London AS Diet per Dr. Alan Ebringer

The information below is taken directly from the kickAS.org website.  You can go directly to that website by clicking the logo below.

kickAS.org website

The London AS Diet

Ankylosing Spondylitis Research Clinic (Professor Alan Ebringer), Department of Rheumatology, The Middlesex Hospital UCH School of Medicine and Infection & Immunity Group, Division of Life Sciences, Kings College, London, UK

THE LONDON “AS” DIET

Low starch/high protein diet for ankylosing spondylitis patients.

It is thought that in some cases a diet low in starches found in flour products and potatoes, and high in proteins and vegetables is of benefit for AS patients.

Ankylosing spondylitis is considered to be a form of “reactive arthritis” following an infection of the terminal ileum and ascending colon by the bowel microbe Klebsiella. Specific anti- Klebsiella antibodies in AS patients have now been reported from 17 different countries: England, Finland, Germany, Sweden, Netherlands, Scotland, Spain, Belgium, Slovakia, Japan, China, Australia, Canada, USA, Mexico, Argentina, and Turkey.

Over 95% of AS patients possess the HLA-B27 antigen whilst it is present only in 8% of the general population. The Klebsiella microbe has molecules which resemble HLA-B27 and this is the reason why AS patients generally belong to the HLA-B27 group.

In addition, the pullulanase molecule of the Klebsiella microbe crossreacts with type I collagen found in tendons and bone and also with type IV collagen found in basement membranes of retina and uvea, thereby explaining the pathological sites of AS.

When one eats large amounts of starchy foods (bread, potatoes, cakes and pasta), the Klebsiella bacteria feed on it, multiply and then the immune system of the patient makes antibodies against the microbe and some of those antibodies will also have activity against HLA-B27 and against collagens in the spine and uvea, thereby acting as tissue damaging autoantibodies – hence the need to ABSTAIN from these foods.

Since the mesentery of the bowel is attached to the front of the lumbar spine, it is inevitable that BACKACHE in the lumbar area will be a feature of AS.

One simple way of reducing this inflammation is to reduce the daily intake of STARCHY FOODS. However, consult your doctor before going on the diet.

The higher the intake of starchy foods, the higher the inflammatory activity.

You can eat SMALL amounts of starchy foods but it the AS is very active, it is best to eat a lot more protein and vegetables.

However, if the AS is inactive, the diet can be less rigidly followed.

Essentially, it means REDUCE BREAD, POTATOES, CAKES and PASTA and INCREASE the intake of MEAT, FISH, FRUITS and VEGETABLES.

References:

1. Ebringer and Wilson C. The use of a low starch diet in the treatment of patients suffering from ankylosing spondylitis. Clinical Rheumatology 1996; 15 Suppl. 1, 61-65.

2. Ebringer A. Ankylosing spondylitis is caused by Klebsiella. Rheumatic Disease Clinics of North America, 1992 1/105-121

REDUCE THE FOLLOWING

  1. Bread and flour products:
    Bread (white, brown, wholemeal, etc.) in very limited amounts.
    Crispbreads, biscuits, cream crakers, twiglets.
    Cakes, puddings and pies.
    Pastas, spaghetti, noodles, macaronis, pizzas, chappati, pitta bread, popcorn.
  2. Rice
    Brown, white, boiled, fried or in puddings.
  3. Potatoes

Chips, baked, boiled, roasted or mashed potatoes, and potato crisps to be avoided.

INCREASE THE FOLLOWING: EAT PLENTY OF PROTEINS, VEGEATABLES, AND FRUITS:

  1. Meat
    Beef, pork, lamb, sausages, bacon, salami, pate, corned beef, potted meats, ham and veal. Venison. Chicken, turkey, duck or any other poultry meats.
  2. Fish
    White fish: Cod, haddock, plaice, dover sole.
    Herring, salmon, mackerel, tuna, sardines fresh or tinned in oil, brine, or tomato.
    Shellfish: Crab, lobster, prawns, scampi, cockles mussels, oysters.
  3. Milk and Milk Products
  4. Eggs
    Prepared in any manner.
  5. Vegetables
    All green vegetables, cabbage, cauliflower, sprouts, courgettes, peppers, mushrooms, spinach, broccoli or carrots.
  6. Fruits

All kinds of fruits.

NORMAL INTAKE ONLY: FATS AND SUGARS.

NO RESTRICTIONS ON BEVERAGES OR SPICES (Pepper, salt or herbs)

Medical Disclaimer
The information provided on the SickOpportunity website is not to be construed as medical advice.. In pregnancy, a low carbohydrate diet is potentially harmful to fetal development. Only your personal doctor can make the best suggestions about your health and treatment.  Everyone needs a diet that meets their nutritional needs, if in doubt consult a qualified dietician. SickOpportunity and its members are not legally liable for the content, information or opinions expressed therein.

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  • http://twitter.com/Boudicca3 Boudicca

    I have been following a low starch diet for three years. Since doing so I have been in (almost) complete remission from AS – after twenty years of constant pain, cutting out starch foods has stopped the spinal fusion, chronic constrocondritus, sciatica, constant stomach and colon pain; I can now eat the odd piece of toast or cake without harm; if I was to do so constantly, however, I would experience a flare, i.e. night sweats, pain, fusion and be back at square one. I would urge all AS sufferers to give the diet a go – and then buy Carol Sinclairs low-starch diet book as an aid. I am a semi-vegetarian (I now eat occasionally fish) and manage to do the diet quite  easily though it did take me some time since I used to live off pasta, rice and pulses. Good Luck

    • http://www.sickopportunity.com Bob Connors

      Glad to hear that you’re having success on the low starch diet.  God knows it’s great to have relief from our AS symptoms.

      My own experience with the low starch diet was not as successful.  Didn’t work at all, in fact.  It wasn’t until I went to an entirely no-starch diet that I found almost immediate success. 

      I’m surprised to hear that you’re “semi-vegetarian” as this diet relies heavily on animal products.  What is a typical couple days worth of meals for you?

      Continued luck,
      Bob

      • ballboygirl

        Hi Bob – Sorry the diet didn’t work for you. I was no-starch for the first year then low starch – now I can eat starch foods (toast & cake) now and again as long as I am then strict. A typical days meal for me is b/fast: protein shake made with soy isolate/seeds/nuts/lecithin/honey in a blender or eggs (mushroom omelettes, fried etc) quorn products: veggie sausages/bacon but in small amounts i.e occasionally and for a treat smoked salmon/scrambled eggs… I make porridge with ground almonds in the winter or have yoghurt, seeds and fruit in the summer. Oh and I eat tofu – scrambled or as a frattata in the oven when I’m sick of eggs – and /or loads of fruit – pineapple as it’s an anti-inflammatory. Lunch I usually go for salads or soups – with cheese or tofu or tuna – I also make spinach ‘bread’ – (best made with frozen spinach and egg white powder)… mix 250g spinach in bowl with 2 egg whites – place on baking tray & flatten out, in oven for 20 mins or so… voila.. Once cool I spread cream cheese or egg mayo on it and eat as sandwiches to take to work… A simple soup is leeks cooked in skimmed milk with veggie stock/spices etc then through a blenda – think, comfortable and filling! Dinners.. well, I eat quorn/veggie burgers and veg or fish or I make my own no-starch lasagne using leek sheets instead of pasta – it’s fabulous! (pasta-eating folk can’t tell the difference); I also eat a lot of stir fries. I make pastry cases out of ground almonds + water or with butter and make pies e.g beetroot and goats cheese is my favourite, or quiches. I also make no-pastry quiches in the oven – just follow the same recipe but put onions or grated cheddar on bottom of pastry dish before adding the eggs/veg and cook as you will. Placing tofu in a blender with veg juices/water and olive oil with herbs and spices and then blizzing makes a wonderful sauce to go with vegetables – just like a white sauce made with flour so I do that too. For desert I go for yoghurt and honey or creme brulee (non-starch) or no starch chocolate brownies made with apple sauce instead of flour. I get recipes from all over the place but tend to check out low-carb/atkins vegetarian books and take from these. I do eat honey and sugar but also stevia… and I eat chocolate and wine (not every day tho!) I carry those small individually wrapped cheeses to work for snacking and apples/grapes as well as avocados. At Xmas I make a luxurious cake from the low-starch book, replacing flour with ground almonds. I’m so used to the way I eat I don’t think other people actually notice that I don’t eat starch foods. And whilst I do eat fish, I usually follow a low starch vegetarian diet and often a vegan one too. It’s not a problem for me now – I guess I just had to use my imagination. I’ve never eaten meat though. Good luck Bob. Hope some of these suggestions help you out!.

        • http://www.sickopportunity.com Bob Connors

          The NSD does work very well for me. The low-starch diet does not. The diet you describe which works for you sounds like no-starch as well. “Cheat days” as you describe are sometimes ok for some of us but my own experience is that I must adhere strictly to no-starch diet thereafter.

        • mehwish

          Hi thanks for this information. My husband is also AS patient and i always inquire to convert normal recipes into completely starch free as just a pinch of starch cause reaction to his body. All your discussion was very helpful for me and I also want to know more about such recipes to make bread or pastry/desserts etc Would you like to recommend me any book or any company specially dealing with foods for AS patients. It would be a great help for me. My email is mehwish.kamran.cfa@gmail.com.

        • Roberta McDonnell

          Great ideas here, thanks so much! I have found, though, that soya milk flares my IBS as do any pulses or seeds, which in turn flares my joints, so I’m limited. I also have to limit eggs but find white fish very well tolerated. I also find ordinary mayo good and it adds a bit of flavour and creaminess as I can’t tolerate dairy (but can have feta cheese – made with goat’s milk so less casein and lactose). Can I also add a little recipe I have been doing for years since i followed Leslie Kenton’s biogenic diet years ago? Cauliflower is very versatile – as is broccoli. I have them with boiled eggs (long stem broccoli lovely as a dipping soldier); crushed cauliflower as a bed for bolognese (though tomatoes a bit dodgy for me); cauliflower mashed with mayo along with fried eggs, replaces the fried soda bread for your full Irish (or English) breakfast; broccoli as a bed for pork, beef or chicken stir fry or curry – and I also found a recipe for cauliflower pizza dough on pinterest (its in my board Nice Food). Thanks again and happy recipe-making :)

  • http://www.facebook.com/jane.e.fearon Jane Emir Fearon

    can i eat butternut squash on this diet

    • http://www.sickopportunity.com Bob Connors

      Maybe. You’ll have to test it with iodine to be sure. It’s likely pretty starchy.

  • http://www.facebook.com/profile.php?id=100001247223633 Hassan Tahir

    what about dairy products can i take milk and yogurt ?

    • http://www.sickopportunity.com Bob Connors

      Some can, some can’t. Give it a try and pay attention to your pain levels. Good luck.

  • LyndaSue

    I am already on a low starchy carb diet for Cushing’s Syndrome and am sensitive to nightshade (potato, tomato, eggplant and peppers), so I already avoid those foods. I also follow a vegetarian diet because of problems with digesting fats, in particular, animal fats. I’ve had some of my worst flare ups while on this diet, so I guess I fall in a different category. Any other ideas?

    • http://www.sickopportunity.com Bob Connors

      Hi LyndaSue,

      I’d recommend heading over to Sara Ballantyne’s website and reading up on her incredible Autoimmune Protocol. Here’s the link: http://www.thepaleomom.com/autoimmunity/the-autoimmune-protocol

      • Roberta McDonnell

        Hi, thanks for all this information. Sarah Ballantyne’s book is excellent, I have found it extremely useful, following low starch with some improvement in symptoms but I fell off the wagon recently resulting in major flare up. I am reading up again and finding great motivation here – thank you :)

        • http://www.sickopportunity.com Bob Connors

          Glad you like her book. She does an excellent job of explaining the science behind various food sensitivities. Sounds like her protocol may be a good fit for you. Congrats!