"The Role of Dairy and Gluten in Canker Sores"
Recurring canker sores, the single most common inflammatory
and ulcerative condition of the mouth, affecting as many as 1 in 5 people.
Ouch.
Sometimes it can be a sign of celiac disease,
a relatively rare autoimmune condition triggered by the wheat protein gluten,
but what about those without celiac disease?
Well, 37 years ago, there was a report of a small group
of recurrent canker sore patients that got better after removing gluten from
their diet, despite the fact that they didn't have any signs of celiac disease.
Now without a control group, you don't know if they would've just gotten better
on their own, but it was interesting enough to spark further study.
Given that small series of patients, they decided to try out a gluten free diet
on 20 folks with recurring canker sores,
again explicitly excluding those known to have celiac disease.
And 5 of the 20 seemed to get better,
and critically then they got worse when they were challenged with gluten.
So even though there was no control group,
in the few that got better, the ulcers came back
when gluten was added back to their diet.
Now, this was not just some random group of canker sore sufferers;
the reason they had gotten intestinal biopsies to rule out celiac
was because they had some other abnormalities.
So you can't extrapolate from this study saying 1 in 5 sufferers
may benefit from cutting out gluten.
Though at least it appears in some people to help.
Though it would have been better if it was a blinded challenge.
I mean if you cut out gluten, or any food,
and just coincidentally happen to feel better,
you might convince yourself that gluten was the culprit.
And so then when the researcher gives you a piece of bread,
maybe just the stress at the thought of your ulcers coming back
may actually help trigger the ulcers coming back.
That's why ideally you do blinded gluten challenges
to see if gluten really is to blame.
For example, if you take people who don't have celiac or a wheat allergy
but nevertheless claim to be sensitive to gluten,
you can test to see if they're fooling themselves
by randomly assigning them to take a capsule with gluten inside
or just a placebo made out of rice starch.
So they're on a gluten free diet and then you give them this pill,
which in the case of the gluten one is equivalent to like two pieces of bread,
and you see if they get worse.
And then just the thought of taking something that might be gluten,
their symptoms shot up.
And this was them just taking a placebo rice starch pill,
but the reason we know this non-celiac gluten sensitivity exists
is that the actual gluten pill made them feel even worse.
And that's specifically what happened in the case of canker sores.
Those who felt they were gluten sensitive
did actually get more canker sores exposed to real as opposed to fake gluten.
Where did they even get the idea in the original study to try cutting out gluten?
Well, back in the '60s, it was reported that the blood of patients
with bad canker sores reacted to certain food proteins like gluten,
but had an even stronger reaction to the milk protein casein.
This has since been more formally tested.
Fifty patients with recurring canker sores were compared
to fifty healthy people for their levels of anti-gluten antibodies—gliadin is
a type of gluten protein—and anti-cows milk protein antibodies.
And the canker sore sufferers were no more likely to react to the gluten,
but the levels of anti-milk proteins were significantly higher;
in fact, the majority reacted to the cows milk.
These results indicate a strong association between high levels
of anti-milk proteins in the blood with recurring canker sores,
but what we care about is do people actually get better or not
when they cut out the milk?
Well, upon hearing their results,
three of the patients spontaneously decided to cut all dairy products
from their diet for a few months to see what happens, and it seemed to help.
No reappearance of the sores in the first patient.
Same with the second, until they had some cows milk ice cream.
And in the third, the ulcers seemed to come with less frequency.
But those were just some observations, not an actual study.
You see the same thing with certain food additives.
Folks with recurring canker sores may react more to certain food dyes,
and so if you try people on a gluten free diet, or a dairy free diet,
or a diet free of certain food additives, you'll get a few cases of people
responding—in this case 6 out of 11: some better on the gluten free,
others better on the milk free, others on the additive free,
but the responses were pretty dramatic, seen within a week.
So seems it might be worth giving these exclusion diets a try
to see if there's a huge improvement.
Can't you just get an allergy test or something?
Apparently not. For example, this poor woman
who suffered from recurring canker sores since she was 2 years old:
multiple, painful lesions in her mouth almost constantly.
They asked her about milk, and she said she rarely drank it
because it appeared to trigger more almost immediately,
so they decided to look into it.
They tested her for sensitivities to dairy, both so-called prick and patch
allergy tests, and they were both negative.
But hey, if she felt worse on dairy, might as well try cutting out all dairy
products completely, and for the first time in her life
the ulcers went away and stayed away,
unless she accidentally had some milk product.
So even if people test negative, it may be worth a try
to cut out all dairy and see what happens.
Look, we know cows milk may play a role in other
allergic and auto-immune type diseases,
and there are these reports going back decades
suggesting at least there's a subgroup of canker sore patients
for which dairy is a causative factor;
however, awareness of this association is rare
among both patients and healthcare providers.
And improvement can happen rapidly.
A boy and a girl both suffering for years with frequent multiple ulcerations,
then apparently cured within two weeks.
We don't know how often it works, but we just know it does, sometimes.
So, as this 2017 paper in the Journal of the American Dental Association suggests,
why not give a cows milk protein elimination trial a try,
particularly before the use of medications with potential side effects?