Written by: Bonnie Feldman, DDS, MBA, Anna Simon, Ellen M. Martin
As our knowledge of nutrition and of food-as-medicine expands, using food as health enhancers and therapy agents has become increasingly popular. Many patients are following dietary guidelines to help mitigate symptoms, based upon a growing understanding that diet and nutrition can either exacerbate or reduce symptom severity. But with this popularity has come the usual wave of wacky fad diets and dubious advice. Let us help 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.
The Best Foods For AS
Certain foods and food components may help manage AS symptoms. The Internet offers an overwhelming amount 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 spondylitis affects people differently and symptoms vary among patients.
This table could offer a good starting point for any AS patient. Combining our own autoimmune knowledge with specific scientific research (1), we’ve crafted our food recommendations for spondylitis patients.
In general, following a generic autoimmune diet, which broadly focuses on eliminating processed foods, dairy, and added sugar, while increasing consumption of vegetables, fruits, fish and other whole foods may help those with AS.
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 AS symptoms.
- Omega-3 fatty acids may decrease the disease activity of AS (2). Foods high in Omega-3 fatty acids include fatty fish, fish oil, chia and flax seeds, and walnuts.
- Since AS primarily affects the bones, calcium and Vitamin D are important in maintaining healthy and strong bones. 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.
Drinking plenty of fluids is always important for keeping your body functioning as best as it can. If you experience gastrointestinal issues, we suggest eating smaller meals and only eating 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 foods that mitigate symptoms.
The Worst Foods for AS
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 can 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 AS patients.
- Alcohol negatively affects bone health and may interact with AS medications, so alcohol, especially heavy use, 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 products may contain more synthetic chemicals (6), which may have greater effects on those with autoimmune diseases or related conditions.
Other Tools for Managing AS
Engage in Mindful Eating
Other aspects of eating are important in combination to being aware of the best and worst foods for your body. Eating smaller, nutritionally-balanced meals could help ease digestion and help fight flare-ups. Chewing your food slowly and engaging your jaw can help activate your oral microbiome and promote better oral health. A key aspect of mindfulness is paying attention to your body’s short and long-term response to a food– if it stings or produces cramping, or diarrhea the next day, consider it a likely bad actor in your diet.
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
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 and Reduce Your Stress
Constant stress is one of the negative by-products of modern life. While our stress responses were beneficial in helping our ancestors avoid predation and other life-threatening situations, constant – but not life-and-death – stressors brought about by modern society can be extremely harmful to our bodies. While helpful in short bursts (we still may need to catch that bus!), our flight-or-fight responses, part of our sympathetic nervous system, can have harmful consequences when constantly activated by non-life-threatening stress. These consequences include triggering or exacerbating flare-ups. 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!
Ankylosing spondylitis is a condition that can affect each patient differently. Following some sort of anti-inflammatory diet and lifestyle habits may help mitigate your symptoms. What worked for your friends, family, or spouse might not work for you. Everyone is unique and experimenting with food therapy may not be an easy fix. Try not to be overwhelmed by all of the recommendations and information out there, try a few changes, go gradually, and trust yourself. At the end of the day, 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.
Check out our other spotlights here
- 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/
- 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
- 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
- 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
- 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
- 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