Restore gut health and improve joint pain
Osteoarthritis (OA) is the most common joint disorder in the United States, affecting over 32.5 million U.S. adults. It’s the most common musculoskeletal condition seen in any medical practice. The majority of patients are aged 60 or older. Painful knee arthritis, for example, occurs in 10% of men and 13% of women over age 60.1 How can a plan to restore gut health assist in joint pain and care?
Traditionally, the causes of OA are older age, female gender, being overweight or obese, repetitive use, weak muscles and knee injury. The standard treatment consists of recommending weight loss to relieve loading on the joints and exercise and physical therapy to improve muscle strength. NSAIDs are often prescribed to relieve inflammation and pain, creating an increased risk of gastrointestinal tract injury, including leaky gut syndrome.2
To the causes and treatment of OA, we now need to add the gut microbiome.
Restore gut health for a gut-joint connection
Like metabolic syndrome and obesity, osteoarthritis is characterized by low-level overall inflammation as well as joint inflammation. People with one or more of these conditions usually also show high levels of lipopolysaccharides (LPS) in their blood.
Also known as endotoxin, LPS is released from the outer cell walls of gram-negative bacteria when they are destroyed in the digestive tract. LPS escapes into the bloodstream when the tight junctions of the intestinal wall open due to leaky gut syndrome, causing systemic inflammation through the inflammasome NLRP3 (an inflammasome is a protein complex that triggers the proinflammatory process).
Among other impacts, LPS causes joint pain and cartilage degradation. Recent research suggests that LPS-driven inflammation might be a critical hidden risk factor for OA. In combination with inflammatory mechanisms from metabolic syndrome and obesity, LPS is a double-hit to the body. The resulting inflammatory response targets the joints.3
Inflammation from LPS indicates an unbalanced gut microbiome, with too many harmful bacteria releasing endotoxins. The functional medicine approach of looking at systems is beneficial for fixing gut dysbiosis. Better diet, prebiotics and probiotics, and more physical activity can shift the balance away from the LPS-producing bacteria and back toward a more diverse array of gut bacteria. When LPS-induced inflammation is reduced, joint pain is usually reduced as well.
Antibodies to gluten, a protein found in wheat, rye and barley, are another significant driver of inflammation and OA. Gluten is two proteins bound together: about 30% is glutenin, and about 70% is gliadin.
People with celiac disease (CD) have an autoimmune response to both gliadin and glutenin; the response damages the villi of the small intestine and causes systemic inflammation. The inflammation is the root cause of autoimmune arthritis that often develops in people with celiac disease — they are four times as likely to have arthritis as people without celiac disease. A gluten-free diet reduces not only celiac symptoms but also joint inflammation.4
People who are allergic or sensitive only to gliadin — non-celiac gluten sensitivity or NCGS — don’t have damage to the villi, but they may have similar digestive symptoms and inflammation that leads to joint pain and osteoarthritis.5
Celiac disease is usually seen as genetic, but recent research suggests that gut dysbiosis may have a significant role in the development and possible treatment of both celiac disease and non-celiac gluten sensitivity. Levels of the beneficial Bifidobacterium tend to be low in people with CD and with NCGS, for example.6
For some people with either condition, raising the level of beneficial bacteria in the gut may improve gluten tolerance, support a strong gut barrier and reduce inflammation. Probiotics alone may not be enough — a study that gave Bifidobacterium supplements to volunteers with celiac disease found they didn’t help.7
While it’s possible that probiotics would be more helpful for NCGS, avoiding foods with gluten and improving the gut microbiome through diet may be more effective. A high-fiber, plant-based diet with fermented and prebiotic foods, along with a prebiotic supplement, is a good approach.
Osteoarthritis can also be driven by lectins and agglutinins, sugar-binding proteins found in all plant foods. They’re especially abundant in beans, peas, lentils, peanuts, nightshade vegetables such as tomatoes, and grains, including wheat, barley, quinoa and rice. Wheat germ agglutinin (WGA) is found in wheat.
In sensitive individuals, lectins and WGA cause digestive upsets, including bloating, vomiting and abdominal pain. The damage can be more severe in some cases. The lectins and WGA may bind to receptor sites on the intestinal mucosal wall and trigger leaky gut syndrome and dysbiosis. They may also be another hidden cause of osteoarthritis.8
The lectins enter the bloodstream through open tight junctions and bind to cartilage and connective tissue, causing inflammation that leads to osteoarthritis.
Because lectins are found in almost all plant foods, they can’t be eliminated from the diet. The damage can be reduced or eliminated by avoiding high-lectin foods such as red kidney beans and thoroughly cooking all beans and legumes. Sensitive individuals may need to cook other high-lectin foods before eating them.9
Restoring the gut microbiome
LPS, gluten and lectins all cause severe disruption to the gut wall and the gut microbiome, causing leaky gut syndrome and dysbiosis. Although the cause is different in each case, the result — systemic inflammation causing joint pain and osteoarthritis — is the same.
Functional medicine excels in tracing inflammation upstream to find root causes, an approach that will often uncover a hidden cause of joint pain and osteoarthritis. If a problem such as gluten intolerance is discovered, dietary changes to eliminate the source are just the first step. Fixing the leaky gut and restoring balance to the gut microbiome are essential.
As the great Dr. Vladimir Janda once said, “He who treats the site of pain is lost.” Nothing may exemplify this more than the gut-to-joint connection.
ROB SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, is a chiropractic doctor, clinical nutritionist, national and international speaker, author of Amazon’s #1 bestseller, “Inside-Out Health,” and founder and CEO of the Westchester Integrative Health Center. The ACA Sports Council named him “Sports Chiropractor of the Year” in 2015. He is on the advisory board for Functional Medicine University and is a seasoned health and wellness expert on both the speaking circuits and within the media, as well as a frequent health expert contributor on national blogs such as Consumer Health Digest. He has appeared on FOX News Channel, FOX, NBC, CBS, ABC, The Wall Street Journal and NewsMax. His new book, “Superhighway to Health,” was published in 2020 and he can be reached at drrobertsilverman.com.
 Zhang Y, Jordan JM. Epidemiology of osteoarthritis [published correction appears in Clin Geriatr Med. 2013 May;29(2): ix]. Clin Geriatr Med. 2010;26(3):355-369. DOI:10.1016/j.cger.2010.03.001.
 Scarpignato C, Hunt RH. Nonsteroidal anti-inflammatory drug-related injury to the gastrointestinal tract: clinical picture, pathogenesis, and prevention. Gastroenterol Clin North Am. 2010;39(3):433-464. DOI:10.1016/j.gtc.2010.08.010.
 Huang Z., Kraus V.B. Does lipopolysaccharide-mediated inflammation have a role in OA? Nat. Rev. Rheumatol. 2016;12:123–129. PMID: 26656661.
 Atteno M, Costa L, Cozzolino A, et al. The enthesopathy of celiac patients: effects of a gluten-free diet. Clin Rheumatol. 2014;33(4):537-541. DOI:10.1007/s10067-014-2534-1.
 Biesiekierski, J. R. et al. Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. The American Journal of Gastroenterology 106, 508–514 (2011).
 Leccioli, V., Oliveri, M., Romeo, M., Berretta, M. & Rossi, P. A New Proposal for the Pathogenic Mechanism of Non-Coeliac/Non-Allergic Gluten/Wheat Sensitivity: Piecing Together the Puzzle of Recent Scientific Evidence. Nutrients 9, (2017).
 Smecuol E, Hwang HJ, Sugai E, et al. Exploratory, randomized, double-blind, placebo-controlled study on the effects of Bifidobacterium infantis natren life start strain super strain in active celiac disease. J Clin Gastroenterol. 2013;47(2):139-147. DOI:10.1097/MCG.0b013e31827759ac.
 Cordain L, Toohey L, Smith MJ, Hickey MS. Modulation of immune function by dietary lectins in rheumatoid arthritis. Br J Nutr. 2000;83(3):207-217. DOI:10.1017/s0007114500000271.
Freed DLJ. Chapter 34: Dietary lectins and disease. In Food Allergy and Intolerance, 2nd Edition, Brostoff J and Challacombe SJ, eds, Saunders Ltd, London, 2002 pp 479-488.