Pasta la vista, AS?

In the previous article Dr Akerkar and This AS Life looked at the theories linking starch, AS and the role starch-loving bacteria Klebsiella pneumonaie  might play. Here, we set our sights on Klebsiella– and the theory that cutting out the starchy food it lives on helps cut down symptoms for people with AS too.1,2

Gut feeling

The evidence linking AS and Klebsiella  is out there, even if it’s a little old nowadays.3,4 Studies have shown high levels of Klebsiella  in the poop of people with AS (Klebsiella  loves to live in the gut, in case you wondered why they looked there). In fact, the levels of the bacteria in people with active disease were higher compared with those who had milder or inactive AS.3

The pattern was the same in blood samples too: people with higher AS disease activity also had higher levels of antibodies that target Klebsiella.4

Carbs on trial

Next came a small study in AS patients: as part of a larger literature review on the topic of starch and AS, data from a small trial of 36 patients who tried a low-starch diet was presented.2 After nine months of a low-starch diet, patients showed a drop in levels of Klebsiella-specific antibodies in their blood. More importantly, their blood also showed lower levels of a marker for AS disease activity; the patients also reported lower levels of painkiller use. These are both indirect signs that their AS had improved.2


"Could carb-free mean AS-free too?"

Light on carbs, light on data

Sadly nearly 20 years on, no further studies have been published to back up these findings, despite the authors’ call for further investigations.2 A single study, with a small number of patients makes it hard for the medical community (or anyone else) to be 100% confident that these positive findings are true for everyone with AS.

It’s not that its thought that the study is wrong, it’s just too small to be conclusive proof. Doing long-term food studies with large numbers of people would be complex, take time and cost money.

Those with AS who are serious about the benefits of going carb free say they have seen significant improvements for their lifestyle change. To echo the advice of previous This AS Life articles on vitamins, plus the Deliciously Ella and Paleo apps, it’s always worth giving diet changes a try, providing you’re careful. If low carbs have worked for some people, who knows, it might work for you too.

Giving carb-free a go

Cutting carbs down – or even cutting them out – is no small feat. You should definitely speak to your doctor before making significant changes to your diet, so you and they can take steps to avoid any unexpected health risks.

You could start slowly by introducing more low GI food or food that’s gluten free into your diet. Another option could be to invest in a spiralizer to help replace pasta and noodles with vegetables instead.

Anecdotal evidence shows a carb-free lifestyle works for some people but not for others. The idea that people often respond in different ways is a very old one at least for medicines.5 Maybe you’ll have luck going carb-free too.

This article was written by Dr Shashank Akerkar, with help from the resident experts at A social site, helping the whole AS community to: Learn. Share. Inspire. Discuss.

1. Rashid T et al. Clin Dev Immunol 2013; 2013:872632.
2. Ebringer A, Wilson C. Clin Rheumatol 1996; 15 Suppl 1: 62–66.
3. Ebringer Ret al. Rheumatol Rehabil 1977; 16:190–196.
4. Trull AK et al. Scand J Rheumatol 1983; 12: 249–253.
5. Clark AJ. Br Med J 1937; 2:307–310.



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Dr Shashank

Consultant Rheumatologist

Dr Shashank Akerkar is a Consultant Rheumatologist at the Mumbai Arthritis Clinic and Research Centre in India. Describing himself as a ‘patient-centric Rheumatologist’, Dr Akerkar regularly tweets and blogs on a range of rheumatology topics (including ankylosing spondylitis). He is also the creator of an app specifically for patients with lupus.

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