Burning Mouth Syndrome with Dr. Susan Sklar: Rational Wellness Podcast 378

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Dr. Susan Sklar discusses Burning Mouth Syndrome with Dr. Ben Weitz.

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Podcast Highlights

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Dr. Susan Sklar is a Harvard-trained gynecologist who practiced medicine at her private practice in Southern California for 30 years, and now consults internationally through her official website SusanSklarMD.com.  Dr. Sklar pursued training in sexual function solutions for men and women and completed the nationally recognized fellowship in Anti-Aging and Regenerative Medicine sponsored by the American Academy of Anti-Aging Medicine. She is certified in the Bredesen Protocol for slowing and reversing early-stage Alzheimer’s disease and its precursor, mild cognitive impairment.  Dr. Sklar’s current professional specialty is the development of breakthrough treatments for Burning Mouth Syndrome, a chronic, neuropathic pain condition that affects primarily menopausal women. Hundreds of women have found relief in the hormone balancing protocols developed by Dr. Sklar in her practice.                               

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

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Podcast Transcript

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz. com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, we’ll be having a discussion with Dr. Susan Sklar about Burning Mouth Syndrome.

Burning Mouth Syndrome is a painful condition that causes a burning, scalding, or tingling sensation in the mouth. It can affect the tongue, lips, gums, inside of the cheeks, roof of the mouth or large areas of the whole mouth.  The burning can be severe, as if the mouth has been injured by a hot drink. Other symptoms include dry mouth or an altered taste in the mouth. Burning Mouth Syndrome can occur every day or may come and go. The symptoms can last for months or years. The majority of patients appear to be post menopausal women.  And while we don’t know what causes it, it may be related to hormones or to specific medications.

Dr. Susan Sklar is a Harvard trained gynecologist who practiced medicine at her private practice in Southern California. for 30 years. And now she consults internationally through her official website, SusanSklarMD.com. Dr. Sklar pursued training in sexual function solutions for men and women and [00:02:00] completed the nationally recognized fellowship in anti aging and regenerative medicine sponsored by A4M. She’s also certified in the Bredesen protocol for slowing and reversing Alzheimer’s disease. And Dr. Sklar’s current professional specialty is the development of breakthrough treatments for Burning Mouth Syndrome, a chronic neuropathic pain condition that affects primarily postmenopausal women, and hundreds of women have found relief And the Hormone Balancing Protocols developed by Dr. Sklar in her practice. So welcome, Dr. Sklar.

Dr. Sklar: Thank you. Yes, that’s all true.

Dr. Weitz: I realize I may have had some version of Burning Mouth Syndrome. I don’t know if this quite qualifies, but after the first time I had COVID I chewed some gum that had mint in it, and my tongue started burning, and every time I would eat anything that had mint or ginger, my tongue would burn.

Dr. Sklar: And then, did it resolve spontaneously?

Dr. Weitz: It lasted about two years, and then just went away.

Dr. Sklar: Whoa, so that’s very interesting. I’ve had people who I didn’t, but I’ve certainly run into people whose burning mouth, which they already had, got significantly worse with COVID. I also had one patient whose mouth pain went away when she got COVID because there’s a mechanism it’s with the mechanism, I don’t know if all of the iterations of COVID still have it, but the initial iteration of COVID, Remember, it could make people quite sick before they felt bad.

People would end up all of a sudden with their PO2s were, down in the [00:04:00] 70s and they had been feeling perfectly okay. So all the usual symptoms of discomfort, pain, air hunger, they didn’t have. And there is a particular mechanism that this woman’s immunologist thought came into play that actually had her burning mouth go away when she had COVID. And that was a couple of years ago. I have not been back in touch with her because she felt better and she, she didn’t need to see me anymore. But mostly the people I see, and it’s impressive that it lasted two years for you because that’s really a significantly long time.  And the actual definition is oral discomfort that lasts for longer than three months and occurs on a daily basis. 

Dr. Weitz: Now, it only occurred if I consumed something that had mint or if I ate ginger.

Dr. Sklar: That’s interesting. And mint is certainly an issue for people with burning mouth. Citrus is. It may be that you had a very mild version that only really [00:05:00] became noticeable when you had an irritant in your mouth.

Dr. Weitz: Yeah. Tell us about your personal health journey. And how you found your way to Functional Medicine and to Burning Mouth Syndrome?

Dr. Sklar: My personal health journey I, originally I was trained as an obstetrician gynecologist and then hence got into the whole field of men’s and women’s sexual medicine, which I did for a while.  And then, I had problems, oh, actually starting In my 30s and early 40s, GI problems and was diagnosed with colitis and put on any number of medications, including steroids, which made me crazy, like I would be up all night and only sleep for two hours a night and, Found myself in my bathroom cleaning the brass handles of the, of this thing at 3 am and saying, What the heck are you doing up at 3 a. m. with the, the brass polish? And never really got better. And [00:06:00] then it was actually an article in a local newspaper that talked about gluten. And everybody knows about gluten elimination now, but this was like, 35 years ago. And I thought, okay that’s not a hard thing to do.  I’ll just stop eating wheat and see what happens. And away went all of my colitis symptoms. And my GI doctor was like, because I had to go for regular colonoscopies and she, the nurses were surprised that I had a diagnosis of colitis and was not on any medication. And my GI doctor, I told her what I was doing and she said when I had my colonoscopy, so are you still doing that?

What diet was it you were doing? The thing with the gluten? And I said yeah. And that’s why I don’t have any symptoms or any lesions anymore. And so I could see the problem. And this is a, was a wonderful doctor, who was super caring. And I thought, Why wouldn’t somebody diagnosed, every time someone gets a [00:07:00] diagnosis of colitis or Crohn’s, why wouldn’t you give them a trial off of gluten and see what it does?  And so I began to see, personally how the conventional medical system fails people.

Dr. Weitz: And yeah, I was amazed over the years that the fact that on average, many gastroenterologists don’t think it matters at all what you eat. How could the study of the tube that the food goes down not matter what food you were putting in?

Dr. Sklar: Yeah, exactly Anyhow when that all was going on was around the same time. I was getting Burned out on OBGYN, dealing with insurance companies, quite frankly, and seeing, oh, 25 to 30 patients a day trying to relate to people in a 15 minute appointment. And I just thought, I can’t do this anymore.  I just, I’m [00:08:00] done. I can’t do it. And then I thought what else am I going to do? I’m not, like some doctors are like authors or there was this local dermatologist who made children’s clothes and she started a shop that carried children’s stuff. And I’m like, I’m not really equipped to do anything else.  That’s been my passion my whole life. So what am I going to do? We actually have a foster son that we took in, one of my kids friends in high school, and he said, I’ve been designing furniture, and I’m designing furniture for somebody who I think you’ll be interested in what she’s doing. She doesn’t want to say much of anything to me about it.

She’s very private about it, but I’ll see what I can find out. And it was somebody who ultimately ended up becoming a very good friend of mine who had been a plastic surgeon and got into the, quote, field of anti aging medicine and working with hormones. And she took me under her wing and, told me what courses to go to, and where to [00:09:00] study, and how to market, and really got me set up.

And so it turns out and it fits in very well, and I let all my gynecology patients know that I have this new practice. So a number of former gynecology patients came into my new functional medicine anti aging practice. Early on, somebody who actually hadn’t been one of my GYN patients, came to see me and I put her on the usual array of hormones for restoration.  Estrogen, Progesterone, Testosterone, DHEA, Pregnenolone, Melatonin, and Thyroid. And this woman happened to be a physical trainer. And she wrote a little testimonial that I put on my website. So this was in 2007. It was a rudimentary one page website. Nobody had blogs and stuff like that.  It was a single page my son set up for me. And she wrote this little testimonial that she said was okay to put on the website. And she said, Since in the two months that I’ve been on a [00:10:00] hormone restoration program, my energy is better, my mood is better, my muscle definition is better, and my burning mouth is not nearly as bad, which I honestly, I hate to say it, I didn’t really pay much attention to it because I kind of didn’t know what it was.

And people started approaching me saying, Oh, you treat burning mouth syndrome? And I was like well, not really. And so I spent an incredible amount of time in the neuroendoimmunology literature. Which is like brain research reviews and other journals trying to figure out what would a hormone have to do with a nerve pain or pain?  And it turns out, a lot. And in fact, these steroids are actually made in our nerves. They’re called Neurosteroids. When I saw the term Neurosteroids, I was like, Oh my goodness, I’ve hit the jackpot because this [00:11:00] explains what I’ve been seeing. 

Dr. Weitz: And repeat that one more time, what you just said?

Dr. Sklar:  There are steroid hormones like DHEA, pregnenolone and progesterone that are made in nerves and they are called neuro steroids.  There are neuroactive steroids, which are steroids made in other places, like the ovaries and the testes, that have actions on the nerves, but there are actually steroids made in these nerves. And they have actions on how nerves function. They’re anti inflammatory, they help nerve to nerve transmission.  And so the best I could figure out, because I didn’t know who to ask about this, was that, these hormones were somehow reducing inflammation and improving these people’s situation. It’s not a permanent fix, it doesn’t cure the situation, but it certainly gives people relief to the point where [00:12:00] They can, basically, it’s not ruling their lives and, you know, you’re a chiropractor, Ben.

You know what chronic pain does to people. For sure. It can destroy your life. It can destroy your relationships. Yes. And when it involves your mouth, it has to do with what you can or can’t eat. And so it ends up that people who have this isolate, don’t go out to dinner. A lot of our socializing is done over meals.

Right. Right. So that kind of goes by the wayside and a lot people’s gauge of how much better they are is what they can eat. Can they drink coffee now? Can they eat salads again? Can they socialize with friends like the one patient I mentioned who finally was able to go to Thanksgiving dinner with the rest of her family?

The other issue that comes up, am I still okay as far as freezing? Okay the other issue that comes up is, as you said, [00:13:00] A lot of the people that have this condition are perimenopausal and menopausal women. Our medical system really does not recognize a lot of what is going on with women as valid.  Thinks women are being hysterical, still. Think women are making it up that it’s in their heads. There are actually articles in the literature That says, Bernie Mouse Syndrome is because women are watching too many upsetting soap operas on TV.

Dr. Weitz: I saw that in one of your articles. It kind of reminds me of IBS, which is another, the most common gastrointestinal condition, which is more common in women, and was often dismissed as a psychological disorder.

Dr. Sklar: Right, exactly. So, women have that discrimination going on, not being believed, and you know, you talked about my website, the people with Burning Mouth Syndrome, of all of the patients I’ve ever met, with all their variety of medical are on the internet more than any other group of patients that I’ve ever encountered.  And it’s not unusual for somebody to tell me something like, yeah, I found you because I went to the Mayo Clinic, Oral Facial Pain Clinic, and they said, no, there’s nothing we can do for you. And I went home and I was crying all night and couldn’t sleep. So I got on my computer and I found you. And I hear that story over and over again.  People with burning mouth are on the computer incessantly.

Dr. Weitz: I was, I was looking around for some of the conventional medical perspectives on things and it looks like one of the most common treatments is to prescribe what you, which is sort of the cure all for almost any pain or neurological condition that they don’t know what else to do, they prescribe [00:15:00] gabapentin.

Dr. Sklar: Right.  Which seems to help a few people, and I, the problem with Gabapentin is side effects. So, people often feel zombie like on Gabapentin, too sedated to do anything. And so, I think there may be a place for it. By the time people come and see me, number one, if it was going to go away on its own, it already did.  If Gabapentin was going to take care of it, they don’t come and see me. But I’ve had people on gabapentin with side effects like sedation, who we’ve put on a hormone program, they feel somewhat better, but not all the way better, maybe, or they get all the way better, and we say, well, let’s try to withdraw the gabapentin so you don’t have so much sedation and problems from it, and they notice that their pain increases.

So sometimes it’s hard to, for people to tell if something’s working or not until you try to withdraw it. Right. So we try to use a low enough dose and other things to support them, but you’re right. Gabapentin, [00:16:00] also pregabalin or Lyrica is frequently used. The other thing that’s big in the literature for oral facial pain and trigeminal neuralgia is duloxetine.

And I have a long list of possible medications that I’m certainly happy to try people on. The problem with those medications is often they have side effects and, you know, what we know about hormone restoration is usually there can be some side effects, but usually there are side benefits. So people like the patient that I mentioned in the very beginning, who was kind of my start in burning mouth syndrome, her energy was better.  Her mood was better. So I see that people get those side benefits from being on hormones.

Dr. Weitz: So how do you diagnose patients with Burning Mouth Syndrome? Is this a purely clinical diagnosis, or are there some tests that can be done?

Dr. Sklar: It’s really clinical. It’s history. And like I said, by the time people see me, they’ve been [00:17:00] to multiple dentists, Ear, Nose, and Throat Doctors, Oral Facial Pain Clinic. So they’ve been examined and everything looks normal. Some of these people probably have small fiber neuropathy. And when I did a survey,

Dr. Weitz: what that is, Yeah,

Dr. Sklar: there are small nerve fibers that can degenerate and cause neuropathic pain. It could happen anywhere in the body and it can be you.  And it has a number of causes. Lyme can cause it. Mold can cause it. Viral illnesses can cause it. It can be an autoimmune reaction. And so very small

Dr. Weitz: Why would it be small nerve fibers?

Dr. Sklar: I don’t know if I have a good answer to you, but it’s the unmyelinated smallest nerve fibers that get affected.  That are sensory fibers. And you can make a diagnosis in a lot of cases by doing skin [00:18:00] biopsies because those small fibers penetrate the skin. And I suspect that in some people, of course, then you want to try to find the underlying cause because it doesn’t just go away on its own. If it’s Lyme, you want to treat the Lyme.  If it’s viruses, you want to treat the viruses. But doing a survey of my patients, about a quarter to a third of them have neuropathy in other places besides their mouth. So they may have peripheral neuropathy in their lower extremities. The patient that I mentioned that was my very first one who got better on hormones had burning on the skin of her shoulders on her back. Some people feel burning up into their nasal passages, down into the trachea and into the lungs and skin anywhere on their bodies. So we’re, I’m starting to look at, and everybody doesn’t get better on a hormone restoration program. The other things that have been brought up as potential contributors are mast cell activation, [00:19:00] Some Dr. Lawrence Afrin, who a lot of, of functional medicine know about in terms of mast cell expertise has a couple of papers out about putting people on histamine blockers like Pepsid, which, you’re not crazy about putting people on something like Pepsid, which is a stomach acid blocker long term, but if you’re talking about somebody not being able to live their life because of severe chronic pain, it’s a trade off.

And I’m using something like Zizol or Claritin or Zyrtex to for H1 blocking. So there seems to be, for some people, a mast cell component. And the more I go along, the more complicated the patients I see tend to be. And so I have a number of patients who have clearly mast cell overactivity, who’s, who get urticaria, hives, whose faces turn red at the, at the drop of a hat.  Who get itchy all over a couple of [00:20:00] people whose throat closes up and have to go to the ER as, a histamine reaction. So histamine and mast cells play a role for some people. The other thing that’s been posited as a possible cause is that this is a post viral, like post herpetic neuralgia.

And there’s a woman named Maria Nagel who’s in Colorado. She’s a neurologist, and she’s written a few papers on treating people with very high dose Valtrex or Valcyclovir. Right, so getting better on Valcyclovir, and it’s high dose for a prolonged period of time, like three to six months. Some people, it seems like, need to be on a maintenance dose long term.  But that has helped some people with burning mouth syndrome get better.

Dr. Weitz: Okay I also saw something about this condition called oral lichen sclerosis as being a cause, and it’s not [00:21:00] clear exactly what this condition is, and have you seen this condition as a factor?

Dr. Sklar: I haven’t I’ve seen more oral lichen planus and which is kind of flat, round lesions that occur in the mouth.  Okay. The lichen sclerosis not so clear about in the oral cavity. 

Dr. Weitz: Maybe it was planus. Yeah, I’m not sure.

Dr. Sklar: I’m very familiar with lichen sclerosis on the vulva having been an OBGYN, but yeah, I’ve certainly lichen planus in the mouth. That does not, I don’t see that very often. Okay.

Dr. Weitz: So are there labs that you run when you get these patients?

Dr. Sklar: Yes, there are labs I run. They don’t make a diagnosis of Burning Mouth Syndrome, but they help me rule things in and out. I do viral panels for varicella and herpes. It seems like a lot of these people have reactivated Epstein Barr virus, and I’m not [00:22:00] sure what role that plays in chronic pain.

Dr. Weitz: Right.

Dr. Sklar: There are a number of papers in the literature about micronutrient deficiencies and Burning Mouth syndrome.

Dr. Weitz: What’s your favorite, what’s your favorite viral panel that you like to run for clinicians out there?

Dr. Sklar: Usually I start with what people’s insurance will cover, so I will do Varicella, IgG, and IgM.

Dr. Weitz: Okay.

Dr. Sklar: Herpes type 1 and 2 IgG, Quest is no longer doing the IgM. I checked for Epstein Barr early antigen, as well as Epstein Barr VCA and eBNA.  Those are probably the main ones.

Dr. Weitz: Okay.

Dr. Sklar: Yeah. And I know there are some, good labs that do viral like Cyrix and or immunosciences, but

Dr. Weitz: Yeah. And Vibrain also has a viral panel.

Dr. Sklar: Right? Yeah. I haven’t used those. I mainly use Quest and LabCorp.

Dr. Weitz: Okay. [00:23:00]

Dr. Sklar: And then I check for micronutrient deficiencies.

Okay. So magnesium.

Dr. Weitz: How do you check for that? Do you run one of the micronutrient panels?

Dr. Sklar: No, again, I just use Quest and LabCorp, yeah, our Red Blood Cell Magnesium Copper and Zinc. CoQ10 levels

Dr. Weitz: Vitamin D, Omega 3. 

Dr. Sklar: Oh, definitely Vitamin D. I’ve had some people who got better, we did their labs, they were going to get their hormones.  Prescriptions and that sort of thing, but they went ahead and started on vitamin D because their vitamin D’s were incredibly low and their pain significantly improved. So definitely vitamin D is really important. I actually Probably an

Dr. Weitz: iron panel as well, right?

Dr. Sklar: We do iron, yep, ferritin. And then the other thing that can be helpful if this is central pain syndrome is low dose naltrexone.  So not so much in the talking more about treatment than lab testing.

Dr. Weitz: Tell us about low dose naltrexone for patients [00:24:00] and practitioners who are listening who are not familiar with it.

Dr. Sklar: So, low dose naltrexone, I was first introduced to for treatment of autoimmunity because it’s anti inflammatory.

Dr. Weitz: Right.

Dr. Sklar: And and it’s, and people, patients get freaked out. You have to explain to them what naltrexone is. And it doesn’t mean that they aren’t. Opioid addict but it is low dose of naltrexone and naltrexone for opiate addiction and reversal is treated at like 50 milligrams a pill. Low dose naltrexone is anywhere from 1.5 up to, I use a maximum of 9 milligrams. Some people use ultra low dose naltrexone, but I have less experience with that. And it’s been found to help central pain syndromes. Pain can live in your mouth, and if it’s a nerve in your mouth, if you inject local anesthesia into that nerve, It should relieve your pain [00:25:00] and numb your tongue.

The many of the, most of the people I see with burning mouth syndrome, if you do that, they would still have their pain because their pain now lives in the brain, not only in their tongue. And so for those central pain syndromes, low dose naltrexone helps the release of our natural. opioids that our body can produce.

So our natural endorphins and opioids and help with reducing pain. So I usually start people on a hormone restoration program. We see how it goes for a month or so. If things start getting better, great. If not, we add low dose naltrexone, and also at the same time I’m correcting iron deficiency or magnesium co Q10, all the micronutrients and vitamin D at the same time.

Dr. Weitz: So tell us about your hormone restoration program. Do you, how do you test the hormones? How do you prescribe and [00:26:00] how much in general are typical treatment protocols for you?

Dr. Sklar: Again, I use the regular commercial labs and test estradiol, progesterone, testosterone free and total thyroid 3T3, 3T4, and thyroid stimulating hormone and DHEA and pregnenolone.  And I try to have treatment levels, after treatment. in the range of a young adult. So I try to have estrogen levels between 60 and 80, maybe not as high as the young menstruating women, but I don’t want it in the hundreds for postmenopausal women. Progesterone between 10 and 20, which is the luteal phase optimal level at ovulation, or rather 14, like five to seven days after ovulation.  DHEA, I try to put pretty high a lot of us in functional medicine use pretty high [00:27:00] amounts of DHEA and don’t feel like there’s really an upper limit. In terms

Dr. Weitz: Give us an idea of what Of dosing. Level of dosing of supplements and then what level on the blood do you like to see?

Dr. Sklar: Right.  So for estrogen, I usually have people use an estradiol patch. Okay. And they use anywhere from 0. 025 to usually 0. 5 is, 0. 05 is enough in a bi weekly patch progesterone people are on 100 to 200 milligrams of micronized oral estrogen, which I like to use because one of the things that oral estrogen does is get metabolized to something called allopregnanolone.  And allopregnolone is a really potent, calming, anti inflammatory, neurosteroid, neuroactive steroid.

Dr. Weitz: Oral progesterone, right?

Dr. Sklar: Oral, so topical progesterone does not go through that conversion. Into allopregnolone. So I intentionally will use oral progesterone. [00:28:00] And there’s debates about all of this in the, I think

Dr. Weitz: it’s pretty typical for a lot in the functional medicine community to use a topical estrogen and an oral progesterone.

Dr. Sklar: Okay. Yeah. I was just listening to a talk by an expert who said don’t use oral progesterone. It goes through bad metabolism in the liver. And I was like, I don’t agree with that. We use DHEA and usually for women, it’s anywhere from 25 to 50 milligrams a day. For men 50 maybe to 100 Pregnenolone, and I see some people with like incredible low DHEA and Pregnenolone levels anywhere from 50 to 100 milligrams of Pregnenolone in a day.

Okay. Thyroid, I like to have people’s T3 in the upper quartile of normal, so if your reference range is 2. 3 to 4. 2, have it [00:29:00] somewhere 3. 5 to 4. 2. And testosterone for women to see, again, at the upper end of the normal range. For women, it’s somewhere around 35 to 45. For total testosterone.  And so the dose of testosterone I’ll use is somewhere anywhere from, oh, one to up to five milligrams a day, mostly around 2. 5 milligrams a day in a topical cream.

Dr. Weitz: Are there some women that you will not recommend hormones for?

Dr. Sklar: Yes. I had one patient who has I’m trying to remember, it wasn’t factor V Leiden, but she had a blood clotting diathesis and her hematologist said no hormones whatsoever.  And we did everything else, put her on low dose naltrexone, corrected all the micronutrients. He did let her be on vitamin D and her pain improved significantly. Women who have had breast [00:30:00] cancer, I have them check with their oncologist. Some oncologists are okay with women using not estrogen necessarily, but DHEA and pregnenolone, they’re not so worried about the downstream effects.  So I would say those are the two main classes of people in whom I would not use hormones and of course men who have had prostate cancer.

Dr. Weitz: I guess there’s certain medications that can trigger burning mouth as well.

Dr. Sklar: There are. There are certain anti hypertense drugs. Antihypertensive, like the angiotensin receptor blockers. I’m always trying to have people do a trial off of those. I haven’t really found that to be a big contributor, I must say.  That, that hasn’t panned out to provide people with a whole lot of relief. Quite honestly. Okay,

Dr. Weitz: so even though maybe they triggered it, they take him off, it doesn’t make it go away.

Dr. Sklar: It doesn’t seem like it, no.

Dr. Weitz: Okay, so [00:31:00] what percentage of the patients that you’re treating for Bernie Mouth get a fair amount of relief?

Dr. Sklar: Yeah, so somewhere around probably 60 to 65% which may not sound real high, but you’ve got to realize these are people that have been everywhere to all the major pain clinics and then I realized there were people that would not be able to come and actually become a patient, and so I developed a supplement called BMS Advanced Support Burning Mouth Syndrome.  We abbreviate BMS and I put DHEA and pregnenolone in it. Oh, B12, I forgot to mention, but certainly B12 is really important for nerve function. So it has methylfolate in it. And And Lipoic Acid because there’s some literature that shows that Lipoic Acid helps neuropathic pain. And I put it together in a supplement and it turns out it’s not effective for everybody, but about 25 or 30 percent of people get [00:32:00] really dramatic relief of their burning mouth and have just ordered it for years.  If you’re one of those people, it ends up really good for you. So that is available for people who are not going to actually become patients of mine.

Dr. Weitz: What’s your guess how many people out there are suffering with this condition?

Dr. Sklar: So there are really wide estimates, but probably millions.  I hear from people all over the world. I have a course for patients, takes people through, takes the public through the different kinds of things that might be, it might be a virus, it might be this, it might be that, what the conventional system, how it evaluates you, how to find a practitioner that might know something about hormone restoration.  And we had people from Australia and a whole variety of places. I hear from people in Europe fairly often about wanting to order a supplement. I do hear from people all over the place.

Dr. Weitz: Does diet play a [00:33:00] role?

Dr. Sklar: For some people it does. I encourage people to do a gluten free diet and a sugar elimination.  And that has made a dramatic difference for some people.

Dr. Weitz: So sugar elimination, you mean like gradually eliminating sugar or just stop?

Dr. Sklar: If you can just stop it, sugar is really inflammatory. Absolutely. Yeah, so I try to get people just to stop cold turkey. Yeah, I

Dr. Weitz: have a lot of patients. Gluten, Dairy, Sugar, just take it out right away.

Dr. Sklar: So one of the problems with these patients is their nutrition, because a lot of times they end up all they can eat is like rice and oatmeal. And so they become very nutritionally deprived. And so I try not to, I’m not sure how much dairy plays a role. So if they can eat yogurt because it’s smooth and it’s cool.  I try not to eliminate that, but gluten certainly seems to be a big one. And then people will [00:34:00] naturally, like I said, not eat oranges and grapefruit and spicy foods because it’s just too painful.

Dr. Weitz: That’s great. Those are the questions that I had prepared. Anything else you want to tell us about this condition and to help give some hope to people out there who are dealing with it?

Dr. Sklar: Yeah, absolutely. And I really appreciate this opportunity, Ben.  So often people are made to feel like it’s in their head and it’s not in your head. If you feel pain, You need to pursue it until you find somebody who can help you and take you seriously, because that’s the most heartbreaking part of it.  I’ve had patients who were admitted to mental institutions because their doctors thought they were that crazy. And yeah, it’s, it can get really extreme. You really need to pursue care until you find somebody who [00:35:00] believes you, and at least can start. looking into treatment and help for you.

Dr. Weitz: How can those listening or viewing get a hold of you and find out how you can help them?

Dr. Sklar: Yeah. I have a new website called www. susansklarmd. com. Okay. I recently sold my functional medicine practice. So there is still a Sklar Center website. But that’s no longer the Burning Mouth website.

Dr. Weitz:  Interesting.

Dr. Sklar:  Yes. So my new website is called Dr. Susan Sklar’s Hope for Burning Mouth. Okay. And so www. SusanSklarMD. com will take you to the website. I also have a Hope for Burning Mouth YouTube channel that has a ton of videos and a lot of information.

Dr. Weitz: And you mentioned you have a training program as well.[00:36:00]

Dr. Sklar: I have on my website, people can sign up for an educational program. It’s got 12 modules. It’s very detailed and has references and can help direct people to try to figure out how they can get help. And I’m working on a course.

Dr. Weitz: patients or practitioners?

Dr. Sklar: I’m sorry, what did you say?

Dr. Weitz: Oh is that for patients or practitioners?

Dr. Sklar: So that’s for patients. Okay. And I have a partially done course for practitioners. Oh. Yeah, so all the detailed research and papers I just filed away because someday there’s going to be a practitioner’s course.

Dr. Weitz: Okay. That’s great. Thank you so much, Susan.

Dr. Sklar: You’re so welcome. Thank you for having me.

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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111.  And we can set you up for a consultation for functional medicine. And I will talk to everybody next week.