The interplay of Fiber, Probiotics, and Diet in Maintaining a Healthy Gut in Autoimmune Arthritis

Did you know that recent research shows that diet, treating the living organisms, consisting of mostly bacteria, lining your gut, known as your microbiome may treat or prevent inflammatory diseases like arthritis? There is an interplay between our diet, the amount of fiber and probiotics we consume, and the health of our microbiome. Maintaining a healthy gut with autoimmune diseases such as arthritis is important.

The standard American diet (SAD) has resulted in an overall unhealthy microbiome compared to other societies because it significantly lacks fiber. Comparatively, Mediterranean societies, have a much higher intake of vegetables, fruits, and nuts containing fiber. Fiber becomes a source of energy for our gut cells and the microbes within the gut lining.

Resistant starches within fiber in corn, nuts, vegetables, fruit, and wheat are fermented by the gut microbiota, producing dietary metabolites called short-chain fatty acids or SCFAs. Examples include acetate, propionate, and butyrate. SCFAs help to maintain gut homeostasis (balance) and function and promote an intact gut lining. When there are not enough SCFAs, the gut may become “leaky”.

A leaky gut may lead to the development of autoimmune conditions such as rheumatoid arthritis (RA). SCFAs protect the gut by promoting tight junctions in the gut lining to prevent the gut from becoming leaky, yet support appropriate transportation of nutrients. Once you have a leaky gut, no matter how much fiber you consume, your SCFA production will be limited until it heals.

Certain foods, toxins, food sensitivities, and medications can contribute to a leaky gut. For example, people with arthritis commonly take medications that can disrupt the gut. This supports the gut to become “leaky” which means that these substances are leaking outside of the gut lining and into the circulation, causing immune complexes and reactions which increase inflammation, enhance autoimmunity.

A leaky gut and medications to treat arthritis may disrupt the gut’s normal microbiome, leading to dysbiosis, otherwise known as an imbalance of the microbiota of the gut. When this occurs, people may become more susceptible to infection with bacteria, viruses, or even parasites. Leaky gut may also be both a result of or a contributor to the development of food sensitivities.

Probiotic supplementation may help. Studies on animals receiving either activated or inactivated probiotics have demonstrated that probiotics, especially those with bifidobacterium may downregulate markers of arthritis and therefore be a powerful part of an arthritis regimen. [i]  [ii] A systematic study reviewed the therapeutic effect of probiotics on rheumatoid arthritis based on randomized control trials, finding that probiotics lowered pro-inflammatory substances called cytokines, specifically IL-6 (Interleukin-6) in rheumatoid arthritis.[iii]

Dietary metabolites and the gut microbiota have been found to control inflammation in inflammatory and autoimmune diseases. [iv] Supplementation with SCFAs may help support people to maintain adequate microbiota, in particular, Clostridiales and Bacteroidales, which are predominant producers of SCFAs. Supplementation with dietary metabolites, while less common and less researched than supplementation with probiotics, may include butyrate supplementation. Further study is needed to understand how they work in humans. Examples of foods that contain butyric acid include ghee, sauerkraut, milk, parmesan cheese, and red meat. However, many of these foods may need to be restricted in autoimmune disease and, in of themselves also do not contain large amounts of butyric acid.

Probiotics modulate SCFAs. Bacterial fermentation of carbohydrates and proteins produces SCFA which are major mediators in linking nutrition, gut microbiota, physiology and pathology. [v] The main goal should be to increase SCFAs and beneficial bacteria to support an intact gut lining.

The use of both food and supplements is particularly meaningful in people with Rheumatoid Arthritis. Drugs that are given to help relieve symptoms of inflammation such as non-steroidal anti-inflammatory drugs or NSAIDs, corticosteroids, and methotrexate disrupt the gut’s epithelium. What is even more important, however, is to get to the root cause of what is triggering the autoimmune response. An anti-inflammatory diet, for example, reduces exposure to food substances that commonly contribute to leaky gut and promote inflammation that can exacerbate arthritis. Testing for food sensitivities can help more specifically identify offending food substances such as wheat, corn, dairy, or other foods.

While there are other important supplements to address inflammation in arthritis patients, the intent of this article was to focus on the interplay of fiber, probiotics, and SCFAs. Ideally, through decreasing inflammation triggers for arthritis, adequate fiber intake, and appropriate supplementation to heal the gut (not limited to what is addressed in this article), the arthritis sufferer may experience less inflammation and pain.

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[i] Achi SA, Talahalli RR, Halami PM.Prophylactic effects of probiotic Bifidobacterium spp. in the resolution of inflammation in arthritic rats. Appl Microbiol Biotechnol. 2019 Jun 5. Epub 2019 Jun 5. PMID: 31168650.

[ii] Uchiyama K, Naito Y, Takagi T. Intestinal microbiome as a novel therapeutic target for local and systemic inflammation. Pharmacol Ther. 2019 Mar 12. Epub 2019 Mar 12. PMID: 30877020.

[iii] Mohammed AT, Khattab M, Ahmed AM, Turk T, Sakr N, Khalil AM, Abdelhalim M, Sawaf B, Hirayama K, Huy NT.The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clin Rheumatol. 2017 Sep 15. Epub 2017 Sep 15. PMID: 28914373.

[iv] Richards, JL, Yap, YA, McLeo KH, Mackay CR, Marino E. Dietary metabolites and the gut microbiota: an alternative approach to control inflammatory and autoimmune diseases

 Clin Transl Immunology. 2016 May; 5(5): e82. Published online 2016 May 13. doi: 10.1038/cti.2016.29

[v] Rios-Covian D, et al. (2016). Intestinal short chain fatty acids and their link with diet and human health. DOI:3389/2Ffmicb.2016.00185

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