London AS Diet per Dr. Alan Ebringer

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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


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.



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


  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.


  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.



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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  • 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

    • 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,

      • 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!.

        • 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

        • 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 🙂

  • can i eat butternut squash on this diet

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

  • what about dairy products can i take milk and yogurt ?

    • 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?

    • Hi LyndaSue,

      I’d recommend heading over to Sara Ballantyne’s website and reading up on her incredible Autoimmune Protocol. Here’s the link:

      • 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 🙂

        • 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!

  • Iurii Osadchuk

    Hi to everyone. I am new to NSD, just wanted to ask you what If my NSAIDs contain some starch. Can I continue taking them or should I stop immediately?(without them I have fever ever night)

    • Keep taking your medication and try to find some sort of alternative medication, possibly in liquid form, which does not contain starch. I don’t think people should ever stop taking meds unless under their doctor’s supervision. You may be able to cut down on the meds over time if you have good results on the diet (this is what I did. the diet reduced my symptoms and so I started skipping my meds as I made more progress on the diet).

    • Tansysmom

      NSAIDs are a bad idea if taken for very long. They will eventually cause kidney and/or liver damage.

  • Weird Ones

    I find this information about antibodies fascinating, and appreciate you posting this article. Do you have any knowledge of auto-inflammatory diseases such as CRMO and SAPHO Syndrome? They are related in many ways to AS. Similar to the ingestion of starch in AS, I have additional reactions to the ingestion of fruits, tomatoes, and dairy. I know tomatoes are nightshades, and a lot of people have bad reactions to dairy, but my reaction to fruits is similar to what I experience with tomatoes, so I think it stems from a different cause than the nightshade issue, perhaps.

    in any case, foods like fruits and tomatoes, including vinegar, wine and salad dressings, cause my tissues (skin, mucosa, eyes) to become painfully dry, nearly dehydrated, within minutes of ingesting them. Do you have any thoughts of this unique manifestation, or know of any researchers studying such things?

    • Thanks for the comment/question. I don’t have any experience with CRMO or SAPHO. I’d recommend checking out Sarah Ballantyne’s blog She’s a scientist and has extensive knowledge of all things autoimmune. Good luck!

  • Helen

    Hi there, I just discovered these discussions so not sure if it is still active but I was trying to find someone who could help!! I started my no starch diet 3 weeks ago and still wake with chronic pain every morning in my lower back and read that for most people the level of pain reduces pretty much instantly! I have AS and IBS. I am living on bacon and eggs salad meat fish cooked vegetables (swede cabbage broc carrots) no potatoes rice bread etc and drinking tea with sugar and eating dairy milk chocolate – that is pretty much all! Why isn’t this working for me??? I don’t take any medication as wanted to try this whilst on a meds break after having a baby this year. I guess maybe it’s a low starch rather than no starch ? To stick to this diet I am eating the foods I like rather than eating things I dislike which is likely to end up not being able to stick with it. Any advice please would be welcome thanks 🙂

    • Caute

      My advice. Buy a bottle of iodine and test all food. Most vegetables are starch – why, for instance, are you even touching carrots which are high starch? You need to be very strict at first – that means no starch vegetables at all. Also note that many fruit, unless picked ripe is starch loaded. Buy Carole Sinclairs excellent book ‘the IBS low starch diet’ and read it carefully. If you have been in constant pain for years you need to give the diet a few months but reading your comment, if you’ve been eating starch vegetables, you haven’t been following the diet. You need to eat low starch vegetables and be very strict at first. Also are you exercising every morning? This is important as well. Also ensure you are drinking lactose free milk and that you check every single convenience food e.g. Most sauces are high in starch as are deserts. Once the pain goes and you’ve followed the diet religiously, in future you will be able to eat starch foods now and again without having a flare but only you will learn how much and when this is.

      • Helen

        Thanks for that, I have ordered her book but thought veg other than potatoes were okay – I mainly lived on white bread and pasta and potatoes and biscuits (!!) previously so a huge change for me already – I also have cut out all sauces except for mint and have had butter instead of gravy on my veg. I am even buying plain yoghurt and adding honey and thought I had covered everything, so I just didn’t realise that veg had so much starch!! That must be where I’ve gone wrong :/ I will read her book and check out all the veg and maybe just live on salad !!! Thank you for your help

        • Caute

          I wish you luck Helen. I was very strict for about 3 years; then I found I could eat starch now and then but too much would create a flare (hot sweats followed by pain and return of all the old symptoms) but when I cut out completely again I now find I can eat starch foods now and again – so Xmas I go all out with roast potatoes and eat pasta once a month – that sort of thing (everyone is different) – If you think of it in terms of the Klebsiella microbe – that lives in the gut and feeds on starch which then seeps through to the spine – I think it’s easier to understand. Once starved it cannot ‘reproduce’ so if it’s get some starch once it has been starved of it completely it will flare up only slightly but too much and it increases and gets back into the habit. The Sinclair book is excellent because it shows how food producing actually produces starch in fruit and veg when there should not be able – e.g. Bananas picked ripe contain no starch as this has turned to sugar but picked green and then ripened in a warehouse means they are very starchy and remain as such. If you want to eat safe vegetables I would stick to spinach, broccoli and asparagus and to grapes and pineapple for fruit (pineapple contains brome in which is an anti-inflammatory)

          [NB. If you want some safe “bread” – buy frozen spinach, defrost it and then mix with egg white (reconstituted egg white is fine) adding garlic clove salt and pepper. Cover an oven tray with parchment paper and cover the with mixture , prodding with a fork to flatten it out; bake in slow oven until the edges are brown (about 20 minutes) – then allow to cool. You can use this to put spreads and even make sandwiches and put under the grill. … Asides from Sinclair’s book, do look at low carb recipes on the net – oh and putting soft tofu in a blender with some water, oil and mustard powder/garlic and tomato purée and then zapping creates a beautiful smooth protein pasta sauce – make a lasagne replacing the pasta with leeks – boil leeks then when soft spread out flat and allow to dry – use just like lasagne – your guests won’t even be able to tell it’s not real pasta! Honestly… You’ll get used to the change – it’s not so hard… ]

          • Helen

            Thank you very much for the info and encouragement – looks like I will need to learn to cook 😉 otherwise I will soon get sick of salad and meat every day! Thank you I will try these ideas – a sandwich would be so good!!

          • Tansysmom

            I found Sinclair’s book to be extremely strict and very limited as to what one can eat. Also, since it’s basically a Ketogenic diet, how does one avoid losing too much weight?

      • Barnett J. Weiss Bud

        Actually, raw carrots strips in a little organic white vinegar and a little coconut oil with kosher or sea salt helps to kill off some of the bad bacteria and Floraphage can be helpful with this as well. Carrots carry their own earthborne antibiotics which attack the bad bacteria. Well Cooked mushrooms ( till they are translucent also help. Many especially raw low starch green veggies are agrivating to the gut; cooked is better. Aspirin is also very helpful NOT EXCEDRIN AND OTHER NSAIDs . Uncoated full Aspirin like two a day taken with warm milk and once every few days. Aspirin does much more than act as a blood thinner or nsaid. See

        take vitamin K2 to balance the anticoagalent effects of that amount of aspirin in the 15 mg capsules available on line. Take one 15 mg cap every few days. It’s stored in fat tissue and continues to be available over the fewcto 5 or 6 days after digesting it. I’d do a Total no starch diet and start with 3 day fast using lemon juice, good organic B grade maple syrup and cayenne to tolerance in the well filtered preferably fluoride Free water and take 1/2 teaspoon or so of sea salt a pinch at a time throughout the day. Then using intermittent fasting regularly. Not too much protein fill out diet with good fats. 2% milk needs to be pasture raised and organic. Milk is good and try Bery sweet organic orange juice without pulp. Has many good things in it.

  • Tansysmom

    Right now pretty much everything hurts. I have tight muscles, ligaments, and tendons that get strained/sprained way too easily, and it takes forever for these things to heal. It seems that inflammation sets in and keeps the pain going long after it should be gone. Does AS do that?? I am fairly comfortable while sitting down and not moving around, but standing up hurts like the dickens. Exercise, other than walking, makes me worse–nside and outside of thighs, wrists, elbows, a couple of swollen finger joints, lower back. My doctor has been no help. I do have the HLA B27 marker but no spinal fusing. My daughter has been diagnosed with AS, and my mom might have had it too. I am wondering if I have AS or if something as simple as nightshade sensitivity could cause all this muscle/joint pain.

    • Sorry about all the pain you’re having. It’s so hard to say what could be going on. If it were me, I would start interviewing new doctors right away. Maybe you can find someone who is open to running some additional blood tests and helping you with some dietary interventions. Integrative doctors maybe? Assuming you and your doctor eliminate other obvious diseases, then maybe try doing some dietary interventions. it’s hard work at first, but you can certainly figure out if you have a single food sensitivity. Good luck!