Sjogrens Syndrome treatment, vitamins, herbs and supplements, natural and alternative treatment by Ray Sahelian, M.D.

Sjogren's syndrome is an autoimmune disease that attacks the body's moisture-producing glands, leading to progressively worsening dry mouth, eyes, vagina and skin, as well as fatigue. The syndrome is associated with rheumatic disorders and can also affect the kidneys, blood vessels, lungs, liver, pancreas and brain. It is estimated that as many as 4 million in the United States have this syndrome, with most cases occurring in adults 40 years of age or older and in women (90 percent).

Natural, alternative, herbal treatment
I am not aware of human studies that have evaluated the role of herbs and supplements in the treatment of Sjogren's disease. I will update this site as more information is available. It appears that EGCG found in green tea should be studied further.

Green tea for Sjogren's syndrome, EGCG may be helpful
Green tea polyphenols reduce autoimmune symptoms in a murine model for human Sjogren's syndrome and protect human salivary acinar cells from TNF-alpha-induced cytotoxicity.
Autoimmunity. 2007. Department of Oral Biology and Maxillofacial Pathology, School of Dentistry, Medical College of Georgia, Augusta, GA, USA.
Sjogren's syndrome is a relatively common autoimmune disorder. A key feature is lymphocytic infiltration of the salivary and lacrimal glands, associated with the destruction of secretory functions of these glands. Current treatment of Sjogren's syndrome targets the symptoms but is unable to reduce or prevent the damage to the glands. We reported previously that the major green tea polyphenol epigallocatechin-3-gallate (EGCG) inhibits autoantigen expression in normal human keratinocytes and immortalized normal human salivary acinar cells. However, In this study we demonstrate that in the NOD mouse, a model for human Sjogren's syndrome, oral administration of green tea extract reduced the serum total autoantibody levels and the autoimmune-induced lymphocytic infiltration of the submandibular glands. Further, we show that EGCG protected normal human salivary acinar cells from TNF-alpha-induced cytotoxicity. In conclusion, green tea may provide a degree of protection against autoimmune-induced tissue damage in Sjogren's syndrome, mediated in part through activation of MAPK elements.

Green tea contains several antioxidants that have been shown to curb inflammation, prevent cell death, and possibly even ward off cancer. Dr. Stephen D. Hsu of the Medical College of Georgia in Augusta tested the effects of EGCG in laboratory mice with type 1 diabetes and Sjogren's syndrome. They fed the mice plain water or water with 0.2 percent EGCG. EGCG reduced the severity and delayed the onset of salivary gland damage associated with Sjogren's syndrome. EGCG also dramatically slowed the development of type 1 diabetes in the rodents. Both type 1 diabetes and Sjogren's syndrome are autoimmune diseases. The salivary gland cells that were under autoimmune attack were actually multiplying, but EGCG slowed this proliferation. Life Sciences, 2008.

Email - I have Sjogren's Syndrome. At the time I was diagnosed I was drinking 130 ounces + of water per day for 2 years, with still no relief from dry mouth. When I received my diagnosis I immediately came across the U of GA research study with green tea. I started drinking it that day. Within 24 hours I felt my left sublingual gland begining to excrete what looked like saliva but tasted like mucous, it felt strange- like oozing out-- for about 2 days. After that I had what feels to me normal salivary production. I have since only needed about 60 ounces of fluid per day (mostly is comprised of green tea and a cup of coffee). The biggest benefit is that I no longer feel dry mouth, even with such a reduction in fluid intake. I hope that is will also help the rest of my organs/glands from attack, but I find no research about this.

Email - I got Sjogrens in the summer of 2009. I had super dry eyes, thirst, and dry mouth with occasional painful cracking of tongue. I researched as much as I could about supplements because conventional treatment is only geared to symptomatic relief and not the root cause of the problem. Below is the list of supplements that I take. It took about a month or six weeks to see results, and I doubled the dose (taking the supplement regime listed below in the morning and at night) until symptoms subsided. I did, at one point (winter 2009), stop taking the supplements and my symptoms returned. I had to start all over again and I am pretty symptom free almost all the time. I also learned never to take anything that ‘boosts’ the immune system (activamune)—these made my symptoms worse. My ‘research’ focused on anti-inflammatory action and modulation or regulation of the immune system. I used google scholar for most of the information. I have tried to share this information with friends who have autoimmune disease, such as MS and arthritis, but none of them will give it a go. My regime per day: Tumeric 1,600 mg, 5-loxin 150 mg, ginger root 1,100 mg, apigenin 50 mg, green tea extract 160 mg, fish oil 2,400 mg, flaxseed oil 1,200 mg, resveratrol 150 mg, vitamin D, E, B. I may add rosemary extract to this list in the near future.

Fish oils
Effect of omega-3 and vitamin E supplementation on dry mouth in patients with Sjögren's syndrome.
Spec Care Dentist. 2010. Division of Oral Medicine and Dental Research, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.
To determine whether omega-3 (n-3) increases saliva production in patients with Sjögren's syndrome, 61 patients received either wheat germ oil or n-3 supplement (TheraTears Nutrition ®) in a prospective, randomized, double-masked trial. The outcomes assessed were salivary secretion and markers for oral inflammation. The differences between the n-3 group and wheat germ oil group were not statistically significant. In this pilot study, supplementation with n-3 was not found to be significantly better than wheat germ oil in stimulating saliva production in patients with Sjögren's syndrome.

DHEA
Low serum levels of sex steroids are associated with disease characteristics in primary Sjogren's syndrome; supplementation with dehydroepiandrosterone restores the concentrations.
J Clin Endocrinol Metab. 2009. Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
Serum levels of the sex steroid prohormones dehydroepiandrosterone and DHEA sulfate (DHEA-S) decline upon aging and are reduced in primary Sjogren's syndrome.  Twenty-three postmenopausal women with primary Sjogren's syndrome and subnormal levels of DHEA-S were included in a randomized, 9-month, controlled, double blind crossover study.  Baseline erythrocyte sedimentation rate was inversely correlated with testosterone (Testo), dihydrotestosterone, and DHEA-S. Dry mouth symptoms correlated with low Testo and androstenedione, whereas dry eyes correlated with low estrogens, most strongly estrone). Presence of anti-SS-A and/or anti-SS-B was independently associated with low estradiol. All metabolites increased during DHEA but not during placebo. The relative increases were less for estrogens and Testo compared to dihydrotestosterone and glucuronidated androgen metabolites. Dry mouth symptoms decreased during DHEA therapy. Disease manifestations in primary Sjogren's syndrome were associated with low sex hormone levels, dry mouth symptoms with low androgens, and dry eyes with low estrogens. Exogenous DHEA was preferentially transformed into androgens rather than into estrogens.

Symptoms
Dryness of the mouth and eyes results from involvement of the salivary and lacrimal glands.

Diagnosis of Sjogren's syndrome
This is a chronic autoimmune disorder of the exocrine glands with associated lymphocytic infiltrates of the affected glands. The accessibility of salivary and lacrimal glands to biopsy enables study of the molecular biology of a tissue-specific autoimmune process. The exocrinopathy can be encountered alone (primary Sjogren's syndrome) or in the presence of another autoimmune disorder such as rheumatoid arthritis, systemic lupus erythematosus, or progressive systemic sclerosis. A new international consensus for diagnosis requires objective signs and symptoms of dryness including a characteristic appearance of a biopsy sample from a minor salivary gland or autoantibody such as anti-SS-A. Exclusions to the diagnosis include infections with HIV, human T-lymphotropic virus type I, or hepatitis C virus.

Cause of  Sjogrens disease
The cause is complex and the factors initiating and driving autoimmunity in this disease are largely unknown. Certain disturbances of the immune system (i.e. B-cell hyperreactivity and enhanced levels of B-cell-activating factor/B-lymphocyte stimulator) play a central role in this entity. Whether this is a primary abnormality or the result of predisposing factors or infectious, e.g. viral, agents remains uncertain..

Sjogrens treatment options
Keratoconjunctivitis sicca (KCS), the main ocular manifestation of SS, is managed with tear substitutes, as well as local and systemic stimulators of tear secretion and supportive surgical procedures. Management of oral manifestations includes intense oral hygiene, prevention and treatment of oral infections, use of saliva substitutes, and local and systematic stimulation of salivary secretion. Cholinergic agents, such as pilocarpine and cevimeline are the cornerstone of current therapy in SS. Corticosteroids, cyclophoshamide, and nucleoside analogues are reserved for severe extraglandular manifestations of SS.

Treatment includes topical agents to improve moisture and decrease inflammation. Systemic therapy includes steroidal and non-steroidal anti-inflammatory agents, disease-modifying agents, and cytotoxic agents to address the extraglandular manifestations involving skin, lung, heart, kidneys, and nervous system (peripheral and central) and haematological and lymphoproliferative disorders. The most difficult challenge in diagnosis and therapy is patients with symptoms of fibromyalgia (arthralgia, myalgia, fatigue) and oral and ocular dryness in the presence of circulating antinuclear antibodies.

Complications

Heart disease
Valvular regurgitation, pericardial effusion, pulmonary hypertension and increased left ventricular mass index occur with a higher frequency in patients with primary Sjögren's syndrome and no clinically apparent heart disease.

Lymphoma

Compared to the general population, patients with Sjogren's syndrome have an increased risk of developing non-Hodgkin's lymphoma.

Natural treatment emails
I have Sjogren's Syndrome (mucous membranes do not produce enough moisture) Also severe hot flashes/night sweats, constipation. Fresh Rehmannia has been suggested. Does rehmannia help?
    I have not come across research regarding the use of rehmannia herb for this disease.

I've just now found this website, and note that Dr. Shahelian is generally no fan of megadoses. Not asking WHAT dosages to take of methylcobalamin or alpha lipoic acid, just what he would consider TOO MUCH per day or per week. I'm 73, female, and diagnosed in the last three months with Sjogren's Syndrome plus small fiber sensory neuropathy (no fun).
    Each person is different but I find 50 mg of R alpha lipoic acid about twice a week is reasonable and 1 mg of methylcobalamin once or twice a week is also a good option although there can be wide variations in terms of peoples' needs and requirements depending on their body chemistry, diet, other supplements used, medications, health condition, etc.

I would like to know if Lutein with Zeaxanthin would help with this condition. Also if you knew of anything else that might benefit.
    I have not seen such studies and don't know if lutein and zeaxanthin would offer any help.