Dietary And Lifestyle Considerations
Dry mouth, a common symptom in Sjögren syndrome, can be a significant burden, causing eating difficulties, increased susceptibility to dental cavities, oral discomfort or irritation, undernutrition, and decreased social interaction. Therefore, ensuring adequate nutrition should be a primary objective for Sjögren patients. The following recommendations may be helpful (Wilkinson 2017; Frosio 2017; Sobhani 1998; Villa 2015; Cassolato 2003; Jensen 2014):
- Consume a well-balanced diet supplying adequate calories.
- Moisten foods by adding broths, mayonnaise, yogurt, or sauces to make them easy to swallow.
- Consume plenty of fluids, especially water, with meals.
- Eat foods high in fiber to help promote healthy bowel function (eg, fruits and vegetables).
- Avoid irritants such as alcohol and spicy or salty foods.
Anti-inflammatory diet. Since inflammation is a major feature of Sjögren syndrome, patients are encouraged to consume an anti-inflammatory diet, including omega-3 fatty acid-rich cold-water fish such as salmon, tuna, and mackerel (Foulks 2015; Wilkinson 2017). The typical Western diet is high in pro-inflammatory omega-6 fats and low in anti-inflammatory omega-3 fats. In fact, the ratio of omega-6 to omega-3 fats in Western diets is nearly 17:1, whereas a healthy ratio, according to some researchers, may be closer to 4:1 (Simopoulos 2016; Barabino 2003; Simopoulos 2002).
In the landmark Women’s Health Study, greater dietary intake of omega-3 fatty acids was associated with a lower incidence of dry eye in women aged 45 to 84. In addition, women who had higher omega-6:omega-3 fatty acid intake ratios had increased dry eye risk (Simopoulos 2016; Miljanovic 2005). In a randomized controlled trial of patients with dry eye, 65% of patients who received 1000 mg omega-3 fatty acids from fish daily for three months had improvement in symptoms versus 33% in the placebo group (Bhargava 2013).
Food hypersensitivities. It has been observed that Sjögren syndrome patients who have irritable bowel syndrome-like symptoms may have food hypersensitivities (Kim-Lee 2015). Tests such as the IgG antibody test for specific food sensitivities may help Sjögren patients identify and eliminate problematic foods (Shikhman 2011). One study reported a high prevalence (25%) of gluten sensitivity in Sjögren patients based on inflammatory response to a rectal gluten challenge (Liden 2007). In another clinical study, avoiding food allergens eliminated digestive symptoms such as abdominal pain, bloating, and diarrhea in Sjögren patients (Kim-Lee 2015). In a case study of a patient diagnosed with Sjögren syndrome and gluten sensitivity, following a gluten-free and dairy-free diet in addition to supplemental iron, vitamin D, probiotics, and digestive enzymes, eliminated eye dryness and digestive symptoms such as abdominal pain, bloating, and irregular bowel movements (Shikhman 2011).
Eye care tips (Rischmueller 2016; NIH 2016a; Greenbaum 1982; Javadi 2011; Pan 2013):
- Blink more frequently and avoid extended periods of reading, computer use, and other activities that reduce blinking rate.
- Avoid medications that can cause dryness such as antihistamines, decongestants, diuretics, and antidepressants.
- Avoid smoking and smoke exposure.
- Use caution with cosmetics, facial creams, or eye drops that may irritate the eyes.
- Protect eyes against dry or windy conditions.
- Consider using humidifiers at home and in the workplace.
Oral hygiene (Rischmueller 2016; NIH 2016a; Stefanski 2017; Bolstad 2016; Miranda-Rius 2015; Aguirre 1997):
- Because the rate of early tooth loss in Sjögren patients is about twice as high as in the general population, having regular dental cleanings and a dental exam every 3‒4 months is especially important.
- Sip or drink water frequently and avoid mouthwashes that contain alcohol.
- Avoid mouth breathing by treating sinusitis or rhinitis; consider treatment with corticosteroid or saline nasal sprays instead of antihistamines.
- Floss teeth daily.
- Avoid sugar between meals.
- Consult with your physician if you are taking medications that can cause dryness such as antihistamines, decongestants, and diuretics.
Aerobic exercise has been shown to significantly improve physical function and reduce fatigue and depression in patients with primary Sjögren syndrome (Strombeck, Theander 2007; Strombeck, Jacobsson 2007). A number of studies have revealed that physical activity is associated with reduced chronic inflammation (Beavers 2010).
Acupuncture may be a potential treatment option for dry eye management. Some human studies have demonstrated that acupuncture can improve tear secretion and wellbeing in patients with dry eye (Yang 2015). The benefits of acupuncture may be due to modulation of the autonomic nervous system and immune system resulting in decreased inflammation of the eye surface (Lin 2014; Kim, Kang 2012).
In a review of several clinical trials, acupuncture was found to be more effective than artificial tears in various objective measures of dry eye symptoms (Yang 2015). In addition, symptom improvement resulting from acupuncture appears to be longer lasting than that obtained with artificial tears. In a comparison trial, participants with moderate-to-severe dry eye were treated for four weeks with either acupuncture or artificial tears. Similar improvements were seen at the end of treatment; however, only participants who received acupuncture had sustained improvement eight weeks after the end of treatment (Kim, Kang 2012).