New research suggests that electroacupuncture not only alleviates osteoarthritic knee pain, but it may do so, in part, by enhancing the gut microbiota to modulate inflammation.1Wang TQ, et al. Effect of Electroacupuncture on Gut Microbiota in Participants With Knee Osteoarthritis. Front Cell Infect Microbiol. 2021;11:597431.
There is a growing body of evidence that suggests osteoarthritis (OA) is not only a ‘wear and tear’ condition, but that systemic inflammation may be a key contributor. For example, a large (N=1,427) population based study from the Netherlands found that an abundance of Streptococcus species causes an imbalance in the gut-microbiome which contributes to low-grade systemic and local inflammation and leads to increased OA knee pain.2Boer CG, et al. Intestinal microbiome composition and its relation to joint pain and inflammation. Nat Commun. 2019;10(1):4881. This mounting evidence is summarized in a recent consensus statement, which strongly suggests that the prevalence of OA increases not only because of wear and tear but also from our current lifestyles, “in particular physical inactivity and diets low in fiber and rich in sugar and saturated fats, which promote chronic low-grade inflammation and obesity.”3Biver E, et al. Gut microbiota and osteoarthritis management: An expert consensus of the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Ageing Res Rev. 2019;55:100946.
Building off this emerging evidence, an exploratory study assessed the effects of electroacupuncture on knee OA and the gut microbiota.4Wang TQ, et al. Effect of Electroacupuncture on Gut Microbiota in Participants With Knee Osteoarthritis. Front Cell Infect Microbiol. 2021;11:597431 In this trial, a small cohort of participants (N=60) were observed from within a larger trial (N=480).5Tu JF, et al. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Rheumatol. 2021;73(3):448-58 (Results of that larger trial suggest electroacupuncture outperforms manual acupuncture and sham acupuncture controls for the treatment of knee OA). The small exploratory study focused on the gut microbiome and suggested that electroacupuncture not only improved knee OA, but modified the composition of the gut microbiome too.
Although this message is not new to acupuncture providers, a reminder that lifestyle is foundational, even for patients with knee OA. If you have patients with knee OA, it may be beneficial to ask them about their diet and recommend modifications such as adding pre/pro-biotic foods, increasing fiber and decreasing sugars and saturated fat. If you are using manual acupuncture, try electroacupuncture as this new research suggests it may enhance the effects (100/2Hz: LR-8 : GB-33 & 2 ashi adjacent points; see study for details.