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Watch your tongue! You may learn something. - (9/22/2020)

By Dr. Ron Gasbarro

Andy came into the pharmacy, walked up to the pharmacist, and stuck out his tongue. “Hey, doc,” he garbled. “Does my tongue look funny?” The pharmacist thought that everyone’s tongue looked peculiar. Different shapes, sizes, and a fantastic array of colors. Andy’s tongue had a white coating on it. So what?

The tongue is consists of a muscle group that is hugely diverse in function, from very satisfying to extremely caustic. The tongue allows us to taste food. What would a chocolate ice cream cone be without the pleasure of licking it? It enables us to get food ready to pass down our throat into our stomach. The tongue allows us to speak and communicate our thoughts to others. The tongue also gets us into trouble. It is a portal for the wonders of food, if taken to an extreme, would make us enemies with our bathroom scale. Sticking one’s tongue out at someone is a childish, rude gesture. Except in Tibet, where its citizens consider it a courteous form of greeting.  

But color? What does the shade of one’s tongue have to do with the rest of one’s body? Andy’s tongue has a pale white film on it. What does this say? A white tongue is the product of an overgrowth and swelling of the finger-like projections (papillae) on the tongue's surface. Debris, bacteria, and dead cells crowd around the inflamed and swollen papillae to create this coating. While this film is common, it indicates some bad habits, such as smoking, a soft "mashed potato" diet, dehydration, and poor oral hygiene. The result can also be atomic halitosis and rotted teeth. Mouthwash will not break through this coating. Instead, brush or scrape the tongue during tooth brushing to clean the surface and stimulate the papillae back to health. White patches that cannot be scraped off are more concerning. They can be caused by the prolonged use of antibiotics, which may bring on an oral yeast infection. An antifungal drug, such as nystatin, is the usual treatment. Such patches are also generated by tobacco use and could be the first sign of oral cancer. Ask your doctor or dentist for advice if they occur. 

If your tongue flips from pink to bright red – and you have not been sucking on a cherry Popsicle® - then you may have vitamin B12 deficiency. B12 is necessary for red blood cells to shuttle nourishing oxygen around your body. Its deficit often culminates in neurological problems, such as dementia. Boost your B12 intake by eating red meats (in moderation), salmon, tuna, and dairy products. 

Traditional Chinese medicine relies on the tongue for the diagnosis of type 2 diabetes. In essence, diabetics have a high prevalence of having a tongue with thick fur, usually yellow, and possibly a bluish tint. These signs can serve as a preliminary non-invasive screening procedure in the early detection of diabetes. If the signs point to the disease, specific blood work will follow.

A purple tongue can signal poor circulation and high blood cholesterol, manifesting as depression and a loss of energy. Increased exercise and subscribing to a diet that focuses on fruits and vegetables can resolve this problem. If the tongue is beige and pale, then iron deficiency could be the culprit. Other symptoms that go along with a pallid tongue include tiredness, dizziness, and abnormal heart rhythms.

The pharmacist suggested that Andy change his toothbrush every month and explained how to scrape the crud off his tongue. The pharmacist also advised Andy to get simple blood work done to assess for any abnormalities. Andy was glad for his pointers, and *fwap!* snapped his tongue back into his mouth.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.

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