What follows is a summary of Ebringer’s theory about using diet to successfully manage ankylosing spondylitis.

It’s variously been called the ‘London AS Diet’, ‘The Low/No Starch Diet’ and ‘The Starch Free Diet’.

If you haven’t already done so, check out the fantastic video that Sean Codling and Mick Coulter put together where you can see Professor Ebringer explaining it in his own words.

I hope I’ve covered the key elements below, but as ever, it’s always best to supplement this with your own viewing and research.

About ankylosing spondylitis

Ankylosing spondylitis (AS) is a debilitating inflammatory disease that affects the spine. It causes muscle stiffness and painful, prolonged backache, typically in the sacroiliac joints.

This can make it difficult for people with AS to get up in the morning due to the severe stiffness, often leading them to roll out of bed. Inflammation can be measured objectively in patients with AS through something called elevated erythrocyte sedimentation rate (ESR) and C-reactive proteins (CRP).

The creation of ankylosing spondylitis diet: a timeline of events

In 1973 Dr. D.C.A. James from Westminster Hospital discovered that 96% of AS patients carried a gene variant called HLA-B27. In the general UK population, the frequency is only 8%.

This discrepancy led to further research…

At this point Alan Ebringer, a prominent researcher at the time, was introduced to the mystery of why AS was so prevalent among HLA-B27 carriers.

He drew parallels with rheumatic fever, where antibodies against the Streptococcus bacteria attack the heart valves. He hypothesised a similar mechanism for AS.

His subsequent studies found a surprising link between AS and the Klebsiella bacteria, a microbe found in the human gut.

Rabbits injected with HLA-B27 showed a reaction to Klebsiella. Furthermore, AS patients had elevated levels of antibodies against Klebsiella but not other microbes. These findings have been corroborated in 18 countries in total which, indicates there could be a global link.

Ebringer proposed that the disease mechanism involves Klebsiella evoking antibodies, which then produce autoantibodies that attack the spine’s collagen. It’s this that leads to the pain and backache familiar to patients with AS.

This process is something he calls “molecular mimicry,” whereby the body’s immune system mistakenly attacks its own tissues.

Just as in rheumatic fever where antibodies against Streptococcus mistakenly target heart valves, in AS, antibodies target both the HLA-B27 blood group and spine collagen.

A crucial treatment insight came in 1982 when Ebringer discovered that reducing the dietary intake of starch could decrease the growth of Klebsiella in the gut. By cutting out foods like bread, potatoes, cakes, pasta, and rice, the number of bacteria decreases. This then leads to a reduction in the harmful antibodies that attack the spine.

The idea here behind this is focusing on root cause. What’s causing the immune system to attack itself and how do we stop that, rather than solely trying to treat the symptoms.

The diet has been adopted successfully by hundreds (likely thousands) of AS patients worldwide. Many have reported a dramatic or even a complete cessation of symptoms.

Challenges to be aware of

The introduction of a diet like this can be challenging.

Many patients struggle to give up staple foods, and despite the potential benefits, find the dietary change simply too restrictive.

While 95% of AS patients have HLA-B27, the remaining 5% who don’t, might be high-starch consumers. Some reports indicate that even HLA-B27 negative AS patients benefit from a low-starch diet.

Medical science’s hesitation to accept these findings stems from its inherent conservatism and the pharmaceutical industry’s influence (you can’t charge for, or profit from, dietary interventions).

Anti-inflammatory drugs can help treat symptoms, but they don’t address the root cause as Ebringer’s dietary recommendation does. Combining both approaches might offer even better results.

While ankylosing spondylitis remains a challenge to treat and diagnose, Ebringer’s research offers a compelling look at its potential causes and treatments. With further exploration and open-mindedness, better solutions may be on the horizon for AS patients.