Food Spotlight on Ankylosing Spondylitis (AS)

As knowledge of nutrition and food-as-medicine expands, using food as therapy to support health and wellbeing has become increasingly popular. This is especially the case for patients with autoimmune and autoinflammatory conditions. For example self-experimenting patients with Ankylosing Spondylitis are finding foods can help (or hurt) their condition. More and more such fearless experimenters follow special diets to mitigate symptoms and prevent flares. But with this popularity has come the usual wave of one-size-fits-all “miracle” fad diets and dubious advice. Our Food Spotlight series helps you wade through the ocean of information to start experimenting with your diet for better health.

What is Ankylosing Spondylitis?

Ankylosing spondylitis is a type of systemic inflammatory arthritis that primarily affects the spine, especially the lower (lumbar) vertebrae and the sacroiliac joints. Over time, inflammation of the entheses (connective tissue) of the spine leads to scarring of this tissue and eventually the formation of extra bone. This can lead to less spinal flexibility and a hunched posture. Symptoms include chronic pain, stiffness in the back and hips, and fatigue.

Eye inflammation is also common–symptoms include pain, blurred vision, and light sensitivity. As a systemic condition, many parts of the body can be affected and in pain such as; chest, ribs, hips, heels, and shoulders. As with most immunological diseases, the course of AS is highly variable, not only from person to person but within individual patients; symptom flares and periods of remission are typical. That’s why looking into food choices may help Ankylosing Spondylitis patients.

General diet suggestions

In general, patients with AS may benefit from following a generic autoimmune, anti-inflammatory diet, which focuses on avoiding processed foods, dairy and added sugar while eating more vegetables, fruits, fish and other whole foods. Maintaining a healthy weight is also important for ankylosing spondylitis patients, as excess weight stresses bones and joints.

There are also a few specific foods and food components that may help reduce Ankylosing Spondylitis symptoms.

  • Omega-3 fatty acids may decrease disease activity (2). Foods high in Omega-3 fatty acids include fatty fish, fish oil, chia and flax seeds, and walnuts. Additionally, Omega-3 supplements are widely available.
  • Since AS primarily affects bones, calcium and Vitamin D are important. Additionally, high levels of Vitamin D may decrease both the risk and symptoms of AS (3). Foods high in calcium include leafy greens, almonds, tofu, fortified cereals and dairy foods if you tolerate them. Good sources of Vitamin D include sunlight as well as seafood, egg yolks, fish oil, and fortified foods. Furthermore, vitamin D supplements are inexpensive and easy to find.

Drinking plenty of fluids is important for keeping your body functioning as best it can. If you feel gastric distress, we suggest eating smaller meals and only when you’re hungry to minimize stomach pain. We also recommend keeping a food diary to track foods that trigger your symptoms, as well as finfing foods that mitigate symptoms.

The best foods for ankylosing spondylitis patients

Certain foods and food components may help manage AS symptoms. The Internet offers an overwhelming number of diet ideas, including the London AS Diet, and the Autoimmune Protocol (AIP) and Gut and Psychology Syndrome (GAPS) diets for inflammatory diseases. Check out our post on autoimmune diet comparisons to learn more about these different diets. While we do believe that following a diet that emphasizes anti-inflammatory and antioxidant-rich foods should help people with ankylosing spondylitis, we don’t believe in a one-diet-for-all approach, because AS affects people differently and symptoms vary among patients.

This best foods table offers a starting point for any Ankylosing Spondylitis patient. Combining our own autoimmune and anti-inflammatory knowledge with specific scientific research (1), we’ve crafted our food recommendations for AS patients.

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The worst foods for Ankylosing Spondylitis patients

In contrast to anti-inflammatory foods, there are also pro-inflammatory foods that should be avoided. These include processed meats, sodas and sugary beverages, salty snacks, packaged sweets, and refined carbohydrates. Unfortunately, these foods are also easy to reach for when stress eating or snacking. If you suffer from AS, these types of foods may intensify any symptoms you’re already experiencing.

The London AS diet is a low-starch diet designed to reduce AS symptoms. It suggests eating fewer starches, including bread, pasta, potatoes, pastries, and rice (4). However, there has not been extensive research on this diet, so it is undetermined whether it is effective or not for AS patients.

In addition to the generic pro-inflammatory foods listed in the table below, there are some more specific foods that might be harmful to Ankylosing Spondylitis patients.

  • Alcohol negatively affects bone health and may interact with AS medications, so alcohol, especially heavy or binge drinking, should be avoided.
  • A high-fat diet has been linked to arthritis and joint pain (5). Limiting saturated fats (but still including unsaturated or “good” fats in your diet) may help ease symptoms.

Conventional food products may contain more synthetic chemicals (6), which may have greater effects on those with autoimmune diseases or related conditions.

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More tips for managing ankylosing spondylitis

Engage in mindful eating

Other aspects of eating are important in combination to being aware of the best and worst foods for your body. For example, eating smaller, nutritionally-balanced meals could ease digestion and help fight flare-ups. Additionally, chewing your food slowly and engaging your jaw can activate your oral microbiome and promote better oral health. And a key aspect of mindfulness is paying attention to your body’s short and long-term response to a food. If it stings, burns, produces cramping or diarrhea the next day, consider it a likely bad actor.

What you drink matters too! Water normalizes the pH of your mouth healthy human saliva has a pH of 7.4. When we consume acidic foods and beverages, such as fruit juice and soda, our oral pH is thrown out of balance (not to mention the additional sugar and calorie intake). When the pH within our mouths falls below 5.5, demineralization occurs, making us more susceptible to oral diseases, such as dental caries and periodontal disease. Drinking plenty of water daily can help maintain a healthy mouth pH, in addition to keeping you hydrated. When drinking tea, coffee, juice, alcohol, or kombucha, we recommend following with a glass of water for optimal oral health.

Exercise, exercise, exercise (but carefully)

Staying active is incredibly important to maintaining healthy living. It is even more important for those who suffer from AS and other autoimmune diseases because exercise can help reduce inflammation and alleviate symptoms. Exercise can take many forms, from higher-intensity training like running or playing sports to lower-intensity exercises like walking, yoga, Pilates or other movement therapies. Choose something you enjoy and can do consistently. Get our free ebook on movement therapy to explore more options!

Relax, sleep and reduce stress

Chronic stress is one of the negative by-products of modern life. While our stress responses helped our ancestors avoid predation and other life-or-death threats, constant stress is harmful to our bodies. Although these reflexes may be great in short bursts (because we still need to catch that bus!), our flight-or-fight responses can cause harm when constantly activated by non-life-threatening stress. Such harmful consequences include triggering or exacerbating flares. It is therefore important for those with AS to reduce overall stress.

One of the easiest ways to do this is to make sure you are getting enough sleep. Most people do not get the recommended 7-9 hours of sleep daily. Whether taking an afternoon nap, going to bed earlier, or (if scheduling permits) sleeping later, emphasis should be on consistent restful sleep. Regular sleep habits are helpful in reducing insomnia and encouraging deep, restful sleep. So is making sure you get early morning blue light and do not expose your eyes to blue light (e.g., screens), close to the time you sleep.

Relaxation throughout the day is also important. This could mean an early morning workout, an afternoon yoga class, or even taking 15 minutes in the middle of the day just to focus on your breathing. Figure out what works best for you and do it. Take the time to be the best version of yourself: your stress will go down, your body will feel better, and your productivity may even increase!

In summary

Ankylosing spondylitis affects each patient differently. Identifying and avoiding trigger foods, following an anti-inflammatory diet and good lifestyle habits may help mitigate symptoms. What worked for your friends, family, or spouse might not work for you. Remember, everyone is unique and experimenting with food therapy may not be an easy fix. So, don’t be overwhelmed by all of the recommendations and information out there, try a few changes, go gradually, and trust yourself. Finally, you are your greatest advocate and you know your body best. Fearlessly experiment with your dietary options and be mindful of your reactions. Our free food therapy e-book can help guide you through this process of experimentation.

Have you tried any autoimmune specific diets? What foods work/don’t work for your body? Let us know in the comments.

Written by: Bonnie Feldman, DDS, MBA, Anna Simon, Ellen M. Martin

Check out our other spotlights here


Reference

  1. Macfarlane, T et al. “Relationship between diet and ankylosing spondylitis: A systematic review” European Journal of Rheumatology. Vol 5(1). 2018. 45-52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895151/
  2. Sundstrom, B et al. “Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis” Scand J Rheumatol. Vol 35(5). 2006. 359-62. https://www.ncbi.nlm.nih.gov/pubmed/17062435
  3. Cai, G et al. “Vitamin D in ankylosing spondylitis: review and meta-analysis” Clin Chim Acta. 2015. 316-22. https://www.ncbi.nlm.nih.gov/pubmed/25199851  
  4. Ebringer, A & Wilson, C. “The Use of a Low Starch Diet in the Treatment of Patients Suffering from Ankylosing Spondylitis” Clinical Rheumatology. Vol 15(1). 1996. 62-66. https://link.springer.com/article/10.1007/BF03342649
  5. Schott, E et al. “Targeting the gut microbiome to treat the osteoarthritis of obesity” JCI Insight. Vol 3(8). 2018. https://doi.org/10.1172/jci.insight.95997
  6. Smith-Spangler, C et al. “Are organic foods safer or healthier than conventional alternatives?: a systematic review” Annals of Internal Medicine. Vol 157(5). 2012. 348-366. https://www.ncbi.nlm.nih.gov/pubmed/22944875

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