Burning mouth syndrome
A 55-year-old woman (recently postmenopausal) visited the clinic with an unusual presentation.
For about two to three years, she had been suffering from an intermittent burning and tingling sensation in her mouth. She had been to her doctor who had suggested medication, but she was wondering if there was any alternative. On investigation, she had no obvious mouth changes.
This condition appears to affect women more than men, affecting 20–30 per cent of menopausal women, in particular, in varying degrees of severity. According to research, it can last several years and there are no obvious causes in many cases (although thyroid conditions, autoimmune disease and pharmaceuticals can be implicated in some cases).
On questioning her further, she was not taking any pharmaceutical treatments as she generally tried to avoid these (there are some drugs that can cause this condition). She also complained of a very dry mouth, was always thirsty, couldn’t taste her food like she used to (can indicate a zinc deficiency) and was left with an unpleasant metallic taste in her mouth after eating and after cleaning her teeth. She had her own teeth (no dentures) but had some digestive problems (mainly reflux and heartburn), possibly related to food allergies or intolerances. The burning mouth sensation was intermittent but appeared to be getting worse and she was experiencing the symptoms more frequently. Her energy was very low.
Several blood tests were recommended from her GP, including a full blood count (FBC), iron stores, homocysteine, vitamin B12 and folic acid, vitamin D, zinc, copper and ceruloplasmin (for zinc: copper balance), thyroid function tests and antinuclear antibodies (to check if there was an underlying autoimmune condition). Cytotoxic food allergy testing was also recommended. She was reacting to wheat (mainly) and barley, capsicum, soy and dairy. She also had a mild yeast infection and loved sugar but was trying to minimise this in her diet. Due to menopausal changes, she was not sleeping well and was increasingly stressed, due partly to her symptoms and the lack of sleep.
Her blood test results showed high levels of homocysteine (an important liver methylation pathway, associated with vitamins B12, B6 and folate deficiencies), low zinc compared to copper, normal folate and high B12 (but this can indicate problems with metabolism and was therefore considered an inaccurate reading). Her FBC was essentially normal, but her ferritin levels were down. Otherwise, her blood tests were within normal range. These tests provided valuable information regarding possible contributing factors.
As such, there were various dietary and supplemental recommendations suggested. Initially focusing on diet, she needed to avoid the allergenic foods (wheat and dairy are commonly involved in reflux symptoms). This was a challenge for her, but she liked cooking, so recipes were supplied utilising alternative grains such as buckwheat, sorghum and rice. Coconut milk was suggested as an alternative to dairy and worked well.
Supplements recommended included lactoferrin (regulates iron absorption as well as digestion) and chewable deglycyrrhizinated licorice root tablets to reduce reflux symptoms. This form of licorice does not lower potassium to the same extent as the untreated root, so has less impact on blood pressure. Slippery elm was suggested mixed in organic coconut kefir to improve gut lining and the microbiome.
Methylation factors (including vitamin B12, folic acid and B6) were recommended to lower homocysteine, and zinc was recommended with the night meal. Alpha lipoic acid has also been shown to improve burning mouth syndrome along with blood sugar and liver pathways, so this was added.
A herb mix including Pau D’arco (antifungal), St Mary’s thistle and dandelion (liver), meadowsweet and marshmallow for gut lining and ashwagandha for stress was prescribed.
Topically, she was advised to get rid of her toothpaste and brush her teeth with bicarb soda instead (one drop of peppermint oil was added to this for flavour and digestive health). A teaspoon of raw honey was recommended once or twice a day as it moistens the mouth and regulates oral bacteria. Oil pulling was also recommended as this can relieve a dry mouth — as can practising nasal breathing. Many people with dry mouths have problems with sinuses (associated with food allergies) and mouth breathe at night. Avoiding alcohol-based mouthwashes was essential.
Melatonin was recommended to assist with sleep, and it was very successful.
She followed this programme (with small changes) for 12 months and found that her symptoms, while slow in changing, over time improved measurably. She also experienced better sleep and her energy and digestion improved. She was very happy with the result, and as she remains symptom-free, she has continued with much of the same programme indefinitely.
