Canker sores (“aphthous ulcers” or “apthous stomatitis,” technically speaking) are a common symptom in otherwise asymptomatic undiagnosed celiac patients. Some research suggest they may also be a common symptom in patients of non-celiac gluten sensitivity (NCGS). They manifest as recurrent ulcers in the mucosal lining of the mouth.
About 20% of the general population experiences these canker sores, so not all cases are associated with gluten intolerance or celiac disease. Most cases develop during adolescence or early adulthood, then seem to disappear a few years later (without a known reason).
Because people with celiac disease experience aphthous stomatitis more often than people in the general population, there is a statistical association between the two conditions. If an immediate family member has been diagnosed with celiac disease and you have recurring canker sores, you should bring these possible celiac symptoms to the attention of your doctor right away.
In addition, the Journal of the Canadian Dental Association published a clinical guide for identifying and diagnosing celiac-related dental defects, wherein they suggested that celiac disease should always be considered when recurrent oral aphthous ulcers are present.
However, having frequent canker sores is common and these little mouth sores have a wide variety of triggers, so don’t assume celiac disease is always their source. What causes canker sores and how might you treat them?
Nutrition For Canker Sore Treatment
Beyond your gluten-free diet, emphasizing certain nutrients may help prevent or minimize these frustrating mouth ulcers. If your diet is low in folate, vitamin B6, vitamin B12 or zinc, you may increase your risk for recurring canker sores. Try to incorporate more foods containing these nutrients, but if a blood test reveals you’re low in one or more of them, you may need to take a supplement.
In particular, there appears to be a distinct association with a vitamin B12 deficiency and recurring canker sores. This was discovered by researchers at the University of Connecticut in a study published in the Journal of Oral Pathology & Medicine. They studied 100 people with recurring canker sores and discovered a strong correlation between low vitamin B12 levels and a high frequency of canker sores.
So in addition to a low sugar gluten-free diet, I recommend temporarily supplementing with vitamin B12. See if this lowers the frequency of your canker sores.
My Thoughts On Canker Sores And Gluten Sensitivity
My own personal conjecture is that aphthous stomatitis occurs more often in individuals with a non-celiac gluten sensitivity than with celiac disease. I base this conjecture partly on anecdotal evidence with my newsletter readers, but also on evidence that suggests aphthous stomatitis may be caused by a T cell mediated immune response — and the pro-inflammatory cytokines drawn to the area as a result of that response.
A recent study, conducted by the Beth Israel Deaconess Medical Center at the Harvard Medical School, suggests NCGS may involve the innate immune system (rather than the adaptive immune system along with the innate system, as occurs in celiac disease).
Patients suffering from NCGS often have a higher concentration of immune proteins known as TLRs (“Toll-like receptors”). These TLRs can produce pro-inflammatory cytokines, which course through your body triggering inflammation. A wide range of abnormal responses may occur as a result of this trigger for systemic inflammation, including aphthous stomatitis.
Again, this is just my own conjecture here. However, there is quite a bit of anecdotal evidence of people relieving canker sores with a gluten-free diet. It would be interesting to see a study that isolated non-celiac canker sore patients and evaluated whether or not a gluten-free diet helped them.