Features April 2019 Issue

Microbiome and Inflammation

Don't neglect the trillions of microorganisms in your body that are keeping you healthy.

If you've never heard of the microbiome, get ready. You probably will see this word pop up more and more. "This is an emerging area of medical research with the potential to reveal greater understanding and new approaches to treatment for many different diseases," says Chad Deal, MD, Head of the Center for Osteoporosis and Metabolic Bone Disease at Cleveland Clinic and Associate Editor of Arthritis Advisor.

What Is the Microbiome?

You may be surprised to learn that trillions of bacteria and other microorganisms inhabit the human body, a number that just about equals the total number of cells. These tiny organisms, which reside on the skin and in the mouth, female genital tract, and primarily the intestines, are collectively referred to as the microbiome. The microbiome has wide-ranging effects on health.

While bacteria, viruses, and other microbes can cause infection and other diseases, they aren't all bad. In fact, we need the "good" types of these organisms. They aid digestion and influence many other functions, including the immune system.

Humans and their microbiome have evolved over millennia to exist in mutually beneficial ways to keep us healthy. A diverse mix of different types of microbes is necessary for optimal health. If the delicate balance is disturbed, problems can arise. External influences, such as diet, use of antibiotics, where you live and travel, stress and other factors, can alter the microbiome.

Effects on Immunity

8 Microbiome

belchonock | Getty Images

The interaction among the microbial contents of the microbiome and the body is quite complex, and researchers are working on understanding it. There is evidence to show a connection between the microbiome and diseases and conditions with an inflammatory component, including conditions involving bones, joints and muscles.

About 70 percent of the body's immune cells, including inflammatory cells, are located in the gastrointestinal tract. "There is evidence that altering the gut microbiome can affect inflammation," says Dr. Deal.


People with the bone-thinning disease osteoporosis are at risk for bone fractures. Studies have shown that having elevated levels of C-reactive protein, which is a marker of inflammation, is associated with low bone density and increased risk for bone fractures.

"This and other research points to a role of inflammation in osteoporosis that may be influenced by changes in the microbiome," says Dr. Deal.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that affects primarily the lining of joints. The cause is not known, but it is likely the result of some environmental trigger in genetically susceptible people. The trigger may involve the microbiome.

There's a known link between periodontal disease and rheumatoid arthritis. The possible common culprit is a bacterial component of the oral microbiome called Porphyromonas gingivalis. Researchers are also finding that changes in the microbiome in the intestines may be involved in rheumatoid arthritis.

Muscle Weakness and Frailty

As we get older, we lose muscle mass and strength, which can lead to frailty. "There appears to be a relationship with our microbiome," says Dr. Deal. Some studies have found an association between frailty and low-grade inflammation. And other research points to changes in the populations of certain bacteria in the gut influencing muscle weakness (a condition called sarcopenia) and frailty.

Balance Your Microbiome

Even though research on the microbiome is still in the early stages, we know there are benefits to paying attention to our microbiome. "It's actually something that is alterable," says Dr. Deal. We can positively impact our microbiome through lifestyle measures, such as diet, and avoiding overuse of antibiotics.

Antibiotics eliminate bacteria that cause disease, but they can also destroy some of the good bacteria. Those bacteria will repopulate, but overuse of antibiotics may eventually lead to upsetting the balance.

Probiotic supplements, which contain beneficial microorganisms, may help rebalance the microbiome. However, the right mix of organisms for optimal health is still not clear. Prebiotics are foods(often high in fiber) that act as food for the gut microbiome. They improve the balance of microorganisms.

The surest way to support your microbiome is a shift toward a plant-based diet. "This approach doesn't do harm, and has the potential for great benefit," says Dr.Deal.

Feed Your Microbiome

Keep beneficial bacteria in a healthy balance:
1. Avoid unnecessary use of antibiotics. For example, don’t take an antibiotic for a cold, which is caused by a virus.
2. Eat foods that contain microorganisms, such as yogurt, sauerkraut and pickled vegetables.
3. Eat a plant-based diet. Good bacteria feed on greens and other vegetables.
4. Some foods contain prebiotics, which can alter the microbiome in beneficial ways. Examples include:
- Onions
- Leeks
- Asparagus
- Garlic
- Bananas
- Oats and barley
5. Eat more fiber, which enriches the good bacteria.
6. Consider a probiotic supplement.

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