Sunday, April 18, 2010

Folic Acid: Mouth Sores vs. Cancer Risk

Ouch. Last Wednesday or Thursday, I noticed that I must have burned the roof of my mouth. I didn't remember eating anything so hot that it could singe the skin, but the tenderness in one spot let me know that I must have.

Friday it still hadn't really healed over. In fact, it seemed to be worse. Saturday afternoon, I realized that I had another tender spot in my mouth and a slight metallic taste was developing. Sometime in the afternoon, I realized what was really going on.

I have developed some mouth sores. Ouch and yuck. Why are these showing up now?

Last month when I visited with my rheumatologist, she asked if I had ever developed mouth sores before. No, I haven't. Why did she ask this? I take methotrexate.

Methotrexate is used to treat different types of cancer, but it is also used to treat rheumatoid arthritis. Methotrexate is an antimetabolite and antifolate drug which inhibits unusal rapid cell growth.

One of the many possible side effects of methotrexate is mouth ulcers, or mouth sores. To help prevent this and other side effects, it is customary to take supplementary folic acid which comes in 400mcg (otc) or 1mg (prescription). I had been taking 1.2mg daily for the past three years.

Based on research published in the Journal of the American Medical Association last fall (and other research studies), my rheumatologist suggested that I stop taking folic acid. Why, do you ask?

High doses of folic acid have been associated with an increased risk of developing lung cancer. The risk remains small, but an increase is an increase. Since I had not experienced many of the nasty side effects of methotrexate, my doctor simply wanted me to stop the folic acid, which may or may not have been helping to alleviate those potential side effects.

Well, one month off of the daily supplementation and I am beginning to develop mouth problems. So on the way home from a busy day accompanying several students at solo festival, I stopped at the grocery store.

My shopping list was short: Folic Acid!!

I immediately took four tablets as soon as I got home and will do so daily until my mouth feels good again. Hopefully at that point I can decrease the amount I need to keep the sores away without increasing the risk of cancer, especially since cancer has run in my family.

Hopefully, it won't be too long before my mouth is in tip top shape once again. :)


  1. Do you have any other side effects from the Methotrexate?

  2. Hi MissDazey,

    No. I've not really experienced too many side effects from MTX. Maybe a little hair thinning but not enough to be too concerned. Thankfully I had plenty of hair to start with.

    I take the pills right before going to bed and I've never had the nausea some people do. I've been taking 25mg weekly without too much difficulty. I'm fortunate.

    I know that a lot of people are scared of methotrexate, but I wouldn't want to be without it. I tested what it would be like to go off it last spring and within two weeks, I was in lots of pain and swelling increased tremendously. That experiment didn't last long. LOL.

  3. Hi,
    no knowledge of "Methotrexate," but the sentiment is very familiar, one medical treatment causing another medical problem - very frustrating!

    I'm taking my stupid daily shot, so now what?

  4. Interesting on the cancer link with the folic. I'd not heard that, but as my side effects on the MTX are pretty mild with the folic acid I think I'll continue with it for now. Like you I have some hair thinning but have tons of hair to spare. Only other thing I get is a little tiredness a day or two after my dose and an occasional stomach ache a few hours after my dose.

  5. When I was on methatrexate injections, I was given a script for FOLINIC acid, not folic. There is a difference. Higher doses of folic acid can be harmful. Folinic acid is the form that it's converted to in your system. (very simplified version of the whole story...I'll let you do the transcribing Lisa :)

  6. When I was given methotrexate I had no problems, probably because it was such a low dose. There was no mention of possible mouth sores.

    But OUCH, Linda. I'm thinking of biting into pizza with a molten piece of cheese that sticks to and burns off the roof of my mouth. No fun at all. I'm glad you connected the dots so quickly, and hope you're on the mend soon.

  7. Hi Lisa:

    The vitamin supplement LYSINE is also good for preventing mouth sores. Mine were due to acid in my system and the Lysine nipped it in the bud within 3 days. Keeping it on one's daily intake keeps mouth sores at bay.

    Also, if they are bothering you presently, painting them with a little Milk of Magnesia on a Q-tip 3 times a day helps alot.

    Sorry you are experiencing them. Hope you feel better soon.

  8. Thanks so much for the suggestions and support. Already there is huge improvement and one side of the roof of my mouth is feeling normal. The other side still feels chewed-up but it is also better.

    I am amazed at how quickly the situation can improve with a little bit of supplementation.

    Bubbie, I have to be honest and admit that I've not really understood the Folic Acid vs. Folinic Acid situation. At the beginning, my doctor literally prescribed 1mg of Folic Acid and said that I could use otc just as easily. ?

    Anne, if I had had some Milk of Magnesia, that suggestion would have come in handy yesterday and Saturday.

    btw, my eye is back to the normal 'looking through slightly wavy glass' perception. I'll take it. :)

  9. whole cloves are good for toothaches, maybe mouth sores too?

  10. Hi Lisa,

    I take Lysine when I get any mouth sores. I just don't take it on a regular basis as I should. FYI--there is a mouth rinse you can get just about anywhere called Peroxyl that will help alleviate the discomfort and help mouth sores heal quicker.

    Good luck!

  11. Mouth sores have attacked me, Ive only been on MTX for one week in the same week I had a PET Scan so radiation, my mouth is filled and they keep coming, Ive received a Script for them, a mouth wash the folic acid, lysine, Ive taken it all and they just keep coming!!! Help

  12. Mouth sores have attacked me, Ive only been on MTX for one week in the same week I had a PET Scan so radiation, my mouth is filled and they keep coming, Ive received a Script for them, a mouth wash the folic acid, lysine, Ive taken it all and they just keep coming!!! Help