Case 8: Canker Sores:
A Functional Diagnostic
Medicine Approach

LeAnn was initially seen in our office for a primary complaint of canker sores aka: aphthous ulcers. The canker sores had been persistent for a period of six months. All traditional medical treatment including a medicated mouthwash called Peridex, Triamcinolone acetonide, commonly known as Kenalog and a new medication called Aphthasol all failed in providing long term relief. LeAnn, in addition to the prescribed medication she also tried salt water rinses and Lysine. Unfortunately, the problem persisted.

She was literally in tears when she initially consulted with us. According to LeAnn, her ability to enjoy life was compromised. She simply did not know what else to do and was desperate for an answer.

Like all patients we see for functional diagnostic medicine consults, LeAnn was required to complete our 41 page medical questionnaire. In addition, we had our staff obtain her medical records from the two physicians who she consulted for the canker sores.

Based on our review of her questionnaire and medical records, we had a strong suspicion that her primary problem was due to an iron deficiency and/or B-12 deficiency. In order to confirm our suspicions, we ordered a CBC differential. The following are the results of the CBC:

Comments: As suspected her red blood cells were clinically depressed at 3.97 and her hemoglobin and hematocrit were borderline depressed. This was followed with a ferritin test. Again, the findings tightened our suspicion with the ferritin listed at 17.  With her depressed white blood cells and neutrophils, we decided to order a methylmalonate test. Methylmalonate is a sensitive functional marker for vitamin B12; high levels of methylmalonate indicate vitamin B12 deficiency. LeAnn's results were listed at 4.2. Optimal is below 3.4

Treatment: Based on these findings, we started LeAnn on a light iron therapy and sublingual B-12.

Results: It has been approximately seven weeks since LeAnn started on the iron therapy and the sublingual B-12. As of this writing she has been "completely" free of canker sores for the last three and half weeks. No other treatment was rendered except iron and sublingual B-12 therapy.

Comments: It totally amazes us that traditional medicine overlooks something so simple like iron and B-12 therapy. We are appalled at the global advice offered on traditional medical sites like WebMD and Mayo Clinic. In fact, these sites even make the statement.."some people "think" that B12 and iron may help". Come on, we don't just think, this is uncalled for and something we see running rampant in the traditional medicine circles. Like we said, we don't just think, no, we run the appropriate medical labs to PROVE and DOCUMENT our findings. Then we treat what we find based on objective findings. Look below at some of the medical citations on the clear relationship between B-12 and iron deficiency and canker sores. Well, anyway, you get the point.

** QUICK SIDE NOTE: Some doctors reading this may say, why don't we just do a trial of iron and sublingual B-12 and see what happens? Well, the reason is five fold.

1. Testing allows us to pinpoint the probable cause of a patient's health challenge

2. Testing increases patient compliance.

3. Testing provides a baseline to determine if the treatment is successful. we always re-test our positive findings after a short period of treatment. With an increase in ferritin and a decrease of methylmalonate, we are assured that our treatment is working and it also increases the patient's confidence in the treatment. Remember, treatment is based on objective results NOT just subjective findings. Think about it. If the patient decides to stop treatment before the objective testing has improved, there is a strong likelihood of an exacerbation.

4. Testing provides ammunition to send to the patient's primary physician showing him or her the value of functional diagnostic medicine thinking.

5. Testing also has one HUGE advantage that is rarely considered but plays a major role in the success of your practice. You see, patients love to show their friends and family "hard data". we NEVER give a patient a xerox copy of the test results, we give them the full color version. Don't think for one second that patients are not showing everyone they come in contact with their lab results. And guess who gets all the credit when the patient gets well? Of course you do!! Talk about building your credibility!! we promise you will be the next American Hero!!

Medical Citations:

Piskin S, Sayan C, Durukan N, Senol M. Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis. J Eur Acad Dermatol Venereol. 2002 Jan;16(1):66-7.

Challacombe SJ, Scully C, Keevil B, Lehner T. Serum ferritin in recurrent oral ulceration.
J Oral Pathol. 1983 Aug;12(4):290-9.

Koybasi S, Parlak AH, Serin E, Yilmaz F, Serin D. Recurrent aphthous stomatitis: investigation of possible etiologic factors. Am J Otolaryngol. 2006 Jul-Aug;27(4):229-32.

Weusten BL, van de Wiel A. Aphthous ulcers and vitamin B12 deficiency. Neth J Med. 1998 Oct;53(4):172-5.

Wray D, Ferguson MM, Mason DK, Hutcheon AW, Dagg JH. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. Br Med J. 1975 May 31;2(5969):490-3.

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