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Sjogren’s Syndrome Solutions

September 20, 2011 Written by JP    [Font too small?]

This year’s U.S. Open was marked by an unexpected medical headline. Venus Williams, a top ranked singles and doubles tennis player, announced that she was dropping out of the prestigious tournament because of debilitating symptoms relating to Sjogren’s syndrome. This autoimmune condition can manifest itself in a number of ways including musculoskeletal pain, persistent fatigue and severe dryness in the eyes and mouth. Thankfully, preliminary research points to several natural options that may help manage it.

The first alternative to consider is an “elimination diet” that avoids common food allergens such as gluten and milk. Food allergies and sensitivities appear to be relatively common in those with Sjogren’s syndrome and their removal may lead to immunological and symptomatic improvements. Next on my list is a select group of lipids worth noting: borage oil, evening primrose oil and sea buckthorn oil. These nutritional supplements provide rare fatty acids (gamma-linolenic acid and palmitoleic acid) which may reduce some of the primary symptoms of Sjogren’s syndrome, namely, dry eyes and mouth, and fatigue. Last, but not least, an old study dating all the way back to 1986 describes the utility of an amino acid-based antioxidant known as N-acetylcysteine (NAC). A 4 week trial involving 51 patients with Sjogren’s syndrome determined that NAC outperformed a placebo by decreasing several indicators of oral and ocular discomfort. The dosage used in the study was 200 mg of NAC, thrice daily.

My hope is that natural and safe alternatives such as these will one day enter the medical mainstream and help all those with Sjogren’s syndrome live active and healthier lives.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Reversal of Premature Ovarian Failure in a Patient With Sjögren (link)

Study 2 – Cow’s Milk Protein Sensitivity Assessed By the Mucosal Patch (link)

Study 3 – Gluten Sensitivity in Patients With Primary Sjögren’s (link)

Study 4 – Systemic Omega-6 Essential Fatty Acid Treatment and … (link)

Study 5 – Patients With Primary Sjögren’s Syndrome Treated for Two (link)

Study 6 – Effects of Oral Sea Buckthorn Oil On Tear Film Fatty Acids (link)

Study 7 – A Double-Blind, Cross-Over, Study of Oral N-Acetylcysteine (link)

Gamma-Linolenic Acid May Control Dry Eye Signs & Symptoms

Source: Invest. Ophthalmol. Vis. Sci. December 2005 vol. 46 no. 12 4474-4479 (link)

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Posted in Alternative Therapies, Nutrition, Nutritional Supplements

10 Comments & Updates to “Sjogren’s Syndrome Solutions”

  1. James Lockwood Says:


    There already is a natural highly effective treatment for Sjogren’s syndrome. You can take a look at this discussion group for more information about helminthic therapy.

  2. James Lockwood Says:

    Sorry, that web address is:

  3. JP Says:

    Thanks for the tip, James. I’ll look into it.

    Be well!


  4. Iggy Dalrymple Says:

    Speaking of helminthic therapy, I’m seriously considering it for my asthma. Acupuncture worked for me for years but no longer. My sister died from asthma a few years ago. The medication is almost as bad as the disease.

    I live in hookworm country. Growing up, the school kids were tested each year and I was usually the only kid in my class to test negative. I was a city boy but we all went barefoot in the summer. I bet I’d be asthma free if I had caught hookworms.

  5. JP Says:

    Update: Fish oil benefits dry eyes caused by lengthy computer time …


    Cont Lens Anterior Eye. 2015 Feb 16.

    Oral omega-3 fatty acids treatment in computer vision syndrome related dry eye.

    PURPOSE: To assess the efficacy of dietary consumption of omega-3 fatty acids (O3FAs) on dry eye symptoms, Schirmer test, tear film break up time (TBUT) and conjunctival impression cytology (CIC) in patients with computer vision syndrome.

    SETTING AND DESIGN: Interventional, randomized, double blind, multi-centric study.
    METHODS: Four hundred and seventy eight symptomatic patients using computers for more than 3h per day for minimum 1 year were randomized into two groups: 220 patients received two capsules of omega-3 fatty acids each containing 180mg eicosapentaenoic acid (EPA) and 120mg docosahexaenoic acid (DHA) daily (O3FA group) and 236 patients received two capsules of a placebo containing olive oil daily for 3 months (placebo group). The primary outcome measure was improvement in dry eye symptoms and secondary outcome measures were improvement in Nelson grade and an increase in Schirmer and TBUT scores at 3 months.

    RESULTS: In the placebo group, before dietary intervention, the mean symptom score, Schirmer, TBUT and CIC scores were 7.5±2, 19.9±4.7mm, 11.5±2s and 1±0.9 respectively, and 3 months later were 6.8±2.2, 20.5±4.7mm, 12±2.2s and 0.9±0.9 respectively. In the O3FA group, these values were 8.0±2.6, 20.1±4.2mm, 11.7±1.6s and 1.2±0.8 before dietary intervention and 3.9±2.2, 21.4±4mm, 15±1.7s, 0.5±0.6 after 3 months of intervention, respectively.

    CONCLUSION: This study demonstrates the beneficial effect of orally administered O3FAs in alleviating dry eye symptoms, decreasing tear evaporation rate and improving Nelson grade in patients suffering from computer vision syndrome related dry eye.

    Be well!


  6. JP Says:

    Update: Maqui berry extract shows promise re: dry eye symptoms …


    Panminerva Med. 2014 Sep;56(3 Suppl 1):1-6.

    MaquiBright™ standardized maqui berry extract significantly increases tear fluid production and ameliorates dry eye-related symptoms in a clinical pilot trial.

    AIM: Dry eye symptoms, resulting from insufficient tear fluid generation, represent a considerable burden for a largely underestimated number of people. We concluded from earlier pre-clinical investigations that the etiology of dry eyes encompasses oxidative stress burden to lachrymal glands and that antioxidant MaquiBright™ Aristotelia chilensis berry extract helps restore glandular activity.

    METHODS: In this pilot trial we investigated 13 healthy volunteers with moderately dry eyes using Schirmer test, as well as a questionnaire which allows for estimating the impact of dry eyes on daily routines. Study participants were assigned to one of two groups, receiving MaquiBright™ at daily dosage of either 30 mg (N.=7) or 60 mg (N.=6) over a period of 60 days. Both groups presented with significantly (P<0.05) improved tear fluid volume already after 30 days treatment. Schirmer test showed an increase from baseline 16.3±2.6 mm to 24.4±4.8 mm (P<0.05) with 30 mg MaquiBright™ and from 18.7±1.9 mm to 27.6±3.4 mm with 60 mg (P<0.05), respectively. Following treatment with 30 mg MaquiBright™ for further 30 days, tear fluid volume dropped slightly to 20.5±2.8 mm, whereas the improvement persisted with 60 mg treatment at 27.1±2.7 mm after 60 days treatment (P<0.05 vs. baseline).

    RESULTS: The burden of eye dryness on daily routines was evaluated employing the "Dry Eye-related Quality of life Score" (DEQS), with values spanning from zero (impact) to a maximum score of 60. Participants had comparable baseline values of 41.0±7.7 (30 mg) and 40.2±6.3 (60 mg). With 30 mg treatment the score significantly decreased to 21.8±3.9 and 18.9±3.9, after 30 and 60 days, respectively. With 60 mg treatment the DEQS significantly decreased to 26.9±5.3 and 11.1±2.7, after 30 and 60 days, respectively. Blood was drawn for safety analyses (complete blood rheology and -chemistry) at all three investigative time points without negative findings.

    CONCLUSION: In conclusion, while daily supplementation with 30 mg MaquiBright™ is effective, the dosage of 60 significantly increased tear fluid volume at all investigative time points and decreased dry eye symptoms to almost a quarter from initial values after two months treatment.

    Be well!


  7. JP Says:

    Updated 06/12/16:


    Clin Interv Aging. 2016 May 19;11:571-8.

    Oral supplementation with a nutraceutical formulation containing omega-3 fatty acids, vitamins, minerals, and antioxidants in a large series of patients with dry eye symptoms: results of a prospective study.

    PURPOSE: To assess the benefits and tolerability of a dietary supplement based on omega-3 fatty acids to relieve dry eye symptoms.

    METHODS: A total of 1,419 patients (74.3% women, mean age 58.9 years) with dry eye syndrome using artificial tears participated in a 12-week prospective study. Patients were instructed to take 3 capsules/day of the nutraceutical formulation (Brudysec(®) 1.5 g). Study variables were dry eye symptoms (scratchy and stinging sensation, eye redness, grittiness, painful and tired eyes, grating sensation, and blurry vision), conjunctival hyperemia, tear breakup time (TBUT), Schrimer I test, and Oxford grading scheme.

    RESULTS: At 12 weeks, each dry eye symptom improved significantly (P<0.001), and the use of artificial tears decreased significantly from 3.77 (standard deviation [SD] =2.08) at baseline to 3.45 (SD =1.72) (P<0.01). In addition, the Schirmer test scores and the TBUT increased significantly, and there was an increase in patients grading 0-I in the Oxford scale and a decrease of those grading IV-V. Significant differences in improvements of dry eye symptoms were also found in compliant versus noncompliant patients as well as in those with moderate/severe versus none/mild conjunctival hyperemia.

    CONCLUSION: Oral ω-3 fatty acids supplementation was an effective treatment for dry eye symptoms.

    Be well!


  8. JP Says:

    Updated 06/15/16:


    Clin Ophthalmol. 2016 May 9;10:813-20.

    A randomized, double-blind, placebo-controlled study of oral antioxidant supplement therapy in patients with dry eye syndrome.

    PURPOSE: To evaluate the efficacy of oral antioxidant supplementation in the treatment of patients with dry eye syndrome (DES).

    METHODS: A prospective, randomized, double-blinded study compared the effects of an antioxidant supplement (containing anthocyanosides, astaxanthin, vitamins A, C, and E, and several herbal extracts, including Cassiae semen and Ophiopogonis japonicus) with placebo on patients with DES. We assessed dry eye symptoms, visual acuity, Schirmer’s test, tear film breakup time, cornea and conjunctiva fluorescein staining, serum anti-SSA/anti-SSB antibodies, and the level of reactive oxygen species (ROS) in tears. The supplementation period was 8 weeks and patients were followed up every 4 weeks for 16 weeks. A linear mixed model was used to compare the groups, while within-group differences were tested by repeated-measures analysis of variance.

    RESULTS: Forty-three patients, 20 and 23 in treatment and placebo groups, respectively, completed the study. Liver and renal functions were normal. Diastolic blood pressure decreased in the treatment group. There were no significant differences in systolic blood pressure, dry eye symptoms, serum anti-SSA and anti-SSB, visual acuity, intraocular pressure, or fluorescein corneal staining between the groups. Tear film breakup time scores and Schirmer’s test without topical anesthesia significantly improved in the treatment group. Tear ROS level differed between the groups and decreased after treatment. Overall subjective impression revealed a significant improvement with treatment compared with placebo.

    CONCLUSION: Oral antioxidant supplementations may increase tear production and improve tear film stability by reducing tear ROS. The vegetable-based antioxidant supplement used in this study is safe and can be utilized as an adjuvant therapy to conventional artificial tear therapy for patients with DES.

    Be well!


  9. JP Says:

    Updated 11/11/16:


    Ophthalmology. 2016 Nov 3.

    A Randomized, Double-Masked, Placebo-Controlled Clinical Trial of Two Forms of Omega-3 Supplements for Treating Dry Eye Disease.

    PURPOSE: To assess the efficacy of 2 forms of oral long-chain omega-3 (ω-3) essential fatty acid (EFA) supplements, phospholipid (krill oil) and triacylglyceride (fish oil), for treating dry eye disease (DED).

    DESIGN: Randomized, double-masked, placebo-controlled clinical trial.

    PARTICIPANTS: This study was conducted at a single site and involved 60 participants with mild to moderate DED who were randomized (1:1:1) to 1 of 3 groups: placebo (olive oil), krill oil, or fish oil supplements.

    METHODS: Participants received 1 of the 3 interventions: placebo (olive oil 1500 mg/day), krill oil (945 mg/day eicosapentaenoic acid [EPA], + 510 mg/day docosahexaenoic acid [DHA]), or fish oil (1000 mg/day EPA + 500 mg/day DHA) for 90 days, with monthly study visits.

    MAIN OUTCOME MEASURES: Primary outcome measures were mean change in (1) tear osmolarity and (2) DED symptoms (Ocular Surface Disease Index [OSDI] score) between days 1 and 90. Secondary outcomes included mean change in key clinical signs (tear stability, tear production, ocular surface staining, bulbar and limbal redness, tear volume, anterior blepharitis, meibomian gland capping) and tear inflammatory cytokine levels.

    RESULTS: In total, 54 participants completed the study. At day 90, tear osmolarity was reduced from baseline with both krill oil (mean ± standard error of the mean: -18.6±4.5 mOsmol/l; n = 18; P < 0.001) and fish oil (-19.8±3.9 mOsmol/l; n = 19; P < 0.001) supplements, compared with placebo (-1.5±4.4 mOsmol/l; n = 17). OSDI score was significantly reduced at day 90 relative to baseline in the krill oil group only, compared with placebo (-18.6±2.4 vs. -10.5±3.3; P = 0.02). At day 90, there were also relative improvements in tear breakup time and ocular bulbar redness, compared with placebo, for both forms of ω-3 EFAs. Basal tear levels of the proinflammatory cytokine interleukin 17A were significantly reduced in the krill oil group, compared with placebo, at day 90 (-27.1±10.9 vs. 46.5±30.4 pg/ml; P = 0.02). CONCLUSIONS: A moderate daily dose of both forms of long-chain ω-3 EFAs, for 3 months, resulted in reduced tear osmolarity and increased tear stability in people with DED. Omega-3 EFAs in a predominantly phospholipid form (krill oil) may confer additional therapeutic benefit, with improvements in DED symptoms and lower basal tear levels of interleukin 17A, relative to placebo. Be well! JP

  10. JP Says:

    Updated 10/18/18:


    Minerva Cardioangiol. 2018 Oct;66(5):543-546.

    Efficacy of Pycnogenol® supplementation in remission phases of Sjögren syndrome.

    BACKGROUND: The aim of this study was to evaluate the effects of Pycnogenol® supplementation in otherwise healthy subjects with Sjögren syndrome (SS) in a remission phase, who experienced persisting symptoms impairing their quality of life.

    METHODS: The control group receiving only standard treatment was composed of 14 subjects, the supplement group included 16 subjects who used Pycnogenol® supplementation.

    RESULTS: ESR and oxidative stress levels were high in all subjects at inclusion; both decreased significantly with supplementation (P<0.05). Pycnogenol® significantly improved the majority of symptoms (dry eyes and mouth dryness), diminishing the need for corticosteroids and other treatments.

    CONCLUSIONS: Pycnogenol® supplementation in patients with SS in a remission phase may be effective to control inflammation and reduce symptoms.

    Be well!


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