Sjögren's syndrome (SS) is a chronic autoimmune disease primarily known for causing persistent dryness of the eyes (xerophthalmia) and mouth (xerostomia). The disease causes your immune system to attack glands that produce tears and saliva, affecting your body’s ability to produce moisture. Common symptoms of Sjögren’s syndrome include dry mouth and eyes, joint pain, swelling, dry skin, dry throat, dry nasal passages, vaginal dryness, and difficulty swallowing.
While there is no cure for Sjögren’s syndrome, modifying your diet can help to treat symptoms, provide a higher quality of life, and improve your overall health. Combined with a prescribed treatment plan, a moderated diet can help to prevent or reduce dryness and inflammation from Sjögren’s syndrome.
How Diet Affects Sjögren’s Symptoms
Diet can play a big role when it comes to Sjögren’s management, and that is because food can provide you with the nutrients your body needs to heal - or it can contribute to the disease process. The right foods provide your body with the building blocks it needs to heal - such as minerals, vitamins, phytonutrients, antioxidants, amino acids and pre and pro-biotics (amongst many others). These components support your body to function optimally and facilitate the healing process. The wrong foods can leave your body depleted of these essential nutrients, and overflowing in some other harmful ones, which can cause inflammation and contribute to the disease process. Therefore, the right diet for Sjögren's is all about getting to know how your body functions, and finding the right balance for your specific needs and your specific body. The nutrients and foods that each body needs to thrive are highly individual. No two people are the same when it comes to diet, and that is why 'one-size-fits-all' approaches are seldom successful. The wrong foods can make Sjögren's symptoms worse.
There is increasing research to support the role of diet in the management of Sjögren's and other rheumatic and autoimmune conditions.
General Dietary Guidelines
While there is no one-size-fits-all, there are some simple dietary guidelines which are likely to benefit the majority of people living with Sjögren’s. These guidelines serve as the foundational pillars of good health and have been consistently supported by research in their ability to enhance well-being and reduce inflammation across a range of populations.
Read also: The Hoxsey Diet
Focus on Whole, Unprocessed Foods
These are foods which have undergone minimal or no processing, and therefore retain most of their vitamins and nutrients, which the body needs to repair and heal. Studies show associations between eating minimally processed foods and reduced inflammatory markers. A good rule of thumb is to ask yourself 'how close is this food to its 'original' form?'. For example, fresh or frozen fruits and vegetables are exactly like their original form, but a frozen ready-made pizza is not. Whole foods are the cornerstone of a healing Sjögren's diet.
Minimize Highly Processed Foods
Likewise, steering clear of highly processed foods is a key element of a Sjögren's-friendly diet. Highly processed foods have been shown time and time again to contribute to inflammation. These foods are often loaded with additives, preservatives and added sugars, which can trigger inflammation and worsen Sjögren's symptoms. Opting for whole, unprocessed foods is a healthier choice to support your well-being and help you manage your symptoms.
Stay Hydrated
One of the most important things you can do to manage your Sjogren’s symptoms is to stay hydrated. Eating foods that are high in water content, such as fruits and vegetables, can help keep you hydrated and reduce the symptoms of dry mouth and eyes. It is vital to stay well-hydrated to help your body function optimally. Water, unsweetened herbal teas, and clear homemade broths are some great options, so make sure to sip on these throughout the day.
Foods to Include in Your Diet
Maintaining a diet rich in foods with anti-inflammatory effects can reduce dryness symptoms and provide relief from other associated conditions. Incorporating a diet rich in hydrating fruits and vegetables, Omega-3 fatty acids, whole grains, nuts and seeds, fermented foods, leafy greens, herbs, and spices can help manage the symptoms of Sjogren’s syndrome and support overall health.
Hydrating Foods
Eating foods that are high in water content, such as fruits and vegetables, can help keep you hydrated and reduce the symptoms of dry mouth and eyes. Some of the best foods to eat include:
Read also: Walnut Keto Guide
- Fruits: Watermelon, cantaloupe, grapes, oranges, and other fruits are all great sources of hydration.
- Vegetables: Cucumbers, celery, lettuce, and leafy greens are all high in water content and can help keep you hydrated.
- Soup: Broth-based soups are a great way to hydrate and nourish your body, especially if you have difficulty swallowing or chewing due to Sjogren’s symptoms.
Anti-Inflammatory Foods
Inflammation is a common problem for people with Sjogren’s syndrome, and it can cause joint pain, fatigue, and other symptoms. To reduce inflammation and manage your symptoms, it’s important to eat a diet that’s rich in anti-inflammatory foods. Some foods high in anti-inflammatory benefits include:
- Leafy green vegetables
- Nuts
- Fruits
- Turmeric
- Ginger
- Garlic
- Fatty fish
- Olives and olive oil
- Avocado
- Whole grains
Omega-3 Rich Foods
Omega-3 fatty acids have anti-inflammatory properties and can help reduce the symptoms of Sjogren’s syndrome. By modulating the inflammatory response, omega-3 fatty acids can help alleviate symptoms such as dryness, pain, and fatigue associated with Sjögren's. Additionally, omega-3 fatty acids have been shown to support overall immune function and promote healthy cellular membranes, which may further benefit those of you with Sjögren's. Foods that are high in Omega-3 include salmon, mackerel, and sardines. Fish oil is beneficial in some patients. Eat Wild-caught Oily Fish 2-3 Times Per Week
Fiber-Rich Foods
Fiber is important for digestive health and can help regulate the digestive system, reducing symptoms like constipation and diarrhea. Whole grains: Oatmeal, brown rice, and other whole grains are high in fiber and can help regulate the digestive system.
Fermented Foods
Fermented foods, such as yogurt and kefir, are rich in probiotics, which can help support gut health and reduce inflammation.
Herbs and Spices
Herbs and spices, such as turmeric and ginger, are natural anti-inflammatories that can help reduce symptoms of Sjogren’s syndrome. These flavorful additions not only enhance the taste of your dishes but can also offer potential anti-inflammatory and antioxidant benefits. Incorporating a variety of herbs and spices into your meals can be a tasty way to support your well-being. So, don't be shy - get creative in the kitchen and explore the world of seasonings to make your meals both delicious and Sjögren's-friendly.
Read also: Weight Loss with Low-FODMAP
Foods to Avoid
Pursuing the Sjögren’s diet or a similar anti-inflammatory diet means eliminating common trigger foods and allergens. There are a range of foods that can make symptoms of Sjögren disease worse or trigger new symptoms or complications.
Some foods to avoid include:
- Red meat
- Processed foods
- Fried foods
- Dairy
- Sugars and sweets
- Alcohol
- Soda
- Gluten
- Refined grains
- Safflower, corn, and canola oils
- Sugary beverages
- Carbonated drinks
- Foods containing excess salt, added sugar, or unhealthy fats
- Caffeine
- Fatty, spicy, and acidic foods, which can trigger GERD symptoms
Some foods affect people differently. Though these foods can trigger inflammation and worsen Sjögren’s syndrome symptoms, some can be eaten in moderation. This specifically applies to some dairy products, such as yogurt and cheese. If your symptoms begin to worsen after eating specific foods, consider eliminating them from your diet. Also, discuss your symptoms with your doctor to ensure you receive the best treatment.
It's worth considering the role that alcohol has in your diet. Alcohol can have various effects on the body, including dehydration and inflammation, which can exacerbate Sjögren's symptoms, and especially dryness. Many people with Sjögren's find that limiting or eliminating alcohol can lead to improvements in their overall well-being and symptoms.
Cooking Tips for Dry Mouth
How you cook your foods can also affect dry mouth symptoms. Here are some additional tips to make your meals more enjoyable:
- If you choose to make a sandwich, consider adding vegetables that are high in moisture, such as cucumbers.
- Adding sauces to your meals can ease swallowing, but use creamy sauces in moderation to limit fat content.
- Try soups and smoothies as alternatives to dry foods.
- Drink with your meals to ease swallowing.
- Soften your foods with broth.
- Tender-cook your meats to prevent them from drying out.
- Beneficial cooking methods include: boiling, baking in water, slow cooking, and pressure cooking.
- Soft, moist dishes include: soups, stews, sauces, and smoothies.
The Mediterranean Diet and Sjögren's Syndrome
It is interesting to note that some research has found autoimmune diseases, including Sjögren disease, to be less prevalent among those following a Mediterranean diet. Adherence to a Mediterranean diet has been associated with reduction in other autoimmune diseases. In the adjusted model, a higher total MDS (mean ± SD, 9.41±2.31 points) was associated with lower odds of pSS (OR 0.81, 95% CI 0.66-0.99; p=0.038) per one unit of MDS. Among MDS components, the strongest association was seen with fish with OR 0.44 (95% CI 0.24-0.83; p=0.01) in the comparison between <1 portion/week and 1 to 2.5 portions/week.
This Creaky Joints article provides a simple overview of known anti-inflammatory foods. It is similar to the Mediterranean diet, which has been demonstrated by multiple studies to benefit a wide variety of inflammatory conditions.
Plant-Based Diets and Sjögren's Syndrome
In a recent case report published in the journal Frontiers in Nutrition, researchers discuss three case studies wherein women (ages 40, 54, and 45 years) suffering from Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE) reported remission of their symptoms following switching their diets to customized plant-based nutritional regimes. The diet consists mainly of leafy greens, omega-3 fatty acids, and cruciferous vegetables.
The findings in the current case report are overwhelmingly positive, with all three cases experiencing significantly and astonishingly rapid symptom remission following strict adherence to the RRP intervention. Encouragingly, symptom remission was observed to be long-term, with two of the three surviving cases reporting ongoing symptom-free periods of 6 and 7 years, respectively. These findings highlight the profound impacts of dietary interventions in treating chronic diseases, including SLE and SS. Of particular interest are plant-based diets, rich in natural nutraceuticals, which are only now coming to the forefront of biomedical and clinical research.
Addressing Gut Health
Recent studies have shown that a plant-based nutritional protocol-rich in leafy greens, cruciferous vegetables, and omega-3 fatty acids-can significantly alleviate symptoms such as dry eyes and dry mouth. The ideal diet for Sjögren’s syndrome must address the root cause of inflammation-gut microbiome dysfunction. For example, while a low FODMAP diet might reduce gastrointestinal discomfort in the short term, it does not provide the necessary phytonutrients and antioxidants that help modulate immune function over time.
Gut dysbiosis is closely linked to autoimmune activity in Sjögren’s syndrome. Microbiome analyses-via stool sequencing or targeted metagenomic panels-can identify imbalances in key bacterial genera. Food sensitivities-common to gluten, dairy, or nightshade vegetables-can exacerbate dryness and inflammation. Mediator-release assays or serum IgG4 panels help pinpoint specific triggers, enabling targeted elimination and reintroduction.
Additional Considerations
The Nutrition/Diet/Health Influencer Industry
Most clinicians do not have the time, training, or resources to offer diet and other lifestyle support, even though these are an important part of Sjogren’s management. Not knowing where to turn, Sjogren’s patients may spend hundreds, sometimes thousands, of dollars on alternative practitioners or non-credentialed health influencers. These practitioners often promote restrictive diets, claiming that their program can reverse or cure autoimmune diseases. Special diets may be just one part of a bigger “detox program” that includes expensive laboratory tests, supplements, and other products that are not supported by scientific evidence.
Why are restrictive diets so popular?
Desperate to feel better, people with Sjogren’s are often willing to try extreme diets. These diets are usually marketed by highlighting dramatic success stories. Testimonials are inspiring, but they are not scientific evidence. People who feel worse or do not benefit from a diet are not mentioned. That is not how science works. Every outcome must be looked at in a systematic way, not just the positive ones.
What about the Autoimmune Protocol (AIP) diet?
There are Sjogren’s patients who describe a remarkable, sustained improvement on the AIP diet. Others experience no obvious benefit or even feel worse on this diet. As with Keto and Paleo diets, current scientific evidence is inadequate to show that the AIP is effective for Sjogren’s patients as a group. It is possible that the AIP does help a subset of patients. While the AIP is more nutritionally sound than Keto or Paleo, the AIP labels nightshade vegetables (eggplant, tomatoes, peppers, etc.) as inflammatory, despite a lack of evidence to support that claim. Even though the AIP diet is designed to reintroduce foods slowly, some people hesitate to do this because they fearful of getting worse.
Supplements
Omega-3 fatty acids may be beneficial for symptoms of dry eye, but the degree of benefit from such supplements is uncertain. A reasonable daily dose is from 1000 to up to 3000 mg daily. Adequate levels of vitamin D have been shown to be beneficial for people with autoimmune disease. Some people with Sjögren’s have a related autoimmune condition (pernicious anemia) that impairs vitamin B12 absorption. This can be tested by your physician. Low-dose naltrexone may be beneficial for some people with Sjögren’s, as evidenced by anecdotal case reports. It has not been studied formally in Sjögren’s with placebo-controlled clinical trials. In the case reports, the naltrexone therapy seemed to improve joint pain and fatigue. The usual adult dosage of low-dose naltrexone for autoimmune conditions 1.75-4.5mg taken orally once daily at bedtime. It is best to start at 1.5 to 3.0mg per day and adjust the dose up to 4.5 mg per day as needed. Low-dose naltrexone has virtually no side effects.