Gut Health and Osteoporosis❤️

Let's talk about how your gut 🦠 health and bone health💪are connected.

You already know that what you eat directly affects your bone health. Eating enough protein, and getting sufficient Vitamin D, as well as calcium are the foundations of rebuilding after a diagnosis of osteoporosis or osteopenia.

But what happens with your healthy diet once it enters your digestive tract? Does your gut health matter?

In a nutshell, YES!

We are truly at the beginning stages of knowing exactly what a healthy gut looks like, and how to restore it if there are problems. But, if osteoporosis is a metabolic disorder, we need to look at our gut health.

Anatomy First: Your small and large intestines are responsible for the majority of your nutrient absorption. Your small intestine begins at the end of your stomach. Your food travels about 18 feet through your small intestine before continuing to your large intestine. As you can imagine, most digestion occurs along this 18-foot path. Some digestion occurs in the large intestine before the remainder of the waste moves out through the rectum.

Inside the lining of the small intestine is a rich and diverse microbiome. Over 1000 species of bacteria, viruses, and fungi live in your gut and assist with digestion and absorption of nutrients and minerals, biosynthesis of vitamins and amino acids, and carbohydrate fermentation (Conway, Duggal, 2021).

It is thought that by the age of 3, most of us have established our gut microbiome. But some factors can change its makeup, including the use of antibiotics, alcohol, medications, and exercise.

Do people with osteoporosis have something happening that interferes with the absorption of nutrients and disrupts their gut health?

The gut-bone axis. In 2022, He and Chen published a review in Osteoporosis International titled: The potential mechanism of the microbiota‑gut‑bone axis in osteoporosis: a review. The authors did a thorough investigation of the relationship between gut health and bone health. They found that prebiotics, probiotics, and traditional Chinese medicine have promising, but not yet proven, positive effects on gut health. Almost all studies connecting gut health and bone loss have been done on mice and rats, and the findings are at the cellular level.

Clinical trials with post-menopausal women who take specific pre or probiotics have not been done, and therefore, specific recommendations about what to take, how to take it, and when cannot be made.

In 2024, Zhang et al. released a paper titled: Diets intervene osteoporosis via gut-bone Axis. The authors of this paper analyzed different diets, such as a vegan diet, Mediterranean diet, Ketogenic, traditional Western, and others to see if there were differences in regards to osteoporosis. Like the other study, while there are strong indicators that diet and your gut affect your bone status, there are not enough studies to make anything but broad generalizations.

What are the broad generalizations?

✅ Diets are hard to evaluate long-term because people change their diets over time
✅ Inflammation, brought on by a poor diet, stress, medications, or lack of exercise, affects bone-building
✅ Osteoclasts and osteoblast activity may be affected by the gut microbiome, and therefore future interventions can be targeted to the gut.
✅ Exercise does alter the gut microbiome, potentially lowering inflammation by increasing blood circulation, similar to how it helps with your heart health while potentially increasing bone strength
✅ A Mediterranean or anti-inflammatory diet is probably best. Food diversity, including fruits, vegetables, beans, fish, nuts, seeds, fermented foods, low sugar, minimally processed food, as well as limited alcohol will help your gut stay healthy

What about probiotics and prebiotics?

We do not have any specific, evidence-based recommendations on what to take or how much to take. This remains an unregulated industry. Taking a pre- or probiotic by mouth means it has to pass through your stomach, which is acidic. It is thought that most of these supplements are deactivated by the acid in the stomach and do not make it to the gut. A probiotic would need to be able to withstand a pH of 2 to make it out of the stomach.

What makes it through to the gut?

FOOD!!
​Fermented foods, such as pickles, sauerkraut, kimchi, and yogurt. Others include tempeh, Kombucha, aged cheese, fermented cottage cheese, and miso.

🦠That's it. As always, my references are listed below.
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I hope you found this helpful.
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Here is to your healthy gut,

Andrea Trombley PT, DPT

References:

Conway, J., & A Duggal, N. (2021). Ageing of the gut microbiome: Potential influences on immune senescence and inflammageing. Ageing research reviews, 68, 101323. https://doi.org/10.1016/j.arr.2021.101323

He, Y., & Chen, Y. (2022). The potential mechanism of the microbiota-gut-bone axis in osteoporosis: a review. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 33(12), 2495–2506. https://doi.org/10.1007/s00198-022-06557-x

Koga Y. Microbiota in the stomach and application of probiotics to gastroduodenal diseases. World J Gastroenterol. 2022 Dec 21;28(47):6702-6715. doi: 10.3748/wjg.v28.i47.6702. PMID: 36620346; PMCID: PMC9813937.

Zhang YW, Cao MM, Li YJ, Chen XX, Yu Q, Rui YF. A narrative review of the moderating effects and repercussion of exercise intervention on osteoporosis: ingenious involvement of gut microbiota and its metabolites. J Transl Med. 2022 Oct 27;20(1):490. doi: 10.1186/s12967-022-03700-4. PMID: 36303163; PMCID: PMC9615371.

Zhang, Y. W., Song, P. R., Wang, S. C., Liu, H., Shi, Z. M., & Su, J. C. (2024). Diets intervene osteoporosis via gut-bone axis. Gut microbes, 16(1), 2295432. https://doi.org/10.1080/19490976.2023.2295432

The information provided is for general educational purposes only and is not intended to serve as medical or physical therapy advice to any individual. Please consult with your physician before starting any new exercise program. Any exercise has the potential to cause injury or physical problems.