I see quite a few patients with rheumatoid arthritis, and other autoimmune arthropathies, and what is the first thing I do? Give them anti-inflammatory medications? Give them immune-modulaters? No! Chances are, their rheumatologists have already done this. The first thing I will always do with patients in this category is address their digestive health. What does digestion have to do with systemic inflammation? Everything!
If you think about it, the intestines are really the main barrier that separate us from the outside world. They have to be extremely selective about what they let in and what they keep out. Immune cells constantly patrol the intestinal barrier, attempting to keep foreign invaders from entering the circulation. Enzymes and microbes help to break down foods, assuring that only the nutrients we need are allowed to pass through. We take this whole process for granted, but the level of intricacy at which everything must stay in check is astounding!
When it comes to rheumatoid arthritis, our biggest concern with respect to intestinal health is an increase in permeability (“intestinal hyperpermeability” or “leaky-gut syndrome”). The causes of this are numerous, but can include stress, food allergies, intestinal inflammation, medications, genetic influences, and exposure to environmental toxins. Normally, your intestinal cells are bound by “tight junctions”, which are meant to prevent undigested foods from passing through the intestines into the bloodstream. So, when your body is exposed to substances that are pro-inflammatory, the intestines can usually limit any negative effects with a localized immune response. However, when various factors (as mentioned above) affect intestinal permeability, antigens are able to bypass the intestinal immune response, allowing them to mobilize throughout the body, causing a systemic inflammatory response. The body then begins to attack itself because it’s primary defense (the intestinal barrier) has been compromised, forcing other parts of the immune system to become overactive. Thus, it’s not surprising that a wide range of gastrointestinal and systemic disorders are associated with abnormal intestinal permeability. According to a 2003 article in the Journal of Gastroenterology and Hepatology, systemic lupus (SLE), juvenile arthritis, eczema, sarcoidosis, psoriasis, inflammatory bowel disease, and a number of other chronic disorders can be linked to intestinal hyperpermeability.
So, what do most doctors instruct their patients with auto-immune disease to do? Take NSAID medications. What do these medications do? Increase intestinal permeability! They may temporarily relieve the pain, but the approach of using NSAIDs and immune suppressants is not sustainable, and is most likely worsening the long-term prognosis of auto-immune arthropathies. While a number of respected journals have discussed the link between intestinal hyperpermeability and systemic inflammation, this concept is largely ignored by conventional rheumatologists. Repairing the gut needs to be the first line of defense when dealing with auto-immune disease. Otherwise, as long as antigens continue to be able to “slip past” the intestines, it will be impossible for the immune system to regain control of itself.
What should you do if you have an auto-immune disease, or if leaky gut is a potential concern? If you want a more definitive assessment, there are tests that can be performed to measure the severity of intestinal permeability. Comprehensive stool testing can also be performed to evaluate the bacterial environment of the intestines, including the overgrowth of any foreign microorganisms that may need to be dealt with. A doctor who has experience with treating leaky gut will then need to determine which factors are contributing the most, whether it be food allergies, stress, or medications. Once these underlying obstacles are removed, nutritional interventions which help to initiate intestinal healing can then be implemented.
The concept of a “leaky gut” is not new to naturopathic medicine. Even though it has begun to gain traction in conventional medical journals over the last 10 years, it’s certainly far from being the “standard of care” in rheumatology practices. If you are suffering from any form of auto-immune inflammation, whether it be inflammatory bowel disease, rheumatoid arthritis, or psoriasis, you seriously need to address the underlying causes that may be affecting your digestive health. While the connection may not seem obvious at first, healing the gut will be the most important step you can take towards stabilizing any systemic form of inflammation.