Ask The Doctor: January 2022
I am struggling with bad breath. What can I do?
Bad breath can occur for many reasons, such as poor oral health, consuming certain foods and drinks, and taking some medications. In general, most bad breath is caused by bacteria in the mouth working to dissolve food particles. The bacteria basically ferment the particles, creating a foul smell in the process. The type of bacteria that does this is more prevalent in people who have periodontal diseases, such as gingivitis and periodontitis. These diseases inflame and destroy structures around the teeth and gums The resulting pockets provide the perfect place for mouth bacteria to thrive. Daily flossing and brushing can help reduce the bacterial buildup and dislodge food particles.
Another bad-breath culprit is dry mouth (xerostomia in medical terms). Causes of dry mouth include stress, dehydration, some medications (e.g., antidepressants, diuretics, drugs for urinary incontinence), and radiation and chemotherapy. Sip on water throughout the day, and also try sucking on sugar-free citrus candy or chewing gum to stimulate saliva production, which helps wash the mouth. You can also try over-the-counter saliva substitutes. Look for those that contain xylito (e.g., Mouth Kote) or hydroxyethyl cellulose (Biotene). Obviously, certain foods like garlic and onion, especially when eaten raw, cause mouth odors. Coffee can, too. After certain foods are digested, the odors pass from the bloodstream into the lungs. Upon exhaling, the unpleasant odors can be detected. It can take about three hours for these odors to clear the system. Unfortunately brushing your teeth won’t make them go away. Mouthwashes can help, but they tend to wear off quickly. Ask your dentist about the ideal mouthwash for you. Less common causes of bad breath include sinus and lung infections, and cancer of the mouth or throat. Regular dental exams can catch problems before they escalate into periodontal diseases. Some people benefit from twice yearly cleanings.
I can feel a lump on my throat that my doctor says is a goiter and not to worry. Can you tell me more about this?
In all likelihood you have what’s called a nontoxic goiter, which is a noncancerous growth on the thyroid gland that does not disrupt thyroid function. These are typically caused by metabolic abnormalities or thyroid hormone deficiency. Infections also can cause these growths. Sometimes nontoxic goiters form temporarily after menopause and can disappear. About 6% of women over age 60 have nodules that can be felt externally, and many more have very small ones that can’t be felt but are detected by ultrasound. Doctors typically keep an eye on these growths. Any suspicious tissue should be biopsied. Most nontoxic goiters don’t cause problems. But sometimes they can get bigger and press on the throat, causing a hoarse voice or difficulty swallowing. If that occurs, the mass can be surgically removed or treated with radioactive iodine. Specialists who treat thyroid issues are called endocrinologists. A small percentage of nontoxic goiters can evolve to become malignant, which is why they need lifelong surveillance.
Is sprouted-grain bread better for controlling blood sugar?
That depends on what you compare it to. Sprouted-grain bread is a better choice than white bread for glucose control, but it’s only slightly better when compared to whole-grain bread. In general, blood glucose levels go up when you eat any carbohydrates. But the more fiber a carbohydrate food has, the slower that glucose is digested and absorbed. Conversely, refined carbs, such as white bread and white rice, have little to no fiber, which is why they cause blood sugar to spike quickly. Everyone responds differently to the type and amount of carbohydrate consumed, but bread made from whole or sprouted whole grains is better for blood sugar control than bread made from refined white flour.
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