For years, Megan* thought her rheumatoid arthritis flares were random.

During a flare, she woke up exhausted no matter how much she slept. Her joints were stiff and ached every day for hours. She felt like she was twice her age due to hobbling around the morning and being slow to get going. And the bloating? Some days, it made her look six months pregnant.

Her doctors said it was "part of having an autoimmune disease." By the time I met her, she was miserable multiple days each month despite being on maximum doses of medications for her symptoms.

As I talked to her, I wondered about the bloating - an unusual aspect of rheumatoid arthritis. We did additional testing for this, and as it turns out, her gut health was a separate problem that was influencing her immune system. Research shows that gut health is an important aspect of all inflammatory arthritis, not only rheumatoid arthritis.

In Megan’s case, the gut microbiome was not normal, causing chronic inflammation that sent her immune system into overdrive. When she started addressing her gut health, everything changed.

The Science Behind the Gut-Autoimmune Connection

Most people don’t realize this, but 70% of the immune system lives in the gut. That means when your intestinal health is off balance, your immune system can go haywire.

🚨 Inflammation: When the gut lining becomes too permeable, toxins and undigested food particles enter the bloodstream, triggering an immune response. Sometimes, you may hear the term “leaky gut,” which is a similar idea for what is happening.

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🚨 Food sensitivities: Certain foods (even healthy ones!) can worsen autoimmune symptoms if your gut is compromised.

🚨 Microbiome imbalances: Too much "bad" bacteria and not enough "good" bacteria can contribute to inflammation. Prebiotics and probiotics play an important role in gut health, but there are many other factors. Here are a few:

• How you were born (c-section versus vaginal)
• How much sweetener (natural or not) and fiber are in your diet
• How many antibiotics have you taken
• Whether you’ve used anti-inflammatory medications (eg, ibuprofen) or anti-acid medications (eg, tums)
• Whether you drink alcohol or use tobacco products
• How much high-quality sleep you get
• Whether you live with chronic stress
• Your exposure to sex hormones (estrogen, progesterone, testosterone)
• Your age and life stage

Understanding and addressing these influences can be a key step in managing autoimmune diseases and improving health.

How Gut Health Impacts Autoimmune Disease

If your gut is out of balance, your immune system may be too:

🔹 Dysbiosis (bad gut bacteria overgrowth) can confuse the immune system, leading to attacks on healthy tissues.
🔹 Chronic gut inflammation doesn’t stay in the gut—it spreads throughout the body, triggering autoimmune flares.

Steps to Improve Gut Health

If you're dealing with an autoimmune disease, healing your gut could make a huge difference. Here’s where to start:

✅ Cut back on processed foods and sweeteners (natural and artificial) – These disrupt gut bacteria and fuel inflammation.
✅ Increase fiber, fermented foods, and prebiotics – Think leafy greens, sauerkraut, and slowly digesting starches to feed beneficial gut bacteria.
✅ Consider functional testing – Stool tests and food sensitivity testing can pinpoint specific gut imbalances. Not all of these tests are covered by insurance, but that doesn’t negate their value in select patients.

Your Gut Could Be the Missing Link

Megan spent years trying everything—but it wasn’t until she focused on gut health that she saw real progress.

If you’ve been struggling with stubborn autoimmune symptoms, your gut may be the key to relief.

🔹 Share this email with someone who needs to hear this. Because healing your gut means healing your whole body. 💙

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For Megan, fixing her gut was the missing piece in managing her arthritis.

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To Your Health,

Amy Loden Tiffany, MD

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*Name changed to protect privacy.

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