What is a low-starch diet? It is the reduction of both carbohydrates & starches. All carbohydrates are starches, but not all starches are carbohydrates. What is starch? Starches are long complex chains of simple sugars. Also referred to as complex carbohydrates. Complex carbohydrates are essentially sugar molecules, specifically several sugar molecules linked together. Long chains of these sugar molecules serve as energy storage for plants and when we eat them our bodies then convert these carbohydrates into its own energy source. To clarify carbohydrates from plants fall into the low glycemic category, because they are made up of cellulose, which is the rigid cell wall of plants giving them their shape, also known as dietary fiber. It is the high glycemic or simple carbohydrates that cause the most need for concern in a typical diet. Higher glycemic foods, include many high carbohydrates foods, such as breads pizza, beans, potatoes, corn, rice, grains etc. In a typical diet eating balanced portions of legumes, higher carbohydrate vegetables, breads, pasta and cereals would be considered healthy. In a diet meant to control symptoms relating Anklylosing Spondylitis & IBS, these foods might need to be reduced considerably or avoided completely.
Why is it that Certain Individuals Afflicted with Ankylosing Spondylitis Benefit from a Low-Starch Diet? In 1973 through extensive research, scientist discovered at the time that over 95% of A.S. patients had HLA-B27, however not everyone with the HLA-B27 gene ended up with AS. Thanks to additional research in 1975 at Kings College & The Middlesex Hospital in London it was discovered that the environmental agent highly active in A.S. cases was a pathogen known as Klebsiella.
Klebsiella is a microbe that ordinarily lives in the intestines without incident, but in A.S. sufferers with the gene HLA-B27, it is suspected that there is an overflow. What happens during a flare-up is that the A.S./HLA-B27 sufferer’s body is producing more Klebsiella antibodies. When you eat high quantities of starch you are contributing to the increase of Klebsiella in the bowel flora, when you have more Klebsiella than normal, your body begins to produce more antibodies causing an inflammatory response. A revolving cycle erupts, because Klebsiella thrives on undigested starch, the more starch you eat the more Klebsiella you have. The more Klebsiella you have, the more Klebsiella antibodies your body will produce, the more Klebsiella antibodies your body produces the more flare-ups you’ll have, including severe IBS symptoms for some.
Is HLA-B27 the only Identifiable Gene for Ankylosing Spondylitis? No, thanks to much scientific research in recent years we’ve discovered that there are a number of individuals with Ankylosing Spondylitis who do not have the gene HLA-B27 and in the last 4 years, researchers have uncovered several new genes which are directly linked to AS. Additionally, there are also many different diseases which fall under the umbrella of Spondyloarthropathies. HLA-B27 was discovered nearly 38 years ago, so there have been numerous studies linked to this specific gene. AS sufferers who do not have HLA-B27 will not have an an overgrowth of Klebsiella, per the 1975 Kings College & Middlesex Hospital study. However, according to research done by Linus Pauling Institute, or LPI at Oregon State University on inflammation, the Non-HLA-B27 group of individuals would benefit from a low-carb eating regimen. Simply put, high glycemic carbohydrates contribute to inflammation and it is theorized that starches feed the bowel microbe Klebsiella, which is supposedly very active in the HLA-B27 Ankylosing Spondylitis group. HLA-B27 gene carriers with AS wanting to reduce the number of flares, according to this study would need to limit their starch intake & the Non-HLA-B27 group would need to reduce their carb consumption.
The Research that “The Low-Starch Diet” is based upon & is it a Cure?: During my quest for answers and my own personal research on this subject, I discovered that the research relating to Ankylosing Spondylitis, HLA-B27 and Klebsiella is quite controversial in some circles. In fact, this subject has been discussed in the UK over the past 38 years, with those who are for and some who are against being split more or less right down the middle. In spite of the controversy within the community of people who have Ankylosing Spondylitis, regarding “The Low-Starch Diet and whether Klebsiella is truly the culprit, or if Dr. Ebringer’s results have been duplicated successfully or not, is completely irrelevant to me. I’m only interested in results and the results for me have been positive, as it has for many with early onset, moderate and even some more severe cases of Ankylosing Spondylitis and those with IBS who have made similar dietary changes. While it’s important to keep in mind that there is no magic bullet, cookie cutter, one size fits all diet for anyone, nor is this article promoting a cure, only an alternative method to managing AS and symptoms relating to IBS. I also feel diet alone is NOT the answer. One must adopt a “whole body” approach to managing their disease as it is outlined here on The Positive Pear. It is also highly recommended when eating for the purpose of healing, to avoid GMO foods & Bioengineered Wheat which are known to trigger an inflammatory response, allergic reactions and wreak havoc on the stomach and intestinal tract. Those living with autoimmune disease, should also be wary of anyone promoting a single way of eating as a “cure” for their disease, especially when the disease itself is incurable. It is important to know your body and your symptoms well, while also paying close attention to how your body reacts to certain foods that you eat. Some individuals do quite well with low-carb, or a simple elimination of wheat-gluten, while others are forced to eliminate not only simple carbs, but also many higher-starch complex carbs, grains, wheat-gluten and additional sugars as well.
What is the Difference Between a Low-Carb & a Low-Starch? It really boils down to the types of foods that you can and can not eat, low-carb allows for individual consumption of “good carbs” low-glycemic carbohydrates, and all fruit & vegetables while avoiding all simple carbs. Whereas individuals attempting to eat low-starch might need to reduce considerably or potentially avoid many foods that are safe for low-carb consumption, including some complex carbohydrate vegetables, such as, beans, soy beans, peas, lentils, carrots and sweet potatoes. Safe low glycemic foods for low-starch eating would include: green leafy vegetables, green beans, artichokes, asparagus, etc. Other inflammatory culprits to avoid for both groups are: dairy, nightshade vegetables, gluten & high amounts of sodium.
According to research of Dr. Alan Ebringer, professor of Immunology & Rheumatology consultant to several medical schools and hospitals, the London A.S. low-starch diet is most beneficial in the early stages of an A.S. diagnosis and works best when combined with low dosages of anti-inflammatory medications (NSAIDs) (or for those who prefer to avoid the harmful effects of the meds, Ginger Root)
Irritable Bowel Syndrome (IBS) & the HLA-B27 Ankylosing Spondylitis Connection: As if having Ankylosing Spondylitis with its numerous symptoms isn’t enough, it is suspected that within HLA-B27 blood group that these individuals are also prone to Irritable Bowel Syndrome (IBS). The source for this theory is a book by Carol Sinclair which connects HLA-B27 Ankylosing Spondylitis, and IBS in a very clear and concise manner. IBS is your body’s inability to digest certain foods. As with many chronic conditions, there might be several different forms of IBS and some may experience more severe symptoms than others. The symptoms of IBS are not pleasant, from bloating, stomach distention to full-blown pain and agony. Perhaps even alternating bouts of diarrhea and constipation. The older you get the worse IBS can become. As I can trace my AS to childhood, I can also trace my food intolerance and digestive issues to the same time frame. Of course there are other contributing factors for some AS individuals, such as Chronic Fatigue Syndrome and potentially damage to the stomach and pancreas as a result of taking medications meant to control symptoms of AS, as well as gluten intolerance due to excessive consumption of bioengineered wheat.
There are other conditions and diseases which have similar or overlapping symptoms to IBS such as, medication induced Gastritis prophylaxis, Pancreatitis, Pancreatic Cancer, ulcers, Crohn’s, diverticulitis & ulcerative colitis. When there is dramatic pain, weight loss and even difficulty swallowing food, these symptoms should be reported to your doctor, as further monitoring and medical attention are required for these conditions. Diverticulitis, is another chronic condition which effects the intestines, usually develops with age and may be a direct result of IBS.
Can I Expect a link Medically Between HLA-B27 Anklosing Spondylitis & IBS? Many descriptions of AS include the inflammation of the intestines, relating to diseases of the bowel. However, if you do not have IBD, which is confirmed by a colonoscopy, then you might be left on your own. Where IBS is suspected doctors might simply resort to treating the symptoms. Especially since several types of chronic stomach discomfort can easily be traced NSAIDs or other harsh medications. Often doctors prescribe OTC medications to treat the many symptoms relating to IBS, such as Prilosec for the stomach upset and Metamucil and Benefiber for the constipation and so on. Treating only the symptoms does nothing to resolve the overall problem, which is reducing the number of IBS flares. After a bout with H. Phylori & Gastritis prophylaxis, I was still experiencing severe pain and discomfort even after eliminating the infection, but I refuse to give up on finding a natural alternative to controlling my IBS symptoms and that perseverance lead me to discover “The IBS Low-Starch Diet”. Which was instrumental in helping me understand the importance of eliminating starches, in spite of being a vegan who ate very few simple carbs.
Where Should I Begin? If you’re ready to give eating regimen a go, it is important to know that each person will have to determine the proper amounts of starch intake for their symptoms. One individual’s low-starch intake might vary considerably from another’s and the same with low-carb intake. It is important to balance your new-found eating plan with a reasonable amount of lean protein, many green leafy vegetables, fresh low-starch fruit in moderation, ample water, as well as omega 3-6-9, vitamins, minerals and amino acids combined with regular exercise, in an effort to compensate for what you are now loosing with being on such a restricted eating plan. If you’re also looking for a way to manage pain & inflammation naturally consider adding Ginger Root to your daily regimen. The need for reduced starch will diminish once the healing takes place and once your symptoms subside, you might find that you can return to eating higher amounts of starch when you’re feeling well, while limiting the amounts of starch on high flare days. You are probably wondering how to start and precisely what you can eat. I would highly suggest using a food journal to note your reactions to specific foods, then immediately begin eliminating the major culprits such as: processed foods, breads, pastas, cakes, potatoes and all flour products. Focus more on eating vegetables, then note how your body reacts when eating these foods. You might find that you are fine with eating some higher starch veggies than you were with eating simple carbohydrates, or you might find that you’ll also need to eliminate starchy vegetables as well. When eliminating high starch foods from your diet, do so one by one. It is important to log your physical reactions for your own knowledge and when communicating your experiences to your doctor. Keep liquid iodine on hand to test your foods and if the food in question turn black, then its high in starch. (Discard & do not eat any tested portions) I’ll eventually post a low-starch food list and as this blog is new, there are a few low-starch recipes and food suggestions, but more are coming.
Is this Diet Endorsed by Doctors? Most doctors typically avoid recommending a specific eating regimen to control symptoms and usually leave this decision to their patients. Just so you’re aware, eating less than 130 grams of carbs per day, can lead to a buildup of keatones in the body. Ketosis can not only affect the breath, but can lead to a build up of uric acid in the blood. According to the American Medical Association, it is also important to limit the amounts of purine rich foods, when following a higher protein, low-carb or low-starch eating regimen, as high levels of uric acid in the blood cause crystals in the joints contributing to Gout. When you must maintain a low-starch diet to control symptoms of AS, or related IBS, it really becomes about choosing the lessor of two evils. However, it is helpful to eat at least the minimum amount of carbs and avoid excessive amounts of purine rich foods such as: anchovies, mushrooms, spinach, asparagus & cauliflower. Instead eat higher amounts of low-purine fruits & vegetables, while specifically increasing your intake of salmon, flax & fish oils, such as omega 3-6-9’s, dark berries and sugar-free,100% pure cranberry juice, to cleanse the kidneys in an effort to avoid UTIs and perhaps even kidney stones. Be sure to also drink plenty of water, as a higher protein, low-starch and low-carb diets can easily dehydrate.
Though there are many highly marketed low carb diets on the web, which are all the new craze, it is not recommended that otherwise healthy individuals engage in low-carb or low-starch eating, other than those looking for alternative methods to managing symptoms of specific diseases or chronic conditions, such as Ankylosing Spondylitis, Chronic Fatigue Syndrome, Fibromyalgia, Diabetes & IBS to mention a few. It is highly recommended that you educate yourself about your disease or chronic invisible illness, then work closely with you health care professional to arrive at a course of treatment that actually works for you. Prior to beginning any major dietary changes consult with your doctor. This article is for informational purposes only and in no way promotes anything listed here as a cure for any disease.
Professor Alan Ebringer on Diet and Ankylosing Spondylitis:
London AS Low-Starch Diet based on research performed by: Dr. Alan Ebringer of Kings College: 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
The Food Hospital Recently Aired an Episode Covering AS & Klebsiella Video Bite:
The Food Hospital: Kate Case Study & low-Starch Diet Success, Ebringer research/conclusion on HLA-B27 & Klebsiella, What is Starch?, What are Carbohydrates?, London AS low-starch diet, AS & HLA-B27, HLA-B27, Other genetic markers, New AS genes discovered over the last four years, Singapore and China Scientists Identify New Genes Associated With Ankylosing Spondylitis (AS), Why Starchy Food May Be Hazardous to Your Health, American Medical Association Volume 78 on low-purine foods, Spondyloarthritis or spondyloarthropathy