Can rheumatoid arthritis cause stomach problems?

Rheumatoid Arthritis (RA) is an autoimmune disease that affects up to 1% of the population—approximately 78 million people. Genetic predisposition is a factor behind RA, but, as with other autoimmune diseases, environmental and dietary factors are also at play. 

Unsurprisingly, as in many other autoimmune diseases, folks who have RA also have poor gut health. 

So what’s the dealio?

Can Rheumatoid Arthritis cause stomach problems?

What’s the connection between gut health and joint pain?

Well, while there isn’t a short and sweet answer to these questions, the information is fascinating. Read on for all the science!

The question of whether Rheumatoid Arthritis can cause stomach problems might seem strange! However, if you suffer from RA and also experience stomach problems, you might be suspicious about their connection. And you should be! Functional nutrition is all about connecting the dots, and it pays to be your own health detective. 

Let’s take a look at the researched connections between joint pain and gut health, and dig a little deeper to find why this link exists. Finally, we’ll cover some practical gut and joint healing solutions.

Those with Rheumatoid Arthritis are more likely to have functional gastrointestinal disorders like indigestion, IBS (1,2), and GERD (3). One study found that those with celiac disease had increased markers of very early-stage RA (4).

In a large study on RA and GERD, researchers discovered that 22% of those with RA developed GERD, as compared to 15% of healthy folks. Not surprisingly, when the researchers looked at a separate group of GERD sufferers, they found they were more likely to develop RA! This pattern suggests the possibility of a bi-directional relationship between RA and GERD, meaning they influence each other. 

Although the evidence is limited, these studies provide some proof that there is a link between Rheumatoid Arthritis and stomach problems. So, if you feel like your RA is causing stomach problems, you’re not crazy! Now let’s dive into the most critical part—why this connection exists and what we can do to get to the root of the problem.

Increased inflammation, sympathetic nervous system dominance, and gut dysbiosis may contribute to the connection between Rheumatoid Arthritis and stomach problems.

Folks with RA have increased inflammation which ramps up stress. This increased stress leads to elevated sympathetic nervous system activity (5). The sympathetic nervous system’s most famous job is your fight or flight response, activated by stressful situations. Think of the rise in heart rate and jitters you get from a scary situation—this is fight or flight. We are often “stuck” in sympathetic mode and don’t realize it, and this stressed state becomes our normal. Typically, an overactive sympathetic nervous system response can result in feelings of nausea, indigestion, and gas. Operating in fight or flight mode may also increase gut hypersensitivity (6), which is implicated in gut problems like IBS. 

It is well documented that those with Rheumatoid Arthritis have altered gut microbiota and leaky gut (7). However, it is not entirely clear whether the RA worsens gut health or whether these imbalances cause RA to develop (7). In my professional opinion, it is probably both. Compromised gut health is a risk factor for RA, just as it is for other autoimmune diseases. This is because gut microbes regulate the immune system (8). 

Fascinatingly, there is a published case study on a young woman with refractory RA (in other words, RA that isn’t responding to treatment) that was successfully treated with a fecal microbial transplant, aka poop transplant (9). This example illustrates how much our gut microbes can drive diseases such as RA.

Thankfully, there are some practical solutions for the stomach problems connected to rheumatoid arthritis.

Supporting the gut with healing food and probiotics can help both RA and stomach problems (8, 11,12,13). According to recent research, the best probiotic candidate for RA is Lactobacillus casei, especially the strain Lactobacillus casei 01 (8). The really cool thing about probiotics is that different strains do different things—this specific strain seems to be effective at reducing inflammation and symptoms in those with RA. 

When it comes to diet, evidence suggests that the Standard American Diet, high in processed foods, sugar, inflammatory fats, and low in nutrient-dense, anti-inflammatory foods, is associated with RA (10). Not surprisingly, this type of nutrient-poor eating pattern is also linked to gut dysbiosis. Certain ingredients may exacerbate RA, such as trans-fats, high-fructose corn syrup, refined sugar, gluten, nitrites, coffee, and milk (10). 

So what kinds of foods are good for gut health AND joint pain? Omega-3 rich foods like salmon and sardines, extra virgin olive oil, antioxidant-rich veggies and fruits, and foods high in fiber and low on the glycemic index (10). These foods are documented to be beneficial for RA and, you guessed it, are also great for gut health! Along with the examples above, do your best to get a little extra vitamin D via foods, supplements, or sunshine.

If you suffer from RA and you’d like to try a holistic, food-first approach to managing your symptoms, The Good Poopers Club is a great place to start! We eliminate the most inflammatory foods from the Standard American Diet and increase foods with Omega-3 fatty acids, antioxidants, and nutrients that help reduce inflammation.