Sjogren’s Syndrome and the Microbiome

A reader asked about Sjögren’s syndrome. They were very frustrated by the lack of treatments. The following is what I could find based on the assumption that it is Microbiome connected. Specifically, I am assuming the microbiome in the mouth, nasal cavity etc. is a significant factor for Sjögren’s syndrome

“In systemic autoimmune diseases (SADs) such as rheumatoid arthritis, systemic lupus erythematosus and Sjögren’s syndrome[SS], the immune system is deranged to a chronic inflammatory state and autoantibodies are an important hallmark. Specific bacteria and/or a dysbiosis in the human microbiome can lead to local mucosal inflammation and increased intestinal permeability.” [2016]

“In this review article, we discuss links of the oral microbiota to a group of autoimmune diseases, i.e., Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE), Crohn’s disease (CD), and rheumatoid arthritis (RA). We particularly focus on factors that affect the balance between the immune system and the composition of microbiota leading to dysbiosis, loss of tolerance and subsequent autoimmune disease progression and maintenance” [2016]

Microbiome Shifts

  • “The relative abundance of Proteobacteria in Sjögren’s syndrome[SS] group was lower compared to controls (P=0.002)….. The numbers of genera in SS group and in control group were 248 and 270,” [2016]
  • ” Raised antibody levels to Prevotella denticola were found in the pSS, RA and periodontitis groups compared to the OA group.”[2016]
  • “Subjects with primary Sjögren’s syndrome [pSS] harbored increased levels of L. acidophilus and non-oral species, while SS sufferers generally had lower proportions of gram-negative species.” [20072007]
  • ” In the pSS group, 85% of subjects had high numbers of mutans streptococci despite good oral hygiene, frequent dental visits and fluoride use…The results indicate that changes in the oral microflora associated with hyposalivation are related to the reason for the hyposalivation rather than to the magnitude of the decrease in the salivary secretion rate.” [2003]
  • “Subjects with hyposalivation have a marked increase in lactobacilli. Of the strains analysed this far 95% gave a pH <5.5 at sucrose-fermentation. A pH <5.5 was obtained for 82% of the strains with mannitol, 75% with sorbitol and 32% with xylitol. As those sugar substitutes are included in tooth pastes, chewing gums and saliva-stimulating tablets and sprays, it is likely that the lactobacilli are further promoted in subjects with hyposalivation.” [2004]
  • “The ability to produce acids from sugars and sugar alcohols was highest among strains of Lactobacillus rhamnosus, Lactobacillus casei and Lactobacillus paracaseiand lowest among Lactobacillus fermentum strains.” [2013]
  • “Compared with healthy controls, subjects with pSS harbored higher numbers and frequencies of Streptococcus mutans,Lactobacillus spp., and Candida albicans in the supragingival plaque… In the gingival crevice region, the pSS group harbored slightly lower proportions of Fusobacterium nucleatum and Prevotella intermedia/Prevotella nigrescens than controls.” [2001] [1997]
  • “A significantly greater percentage of patients with severely reduced salivation had high counts of Lactobacillus spp. (P<0.01).” [2011]

Bottom Line

Sjögren’s syndrome is sometimes seen with CFS. It appears that it is an OVERGROWTH of Lactobacillus Acidophilus in the mouth. The chemicals created by it kills E.Coli and thus are passed down to the guts where it results in low or no E.Coli in a CFS patient guts (L.Acid. is a very effective killer of E.coli). So both the mouth and the guts need correction!

We want to reduce Lactobacillus and Streptococcus mutans in the oral cavity specifically. The rest of the body is a very different question.

Since we want the effect in the oral cavity, then rinsing the mouth and not swallowing (to prevent possible side-effects in the guts) may be preferred.