Reduce the Risk of Arthritis by Improving the Microbiome

Even experts at mainstream institutions like the Arthritis Foundation, Mayo Clinic and Johns Hopkins acknowledge that certain types of arthritis can be triggered or exacerbated by an imbalance in the gut microbiome if a patient is predisposed to the condition.

See Types of Arthritis

Unfortunately, there are no established therapies for manipulating the gut microbiome to treat diseases such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, early research suggests there are several ways to maintain or improve the gut’s overall microbial diversity and health.

See The Science Behind Leaky Gut, the Gut Microbiome, and Arthritis

Avoid unnecessary antibiotic treatment. Antibiotics can kill bacteria that cause infection, but they can also kill normal, beneficial bacteria. Taking an oral antibiotic can reduce the gut’s microbial diversity ¹ Dethlefsen L, Huse S, Sogin ML, Relman DA. The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing. PLoS Biol. 2008;6(11):e280. and permanently change a gut microbiome. ² Blaser MJ, Falkow S. What are the consequences of the disappearing human microbiota?. Nat Rev Microbiol. 2009;7(12):887-94.

One step a patient can take to avoid oral antibiotics is to ask the doctor for an injection of antibiotics. If the doctor agrees, the injected medicine is likely to be as beneficial as an oral dose --unless, of course, the infection is in the gut.

Patients who are hesitant to take an antibiotic can ask their health care providers questions, such as, “What will happen if I don’t take this antibiotic? Is there another option?” A health care provider can explain whether or not an antibiotic is necessary.

Make dietary changes. Most experts agree that diet can influence the immune system by affecting changes in the gut microbiome. ³ Mackos AR, Varaljay VA, Maltz R, Gur TL, Bailey MT. Role of the Intestinal Microbiota in Host Responses to Stressor Exposure. Int Rev Neurobiol. 2016;131:1-19 ^{, 4} Abhari K, Shekarforoush SS, Hosseinzadeh S, Nazifi S, Sajedianfard J, Eskandari MH. The effects of orally administered Bacillus coagulans and inulin on prevention and progression of rheumatoid arthritis in rats. Food Nutr Res. 2016 Jul 15;60:30876 ^{, 5} DeChristopher LR, Uribarri J, Tucker KL. Intake of high-fructose corn syrup sweetened soft drinks, fruit drinks and apple juice is associated with prevalent arthritis in US adults, aged 20-30 years. Nutr Diabetes. 2016 Mar 7;6:e199 ^{, 6} Rashid T, Wilson C, Ebringer A. The link between ankylosing spondylitis, Crohn's disease, Klebsiella, and starch consumption. Clin Dev Immunol. 2013;2013:872632. A diet that emphasizes raw leafy greens supports beneficial bacteria that can produce chemicals that help to regulate inflammation in the body. In addition, fermented foods, such as sauerkraut and kimchi, may be beneficial due to the presence of bacterial and fungal products that stimulate the immune system. ⁷ Ashraf R, Shah NP. Immune system stimulation by probiotic microorganisms. Crit Rev Food Sci Nutr. 2014;54(7):938-56.

See An Anti-Inflammatory Diet for Arthritis

…And stick to them. Dietary changes can cause temporary shifts in the gut microbiome relatively quickly, but permanent change takes 9 to 15 months. ⁸ Thaiss CA, Itav S, Rothschild D, et al. Persistent microbiome alterations modulate the rate of post-dieting weight regain. Nature. 2016;

See Improving the Gut Microbiome and Arthritis Symptoms with Diet

Exercise more. Regular moderate exercise seems to make positive changes to the gut microbiome, which have been linked to decreases in inflammation. ⁹ Campbell SC, Wisniewski PJ 2nd. Exercise is a Novel Promoter of Intestinal Health and Microbial Diversity. Exerc Sport Sci Rev. 2017 Jan;45(1):41-47. ^{, 10} Estaki M, Pither J, Baumeister P, Little JP, Gill SK, Ghosh S, Ahmadi-Vand Z, Marsden KR, Gibson DL. Cardiorespiratory fitness as a predictor of intestinal microbial diversity and distinct metagenomic functions. Microbiome. 2016 Aug 8;4(1):42 ^{, 11} Yano H, Uchida M, Oyanagi E, Iemitsu M, Onodera S, Kremenik MJ, Miyachi M. Voluntary Exercise Attenuates Obesity and Systemic Inflammation by Alteration of Gut Microbiota in TLR5-Deficient Mice: 2658 Board #181 June 3, 9: 30 AM - 11: 00 AM. Med Sci Sports Exerc. 2016 May;48(5 Suppl 1):742.

See Exercising with Arthritis

Meditate and be mindful. Stress and anxiety may affect the gut microbiome, and vice versa. ¹² Malan-muller S, Valles-colomer M, Raes J, Lowry CA, Seedat S, Hemmings SMJ. The Gut Microbiome and Mental Health: Implications for Anxiety- and Trauma-Related Disorders. OMICS. 2017; ^{, 13} Velin AK, Ericson AC, Braaf Y, Wallon C, Söderholm JD. Increased antigen and bacterial uptake in follicle associated epithelium induced by chronic psychological stress in rats. Gut. 2004;53(4):494-500. ^{, 14} Sharkey KA, Savidge TC. Role of enteric neurotransmission in host defense and protection of the gastrointestinal tract. Auton Neurosci. 2014;181:94-106. ^{, 15} Selkirk GA, Mclellan TM, Wright HE, Rhind SG. Mild endotoxemia, NF-kappaB translocation, and cytokine increase during exertional heat stress in trained and untrained individuals. Am J Physiol Regul Integr Comp Physiol. 2008;295(2):R611-23. Meditating and practicing mindfulness can reduce the levels of hormones associated with stress and anxiety, which can change the gut microbiome.

Stop smoking. Smoking affects the gut microbiome, including microbes in the mouth. ¹⁶ Biedermann L, Zeitz J, Mwinyi J, Sutter-Minder E, Rehman A, Ott SJ, Steurer-Stey C, Frei A, Frei P, Scharl M, et al. Smoking cessation induces profound changes in the composition of the intestinal microbiota in humans. PLoS One. 2013;8:e59260. Smokers are at a greater risk for periodontal disease, which is associated with rheumatoid arthritis and may be a precursor to it. ¹⁷ Scher JU, Bretz WA, Abramson SB. Periodontal disease and subgingival microbiota as contributors for rheumatoid arthritis pathogenesis: modifiable risk factors?. Curr Opin Rheumatol. 2014;26(4):424-9. (Smoking is already an established risk factor for RA.)

Interact with nature. Things like outdoor recreation, petting domesticated animals (not wild ones), and gardening expose a person to rich microbial diversity and help train a healthy immune system. ¹⁸ Von mutius E. Allergies, infections and the hygiene hypothesis--the epidemiological evidence. Immunobiology. 2007;212(6):433-9. This is especially important for young children with developing immune systems; adult immune systems are more difficult to re-program.

Consider taking a probiotic. There is evidence that probiotic supplements can reduce RA symptoms. ¹⁹ Wang P, Tao JH, Pan HF. Probiotic bacteria: a viable adjuvant therapy for relieving symptoms of rheumatoid arthritis. Inflammopharmacology. 2016 Oct;24(5):189-196 ^{, 20} Alipour B, Homayouni-Rad A, Vaghef-Mehrabany E, Sharif SK, Vaghef-Mehrabany L, Asghari-Jafarabadi M, Nakhjavani MR, Mohtadi-Nia J. Effects of Lactobacillus casei supplementation on disease activity and inflammatory cytokines in rheumatoid arthritis patients: a randomized double-blind clinical trial. Int J Rheum Dis. 2014 Jun;17(5):519-27 ^{, 21} Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A, Sharif SK, Asghari-Jafarabadi M, Zavvari S. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition. 2014 Apr;30(4):430-5 It is not clear that taking a probiotic supplement works by changing the microbiome, but the live bacteria in the probiotic may stimulate the immune system, which can effect change in RA symptoms. To maintain this effect it may be necessary to take the probiotic long term; however, that has not yet been proven.

See Dietary Supplements for Treating Arthritis

It is important to note that healthy people do not necessarily benefit from taking a probiotic. Also, probiotics are considered supplements and not regulated by the FDA. People shopping for probiotics are advised to consult with their doctor and choose a reputable brand and vendor.

It is much easier to foster a healthy gut microbiome than to repair a damaged one. Children aged 0 to 3, who have developing immune systems, may benefit from taking some or all of the steps listed above. But the rule of thumb is try and eat a balanced healthy diet, reducing sugar and fat intake, or at least replacing saturated fats with good fats, such as those found in nuts.

See Foods for a Healthier Gut and Less Arthritis Pain

It is less clear whether the steps listed above can help older children and adults who have already developed immune systems. For example, many studies indicate there is a connection between diet and the gut microbiome and arthritic disease, but the exact connection is not well understood, and research is ongoing. Until much more is known, mainstream medical organizations will not endorse specific treatments or prevention plans that aim to alter the gut microbiome.

In general, medical professionals agree that many patients can improve their symptoms by losing weight, eating healthily, and being physically active.