Q: I’ve been wondering if you have any advice that can help me get rid of canker sores. I seem to get them all the time, and it’s quite a nuisance! Thanks again.

––K.S., Roanoke, VA

Dr. Wright: You may not be thrilled to hear the advice, since it may require some substantial changes to your normal diet. But I promise that if you give it a try, you will be able to reduce the number of canker sore outbreaks you experience or even eliminate them altogether.

First and foremost, eliminate refined sugar from your diet. Sugar reduces the germ-fighting capability of white blood cells so they can’t fight micro-organisms associated with canker sores effectively. I know this is easier said than done—sugar, in many forms (such as high-fructose corn syrup, dextrose, dextrin, matodextrin, and many others) is hiding in some very unlikely places including fruit juices claiming to be “all natural,” canned soups, and even packaged breads. It’s not much fun, and it could make your trips to the grocery store last a little longer in the beginning, but reading the labels of foods on the supermarket shelves is very important.

But before you begin thinking I’m the “sweetness Scrooge,” there are some all-natural alternatives to sugar that can easily satisfy even the most persistent of sweet tooths. You can use raw, uncooked honey, molasses, 100-percent-pure maple syrup, or the herb stevia. All of these items are available in natural food stores.

Second, you should consider the role of food allergies. When you think of food allergies, you might picture the violent and dangerous reactions some people have to things like peanuts or shellfish. But many of my patients are surprised to learn that food allergies can be much more subtle than that, contributing to all sorts of seemingly unrelated health problems—including canker sores. The good news is that once your food allergies have been identified, you can almost always desensitize yourself to the culprits so that they can be re-introduced into your diet. You will need the help of a good physician trained in these sorts of procedures, though.

For a referral to one in your area, contact the American Academy of Environmental Medicine or the American College for Advancement in Medicine.

The herpes virus is another condition associated with various preconceived notions, but it’s actually much more widespread than you may think. There are a number of different strains of the herpes family of viruses, some of which cause common illnesses like chicken pox, shingles, and—you guessed it—canker sores. This type of canker sore often starts with tiny blister-like outbreaks clumped tightly together, which rapidly break open forming the typical canker ulceration.

Controlling herpes-related canker sores also involves some dietary changes. The amino acid arginine encourages the growth of the herpes virus, so cut back on foods high in arginine like grains, seeds, beans, nuts, and chocolate. I know that last item on the list can be a real struggle for some people, and I’d never be so bold as to tell a full-fledged chocoholic to stop eating it entirely. But try it out for a while to see if your outbreaks decrease. If they do, save your chocolate indulgences for special occasions. Just remember that the less you eat of these foods, the better you’ll feel.

Lysine is an amino acid that discourages the growth of the herpes virus, so you may want to increase your intake of lysine-rich foods like beef, pork, chicken, fish, and most animal proteins. If you’re a vegetarian, or just prefer not to eat much meat, taking lysine supplements can also be effective. Some people have told me that if they take enough lysine—sometimes 2 to 4 grams daily (which fortunately is safe)—they can continue to eat high-arginine foods (especially chocolate, of course!) and not suffer the herpes and/or canker sore consequences. Of course, since nearly all the chocolate you find in stores is high in sugar, I don’t recommend this strategy except for occasional use.

In addition, there are several nutrients that can help. Iron, folic acid, vitamin B12, and zinc can all aid in preventing canker sores. Iron deficiency can facilitate an outbreak, so you should have your doctor check your iron levels. If they are low, I usually recommend daily supplementation with iron.

Folic acid is an important nutrient for maintaining good oral health in general. Look for the “methylfolate” and “folinic acid” forms, which are better metabolized by the body. You can also find folic acid mouthwash products in your local health food store.

Zinc stimulates the immune system by promoting the ability of white blood cells to fight a whole variety of germs, including the herpes virus.

When I’m working with patients with recurrent canker sore outbreaks, I generally prescribe the following dosage guidelines (but you should talk to your personal physician to determine the best amounts for you): 30 to 60 milligrams of iron daily; 800 to 2,400 micrograms of methylfolate or folinic acid daily taken along with 2,000 micrograms of vitamin B12; and 30 milligrams of zinc picolinate daily.For periods of severe herpes-related outbreaks, I usually recommend 2,000 milligrams of lysine, three to four times daily taken in between meals; 500 to 600 micrograms of selenium daily; and 10 to 15 milligrams of lithium daily. (Both selenium and lithium significantly interfere with herpes virus self-reproduction.) Vitamin C should be taken as well, in approximately the same amounts as lysine. For convenience, and since safe, low-dose, temporary-use lithium is very hard to find, I’ve worked with Bio-Tech Pharmacal (800-345-1199, www.bio-tech-pharm.com) to make a combination formula called “HPX” or “HPX2” that contains all these (and several more) nutrients. Check with your local natural food store or compounding pharmacy, or with the Tahoma Clinic Dispensary.

For long-term prevention of canker sores, I advise taking 2,000 to 3,000 milligrams of lysine daily in between meals, along with smaller amounts of the nutrients mentioned above. When taking lysine, also take an equivalent amount of vitamin C.

Canker sores can be a nuisance, and you may be concerned that the changes you must make to eliminate them are just as big a hassle. But I can assure you that what might be a drastic shift at first will soon become second nature, and you’ll have the added benefit of being rid of your canker sores once and for all. And the rest of your body will be much healthier too!

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