem. Thanks for confirming my suspicions!

    My pleasure.



  7. Speaking of nitrosamines, what’s your view of meats that are preserved with sodium nitrite? Also to be avoided?

    Hi Gary–

    A little is probably okay.  I wouldn’t make it the main way I eat meat, though.



  8. Very interesting. I have this. I’ve had extensive dental work in the last 6 months trying to undo 20 years of neglect – a “deep cleaning” and finally two rounds of oral surgery. And for the first time in many years my gums no longer bleed when I brush. But the dentist said that periodontal disease is like diabetes – once you have it you never get rid of it. All you can do is control it.

    Hi Victoria–

    I suspect your dentist is right, sort of.  I think that you can get rid of it with the proper diet, but you could also say that the proper diet controls it.



  9. Here’s a little something I dug up once to justify my not flossing (I eat paleo):

    “In addition to a lack of consistent epidemiologic evidence on a role of plaque in the etiology of chronic periodontitis, there is ecologic evidence that suggests that periodontitis prevalence is not dependent on access to traditional personal oral hygiene tools. Despite the absence of traditional Western personal oral hygiene aids in many parts of rural Africa, the prevalence of periodontitis is generally low [4]. In contrast, in the USA population, African-Americans have the highest susceptibility to periodontitis [1]. Similar epidemiologic trends have been observed for diabetes and coronary heart disease. Such trends appear paradoxical since the absence of traditional oral hygiene methods in rural Africa would be expected to be associated with a higher incidence of chronic periodontitis, the opposite of what is observed. While it is possible that chewing sticks with their natural antimicrobials [10] are more effective than Western personal oral hygiene aids, alternative explanations such as Neel’s thrifty gene hypothesis [22] or lifestyle factors such as smoking appear more consistent with explaining the epidemiology of chronic diseases such as diabetes [8] or periodontitis.”

    They don’t mention diet as a risk factor, but it would certainly explain the discrepancy between rural Africans and African-Americans. You can read the full article here.

    On another note…did you ever take up cold showers or rinses since reading that article I sent you on increased glutathione, superoxide dismutase and catalse in cold water swimmers?

    I recently came across this link, which though completely anecdotal, supported the idea of brief cold water exposure promoting longevity.

    Hi M–

    Thanks for the link on paleo peridontal.

    I take plunges into Lake Tahoe from time to time, but nothing on a regular basis.  I probably should do it more often, but I just can’t bring myself to.



  10. Hello Dr. Eades!
    I just finished watching the pbs special about heart disease. The pushers of the cholesterol theory and statins seemed pretty smug, it’s depressing thinking that half of America will have seen that and take it is as gospel. Did you happen to see it, and will you be commenting on it?
    But the real reason for this post: Are there any data about survival rates for pancreatic cancer sufferers who drastically change their diet and cut back on the carbs? Perhaps the survival rates are so low because patients follow the misguided dietary advice of their physicians and the media. Any thoughts?

    Hi Norman–

    No, I didn’t see the PBS special on heart disease, but I can only imagine.  Especially if they trotted out all the usual suspects as ‘experts.’

    I don’t have an answer to your question about survivability of patients with pancreatic cancer who go on a proper diet.  Unfortunately, most of them – at least the ones who try to change their diets – seem to go on low-fat, high-carb diets based on the mistaken notion that these are more ‘natural’ and are what the mainstream deems as more ‘healthful.’



  11. I googled “pbs special heart disease”

    The transcript, and presumably the programme too, contained bits from your old friends from Framingham, Drs Castelli and Kannel, plus Steve Nissen and Daniel Levy. As you say the usual culprits!

    Hi Neil–

    I figured as much.



  12. We know what sugar does to teeth. Why doesn’t that same logic proceed with anything that negatively affects the pancreas? I am getting sleepy so I don’t know if I am making any sense. But here is something that I would like to relate.

    As a kid, I was a low carber. I didn’t like rice, pasta, breads. They made me feel over full after a couple of bites. However, I had a great love for meats and vegetables. My dad was one who did not believe in regular costly check-ups. The only time we kids ever saw a dentist was when we had a cavity. I never saw a dentist until I experienced my first pregnancy at the age of 25. That was when I had my first cavity.Of course, now ( 25 years later ),my family and I visit the dentist on a regular basis. But what do you think helped me to a live my first 25 years of life without one cavity, no periodontal disease…nada?

    Another story: I began low carbing 4 years ago. For about 3 years after beginning this regimen, we had no dental coverage so we did not visit the dentist.Finally, after 3 years we found an affordable dental plan. When I went to the dentist for a check-up and cleaning I was told that my teeth weren’t bad at all.I had no cavities. The only treatment I received was a routine cleaning that I barely even needed according to the dentist.

    Just a Speculation,

    Hi Mary–

    Thanks for the report.  I’ve heard the same from many others.  It’s pretty clear that a low-carb diet is good for the teeth and good for the gums.



  13. Since I followed your diet after reading your book, Protein Power Lifeplan and Protein Power, 3 years ago, I have not had any tooth problems. My dentist is not very happy with me now.

    Your plan truly works!! Thanks.

    Hi Melanie–

    I’m always happy to annoy dentists by depriving them of bad teeth to work on.



  14. Dr. Eades,

    I recently heard about the correlation with medical problems and perio. disease. I feel that my father has serious perio. problems. His gums are receding and his roots are starting to show and his teeth are loosening. We do not have insurance and I am afraid of it getting worse. My father does not understand how this can affect him in so many ways. What do you suggest? See a dentist first? Or a doctor? I really worry about him. He is not overweight, he quit smoking for nearly 8 years and recently became a Vegetarian for 2 years. Thank you so much for this informative article. I hope to hear from you soon.


    Hi Lisa–

    His first trip should be to the dentist.  If his gum disease is bad enough, the dentist will probably refer him to a periodontist.  The vegetarian diet isn’t helping his condition a whole lot.  He needs to be treated sooner rather than later.

    Good luck.


  15. I’d like to know more about low-carb (low/no grain) diets. For us computationaly challanged people, how do I subscribe to your blog?


    Hi Dave–

    I’m computationally challenged myself, so I don’t have a clue.  I’ll post this comment, and I’m sure someone out there will tell us.