Exploring the Impact of Low Starch Diet on Ankylosing Spondylitis: Fact or Fiction?

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Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Ankylosing Spondylitis (AS) is a chronic inflammatory condition that primarily affects the spine and sacroiliac joints. Over time, it can lead to severe pain, stiffness, and even fusion of the vertebrae.

Although various treatment options exist, many patients explore alternative approaches to manage their symptoms.

One such approach is a low starch diet, which has gained popularity among some AS patients.

In this blog post, we will examine the evidence behind low starch diets for AS and discuss their potential efficacy.

The Rise of Diet Therapies

A book claimed that a man cured his Ankylosing Spondylitis by adopting a strict diet that eliminated all starch, lactose, and sugar. This meant excluding flour, corn, bread, pasta, fruits, vegetables, and beans from his diet. Although the idea of treating Ankylosing Spondylitis with diet therapy may sound appealing, it is crucial to consider whether there is any scientific evidence supporting this approach.

Diet therapies have gained popularity due to the limitations of conventional treatment options. However, when studied rigorously, they often do not show a significant impact on the condition. This is partly because it is challenging to study diets in a controlled manner, as participants are aware of their dietary choices.

The Role of Antibiotics and Bowel Flora

Some believe that changing bowel flora through diet might have a therapeutic effect on Ankylosing Spondylitis. This idea is linked to the use of antibiotic therapy for rheumatoid arthritis and ankylosing spondylitis.

Certain antibiotics, such as minocycline and tetracyclines, have a mild anti-inflammatory effect similar to that of nonsteroidal anti-inflammatory drugs (NSAIDs) like Motrin.

However, this anti-inflammatory effect is only mildly significant and not clinically important. When subjected to rigorous clinical trials involving large numbers of patients, antibiotics like minocycline show a statistically significant effect, but this is due to their mild anti-inflammatory properties rather than a specific impact on AS.

The London Ankylosing Spondylitis Diet: Low or No Starch

The London Ankylosing Spondylitis diet focuses on reducing starch intake to starve Klebsiella bacteria. Here are some of the safe foods and foods to avoid for those following the London AS diet:

Safe Foods:

  • Meat: chicken, beef, lamb, turkey, and pork
  • Eggs
  • Fish and seafood
  • Tofu (vegetarian option)
  • Non-starchy vegetables: spinach, cabbage, cucumber, onion, tomato, carrot, capsicum, celery, spring onion, broccoli, mushroom, and fresh and dried herbs

Foods to Avoid:

  • Starchy vegetables: potato, sweet potato, radish, beetroot, yams, taro, pumpkin, and arrowroot
  • Lentils and pulses: peas, split peas, beans, chickpeas, and dal
  • Nuts: peanuts, cashew nuts, chestnuts, and pecans (due to their starch content); walnuts, pine nuts, and blanched almonds are allowed
  • Fruits: green banana (high in starch)
  • Grains: wheat, bran, barley, rye, oats, rice, maize, and buckwheat

Dairy is considered a fringe food as it doesn’t contain starch, but casein and lactose may serve as secondary food sources for Klebsiella bacteria. Some Ankylosing Spondylitis patients may tolerate dairy, while others may not.

Many spices used in Indian cuisine are starchy and should be avoided. Raisins and dates are allowed among dried fruits, while tea, coffee, herbal tea, and non-pulpy fruit juices are permitted.

No One-Size-Fits-All Diet

There is no single best diet for everyone with Ankylosing Spondylitis. People have different needs, preferences, and reactions to various foods. What works for one person might not work for another.

Some common dietary approaches for Ankylosing Spondylitis include vegan, vegetarian, paleo, keto, and low-carb diets. However, universally, it’s essential to reduce sugar and processed carbs intake.

If you’re looking to make changes to your diet to reduce inflammation, we recommend starting small. Try eliminating processed foods and sugars, which are known to cause inflammation. Once you feel the benefits of this change, you can make further adjustments to your diet.

We also advise against giving up on a particular diet if it doesn’t work for you. Different diets work for different people, and it’s important to find what works for you sustainably. For example, if you’ve tried a low-starch or keto diet and found that it didn’t work for you, don’t give up on the idea of making changes to your diet altogether.

Importance of Protein

Consuming an adequate amount of protein is crucial for joint health in individuals with Ankylosing Spondylitis. It helps build muscle, protect joints, and strengthen bones.

Aim for about one gram of protein per pound of body weight or desired body weight. Protein sources can include meat, fish, eggs, dairy, and protein powder. Additionally, easily digestible protein sources like whey protein isolate can help meet daily protein requirements.

Dairy and Fat Considerations

Some people with AS may find that eliminating dairy from their diet improves their symptoms. However, others may be able to tolerate certain cultured dairy products, like cottage cheese and yogurt, which can be easier on the stomach. It’s essential to experiment and find what works best for you.

When it comes to fat intake, it’s crucial to find the right balance. Healthy fat sources include olive oil, olives, avocados, and nuts. However, be mindful not to over-consume fat, as this can lead to weight gain, which can negatively impact joint health.

The Verdict on Low Starch Diets for Ankylosing Spondylitis

When it comes to alternative treatments like low starch diets and antibiotics for AS, their popularity often outpaces the scientific evidence supporting their efficacy. When subjected to rigorous proof, these approaches often fail to demonstrate significant benefits for Ankylosing Spondylitis patients.

In conclusion, while a low starch diet may be a healthy choice for some individuals, there is no strong evidence to support its effectiveness in treating ankylosing spondylitis. Patients should consult with their healthcare provider before adopting any dietary changes or alternative treatments for Ankylosing Spondylitis to ensure they are following a safe and effective management plan.


  1. Eliminate processed foods and sugars: As mentioned earlier, these are known to cause inflammation. Instead, opt for whole, unprocessed foods and natural sweeteners like honey or maple syrup.
  2. Incorporate more protein: The speaker found that a protein-based diet was most effective for him. Try adding more lean meats, fish, eggs, and legumes to your diet.
  3. Eat more fruits and vegetables: These are rich in anti-inflammatory nutrients like vitamins, minerals, and antioxidants. Aim for at least five servings of fruits and vegetables per day.
  4. Experiment with intermittent fasting: The speaker found that intermittent fasting helped him feel better overall. Try limiting your eating window to eight hours per day, or fasting for 16 hours and eating during an eight-hour window.
  5. Listen to your body: The speaker found that he could tell when a food was causing inflammation by the way he felt the next day. Pay attention to how your body reacts to different foods, and make adjustments accordingly.

Remember, there’s no one-size-fits-all diet for reducing inflammation. It’s important to find what works for you and make sustainable changes over time. By starting small and listening to your body, you can make big improvements in your health and reduce inflammation naturally.

Making small changes to your diet can have a big impact on inflammation. By eliminating processed foods and sugars, incorporating more protein and fruits and vegetables, experimenting with intermittent fasting, and listening to your body, you can find a sustainable diet that works for you. Don’t give up if one diet doesn’t work for you, and remember that everyone’s journey is different. With a little patience and experimentation, you can reduce inflammation and feel your best.

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

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