RELATED: Does the Autoimmune Protocol Diet Help Rheumatoid Arthritis? What’s the hype, and what’s real? And can probiotics help with rheumatoid arthritis (RA) or psoriatic arthritis (PsA)? Here’s a little background.
Understanding the Gut Microbiome’s Function
The gut microbiome, which consists of trillions of bacteria, viruses, fungi, and other tiny creatures known as microbiota, performs many critical functions, such as digesting certain types of carbohydrates, helping the immune system, and fighting off pathogens (disease-causing microbes). In order for the gut microbiome to function effectively, it should be balanced and diverse. Good bacteria may complement traditional RA and PsA treatment, but there’s still a lot to learn.
Gut Health and Overall Health
You may think of bacteria as harmful microbes that cause infection and disease. But the truth is, our bodies are home to trillions of beneficial bacteria that help regulate our digestive systems, ensure proper elimination, and support immunity.
Your Gut and Arthritis: The Connection
In the past few years, researchers have found strong connections between gut health, rheumatoid arthritis symptoms, and disease progression. Indeed, a study published in the March 30, 2019, issue of Journal of Clinical Medicine found altered gut microbiota and microbial function in people in early stages of RA. In addition, people with PsA have lower levels of “good” bacteria in their gut than people without the condition, according to a study published in the December 2019 issue of Best Practice & Research: Clinical Rheumatology.
Food Versus Pills: The Probiotics Debate
Some healthcare practitioners recommend that patients increase their consumption of probiotics, the beneficial bacteria found in yogurt and other foods as well as in supplements. A systematic review and meta-analysis of previous studies published in the February 2017 issue of Engineering found that probiotic supplementation showed a limited improvement in people with RA, but noted that more quality studies need to be done. Another study, published in the June 2020 issue of Nutrients, also found a reduction of disease activity and gut permeability among people with PsA who took probiotics. These effects were not sustained after they stopped taking the supplements. RELATED: Eat These 10 Foods to Beat Arthritis Inflammation
The Probiotic Plan
“One of the reasons many chronic diseases, including autoimmune diseases, are on the rise is increased intestinal permeability, or leaky gut,” says Drew Sinatra, ND, a naturopathic physician who practices in Northern California and also works with Health Directions, a health and wellness company located in Maryland. “This can lead to immune dysfunction, setting the stage for autoimmune diseases to develop and progress.” While some perceive leaky gut as a concept credited more by integrative medicine practitioners than by mainstream doctors, Michael Camilleri, MD, of the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, described leaky gut in the May 2019 issue of Gut. He wrote that leaky gut “is when the microbial balance in your gut “gets out of whack — say because of chronic stress, chronic constipation, exposure to environmental toxins like pesticides, eating a poor diet or taking an antibiotic that wipes out a lot those microbes — the ‘bad’ bacteria cut holes in the fence, and some of them, along with food particles and toxins, leak into the bloodstream. When your immune system sees organisms where they do not belong, it attacks, causing irritation and inflammation.” RELATED: Manage Stress With Integrative Medicine In the published study, he added that “the leakage in leaky gut may be responsible for a huge variety of health issues, ranging from minor (bloating, cramps, fatigue, food allergies and sensitivities, gas, and headaches) to bigger things such as autoimmune conditions, depression and other mood disorders, diabetes, inflammatory bowel disease, and multiple sclerosis.” “With any autoimmune disease, I recommend a combination of diet, herbal medicines, and supplements, including probiotics,” Dr. Sinatra says. “It can take six months or longer to see big changes, but often symptoms improve within a few weeks.” Still, Sinatra says, there are limitations in the research supporting the benefits of probiotics. “While studies show that people with certain autoimmune diseases have less microbial diversity, there is no evidence to suggest that taking a probiotic can increase that diversity.” Plus, he says, “There haven’t been any studies looking at how probiotics affect clinical outcomes or microbial diversity in people taking biologics.” (Biologics are medications that block specific immune-system activity.) Sinatra says that patients need to talk with their healthcare provider before making a decision to take a probiotic supplement with a biologic, and do not replace any existing therapies or medications with supplements.
Foods That Offer a Probiotic Boost
While definitive connections between the gut microbiome and RA have yet to be confirmed, it can’t hurt for you to introduce healthful probiotics into your system via healthy foods. Bonnie Taub-Dix, RDN, the author of Read It Before You Eat It — Taking You From Label to Table, says, “It’s better to get probiotics through real, whole foods rather than supplements. They don’t only contain probiotics; food also contains an array of other nutrients that are important for good health, like vitamins and minerals. Whole foods also boost satiety and reduce appetite because of their high fiber content,” she says. To up your probiotic intake, chow down on fermented foods, such as pickles, sauerkraut, kimchi, yogurt with live cultures, and kefir. RELATED: A Comprehensive Guide to Kefir: Definition, How It’s Made, Benefits, and More
Concerns About Supplement Quality
Remember that probiotics sold as dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA). In 2020, when ConsumerLab.com tested 23 probiotics sold in the United States, one liquid probiotic was discovered to be contaminated with a pathogenic bacteria, capsules of another probiotic failed to live up to its claim of being enteric-coated, and a pet product provided far fewer viable cells than promised.
Picking the Best Probiotic to Take
If you do want to try probiotic supplements, take them daily. Probiotics will survive only a few days to about three weeks in your system after you stop taking them. In addition, ConsumerLab.com says to look for the following on the labels:
Number of live organisms Since our gut bacteria population is in the trillions, anything less than 1 billion CFUs (colony-forming units) is just a drop in the bucket, and several billion may be better. “And for formulas that list their strength in milligrams, you want to look for one that contains at least 350 milligrams of probiotics,” Sinatra adds.Organism survival factor Active organisms eventually die. Typically manufacturers factor that in by displaying the amount you should expect at the expiration date. Some products, however, list the amount at the time of manufacture, and that amount can decrease by as much as 50 percent before the sell-by date.
To ensure purity, read labels carefully, look for supplements that are rigorously screened for contaminants, and consult with your healthcare team.
Choose the Right Kind of Probiotic
There are a number of different kinds of probiotics to choose from. Some people benefit from taking lactic-acid probiotics like Lactobacillus or Bifidobacterium, while others do better with yeast-derived probiotics like Saccharomyces boulardii or soil-based organisms like Bacillus. For some people, a combination of all three probiotic types is ideal.
