 Canker sores can be a painful, recurring inflammatory process of the lining of our mouths, and similar 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. OK, 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 2 grams of vitamin C a day. That's considered the tolerable upper daily limit for adults before you start getting diarrhea, and 1,200 milligrams may do that in a 12-year-old. But it's all about risks and benefits. How did they do? 15 out of 16 cut the number of canker sores they were getting at least in half. Within three months before they started the vitamin C, they averaged four canker sores, but in three months they were on it, had less than one on average. Then they tried stopping the sea for another three months, and the ulcers started coming back, and so they added the sea back and the canker sore rate dropped again. What about applying antioxidants directly? Like a turmeric gel containing 2% curcumin, the yellow pigment of the spiced turmeric, swamped directly onto the canker sores twice a day. It did seem to significantly reduce pain intensity and ulcer size compared to placebo, 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 their 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 the 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, that's something that doesn't give you diarrhea. 31 patients with recurring canker sores were split up into two groups, getting either 20 milligrams 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 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, 30-year-old woman with four years of recurring canker sores, eating so few animal products and no supplementation, she became vitamin B12 deficient. She started feeling weak, and tired, 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 anytime 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 showed evidence of hematonic deficiencies, in other words, blood-forming nutrient deficiencies compared to less than 1 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. OK, so you could see how vitamin and mineral supplements might help people who are deficient, but might a supplement like vitamin B12 help even people not B12 deficient? Apparently so. As the title says, cyanocobalamin, the most common form of submental 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 1,000 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 in the level of pain were significantly reduced. And again, regardless of the initial vitamin B12 levels in their 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 starts working. Whereas if you apply B12 directly to the canker sore, a randomized, double-blind, placebo-controlled trial of a B12 ointment applied directly to the canker sores, you can get at least significant reduction in pain within two days compared to placebo. And again, it doesn't matter whether your vitamin B12 deficient or not.