So today we will talk about integrative therapy for Sjogren’s Syndrome. This is the protocol which was developed in our clinic which is Institute for Specialized Medicine together with Gluten Free Remedies. As most of you know Sjogren’s Syndrome is the most common autoimmune disease affecting humans and specifically the disease affects women. It’s much more prevalent among women than in men. Sjogren’s Syndrome is known as a disease which can cause dryness and dryness can affect eyes, mouth as well as genital organs. So the dryness can be very debilitating and create problems with eye vision, extreme thirst and with different sexual dysfunctions. In addition, Sjogren’s Syndrome can cause muscle pain, joint pain various gastrointestinal problems, neurological problems as well as problems with cognitive function. So Sjogren’s Syndrome is an autoimmune disease which affects mainly exocrine glands. These are the glands which produce saliva and tears as well as glands producing various digestive enzymes, such as pancreas. And also it can affect glands producing sweat. The mechanism linked to Sjogren’s Syndrome is definitely an autoimmune process and it results in infiltration of various exocrine glands with lymphocytes. Subsequently these lymphocytes become activated and they destroy normal gland tissue and the organ becomes dysfunctional. There are several key mechanisms which contribute to Sjogren’s Syndrome. Right now there is a thinking process behind Sjogren’s Syndrome that it is an autoimmune disease which obviously has a genetic background, but at the same time is strongly linked to certain viruses. Such as Epstein Barr virus known as EBV and cytomegalovirus known as CMV. So as a consequence of interplay between various viral infections and genetic factors the immune system gets out of control. And then what happens? Number one the process results in the changes in TH1 and TH2 ratio. These are T cells which mediate various aspects of our immune balance and the TH1 cells become dominant and they trigger various autoimmune responses. The second mechanism is linked to so called TH17 cells and disbalance between T cells which regulate normal immune response and autoimmune responses. As a consequence there is increased production, proliferation of TH17 cells. In addition, there are several well recognized markers of Sjogren’s Syndrome which also facilitate various autoimmune problems. So first of all these include antibodies to SSA and SSB antigens. These antibodies are definitely pathogenic and they have been associated with various pathological processes. In addition, recently another subset of antibodies have been recognized as pathogenic. These are antibodies which affect muscarinic M3 receptor So after interaction between antibodies and M3 receptor there is a downstream event which affects water channel knows as aquaporin-5. And as a consequence, the cells start producing less and less fluid and our saliva for example gets much more viscous our tears become much more viscous. And so this is the whole mark of Sjogren’s Syndrome. In addition over the last several years another pathogenic process was recognized and the process was linked to abnormal methylation of epithelial DNA in epithelial cells. As some of you know methylation is a process which regulates switching of the gene on and off and defective methylation can reactivate genes which in normal conditions should be dormant. Therefore abnormal methylation is another pathogenic process which contributes to reactivation of the autoimmune response. So based on pathogenisis and clinical symptoms of Sjogren’s Syndrome there are three main goals in the therapy of Sjogren’s Syndrome. And these goals can be achieved with either drugs or natural products and today we’ll talk about natural approach to treat Sjogren’s Syndrome and this approach can be as efficient as drugs. So the first process is a process focused on improving dryness Second we need to normalize poorly controlled autoimmune responses and finally one topic which also needs to be in focus is prevention of malignancies. So what’s been shown is that patient’s with Sjogren’s Syndrome have significantly increased risk of malignancies specifically lymphomas. And controlling of Sjogren’s Syndrome activity can significantly reduce the risk of lymphomas. So what is our recipe? So we created a protocol where we are using a combination of several natural products. And each of these products target one or two specific pathogenic mechanisms. So how can we improve dryness? We are using three natural products which we’ve found to be very efficient in our practice One is a product called SalivaStim and two oils one is Black Currant Seed Oil and Krill Oil. The next process is focused, or the next approach is focused on normalization of autoimmune responses. And for this reason we are using an extract from wormwood known as Artemisinin we are using a famous Chinese mushroom which is Cordyceps Sinensis we are using N-Acetylcysteine, we are using very concentrated broccoli extract containing high concentration of I3C/DIM, which is indole-3-carbinol and DIM as well as Krill Oil and Black Currant Seed Oil. Another therapeutic path is the correction of methylation defect that’s something which can be achieved with a product called TMG Plus. TMG stands for Trimethylglycine, which is a key methylation agent. In addition TMG Plus contains methyl B-12, Methylfolate and B6. The normalization of methylation process is a key step in controlling of Sjogren’s Syndrome. Finally one of the goals is to prevent malignancies or to reduce the risk of malignancies. And this can be achieved with three products such as Artemisinin, Indole-3-Carbinol/DIM and SalivaStim. Now we’ll talk briefly about certain products that we have in our arsenal. The first one is Artemisinin. So Artemisinin is a chemically defined substance from the Chinese herb known as Wormwood. So Artemisinin has a unique scope of activities it does inhibit very efficiently Epstein Barr Virus and Cytomegalovirus and this unique property of Artemisinin we are using all of the time in our practice. Artemisinin also inhibits TH1 responses and it shifts TH1/TH2 ratio toward TH2. It also suppresses TH17 cells which facilitate autoimmune responses. And finally there is very strong data that Artemisinin can inhibit abnormal B cell proliferation and suppress autoantibody production. SalivaStim is another featured product of Gluten Free Remedies SalivaStim is unique because it increases expression of Aquaporin-5 and in many clinical trials was shown to increase production of saliva and tears. And this is the product which it’s strength is very very similar to a lot of prescription products such as Pilocarpine and Cevimeline known as Evoxac in terms of stimulation of saliva and tear production. N-Acetylcysteine is another natural product which can optimize TH1 and TH2 ratio as well as inhibit TH17 responses. In addition it is one of the strongest natural antioxidants and it stimulates production of glutathione. It is well recognized that the production of glutathione is inhibited in patient’s with Sjogren’s Syndrome. Another natural product which is a part of our scope of remedies for Sjogren’s Syndrome is Indole-3-Carbinol/DIM As I mentioned before it is a natural highly concentrated extract from broccoli sprouts so I3C/DIM optimize TH1/TH2 responses. It protects salivary and lacrimal glands from the damaging effects of estrogens. It is very well recognized that women who are over producers of estrogen are at high risk of having Sjogren’s Syndrome. In addition it protects epithelial cells and lacrimal glands from certain environmental factors and it also possesses a very strong antiviral activity. Black Currant Seed Oil and Krill Oil are natural products which normalize TH1 and TH2 responses as well as inhibit various inflammatory processes through COX1/COX2 mechanisms. Cordyceps Sinensis is used in our practice as a very very synergistic product with Artemisinin It’s a classical combination of traditional Chinese medicine. In addition by itself it has certain antiviral and antimicrobial activity and it is also capable of normalizing TH1 and TH2 responses. The next slide shows the dosage regime which we are using in our practice. There are a couple of comments that I want to make In general, we start our patients on one product at a time and we try one product for three or four days, see how patients tolerate them and then we will move forward with the second one. So among all products that are listed on this slide, I want to specifically mention Artemisinin. As a part of good practice, I would strongly recommend to check liver function at least every 6-8 weeks in patients who take Artemisinin. Because there is a small chance that Artemisinin can cause non-specific liver damage and elevation of liver enzymes. So Sjogren’s Syndrome not only affects salivary glands and lacrimal glands, but also can cause a number of satellite problems such as various gastrointestinal problems including dysmotility, poor production of digestive enzymes and so on and so on. And because of the dryness quite a few patients who have Sjogren’s Syndrome they are dealing with chronic candida or yeast infection. Because of that we are using some supplements as a part of the adjunct therapy. These supplements include known things such as digestive enzymes Triphala, which helps us to move the bowel. Probiotics, prebiotics and the scope of leaky gut products which are available as a part of Gluten Free Remedies In addition, as a part of candida control or yeast control we are using our featured product Candidacillin in a combination with Berberine and Black Walnut Hulls. That’s the protocol which we would like to introduce and that’s the protocol which we have been using in our practice for a while with great success.