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Diet and Nutrition

Health, Nutrition and Canker Sores

06/22/1998

Question:

Can health and nutrition affect the amount of canker sores and individual may encounter? It seems as though when I am worn down this occurrs.

Answer:

Aphthous ulcers, often referred to as canker sores are painful lesions that occur on the mucous membranes (the soft tissues inside your mouth). They are quite common and affect about 20% of the population. A fraction of these affected individuals will get frequent recurrences of this nuisance lesion. In rare instances, frequent recurrences may be associated with an underlying illness, such as Crohn's disease or an immune disorder. Canker sores are occassionally confused with oral herpes lesions which can cause painful ulcers or blister-type lesions of the lips and mouth. The treatment for herpes, a condition caused by a virus, is quite different from that of canker sores. If you are unsure which type of condition you have, consult your dentist or physician. A number of theories have been put forth to explain why aphthous ulcers occur. Possible causative agents include viruses, a defect in immune function, mouth trauma, hypersensitivity to a food in the diet or other substance, and higher levels of steroids in the saliva caused by stress or anxiety. It is quite possible that more than one will be eventually proven to cause apthous ulcers. Several treatments have been suggested for people who experience recurrent apthous ulcers. No one treatment has worked for everyone. Two nutritional therapies have been studied with some success. In addition to consuming a healthy diet (5 servings of fruits and vegetables daily, etc), you may wish to experiment and see if either of these dietary regimens works for you: 1. In several studies, some individuals with recurrent apthous ulcers have been found to be deficient in one or more of the B vitamins (thiamine(B1), riboflavin(B2), pyridoxine(B6), folic acid and B12). Iron deficiency can also be associated with apthous ulcers. A diet rich in fruits, vegetables and whole grains should be sufficient to provide the bulk of these vitamins with the exception of B12; Vitamin B12 comes primarily from animal and dairy sources. If your dietary habits are less than ideal, you may want to consider a B-complex multivitamin. You may also want to consider having your doctor check your iron levels. Several individuals have discovered that certain foods in their diet increase the frequency of their aphthous ulcers. You may want to try identifying common foods in your diet and stopping them for a week or two to see if your ulcers go away. A more complex, but perhaps effective, way to determine whether or not you have a food sensitivity is to go on a cereal and fruit-free elimination diet for 2-8 weeks. (I recommend consulting your physician and/or a dietician for more specifics on how to do this and assess the medical safety of trying this diet.) Some patients have also undergone skin testing to determine whether or not they have food allergies. When an allergic reaction has been identified by skin testing, elimination of this food from the diet usually results in significant relief from frequent aphthous ulcers. (Your physician can refer you to an allergist if you wish to explore this option further.) The most common food allergies associated with recurrent aphthous ulcers involved benzoic acid, a preservative, and cinnamaldehyde, a flavoring agent often used in toothpaste and gum. Other foods which have been associated with aphthous ulcers less commonly have included figs, cheese, acid foods (tomatoes, citrus, pineapple), milk and wheat flour. Gluten, a protein in wheat, oats, rye and barley, has also been implicated. Gluten sensitivity is associated with a disease called celiac sprue which can cause a number of severe gastrointestinal problems. A recent study has suggested that gluten is unlikely to be a cause of aphthous ulcers if other signs of celiac sprue are not present. References: Hay, KD et al The use of the elimination diet in the treatment of recurrent aphthous ulceration of the oral cavity. Oral Surgery 57:504-507 1984. Hunter, IP Effects of dietary gluten elimination in patients with recurrent minor aphthous stomatitits and no detectable gluten enteropathy. Oral Surgery 75(5):595-8 1993. Nolan, A et al Recurrent aphthous ulceration: vitamin B1, B2, and B6 status and response to replacement therapy. J Oral Pathol Med 20:389-91 1991. Nolan, A et al Recurrent aphthous ulceration and food sensitivity. J Oral Pathol Med 20:473-5 1991.

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Response by:

Jill Foster, MD
Formerly, Assistant Professor
College of Medicine
University of Cincinnati