Wednesday, March 4, 2009

Sjogren's Nutrition

Image by lockstockb

Someone asked me recently, "What should I be eating if I have Sjogren's syndrome?"

That's a great question. But frankly, I was surprised that someone would ask me this if they had read my blog for any length of time. With respect to healthy eating habits, I would be the complete antitheses of the ideal Sjogren's syndrome poster child. 

(For examples of pathetic eating habits, read this and this and definitely this, for starters).

Because this is an excellent question, and about a topic which I would benefit enormously by knowing more, I decided to do some serious reading. Obviously, healthy eating habits and good nutrition are important for all of us, even for those lucky few who don't have weight issues, do not deal with any chronic diseases, and are capable of rigorous exercise on a frequent basis. 

The New Sjogren's Syndrome Handbook edited by Daniel J. Wallace, MD, summarizes the importance of good nutrition in this way:
"Good nutrition can influence mood, energy level, thinking ability, and sleep. It is not simply a matter of eating a certain food or taking a certain vitamin and having the Sjogren's syndrome go away......It is a matter of eating to increase health and stamina and to improve the chemistry in the body, including the brain."
The USDA food pyramid  offers this to explain the basics of healthy nutrition:

I think we all know the value of eating lots of whole grains, fruits and vegetables, moderate amounts of dairy and protein, and small amounts of fats, oils and sweets. That being said, I think my reader was asking for more dietary guidelines specifically for those dealing with Sjogren's syndrome. 

I want to be clear: There is no miracle food to cure autoimmune disease. I sure wish there was. But for Sjoggies, what we eat, and how we eat it, can significantly change our day to day experience with autoimmune disease. 

It seems to be the easiest thing to do: grab a cup and start chugging caffeine to provide a quick energy boost. It's hard to resist this fix for fatigue, but long term reliance on caffeine may not be a good idea: 
"Within five minutes after you drink your morning coffee, the caffeine begins to stimulate your central nervous system, triggering the release of stress hormones in your body, causing a stress ("fight or flight" ) response. The stress hormonesare useful if you need to prepare yourself to fight or flee a dangerous situation, but if you are simply sitting at your desk you may feel a short charge of alertness, quickly followed by feelings of agitation. Within the next hour or so, after the stress response dissipates, you will probably feel more tired and hungry. At these low-energy times, many people reach for another cup of coffee, or eat a snack that is often high in sugar to "pep up" and stay alert. However, both caffeine and sugar only give you temporary feelings of increased energy, which quickly dissipate. For some people, this cycle of low energy followed by an infusion of caffeine or food continues the entire day -- leaving them feeling exhausted and unable to focus by 3:00 p.m. because they are drained from the ups and downs in energy their body endured throughout the day. "
Active Wellness By Gayle Reichler MS RD CDN
Other food choices may influence energy levels: 
"Carbohydrates can alter the level of serotonin in your brain and bring on feelings of calm and relaxation. That can make them a good before-bedtimesnack, but less good in the middle of the day.

One lunch trick to help you overcome the temptation to nap is to eat pure protein. Protein is broken down into its amino-acid building blocks during digestion. One amino acid, tyrosine, increases the production of the chemicals that are also released when you are under acute mental or physical stress and are well known for their ability to increase levels of alertness and energy levels.

For maximum effect, eat only protein, as carbohydrates will interfere with its effect."
Fish oil, and other sources of omega 3 fatty acids, have received widespread attention recently for their anti-inflammatory effects. Some studies report a decrease in dry eye symptoms after increasing their intake of these beneficial oils. Fish oils are available in supplement form, or of course, found in fatty fish such as salmon. Flax seed oil supplements are also another source of omega 3 fatty acids. You can read more about the beneficial properties of flax seed oil here, on the Mayo Clinic website. As always, never begin taking any supplement without checking with your doctor first, and ask for his/her suggestions for dosage instructions.  

Another potential anti-inflammatory found in foods is moderate consumption of ethanol, or the alcohol found in beer and liquors, as outlined in this 2008 study

Decreased Saliva Production:
The mechanical act of chewing, swallowing, and digesting food is impacted by a decrease in saliva production in SS. Veterans of this disease understand the impossibility of simply eating a soda cracker, or a piece of bread or any dry food. Dry foods need to be dunked or followed with a chaser. Obviously, foods with higher moisture content are easier to chew and swallow. 

Water is important for those dealing with SS for several reasons. Drinking water frequently in small amounts is soothing to a dry mouth. But adequate non-sugary fluid intake also assists in other ways. Dental caries are a significant problem for those with decreased saliva issues. Drinking water or chewing sugar-free gum after meals helps clear the mouth and teeth of residual food and helps reduce cavities, along with meticulous regular brushing and flossing. 
A decrease in saliva can also result in constipation by reducing the viscosity of the food bolus moving through the intestine. Increased fluid intake along with eating adequate amounts of those healthy fruits and vegetables found on the food pyramid can reduce constipation. 

Irritable Bowel Syndrome and Food Intolerances: 
These nasty conditions frequently accompany autoimmune disease, as discussed in an earlier post. However, as outlined in this NIH article, some dietary strategies can help in IBS management:
  • Fatty foods, milk products, chocolate, alcohol, and caffeinated and carbonated drinks can trigger symptoms.
  • Eating foods with fiber and eating small meals throughout the day may reduce symptoms.
Overall, good nutrition is important for everyone. But for those with any kind of health issues, including Sjogren's syndrome, healthy eating habits can be another valuable asset in managing their disease. 


Charlotte said...

Great advice for the most part - my health problems are different but include fatigue and low saliva production, and I've noticed a definite improvement since I started living mostly off vegetables. It's also cheap!

I'm a bit skeptical of the advice that eating pure protein "increases the production of the chemicals that are also released when you are under acute mental or physical stress". How is that supposed to be different from what caffeine does, and why are there no side effects? Not to be snobby about it, but the quality of degrees in nutrition is pretty varied and Sue Gilbert doesn't appear to have the more demanding dietician's qualifications. Most of what she says in that article is sensible, but there are a few red flags - recommending supplements for everyone and the minimally processed food myth, for starters.

Take care, and watch out for quacks! I love the blog, but don't comment often as I usually read it in my RSS feed.

lindoreen said...

I have had symptoms of Sjogren's for a couple of years and was diagnosed seven months ago. I went on the recommended meds but went the naturopathic route as well. I started cleansing toxins from my body and filling myself up with the nutrient dense shakes from Isagenix Maybe I am in remission, but within a month a no longer was achey or stiff and was bounding up the stairs. A homeopath helped with saliva and tear production. I am not perfect, still have better or worse days, but I am SO much better. Medication is not the only answer.

Anonymous said...

Terrific information. Did not get this much from doctor!

Mayweather said...

"Good nutrition" is easy to say. What constitutes "good" is another matter.

In 2004 Dr. Alessio Fasano discovered that the connection between celiac disease and wheat ingestion is caused by the small intestines releasing zonulin. Zonulin defeats the tight junctions between intestinal cells, and passes undigested lumen into the bloodstream. Since that discovery there have been two other discoveries. 1) All autoimmune diseases begin with zonulin and gut porosity. 2) The zonulin reaction is caused by bad bacteria in the microbiome of the small intestine. Wheat contains gluten protein, but any food with reactive proteins can produce the same response, particularly in the presence of fructose sugar .....anything which tastes sweet .....yes anything.

Different people react differently to different foods. However, common culprits include grassy grains (wheat, barley, rye and oats), legumes (beans, peas and peanuts), nightshades (tomatoes, potatoes and peppers), all dairy (lactose and casein A1), nuts, eggs, and foods with zeaxanthin and other polyphenol dyes.

Addison John said...

i've never tried it but coffee has always hurt my stomach. i'm thinking about trying it but i'm not sure which one to try, i've seen helva and puroast but i also saw something called buisman's coffee flavor activator. it looks interesting but i'm not sure if it would actually work so i'm just wondering if anyone's heard of this or tried it and if it actually is gentler on your stomach. also which kind of low acid coffee is best?
swiss water process decaf

Unknown said...

Mouth dryness when swallowing has me eating differently. I need thinner sandwiches, wraps and softer foods. Sugar is my downfall, craving has me choosing chocolate granola with chia seed the other day. I would rather have eaten cake, cookies or candies because fatigue makes me crave carbs. My eyes have gotten drier. They burn and ache, accompanied with migraines. How bad can my dry eyes get? It's disabling when lying down with my eyes closed can be only a small relief.