Why do I need to think about gut health when I have come to see you with knee pain?

Over the past few years, gut health has received a lot of attention and there are a lot of products being sold for so-called gut health.

As a concept it is a bit difficult to imagine as we cannot directly see our gut and the millions of bacteria that reside there, in the way that you can see your arm or your leg. It can be hard to make the connection between what we eat and do, our gut bacteria and how we feel.

But understanding the significance of your gut bacteria or microbiome and its connection to good health, may help you make decisions every day that optimise it’s function.

Why is it worth considering your gut health?

The health of the microbiome is the foundation of your mental and physical wellbeing.

There are 100 trillion microbes lining the gut, the function and significance of which is only starting to be understood. These microbes control not just the local environment where they reside in the lining of the gut, but send signals to our brain.  Neurotransmitters are chemical messengers that are essential for nerves to function. They have a significant impact on our behaviour and emotions and are involved in regulation of our sleep, mood, motivation and pain perception, and many other processes in the body. The bulk of neurotransmitters are made by gut microbes. Therefore, supporting these gut microbes with lifestyle and nutrient dense whole foods will promote healthy levels of neurotransmitters.

What is leaky gut and why do we want to protect ourselves from developing this?

You may have heard of leaky gut in relation to IBS/irritable bowel syndrome, but the concept is really worth understanding in relation to overall health, free of chronic disease.

The gut lining is made up of specialised cells in a single layer that are continuously being replaced.  It is exposed to the food we ingest, toxins and microbes(bacteria) as well as the microbes that live there. The state and functioning of the gut lining is dynamic. What that means is that is always changing and not rigid in it structure or function. It is a dynamic barrier which means that it is selectively permeable (lets stuff through) after a meal so the nutrients are absorbed but does not let through toxins that might cause havoc in your body. In good health, this is a tightly controlled mechanism and happens unconsciously.

The microbes that naturally reside in our gut control what is let through. But when these ‘good’ microbes are out of balance, the barrier starts to let things through that it is not supposed to, which is why it is called ‘leaky gut’. These are called toxins, and in tiny amounts we can deal with and remain healthy. However, in abnormal quantities, the toxins get through to the brain circulation, which leads to signals being turned on which trigger inflammation in other parts of our body.

The consequences of letting through toxins into the circulation is chronic low-grade inflammation, because they end up in your immune system which you body responds to like a bacterial invasion.

Chronic low-grade inflammation is the foundation for chronic disease such as: inflamed joints, diabetes, cardiovascular disease, weight gain, autoimmune conditions eg eczema, psoriasis, thyroiditis, brain disorders eg dementia, anxiety, depression, sex hormone imbalance (for men and women – but particularly during perimenopause) etc.

What disrupts the microbial balance?

Stress, a diet lacking in nutritious whole foods, lack of regular exercise and sleep.

The gut is directly connected to our nervous system. 

In short, regulated bursts, some stress is fundamental to good health and makes us resilient. However, when our nervous system is revved up without a break, to release adrenalin and cortisol this changes the gut microbes lining our gut, and this results in leaky gut.

It is worth mentioning the autonomic nervous system here to better understand how this is related to gut health.  This is split in the sympathetic and parasympathetic systems. The parasympathetic systems is about rest and digest and is associated with feelings of relaxation and feeling safe. It exerts its effect through the vagus nerve which has connections throughout our body, but especially in the gut. The sympathetic nervous system is engaged during periods o stress and threat. We ne ed the sympathetic nervous system to protect us and to perform, but this becomes problematic when it is sustained. We need to balance this out by stimulating the parasympathetic system. Lifestyle tools at our disposal include regular gentle to moderate exercise, healthy relationships, being in nature, protecting our sleep, having interests that make us relax.

As well as stress, other factors like antibiotic courses (which must be taken when appropriate), eating a lot of ultra processed foods and not exercising regularly disturbs the fine balance of good microbes.

Making small changes in relation to all of the above stressors, can have a hugely positive impact on our general wellbeing.

This might look like, marking out regular breaks from work, going for short walks outside in daylight (our gut microbes respond to light exposure), eating whole foods (not from a packet with long lists of ingredients that you do not have in the kitchen) 80% of the time, prioritising sleep with regular bedtime and waketimes and reducing alcohol consumption.

You may have had a flare up of knee pain that was not triggered by a specific injury or trauma and seemed to be ‘out of the blue’.  This may have been triggered by a transient period of leaky gut resulting in the inflammation and swelling in your knee. Treating the specific acute problem is absolutely important, but hopefully this information will provide a greater understanding of why looking at your overall wellbeing will protect you from further episodes.

Gut supplements:

Getting your diet right is always priority before adding in supplements.

No supplement is a substitute for good diet and lifestyle. Spending lots of products and consuming frequent ultra processed foods makes it harder for your body to get the benefits.

If you have comfortable regular bowel movements, not troubled by bloating or discomfort, sleep well, you are a healthy weight and have good energy levels, that means your diet is working for you and supplementation is not required.

What should you look for and what exactly are gut health products:

When purchasing a product, avoid those with added sugar/artificial ingredients.

They may be labelled prebiotics (feed the gut microbes) and probiotics (live microbes). Both of these can be found in food and supplements and getting a variety from different sources is ideal, as no one product or food delivers everything. Having a variety is the foundation for good gut health.

It is worth also keeping in mind that we are all different and there is an element of trying out and seeing what works for you.

Examples of Prebiotics:

Inulin powder (soluble fibre usually from chicory root or corn)

Garlic/onions/artichoke/dandelion greens

Examples of Probiotics:

These can be capsules/powders/readymade drinks and usually contain a variety of bacteria.

And can be found in foods usually with labels such as live, fermented and cultures.

(The process of fermentation allows the nutrients and benefits to be more bioavailable and reduces the antinutrients occurring naturally in some foods.) Examples include:

Yoghurt and kefir

Cheeses

Kimchi/sauerkraut

Kombucha

Postbiotics:

These are the products made by the gut microbes which have been shown to be beneficial to not only gut health and the barrier function, but overall health and immunity. These by-products then support other microbes which are beneficial. Not so easy to purchase on their own, but eating certain foods can help your microbes produce these substances. These include the same foods containing the probiotics:

Yoghurt and kefir

Hard cheeses eg cheddar/gouda/parmesan

Sourdough bread

Kombucha

Tempeh (fermented soy product also high in protein)

Incorporating a little of a variety of these foods can support your gut microbiome which in turn will look after all of your body and mind.

Take home points:

Diet and lifestyle are the most important tools to protect our gut health.

Eating a wholefood diet (whether you eat meat or not) – this means buying food that has minimal added ingredients. Choosing a variety of foods that contain pre- and pro-biotic ingredients.

Manage stress by taking regular exercise, planning your work schedule around regular breaks, 

prioritising sleep

Consider supplementation.