Canker Sores BEGONE!

Canker sores have a wide array of contributors which are often mistaken for causes. But eating lemons is not a surefire path to a canker sore. As we will explore, canker sores are increasingly understood as a T-cell-mediated inflammatory response in the oral mucosa, meaning that your immune system is overreacting to normal stimuli. This shows up strongly in behçet’s disease, celiac disease, and inflammatory bowel disease – but of course, you do not need to have one of these to get a canker sore!

Research also shows links between canker sores and oral streptococcus sanguinis overgrowth, reduced microbial diversity, and fungal involvement – especially in stubborn cases. In most cases, however, improving lymphatic drainage, addressing pH imbalance, and addressing nutritional deficiencies will cause canker sores to rapidly heal. Let us now explore all of this together.

What is a canker sore?

A canker sore is a small ulcer in your mouth. An “ulcer” just being a fancy term for a breakage of your skin. Sores inside your mouth feel different than sores outside your mouth – and you can’t use a bandage to protect them. Canker sores (or “aphthous ulcers”) can also be thought of as “shallow lesions” that develop on the inside of your cheeks, tongues and/or on your gums. Unlike cold sores, canker sores don’t occur on the surface of your lips and they aren’t contagious.

What causes canker sores?

Not everyone gets canker sores from drinking orange juice – because acidic foods are not the root cause. Historically, most research around canker sores focused on creating topical treatments and drugs to cure them – not on what causes them. Now, however, we have some more information on the cascade of events which leads to these painful, pesky oral sores. It is important to note that something can contribute to a canker sore forming without causing irritation at the time.

Canker Sore Causes:

• Immune activation (from gluten, dairy, cacao, benzoates, nuts, and/or sulfites).
• Injury within the mouth, such as biting one’s cheek or tongue (although this will often heal very quickly unless one or more of the other items on this list are at play!).
• Sodium Lauryl Sulfate, a common toothpaste ingredient, has been shown in studies to thin the mucosal barrier and increase ulcer frequency and severity. 
• L-lysine deficiency.
• L-glutamine deficiency. 
• Vitamin deficiencies, particularly B₁₂ (cobalamin) and B₉ (folate/folic acid), and zinc.
• Sensitivity or allergy to cinnamaldehyde which is found in cinnamon and cinnamon essential oil. 
• Emotional trauma related to verbalizing, speaking, being creative, or being authentic.

Canker Sores Irritators:

• Excessive consumption of acidic or spicy foods such as vinegar, hot peppers, ascorbic acid (synthetic vitamin C), and citrus.
• Excessive consumption of foods with enzymes that break down the lining of the mouth, namely kiwis and pineapples.
• Consumption of refined sugars, particularly in large quantities or when combined with acidic foods.
• Overload of stagnant lymph fluid stored in your cheeks and gums – often caused by toxic diet combined with a sedentary lifestyle.
• Dehydration from any combination of breathing dry air, not drinking enough water, and/or eating dehydrating foods such as nuts, cheese, certain fried foods (French fries, etc), meats, and excessively salty food (especially pure sodium-chloride).
• Stress and the hormonal imbalances that accompany stress.
• Low progesterone and high prostaglandins – as is often the case right before menstruation. 
• Oral pH imbalance caused through diet or stress.
• Autoimmune disorders.

Canker sores generally don’t require treatment – they’ll heal on their own . . . eventually. Meanwhile, they’re painful. But more than that, they indicate something isn’t right. If your body is mysteriously breaking out in open lesions, something is out of balance! 

While you have a canker sore you want to abstain from exacerbating foods such as oranges to some extent, and certainly from pineapples, but know that these are likely not the root cause unless they are specifically an inflammatory trigger for you. If you have mast cell activation syndrome (MCAS), then certain foods high in histamine can trigger a wide variety of inflammatory symptoms – including canker sores.  

Preventing Canker sores

If you are reading this page, you are probably unsure why you get canker sores. Any symptom (from running nose to aching feet) can come from myriad sources, and canker sores are no exception. For this reason, you will likely want to employ many of the strategies on this page. Some of them may only work when synergistically combined with others.

Furthermore, emotional patterns create physical patterns. As most recently summarized in the masterpiece book, The Myth of Normal, our physical diseases manifest from our unresolved negative experiences. While this idea still feels radical to many people today, it is increasingly scientifically verified. However, this does not mean that going to talk therapy is going to heal your canker sores. What it does mean is that addressing a symptom in one way often leads to another symptom arising in a similar way, or even the same symptom returning even though you continue to use solutions which did work for years. 

With my clients, I have found that approaching a symptom from multiple angles actually begins to address unmet emotional needs. We can speculate as to why this is, but one simple explanation is that using a wide array of healing, nourishing modalities in your life is self-loving.

If you would like to be more proactive about healing emotionally and connecting with your subconscious, consider looking into the wide array of consciousness alchemy practices. 

Hydration 

Stay hydrated! And not just in your mouth. Signs of dehydration include: dry skin, constipation, canker sores (heh), fatigue, irritated eyes, bleeding sinuses, and headaches.

Drink at least a quart of water every twelve hours. Tea and coffee are not hydrating. Be sure you are actually drinking water.

If your lips, mouth, hands, or eyes are getting dry overnight, use a humidifier.

Address Constipation 

If you struggle with recurring constipation, I urge to you find solutions that work and incorporate them into your daily lifestyle. If you don’t poop on a single day, that’s constipation. A tremendous amount of conditions go back to bowel dysfunction – because if you are unable to eliminate toxins and absorb nutrients effectively, there will be spillover affects in every organ of your body.

Chronic constipation is more common than you likely realize. Daily poops are not actually proof that you are not constipated, as material can still be stuck in your colon and upper intestines whilst still allowing some material to pass through. Furthermore, diarrhea can be thought of as a subset of constipation, as this also generally involves some material being stuck while a watery slurry passes on through. This is common with small intestinal bacterial overgrowth (SIBO), and hypermobility disorders such as Ehler's Danlos (EDS), and hypermobility spectrum disorder (HSD) – the latter of which being a condition which has caused me constipation struggles since birth.

Improving colon transit is very individual. I have devised numerous different protocols over the years for a wide variety of clients. In some cases, increasing soluble fiber is enough: hydrated chia and flaxseeds. Lettuce and leafy greens in general tend to help as these are not only rich in fiber and water, but also alkaline minerals. Taking magnesium citrate daily can be used as a colon stimulant. For years, I took magnesium citrate in kombucha or sparkling water and called it my daily “mag-fizz”.

If increasing magnesium is insufficient and/or fiber is not practical due to your particular digestive complaints, there we turn to high vitamin-C foods like bell peppers, kiwis, or vitamin C supplementation (from whole foods). Fruit, in general, helps many people stay regular: blueberries, bananas, and apples. If these do not work or are not optimal for your body, then Ayruvedic herbs can be utilized. 

Remember that this is all very individual. In my case, bananas do help me poop, but they are a canker sore trigger for me (likely due to causing an immune response)! Depending on which flora are imbalanced in your gut, prebiotic foods may be triggers in general. Side effects from bananas may be bloating or skin irritation. Plantains can be a powerful motility regulator, but for some people, these prebiotic foods can lead to inflammatory joint pain. Prunes (dried plums) are a common remedy for constipation, but these are very sweet and they can cause gas. If a food is giving you gas which is painful, especially foul-smelling, and especially abundant, then that food is making things worse rather than better and should be either omitted or reduced.

In addition to food, it is also worth looking at the emotional causes perpetuating any health condition. You can learn more about the emotional causes of constipation in this article.

Maintaining Oral pH Balance 

Since a thorough solution means keeping the pH balance in your mouth at a healthy 7 to 7.2, you’ll want to pay special attention to keeping your stress levels down. It’s been scientifically proven that negative moods lower the pH of the saliva. If your saliva’s pH gets below 5.5 you begin to lose minerals from your teeth, and this has also been associated with the generation of canker sores.

You can compensate for this by rinsing your mouth with an easy solution of water and baking soda. Just drop a pinch of baking soda in quarter-pint of water and then swish the solution in your mouth. If you do this every time you feel stressed and after meals, you’ve solved the pH problem in your mouth. Unfortunately, this doesn’t compensate for all the other devastating impacts of eating a demineralizing and demoralizing diet. While a rinse with baking soda is a great measure against acute problems (like removing bile from your mouth after vomiting), it isn’t something you should have to rely on multiple times each day. Also, if acidic saliva or tooth decay is a concern for you, you may be interested in: Raederle’s Teeth Remineralizing Master Class. 

Maintain Levels of B₁₂

Take a sub-lingual B₁₂ once per week. (I used to be opposed to supplements, but I changed my mind over time. To understand why read this other article of mine.)

Consume L-Glutamine

Consume foods rich in l-glutamine at least once every other day, such as red cabbage, spirulina, asparagus, and parsley.

Consume L-Lysine 

Consume foods rich in l-lysine at least once every other day, such as spirulina, parsley, spinach, leeks, horseradish, onions, and radishes. I found that I was not able to get enough lysine through food alone and began supplementing with it daily in 2022. This has resulted in myriad benefits, including being able to eat cinnamon in moderation without a canker sore immediately forming.

If you want a whole food source, I recommend ordering organic spirulina tablets right away; these are a fantastic source of l-lysine and other amino acids which help you rapidly repair your skin – including internal skin on the inside of your mouth, your stomach lining, and your intestinal lining. When I was introduced to spirulina tablets it felt like a miracle. I had tried incorporating spirulina powder into my diet, but the strong flavor only paired well in limited contexts and thus, I didn’t consume it regularly. Having the tablets on hand made it easy to take them daily and to up my intake if a canker sore started to develop.

Prior to 2018 (when I was introduced to spirulina tablets), I had tried “everything.” I had tried increasing my vegetable intake. I tried taking out all the fruits that were “causing” me canker sores (oranges, tomatoes, kiwis, pineapples, raspberries, etc). I tried eliminating everything tart and sweet and yet I would still would get canker sores whenever I was even a little stressed or a little dehydrated. In other words, any time I traveled or had a busy day! Ugh.

In 2018 I learned that spirulina is a concentrated source of l-glutamine, the most critical amino acid for repairing ulcers in the mouth and stomach. Cabbage is also a high source which is one of the reasons that raw, fresh cabbage juice on an empty stomach is a long-standing cure for stomach ulcers. Spirulina, however, is also a good source of a wide variety of trace minerals and co-factors for l-glutamine, and much easier to keep “on hand” than cabbage. In the past I’ve sneaked spirulina powder into desserts since it seemed to clash flavors with everything savory. I found I could sneak it into raw banana ice cream and similar recipes. However, daily consumption never stuck because I couldn’t find a way to consume the powder in enough recipes. Then, I discovered organic spirulina tablets. For years I was able to keep the continual recurring canker sores at bay with just four spirulina tablets a day. Spirulina gives me more energy and improves my digestion to.

Spirulina may not be all it takes for you to get rid of a chronic canker sore problem, so I suggest employing other strategies as well, like taking any refined sweeteners out of your diet. Refined sugar products (cane sugar, brown sugar, molasses, etc) rob your body of minerals, hurt your pancreas, imbalance your hormones, and ultimately cause you to age far more rapidly. When you can use fresh or dried fruits to sweeten foods just as well, there really is no excuse for including refined sugars in your diet. They’re an addiction, and science has proven them to be more addictive than heroin! 

Avoid Chewing on Yourself 

Break any habits of chewing on your lips or cheeks. Use self-hypnosis if you have this habit. Repeat this to yourself several times each day: “My teeth, jaw and tongue are relaxed in every mood and situation.”

Eat Consciously & Compensate Accordingly

Whenever you eat cinnamon, spicy foods, citrus, pineapple or kiwi, immediately stop eating if you notice any discomfort in your mouth. Stay alert for discomfort. Eating consciously can help with a wide array of human health complaints. Follow-up with water and a baking-soda rinse if discomfort occurs. Also, take extra spirulina tablets, lysine capsules, glutamine, and magnesium accordingly – as getting the nutritional support before you have an established sore is much more effective than taking it after it is already established.

Read Labels

You may already be aware that you are sensitive to cinnamon or cayenne. But have you read all the labels of your tea blends, your toothpaste, and your supplements? Many clients discover that they have foods or herbs which they are sensitive to in multiple areas of their diet. Individuals have differing levels of sensitivity to cinnamaldehyde, so assess if cinnamon is a factor for you through observing any changes you experience when entirely avoiding it versus consuming it regularly. But in order to test this, you really must check all your supplements and oral products. It may be hiding in your mouthwash, your nutritional gummies, your protein powder. If reading labels is exhausting and annoying, then try reading just one label per day. 

Lymphatic Massage

Perform lymphatic self-massage on your face. You can use ecosia to look up videos on this. 

Lymphatic massage is something that came naturally to me as a child, long before I knew what it was called or what it was for. As someone with a hyperactive trigeminal (face) nerve since birth, I have always found facial massage highly beneficial. It helps reduce the frequency and severity of migraines, pimples, canker sores, sore throats, sinus infections, and ear infections. With the exception of migraines, these things all have one thing in common: stagnant lymph fluid in the face and throat. (The migraine bit has to do with the trigeminal nerve which spans your entire face. Thus, when you massage your face, you are doing lymph work and trigeminal nerve work at the same time.)

Reduce Stress

Reduce stress through regular exercise, taking breaks from computer work, deep breathing, reading relaxing fiction, meditation, journaling, and conversing with friends who uplift you. Everyone says we should reduce stress, but few people say how, so that is why I have chosen to open this section with specific suggestions. In particular, I have found it helpful to set an alarm for every half an hour while I am at my desk. When that alarm goes off, there is no particular agenda besides taking my eyes off the screen, checking in with my body, and addressing my bodily needs. This usually includes palming my eyes (trigeminal relaxation), using the bathroom, stretching my shoulders, and sometimes a brief visit to my yoga mat. If I have a cankersore at the time, this alarm can also serve as a reminder to drink water, to swish with baking-soda water, to spray the sore with silver, or to use CankerCare on the sore.

Consume Zinc

Consume foods rich in zinc at least every other day. Foods rich in zinc which are not dehydrating include alfalfa sprouts (be sure they’re organic), basil, broccoli raab, parsley, asparagus, cardamom, spinach, thyme, cilantro, dill, cauliflower, chard, arugula, sage, lettuce, peeled cucumber with seeds removed, and blackberries. 

Other foods rich in zinc – which may be dehydrating but still have good, noninflammatory properties and good mineral balance – include oysters, shrimp, hemp seeds, sesame seed (tahini), eggs (pasture-raised only!), and liver (from grass-fed cows or pasture-raised chickens). 

Foods rich in zinc which are only appropriate in moderate due to other issues with these foods include poppy seeds, pumpkin seeds, and pine nuts.

Bell peppers and goji berries are also relatively rich in zinc and vitamin C besides, but these are nightshades which can be a strong irritant and immune stimulant for some, so eat these with some caution if canker sores are a recurring issue for you. Most humans are at least a tiny bit sensitive to eating large amounts of nightshades (peppers, potatoes, eggplant, etc), especially if they are raw.

Peas, zucchini and lentil sprouts are also rich in zinc, but some clients seem to be reactive to their lectin content. All people are sensitive to lectins to some degree, which is why raw kidney beans are toxic to humans. Gluten is also a lectin, by the by. As always, dietary needs are very individual.

If you’re intolerant of gluten, have stomach ulcers, irritable bowel syndrome, acid reflux, arthritic pain, or chronic lethargy, then you may be interested in my article on eating a low-lectin diet: My First Three Weeks on the Plant Paradox Program.

If you’re looking to figure out what foods are rich in what substances in a reliable, easy way, I created my own mega-reference for my own personal use (because no tool out there met my exacting needs and impatience for learning accurately how foods compared to one another). The charts I created turned out to be so useful that I turned them into a book, The Ultimate Nutrition Reference. If you’re ready to understand foods as you never have before, get yourself a copy right now.

If you are looking to buy zinc as a supplement specifically for canker sore prevention, look for zinc carnosine, which is zinc bound to L-carnosine (a dipeptide involved in tissue repair). While regular zinc supports immune function broadly, zinc carnosine adheres to damaged tissue and releases zinc slowly at the site. Thus, it is specifically used in healing ulcers (both of the mouth and stomach).

Oral Probiotics

As I have mentioned elsewhere, I have found the fermented coconut water product known as Inner Eco to be very effective for many oral complaints, including reducing the occurrence of canker sores. You can also specifically look for chewables or lozenges which contain streptococcus salivarius K12 and/or lactobacillus reuteri. These are meant to colonize your mouth and throat, compete with harmful microbes, and modulate immune signaling locally.

Treating Canker Sores

Many common tips are actually really bad. Don’t suck on popsicles to numb them. Do not add sugar to a problem that is clearly exacerbated by sugar because it “feels good” in the short run. That is akin to the bad advice my mother received as a child from her doctor – ice-cream for a sore throat! Also, don’t use alum. Alum is a remedy that was going around in my childhood, but this sketchy product includes trace amounts of aluminum which is not a beneficial trace mineral. Okay, okay, enough about the bad ideas, and let us progress to good ones!

Water Floss 

For immediate treatment, I’ve found that a water flosser one of the most powerful interventions. I originally purchased my water flosser when I had a case of pericoronitis due to the gum flap that was still hanging out over my wisdom tooth. The water flosser is an amazing device; the horrible pain I had been experiencing was reduced even on the first use, and continued to diminish with each use and was entirely gone within a few days. I’ve found the water flosser to be similarly useful for canker sores.

A water flosser can mechanically break up the biofilms that bacteria have made to protect themselves, making this technique a powerful combination with any other topical treatment. It will also clean out other debris in the sore and help restore hydration to an area of your mouth which may be chronically dry.

To use a water flosser on a sore: set your flosser to the lowest setting, aim the stream of water at the sore. Slowing increase the setting so that the pain is where you can barely tolerate it. At first, this is usually speed three or four for me (out of ten). Hold the stream of water on the sore for a minimum of ten seconds. Repeat this several times a day. While this will hurt at first, relief is usually very rapid after the fact.

If you do not have a water flosser and do not wish to buy one, you can also use the stream of water in your shower. Of course, spit out the water afterward – in either case.

Silver 

In 2020 I discovered silver spray, which can be used to spray the canker sore to decrease bacterial imbalances in the area and in your mouth in general. This is something easy, odorless, and (nearly) flavorless which you can use during a long car ride or while on an airplane.  

Deglycyrrhizinated Licorice (DGL)

Ddeglycyrrhizinated licorice is, well, licorice – with the glycyrrhizin removed so it doesn’t raise your blood pressure. Taking this in capsule form may help some, but contact with your mouth will be most effective for rapid treatment. It will increase mucus production, promote skin repair, and have mild anti-inflammatory effects. I primarily recommend this to clients with stomach complaints, but it can be quite useful for the oral cavity as well. For oral treatment, get chewable tablets. For stomach upset, get capsules. You can open the capsules if you happen to already have some, but the flavor is earthy bitterness with tree root notes.

Melatonin

We think of melatonin as a sleep hormone, but like all hormones (including neurotransmitters), it does a vast multitude of things. Melatonin serves as a mitochondrial repair molecule throughout your body. A generally safe range is 0.3 milligrams to 3 milligrams. While more is sometimes used in studies, higher amounts can backfire – especially in sensitive systems. Melatonin helps by reducing oxidative stress, modulating immune response, and by supporting tissue regeneration.

In addition to taking melatonin capsules for systemic benefit, you can also get it as an oral gel which is applied directly to the sore. This can promote faster healing while also reducing pain.

Bromelain

While eating 🍍 pineapples – a potent source of bromelain – is not advised when you have a canker sore, the bromelain itself may be quite helpful. Bromelain as an isolated enzyme reduces swelling and helps break down inflammatory proteins.

Vegetable Juice

Drink vegetable smoothies/juices that don’t contain anything acidic or overly sweet. This especially helps if you include cilantro, cabbage, parsley, kale, and/or spinach.

Water Swish

Sip water throughout the day and swish your mouth with every sip.

Baking Soda Solution 

Rinse your mouth with baking soda solution and/or hydrogen peroxide and/or aloe juice.

Salt Water 

Gargle with warm salt water. This is also great for sinus infections, sore throats, and ear infections.

Toothpaste

Brush your teeth with a mixture that does not include sodium lauryl sulfate. One of my favorites is Uncle Harry’s Toothpaste which has great flavor, texture, and results. Uncle Harry’s Toothpaste also has the benefit of being cinnamon-free. Another favorite of mine is The Dirt Toothpaste, particularly their cacao mint flavor. I have also sought options which are plastic-free and mint-free, and found the fabulous Dr Tungs Herbal Toothpowder Tabs.

Avoid Burns

Avoid burning your mouth with hot foods and hot drinks. However, warm green tea is usually helpful. You can refrigerate the tea bag after making and drinking the tea and then put the tea bag in your mouth on the sore for a minute at a time for even deeper relief.

Celery

Chew celery (gently). This tends to numb the sore while providing electrolyte balance to the mouth.
Brush your teeth consciously and don’t hit the sore. While using a water flosser directly on the sore is helpful, but brushing it is usually too abrasive. On the same note, avoid excessive abrasion from textured food (absolutely no chips or crackers).

Essential Oils (with Caution)

Apply a numbing, disinfecting substance or essential oil to the sore. Some great choices are silver, clove essential oil, or use an amazing blend like Quantum Health’s Canker Care. I personally use this product (since I discovered it in 2020) and wish it had been in my life earlier. It has ingredients that soothe and numb the sore, but also ingredients that help address common root causes of canker sores. Check out these ingredients: Aloe, Calendula, Myrrha, B₁₂, Dipotassium Glyrrhizinate (DGL, Licorice), Echinacea, Clove, Goldenseal, Lysine, Tea tree, Cajuputi, Peppermint, Propolis, and Zinc!

 

If you’re interested in learning more about healthy oral hygiene, read my extensive article called Cure Pericoronitis & Periodontitis Naturally. This article goes into a variety of unusual oral hygiene practices not mentioned in most readily available sources.

Wishing you healthy gums, tongue, cheeks, and psyche,

Raederle

The Consciousness Alchemist

Note: I originally drafted this article in January 2017. It was updated a lot in 2018, a little in 2020, and just went through an overhaul on May 5th 2026.

Akkermansia Muciniphila: A Key Bacteria for a Healthy Gut . . . Of which I have none?

In my GI-MAP test from Diagnostic Solutions Laboratory, I had “no detectable levels” of the commensal (beneficial) bacterial family known as Akkermansia muciniphila. My Australian practitioner from The Functional Gut Clinic told me that she believed I probably did have some of this bacteria, but that it was simply below a threshold where it was likely to show up on a test. She believed that if I incorporated foods that akkermansia could eat, I would be able to regrow this population in my microbiome and experience benefits.

This leads to a great many questions which I will endeavor to answer here, including how one’s akkermansia population might be depleted, the consequences of its depletion, and how one might build it back up.

Akkermansia Muciniphila

Wikipedia says, “A. muciniphila is found in about 90% of healthy humans, and makes up 1% to 3% of the fecal microbiota and colonizes the gut during the first year of life. Its prevalence can decrease with age or in disease states.” And, “A. muciniphila is able to use mucin as its sole source of carbon, nitrogen and energy, and is hence considered a specialist.” This is why “mucin” is in the name! While akkermansia muciniphila is “eating” your mucin – your mucosal lining in your intestines – it produces beneficial products such as short chain fatty acids which aid in growth of other bacteria which overall leads to a healthy mucus turnover.

What Causes “No Detectable Akkermansia Muciniphila?”

A lack of detectable Akkermansia muciniphila (sometimes called A. muciniphila) in a microbiome test could suggest significant gut microbiome dysbiosis because it is a keystone bacterium that plays a crucial role in gut barrier integrity, metabolism, and immune regulation. Without it, you may be in for some deep doo-doo.

There are several reasons why Akkermansia levels could drop to the point of being  undetectable, which I’ll now innumerate.

Akkermansia thrives on mucin and certain prebiotic fibers. Without the right polyphenols and resistant starch, your akkermansia populations can starve.

For example, akkermansia likes the polyphenols present in berries, pomegranate, green tea, and cacao (plain chocolate bean either in whole form or powdered). If you were embarking on a GAPS diet or carnivore diet, you may be healing one condition whilst simultaneously starving your akkermansia populations, which could be why some people develop issues after persisting on these diets long-term. (For those who thrive on these diets long-term, they likely have a microbiome balance which manages to do well even in the absence of akkermansia.)

A diet high in refined sugars and processed foods can reduce akkermansia populations. As usual, a diet with a wide variety of colorful fruits and vegetables, and generally as much variety as possible – without that variety extending to chemical factory-made concoctions – is going to support a diverse, robust ecosystem living in your gut. Although, many healthy foods, such as broccoli, cabbage and eggs, can be taken off the table if you develop an overgrowth of desulfovibrio. Thus, just because “variety is good” doesn’t mean that everyone from all walks of life can or should eat an omnivorous diet with hundreds of different foods. But if your microbiome is already very healthy, then variety will help keep it that way.

Antibiotics (and some medications), of course, can wipe out akkermansia, particularly if there’s repeated or long-term use. In my case, it’s possible that all the antibiotics I was prescribed as a child may have wiped this species out when I was young. If this species is truly absent for me, rather than merely at “very low levels that can’t be detected,” this could explain some of my lifelong struggles (which led me to become the most health-disciplined person almost anyone has ever met). When we look at the serious consequences for low akkermansia populations, you may begin to see why.

NSAIDs may negatively impact Akkermansia levels by altering the gut microbiota and reducing mucus layer integrity. In fact, in Dr. Steven Gundry’s book, The Plant Paradox, he specifically advises against ever taking a NSAID if you don’t absolutely have to. Nonsteroidal anti-inflammatory agents (usually abbreviated to NSAIDs) are a group of medicines that relieve pain and fever and reduce inflammation – and almost all of us have taken them at some point. These include things like Aleve and ibuprofen. These things are known to be highly detrimental to one’s microbiome, which is a critical part of  your ability to ward off disease, produce neurotransmitters, and absorb nutrition. It’s serious stuff to go around killing off your microbiome – especially when we’re just talking about some temporary pain relief.

Even without antibiotics or NSAIDs involved, you may still end up with depleted akkermansia through having gut inflammation from other causes. A poor diet combined with a viral infection (such as Epstein Barr) could begin a microbial imbalance which could become increasingly worse over time – particularly if your akkermansia population is simultaneously being starved. Diarrhea can compound this trend, as high gut motility can decrease Akkermansia’s ability to colonize and persist. Although whether this ever happens without any antibiotics or NSAIDs ever being part of the picture is unsure – it’s purely an educated guess that it could happen.

Chemotherapy and immunosuppressants overall alter microbiome composition, generally in a way that includes reducing akkermansia.

It’s hard to say which came first in some cases – did low akkermansia levels contribute to causing a condition, or did a condition cause low akkermansia? While that’s unclear, low akkermansia levels are associated with diabetes (type two), obesity, rheumatoid arthritis, multiple sclerosis, irritable bowel syndrome, and leaky gut.

Repercussions of No/Low Akkermansia

Akkermansia helps stimulate mucin production, which strengthens your gut lining. Without it, your gut barrier may become compromised, increasing the risk of intestinal permeability – usually simply called “leaky gut.” From there, you end up with chronic low-grade inflammation, food sensitivities, and autoimmune activation.

Low levels of akkermansia are associated with obesity and diabetes (type two – which is the kind you develop during your life, rather than the ‘from birth’ kind). Because higher levels of akkermansia have been found in “skinny people” there has been a bit of a buzz about this particular gut bug, leading to probiotic companies beginning to advertise akkermansia content. Unfortunately, this may not be all it is cracked up to be, as I’ll discuss later in this article.

Akkermansia has anti-inflammatory properties, and, thus, unsurprisingly, low levels of akkermansia are linked to chronic conditions like: Inflammatory Bowel Disease (IBD), Multiple Sclerosis (MS), and Rheumatoid Arthritis (RA). You can think of the microbes living inside you as an essential part of your immune system. They work in cooperation with your own defensive mechanisms, but more than that, your commensal microbes are your first line of defense. Akkermansia is a great friend to have on your side.

Without akkermansia working with your immune system, there seems to be a tendency for your immune system to become overactive, increasing the risk of autoimmune diseases and allergies.

Feeding Your Akkermansia

When it comes to complex cases like my own, feeding akkermansia sounds a bit challenging. One of its primary food sources, galacto-oligosaccharides, is a specific trigger for extreme bloating, gas-pains, and constipation. If you’re on a low FODMAP diet for the same reason as myself, you may be starving your akkermansia, which may lead to further complications down the line. For this reason, when it comes to certain foods, it may be better to eat extremely small amounts that are within your comfort threshold, rather than fully eliminating them. When it comes to genetically modified organisms or additives like maltodextrin, absolutely eliminate these things completely. But maybe when it comes to beans, the answer might be to eat one bite, or even one bean, rather than none.

Galacto-oligosaccharides (GOS) are particularly high in jerusalem artichokes – 7.5 grams per 100 grams. In lentils, it’s 3.8 grams per 100 grams, and lima beans come in at 2.9 grams. It strikes me that lima beans were my favorite food as a kid. Maybe I was craving them in order to feed the akkermansia that I still had at the time!

Garbanzo beans come in after limas at 1.2 grams per 100 grams, and onions and butter beans both at 0.2 grams per 100 grams. These numbers, of course, are just based on some particular samples which were tested – the amounts will vary depending on growing conditions and preparation. In fact, part of why soaking and cooking beans helps is because it reduces GOS content. Some people even recommend soaking beans with baking soda to reduce it even further. If digestive distress from galacto-oligosaccharides is really so bad and so common, maybe we should be simply reducing the amount of beans we eat dramatically – without eliminating them entirely. I’m really not kidding about “maybe eat just one bean.”

Beyond feeding akkermansia the particular sort of fermentable saccharides it desires, you can also improve the favorability of the environment of your digestive system. Many polyphenols (which is basically a class of antioxidants, which I demonstrate in this essay) indirectly help akkermansia.

Ellagic acid from pomegranates is converted into urolithins, which have been shown to promote akkermansia muciniphila growth. Also, ellagic acid (and the catechins in green tea) have been linked to increased mucin production – which is where akkermansia lives and eats. And if you haven’t noticed already, the notion from a decade or two ago that you wanted a “mucus-free body” has basically been debunked. Having a healthy, regenerating mucosal lining in your intestines is really important, and it’s one of the key roles that akkermansia has for us.

Certain polyphenols (like those in berries and cacao) increase the fermentation of fibers into short-chain-fatty-acids, and others modulate the activity of butyrate-producing bacteria, and butyrate has been shown to enhance akkermansia abundance. Short-chain-fatty-acids and butyrate are both essential for healthy motility.

Hot take: fiber doesn’t move through your gut like a thousand brooms cleaning up! That’s what I used to believe when I was early in my health research sixteen years ago. I believe I even said such things about fiber at many talks and on the web. I was utterly wrong. Fiber feeds certain microbes, and it is actually your microbiome that determines how things are moving through your gut. In fact, more fiber does not always mean more motility; depending on your specific microbiome balance, certain prebiotics could make matters worse.

Furthermore, it’s not necessarily “the fiber” in a food that is increasing motility! If that were the case, then two foods containing the same amount of fiber should have the same motility impact. (That pun just keeps cropping – dumping? – up.) But blueberries have far more motility impact than high-fiber grains. That’s because of the antioxidants in blueberries feeding certain microbes which in turn generate other compounds.

Okay, so polyphenols (antioxidants) stimulate the intestinal epithelial cells to increase mucin secretion (a mucus layer lining the gut and helping it stay healthy). So which antioxidants in particular are helpful for akkermansia? If you’ve looked at my antioxidant chart, you’ll recognize these four classes of polyphenol: flavonoids (yes, that sounds like “flavor” because it is associated with the flavor of the food!), phenolic acids, stilbenes, and lignans (which you may have seen on your flax oil bottle advertising “highest lignan!”).

All of the following polyphenols are associated with higher levels of akkermansia.

Flavonoids

🟣 Catechins, which are important for cardiovascular health, weight management, and brain function.

✔ Cacao

✔ Green Tea Leaves

✔ Apricot

🟣 Anthocyanins, which are known for reducing oxidative stress and inflammation, supporting eye health, and improving cardiovascular health.

✔ Black Elderberries

✔ Black chokeberries (Aronia)

✔ Blackcurrants

✔ Blueberries

✔ Blackberries

🟣 Quercetin, known for helping liver regeneration, and it’s anti-inflammatory, antihistamine, and antiviral properties.

✔ Elderberries

✔ Capers

✔ Cranberries

✔ Red onions

✔ Lovage Leaves

✔ Radish Leaves

🟣 Isoflavones are phytoestrogens which are linked to reduced menopausal symptoms and a lower risk of certain cancers. Although there’s been some debate about how beneficial these are. Isoflavones are found in soy products, but you must be extra careful to only consume certified organic soy as conventional soy is a high-spray, high-glyphosate residue crop which is known for destroying your microbiome.

✔ Natto – a particular form of soy fermentation which creates a lot of K2, an essential missing nutrient in most modern diets. Having K2 or not is the difference between having dental plaque, osteoporosis, and heart disease, or having healthy teeth, bones, and arteries.

Phenolic Acids

🟣Ellagic Acid exhibits anti-carcinogenic and anti-inflammatory properties. Some studies have even investigated it for its ability to inhibit cancerous tumors.

✔ Pomegranate

✔ Cloudberries

✔ Blackberries

✔ Raspberries

🟣Ferulic Acid is associated with healthy skin and preventing skin damage.

✔ Tomatoes

✔ Oranges
✔ Spinach

🟣Chlorogenic Acid is associated with reduced blood pressure and improved glucose metabolism.

✔ Sunflower Seeds

✔ Blueberries

✔ Artichokes

Stilbenes

🟣Resveratrol is known for its potential in promoting heart health and longevity.

✔ Red wine

✔ Red grape juice

✔ Black grapes

✔ Mulberries

✔ Japanese knotweed (source for Itodori tea)

Lignans

🟣Secoisolariciresinol is correlated with a reduced risks of hormone-related cancers and improved heart health.

✔ Flax seeds

✔ Sesame seeds

Side note: Flax and sesame are some of the healthiest seeds for a wide variety of reasons. For example, sesame seeds are one of the only seeds with more calcium than phosphorus.

Of course, as always, nutritional content in foods varies based on cultivation practices, processing, and preparation methods. So just because something usually contains a lot of a given antioxidant doesn’t mean the particular cultivar (type) you’re getting, or the particular farm you’re sourcing from is conducive to being high in that antioxidant. Hence, a variety of nutrient-rich foods from a variety of sources with sustainable, regenerative, and wholesome practices will yield the best results for your microbiome.

In a moment I’m going to recap which foods which may help akkermansia populations rise (as well as other lifestyle tips!). If you know you’re sensitive to some of these foods when consumed in large amounts, you may try incorporating very small amounts of them. One way to do this is to acquire a whole-foods supplement powder which contains trace amounts of a wide spectrum of whole vegetables and fruits. Often these trace amounts aren’t enough to trigger symptoms while still being enough to help support a diverse microbiome.

For example, I consume supplements that contain trace amounts of garlic, broccoli, radish sprouts, squash, and sweet potatoes and these supplements don’t bother me even though adding these foods to my meals creates severe adverse reactions. If you react to some of these foods too, you might investigate if it could be a less-known form of SIBO from “sulfur reducing” bacteria.

✔ Increase Polyphenol-Rich Foods, especially pomegranate, cranberries, blueberries, green tea, cacao, flax seeds, grapes, elderberries, aronia, red onions, and natto. 

✔ Increase Prebiotic Fibers (if tolerated): including resistant starches such green bananas, cooked-and-cooled potatoes, and plantains; and chicory root. If you’re sensitive to FODMAPS, please be very careful with this suggestion. You don’t want to flood your body with problematic compounds like hydrogen sulfide and end up feeling like a mess of brain fog, dizziness, muscle cramps, bloating, and motility problems.

✔ Supplement for akkermansia if possible or practical. These probiotic supplements are just coming onto the market and seem to have limited effectiveness thus far. One insightful reviewer explained: “Recent studies showed benefits of Akkermansia Muciniphila at regulating GLP-1. The problem is that the dosages were significantly higher than the ones contained in Pendulum Akkermansia Probiotic.

“First understand the dosage notation. AFU stands for Active Fluorescent Units. It’s a method used to measure the viable cell counts in probiotic supplements. Unlike CFU (Colony Forming Units), which counts only the cells that can form colonies, AFU uses flow cytometry to count all viable cells, including those that might not form colonies but are still alive and potentially beneficial. Using the product’s metric for the sake of standardization of terms, we then can examine studied doses and protocols that showed effective outcomes.

“The studies used well over what is in this supplement (somewhere in the order of 100 times higher dose per day!) to achieve therapeutic benefits and weight loss. Most studies that have shown significant results used in the range of 10 billion AFU per day. That would require you to take a hundred of these tabs a day. This underscores the problem that has emerged from having no regulations or outcome expectations for supplements.”

Keep your eyes out for more potent and affordable akkermansia supplements, and message me on social media if you see something promising!

✔ Butyrate supplements or foods rich in butyrate may also be useful as this feeds beneficial bacteria that supports akkermansia.

✔ Other supplements, such as inulin, arabinogalactan, or pomegranate extract can promote akkermansia growth. Once again, be very tentative if you’re sensitive to prebiotics and/or FODMAPS.

✔ Avoid processed foods, refined sweaters, artificial sweeteners, and sugar alcohol additives which can negatively affect akkermansia.

✔ Some evidence suggests that regular physical activity and cold therapy (like cold showers) increase akkermansia levels.

✔ Avoid antibiotics and NSAIDs unless absolutely necessary.

✔ Manage your stress and sleep. You’re probably tired of hearing this, but it’s critical for every system in your body. Stress wreaks havoc on your microbiome – and everything else in your body.

Overview

In healthy individuals, akkermansia typically comprises 1-5% of the gut microbiome, but in those with chronic conditions, it can be nearly absent. A healthy gut microbiome maintains a balance between akkermansia and beneficial butyrate producers like Faecalibacterium prausnitzii. Some studies suggest that a significant percentage of individuals in modern societies have low or undetectable akkermansia, primarily due to diet, antibiotics, and medication use.

A complete absence of Akkermansia muciniphila is a strong indicator of gut dysbiosis, poor mucosal integrity, and potential metabolic or immune dysfunction. Akkermansia deficiency often coexists with other microbiome imbalances and should be addressed through dietary, lifestyle, and microbiome-restoring interventions. If you live in a country or region where it is possible to get a fecal transplant, this may be the most surefire way to get promising results.

As always, if you have health insurance and/or can otherwise afford a practitioner’s help, please get testing and guidance for how to best proceed with restoring your microbiome health.

— Raederle Phoenix