As someone who works closely with peripheral artery disease patients every day, I’m always looking for connections that might help us better understand and treat this complex condition. Recently, research has revealed something that should make every PAD patient pay attention: your gut health isn’t just affecting your arteries—it’s impacting your bones too.
The Emerging Science: Gut Health’s Dual Impact
We’ve already seen compelling evidence that gut health plays a significant role in vascular disease, including PAD. Imbalances in gut bacteria contribute to inflammation and can worsen atherosclerosis—the same process that restricts blood flow in your legs.[1]
But here’s where it gets interesting. In our recent interview with NP Deidre Arms from Aspire Wellness Integrative Health, we discovered that this same gut dysfunction simultaneously undermines your bone health. It’s a double whammy for PAD patients that too few doctors are discussing.
“Your gut helps regulate your calcium absorption, your bone remodeling and inflammation,” NP Deidre explained. “And inflammation, as you know, plays a huge role in all chronic conditions.”
Why This Double Trouble Matters for PAD Patients
For someone with PAD, this connection creates a potentially dangerous scenario:
- Your compromised gut health contributes to arterial inflammation and plaque buildup, worsening your PAD symptoms
- Simultaneously, that same gut dysfunction prevents proper absorption of bone-building nutrients and triggers inflammation that weakens your bones[3]
- The result? Potentially fragile bones in someone who already has mobility challenges from poor circulation
This is particularly concerning because PAD patients are often encouraged to walk to improve circulation—but how safe is that walking if your bones are simultaneously being weakened?
A Real-World Example
NP Deidre shared a compelling case that illustrates this exact connection:
“I have a patient in his 50s who has had osteoporosis for a while now, and he has low testosterone. He had gut absorption issues with H. pylori. And so when you have H. pylori, you’re not always absorbing minerals and nutrients that you need to build bone mass.”
This patient’s story demonstrates exactly how gut problems (H. pylori infection) directly contributed to bone health issues (osteoporosis). For PAD patients who may already have compromised nutrient delivery due to poor circulation, adding gut absorption problems creates that “double trouble” scenario we’re concerned about.
The Overlooked Connection to PAD Management
When you’re focused on managing PAD symptoms like leg pain and claudication, bone health might be the last thing on your mind. But consider this: if your bones become weakened due to the same gut issues that are worsening your PAD, you’re facing increased fall and fracture risks at precisely the time when staying mobile is most critical for your vascular health.
“Your fall risk is high with osteoporosis, but it’s extremely high with osteosarcopenia,” NP Deidre warned, referring to the condition that combines bone loss with muscle loss.
For PAD patients, this creates a vicious cycle:
- PAD limits walking ability
- Limited walking leads to bone and muscle weakness
- Bone and muscle weakness increases fall risk
- Falls can lead to fractures and further immobility
- Immobility worsens PAD
Breaking this cycle means addressing both vascular health AND bone health—and the gut appears to be a critical connection between them.
What’s Happening in Your Gut?
“When we have a diverse, healthy gut, it helps boost our bone health. If we’re somebody who has imbalances or we’re using a lot of antibiotics or even other medications, we can increase our fracture risk,” NP Deidre explained.
Several gut-related mechanisms affect both PAD and bone health:
- Inflammation: Gut dysbiosis triggers systemic inflammation that impacts both blood vessels and bones[2]
- Nutrient Absorption: Poor gut health prevents absorption of nutrients needed for both vascular and bone health[3]
- Microbial Metabolites: Certain gut bacteria produce compounds that either protect or damage blood vessels and bones
- Intestinal Permeability: “Leaky gut” allows inflammatory substances to enter circulation, affecting multiple systems
As NP Deidre said several times during our interview, “It’s all about your gut!” This statement holds particularly true for PAD patients facing this double threat.
Testing: Finding Out Where You Stand
How do you know if your gut is creating this double trouble situation? NP Deidre recommends comprehensive testing:
“I recommend a stool test. My favorite is the Vibrant Wellness test because it looks at inflammatory markers pretty significantly compared to some of the other ones that I’ve looked at.”
For bone health assessment, she suggests:
- DEXA scans to measure bone density
- Hand grip strength testing as a predictor of frailty and fracture risk
These tests help create a complete picture of how your gut health might be affecting both your vascular system and your bones.
Breaking the Cycle: Practical Solutions
The good news is that addressing gut health could potentially improve both your PAD and bone health simultaneously. NP Deidre shared several strategies:
Supporting Your Gut
- Identify and address specific gut pathogens through comprehensive testing
- Consider targeted probiotics when needed to diversify gut bacteria
- Support your gut lining with nutrients like Akkermansia, which “is great at building that mucosal lining”
- Reduce gut inflammation through diet and stress management
Protecting Your Bones
- “Get on your feet and start moving, walking, building those muscles. Don’t allow your muscles to waste,” advises NP Deidre
- Optimize vitamin D levels, which is “hands down probably one of the top supplements we end up prescribing”[3]
- Consider vitamin K2 (MK7), which “directs calcium to the bones and teeth and away from the arteries” (particularly important for PAD patients concerned about arterial calcification)
- Support collagen formation, which “provides the amino acids for the bone matrix”
- Reduce inflammation with omega-3s, which are “really important, not only for your cardiovascular, but it helps to reduce inflammation that contributes to bone loss”
Additional Considerations
- Review medications that may impact both gut and bone health
- Focus on mitochondrial support, as “the mitochondria in our cells plays a role in bone turnover and repair”
- Address hormonal factors when relevant (estrogen for women, testosterone for men)
A Call to Action for PAD Patients
If you’re living with PAD, this gut-bone-artery connection means you need to be especially vigilant about your gut health. The same gut issues that are potentially worsening your circulation could simultaneously be undermining your bone strength—creating that dangerous “double trouble” scenario.
For more information on PAD or to find additional resources, call our Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS (1-833-723-5347). Connect with our supportive community at www.PADsupportgroup.org where you can share experiences and learn from others facing similar challenges.
Don’t forget to subscribe to our YouTube channels at youtube.com/@thewaytomyheart and youtube.com/@NpDeidre for more expert interviews like this one. Our next session will focus on homocysteine, another critical factor in vascular health.
Remember, addressing your gut health isn’t just about improving your PAD symptoms—it’s about protecting your entire body, including your precious bones. This comprehensive approach could be the key to maintaining both mobility and independence as you manage your PAD.
References
- Bortolin M, Hiatt WR, et al. Narrative review of the association between gut microbiota and peripheral artery disease. Ann Vasc Surg. 2024.
- Shi H, Yuan X, et al. Genetic support of the causal association between gut microbiota and peripheral artery disease: a bidirectional Mendelian randomization study. Aging. 2024;16:762-778.
- Chen YC, Greenbaum J, et al. Gut Microbiome and Osteoporosis. Curr Osteoporos Rep. 2020;18(3):344-353.
- Duffuler P, Bhullar KS, Wu J. Targeting gut microbiota in osteoporosis: impact of the microbial-based functional food ingredients. Food Science and Human Wellness. 2024;13(1):1-15.
- Prato S, Viglianti D, et al. Gut microbiome and bone health: update on mechanisms, clinical evidence, and emerging therapeutic options. Osteoporos Int. 2024.