Many people rely on ibuprofen to help them manage knee pain. But as I support repeatedly in my book The Fix, everything is connected. Knee pain isn’t in a separate universe from the rest of the body, even though doctors may act as if it were. (“Ma’am, you’ll have to go see a knee specialist for that pain. You can find her office right next to the gastroenterologist that you’ll be seeing after you’ve been on that pain medication for awhile.”) In 1999, one of medicine’s top journals—the New England Journal of Medicine—published an article stating that NSAIDS (nonsteroidal anti-inflammatory drugs such as ibuprofen) cause about 16,500 deaths per year, just from gastrointestinal side effects. Side effects such as liver problems, blood disorders, vision problems, etc. are not limited only to those people who take NSAIDS long-term. These unwelcome challenges are risks from the first dose onward. Not only that, we also know that taking NSAIDS can delay tissue healing. After all, they interfere with the body’s well-designed methods for healing damage.
But perhaps more importantly, we also know that taking ibuprofen decimates the friendly flora in your gut. And friendly flora (probiotics) are critical to reducing body inflammation.
A healthy gut biome leads to a balanced inflammatory response
There are about 100 trillion or so bacteria inside you that are beneficial to your body. They keep you healthy. They help digest food, they detoxify poisons, they are part of your immune system and they even act as a protective barrier on your skin and inside your body, keeping out the dangerous pathogenic bacteria. These helpful bacteria are called probiotics. Your body contains some unhealthy bacteria also, and probiotics keep these numbers down so that your health is not compromised. If you have about 85% good bacteria vs. only 15% bad bacteria, you are probably in pretty good shape.
Most Americans have an unhealthy gut
But most Americans have fairly unhealthy gastrointestinal systems. If you measure love by behavioral results, it becomes clear that we hate our guts. The levels of friendly flora (the probiotics that live in our gastrointestinal system) in our guts should be much higher than they typically are, and this problem only gets worse as we age.
* Our ability to produce sufficient hydrochloric acid to digest food well worsens as we get older, with consequent ill effects on friendly flora.
* We eat poorly (too few vegetables, too much sugar and flour, and too few fermented foods). Overeating, not chewing our food well, and not relaxing while we eat are associated with poor digestion and consequently reduced friendly flora.
* We use high numbers of substances that kill these beneficial microbes (antibiotics, antibacterial soaps, chlorinated and fluoridated water, pharmaceuticals, etc.)
Our immune system has to fight harder
As a result we end up with a decidedly damaging overgrowth of unfriendly bacteria, viruses and fungi in the small and large intestines. Our immune system has to sweep in to fight much harder to control these problems, because the friendly flora that should have been in the gut to do the job are not there.
Such an overactive response from the immune system can trigger food allergies, and imbalanced intestinal bacteria can further damage the gut. The next paragraph details even more escalating problems that can result from the interactive effects of imbalances in the gut flora.
Food allergies cause not only increased inflammation but also problems in the absorption of nutrients needed to sustain good health. Gut functioning continues to become more problematic as soon as the gut cannot regenerate itself as well as it could formerly, and the GI system becomes even more permeable (this is also called “leaky gut”). Not only does this raise systemic inflammation, but it also allows problematic bacteria that should have been killed in the stomach to escape into the bloodstream where the bacteria can latch onto cells in the joints and soft tissue. The battle escalates, and now the immune system, continuing to try to get rid of this enemy bacteria, attacks it in the joints, resulting in further inflammation and pain. Now the person has pain in the knees and when they take ibuprofen to manage the pain, more damage results, for not only does this painkiller destroy friendly flora, but ibuprofen is in itself damaging to the mucosal lining in the gut.
Bacteria may be causing your inflammation
In yet a further example of the interconnectedness of bodily systems in the big chronic-inflammation picture, bacteria may exist in the mouth or gut and actually cause inflammation in the joints. Unfortunately, an inadequate probiotic population may not be strong enough to kill that bacteria.
The big link here is between gut health and inflammation. That’s a major message. The health of your gut microbiome (that is, your population of probiotics or friendly flora) is your first line of defense against almost every health challenge, including inflammation! 
The gut bacteria profile is related to obesity
Interestingly, evidence shows that the gut microbiome profile is related to obesity and that people who are more obese show different patterns of friendly flora in their guts than those of thinner folks. Not only that, but when obese people lose weight, their gut flora change and look more like those of thinner persons . Children who are overweight also appear to have different gut flora patterns compared to children at normal weights . We also know that gut bacteria influence how much nutrition people can extract from the food they eat . Perhaps even more thought-provoking a fact to consider is that we now know that gut microbes influence the body’s insulin resistance, which further influences inflammation ! If you stick to that memorable saying: “If it’s white, do not bite,” your gut microbiome will benefit as some unfriendly strains of microflora can be significantly reduced when the intake of refined carbs is reduced .
Friendly gut flora
The problem is not only whether or not there is enough friendly flora in the gut—it’s also about the variety of friendly flora in the gut. Each of us are host to several thousand different species of bacteria, and in this case, more is better. Recent research published in the journal Nature  showed that people with more genetic variety in their gut bacteria were healthier in general. People with less variety in their gut flora were more likely to be obese, more likely to gain weight over time, had higher cholesterol and more insulin resistance. The researchers were able to identify certain strains of bacteria that were associated with higher overall bacteria variety and other strains that were associated with less variability. The strains [a] that indicated higher variability are also anti-inflammatory probiotics whereas—you guessed it—the strains found in people with less variability are strains known to be pro-inflammatory and pathogenic. A related study , also linking inflammation to gut bacteria, showed that people who ate less junk food had more variability in their gut biomes, but the researchers also found that people with low levels of friendly flora to begin with were not able to increase their bacteria variability just by eating more healthy foods. So the solution is threefold: 1) you need more friendly flora, and 2) you need more variety in friendly flora, and 3) you need to eat more healthful foods.
[a] Faecalibacterium, Bifidobacterium, and Lactobacillus are the probiotic strains reported. Each of these names is a family name; there are lots of kinds of Bifidobacterium, for example.
Are you improving your gut health through absorbing the marvelous array of beneficial phytochemicals found in plant foods? For instance, phenols in grapes can help prevent pathogens such as salmonella from growing in the gut, and the resveratrol likewise found in grapes benefits friendly flora while helping rid the body of problematic microbes.
Part of what the gut does is protect us from any dangerous pathogens found in the food we eat. Friendly flora and stomach acid are the fighters here, and when we reduce stomach acid to unhealthy levels and/or when we take antibiotics and thereby kill probiotics, then we have systematically gotten rid of most of our immune system.
Quorum Sensing is Cool!
Probiotics do something called “quorum sensing” by which they are able to sense how many of their particular strain exist in the gut biome. When there aren’t enough of their particular strain of probiotics, those probiotics simply can’t take the kinds of helpful, pro-health actions that we hope for. Helpful bacteria can take action only when there are enough of them do those actions. You have to reach critical mass before you get the benefits you are looking for. The take-home message here is this: Don’t give up. Even if you don’t see any benefits to your intake of probiotics, it doesn’t mean what you’re doing is worthless. Perhaps you haven’t yet reached critical mass.
It’s amazing how many times we make a health change for a few days or weeks and then discard that change because it seems to us (in our impatience!) that it’s not working. Give it time!
It’s about your lifestyle
It all comes back to lifestyle. You either lead a pro-inflammatory lifestyle or a balanced and anti-inflammatory lifestyle. What you eat, how you sleep, whether or not you exercise, how much perceived stress is in your life and the extent to which you use pharmaceuticals all make a significant difference in terms of your ability to enjoy a body that has a beneficial gut biome. Better gut health leads to less systemic inflammation. In contrast, poor gut health damages the body’s immune system and leads to inflammation that results in a damaged, inflamed GI tract. A damaged, inflamed GI tract produces frequent painful gas, diarrhea or constipation, heartburn or reflux. It’s not many easy steps from occasional gut inflammation to truly problematic systemic, chronic inflammation.
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