Skip to content

Sjögren’s Syndrome 

Testing the Eyes for Sjogren's Syndrome.
Testing the Eye for Tear Production (L) and Damage to Conjunctiva from Dryness (R).

What Is Sjögren’s Syndrome?

[dropcap]S[/dropcap]jögren’s syndrome is a systemic inflammatory autoimmune disease with a chronic, progressive course that primarily attacks the lacrimal glands of the eye and the salivary glands of the mouth, which are exocrine glands. Exocrine glands secrete the substances they produce through a duct.

Sjögren’s syndrome is ordinarily characterized by dysfunction of the lacrimal glands to produce tears causing dry eye and the salivary glands to produce saliva causing dry mouth, but is not limited by or to these features.

Besides involvement of these exocrine glands, there may be involvement of other parts of the body, termed extraglandular, which may be more severe than eye or mouth features.

There is not yet agreement on classifying Sjögren’s syndrome. Primary and secondary are the two forms generally accepted.1 Both forms can cause mild to severe disease, called the spectrum:

  • Primary Sjögren syndrome. Disease occurs without involvement of other linked autoimmune disorders. In addition to the eyes and mouth, the nose, throat and skin may also be affected and joints, lungs, kidneys, blood vessels, digestive organs and nerves as well.2 Systemic manifestations (other than eyes and mouth) concern a third of patients, including lymphoma in 5% of the patients.3
  • Secondary Sjögren’s syndrome. Disease complicates other autoimmune disease such as systemic lupus erythematosus, rheumatoid arthritis, primary biliary cirrhosis, and celiac disease.

Diagnosis  of Sjögren’s syndrome is made by most doctors based on Schimer’s test for tears and unstimulated whole salivary flow to assess objective eye and oral involvement, since these are the tests most physicians use in clinical practice.4 Specific antibody tests would be  positive for anti-Ro (SSA)/anti-La (SSB) autoantibodies. Sjögren’s syndrome should also be considered when extraglandular manifestations such as vasculitis, polyneuropathy or arthritis occur, even when the patients do not complain of dry eyes and mouth.5

There is no cure for Sjögren’s syndrome. Treatment is aimed to diminish symptoms. For example, steroids and Ibupropen are used to decrease inflammation and pain in joints. Artificial tears and ointments are used for dry eye.

Most people who develop Sjogren’s syndrome are older than 40 years. Nine of ten people with Sjögren’s syndrome are women.2

What Is Sjögren’s Syndrome In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Huang YF, Cheng Q, Jiang CM, An S, Xiao L, Gou YC, Yu WJ, Lei L, Chen QM, Wang Y, Wang J. The immune factors involved in the pathogenesis, diagnosis, and treatment of Sjogren’s syndrome. Clin Dev Immunol. 2013;2013:160491. doi: 10.1155/2013/160491. Epub 2013 Jul 9. [↩]
  2. nlm.nih.gov [↩] [↩]
  3. Fazaa A, Bourcier T, Chatelus E, Sordet C, Theulin A, Sibilia J, Gottenberg JE. Classification criteria and treatment modalities in primary Sjögren’s syndrome. Expert Rev Clin Immunol. 2014 Apr;10(4):543-51. doi: 10.1586/1744666X.2014.897230. [↩]
  4. Cornec D, Saraux A, Cochener B, Pers JO, Jousse-Joulin S, Renaudineau Y, Marhadour T, Devauchelle-Pensec V. Level of agreement between 2002 American-European Consensus Group and 2012 American College of Rheumatology classification criteria for Sjogren’s syndrome and reasons for discrepancies. Arthritis Res Ther. 2014 Mar 19;16(2):R74. [↩]
  5. Witte T. Pathogenesis and diagnosis of Sjögren’s syndrome. Z  Rheumatol. 2010 Feb;69(1):50-6. doi: 10.1007/s00393-009-0519-2. [↩]

DHA (Docosahexaenoic Acid) Deficiency

Smoked Salmon...Brain Food that's Good for the Eyes!
Salmon…Brain Food That’s Good for Your Eyes, Heart, Blood Vessels, Blood Sugar, Liver, Muscles, and Fights Inflammation!

What Is DHA?

[dropcap]D[/dropcap]ocosahexaenoic acid (DHA) is an essential omega-3 fatty acid that is abundant in the brain, being crucial in brain structure. As such DHA is a key component of neuronal membranes together with arachidonic acid (a major opposing omega-6 fatty acid), making up 15-20% of the brain’s dry mass.

This polyunsaturated fatty acid is obtained from fish sources of food.

In healthy human volunteers, positron emission tomography (PET) has shown that the normal human brain consumes 4.6 mg/day of DHA.1

DHA is particularly concentrated in highly active membranes such as nerve synapses (junctions) and photoreceptors in the eye (retina).

Q: How much DHA is in the retina?

A: DHA makes up more than 30% of the retina.2

In other roles, DHA is an  important building material for the eicosanoids, a large group of highly bioactive hormone-like substances including prostaglandins, leukotrienes, and thromboxanes that are involved in blood clotting, inflammation, and vasoconstriction.

DHA has been shown to increase insulin sensitivity as opposed to the opposite problem of insulin resistance, to improve muscle mass, and protect against non-alcoholic fatty liver disease.3

Egert et al. in a study of people aged 19 to 43 years with normal cholesterol showed that DHA intake significantly increased serum HDL (good) cholesterol. Also, DHA significantly decreased fasting serum triglycerides.4

What Is DHA Deficiency In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Rapoport SI. Brain arachidonic and docosahexaenoic acid cascades are selectively altered by drugs, diet and disease. Prostaglandins Leukot Essent Fatty Acids. 2008 Sep-Nov;79(3-5):153-6. Epub 2008 Oct 29. [↩]
  2. Richardson AJ. The importance of omega-3 fatty acids for behavior, cognition, and mood. Scandinavian Journal of Nutrition. 2003;47(2):92-8 [↩]
  3. Espinosa A, Valenzuela R, González-Mañán D, D’Espessailles A, Guillermo Gormaz J, Barrera C, Tapia G. Prevention of liver steatosis through fish oil supplementation: correlation of oxidative stress with insulin resistance and liver fatty acid content. Arch Latinoam Nutr. 2013 Mar;63(1):29-36. [↩]
  4. Egert S, Kannenberg F, Somoza V, et al. Dietary alpha-linolenic acid, EPA, and DHA have differential effects on LDL fatty acid composition but similar effects on serum lipid profiles in normolipidemic humans. J Nutr. 2009;139:861–868. doi: 10.3945/jn.108.103861 [↩]

EPA (Eicosapentaenoic Acid) Deficiency

Macherel...
Macherel…EPA Rich!

What Is EPA?

[dropcap]E[/dropcap]PA (eicosapentaenoic acid) is an essential omega-3 fatty acid that is crucial for fetal brain and retina development and the child’s subsequent neurodevelopment among very many other activities in people of all ages.

Omega-3 fatty acids  are polyunsaturated long chain fatty acids which must be obtained from animal foods since they do not occur in plants.

In all ages, EPA is essential for normal brain function.

Q: Why is EPA essential to the way the brain works?

A: EPA helps nerve cells in the brain to communicate with each other.

In pregnancy, EPA may also play a role in determining the length of gestation and in preventing perinatal depression in the mother.1 and is essential for normal growth in children.

EPA is important building material for the eicosanoids, a large group of highly bioactive hormone-like substances including prostaglandins, leukotrienes, and thromboxanes that are involved in blood clotting, inflammation, and vasoconstriction. Its many important functions are described below.

What Is EPA Deficiency?

Sources:
  1. Coletta JM, Bell SJ, and Roman AS. Omega-3 Fatty Acids and Pregnancy. Rev Obstet Gynecol. 2010 Fall; 3(4): 163–171 [↩]

Vitamin A Deficiency

Mango Salad.
Mango Salad.

What Is Vitamin A?

[dropcap]V[/dropcap]itamin A is a family of fat-soluble compounds that are essential for health, vision, protection of the body, reproduction, and normal growth of children before and after birth.

Q: What is the family of vitamin A?

A: The natural vitamin A family members are called retinoids. Retinoids are found only in animal food sources. They include retinol (alcohol form), retinal (aldehyde form), and retinoic acid (acid form).

In the plant kingdom, pigments called carotenoids can yield retinoids on metabolism in the body. Carotenoids that can converted to retinol include β-carotene, α-carotene, and β-cryptoxanthin.1

There are hundreds of various carotenoids although only a few have been researched including beta-carotene, lycopene, lutein and zeaxanthin.

Fruits and vegetables that are a rich source of carotenoids are thought to provide health benefits by decreasing the risk of various diseases, particularly eye diseases and certain cancers (esophageal, stomach, pancreatic, bladder and cervical). In this respect, research shows that the regular consumption of fruits and vegetables may prevent 20% of most types of cancers.2

In part, the beneficial effects of carotenoids are thought to be due to their role as antioxidants. Lutein and zeaxanthin may be protective in eye disease because they absorb damaging blue light that enters the eye.3

The antioxidant effects appear to be highest in fresh fruit as compared to preserved fruit. A study of fresh peach pulps and peel in animals demonstrated highest antioxidant and anti-inflammatory effects in fresh fruits preventing against induced damage in animal tissues.4

A study investigating the specific anti-inflammatory and anti-oxidant micronutrients that reduce oxidative stress showed that adolescents with metabolic syndrome (MetS) had consistently lower carotenoid concentrations compared with their counterparts without MetS. MetS prevalence was estimated at 7% among boys and 3% among girls.5

What Is Vitamin A Deficiency In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Maggio M, de Vita F, Lauretani F, et al. Relationship between Carotenoids, Retinol, and Estradiol Levels in Older Women. Nutrients. 2015 Aug 5;7(8):6506-19. doi: 10.3390/nu7085296. [↩]
  2. Gasparotto J, Somensi N, Bortolin RC, Moresco KS, Girardi CS, Klafke K, Rabelo TK, Morrone Mda S, Vizzotto M, Raseira Mdo C, Moreira JC, Gelain DP. Effects of different products of peach (Prunus persica L. Batsch) from a variety developed in southern Brazil on oxidative stress and inflammatory parameters in vitro and ex vivo. J Clin Biochem Nutr. 2014 Sep;55(2):110-9. doi: 10.3164/jcbn.13-97. Epub 2014 Sep 1. [↩]
  3. Krinsky NI1, Johnson EJ. Carotenoid actions and their relation to health and disease. ((Mol Aspects Med. 2005 Dec;26(6):459-516. [↩]
  4. Gasparotto J, Somensi N, Bortolin RC, Moresco KS, Girardi CS, Klafke K, Rabelo TK, Morrone Mda S, Vizzotto M, Raseira Mdo C, Moreira JC, Gelain DP. Effects of different products of peach (Prunus persica L. Batsch) from a variety developed in southern Brazil on oxidative stress and inflammatory parameters in vitro and ex vivo. J Clin Biochem Nutr. 2014 Sep;55(2):110-9. doi: 10.3164/jcbn.13-97. [↩]
  5. TGBeydoun MA, Canas JA, Beydoun HA, Chen X, Shroff MR, Zonderman AB. Serum antioxidant concentrations and metabolic syndrome are associated among U.S. adolescents in recent national surveys. J Nutr. 2012 Sep;142(9):1693-704. doi: 10.3945/jn.112.160416. [↩]

Dry Eye, Autoimmune (Keratoconjunctivitis Sicca)

Eye Stabilized with Cyclosporin Drops.
Eye Stabilized with Cyclosporin Eye Drops. Inflammation Controlled,  Still Edematous. GFW

What Is Keratoconjunctivitis Sicca?

Keratoconjunctivitis sicca is a distressing autoimmune form of dry eye that causes chronic bilateral dessication (dryness of both eyes) with inflammation of the conjunctiva and cornea due to tear abnormality.

Little sores develop that cause the symptoms and which can be seen through staining procedures. Thickening of the cornea may result, impairing vision, but there is not loss of tissue.

Q: What is tear abnormality?

A: Tear abnormality means that something is wrong with production of tears that continuously bathe the eyes to keep them moist, create a smooth surface for clear vision, nourish the cornea, wash away debris, and protect against germ invasion.

These tears are not the same composition as the tears produced when crying. Rather, they are a complex three layer fluid called the tear film. The tear film is made by the combined action of three eye structures: lacrimal glands produce an aqueous layer, Meibomian glands in the eyelids produce a lipid (oil) layer that coats the aqueous layer, and goblet cells in the conjunctiva produce a mucous layer that spreads the tear layer.

A qualitative and quantitative deficiency of tears can lead to the persistent and progressive damage of the ocular surface with a compromised wound-healing process. 

What Is Keratoconjunctivitis Sicca In Celiac Disease and/or Gluten Sensitivity?

Keratomalacia

Keratomalacia in a severely malnourished 10-month-old Indonesian boy. (Sommer A, Sugana T: Corneal xerophthalmia and keratomalacia. Arch Ophthalmol 100:404, 1982)
Keratomalacia in a severely malnourished 10-month-old Indonesian boy.1

What Is Keratomalacia?

[dropcap]K[/dropcap]eratomalacia is a severe non-inflammatory eye condition characterized by a hazy, dry cornea that becomes softened and denuded (loss of protective layer), which when liquified is then irreversibly destroying the eyeball and causing blindness.

The conjunctiva and lacrimal glands (tear producing) are also affected resulting in ulceration of the eye surface with, or without, Bitot’s spots (foamy patches) because these tissues also require adequate vitamin A to function normally.

The conjunctiva is the mucous membrane that lines the inside of the eyelids and covers the eyeball surface, also called the white of eye.

Q: What does the term keratomalcia mean?

A: In the term keratomalcia, kerato refers to the cornea and malacia means softening of the tissues.

What Is Keratomalacia In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Sommer A, Sugana T: Corneal xerophthalmia and keratomalacia. Arch Ophthalmol 100:404, 1982 [↩]