Dr Mellanby’s Remineralizing Diet

In the 1920’s and 30’s Dr May Mellanby conducted diet trials to determine the effect of vitamin D and nutrition on the development of tooth decay.  Importantly, these trials were conducted in resident hospitals and orphanages, which allowed precise control over food intake.

Compared to the Standard Diet of the day, Dr Mellanby obtained remarkable results with the Remineralizing Diet.  Over a six month period, those children following the Remineralizing Diet experienced very few new cavities, with the widespread arrest and healing of pre-existing decay, while those children on the Standard Diet continued to developed more new cavities with no healing.

Comparison between the Standard and Mineralizing Diets. The children on the Remineralizing Diet experienced almost no new cavities, with widespread healing of existing cavities.

The second remarkable aspect of Dr Mellanby’s Remineralizing Diet was how unremarkable the food was.  Basically it consisted of balanced, though stodgy British fare, supplemented with vitamin D and rich in calcium.  It contained no organ meats, bone marrow, shellfish or fermented foods.  The meat and dairy products were likely from grass-fed animals, however it is not stated whether the dairy was raw or pasteurized.

The main features of the diet were:

  • Vitamin D was supplement using cod liver oil and vitamin D supplements to about 2000 IU per day.
  • Milk was served with all meals so that each child received about one quart per day.   This provided about 1200mg of calcium out of a daily total of 1700mg, and also provided considerable phosphorus;
  • Added sugar (including jam and syrup) was limit to 57 g per day, or about 14 teaspoons.   Today in the US, children and adolescents consume on average 26 teaspoons of added sugar per day.
  • The diet contained no cereal, bread, rice or other grains.  Carbohydrates in the diet came from potatoes, fruit and vegetables, milk and sugar.

Sample meals from the Remineralizing Diet are given below:

  • Omelet, cocoa with milk.
  • Scrambled egg, milk, fresh salad.
  • Omelet containing 2oz ground beef.
  • Fish-cake with potatoes dipped in egg and fried.
  • Bacon, fried or finely chopped with parsley and scrambled egg.
Lunch(Main meal of day)
  • Potatoes, steamed ground beef, carrots, stewed fruit.
  • Irish Stew, potatoes, stewed fruit.
  • Cold meat cut into small pieces with cold dried carrot, onion and potato, and served on lettuce leaf.
  • Fresh fruit salad with egg, custard or cream.
  • Tinned pineapple with jello.
  • Baked apple with center filled with golden syrup before baking.
  • Minced beef warmed with Bovril, green salad.
  • Potato cakes or fish cakes.
  • Eggs, cooked in various ways.
Evening Snack (Supper)
  • Fish and potatoes fried in dripping.
  • Thick potato soup made with milk.
  • Lentil or celery soup made with milk.
  • Cheese, served in various ways.
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Can Cavities Really Be Healed?

In a word…Yes! Dentists use the term “arrested” to describe dental caries in which the decay process has stopped and the decay is no longer active.  In lay terms, arrested can be considered the same as healed.

The arrest and healing of tooth decay has been described many times in leading dental text books and  journals.

A few examples (to paraphrase):

Teeth containing large cavities, which ordinarily would have an area of softened dentin surrounding the zone of destruction, were found instead to be very dense.  Open cavities showed no signs of progress months after they were first observed.

Dr J.D. Boyd, MD and Dr. C.L. Drain, DDS, 1928

In active decay the tissue for some distance below the surface is more or less depleted in minerals and feels “soft” to the dental probe.  In early stages of arrest the surface zone may feel rough or leathery.  In the next stage the surface is found to be hard but rough, and later the irregularities may be removed by mechanical abrasion.  This process may take months or years, but eventually the surface may become quite hard, smooth and polished, but active decay may have stopped long before this stage is reached.

Dr May Mellanby, DSc, 1933

One of the most severe tests of a nutritional program, accordingly, is the test of its power to check tooth decay completely, even without fillings.  If diet has been sufficiently improved, bacterial growth will not only be inhibited, but the leathery decayed dentin will become mineralized from the saliva by a process similar to petrification. When scraped with a steel instrument it frequently takes on a density like very hard wood and occasionally takes even a glassy surface.

Dr W.A. Price, DDS, 1934

From "Essentials of Dental Caries", Dr Edwina Kidd, 3rd Ed, 2005.

To the left is an example of an arrested cavity.  Despite the decay having advanced well into dentin, the exposed dentin was hard and shiny. The tooth had been in this state for at least 10 years.

This example is admittedly not very attractive (to say the least), but does show that tooth decay can heal even when it has advanced beyond the enamel and well into the dentin.

Note that while the decay has been arrested, the cavity does not infill.

From "Oral Histology: Development, structure and function", Dr A.R. Ten Cate, 2nd Ed., 1985. (click for larger image)

When a tooth is attacked by decay or suffers an injury such as a chip, if nutrition is good, it responds by depositing what is referred to today as reparative or tertiary dentin.  (In Dr Mellanby’s time it was called secondary dentin).  The reparative dentin forms only in the area affected by decay or injury, and is an attempt by the tooth to protect the pulp.

As healing progresses, the decayed and exposed dentin can become remineralized, ultimately forming a hard, dense, glassy surface.

In her careful experiments, Dr May Mellanby demonstrated that the same nutritional conditions that support development of strong, well mineralized teeth, also support the arrest of dental decay, development of reparative dentin and tooth remineralization.  That is, optimal supplementation of vitamin D, together with adequate calcium and phosphorus and a calcifying diet with restricted intake of sugar and cereal grains. Dr Weston Price found even better results when vitamin K2 was also supplemented.

From Dr May Mellanby

This is an example of a healed tooth viewed under the microscope after treatment with the calcifying diet rich in vitamin D, calcium and phosphorus.  The decay has been fully arrested. There is a thick layer of well-calcified reparative dentin (2D) protecting the pulp, and the surface is hard and smooth with no decay.

When tooth decay is active, the goal of nutritional supplements and diet is to create the optimal dietary and nutritional environment that harnesses the body’s defenses and supports the natural arrest of the decay and remineralization of the affected areas.  In other words, to create the conditions that allow teeth to heal…naturally and without dental intervention.

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Taro and Sweet Potato

If the carbohydrate in the diet consisted of rice, bread and grain food, the teeth decayed and disintegrated quickly.  If the carbohydrate was in the form of poi and sweet potato, defective teeth do not decay and eventually become hard and smooth.  We regard the role of bacteria as relatively unimportant, since their effect upon teeth may be controlled by diet.

Dr Martha R. Jones

Captain Cook landed in Hawaii in 1778.  He found people who were tall, brown skinned with great muscular strength and broad dental arches.  Dental decay was rare or unknown.  The principal food crops were taro, usually consumed as poi,  and sweet potato, which together made up 60 to 75% of the diet.   Coconuts, fruit, fish and shellfish made up most of the remainder.  Milk and grain foods were unknown.

Fast forward to the 1920’s.  Rice, bread and other grain products had largely replaced taro and sweet potatoes as the staple.  Early childhood caries (ECC) were rampant amongst the breast-fed children of plantation labourers.   Tooth decay was so aggressive that it was frequently necessary for infants to have teeth removed before they reached their first birthday.  By 2 years, almost 100% of those children were affected.  Almost all of the plantation babies had pitted, soft chalky teeth from which the enamel was sometimes completely absent.  The decay progressed in broad lines across the teeth, rather than in pits and fissures, and was associated with growth “spurts”.  Active children who played outside in the sun were more susceptible.  Rampant decay rarely occurred in those who did not eat grains, but instead consumed the traditional taro and sweet potatoes.

The children appear to have been grossly deficient in calcifying minerals, especially calcium, and possibly phosphorus and magnesium.  A study was undertaken whereby 11 babies were provided diets rich in calcium, phosphorus and vitamins with supplementation by a quart of cow’s milk per day for nine months, together with fruit vegetable, egg and meats.   When consumed with a diet where 30 to 40% of the calories came from grains, this supplementation did not prevent the rampant decay.  However, when taro and sweet potatoes were substituted for the grains in the diet, rampant caries was prevented in 39 out of the 42 (or 93%) of the infants.

It apparently matters not whether the teeth are crooked or well spaced; whether the oral hygiene is practiced or not; whether the tooth structure is hypoplastic or perfect, or whether there is even any enamel present.  We have never known a case of active caries in a normal adult who obtains 60 to 70% of the calories of his diet from poi and sweet potatoes.

Jones, M.R., and others, 1934: Taro and sweet potatoes versus grain foods in relation to health and decay in Hawaii”, The Dental Cosmos, 74, 395-409. [Link]

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Something Highly Unusual…

Dr C.L. Drain noticed something highly unusual.  The year was 1927.  During routine dental examination of hospital patients he discovered the complete arrest and healing of cavities in 28 children.  Teeth containing large cavities, which ordinarily would have an area of softened dentin surrounding the zone of destruction, were found instead to be very dense.  Open cavities showed no signs of progress months after they were first observed.  And some teeth showing unquestionable arrest of cavities were found in the most poorly kept mouths.

Dental Examination, 1930's

When these dental observations were cross-checked with the patients’ histories, it was found that without exception the children with arrested caries were all diabetic patients under the care of Dr J.D. Boyd.  Diet, together with minimal insulin, was being used successfully to control the children’s condition.  The children were fed a diet in which fat, rather than carbohydrate, was used as the chief source of energy.  To a large extent it consisted of milk, cream, butter, eggs, meat, cod liver oil, bulky vegetables and fruit.  The daily menu included approximately one quart of milk and cream.  The fat was furnished principally as cream, butter and egg yolk.  The diet contained no sugar, bread or cereal grains.

For the children following this diet for two months or longer, in every instance the decay was arrested.  Soft decaying dentin changed to one “of stony hardness”, with no advance in the destructive process.

Julian D. Boyd, M.D. and C. L. Drain, D.D.S., 1928: The Arrest of Dental Caries in Childhood. J Am Med Assoc. 1928; 90(23):1867-1869. [Link]

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Paying for his civilization with his teeth!

Dr Leuman Waugh, University of Buffalo. Early 1900's.

In 1908, while Dr Leuman Waugh was a Professor of Pathology at the University of Buffalo, he attended a presentation by the curator of physical anthropology at the Smithsonian Institute dental conditions of the Inuit (Eskimo) race.  The Dr. Waugh was mesmerized by the presentation, and eagerly accepted an opportunity to study the extensive collection of Inuit skulls in the museum.  It had become his ambition to see first-hand in the living the caries-free mouths, the massive jaws and the strong, regularly aligned teeth of the Inuit, which combine to produce such outstanding examples of normal, efficient occlusion.

In 1921, Dr Waugh had his chance, and travelled to Labrador (now part of Canada).  Eagerly, he looked forward to the opportunity of examining the mouths of the Inuit people.  On arrival at a missionary settlement, to his utter astonishment, instead of the best dental conditions, he found probably the worst he had ever seen!

Dr Waugh made subsequent trips to the arctic under the auspices of the US Health Service to survey the dental health of the Eskimo and to determine the composition of their diet.  He found that as long as the Inuit lived the primitive, nomadic life of his ancestors, he displayed magnificent teeth and jaws.  However, when he adopted the “white man’s diet and mode of living”, there was a marked deterioration in the size and strength of the jaws, and irregularity of the teeth becomes extreme, as in “American white children”.  This occurs in even one generation, and was due to changes in the food, particularly the introduction of soft, sweet foods, sugar and white flour, which displaced the traditional foods, consisting of  caribou, seal, whale, bear, moose, fish, walruses, trapped animals, birds and their eggs, and whatever vegetation and berries they could gather during the brief arctic summer.  The natural diet consisted almost entirely of fat and protein, with fat varying between 35 and 65 percent of the diet, depending upon the time of year.

A few years later in the 1930’s, Dr Weston Price carried out a study on the American Eskimo, mainly along the southwestern seacoast of Alaska. His findings corroborate those of Waugh. Price found that the most remote Eskimos had perfect dentitions with normal occlusions. Caries incidence was found to be 0.09 per cent of the teeth examined in this group. This rate jumped to 13 per cent in a group of Eskimos experiencing their initial contact with civilization. At established settlements with trading posts, the caries incidence soared to 30 to 50 per cent of the teeth examined. Price also pointed out the physical degeneration of the middle and lower face and dental arches which accompanied this shift to the soft, high-carbohydrate diet of the white man.

Price noted no facial or dental irregularities among the primitive Eskimos, but the modernized Eskimos showed narrowed dental arches, and a narrowed base of the nose. As a result of these changes, chronic mouth breathing and irregularities in tooth alignment and jaw relationships were common.

Dr Waugh realized that the Inuit were “veritably paying for his civilization with his teeth.”

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Dr May Mellanby: A Remarkable Dental Researcher

During the 1920’s and 30’s, Dr May Mellanby undertook “one of the most persistent and intensive investigations that Great Britain has ever seen.”  Those investigations included laboratory and clinical studies of the relationship between diet and teeth, and was published in the leading medical journals of the day.  The complete study is contained in 3 volumes of Diet and the Teeth: An Experimental Study.  A summary of the research by Sir Edward Mellanby can be downloaded here.

Lady May Mellanby (on right) in 1955

Lady Mellanby’s  interest in dental research was sparked by her husband, Sir Edward Mellanby, who played a key role in the discovery of vitamin D.  Sir Edward was investigating the effect of diet on the development of the disease rickets, which was the scourge of that time.  Lady Mellanby noticed that as well as rickets (a bone disease that develops in children usually due to a deficiency of vitamin D), poor diet also affected the structure of developing teeth.

Over the subsequent 20 years she was able to demonstrate that the health and structure of teeth and their susceptibility to decay was determined by the state of the nutrition at the time of tooth formation, beginning before birth.  In animal experiments on dogs it was shown that a maternal diet during pregnancy poor in vitamin D with inadequate calcium and phosphorus would cause significant dental defects in the offspring including:

(1) Thick and poorly calcified jaw bone,

(2) Irregularity in the arrangement of the teeth,

(3) Delay in the eruption of the permanent teeth,

(4) Interference with the calcification of the enamel, which is often defectively formed, and

(5) Interference with the calcification of the dentin, which is often poorly calcified.

Unfortunately, these defects are not just limited to animals, but can also be observed in children.  The defectively formed teeth are highly prone to subsequent development of tooth decay.  However, Lady Mellanby and contemporaries demonstrated conclusively that, despite poorly developed enamel and calcified dentin, with high levels of vitamin D, together with adequate calcium and phosphorus, and particularly in the absence of cereal grains, not only could tooth decay be prevented, but active cavities could consistently be arrested, reversed and that teeth can actually respond and heal without dental intervention.

The discovery by Mrs. Mellanby of the control of tooth formation by the calcifying vitamin, now known as vitamin D, was first published in 1918, and it is now possible to make some estimate of its influence on dental science in general.  It is no exaggeration to say that it has indeed been revolutionary. Medical Research Council of Great Britain, 1934.

Lady Mellanby died in 1978.

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