In a recent case report published in the journal Frontiers in Nutrition, researchers discuss three case studies wherein women (ages 40, 54, and 45 years) suffering from Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE) reported remission of their symptoms following switching their diets to customized plant-based nutritional regimes. The diet consists mainly of leafy greens, omega-3 fatty acids, and cruciferous vegetables. While three isolated case studies are insufficient to establish causality or mechanisms, the success rate of these dietary interventions and their long-lasting effects (6 and 7 years) bookmark them as promising natural future interventions against these chronic diseases.
Case series: raw, whole, plant-based nutrition protocol rapidly reverses symptoms in three women with systemic lupus erythematosus and Sjӧgren’s syndrome. Image Credit: Maja Drazic / Shutterstock
Sjögren's syndrome, systemic lupus erythematosus, and the potential of dietary interventions
Sjögren's syndrome (SS) is a chronic autoimmune disease wherein moisture-producing glands, especially around the eyes and mouth, are damaged, leading to xerophthalmia (dry eyes) and xerostomia (mouth dryness). SS is often found in combination with systemic lupus erythematosus (SLE), another chronic autoimmune condition, albeit much less studied. Both conditions may be characterized by joint pain, severe swelling, and rashes, the latter of which can be found in a butterfly pattern on SLE patients' cheeks and noses.
While generally discomfort-inducing, SLE has been found to be associated with more serious conditions such as nephritis and pleuritis, making its increasing global prevalence alarming. SLE is currently estimated to affect 9.26 of every 100,000 men and 78.73 of every 100,000 women, though the reasons for this sexual dichotomy remain unknown.
Health behaviors, particularly sleep habits, physical activity levels, and dietary patterns, are increasingly being highlighted for their influence (both positive and adverse) on chronic disease. A growing body of literature documents the health benefits of maintaining good diet behaviors and sticking to healthy dietary regimes such as the Mediterranean diet. Research on whole-food, plant-based (WFPB) diets, in particular, suggests that these foods are capable of promoting positive weight and cardiometabolic outcomes.
These diets are developed with a focus on the consumption of raw foods, including high intakes of cruciferous vegetables, leafy greens, and seeds or oils rich in omega-3 fatty acids, in tandem with strict avoidance of processed foods, added oils, animal products, and added sugars. While not formally tested within a scientific framework, previous reviews have hypothesized that healthy vegetarian diets may help prevent or even reverse SS and SLE. Scientific verification of this hypothesis would serve to not only further improve vegetarian diets' stellar reputation but also form the basis for novel research aimed at discovering natural and safe interventions against chronic and debilitating diseases.
About the study
The present study summarises and discusses three case reports involving women suffering from both SLE and SS, who, following adherence to a strict 'Rapid Recovery Program (RRP)' developed by Dr. Brooke Goldner (BG), the study's first author. The women were subject to daily monitoring, follow-up, and personalized dietary modification over four or six weeks.
"On the recovery protocol, while raw vegetable intake is allowed ad libitum, minimum daily intakes are set as follows: 16 oz. leafy greens (i.e. spinach, kale) and cruciferous vegetables; ½ cup flax or chia seed or 3 tablespoons cold pressed flaxseed oil; and 96–128 oz. of water. Fruit is recommended at no greater than 25% of total dietary intake to ensure that patients are able to consume the recommended amount of raw vegetables before reaching satiety. Vitamin B12 and vitamin D supplementation is recommended."
Since the dietary intervention is intended to be long-term, it allows for the incorporation of a 'maintenance period' wherein the consumption of cooked plant foods is allowed following symptom remission. If the maintenance period results in a symptom relapse, the RRP is reinitiated.
"After 6 months of remission, processed vegan foods, foods with sugar or oil, and alcohol are allowed 1–2 times/week (termed 'recreational eating'), while otherwise continuing the maintenance protocol, if patients remain asymptomatic."
The cases themselves are diverse – the first consists of a 40-year-old woman who was diagnosed with SLE and SS in 2013 during her ninth month of pregnancy. Her symptoms included extreme photosensitivity, leg pain, and fatigue, for which the clinically recommended intervention was hydroxychloroquine (SLE and SS management) and aspirin (to prevent blood clots and potential miscarriage). Her RRP course began in April 2017 and lasted four weeks.
The second case is that of a 54-year-old woman who experienced undiagnosed SLE- and SS-associated photosensitivity, butterfly rash, itchy scalp, and constant fatigue since 2006. Her SLE escalated to pleurisy in May 2015, and she was diagnosed in July of the same year with reported eye inflammation. Her RRP course commenced in early March 2017.
The final case is that of a 45-year-old woman who experienced the symptoms of SLE and SS between 2003 and 2008 but in whom the diseases were not formally diagnosed till her fourth child developed neonatal lupus in late 2008. Between 2008 and 2012, this case was clinically prescribed levothyroxine, azathioprine, and methotrexate, but with no symptomatic improvement. The incorporation of hydroxychloroquine into her clinical intervention regimen in 2012 helped suppress symptoms.
"In September 2020, due to extreme stress related to Covid-19, her symptoms exacerbated significantly, including extreme fatigue, pain, a migraine that lasted for 4 months, a diagnosis of hyponatremia with hospitalization, and extreme light sensitivity and eye pain, described as varying from a feeling of "someone squeezing my eyes" to a feeling of grittiness or sand in the eyes that prevented her from being able to open both eyes at the same time."
The third case began the RRP program in June 2021.
Study findings
The findings in the current case report are overwhelmingly positive, with all three cases experiencing significantly and astonishingly rapid symptom remission following strict adherence to the RRP intervention. Symptom remission was observed to begin as early as day 2 (Case 1), with four weeks representing the longest that symptoms persisted following course initiation.
Encouragingly, symptom remission was observed to be long-term, with two of the three surviving cases reporting ongoing symptom-free periods of 6 and 7 years, respectively. In all cases, the women were able to stop using their prescription drugs in favor of RRP.
These findings highlight the profound impacts of dietary interventions in treating chronic diseases, including SLE and SS. Of particular interest are plant-based diets, rich in natural nutraceuticals, which are only now coming to the forefront of biomedical and clinical research. Findings such as these inform the general public of optimal dietary choices and form the basis for future research aimed at unraveling the potential of our natural world.
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