How your Digestive Health may be contributing to your Joint Pain
As an Osteopath in Doha, many people come to see me about long-standing aches and pains in their muscles and joints such as lower back pain. On questioning, it soon becomes apparent that many are also experiencing other symptoms that they believe are unrelated. One of the most common issues I encounter alongside common complaints like lower back pain is digestive health problems such as diarrhea, constipation, gas, and bloating.
The digestive system, or gut, is now regarded as our second brain, and an unhealthy or dysfunctional digestive system can, not only significantly impact our mood, memory, thoughts and emotions, but also contribute to aches and pains in our muscles and joints.
Digestive problems can often go under the radar because many people don’t take them seriously, and often go about their daily lives just putting up with them. In many cases, conventional medical tests such as endoscopy, colonoscopy and blood tests can appear normal, with no organic condition being identified. In fact, many people actually think it’s quite normal to have an inconsistent digestive system!
Typical signs and symptoms of an unhappy digestive system are:
- odorous gas
- stomach pain
- constipation/ diarrhea
Aside from the above signs and symptoms, there are also a number of common issues related to an unhappy gut that occur outside of the digestive system such as:
- foggy mind
- skin rashes
- joint and muscle pain
There is now a growing awareness and recognition that digestive problems can contribute to a variety of aches and pains in our muscles and joints such as lower back pain.
Some of the most common digestive imbalances are:
- Low or high gastric acid production (Hypo or hyperchloridia).
- Lack of enzyme secretion (from pancreas or villi in small intestine).
- An imbalance of gut bacteria (dysbiosis), which can include yeast or bacterial overgrowth, parasitic infections and diminished levels of friendly bacteria.
Making Big Differences with Small Changes- The Pareto Principle
The Pareto Principle, or the 80/20 rule, states that approximately 80% of consequences or effects are a result of 20% of causes or inputs. We could apply this general concept to our digestive health because, in many cases, it is only a few inputs that are responsible for the majority of symptoms.
It may be just one regularly eaten food that causes a variety of problems. As an example, intolerance to foods containing wheat or dairy can cause a cluster of symptoms that include joint pain, skin rash, depression, headaches, bloating, abdominal pain and flatulence
In the same way that just a few inputs can be responsible for a variety of symptoms, a few dietary exclusions can be responsible for the majority of health improvements. I have witnessed this first hand with participants of the 31 Day Health Transformation Programme, many of whom have experienced significant reductions and even resolution of symptoms by simply avoiding foods containing gluten, dairy and refined sugar for just three weeks.
Click here to view some of the most common food intolerances.
Because some food intolerances and sensitivities can be mild and may not produce immediate symptoms, many people are unaware of the connection between what they are eating and the symptoms they are suffering. Some of the most common intolerances are a result of the body not producing the enzymes to be able to breakdown substances such as gluten and lactose.
Unlike food intolerances, food allergies can be more serious. Substances, known as antigens, within certain foods can cause an immediate reaction from the immune system that produces symptoms such as swelling, itching, hives, wheezing, difficulty breathing and even death.
Some of the most common food allergies are:
- tree nuts
- shellfish and fish
Poor Diet, Joint Pain and an Overactive Immune System
Our digestive systems contains approximately 10 times more bacterial cells than human cells. These cells are involved in a number of vital metabolic processes including the breakdown and absorption of nutrients, production of hormones and vitamins, and defense against pathogens and toxins.
In the average lifetime, approximately 60 tonnes of food passes through our digestive system, along with many nasties from the environment that can potentially harm us, such as parasites, fungi, and harmful bacteria.
Our gut bacteria interact with our immune system via something called gut associated lymphoid tissue (GALT). This tissue, which is located throughout our digestive tract, makes up the largest part of the immune system, and is an important site for the development of our tolerance against illness and disease.
The gut is also responsible for production and activation of T helper cells, which regulate the way our immune system responds to the food we eat. An unbalanced ratio of T cells can contribute to inflammatory autoimmune conditions such as rheumatoid arthritis, irritable bowel disease, psoriasis and coeliac disease.
An unhealthy balance of bacteria in the digestive system (dysbiosis) can also compromise our defences, promote inflammation, and exacerbate aches and pains such as lower back pain. Research suggests that the gut bacteria differs in people who suffer from common conditions such as Osteoarthritis and Rheumatoid arthritis. In addition, people with these conditions also tend to have a predisposition to stomach issues including bloating, irregular bowel habits and indigestion.
The storage protein gliadin, which is a component of gluten, can damage the wall of the small intestine. These proteins can resist digestion, contribute to inflammation, and dysbiosis . A permeable intestinal barrier can result in inflammatory reactions, which contribute to diseases such as Type 2 Diabetes and Rheumatoid Arthritis. In addition, the regular use of drugs such as paracetomol and non-steroidal anti-inflammatories (ibuprofen, naproxen, etc) can also harm the digestive system.
Osteoarthritis, which is normally perceived as a simple degeneration of cartilage due to age, is now regarded as a far more complex process with significant immune system and inflammatory involvement.
Eating a nutritious diet is all well and good but if we are not absorbing the precious nutrients from the food we eat, we may just be pouring water into a leaking bucket!
Simple Steps for Better Digestive Health and Less Joint Pain
Because of our bio-individuality, and a never ending stream of conflicting advice, finding the ultimate diet can be a minefield . However, we should all prioritize good digestion by developing and maintaining a rich and diverse gut microbiome (composition of gut bacteria), and a healthy intestinal barrier. As a consequence, this will benefit our immune system and protect us from the myriad of symptoms associated with a compromised digestive system.
Eliminate to Illuminate
Probably the best way to start this process is with a simple elimination diet that takes out some of the most common dietary offenders such as gluten and dairy. Although there doesn’t seem to be a lot of established research on the best time period over which to perform an elimination diet, a two to four week elimination phase has shown improvements in children with food allergies.
The more foods you avoid during the elimination phase the harder it will be to stick to, so only eliminate foods that you suspect to be problematic. The foods mentioned earlier are some of the most common culprits, so start with a few of the most obvious.
During your elimination or as we like to call it ‘illumination’ phase, focus on what you can eat rather than what you cannot. When people focus too heavily on what they are avoiding, it can create temptation and an internal pressure which makes the experience harder to sustain. Temptation and pressure will work against the ideal outcome of adopting new and better eating habits.
During the 31 Day Health Transformation, we ask participants to avoid foods containing gluten, dairy, refined sugar, caffeine and alcohol for 3 weeks. This leaves an abundance of foods to choose from. We also provide a comprehensive recipe book and nutrition guide to support the journey. To date, participants have experienced a number of health improvements including reductions in joint pain, pre-menstrual symptoms, fatigue, headaches, body fat, reflux etc.
Check out some of our participant testimonials here
As a result of the beneficial changes experienced by the majority of participants, many choose to continue most of the exclusions as a lifestyle choice. That said, if you ‘fall off the wagon’ by eating or drinking your excluded items, just pick up and start again the next day.
Each act of self-discipline, whether it be 3 days or 3 weeks, will bolster your confidence, familiarity and capacity to sustain eating habits that transform your health and happiness!
For more information on what’s right for you, how to reintroduce foods, and what to look out for, get in touch with us.
Check your poop as a gauge of good gut health
A simple way of gauging your digestive health is by observing what comes out of it! The Bristol Stool chart was developed as a guide to standardize different forms and consistencies of poop. The consistency of our poop is related to the amount of time it takes to pass through the digestive system. This transit time is a key determinant of the bacterial diversity and richness within our gut. Loose stools such as diarrhea pass through the digestive system quicker, and are associated with a poorer composition and variety of gut bacteria.
Go deeper into detail with an ‘At-Home’ Gut Test
If you want to get a more accurate picture of how your digestive system is performing, and how the foods you are eating are affecting you, take a gut-microbiome test. This simply requires you to send a sample of your poop to a lab where they will identify the different types and amounts of gut bacteria housed in your digestive system, as well as what they are producing.
VIOME is a highly rated provider of at-home microbiome test kits that provide you with in-depth analysis of your gut bacteria, as well as personalized feedback and recommendations on what to eat to improve your digestive and overall health. For a more detailed run down of how Viome works, click here.
Common Sense Eating for a Happier Gut
No carbs before marbs!
Dietary carbohydrates have come under intense scrutiny regarding their contribution to levels of inflammation in the body. The evidence seems to indicate that the amount of inflammatory markers present in the body is influenced by the amount of glucose released (glycemic load) after eating certain types of carbohydrate.
Excessively high levels of blood sugar and insulin increase the production of pro- inflammatory substances in the body. Eating less refined and more complex carbs with a higher fibre content has been shown to reduce markers of low-grade inflammation. Interestingly enough, research has shown that eating sugar in the form of fructose on an empty stomach increases the presence of pro-inflammatory markers in the body but not glucose or sucrose.
Ditch the dodgy fats
Some fats are also responsible for increasing the presence of inflammatory markers. Trans fats are basically unhealthy substances mostly created by the chemical process of hydrogenation, which solidifies the oils, enhances taste, texture and increases shelf life of products. Foods such as cakes, biscuits, margarine, frozen pizzas and crackers all contain varying amounts of these unhealthy fats. Both trans fats and industrialized seed oils, such as vegetable oil and sunflower oil, increase levels of inflammatory markers, increase inflammation inside blood vessels, and the risk of cardiovascular disease.
Research concerning the effect of our diet on levels of inflammation in the body has found that eating foods containing the beneficial compounds known as flavonoids, can reduce the level of inflammatory substances in the body. However, individual blood markers of inflammation such as the substance C Reactive Protein (CRP) do not accurately reflect inflammation inside tissues of the body. Whether a reduction of these substances has an actual impact on inflammation within the bodily tissues and compartments is yet to be established.
Despite the lack of clarity around the impact of our diet on levels of inflammation, you’re certainly not doing yourself any harm by increasing the amount of green veggies and berries in your diet. Be sure to eat plenty of blue berries, strawberries, apples, parsley, green leafy veg and drink lots of green tea!
Feed your Good Gut Bugs to Beat Back Pain
The most practical approach to promoting gut health is to eat foods that feed our good bacteria. Pre-biotics are defined as non-digestible food ingredients that improve our health by selectively promoting the growth of various bacteria in the colon. The majority of these ingredients are in the form of fibre, which resist digestion in the small intestine to reach the colon where, through the process of fermentation, they feed our good bacteria.
The fuel that these prebiotic foods produce for our good gut bugs (short chain fatty acids) also help to:
- Improve immune system defense
- Reduce the risk of colon cancer
- Reduce the risk of allergies
- Decrease population of bad bacteria and viruses that cause disease
- Improve gut motility (movement of organisms and fluid around the gut) Improve the condition and function of the intestinal wall
The use of both pre and probiotics to improve health is an emerging therapy that is already showing beneficial outcomes in a number of chronic inflammatory-related conditions such as diabetes, obesity, heart & kidney disease.
Common prebiotic foods include:
- Wheat Bran (outer layer of the whole wheat grain)
Unfortunately, in a number of people with digestive issues, some of these prebiotic foods may actually make matters worse. The symptoms of irritable bowel syndrome (IBS), which include bloating, gas, stomach pain, diarrhea and constipation, can be resolved by following a diet that excludes many of the foods which contain the beneficial prebiotic ingredients.
Stress is also major contributing factor in IBS, which has been described as a combination of irritable bowel and irritable brain.
This dietary approach known as the FODMAP diet, is essentially an elimination diet, where foods are excluded over a 2-6 week period and then carefully reintroduced to help identify the foods that trigger symptoms.
Probiotics, which are live strains of micro-organisms that provide health benefits when consumed in adequate amounts, have become very popular over recent years. Some of the most common species of probiotics, Lactobacilli and Bifidobacteria, can be found in a wide range of foods, some of the most obvious being fermented foods such as sauerkraut, kefir, yoghurt, cheese and pickles.
Probiotic supplements are regarded as generally beneficial in the treatment and prevention of various digestive conditions, however research into which specific probiotic species and strains are best suited to individual people and conditions is currently lacking.
Many people take probiotic supplements to boost their digestive health, especially after taking a course of antibiotics. Unfortunately, it is not clear whether taking a probiotic supplement is an effective way of restoring our normal gut bacteria. Taking a general probiotic supplement may actually prevent our normal microbiome from returning to normal after use of antibiotics. In addition, many people do not benefit from probiotic supplements due to it being naturally expelled by the digestive system.
Because we all possess a unique and diverse balance of gut bacteria, we should really only consider probiotic supplements, that have either been rigorously tested amongst a diverse population of people, or are tailored to the characteristics of our individual microbiome.
At present, the somewhat less appealing procedure of fecal transplant is more effective at restoring our normal gut bacterial environment, because it uses our own bacteria. Even a single transplant of poop from a healthy donor has shown promise in a number of conditions including C difficile infection and IBS.
As little as 3 x 30 minutes of moderate intensity exercise per week can increase our levels of health-promoting gut bacteria.
So in summary…
If you’re having treatment for joint pain or low back pain, be sure to tell your practitioner about any other symptoms you may be experiencing, serious or not, because they may well be contributing to the experience.
And if you’re a therapist, remember to ask!
Persistent aches and pains in our muscles and joints can be exacerbated by what we eat and the health of our digestive system.
An unhealthy balance of gut bacteria and a compromised gut barrier can increase inflammation.
Inflammation makes our nervous system more sensitive and makes things hurt more, so when we control inflammation we can also reduce aches and pains!
Start your exploration into a happier gut and happier joints with a gentle elimination diet that excludes common or suspected trigger foods such as wheat, dairy and sugar for at least 3 weeks.
Begin to include as many of the prebiotic foods mentioned earlier into your daily diet, in order to feed your good gut bugs. However, be aware that some of these prebiotic foods may actually cause symptoms such as gas, bloating, diarrhea and constipation (especially if you have IBS).
If this is the case try the FODMAP approach for 3 weeks and then carefully reintroduce the prebiotic foods that do not trigger symptoms.
In addition, regularly consume some probiotic foods such as sauerkraut and kefir (if you’re excluding dairy, try coconut kefir). If none of those take your fancy, consider a good quality probiotic supplement that has evidence of benefit for your particular health goal/s.
Remember your gut bacteria is changing from day to day in response to the food you eat, so these are long-term dietary additions as opposed to a quick-fix (like a course of anti-biotics).
Often, treating chronic joint pain such as lower back pain is like trying to get rid of the smoke instead of the putting out the fire! Chronic aches and pains are just symptoms which often have a variety of contributing factors that have nothing to do with the actual part of the body that hurts! These include poor diet, systemic inflammation, stress. a sensitive nervous system and stress etc.
If we use Pareto’s 80/20 rule as a theory for improving our health, improving the function of our digestive system could be the 20% of effort that gets rid of 80% of our aches and pains!
As an Osteopath and Health Coach in Doha I can provide you with personalised dietary guidance that will not only aid your recovery from pain and injury, but also help you experience the vibrant health you deserve.
For more information on how to beat your back pain and improve your digestive health get in touch with us.