Everything you need to know about Sjögren's and gut health
- Paloma Miquel
- 5 days ago
- 6 min read
Did you know that up to 92% of those suffering with Sjogren's also suffer with digestive symptoms?
And despite digestive symptoms being so common with Sjogren's, they are also some of the most overlooked by conventional medicine.
And this is significant, because not only can symptoms like acid reflux, bloating, and constipation seriously impact daily life, but when gut health and digestive function are compromised, it can cause nutrient deficiencies, drive inflammation, and trigger Sjögren’s symptoms across the body - as we frequently see in our practice.
In this article, we will look at the most common digestive issues in Sjögren’s, the vital role of the gut microbiome for digestive system health, what harms digestion, and simple ways you can support your gut to ultimately improve your Sjogren's symptoms.
How Sjögren’s affects digestive health
Studies and clinical experience show that a large majority of people with Sjogren's experience digestive issues - possibly in the range of 80 to 95% of people.
The most common digestive symptoms related to Sjögren's include:
Reflux and heartburn
Bloating and excessive gas
Constipation and/or diarrhoea
Abdominal pain
Nausea and vomiting
Feeling full quickly
Too often, these symptoms are brushed off as “just IBS.” However, these issues should not to be ignored: they can interfere with nutrient absorption, increase systemic inflammation, and worsen fatigue, pain, and other autoimmune symptoms. Addressing these problems is therefore a key part of the healing process.
Potential causes
As with all aspects of health, digestive issues are not isolated events. Rather, they form part of the wider landscape of a person’s health, constantly influencing (and being influenced by) other systems in the body.
In Sjögren’s, it is often impossible to determine what came first: the disease itself or the digestive issues. Digestive problems may contribute to the development of Sjögren’s, while at the same time being a consequence of it.
Some of the main reasons why Sjögren’s can cause digestive issues include:
Reduced saliva production, leading to fewer enzymes to break down food
Low stomach acid, making it harder to absorb protein, vitamin B12, iron, magnesium, and other nutrients
Poor bile and enzyme flow, causing difficulty digesting fats, along with nausea and bloating
Gut dysbiosis, which can drive inflammation, increase intestinal permeability (“leaky gut”), cause symptoms like bloating, and potentially worsen autoimmune activity
Why digestive health should be a top priority in Sjögren’s
The gut is central to health because it affects every system in the body.
For those with Sjögren’s, gut health is especially important because:
The immune system relies on gut balance to distinguish safety from threat.
The hormonal system is influenced by the nutrients we absorb, and stress signals from the gut.
The nervous system receives constant input from the digestive tract, affecting motility, mood, and resilience.
Therefore, when the gut isn’t functioning properly, it can lead to nutrient deficiencies from poor absorption; systemic inflammation; leaky gut (intestinal permeability) and endotoxemia (bacteria in the blood), which allow inflammatory particles into the bloodstream; and overall, worsened autoimmune activity.
This is why gut health should always be a top priority in Sjogren's symptom management.
The gut microbiome and Sjögren’s
Your digestive system is home to trillions of bacteria, fungi, and other microbes, which are collectively known as the gut microbiome.
For those with Sjögren’s, this ecosystem is especially important because it maintains the gut barrier, protecting against “leaky gut”; defends against pathogens that can trigger inflammation; and it sends constant “safety” or “danger” signals to the brain and nervous system.
When the gut microbiome is out of balance (a state called dysbiosis), research shows it may be linked to more active disease and increased inflammation in people with Sjogren's (Mandl et al., 2017; Shen et al., 2024), which is why supporting gut bacteria in Sjögren’s may be crucial to help reduce disease activity and improve symptoms.
What harms digestive health and the microbiome
Several factors can undermine digestion and microbiome balance in Sjögren’s, including:
Medications such as PPIs (acid blockers) and antibiotics, which alter stomach acid or microbial diversity
Poor diet, especially those which are low in fibre and high in fats and ultra-processed foods
Stress and nervous system dysregulation, which slow gut motility and affect microbial balance
Environmental toxins, which place extra burden on gut and liver function
When we understand the factors that worsen digestive health, we’re much better equipped to learn how to improve digestive health in an effective way.
How to support digestive function and gut health with Sjögren’s
Both intestinal cells and the gut microbiome adapt quickly to any changes introduced - this means that, with the right tools and support, most people can expect to see improvements in their digestive health in days to weeks (add reference to our clients/testimonials?).
The most effective strategies include:
Dietary support: Aiming for a diverse, high-antioxidant diet rich in whole foods to promote motility and microbial diversity (Ross et al., 2024).
Digestibility support: Choosing moist, soaked, or blended foods and eating mindfully to ease dryness and support breakdown. Examples include soups, stews, smoothies, and fermented foods.
Lifestyle support: Prioritising stress management, quality sleep, energy management, and balanced exercise/movement.
It's important to note that in the case of suspected food intolerances or allergies, personalisation will be needed. Always speak with a health professional before making significant changes to your diet.
A final note on stress and digestion
Stress has a powerful impact on digestion. The gut and nervous system are in constant communication, and chronic stress can slow gut motility, increase bloating, and aggravate reflux or constipation.
For many people, working on stress management may be a higher priority than making dietary changes. Therefore, for those with Sjögren’s who are looking to improve both their digestive and general health, managing stress is also an essential part of healing and should not be understated.
To summarise:
We hope that this article has shown that the body is a highly complex and inter-connected organism, and that the actions you take to support your digestive health will also benefit your nervous, immune and hormonal systems (and vice-versa).
By supporting your gut with the right foods, daily habits, and stress management, you will be able to reduce digestive symptoms, calm inflammation, restore physical and mental balance, and improve your overall well-being with Sjögren's.
What are the "5 Fundamentals for Healing with Sjögren's"?
Supporting your gut health plays a key role in addressing Sjögren’s effectively, but there are the other key areas that also need support in order to gain lasting improvement of your symptoms.
Having worked with Sjögren's exclusively since 2021, we have found that there are five key fundamentals that need to be included in every effective healing plan.
To learn what these fundamental factors are and how you can implement them in your life - along with practical exercises - register for our free "5 Fundamentals to Healing with Sjögren's" webinar.
What you'll learn:
How to address the root causes of Sjogren's
The five key components of an effective healing plan
Practical exercises and actionable takeaways
Real life patient examples
References and further reading:
Mandl, Thomas, Jan Marsal, Peter Olsson, Bodil Ohlsson, and Kristofer Andréasson. “Severe Intestinal Dysbiosis Is Prevalent in Primary Sjögren’s Syndrome and Is Associated with Systemic Disease Activity.” Arthritis Research & Therapy 19, no. 1 (October 24, 2017): 1–7. https://doi.org/10.1186/s13075-017-1446-2.
Parreau et al. “Abdominal Symptoms during Sjogren’s Syndrome: A Pilot Study.” Advances in Rheumatology 61, no. 1 (January 19, 2021): 1–8. https://doi.org/10.1186/s42358-021-00164-w.
Ross, Fiona C., Dhrati Patangia, Ghjuvan Grimaud, Aonghus Lavelle, Eugene M. Dempsey, R. Paul Ross, and Catherine Stanton. “The Interplay between Diet and the Gut Microbiome: Implications for Health and Disease.” Nature Reviews Microbiology 22, no. 11 (July 15, 2024): 671–86. https://doi.org/10.1038/s41579-024-01068-4.
Shen, Yue, Xue Yu, Qiao Wang, Xinyi Yao, Dingqi Lu, Donghai Zhou, and Xinchang Wang. “Association between Primary Sjögren’s Syndrome and Gut Microbiota Disruption: A Systematic Review and Meta-Analysis.” Clinical Rheumatology 43, no. 2 (September 8, 2023): 603–19. https://doi.org/10.1007/s10067-023-06754-x.
Sjögren’s Foundation (2024). Listen to your gut: David’s experience with fatigue and GI symptoms. Retrieved from https://sjogrens.org/blog/2024/listen-to-your-gut-davids-experience-with-fatigue-and-gi-symptoms