Arthritis, Inflammation and Leaky Gut

If you've got arthritis, you know how painful it can be.  Approximately half of all people over 65 report having arthritis with symptoms of swelling, limitation of motion, or pain.  The regions of the body most affected are the hands, neck, lower back, hip and shoulder.

There are three types of arthritis with a known cause:

  • Traumatic Arthritis - Joints can be inflamed as a result of an injury, such as from tripping and spraining an ankle.
  • Suppurative or Septic Arthritis – Joints can be infected with bacteria from the blood stream.  This tends to occur in infants and young children.
  • Gouty Arthritis – Uric acid crystals can accumulate in the joints.
Other forms of arthritis are said by doctors to have “no known cause.” Arthritis of “no known cause” can be divided into two broad categories:

  • Degenerative (osteoarthritis) - This is the most common arthritis found in people living in Western civilizations.  It is seen in x-rays of the hands in over 70% of people who are 65 years and older.
  • Inflammatory - This includes juvenile rheumatoid arthritis, rheumatoid arthritis, psoriatic arthritis, lupus, and ankylosing spondylitis (AS). These aggressive diseases affect less than 5% of the people living in the United States today. 
Arthritis just means inflammation of a joint.  Arthritis is not a genetic disease, nor is it an inevitable part of growing older.  Many studies have linked the inflammation of arthritis to our Western diet.

As recently as 1957, no case of rheumatoid arthritis could be found on the continent of Africa.  These once unknown joint diseases have now become common as people have migrated to wealthier nations or moved to the big cities in their native countries.  With these changes people have abandoned their traditional diets of grains and vegetables for meat, dairy products, and highly processed foods.

Although unknown in Africa before 1960, African-Americans now lead in the incidence of lupus in the US.  The mechanisms by which an unhealthy diet causes inflammatory arthritis are complex and poorly understood, but involve our intestine and immune system.

Leaky gut syndrome has been theoretically suspected as a major factor in a wide range of food and chemical sensitivities, arthritis, asthma, headaches, digestive problems of varying seriousness and chronic fatigue.

Our intestinal lining (or gut wall) is a semi-permeable membrane, like a sieve, that allows small molecules (the products of digestion) to pass through, and blocks the larger molecules. These larger molecules then travel through our intestine and are eliminated. When functioning as intended, the gut wall prevents those larger molecules from stimulating food sensitivity and inflammatory reactions.

Infections, toxins (such as drugs, chemotherapy, anti-inflammatory medications) and an unhealthy diet (too high in fat, cholesterol, and animal protein) can compromise the barrier and allow large molecules to pass into the blood.  This condition of increased intestinal permeability is referred to as a "leaky gut."

Patients with inflammatory arthritis have been shown to have inflammation of the intestinal tract resulting in increased permeability.

What to do about "leaky gut?"

In scientific studies, fasting has been shown to decrease intestinal permeability, thus making the gut "less leaky."  This may be one of the reasons fasting has been shown to dramatically benefit patients with rheumatoid arthritis.  When patients return after the fast to a diet with dairy products, the gut becomes more permeable and the arthritis returns.  An unhealthy diet containing dairy and other animal products causes inflammation of the intestinal surfaces and thereby increases the passage of dietary and/or bacterial antigens (foreign proteins).

Some components of the rich American diet are known to impair the function of the immune system.  Vegetable oils (both the omega-3 and the omega-6 variety) are particularly strong suppressors of the immune system.  Low-fat diets have been shown to retard the development of autoimmune diseases, similar to lupus and rheumatoid arthritis, in experimental animals. Those vegan diets that have failed to help arthritis patients have been high in vegetable oils, which are known to damage intestinal integrity.

The importance of the overall diet cannot be overemphasized.  Proper foods such as whole starches, vegetables and fruits, keep the intestinal barriers strong and the immune system in a fighting condition. In addition to being free of animal products, the diet must be low in fat of all kinds - vegetable oil (even olive oil, corn, safflower, and flaxseed oil) and animal fat.  When it comes to blaming individual foods, dairy products seem to be the most troublesome foods, causing the most common and severe reactions.  Many reports indicate grains, such as corn and wheat can also aggravate the symptoms.  The truth seems to be almost any food can cause trouble, but few people react to vegetable foods.

The immune suppressing quality of oils (for example, fish oil and primrose oil) has been used to suppress the pain and inflammation of arthritis, but like too many drug therapies the ultimate outcome may not be best for the patient.  Suppression of the immune system prevents it from doing its work of removing invading foreign proteins.
One dangerous paradox in arthritis treatment is that the drugs most commonly used to treat arthritis are toxins to the intestinal barrier.  All commonly used nonsteroidal anti-inflammatory drugs (like Advil, Motrin, Naprosyn, etc.), apart from aspirin and nabumetone (Relafen), are associated with increased intestinal permeability in man. While reversible in the short term, it may take months to improve the barrier following prolonged use.

What won't change in either form of arthritis with a change of diet, is the permanent destruction, stiffness and deformity which has already happened through years of disease.

If you suffer from arthritis (either degenerative or inflammatory), try changing your diet for at least two  weeks.  Eat only whole starches (sweet potatoes, brown rice), vegetables (green and yellow) and fruits (except citrus).  Water is your beverage. 
After 2 weeks, you should be feeling much better.  At that point you can add in grains and citrus.  If you start to have symptoms again, eliminate those and add them back in one at a time to see if you can decide which food(s) cause the adverse reaction.

Stop taking any nonsteroidal anti-inflammatory drugs, and if necessary, replace with aspirin or nabumetone (Relafen).

If you try this "anti-arthritis" diet, write a comment and let me know how it worked for you.  
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Periodontal Disease, CVD, Inflammation, the CRP and Leaky Gut

What is the link between periodontal disease and heart disease?

I think a number of dentists believe they can cure heart disease through curing periodontal disease.  How do you cure periodontal disease?

A patient comes in every 3-4 months and the hygienist scrapes the tartar off the teeth, injects some medicine or bacteria-killing ozone and tells the patient to continue brushing and flossing.

They come back 3-months later and still have a few bleeding points and the same ritual is gone through.

How many of your patients have you actually cured and put them back on a 6-month recall?

I realize that not taking care of your body can obviously cause problems.  If you smoke, if you get obese, if you get diabetes, if you seldom brush your teeth and you don't ever get your teeth professionally cleaned.  Then, you can obviously be in some trouble.

I'm venturing to ask you to think in a new direction - not the latest gel or bacteria-testing scheme - but in something totally different.  A new way of eating.

What if you could show your patients that periodontal disease if just a window on a number of other things that are going wrong in their bodies.  I bet if you surveyed your perio patients who have come in for regular professional cleanings and have brushed their teeth you will find they are doing some other risky behaviors.  You may find that they have elevated blood pressure or cholesterol.  They may have a BMI at 30 or higher.  Their triglyceride level is probably >80.

Of course there is a connection between perio and heart disease!  They both have the same risk factors.

I know there is a new cure for perio every other day and now there is an expensive new course designed to teach dentists the importance of a number of tests so dentists and their patients can find out if they are at risk for diabetes, heart attack or stroke.

What in the world causes "chronic inflammation?"

Unfortunately chronic inflammation is not too hard to reverse.  Just change your eating habits.  We previously discussed the concept of "leaky gut" caused by large particles able to get into the blood stream.  Caused by surgery, toxins, meat, dairy, and other food sensitivies.


Inflammation is a hot topic these days.  In the dental office you hear a lot about the relationship between inflammatory periodontal disease and cardiovascular disease.

There is even a new program for dentists to learn whether they have chronic inflammation which could lead to diabetes, heart attack or stroke.  Then they are instructed how to send patients for the same tests.

I have a much easier idea for you and then for your patients.

Calculate your BMI, find out your total cholesterol, your triglyceride level, your CRP and your blood pressure.  You can get these tests done through a local independent lab (if you don't want to go to your MD) and the cost will be under $200.  If any of them are high, you may be headed for diabetes, stroke or a heart attack.

Why do doctors and dentists think that expensive tests and pills are the way to save us? Just change your damn diet and live without worrying about this chronic inflammation.

Testing for Inflammation

The high sensitivity CRP (hs-CRP) is a test that measures very small amounts of CRP in the blood and is ordered most frequently for seemingly healthy people to assess their potential risk for heart problems.  Inflammation (swelling) is a risk factor for heart disease, heart attack, sudden death, stroke and peripheral arterial disease.  It has also been linked to an increased risk of restenosis, or the re-closing of an artery that has been treated with balloon angioplasty.  CRP seems to be at least as predictive of cardiac risk as cholesterol levels. 

CRP is a protein found in the blood and what we call a "marker" for inflammation, meaning its presence indicates a heightened state of inflammation in the body. Inflammation is a normal response to many physical states including fever, injury and infection. Inflammation plays a role in the initiation and progression of cardiovascular disease.

How Can I Be Tested?

A simple blood test can be done at the same time as a cholesterol screening. The high-sensitivity C-reactive protein (HS-CRP) test, helps determine heart disease risk and is widely available.

This test may be measured any time of the day without fasting.

The American Heart Association recommends HS-CRP as part of routine screening for those who are at intermediate risk for heart disease.


Less 1.0 mg/L = Low Risk for CVD

1.0 – 2.9 mg/L = Intermediate Risk for CVD

Greater than 3.0 mg/L High Risk for CVD

Readings of 50 and above are possible, but we generally attribute a level higher than 10 to inflammation due to other conditions, such as an infection, illness, or a serious flare-up of arthritis, can raise CRP levels.

Therefore, testing should not occur while ill or injured. The HS-CRP should be ordered to evaluate CVD risk in apparently healthy individuals who have not had recent infection or other serious illness. Those who have levels of higher than 10 should be evaluated for other sources of inflammation.

It is well established that systemic inflammatory diseases contribute to the potential for plaque rupture/erosions which create thrombotic events resulting in plaque growth patterns, microvascular thrombus activity that manifests itself with end stage diseases such as vascular dementia and peripheral vascular disease or major symptomatic events such as heart attacks and strokes.

We, Bale/Doneen/Nabors, believe that a strong association of periodontal disease and vascular disease exists with the trend for reduced systemic inflammation and improved endothelial health when effective periodontal therapy is achieved.  We also recommend that the evaluation and treatment of periodontal disease along with appropriate medical care be included in any strategy for the prevention of cardiovascular disease.  Both the medical and dental communities should realize that there are positive health benefits when both fields of medicine work in harmony for the prevention of atherosclerotic vascular disease. In light of the above we, Bale/Doneen/Nabors, believe any healthcare program designed to maintain CV wellness should assess individuals for PD and when present, it should be therapeutically managed as both an oral disease of significance as well as a possible strategy to reduce CV risk.

Other common inflammatory diseases of the arteries include:

macular degeneration

hearing loss


heart attacks


kidney failure

bowel infarction

degenerative disks

claudication (legs)



Blood Tests Show Signs of Inflammation

There is much discussion these days in the scientific journals and the lay press about inflammation, foods, and chronic diseases, especially atherosclerosis, arthritis, and cancer. Populations of people who follow starch-based diets with fruits and vegetables show strong evidence of reduced inflammation in their bodies based on blood tests such as C-reactive protein (CRP).  These same people also have much less heart disease, arthritis, and cancer than do populations of people who consume diets high in animal (saturated) fats and trans fats. The foods themselves do not directly change these inflammatory markers. The elevations in these blood factors are the body’s response to the injury caused by the foods.

As an example, C-reactive protein (CRP), measured by a blood test, is a very sensitive indicator of inflammation going on anywhere in the body.  It is non-specific—in other words, it does not tell you the source of the inflammation—a rise could be from an infection in your toe, arthritis in your knuckles, a bad cold, or the trauma of a motorcycle accident. C-reactive protein provides non-specific information similar to an elevation of the body temperature, called a “fever.”  When the walls of your arteries are inflamed during the active phases of atherosclerosis, C-reactive protein rises—predicting a higher future risk of artery failure, commonly known as a heart attack or a stroke.

If your health is getting worse it is not because your body is failing you—efforts to heal never stop—not for a moment. The reason for your continued decline is because the damage is ongoing. For disease to progress, injury must outpace healing.  Reversing disease is simply a matter of turning this scenario around.  To be specific, stop the ongoing injury, which is usually self-induced.  (However, there is a point reached where disease is irreversible, because the injury is too severe and/or the body is too worn out to recover. Fortunately, few of my patients are in that much trouble.)

Let's consider some familiar examples of self-induced injuries and the body’s efforts to heal.  A cigarette smoker inhales toxic gaseous particles 20 and more times a day. With each puff, the lungs become more irritated and inflamed. They fight back by coughing and producing mucous in order to remove the poisons. Because of the addictive properties of the tobacco, the injury continues hour after hour, day after day, year after year.  Eventually, the some of the red, swollen lung dies and is replaced by non-functioning scar tissues.  The result is diminished lung capacity (emphysema). Chronic inflammation can also lay the foundation for lung cancer. Serious lung disease is not inevitable. Many smokers gain wisdom and strength, and are able to quit injuring themselves before the damage is irreversible—the lungs heal and breathing recovers.  Toxic damage to the liver by alcohol, and overexposure of the skin to excess sunlight are other everyday examples of chronic injuries due to unwise behaviors. In these cases also, the body responds with efforts to heal, beginning with inflammation. Greater recovery is expected the sooner the repeated injury is stopped.

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