Diets for Ankylosing Spondylitis and Axial Spondyloarthritis Part 1: The Low/No Starch Diet

The first lifestyle modification many of us look for is an ideal diet for ankylosing spondylitis or axial spondyloarthritis.

And with good reason; there are thousands of anecdotal reports of people who have reduced their symptoms and improved their quality of life by simply changing the way they eat.

So how do you know where to begin, or who to listen to when it comes to diet?

In this series of articles I delve into the most popular dietary approaches currently being used by people with AS.

The Low/No Starch Diet for Ankylosing Spondylitis (also known as the London Diet) is by far the most well known and widely applied diet within the AS community.

It was originally developed by British rheumatologist Alan Ebringer who in the 1970’s discovered an overgrowth of the starch-feeding bacteria Klebsiella in the digestive tracts of his patients with Ankylosing Spondylitis. Dr Ebringer went on to recommend a low starch diet to his patients and found that symptoms dramatically reduced for the period of time that patients removed high-starch foods from their diet.

Today there are a number of websites, online communities, books and blog posts devoted to the starch/AS connection. The Facebook Group ‘The Low/No Starch Lifestyle for Ankylosing Spondylitis‘ has 12,000 members, many of whom post recipes and share their tips in this very active community.

What’s involved?

As the name implies, this diet requires you to eliminate as much starch from your diet as possible, with most people settling at a level they can tolerate (ranging from low to zero).

High starch foods include bread, pasta, grains, potatoes, bananas, legumes and some nuts.

Added starches are widely used as thickeners and fillers commercially, and are therefore present in the majority of processed foods.

It is possible to check whether foods contain starch by testing with iodine, so this is a common practice among those following the diet.

As starch tolerance can vary from person to person it is recommended to follow an elimination protocol and slowly reintroduce foods while monitoring for a reaction.

Pro’s

• it’s effective; most people who have applied the diet as recommended have found it to be helpful in relieving painful symptoms of AS, especially when followed very strictly (ie zero starch).
• it’s possible to have a reasonably varied diet of nourishing foods when doing low starch (think simple meat, vegetables, fruit and dairy) providing you are happy to cook at home
• the diet is not difficult to understand nor is it expensive to implement
• there is an active online community with many helpful resources to tap into, including recipes and advice on eliminating starch

Con’s

• eating out, travelling, or finding friends happy to entertain you becomes very difficult; hidden starch is in many foods and this is not a commonly understood or accepted dietary preference
• even supplements and medications can contain starchy fillers or coatings
• going low or no starch over a long period of time has raised concerns among experts due to eliminating resistant starch and fibre, which are important food sources for beneficial bacteria
• once you return to eating starch your symptoms will generally return, so it’s essentially a dietary form of symptom management more than a healing protocol
• this is a tough diet to stick to because of the variety of foods that it excludes, many of them otherwise healthy choices

Who is Low/No Starch approach best suited to?

While some people have adopted this as a permanent dietary approach, The Low/No Starch diet can also offer a great circuit breaker on a short term basis.

For most people, though not all, eliminating starch completely will result in fairly dramatic pain reduction within a matter of days. This can be an effective way to stop a flare in its tracks or simply have a break from chronic pain.

There are also those people who have implemented the diet over a period of months or years then found they can reintroduce starchy foods without symptoms resuming. These are all anecdotal reports and results vary.

The important takeaway once again is that individual results vary and a degree of self-experimentation is required.

As with all significant dietary change, please check in with your healthcare team before you begin.

Further resources to check out:

The Kick AS Community http://www.kickas.org/as_dietary_primer.shtml

The IBS Low Starch Diet by Carol Sinclair (print book with recipes and information)

Pub Med Article https://pubmed.ncbi.nlm.nih.gov/8835506/

Blog Posts:

https://www.phoenixhelix.com/2014/05/25/the-great-starch-experiment/

https://chriskresser.com/hla-b27-and-autoimmune-disease-is-a-low-starch-diet-the-solution/