Gut health is a BIG topic. An ever expanding at rapid pace area of research with new studies and findings emerging daily. Some of you would have been trusting your gut for years, appreciating the pivotal role it plays in nourishing our body. I still hear the words of a brilliant naturopath I had some 25 years ago who reminded me often that it all starts with gut health.
At the time it was very controversial because it was not a conversation conventional medicine was having. I thought I would have received a scoff and an eye roll if I mentioned it back then.
But that is changing. I can have that conversation now with my conventional health team without feeling less than. Is that change in conversation something you've noticed too?
Often when the Gut is spoken of, we're talking about our Gastrointestinal system (GI system). It extends from our mouth to our anus.
Each section of your GI tract houses different microbes. Some of these might be familiar to you. We are thought to have more microbes in in our body than human cells, that's how much influence they have on our health. More on that below.
The Role Of Our Gut In Bone Health
When we're talking bone health and our gut we're essentially considering its features and what it does for us. Considerations like:
- Digestion - the breaking down of what we eat and drink into smaller pieces
- Absorption - of nutrients from those smaller pieces
- The Microbiome - its role in extracting nutrients, making vitamin B & K, shaping our immune system and protecting our body from pathogens (Zoe Health)
- Intestinal Permeability - and Leaky Gut
Digestion:
Starts in the mouth and with chewing. The more we chew the more we break down food into smaller manageable pieces ready for nutrient extraction. We are not able to effectively digest when we're under stress.
"When we're stressed, our brain activates the sympathetic nervous system. The sympathetic nervous system is our flight-or-fight response: it prepares the body to protect itself against imminent danger by conserving functions that aren't immediately needed for survival. That includes digestion. The emptying of the stomach is delayed, which can lead to a stomachache, indigestion, heartburn and nausea. As the stomach is slowing down, stress causes increased motor function in the large intestine. So at the same time that you're stressed, you might experience bowel urgency or diarrhea." (Henry Ford Health)
Poor digestion sets us up for less effective next steps in the process.
Absorption:
As we've talked about in many previous editions about our midlife health, stress yet again plays a significant part here in the contribution of Inflammation. If your GI tract is inflamed it's less able to effectively absorb all the helpful nutrients from our food and drink. It can encourage the overgrowth of unhelpful bacteria which further aggravates absorption effectiveness.
The more inflammation we have in our body over time (chronic inflammation) the weaker our bones also become over time.
GI conditions come into play here, often associated with increased inflammation. We listed these in the Bone Health Series - Risk Factors when we talked about the risks that potentially invite poor bone health (scroll the Blog to find it). For example:
- Celiac disease*
- Inflammatory bowel disease (IBD) - Crohn's disease and ulcerative colitis
- Weight loss surgeries
Manage your inflammation, improve your bone heath. Consider consuming less inflammatory foods such as sugary foods and drinks (including many artificially sweetened foods and drinks), ultra-processed foods and any foods that you notice don't seem to agree with you. Listen to your body's cues.
My new endocrinologist, when she took me on as a patient, ordered different and new blood tests, one of which included checking for Celiac disease even though I had no symptoms. And that is often the case, you don't. There's certainly a strong link here between it and bone health.
The Microbiome:
The intestinal microbiome is certainly a hot topic of research study right now with more on its way. There is much we still need to learn but its encouraging that we are willing to do so, opening up the conversation between the inter-relatedness of our body's systems, with our gut health right in the centre.
"Recently, the gut microbiome has been shown to play an important role in regulating bone mass. Therefore, targeting the gut microbiome may be a potential alternative avenue for those with osteopenia or osteoporosis." (Healthy Gut, Healthy Bones: Targeting the Gut Microbiome to Promote Bone Health - Frontiersin.org)
According to Zoe.com our gut microbiome has a number of jobs, including:
• extracting nutrients from food
• digesting fiber and proteins from food
• making vitamins B and K
• shaping the immune system
• protecting the body from pathogens
One key job the gut microbiome performs is to digest fiber from the food you eat. Your microbes turn fiber into molecules, or metabolites, such as short-chain fatty acids (SCFAs).
These metabolites are important for a range of things, including gut health, blood sugar and blood fat control, appetite control, and the immune system.
They're also potentially important for Bone Health.
"Emerging research suggests that gut microbiota regulates bone metabolism through multiple mechanisms. Short-chain fatty acids (SCFAs) produced from microbial fermentation of dietary fiber beneficially impact bone health. Preclinical studies indicate that SCFAs such as butyrate and propionate prevent bone loss in osteoporosis models by inhibiting osteoclastogenesis and immune modulation. Early clinical data also suggest that SCFA supplementation may improve bone turnover markers in postmenopausal women."(From: The role of short-chain fatty acids in the regulation of osteoporosis: new perspectives from gut microbiota to bone health: A review)
They also go on to say..."In summary, the gut microbiome significantly impacts bone health, participating in the regulation of bone metabolism through various mechanisms. The composition and activity of the gut microbiome are closely linked to the development of bone diseases; hence, modulating the gut microbiome may become an effective strategy for treating these conditions. However, research in this field is still evolving, and more clinical trials are needed in the future to ascertain the efficacy of these findings in humans."
Because many of these studies have been done on mice. Next is to do more more on humans. It's certainly a space to watch.
Dysbiosis:
When our gut microbes are 'out of balance' it's called Dysbiosis. This potentially promotes inflammation, making us more susceptible to infection. Bone resorption is also impacted, promoting the increased production of osteoclasts. Recall bone remodelling from Edition #1 in this Bone Health Series. We want to ideally decrease the acceleration of osteoclast activity (cells that break down bone) and promote osteoblast (bone building cells).
It's a multi-system impact "...recent discoveries highlight the critical role of gut microbiota in bone metabolism. Numerous studies demonstrate the implication of dysbiosis on bone loss and, bone disorders through the modulation of the host metabolic system, immune system, and endocrine system." (From the article: Targeting gut microbiota in osteoporosis: impact of the microbial-based functional food ingredients - Science Direct)
Understanding the impact our gut microbiome has on our bones looks promising, but more research needs to be done. A great reason to keep it on our radar.
Fun Fact: A new niche research field, growing rapidly is one where 'bone meets bugs' - Osteomicrobiology. Its purpose is to delve into the role of the gut microbiome on bone metabolism and health. To bridge the gap between bone physiology, gastroenterology, immunology and microbiology. (dwscientific.com) Cool! We will be the beneficiaries of this research girls!
Looking after your Gut Microbiome
So if it's important to have a well balanced microbiome potentially for optimal bone health, how do we do that? Let's look to the research.
"From knowledge gathered so far, it seems that restoring the balancing in GM using probiotics or prebiotics may be beneficial in restoring bone health. However, there are still many questions to be answered before the use of probiotics should be recommended to the aging community who are more susceptible to osteopenia." (Healthy Gut, Healthy Bones: Targeting the Gut Microbiome to Promote Bone Health - Frontiersin.org)
Probiotics:
Help to break down the food so our intestines can better absorb nutrients. They help to produce those SCFA's mentioned above. Good sources of probiotics occur in mostly in fermented foods like yoghurt (with live cultures and less sugar), kefir, miso, sauerkraut and kimchi, some cheeses and sourdough bread. This article from Healthline goes into more detail.
Prebiotics:
Probiotics LOVE fibre. That's what they feed on very happily. What probiotics feed on are called Prebiotics. Great sources of prebiotics are garlic, onions, bananas (especially the slightly green ones), asparagus, flaxseeds, apples and whole oats. This Healthline article mentions many more.
Intestinal Permeability - Leaky Gut
Again, a concept my Naturopath 25 years ago was talking to me about. But Leaky gut syndrome is a hypothetical condition that's not currently recognised as a medical diagnosis. It's based on the concept of increased intestinal permeability, which occurs in some gastrointestinal diseases. Hmmm.
"Leaky gut syndrome is a theory that intestinal permeability is not only a symptom of gastrointestinal disease but an underlying cause that develops independently. If your intestinal barrier is impaired, it may be letting toxins into your bloodstream. These toxins may trigger an inflammatory response that may manifest as various diseases." (Cleveland Health)
So basically if you believe in the theory (as many naturopathic and integrational doctors do and so does my husband's Gastroenterologist. My husband has ulcerative colitis) you believe that leaky gut promotes inflammation and decreases nutrient absorption. Because chronic inflammation increases osteoclast activity, and leaky gut promotes inflammation it could be that leaky gut attributes to increased osteoclast activity. But more needs to be investigated to quantify this. Dr Doug from Optimal Human Health talks about that here.
Treatments - What Can Help Up Can Harm Our Bones
Some medications can have a negative impact on our bone health. Common culprits are steroids such as prednisone (often used to treat Rheumatoid Arthritis, lupus and asthma). These man made cortisol based medications can interfere with osteoblast (bone building cells) activity and increase osteoclast activity (bone break down cells). They also interfere with Calcium absorption. See Healthy Bones Australia for more information.
The medications we take are a very personal decision and one you make with your doctors based on risk benefit considerations. If bone health is not a part of your discussions or testing and you are on these medications, please have the conversations about it.
How Do You Know if your Gut Health Is Impacting Your Bone Health?
It's a bit of a web. You'd be doing specific testing for conditions associated with bone loss like the GI conditions mentioned above. These would be done as blood tests. You'd then be testing for your bone mass condition with a DEXA scan or REMS bone scan. We talked about those in the Bone Health Series - Knowing Your Bone Health Status. Scroll the blog to find it. It's not far away.
Some health practitioners may do a stool test to assess your gut microbiome make up, to give you clues. Like this company here in Australia. There may be others. I know nothing about this company nor have I used their services so if it's something you're interested in, talk to your health team about it.
Final Thoughts
We may be doing all the right things - eating well for our bones, exercising correctly, reducing the risks associated with promoting bone loss and yet, we feel like we're just not making progress when it comes to building bone. Looking at our gut health could be the missing piece.
If you're not at the stage of monitoring your bone health regularly (hmmm) then having your gut health top of mind, on your bone health radar is something that will certainly serve you well.
To keep in mind when you have conversations with your health team.
Remember the contents of this are meant for education purposes only. This newsletter is here to spark thoughts and conversations not to give advice. Conversation not consultation. I'm not a doctor or a qualified health professional offering advice. That's on you to glean from your health team and determine what's best for you.
Take care, and be kind to you. Because girl...you are just getting started.
Anita xx
p.s. Scroll to look out for other blog posts in my Bone Health Series. They're near by so it won't take long to find them :)
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