<<Disclaimer: Verify this information before applying it to your situation.>>

I posted an inquiry about canker sores to this list.  Quite a number of you
responded to the effect that canker sores decreased or disappeared after
going on a g-f diet.  Whether this is directly related to celiac or simply
to better nutrition once on the g-f diet isn't clear to me.   This is a
slightly edited compilation of the comments:

I have had consistent canker sores, which doctors and dentists have "waved
away" as temporary for the past 15 years.  I have been recently diagnosed
with Celiac disease after going 1 1/2 years with continuous diarrhea.
Needless to say, quite a bit of weight was lost and anaemia set in.  Now, I
find that, without Gluten, I have not had a single canker!

>>I used to get canker sores all the time before I started the gf diet about 9
>>years ago.  I can't remember having any since then.  I haven't really thought
>>to make the connection but it sure sounds like you may have something here.
>> Please post a summary of your responses.

When I read your post, I remembered reading an article about the
relationship of canker sores
to toothpaste. As I couldn't remember the toothpaste which was
recommended for canker sore sufferers, I didn't reply to your post.
Just this evening I ran across some info; most toothpastes contain
SLS(sodium lauryl sulphate). When sufferers used a toothpaste without
that, they showed a 70% reduction in outbreak. The toothpaste is
Natural Rembrandt Whitening Toothpaste. There are several brands of
Rembrandt toothpaste, but this one is SLS-free.

I also get canker sores when I eat gluten.  When I'm gf I might get a
>>few but not as bad.  One remedy is lysine.  I don't know why it helps
>>since it is supposed to only work on cold sores (they are a form of
>>herpes virus which can't live in the presence of lysine).  I take a
>>couple of grams of lysine a day and the sores are minimal.  Also, avoid
>>dairy, chocolate and sugar as much as possible during outbreaks.  I
>>found a product called Aloe vera detox by Naturade it makes a big
>>difference in the healing of canker sores for me.  Assuming that the
>>canker sores are a reflection of sores in my intestine, the healing of
>>the intestine also heals my mouth sores.

>My experience confirms link between gluten ingestion and canker sores.
> Pre-GF diet I had frequent bouts of canker sores.  Since going GF about 6
>months ago, no canker sores, except when I went off the diet for about 1 week
>preparatory to biopsy. After 5 days eating wheat again, I got the most
>ferocious case of canker sores I ever had.  By the way, Zylactin, which is an
>over-the-counter goo that forms a skin over the sores, is the only thing I've
>found which brings relief from discomfort and speeds healing.  I should add,
>my biopsy was negative.  Nevertheless, I remain GF due to bloating, diarrhea
>and canker sores whenever I eat gluten.  Caprylic acid (to control candida)
>also helps me.
>>
>>While I do not have Celiac Disease, my 5 year old does, I do suffer from
>>canker sores.  At one point they were as large as dimes.  A dermatologist
>>recommended Viadent oral rinse.  As soon as I read the post, I ran to the
>>medicine cabinet, grabbed the bottle, and called the Colgate company.  They
>>assured me that it is gluten free.  I use it a couple times a day as soon as
>>I feel the sensation of a sore coming on. I rarely get sores now
>>
>>As a child growing up I had canker sores, cold sores, fever
>>blisters, etc. so often that every picture of me in school
>>shows me with blisters on my lips. I was diagnosed 5 years
>>ago with celiac and rarely ever have a blister now. I think
>>there is a correlation between the two (at least for me).
>>
  I dont know about all, but I used to get canker sores all the time
>before dx.  Since dx, 5 yrs ago, I've only had them a couple times, and each
>time could trace them to accidental ingestion of gluten.  Coincidence??  I
>dont think so.  I also know of a couple other people in our group with the
>same reaction.  it also seems to occur if you are using the wrong lipstick or
>gloss.
__________________________________________
From: Can A GLUTEN-FREE DIET HELP? How? by Lloyd Rosenvold, M.D., [Keats
Publishing, 27 Pine Street (Box 876) New Canaan, CT 06840-0876, 1992, ISBN
0-87983-538-9] Pages 123-124. Aphthous Stomatitis -- ("Canker" Sores in the
Mouth)
We have known for many years that "canker" sores in the mouth were sometimes
associated with vitamin B deficiency. So also with food allergies. For
example, I have known a person who developed allergy to soy products and
when he would eat them tiny painful ulcers would develop along the sides of
his tongue. Often at the same time circumscribed painful areas would develop
in his stomach. these we believed were similar tiny ulcers such as seen on
the tongue. When soy was discontinued the mouth ulcers would heal and when
the pain there went away, so also did the pained areas in the stomach,
probably indication that the gastric ulcers also healed.

Now we learn from several medical journal reports that these mouth ulcers
can be associated with CD [Celiac Disease]. One report (in Gut 21:223-226,
1980) found two cases of the mouth ulcers in 50 patients with CD.

In another report (in Digestive Diseases & Sciences 26[8]:737-740,1981) out
of 20 patients with recurrent aphthous ulcers, 25% showed favorable
responses to a withdrawal of gluten from the diet. In this study none had
demonstrable intestinal lesions. Either they did not have CD, or else the
disease was in such early stages that the intestinal lesions could not be
demonstrated on biopsy. (Compare with the report from Holland that follows.)

In a report from Holland (Netherlands J. of Med. 31:256-262,1987), 168
patients with CD were studied, of whom 28% complained of mouth ulcerations
from time to time.

Just what kind of cytotoxin or neurotoxin is produced in the intestinal
lesions that can travel via the bloodstream and produce ulcers in the mouth
we do not know. We must conclude from this study that any person with
recurrent aphthous stomatitis ulcers should certainly receive the benefit of
studies to check on CD and perhaps a trial of a GF diet for several months.
_______________________________

I hadnt really thought about that before, but now I realize that
since i started my GF diet in January, I havnt had a single canker
sore! i used to have them semi-frequently (once a month or so), so i
guess these may be influenced by gluten in the diet.

________________________________________
"Encyclopedia of Natural Medicine" by Michael Murray, ND and Joseph
Pizzorno, ND, Prima Publishing, 1995, ISBN 1-55958-092-5 (hard cover); ISBN
1-55958-091-7 (pbk.) (they also wrote "A Textbook of Natural Medicine")
From: Chapter 56, pages 425-427:
MOUTH ULCERS
* Single or clustered shallow painful ulcers found anywhere in the oral
cavity
* Lesions are from 1 to 15 mm in diameter, have fairly even bordered, are
surrounded by a reddened border and are often covered by a white membrane.
* Lesions usually resolve in 7 to 21 days, but are recurrent in many
people.

General Considerations --------- Recurrent canker sores, mouth ulcers of
aphthous stomatitis is an extremely common condition, estimated to affect 20
percent of the population. the
cause of recurrent canker sores, based on studies of initiating factors,
appears to be related to food sensitivities, stress and nutritional
deficiency.

Therapy ------ Food and environmental allergens

The oral cavity is, obviously, the first site of contact for ingested, and
many inhaled allergens.. The association of recurrent mouth ulcers with
increased serum antibodies to food antigens suggests an allergic reation is
involved. Furthermore, allergic antibody-bearing lymphocytes are
significantly increased in mouth ulcers and mast cells are increased in
tissue sections from prodromal stages of recurrent ulcers. Mast cell
release of histamine and other inflamatory particles play an imporant role
in the production of a mouth ulcer. A diet eliminating allergens has been
shown to have good theraputic results.

Stress is often a precipitating factor in recurrent mouth ulcers,
suggesting a breakdown in normal host protective factors. Stress greatly
increases the development of allergies..

Nutritional Deficiency -- A study of 330 patients with recurrent mouth
ulcers found that 14.2% were deficient in iron, folate or vitamin B12, or a
combination of these
nutrients. When these patients' deficiencies were corrected by
supplementation, the majority had complete remission. Other studies have
shown similar deficiency rates for the same nutrients and equally good
response to supplementation. Zinc supplementation has also been shown to be
effective in some patients (particularly those with low serum zinc levels.)

Gluten Sensitivity ----- The incidence of recurrent mouth ulcers is
increased in patients with
coeliac disease, a condition caused by sensitivity to wheat gluten. Biopsy
of the small intestine in 33 patients with recurrent mouth ulcers showed
eight to have the intestinal damage of coeliac disease, along with signs of
allergic reactions to food antigens. The remaining patients also exhibited
these types of signs, but to a lesser degree.

An underlying gluten sensitivity would also contribute to nutritional
deficiencies. Withdrawing gluten from the diet results in complete
remission of recurrent mouth ulcers in patients with coeliac disease and
usually some improvement in the rest of the patients.

Flavonoids --- Several flavonoids are known to inhibit mast cell
degranulation, basophil
histamine release and the formation of other mediators of inflammation. The
anti-allergy drug di-sodium cromogylcate, a compound very similar in
structure and function to the flavonoids, has been shown to be effective in
the treatment of recurrent mouth ulcers, resulting in an increase in the
number of ulcer-free days and in mild symptomatic relief. Several
flavonoids, including quercetin, acacetin, apigenin, chrysin and phloretin
have also shown anti-allergy effects similar to disodium cromoglycate.

Treatment --- The data described above suggests that no single factor is solely
responsible for the initiation of mouth ulcers in any specific individual.
The therapeutic approach to mouth ulcers is similar to that in other
diseases with an allergy basis. Foremost is the recognition and control of
allergens, particularly gluten. In addition, nutrient deficiencies need to
be corrected and anti-inflamatory nutrients prescribed.

Diet--- The diet should be low in animal products, high in complex carbohydrates
and free of known allergens and all gluten sources (wheat, oats and
barley).

Supplements--- *Vitamin c, 1 g per day
*Zinc (picolinate), 25 mg per day
*Multiple vitamin and mineral, one to five times the recommended dietary
allowance
*Mixed Bioflavonoids, 1 g per day
I looked up mouth ulcers in the Merck Manual (16th edition). It said
"Etiology is unknown, but several factors point toward a localized immune
reaction. Deficiencies of iron, vitamin B12 and folic acid increase
susceptibility. Stress and local trauma are usually the predominant
precipitating factors."
_________________________________________

>>My husband constantly is plagued with canker sores throughout his mouth.
>>He has tried Zofirax (sp) but to little avail.

Vitamin deficiencies have indeed been linked to apthous ulcers (the proper
name for canker sores).  The reason Zovirax didn't work is that
Zovirax is specifically for the herpes virus (i.e. cold sores,
shingles, chicken pox, et. alia)  Frequently apthous ulcers are
misdiagnosed by well-meaning doctors as herpes virus, even though the
two affect different tissues in the mouth.  One only affects
keratinized tissue, i.e. the gums (the tissue is harder than regular
tissue), the other only soft tissue (i.e. lips and tongue).  For
immediate relief of the pain of canker sores, use something along the
lines of Chloraseptic spray, or Sucrets Extra Strength.  Both have
anaesthetic properties that help reduce the pain.  Then go see your
DENTIST.  There is TREATMENT for canker sores; it is similar to
chemical cauterization and it is a little painful; however, the pain
is temporary and alleviated with ibuprofen, etc., and Guess What!
The sore heals in 24 hours afterwards.

My recent post concerning canker sores and celiac brought a number of
responses. Most who commented said that their Behcet-caused canker sores had
abated after being on a GF diet. Some, however confused canker sores (inside
the mouth) with cold sores on the lips and outside the mouth. I have
therefore modified my data sheet to clarify the difference.

I also remember hearing that sodium laurel sulfate, an ingredient common
to toothpaste can bring on these eruptions.  Rembrandt natural
toothpaste is one of the few I have found that are sodium laurel
sulfate-free.

Before diagnosis I suffered with very bad canker sores.  My consultant said
that they were very much an indication of CD.  I still get an occasional
sore but I think this is more due to trauma that diet.  I was recommended
many years ago, by a dentist, a paste called Adcortyl in Orabase.  Don't
know if you can get it in the US, but in England it is on prescription
only.  It is really very good.
I can't say how true it is, but I used to get canker sores a lot.  I have
not gotten one since going gluten free.  Coincidence?  I don't know.