Targeted Nutritional Strategies
Essential Fatty Acids: Supporting Healthy Glands
Traditional drugs offer considerable potency in dealing with Sjögren's syndrome, but side effects make them a mixed blessing. In addition, pharmacological approaches target symptoms without addressing underlying causes or related health issues. Nutritional support may be successful, not only in mitigating the side effects of drugs, but in lowering doses as well.
Essential fatty acids (EFAs) and eicosanoids, short-lived “messenger” hormones derived from EFAs, have been implicated in the abnormal function of salivary and lachrymal glands. Measurements in Sjögren's syndrome patients have shown that EFA deficiencies are present (Oxholm 1998), and controlled clinical trials of supplementation with EFAs, including gamma-linolenic acid (GLA), have yielded positive results (Horrobin 1984).
Omega-3 and omega-6 fatty acids (EFAs) have been shown to alleviate symptoms of autoimmune disease by supporting the immune system and reducing inflammation (Harbige 1998; Horrobin 1984; Horrobin 1986; Oxholm 1986). EFAs accomplish this in several ways:
- Determining whether genes are expressed
- Producing eicosanoids and cytokines
- Activating antioxidant enzymes
Cytokines. Cytokines are intercellular messenger chemicals that can be pro- or anti-inflammatory. Essential fatty acids support production of anti-inflammatory cytokines (Harbige 1998).
Gamma-linolenic acid (GLA). GLA is important to the production of the anti-inflammatory prostaglandin E1 (PGE1). Evening primrose oil, which is rich in GLA, may correct immunologic defects, halt atrophy of salivary and lachrymal glands, and increase PGE1. Direct supplementation with GLA has resulted in clinical improvement in Sjögren's syndrome, scleroderma, and other conditions (eg, high blood pressure and high cholesterol) (Horrobin 1981).
Green tea extract. Green tea’s antioxidant and anti-inflammatory effects have led scientists to propose that it may have a role in fighting autoimmune diseases such as Sjogren’s syndrome. In the laboratory, green tea catechins stimulated changes in human cells that make them less susceptible to autoimmune attack by the immune system. Additionally, green tea dramatically decreased inflammation in healthy tissues, another change indicative of decreased autoimmune activity (Hsu 2005).
There is evidence that thymus extracts can improve the functioning and numbers of T cells and stimulate conversion of immature T6 cells (thymocytes) into non-dedicated T3 cells (Kouttab 1989; Wilson 1999). Thymominetic drugs, such as as levamisole and isoprinosine, stimulate the thymus and may be beneficial to T cell development (Hadden 1989). Because immature T cells have been implicated in Sjögren's syndrome, Life Extension believes that thymus extract may help reduce the severity of symptoms associated with the disease.
The amino acid L-glutamine heals the intestinal lining and improves its mucosal structure (Klimberg 1990). Beneficial intestinal bacteria, such as Lactobacillus acidophilus and Bifidobacterium bifidus, and fructooligosaccharides (ie, a form of sugar that can enhance beneficial bacteria) provide gastrointestinal tract support by increasing the gut population of healthy microflora.
Aristotelia chilensis Berry Extract
Aristotelia chilensis (A. chilensis) (Maqui) is a berry-producing plant native to forests in certain regions of South America as well as parts of Asia, Australia, and the Pacific Region (Schreckinger 2010; Romanucci 2016). Analysis of phytonutrients from A. chilensis has revealed high concentrations of anthocyanins including cyanidins and delphinidins, flavonol glycosides, and ellagic acids (Brauch 2016). Maqui berry is an especially rich source of delphinidins, a specific type of anthocyanin with powerful anti-inflammatory and free radical-quenching capacity, and other bioactive properties that include protection of blood vessels and protection against sun damage (Watson 2015).
Inflammation causes the dry eyes that trouble Sjögren’s syndrome patients as well as those with dry eye disease (Calonge 2010; Chen 2014; Coursey 2014; Wei 2014). Delphinidins, believed to be the most important anthocyanin component of A. chilensis berry extract, have been shown to dose-dependently inhibit the inflammatory mediators nuclear factor-kappa B and COX-2; and A. chilensis extract has demonstrated, in a laboratory model, powerful ocular protective properties (Tanaka 2013; Watson 2015). In a rodent model of dry eyes and impaired tear secretion, a delphinidin-rich A. chilensis berry extract effectively inhibited oxidative stress in tear gland tissue and preserved tear secretion (Nakamura 2014).
When people with moderately dry eyes (who had not been diagnosed with Sjögren's syndrome) consumed 30 or 60 mg A. chilensis berry extract taken for 60 days, a substantial improvement in tear fluid amount, compared with baseline, occurred within 30 days. Those in the 60 mg group experienced a more durable improvement, with a 45% increase in tear production compared with baseline, and substantial improvement in dry eye-related quality of life score, a patient-reported measure of eye function, comfort, and symptoms (Hitoe 2014).
White Peony Extract
White peony (Paeonia lactiflora) root is a traditional Chinese medicinal herb that contains bioactive compounds called glucosides. A water and alcohol extract of the peony root, known as total glucosides of peony, has more than 15 identified compounds. The most active and abundant of these is paeoniflorin, which represents more than 90% of the total glucosides of peony (Feng 2016; He 2011). A number of studies have shown paeoniflorin and total glucosides of peony have immunomodulatory, anti-inflammatory, and pain-relieving properties, and provide supportive evidence for peony’s historical use in the treatment of autoimmune conditions, including Sjögren’s syndrome (Feng 2016; Zhang 2012; He 2011).
In a six-month, randomized, placebo-controlled clinical trial in 45 patients with Sjögren’s syndrome, treatment with total glucosides of peony resulted in greater improvement in salivary gland function and significantly lower levels of inflammatory markers and cytokines (Zhou 2016). An observational study compared 27 subjects with Sjögren’s syndrome that were treated with either total glucosides of peony or hydroxychloroquine sulfate (Plaquenil) for two years. Researchers noted decreased gamma globulin levels (indicating less autoimmune activity) and increased saliva flow after six months and improved tear production after 12 months of treatment with peony. The two treatments were found to be comparable in terms of effectiveness, with a less severe adverse effect profile noted in the peony group (Zhang 2007).
Laboratory and animal investigations into the actions of total glucosides of peony indicate that in conditions of immune over-activation, peony improves immune regulation and quiets immune over-activity (He 2011). In a mouse model of Sjögren’s syndrome’s impact on salivary glands, total glucosides of peony protected the salivary glands, while a combination of hydroxychloroquine plus total glucosides of peony resulted in less damage than either alone (Wu 2015). In another study in mice with Sjögren’s syndrome, peony extract inhibited the expression of the inflammatory cytokines interferon-gamma and interleukin-4 (Wu 2016). Paeoniflorin alone reduced levels of a novel inflammatory factor in the salivary glands of mice with Sjögren’s syndrome (Li 2016).