Gut Microbiome Impacts Joint Health

April 24, 2023 | Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

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 Gut Microbiome Impacts Joint Health
Keeping your joints healthy is dependent on a number of factors. In recent articles, I have highlighted several aspects of joint health, including mitochondria, trace minerals, collagen, flavonoids and spices, hyaluronic acid, MSM sulfur, and others. In addition to these factors, your gut microbiome has a profound impact on how well your joints age and maintain their durability throughout your life.

Gut-Joint Axis

In the last several years, scientists have learned vast amounts of information from the Microbiome Project. This project refers to the study of the flora in your body, in particular gut flora and its role in health. The 100 trillion-plus flora in your gut outnumbers all other cells in your body. Researchers have found that the gut microbiome and their metabolites directly impact all organs and tissues. In joint health, this connection is known as the gut-joint axis.

The gut-joint axis is a bi-directional relationship between your gut microbiome and your joints. Gut flora impacts and regulates intestinal lining integrity, immune defense, and inflammatory compound levels that affect joints. Current research shows that a dysfunctional, dysbiotic gut hastens joint aging due to a disruption of the gut-joint axis.

The Gut Microbiome

The gut microbiome consists of bacteria, viruses, yeasts, and parasites that coexist together. Most of the microbiome is found in the large and small intestines and are beneficial or friendly flora. There are also non-beneficial flora that promote adverse tissue changes.

Your gut flora produces numerous compounds that affect production and activity of immune cells and pro- and anti-inflammatory compounds. Gut flora quality and levels directly affect the integrity of the mucosal barrier in your intestinal tract.

In addition, your beneficial flora digests your food, helps make some nutrients like B vitamins and vitamin K1 and are needed to absorb nutrients from your diet. Poor absorption of nutrients affects cellular repair in your joints.

A healthy gut microbiome has robust amounts and several classes and species of beneficial flora. Some important beneficial species include Lactobacillus casei, Lactobacillus reuteri, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Bifidobacterium longum, Saccharomyces boulardi and many others etc.


The predominance of non-beneficial bacteria or flora in your gut is undesirable and is called dysbiosis. Dysbiosis in your gut provokes damage to the mucosal layer of your gut which triggers intestinal inflammation and injury. Non-beneficial flora in dysbiosis release toxic metabolites and pro-inflammatory cytokines into blood vessels that can travel to your knees, hips, and spine etc. provoking injury to joint tissues.

Cell, animal, and human studies show a complex interaction of the gut-joint axis and joint deterioration. The interactive metabolic “talk” between the gut flora and joints depends on the type of flora present.

Studies show that some non-beneficial flora may affect only the knees or the hands whereas other flora may create more of a systemic inflammatory reaction to multiple joints. These findings of germ overgrowth or dysbiosis correlate with decreased levels of beneficial flora like Bifidobacterium longum, Faecalibacterium or Lactobacillus.

Gut and Joint Deterioration Unrelated to Mechanical Stress

Studies show that lower levels of Lactobacillus in the intestinal tract of obese animals are associated with joint deterioration and correlate with increased intestinal permeability. Findings also show that a bacterial toxin called LPS (lipopolysaccharides) from non-beneficial flora, is released into the blood stream and travels to the synovial fluid in joints causing inflammatory response and oxidative stress.

Research in humans supports this disruption of the gut-joint axis, i.e. gut dysbiosis, changes in intestinal permeability, and increased LPS toxins lead to joint deterioration. This leads to joint deterioration unrelated to trauma or mechanical stress.

A February 2022 publication showed that increased intestinal permeability and high levels of LPS in the blood stream was a driving factor for joint breakdown in obese women. Other studies in obese adults confirm definitive changes in the gut flora, increased intestinal permeability, and low-level chronic immune-related inflammatory reactions that cause joint stress.

Increased intestinal permeability is also known as “Leaky Gut Syndrome”. More information may be found in the article Leaky Gut Syndrome: More Than Just a Gut Problem.

Things that Change the Gut-Joint Axis

Age, diet, lifestyle, metabolic syndrome and obesity contribute to joint deterioration and interfere with gut microbiome vitality. Increased age is linked with less microbiome diversity and a smaller microbiome.

High fat diets and high sugar diets promote joint breakdown. These high-calorie, nutrient-poor diets, or the Western diet, provoke harmful pro-inflammatory effects within the gut, joints, and metabolism.

Poor food quality with lack of nutrients disrupts your beneficial microbiome and increases intestinal lining permeability. These diets are associated with lower levels of beneficial Lactobacillus, higher LPS levels, and greater joint inflammation.

Medications and Gut Microbiome

Numerous medications like antibiotics, NSAIDs, which includes aspirin, steroids, and acid-blocking medications also adversely impact your gut microbiome. Learn more about this in the article: Non-Antibiotic Drugs Found to Harm Gut Flora.

Foods that Improve Your Microbiome

A whole foods diet is the most fundamental approach for any aspect of health and repair. Consume whole, unrefined foods, preferably organic and free-range, at least 80 percent of the time. Avoid or substantially reduce high-fat, high sugar/added sugar rich foods.

Strive for 5-13 servings of fruits and vegetables per day, preferably organic. Avoid the “Dirty Dozen” or the produce with the highest amounts of applied pesticides/herbicides. Gluten intolerance also causes changes in intestinal permeability.

If you are following a plant-based diet, here is some important information:

• Navigating a Plant-Based Diet: What You Need to Know for Optimal Health

• Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions

Fiber and Short Chain Fatty Acids

Short Chain Fatty Acids (SCFAs) are critical for your gut microbiome. SCFAs like butyrate support intestinal lining integrity, improve bowel motility, reduce gut flora inflammatory reactions, support immune system homeostasis in the gut, and much more. Studies show that higher fiber intake promotes SCFAs levels and a downward shift in joint inflammation. Beneficial bacteria feed on fiber to produce SCFAs. Fiber-rich diets are required to produce SCFAs.

Fiber is only found in plant-based foods, i.e., fruits, vegetables, grains, seeds, nuts, beans and legumes. Fiber is not found in oils or animal proteins unless the food has been processed or altered in some manner. Processed, refined foods have very little fiber. Adults need at least 25-40 grams of fiber per day. Americans consume on average 10-15 grams per day.

More information about fiber and SCFAs may be found in the article Oat Beta Glucan – Nature’s Heart Healthy Wonder.


FOS or fructo-oligosaccharides, a prebiotic, may play a significant role in joint health. Researchers evaluated the effect of FOS in obese mice with joint deterioration. FOS, a type of prebiotic fiber, was found to help restore healthy flora and support immune modulation.

FOS modulated colon macrophage activity which led to a reduction of gut and joint inflammatory activity but protected joint cartilage. Colon macrophages are a type of white blood cell found in the large intestine that plays a role in health and homeostasis of inflammatory responses.

Foods rich in prebiotic fibers are barley, tomato, onion, banana, rye, lentils, legumes, garlic, honey and others. These prebiotic foods feed bacterial fermentation which leads to the production of beneficial short chain fatty acids. These are beneficial foods that may naturally increase small amounts of bowel gas, however if you have SIBO/SIFO, these foods may need to be restricted until the germ overgrowth is under control.

FOS and other prebiotic nutrients may be found in GI & Muscle Helper, Super Dophilus, Super Immune Booster, and Immune Plus. Research suggests that FOS supports Lactobacillus and arabinogalactan, increases the concentration of total bacteria, beneficial Bacteroidetes and Bifidobacterium and decreases levels of some non-beneficial bacteria.


Probiotics or beneficial bacteria are essential for a healthy gut microbiome. Probiotic-rich foods include dairy and plant-based yogurts/kefirs, fermented vegetables, and kombucha.

Supplemental probiotics are found in our products Super Dophilus and Vital UT. Rotate your dietary and supplemental sources of probiotics periodically to help sustain healthy diversity of your gut microbiome. Beneficial flora thrives with prebiotics and a diverse whole foods diet.

Healthy Lifestyle

Avoid fluoridated water as fluoride can disturb your gut flora. Moderate exercise also supports healthy gut flora.

Twenty-first century stressors with diet, lifestyle, management of toxins, and stress are prevalent today. These factors impact the trillions of cells in your digestive tract and the rest of you. Your gut microbiome health is challenged with the Western lifestyle, dietary, and environmental stressors. Make positive choices everyday to help reduce the challenges that modern stress brings to your gut and joint health. Joint replacement surgery is an important option with end-stage joint deterioration, but it is never as good as the original healthy joint.

Additional information may be found here:

Leaky Gut Syndrome: More Than Just a Gut Problem

Healthy Gut Flora Is Essential – Are You Taking the Right Probiotics

Exercise Endurance and Energy Linked to Gut Health

Exercise and Mitochondria: Use It and Nurture It

SIBO Linked with Thyroid Medication and More

Gluten Intolerance, Gut Problems Linked with Roundup Toxicity

Gluten Intolerance: What Does It Look Like?

The Many Faces of Gluten Intolerance

New Dangers of Glyphosate

Fiber and Your Gut Mucosal Lining

Healthy Mucosal Barriers Makes for a Healthier You

Glutamine: Critial for Gut, Immune System, and Muscle during Stress and Aging

The Three Most Important Things for Health

Top Essentials for Daily Health – What’s Your Health Trend?

Fluoride Lowers IQ in Children

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