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Thoughts from a leading integrative physician and medical insider

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Featured Article for Discussion

“Gut-joint axis: cross reactive food antibodies in rheumatoid arthritis”

J. Gut 2006;55:1240

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Today’s article may come as a surprise: your gut may be responsible for joint aches and pains. Many joint problems stem from bad diets, poor digestion, and faulty intestinal function.

So, if you are struggling with arthritis, or other joint diseases, you would do well to consider taking a hard look at your diet and your bowel functions.

Overgrowth of Bacteria Linked to Joint Problems

Here’s how it goes. First we lose digestive acids as we age. Digestive acids kill bad bacteria in the gut.

Absence of these digestive acids – along with overuse of antacids and the infamous “purple pills” -- facilitates bacterial invasion and growth in undesirable places – namely, our small intestine.

When bad bacteria enter our small intestine, they can easily grow out of control and push our immune system into overdrive. With more invaders to process, our immune system can become hyper-vigilant, attacking food particles as well as the invading bacteria.

An allergic response to food creates a vicious spiral of malabsorption of nutrients and gut function decline.

First, overgrown bacteria consume more carbs, so that we end up with fewer carbs to fuel ourselves, which leads to weight loss (and is associated with low hemoglobin, albumin, and/or calcium levels as well).

Second, the small intestine normally involves quite rapid cell turnover to maintain its protective barrier against toxic/antigenic waste it carries.
Without proper nutrition, the intestinal mucosa cannot regenerate itself and it becomes permeable, a condition otherwise known as “leaky gut syndrome.”

A leaky gut then allows overgrown bacteria and fungi in the small intestine to leak into the blood stream and ultimately attach to soft tissue cells and joints.

Finally, the immune system attacks bacteria in muscle tissues and joints, causing an inflammatory response, which causes pain in muscles and joints.

Unfortunately, docs usually prescribe NSAIDs, which further increase leaky gut syndrome, and the whole process keeps getting reinforced with predictably chronic pain created in joints and soft tissues.

Symptoms of Bacterial Overgrowth in the Small Intestine

The article “Small bowel bacterial overgrowth” (J. Geriatrics 2006;61:21) points out that bacteria overgrowth is very common in the elderly and in at least 15% of so-called normal “healthy” populations too.

Unfortunately, overgrowth of intestinal bacteria is more likely in those over 60 with inflammatory bowel disease, adhesions, lymphoma, tuberculosis, neuropathy of diabetes, scleroderma, and immuno-deficiency. Physical inactivity, reduced fluid intake and fiber are also predisposing factors.

Bacterial overgrowth may show up as bad breath, diarrhea, abdominal pain, and bloating – all due to the malabsorption of proteins, fats, and carbs.

Bad Breath – Breath tests are useful for diagnosis, since bacterial overgrowth amplifies hydrogen and carbon dioxide output. About 15% of patients produce methane, rather than hydrogen, so, methane should be routinely measured. Although, it doesn’t take an office visit to notice these characters, especially when we’re next to them in closed places, like elevators.
However, breath tests are cumbersome. The day before a test, one has to refrain from eating high fiber foods, bread, and pasta and avoid laxatives and antibiotics.

Bloating -- Hydrogen and carbon dioxide are produced in more quantities from the metabolism of carbohydrates, especially refined carbs. So, the bloating you may be treating with Gaviscon is not going to get better unless you stop this overgrowth problem.

Malnutrition -- Overgrowth of bacteria can destroy bile acids, leading to less fat absorption and fewer fat-soluble vitamins (A,D,E,K) being absorbed. Serum B12 levels are usually low because bacterial overgrowth uses up B12. This may lead to anemia with high MCV (a red blood cell test,) and neurologic problems. Folic acid is synthesized by bacteria, so, it may be high (however, iron is typically low, due to mucosal injury.)

Weight Loss / Bone Loss -- Malabsorption leads to weight loss, reduced triceps skinfold, and low hemoglobin, albumin and/or calcium levels. Resulting malabsorption of nutrients is a significant contributor to bone thinning and fractures. Rather than taking drugs for your bones, see if you may be having trouble absorbing nutrients, particularly minerals.

Diet Changes & An Annual “Bowel Detox”

For the most part, joint problems come from poor diet, digestion, and intestinal function.

When it comes to diet, the article “A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food allergens” (J. Rheumatology 2001;40:1175) makes a good case for going vegan and going gluten-free in your diet.

You may say it is too hard to eat vegan and get off wheat. Perhaps, but, if you are suffering mightily, and you are given a prescription of Vioxx, you may do a quick analysis of the pros and cons and decide that a diet high in veggies, if not totally vegan, is well worth your investment.

Meanwhile, intestinal bacterial overgrowth is an incredibly common problem for anyone with any disease – but particularly for those suffering joint pain.

Thus, I prefer to do a “bowel detox” every year on everyone, including myself.

The program involves eating mostly raw foods for 14 days, drinking lots of fresh water, herbal agents against bacterial overgrowth. In some tough cases, I use prescription antibiotics that are designed to wash right through the bowels and not be absorbed (e.g., Rifaximin). Probiotics should be used at high dose (5-30/day,) as well as lots of fiber (as in over 50 grams daily).

I also recommend the following to support your detox:
Digestive enzymes: 1-2 before each meal
Omega oils: 2 softgels twice a day
Peppermint oil
Rice protein (which contains glutamine, arginine 1-2 grams): twice a day
Vitamin D3: 2,000 IU per day

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Dr. Rodier practices integrative medicine at the Pioneer Health Clinic just outside Salt Lake City, UT. He's an adjunct professor for the University of Utah's School of Medicine.

Dr. Rodier offers nutritional consultations via phone. Please inquire for details.

To contact Dr. Rodier, write to hugo@ourhealthcoop.com, or for more information, visit his web site at: www.hugorodier.com.

Read more from Dr. Rodier in his blog: Cutting-edge musings on health & healing