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In recent years, it has been hypothesized that the increasing incidence of autoimmune diseases may be due, in part, to shifts in the gut microbiota.1 Dysbiosis in the gut microbiome may trigger gut barrier dysfunction such as changes in tight junctions, mucous layers, and secretion of immunoglobulin A and intraepithelial lymphocytes.2 Further, research suggests that gut dysbiosis may influence a systemic immune response and impact pain thresholds in some autoimmune conditions like Guillain-Barré syndrome,3 systemic lupus erythematous (SLE),1,4 multiple sclerosis (MS),5 and rheumatoid arthritis (RA).1,4,6
Pain Thresholds and Gut Composition
Gut microflora can be modulated by extrinsic factors, including dietary habits, lifestyle, infection, and early microbial exposure, as well as intrinsic factors such as metabolites, immunity, and hormones.2 Specific to pain thresholds, is it possible to manage the pain of autoimmune diseases by changing the composition of the gut microbiota? Research is still in its infancy, but some studies show promising results. A small, single-blind dietary intervention found that a low-fat vegan diet may improve RA symptoms, including the degree of pain, joint tenderness, and joint swelling.7 One randomized clinical trial found that a gluten-free vegan diet decreases immunoglobulin G (IgG), an often elevated proinflammatory antibody in RA patients.8
Probiotic supplementation has also shown promise in improving inflammatory and oxidative stress markers in patients with MS,9 with some bacterial probiotic strains reducing the number of inflammatory monocytes.10 Recently, a prospective randomized double-blind placebo-controlled clinical trial was initiated to evaluate whether probiotic treatment with Saccharomyces boulardii could improve mental health, quality of life, fatigue, pain, and indices of inflammation and oxidative stress in patients with MS.11 The results of this study are forthcoming.
Pain Medications & gut support
One of the common treatments for chronic pain frequently experienced by autoimmune patients12 is nonsteroidal anti-inflammatory drugs (NSAIDs), which are known to increase intestinal permeability and can lead to endotoxemia, enteropathy, and further complications.13,14 Reducing these potential side effects from pain medications in autoimmune patients is possible. IFM educator Helen Messier, PhD, MD, shares ways to support gut health while also addressing pain related to autoimmunity.
Researchers continue to explore the microbiome as a means of discovering safe and non-pharmacologic methods for managing the painful symptoms of autoimmune disorders. The gut-brain axis plays an integral role in human health and disease,2,3 and a deeper understanding of this bidirectional communication and homeostatic interplay between the gut microbiota and the central nervous system may aid the discovery of new therapeutic targets for autoimmune patients.
It remains unclear, however, whether dysfunction in gut microbiota is the cause or the consequence of autoimmune disease. Either way, there is promising evidence that modifying the microbiome may help reduce pain for at least some patients with these common diseases. Learn more about beneficial lifestyle-based approaches for reducing pain in your patients at IFM’s upcoming Bioenergetics Advanced Practice Module (APM).
- Xu Huihui, Liu M, Cao J, et al. The dynamic interplay between gut microbiota and autoimmune diseases. J Immunol Res. 2019;2019:7546047. doi:10.1155/2019/7546047
- Zhu S, Jiang Y, Xu K, et al. The progress of gut microbiome research related to brain disorders. J Neuroinflammation. 2020;17(1):25. doi:10.1186/s12974-020-1705-z
- Catanzaro R, Anzalone M, Calabrese F, et al. The gut microbiota and its correlations with the central nervous system disorders. Panminerva Med. 2015;57(3):127-143.
- Wang Y, Wei J, Zhang W, et al. Gut dysbiosis in rheumatic diseases: a systematic review and meta-analysis of 92 observational studies. EBioMedicine. 2022;80:104055. doi:10.1016/j.ebiom.2022.104055
- Rodriguez M, Wootla B, Anderson G. Multiple sclerosis, gut microbiota and permeability: role of tryptophan catabolites, depression, and the driving down of local melatonin. Curr Pharm Des. 2016;22(40):6134-6141. doi:10.2174/1381612822666160915160520
- Alwarith J, Kahleova H, Rembert E, et al. Nutrition interventions in rheumatoid arthritis: the potential use of plant-based diets. A review. Front Nutr. 2019;10(6):141. doi:10.3389/fnut.2019.00141
- McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002;8(1):71-75. doi:10.1089/107555302753507195
- Hafström I, Ringertz B, Spångberg A, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford). 2001;40(10):1175-1179. doi:10.1093/rheumatology/40.10.1175
- Jiang J, Chu C, Wu C, et al. Efficacy of probiotics in multiple sclerosis: a systematic review of preclinical trials and meta-analysis of randomized controlled trials. Food Funct. 2021;12(6):2354-2377. doi:10.1039/d0fo03203d
- Tankou SK, Regev K, Healy BC, et al. A probiotic modulates the microbiome and immunity in multiple sclerosis. Ann Neurol. 2018;83(6):1147-1161. doi:10.1002/ana.25244
- Aghamohammadi D, Ayromlou H, Dolatkhah N, Jahanjoo F, Shakouri SK. The effects of probiotic Saccharomyces boulardii on the mental health, quality of life, fatigue, pain, and indices of inflammation and oxidative stress in patients with multiple sclerosis: study protocol for a double-blind randomized controlled clinical trial. Trials. 2019;20(1):379. doi:10.1186/s13063-019-3454-9
- Mifflin KA, Kerr BJ. Pain in autoimmune disorders. J Neurosci Res. 2017;95(6):1282-1294. doi:1002/jnr.23844
- Utzeri E, Usai P. Role of non-steroidal anti-inflammatory drugs on intestinal permeability and nonalcoholic fatty liver disease. World J Gastroenterol. 2017;23(22):3954-3963. doi:10.3748/wjg.v23.i22.3954
- Bjarnason I, Takeuchi K. Intestinal permeability in the pathogenesis of NSAID-induced enteropathy. J Gastroenterol. 2009;44(Suppl 19):23-29. doi:10.1007/s00535-008-2266-6