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A few months ago, after a routine teeth cleaning, I was surprised to find that I landed firmly in the 90th percentile of dental patients. Put another way, I had lived through 25 years of life without experiencing a single cavity. This was, however, not entirely surprising since I’ve never been afraid of the dentist's nor have I been lackadaisical about daily maintenance. Still, over the years I’ve spoken to many clients and dental professionals alike that are concerned about decaying dental health and its relation to increased training load - specifically ultra distance and long course triathletes.

Naturally, this apparent mismatch of my training volume and the above-average oral health made for some interesting food for thought. As an athlete, I’m still developing in many senses- I have however had 10,000-mile years on the bike, traveled across the country for mountain bike, road, and cyclocross championships, and chased many state and collegiate point series over the years. The issues of maintaining health and longevity have always been important to serious racers and athletes - isn’t the reason we train and race to add more value to our lives, not diminish it?

Next, I went through a few contacts that I’ve picked up through racing and through business - many Doctors of Dental Surgery have sent us letters, notes, emails, and commented on the importance of oral health for longevity. Hopefully that’s not new information for you! Detriments to diet, beverages, habits, and maintenance all play a role in oral health. So the real question is which products targeted to athletes (of all ages) actually support consistent, long-term dental health? And the related question, what evidence is available to back up these claims?

“I think Joy covered most of the basics on sugar but I did want to address your concerns about citric acid. Citric acid is Generally Recognized As Safe (GRAS) by the FDA and 40% of beverage companies use this product safely in their formulations. There isn't too much research out on the detriments of citric acid as I don't see many risks related. Citric acid can actually be used as an antioxidant and anti-fatigue ingredient for athletes”

That was one response I received when I solicited a popular Colorado-based sports drink company on what they knew about the ingredients their products contained. The response demonstrates not just the use of facts without context, but also the haphazard guesswork involved when companies formulate products for serious, hard training athletes. I was, however, concerned with the presentation of scientific research without consideration and thorough analysis that would make it meaningful enough to stand up to my original question - a real person training in the real world concerned about both short-term and long-term health.

Let’s break this part down, “citric acid can actually be used as an antioxidant and anti-fatigue ingredient…”. The ideas presented are believable enough on the surface. Sure, citric acid is present in many fruits and vegetables, and is generally safe and has positive effects. The studies which are few are far between, but nonetheless, confirm that citric acid in plain water strongly correlates to having antioxidant properties. But once we proceed a step further and calculate how much and how often a product - and in this case, a product containing citric acid and simple sugar- is in contact with one of the more delicate parts of the body it’s clear to see the complete lack of logic employed.

Take for example, a 2011 study by The Science of Dentistry with the rather telling title, “Why Gatorade Erodes Teeth Faster than Red Bull and Coke”. From two separate & often quoted studies, the author points out the conflict of interest involved:

Craig Horswill, PhD, senior research fellow at the Gatorade Sports Science Institute, in 2005 reported a study of saliva flow in endurance athletes who drank Gatorade, diluted orange juice, a homemade sports drink, or water. The study showed that if the sports drinks had any effect, it was to decrease dehydration and increase saliva flow, which reduces cavity formation.

More to the point, a 2002 Ohio State University study of 304 athletes found no link between sports-drink use and dental erosion. The study was sponsored by Quaker Oats, which makes Gatorade. “Dental erosion among users of sports drinks in the Ohio State study was the same as it was in nonusers,” said Hoswill. “And they averaged 10 years of sports drink use.” Ignelzi says that what matters most isn’t which beverage people drink. It’s how and when they drink it.

And what about studying oral health from a position free from an agency problem? The findings available prove “On the enamel, Gatorade was significantly more corrosive than Red Bull and Coke. Red Bull and Coke, in turn, were significantly more corrosive than Diet Coke and apple juice. (...) On the roots of the teeth, Gatorade was more corrosive than Red Bull. Coke, apple juice, and Diet Coke followed in that order. The difference in the effect isn’t simply due to their sugar content. Gatorade is 6 percent carbohydrates, mostly sugars. Coke is about 10% sugar. Both are acidic beverages”

The stance I am firmly taking is to seriously consider the applicable evidence on hand. Studies with independently controlled variables, run over a short period of time, often with funding from the very sources they wish to examine, should be taken with a serious grain of salt. What really matters? That the beverages consumed before, during, and after exercise promote and shouldn’t diminish oral health. How and when you drink acidic, sugary drinks must be extremely limited, and if at all possible, completely separate from any training - especially if it’s endurance training. You owe it to yourself to protect the many years and dollars you’ve invested in your sport, teeth, and health, to keep gaining value from doing what you truly enjoy doing.

Source: The Science of Dentistry

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