Patients frequently reveal back pain and general body aches and discomfort; however, it is important to consider differential diagnoses beyond neuro-skeletal disorders. As a primary care provider (PCP), familiarity with the patient’s comprehensive medical history and a holistic approach to assessment can enhance overall patient wellness.

The gastrointestinal system may represent a potential source of spinal pain. Two orthopedic experts provide more details on the subject.

PCPs: Gut Health’s Effect on Spine Health

Gut microbiome may affect spine health in a few ways.

“It’s a super interesting and emerging areas in our field,” said Amit Jain, MD, MBA, chief of Minimally Invasive Spine Surgery, Johns Hopkins Hospital, Johns Hopkins University in Baltimore.

He said the gut can influence immune modulation and systemic inflammation, affect metabolite production and nutrient resorption, and there is even some evidence that there is some translocation of bacteria from the gut to the spine, which can directly affect disc health.

Also, there is an impact of inflammation and diet on spinal health. Inflammation and dietary factors significantly affect spinal issues and pain through the gut-brain-spine axis, where diet modulates gut microbiota composition, which in turn regulates systemic and local inflammatory pathways that affect spinal tissues, Jain said.

Clinical Data Supports the Connection

Recent research reveals a causal relationship between the balance of gut microbiota and spinal health, including pain and degenerative conditions such as intervertebral disc degeneration, Jain said. For instance, a recent study that analyzed data from the Dutch Microbiome Project and FinnGen clinical consortium identified 20 gut microbial taxa with significant associations to intervertebral disc disease.

“So the relationship is definitely there, but more research will reveal how we can leverage this to improve spine health,” Jain said.

An Imbalanced Gut Can Affect Spinal Health

An imbalanced gut microbiome, dysbiosis, may promote systemic and local inflammation by releasing proinflammatory compounds. “These proinflammatory molecules can harm the spinal elements including intervertebral discs and bone. Basically, dysbiosis increases gut permeability (‘leaky gut’) allowing bacterial products such as lipopolysaccharide and other metabolites to enter the bloodstream,” Jain explained. These compounds trigger immune activation and systemic inflammation, which can reach and affect distant tissues, he said.

There’s even more of an intersection, said Theresa J.C. Pazionis, MD, MA, spine surgeon and associate professor of Orthopedic Surgery & Sports Medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia.

“An imbalanced gut microbiome can increase intestinal permeability, allowing bacterial metabolites and endotoxins to enter systemic circulation,” she said,

Specifically, Pazionis said this contributes to chronic low-grade inflammation, which may:

• Sensitize spinal pain pathways
• Accelerate disc degeneration
• Negatively affect bone remodeling
• Impair tissue healing and recovery

There’s another implication. “From a surgical perspective, patients with higher inflammatory burden often experience more pain, slower recovery, and worse functional outcomes, even when imaging findings are similar,” Pazionis also said.

How Excess Weight Affects Gait, Posture, and Spine

Discussing weight with patients is best discussed in a nonjudgmental and respectful tone. Advise patients — while adhering to sensitivity standards — that excess body weight significantly impairs gait, spinal health, and posture through increased mechanical loading, altered biomechanics, and reduced spinal mobility, said Jain. “These effects are particularly pronounced at BMI levels above 30,” he said.

Moreover, he recommends telling patients that regular “moderate exercise supports both gut microbiome balance and musculoskeletal health through multiple mechanisms, including modulation of inflammatory pathways and improvement of metabolic function.”

What Are Probiotics Implications?

Jain told Medscape Medical News there is some evidence that probiotic supplementation with Lactobacillus and Bifidobacterium species shows promise for supporting spinal and bone health by modulating gut microbiota, reducing inflammation, and enhancing mineral absorption.”

However, the evidence is somewhat limited, and higher quality studies are needed.

“Nonetheless, there are other general benefits of these probiotics,” he said.

Pazionis said probiotic strains such as Lactobacillus and Bifidobacterium have demonstrated benefits in:

• Reducing systemic inflammatory markers
• Supporting gut barrier integrity
• Modulating immune responses
• Improving metabolic parameters

She also said that while direct evidence that probiotics improve spinal pathology is limited, these effects may indirectly support spinal health by reducing inflammation and pain sensitivity.

“Probiotics should be viewed as adjunctive, not primary, interventions — particularly useful in patients with chronic pain, metabolic syndrome, or inflammatory conditions,” Pazionis said.

Gut Health Tips PCPs Can Suggest to Enhance Spine Health

Per Pazionis, consider these practical, low-risk recommendations for your patients:

• Increase dietary fiber (vegetables, legumes, and whole foods) to promote microbial diversity
• Ensure adequate protein intake to preserve muscle mass and spinal support
• Reduce ultraprocessed carbohydrates and sugars, which promote dysbiosis and inflammation
• Encourage fermented foods if tolerated
• Maintain hydration and regular bowel habits

In addition, she said the below directives can affect spine symptoms.

• Adequate sleep to regulate inflammatory pathways.
• Regular physical activity to support gut motility and spinal stability.
• Stress management as chronic stress alters gut microbiota and pain perception.
• Avoidance of unnecessary antibiotics when appropriate.

Jain reported having no disclosures.

Pazionis had disclosures from Medtronic, Globus Medical, Carlsmed, Spinal Elements, ZimVie, Cirripedes, Silony Spine, Camber Spine Med Tech, and SI-Bone.