Medicine loves to put complicated labels on simple conditions and canker sores are no exception. They are usually dubbed as aphthous stomatitis and if they are recurring they are called RAU or recurring aphthous ulcers. I’ll just stick to canker sores as we’ve all most likely had one in our lives, and they are not pleasant. The pathogenesis or cause of canker sores, while not completely understood, is thought to be a cell mediated immune reaction. Conventional treatment is usually confined to either anesthetics or topical glucocorticoids.
However, orthomolecular nutrition and Chinese medicine also have something to say about why they occur and how they should be treated. What both modalities agree on is that food allergy or sensitivity is a common cause and elimination diets are useful to determine if this is the case. The most typical food culprits are wheat, dairy and citrus fruits, and some common irritants include citric acid, acetic acid (aka vinegar) and cinnamon.
In Chinese medicine, foods are classified according to their natures which can either be hot, warm, neutral, cool or cold. The above irritants are of a hot nature, hence too much heat would cause ulcer formation. Alcohol also possesses a hot nature, which means it could also be an irritant to the oral mucosa. Chinese herbal formulas such as Dao Chi San and Tian Wang Bu Xin Dan are also used to cool heat for canker sores.
Orthomolecular medicine looks at using nutrients in their proper dosage to treat disease, which is usually far in excess of the RDA or recommended dietary allowance that is often quoted for most nutrients. The most common deficiencies for this condition are B vitamins and iron (especially in those with celiac disease or ulcerative colitis). Vitamin B12 is also generally low in patients with canker sores. Two other important nutrients for this condition are Vitamin C and Zinc as these two nutrients are necessary for connective tissue formation and repair. Dosages for Vitamin C would generally start at 3000mg in divided doses, and zinc would be 30-60mg for the first 3 months and then halve that dose. Although long term zinc supplementation should always include copper in a 10/1 ratio in favor of zinc in order to prevent inducing copper deficiency.
Finally, one irritant that has been well known to irritate and dry out the oral mucosa is sodium laurel sulfate or SLS, which is a detergent commonly found in most commercial toothpastes. When canker sores are a problem, one should use a toothpaste that doesn’t contain SLS.
Be Well and Be Zen
Gaby., Nutritional Medicine (2011)., Ch 256, p. 939-42., ISBN13: 978-0-9828850-0-0. Fritz Perlberg Publishing, Concord, NH.
Bensky, R. Barolet., Chinese Herbal Medicine: Formulas & Strategies (1990)., ps. 378-79, 95., ISBN:0-939616-10-6., Eastland Press Inc., Seattle, WA.