What causes canker sores and how can I treat them? I get them all the time!

There is considerable debate on this issue. Some say a nutritional deficiency, some say immune system weakness, some say food sensitivity, some say chemical irritants. I say they're correct.

I used to have canker sores all the time and have avoided them in recent years. I take a shotgun approach to the problem. First comes the immune system-weakening ability of refined sugar (and refined starch, which converts to sugar immediately). It should be avoided as much as possible. Even fruit juice is pretty concentrated sugar, so stick with whole fruit if you must have something sweet.

Keep a food diary to see whether outbreaks are attached to certain foods or items that you put in your mouth. It can be foods ("good" or "bad"), chewing gum, colors, flavors, preservatives, you name it. If there are suspects, give them up for seven days and then see whether, on re-introduction, you get any symptoms that bother you at all (they don't have to be canker sores).

I always suggest a strong multivitamin and mineral supplement plus extra vitamin C to everyone, and this is no exception. It may be helpful, as any one of a number of nutrients may be permitting the occurrence of these sores. Once they occur, extra vitamin C can help them heal, though occasionally I hear that the acid form of C sets some people off.

Zinc and vitamin A (not beta-carotene) are also helpful. Consider 30 milligrams a day of zinc for two weeks and 25,000 IU of natural fish oil A (I usually use twice that amount, but ask your doctor) for two to four weeks, with lower doses for maintenance.

Best of luck preventing this painful, irritating problem, and Good Health.

A.N. Spreen, M.D.