MORE REASON TO STICK TO TRADITIONAL INDIAN DIETS & JUNK THE CEREALS, OATS, AND FLAKES

I have long held the view that traditional Indian diet and cuisine handed down to us from our vedic times is best suited to our country and our people. Here is one more reason to junk the breakfast cereals, oats, and flakes and stick to traditional Indian diets.

This report (which is based on a paper published in Current Science) shows how traditional Indian food like Idlis and Dosas and food items like sprouts increase bioavailability (of essential nutrients) as they have undergone soaking, fermentation, and germination which reduces the presence of phytates in the food (which block absorption of nutrients particularly iron and zinc).

The report also points to the importance of focusing research on enhancing bioavailability of food rather than on biofortification.

Alcohol and the human brain - New research shows abstinence is the best bet

The BMJ (British Medical Journal) in an editorial piece* last week (June 6, 2017) confirmed what was known to most people simply based on anecdotal and empirical evidence - "Even moderate drinking is linked to pathological changes in the Brain" This flies in the face of several years of reporting by the scientific community that mild-to-moderate alcohol consumption is associated with a protective effect against "all cause dementia"

It was this so called "protective effect" that was used by alcoholics, "social drinkers", breweries, and manufacturers of alcoholic beverages to push their case and bring more people into the ambit of "alcoholics" and push the profits of these alcohol manufacturers.

It is important to understand that an alcoholic drink/beverage is a "liquid drug" that contains a substantial amount (anywhere between 5% to 40% depending on whether you are drinking beer, wine, or one of the "distilled" drinks) of ethyl alcohol or ethanol which when consumed in small/moderate quantities induces a sense of euphoria, increased sociability (an euphemism for making a fool of oneself), excitability, and reduced anxiety. In larger doses it causes intoxication (drunkenness), instability, stupor, slurred speech, and unconsciousness. Long-term drinking leads to alcoholic dependence, abuse, addiction, and associated serious health consequences. 

The image on the right shows the structural damage that has occurred to the brain of an alcohol dependent man compared to "Age-matched" healthy man (a control). Significant erosion and thinning of the corpus callosum is clearly visible along with enlargement of the ventricles and widespread atrophy of the brain cortex. The Corpus Callosum is a bundle of nerve tissue that connects the two halves of the brain (right and left hemispheres) and facilitates communication between them. The Corpus Callosum also contains the largest amount of white matter within the brain (which is different from the gray matter which is used by the brain for the purpose of computation, thinking, and memory storage). The white matter is key to communication between various parts of the brain.

Clearly the damage that alcohol causes to the brain has been known for a long time. What was not known or rather more likely deliberately suppressed was the fact that even mild to moderate drinking can have serious consequences on brain health. The fact is that it is almost impossible to remain a "moderate" or "controlled" drinker because of a factor known as "Alcohol Tolerance"  

In chronic drinkers, consumption of a constant amount of alcohol produces a progressively lesser effect i.e. the proverbial "KICK" goes missing. This leads to a compensatory and proportionate increase in the quantity of alcohol consumed which in turn triggers the cycle of alcohol addiction, dependence...

Over time continued heavy alcohol consumption over several years leads to another condition called "Reverse Tolerance" - result of a liver so damaged by chronic alcohol abuse that it loses its ability to metabolize the alcohol consumed - this leads to a rapid and steep build-up of Blood Alcohol Concentration (BAC) and more rapid intoxication - A cycle that ultimately leads to hospitalization and death.

This recent study that debunks earlier theories of the effects of alcohol on the brain was a prospective cohort of 550 civil servants none of whom were alcohol dependent. Study participants underwent brain scans/imaging in order to examine the relationship between average alcohol use, cognition, and brain structure. Average/Moderate alcohol use was associated with:

1. Reduced right hippocampal volume
2. Even moderate drinkers (21 units per week) were three times more likely to suffer hippocampal atrophy
3. Higher the alcohol consumption, greater the reduction in white matter integrity and faster the decline in executive function

This adds to the already existing burden of alcohol related brain damage (ARBD) which is estimated to account for 10-24% of all cases of dementia and 10% of early onset dementia. Heavy intake/consumption is associated with potentially severe impairments in memory and executive function.

Given what this study confirms, abstinence or the avoidance of alcohol, mild or moderate may well be the best bet to preserve brain health.

1. Welch AK. "Alcohol Consumption and brain health" [BMJ 2017;357:j2645 doi: 10.1136/bmj.j2645 (Published 2017 June 06)]
2. Buhler M, Mann K. Alcohol Clin Exp Res. 2011; 35(10):1771-1793.

The benefits of "Earthing" reconnecting to the Earth we live on

Earthing refers to the practice of connecting or rather reconnecting (as the modern case may be) to the Earth's natural energy by (a) Walking barefoot on natural surfaces like soil, sand, grass, gravel (b) Sitting or lying on the floor (c) Working in the garden for example with bare feet and hands.

Increasing evidence from numerous scientific studies is showing how human disconnection from the Earth may be an important, insidious, and often overlooked factor in human physiological dysfunction and disease. It may also be one of the reasons for the steep rise in non-communicable, inflammatory-related chronic diseases around the globe.

The introduction of the "insulating" footwear where rubber and plastic soles replaced animal leather was the first step in this "disconnection" process. Modernization which led to vertical growth in cities where apartments and high-rise buildings replaced traditional homes was the second major cause. Artificial tiles that replaced natural granite and stone floors was the third. Elevated beds that disconnected humans from the floor during the night was the fourth. Finally, the complete discarding of sitting on the floor or walking barefoot at least at home and on natural surfaces (grass, soil, sand, gravel) is the fifth and final nail in the coffin.

The Earth surface is known to have a negative electrical potential. When humans are in direct contact with the ground (while walking, sitting, or lying down) the earth's electrons can be conducted to their bodies bringing the human body to the same electrical potential as the Earth - a state of equilibrium that has shown to be of great benefit in maintaining optimal health and preventing several non-communicable, inflammatory-related chronic diseases. This in effect is the "antioxidant" effect that neutralizes free radicals in the human body.

The benefits of Earthing are innumerable and those listed below are by no means exhaustive, but are the most obvious:

1. Lowers stress and promotes calmness
2. Normalizes the biological rhythm
3. Enhances immune response and helps improve many symptoms of chronic inflammation
4. Improves gait, balance, and helps reduce / relieve chronic pain
5. Re-establish the natural connect between the Earth and the human body

It is time to make minor changes in our lifestyles and these could include a few or all of these:

1. Shun footwear inside the house
2. Sit or lie on the floor at home 
3. Walk barefoot on natural surfaces like grass, soil, sand, or gravel whenever and wherever possible
4. Look at setting aside places within the house where it is possible to re-establish an Earth-connect

An earlier article I had written on the benefits of barefoot walking maybe useful and relevant here - (Click to Read)

References:

1. Oschman L, et al. 2015; J Inflamm Res. 2015; 8: 83–96.
2. Chevalier G, et al. Journal of Environmental and Public Health. 2012; Hindawi Publishing Corporation. 1-8.

The Hand Sanitizer Myth – 5 reasons why you might want to quit using it

It has become fashionable nowadays to squirt a blob of Hand Sanitizer gel onto our palms, rub them together vigorously and voila we think our hands are clean and microbe-free!

Hand sanitizers have become so commonplace amongst certain sections of the society that they are being preferred over the traditional soap and water wash-routine. Children carry it in their school bags and professionals in their handbags and backpacks.

Here are 5 reasons you might want to say goodbye to that Hand sanitizer:

1. Antibiotic Resistance: Most of us are floating in a microbial soup – they are all over us, inside us, and also part of our genetic code. Most microbes are beneficial to humans and there is a fine balance that is maintained between the “good” and “bad” bacteria – it is when this balance is upset that we suffer from a stomach upset for example and the doctor asks us to take a pill with several million “good” bacteria in them – Lactobacilli (the same bacteria present in curd/yoghurt). Many hand sanitizers contain the chemical “Triclosan” which besides being a chemical that can cause hormonal issues also contributes to antibiotic resistance. In other words using hand sanitizers may actually lower our body’s ability to resist or fight microbial challenges – the classical silver bullet that doesn’t differentiate between the “Good” and the “Bad”.
   
2. Alcohol poisoning: 90% of hand sanitizers reportedly contain alcohol either in the form of ethyl alcohol (Ethanol) or isopropyl alcohol or a combination of the two in concentrations ranging from a low of 60% to a high of 90% (As per the US-FDA, they don’t work at concentrations lower than that). That would translate to about a few shots of raw, hard liquor from a few squirts! Children (and some adults) who accidentally ingest the hand sanitizer can suffer from serious consequences of alcohol poisoning.
   
3. Hormonal imbalance & Lowered immunity: Triclosan, the active ingredient in some hand sanitizers (and also toothpastes and mouth washes) can cause hormonal imbalances according to the US-FDA. Further, Triclosan may actually cause bacteria to adapt and become more resistant to standard antibiotic therapy. Studies have also shown that “ultra-clean” environments are actually not that good for children and that Triclosan in Hand sanitizers can lower immunity and immune response particularly in children. The old habit of children ingesting a little dirt may actually not be that bad after all!
   
4. Increases skin’s absorption of BPA: Recent studies have shown that hand sanitizers increase the skin’s absorption of a dangerous chemical – Bisphenol-A (BPA) – this chemical is used in making clear plastic packaging for food, clear plastic bottles, and thermal paper receipts (those little receipts that you get when you swipe your card, or when you buy a bus ticket). BPA is a known endocrine toxin that can cause serious harm.
   
5. The fragrance/odor of Hand sanitizers: The fragrance and the icky sweet smell that Hand sanitizers give-off can be quite harmful to those who are allergic to fragrances. If the fragrance is derived from phthalates then it can harm major organs in the body including liver, kidneys, and lungs.

A safer alternative is washing hands with plain, normal soap (not antibacterial) and water. You can always carry a small soap with you. If soap is not available then a good mechanical scrubbing of the hands under running water for 20 seconds should suffice – pay special attention to areas that can harbor dirt and debris – between fingers and under nails.

References: 

1. Available at: http://www.webmd.com/cold-and-flu/news/20160629/fda-asks-how-safe-is-that-hand-sanitizer#1. Last accessed: April 10. 2017.
2. Available at: http://atlanta.cbslocal.com/2015/06/15/study-warns-hand-sanitizer/. Last accessed: April 10. 2017
3. Available at: http://www.thehealthsite.com/diseases-conditions/hand-sanitizers-9-reasons-you-should-think-before-using-them. Last accessed: April 10. 2017
4. Kurumi Fukushima: “5 hidden dangers of hand sanitizers” – The street.

Daily eye care regimen in ayurveda

In ayurveda, the eye is referred to as the "The seat of fire". This is based on the ayurvedic belief that the eyes have a tendency to "build-up" heat and are basically "pitta" in nature. 

Although modern medicine may not subscribe to this view of "heat" etc. the fact remains that at a practical level one does feel a burning sensation in the eyes after a long session in front of a computer or after a long day out in the Sun. Below are a few tips that are recommended in ayurveda - these form part of Dinacharya (daily routine):

1. Bathing / Washing the eyes: This has to be done first thing in the morning along with cleaning of the teeth and scraping of the tongue. This can be done by using an eye-cup filled with clean, cool water. If an eye-cup is not available, any cup that allows the eyeball to be immersed in water is good enough. Blink your eyes several times and then discard the water and refill the cup - this can be repeated two to three times. Doing this procedure again in the evening after a day at office or at work also helps in cleaning and cooling the eye. Once a week the eyes can be washed with a solution made by soaking Triphala churna (powder) overnight in a class of water - Take a pinch of the Triphala, dissolve it in lukewarm water, strain to get a clear solution. Triphala as the name suggests is made by combining three fruits - Amalaki (Emblica officinalis), Bibhitaki (Terminalia belerica), and Haritaki (Terminalia chebula). In Ayurveda Triphala is known to have the property of balancing the three doshas - Vata, Pitta, and Kapha.
2. Eye Massage: This is a wonderful exercise for those who have to stare at a computer screen for long hours and for anyone who has a habit of staring at digital screens for long. Use your index finger and thumb to gently massage along the orbit of the eye (the bony socket around the eye). Then gently using the same two fingers massage along the line of the eyebrows as if you are straightening them out - this helps improve blood circulation and will immediately rejuvenate tired eyes. Finally use your thumb to gently press and massage your eyelids exerting minimal pressure on the eyeballs.
3. Eye palming: Do this once every hour, particularly if you sit in front of a computer all day or are a mobile phone addict. Rub the palms of your hands together vigorously so that the friction generates heat. Then close your eyes and cup your palms over your eyes for about 30 seconds. Gently open your eyes and stare away into the distance (do not focus on anything) for another 30 seconds. This 1-minute practice once every hour should go a long way in reducing / preventing Computer Vision Syndrome and fatigue due to digital screens.
4.  Eye poultice: Take a soft cotton cloth, soak it in cool water, lie down on your back and place this cotton cloth across your closed eyes for about 3-5 minutes everyday after your come back from work. Additionally, you could add a few drops of Aloevera or pure rose water for a greater cooling effect.
5. Basic eye exercises: It is important to exercise the muscles of the eyes. Preferably this should be done early in the morning. Sit down either in Sukhasana (if you can) or in a comfortable chair. Move your eyes slowly Up and then Down ensuring that you hold each position for a few seconds. Then move your eyes to the Left and then to the Right. Make sure that only your eyes move and not your head as well. Finally move your eyes to the Top-Right corner of the room and then to the Bottom-Left corner of the room and then switch (Top-Left and Bottom-Right). There are other advanced exercises that can be learnt by those who are interested but for most people these should be enough provided they are practiced everyday.

Needless to mention a diet rich in vegetables and fruits rich in Vitamin-A is also an essential part of any eye-care regimen.

Natural and safer alternatives to commercial shampoo

Even a simple search of the net will throw up several alternatives to shampoo with their own claims of being natural, safe, environment friendly etc starting with Baking Soda (Yes, you heard that right) to natural soap bars, DIY (Do-it-yourself) shampoo and what not. 

However, in keeping with my own policy of never endorsing through this site any product that (1) I have not tried out myself and (2) does not have a body of reliable evidence (research, anecdotal, historical, traditional), I am going to make only one recommendation:

Combination of Shikakai (Acacia Concinna) and Arappu (Albizia Amara) in the ratio of 1:1 mixed thoroughly, stored in airtight containers and reconstituted into a paste with warm to hot water just before a shower. There are several suggestions and additions to this basic combination but in my opinion they are bells and whistles and can be added based on individual preferences - these include - Soap nut powder (Reetha), Henna, Amla and dried powder of hibiscus petals.

In Ayurveda, seborrhoeic dermatitis (dandruff), or pityriasis capitis is known as "Darunaka" under the broad head of Ksudra Roga formed by the sandhi (meeting of two words) "Daruna" meaning "cracked or flaking scalp" and "Kandura" meaning "Itchy scalp"

Of the various natural alternatives available, Shikakai (extracted from the bark, leaves or pods) is one of the few natural alternatives that has been tested scientifically and proven to be safe and effective. It helps reduce scaling, itching, dryness and greasiness of scalp after treatment while prolonging the interval between scaling. (Click to read).

Shikakai Pod

Further, Shikakai is known to have a pH close to the pH of normal human hair (4.5 - 5.5), is non-aggressive, has mild anti-fungal, and anti-lice properties, helps detangle long and difficult to manage hair, helps retain natural hair/scalp oil, produces just the right amount of foam, clears dandruff, cleans scalp and hair, while imparting shine and bounce.

Arapu Leaves

Arappu powder the other part of this combination is made by powdering the dried leaves of the Arappu plant Albizia Amara. Arappu finds mention in ancient siddha literature and is referred to as a "hair tonic" that completes this combination by playing the role of a conditioner. Siddha medicine also talks about its "cooling" effect on the head/body.

Soap nut powder and Arappu powder

Shikakai and arappu powders are now available "ready-to-use" and simply need to be mixed at home and transferred to containers.

The SRK brand of Shikakai and Arappu read-to-use powder is available in Mysuru (Karnataka, India). I am not a brand ambassador for them but this is the brand we have been using for a long time and they are a trustworthy brand. They even retail online at: (Click) There are several other brands available including the Shanmugananda brand in Bengaluru (Karnataka, India) and so on. 




It is important to not let go of traditional and natural methods that have stood the test of time. Agreed, that using them may not be as convenient as squeezing a dollop of shampoo but the benefits they offer in terms of safety and health far outweigh the small inconveniences associated with their use.



References and image credits:
1. Ediriweers S, et al. JAHM. 2014;2(7)14-17.
2. Ganesan S, et al. eJournal of Indian Medicine Volume 1 (2007–2008), 1–18.
3. Images: Shikakai pod: Available at: https://beauty.onehowto.com/article/how-to-use-shikakai-for-hair-wash-11713.html. Alice Marini. Last acessed: March 22, 2017.
4. Image of Arapu leaves: http://foodherbs.shopclues.com/arappu-powder-natural-hair-conditioner.html. Last accessed: March 22, 2017

The problem with Shampoo (2)

The first post on the "problem with shampoo" (click to read) listed the generic ingredients that go into making shampoo and argued why most ingredients are not really essential and may actually cause more harm than good. This post looks at each of these ingredients in greater detail.

Surfactants/Detergent: Shampoos work by employing detergents that are both lipophilic (fat-loving) and hydrophilic (water-loving). The lipophilic action helps in attaching to sebum (natural oil secreted by the skin/scalp) and the hydrophilic action helps removal of this sebum when hair is washed/rinsed with water. Typically shampoos contain combinations of different detergents to achieve desired results: very oily hair = strong detergent; dry hair = mild detergent and so on. Based on polarity and chemical ionic properties, shampoo detergents can be further classified but that would be too technical and beyond the scope of this post and hence not discussed. Examples of a few detergents/surfactants used in shampoos include:

• Lauryl Sulfates: Usually listed as a second or third ingredient on the label, under the names sodium lauryl sulfate (SLS), triethanolamine lauryl sulfate, and ammonium lauryl sulfate (ALS).
• Laureth Sulfates: One of the most common primary detergents in shampoo designed for normal-to-dry hair and popular with consumers because they produce luxuriant foam. They would be listed under the names sodium laureth sulfate (SLES), triethanolamine laureth sulfate, and ammonium laureth sulfate.

Pick up any popular shampoo brand and it will usually contain either Lauryl or Laureth Sulphate as an active ingredient. A few exclusive shampoos have entered the market that claim to be "SLS-free".

• Sarcosines: Not usually used as primary detergents as they are poor cleansers but excellent conditioners and therefore are often added to shampoos that offer the "added benefits of conditioning" - the bounce, the shine and all the bells and whistles that we fall for. These detergents would be listed as lauryl sarcosine and sodium lauryl sarcosinate.
• Sulfosuccinates: Very strong detergents that are usually present in shampoos for very oily hair and listed as disodium oleamine sulfosuccinate and sodium dioctyl sulfosuccinate.
• Other detergents: Include polyoxyethylene fatty alcohols, polyoxyethylene sorbitol esters and alkanolamides which are milder and usually feature as secondary detergents. Some ingredients like cocamidopropyl betaine and sodium lauraminopropionate are found in baby shampoos because they are non-irritating to the eyes or so goes the claim but if the truth of the pudding is in the eating, then allow it to run into a baby's eyes and the truth will emerge.

A recent trend is the return of "Natural Cleansers" derived from plant sources such as Sarasparilla, soapwort, ivy agave etc. which are called "natural saponins" - They have excellent foaming properties but are poor cleansers and work only when used in very high concentrations. Marketers get over this problem by combining these with synthetic detergents listed above - The synthetic detergents do all the cleansing while the "natural detergents" do the marketing and selling - "Herbal, Natural, Ayurvedic etc. etc.

Although detergents such as SLS, SLES have not yet been classified as carcinogenic (cancer-causing) there have been persistent and troubling reports from various studies that point to how these detergents and several others used in shampoos, toothpastes, soaps are serious and often dangerous irritants. The International Journal of Trichology recommends that these detergents should not be used in concentrations above 1%. The full article can be read here. At higher concentrations, SLS can be a very harmful irritant. At a concentration of 10% it caused serious corneal / eye damage in rabbits. One other concern with SLS is the risk of contamination with 1,4 Dioxane a confirmed carcinogen when it is extracted through a process called ethoxylation (the suffix "Eth" in SLS comes from this process of ethoxylation). Then again, the question that needs to be asked is why is a detergent that is also used as an industrial cleanser present in cosmetic and personal care products?

There is a lot more that can be said and a lot, lot more that should cause concern but that should be the topic of another post that will look at the other ingredients that make up shampoo formulations and the associated concerns, risks, and issues.

References:

1. http://journals.sagepub.com/doi/abs/10.3109/10915818309142005
2. https://www.forbes.com/sites/quora/2016/03/16/is-common-shampoo-ingredient-sodium-laureth-sulfate-harmful/#63932b6b7543
3. http://articles.mercola.com/sites/articles/archive/2010/07/13/sodium-lauryl-sulfate.aspx

The problem with Shampoo (1)

This is going to be a three-part article because there is so much to discuss with regard to commercial shampoo.

Most commercial shampoos available in the market are not good for your hair or scalp. Advertisements for shampoos would have us believe that if we did not shampoo our hair everyday and use a conditioner on top of that we would be left with dry, frayed, and gritty hair - nothing could be further from the truth. 

The truth is most shampoos are in reality cocktails of chemicals and detergents that can cause more harm than good. The table* below gives a summary of generic ingredients that go into making a shampoo:

Ingredient	Purpose	Remarks
Detergent/Surfactant	Remove dirt, sebum, and skin scales from scalp
Foaming agent	Build froth/suds	Not essential. Present because consumers believe foam equals better cleansing (though the two are unrelated)
Conditioner	Smoothens hair after sebum removal by detergent
Thickener	Thickens shampoo consistency	Not essential. Present because consumers believe thick shampoos are better
Opacifier	To make shampoo opaque as opposed to translucent	Only for aesthetic reasons. Not essential ingredient
Sequestering agent	Prevent soap scum from sticking to hair, particularly in the presence of hard water	Basic difference soap bar and liquid shampoo
Fragrance	Enhance consumer acceptance	Not essential
Preservative	Prevent microbial and fungal contamination during storage
pH stabilizers	To prevent damage to hair from shampoo as Hair is acidic and most shampoos / cleansers are alkaline	Present only to minimize damage caused by the shampoo itself
Special Additives	Usually marketing aids, specific to each brand	Marketing gimmick, not essential

As we can see from the above table, out of the 10 generic ingredients listed, 5 ingredients are not essential, 1 ingredient (Conditioner) is optional, 1 other ingredient (Preservative) has nothing to do with hair cleansing but is added only to increase product shelf-life, and finally, 1 ingredient (pH stabilizer) which is present only to minimize the damage that the shampoo itself causes to your hair! 

That leaves us with 2 ingredients that are essential but with debatable safety records. 

In the second part of this article, each of these ingredients will be discussed in greater detail along with a look at some of the top brands, what they actually contain, and how their "customer promise" is just a lot of bunkum. The third and final part will look at natural and traditional alternatives to shampoo

*Table adapted from: Draelos DZ. International Journal of Trichology. 2010;2(1):24-29.

Ayurveda and oral health - Cleaning the teeth, gums, and tongue

Ayurveda which owes its origin to the Vedas is by far the most ancient oral-treatise (subsequently written) on medicine. The Charaka and Sushruta Samhitas are merely compilations and commentaries of what is extant in the Vedas. The primary focus of Ayurveda is disease-prevention. Even when used as therapy Ayurveda retains its focus on treating the "Cause" and not the symptoms. This is one of the reasons why Allopathy is more popular as it provides fast symptomatic relief (even if and usually not a permanent cure). Oral health is given a lot of importance in Ayurveda. 

Below is a summary of recommendations from Charaka's Samhita along with comments:

• Cleaning of the Teeth: (1) To be done two times a day and after every meal (2) Clean the teeth with the crushed twigs of plants such as Karanja (Millettia pinnata; Honge in Kannada, Pungai in Tamil, Kanuga in Telugu), Jati (Jasmine), Arka* (Yerukkai in Tamil, Ekka in Kannada), Babul (Acacia arabica; Karuvela-maram in Tamil, Karijali in Kannada) and Neem (Azadirachta indica) - the idea being, one must use a cleansing agent that has astringent, pungent, and bitter properties. (3) While cleaning, care should be taken not to injure the gums.

Nowadays, we use plastic toothbrushes with nylon bristles to clean our teeth without stopping to think how when we are concerned about plastic lunch boxes, and the use of plastic for food storage, we don't worry about repeatedly inserting a plastic toothbrush into our oral cavity! 
Additionally, studies have also shown that toothbrushes harbour innumerable bacteria. The American Dental Association (ADA) in its position statement says the following : 

"...It may also be possible for microorganisms that are present in the environment where the toothbrush is stored to establish themselves on the brush. Toothbrushes may even have bacteria on them right out of the box since they are not required to be sold in a sterile package." (ADA-position)

The presence of microorganisms in brush-bristles is particularly possible given how "attached" toilets are the norm today and the chances of fecal bacteria getting transferred to toothbrushes is very high. You can read about it here: (Fecal Matter in toothbrushes).
Studies have also shown that tooth-powder and a clean index finger is better than toothpaste and brush but that will be the subject of a different post. 

Let us now explore the rest of Charaka's recommendations:

• Cleaning of the Tongue: The tongue is to be cleaned with a curved and not very sharp scraper made of gold, silver, copper, tin, or brass (steel scrapers are available nowadays). Cleaning has to be from the root of the tongue downwards as the tongue tends to collect dirt nearer its root. Tongue cleaning/scraping is one of the most important methods to prevent halitosis / bad-breath. You can read more here (Halitosis).
• Oil-pulling / gargling: Oil-pulling or gargling with oil (Gingelly/Sesame/Til oil) must be done everyday. According to Charaka, it helps to prevent mouth ulcers, dental caries (cavities, tooth-decay), and teeth-sensitivity. It is also useful in preventing and managing tooth-ache and helps in firming-up the gums.
• Massaging and polishing the Teeth & Gums: Use the forefinger (index / pointer) and thumb to polish the teeth and massage the gums after cleaning and gargling.

These are Charaka's recommendations on oral health and they are relevant even today. 

Finally, on the subject of tooth-powders my personal favourite is the Nanjangud (B.V. Pundit's) toothpowder which is probably the only non-chemical tooth-powder around. They even have an online store at: B.V. Pundit-Sadvaidyasala. 

*I am not sure about the use of Arka as a tooth cleanser, but Charaka does mention it.
Ref: M.S. Valiathan. The Legacy of Charaka. University Press. 2009.