What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is an autoimune disease that can be treated effectively with diet, exercise, and therapies.
Although Ankylosing Spondylitis is widely seen as a disease of old people who end up with severely curved spines, its actually a disease that commonly starts young, but is frequently misdiagnosed for decades
To start out this page with a shift away from the usual image of a stooped and disabled AS sufferer, here is a photo of Helgi Olafson, a 30 year old endurance athlete who was first diagnosed with AS aged 19.
What is Ankylosing Spondylitis (AS)?
Ankylosing Spondylitis (pronounced ankle-low-zing spond-ill-eye-tiss) is an auto-immune disease in which the immune system mistakenly attacks your own body.
It is a chronic and progressive inflammatory form of arthritis that mainly affects the joints of the spine (vertebrae).
Inflammation causes back pain and stiffness. The back pain is often severe, long term and usually also includes other joints such as hips, knees, and ribs, which can make it hard to breathe, leading to extreme pain when sneezing or coughing (to the point of passing out)
There is usually neck stiffness, sore muscles, tight hamstrings, overall stiffness, and often Irritable Bowel Syndrome (IBS) is also present.
There is fatigue from the body fighting the inflammatory process and also from the ongoing stiffness and pain
Younger people with AS symptoms seem to be becoming increasingly common, but they don’t usually display the curved spine and fused joints that older people with AS often do.
Over time, many younger people with AS may go on to develop a severely stooped forward rounding of the back, along with bone fusions, but spine curvature is a poor indicator of AS, simply because most people with AS start to suffer from it from the ages of 15-35, long before any spine curvature or fusing is evident…
About 90 percent of people with ankylosing spondylitis test positive for the gene HLA-B27, but although testing for this marker is widely taken to be proof of AS, around 10% don’t test positive, and the pain killing drugs that are doled out to people with AS make he underlying disease far worse, so medical diagnosis in many cases is not even benificial.
For a person who can still cope with exercise that is probably a good way to treat the disease. But 30 years down the track exercise may no longer be a viable option, and a No Starch diet may become the most important treatment .
In long term, severe, advanced cases, vertebrae fuse together causing the spine to lock up. This poor man below is a really extreme example, after years of pain, he is now in this state – Kevin Andrews – This is the image many people have of an AS sufferer
Is there a way to reverse the underlying disease and heal from the symptoms of Ankylosing Spondylitis (AS)?
A No Starch Diet (NSD) can in many cases relieve symptoms of Irritable Bowel Syndrome (IBS), Ankylosing Spondylitis & Arthritis. For many people even just a IBS low starch diet (LSD) will do the trick.
This doesn’t necessarily heal or reverse the disease but can relieve the symptoms and stop them from getting worse, as long as the diet is maintained.
It is possible that if the underlying klebsiella infestation (more on that shortly) is appropriately treated, the strictness of the diet may not need to continue indefinitely. But some form of restricted starch diet will probably need to be followed for life.
The IBS low starch diet (LSD)
This book is a great introduction to treating IBS and AS with a low starch diet (LSD) because it is well written, relatively easy to read and understand. The low starch diet (LSD) is an easier starting point, and for many people leads to rapid improvements.
A complete No Starch Diet (NSD) is more effective for some people, but it’s also more demanding to follow.
Gut and Psychology Syndrome by Natasha Campbell-McBride
This diet is step up from most of the AS diets and addresses one of the real underlying AS issues of gut health. It’s very low starch and can be easily tweaked to become no starch.
It’s a well-researched, science-based summary of the genetic-nutritional-biochemical factors that link Autism, ADD, ADHD, Dyspraxia, Dyslexia, Depression and Schizophrenia to digestive dysfunction. Dr. Campbell-McBride applied her training in neurology and nutrition to help her own autistic son.
The GAPS diet brings together the best of the dietary aspects that are helpful for both gut dysfunction and mental or developmental issues. This brings together aspects of the SCD (Specific Carbohydrate diet), gluten and casein free approaches, restoring digestive balance, and clearing toxins.
Dr Natasha is currently writing a book about using the same diet to treat auto-immune disease
The Autoimmune Paleo Protocol
Another diet that is similar to GAPS and is now very popular is the Paleo or Primal diet. For cases of autoimmunity, there is a stricter version that some people need to follow, that also excludes eggs, dairy, nuts and seeds, to further reduce inflammation.
Real Food diet for Ankylosing Spondilitis
If we look at the commonalities of these approaches, we can see the Core foods that they all agree on, plus the possible extras that might work for you
CORE foods in the chart below are generally considered safe by the following range of diets (though it is still possible to have a sensitivity to them): GAPS / SCD / IBS low starch / Autoimmune Paleo (AIP) / Anti candida
(FODMAPS / Low salicylate have the same safe proteins and fats, but veges & fruits are different)
* are generally considered as Healing foods, though some anti-candida diets don’t allow ferments
PROVISIONAL foods are allowed on some diets but not others, so need to be assessed for each person.
Notes on the PROVISIONAL foods:
(1) pork digests best if cured, but bacon usually has a sweetener
(2) common allergen, not allowed on AIP, sometimes can tolerate yolks but not whites (3) common allergen
(4) valuable food if tolerated
(5) not allowed on anti-candida
(6) not allowed on anti-candida, allowed on GAPS
(7) blackcurrants, cranberries lowest in sugar
(8) not allowed on anti-candida
(9) not allowed on AIP, macadamias/ almonds/ walnuts lowest starch; but almonds fairly common allergen
(10) a legume so quite high carb
(11) not allowed on GAPS till digestion settled
(12) allowed on GAPS as they contain single sugars
(13) check carefully for added starch
(14) not allowed till later in GAPS
(15) check different forms
(16) allowed on GAPS as single sugars
(17) mostly vege, with a little fruit; detoxing food on GAPS but not allowed on anti-candida
(18) need to make sure all sugar has been fermented
(19 & 20) assess your own tolerance
Some of the AVOID foods may be able to be added back after some healing has taken place
How to test foods for starch using iodine
Nascent Iodine works well for testing as it’s a light brown colour and turns black or dark brown in the presence of starch
All the cells in your body contain and make use of iodine. It is concentrated in the glandular system of your body, with your thyroid containing the highest amount compared to any other organ. Significant amounts are also stockpiled in numerous other areas of the body including the salivary glands, cerebrospinal fluid and the brain, gastric mucosa, choroid plexus, breasts, and ovaries.
Our modern diets are often to low in iodine and iodine supplementation can be helpful in cases of deficiency.
After testing different microbes in rabbits (injected with HLA-B27 lymphocytes) a bowel microbe called Klebsiella was identified. Klebsiella appeared to have molecules that resembled the HLA-B27 blood group and also the collagens found in the spine and large joints.
Klebsiella microbes are a normal component of human bowel flora, but AS patients tested were found to have greater amounts in their stools. Elevated levels of antibodies to Klebsiella were found in AS patients, especially during the active phase of the disease, i.e during flare-ups.
Further studies in other countries also found elevated anti-bodies to klebsiella in AS patients. The next problem was getting rid of the klebsiella. Antibiotics will kill it, however reinfection is likely. The answer came, like many discoveries, by accident.
One of Ebringer’s patients wanted to lose weight, and asked for a diet plan that would work. He devised an unconventional plan. As much steak and tomatoes as you can eat, plus a bottle of red wine a day! When he next saw the doctor he remarked “Not only have I lost weight, but my joint and back pains have disappeared!”
The penny dropped for Ebringer, the diet lacked starch, the klebsiella must be living in the gut feeding on undigested starch. Tests on patients confirmed this, and he found several nutrition studies that demonstrated bacterial growth in the colon is fed by dietary starch.
Ebringer tested a no starch diet on hundreds of AS patients at the Middlesex Hospital in London. These patients continued their medication, however he found he could achieve therapeutic effects with much lower levels of drugs. The low starch diet was found to be particularly effective for those with early stages of the disease, before irreversible spine and joint damage
Kick AS is a huge AS site with a lot of interesting information
But unfortunately, despite having some OK (but often pretty rudimentary) dietary advice much of it is fundamentally built on these two horrible myths:
1 “There is no cure for ankylosing spondylitis” (ie, all the people who have successfully overcome it using dietary changes don’t count)
2. “The doctor aims to relieve the symptoms” (ie mask the symptoms using drugs that worsen the underlying disease)
If you can ignore this misinformation and go past it there is plenty of useful content on the site
The site has a wide ranging discussion forum
It also includes a handy list of the starch content of common foods
The link between Nightshades and Arthritis
Nightshades belong to the Solanaceae family which includes over 2,000 species. They also include some of the most popular foods consumed today; such as tomatoes, potatoes, all types of peppers, and eggplant.
Although not truly nightshades, blueberries, huckleberries, goji berries and ashwaganda all share the same inflammation-inducing alkaloids.
Don’t mask the Symptoms with drugs
Many people with AS who listen to doctors seem to end up taking drugs like Humira – here’s an eye opening list of over 100 side effects from this extremely dangerous drug (another side effect not included on this list is that it makes the underlying AS condition worse by destroying the gut lining):
Also dangerous and widely prescribed are NSAIDs (Non-steroidal Anti-inflammatory Drugs) In damaging the gut lining they are one of the worst possible things to take for any disease related to a gut disorder (ie. AS)
“Every year 14,000 Americans die from internal bleeding caused by taking NSAIDs. These drugs destroy the lining of the stomach and intestines and cause so much damage that patients literally bleed to death”
Reversing Autoimmune disease through the Paleo Diet and Lifestyle
Ankylosing spondylitis (AS) is an autoimmune condition that attacks the spine. Charles Comey had symptoms for six years before getting diagnosed. He thought his increasing pain and disability were simply old injuries refusing to heal.
When his AS peaked, he was living a life of constant pain and had also developed a dangerous heart condition (cardiomyopathy). Charles was offered immunosuppressant drugs, but he decided to try a healing diet first. After two weeks on a no-starch version of the paleo diet, his pain reduced to a 0-1
A very interesting site by Bob Connors who has successfully treated his ankylosing spondylitis, using a No-Starch diet.
Sweet potatoes: avoid at all costs. They’re all starch and won’t help you at all. Eat more fat if you’re not feeling full. Avocados, nuts, fatty meats, etc.
Fatty meats: in a word, YES! Eat the hell out of fatty meats. Whomever told you that they’re dangerous is misinformed and likely brainwashed by years of listening to the standard establishment BS. Read, “Why We Get Fat and What To Do About It” by Gary Taubes. Fatty meats are what our ancestors have been eating for millions of years. And eating fat doesn’t make you fat, eating sugar (carbs, glucose, fructose, etc.) makes you fat
Fruit: over rated in my opinion. I eat lots of berries but avoid almost everything else. As long as it’s not packed with starch (unripened apples, etc.) you should be fine eating most fruits if that’s what you want to do. But you should test your fruit with iodine first to see starch content.
Eggs: I eat a ton of them and have no issues. Everyone is
different, however, and if you have a reaction then don’t eat them. But you need to keep a food journal and keep track of how you feel after meals. That’s simply the only way to do it while you’re learning about your body over the 1st year or so of this diet. No easy way around it.
Nuts: I stick to macadamia, walnuts, and almonds. No peanuts (not a
nut), no cashews either. Pecans occasionally. Sprouted or unsprouted
is up to you and your reactions moving forward.
One size does not fit all
Everyone is different in their dietary requirements. But a common pattern seems to be that many dietary theories that say everyone is the same and needs the same foods.
An example of a site that sets off my alarm bells based firstly on its name is “The Perfect Diet” – http://perfecthealthdiet.com/
Although there is lots of good advice on this site, it then sets off my next warning siren by saying that rice and beer should be consumed regularly… (Along with fruits, berries, alcohol, chocolate, dextrose, and rice syrup)
The “Perfect” Diet works out to about 600 carb calories, primarily from starches, so despite being recommended on some AS sites, it’s a very “imperfect” diet for an AS sufferer. This is why I’m picking on it here. And there are many far worse diets being recommended to people with AS.
Even starting off with a very basic nutrient, water, we are regularly told how much we “should” drink. But the requirements in a hot location are very different to a cold one, and a large athlete will probably need far more than a small receptionist, for example.
Fluoridated water from a tap in NZ or USA is very different to clean mineral water. And even if beer really was a good drink for someone, the ingredients, including the water, and the length of fermentation, would make a vast difference to how nutritious it was.
We all really need to test our own reactions to foods, and not religiously follow anyone’s guidelines, including ours!
Many people have found that AS can be reversed on a strict No Starch diet, but it’s not always easy. Reversing it is easier than living with the pain though. The choice to keep in mind is, if it comes down to hunger vs agony, sometimes it may better to go with the hunger.