Friday Favorites: Best Supplement for Canker Sores

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Canker sores can be a painful, recurring inflammatory process of the lining of our mouths. And, “[s]imilar to other chronic inflammatory conditions,…DNA…damage [due to] oxidative stress [free radicals] is thought to play a…role.” Normally, free radical “production is balanced with antioxidants.” However, if the free radical concentration gets too high, and our antioxidant enzymes and the antioxidants we get in our diet “cannot [adequately] compensate” for these radicals, the balance is shifted in a pro-oxidant direction, which can lead to oxidative damage within our body. Okay; so, do those with recurring canker sores have fewer antioxidants, more oxidation, and more DNA damage? Yes, yes, and yes. More pro-oxidants and more oxidative stress in their bloodstream, lower antioxidant status, and more DNA damage—suggesting it might be possible for antioxidants to help, but you don’t know, until you…put it to the test.

16 boys and girls around age 12 with recurring canker sores given a whopping two grams of vitamin C a day. That’s considered the tolerable upper daily limit for adults before you start getting diarrhea, and 1,200 mg may do that in a 12-year-old. But, it’s all about risks versus benefits. How did they do? 15 out of 16 cut the number of canker sores they were getting at least in half. In the three months before they started the vitamin C, they averaged four canker sores, but in the three months they were on it, they had less than one on average. Then, they tried stopping the C for another three months, and the ulcers started coming back. So, they added the C back, and the canker sore rate dropped again.

What about applying antioxidants directly, like a turmeric gel—a gel containing 2% curcumin, the yellow pigment in the spice turmeric? Swabbed directly onto the canker sores twice a day, it did seem to “significantly reduce…pain intensity” and ulcer size compared to placebo, and compared to a gel containing no active ingredient. But, it would be nice to see a comparison to some active treatment, and from an independent research group not funded by the curcumin gel manufacturer. And…here it is. A randomized clinical trial: a generic 2% curcumin gel versus a prescription steroid gel, and the curcumin worked just as well, providing “strong evidence that [it] can be used as an effective and safer alternative to steroids” for the treatment of recurring canker sores.

But, if you remember, topical honey beat out that same steroid for both ulcer healing, compared to the steroid, and pain reduction, compared to the steroid. So, if you’re going to use something topically, honey seems best. But, what if you just want to swallow something instead—but something that doesn’t give you diarrhea?

31 patients with recurring canker sores were split into two groups, getting either 20 mg of yeast beta-glucan fiber a day or placebo. That’s the amount found in just an eighth of a teaspoon of brewer’s yeast or nutritional yeast. In the placebo group, no significant change, whereas in the yeast group, ulcer severity was cut nearly in half; so, that’s something else you can try.

If it’s an antioxidant thing, can’t you just eat a plant-based diet, lots of fruits and vegetables, and treat it that way? That’s never been put to the test, though a plant-based diet could also make things worse, if one is not ensuring a regular reliable source of vitamin B12 through supplements or fortified foods. For example, a 30-year-old woman with four years of recurring canker sores eating so few animal products, and no supplementation, she became vitamin B12-deficient and started feeling weakness, tiredness, numbness, and tingling. So, they immediately started her on B12, and, thankfully, her B12 deficiency symptoms got better. But, so did her canker sores—”a rapid and complete recovery” within weeks of starting B12, after years of suffering.

We’ve known B12 deficiency could lead to canker sores since the 70s—so much so that a recommendation has been made to consider B12 deficiency any time you see a patient with recurring canker sores. In fact, a number of nutrient deficiencies may do it. If you compare the lab tests of those with recurrent canker sores to those without, more than half of the canker-sore group show evidence of “haematinic deficiencies”—in other words, blood-forming nutrient deficiencies, compared to less than one in 10 in the non-canker sore group. So, we’re talking like iron deficiency and folate deficiency, in addition to B12 deficiency. So, they gave them supplements and their canker sores improved, especially among those who didn’t have a family history of canker sore problems.

Okay; you could see how vitamin and mineral supplements might help people who are deficient. But might a supplement like vitamin B12 help even in people not B12-deficient? Apparently so. As the title says” Cyanocobalamin [the most common form of supplemental B12] may be beneficial in the treatment of recurrent [canker sores] even when vitamin B12 levels are normal.” They took a group of 72 patients with frequent canker sores, and gave them B12—regardless of what their levels were—and in 96% of cases, they got better. And, that was among both those who started out deficient, and those who started out with regular B12 levels in their blood. But, there was no control group. So, you don’t know how many would have gotten better anyway. And, they injected the B12, and injections can have an even greater placebo effect than pills, especially, perhaps, with something like B12, which has a striking mad-scientist-looking ruby red color in the syringe. But, there had never been a randomized, double-blind placebo-controlled trial of oral B12 for canker sores until, there was.

A thousand micrograms of sublingual B12 a day for six months, and it took five months, but eventually: “The duration of [canker] outbreaks, the number of ulcers, and the level of pain were reduced significantly”—and again, “regardless of initial vitamin B12 levels in the blood.” So, B12-deficient or not, vitamin B12 supplements seemed to help. By the end of the study, twice as many in the B12 group appeared to have been cured.

So, vitamin B12 supplements represent a “simple, inexpensive,…low-risk,…effective” treatment, though it appeared to take months before it started working—whereas if you apply B12 directly to the canker sores, a randomized, double-blind placebo-controlled trial of a B12 ointment, applied directly to the canker sores, you can get at least a significant reduction in pain within two days, compared to placebo. And again, it doesn’t matter whether you’re vitamin B12-deficient or not.

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Image credit: Bicanski via Pixnio. Image has been modified.

Motion graphics by Avocado Video.