Re-Thinking Canker Sores

So I’ve been thinking about Canker Sore’s (Aphthous Ulcers or Aphthous Stomatitis). I’ve had these painful canker sores since I was a young child. I would get them on a regular basis, sometimes in three’s or fours. If I chomped my lip or cheek a day or so later, I would get one of these painful sores that would stay around for approximately 2 weeks. I remember trying to burn them off with silver nitrate, changing tooth pastes, take supplements, and try topical steroids. None of it ever worked. I learned to live with them.

Canker Sore=Aphthous Ulcer=Aphthous Stomatitis

Apthous Ulcers, “Canker Sores” are a fairly significant problem. Epidemiological studies show an average prevalence between 15% and 30%. With approximately 10% of the population suffering from Recurrent Aphthous Stomatitis “ulcers”. (Source: Wiki:Aphthous_Ulcer yes I use Wikipedia for research. There are two referenced studies on the Wiki)

Approximately 3 years ago I was diagnosed with Celiac Disease. The protein of wheat “gluten” causes an inflammatory reaction in the lining of the small intestine that allows lining of the small intestine to be permeable. This allows food particles and other stuff to move beyond the barrier of the intestinal lining. The treatment of Celiac Disease is a Gluten Free Diet. Remove wheat/gluten and this allows the intestinal lining to heal. After my diagnosis I started to look into whether or not Celiac Disease was related at all to Aphthous Ulcers and I did find some research as evidenced by the number of entries in Google Scholar related to Celiac Diease and Aphthous Ulcers. I even wrote about one study relating Celiac Disease and Aphthous Ulcers, previously. To treat my Celiac Disease I went on a Gluten Free diet and figured I’d see what would happen in regards to the canker sores.

A few months on a gluten free diet I noticed the frequency and duration had decreased. Not only did I rarely get them but they would only last for a few days and then go away. Obviously this is a tiny sample size of one. I definitely had improvement but still got them on occasion. This corresponds with current research about modern wheat and what it does to the intestinal lining, even those that don’t have celiac disease. Remove wheat and allow the lining to start to heal. The number one cause of intestinal permeability is Modern Wheat! According to Dr. William Davis M.D. author of the NY Times Bestseller Wheat Belly, it’s not necessary to have Celiac Disease to have intestinal permeability. This post from the WheatBellyBlog- Modern Wheat: A Terrorist’s Delight explains that wheat is the primary instigator of intestinal permeability. Removing wheat appears to only be the beginning.

Fast forward approximately 2 years. I still wondered if the gluten free diet was doing what it was supposed to do and heal my fragile intestinal lining. There is evidence that only a small percentage of Celiac patients will heal on a Gluten Free diet alone.  So I started to investigate how to determine if my gut was healing. I had a blood test done for the Cyrex Labs Array 4. It’s a blood test that checks for IgG and IgA for various other cross reactive foods that mimic gluten to also promote intestinal permeability. My blood test came back showing elevated levels of dairy, millet and rice. I read this that my gut wasn’t healing. I was experiencing cross reactivity to dairy, rice and millet. These foods were reacting just like gluten was. For an in depth review of Cross Reactivity read this article from Dr. Tom O’Bryan.

I have been off dairy for approximately 5 months. A few weeks ago I chomped my lower lips 3 times in the same place just days apart and no canker sore! It healed like I would assume any self inflicted bite would heal, without a painful ulcer. Again this is a very small sample size, but it’s a change and a positive one. I wonder if it’s safe to assume that my gut lining is starting to heal? I’m planning on having both Cyrex Labs Array 2(this test measures health of the intestinal lining) and 4 done at regular intervals to see how things are healing.

So back to Google Scholar to find if there were any studies related milk and Aphthous Ulcers and I found this study from 2009. Which provided evidence of patients that suffered from Recurrent Aphthous Ulcers had significantly higher levels of Cow’s Milk antibody in their blood samples, the immune system has detected milk protein in the blood and has tried to remove it. How did these patients form antibodies to Cow’s Milk in their blood? My guess is through a permeable intestinal lining.

Heal the Gut, Heal the painful lesions on the mucosa of the mouth? As a dentist I see canker sores all time. I see other ulcerative type lesions from Lichen Planus and Sjogren’s disease. I have a hunch these are related to intestinal permeability as well. I’m beginning to understand these are linked to a problem greater than Celiac Disease. That problem is intestinal permeability.

Questions that need to be answered

  • Could these types of lesions be used to help determine the health of intestinal lining?
  • Why do some with intestinal permeability get canker sores and other don’t?
  • If these are occurring in the mouth are they actually occurring in the intestinal lining as well?
Thank you for reading this far, I’d appreciate hearing your comments below and grateful if you’d share with your networks.


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  • Vivek Oct 10, 2012 @ 10:41

    Great info. Loved reading it. Hope to read more as you make new comnections

  • Wendy Oct 11, 2012 @ 2:34

    Thank you for taking the time to type this up and include all the resources that you did. It is appreciated.

    • Doug S Oct 11, 2012 @ 13:39

      You’re welcome!

  • Helen Wenley Oct 14, 2012 @ 3:40

    Have you read Dr Steven Gundry’s book ‘Diet Evolution’? Dr G says ‘a healthy grain is an oxymoron. I have been following Phase one of Dr G’s program since the beginning of August and for the first time in 10 years of healthy eating, my ‘wheat belly’ waist size has reduced by 2 inches.

    • Doug S Oct 15, 2012 @ 4:30

      Hi Helen. I haven’t heard of that book until now. I’ll have to check it out! Thanks for the info! Congrats on the loss of inches.

  • AJ Oct 16, 2012 @ 9:49

    I think there´s a connection to lack in B-vitamins and possibly zink too. Before being diagnosed celiac your intestines cannot take advantage of the food and food being missed the most are b-vitamins, zink and iron. You are always low on these tests just after being diagnosed. If you can catch up you will soon get back to normal levels again and the cranker sores will disappear. For those that do not heal the intestines, they will continue having the sores…. That´s my theory. And yes, I agree with you that you can for certain tell there is an intestinal problem when you find these kinds of sores… Do you as a dentist also look for “Celiac teeth” in children – that is with damages enamel due to malnutrition of an undiscovered sprue?

    • Doug S Oct 16, 2012 @ 14:36

      Hi Aj, Thanks for commenting! This makes sense. Nobody really knows the mechanism. Is it related to nutritional deficiency? Maybe? Probably? Or is it the mere fact that there is break down caused by gluten/milk/corn to the lining of the intestine and if it’s happening there it could also happen as canker sores in the mouth. regardless of nutritional deficiency or not. Hopefully we’ll be able to figure it out one day. I do look for signs in the teeth of celiac disease. I wrote previously about the connection of white spots on teeth and celiac disease here:

  • TS Aug 24, 2013 @ 10:01

    As a dentist please, please look into gum loss as well! I have had 2 tooth grafts, 1 before being diagnosed with celiac disease and one after. I have been gluten free 5 years and am trying to avoid a predicted 3rd graft. They are painful!

    • Doug S Aug 24, 2013 @ 10:19

      Hi TS thanks for chiming in… I’m not sure what the connection is but I do think there is a connection to gingival healing/health and celiac patients. It’s a topic that I’ve been researching…

  • Gonçalo barreto Aug 12, 2014 @ 2:33

    can I use your picture to our research webpage in Finland

  • Nadia Apr 3, 2015 @ 19:14

    I have always suspected there was a connection with my Canker sores and Leaky gut. I would always get the sores when I would eat more sugar, which I now know increases gut permeability. I always felt intuitively that my sores were trying to tell me something. Now it strikes me that the mucosa of the mouth is very similar in texture and nature to the gut mucosa. It’s like a mirror into how the gut is doing. Thanks for writing this, I’m sure there will be more research on it eventually.

  • Jessica Nov 7, 2015 @ 20:23

    Hello! I’ve been dealing with chronic cankers for the past almost 6 months now. No one really knows what’s going on. I have had blood work done for everything under the sun including vitamin deficiency and autoimmune diseases. Everything came back normal except for my inflammation markers (c-reactive, sed rat) were high. Recently saw someone practicing natural medicine in which they tested my saliva, urine, thermal scan imaging and did a live blood analysis. He said I have got candida as well as leaky gut. Could this really be the root of all this for this long ?? My doctor is not convinced, he has prescribed colchicine. Please some information would be appreciated. Thank you.

    • Doug S Nov 7, 2015 @ 21:57

      It’s possible as are other things. Ask your physician to run a Celiac Panel…. Do some research into the diagnosis of Celiac Disease. It may require a referral to a Gastroenterologist. It can be a tricky diagnosis, but it’s definitely worth exploring. It may not be the cause maybe it may help you down another path.