Ankylosing Spondylitis and Rheumatic Fever: The Story of Molecular Mimicry

Many people who suffer from ankylosing spondylitis have a hard time believing that their massively painful and debilitating disease is likely caused by the tiny bacterium Klebsiella.  I’ll admit that I had a hard time believing it myself when I first stumbled across the kickas.org website soon after my AS diagnosis in 2006.  But I was in tremendous pain at that time and so I was willing to suspend my disbelief and at least try the London No Starch diet advocated by Dr. Alan Ebringer and described in detail on the kickas.org website.  I figured that I could test the diet myself and do more research simultaneously.

Turns out it was a very good plan because my symptoms ceased almost immediately.  No more pain. I was intrigued.

I’ve written here about the role that klebsiella plays in causing ankylosing spondylitis, but a brief recap would go something like this:

• You eat starch
• Starch enters your large intestine as sugar
• Sugar feeds a common gut bacteria called klebsiella
• Klebsiella multiplies exponentially
• Your immune system responds by attacking the Klebs
• Your immune system inadvertently attacks your own body’s cells as well
• That’s a flare, and it hurts

The key to all of this is understanding that folks who are HLA-B27 positive share a cell surface marker, or antigen, with the bacteria klebsiella.  That simply means that from the surface, certain of our cells “look” like a klebsiella in so far as they have similar markings, or surface proteins.  This is a problem for us because when our immune system detects an invader it uses such surface proteins as a way to identify a foreign body, and then it specifically manufactures a weapon (antibody) to fit the attacker.  So you can see how making a weapon to “fit” the attacker Klebsiella would also inadvertently target our own cells because both us and the Klebs share the HLA-B27 gene (or at least the surface protein the HLA-B27 codes for).

But I’ve Never Heard Of This…And My Doctor Never Told Me Either

Well, I can’t speak to why your doctor (and my doctor too) never mentioned this possible link between Klebs and AS.  To my mind if there’s even a chance that a freaking simple diet could effectively treat a patient with AS then every effing Rheumatologist in the world should be suggesting diet as a first treatment BEFORE starting patients on potentially harmful immune suppressant drugs and/or NSAIDs.  But that’s just my opinion, and who the hell am I to question a DOCTOR.

But this bacterial cause of an auto immune disease really isn’t that much of a stretch of the medical imagination.  Consider the disease rheumatic fever.  According to the Mayo Clinic website on rheumatic fever:

Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat. Strep throat is caused by infection with group A Streptococcus bacteria……

The exact link between strep infection and rheumatic fever isn’t clear, but it appears that the bacterium “plays tricks” on the immune system. The strep bacterium contains a protein similar to one found in certain tissues of the body. Therefore, immune system cells that would normally target the bacterium may treat the body’s own tissues as if they were infectious agents — particularly tissues of the heart, joints, skin and central nervous system. This immune system reaction results in inflammation.

Does this sound at all familiar?  I know.

So do you still think this idea of a bacterial cause for ankylosing spondylitis is crazy?  Are you at least intrigued enough to read a few papers and maybe, just maybe try something different from the drug cocktail you’re currently on?  Are you as pissed at your Rheumatologist as I was?  I know that I was pretty upset and I’m glad I tried the No Starch Diet instead of continuing on with my meds.  Sorry drug companies, you can keep your pills.

The truth is that it’s easier now in 2011 to follow a no starch diet because of the popularity of the Paleo and Primal movements.  AS sufferers can easily hijack these diets for their own evil purposes.  There are literally thousands of blogs, books, and cookbooks just brimming with testimonials, instructions, and recipes for THE EXACT DIET you need to treat your ankylosing spondylitis.  Just be sure to adjust any recipes with starchy tubers to conform to our no starch policy, ie don’t eat them, substitute some other ingredient like carrot or broccoli.   Here are a few Paleo and Primal resources to get you started:

• Dr. Loren Cordain is the godfather of the paleo movement.  Visit  The Paleo Diet website.
• Robb Wolf has a great website and a very good Paleo book called The Paleo Solution.
• Mark Sisson is the founder/creator/God of the Primal movement. Check out his blog here, and his amazing book, The Primal Blueprint is worth a read.