Interested in finding new ways to address inflammation? Have you considered the impact of your patient’s gut microbiome on inflammation? Have you considered how your patient’s microbiome could be impacting their arthritis? Dive in to learn more!
While we typically think of physiotherapy as being concerned with musculoskeletal health, Physical Therapy in a broader context is concerned with all things ‘health’! In light of advancements in research and knowledge, we might be doing our patients a disservice if we aren’t looking at all factors that could be impacting health. Non-traditional natural therapies (or discussions) that address inflammation is one topic that rehab practitioners should consider engaging in with their clients.
1. The following study was one that should spark some curiosity.
Amrita Vijay, Afroditi Kouraki, Sameer Gohir, James Turnbull, Anthony Kelly, Vicky Chapman, David A Barrett, William J Bulsiewicz, Ana M Valdes. The anti-inflammatory effect of bacterial short chain fatty acids is partially mediated by endocannabinoids. Gut Microbes, 2021; 13 (1).
In short, the researchers found that exercise intervention in people with arthritis, did not just reduce their pain, but it also lowered the levels of inflammatory substances. How this was done was what was most interesting! They found that the exercise intervention (strengthening exercises daily for six weeks), increased endocannabinoids which was strongly linked to changes in the gut microbes and anti-inflammatory substances produced by the gut microbes. The study suggests that there may be other pathways involved in the modulation of the immune system via the gut microbiome.
2. Another study (on mice this time) looked at obesity, osteoarthritis, and gut microbiome dysbiosis (a reduction in microbial diversity).
Schott EM, Farnsworth CW, Grier A, Lillis JA, Soniwala S, Dadourian GH, Bell RD, Doolittle ML, Villani DA, Awad H, Ketz JP, Kamal F, Ackert-Bicknell C, Ashton JM, Gill SR, Mooney RA, Zuscik MJ. Targeting the gut microbiome to treat the osteoarthritis of obesity. JCI Insight. 2018 Apr 19;3(8):e95997.
They reported that - compared with the lean murine gut - obesity is associated with loss of beneficial Bifidobacteria, while key proinflammatory species gain in abundance. Oligofructose (a non-digestible prebiotic fiber) supplementation restores the lean gut microbiome in obese mice, in part, by supporting key commensal microflora, particularly Bifidobacterium pseudolongum. This is associated with reduced inflammation in the colon, circulation, and knee and protection from OA.
3. However, it might not be as direct of a correlation as the studies suggest.
Sánchez Romero EA, Meléndez Oliva E, Alonso Pérez JL, Martín Pérez S, Turroni S, Marchese L, Villafañe JH. Relationship between the Gut Microbiome and Osteoarthritis Pain: Review of the Literature. Nutrients. 2021 Feb 24;13(3):716.
This study concluded that despite encouraging results, their review highlights the paucity of high-quality studies addressing the potential role of the gut microbiome in OA-related pain, along with the disparity of the techniques used so far, making it impossible to draw firm conclusions on the topic.
4. That being said…
Hutchinson AN, Bergh C, Kruger K, Sűsserová M, Allen J, Améen S, Tingö L. The Effect of Probiotics on Health Outcomes in the Elderly: A Systematic Review of Randomized, Placebo-Controlled Studies. Microorganisms. 2021 Jun 21;9(6):1344.
This systematic review concluded that probiotics appear to be efficacious in modifying gut microbiota composition in healthy older adults and have moderate effects on immune function. However, the effect of probiotic supplementation on other health outcomes remains inconclusive.
Where does that leave us?
Well, the correlation between exercise and gut microbes in interesting to me. I suppose we already know that exercise is good for joint pain, but now we know one of the reasons why.
Nutritional supplementation by way of probiotics, prebiotics, (and even joint supplementation) does seem to have an impact on gut microbiome, and the gut microbiome seems to have positive effects on inflammation… which helps with joint osteoarthritis.
So, perhaps in addition to our exercise prescriptions, perhaps we also need to discuss supplements that can improve the gut microbiome as well.
Food for thought!