Rectifying My Own Ignorance: The Gut Biome and Spondylitis

Even knowing that so many illnesses that seem so far removed from the gut actually start there (autism, Parkinson’s, depression, etc.), I am constantly amazed when I come across yet another one.  Today, I’m writing about an article I just finished reading on Ankylosing Spondylitis.

According to the Spondylitis Association of America, “Common features of spondyloarthritis include inflammatory back pain, as well as pain and inflammation in the pelvis, neck, intestine, eyes, heels, and various larger joints….Common features of spondyloarthritis include inflammatory back pain, as well as pain and inflammation in the pelvis, neck, intestine, eyes, heels, and various larger joints.”[i]

I had heard of the illness, but knew nothing about it, and you know me…never content to remain in ignorance.  I learned that it is a member of a family of rheumatic diseases that includes enteropathic arthritis, reactive arthritis, undifferentiated spondyloarthritis, juvenile spondyloarthritis, and psoriatic arthritis. (I’d heard of the last one as the famous golfer, Phil Michelson, suffers from it.)  I have learned that there is really no doubt that it starts in the gut.  And maybe most remarkable of all:  I learned that about 2.7 million people suffer from spondylitis in the USA, which is almost 3X the number of people with Parkinson’s.  (According to of the Parkinson’s Foundation, “Nearly one million will be living with Parkinson’s disease (PD) in the U.S. by 2020, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease (or Amyotrophic Lateral Sclerosis).”[ii]

So spondylitis sufferers vastly outnumber all those well-known illnesses…and yet virtually no one has heard of it.

As Biome Buzz readers, you are like me, and want to know.  🙂

A Possible Role of Intestinal Microbiota in the Pathogenesis of Ankylosing Spondylitis[iii] was a fascinating read.  Here are 6 highlights:

1. There is a genetic predisposition to developing Ankylosing Spondylitis (AS). 90-95% of people diagnosed with it are positive for the genetic marker HLA-B27.  Amazingly, in animal studies, rats with this genetic marker do not develop AS if they are raised in a germ-free environment.  “However, the arthritis develops when commensal bacteria, such as Bacteroides vulgalus, are introduced into these germfree models.”
2. There are specific pathogenic bacteria that may play a role in the development of the disease, including Klebsiella pneumoniae. While not yet proven, there is almost certainly an association.
3. “Almost 70 percent of patients with AS have subclinical gut inflammation, which indicates that the two diseases may be similar entities with a common origin, that is gut dysbiosis.” In fact, the enteropathic arthritis I mentioned above is arthritis associated with inflammatory bowel disease.
4. A 2007 study: patients with AS were given Moxifloxacin, an antibiotic that works against both Gram-positive and negative bacteria. The results “…have shown that AS patients treated with Moxifloxacin resulted in a significant and sustained improvement…”  Serum inflammatory markers were greatly reduced after 12 weeks.
5. The paper cites two interesting studies on specific probiotic strains that may be helpful. Lactobacillus casei, “…has potent anti-inflammatory and antiarthritic effect.”  In this study they found that it has, “…significant preventative effect on collagen-induced arthritis rat model.”  In the second study, the species, Lactobacillus rhamnosus, seemed to partially prevent relapse of colitis in rats with the HLA-B27 genetic marker.  Also, prebiotics (specifically inulin and FOS) also decreased colitis in these rats, as well as increased levels of good bacteria and decreased pro-inflammatory cytokines.
6. A low starch diet, like the Specific Carbohydrate Diet for example, may be beneficial. The few studies done have shown relief of symptoms, and a significant drop in blood inflammatory markers.  What’s also really interesting is that in vitro, sugars like glucose, sucrose and lactose (substrates) cause a 10-fold increase in Klebsiella microbes per gram of   substrate, “…showing that carbohydrates are highly necessary for growth and replications of Klebsiella or even other related enteropathics [gut pathogens].”

The take-away message is pertinent to anyone suffering from any kind of autoimmune and/or inflammatory disease.  Genes certainly play a role in terms of increasing susceptibility to specific illnesses, but it takes an environmental insult – a disruption of the gut flora – to invoke disease.  Most people with the HLA-B27 will not develop AS…and conversely, not everyone with AS has that particular genetic marker.  If we could just learn to support and protect our biomes, starting at birth, the number of people suffering from these horrendous life-long illnesses would undoubtedly drop dramatically.

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[i] https://www.spondylitis.org/Overview

[ii] http://parkinson.org/Understanding-Parkinsons/Causes-and-Statistics/Statistics

[iii] Yang, L, Wang, L, Wang, X, Xian, CJ, Lu, H. A possible role of intestinal microbiota in the pathogenesis of Ankylosing Spondylitis.  International Journal of Molecular Sciences. 2016;17(12).  doi: 10.3390/ijms17122126.