Sjogren’s syndrome is an autoimmune disease that affects salivary glands in the mouth and tear glands in the eyes. The immune system malfunctions and attacks these glands leading to dry eyes and mouth. Sjogren’s syndrome is one of the most prevalent autoimmune disorders, striking as many as 0.5% of Australians (mainly women).
There are many over the counter products available to help ameliorate dry mouth and eyes including artificial tears. Essential fatty acids, curcumin, antioxidants and following an anti-inflammatory diet will provide the best results against symptoms, inflammation and disease progression.
Autoimmunity and Sjogren’s syndrome
Exactly why the immune system attacks itself is poorly understood. It is believed to occur due to a combination of genes, environment, hormonal and immune factors. In Sjogren’s syndrome predisposing genetic factors include HLA B8 and HLA DR3/W52, with environmental triggers involving Epstein-Barr virus, coxsackie virus B and chronic hepatitis C virus.
Around 50% of people with Sjogren’s syndrome have another condition such as scleroderma, lupus or rheumatoid arthritis. This is known as secondary Sjogren’s syndrome. In the absence of an associated autoimmune disease, the disease is known as primary Sjogren’s syndrome. In a small number of people, Sjogren’s syndrome may be associated with lymphoma (cancer of the lymph glands).
Symptoms of Sjogren’s syndrome
The more common symptoms of Sjogren’s syndrome include:
- dry eyes (including irritation, gritty feeling or painful burning)
- dry mouth
- difficulty with chewing or swallowing, especially dry foods
- swelling and tenderness of the glands around the face, neck, armpits and groin
- fatigue
- joint pain and general achiness
Other areas affected
Sjogren’s syndrome is a systemic condition, which means it can affect the entire body. The mucus membranes of the nose and vagina and internal organs (including kidneys, blood vessels, intestines, lungs, heart and liver) may become inflamed. The structures of the circulatory and nervous systems can also be affected. Common complications include dental decay, skin rashes and an increased susceptibility to oral thrush.
Many patients experience debilitating fatigue and joint pain. Symptoms can plateau, intensify, or go into remission. Some people experience minor symptoms, while others suffer debilitating symptoms that greatly impair their quality of life.
Over the counter products
There are many products available over the counter in pharmacy that can help to alleviate the symptoms of dry eyes and mouth. Preservative free eye drops and ointments can be applied throughout the day. There are also a wide range of products to assist in mouth lubrication including chewing gum, toothpaste, gels, sprays and mouthwash.
Lotions for dry skin, saline nasal sprays and natural vaginal lubricants may be beneficial if there is discomfort in these areas.
Naturopathic perspective
Vitamin D
There is increasing evidence indicating that vitamin D is important in the initiation and propagation of a range of autoimmune diseases, include Sjogren’s syndrome. A 2015 study found that people with Sjogren’s syndrome are more likely to have a vitamin D deficiency. Another study found that low levels of vitamin-D correlated with the presence of peripheral neuropathy and lymphoma among Sjogren’s syndrome patients.
Omega-3
Essential fatty acids found in fish oil and flaxseed oil can be beneficial in reducing inflammation – which is very beneficial to people with Sjogren’s syndrome. They also help to alleviate the symptoms of dry eyes and mouth. A number of population studies have suggested that hyperlipidemia (high levels of fat particles in the blood) and a diet low in omega-3 fatty acids are risks factor for dry eye disease.
Curcumin
For centuries it has been known that turmeric exerts powerful anti-inflammatory and antioxidant properties. The active component, curcumin, has been found to be helpful in reducing cellular infiltration in the salivary glands which causes damage in Sjogren’s syndrome.
Anti-inflammatory diet
Diets high in grains, meat, poultry, dairy, sugar, trans fats and processed foods can exacerbate inflammation. On the other hand, alkaline foods including vegetables, fruits and selected nuts and seeds can reduce inflammation due to their high antioxidant content. Aim to have 6 serves of vegetables a day, 2-3 serves of fruit, 3-5 serves of protein (eggs, lentils, legumes, seafood, fish and meat) and 2 serves of raw nuts and seeds. One small serve of wholemeal grains and dairy are optional if there are no intolerances. Good foods to include in the diet include brassica vegetables (broccoli, cabbage, brussels sprouts), garlic, turmeric, ginger, soluble fibre (slippery elm and psyllium husks), fermented foods and oily fish (sardines, herring, salmon and tuna).
Nutritional antioxidants
Scavenging nutrients slow the reactions of oxidation by transforming molecules into less-aggressive compounds.
These nutrients are water-soluble vitamins, such as vitamin C and the B vitamins, or fat-soluble vitamins located in cellular membranes, such as vitamins A, E, and D, and specific carotenoids, including lutein and zeaxanthin.
The base layer of the tear film, including goblet cells and mucin production, is vitamin A-dependent and deficiency may promote dry eyes.
Digestive support
Drink frequent sips of water to keep mouth moist. Eat soft, moist foods if you have trouble swallowing. Eat smaller, more frequent meals to stimulate saliva flow and avoid salty, acidic or spicy foods and carbonated drinks that may be painful if your mouth is dry. Avoid sugar to prevent dental decay. Supplementing with bitter herbs such as gentian can help increase saliva and promote digestion of food. Vegetarian digestive enzymes and probiotics may also assist in promoting healthy immune and digestive function.
Tips for daily living
- restrict intake of sugar to help prevent dental decay
- maintain good dental hygiene and visit your dentist regularly
- use a humidifier or vaporiser to maintain a comfortable level of air moisture indoors
- avoid drafts from air conditioners, fans and radiators
- wear protective eye-wear to avoid exposure to the wind or sun
- exercise regularly and reduce stress to help your overall health and wellbeing
- avoid alcohol and cigarette smoke
References
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sjogrens-syndrome
http://www.sjogrens.org.au/
Kurien BT, Harris VM, Quadri SM, Coutinho-de Souza P, Cavett J, Moyer A, Ittiq B, Metcalf A, Ramji HF, Truong D, Kumar R, Koelsch KA, Centola M, Payne A, Danda D, Scofield RH. Significantly reduced lymphadenopathy, salivary gland infiltrates and proteinuria in MRL-lpr/lpr mice treated with ultrasoluble curcumin/turmeric: increased survival with curcumin treatment. Lupus Sci Med. 2015 Sep 8;2(1):e000114 https://www.ncbi.nlm.nih.gov/pubmed/26380101
Erten Ş, Şahin A, Altunoğlu A, Gemcioğlu E, Koca C. Comparison of plasma vitamin D levels in patients with Sjögren's syndrome and healthy subjects. Int J Rheum Dis. 2015 Jan;18(1):70-5 https://www.ncbi.nlm.nih.gov/pubmed/24467766
Agmon-Levin N, Kivity S, Tzioufas AG, López Hoyos M, Rozman B, Efes I, Shapira Y, Shamis A, Amital H, Youinou P, Shoenfeld Y. Low levels of vitamin-D are associated with neuropathy and lymphoma among patients with Sjögren's syndrome. J Autoimmun. 2012 Sep;39(3):234-9 https://www.ncbi.nlm.nih.gov/pubmed/22835660
Jalbert I. Diet, nutraceuticals and the tear film. Exp Eye Res. 2013 Dec;117:138-46 https://www.ncbi.nlm.nih.gov/pubmed/24012987
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