Rheumatoid Arthritis and Juvenile Idiopathic Arthritis: The Leaky Gut Connection by Heidi Tolle - Student Member NANP
An estimated one and a half million Americans, mostly women between the ages of thirty and sixty, suffer from Rheumatoid Arthritis. It is a chronic, painful condition of unstable, swollen, irreversibly deformed joints (often visible in the hands and wrists) that can lead to cartilage and bone damage and even heart and respiratory complications. It is definitely genetic...several genetic markers have been identified. However, the onset of symptoms and flare-ups follows the mysterious triggering of an aggressive auto-immune attack that creates inflammation havoc in the body, mainly by thickening the synovial fluid in joints.
If you go to the Arthritis Foundation website, read about Rheumatoid Arthritis, and click on the hyperlink: "causes," you will find mention of an immune system gone awry, genes, bacteria, environment, and obesity. It does not suggest or even hint that diet, medication, or gut-biome microflora have anything to do with the onset or propagation of this condition. There is a body of solid research and convincing anecdotal testimony that strongly connects the auto-immune aspect of Rheumatoid Arthritis to increased gut permeability and its underlying causes.
It has been found that Rheumatoid Arthritis patients have a much higher presence of Prevotella copri bacteria as well as antibodies for Bartonella bacteria than the general population. When P.copri or other pathogens are present in the gut, the populations of healthy microbes there decline. It is working knowledge in the functional nutrition world that an unbalanced microbiome can lead to inflammation of the small intestinal lining. When this lining is inflamed, the tight junctions between cells become lax, creating a scenario in which detrimental effects cascade. Through these loose cell junctions, metabolic wastes, microbial toxins, and partially digested food particles can slip into the bloodstream, instead of being contained and removed by the digestive system.
This compromised condition of the semi-permeable intestinal membrane is commonly referred to as leaky gut. Leaky gut can put too much stress on the liver and lymphatic system, calling for an emergency immune response. In the case of food particles wandering into the bloodstream, the immune system, through specific antigen-antibody markers, tags some of these particles as foreign irritants. Then every time a particular type of food substance, such as gluten or dairy, touches the epithelial lining of the small intestine, an inflammatory immune response occurs, further damaging this critically important barrier.
This immune response to food particles can express itself as food allergies, irritable bowel syndrome, gallbladder disease, varieties of arthritis, fibromyalgia, and other chronic inflammatory diseases. The inflammation from an unbalanced micro-biome leads to leaky gut which leads to more inflammation, setting up an increasingly damaging cycle that may go undiagnosed and without intervention, until an individual is in a critical state.
The peak of the crisis is reached when this cycle perpetuates into a self-destruct mode. How does this happen? In response to the chaos of leaky gut, immune antibodies are unleashed. The antigens, the tagged targets of immune antibodies, on the leaked food can resemble the antigens found in natural tissues. Over time, this confusion causes protective antibodies to actually attack body tissues. This self-inflicted destruction of body tissue by its own immune system is known as an auto-immune response. Rheumatoid arthritis is one such auto-immune disease. Others include multiple sclerosis, lupus, and thyroiditis.
Many of these diseases are conventionally seen as something that an individual simply “inherits”. Certainly, diseases like Rheumatoid Arthritis do have genetic components. The genetic tendency for such diseases may lay unexpressed for a long time, or forever, unless triggered. It is the triggers that are often misunderstood. One trigger often passed over by medical practitioners is dysbiosis of the gut bacteria. As discussed above, an unhealthy gut microbiome can set the stage for leaky-gut complications which in turn are thought to trigger the auto-immune response. Ultimately, auto-immunity results in debilitating symptoms for millions of people.
Because they steer clear of the leaky gut connection, conventional Rheumatoid Arthritis therapies may exacerbate the conditions they are meant to heal. Traditional clinical treatments include Naproxen or other non-steroidal anti-inflammatory pain relievers. Paradoxically, these substances viciously inflame the already compromised small-intestinal lining, increasing gut permeability (leaky gut) even further, and amplifying the auto-immune scenario. Additionally, courses of antibiotics may be given to discourage the growth of the pathogenic bacteria that trigger the Rheumatoid Arthritis genes. Ironically, antibiotics have a detrimental effect on commensal bacteria, disrupting the balance in the gut microbiome even further, and consequently deepening the disease cycle.
Young children can suffer from a tragic version of rheumatoid arthritis called JIA...Juvenile Idiopathic Arthritis. Along with antibiotics, and NSAIDS, standard treatment may include an immune-suppressing drug to reduce the pain-causing inflammation in the joints. Because this medication suppresses the immune system, enormous stress is put on the liver and lymphatics in a system with unbalanced microbiota. This promotes further gut inflammation issues that feed into the auto-immune cycle.
Whereas Rheumatoid Arthritis is most likely triggered initially by the presence of a particular bacteria, Juvenile Idiopathic Arthritis is thought to be triggered either by infection and the ensuing antibiotic treatment OR a gluten or dairy allergy or intolerance. In either case, the gut lining becomes inflamed and triggers an auto-immune cascade. Then the young person suffers pain, compromised immunity, malnutrition due to malabsorption of nutrients, food intolerance, less ability to tolerate everyday environmental toxins, HPA axis dysfunction, and dependence on medications to treat debilitating symptoms.
A holistic protocol for supporting gut health in clients with rheumatoid arthritis might include high dosing of probiotics (especially S. salivary and B. coagulans, which have purported "immuno-modulating effects") while eliminating gluten and/or dairy for a time. This combination is meant to stop the escalation of dysbiosis and inflammation and the propensity for rheumatoid arthritis flare-ups. Additionally, the protocol may include fermented foods (containing active live cultures of probiota), coconut oil and L-glutamine (supplements for gut support), and an anti-inflammatory diet rich in fiber and pre-biotic foods to support healthy commensal gut bacteria.
An anecdotal holistic protocol for supporting gut health and addressing pain from inflammation in children with Juvenile Idiopathic Arthritis was described in a New York Times article, "The Boy with a Thorn in His Joints." The protocol was comprised of six weeks of the elimination of inflammatory food groups; gluten, dairy, nightshades, and refined sugar from the diet; daily probiotics; daily dose (2 tablespoons) of Montmorency sour cherry juice; 2000 mg omega 3 from fish oil; Ibuprofen and Tylenol in place of Naproxen; and 1/4 teaspoon of a Chinese traditional medicine called "four marvels" powder. While many things were also in play, such as simultaneous treatment with an immune suppressant drug, and the possibility of natural disease remission, the anti-inflammatory nutrition protocol was the intervention that seems responsible for breaking the auto-immune cycle and resulted in symptom relief.
Research-based functional, holistic nutrition offers valuable insights into auto-immune diseases like Rheumatoid Arthritis and Juvenile Idiopathic Arthritis. Leaky gut is a real condition in which dangerous inflammation ramps up to chronic, debilitating auto-immune symptoms. Understanding how specific genetic predispositions can be triggered initially by an imbalance in gut microbiota is key to creating new holistic protocols for managing auto-immune diseases. Holistic nutrition may offer solutions for removing or defusing, underlying triggers and finally bringing natural symptom relief for individuals bearing the burden of despair that too often comes with conventional treatment of chronic autoimmunity.
Sources Cited:
Boynes-Shuck, A. Could balancing our gut bacteria be key to unlocking RA?" Healthline. https://www.healthline.com/health-news/could-balancing-gut-bacteria-be-key-to-unlocking-ra-012715. January 28, 2015. October 22, 2017.
Campbell AW. Autoimmunity and the Gut. Autoimmune Diseases. 2014;2014:152428. doi:10.1155/2014/152428.
Grisanti, R. Leaky gut: Can this be destroying your health? Functional Medicine University. www.functionalmedicineuniversity.com/public/Leaky-Gut.cfm. Publication date: not found. Accessed date: October 22, 2017.
Meadows, S. The boy with a thorn in his joints. The New York Times. 2013: February 1. https://www.functionalmedicineuniversity.com/article.pdf. October 22, 2017.
Heidi Tolle is a currently a Portland Community College, functional nutrition program student residing in Hillsboro, Oregon.
She hopes to live out a food life that sets an example of embracing wellness for her three young adult children.
Heidi has taught middle school biological and physical science.