More commonly known as canker sores, recurrent aphthous stomatitis (RAS) can be quite a nuisance. The sores can interfere with eating, talking, brushing, flossing, and quality of life in general. Chances are, you may have experienced them. They are single or multiple sores in the mouth, usually on the softer mucosal areas, not on the more rigid gum tissues. They appear as small whitish spots with reddened borders and are very painful. They are more common in those aged ten to nineteen years, and, fortunately,  the incidence decreases with age. (1)

 One of the defining features of recurrent aphthous stomatitis is that they are not associated with any underlying systemic illnesses. If systemic disease is present, they are known as aphthous ulcerations and are considered symptoms of those diseases. Celiac, Crohn's, AIDS, and other illnesses are some conditions associated with aphthous ulcerations. 

The causes of RAS is unknown. There is evidence, however, that low vitamin D and systemic inflammation are associated with RAS. (2,3) The lesions appear, linger for about two weeks, and resolve, only to return in several weeks to months. They do not leave scars. Western medicine claims there are no known preventive treatments.

When the sores are mild, patients can usually put up with the symptoms without treatment. When the lesions are more numerous and painful, we can treat them with topical steroids (Kenalog) in a protective gel (Orabase). Topical anesthetics like Orajel can also be useful. 

The best natural treatment is honey. In 2014 researchers studied 94 subjects and compared the effects of honey, Orabase, and topical steroids. The honey was better than the other two at reducing the sores' size, pain, and redness. (4)

Because the sores are associated with systemic inflammation, I believe that they can be preventable, and I have seen this first-hand in patients. There are numerous ways to reduce inflammation, but today I want to cover three important ones.

Sleep

One of the major contributors to inflammation is lack of sleep. Many of the hormones associated with sleep, such as cortisol and melatonin, help diminish inflammation. Tissues can become damaged over time, leading to high levels of inflammatory cytokines. (5) You should aim for about eight hours of sleep every night without fail. Read my post on how to sleep better here.

Diet

Researchers used data from the Nurses' Health Study and identified a dietary pattern related to inflammatory markers' bloodborne levels. They used C-reactive protein, interleukin-6, and tumor necrosis factor α receptor 2 as specific markers. (6)The goal of dozens of independent researchers is to develop a Dietary Inflammatory Index (DDI) to assess diet's relationship to health outcomes ranging from blood concentrations of inflammatory cytokines to chronic diseases. (7) We are a way off from a definitive DDI, But if you cut out processed carbs and seed oils like Canola and soy and eat whole foods, you will decrease your level of inflammation and probably decrease your chances of getting canker sores. 

I also recommend that you track your nutrient intake with an app like myfitnesspal. Adequate nutrient intake is how we maintain health; therefore, a lack of nutrients leads to degradation and inflammation. You don't need to track your diet for more than a week to get an idea of which nutrients you need.

Stress

Chronic stress is associated with elevated inflammation markers, including concentrations of cytokines and C-reactive protein (CRP). These markers and others are associated with accelerated progression of diseases that involve inflammation, including canker sores. (8) Therefore, it is an excellent idea to minimize the effects of stress. Yoga and meditation are two popular methods to diminish the impact of stress. I have written about some of the other ways to do that here. 

While the things I mentioned today are very worthwhile endeavors, they are not a guarantee that you won't experience canker sores and other forms of inflammation. There are too many variables in life ever to gain complete control over our health. But that should not deter us from our efforts. Finally, remember, if you do get a canker sore, you can use the best tasting edible medicine around-honey.