This post about gluten’s effect on canker sores, cold sores and geographic tongue contains affiliate links. No information should be used as a substitute for medical advice from your doctor. Please see my disclosures and disclaimers.

The topic of celiac disease and mouth sores keeps coming up in my Gluten Free Diet Support Group (on Facebook), so I thought I would explore this topic a bit in today’s post.

Beware, though, because I’m about to get personal!

Before I was diagnosed with celiac disease, I suffered from a few embarrassing mouth issues. I had canker sores, occasional cold sores and chronic geographic tongue.

These conditions were sometimes painful, always majorly embarrassing, and, on top of it all, I had no idea what caused them to happen in the first place (I was just a kid dealing with this stuff!).

I have now come to see the mouth as the doorway to the gut. My gut wasn’t right, and my mouth was showing signs of disorder.

In this article, I will discuss how these mouth sores may have been oral manifestations of my unmanaged celiac disease.

What are Canker Sores, Cold Sores and Geographic Tongue?

First, let’s define each of these mouth disorders.

Canker Sores: Canker sores, or aphthous ulcers, are found on the soft tissues inside your mouth and on your lips, cheeks and tongue. Canker sores can be painful.

While the exact trigger of a canker sore is unknown, many say it is triggered by a vitamin deficiency, weak immune system (hello celiac disease!), food sensitivities and hormonal changes. Canker sores aren’t viral nor contagious like cold sores.

Cold Sores: Cold sores are caused by a virus called herpes simplex virus and they are contagious (it’s wise to not touch your lips, kiss or share drinks when you have an outbreak). Cold sores are inflamed blisters that typically occur on the external surfaces of your lips although they can also occur on your nose, cheeks or eyes.

Don’t judge someone for having a cold sore because ninety percent of all people get at least one cold sore in their lifetime! Many people develop antibodies to cold sores after their first one and never have to deal with them again, but about 40 percent of the population gets recurring cold sores. Why the virus afflicts some more than others is unknown.

Geographic Tongue: Geographic tongue, or benign migratory glossitis, is another one of those unexplained phenomenons that occurs inside the mouth. The condition gets its name from the map-like appearance that shows up on the top and side of the tongue. It almost looks like crop circles on the tongue.

The cause of geographic is unknown, although some consider geographic tongue an oral form of psoriasis. Geographic tongue affects 1-2.5 percent of the population and unlike cold sores, it is not viral nor contagious. I can attest that geographic tongue feels like your tongue is chronically inflamed.

How Do these Conditions Relate to Celiac Disease and Gluten Sensitivities?

It’s hard to believe that some of the early signs of celiac disease can begin in your mouth, but it does. This makes your dentist a viable – if not crucial – part of the diagnosis team.

I’ve asked every doctor and dentist since childhood about my geographic tongue. I was told not to worry about it, it’s nothing. In other words, it was just something I had to live with.

I’ve realized over the years that these mouth conditions may have be tied to undiagnosed celiac disease or early celiac disease development. While the research isn’t quite there to make this firm correlation, there are inklings of truth from the research currently available.

Canker Sores Tied to Celiac Disease?

Did you know that people with celiac disease are more prone to canker sores than the rest of the population?

In a large survey of a Canadian population with confirmed celiac disease, 16 percent of children with celiac disease and 26 percent of adults with celiac disease reported having recurrent oral ulcers.

While the exact cause of canker sores is unknown, many researchers believe it to be related to iron, B12, and folate deficiencies, which are nutritional deficiencies commonly found in people with unmanaged celiac disease.

Additionally, five percent of patients with recurrent canker sores had celiac disease. It may not sound like a lot, but this is FIVE TIMES the rate of celiac disease in the general population, making a strong case for those with recurrent canker sores to get tested for celiac disease.

Cold Sores Tied to Gluten?

While I cannot find data to support my experiences, I have to tell you that I have NOT had a cold sore since I implemented a gluten-free diet seven years ago.

While your body develops antibodies to cold sores over time, and many people can grow out of cold sores, it can’t just be coincidental that this virus disappeared the minute I broke things off with gluten. Could there be a correlation? I think so.

Your doctor will tell you that cold sores are viral and there is no scientifically proven direct connection between the consumption of gluten and cold sores. However, experts say a cold sore outbreak can be triggered by a compromised or weakened immune system. In other words, if you have the virus, and your immune system is out of sorts because you have undiagnosed celiac disease, perhaps it’s the perfect storm for a cold sore to rear its ugly head.

This theory might explain why once I eliminated gluten and finally managed my celiac disease, I was able to rebuild my immune system and keep the cold sores away.

Geographic Tongue and Gluten

Unfortunately I get geographic tongue from time to time despite being fully gluten-free. It could signal that I’ve had trace gluten exposure but I cannot know for sure. Regardless, those pesky crop circles have plagued my tongue for decades, although they have since been downgraded to a slight and occasional annoyance.

Evidence suggests there is a strong tie between geographic tongue and celiac disease.

One study found that 15 percent of individuals with geographic tongue had celiac disease. This is 15 times the rate of celiac disease in the general population – wow!

On top of that, only a fraction of the 15 percent of patients with geographic tongue had any gastrointestinal symptoms that most people associate with celiac disease. This means that the individuals with geographic tongue had “silent” or “atypical” forms of celiac disease.

Research suggests that any inflammation in the mouth, geographic tongue included, may be caused by a Vitamin B12 deficiency. Again, people with unmanaged or undiagnosed celiac disease often suffer from a slew of nutrient deficiencies.

Mind Your Mouth

Celiac disease – and gluten sensitivities – can manifest itself in your mouth in more ways than sores. It can also be evident through receding gums, gum disease, excessive cavities and even discolored enamel. All of these issues can be the sign of nutrition deficiencies … and nutritional deficiencies are a roaring symptom of celiac disease.

Dentists need to be aware of such oral manifestations of celiac disease because they can be an important part of the celiac disease diagnostic team.

If a dentist or doctor sees recurring canker sores, geographic tongue or even cold sores when treating a patient, they should encourage that patient to get tested for celiac disease.

Additionally, if you are suffering from any of these mouth sore disorders, consider the following:

(1) Are You Eating Gluten? Make sure you’re not eating any gluten, even accidentally, as mouth sores might be a manifestation of continued or accidental gluten exposure. Do not allow yourself “cheat” days.

(2) Are You Getting Enough Nutrients? Experts agree mouth sores can be the sign of a Vitamin B deficiency or other nutrient deficiencies. Make sure you’re eating plenty of fruits and vegetables, and take a daily supplement. I recommend this brand for a daily supplementation, and these for Vitamin B12 supplementation.

(3) How’s Your Gut Health? Remember, the mouth is the gateway to your gut. Improve your gut health and you’ll improve your whole body health. I write a lot about the benefits of probiotics and why people with celiac disease should pay attention to their guts.

(4) Do You Really Know Your Symptoms? Remember, celiac disease can manifest itself in many ways. Even if you don’t have traditional gastrointestinal issues traditionally associated with celiac disease, it doesn’t mean you don’t have the autoimmune disease. If you suffer from canker sores, cold sores or geographic tongue, get tested for celiac disease – it’s the only way to know for sure.

Your Turn

Do you (or did you) suffer from any of these oral manifestations of celiac disease? Did your symptoms improve or clear up upon ditching the gluten? What other tips do you have to keeping mouth sores at bay?