Heal Your Gut, Heal Your Joints

June had been diagnosed with rheumatoid arthritis two years before I met her. The 68-year-old working, married mother of four was at the end of her rope. She’d been prescribed three strong medicines — prednisone, methotrexate, and, most recently, hydroxychloroquine — and she was taking over-the-counter pain relievers daily. Yet the pain in her hands was so severe that she couldn’t open a water bottle, carry a book, or brush her hair. Putting on a bra was so excruciating that she needed her spouse’s help getting dressed. She also suffered severe fatigue and knee pain.

For an independent, busy woman, it was devastating. 

During her first visit to my clinic, I prescribed a protocol that addressed her symptoms with food and lifestyle changes. Within three months, June was able to open water bottles more easily, brush her hair, and get dressed on her own. Her knee issues improved, and her energy level was higher than it had been in months, maybe years. 

She was also able to reduce her prednisone dose by half and was taking pain relievers three or four days per week instead of daily. 

And that was just the beginning.

I share June’s story because it shows that, with patience and perseverance, there is hope for arthritis sufferers. Instead of focusing on the symptoms, however, treatment plans must get to the root of the problem — and often this means addressing the health of the gut. 

Arthritis and Inflammation

The most common misconception about arthritis is that the disease strikes only old people. Yet, from 2010 to 2012, 7.3 percent of Americans ages 18 to 44 reported being diagnosed with the condition, while 30.3 percent of individuals between 45 and 64 were afflicted, according to the Centers for Disease Control and Prevention. This is almost one-third of middle-age Americans. And those numbers are on the rise, with an estimated 1 million new cases being diagnosed every year. 

An arthritis diagnosis can feel like a life sentence. But it doesn’t have to be, and here’s why: Its root causes are treatable.

Inflammation exacerbates joint symptoms. From a functional-medicine perspective, the gut is the root of all inflammatory arthritic conditions. So, for all forms of arthritis, an anti-inflammatory protocol that treats the gut will improve symptoms and reduce the need for medication. This is true whether the cause is autoimmunity, as with rheumatoid arthritis, or injury and overuse, in the case of osteoarthritis. 

In light of the vast research devoted to leaky gut syndrome in recent years, leading experts now conclude that gut dysbiosis — an overgrowth of yeast, harmful bacteria, and parasites that overwhelms beneficial gut bacteria — is often behind the development of arthritis. It is a powerful source of bodywide inflammation. 

And you can suffer from dysbiosis without exhibiting any symptoms. It can be caused by stress, antibiotics, proton pump inhibitors and antacids, traveler’s diarrhea and other infections, and dietary issues. 

Dysbiosis damages the intestinal lining and causes the gut to leak, allowing bacteria and microscopic undigested food particles to enter the bloodstream. Because these substances don’t belong there, the immune system treats them as invaders and releases an inflammatory cascade to vanquish them, which eventually leads to system-wide inflammation. Those gut bacteria also get into the synovial fluid of the joints, causing pain and inflammation. (For more on gut dysbiosis, see “How to Heal a Leaky Gut.”) 

This is why the only way to cure arthritis at its roots is to heal and balance your gut bacteria while addressing all the factors, including stress, that might be disrupting your gut health and triggering inflammation.

Healing the Gut, Healing the Joints 

The onset of June’s symptoms appeared to have nothing to do with her digestive system, but test results revealed severe dysbiosis. She had a history of digestive troubles: ulcerative colitis in her 20s, repeated parasitic infections while living abroad in her 30s and 40s, and a lapse in her otherwise healthy-eating habits in her 60s. She’d lived in Asia and eaten lots of soy, fish, rice, and vegetables, but had returned to eating more dairy and processed foods when she moved home to Connecticut.

In addition to having a damaged gut and an inflammatory diet, June had developed Raynaud’s syndrome, a condition that caused the blood vessels in her hands to constrict in the cold, restricting oxygen flow to her joints. She had also broken a toe, which eventually became arthritic. This combination contributed to her rheumatoid-arthritis symptoms. 

Instead of increasing her medications, I started by treating her gut dysbiosis with herbs, such as berberine, and supplements. She began taking glutamine, an amino acid that helps repair the intestinal lining; an antifungal to bring yeast overgrowth under control; and a probiotic. 

June also embarked on an elimination diet I designed (see “Step 1: Dietary Jump-Start” later in this article) that helps determine whether any common factors and foods — including dairy, eggs, gluten, corn, soy, and nightshade vegetables, such as tomatoes, eggplant, and potatoes — were triggering her symptoms. I also recommended she include plenty of anti-inflammatory vegetables, olive oil, nuts, legumes, and some fish in her diet. 

When June stuck to her food plan, her symptoms improved. When she got stressed at her job and couldn’t follow it, they got worse. This made the role of food and gut health in her arthritis symptoms clear to her. 

After 13 months, she finally felt great. “I could live this way for the rest of my life,” she told me. Our primary goal at that point was to keep treating her gut until a stool test showed the dysbiosis was gone. This would help prevent another flare-up or relapse and help her taper off medication. This took about 21 months. 

Healing the gut usually requires several rounds of treatment, but the patience is often richly rewarded.

(Download a free copy of “The Institute for Functional Medicine’s Elimination Diet Comprehensive Guide.”)

Stress and the Gut

Sometimes restoring the gut involves more than just changing diet and treating the microbiome. Over my years of practice, I began to notice a common thread in the cases of my arthritis patients who really struggled to heal: They had all experienced traumatic stress. 

A 2010 study supported my observations. It found that patients who suffered from persistent posttraumatic stress disorder (PTSD) were more likely to develop an inflammatory condition, such as rheumatoid arthritis.

PTSD may trigger inflammation because the body stays in the stress response. In active stress, cortisol levels rise in preparation for danger, resulting in an increased heart rate, a clenched stomach, and a racing mind. This response also shunts blood away from the digestive system in preparation for fighting or fleeing, further weakening digestion — all a prescription for gut troubles. 

Under normal conditions, when the stress response comes and goes, cortisol actually helps regulate inflammation. But when the body has been chronically stressed for a long time, it can respond by reducing cortisol production so much that it can’t perform its normal function. This leads to increased inflammation and inflammation-related diseases.

This is why my arthritis protocol includes mind-body practices. Studies have shown that if your mind is stuck in a loop of anxiety, worry, and grief, it changes your internal terrain to a place of “dis-ease.” 

To unravel this, your mind needs to let go of this pattern. The best way I’ve found is to practice a technique that helps you become aware of what you’re feeling each and every moment. This helps you catch yourself in the stress response.

To illustrate this point, consider my patient Jorge. I met him when he was 19 and suffering from juvenile rheumatoid arthritis, which doctors had diagnosed when he was 5. He grew up in Haiti, where he suffered from severe digestive issues and food intolerances even as a toddler. Still, he was able to manage his arthritis symptoms with aspirin. 

Then a devastating earthquake struck Haiti in 2010 when Jorge was 15. Although he was not harmed, his mother was trapped in the rubble of a building for 18 hours and spent three weeks in intensive care. She survived, but the episode exacerbated Jorge’s symptoms, requiring him to take large doses of the steroid prednisone to manage his pain.

At the time we met, he needed crutches because his knees were so swollen and painful that they couldn’t bear any weight. His symptoms improved slowly after we treated his gut and changed his diet, but we were struggling to wean him from the prednisone, managing to drop his dose by only 2 mg every three to four months.

Then something wonderful happened. During a Skype call, Jorge looked healthier than I had ever seen him. He excitedly told me that he had reduced his dose of prednisone by 5 mg since our last call, and he was able to go up and down the stairs without pain. When I asked him what had helped him make that change, he told me that he had started meditating every day, adding that it was the only thing he had done differently.  

I’ve seen many other people benefit from mind-body practices that help address trauma. I am confident that the mind-body-spirit connection and awareness are important sources of nourishment, ones that can significantly improve your internal environment.

The Healing Arthritis Protocol

My functional-medicine approach to treating arthritis focuses on “changing the terrain” in the body. It starts with healing the gut and addressing all the things that might be causing it harm — including problem foods, hostile microbes, and chronic stress. This is a brief summary of the basic plan. If you’d like to know all the details, please see my book Healing Arthritis.

Dietary Jump-Start

The first step to healing arthritis begins with a two-week protocol designed to repair the gut and remove foods that might trigger inflammatory symptoms. I call this a jump-start because many people experience a dramatic improvement just from eating differently. Using food as medicine is a core part of my approach to treating arthritis and all inflammatory conditions. 

The Leaky Gut Diet for Arthritis removes the following from your diet:

• Gluten
• Peanuts
• Dairy
• Sugar
• Soy
• Processed-flour products
• Corn
• Alcohol
• Eggs
• Nightshade vegetables, such as tomatoes, potatoes, eggplant, and peppers

The goal of an elimination diet is to help you feel better while identifying which foods might be a problem for you, so you can create your own personalized food plan once you reach step 3. 

I recommend a version of the Mediterranean-style diet — plenty of vegetables, lean protein, and healthy fat from olive oil and nuts — but above all, I encourage you to focus on the quality of your choices throughout the entire healing protocol. Here’s what that means:

1. Increase fiber, micronutrients, and phytonutrients by eating a rainbow of vegetables and fruits. 
2. Remove refined sugar and refined grains, such as those found in cookies, cakes, and bread. 
3. Improve the quality of your fats by eliminating refined and hydrogenated varieties.
4. Eat better animal proteins, sticking to grassfed and grass-finished beef, free-range chicken, and wild or sustainably farmed low-mercury fish. 
5. Avoid processed foods — especially things you make from a box — and instead choose whole foods and fresh plant foods.

2) Intensive Gut Repair

During the second step, you continue the elimination diet and focus on cleansing and repairing the gut. A healthy gut lining and thriving microbiome help prevent the inflammatory cascade that so often causes joint pain.

The two-month clean-and-repair process involves removing harmful bacteria, yeast, and parasites with herbal supplements; supporting digestion with enzymes; repairing the intestinal lining to treat leaky gut; and restoring beneficial gut bacteria with probiotics.

This is a sampling of some of the gut-repair supplements I use during this phase: 

• Herbal treatments, such as berberine and oregano oil, plus garlic, for treating dysbiosis.
• Enzymes that assist with digestion include betaine to support stomach-acid production; lipase, amylase, and protease to improve pancreatic function; and bile acids or dandelion root to support the liver and gallbladder in fat digestion. (Go here to learn more about digestive enzymes.)
• Nutrients such as L-glutamine, curcumin, and zinc carnosine for healing leaky gut.
• Probiotics for restoring healthy gut bacteria.

3) Finishing What You Started

For deeper, long-lasting change, you have to finish what you started and develop a program that becomes a permanent lifestyle change. 

In the third step, you’ll develop healthy new habits that will support you for a lifetime. Quick fixes are a good jump-start, but they don’t truly solve anything. 

In this six-month stage, you’ll continue your anti-inflammatory and gut-healing supplements, add some joint support with collagen, and begin the mind-body practice of your choice, such as meditation, yoga, or conscious-breathing exercises. 

You’ll also begin to transition out of the elimination diet to see if you can tolerate any of those foods without triggering symptoms. (Instructions for reintroduction are in the book.) 

At this point you’re ready to adopt the Healthy Eating Plan, which focuses on quality foods but offers more flexibility. Overly restrictive diets are not sustainable — and you need something you can live with. 

Your goal is to follow the Healthy Eating Plan 90 percent of the time, so you get the benefits of quality foods that will help you build resilience when you “cheat.” The plan has five simple goals:

1. Focus on foods that reduce inflammation, including colorful produce and healthy fats from olive oil and nuts. This also includes anti-inflammatory herbs and spices like turmeric, ginger, and rosemary.
2. Include foods that support gut health, such as probiotic fermented vegetables and prebiotic garlic. 
3. Avoid inflammatory foods 90 percent of the time. This sets you up to tolerate “treat foods,” like dairy or gluten, from time to time.  
4. Avoid toxins by sticking with organic produce and avoiding plastic packaging.
5. Choose quality food. Eat organic produce and proteins from grassfed and grass-finished animals; avoid processed foods.

Shifting your body on the deepest level toward resiliency and health is the ultimate goal of the Healing Arthritis Protocol. If you follow the diet and gut-cleanse part of this program, you will feel better. 

But the effect will be short-lived if you go back to your old habits. Additionally, ignoring how stress and trauma influence your health may prevent the lifestyle shift needed for permanent healing. 

Healing the gut takes time and commitment. Don’t be concerned when it seems to be taking months, or longer. Remember, every healing journey must begin with a few first steps. 

From Healing Arthritis: Your 3-Step Guide to Conquering Arthritis Naturally, by Susan Blum. Copyright © 2017 by Susan Blum, MD. Reprinted by permission of Scribner, an Imprint of Simon & Schuster, Inc.

What Is Arthritis?

There are many kinds of arthritis, but they can be grouped into three major categories:

1. Inflammatory Arthritis

This category includes several auto­immune conditions, with rheumatoid arthritis (RA) being the most common. RA affects almost 68 million people worldwide. (Three times as many women as men suffer from RA.) This category also includes psoriatic arthritis and ankylosing spondylitis, as well as other autoimmune diseases, such as lupus, that include arthritis as one of their symptoms. 

Undifferentiated arthritis (UA) — a condition in which symptoms are present but blood tests don’t reveal any markers — is considered an early stage of inflammatory arthritis. Thirty percent of people with UA eventually develop RA, which highlights the importance of treating it with an early intervention program that addresses diet and stress.

2. Osteoarthritis

Also referred to as degenerative joint disease, osteoarthritis (OA) is common and often triggered by a joint injury or by repetitive use over time. While injury and overuse are definitely risk factors for OA, recent research suggests that obesity, diabetes, and an inflammatory diet affect its development, as well as its pain levels.

3. Infectious Arthritis 

Infections can also cause arthritis. The source can be bacterial (as with Lyme disease), viral, or a reaction to an infection somewhere else in the body (called reactive arthritis). If you’re noticing symptoms, it’s critical to test for underlying infections, because infectious or reactive arthritis symptoms can’t be resolved without treating them.