The Dr. Hyman Show - Getting Rid Of Cold Sores And Canker Sores with Dr. Elizabeth Boham

Episode Date: December 21, 2020

Getting Rid Of Cold Sores And Canker Sores | This episode is sponsored by Thrive Market and Apeel While there is a difference between cold sores and canker sores, they are similar in that common occurrence of either is an indication that something is out of balance in the body. Most of us have had canker sores at one time or another. They usually occur at the side of your mouth, by your cheek, inside of your cheek, or underneath your tongue, and they can be quite painful. As opposed to cold sores, canker sores are not infections. Cold sores, however, are contagious, often forming inside your mouth, near your teeth, or on the lips; they result from herpes simplex virus.  In this episode, Dr. Hyman sits down with Dr. Elizabeth Boham to discuss what frequent recurrence of cold sore or canker sores might be indicating, and how they treat patients experiencing these issues. Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well. This episode is sponsored by Thrive Market and Apeel. Right now, Thrive is offering all Doctor's Farmacy listeners an amazing deal. Select a free gift from Thrive Market when you sign up for a 1-year membership. And, any time you spend more than $49 you’ll get free carbon-neutral shipping. Just head over to thrivemarket.com/Hyman.  Apeel, a family of plant-derived coatings that, when applied to the outside of produce, keeps it fresh two times longer, is doing amazing things to extend the shelf life of fruits and vegetables. If you want to learn more about Apeel, check out their frequently asked questions page at apeel.com/faqs.  In this conversation, Dr. Hyman and Dr. Boham discuss: The difference between canker sores and cold sores Reasons for recurring canker sores, ranging from celiacs disease to immune dysfunction to food reactions, nutritional deficiencies, and more The relationship between digestion and canker sores The prevalence of herpes simplex virus I Common cold sore triggers, including stress, nutritional deficiency, and more The relationship between recurrent cold sores and the health of your immune system Additional Resources The New Science Of Immuno-Rejuvenation https://drhyman.com/blog/2020/04/20/podcast-ep105/ Is Gluten-Free A Fad Or Is Gluten A Real Threat To Our Health? with Maggie Ward https://drhyman.com/blog/2020/11/30/podcast-hc32/ What Not To Eat https://drhyman.com/blog/2018/03/30/what-not-to-eat/ What Not To Eat: Part II https://drhyman.com/blog/2018/04/20/what-not-to-eat-part-2/

Coming up on this episode of The Doctor's Pharmacy. One of the most common reasons when we have people who have a lot of canker sores, you know, whether they test positive for celiac or just we think it's gluten sensitivity or we don't have a full positive celiac test, but when they take away gluten, they often will clear up. Hey everyone, it's Dr. Hyman here. I always say your body is your best doctor. And if you listen closely and pay attention, your body will let you know which foods make you feel awesome and which don't. From years of listening to my body, I know that eating refined grains just does not work for me. Most of the time I stick with a ton of colorful veggies, some quality protein,

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Welcome to this special episode called House Call where we talk about some tough issues that affect so many people that are really not well dealt with with traditional medicine. And today we're going to talk about the mouth, cold sores and canker sores, which are annoying. They're not life-threatening, but they can make you miserable. And they're not too pretty either for people. So today we have with us our physician from the Ultrawanna Center, Dr. Liz Bohem, who's my friend and colleague for over two decades. She's an incredible physician, family doctor, training nutritional medicine, also a registered dietitian and an exercise physiologist, what I'd love all doctors to be. And she is teaching all over the world functional medicine. She's now part of our GI course, which is great, the Institute for Functional Medicine. And

she's got her own wonderful CD called Breast Wellness because she went through breast cancer and has a lot to say about it and a lot to teach. So welcome, Liz, back to Housecall. Thank you, Mark. It's great to be with you. Fantastic. So let's get right into it. Canker sores.

What are canker sores? We've all probably had them one time or another. Why are they a problem? And what do they signify? And how do we think about them differently in functional medicine than traditional medicine? Absolutely. So canker sores are those ulcers, those sores that you get in your mouth. They're usually at the side of your mouth, you know, by your cheek, inside of your cheek,

that is, underneath your tongue. Those are some typical places for them. And they are about three to five millimeters in size. And they are a sore that comes, if you look at them, they'll look like a round circle. They're reddish. Sometimes they'll have like a yellow coating on it. Yeah. And they hurt like heck. They hurt like heck. Yes. And like you said, most of us have had them at least once or twice. And having one once or twice is not a big deal, right? Or even more than that.

But what we get concerned about or what we want to talk a little bit about are those people that are getting lots and lots of canker sores. And could that mean that there's something we need to be looking into and thinking about? Yeah, I mean, I think that's right. I think, you know, in traditional medicine, we go, oh, well, canker sore is not a big deal. You know, swish your mouth with like tetracycline and Benadryl was the cocktail we used to use. Yep.

And that'll help reduce the pain and inflammation. But there really wasn't ever a conversation about, well, what was the cause of these? And how do we diagnose the root cause and make it so people don't get them anymore? Absolutely. And what does a functional medicine doctor think when they see a canker sore? Again, if it's an isolated incident, it might not be a big deal at all. But if people are getting them all the time or even a couple times a month or even five or six times a year, it makes you want to ask that question, why? What could be going on?

And there could be many things from celiac disease to an impact in the immune system not working properly to eating a food that causes inflammation for your body. So celiac disease, it would be gluten, but there's other foods that for people can be inflammatory for them. It's like a food sensitivity or food reaction. Definitely we see it with some food additives. So some food coloring and some food additives, people will get canker sores. There uh, more rare situations where people get lots and lots of canker sores, uh, Bechette's, uh, they'll get sores in their mouth and other areas of their body. So, you know, that's an autoimmune process. Uh, uh, another autoimmune process, lupus can, can cause some recurrent sores in the

mouth as well. Um, and of course, nutritional deficiencies. You know, that's something I think about all the time. We know B12 deficiencies, B vitamin deficiencies. So I'm thinking when somebody's coming in with recurrent canker sores, those are things I'm thinking about. Yeah. So it could be some of the foods we're eating or the chemicals in our food. You know, the average American eats three to five pounds of food additives a year. We think, oh, it's a little additive here. When you add it all up with all the crap we eat, it's three to five pounds. And a lot of these things are really immunoreactive. It can be very inflammatory,

irritating, and can cause these canker sores. But we mentioned also Bichette's and lupus. These are autoimmune diseases. But what's really striking to me, and after doing functional medicine for decades, is that so many people with canker sores really have gluten problems. Absolutely. And I remember one of my friends was a Harvard-trained doctor who started having really severe recurrent canker sores. We call it aphidostomatitis, but it's like a really nasty, nasty case of this. And I said, have you checked yourself for celiac disease? He's like, no. And I'm like, well,

check. And he had it and he stopped eating gluten and everything went away. I see that all the time. I mean, that's probably one of the most common reasons when we have people who have a lot of canker sores, you know, whether they test positive for celiac or just we think it's gluten sensitivity or we don't have a full positive celiac test, but when they take away gluten, they often will clear up, which is phenomenal and a wonderful response. The other thing, you know, I was thinking when you were talking about the food additives and food coloring, you know, Halloween is a time where kids will get canker sores all the time right after Halloween, you know, all of those, all of that, you know,

the candies that have, they're eating so much of it with a lot of additives and, and coloring and stuff. And so, you know, people will notice that that's a time where they get a lot of them. That's true. You know, I remember when I was really sick with, you know, chronic fatigue and my immune system wasn't working right and my gut was a mess. I used to get tons of canker sores. It was terrible. I'd get them in my tongue. I'd get them in my cheeks.

It was horrible. Once you start to get things back in balance and fix your gut and your nutritional status, really, really makes a huge difference. So tell us about this patient you had. It was a young woman who had really bad canker sores. Yeah. You know, I just want to mention one thing about that and then we'll delve into this case. You know, when things are out of balance in the digestive system,

there's a lot of inflammation in there. And so the ability for the body to digest and absorb your nutrients is much less. And so, and the oral mucosa, the cells in your mouth and the digestive system, you know, need a lot of regular nutrition. So many times we see nutritional deficiencies show up first in the mouth and the gut area because they're just getting turned over so quickly. And so, you know, you think a lot about those B vitamins that are necessary for healing and zinc that's necessary for healing. So when you mentioned when your body was depleted, you know, there may have been some just decreased

absorption of some nutrients that are so necessary. Yeah, I think you're right. And you get those cracking at the corners of your mouth. That's called chelosis. That can be also from B vitamin deficiencies. So yeah, I had that. I mean, it's interesting to see what happens when you start looking at this stuff. You go, wow.

Because you teach a whole course on the nutrition physical examination. Yes. Or through looking at various signs on your body, you can pick up nutritional deficiencies that may be related to some of these things. Yeah. So with Dr. Michael Stone. So that's fun. So yeah.

So this woman was a 25 year old woman who had regular canker sores her, her whole life. She had them as a kid, she had them in her teenage years, she was getting them probably once a month. And sometimes she'd have multiple canker sores. And they were kind of, they were painful and no, no fun, like, you know, you mentioned. And, and she was always thin. So she was always on the thin side. She had some digestive issues, some diarrhea, some bloating. But otherwise, she was healthy. Oh, she was told she had iron deficiency. So she was low in iron. But otherwise, not really anything that would make you think she was ill or sick in any way. But she just wasn't, you know,

she wanted to kind of deal with these canker sores and came in. And so we decided to test her for celiac disease because as we were mentioning, it's gluten and wheat can be a common cause of these canker sores for some people. And- It also causes irritable bowel

and prevent you from absorbing iron and make you not be able to gain weight, all the things she was exhibiting. Exactly, exactly. And so, and she tested positive conventionally absorbing iron and make you not be able to gain weight. All the things she was exhibiting. Exactly. Exactly. And so, and she tested positive conventionally with regular celiac testing. She was, she was positive. Her tissue transglutaminase was elevated.

So we were like, oh my goodness, you have celiac disease. And, and so she stopped eating gluten. It was like a miracle. It was kind of, she stopped eating gluten and the canker sores went away. And so did her dual bowel and her iron stopped eating gluten. It was like a miracle. It was kind of. She stopped eating gluten, and the canker sores went away. And so did irritable bowel and her iron deficiency. Exactly. She started gaining weight, I'm sure. She did. I mean, the iron and the weight took a little bit more time,

but the canker sores and the irritable bowel went away right away. It's pretty amazing when you think about how common this is, you know, because we've talked a lot about gluten on this podcast, but even people who don't have celiac, they can have non-celiac gluten sensitivity. So they're not on the full-blown celiac numbers on the lab test, but they're in that continuum, and they can still have all the same problems. And the thing people don't realize is that, doctors don't realize is that, you know that they think, oh, the problem you have is canker sores. That's the diagnosis. That's not the diagnosis. That's just a symptom.

What's the cause? And that's what's so different about functional medicine. It's what we do here at the Ultra Wellness Center that's so unique is we're really medical detectives that look at the cause. And it may be different for different people. Some people's canker sores might be caused by a food additive or maybe it's because of a food sensitivity or maybe it's gluten or maybe something else. So I think that's really the beautiful thing about functional medicines. We can kind of drill down. Yeah. You want to look for that underlying root cause. And then, you know, if it is more of an autoimmune, if for somebody it's more of an autoimmune condition, then you have to ask that question. Why, right?

Why did they have this autoimmune condition? What is out of balance in their body? What's triggering it? And we can't always answer those questions, but they're really important questions to ask because that really influences how we treat them. So we're not just treating the outward symptom of the canker sore, but looking for that underlying root cause. Yeah, amazing. And people don't have to suffer from it because it's so annoying. They're terrible. Let's talk about something else that's very common in the mouth, cold sores, which are way more common even than canker sores. It affects so many people

and it's an embarrassing thing to get. People worry about kissing. It's just unsightly. And in functional medicine, there's a lot you can do to actually prevent you from getting these cold sores. So tell us about why we get them, how they come, and what kind of the story is a little bit about cold sores.

I mean, one good thing to recognize, because sometimes cold sores and canker sores can get confusing for people. So canker sores that we started with are not infectious. So you're not going to transmit anything to somebody else if you have canker sores inside your mouth, inside the inside of your cheek. And canker sores won't come out on your lips. So cold sores,res, cold sores, which typically, uh, when you get a reoccurrence of, of cold sores, they typically more, they, you know, they can happen inside your mouth, like near your teeth and in certain areas of your mouth, but they often will come out on the lips, right? Right on that border. Yes, they can go. Yes. And they can come out on your skin too as well. And cold sores are because of the HSV virus.

So the herpes simplex virus. And so herpes, typically herpes virus that affects the head and neck, like the mouth area is herpes simplex virus one. And this is infectious, right? We can pass it to one another. In fact, I was reading about 66% of the world population has had exposure to, has an HSV1 infection. And so it's very common. And we can transmit it through kissing, sharing cups or straws. We can, of course, transmit it through sexual contact with other people. But even the oral herpes, HSV-1, you know, just close contact with people.

Yeah. Yeah. And it's really common. And, you know, usually what happens is you get an initial infection where you get kind of sick. So if you're a kid, you basically get maybe a cold or something. You'll get a sore throat. You'll get maybe sores.

And then it goes away. But it doesn't really go away. Right. So with certain viruses, they just sort of linger on. I mean, if you get a cold, you get a cold, it goes away. Herpes stays around for your whole life. Yeah. And it ends up living in the nerves. And then there are certain triggers.

So what are the kinds of triggers that we see for these cold sores to come out? Yeah. So people will notice when they're stressed. So when they're exhausted or stressed, or they have another infection, sometimes they will come out. So if the body's depleted in any way, sunshine for some people, getting dental work for some people will also trigger them. And definitely nutritional depletion, we can talk a little bit more about that. So when people are getting lots of these cold sores and they

keep, so you mentioned you got, you had the initial infection and then it lays dormant in the nerves and then it, you can get a reactivation, right? It can get reactivated and come out. You can see the cold sore on the mouth, right? On the lips. And so when, when that has happening a lot, then you've got to say, well, why is this person's body depleted, right? Why is their immune system not able to kind of keep this at bay? Why is it that the immune system is not able to keep this virus in the nerves, right? It's letting it, it's coming back out and getting reactivated on that person. And we transmit it typically when you have the cold sore, right?

But you can transmit it when you're asymptomatic, especially like right before a cold sore comes on. There is possibility to transmit it at that time as well. So you really brought up something super important, which is that our risk of getting recurrent cold sores is directly tied to the state of our immune system. Yes. And in functional medicine, you know, it's very different, our approach than traditional medicine, where you go to your doctor, say, well, how can I boost my immune system? Like, I don't know, sleep and eat good and maybe exercise and, I don't know, take a vitamin. I mean, there really isn't a whole strategy for how do we create immunoresilience or as our mentor jeffrey bland

calls immunorejuvenation and particularly now in the time of covid and the the increased risk for those whose immune systems aren't working yeah well it's really important to understand how do you maximize the function of your immune system? Because we're going to get into the specifics of actually how to treat the cold sores when they come or to prevent them. But what the foundation of it really is, this whole idea of immunoresilience, immunorejuvenation, and supporting our immune system. So what are the strategies from a functional medicine perspective that we use to help rejuvenate someone's immune system and make them more resilient?

It's so critical. It's so critical for this, for prevention of these cold sores, but for, as you mentioned, all sorts of viral viruses that you want to prevent or all sorts of infections that we want to prevent. And how can we support our immune system in the best way possible? I mean, we always start with food first because it's so powerful, right? You know, making sure people are getting adequate, adequate nutrition, making sure they're getting adequate protein, making sure they're getting adequate minerals, making sure they're able to digest and absorb those things properly, making sure that they're getting adequate zinc, which is so important for the immune system and, you know, is in a lot of our foods, but sometimes people get a little deficient.

Vitamin D. Vitamin D is important. Vitamin C is important. So, but really it comes down to that good, healthy diet, right? So when people are wasting their calories on foods that are highly processed and refined and low in nutrients, then they're not gonna get what the body needs for the immune system to work properly. So I mean, it really all comes down to nutritional density.

And sugar is a huge suppression factor for the immune system, sugar and starch. So if you eat flour or sugar, you're literally shutting down your immune system. Yeah, yeah. We know that when our blood sugar is high, our immune system doesn't work as well. Our natural killer cells don't go out

and find those things that they need to get rid of. All aspects of both the innate and adaptive immune system don't work well when our blood sugar is high. So balancing, the simple act of balancing your blood sugar is critical. Yeah, that's why diabetes has so many infections and they're hard to treat infections.

And of course, the usual things like exercise, sleep, learning, stress reduction techniques, all that, being in nature, the usual things like exercise, sleep, learning, stress reduction techniques, all that, being in nature, all those things are critical. But there are some really powerful things we can do in addition to that to help people prevent cold sores, which I found very, very effective in my practice. You talk about a woman you saw who was a 25-year-old who had these recurrent cold sores and some of the things you did for her. So tell us about her and what you did and how we can start to think about approaching these patients. Yeah. So this 25-year-old was trying to stay thin. So she was she was working, she'd always worked very hard in terms of her diet to stay thin.

And so she was, she, she restricted her diet. She wasn't, I mean, she wasn't to the point of full blown anorexia, but she was very restrictive. She was very careful, you know, with what she ate. And so, so her, her calorie intake was a little on the lower end. And she always got colds and flus. She was sick all the time. And she regularly, we were getting these cold sores. And she was run down and worn out, but really frustrated with these cold sores. And she also had some digestive issues.

She had some diarrhea and bloating. And so when we got her history, these reoccurring cold sores, it made me really go, okay, what is going on with her immune system? And what can we do to properly support it. And as I mentioned, because of her digestion and the restriction of her, her calories, I was really concerned about her nutritional status. You know, I was worried that she was, she was having some nutritional insufficiencies that was, that were weakening her immune system function. And so, you know, we, we added in some, some zinc, we added in a bunch of vitamin C, we got our vitamin D levels up, we got her on a good multivitamin, some good essential fats, we work to help her body digest and absorb her food better. But we we also added in some lysine. And lysine is a really interesting amino acid that is very helpful for cold sores. Many people have tried this who've had cold sores,

they've read about it on the internet or tried it. And they notice also when they come in to see me, they're like, it does really help. And it works very well to prevent these cold sore outbreaks for people. And typically, people will take lysine, which is an amino acid building block of protein. They'll take about a thousand milligrams or 500 milligrams twice a day for prevention and may take up to 3000 milligrams for treatment or when they feel an outbreak coming on. And at the beginning, we often have to give them more. And then over time, we can lower the amount that they need. Because she was so restrictive, we also gave her some general amino acids just because she needed the baseline amino acids to build up her body. And, and we really worked with her, our nutritionists worked really well with her

to just help her increase, you know, you know, increase her intake of her calories and her protein more. And what was phenomenal, she didn't gain weight, you know, and her intake of her calories and her protein more. And what was phenomenal, she didn't gain weight, you know, and we often see that, you know, people kind of get that in their head that they can only eat a certain amount because they'll gain weight if they don't or whatever. And she didn't gain weight at all. She was just healthier. Her immune system worked better. She got out of that pattern of getting all those recurrent system worked better. She didn't, she, she got out of that, that pattern of getting all those recurrent cold sores. She wasn't getting colds or flus as much anymore. You know, she was just, her immune system was, was more resilient.

It's amazing. And, you know, I think you bring up this whole idea of lysine and, and there are a number of foods that are very high lysine. One of them is quinoa, which is a grain that's from South America. And unfortunately, we're taking it all from the South Americans. So they're all getting obese because they have to switch to rice because they can't afford their quinoa anymore. But it's a great source of lysine. And what's also interesting is that there's a relationship between arginine, which is another amino acid, and lysine. And so one of the foods that has the highest levels of arginine is almonds. So amino acid, and lysine. And so one of the foods that has the highest levels of arginine is almonds. So people, for example, are coming eating a lot of almonds and

they keep getting cold sores. I tell them to cut out the almonds and choose other nuts which have less arginine. Yeah, that's a great point. And I also had somebody who was taking a protein supplement, like they were getting it, it had a protein powder, but some amino acids in it and it had arginine in it. And so she wasn't getting cold sores for many, many years and then started this protein powder. And it shifted that balance that you were talking about, right? Her arginine level went up and that impacts your lysine. So in a sense, her lysine went down

and then she started getting the cold sores again. And we realized, aha, it was that protein powder. Yeah, and you can bump up the lysine by taking it as a supplement. So yeah, I think there's some really simple things you can do. Some people do need, who really maybe can't get their systems fully operational, may need an antiviral like Valtrex or others to help. I'm not opposed to that. They're generally pretty safe medications.

But often when you focus on the things you talked about, which is your underlying immune function, which is a whole foods healthy diet, getting rid of the junk, sugar and processed foods, exercise, sleep, stress reduction, taking the basic things like zinc, lysine, vitamin C, and others, and probiotics to help your gut immune system, can make a huge difference in people's health. So, you know, this sort of underscores the approach we take in functional medicine, which is not just to treat the symptom or the disease, but treat the soil. And I think in functional medicine, I think it's more like being a regenerative farmer than a industrial farmer. We're trying to regenerate the health of the soil so the plants just don't need any chemicals and they don't need any input. The soil itself is the source of all the nutrition and the healing that the plants need. And I think that's something we could learn a lot from

in medicine and I think we need to move from a, basically an agricultural system that is destructive and uses all these agrochemicals to a regenerative one. I think we also need to move from a healthcare system that just focuses on immune suppressing or suppressive medications that block, inhibit, or anti something in our body to regenerative medicine, which helps us to regenerate health

and regenerate our immune systems. And I think we have a long way to go, but I think it's really an interesting moment in healthcare right now where we really are seeing the need to actually do this. Absolutely, absolutely. And what we do to help with preventing these issues can help our whole body feel better. Yeah. I mean, even with COVID-19,

there's a lot of research going on around vitamin D, vitamin C, and zinc. And so these are just basic ideas that are not that hard to understand. These nutrients are not expensive. They're easy to access. And I think we all could use a little boost right now, given the state of our world, the COVID pandemic and the increased stress around us. So Liz, thank you so much for being again on the House Call episode of The Doctor's Pharmacy. It's been great to have you. If you love this podcast, we'd love to have you share with your friends and family on social media. Leave a comment. Tell us, have you struggled with cold sores or canker sores and how have you dealt with it? And of course, subscribe wherever you get your

podcasts. And we'll see you next time on The Doctor's Pharmacy. Thank you, Mark. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter.

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