Ankylosing Spondylitis

Flexible Wellness Plan

A simple step-by-step plan you can follow

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1. Diet

Stick to these foods until you hit ‘pain free’

You’ll get the best results, in my opinion, if you stick only to the items on this list (it certainly makes shopping lists easy).

Don’t worry, this isn’t your forever list! This is just to get you to ‘pain free’. Stay strict and don’t cheat, the pay off is worth it.

diet gut heroes
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Meat and Fish

โœ… Meat (any)

โœ… Seafood (any)
(especially oily fish)

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Sauces and Dressings

โœ… Avocado oil

โœ… Olive oil

โœ… Salt

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Dairy

โœ… Almond milk

โœ… Goat yoghurt (small amounts)

โœ… Eggs (small amounts)

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Vegetables and Salad

โœ… Broccoli

โœ… Cabbage

โœ… Courgette/zucchini

โœ… Cucumber

โœ… Leeks

โœ… Mushrooms (a funghi!)

โœ… Okra

โœ… Radish

โœ… Sauerkraut

โœ… All leafy green salad

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Important: Avoid the following at all costs

๐Ÿ”— Click here

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Fruit

โœ… Avocado

โœ… Olives

โœ… Berries (blueberries, blackberries, raspberries, strawberries) small amounts

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Nuts and Seeds

โœ… Chia seeds

โœ… Macadamia nuts (small amounts)

๐Ÿšซ Try to avoid nuts at start of diet

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Cold Drinks

โœ… Water

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Hot Drinks

โœ… Black coffee

โœ… Tea or coffee with almond milk

โœ… Herbal tea

โœ… Bone Broth

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Alcoholic Drinks

โœ… Beer (lager or pale ale), small amounts

โœ… Red wine, small amounts

โœ… Clear spirits (vodka, tequila, mescal, gin), small amounts

๐Ÿšซ Avoid any sugary mixers (tonic etc), rums, liqueurs, white wine or rose

Supporting Evidence

The Use of a Low Starch Diet in the Treatment of Patients Suffering from Ankylosing Spondylitis

The association of HLA-B27 and Klebsiella pneumoniae in ankylosing spondylitis: A systematic review

The glucose transporter GLUT3 controls T helper 17 cell responses through glycolytic-epigenetic reprogramming

Why such a restricted list?!

It’s vital to establish your baseline first. Once you get you to ‘pain free’ (or close to it) you can start to reintroduce certain foods back in, one by one.

That’s why it’s really important to keep track daily of everything you’ve eaten, your pain levels and so on.

Use whatever method works best for you and stick to it. If you want a Wellness Plan spreadsheet you can copy and adapt, I’ve made one for you here.

You can do this. I am really badly organised, terrible at maths and hate spreadsheets. I managed to do this (and stick to it) and as I write this I am pain free. I haven’t even taken so much as an NSAID in over two years!

๐Ÿ’ก Still experiencing issues?

Maybe you’ve tried the diet for a while and experienced a littleย relief but not great relief… or maybe some issues have improved but others have actually got worse… or maybe you don’t feel any different!

If that’s you, please don’t worry, there are lots of things it could be.

You will get to the bottom of it. It’s a case of putting your detective hat on and persevering.

1. It takes time. Dietary changes are not like popping a pill or having an injection and getting instant relief. It may have taken years, even decades for your gut and microbiome to get to this state. Many find it can take weeks or months to start noticing a positive impact.

2. You may be reacting to other food intolerances. This can confuse the main experiment. When you shift your diet significantly that can often mean having a lot more of one ingredient than usual, or a new ingredient entirely (something that your body is not used to). If you have an adverse reaction this can set off new and existing issues.

e.g. Someone starts on a strict candida diet to help with bloating and other issues. As part of this, they cut out gluten and start baking with buckwheat for the first time. The sudden intake of buckwheat (very high in oxalates), triggers a stream of painful oxalate issues.

Here is a list of some of the most common along with links to helpful support groups:

Oxalates

Helpful Facebook Group:
๐Ÿ‘ฅ Trying Low Oxalates

Histamines

๐Ÿ—’๏ธ Read more here

Helpful Facebook Group:
๐Ÿ‘ฅ Histamine Intolerance

Candida

Helpful Facebook Group:
๐Ÿ‘ฅ Candida Support & Info

Salicylates

๐Ÿ—’๏ธ Read more here

Helpful Facebook Group:
๐Ÿ‘ฅ Salicylate Sensitivity

Sulfites

Helpful Facebook Group:
๐Ÿ‘ฅ Sulfites No More

SIBO

Helpful Facebook Group:
๐Ÿ‘ฅ SIBO Discussion/Support

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2. Movement

Keeping moving is essential

Multiple studies have shown that movement and stretching are an essential part of managing ankylosing spondlyitis.

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Walk 12k+ steps a day (if possible) โœ”๏ธ

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15+ minutes stretching, 5 times a week โœ”๏ธ

Lying on a mat and doing yoga or pilates might be too much for you right now (hopefully this is something you’ll be able to build up to!). To start with I recommend following the exercises that Emily Clarke from the NASS has put together.

stretching gut heroes

Walking benefits

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Walking is a great way to move the joints and improve flexibility and AS symptoms

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It is easier on the joints (less load bearing) which is perfect when you’re starting out

Stretching benefits

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Helps to keep your joints moving and flexible and supple

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If you have a smartphone or smartwatch it will track your steps for you for free. You can set targets to help you stay on track

Supporting Evidence

Investigation of the effectiveness of aerobic exercise training in individuals with ankylosing spondylitis: Randomized controlled study

The role of passive stretching in the treatment of ankylosing spondylitis

Effects of a Multimodal Exercise Program for People With Ankylosing Spondylitis

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3. Mindset

Stay motivated, stay positive!ย  (+ get support from me and others!)

You can do this.

Every one of the rheumatologists I’ve seen told me that diet, as a treatment for AS, was at best ‘inconclusive’. Not one of them had even heard of the London AS diet which was prescribed under the NHS for many years and had wildly successful results.

So I pushed on anyway…

Today (after over 20 years with AS) I no longer take any medication for my ankylosing spondylitis.

My rheumatologist is now HAPPY for me not to take methotrexate or biologics.

My blood inflammatory markers are low. My cholestrol (on this crazy diet) is excellent. My heart rate and blood pressure is healthy. I sleep better. My mobility is improving all the time. I have more energy than I’ve had since my twenties.ย  Most importantly I am 90 – 95% pain free.

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Read my diary entries (see the rollercoaster)

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Join and read the posts on the KickAS forum

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Join the The Low/No Starch Lifestyle for Ankylosing Spondylitis Facebook forum

Mindset Gut Heroes

Forum benefits

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KickAS has over half a million invaluable posts. It most people’s entry point to the Low/No Starch Diet for AS and is a hive of fantastic information and success stories

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Low/No Starch Facebook group for AS is a wonderfully supportive and positive group. It’s a great place to talk to others and stay motivated and learn about what’s working for others

Diary benefits

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Adjusting to this new lifestyle is challenging. There are ups and downs and this will be different to anything you’re used to. But it gets so much easier and the payoff, if you stick with it, can be huge. Sometimes seeing someone else’s journey helps you know you’re not going it alone

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4. Supplements

These supplements could help with AS aches and fatigue

There’s a lot of debate over the efficacy of supplements. Are they properly absorbed by the body? Do they really make a difference? Always do your own research but here are 3 supplements which have had a measureable effect on my own AS management over 2 years of testing.

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Magnesium Malate OR Magnesium Glycinate (powder form) โœ”๏ธ

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Electrolytes (powder form) โœ”๏ธ

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Vitamin D & Omega 3 (gel caps) โœ”๏ธ

supplements gut heroes
Should You Choose Magnesium Malate or Magnesium Glycinate?

There are many forms of magnesium available. Modern diets mean most of us are deficient in magnesium so supplementation can be an effective way to top up. This is especially the case for people with autoimmune disease like ankylosing spondylitis.

Magnesium deficiency can lead to muscle cramps and other issues. That’s why people with AS may find that supplementing with magnesium could help reduce night cramps. Here are the two options I prefer and have repeatedly tested:

Magnesium Malate is the most bioavailable source of magnesium. It is most easily absorbed by the human body making it the best choice for most. You will get a noticeable energy bump from malate so I’d recommend taking it during the day time.

Magnesium Glycinate is another excellent form of magnesium. It can help promote feelings of sleepiness (and many people use it to help them get to sleep) so if you take this one do so just before bed.

Why Vitamin D & Omega 3?

Omega 3 is great for joints and Vitamin D is an essential vitamin, especially if you don’t get to spend much time outdoors.

You can often find the two combined in one capsule. I recommended gel caps because they tend not to contain any starch (although always check the label).

Magnesium benefits

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Can really, dramatically help ease (or get rid of) night cramps for many

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Can provide a boost to energy and focus (magnesium malate) if taken during the day or promote a feeling of sleepiness (magnesium glycinate) if taken at night

Vitamin D & Omega 3 benefits

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Both vitamins are essential to our diet

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While you are unlikely to notice any immediate or short term effect, they yield benefits over the long term

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Want daytime energy and night time sleepiness? Try both and just take half a dose of each. Take malate during the day and glycinate before you go to bed

Supporting Evidence

Clinical and pathogenetic values of disorders of mineral metabolism in ankylosing spondylitis

Timeline (Bioavailability) of Magnesium Compounds in Hours: Which Magnesium Compound Works Best?

Vitamin D in ankylosing spondylitis: Review and meta-analysis

Supplementation of omegaโ€3 fatty acids in patients with ankylosing spondylitis

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5. Sleep

Do everything you can to boost your sleep

The cruel thing about ankylosing spondylitis is that it decimates your sleep. At my worst I was waking up every 15 minutes each night and felt exhausted every day. Paradoxically one of the best ways to manage AS is to get quality sleep but this can be hard if the AS is preventing you from sleeping in the first place.

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Try to give yourself 7 hours+ sleep a night โœ”๏ธ

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Ensure your bedroom is pitch black. Avoid blue light (screens etc) 1 hour before bed โœ”๏ธ

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Avoid eating at least 2 hours before bed โœ”๏ธ

Don’t worry if your sleeping conditions aren’t perfect, just do what you can.

Sleeping Gut Heroes

Tip 1: If you are having trouble getting to sleep in the first place consider mixing some magnesium glycinate powder with water and taking it just before bed.

Tip 2: If you are in flare consider putting a heat pad on timer under your back in bed to help you get off to sleep. Biofreeze (or other heat/freeze gels) applied to the affected area can also help.

Sleep benefits

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Helps the body repair damaged tissues, which can reduce inflammation and alleviate pain

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Proper sleep can also help improve pain tolerance, making it easier to cope with the discomfort associated with AS

More benefits

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Sleep also modulates the immune response and help reduce inflammation levels in the body

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Good sleep can help boost energy levels, making it easier to do physical activities, such as exercise and stretching

Supporting Evidence

A wake-up call for sleep in rheumatic diseases

Perception of Sleep Disturbances due to Bedtime Use of Blue Light-Emitting Devices and Its Impact on Habits and Sleep Quality among Young Medical Students

Role of sleep deprivation in immune-related disease risk and outcomes

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Meal Ideas

โฒ๏ธ 3 min prep, 5 min cook
๐ŸŒฑ Elimination diet friendly

Lemon Herb Salmon With Broccoli

๐Ÿฝ๏ธ Lemon Herb Salmon with Steamed Broccoli

โฒ๏ธ 3 min prep, no cooking time!
๐ŸŒฑ Elimination diet friendly

Smoked-Salmon-and-Avocado

๐Ÿฝ๏ธ Chicken, Broccoli and Blueberry Salad

โฒ๏ธ 3 min prep, 5 min cook
๐ŸŒฑ Elimination diet friendly

Prawn Courgette and Mushroom Skewers

๐Ÿฝ๏ธ Prawn, Courgette and Mushroom Skewers

โฒ๏ธ 3 min prep, 5 min cook
๐ŸŒฑ Elimination diet friendly

Seared Sea Bass with Olive Tapenade

๐Ÿฝ๏ธ Seared Sea Bass with Olive Tapenade

โฒ๏ธ 3 min prep, no cooking time!
๐ŸŒฑ Elimination diet friendly

Beef and broccoli Stir-Fry

๐Ÿฝ๏ธ Beef and Broccoli Stir-Fry

โฒ๏ธ 3 min prep, 5 min cook
๐ŸŒฑ Elimination diet friendly

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Great Resources and Further Reading

๐Ÿ”— Spondylitis.org

๐Ÿ”— Nass.co.uk

๐Ÿ”— KickAS.org