Joint Pain, Gut Health, and Inflammation

With almost 53 million Americans battling the chronic aches and pains of joint inflammation (1 in 5 adults, according to the CDC), it’s important to know that your diet can play a key role in putting out the inflammatory fire affecting your muscles, tendons, and joints.
Joint pain can, of course, be due to injuries and sprains, but even in those cases, you can choose foods that will speed your recovery, or drive you deeper into pain, depending on what’s on your plate.
Inflammation: the Common Thread in Chronic Disease
Inflammation is a normal part of the body’s healing process. Just think of getting a cut on your finger: as the wound heals, the skin around it grows red, swollen, and warm. This is because of the white blood cells flooding the area in order to promote healing.
paincycle-1But when there’s an ongoing imbalance in the body – often because of lifestyle factors – inflammation goes into overdrive and becomes chronic. Chronic inflammation is at the root of a wide range of diseases including:

  • heart disease
  • Alzheimer’s
  • asthma
  • inflammatory bowel disease
  • rheumatoid arthritis
  • osteoarthritis
  • autoimmune disease

In this article, we’re taking a special look at musculoskeletal pain, which is a common symptom of chronic inflammation.
Foods that Cause Inflammation
Unfortunately, the Standard American Diet (appropriately referred to as SAD) is high in foods that promote inflammation, including:

  • an excess of sugar and refined carbohydrates
  • an excess of sodium chloride (salt)
  • food additives
  • trans-fatty acids
  • vegetable oils rich in omega-6 fatty acids

The last item – omega-6 fatty acids – is a key player in modern diets and inflammation. You see, the body needs both omega-6 and omega-3 fatty acids (omega-6’s create inflammation and omega-3’s fight it). Our pre-historic ancestors had an ideal ratio of 1:1 in their diet, meaning their omega-6 fatty acids were entirely balanced out by their intake of omega-3’s. Instead, the SAD typically has 15 times the omega-6s compared to omega-3s (ratio of 15:1)! Whenever there is a ratio of 4:1 or higher, inflammation and pain can become rampant in the body.
Adding insult to injury, the SAD is also deficient in some of the best foods to fight inflammation: fresh fruits and vegetables. Without fresh produce in the diet, there’s a deficiency of fiber, phytonutrients, vitamins, minerals and healthy fatty acids.
Foods that Fight Inflammation
As a general rule, the best foods that fight inflammation (and oxidation) are fresh fruits and vegetables, and foods that are rich in omega-3 fatty acids.
Two diets in particular are rich in anti-inflammatory, antioxidant foods: the Paleo diet, and the Mediterranean diet. 
The Mediterranean diet mainly consists of:131310-130878-1

  • legumes
  • nuts and seeds
  • whole grains
  • fruits and vegetables
  • fish and lean meats

The Paleo diet mainly consists of:

  • fruits and vegetables
  • meats, fish, and fats containing omega-3 fatty acids
  • nuts and seeds

Although they’re similar, the Paleo diet excludes all grains, on the premise that the human digestive system hasn’t evolved to handle grains. Grains and starchy foods like potatoes also spike insulin, which creates inflammation in the body.
Vegan and vegetarian diets have also been advocated to reduce inflammation because of their antioxidant, anti-inflammatory, and alkalizing properties. Also, the high fiber and chlorophyll content are cleansing and help to balance gut flora (read on to find out why gut flora is so important).
By experimenting with these dietary guidelines to find the approach that works best for you, you’ll be well on your way to resolving your joint pain.
Personalizing Your Plan
While most foods fall along clear lines in terms of whether they’re pro- or anti-inflammatory, you can also be intolerant to certain foods that are normally beneficial.
We’re all aware of the anaphylactic shock to a peanut allergy, for example, but food intolerances can show up in less obvious ways, including joint and muscle pain. When you’re intolerant of certain foods and you continue to eat them, the intestinal lining becomes permeable, which then allows antibodies and toxins to enter the bloodstream (more on this below). Eventually, those substances get deposited in the joints and other tissues, creating inflammation and pain.
An elimination diet can identify which foods you may be intolerant to. It entails:

  • an elimination phase of 3-weeks, followed by the slow reintroduction of foods
  • in the elimination phase, allergenic foods are avoided (such as eggs, gluten, dairy, peanuts, sugar, corn, and soy)
  • once symptoms resolve (i.e. as joint and muscle pain disappear), you begin to slowly add back in one food every few days, noticing if symptoms reappear when certain foods are reintroduced
  • a food diary is used throughout the process to carefully track foods and the disappearance/reappearance of symptoms.

Gut Health and Joint Health
Our health is directly linked to the 500 species of beneficial microflora (bacteria) that live in our intestinal tract. These beneficial microflora have coevolved with humans in a symbiotic relationship, and the human body actually contains 10 times as many bacteria as human cells!
In this symbiotic relationship, the bacteria in our gut do the following work for us:

  • produce vitamins B and Kimages-1
  • produce short-chain fatty acids
  • regulate pH
  • produce anti-microbial compounds
  • stimulate the immune system

Unfortunately, this symbiotic relationship is disrupted if the microflora becomes imbalanced because of antibiotics or a highly processed diet. This condition of imbalanced microflora (a deficiency of beneficial organisms and an excess of harmful ones) is known as gut dysbiosis.
In this situation, symptoms will show up in parts of the body that appear to have no connection to the gut. For example, 70% of patients with fibromyalgia (a chronic pain syndrome) have IBS, which has been linked to small intestinal bacterial overgrowth (SIBO).
This new area of science is beginning to identify the “gut related axis’”, which includes the gut-joint axis (how gut health relates to joint health).
Leaky Gut, Autoimmunity, and Joint Pain
An imbalance in microflora in the gastrointestinal tract can lead to inflammation throughout the body in several ways:

  • harmful debris from bacteria circulate in the body
  • nutrients from food aren’t fully absorbed
  • nutrient deficiencies may develop
  • the intestinal lining becomes permeable (also known as “leaky gut”)

Normally, the cells that line the intestinal tract are joined by tight junctions. When those junctions are harmed, the intestinal lining becomes “leaky”. At that point, substances can pass through that wouldn’t normally pass through, such as antibodies to food you’re intolerant to. Harmful debris shed by bacteria can also “leak” through and then act as toxins in the body.
Once those substances pass into circulation in the body, they can wind up in muscles, tendons, and joints that become painful and inflamed.
Along those same lines, there’s a direct relationship between “leaky gut” and autoimmunity (when the immune system attacks the body). When molecules pass through the intestinal lining that normally wouldn’t pass through, the immune system develops antibodies to attack these “foreign invaders”. The antibodies can then attack the body’s own tissues, such as in rheumatoid arthritis where the immune system attacks the joints.
 
The best way to rebalance the microflora is to follow the anti-inflammatory diets and/or elimination diets mentioned above. Above all, avoid high glycemic, fermentable and allergenic foods when healing the gut lining.
Supplements for Joint Health
Several supplements can play a key role in taming inflammation and joint pain:

  • Omega-3 fatty acids found in fish oil (EPA/DHA): omega-3 fatty acids are utilized within the cell walls and help to “turn off” the immune system’s inflammatory response
  • Gingerroot: gingerols – the active component in ginger – have a powerful antioxidant and anti-inflammatory effect. Can be taken in capsule form, or use the fresh root as a tea or in food.
  • Turmeric: the active compound, called curcumin, has antioxidant, anti-inflammatory, and anti-cancer properties. Use abundantly as a spice in food, or take in capsule form.
  • Boswellia: has the ability to inhibit the production of cytokines (the chemical “bullets” fired by the immune system) in autoimmune arthritis.

For more information on nutrition, exercise and physical therapy visit www.joetatta.com.
References
CDC Arthritis Statistics http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm
Seaman DR. The diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physiol Ther. 2002 Mar-Apr;25(3):168-79.
Carrera-Bastos, M. Fontes-Villalba, J. H.O. Keefe, S Lidenberg, and L. Cordain, “The Western diet and lifestyle and diseases of civilization,” Research Preports in Clinical Cardiology, vol. 2, pp. 15-35, 2012.
Vasquez A, Musculoskeletal Pain: Expanded Clinical Strategies. Gig Harbor, WA; The Institute for Functional Medicine 2002.
Simopoulus AP, Robinson J. The Omega Plan. New York. Harper Collins, 1883.
Simopoulos AP. Importance of the omega-6/omega-3 balance in health and disease: evolutionary aspects of diet. World Rev Nutr Diet. 2011;102:10-21.
Cordain L. The Paleolithic Diet. Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat. Indianapolis, Ind: John Wiley an Son. 2002.
Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292:1433-1439.
De Lorgeril M, Salen P, Martin JL, Monjaud I, Boucher P, Mamelle N. Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med. 1998;158:1181-1187.
O’Keefe JH Jr, Harris WS. From Inuit to implementation: omega-3 fatty acids come of age. Mayo Clin Proc. 2000 Jun;75(6):607-14
Rodriguez-Casado A. The Health Potential of Fruits and Vegetables Phytochemicals: Notable Examples. Crit Rev Food Sci Nutr. 2014 Sep 16:0.
Begmark S. Ecological control of the gastrointestinal tract: the role of probiotic flora. Gut 1998. 42:2-7.
Mountzouris KC, McCartney AL, Gibson GR. Intestinal microflora of human infants and current trends for its nutritional modulation. Br J Nutr. 2002;87:405-20.
Scott LV1, Clarke G, Dinan TG. The brain-gut axis: a target for treating stress-related disorders.
Vasquez A. Reducing pain and inflammation naturally, part 6: Nutritional and botanical treatment against “silent infections” and gastrointestinal dysbiosis, commonly overlooked causes of neuromusculoskeletal inflammation and chronic health problems. Nutritioanl PRespectives. January 2006:5-21.
Cypers H, Van Praet L, Varkas G, Elewaut D. Relevance of the gut/joint axis for the management of spondyloarthritis in daily clinical practice. J Crohns Colitis. 2010 Sep;4(3):257-68.
Brakenhoff LK, van der Heijde DM, Hommes DW, Huizinga TW, Fidder HH. The joint-gut axis in inflammatory bowel diseases. Curr Opin Rheumatol. 2010 Jul;22(4):368-74.
Jacques P, Elewaut D, Mielants H Curr Opin Rheumatol. Interactions between gut inflammation and arthritis/spondylitis. 2010 Jul;22(4):368-74.
Moran CP, Shanahan F. Gut microbiota and obesity: Role in aetiology and potential therapeutic target. Best Pract Res Clin Gastroenterol. 2014 Aug;28(4):585-597.
Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P. The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis. Gut. 2006 Sep;55(9):1240-7
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