Understanding the role of gut bacteria in Sjögren's syndrome

Sjögren's syndrome is a chronic autoimmune disorder characterised by dryness of the eyes and mouth due to inflammation and dysfunction of the salivary and lacrimal glands. 

Sjogren’s syndrome is a systemic autoimmune condition, so as with other systemic conditions, it can be difficult to diagnose as the symptoms could relate to many different disorders.

For example, I was never diagnosed with Sjogren’s, but I used to have chronically dry eyes, which, when I was working in a corporate office, would stream to the point that it affected my vision, which is a typical symptom of dry eyes. 

My dentist also told me that my saliva glands were inflamed, and at the time, I had a chronically dry mouth, so I was meant to be referred to a specialist. However, I didn’t hear anything more about it, and by the time I remembered, my symptoms were improving, so I didn’t follow up.

It’s worth understanding how different symptoms combine in systemic autoimmune diseases, as piecing these together can provide insight into the underlying cause.

While the exact cause of Sjögren's syndrome remains elusive, emerging research has highlighted the potential role of gut bacteria in its development. 

This article explores the key factors, including specific gut bacteria, implicated in the pathogenesis of Sjögren's syndrome.

The gut microbiota and autoimmunity

The human gut harbours a diverse community of microorganisms collectively known as the gut microbiota. These microbes are crucial in maintaining intestinal homeostasis, modulating immune responses, and influencing systemic health. 

Imagine the gut microbiota as an office teeming with workers: beneficial bacteria act as efficient managers maintaining order and balance, while functional bacteria are the specialists performing essential tasks like nutrient processing and immune regulation. 

Commensal bacteria serve as the diligent support staff handling daily maintenance, ensuring smooth operations. 

However, when harmful bacteria – akin to office troublemakers – invade, they disrupt the workflow, causing chaos and illness, such as autoimmune disease.

That is why stool testing can be so beneficial. It not only tests for maldigestion, inflammation, and dysbiosis but also provides a full profile of the different gut bacteria residing in your gut, so you know where your internal office might be lacking resources. The good news is that there is something that you can do naturally to help if you have missing employees. 

Gut dysbiosis and Sjögren's syndrome

Disruptions in the composition and function of gut bacteria, termed dysbiosis, have been increasingly linked to various autoimmune diseases, including Sjögren's syndrome.

Research into the relationship between gut bacteria and Sjögren's syndrome is still in its early stages, but several key findings about gut issues in those with Sjögren's syndrome have been identified.

For example, those with Sjögren's syndrome often exhibit altered gut microbiota compositions compared to healthy controls. This dysbiosis may include reduced microbial diversity and imbalances in specific bacterial taxa. 

Most of the clients I have worked with who have had Sjogren’s have had no growth of key bacteria in their gut and a high growth of more harmful bacteria, which can create chaos at the gut barrier. 

Dysbiosis can increase intestinal permeability, allowing microbial products such as lipopolysaccharides (LPS) to translocate into the bloodstream. 

LPS, found in gram-negative bacteria, can contribute to cross-reactivity in Sjögren's syndrome by triggering immune responses that mistakenly target the body's own tissues. 

This occurs through molecular mimicry, where LPS resembles self-antigens in salivary and lacrimal glands, leading to autoimmune attacks. LPS can also cause bystander activation of immune cells, enhance the presentation of autoantigens, and induce inflammation that damages tissues and exposes hidden antigens, all of which exacerbate autoimmune reactions in Sjögren's syndrome.

The pattern I see commonly in my clients with Sjogren’s syndrome is an inability to break down fats in their gut, which can be linked to gallbladder and liver function. They also have a high growth of gram-negative bacteria, which means more production of LPS. More LPS leads to more inflammation and autoimmunity. 

Conversely, beneficial gut bacteria such as Lactobacillus and Bifidobacterium species have immunoregulatory properties that help maintain immune tolerance and reduce inflammation. The depletion of these beneficial bacteria may, therefore, contribute to autoimmune dysregulation. And at least 50% of my clients with autoimmune diseases have very low or no growth of these beneficial bacteria. 

Mechanisms of gut-immune axis in Sjögren's syndrome

The gut-immune axis refers to the bidirectional communication between gut microbiota and the immune system. 

In the context of Sjögren's syndrome, this interaction is thought to influence autoimmune processes through several mechanisms. For example, gut bacteria influence mucosal immune responses, which are interconnected with mucosal surfaces in the eyes and mouth affected by Sjögren's syndrome.

One vital beneficial bacteria in the mucosal immune system is Akkermansia muciniphila. This bacteria plays a crucial role in maintaining the integrity of mucosal surfaces by degrading mucin and promoting mucus production. 

In Sjögren's syndrome, reduced levels of Akkermansia may lead to impaired gut barrier function, contributing to systemic inflammation and potentially exacerbating autoimmune attacks on mucosal surfaces, including the salivary and lacrimal glands. Akkermanisia thrives on polyphenol-rich foods, so if your diet is lacking in these, then your growth of Akkermansia is likely to be reduced. 

But there is hope. In my clinical practice, The Autoimmunity Nutritionist, I have seen many clients with unbearable Sjogren’s syndrome find relief after working on their gut health, and the same happened to me, too. 

However, while the link between gut bacteria and Sjögren's syndrome is promising, further research is needed to elucidate specific bacterial strains and mechanisms involved. 

It would also be valuable to know the microbial signatures or biomarkers that could predict disease susceptibility so that those with Sjögren's syndrome or those at risk of Sjögren's syndrome can take a proactive approach. 

Your gut is central to every system and organ in your body, so whether you have an autoimmune disease or an inflammatory condition, working on your gut health should be your main priority when it comes to reducing your symptoms and having long-lasting results.