Managing Ankylosing Spondylitis With Diet

By

Marijke Vroomen Durning, RN

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In the last few decades, scientists have recognized that everything in our bodies is connected. Whereas we used to think individual body systems functioned relatively independently, now we know that decisions we make impact every organ and tissue.

And we’re learning that what we eat affects how each of the different parts of our bodies function. The good news is this knowledge can help us better manage chronic conditions, like ankylosing spondylitis (AS).

AS is a type of chronic inflammatory arthritis affecting the joints in the spine. It might not seem like a spine disease would be impacted by the food we eat, but it’s important to note that AS is an inflammatory condition, meaning it’s caused by inflammation. And while there are many factors that produce inflammation, food is a major one. Plus, what you eat contributes to your weight and overall health—two aspects that can affect your AS. That’s why being mindful of your diet choices can help you manage this chronic disease.

A well-balanced diet relieves pain and fatigue.

Part of managing AS is staying generally healthy. Regardless of your health condition, everyone should eat a well-balanced diet—but what is that exactly? The term means eating healthy foods sensibly. According to ChooseMyPlate, a United States Department of Agriculture (USDA) initiative, half your plate should comprise fruits and vegetables, and the rest of the plate should be grain and proteins, with dairy alongside. Processed foods and foods high in fat, salt and sugar shouldn’t be a regular part of your diet.

Eating a balanced diet also means not overeating. According to the U.S. Department of Human and Health Services (HHS), the average American diet exceeds the number of required calories, mostly from added sugars, refined grains, sodium (salt), and saturated fat. This is a contributing factor to weight gain and carrying extra weight on your body puts stress on your joints and your back, which is an even bigger concern for people with AS. Excess weight may mean excess pain for AS patients. Additionally, being overweight can increase feelings of fatigue, already a key symptom of AS. To relieve pain and keep your energy up, you’ve got to eat nutrient-rich foods that keep you slim and awake all day.

Get to your ideal weight by choosing healthy foods and eating in moderation. To determine healthy portions, just use your hand as a measuring tool:

  • Your clenched fist is about the size of 1 cup. Use your fist to measure out a healthy serving size of vegetables (1 cup) or dry cereal, cooked pasta, or rice (1/2 cup).

  • The tip of your thumb is roughly 1 teaspoon. Stick to one teaspoon of high-fat foods like peanut butter and mayonnaise.

  • Your palm is about the size of 3 oz of meat. Try to eat two servings (6 oz) of lean meats like poultry, fish, and beef every day.

If you’re overweight and would like to lose weight, speak with your healthcare provider to review what methods would be best for you.

Decrease inflammation to decrease AS pain.

Managing AS means choosing to eat foods that don’t increase inflammation. To take control of your AS, avoid known inflammatory foods like:

  • Alcohol

  • Aspartame, an artificial sweetener found in many “sugar-free” products.

  • Mono-sodium glutamate (MSG), which adds flavor and is most commonly found in soy sauce and in Asian cuisine; however, it can also show up in processed foods, like deli meats.

  • Saturated fats, found in foods such as pizza, cheese, red meat, and full-fat dairy products.

  • Sugar, which may be listed on labels as fructose and sucrose.

  • Trans-fats (partially hydrogenated oils), found particularly in fast food, fried food, processed food, margarine, shortening, and lard.

  • Refined white flour and white rice, found in white breads and cereals.

However, there are foods that may lower or fight inflammation, and if added to your diet, they can help stabilize your disease and reduce symptoms. They include:

  • Fatty fish like salmon, mackerel, tuna and sardines.

  • Fruits, including strawberries, blueberries, cherries, tomatoes, and oranges.

  • Green leafy vegetables, such as spinach and kale.

  • Nuts like almonds and walnuts.

  • Olive oil, particularly extra virgin olive oil.

Using certain spices may also help reduce inflammation, so you might want to include them in your cooking along with anti-inflammatory foods. These include:

  • Turmeric, a yellow spice commonly used in South Asian cuisine, clinically proven to reduce inflammation.

  • Ginger, made up of chemicals called gingerol and shogaol that block inflammation from occurring.

  • Cinnamon, which contains antioxidants to help repair cells damaged by inflammation.

  • Cayenne, a spice containing capsaicinoids, compounds that reduce inflammation.

  • Garlic, which adds lots of flavor and fights inflammation.

It can sometimes be difficult to get all the nutrients you need, so supplement pills or capsules can be a beneficial addition to your diet. Always consult your doctor before adding supplements to your daily routine. To fight inflammation, try taking:

  • Fish oil, which contains omega-3 fatty acids known to decrease inflammation.

  • Curcumin, a component of the spice turmeric, which has been proven in clinical studies to lower inflammation; take it with some black pepper to enhance its effects.

  • Vitamin D, which has been proven to decrease symptoms in people with AS.

Making changes in your diet to eliminate or reduce foods that increase inflammation and adding foods that combat it may help make a difference in how you feel.

Finding Which Foods Hurt and Which Help

Learning which foods help us and which may hurt us can take some detective work. Ask your doctor about an elimination diet. You begin by completely removing inflammatory foods from your diet for about two weeks to see if there is any difference in how you feel. Once your body has been free of inflammatory foods for that period, reintroduce the foods slowly, one at a time, taking stock of how your body responds. Keep a food diary daily to track your intake and symptoms. With some foods, you may notice an increase in symptoms or discomfort right away while with others, it may take a week or two. If the food does cause pain or discomfort again, you can eliminate it from your diet completely.

There is no specific diet known to help people with AS, but a doctor in the United Kingdom developed the London AS/Low-Starch Diet that may help. The doctor found that some people with AS have a bacteria (Klebsiella) in their stomach, which feeds on starch. By following a low-starch diet, the bacteria cannot survive and this may lessen AS symptoms. The diet calls for completely eliminating bread and bread products, rice and potatoes, and encouraging consumption of meat, fish, dairy, eggs, vegetables and fruits. As with all diets, consult with your physician before embarking on something new.

Food May Help Reduce the Risk of Osteoporosis

People who have ankylosing spondylitis have a higher risk of developing osteoporosis, or thinning of your bones. This makes it even more important for you to eat a healthy diet that promotes bone health, increasing your consumption of calcium and vitamin D. Foods containing high levels of these two nutrients include:

  • Dairy products

  • Green vegetables like kale and broccoli

  • Fortified fruit juices

You can also get vitamin D from sunlight as it is absorbed in your skin.

While following a special diet can be intimidating, making healthier food choices can greatly help relieve pain caused by AS and reduce your risk of osteoporosis down the road. To get started, think of your new diet as a journey of discovery. Be creative, try new foods, buy a new cookbook, or even take cooking lessons. Once you’ve gotten in the pattern of making healthy diet decisions to manage your AS, the benefits will outweigh the challenges.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Feb 23, 2017

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Medical References

  1. Questions and Answers about Ankylosing Spondylitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Part of the National Institutes of Health. https://www.niams.nih.gov/Health_Info/Ankylosing_Spondylitis/#b
  2. Ankylosing Spondylitis. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/
  3. 8 Food Ingredients That Can Cause Inflammation. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/arthritis-diet/foods-to-avoid-limit/food-ingredients-and-inflammation.php
  4. Foods that fight inflammation. Harvard Health Publications. http://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
  5. Correct Portion Sizes: How to Keep Portion Distortion in Check. Dairy Council of California. http://www.healthyeating.org/Healthy-Eating/Healthy-Living/Weight-Management/Article-Viewer/Article/348/Correct-Portion-Sizes-How-to-Keep-Portion-Distortion-in-Check.aspx
  6. USDA. ChooseMyPlate. https://www.choosemyplate.gov/
  7. President's Council on Fitness, Sports & Nutrition. HHS.gov. https://www.fitness.gov/resource-center/facts-and-statistics/
  8. Best Spices for Arthritis. Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/arthritis-diet/best-foods-for-arthritis/best-spices-f...
  9. The London AS/Low-Starch Diet. Spondylitis Association of America. http://www.spondylitis.org/Diet-Nutrition/London-AS-Low-Starch-Diet

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