It is often the case that a pain in a joint does not always emanate from a joint. Instead, it is an inflammatory cascade that originates from somewhere else and spreads to either the spine or an extremity. After listening to a 2-hour lecture called A 21^st century approach to Musculoskeletal problems by Dr. Robert Silverman he confirmed the more innovative ideas about gut health and its relationship to pain often discussed in Chiropractic today. Dr. Silverman author of a book called Inside Out Health, describes by focusing only on the point of pain we may be chasing a red herring in our current approach to pain. A term called leaky gut syndrome that has multifactorial causes is often the root cause of pain. Below is a synopsis of the causes of why leaky gut is so prevalent today, how to diagnose it, and what to do about it.

Leaky Gut Syndrome

This diagram shows how food sensitivities and pathogens, and toxins disrupt the protective barrier in our gut. Leakage between the epithelial lining can allow the escape of these pathogens/toxins or the inflammatory chemicals that they induce, and it can then migrate elsewhere in the body. That could result in a painful joint or more seriously an autoimmune inflammatory pain.

What is the problem?

Sugar consumption – 160 lbs. per year

Wheat consumption – 146 lbs. per year. Non celiac gluten sensitivity affects about 14% of the U.S. or about one billion people worldwide.

Pesticide exposure – Glyphosate and celiac disease have risen in tandem since the 1970’s.

Caloric sweeteners – 142 lbs. per year

Eighty-seven percent rise in vegetable oils since 1970, 30% increase in simple carbohydrate consumption since 1965, a decrease in fat intake by 25%.

Rise in diabesity and food allergies 90% of sensitivities are either milk, soy, eggs, wheat, peanuts, tree nuts, and shellfish.

Medications – 35 million lbs. of antibiotics produced each year, 80% given to livestock. The CDC says 30% of antibiotic prescriptions are unnecessary. They deplete B vitamins and upset the natural microbiome of our gut.

Toxins/Stress Triclosan, a common toothpaste ingredient causes gut inflammation, is associated with IBS and colitis and colon cancer.

Bacterial toxins: LPS – lipopolysaccharides – Commonly a toxin from gram negative bacteria damages mitochondria and increases inflammatory cytokines causing damage to the gut lining. It is associated with systemic inflammation of joints and organs and may play a role in the exacerbation of autoimmune diseases. It also causes an increased sensitivity to pain. Cytolethal distending toxin B (CdtB) released by E. coli, salmonella, shigella, and Campylobacteria jejuni, is eleven times more inflammatory than LPS and capable of creating extreme inflammatory responses systemically in the body.

Pathogenic microbes – for example Klebsiella pneumonia. This bacterium is associated with reactive arthritis. In genetically susceptible people they might have a genetic positive test for HLA-B27 and have higher levels of IgG antibodies to Klebsiella and this could result in ankylosing spondylitis. Bacteria produced D-Lactic acid is a neurotoxin and it causes muscle pain and confusion. These bacteria produce tryptophanase an enzyme that leads to tryptophan and serotonin/melatonin deficiency and increased neurodegenerative disease.

Diagnosis of leaky gut syndrome

Zonulin: Is a protein found between the cells of the intestinal tract. Elevated levels indicate a breakdown of the protective barrier. It is also associated with autoimmune diseases, celiac disease, rheumatoid arthritis, type 1 diabetes, adult glucose intolerance, asthma, and M.S.

Actomysin IgA: is also associated with celiac disease, IBD, IBS, and SIBO

Occludin/Zonulin IgG, IgA, IgM, becomes elevated with stress, and excessive NSAID use.

Lipopolysaccharides IgG, IgA, IgM

Diagnosis of Joint Autoimmunity

Arthritic Peptide:  Associated with mixed connective tissue disease, Rheumatoid Arthritis, and Osteoarthritis

Collagen antibody: Lupus, Arthritis

Fibulin antibody: Associated with Osteoarthritis

MMP-1 and MMP-9: expression of these markers would indicate a degrading of type 1 and 3 collagen.

In all the above it is possible to have non-celiac gluten sensitivity which mimics all the same symptoms of celiac disease. The most common are abdominal pain, constipation, diarrhea, and gas. What is less obvious is symptoms such as anemia, anxiety, arthralgia (joint pain), ataxia (unsteady gait), depression, rashes, fatigue, headaches, irritability, myalgias (muscle pain), and peripheral neuropathy. People with thyroid problems are often a result of this sensitivity because the two most common sensitivities gluten and casein bind readily to thyroid tissue in what scientists call molecular mimicry triggering thyroid antibodies that then attack the thyroid.

The super 7(R) Action Plan is an initiative-taking solution

Lifestyle and Nutritional Considerations make up this protocol.

1. Reset diet/lifestyle/mindset: Keto, anti-inflammatory diet/Mediterranean diet. Decrease stress. Increase exercise.
2. Remove unwanted pathogens: Oregano oil, Berberine, Garlic
3. Replace needed digestive enzymes and stomach acid: Betaine HCL, Pancreatic enzymes, bile acids
4. Regenerate damaged intestinal mucosa: L-glutamine, Aloe, MSM, Slippery Elm, Fish oil, glucosamine, zinc, Vitamin D, Glutathione
5. Re-inoculate with quality pre and probiotics: High fiber foods for prebiotics. B. lactis B420 to decrease LPS translocation, L. salivarius UCC118 to fix tight junction, L. acidophilus & B. lactis Bi-07 to help with IBS, and bloating, L. rhamnosus JB-1 for vagally-mediated microbiota effect on mood, Bifidobacterium longum NCC3001 for non-infectious chronic, low-grade gut inflammation, vagal integrity. Spore based probiotics for increased LPS, reduction in triglycerides, and inflammatory cytokines. Bacillus subtilis inhibits Candida Albicans, E. coli, and S. aureus. Xylooligosaccharides (XOS) (Prebiotics) to increase acetic acid and butyrate in large intestine, and Bacteroides fragilis bacteria and Bifidobacterium by 86%. Butyrate helps with barrier integrity in the small and large intestine, decreases LPS absorption, enhances colonic motility, insulin sensitivity, mitochondrial function, BDNF (brain derived neurotropic factor), reduces TNF-Alpha, and cytokine IL-6 and IL-12. Acetate decreases the expression of genes in the liver that produce fatty acid storage, so it activates the burning of fat.
6. Reintroduce certain foods from step 2, but very slowly
7. Retain your health and GI integrity: Stay on supplements to retain health! If joint problems persist consider curcumin, Boswellia, ginger, minerals, collagen powder, or amino acid supplement.

 Conclusion

With chronic musculoskeletal pain and joint pain, it is at times necessary to look “outside the box.”  The tests and treatments discussed here represent innovative ideas in the relationship between pain and the inflammatory reactions taking place within our gastrointestinal tract. Dr. Silverman also presents innovative blood markers to confirm inflammatory processes in the body. Coupled with a diagnostic DNA stool analysis that I presently use with Diagnostic Solutions, it would be easier to see if a patient has the microbial stress too.