Did you know there is a link between joint pain and our gut?

Whilst genes, our environment, gender and age have long been known to be factors for increasing the risk for joint pain or joint conditions such as arthritis or rheumatoid arthritis, scientists now know that the gut also plays a role and in particular the microbes that reside there. 

Several studies have shown that those with Rheumatoid Arthritis have a distinct pattern of gut microbes including high levels of a specific bacteria called Prevotella copri (1).  low levels of the family (genus) Bifidobacterium (2) and other disease causing bacteria (3). 

People who have the gene HLA B27 are known to have an increased risk of developing ankylosing spondylitis, psoriatic arthritis, and other joint/bone diseases. This specific gene alters the gut microbiome (4).

Studies have also shown that (intestinal hyperpermeability (aka ‘leaky gut’) and an imbalance of gut bacteria (dysbiosis) is associated with joint pain and disease (5).  

Leaky Gut and Dysbiosis

Our intestines, when they are healthy, are naturally ‘permeable’ and allow nutrients to absorb across the gut lining and enter the bloodstream. If the gut lining becomes damaged through inflammation then larger particles (bacteria and food particles) cross into the bloodstream and cause increased inflammation and immune defense response. Some bacteria that cross over contain sugar-fat compounds on their cell wall called lipopolysaccharides (LPS). These stimulate the immune system and drive inflammation in various parts of the body including the brain, the lungs and the joints – leading to pain and swelling (6, 7). 

A 2020 review (8) showed that dysbiosis contributed to the development of osteoarthritis (usually considered to be just due to ‘wear and tear’ and ‘ageing’). Changing the composition of the microbiome slowed the progression of arthritis. Researchers are now focusing on using this knowledge to design treatments using ‘nutraceuticals’ such as collagen, chondroitin sulfate and glucosamine amongst others.  These supplements have long been recommended for joint support but the research now suggests that they all influence the gut microbiome by being pre-biotics, which could explain their effectiveness, 

For example, Chondroitin reduces the inflammatory ‘proteobacteria’ and increases the anti-inflammatory ‘Bacteroidetes’. This specific group of bacteria blocks ‘stress-induced intestinal inflammation’. Glutamine and collagen (type 2) have also been shown to change the diversity of bacteria to more anti-inflammatory promoting ones. 


Key Takeaways:

  • Diet influences the gut microbiome
  • The gut microbiome affects all health (not just the gut)
  • The best way to ensure a healthy gut microbiome and therefore a healthy gut is to feed the ‘good bugs’ and ensure a healthy diversity and balance (9).

Whilst some researchers believe that changes to the gut microbiome only occur as long as the healthy diet does. Professors Rob Knight and Jack Gilbert believe that permanent change is possible after 9 – 15 months of staying on a ‘healthy diet’ (10).  What is a healthy diet?  The Mediterranean type diet – one that is rich in vegetables, legumes, nuts, seeds, fermented dairy, fruit, small amounts of fish and lean meats, sourdough bread, olive oil, herbs and a bonus helping of Asian spices.  

Tips to support your gut to prevent or reduce joint pain:

  1. It is thought that people with arthritis may have food sensitivities of which they are not aware. Intolerances can lead to inflammation and joint pain. Get checked – try my Reactivity Reset and find out which foods could be exacerbating your symptoms.
  2. Eat vegetables (5-9 serves), eat fibre rich and prebiotic foods to ensure you are fueling your good bacteria. The more diverse your plant intake the more diverse your gut bacteria.  Plants are also naturally anti-inflammatory and inflammation drives joint pain and disease. 
  3. Reduce foods and drinks which drive inflammation – refined carbohydrates, sugar dense food and drink, refined and highly processed fats, excess alcohol, excess red and processed meat, and dairy and gluten (IF you are sensitive to them). 
  4. Consider probiotic/fermented foods such as kefir, kombucha, yogurt, sauerkraut, kefir, miso, tempeh, apple cider vinegar and sourdough products. Start small and work up – try and have a dollop of slurp at every meal. 
  5. Consider supplementing with prebiotics, probiotics, glutamine, zinc chondroitin, collagen type 2, turmeric and sulforaphane which either influence the gut microbiota or reduce inflammation. 



  1. https://pubmed.ncbi.nlm.nih.gov/27863183/
  2. https://pubmed.ncbi.nlm.nih.gov/18528968/
  3. https://pubmed.ncbi.nlm.nih.gov/7981990/
  4. https://pubmed.ncbi.nlm.nih.gov/21792826/
  5. https://pubmed.ncbi.nlm.nih.gov/11581570/
  6. https://pubmed.ncbi.nlm.nih.gov/24900918/
  7. https://pubmed.ncbi.nlm.nih.gov/11581570/
  8. https://pubmed.ncbi.nlm.nih.gov/26191211/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903327/
  10. .https://pubmed.ncbi.nlm.nih.gov/19343057/
  11. Gilbert, J and Knight, R. Dirt Is Good: The Advantage of Germs for Your Child’s Developing Immune System. New York: St. Martin’s Press. 2017;105.
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602494/


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Email me at sarahb@sarahbrenchleynaturopathy.com 

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