Halitosis May Be Linked to Dyspepsia

Put Mastic to Work for You

Halitosis May Be Linked to Dyspepsia
Killer breath is likely to disappear, however, when mastic kills H. pylori

By Aaron W. Jensen, Ph.D.

Bad breath is better than no breath at all.

hat quotation is hard to argue with, but it doesn’t mean that you have to accept bad breath (halitosis) and go on your merry way. What’s the alternative? Well, for starters, you can be proactive and fight halitosis by practicing good oral hygiene. Besides providing you with a blinding smile and healthy gums, this is the best way to freshen your breath, because it reduces bacterial growth in your mouth.

In many ways, your mouth is a perfect haven for all sorts of bacteria. It’s warm, it’s moist, and best of all, it’s well nourished by a steady stream of nutrients (carbohydrates, fats, and proteins) that you thoughtfully provide by eating and drinking. As a result, there are far more bacteria in your mouth (and nose) than you probably care to think about. What’s worse, they can reproduce at a prodigious rate: under optimal conditions, bacteria can divide about every 20 minutes, which means that a single bacterium could generate a colony of over 16 million descendants in just 8 hours!

As the army of bacteria in your mouth goes about its business of multiplying and dying, it can generate foul-smelling waste products, such as hydrogen sulfide and methyl mercaptan, which are metabolic byproducts of the sulfur-containing amino acids methionine and cysteine. Another disgusting compound, with an odor vividly suggested by its name, cadaverine, comes from the breakdown of a different amino acid, lysine.

Threefold Oral Hygiene with Mastic

How do you stop these nasty molecules from giving you breath that could drop King Kong at ten paces? Simple—get rid of the bacteria that produce them. That’s not easy, though, because every time you put something in your mouth, you repopulate it with a host of bacterial pioneers that want to set up camp.

Frequent mouth rinsing, brushing, and gum chewing are effective against halitosis in most people. All sugarless chewing gums work well, but one made from mastic—a natural gum resin derived from the mastic tree—may be a particularly good choice for improving your breath, because it also has antibacterial properties, as we will see below. Mastic gum is even cited in the Talmud, which recommends it as a remedy for bad breath (see the sidebar on this topic). Mastic can also be obtained in the form of mouthwash and toothpaste, rounding out the three methods of breath control mentioned above.

The Talmud Teaches–About Halitosis, Yet

The Talmud, a collection of ancient rabbinical writings that provide the basic underpinnings for the Jewish faith, has an interesting take on halitosis: it states that bad breath is sufficient grounds for divorce! In a recent paper that examines the Talmudic teachings on this subject, dental researchers from Tel Aviv University summarize the relationship between marriage and bad breath.1 “In the Talmud,” they write, “bad breath is considered a serious disability, particularly regarding spouses and priests. The Talmud considers bad breath to be a major ground for divorce, and prohibits priests with bad breath from carrying out holy duties.” Wow, they don’t mess around.

Before the divorce is granted, however, why not try one of the remedies, including mastic gum, recommended in the Talmud itself: “It is forbidden to chew mastic on Sabbath, yet it is permitted for the prevention of oral malodor.” How’s that for an endorsement?

It should be noted that in the time of the Talmud, the inability to treat effectively many of the conditions that could lead to bad breath, such as the advanced stages of gingivitis, periodontal disease, oral ulcers, and diabetes, may have severely pushed the limits of marital intimacy, even among the most romantic couples. One can’t help but wonder how many marriages might have been saved during those times by a good toothbrush, some zesty toothpaste, a bit of sparkling mouthwash, and a snappy breath mint. Mastic gum, anyone?

  1. Shifman A, Orenbuch S, Rosenberg M. Bad breath—a major disability according to the Talmud. Israeli Med Assoc J 2002 Oct;4:843-5.

H. pylori Is Nothing but Trouble for Your Stomach

Many kinds of bacteria populate your mouth. Some are innocuous, while others, such as Helicobacter pylori, have a more sinister side and can give rise to ailments far more serious than halitosis. H. pylori can flourish in your mouth, but oddly, it is also perfectly at home in the corrosively acidic environment of your stomach. It has an ingenious mechanism of secreting a buffer layer of ammonia to counteract the stomach acid, which kills most other kinds of bacteria. While thus protected from the body’s natural defenses, H. pylori burrows through the stomach’s mucosal lining and takes up more or less permanent residence—unless you do something about it—in the underlying cell layer, where it can eventually cause ulcers to form.

H. pylori is, in fact, the primary cause of ulcers—both gastric (stomach) and duodenal, which collectively are called peptic ulcers. It is also the most frequent cause of gastritis (inflammation of the stomach lining), and it may be a contributing factor in other gastrointestinal disorders, including indigestion, heartburn, and dyspepsia. (See the sidebar “H. pylori Hates Your Guts.”)

H. pylori Hates Your Guts

The Centers for Disease Control and Prevention (CDC) estimates that 90% of all duodenal ulcers and 80% of all gastric ulcers are linked to H. pylori infection. This evil little bug also increases the risk of gastritis and slows recovery from the symptoms of gastroesophageal reflux disease (GERD). Furthermore, H. pylori infection increases the risk of stomach cancer 2-to-6-fold. Those are solid reasons for wanting to be pylori-free.

But are you home free once you rid yourself of H. pylori? Maybe, maybe not. Because about half the world’s population is believed to be infected with this bacterium, and because it can be spread by human contact, chances of reinfection are high. Add to that the fact that food (particularly meat) and many communal water sources are often contaminated with H. pylori, and you really have to be on your guard. Once you’re reinfected, it’s back to square one. You’ve been there and done that, and you don’t want to have to do it again.

Here’s where good oral hygiene comes in. Anything you do to reduce the growth of bacteria in your mouth decreases the risk that H. pylori will recolonize your mouth and then, almost inevitably, your gut. Chewing gum seems to be especially effective, because the mechanical removal of debris and leftover sugars removes the vital nutrients that bacteria thrive on. So the next time you pop that gum in your mouth (sugar-free, of course, and preferably mastic), remember that you’re doing your breath and your gut a good turn.

Dyspepsia, by the way, is a pain or discomfort in the upper abdomen or chest that’s often described in terms of gnawing or burning, often with a sensation of fullness (having gas). It has many causes, notably peptic ulcers and gastritis, but it can also be caused by several other conditions, including stomach cancer, acid reflux, lactose intolerance, irritable bowel syndrome, gallbladder inflammation, and even anxiety or depression.

Halitosis Comes from the Mouth (Duh)

But how are stomach ailments related to bad breath, you ask? It’s a good question, because medical and dental experts say that the overwhelming majority of cases of halitosis originate in the mouth, with most of the rest coming from the nasal passages. In relatively rare cases, halitosis can originate elsewhere in the body as a result of certain diseases, such as liver failure, kidney failure, respiratory tract infections, lung abscesses, and severe, uncontrolled diabetes. It almost never comes directly from the stomach except during belching or, sometimes, with acid reflux, because ordinarily the stomach is hermetically sealed. For that we can be most grateful, considering the foul-smelling chemical processes going on in there.*

*Bad breath from eating foods such as garlic and onions does not come from the stomach, by the way. It comes from the bloodstream via the lungs, which release gaseous products of the metabolism of these (and many other) foods. Oral hygiene has no effect on this process.

H. pylori Eradicated in Patients with Nonulcer Dyspepsia

It comes as a surprise, therefore, that a group of researchers in Turkey claim that halitosis may be linked with the presence of H. pylori in patients who have a common stomach condition called nonulcer dyspepsia (i.e., dyspepsia that is not caused by an ulcer).1 There is a higher rate of H. pylori infection in people with nonulcer dyspepsia (NUD) than in those without it, but H. pylori is also extremely common in people who have no gastrointestinal symptoms at all, as well as in people who do not have halitosis.

But because other researchers had suggested that H. pylori might be linked with halitosis, the Turkish group set out to determine whether eradication of H. pylori would affect the occurrence of this condition in patients with NUD. They followed the progress of 148 men and women (aged 20–70, average 38) who tested positive for H. pylori and were then treated for it, using a regimen called triple therapy. This entails a twice-daily administration of three different drugs for 14 days. Typically, two of the drugs are antibiotics, and the third is a proton pump inhibitor, used to reduce acid levels in the stomach. When the patients were again evaluated 4–6 weeks after this therapy, it was found that eradication of H. pylori had been successful in 109 of them (74%).

Of the 109 patients in whom
H. pylori had been eradicated,
only 3 (2.8%) still suffered from
halitosis—a nearly complete
wipeout of the condition.

Regardless of whether or not H. pylori had been eradicated, almost all the patient symptoms recorded by the researchers were dramatically reduced (the one exception was heartburn). They included bloating, diurnal and nocturnal pain, nausea, and . . . halitosis, which dropped from 62% before treatment to 13% afterward. The most dramatic improvement, however, occurred in patients in whom H. pylori had been eradicated. Of the 109 patients in this category, only 3 (2.8%) still suffered from halitosis—a nearly complete wipeout of the condition.

Halitosis May Be Linked with H. pylori

Although this research is intriguing, it’s not clear that halitosis was actually a symptom of NUD in the first place, or that it was a symptom of H. pylori infection independent of NUD. Nor is it clear that eliminating H. pylori was responsible for nearly eliminating the patients’ halitosis. Triple therapy, after all, kills many other kinds of bacteria besides H. pylori. It must be noted, too, that the patients’ breath was not evaluated for halitosis by chemical analysis, but rather by the testimony of relatives—a highly subjective and unreliable method at best. Furthermore, the study was not placebo-controlled, making a bad situation that much worse in terms of the data having any real meaning.

Nonetheless, from various lines of reasoning, the authors concluded that halitosis may be a symptom of H. pylori infection rather than of NUD, even though they also cited evidence that there is apparently no link between oral H. pylori infection and halitosis. Based on their results, they suggested that, for patients with NUD, the presence of halitosis may be a justification for undergoing eradication therapy.

Mastic Kills H. pylori

Triple therapy is an effective but aggressive (and expensive) way to get rid of H. pylori, and each of the drugs has undesirable side effects (see Mastic: No-Compromise Ulcer Eradication in Life Enhancement, October 2000). If this approach gives you pause, you might want to try a safe, natural, economical alternative, namely, mastic. Mastic is the gum resin from a small evergreen tree (Pistacia lentiscus) that grows almost exclusively on the small Greek island of Chios in the Aegean Sea. It has been used for millennia to calm digestive ills as well as a variety of other ailments (see Mastic Is More Than an Antibacterial in Life Enhancement, December 2002).

Only in the last few years, however, have we begun to understand how mastic works to aid the digestive system and improve breath. We now know that it packs a potent antibacterial punch that enables it to kill H. pylori.2 In addition, mastic attacks and kills a variety of other unwanted bacteria, notably Escherichia coli and Staphylococcus aureus.3

Thank You, Mother Nature

Nature has an arsenal of other agents besides mastic that destroy bacteria. Some of these bacterial annihilators come in innocent guises, such as those of St. John’s wort, thyme, and cinnamon. St. John’s wort contains hyperforin, a particularly resourceful compound that can destroy bacteria that have become resistant to conventional antibiotics. Thyme and cinnamon have the specific ability to inhibit the growth of H. pylori.

If you—or, more likely, those around you—are bothered by halitosis, you owe it to them to do something about it, whether it has anything to do with H. pylori or not. You owe it to yourself, however, to ensure that your gastrointestinal tract is as healthy as possible. That means ridding it of H. pylori, because of its known connections with gastritis and ulcers, which can lead to stomach cancer. Since Mother Nature has been so kind as to provide mastic for this purpose, it would be nice to give her a thank-you kiss on the cheek. But first, make sure your breath is fresh!


  1. Serin E, Gumurdulu Y, Kayaselcuk F, Ozer B, Yilmaz U, Boyacioglu S. Halitosis in patients with Helicobacter pylori-positive non-ulcer dyspepsia: an indication for eradication therapy? Eur J Int Med 2003;14:45-8.
  2. Huwez FU, Thirlwell D, Cockayne A, Ala’Aldeen DAA. Mastic gum kills Helicobacter pylori. N Engl J Med 1998;339:1946.
  3. Iauk L, Ragusa S, Rapisarda A, et al. In vitro antimicrobial activity of Pistacia lentiscus L. extracts: preliminary report. J Chemother 1996;8:207-9.

Dr. Jensen is a cell biologist who has conducted research in England, Germany, and the United States. He has taught college courses in biology and nutrition and has written extensively on medical and scientific topics.

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