THE GUT AND THEJOINT (PETRA HUNTER, BHSC(NAT), ND)
Over a lifetime, the CIT has to process many tonnes of food. Unfortunately, this also provides exposure to a large range of toxic compounds, dietary antigens, micro-organisms. and bacterial products. To prevent these substances being absorbed, a very sophisticated physiological barrier is formed by the mucous layer (glycocalyx), the epithelial cells, tight junctions, and the gut-associated lymphoid tissue (GALT).

WHEN THINGS GO WRONG

Under normal circumstances, the epithelial lining is reasonably leak-proof. Increased permeability, also known as “leaky gut”, has been identified in numerous local and systemic conditions, including acute gastroenteritis, ankylosing spondylitis, arthritis, asthma, coeliac disease, eczema, food allergy, inflammatory bowel disease (IBD), and rheumatoid arthritis. Many factors can stress, irritate and inflame the intestinal lining to cause increased permeability, as summarised in Table 1. Increased intestinal permeability (IP) can lead to diffusion of antigenic food materials and translocation of bacteria from the gut to extra-intestinal sites. When large molecules gain systemic entry, the immune system may respond by producing antibodies that cause a reaction against what would otherwise be a harmless compound.

GUT-JOINT RELATIONSHIP

It has been clearly established that IP occurs in various types of arthritis. For a long time use of NSAIDs (non-steroidal anti-inflammatory drugs) was thought to initiate Ip in arthritic patients, but recently, research has demonstrated that a pre-existing increase in IP is involved in disease pathogenesis.5 NSAID use may still be an exacerbating factor.

HEALING THE GUT

To effectively treat abnormal Ip and its associated conditions, three primary areas must be addressed:
Healing the inflamed intestinal mucosa – Nutritional support should include glutamine, n-acetyl-glucosamine, and soluble fibre.
Preventing further damage – Avoid exposure to toxins and irritants. Quercetin may help prevent further damage.
Correcting dysbiosis – Re-establish healthy intestinal flora using probiotics containing lactobacilli and bifidobacteria species.

GLUTAMINE

Glutamine is the primary fuel source for enterocytes and aids in their proliferation and repair. Adequate levels are essential to maintain intestinal barrier function and regulation of tight junctions.6 Glutamine supplementation increases the height of intestinal villi, stimulates gut mucosal cellular proliferation, and maintains mucosal integrity.T Glutamine is presently the best-known compound for reducing IP. Glutamine also increases the synthesis of sIgA (secretory immunoglobulin A). SIgA is vital to the function of the intestinal immune system and the prevention of bacterial translocation.

N-ACETYL-G LUCOSAM IN E (NAG)

The intestinal glycocalyx is the most superficial layer of the gut mucosa and serves to protect the underlying tissues against enzyme exposure/ gastric acid, and bacterial onslaught. NAG is an integral component of the glycocalyx and therefore plays an important role in the maintenance and repair of the intestinal mucous membranes. NAG is also an effective promoter of bifidobacteria. Oral supplementation with NAG has shown promise in the treatment of chronic IBD in children.

SOLUBLE FIBRE/MUCILAGE

Fibre encourages the growth of beneficial bacteria and suppresses the growth of harmful pathogens. When fermented by colonic bacteria, soluble fibre produces short-chain fatty acids – another primary fuel used in the colon. Slippery elm is frequently used as a source of soluble fibre. It also contains large amounts of mucilage, which forms a gel-like, soothing film over inflamed mucous membranes and stimulates healing. Another popular mucilage containing plant that may be used in gastrointestinal disorders is aloe vera. Its anti-inflammatory properties may provide welcome relief in IBD.

QUERCETIN

Quercetin is beneficial in most inflammatory conditions. The anti-inflammatory activity of quercetin lies largely in its antioxidant properties as well as its inhibitory effects on pro-inflammatory enzymes (cyclooxygenase and lipoxygenase) and the subsequent inhibition of inflammatory mediators, including leukotrienes and prostaglandins. Excessive leukotriene production has been linked to IBD. Quercetin’s anti-inflammatory effects also extends to the inhibition of histamine release by mast cells and basophils (degranulation). Mast cell degranulation is believed to promote inflammatory responses and mucosal injury.

PROBIOTICS

Optimal function of the GIT depends on a balanced co-existence between more than 100 000 billion resident micro-organisms of different species. Such an environment promotes gut maturation and integrity enhances mucosal carrier function, stimulates mucosal production of molecules that downregulate inflammatory responses, suppresses growth of pathogenic bacteria, blocks epithelial attachment by pathogens, and modulates host immune responses. Oral ingestion of these health-promoting microbes via probiotic supplementation also exerts extraintestinal effects, including on the joints. Research has demonstrated a relationship believe the gastrointestinal microbiota, mucosal and systemic immune responses and the development of arthritis. Lactic acid bacteria have been shown to significantly downregulate proinflammatory cytokines and in this way, relieve the symptoms of rheumatoid arthritis.

FISH OILS (OMEGA-3 FATTY ACIDS; EPA/DHA)

Omega-3 fatty acids are beneficial in the management of intestinal inflammation and increased IP by reducing the production of pro-inflammatory mediators and cytokines. Fish oil supplementation has been shown to modify inflammatory mediator profiles in patients with IBD, and reduce the rate of relapse in patients with Crohn’s disease. In patients with ulcerative colitis, fish oil supplementation resulted in clinical improvement as well as the reduction, and in some cases/elimination of anti-inflammatory drug use. The effectiveness of fish oil in the treatment of arthritis has been well documented, with one study showing that omega-3 fatty acids are as effective as ibuprofen in reducing arthritic pain. Causes of Intestinal Permeability
Nutritional Deficiencies, in particular glutamine
Emotional stress
Pharmaceutical drugs, especially antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs)
Alcohol abuse
Gastrointestinal parasites
Intestinal bacterial infections or overgrowth
Ingestion of junk food
Excessive consumption of sugary foods
Excessive consumption of sugary foods
Food allergies
“Take Home” Tips For the Patient with Gut-joint Problems Many dietary and lifestyle factors can aggravate your condition, therefore: Avoid: Consumption of sugary foods and drinks Junk food Foods that cause you discomfort after eating Alcohol Excessive caffeine intake Food additives, preservatives, pesticides and other food contaminants High consumption of omega-6 fats (most vegetable oils) When possible: pharmaceutical drugs, in particular, antibiotics and non-steroidal anti-inflammatory drugs Prolonged stress Sedentary lifestyle Include more of: Fresh, wholesome foods, eat a balanced diet Fibre-rich foods Foods rich in omega-3 fatty acids (oily fish) Spices that have an anti-inflammatory effect, such as turmeric, ginger and garlic Drink plenty of water Exercise (must be appropriate for your condition; discuss with your healthcare provider) Also: Try to keep your weight within the normal range; excess body weight places stress on the joints, especially weight-bearing joints such as the knees and hips.

STRUCTURE and SUPPLEMENTS

Many chiropractors are now looking to address the cellular/chemical aspects of joint conditions through supplementation. Katrina Huges, BScChiro, MChiro With today’s society becoming progressively more sedentary, chiropractors are seeing in an increased prevalence of spinal and pelvic degenerative/inflammatory joint conditions such as arthritis. Potential explanations for this increase may be lifestyle factors including adverse workstation ergonomics, poor posture, a lack of physical activity, insufficient diet, and increased stress – just to name a few.

CAUSE & AFFECT

Structures of joints most frequently affected in degenerative/inflammatory joint conditions are the articular cartilage, subchondral bone, joint capsule and the muscles adjacent to the affected joint. In most areas, the tendons that cross the joint are the most important stabilising factor. Surprisingly, the condition of the articular surface plays only a minimal role in joint stability. Commonly, problems of the joints present with pain and swelling around the affected area(s); are worse in the mornings and in colder months; and click grind and clunk with movement.

ENTER: THE CHIRO

As a chiropractor, not only is the affected joint(s) assessed – the joints above and below the area(s) are taken into consideration as well as any potential contributing factors, such as trauma, family history, previous surgeries and lifestyle. A traditional chiropractic approach to typical joint degeneration is of a physical nature. It will seek to restore balance and symmetry to the spine and pelvis through the application of specific spinal and pelvic adjustments/mobilisations. The objective of this type of therapy is to reduce pressure, asymmetry and swelling of the joints, ultimately reducing the pressure on the nervous system and preventing further degeneration o{ the pelvis and spinal segments. Chiropractic philosophy tells us that through removal of interference to the nervous system the body can heal itself. Howeve4, the use of natural supplements can help rebuild and support affected structures and prevent future joint damage and degeneration.

SUPPLEMENTS

As the physical component of joint con&tions is only half of the picture, many chiropractors are now looking to address the cellular/chemical aspects of these conditions through supplementation, rather than advising commonly used pharmaceutical medications. The physical structure of joints is made from a combination of substances that become less abundant when a joint suffers any form of joint condition. For instance, cartilage matrix is comprised of: 65-80% water, giving the joint resilience and the ability to act as a shock absorber; collagen, which forms the structural framework; proteoglycans and glycosaminoglycans, which trap water and act like a sponge; and chondrocytes which release destructive enzymes and manufacture new collagen and proteoglycans.Cartilage ground substance consists of large amounts of chondroitin sulfate, hyaluronic acid and water; hence the importance of ensuring these essential substances are present in sufficient quantities through adequate supplementation. In acute conditions, an anti-inflammatory protocol is necessary to allow quick relief from any unpleasant symptoms. Supplements such as InflamEze Activ combine the anti-inflammatory properties of devil’s claw, cat’s claw and curcumin – all traditionally used in the treatment of arthritis, rheumatism and other inflammatory conditions. In more chronic cases, a continuing anti-inflammatory management plan is advised. Omega-3 EPA/DHA supplementation is the most common form of natural anti-inflammatory aids. Omega-3 EPA and DHA have been shown to downregulate the production of inflammatory mediators found in patients with joint conditions, but also helps prevent inflammatory infiltrate from further damaging the joint. While addressing the anti-inflammatory aspects of joint conditions, supplementing with a glucosamine/chondroitin/MSM complex is also highly recommended in most instances. Prolonged use of glucosamine sulfate and chondroitin has been shown to help slow the progression of joint degeneration due to their role in the synthesis of glycosaminoglycans and proteoglycans that form the structural matrix of joints. Glucosamine is the major building block for structures such as tendons, ligaments, nails, skin, bones, eyes, heart valves, and synovial fluid in the joints. In its sulfated form, glucosamine provides cartilage with its structure, strength and shock-absorbing properties. Glucosamine levels directly influence the number of proteoglycans that are produced and thus how much water can be held within the joint. In short, glucosamine sulfate provides the building blocks joints need to repair damage to their bone, cartilage and synovial fluid components. Chondroitin acts as a “liquid magnet” helping joint fluid retention and minimizing bone-on-bone friction. Chondroitin has also been found to stimulate the production of collagen and proteoglycans within the cartilage matrix. MSM, or methylsulfonylmethane, a major constituent of collagen. It provides the sulfur the body needs to ensure that the connective tissue surrounding the joint is healthy, supportive and stable. Less frequently used but nonetheless successful in supporting the treatment of joint conditions is vitamin C. Vitamin C is essential for the production and maintenance of strong collagen. This is necessary to ensure proper strength and functioning of tendons, ligaments and cartilage. It is a natural destressor, detoxification agent and antioxidant, helping to rid the body of free radicals that cause jopint damage, such as the inflammatory inflitrate found in joint conditions.

Life Advice

In addition to the treatment and prevention of joint conditions through chiropractic and supplementation, lifestyle factors must also be dealt with. The following are advised to help prevent joint damage: A diet high in omega-3s, ie more fish, nuts & seeds Maintain an ideal body weight Gentle regular exercise, such as swimming Ensure proper recovery after injury Optimise biomechanics to reduce stress on the joints, such as ensuring proper workstation ergonimics and good posture. The successful treatment and prevention of degenerative/inflammatory joint conditions must take a multifaceted approach, with considerations for lifestyle, physical and chemical factors. educatiuon of patients is also vital for their long term joint health as the population continue to grow older, live longer, and become more sedentary and overweight – the latter of which, if addressed can.
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