How A Low Starch Diet Could Ease Ankylosing Spondylitis Symptoms

Like so many scientific discoveries, this one came about quite by accident. Dr Alan Ebringer, a rheumatologist based here in the UK, put one of his patients on a high-protein, low-starch diet for weight loss reasons. Little did he know that that one small step would end up being a giant leap forward in treating a rare autoimmune disease called ankylosing spondylitis (AS) (Ebringer A, Wilson C. Clin Rheumatol 1996; 15 (suppl 1): 62).

AS is a chronic inflammatory disorder and type of arthritis, which mainly affects the lower lumbar spine and sacroiliac joints, which are located either side of your spine. One in 2,000 people in the UK suffer from the condition, which is far more common, and often more severe, in men than it is in women. Common symptoms include chronic inflammation, pain, and stiffness especially in the lower back. In advanced stages of AS, fusion of the spine occurs, which can lead to considerable disability.

As is often the case with auto-immune disorders, the underlying cause of this disease puzzled researchers for years. But as it turns out, the same person who found a way to treat the disease is also the one who discovered the root cause.

Before I go into that, though, I need to give you a little background. The disease mainly occurs in individuals who have the tissue marker known as HLA-B27. These tissue markers determine immune system responses and organ transplant compatibilities. Although most people who have this tissue marker do not get AS, around 80 to 90 per cent of people with AS have this tissue marker. This indicates that there are environmental factors involved in triggering this debilitating disease.

How one doctors ground-breaking research totally transformed our understanding of the disease

Thats where Dr Ebringers discovery comes in. He found unusually high levels of a gut pathogen known as Klebsiella pneumoniae in the stool samples of patients with active forms of the disease (Erbinger A, Wilson C. J Med Microbiol 2000; 49: 305-311). Then he found high levels of antibodies in the blood of AS patients that were reactive to Klebsiella. Dr Ebringer found that some of the Klebsiella antibodies were shown to cross-react with HLA-B27.

In other words, in trying to fight the Klebsiella, the immune system was also causing friendly fire damage by producing an attack that cross-reacted with this tissue marker. And since HLA-B27 is particularly found in the tissue of the lower back, that helps to explain why so much of the immune attack (and therefore the damage) is directed there.

This process in which a microorganism resembles a host so much that the immune system attack on this invader also attacks the body is known as molecular mimicry. This is well accepted as a potential cause of autoimmune disease its just that in most cases, the organism that triggers the immune malfunction is hotly debated.

In the case of AS, though, Dr Ebringer and other scientists have found a link with Klebsiella antibodies in separate studies carried out in 16 different countries. Other researchers in Scandinavia and Germany have also linked Klebsiella to the disease.

Dr Ebringers all-natural AS treatment protocol can eliminate the need for conventional drugs

So this leaves two big questions. How do you get rid of Klebsiella? And does it actually help AS patients if this microbe is eliminated from the body? That brings us back to the high-protein, low-carb diet. Bacterial studies were carried out on 47 people on a high-carb/ low-protein diet and compared to another 45 people on a low-carb/ high-protein diet. Those on the low-carb diet were found to have around 50 times less Klebsiella organisms in their colon (Finegold SM, Sutter VL, Sugihara PT et al. Am J Clin Nutr 1977; 30(11): 1781-1792). Ebringer argued that resistant starch in the diet (starch that cannot be digested by our own enzymes) was feeding the growth of Klebsiella because it could be broken down by bacterial fermentation. This led him to develop the following low-starch diet plan for his AS patients:

1. Increase meat and fish, beans and peas, nuts, vegetables, fruits, milk and milk products.
2. Reduce bread, potatoes, crisps, rice, pasta, cereals, cakes and biscuits.

In an initial study, 36 patients with active AS were put on Ebringers diet. After nine months, measures of inflammation were significantly reduced and most of the patients reported a reduction in their symptoms. In a few cases, symptoms disappeared altogether. Since 1983, Dr Ebringer has used this diet at his clinic with great success. In fact, around half of the AS sufferers who try it dont require any medication to control their disease.

Although these are great results, the process of using diet to eliminate Klebsiella can be greatly helped along by taking a few specific herbs each day that have been found to be active against this microbe and also encourage healthy bowel flora. They include freshly crushed, uncooked garlic or allicin-releasing tablets (1 to 2 cloves or equivalent), Golden seal (2g to 3g), and essential oil of oregano (150mg).

Taking daily doses of the following anti-inflammatory herbs can also help to control symptoms while the low-starch diet and anti-microbial herbs do their work: Boswellia (1,200mg of extract standardized to 60 to 70 per cent boswellic acids), willow bark (doses containing at least 150mg of salicin), ginger (1g to 2g), turmeric (6g to 8g), and celery seed (3g to 5g).