Natural treatments for Sjögren's syndrome

DEFINITION: Treatment of the condition in which the immune system destroys moisture-producing glands.

• PRINCIPAL PROPOSED NATURAL TREATMENTS: Herb-vitamin-mineral combination, N-acetylcysteine
• OTHER PROPOSED NATURAL TREATMENTS: Aloe vera, bovine colostrum, citrus bioflavonoids, dandelion, dehydroepiandrosterone, echinacea, fish oil, flaxseed oil, gamma-linolenic acid, garlic, inositol, magnesium, methionine, olive leaf extract, red clover, vitamin A, vitamin C, vitamin E, zinc

Introduction

Sjögren’s syndrome is an autoimmune condition in which the immune system destroys moisture-producing glands, such as tear glands and salivary glands. When Sjögren’s syndrome occurs by itself, it is called primary Sjögren’s syndrome. When it occurs in the context of other autoimmune conditions, such as rheumatoid arthritis or systemic lupus erythematosus (lupus), it is called secondary Sjögren’s syndrome.

Sjögren’s is most common in women between forty and sixty years of age. Symptoms include dry eyes (sicca), dry mouth (xerostomia), difficulty swallowing, loss of taste and smell, swollen salivary glands, severe dental cavities caused by dry mouth, gastrointestinal issues, oral yeast infections (thrush), and vaginal dryness. Fatigue and joint pain also may occur, ranging in intensity from mild to incapacitating. Sjögren’s can also affect the kidneys, digestive tract, lungs, liver, pancreas, or other internal organs.

As with other autoimmune diseases, the symptoms of Sjögren’s tend to wax and wane. The disease is diagnosed by blood tests and examination of the eyes and mouth. Treatment primarily involves the use of artificial tears, artificial saliva, and vaginal lubricants to relieve dryness. In some cases, anti-inflammatory or immune-suppressant drugs may be used.

Principal Proposed Natural Treatments

N-acetylcysteine. N-acetylcysteine (NAC) is a specially modified form of the dietary amino acid cysteine. When taken orally, NAC helps the body make the important antioxidant enzyme glutathione. NAC is also thought to help loosen secretions, and for this reason, it has been tried as a treatment for Sjögren’s syndrome.

In a double-blind, placebo-controlled crossover trial of twenty-six people with Sjögren’s syndrome, the use of NAC at a dose of 200 milligrams three times per day improved eye-related symptoms. The supplement also showed some promise for mouth-related symptoms, but the effects were less clear-cut. While these are promising results, a much larger trial is necessary to fully document the potential benefits of this treatment approach.

Herb-vitamin-mineral combination. A product containing vitamins and minerals and the herbs paprika, rosemary, peppermint, milfoil, hawthorn, and pumpkin seed has been used in Scandinavia for many years as a treatment for various mouth-related conditions. A double-blind, placebo-controlled study of forty-four people found that four months’ treatment with this combination improved some signs and symptoms of Sjögren’s syndrome, including the rate of salivary flow. A larger study is needed to fully explore the potential benefits of this treatment.

Other Proposed Natural Treatments

Colostrum is the fluid that a woman’s breasts produce during the first day or two after she has given birth. Preliminary evidence suggests that oral hygiene products containing bovine colostrum (colostrum from cows) may provide beneficial effects for the mouth symptoms of Sjögren’s syndrome.

One small study found preliminary evidence that toothpaste containing betaine may be helpful for dry mouth symptoms of Sjögren’s syndrome. Also, gamma-linolenic acid (GLA), an essential fatty acid in the omega-6 family, has been tried as a treatment for the fatigue often associated with Sjögren’s. However, in a six-month, double-blind, placebo-controlled trial of ninety people, the use of GLA failed to prove more effective than placebo. One small double-blind study, however, found that a combination of GLA and the omega-6 fatty acid linoleic acid (found in many vegetable oils) may improve dry-eye symptoms in Sjögren’s. Flax oil, a source of omega-3 fatty acids, has also shown some promise for this latter purpose.

A twelve-month, double-blind, placebo-controlled study failed to find benefits from the hormone dehydroepiandrosterone (DHEA), taken at 200 mg daily. The researchers noted that the belief by participants that they were being given DHEA instead of placebo “was a stronger predictor for improvement of fatigue and well-being than the actual use of DHEA.” An earlier double-blind, placebo-controlled study also failed to find benefit.

Other natural treatments for Sjögren’s are suggested as well. These include evening rose oil, the essential fatty acid gamma-linolenic acid (GLA), omega-6 fatty acids, and sulfur. Numerous other natural products are widely recommended for Sjögren’s syndrome, but they lack supporting scientific evidence. These include aloe vera, citrus bioflavonoids, dandelion, echinacea, fish oil, garlic, inositol, magnesium, methionine, olive leaf extract, red clover, vitamin A, vitamin C, vitamin E, and zinc.

People with Sjögren’s are also recommended to eat an anti-inflammatory diet rich in vegetables, lean proteins, and fruits. Nuts, leafy greens, fatty fish, avocados, olive oil, whole grains, and foods prepared with turmeric, garlic, or ginger have proven to benefit some individuals. To alleviate symptoms, some patients avoid red meat, alcohol, smoking, processed or fried foods, and refined grains as well as safflower, corn, and canola oils. If constipation, diarrhea, or leaky gut syndrome accompany Sjögren’s syndrome, balancing gut bacteria may help alleviate these symptoms and other symptoms that may be indirectly caused by gastrointestinal upset. Opting for goat’s milk products over cow's milk and taking probiotics may improve symptoms. Natural probiotics and gut-friendly foods include sauerkraut, kombucha, miso, kimchi, pickled foods, and tempeh.

Herbs and Supplements to Use with Caution

One case report weakly hints that the herb echinacea may trigger dangerous symptoms (specifically, critical hypokalemic renal tubular acidosis) in people with Sjögren’s. Numerous herbs and supplements may interact adversely with drugs used to treat Sjögren’s syndrome.

Bibliography

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Hartkamp, A., et al. “Effect of Dehydroepiandrosterone Administration on Fatigue, Well-Being, and Functioning in Women with Primary Sjögren’s Syndrome.” Annals of the Rheumatic Diseases, vol. 67, 2008, pp. 91-7. doi:10.1136/ard.2007.071563. Accessed 20 Sept. 2024.

“Herbs and Supplements for Sjogren's Syndrome - Complementary and Alternative Medicine.” St. Luke's Hospital, 2023, www.stlukes-stl.com/health-content/medicine/33/002650.htm. Accessed 27 Aug. 2023.

Minaei, Bagher, et al. "The Role of Diet and Medicinal Herbs for Management of Sjögren’s Syndrome in Traditional Persian Medicine." Iranian Journal of Public Health, vol. 50, no. 11, 2021, pp. 2358-60. doi.org/10.18502/ijph.v50i11.7599. Accessed 20 Sept. 2024.

Olsen, Natalie, et al. “The Sjögren's Syndrome Diet: Beneficial Foods to Eat.” Healthline, 26 June 2023, www.healthline.com/health/sjogrens-syndrome-diet. Accessed 20 Sept. 2024.

Pillemer, S. R., et al. “Pilot Clinical Trial of Dehydroepiandrosterone (DHEA) Versus Placebo for Sjögren’s Syndrome.” Arthritis and Rheumatism, vol. 51, 2004, pp. 601-04.

Rantanen, I., et al. “Effects of a Betaine-Containing Toothpaste on Subjective Symptoms of Dry Mouth.” Journal of Contemporary Dental Practice, vol. 4, 2003, pp. 11-23.

Theander, E., et al. “Gammalinolenic Acid Treatment of Fatigue Associated with Primary Sjögren’s Syndrome.” Scandinavian Journal of Rheumatology, vol. 31, no. 2, 2002, pp. 72-9. doi:10.1080/03009740252937577. Accessed 20 Sept. 2024.