Intestinal Health and Sjögren’s Syndrome

Anke Gooskens


Intestinal Health and Sjögren’s Syndrome


Anke Gooskens   Haarlem Netherlands

27 APRIL 2017


The immune system


In autoimmune diseases, including in Sjogren's disease, intestinal mucosa and intestinal flora are often affected. Consequence is an intestinal hyperpermeability, popularly called a leaky gut. That gives unwanted, large nutrient molecules that can slip through the intestinal epithelial cells. The result is that the immune system starts an immune response, in the form of immune complexes, resulting in (chronic) inflammatory reactions.


Hippocrates the father of Western medicine and founder of the Hippocratic oath said 2500 years ago "all diseases begin in the gut". With 400 m2 intestinal mucosa, the immune system of the intestine is the largest of the entire body. More than 80% of the immune responses in the body come from the gut. It guarantees an almost impenetrable barrier between the outside and inside world for the bacteria, viruses and other pathogens present in the intestine.


It is also a barrier against foreign proteins from food. The body has a great tolerance for nutrition, on the condition that it is properly digested and passes the intact intestinal wall in the intended way, namely through the intestinal mucous cells.A lesson in the immune system


A lesson in the immune system


Before we go deeper into the relationship between autoimmune diseases and intestines, first briefly about the defense (= immune system) and the role of the intestines inside. The immune system includes a non-specific and specific immune system that must control the growth of foreign substances, parasites, yeasts, fungi and other pathogenic microorganisms.


In the digestive tract, the innate non-specific immune system consists of gastric acid that eliminates many harmful microorganisms. Furthermore, the intestinal mucosa is packed with leukocytes (= white blood cells) that attack microorganisms. In addition, it produces natural antibiotics and offers a home to 1.5 kg of good intestinal bacteria. This healthy intestinal flora is of great importance for a balance in our 'soil life' in the intestine and for an intact intestinal mucosa.


The specific defense is an acquired immunity through 'training'. It consists of B and T lymphocytes that are born from stem cells in the red bone marrow. And then they are trained in the spleen or thymus to learn the distinction between what is proper and strange.


The adult B and T cells move through the blood and lymph system to those tissues in need of defense. The B cells switch off specific foreign substances and pathogens through the production of antibodies (= globulins). The T-lymphocytes (= T-cells), including cytotoxic T-cells, T-memory cells, T helper cells and T-suppressor cells, destroy cancer cells and virally or bacterially infected body cells


The immune system in the intestinal mucosa: GALT


The immune system in the gut is called the GALT, the Gut Associated Lymphoid Tissue. This includes the connective tissue directly under the intestinal epithelial layer of a cell thick, containing B, T lymphocytes and phagocytes, lymph nodes (= lymph nodes), Peyer plaques (aggregations of lymphocytes) spread over the intestinal mucosa and the appendix full of lymph node tissue. Note: 1 gram of intestinal tissue contains 1 million immune cells.


The GALT is part of the MALT (Mucosal Associated Lymphoid Tissue), a common immune / lymphatic system of all mucous membranes in the body. In addition to the intestinal mucosa (400 m2), the MALT includes eye, throat, mouth and nasal mucosa (1 m2), skin (2 m2), bronchus mucosa (100 m2), urogenital mucosa (1 m2) and glandular tissue in tonsils. pancreatic gland and the breasts. This lymphatic system ensures that activation of white blood cells in the intestinal mucosa can cause an immune response, via transport through lymph tracts and blood flow, into other mucous membranes. Examples of this type of reaction 'at a distance' are a runny nose, itching on the skin or tightness after eating a certain food allergen.


A properly functioning GALT is required for properly functioning mucous membranes in the body. An intact intestinal mucosa and a balanced intestinal flora are essential for this.An intact intestinal mucosa is essential for good resistance



Factors that undermine are:


1) allergens that damage the intestinal mucosa. The most common allergies are those for gluten, cow's milk, chicken's egg, soy and peanut

2) physical and emotional stress: the stress hormone cortisol has a negative effect on the intestinal mucosa,

3) the presence of intestinal parasites, yeasts and fungi. These produce toxins that affect the intestinal mucosa

4) medicines that affect the intestinal mucosa, such as antibiotics, chemotherapeutics, NSAIDs (Ibuprofen, Aspirin) and the contraceptive pill,

5) chemicals in food and environment

6) alcohol abuse


Factors that promote the construction and maintenance of the intestinal mucosa are:

1) Fibers from fruits and vegetables: colon bacteria live on fiber and produce butyric acid, an energy source for the intestinal mucous cells,

2) L-glutamine: fuel for intestinal epithelial cells and white blood cells

3) Zinc: important mineral in the formation of goblet cells (Goblet cells), and for resistance to inflammation,

4) Vitamin A: for renewal epithelium of mucous membranes,

5) Vitamin D: inhibits inflammatory reactions,

6) Omega-3 fatty acids from fatty fish: EPA & DHA: keep intestinal mucus healthy by beneficial effect on inflammatory inflammation,

  1. Vitamin B12: promotes the functioning of the immune system.


A balanced intestinal flora gives a good resistance

Factors that promote a balanced intestinal flora are:

1) a natural birth: vaccination of intestinal bacteria takes place during birth. Children born with caesarean section have a significantly less varied intestinal flora (= microbiome). The sterile intestine of the baby is grafted with the vagina bacteria of the mother. The vaginal flora is related to the intestinal flora of the mother.

2) (long-term) are fed with breastfeeding: ensures a better intestinal flora. The good intestinal bacteria, bifido-lactobacilli feed the intestinal mucosa and thus keep the mucous membrane intact.

Factors that undermine a balanced intestinal flora are:

1) intestinal infections and long-term diarrhea,

2) chronic (low-grade) intestinal wall infections,

  1. medications such as antibiotics NSAIDs (aspirin, Ibuprofen), gastric acid inhibitors, contraceptives and chemotherapeutic agents, cortisone preparations, osmotic laxatives as bowel preparation for performing and colonoscopy. After an antibiotic treatment, preferably during use, always use a good probiotic with these medicines



Damage to intestinal mucosa and intestinal flora causes leaky gut


In autoimmune diseases, including in Sjogren's disease, intestinal mucosa an intestinal flora are often affected. The result is intestinal hyperpermeability, popularly called a 'leaky gut'. The leaky gut arises because the connections between the intestinal mucous cells (= intestinal epithelial cells), the so-called tight junctions (the customs of our intestines), are damaged.


The result is that unwanted large food molecules can slip through the intestinal epithelial cells. Microorganisms can not pass through the tight junctions because they are many times larger than the resulting openings in the intestinal mucosa. The result is that the immune system starts an immune response against these nutritional proteins, in the form of immune complexes. With IgG related (chronic) inflammatory reactions.



Have Leaky gut examined


What can you do when you suspect a Leaky Gut? One hundred percent certainty can only be obtained by means of a gut biopsy. However, this is cumbersome and expensive. An indirect measurement is the measurement of food intolerances by means of the measurement of IgG food reactions in blood. A high concentration of IgG antibodies of a particular foodstuff indicates regular contact of B lymphocytes with this food allergen.


This antigen-antibody complex is eliminated by inflammation in the body. This inflammatory process takes place continuously when eating a food allergen. An extensive laboratory analysis of blood for the presence of IgG antibodies against foodstuffs, the ImuPro test, can be carried out by the Pro Health Medical laboratory.


It is also possible to have a stool examination conducted by a natural-medicine dietician at a specialized laboratory. By measuring indicators of immunity of mucous membranes (sIgA, Betadefensin 2) and intestinal inflammations (calprotectin, alpha 1 - anti-trypsin, lactoferrin) one gets an idea of ​​the degree of inflammation in the intestinal mucosa.



Nutritional advice for a leaky gut


A) Remove food allergens and food that is intolerant.

In the top 5 of food allergens are: gluten (contains wheat, spelled, barley, rye, kamut and oats), milk (products), eggs, soya (products) and peanuts.

Gluten-free alternatives are buckwheat, quinoa, maize, rice, potato flour, arrowroot,, tapioca, millet, agar-agar, guar (kernel flour) etc 

Oats do not contain gluten, but are often contaminated with gluten-grains at the factory.

Lecithin: is often not digested and affects the intestinal mucosa. It is in beans and all grains, especially wheat.


B) Vary with food and spell out seasonal breaks.

Do not eat the same products every day. Eating allergies every day and throughout the year, causes allergies. Our immune system is not equipped for this.


C) Eat a lot of vegetables, herbs and fruit.

The fibers in vegetables and fruits of the season are a food source for the good bacteria in the intestine. Vegetables that contain a lot of prebiotics, food for the probiotics (= good intestinal flora) are: artichoke, banana, onion, asparagus, leek, Jerusalem artichoke and salsify.


D) Avoid sugar.

Sugar promotes the growth of pathogenic bacteria and fungi. Only eat natural sugars from fruit and vegetables and avoid sugary drinks, cookies and sweets. White flour products such as spaghetti, macaroni and white bread are easily converted into sugars in the digestive tract.


E) Eat as little industrial processed food as possible.

Eat as many natural, unprocessed products as possible, so choose from the fresh, preferably organic, fruit and vegetables. Can be found in the fresh islands in the supermarket. Use real (grass) butter, cold-pressed olive oil from cold, pressed oils.


F) Eat fermented products.

You can think of: sauerkraut, bread drink, fermented vegetable juices, buttermilk, (goat / sheep) yogurt, biogarde, natural sprouts, miso, tamari, shoyu, tempé and kombucha. They contain good intestinal bacteria. Note: it may be sensitive to histamine-free foods such as sauerkraut and other fermented products.


G) Pamper and repair the intestinal mucosa.

- Take your own drawn bone and bone broth ('see youtube: chickenbroth'), distributed throughout the day: 2 cups. Contains the amino acids L-glutamine, gelatin, proline and glycine for building up mucous membranes.

- Use a few tablespoons of unrefined coconut oil daily. It contains MCTs (medium fatty acids): lauric acid and caprylic acid. It nourishes the intestinal mucosa and kills pathogens such as bacteria, fungi / yeasts / viruses. Coconut oil may be heated to a high temperature, unlike olive oil.

- Eat butter or ghee (clarified butter) regularly . Contains vitamin A, D, E and butyric acid. Real butter contains omega-3 fatty acids, but no lactose / milk sugar.

- Avoid vegetable omega-6 fatty acids and fatty meat: this increases the pro-inflammatory prostaglandin E2.

- Take 1 tablespoon of cod liver oil per day.

- Eat wild, oily fish such as salmon, mackerel, herring, sardines 3 times a week. This contains the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), these work anti-inflammatory

- Iron (from red meat) can easily be absorbed into the haem shape. For absorption of iron, lactoferrin, produced by the intestinal mucosa, is required. In case of damage to the intestinal mucosa, supplementation may be necessary. Red meat is rich in zinc and important amino acids for building up the intestinal mucosa

- Use sufficient animal products, meat, fish, eggs, dairy i.v. vitamin B12 for building up intestinal epithelial cells. Numerous diseases in the gastrointestinal tract, also autoimmune diseases, are accompanied by a reduced vitamin B12 intake. Let the vitamin B-12 measure in the blood. The normal value of vitamin B12 is 600-2000 pg / ml *, much higher than the normal value of the physician's laboratory.

- Ginger root stimulates the digestive enzyme, bile acid production. Drink it while you eat

- Aloe Vera repairs the intestinal mucosa, works soothing

- Fermented vegetables contain lactobacilli and are easily digestible

- Turmeric (koenjit / turmeric) prevents inflammation

- Eat a lot of vegetables (steamed and moderately raw). They supply various types of fibers (glyco nutrients) and folic acid. Cabbages (broccoli, cauliflower etc.), carrots, celery, pumpkin, green leafy vegetables.

  • Pumpkin seeds contain B-vitamins, zinc, magnesium (for the production of digestive enzymes and necessary for bowel repair).

H) Remove infectious pathogens

. In particular, the presence of intestinal parasites, fungi / yeasts, bacterial overgrowth in small intestine (SIBO) and colon can affect the intestinal mucosa.

I) Feed the intestines with good probiotics and prebiotics.

- Probiotic foods are fermented vegetables such as sauerkraut. Contain lactobacilli and create a favorable pH in the intestine.

- Prebiotics, food for the probiotics / intestinal bacteria, can be found in: inulin in onion, leek, garlic, artichoke, asparagus

- Fructo Oligo Saccharides (FOS): all kinds of fruits and vegetables, including banana, onion, garlic, asparagus

- Pectin: apples, apricots, carrot, orange, banana, tomatoes, (sweet) potato. If this is not satisfactory, use probiotics, especially if antibiotics have been prescribed

- Galacto-oligosaccharides (CIS) are the ultimate prebiotics. Galacto-oligosaccharides (GOS) are a specific form of prebiotic galactose sugars. It is one of more than 200 biologically active sugars that occur naturally in breast milk. They belong to the group of 'Human Milk Oligosaccharides' (HMO) carbohydrates. They are complex in structure and have a broad spectrum of biological effects that are further rich than just providing nutrition to infants.


Based on the available data, GOS can be regarded as the most ultimate prebiotics. They simply provide a better growth of the intestinal flora than other types of prebiotics such as fructo-oligosaccharides (FOS), xylooligosaccharides (XOS), soya-oligosaccharides (SOS), inulin, lactulose etc. GOS is extremely well tolerated and even during a FODMAP diet and SIBO diet can be used.

The greatest effect on fiber intake by the intestinal flora is obtained by short-chain fatty acids and gases such as hydrogen and carbon dioxide. The short-chain fatty acids are usually in the spotlight as extremely beneficial for the body. Hydrogen gas (H2), on the other hand, is very underexposed. The balance between oxygen and hydrogen or oxidation and reduction is essential in living organisms.


- Eat a lot of vegetables (steamed and moderately raw). They supply various types of fibers (glyco nutrients) and folic acid. Cabbages (broccoli, cauliflower etc.), carrots, celery, pumpkin, green leafy vegetables.

- Pumpkin seeds contain B-vitamins, zinc, magnesium (for the production of digestive enzymes and necessary for bowel repair).


Hydrogen is interesting because it acts as a selective antioxidant that neutralises the most dangerous free radicals (hydroxyl radicals). It is unique in this because it does not disturb other radicals that are important for the functioning of the body. In addition, it activates other antioxidant enzymes, cell protective proteins and functions as an important signaling molecule.


Relaxation gives a stronger intestinal flora

Take rest and time for food and other things. Together with self-reflection and mindfulness this supports the parasympathetic. 


Stress weakens the intestinal flora and the immune system. 


And last but not least: make sure you chew your food well.



Anke Gooskens, natural dietitian


Nederlandse Vereniging van Diëtisten


Vereniging van Natuurgeneeskundig Therapeuten

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