Q. Can you help me? I’ve had a burning sensation on my tongue and the soles of my feet for weeks. I’ve tried Benadryl, OTC hydrocortisone cream and ice packs. Nothing is helping.

My internist has said everything looks all right (though I think the bottoms of my feet look red). I am diabetic and he did a blood test (HbA1c) that showed my blood sugar is under control.

I am presently taking metformin, Crestor, Lexapro, zolpidem and generic Zantac. I’d appreciate any thoughts.

A. Our first thought is to have your doctor check your vitamin B12 status. Burning mouth and burning feet are difficult to diagnose, but both can result from vitamin B12 deficiency. Your diabetes medicine metformin (Glucophage) is associated with an increased risk of vitamin B12 deficiency (Archives of Internal Medicine, Oct. 9, 2006). Acid suppressing drugs like ranitidine (Zantac) may aggravate the problem by making it harder to absorb this nutrient from food.

When vitamin B12 levels fall too low for too long, people may experience irreversible neurological damage. Symptoms to watch out for include fatigue, confusion, loss of appetite, depression, burning tongue, poor memory, weakness or peripheral neuropathy (burning, tingling or numbness in feet or hands).

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  1. gooze

    Trying using the Dr sholls heel cups, only the cups. my feet were awful & my doc told me to wear those and its amazing in the difference. doesn’t seem like something so simple can work, but it does. good luck.

  2. PGW

    Well I was having problems with my feet and they are burning and hurting. I went to my foot Dr an he put me on vitamins an I couldn’t take them but I asked him why my finger nails were so brittle an broke off an he says I need vitamin B Well I started taking it an the burning went away in my feet. My finger nails are better but I have the problem from Neuropathy but it from back damage I’m not diabetic… I hope this helps someone it sure did me. Thanks

  3. w.m.s.

    Burning on the soles of the feet may be onset of neuropathy as well. Get an appointment with a neurologist and have them checked. After over a year of this problem I got checked and found out I had peripheral neuropathy with no diabetes. I currently take Lyrica but even that is not doing the job…it keeps me going but that is all.

  4. ics

    I have burning sensations in my feet to the point of tears. Doctor prescribed Lyrica and it makes me very dizzy she also suggested Centrum Silver but I don’t feel I am receiving the highest amounts of nutrition and wondering if anyone has a diet plan so I could benefit the nutrients needed to subside the burning and enjoy my life.

  5. M.S.S.

    Please tell this person to be screened for Sjogren’s Syndrome. My first symptom was a burning tongue and it took almost a year to be diagnosed by a rheumatologist. My tongue burned because of a fungal infection that was atypical. My foot pain was due to peripheral neuropathy, also a symptom of the Sjogren’s.
    Even with confusion , fatigue and joint pain my B levels and the rest of my blood work was normal. All of these symptoms were before dry eyes. I was sent to 2 ENT’s, the dental school in my city, an internist, and a psychiatrist.

  6. tfm

    On the off chance the two conditions are not related, burning tongue can be a symptom of menopause.

  7. michael

    You may want to investigate the side effects of all those medications that you’re on. The metformin, crestor, lexapro, zolpidem and generic zantac you take could be the root cause. I’d recommend you discuss this with your pharmacist. It seems they have the best knowledge when it comes to biochemistry.

  8. Anna

    “I am diabetic and he did a blood test (HbA1c) that showed my blood sugar is under control.”
    That burning sensation could still be diabetic neuropathy, despite what the doctor said.
    It’s very important to know what % that HbA1C result was (hopefully under 6%) and also what the post prandial (after meal) blood glucose results are (under 140 mg/dl at 2 hours hopefully).
    Most primary care doctors (often internists) and unfortunately many endocrinologists, consider blood glucose to be “under control” or “well controlled” at levels that still allow for significant diabetic complications! The ADA guidelines of achieving A1Cs no higher than 7% or post meal BG up to 160 or 180 mg/dl is too lax. Those numbers are still much higher than “normal” and are not “in control”. 7% HbA1c isn’t a goal to achieve, it is well above the “normal” A1c range and complications will surely be developing and progressing, though perhaps a bit slower than with a higher A1c. Unfortunately, many patients with diabetes are not really given the information they need to get their A1c levels lower, into the safer 5% range.
    The single best way to “control” blood sugar is to restrict the foods that raise blood sugar, that is, sugar and starch foods, carbohydrates. There are no “essential” carbohydrates in the human diet (the body can make glucose from protein and fat and will do so if the diet doesn’t contribute glucose). Any nutrients that carb-rich foods contribute can also be found in numerous non-starchy foods that don’t elevate blood sugar levels. Medications can add a bit more control of a low sugar/low starch diet if diabetes has progressed to the point where diet is not enough. But control of blood glucose with diet is far more effective than with medications, despite the advice of the ADA and the pharmaceutical industry.
    I have quite a bit of experience with this, both as a woman diagnosed with gestational diabetes (high blood sugar during pregnancy) and several years later when I realized my blood sugar was still going too high after meals. I am now 46 yo.
    During the pregnancy, I was prescribed a low-carbohydrate diet by my doctors, and with the help of a dietician, kept my blood glucose very tightly controlled by restricting carbs. To anyone who says that a low-carb diet is inherently unhealthy, I refute that, as it was a very healthy way to gestate a healthy baby, provided real food is consumed, not processed manufactured low-carb pseudo-foods. Every bite I took was densely nutritious whole foods of protein, fat, and non-starchy vegetables, with a very small amount of fruit. I delivered a very healthy baby without complications and I had very little excess pregnancy weight to lose after the birth (about 14 pounds that quickly was gone with breastfeeding). I was told I could go back to my “regular” diet after the birth.
    So I did. I’ve always enjoyed baking bread and pizza, as well as making homemade pasta. And I began to gain weight, about 5 pounds a year. After I gained about 20 pounds, I made the connection to the increased carbs in my diet and the weight gain. I cut those out of my diet, added more protein, fat, and non-starchy veggies, and went back to homecooked, unprocessed whole foods of protein, fat, and non-starchy veggies. I have maintained a normal weight for 4 years and my health is very good.
    About 1.5 years ago I became curious why sugars and starches would be so problematic for me, so I began to experiment with a glucose meter and high carb foods (I had experience using a glucometer during the gestational diabetes). Sure enough, moderate and high carb foods raised my post meal blood glucose into a diabetic range, often between 200-275! If I avoid those foods, my BG rarely goes over 120, and often stays around 100 after meals. A 3 hr GTT and insulin test confirmed my suspicions, I am hyperglycemic and hyperinsulinemic.
    So, I stick to my diet of no grains, mostly unprocessed, mostly home-prepared foods low in sugar and starch, but high in nutrients, and I achieve normal blood glucose ranges 80-120 mg/dl without medications. My diet consists of lots of salads and veggies, with enough protein and fat at every meal. I do not use much artificial sweeteners, as I have found that my taste buds require a lot less to activate them. Treats are some very dark chocolate (70% or greater) and homemade, low sugar ice cream, cheesecake, etc. And believe me, I eat well and enjoy my food.
    Additionally, I maintain a BMI of about 21-22, so my weight remains in a reasonable range. It is very clear to me that much of the current advice about diabetes, glucose control, lab values and diets for diabetics, not to mention medications, is not based on what is truly in the best interest of the patient. I have no doubt that if I hadn’t figured this out myself, in less than ten years I would have been many pounds overweight, and by the time my doctors noticed I was diabetic, I would already have suffered from some complications. Follow the typical advice about diabetes and blood sugar control at your peril.
    I think the man with the burning sensation on the soles of his feet should check his lab tests again and be certain that his diabetes is well-controlled. There is a high likelihood that it isn’t.

  9. PM

    The tip of my tongue has been red, sore and burning for about 3-4 months. The first doctor I saw prescribed “Nystatin” which did not work. The next two physicians did not know what it was. My dentist told me to take a multiple vitamin, but that has not helped. My medications are and have been for some time: Nexium, hydrochlorithyizide, evista, one baby aspirin a day and norvasc.
    Please help

  10. MC

    About 6 months ago and for the first time in my life I developed burning mouth syndrome which included some kind of canker sores. I blamed it on my thyroid. Following advice from a friend I started taking Alpha Lipoic Acid and the burning went away after three days of taking it.

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