A Whole9 guest post by Dr Sult, medical doctor, medical educator, inspirational speaker & the author of Just Be Well: A Book For Seekers of Vibrant Health.
Stiff, painful fingers? Aching knees? A chronic pain in the back? We often attribute these ills to an unfortunate effect of aging. It’s arthritis, we say, resigned. But what if the pain in our joints was actually caused by an imbalance in another part of the body, in the gut?
A recent article in The Atlantic magazine reviews several studies that uncover links between microbes in the gut and other diseases such as rheumatoid arthritis (RA). Rheumatologist Jose Scher found that people with RA had higher levels of a certain type of bug in the intestines than people without RA did. Scher also found that people with psoriatic arthritis had significantly lower levels of a type of bacteria than those without the inflammatory disease.
This connection isn’t just between the gut and arthritis—it’s a connection that can be found between the gut and any type of inflammation in the body.
Maybe you’ve just sprained your ankle and have been on Motrin, trying to hobble through your day, or maybe you’ve been taking birth control pills for years. Or perhaps you just had a viral gastroenteritis. Any of these situations can irritate the small intestine, causing a leaky gut or intestinal permeability—a condition when the food particles passing through the intestine “leak” into the blood stream, triggering the immune system to go into attack mode against the invaders.
In addition, most things that have co-evolved with us and live in our gut are camouflaged so that they can survive there. But when your gut is leaky, the camouflage doesn’t work as well. In fact it can be quite dangerous to us.
When your body tries to make antibodies against a camouflage, it often makes antibodies that inadvertently cross-react with your own body, resulting in autoimmunity. Because the leaky gut results in increased inflammation, if you have a predisposition to inflammation in your joints, this general increase in inflammation in your body will result in joint pain.
The recent research described in The Atlantic provides an interesting perspective on the relationship between leaky gut and more pronounced autoimmune diseases, such as lupus, inflammatory bowel disease, and multiple sclerosis.
This research suggests that even if you are not diagnosed with an autoimmune disease, if you have general joint discomfort, the problem may not dwell in your knee, but in your gut.
In her blog post, 9 Signs You Have a Leaky Gut, Amy Myers, MD outlines some additional symptoms that may indicate the problem is all in your stomach:
- Digestive issues (bloating, gas, irritable bowel syndrome, or diarrhea)
- Seasonal allergies or asthma
- Hormonal imbalances such as PMS
- Autoimmune diseases such as celiac disease, psoriasis or lupus
- Chronic fatigue or fibromyalgia
- Mood issues including depression, anxiety, ADD or ADHD
- Acne, rosacea, eczema
- Candida overgrowth
- Food allergies and intolerances
Counteracting a Leaky Gut
Angela, a patient I describe in my book, came to me because she had restless leg syndrome. As we delved more deeply into her health history, we also discovered she had experienced years of digestive issues, from acid reflux to irritable bowel syndrome—all stemming from a leaky gut.
For Angela, and for my other patients who have leaky gut, I prescribe a five-step approach:
- Remove the irritant. This may be a bacteria or a medicine. Consult with your doctor before discontinuing a prescription medicine, but certainly remove junk food, simple carbohydrates, and alcohol from the mix. In Angela’s case, one of her irritants was actually a proton pump inhibitor (PPI) that she used, ironically, to address her digestive troubles.
- Replace the irritant. Here, we substitute the removed element with healthy digestive constituents, such as hydrochloric acid or digestive enzymes. I gradually decreased Angela’s PPI dosage and introduced a different type of medicine, put her on some natural medicine support for her GI system, and removed bad gut bugs with an antibiotic.
- Re-inoculate the gut. The next step is to provide probiotics and prebiotics to rebuild a healthy gut. Most people are surprised at the amount of probiotics I use (billion and billions), but that is what is necessary to affect the trillions of bacteria in the gut.
- Repair the gut through nutrients such as glutathione, glutamine, vitamins, and minerals. The particular combination is based on a patient’s specific issue with the gut. In Angela’s case, I wanted to reduce the inflammation and help her gut heal. I also increased her magnesium with a supplement, suspecting that a magnesium deficiency caused her restless legs.
- Rebalance is the last step, and it’s one that’s not done in the doctor’s office. Rebalancing is important in understanding how you got the dysfunctional gut in the first place, and how you can prevent it from recurring. Maintaining lifestyle balance, eating a healthy diet, and being aware of stress levels can help you continue your recovery.
As we’ve seen, a leaky gut can be connected to a variety of illnesses, but the good news is, this condition—all its various symptoms—can be treated. The most important thing is recognizing that the discomfort you experience, even if they occur in other places in your body, may all originate in your gut.
Tom Sult is a medical doctor, medical educator, inspirational speaker & the author of Just Be Well: A Book For Seekers of Vibrant Health. Board-certified in family medicine & integrative holistic medicine, Tom is on faculty with the Institute for Functional Medicine and maintains a private practice in Willmar, MN. Join Tom’s crusade to change the way doctors treat their patients at www.justbewell.info. For more information on Tom’s practice please visit the 3rd Opinion website.
(Photo Credits: HaoJan and frankieleon / cc)
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Okay, I have a question. My older sister (18years older) has a ton of health issues. For starters she had her stomach removed (long story as to why) about 18 years ago and her thyroid removed 6 years ago. Well her food choices have been limited greatly. She has a lot of difficulty with meat. To top things off she is a finicky eater. Will not eat fish, she claims it makes her gag. She can’t eat certain veggies because she developed blood clots in her lungs 4 years ago and is taking Warfarin. I believe she is deficient in many ways. She is in chronic pain. Has been told she has arthritis. Has trouble sleeping.
So can you have a leaky gut without a stomach? Can you treat a leaky gut without a stomach? What can she take/eat that will help, be absorbed without a stomach? As for her doctors they are useless. They just want to push more prescriptions on her. She has pretty much given up and I am trying to help her find something that will help her see that this approach does work. Thank you for your time and suggestions.
Charlotte
Wow. I am so sorry to read this!!
First of all the idea that you shouldn’t eat certain vegetables because you’re on warfarin is old thinking. Newer thinking would suggest that she should consult a more knowledgeable doctor. That Dr. very well might put her on a multivitamin with vitamin K. That relatively larger dose of vitamin K would make the tiny doses of vitamin K she gets from her vegetables insignificant and would allow her to have steady blood test for her warfarin while eating vegetables in abundance.
Second you absolutely can have a leaky Gut without a stomach. It is the small intestine that becomes a leaky. Without a stomach it is highly probable she has small intestine bacterial overgrowth and leaky gut.
Your sister is a very complicated case and trying to help her over the Internet would be a great disservice. I would strongly advise you to go to functionalmedicine.org and find a competent functional medicine practitioner somewhere near her.
Tom Sult, MD
Author: JUST BE WELL
justbewell.info
Tom, you state: The recent research described in The Atlantic provides an interesting perspective on the relationship between leaky gut and more pronounced autoimmune diseases, such as lupus, inflammatory bowel disease, and multiple sclerosis.
Where in the Atlantic was leaky gut described or mentioned? Did I miss that? Thanks
Also, Dr. Scher does not seem sold on probiotics – interesting position from someone who studies these microbes.
Perhaps the comment was a bit of poetic license. He is talking about dysbiosis which from my clinicals perspective is almost universally associated with leaky Gut. Much of autoimmunity has been shown to initiate at the level of the gut mucosa secondary to abnormal interactions between the gut immune system in the gut luminal content.
His is one perspective on probiotics. I think that the most powerful way to change the microbio him is through dietary manipulation. Probiotics generally do not colonies that gut. Instead they are placeholders while diet and lifestyle change actually alter the micro biome.
The top toxic exposures to eliminate are tap water, pesticides, NSAIDS, and antibiotics but remember to always consult with your physician if he has prescribed these for you.
hello Dr Tom,
Thanks for the very helpful article! I’ve been having floating stool and bloating since taking MTX (I’ve rheumatoid arthritis). Been off MTX for a month now. Started taking digestive enzyme recently and it worked on day 1. Normalised stool and all that.
the problem is the digestive enzyme capsule triggers an inflammatory response in my shoulder tendon every time I take it. Would you know why that is the case? I’ve only tried one brand of enzyme so far.
Unfortunately, any individual can have nearly any bizarre side effect. I can’t say I’ve ever had a patient with that specific side effect. However, methotrexate will undoubtedly increase leakiness at the gut mucosa. Likely, you’re having an abnormal interaction between the proteins in the enzyme and your immune system that is escalating an inflammatory response.
Without knowing anything about your medical situation, I can’t say anything about you specifically. In general, One should try to fix any dysbiosis and leaky gut. In general, a way to do that would be to use a low carb diet, colostrum, high does probiotics, fish oil and other nutrients such as Curcumin and others. Autoimmune disease in general and rheumatoid arthritis specifically, are something that functional medicine often treats very well. I would encourage you to find a functional medicine practitioner to explore these complex medical issues in more detail.
Look at functionalmedicine.org for a list of practitioners in your area.
Tom Sult, MD
Author: JUST BE WELL
justbewell.info
Thunder god vine may work best when used with conventional RA medications. Use extreme caution with this herb, as it can be poisonous if extracts are derived from other areas of the vine.
Thanks Dr Tom, My doctor also introduced me on all natural remedies for my joint pain. he told me that taking a formulated medicine would only cause another health problem. Right on, i started to eat and live healthy.
Hi Dr Sult,
I accidentally saw your website and kept reading, and found that there were some things that you mentioned above were related to my case. I have been under a lot of medication for about 20 years. Name the NSAID’s and other medications, I have gone through them all. Did X-ray and MRI’s and the doctor does not seem to find anything except that at a stage my uric acid was high. So they put me on Allopurinol and nothing really solved the problem. They also tried giving me cortozin injections in the side of my thighs, which really did not work infact both the sides of my thighs are sore. I have severe pain from my hips all the way to my legs. My legs swell and if you press with your thumb in my shin the muscle remain pressed, it does not come back for a while to its original position. I have had severe gut problem, where my food does not get digested and I either have to immediately go to the washroom or I pass heavy gas, have a bloated stomach once I eat food. I stopped drinking alcohol and am almost done with any red meat, carbohydrates and any softdrinks. I was just wondering whether this could be a leaky gut issue, as the doctors don’t seem to find anything. Could you please advice what remedies could I try. I would really appreciate your feed back. Thank you
Your case is more complex that is going to be answered on line. The whole point of functional medicine is fully understanding the whole story so that we can understand how you got from feeling well in the past to feeling unwell. That will help us create a path back to wellness. I would encourage you to go to the Institute for functional medicine website and find a functional medicine practitioner near you. Functionalmedicine.org
Dear Dr. Sult
For the last 3 years I am constantly seeing consultants and having tests done regarding a problem with my digestion and I am so frustratrated because nobody seems to be able to find the problem!
It started with terrible joint pain in my knees especially when climbing stairs. I had to pull myself up on the banister.
The next thing was back pain and then vomiting. At times the vomiting lasted for 2/3 days – I could not even keep water down and was not able to get out of bed. Another problem was the increase in weight – now 25 kg !
but I cannot eat and always feel full after a few bites. Also I have no taste for food because of the sour taste in my mouth.
My doctor prescribed Esomeprazole and the vomiting has stopped but otherwise everything remains the same.
Acromegaly has been ruled out but I do have a Hiatus Hernia
and my Abdomen hurts and I cannot lay on my stomach.
I would be grateful for your advise if these problems relate in any way to Enzyme deficiency?
Thanks
Kind regards
Chris
Chris
I’m sorry to hear about your difficulties. You obviously have a complex medical condition having failed treatment from multiple physicians. Your case is obviously difficult enough that trying to help you via email is really folly. I would strongly encourage you to see a physician certified by the Institute for functional medicine. You can locate one using http://www.Functionalmedicine.org.
When the diagnosis is elusive and even when there is a diagnosis and the treatment is ineffective functional medicine can often offer a new perspective and new opportunities for intervention. Anytime somebody is sick there really are multiple moving parts. In broad paint strokes one of those moving parts is the disease itself. Most interventions focused on the disease and how to either reduce the symptoms or cure the disease. What is generally largely ignored is the host of the disease, namely you. Functional medicine generally focuses on improving the health of the host to the point that the host simply cannot support disease.
We often talk about “pushing the reset button”in FM. I will often put people on fairly extreme diets for a short period of time to alter the gut microbiom. We will frequently used things like colostrum and probiotics and anti-inflammatory herbs. But without a comprehensive functional medicine assessment it’s unlikely that you’re going to achieve satisfy results.
Tom Sult, MD
Author: JUST BE WELL
justbewell.info
I was diagnosed with Hpylori many years ago, and the steps that you listed I wish it had been available to be sooner. Ulcers
Hmm, I guess I was counteracting this problem unintentionally! I had a very bad fatigue problem for several weeks. I would sleep 12 hours a day and still be sleepy. One day, my brain told me to eat some yogurt or kefir everyday and after day 1, I started feeling so much better! I was able to get by with 5 hours of sleep. I also had some slight mood issues (very light bipolar), which seems to be gone, too. My autoimmune problem (cholinergic urticaria) also died down a bit. But I’m starting to have joint issues now. My joints on the left side of my body–from shoulder joints to finger and ankle joints– had chilling pains (like when you have bare hands holding on to ice for really long and the finger joints start to have this pain) and then a day later, my joints on the right side started having pains too. My chiropractor friend told me it could be a very bad gut problem, so I was searching and encountered this page. It’s very interesting.
Hi. I have Hashimoto’s, rosacea, tendonitis, reflux, burping constantly. I have been diagnosed with leaky gut. I switched integrative doctors after being diagnosed due to the doctors office moving to a farther location. Anyway, I have been unable to afford to go back since my insurance doesn’t cover this type of medical treatment. What do I need to take to repair my leaky gut (vitamins, minerals, etc…)? I am doing a organic Paleo diet but mostly focusing on meat/fish and veggies and 30 minutes of walking a day. Also what probiotic do you consider the “best.” Thank you.