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What Causes Sjögren’s Syndrome

What Causes Sjögren’s Syndrome

What Causes Sjögren’s Syndrome – And How To Manage It

Exactly what causes Sjögren’s syndrome is not known, although autoimmune conditions result from a combination of genetics, toxin exposure, and microbiome dysfunction. Sjögren’s syndrome is a disease that affects the immune system, characterized by a dry mouth and dry eyes. It frequently occurs alongside other autoimmune conditions such as lupus and rheumatoid arthritis.1 Typically, women are more affected than men, and it usually develops in people over 40 years old.2

Sjögren’s syndrome is caused by chronic inflammation that goes unchecked, causing the immune system to become overactive and attack healthy cells, gradually destroying them.

Sjögren’s Syndrome And Increased Rates Of Lymphoma

Lymphomas are typically divided into two categories, Hodgkin’s disease and non-Hodgkin’s lymphoma (NHL). 

While NHL is more common overall, those with Sjögren’s Syndrome have been found to be more likely to develop Hodgkin’s disease. This means that the risk of developing this type of lymphoma is higher in people with Sjögren’s Syndrome than in the general population.3

What Causes Sjögren’s Syndrome – 3-Legged Stool

Foundational health can be described using the analogy of a 3-legged stool. If any of the legs are broken, the stool will not stand up and this will lead to a decline in health. The 3 legs that hold up the stool, limited exposure to stressors, a healthy microbiome, and optimal epigenetic expression, need to be functional to prevent and reduce chronic inflammation. Chronic inflammation is behind autoimmune conditions like Sjögren’s Syndrome.

Read more about inflammation.

What Causes Sjögren’s Syndrome

What Causes Sjögren’s Syndrome – Genetics

Genetics is one of the main causes of Sjogren’s syndrome. Research has shown that certain genes may increase a person’s risk of developing this autoimmune disorder. People with family members who have Sjogren’s syndrome, especially siblings, have an increased chance of developing it too. 

Studies also suggest that certain combinations of genes may increase a person’s risk even more. Additionally, people with certain types of antibodies, such as an antinuclear antibody (ANA) and Ro/SSA autoantibody, have an increased risk of developing Sjogren’s syndrome. Finally, some research suggests that the female sex hormone estrogen may play a role in the development of Sjogren’s syndrome.4

What Causes Sjögren’s Syndrome – Stressors

Stressors are one of the many causes of Sjogren’s Syndrome. Stress can cause an increase in inflammation, which may trigger the symptoms associated with Sjogren’s Syndrome. Psychological stress or physical trauma can both be triggers for Sjögren’s Syndrome. Additionally, emotional stress from life changes and dealing with a chronic illness can also be a factor.5

What Causes Sjögren’s Syndrome – Mitochondria Dysfunction

Mitochondria dysfunction is thought to be a possible cause of Sjögren’s Syndrome. Mitochondria are organelles found in almost every cell in the body, and they are responsible for producing energy through a process called oxidative phosphorylation. When mitochondria don’t work properly, it can lead to fatigue, muscle weakness, and other problems.

In Sjögren’s Syndrome, it is thought that a malfunctioning of the mitochondria in immune cells may lead to an autoimmune response. When this happens, the body starts attacking itself as if it were fighting off foreign invaders or pathogens. This can cause inflammation and damage to tissues and organs, leading to the symptoms of Sjögren’s Syndrome.6

Some studies have found that people with Sjögren’s Syndrome have higher levels of reactive oxygen species (ROS) in their cells, which could contribute to mitochondrial dysfunction.

What Causes Sjögren’s Syndrome - Mitochondria Dysfunction

What Causes Sjögren’s Syndrome – Oxidative Stress

Oxidative stress is a major factor contributing to Sjögren’s Syndrome. Oxidative stress can result from increased production of reactive oxygen species due to inflammation or defective antioxidant systems. It is associated with tissue damage, including joint destruction, in autoimmune rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren’s syndrome.7 

Oxidative stress contributes to inflammation by inducing immune cell activation and the release of proinflammatory cytokines. Treatment strategies targeting oxidative stress are aimed at decreasing inflammation, reducing oxidative damage to tissue, and attenuating disease activity.8

What Causes Sjögren’s Syndrome – Environmental Factors

Infections are another potential cause of Sjögren’s Syndrome. Viruses such as Epstein-Barr virus, Cytomegalovirus, and human herpesvirus 6 have been linked to the condition. Additionally, certain bacteria, including those that cause tuberculosis and hepatitis C, are also known to be related to Sjögren’s Syndrome. It is important to note that many people who have these infections don’t develop Sjögren’s Syndrome, so it is unclear if the infections are directly responsible for the condition.9 10 11 12

What Causes Autoimmune Conditions – Environmental Toxins

Environmental toxins such as heavy metals, chemicals, airborne pollutants, or molds can trigger an autoimmune reaction. Research suggests that these toxins damage the intestinal lining, which allows larger molecules to enter the bloodstream and stimulate an immune response. Additionally, chronic inflammation caused by exposure to environmental toxins leads to autoimmune conditions.

What Causes Sjögren’s Syndrome – Toxins

Environmental factors play a role in the development of Sjogren’s syndrome, including exposure to certain environmental toxins. Certain chemicals, such as benzene, found in polluted air and water, can increase the risk of developing autoimmune conditions like Sjögren’s Syndrome. 

Other studies have suggested that agents such as dichloromethane, perchloroethylene, and toluene, used in manufacturing, and organic solvents found in industrial processes increase the risk of developing Sjögren’s Syndrome.13

What Causes Sjögren’s Syndrome - Toxins

Treating Sjögren’s Syndrome

The typical treatments available for Sjögren’s Syndrome include the use of artificial tears or saliva substitutes to relieve dryness, as well as medications to reduce inflammation and improve the immune system’s response. However, these treatments do little to target the underlying cause of the disease.14

What Causes Sjögren’s Syndrome – Diet

Compared to age-matched controls, women with Sjogren’s Syndrome consume higher amounts of calories, glutamate, carbohydrates, lactose, phosphorus, caffeine, thiamine, and riboflavin. This was attributed to higher milk consumption among women who suffer from Sjogren’s Syndrome.15

Read more about a healthy diet.

What Causes Sjögren’s Syndrome – Low Vitamin D Levels

Low vitamin D levels contribute to the development of Sjögren’s syndrome. Vitamin D helps regulate the immune system and maintain healthy tissue, including the salivary glands which are affected in Sjögren’s patients. Studies have found that patients with Sjögren’s Syndrome had lower than normal vitamin D levels. Vitamin D-rich foods and sun exposure help reduce symptoms of Sjögren’s syndrome and improve overall health in those who are deficient.16

Read more about the connection between low vitamin D levels and autoimmune conditions.

Treating Sjögren’s Syndrome – Vitamin B6

Low vitamin B6 levels are commonly found in people with Sjögren’s Syndrome and can be caused by a variety of factors, including diet, drug interactions, and deficiencies.17 Dietary causes of low vitamin B6 levels include inadequate intake of food sources rich in this nutrient such as fish, grass-fed meat, bananas, and avocados. 

Additionally, certain drugs, such as birth control pills and diuretics, can reduce vitamin B6 levels. Furthermore, a deficiency may be caused by malabsorption issues or problems with the body’s ability to absorb nutrients from food.

Treating Sjögren’s Syndrome – N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is an amino acid derivative with antioxidant properties that may be beneficial for people with Sjögren’s Syndrome. It helps to decrease inflammation and increase the production of saliva and tears by increasing levels of the natural antioxidant glutathione. 

Additionally, some research suggests NAC may help reduce fatigue associated with Sjögren’s syndrome. NAC is available in supplement form and can be taken orally or applied topically. 

Research on NAC in humans suggests that it has strong antioxidant properties and is useful in treating conditions such as heart disease, HIV infection, heavy metal toxicity, and other diseases caused by free radical damage.18

Read more about chronic fatigue syndrome.

Treating Sjögren’s Syndrome – Vitamin B12

People who suffer from Sjögren’s Syndrome have lower vitamin B12 levels than healthy individuals. Vitamin B12 can help reduce inflammation and boost the immune system. Studies have shown that supplementing with Vitamin B12 may be beneficial for people with Sjögren’s Syndrome, as it helps to reduce symptoms such as dryness of the eyes and mouth.19

Taking a daily Vitamin B12 supplement, in conjunction with other supplements, may help to lessen the impact of Sjögren’s Syndrome on a person’s daily life. Additionally, Vitamin B12 has been shown to help improve energy levels in people with Sjögren’s Syndrome, as well as provide an overall sense of well-being.

What Causes Sjögren’s Syndrome - And How To Manage It

What Causes Sjögren’s Syndrome – And How To Manage It

Now that you know what causes Sjögren’s syndrome, a combination of genetic factors environmental factors, an unhealthy microbiome, along with vitamin deficiencies, correcting these deficiencies makes it easier to manage the symptoms. 

Since so many autoimmune conditions correspond with low vitamin D levels, receiving adequate sun exposure or consuming foods that are high in vitamin D is prudent. Additionally, consume foods that contain high concentrations of vitamin B12, vitamin B6, and consider consuming an NAC supplement that will improve free radical scavenging throughout the body.


1 Sjögren’s Syndrome. (2021, April 7). National Institute of Arthritis and Musculoskeletal and Skin Diseases.

2 Sjögren’s syndrome – Symptoms and causes. (2022, August 2). Mayo Clinic. Retrieved September 17, 2022, from

3 Del Papa N, Vitali C. Management of primary Sjögren’s syndrome: recent developments and new classification criteria. Ther Adv Musculoskelet Dis. 2018 Feb;10(2):39-54. doi: 10.1177/1759720X17746319. Epub 2018 Jan 1. PMID: 29387177; PMCID: PMC5784475.

4 Teos LY, Alevizos I. Genetics of Sjögren’s syndrome. Clin Immunol. 2017 Sep;182:41-47. doi: 10.1016/j.clim.2017.04.018. Epub 2017 May 3. PMID: 28476436; PMCID: PMC5660941.

5 Skopouli FN, Katsiougiannis S. How stress contributes to autoimmunity-lessons from Sjögren’s syndrome. FEBS Lett. 2018 Jan;592(1):5-14. doi: 10.1002/1873-3468.12933. Epub 2017 Dec 22. PMID: 29223133.

6 Barrera MJ, Aguilera S, Castro I, Carvajal P, Jara D, Molina C, González S, González MJ. Dysfunctional mitochondria as critical players in the inflammation of autoimmune diseases: Potential role in Sjögren’s syndrome. Autoimmun Rev. 2021 Aug;20(8):102867. doi: 10.1016/j.autrev.2021.102867. Epub 2021 Jun 9. PMID: 34118452.

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8 Liguori I, Russo G, Curcio F, Bulli G, Aran L, Della-Morte D, Gargiulo G, Testa G, Cacciatore F, Bonaduce D, Abete P. Oxidative stress, aging, and diseases. Clin Interv Aging. 2018 Apr 26;13:757-772. doi: 10.2147/CIA.S158513. PMID: 29731617; PMCID: PMC5927356.

9 Fox RI, Pearson G, Vaughan JH. Detection of Epstein-Barr virus-associated antigens and DNA in salivary gland biopsies from patients with Sjogren’s syndrome. J Immunol. 1986 Nov 15;137(10):3162-8. PMID: 3021847.

10 Igoe A, Scofield RH. Autoimmunity and infection in Sjögren’s syndrome. Curr Opin Rheumatol. 2013 Jul;25(4):480-7. doi: 10.1097/BOR.0b013e32836200d2. PMID: 23719365; PMCID: PMC4410971.

11 Sipsas NV, Gamaletsou MN, Moutsopoulos HM. Is Sjögren’s syndrome a retroviral disease? Arthritis Res Ther. 2011 Apr 13;13(2):212. doi: 10.1186/ar3262. PMID: 21489323; PMCID: PMC3132012.

12 Gallo A, Jang SI, Ong HL, Perez P, Tandon M, Ambudkar I, Illei G, Alevizos I. Targeting the Ca(2+) Sensor STIM1 by Exosomal Transfer of Ebv-miR-BART13-3p is Associated with Sjögren’s Syndrome. EBioMedicine. 2016 Aug;10:216-26. doi: 10.1016/j.ebiom.2016.06.041. Epub 2016 Jun 29. PMID: 27381477; PMCID: PMC5006644.

13 Chaigne B, Lasfargues G, Marie I, Hüttenberger B, Lavigne C, Marchand-Adam S, Maillot F, Diot E. Primary Sjögren’s syndrome and occupational risk factors: A case-control study. J Autoimmun. 2015 Jun;60:80-5. doi: 10.1016/j.jaut.2015.04.004. Epub 2015 May 8. PMID: 25963068.

14 Vivino FB, Al-Hashimi I, Khan Z, LeVeque FG, Salisbury PL 3rd, Tran-Johnson TK, Muscoplat CC, Trivedi M, Goldlust B, Gallagher SC. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. Arch Intern Med. 1999 Jan 25;159(2):174-81. doi: 10.1001/archinte.159.2.174. PMID: 9927101.

15 Nesvold MB, Jensen JL, Hove LH, Singh PB, Young A, Palm Ø, Andersen LF, Carlsen MH, Iversen PO. Dietary Intake, Body Composition, and Oral Health Parameters among Female Patients with Primary Sjögren’s Syndrome. Nutrients. 2018 Jul 4;10(7):866. doi: 10.3390/nu10070866. PMID: 29973575; PMCID: PMC6073564.

16 Tincani A, Andreoli L, Cavazzana I, Doria A, Favero M, Fenini MG, Franceschini F, Lojacono A, Nascimbeni G, Santoro A, Semeraro F, Toniati P, Shoenfeld Y. Novel aspects of Sjögren’s syndrome in 2012. BMC Med. 2013 Apr 4;11:93. doi: 10.1186/1741-7015-11-93. PMID: 23556533; PMCID: PMC3616867.

17 Tovar AR, Gómez E, Bourges H, Ortíz V, Kraus A, Torres N. Biochemical deficiency of pyridoxine does not affect interleukin-2 production of lymphocytes from patients with Sjögren’s syndrome. Eur J Clin Nutr. 2002 Nov;56(11):1087-93. doi: 10.1038/sj.ejcn.1601450. PMID: 12428174.

18 N-acetylcysteine. Altern Med Rev. 2000 Oct;5(5):467-71. PMID: 11056417.

19 Urbanski G, Chabrun F, Schaepelynck B, May M, Loiseau M, Schlumberger E, Delattre E, Lavigne C, Lacombe V. Association of Primary Sjögren’s Syndrome and Vitamin B12 Deficiency: A Cross-Sectional Case-Control Study. J Clin Med. 2020 Dec 16;9(12):4063. doi: 10.3390/jcm9124063. PMID: 33339380; PMCID: PMC7765802.

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