If you do not wish to read about diet, by all means please DO NOT READ THIS POST
. And if you have NO EXPERIENCE with REAL NSD, do not bother to pontificate about this treatment option: You can fool yourself and you can fool people who wish to be fooled, but you can neither fool your own body nor those of us who have actually spent our time and energies first getting the diet to work for ourselves, and then seeing it work for many
In fact, if you have AS and do not wish to hear about diet in the future
, I hope you can find a different disease to make you the subject and object of respect, adoration, or attention (or pity…or whatever you want). Maybe you can find someone who is willing to swap with you.
Just rock-a-bye yourself back into your normal sleepwalking state by repeating over and over again: “it’s not my fault…I’m just a victim—of circumstance…there is NO such thing as personal responsibility…there is NO lesson the Universe is trying to teach me—I did not deserve this miserable disease…life is SO unfair!...and AS is NOT perfectly just Darwinism…”
If you have allowed your doctors to talk you out of the diet, or you otherwise do not believe in this method even in light the valid science behind diet, recognize that it is YOUR choice and you should just admit that you have NO INTEREST in treating your AS through dietary means. Be honest and fair to yourself and to others (especially
; avoid creating new negative karma).
NB: The following orientation is not accepted by physicians at this time, however, Ebringer’s work is currently being included in key textbooks—so there is some hope that, in the future, treating doctors will be more aware of the dietary connection with AS.
There IS one recognized medical discipline more accepting of diet and non-mainstream treatments: Naturopathy. Just over 3000 naturopathic doctors (N.D.) are practicing in the United States, however, many states do not yet have licensing provisions for N.D.s.
If you are new to this forum or otherwise interested in the dietary treatment of AS, you should
be better informed about this regimen than the attempts to discredit NSD in recent, very misleading, posts.
The No Starch Diet is NOT:
Sugar-free, fat-free, nightshade-free, chemical-free
The No Starch Diet IS:
A dietary regimen that is alkalizing, laxative, and antiseptic. This diet requires avoidance of all unnatural starches (flour), and soluble starches (potatoes), and limits refined and complex sugars (lactose and galactose, for example) and even all natural—albeit high-concentration—starches (cashews, eggplant, unripened nectarines and mangoes, beans, etc) plus dairy (cheese, milk, etc).
These observations are NOT THEORIES
, but are my actual experiences:
Certain antibiotics help reduce AS symptoms related to inflammation
Employed in combination with the starch-restricted diet. If an antibiotic does not work against AS, I can usually tell within 3 or 4 days. Antibiotics that have no activity against Klebsiella pneumoniae
do not work against AS symptoms, so I believe that Professor Alan Ebringer is correct in his assertion that this specific germ is responsible for AS.
A STRICT DIET ALONE CAN (for some people) totally eliminate AS symptoms related to inflammation
starches and dairy products are totally eliminated, and the diet is kept both alkalizing and laxative: “Eat to live.” After all drugs are eliminated and remission has been achieved, some of these foods (dairy and limited starches like rice) might be introduced back into the diet is small quantities without severe reaction, but careful monitoring is required.
[STRICT: Test everything before putting it in your mouth. Caramel, guar gum, inulin, maltodexterin, modified food starch, and other additives may not indicate using the iodine, but they should not be eaten in any quantity. Even the Communion Host has too much flour to be safe. It would be better to give the priest some starch-free macaroons or meringue cookies to bless and then use them instead of the starchy wafer; even so little starch can be very provocative.]
Fasting reduces or eliminates AS symptoms related to inflammation.
Fasting eliminates IBS, on a temporary basis.
permanently eliminate ulcers, proctitis, diverticulitis, GERD, and colitis.
[Fasting: Drink at least 8 glasses of distilled water daily—nothing else for at least four days up to eighteen days; any longer requires medical supervision and special provision for breaking the fast.]
The Edgar Cayce Three Day Apple Diet helps to reduce symptoms of AS and can reduce or even eliminate a flare and restore energy, provided diet is strictly followed after such a cleansing regimen.
NSAIDs might reduce pain, but can accelerate AS—if taken long-term.
NSAIDs can turn a mild case of AS into a severe case and condition.
Inflammation due to AS leads to fusion that begins as bone spurs, vertebral squaring, and deformity, resulting in osteophytes and syndesmophytes (vertebral bridging).
Fusion depletes bone matrix and can result in fractures, stenosis, collapsed vertebrae, kyphosis, and osteoporosis.
CERTAIN foods can trigger a flare. These are usually fried starches, but even dry starches, in combination with other denatured fats, can also trigger flares.AXIOM ONE: If a massive dosage of French fries and onion rings does not cause a severe flare, you are probably already fully flared with pain meters either pegged or pain sensation dulled by NSAIDs, steroids, or other drugs; you cannot properly evaluate whether you are better or worse from any given stimulus.
A flare can be triggered within 3 hours, but can take 200 hours to subside, even under the best circumstances.
In the past seven years that I have been mostly starch-free, NSAID-free, and often taking antibiotics to control AS symptoms caused by inflammation, I have not had any familiar sequelae that were previously recurrent and persistent:
Plantar fasciitis (heel spurs)
Costochondritis (gone 6 months after starting NSD and antibiotics)
TMJ pain (returns when I eat a little bit of starch—supplements adulterated with fillers)
Asthma (both seasonal and triggered by foods I now eat often)
GERD (exacerbated by NSAIDs)
Knee edema (from septic hip or colitis)
Kidney stones (supplementation with calcium helped before NSD)
Shin splints (periostitis)
I am an ‘indicator;’ my AS activity is directly related to ESR. During the time I lived in The Philippines, I could have my ESR test performed on a walk-in basis (about $8). At times when I was not strict with diet (had a pizza slice at the new Shakey’s they opened in town, also eating peanut butter on occasion and eggplant) my ESR increased to 28 and I started having much pain until I fasted and became more strict with diet. Three weeks of this and my ESR clocked in at 18. The fellow who introduced me to the NSD had ESR over 100 in the same year I did, but the difference was that he found out about Ebringer and diet and I did not. Today his ESR is below 7 and he has less than 15% of the kyphosis I now ‘enjoy.’
Those electrical-shock type pains that used to happen upon movement became milder, and when the bursitis and other pains used to occur due to instant, break-away movements—like when a bolt breaks loose or ice on top of snow breaks through while walking on it—still hurt, but the pains would not last very long as they once did, throbbing for hours or even days later.Some general history:
The diet was pioneered by Giraud Campbell, D.O, as described in “A Doctor’s Proven New Home Cure for Arthritis,” first published around 1972, but he did not call it a (NSD) “no-starch diet.” Later, Carol Sinclair discovered the starch connection, both of these independent of Ebringer, et al, proving the bacterial origin of AS, then prescribing a low-starch diet (LSD) in 1983. Over 20 years later, the average of his 600 patients have provably less damage than usual AS subjects treated at other clinics. Some, adhering more closely to this diet, have maintained nearly normal ROM and show very little kyphosis with no incidence of iritis, plantar fasciitis, and other common sequelae.
There are myriad triggers for AS, which is not a primary disease, but just one result from recurrent episodes of Klebsiella Reactive Arthritis (KRA).
A common trigger is Reiter’s Syndrome, another reactive arthritis that evolves, within about 18 months after infection by Chlamydia trachomatis in a susceptible individual, into KRA/AS. Other triggers include candidiasis, giardiasis, shigellosis, salmonellosis, Ross River virus, hepatitis B vaccination, amoebiasis, etc.
The combination of the ubiquitous bowel germ Klebsiella pneumoniae, along with intestinal lesions (“Crohn’s-like microlesions” have been identified in over 50% of those studied with AS), conspire to produce a response that results in autoimmunity. This mechanism is called ‘molecular mimicry,’ and it is the lymph dimer of the immunoglobulin targeted for this bacterium that is the agent of cellular death and subsequent inflammation: IgA-Kp. These IgA are most often produced in the lymph nodes of the mesentery supporting the bowel and connected to the lower spinal processes; local to the bacterial proliferation and incursion. A note here that AS is not the result of an overactive immune system, but an exhausted primary immune system that allows the bacteria to get past the mucosa, so that the secondary immune response is required.
The goal of reducing dietary starches is to reduce the quantity of bacteria produced in the gut, however, if large colonies of this germ are established within the sub-mucosa and beyond, diet will be of only moderate value, and it will take a very long time to achieve results. I made the decision to use antibiotic agents, in cycles, and in combination with diet, so that a resistive strain did not emerge.
Since most people with AS do not know the original cause of their disease, and it is diffiuclt—and not very accurate—to test for residual colonies, it is often more appropriate to just use natural treatments for each potential cause in no particular sequence.
1) Anti-parasite regimen
2) Anti-protista regimen and protocol
3) Anti-fungal/anti-candida diet and protocol
4) Anti-bacterial diet with antibiotic protocol
5) Sustained low-residual, alkalizing and laxative diet for AS and
General starch-free healing diet and supplements.
These treatments will take at least six months to properly complete, and another three months are required to heal lesions: This is BEFORE a valid trial of the NSD can begin.
I have not taken diflucan or other anti-fungal agents, but I have used metronidazole (Flagyl) to keep the potential for Clostridium overgrowth to a minimum. I do not know whether I had giardiasis at some time in the distant past; it is also a probility.[Addendum, for reference purposes: Letter to SAA August, 2003 to request more dietary information be made available on their website]Food and Ankylosing Spondylitis (AS)Klebsiella-Reactive Arthritis
The general basis for understanding how different foods might affect AS activity relies upon a disease mechanism that has not yet been generally accepted by the medical community: The true pathogenic (germ) initiation of a molecular mimicry reaction. Simply put, the presence of germs causes our immune system to produce a specific antibody that causes collagen damage resulting in inflammation and eventual calcification familiar to us as AS, through a process similar to the way heart tissue can be damaged in rheumatic fever. This is described in the seminal paper entitled “Ankylosing Spondylitis is Caused by Klebsiella,” published in the February 1992 issue of Rheumatic Disease Clinics of North America, volume 18, number 1, by Professor Alan Ebringer, et al.
The paper explains the observation that, in every active case of AS over many studies, significant high levels of just one antibody specific to the pathogen Klebsiella pneumoniae have been identified in blood samples. This is contrasted with no antibodies to this, and many other pathogens, searched for in healthy control subjects. Individuals with rheumatoid arthritis (RA) did exhibit high concentrations of a different antibody (Proteus mirabilis), making differentiation between AS and RA much easier in those laboratories with the equipment and proper techniques for performing these tests. Papers subsequent to this one, propose that AS is the result of many episodes of what should properly be termed “Klebsiella-Reactive Arthritis,” or KRA.
At least one study, unrelated to Ebringer’s work, showed that most long-term AS patients had ‘Crohn’s-like microlesions’ in the ileocecal region of the intestines, making the potential for intestinal flora to act across this membrane, triggering an immune response. Thus, there is some support for the role of the LGS, or ‘Leaky Gut Syndrome,’ in the production of AS.Antibiotics
The first obvious question would be “why don’t antibiotics cure AS?” Although Ebringer’s group did experiment with antibiotics in a clinical setting, there were too many problems to recommend their general employment. Side effects were often serious and this particular germ is genetically very clever so that large numbers of drug-resistant bacteria ‘select-out’ rapidly, especially in the presence of their favorite food.Diet considerations
Their favorite food is also one of our favorite foods: Starches. They especially like fried and oily starches that can also present a large surface area while being digested. Products made from white flour (bread, cake, pasta, doughnuts), or which may otherwise form soluble starches (potatoes) are pure Klebsiella heaven. And, if anything (stress levels, food combinations, etc) extends the transit time of the digesting material even by a few hours, one can well understand the bacterial propagation will proceed at geometric rates.
Prior to Professor Ebringer’s research into diet, a totally independent study had been conducted on the bacterial compliment of Seventh Day Adventist waste versus controls consuming the Standard American Diet. The Adventists are vegetarian and therefore consume far greater quantities of grain than the average carnivore/omnivore. All bacteria were studied, but the specific concentration of Klebsiella pneumoniae is most relevant: The starch-eaters yielded average numbers that were well over an order of magnitude higher than controls: 30,000 bacteria per cubic cm versus 700 in normal subjects.Prior art; common results
Also prior to Ebringer’s dietary approach, another doctor was successfully using diet in the treatment of AS in a clinical environment: Dr. Giraud Campbell, author “A Doctor’s Proven New Home Cure for Arthritis.” Unaware of Ebringer’s work both Carol Sinclair, author “The New IBS Low Starch Diet,” and Jackie LeTissier, author “Food Combining for Vegetarians” (detailed Hay Method of food combining) found that starch restrictive diets controlled their AS, even if they did not know they had this disease at the time of discovery (IBS is another common symptom of AS). It is noted that Ebringer’s work substantiates and provides the scientific answers for these, and other dietary regimens used to help control AS. Physicians have been catching on, and those from Dr. Joseph Mercola and Dr. Nicholas Perricone, to Dr. Jean Seignalet have identified grains and unnatural starches (flour products) as pro-inflammatory. Ebringer’s work is being included in key textbooks, so that physicians in the future will at least be familiar with the requirement for dietary alteration in the treatment of AS.Scientific support
Within the over 60 papers published by Ebringer, and his colleagues, on the topic of AS, there are charts that demonstrate the relationship between disease activity and the blood concentrations of the immunoglobulin specific to Klebsiella pneumoniae (IgA-Kp), and these numbers are interesting because this immune component is unique to lymph, so if the presence is greatly elevated in blood, it must be in spectacular numbers within the lymph and this is some of what people with AS experience; an overburdening of the lymph processes. There are charts which document greatly increased fecal Klebsiella in active AS patients, versus reduced Klebsiella quantities in inactive patients, and fully compelling arguments in support of the molecular mimicry theory. Most impressive, however, are the sedimentation rate tracking charts.
In the majority of patients with AS, Erythrocyte Sedimentation Rate (ESR, or ‘sed rate’) is a general indicator of disease activity. With the development of his “London AS Diet” in mid-1982, Professor Ebringer began suggesting this dietary approach to his patients at the Middlesex AS Clinic. In the paper “The Use of a Low Starch Diet in the Treatment of Patients Suffering from Ankylosing Spondylitis,” by A. Ebringer and C. Wilson, published in Clinical Rheumatology, 1996, 15, suppl. 1, the chart of one patient following the dietary recommendations as the only treatment change, indicates significant long-term reduction of disease activity:
As recently as June, 2003 Professor Ebringer happily reports that “patient B,” in the above chart, remains consistently well below an ESR of 20.
Another impressive chart from the Middlesex AS Clinic, published in Advances in Inflammation Research, Vol. 9: The Spondyloarthropies, Raven press, 1985, in a contribution entitled “The Etiopathogenesis of Ankylosing Spondylitis and the Cross-Tolerance Hypothesis,” by A. Ebringer, M. Baines, M. Childerstone, M. Ghuloom, and T. Ptaszynsk, shows majority ESR reduction in 36 patients with active AS:
On the reduced starch regimen (which was not controlled, but left to the patients’ own discretion), the majority of subjects showed some decrease in ESR at the 9 month evaluation point.
ESR almost certainly drops, along a more aggressive slope, in direct proportion to the amount of starch restriction achieved. Such diet modification is not for everybody, as demonstrated by two opposite-direction measurements and one no-change, but in the long-term management of more serious illness levels, in patients willing to make the effort to improve, the prognosis will certainly be much better. Perhaps many can avoid permanent damage and other more serious sequelae, if made aware of this information.
The London AS Diet was really conceived as an adjunct to conventional therapies, with the goal that patients could use lower doses of medications, overall, thus extending useful lifetimes, and possibly eliminating the more serious side effects, of any drugs employed.Personal experiences and opinions
When I suffered with extreme flares from the AS, I experimented with fasting and found that moderate periods of between 5 and 7 days were usually enough to bring down the worst flare, and I fasted up to 20 days to determine how free from pain I could become. Later, I did notice that fried foods, in particular, could trigger a severe episode. After fasting, however, I always returned to my own vegetarian dietary routine containing plenty of whole grains and starchy vegetables, and the pains sometimes returned in just over a week. If I had been aware of the pathogen-starch connection early enough, I would not have suffered through the many sequelae, including iritis, kidney stones, heel spurs, costochondritis, bursitis, and TMJ, and severe kyphosis resulting in fracture.
I never wanted to admit that starches, my basic staple as a vegetarian, were making my condition worse. The thought of giving them up was very daunting, and if I could have proven that the starch-restrictive diet was of no value to me, I would have gladly done so, but I have to face the truth: It does work quite well, if ever difficult and slow.
The diet did not work overnight for me, and I believe that I have some serious lasting lesions in my intestinal tract that cause even the smallest numbers of this bacterium to cause big problems for me. Initially, I used my own antibiotic regimen, and cleansing routines like the Edgar Cayce 3 Day Apple Diet. After two of these in as many months, I was able to go for extended periods without taking antibiotics; a strict diet alone was sufficient.
Although I have considerable mechanical damage from years of suffering with AS, my condition improved considerably, and I totally stopped having flares and continued to improve for over a year; places where there were pockets of residual inflammation began to relent, and I did experience some greater degree of movement in my shoulders, especially, and to some extent my hips. I can certainly walk longer distances without any pain, where once I begged for a hip replacement. No severe episodes of TMJ, heel spurs, bursitis, and kidney stones, and only once in four years had some hip involvement, water-on-the-knees, and minor iritis. I contrast this with previous constant fatigue and general pain punctuated by relapse into more severe flare every couple of months, kidney stones about twice yearly, and [serious] iritis at least once per year. Almost complete remission from digestive disorders except for one minor battle with colitis in the four years. This, after stopping all antibiotics for four months; the longest I had been without taking them.
I do not use NSAIDs anymore, so do not experience the digestive complications from these drugs, but I do believe that they caused lasting damage to my intestinal tract, and probably accelerated the advancement of my AS.
Patients with HIV and ARC complained that the US FDA was too conservative, and far too slow, in releasing drugs for use against their condition. They both correctly and successfully argued that a drug showing any promise at all should be made available to them because most could run out of time while awaiting rigorous trials. Many bravely took the risks of failure and experimentation upon themselves, and became informed medical consumers. Perhaps those with AS do not feel the same level of urgency that people with HIV have, but from my own experiences, AS damage can sneak up on you and permanently affect your quality of life; it is unwise to procrastinate.
Anyone demanding rigorous, double-blind studies of starch exclusion in the mitigation of AS would never really stick to such a regimen, even in the face of still more compelling scientific evidence. They are waiting for that magic pill to erase common lifestyle choices. Did they ask their bakers for double-blind scientific studies that promote eating bleached and devitalized, micron-sized milled flour products in the first place? What about the car dealer and bartender? Let’s demand their studies about the effects of the products they purvey, also! And how many of the dissenters actually asked their doctors about the ‘double-blind’ studies conducted on the common arthritis drugs they prescribe?
Diet is an inexpensive alteration in lifestyle that can dramatically affect the course of AS. It does not require FDA approval, endorsement by your doctor, or abandonment of most allopathic therapies. It does, however, require some discipline and a sincere personal commitment to take charge of the course of your own case of Ankylosing Spondylitis.