HLA-B27 and Autoimmune Disease - Can a Low-Starch Diet?

HLA-B27 and Autoimmune Disease: Is a Low-Starch Diet the Solution?

by Chris Kresser

Last updated on


Do you have an autoimmune disease? Do starchy foods tend to make your symptoms worse? Mounting evidence suggests that individuals who have autoimmunity related to a particular set of genes called HLA-B27 may benefit from reducing their starch intake. Read on to learn why this is and if a low-starch diet is right for you.

Numerous environmental factors have been implicated in the development of autoimmune disease, including antibiotic use, birth by cesarean section, chemical exposure, poor diet, and sleep deprivation, among others (1, 2, 3, 4, 5). While it is widely believed that disease onset requires an environmental trigger, most autoimmune conditions have a genetic component as well (6).

Genetic information can be a powerful tool in aiding both diagnosis and treatment. One particular group of genes that has been strongly associated with various autoimmune diseases is HLA-B27. In this article, I’ll discuss HLA-B27, the role of a gut microbe called Klebsiella, and why a low-starch diet may be effective for those who have an HLA-B27-associated autoimmune disease.

What’s This about HLA?

HLA is short for human leukocyte antigen. “Leukocytes” are the white blood cells responsible for protecting your body from infection and foreign substances.

“Antigen” in this case refers to cell-surface proteins. Putting it together, HLA is essentially a group of genes that determine which proteins are present on the surface of your immune cells.

Humans have a total of 23 pairs of chromosomes, with one of each pair coming from each parent. You therefore inherit one set of HLA genes from your mother and one from your father, on the maternal and paternal versions of chromosome 6. HLA is a highly polymorphic gene, meaning there are many different possible gene set variants, or “haplotypes,” that you can have.

The astounding number of haplotypes for HLA likely evolved to allow for the fine-tuning of the human adaptive immune system, but certain haplotypes can also predispose an individual to a particular disease of the immune system. You may have read my previous article in which I mentioned the role of HLA haplotypes in susceptibility to mold illness. HLA-DQ haplotypes have also been associated with celiac disease (7), while HLA-DRB1 has been associated with rheumatoid arthritis (8). For the remainder of this article, I’ll focus on HLA-B27 and its connection to autoimmune disease.

The genetic link between autoimmune disease and dietary starch.

HLA-B27 Is Associated with Various Autoimmune Diseases

The prevalence of HLA-B27 varies between ethnic groups and populations worldwide but is generally not a very common haplotype. Only 8 percent of Caucasians, 4 percent of North Africans, 2 to 9 percent of Chinese, and 0.1 to 0.5 percent of Japanese people possess HLA-B27 (9).

The most closely associated autoimmune disease with HLA-B27 is ankylosing spondylitis (AS), an inflammatory disease in which some of the vertebrae of the spine fuse together, inhibiting mobility. An estimated 88 percent of people with AS are HLA-B27 positive, yet only a fraction of HLA-B27-positive people will develop AS (10). Other autoimmune diseases that are associated with an HLA-B27 haplotype include Crohn’s disease, ulcerative colitis, psoriasis, reactive arthritis, and uveitis (11).

Making things a bit more complicated, HLA-B27 is itself polymorphic, with more than 100 different subtypes (12, 13). These are distinguished by a two-digit number added to the “parent” haplotype. Many of the most common subtypes of HLA-B27 (such as B2704 and B2705) are associated with increased risk of AS, while other subtypes (like HLA B2706 and B2709) actually appear to be protective against the disease (14, 15). This is likely due to the structure of the protein encoded by the HLA gene, as we’ll explore more in the next section.

The Klebsiella Connection

As early as 1980, AS patients were identified as having elevated levels of serum IgA, suggesting the abnormal movement of microbes from the gut into the bloodstream (16). More recently, microbiome analyses identified greater abundance of a gram-negative bacterium called Klebsiella in stool samples of patients with AS (17). Fitting with their hypothesis of bacterial influx into the bloodstream, researchers found that these patients also had elevated levels of anti-Klebsiella antibodies in the blood (18).

Biochemical studies have found that Klebsiella have two molecules that carry sequences that closely resemble HLA-B27 (19, 20). Scientists have hypothesized that this “molecular mimicry” allows for cross-reactivity.

In other words, the immune system produces antibodies against Klebsiella in an effort to remove it from the bloodstream, but these antibodies can also “accidentally” bind to HLA-B27. This idea of antibodies binding to “self” is characteristic of autoimmunity.

Although Klebsiella is one of the most widely studied microorganisms in relation to HLA-B27 and autoimmune disease, the concept of cross-reactivity applies to a number of different microbial (and dietary) antigens. For example, Proteus bacteria have been suggested to be involved in the development of rheumatoid arthritis via the same molecular mimicry mechanism as Klebsiella (21). As we’ll see next, knowledge of these mechanisms and the bacteria involved can really help shape our approach to treatment.

Why a Low-Starch Diet Might Help

The composition of the gut microbiota is constantly shaped by the influx of dietary substrates (22), including proteins, fats, and carbohydrates. Within carbohydrates, substrates can be further categorized as simple sugars and polysaccharides like starch or cellulose.

Biochemical studies of Klebsiella have shown that this bacterium does not grow on cellulose derived from plants but can grow readily on more simple sugars (23). Most simple sugars like glucose are absorbed in the proximal small intestine and therefore do not travel as far as the large intestine, where the majority of microbes are located. Simple sugars from the diet are therefore unavailable to Klebsiella.

Starch, however, is not as easily digested or absorbed, and some of it remains intact when foodstuffs finally reach the colon. Klebsiella have been shown to manufacture pullulanase, a starch-debranching enzyme, that enables them to break down starch into simple sugars for energy and growth (24).

Several studies have applied this information in humans. One randomized control trial split people into two groups: a high-carbohydrate, low-protein diet or a low-carbohydrate, high-protein diet. They then compared the abundance of Klebsiella in fecal samples. The average number of Klebsiella was 30,000/gram in the high-carb group compared to 700/gram in the low-carb group (25). Another study found that a low-starch diet reduced total serum IgA in AS patients (26). The majority of these patients also reported a decline in symptom severity and, in some cases, complete remission.

Take Steps toward Remission

Now that you better understand the science behind HLA-B27-associated autoimmune disease, here are three things you can do to take action.

  • Find out your haplotype
    Currently, there is no readily available, user-friendly means of determining HLA haplotype from full genomic sequencing data (from companies like 23andme). While there are a few HLA-related SNPs that can be identified in the raw genetic data, at best these are only correlated with HLA haplotype and do not provide information about subtype. The best and most accurate way to determine your haplotype is to request a blood test from your healthcare practitioner that uses a more targeted DNA sequencing approach to identify which alleles you carry (27).
  • Experiment with your starch/carb intake
    Even if you don’t have access to genetic testing, or if you’re HLA-B27 negative, you can still do a self-experiment to see how you personally tolerate starch. I am a big proponent of n=1 experimentation and finding the diet that is right for you. Eileen Laird of Phoenix Helix has written an excellent post in which she shares the results of her own and several other Paleo autoimmune bloggers’ starch experiments. Many found that they can tolerate some forms of starch but not others. This is really valuable, since we know that a diet devoid of fermentable fiber like starch can be detrimental to the long-term health of the gut microbiota (28).
  • Heal your gut
    At the risk of sounding like a broken record, healing the gut is absolutely critical to achieving and maintaining optimal health. A leaky gut allows bacteria and dietary proteins into the bloodstream, which provokes an immune response. Regardless of your HLA haplotype, strengthening the integrity of the intestinal barrier is an important step towards achieving remission. Supporting a diverse, healthy microbiota can also help to keep Klebsiella and other potentially problematic microbes at bay.

Now I’d like to hear from you. Do you know your HLA haplotype? Have you noticed a change in your autoimmune disease symptoms by increasing or decreasing your starch intake? Share your experience in the comments section below.


Join the conversation

  1. Low Starch/ NO Grains works better for me too. I finally gave up even gluten-free grains, like rice, by my own choice, even though naturopaths still recommended gluten-free grains—but even rice gave me joint pain, lingering fatigue, more brain fog, bloated belly & sluggish digestion. My chiropractor couldn’t figure out why my muscles were so TIGHT and why his adjustments weren’t holding, until I gave up those grains & all starches. Thx for sharing this. Now if I could only fix the chronic fatigue & adrenals.

  2. Low starch/carb does work for me. If I eat them, I literally can feel my feet start to swell as I’m chewing. I would also encourage people to consider that they may have a solanine issue as well which means no peppers or tomatoes. Any nightshade is out which makes the diet even more restrictive and if you’re picky like me..sigh, it’s really hard, but I do feel so much better cutting out the starches. I also have Uveitis as well, so I try to keep my inflammation and stress down. I am HLA-B27 +. I start feeling the difference in a matter of days when I cut out the starch. I haven’t had any back pain for at least 6 years now, but that was due to dealing with some emotion issues. When I let that go, the back pain went with it and I was left to deal with the Uveitis and Gerd. Before I discovered the carb issues, I had gotten fluid in my lungs and heart, but all my test were good for my heart. It’s been a struggle since I was 18 and I’m 52 this year. I just wish I knew about the carbs when I was younger. I think I could have avoided some of the issues if I had.

      • Wow, Nikki…. I can relate to you including the sinusitis. I’m now 58 and only just catching on that it’s not just Gluten but the starches from baked goods. Apart from the classic starchy potato what else do you suggest I eliminate?
        Cheers Tanya

    • Hello and thank you for sharing, Im too Hla-B27 positive. My Rumetologist suggested to follow a gluten-free diet. I just find it so hard to give up the carbs and starches, its like they fuel my body on one hand and hurts it on the other. Ill keep trying.:)

      • I’m not sure how gluten figures into. I think you can still eat starches like potatoes and beans on Gluten, just not wheat starch. I know potatoes are a huge cause of inflammation for me. Really pay attention to your body and how it reacts to different foods. I feel that is the key. We’re all different, so it would make sense that there is not just one diet solution. Yes, it’s hard for me to give up some starches like potatoes. Others, like bread and rice don’t bother me. I miss popcorn lol. Emotionally, it’s hard at first, but then I know I feel so much better without them. The first week is the worse and then it gets easier. It’s kind of upsetting because your first response is to feel deprived or like you’re being forced to give up things you like, but really we’re poisoning our bodies with them. I’m ridiculously picky, that mentally it’s rough, but I just started back up again. Sigh.

        • You have to keep repeating to yourself that you are not giving up foods….you are giving up pain and disability….you are worth the effort! What you are getting back is more vitality, better health, the ability to do things that you sometimes cannot do because you are in to much pain or too exhausted from the inflammation. And even the things you push yourself to do now, while in pain, you will enjoy with so much more quality of life once you remain in remission. It’s all worth it! But you cannot halfway do it and expect to see results. Especially in the beginning, you need to avoid completely 100% all starches to let your body heal. Just cutting out gluten is not nearly enough. You have to cut out all starches. But you can still have carbs. All vegetables are carbs. All fruits are carbs. You can even have green tea with honey in it. Or make cookies out of almond flour with honey for a sweetener. Once you get over the initial starch withdrawals, it gets so much easier and becomes just a natural way of life. I’ve been doing it for 6 years now. I rarely think about the things I cannot eat because there are so so many things I can eat that I am focused on. You mentioned that your body needs carbs for fuel, but carbs are not an efficient source of fuel. Once you cut them out, your body will start using fat as it’s prefered fuel source. This is a much better and efficient source of fuel, and it is what we were meant to use, not all the processed carbs we use today. So you will need to increase your good fats… Avocados will become your friend, as well as coconut and nuts like almonds and walnuts (most other nuts are too starchy), and good quality meats and pasture raised or cree range eggs. How long it takes for your body to adjust and convert to using fats for fuel is different for everyone. It took me only 2 or 3 weeks, but I have heard for others it took 1 month or more. Once it happens, you will no longer feel hungry. Your body will stop asking for starches. You do not want to cheat and eat start eating starches now and then because it will only confuse your body, are starches my fuel source now? Maybe I should not switch and start using fat as a fuel source? My body now burns fat as fuel very efficiently. You will get there. Make grocery lists ahead of time before stepping in the store and then head straight to those items only on your list. You are on a mission. Don’t even look at the other stuff. If your family is supportive to also trying the new diet, then even better! Clean out your kitchen and throw away all the starchy stuff. That way there will be nothing there for you to cheat on and to tempt you. Replace it all with snacks and foods that are not starchy.

          • Thanks for taking the time to give us a pep talk. I truly wish I wasn’t so picky. I will eat almonds and walnuts. I’m trying to make myself eat veggies (I hate most of them and get tired of eating the same things over and over that I barely can tolerate them). I truly wish I liked avocados and coconut, but I don’t. I’m pretty much down to eggs, meat (chicken, steak sometimes Turkey- I can’t have ground beef because it’s more acidic or tomatoes or peppers because they make me swell), cheese, fats (Walnuts and almonds), fish a few times a week and that’s it. And yes, I agree, after a week, I really feel better and already feel the change it’s just mental if I want carbs cause I really don’t want them in fact, I barely have an appetite at all and kind of have to force myself to eat. I tend to leave out fruit because I’m trying to lose weight and it stalls me. My kitchen is already cleaned out. For me, it’s just about sticking to it and not faltering. I’ve been on and off for two years. If I fail, it’s because I truly just get sick of eating the same things. I’m not sure how to change that because of the pickiness and the additional restrictions I have. I just try to suck it up. I’m a work in progress, but it’s a miracle that I have no back pain. I will just have to try to think of ways to be more creative food wise so I can make this a life style change.

      • Fyi, Potatoes are a *Nightshade* plant, which can make people more inflamed, cause lingering fatigue AND joint pain. I cannot eat potatoes or sweet potatoes. Both are also high in *Oxalates*, which cause convert to painful crystals in the body. With RA I would be very careful & log your symptoms after you eat potatoes for several days after eating them. Delayed symptoms can happen up to a week later. Look at the “Raw Vegan” or “AutoImmune-Paleo” diet.

    • It seems there is a little bit of mixing up of terms, and meanings going on here.
      Three main parts of food: protein, fat, carbohydrate.
      Carbohydrate includes: starch (complex chains of simpler sugars); and simple sugars (glucose, lactose, sucrose, fructose and others).
      The Post here is about starch only, not carbs in general. It is the complex carbohydrates that get far enough into the system to feed the Klebsiella, that appear to contribute to the disease.
      The simple sugars don’t appear to be problematic here. There are lots of other potential problems with simple sugars, or large amounts of them.
      Some people, for various purposes, find a low or zero carb diet useful or necessary. Their energy needs have to come from fats mainly and the body switches how it derives energy.

      My purpose here is to advocate the judicious use of glucose to support your energy requirements. (That is if you are not choosing a ketogenic diet).
      May I refer you to my comment of August 29, 2016.
      My son was blooming, on 65 teaspoons of glucose per day.
      I’m not advocating that. But 1 wouldn’t hurt you. 2 wouldn’t hurt you. Probably 10 wouldn’t be too bad, it’s what people get in some soft drinks. Perhaps 1 teaspoon per hour for every waking hour. Perhaps 2.
      It’s up to you.
      It can give you part of what you need.
      It can make you feel better.
      It can stop you feeling grumpy.
      I ran a marathon once. Basically you can’t do it unless you pour in glucose and salt along the way, else your body runs out.
      All the best.

      • Whole Raw Fresh Fruit & Raw Honey is a better option for simple sugars, instead of….. sodas, refined white sugar, High fructose corn syrup, sugar syrup, gatorade etc…

  3. I was a young woman who has been living with Epilepsy for 8 years. When I graduated one year later from high school I had bad migraines which became seizures, which followed by uncontrolled seizures up to 7 a day and as years went on my life stop. I lost my first great paying job and was not allowed to continue college because of my seizures in class. As a result my license was revoke. And it got to the point where I stop living I was trapped in the house because various times I was robbed and treated badly. In 2005 I decided to have brain surgery cause the seizures increased, and my life started to changed although the surgery was great it reduced my seizures but did not take them away and I was able to return to school, and I graduated with honors, and I do what I love to do sing, and write. In 2013 i heard about Doctor Lawson from my sister for his miraculous herbal medicine, I was curious to know how it works. I contact him and then I made an order of his product, i used his herbal product for mouths, His medicine has change my health and worked perfectly well and i am cure from seizure completely, seizure free

  4. (Herbal Cure For Rheumatoid Arthritis (RA))
    I first lost my ability to stand up from a sitting position due to total body weakness. The physician I saw that same week ran a blood test and told me it appeared to be rheumatoid arthritis (RA) few weeks later i came across a testimony of one lady on the internet testifying about a herbal medicine home called perfecthealthherbalmedicinehome,run by dr sithuu, on how they cured her of rheumatoid arthritis (RA).

    • Check out the Plant Paradox-removing lectin foods can help RA and other autoimmune diseases. It helped me so much but then ate almond flour and sweet potatoes and had a flare! Worth the research!

  5. So I was recently diagnosed with Hashimotos and also tested positive for HLA b27… had xrays done and they said no sign of AS. I do have terrible joint pain , especially neck and tailbone, so now I am confused on what that means for me… in 95% it’s AS what is it in the other 5% ??? I am 35yo female. I get massages and adjustments weekly due to pain.

    • Hello! I’ve had AS for years but did not find out about it until last year. Got diagnosed with Hashi’s late last year. Low starch diet combined with AIP for about 6 months so far….And the pain and flare-ups are better. So give the low starch approach a go! The one dilemma I have (and you will too possibly) is – for Hashi’s, we need carbs/ starch, for AS, they hurt us….Where do we go from here :)? My Hashimoto’s has gotten worse since last year, AS better.

    • I just had to reply to your comment after I read it because I feel for you! I had severe hip, neck and spinal pain for years. I’m in my 50’s now and was 19 when I had these symptoms. I was checked for things, had an MRI, back X-rays of my back and they could find nothing. At that time they considered AS a “man’s disease”, so no doctor thought to test me for it. Long story but I was finally diagnosed with AS. It will not show up in X-rays or MRI often and often only when you’ve had it for years. Don’t give up, Find a Rheumatologist with knowledge of this disease. Also check with family member to see if they either have it or have symptoms of it as it is very genetic. It’s also very painful though it can go in and out of remission. It you have the symptoms and the HLA-B27 gene, IMO you have a strong likely hood of having it. It’s also auto-immune so if you have other auto-immune diseases, that increases your chances. I’m mentioning all of that because the more risk factors you have for it, the more likely a doctor is to consider it. I hope you get a correct diagnosis, esp. if you are living in a lot of pain because today they have medication that can treat it. When I was diagnosed so many years ago, there was nothing and I was in horrible pain with no answers and I don’t want anyone else to suffer like that. Mine has gotten better as I’ve gotten older, only that I have about 10 AI diseases now, most are worse. I hope a doctor will listen to you and test you for it and diagnosed you correctly so you can get treatment if you need it.

    • You have to have AS for more than 10 years before the joint damage is sufficient to show up on a mere x ray. It is very, very common for x rays to not show AS. It did not show up in my x-rays either. But then the doctor ordered an MRI which is much more detailed, and that showed the beginnings of the disease. If your doctor did not know that you needed to order an MRI instead of relying solely on a silly x-ray, then you might need a new doctor. This is a big problem with Ankylosing Spondylitis. There’s a huge delay in diagnosis. If you have all the pain and symptoms of AS, and the gene to go along with it, then just proceed assuming that you have it and get started on the diet protocol. Observe if you have relief. But in order to be a true fair test, you must stick strictly to the diet in the beginning and give it a good 3 months trial to see if you feel better.

  6. The problem with varying your diet or anything else to treat yourself if you have AS is that the inflammation attacks are variable – so you might assume causation when it is just coincidence. I long ago read a book in which a physician noted that arthritis (not including osteoarthritis,) allergies, and low blood sugar (hypoglycemia,) tend to occur together, so a diet with no starch or sucrose / dextrose / glucose is probably a good idea for AS patients.

    • This is a useful comment in so far as Physician’s are in an excellent position to notice trends in patients with chronic diseases. The problem however is that not many doctors – due to their high work load and their training are able to do this.
      When it comes to AS – or any other AI condition – it is my experience that medical doctors are not the best people to consult. These diseases remain largely unexplained by conventional medicine. This , however, does not stop many doctors from reaching for a prescription pad and, it is my belief, placing more strain on a system that is already out of balance through the administration of several damaging drugs. There is so much research out there on the role the gut microbiome ( which we can partially control ourselves through diet – not just what we eat but, also how and when eat) plays in driving immune responses and levels of inflammation. The recent research in intermittent fasting – especially on a low carb high fat diet ( eatling loads of fresh vegetables and small amounts of fresh fruit with small amounts of animal protein and healthy fats) is just one example of how one can reduce the impact of many AI diseases and reduce rates of Diabetes II, Alzheimers, Osteoporosis and even depression ( all associated with chronic inflammation) that has gone haywire)

      For those who are interested follow up on the work of Yale Med school researchers ( the anti-inflammatory mechanism of dieting and fasting; the role that klebsiella bacteria play in driving AS and upregulating the HLA-B27 gene; the TED talk by Dr Mark Mattson on intermittent fasting etc.

      • To put all doctors in one category by saying that “medical doctors are not the best to consult” isn’t fair to them or the best thing for a patient. While it’s true that there are doctor’s out there without the experience or competence to correctly diagnose someone, there are just as many great doctor’s who have the experience, who have the competence and most importantly have the determination to figure out what is going on in a patient.

  7. I too have been diagnosed with AS and I have repeatedly asked Doctors if i need to change my Diet and they say Diet has nothing to do with it. I dont have stomach issues mine is inflammation throughout my body, neck, shoulders, feet, knees, back. I have been on Humira which helped tremendously but had to get off it due to Chronic Cough (TB Latent). I have tried other inflammation drugs but they dont work well to bring the inflammation down. Im not giving up, there is something out that will work. I have been sugar free for years now since I have Reactive Hypoglycemic so no sugar for me, I also have been on the Paleo Diet for 6 mos, no relief.

    • May I ask what are you basing your comment that you “have inflammation throughout your body”? Have you had blood tests or any other diagnostic tests? Thank you

    • Have you tried Braggs apple cider vinegar….1 tablespoon in 20 oz of water 3 times daily? I use coconut palm sugar to slightly sweeten the drink. Add to that another 3 20 oz bottles of filtered drinking water thruout the day….I think you will be amazed at the results.

    • I have the same question- how do you determine that you have “inflammation throughout your whole body”? There are blood tests to measure inflammation as well as diseases that may cause inflammation. Most of the time when a person has inflammation, it’s not throughout the whole body. Get a proper diagnosis from a good doctor, only then will you know what you really have and what course of treatment you need. There are ways of eating that can improve inflammation but first you need treatment which is followed only by a correct diagnosis. AS doesn’t normally attack the whole body or small joints. Inflammation is not a disease, it is a symptom of a disease.

      • Just to comment on the above comment where the reader states that inflammation is a symptom of disease. That is what conventional doctors are taught. However from a functional medicine perspective I understand that inflammation is the cause of many chronic diseases including auto-immunity. By reducing and /or preventing inflammation the symptoms of so many diseases actually subside or disappear. In the case of AS the suggestion is that starch feeds the klebsiella bacteria in the gut, thus causing an overgrowth . If the person has a compromised gut wall and leaky gut syndrome these bacteria can enter the blood stream and set up house in the nearest joints – those in the sacro-ileac area.

    • Research The Plant Paradox and a low lectin diet. It helped me until I had a set back with too much starch including sweet potatoes. Food makes a huge difference in our pain levels and in our healing. Anyone who says our diet won’t make a difference is uneducated in my opinion.. I have an autoimmune disease and had pain that basically was completely diminished by removing high lectin foods. I did try AIP for years but no real success for me. Worth the research anyway!

      • Hi Daniel, thank you for sharing your video but I had to cut more than just potatoes and chocolate. Actually I don’t eat all starchy food including sweet potatoes, oats, banana, corn, rice, flour, and beans for the past 4 years and my pain is zero. Dr Alan Ebringer’s research wil be a great source to understand the link between starch and the pain.

  8. Hello and thank you for the informational article. I have been waiting and hoping for more information and research about AS to come to light. I have been on the starch-free diet for six years now, and I am only 34. My symptoms of AS are typically well managed as long as I don’t cheat too much (weakness is sweet potato fries!) and I can honestly say I am better physically than I was six years ago and I know it’s because of the diet. Six years ago I was working a full-time desk job and eating Advil like candy and 1-2 flexeral every four hours too and I would still come home in tears from the pain in my back, neck, shoulders…and I was only 27! I ended up with two herniated discs, bedridden for months, and lost my job. Bored in bed, I used my laptop to do endless hours of research, diving in to every clue from my X-rays and MRI to try to figure out what was wrong. I didn’t want to end up bedridden and addicted to painkillers. Anyways, Long story short, I read Carol Sinclairs book and tried the starch-free diet and within three days I could walk again. I went on and off the diet for months, thinking ‘this is crazy-is this really working or am I just getting better finally?’ Well the conclusion was BOTH, and I’ve been able to manage all my pain with the starch free diet and occasional Advil for six years. I found out later I am HLA-B27 + and so is my mother who now suffers tremendously from a stiff, fused neck and other arthritic symptoms. I’m frustrated today because I waited six months and finally got an appointment with a rheumatologist. She of course didn’t see any active/serious inflammatory response and decided instead that I have “food sensitivities”. To ALL starch? It’s not a big deal, I don’t really NEED the diagnosis, it’s just frustrating since that’s the third specialist I’ve seen that won’t consider me AS. But there is gradual improvement because six years ago when I suggested ankylosis spondylitis my doc looked at me kind of funny and I could tell he didn’t even know what it was. I felt like I needed to educate my doctors on the topic but now in 2017 at least they seem to know what it is. What new knowledge will be available in 20 years? Please just keep the research going. I hope for my own children. Thank you for everything you’re doing to raise awareness and share the information as it becomes available.

    • Thank you for the info. I will buy the Carol Sinclair’s book. I was also wondering about excercising?!! Should I be or not really…I dont want to aggreviate the situation. Thanks again for the insight.

      • Hi Theresa, you should definitely exercise! I also have AS and I find that squats and lunges help strengthen the glutes and lower back and takes pressure off of the SI joint and the muscles give support. Running may be difficult but I find that using an exercise bike helps warm up the joints and the blood flow reduces inflammation from my experience 🙂

    • Adriane hi, have you tried to get bacteria analysis from stood sample? you should to consider also other posible options as reactive arthritis or no xray AS

  9. First I want say thank you, Chris Kresser, for publishing this great article! Finally I see more awareness on what we eat than medication. In 2011, I was diagnosed with AS and HLA-B27 positive. The inflammation got so severe that my both eyes were affected. Also I couldn’t barely walk due to my back pain for almost 6 months so after quitting my job (I couldn’t even drive anymore) I decided to do an extensive research on my own. I tried different diets such as Gerson Therapy and the Low Starch Diet. After combining both the pain disappeared completely and my energy increased so much that I became a triathlete in 2014! My next goal is to complete an Ironman Triathlon in May and bring more awareness about eating habits. I have been training more than 20hrs per week and also I came back to work more than 40hrs weekly without any restrictions. Actually, my excitement for not having pain anymore is so great that I have been having more career advancement than I couldn’t even imagine for the past 3 years!
    So what is the secret? I don’t eat starchy food such as banana, oats, soy, potato, corn, flour, rice, beans. Also I don’t drink alcohol or sodas. It is very restricted but I don’t trade this life for nothing! I don’t get sick anymore, my energy level is super high, and the pain is completely zero for the last 3 years. Basically, I eat plenty of fruits such as apples and grapes (besides banana because it has starch), eggs, meat of any kind, non starch vegetables (tomato, broccoli, carrots etc). The only time I eat processed sugar would be during my long trainings such as energy gels (GU, Cliff), the Caveman bars (non starch bars) and Gatorade. I encourage all of you to try to eat clean at least for 3 months and see if the pain will decrease. Be prepared when your energy level increases (perhaps you will become a triathlete as well). 😀 Trust me, I doubted the first time I read but I am a living example that regardless of the pain you are having today you are more in control that you believe. Change your eating habits and you will see!
    Chris, I would love to help somehow. Let me know and I will be more than glad to share my journey. I tried the Spondylitis Association of America but they never sent me a response back. The secret is not on the medication but how we eat! Good Luck all!

    • Hi Erika,
      that’s great news for you and very inspiring ! two quick questions : how long after starting the no starch diet did you notice a decrease in the pain? I’m only three days in and I think things are getting better but would be interested to how long it took you.

      Also, when you eliminated starch did you go through a period of feeling faint and lacking energy , how long did this last ?

      Rich (AS sufferer)

      • Hi Rich, you are experiencing an energy shortfall, which is not healthy. You must either cut energy expenditure or eat more; more something.
        Work out your calorie intake. Is it high enough?
        By cutting out starch you are cutting out a lot of glucose.
        Glucose by itself is not very harmful if used wisely. It is used extremely effectively in enteral nutrition for various purposes, particularly, inducing remission in new onset Crohn’s Disease sufferers. It is absorbed so fast it has very little chance of passing down the line to feed the wrong bacteria.
        We use it as a management tool with my son who has CD.
        I’d recommend experimenting with glucose
        Our best method so far is to make up a very strong mix with water, which he will sip as he feels necessary. He then washes this down with water to get it off the teeth and gums, remove the oversweet taste and dilute it.
        It is a bit like a long distance runner drinking an electrolyte/energy drink but without the salts.
        I wrote a similar post on August 29th 2016; 2.18pm

      • Hi Rich,

        Hope you feel better soon! It didn’t take too long to decrease my pain (less than 3 weeks) but according to Dr Alan Ebringer you should keep your diet without exception at least 3 months to make sure this diet will really help you. Regarding the lack of energy actually it was completely the opposite!! Tou should eat grapes, apples, eggs, tomato and lean meat as much as you want! Trust me, without starch and processed sugar your body will transform in a machine!

      • I can only speak for myself but when I started a NO starch diet (not a low starch diet, this is an important distinction) I felt relief within days and very noticeable relief within a week and then by 2 weeks I felt great.

        I do think it’s normal to feel a little off when you start a no starch diet, because essentially we are starving out “bad” bacteria in our guts and it is dying. On the way out you can get mildly sick feeling or quite sick for some. Stick with it, it’s a sign you need this diet right now. I would say look up herxheimer reaction, that’s a good description of what is happening. Best to you.

    • Omg please can I reach you. Katcrawford67 (at) gmail. I was a bodybuilder and powerlifting a naturally gifted athlete. About 4 years ago I had a X-ray at chiropractor. It showed I had reverse curve in neck. I had two surgical fusions. My quality of life has gone down so bad. I was diagnosed with autoimmune Hashimotos ..now doctor just did the Hla test. So I’m waiting till next week also had so many X-rays do e I’m body yesterday. Every joint. My eyes are inflamed for quit sometime. Anyways I am dealing with severe depression and thoughts of suicide It scares me I’m only 49 and have a family I want to be there for. A grandson 3 yrs old. I’m so scared. Can you on ease help me. I do t mean to burden you. But can you Mabey send me a diet plan and anything else that can help. I am pressing into prayer and learning to trust the Lord. But I know God helps those who help themselves. I want to be a testimony of being a overcomes to these various things that got ahold of me. Thank you. Love Kathleen

      • I am sure you will overcome all you have been dealing with and one day you will be helping somebody else! Pay forward, right?! I just sent you an email with some pictures of what I have been eating which is fish/chicken, eggs, tomato, olives, and plenty of fruit. It is a very simple diet. The secret is consistency and not eating starch. Everybody is different but I hope it will work for you. I doesn’t hurt to try for at least 3 months, right?!

          • Hi Tanya,

            I cannot attach pictures on the website but basically here is the list. Dr Alan Ebringer says we must not having any exceptions for the first 3 months so you will be able to see if there is a correlation between the inflammation and starch. It may not work for everyone. However the energy level is just amazing!

            Food with starch that I don’t eat: banana, potatoes, wheat (flour), any grains, soys, rice, beans, pasta/pizza, tortillas, protein shakes, processed food with flour or modified starch.

            Food I eat daily as much as I want: meat (any kind), fruit (any kind – except banana), tomato, seasoning, olives/carpers (if you like it), eggs, milk, dairy, salad.

        • Please send me a email also ~ my family was hit with Lyme disease & co-infections & on top of it mold exposure really bad!! I really need to see if I can turn my family around as of right now we have lost everything to doctor bills, medication bills, hospital bills, health insurance bills etc!! My family has been beat down so bad ~ mast cell disease where my daughter stopped breathing while driving ended up medflighted to UW WI traumatic brain trauma along with many other trauma to body. She had jra at 8yrs old so many other chronic health problems it would take all day to type them out ~ my next daughter has hashimotoes really bad hypothyroidism, cfs, fibro, inflammation blood tests exstreamly high, bad pain threw out her body, low grade fevers daily, bad headaches, fatigue so bad, Ana test very high also but children’s hosp says this is just normal ~ youngest daughter low grade fevers daily, faituge, body pains, headaches, ~ all with exstream depression & anxiety and forced medicated because of it … was told anxiety will give you all these things ….. umm really because you medicated my kids up with tons of meds and my girls are still sick, fatigue, pain, etc etc
          We are about to lose our house ~ I do believe in miracles as my daughter was not supposed to live from her accident and if she did we were looking at very long term nursing home, breathing tube for two weeks, we lost her on the third day but the love of a nurse somehow brought her back…they had to document this as “divine intervention” then a treak and feeding tube ~ stage 3 brain trauma and she came back and passed everyone’s expectations two months later she walked out of the hospital and came home to her own bed!! She wasn’t supposed to know who I was… she doesn’t remember anything except for the last week in the hospital… yes, her life has many struggles daily but she is grateful she is here now but that didn’t come easy …. I should write a book but then our memories are shot depending on brain fog due to?? Lyme/mold/bartonella/autoimmune?? Life is so short and you should live a happy life even when everything is croumbleing around you ~ no one can control life but I would like to control what we eat ~
          dkbmama at yahoo.com

          • Hi Diane,
            Just sent you an email.
            I hope you and your family will feel better soon!
            The diet is simple and I love it! Add seasoning and make enjoyable because it really can change your life! You need to stick with it and avoid exception at all cost. Specially the first 3 months. Having no pain and a lot of energy really pay off my limited diet!

            Food with starch I don’t eat: banana, potatoes, wheat (flour), any grains, soys, rice, beans, pasta/pizza, tortillas, protein shakes, processed food with flour or modified starch.

            Food I eat as much as I want: meat (any kind), fruit (any kind – except banana), tomato, seasoning, olives/carpers (if you like it), eggs, milk, dairy, salad.

            Feel free to ask me anything. I strongly believe that in some years from now your life will be much better if you eat healthy consistently.

            I will be praying for your family.

      • I keep bringing up the Plant Paradox book and removing lectin foods and possibly all starch in addition. I have many of your symptoms with anxiety, Hashimoto’s, pain, chronic inflammation and this way of eating removed my pain almost in its entirety until I ate sweet potatoes!!! Then I had a set back so working towards removing all starch and lectins now. We have to be careful what we put into our bodies nutritionally and focus on all the good things we can eat!! BTW-The quote “God helps those that help themselves” is from an Aesop fable and later used in a Greek play. It is not Biblical or true for that matter. We have been given our bodies though and we are to care for them for sure. Hope this helps!

        • I’ve been reading these comments and although I have none of the afflictions talked about, I do have inflammation in my body.
          Just recently I began to focus on TUMERIC and started making “Golden Milk” and drinking one cup of it every day. I think ts doing me a lot of good. There is lots of info on the internet about this and you do have to start slow with a bit at first and the increase it, otherwise you can get stomach aches & diahrrea. Within 10 days I upped it to 1 teaspoon in a cup of liquid and that’s were I am now. After 3 weeks, I’m thrilled to see that my depression which I had practically all my life is gone…also my h-pilori. This is the biggest gain from tumeric. Its not a placebo effect and/or just wishful thinking! (I buy the ground organic 1 lb bags from Swanson).
          My holistic MD will now do blood work to see where I stand in terms of systemic inflammation.
          Wish I knew where Chris & his staff stand on this…also you readers.

  10. Hi I suffer from alopecia areata and have recently found out I have an allergy to starch so have cut most starch out of my diet the only starch am having is watermelons and some vegetables. I’ve had alopecia off and on all my adults life and once lost all my hair on my body and head….starch free diet I undertook and I beleive it all grow back. My mother also suffers from alopecia.

  11. Hi,I suffered a massive attack of ankylosing spondulitis and rheumatoid arthritis 30 years ago, I was in a wheel chair for about 3 months. I was discharged from hospital and told there was nothing they could do for me. Luckily I found an Indian doctor,Shyam Singha,now deceased. He put me on a diet of 7 lbs of grapes a day and hot water. After a month I was allowed to eat raw food,no wheat,no dairy,no sugar,no coffee,no tea,no alcohol no red meat. He also gave me acupuncture and supplements,no idea what the latter were. After 3 years I was allowed to eat cooked food,which made me gag at first. Slowly I reintroduced the other things into my diet. Today I am fine but have just discovered I am HLA B27 positive which explains some of my symptoms. I avoid wheat,alcohol and too much sugar. I find Japanese Matcha Tea is a wonderful tonic. If Dr Singha was still alive I would recommend people to see him,despite his ferocious manner. Best wishes to everyone.

    • Hi Mike, I just found out that my HLA-B27 results came back abnormal, I have been complaining of all over body pain for several years now but no one took it seriously, One thing I have developed was uveitis (blood shot eyes) which can lead to Glaucoma if untreated, and have a lot of lower back pain.so now iam trying to change my diet and hope it wont progress. Thank you for the tip about matcha tea, I will def try it.

  12. I was paleo for a year for AS and it worked well at first because I had switched from a SAD diet to a whole foods diet but I started having the worst symptoms after about four months of marking the switch. Apart from the increased AS symptoms worsening I felt so fatigued and depressed. I decided to stick with it but after I saw my health decrease I decided to get off the paleo diet and move towards a high fat plant based diet without wheat and very low starch. It has been 3 years and I have not had any spinal degradation and back pain, my blood work came out better that it ever has been and best of all I have not bleed in 3 years!

  13. Great article:) I’ve been suffering with symptoms of AS for about 3 years now, though not officially diagnosed. I had my stool tested with an overgrowth of Klebsiella 4+, Citrobacter freudii3+ and E.Coli 3+ infections, and a complete absence of Lactobaccili. I have been low starch but I have not been strict with the diet. I’m hesitant to, but I’ll going to give it a try. I find I can’t mentally function without a certain amount of starch. I did want to share some valuable information that has helped me tremendously though. Between AIP paleo, raw garlic several cloves a day, probiotics, and a supplement called Glutagenics (it has glutamine, aloe, and something else I can’t remember), my back pain is gone. I still have suffer with some shoulder pain though so I’m hoping that will improve with little starch. I really was nonfunctional in 2016 but I’ve come a long way with natural treatment. I also recommend drinking alkaline natural spring water. It’s expensive but even with the other remedies my hand joints were swollen and claw like until I stopped drinking filtered tap water. Here is the research on allicin from garlic and Hbl27–

    • Thats great you are feeling a lot better! Ive been AIP paleo in my healing journey and my take is you started feeling better when inflammatory foods were eliminated when you went AIP.
      Continue AIP and you likely stay in remission. Or reintroduce foods and figure out what is most inflammatory for you. Good luck.

    • Hi Stephanie, apparently you can be on the low starch diet but still eat white rice. This has been my experience. If you introduce rice into your diet you can still have the benefit of getting enough starch into your body. I have heard that it is the type of starch in rice that the Klebsellia bacteria cannot feed on.

    • Glutagenics is a godsend . It also contains licorice extract. It helps to rebuild a damaged gut wall and thus counteracts the effects of leaky gut syndrome.

      • I asked my PCP to order tests to rule out ankylosing spondylitis and she ordered 14-3-3-ETA PROTEIN and Citrulline AB in addition to the HLA B27 antigen. Can anyone comment on these 2 additional tests? Thanks

  14. Thanks for this info Chris! I was diagnosed with AS about two years ago. I immediately started a AIP diet and had amazing results. For the most part I know what triggers the inflammation now and have been pain free for a long time although sometimes I have a flare up when I eat something that has starch hidden in it (like some soup I had the other day).

    • Hi Daniel,
      So glad to hear your AIP diet is working. My husband was diagnosed with AS almost two years ago, and has been on enbrel since diagnosis. When you started your AIP diet were you on any meds? Our Aim is to get off all meds.
      Also, how did you find going on the AIP diet, was it a difficult transition?
      Many thanks

  15. Just wondering about two new flours out on the market, Tigernut and Lupina Flour ( http://www2.netrition.com/lopino_lupin_flour.html?gclid=CjwKEAiAs_PCBRD5nIun9cyu01kSJAA-WD-r2QbPtqPpdtO5hWLdP00TWuPYdRwu2c3zxKeQzuDR7hoCQ2Xw_wcB )
    ( https://www.amazon.com/Organic-Gemini-OG300-TigerNut-Flour/dp/B00NDI94BW/ref=sr_1_1_s_it?s=grocery&ie=UTF8&qid=1482525805&sr=1-1&keywords=Tigernut%2BFlour )

    Any chance Chris, that you will do a report on whether these are safe flours to use occasionally for baked goods. I’m confused about all the different reports about them.

  16. Hi,

    I’m a homzygous A24, B27:05 and B51:09. I have been diagnosed with AS and find for the most part the only food consumption that can make flare ups worse is too much sugar. The best thing for me is to keep active. Even on days during bad flares I go to the gym and make sure I do some stretching, foam rolling and weights.

  17. I am an AS patient also hla-b27 +. After 2 years in pain I came across Dr. Ebringer diet. Preivously I went to a naturopath that reccomended a vegan diet, as I was on it pain worsened to a point where walking was very painful. After a week on the low starch diet (I eliminated all of them) pain went down from 8 to a 2 (now is just 1 or 2). I gradually introduced them to see which ones affected me the most, and found I can take potatos and rice and lentils moderately, however wheat oats and other grains,produces pain within 3 hrs. I will reccomend this diet to any AS patient, best of luck to everyone.

    • Hi Carlos
      Does the diet give guidelines regarding which starches are more likely to be tolerated? I have been low starch, low sugar for over 2 years and would like to add things back in. Sweet potato and paleo starches are problematic but quinoa sort of seems OK in small amounts so far – so I don’t seem to fit the paleo stereotype

    • As long as I can remember my legs have hurt me. My mom would always say growing pains. Now as adult my pain is now in my feet ankles knees.
      I am positive for HLA-b27 my sedrate is a high of 56 my lowest is 24. My swelling in my legs is unbearable at times.i do have IBS.
      I feel so alone. I have to take pain pills so I can work. I would love to talk to others that are in my situation. I’m single. So I have no one to listen to me. What diet would be the best for me?

      • Sandra hi you are not alone…just take a look in kickAS.com and you will see that there are othersome like you ( and me too). So keep mind strong I’m pretty sure we can fight this illness 🙂

      • Hello everyone! My son has this gene and it has resonated in his knees, toes and IBS. He has been on HUMIRA injector for several years now and has done beautifully. He only injects about every other month or as necessary when his knees swell. Its not holistic and has his precautions but it has given him a great quality of life.

      • Sandra-I am sorry. If you are able to research-check out a low lectin diet, The Plant Paradox, though I would strongly consider low to no starch with that also. I had minimal starch and my pain went from like a 9 to a 2 which is dramatic. I recently ate sweet potatoes and had a huge flare up so they don’t work for me. Hope this helps. The right diet lifestyle is key and the changes you make will bring healing. 🙏

    • can you please tell me the diet that your doctor has prescribed to you because i am also suffering from AS from last three years.

  18. I’m going to try a low starch diet for my chronic Iritis. I am HLA B27 positive, but haven’t yet been diagnosed with an autoimmune disorder. I previously self-diagnosed myself with IBD, but started taking probiotics, which have helped tremendously, but not completely. I appreciate the article and the point that maybe some starches are ok. I intend to experiment as you suggest. Thanks!

  19. Thank you so much for this information. I am HLA B27+ and after a bout of reactive arthritis ten years ago, I have iritis, which I treat with steroid drops, and increasingly painful arthritis in my hands. My knuckles are permanently swollen and I have bone spurs on my fingers. I am a visual artist, so apart from the pain, I really need my hands to function well! I went to a rheumatologist and the only treatment she could give me was painkillers and a photocopied sheet of exercises. (I exercise regularly already.) I am going to give the no/low starch diet a try!

  20. When my son was diagnosed with Crohn’s disease his first treatment was enteral nutrition, ie complete liquid food with all the proteins broken down to various smaller parts. The carbs were mostly glucose and maltodextrin.
    It worked absolutely brilliantly. Presumably everything was absorbed high in the intestine, for the most part, and it changed whatever was going on lower down.
    I have also helped him deal with some flaring symptoms by feeding him meat or fish, pan fried and bathed in oil, with the addition of a full vitamin count and glucose drinks; a lot of glucose, like 1300 calories.
    I’m not advocating that. It is a compromise in a bad situation. There is not a lot of fiber.
    But people may consider, and find it useful, to use glucose as a partial replacement for starch. As long as it is imbibed slowly, and or with other food to avoid blood spikes.
    I don’t know.
    Drink for thought!

    • Hello, If your son has that illness care should be taken with maltodextrin, since is basically condensed starch used as a thickener. A book by Carol Sinclair, The IBS Low starch Diet, points out all this subjects, has an interesting prologue by Dr. Ebringer (creator of this whole HLA/starch connection) good luck and health!

      • Thanks Carlos,
        I’ll look out that prologue for sure.
        We keep it simple and don’t use maltodextrin (M) at all. We just try to keep any one glucose dosage quite low; i.e. sipping not drinking.
        M was in some of the enteral nutrition formulas my son tried as his first onset treatment.
        The name seems to cover a range of more or less complicated and sized molecules with different gylycemic indices, presumably with different other effects as well.
        We’re wary of it.

  21. Dr. Alan Ebringer discovered the relationship between starch intake, Klebsiella in the gut, and autoimmunity over 30 years ago. It’s time for modern rheumatology to stand up and take notice: there is no better treatment currently available for ankylosing spondylitis than the low/no-starch diet.

    Devastatingly, apparently this is not even taught in medical school, as none of my rheumatologists had ever heard of it…for shame – complete and utter shame.

    • I agree completely! I have Psoriatic Arthritis and the HLA-B27 gene. I just recently stumbled upon all this information while researching diet ideas. Shouldn’t doctors, especially rheumatologists, at least suggest looking into a diet change? Or point a patient in the right direction? It’s a shame. Drug companies have such control over the medical world.

  22. For about two months, all food I have eaten apart from the odd occasion has been under 3g starch/100g with plenty of dark leafy greens. This is after noticing a connection between starch intake, my bloated tummy and temporal lobe seizures. I actually upped my sugar intake a little as I do not feel okay without carbs (missed opportunity in some peoples view). Despite of this, my weird blood sugars completely stabilised (normal fasting but extremely high postprandial), my tummy stopped looking seven months pregnant and my glands on my neck went down. I don’t know if I am this haplotype or not but I think who the low starch diet does work for, seems to be pretty obvious pretty quickly so worth a shot if any suspicion. It did not solve all my issues, but it is so worth it. I can even tolerate moderate amounts of inulin rich vegetables now – could not before – so I think it is klebsiella.

  23. I test positive for HLA B27 – and discovered this when I was suffering for years with pain/inflammation/depression – was diagnosed with AI – Seronegative Spondylitis that had AS symptoms – as well as Hashimotos. Cleaned up everything I could, went paleo and added in amazing supplements that finally kicked the symptoms. Fast forward, it’s been over 3 years and I have labs that show total remission, no sign of issues, no symptoms, and I went from taking 5-6 prescription Aleve to zero medications or OTCs. I spent so many years feeling hopeless, and wish more people could have the experience I have had in recovering my health.

  24. I find the Klebsiella link interesting. When I tested for MARCoNS, staph was negative but there was an overgrowth of Klebsiella in the nares. I couldn’t find any literature linking overgrowth in the nares to overgrowth in the gut, so I didn’t treat it with the recommended antibiotics. This info makes me wonder if I should as I also have histamine intolerance and Klebsiella is a histamine producing bacteria. I do have AI dx but not the ones mentioned in this article. Does anyone know if overgrowth in the nares is linked to overgrowth in the gut?

  25. Is starch necessary in the diet? And if you don’t get enough do you damage your mucosal layer? (In the same way as very low carb does by starving the bacteria and forcing them to eat the mucus – this causing long term problems)?

    • I’m sorry to hear that it didn’t work for you. What happened when you tried it, what was the “disaster”?

    • This article does not recommend a low-starch diet for everyone. It suggests that it may be helpful in a small subset of people: those with HLA-B27, Klebsiella pneumoniae overgrowth in their gut, and certain autoimmune conditions.

    • cathy, i would really really like to hear what happened to you on the starch free diet. i personally had so much hope with all the success it has had for others, but something went wrong. I would really like to compare notes.

  26. Terrific informative article! I may have AS. I say may, because I believe in the power of mind to heal and stay healthy and have personal experiences to validate.
    Diagnosed initially in my lumbar area, in my late 20s and supposedly confirmed again in my early 60s, but interestingly, I sustained a severe blow to the same lumbar area in my 20s. I’m curious if the injury created an environment to encourage AS. And who knows what else, having had different locations of spinal injuries, exposure to bacteria/viruses/molds, the possibility of latent vaccine reactions, the list of possible aggravators could be long. In my 20s, I was told there was no reversal only that I have it and expect degeneration. Even with the “there is nothing that can be done” statement, I walked out of the chiropractor’s office not accepting that belief. In the last 10 years, I’ve noticed slight discomforts in my lumbar area, but only with a very few specific situations. Now with this new information regarding genetic predisposition, and perhaps possibly having a gene variant, I’m quite a bit more curious.
    I feel fairly certain I have minimized or delayed the degeneration, if I actually have AS, with several decades of using supplements, herbs/botanicals and healthy food choices. I currently am on a Vit D3 protocol to elevate it even higher (much beyond the accepted US standard values), along with increasing glutathione production and of course and maximizing a healthy microbiome. I make limited and selective carbohydrate food choices and have for several years. I really appreciate Chris presenting this information, and everyone sharing the comments and experiences, Thank You!

    • Felt converted reading your story. I am 26 right now, was diagnosed with AS(multiple joint pain, hip, and Hla B27+) 10 year ago, totally ignored the docs and only with the power of mind got rid of multiple joint pain. Life well for about 7 years completely normal and healthy life. Now that I have developed lumber and cervical disc bulges and pain in lower back. I am a little paranoid after looking at the MRI and the pain in my lumbar spine( it probably was a sports injury). Now I don’t know how to go about it, to consider it as slip discs or AS. I would be glad to know how you manage to do well even with these hindrances. It has become difficult for me to imaging myself living for more than 40 years. Any suggestion or opinions are welcome.

  27. I haven’t been diagnosed with anything because I haven’t been to see a doctor about my symptoms (pretty much all the symptoms of SIBO). I’ve done my own research instead and changed my diet completely taking out starch and grains, and my symptoms only return if I slip up in my diet. Since I’ve started this clean, “real food” diet, I’ve felt so much better, not just physically, but mentally as well.

  28. I am HLA-B27 positive with AS and colitis. I went starch free October 2015 & within 24 hours noticed a profound change with my colitis symptoms. The pain took a few more month to be impacted. I was already GF & following a very clean AIP diet, so giving up starch was not that difficult for me. I did notice a decrease in my energy after a month or so on the NSD, so it’s important to be conscious of nutrient density. My rheumatologist doesn’t support this diet however. I am currently med free except for the occasional NSAID.

    • Taking out starch… what is it that is considered starch?
      I’ve asked numerous times to get info or referred to a dietician as I’m no where near diet educated. My body has always done good to crave what I need.
      Nutrient density… please detail this more.
      I have inflammation in my esophagus, so I am limited on my eating ability. So I need to intake what I need explicitly. My Dr’s don’t get it and I get the “eat green, good proteins, and some fruits” talk. I already know that, that’s basic knowledge. But they also tell me to drink lots of water. I told them I try to drink one bottle 20 oz of water, but they say I need to drink 4 times that. If I drank the amount of water they want daily, I would not be able to eat anything as I’d be full for the entire day. One bottle of water fills me up for half a day.

      • Hi Ann – the short answer to your question ‘What is starch?’ is to buy yourself a cheap bottle of iodine from the pharmacy and test foods. If the food turns black with the application of iodine, it contains starch (throw out the tested piece!). More information can be found on the Kickas website.

  29. I have chronic demilating inflammatory polyneuropathy.
    I am wondering if there any documentation of the diet and the disease.
    I have had disease for 16 years ,. My treatment consists of 2 cyclosporine,100mg daily ,. Also 3 plasma phersis treatments weekly.
    I look forward to any knowledge you can offer.
    Thankyou. Richard Austin.

    • Hi Richard Austin
      I viewed your post & I said, “WOW”! I have been diagnosed with that as well, 3 years ago. I’ve met one other person with this disorder. I have NOT gone the traditional route for it doesn’t heal the root cause. With diet changes & supplements + findings of methylation problems & high lead content blocking methylation & addressing those root issues I have been healing. I have hit a plato as my FM Dr. has been only able to take me this far. Looking forward to my first appointment with Dr. Nett. If you haven’t looked into getting an appointment with this group maybe that would help you. Best to you..

  30. I am a female with Ankylosing Spondylitis diagnosed in 1990 when I was in my late teens. I am also HLA B27 positive. I have had only mild reduction in spinal flexibility, but I have had major joint inflammation in hip, knee, shoulder, chest and even jaw and heel (yes, you can get AS inflammation in these odd places). The inflammation of the iris, or Uveitis (iritis) is also part of the Ankylosing Spondylitis autoimmune arthritis syndrome. I have had that too, for many years about 3-4x per year, and the only thing that helps is steroid eye drops every hour, tapering frequency gradually over 6 weeks. AS runs in my family: my grandmother was never diagnosed but she had similar symptoms and also developed kyphosis (a hunchback).

    I believe I’ll avoid my grandmother’s advanced AS condition because of 3 things that have step by step put my AS into remission. Yes, low-starch was part of what helped.

    1. The first thing which greatly reduced the severity and frequency of joint inflammation, was taking high doses of Vitamin B5, of at least 500 mg a day. It is generally protective and took about 3 months to take effect. I only learned over many years of going on and off B5 that it made a significant difference. Megadoses of B5 do not help with my family members’ rheumatoid arthritis or bursitis or frozen shoulder, but it definitely works for my arthritis. An uveitis (eye inflammation) attack has generally come on a few weeks after I’ve been a bit lax with taking my daily B5, and the uveitis heals within 4 weeks (heals much faster than otherwise) when I double my daily Vit B5 dose along with taking the eye medicine.

    2. My joint AS went even further into remission when around 2002 I started thyroid medication for severe hypothyroidism caused by autoimmune thyroiditis (Hashimoto’s), and I also stopped taking birth control pills. My husband realized the best thing he could do for my overall health was to have a vasectomy to get me off contraceptive drugs. The AS was improved to the degree that I only got joint inflammation when I exercised, and I could manage the pain with aspirin or naproxen sodium and reduced joint activity. (Sadly, even mild exercise always made my joint AS worse, not better.)

    3. The final thing that put the AS in joints completely into remission AND put most the Uveitis into remission was in 2012, when I started a low-carb, high-fat, moderate protein diet (borderline keto), and also stopped most cow dairy (I still eat cow butter and goat/sheep dairy). I also went gluten free and mostly grain-free. I found out later that going gluten-free is highly recommended for people with AS as well as Autoimmune Thyroiditis, and can be beneficial for any kind of autoimmune issue really. This change in my daily diet resulted in losing a lot of excess body fat over 12 months, about 1/4 to 1/5 of my total body weight (I went from size 16 to size 4-6 clothes). It also improved my mental health, gave me an overall sense of calmness, and sharpened my cognitive ability. Because of improvements to AS, thyroid health, and weight loss, I can now handle moderate and occasional vigorous exercise without joint inflammation, and I’ve only had 2 episodes of uveitis since then.

    • I am interested in the #3 change you made. What do you and do not eat for the gluten free diet? I am not diet savvy, so I have no clue where to start.

      low-carb, high-fat, moderate protein diet (borderline keto).
      What does that entail? Can and can’t eat foods?
      Just some basic detail would help compared to no help from my numerous Dr’s that tell me I need to eat good proteins and green veggies and all will be fine.

      They act as if this will go away on its own. They act like they have no clue how much pain I’m in. Even when I couldn’t stand up and walk right, my dr asked me in total surprised voice “are you having trouble walking?”. I was in excruciating pain, moaning, teary eyes cause it was so bad. And I have a high pain tolerance, and he knows that. Yet he just seemed oblivious to it all.

      • To reply to your post I am a 63yo male Dx w AS in 1986. No diet made much/any difference and I took Sulfasazine and Celecoxib to help with swollen joints and constant pain. Had joint replacement surgeries etc but not until I switched to the Paleo diet in April did I find some improvement in pain levels, mobility. Month ago got my results from 23andMe and discovered many SNP’s including MTHFR. Now take 8mg/daily of MethylFolate and B12 and swollen knees and hands are finally gone. Get your genetic testing, find out what you are dealing with and go from there. After 30yrs of suffering there is a beautiful bright light at the end of that tunnel! Best of luck and wishing you better health!

      • That’s awful. Check out a low lectin way of eating via The Plant Paradox AND/or the IBS Low Starch Diet. I love the first book and going to order the second one also. Hope it helps. Diet and what we put into our bodies is key for healing-maybe what we leave out is key 😉

    • Hellov there. I’ve had the same(except eyes) symptoms with AS. Diagnosed 10yrs ago, now developed slip discs in lower back. Can you please elaborate on low carb high fat and protein diet. Do you mean, mostly meat and basic veggies? Every information is useful.

  31. Just the other day I found out (ultra sound) that my thyroid has almost been distroyed by autoimmunity and a lot of other hormones are out of whack as well.
    I’m rather confused about the carb issue as well. High carb/low fat is no good for me. Low carb/ high fat makes me crash. When I eat something sweet, like (dried) fruit, I fall asleep. My staple in carbs are plantain and sweet potato. This worked, more or less, for about 10 months. Now, for no reason I can see, I crave sweet and cacao. This is completely new, as I never had a sweet tooth and I always have chocolat in the house without craving it.

    • Perhaps you should try going ZERO carbs for a month and see if that helps. My guess is it will since it most likely will eliminate any and all cravings for sweets/carbs.

      • I’m wondering if going zero carbs for a month would then instruct your T4 to convert to too much RT3 making you short of T3.

    • Perhaps you just need to give the diet more time to feel better. If you’ve been eating carbs it will take your body some time to switch over to the natural state of burning fat for energy, including your brain. This is a good article that describes the process. http://fitness.mercola.com/sites/fitness/archive/2012/08/17/human-body-favors-fat-adaptation.aspx

      When I stopped carbs I felt awful. I had a fever that came and went, horrible cravings, headaches, my trips to the bathroom were urgent…for over a month I was passing blobs of mucous (yes, I said it). My sister-in-law had a similar experience but different. She got a body rash, extreme fatigue, debilitating aches (even worse than before). She even passed out cold a few times.

      I think Chris Kresser has written about fat adaption in the past. So has Mark Sisson and Joseph Mercola.

      What I took from it is that we are all different and what is going on inside our bodies is different so we are not going to react the same. What was miraculous to me was that after months of what seemed like an adjustment period, on a very strict diet, I felt 10 years younger and looked it too. When we switch our diets there’s a lot going on. My doctor described it as the good-guys crowding the bad-guys out and they weren’t leaving without a struggle.

      Give it time. Know that there will be discomfort. It’s a sign you are healing. When I read the comments section here I see so much hope, positive experiences and mentorship. It’s really uplifting and I wish everyone success and health.

  32. Hi

    I have HLA-B27 gene and AS. I am pain-free following a starch-free diet. I recommend reading up on Professor Alan Ebringer’s work. There is also a Facebook group called “The Low/No Starch Diet for Ankylosing Spondylitis” which I suggest anyone to join.

    Good luck…

  33. You want PROOF ????????????????? Then do a no starch diet for a set period of time & see first hand what happens to your body, since for unknown reasons it doesn’t seem to work for everyone, yet does work for many. 2.5 yrs ago I did it, after being convinced of the probable validity, from reading the AS/no starch research, and on the 4th day my Ankylosing Spondy (hla-b27 neg) was already 85% better, and remained better most of the time When I went no dairy as well, it remained about 85% better, but ALL the time ! No more antiinflams, steroids, Tramadol, Tylenol, etc. and the joy of walking again & being able to sit for longer than 3 minutes at a time without sacral pain. Over the course of the past 2.5yrs, did lots of “gut healing” efforts, but I always felt that those darn Klebsiellas were barely “controlled” & at bay only via the diet, but that I just couldn’t fully conquer them. Almost three months ago, I began a dis-parasite protocol, and by the end of the 1st month, I noticed that I felt even way more than 85% better & could FINALLY eat some significant amounts of starch & dairy again, without the usual repercussions. Time will tell how it goes, once I finish off the few remaining capsules of dis-parasite formula. Will have to go back and check my genetic testing for which HLA halotypes I tested as. Don’t wait for your conventional MD to recommend a no starch diet, as it will NEVER happen, and is certainly not necessary. You can control what goes into your mouth and do a trial just by yourself. I would never say it was easy, BUT neither was all that pain and immobility easy. Wishing you all the same degree of empowering success that I have experienced !

  34. I have a starch intolerance and have delayed reactions to grains and potatoes, and other things like tapioca. So I’m following these diet guidelines. My big question though is: How do we fed or gut bacteria while avoiding starch?

  35. I’m 70 y.o. and was diagnosed with HLA B27 some 19 years ago after my first bout of uveitis. I spent the previous 27 years on a farm, and had no problems.

    After moving to the coast, and in an urban environment, I developed severe uveitis and was sent straight to the eye doctor. This move, and the associated stress, bought on the condition..

    I had another bout 3 years later. After reading up on the condition, I started taking probiotics, and cut out eating bread.

    Have had no further problems since then, but have severely restricted my starch intake, but still eat potatoes now and again, and my besan pancakes which are made out of fermented chick pea flour.

    I find that bread is the main culprit which brings on an arthritic twinge.

    Thanks for the article.


  36. I have been on a low-starch diet since 2006, after reading Carol Sinclair’s book ‘The IBS Low – Starch Diet’ and realizing that what she was describing was me in a nutshell. I thoroughly recommend this book if you have tried gluten-free & still experience pain of any sort- A.S., gut, (crohns etc included), joints, back, knee, arthritis of any kind, etc.

    Carol explains how to test foods for starch and how to go about finding which foods affect you.

    This book has a forward by Alan Ebringer former professor of immunology at Kings College, London, who discovered that the Klebsiella bacteria in the gut mimic the B27 gene, and that they feed on starch. If starch is reduced klebsiella numbers are kept in check.

    I have not had blood tests done – it was enough for me to be free of pain. I have enlarged joints on my fingers but they are not painful unless I eat starchy foods, fructose or nightshades.

  37. I have had AS for 11 years. Undiagnosed until 2015. It’s been so enlightening to finally figure out the intense pain all of these years. So many doctors have no clue about how diet can effect health. I would never have guessed that changing my diet could help with my pain. But I switched to the AIP diet in December and my pain left for 5 straight months. I also incorporated doterra’s oils and vitamins. I then quit the diet, got lax, and had pain again. Not as severe but now I’m going back on the diet. I gotta learn to stick to it 🙂 it helps a ton.

  38. Our son (early 40’s) has ulcerative colitis, and so far is managing to keep full-blown flare-ups at bay through diet and supplements without prescription drugs. He had to go naturopathic because he reacted allergically to all the drugs normally used to control the condition, and refused to try remecade since it is a genetically manipulated IV administered med containing both human and trace mouse DNA. So, his diet is non-GMO, dairy-free, soy-free, caffeine-free, alcohol-free, canola-free, gluten-free, processed sugar-free, and at the moment, red meat-free, and no raw veggies. Even a minute amount of these leads to inflammation and colon pain.

    In being gluten-free, he avoids most grains, but tolerates gluten-free oats, grain alternatives, and paleo baked items. Interestingly, he also must avoid all products made with bread yeast, which in doing some research makes sense because baker’s yeast is cultured commercially in either malts or molasses, both of which contain traces of gluten as well as have a relatively high glucose/fructose content. Because of dietary restrictions, he does struggle with some nutrient deficiencies if any inflammation is occasionally present which restricts absorption, so his iron levels can be low along with resultant fatigue and low immunity to fight viral infections

    This article therefore does lend some scientific explanation as to why starch carbs (particularly from gluten grains) and sugars may be factors in triggering the autoimmune disease sequence at the genetic cellular level. He was asked by his gastroenterologist to participate in a scientific study soon to be conducted at the University of Alberta to determine whether inulin and polyglucosaccharide pre-biotics have a positive anti-inflammatory effect without having to surpress the immune system. He refused on the grounds that to participate in the double-blind study he would have to alter his current dietary and supplemental regime, and he did not want to go that route simply because so far what he is doing seems to be working, and he already knows from past experience submitting to the required sigmoid and colonoscopies during the study would set him back with little recourse to manage any resultant adverse flare-up since he has to be drug free! But otherwise, he really is interested in the resultant findings of this study, especially since he already is incorporating pre-biotics and pro-biotics into his current treatment regime, and is fairly low carb.

  39. My father had ankylosing spondylitis. I have celiac and have found that gluten free grains cause many of the same symptoms as gluten (brain fog, achey joints, gastric issues and a toxic feeling that lasts several days). I don’t have this issue with starchy vegetables. This could explain why. Thanks.

  40. 3 weeks on no starch diet. I would say that my pain level went from 7 to 5,5 but I lost weight, what is not very good for me but I continue.

      • I already posted how the Low Starch Diet has tremendously made a difference in managing my symptoms of AS for the last 5 years, and I am HLAB27 positive. I am just curious….is there anyone here who is NOT HLAB27 positive, yet they have still found the Low Starch approach helps them?

  41. I have AS and follow a low starch diet to control my symptoms. Have not been tested for HLA-B27. When my symptoms developed I knew that dietary changes would make difference – we recovered both our children from severeTourettes and OCD through diet and supplements – so I started searching and found the info on low starch for AS. Boom! With persistence and tweaking for individual needs, I went from near non-functioning to living my life. From 7-9 on the pain scale to 1-3. N=1, it works for me.

  42. Hi; I am so grateful for this info! I have palmpustular psoriatic arthritis/spondolitus, negative for HLA B27, but, have significant damage in SI joints and thorasic 6-12 fusing. I am 60 and have had this since mid 40’s but not diagnosed till 2 yrs. ago. I did a round of prednisone/methotrexate for 3 months, quit, and went on starch-free. cut severity of flares by 1/3 and am not bedridden. Flares last 2 to 3 weeks and cycle every 35 days approx. Recently I saw an MD, bio-med researcher dermatologist who told me I need to be on Stelara. Researching this I am unsure as to what to do. I had IBS most of my life until going starch free. I am following all leaky gut protocol/supplements, all of it! Even donating blood as I have excess iron in my blood. I did testing for heavy metals etc. I have better gut/digestion etc. now but still flare and the pain is debilitating. Should I continue on my path or risk going on the biologics. I don’t even take NSAIDS anymore for 2 yrs. now. How long can it take and can I send this into remission? Hard ??’s to answer I know! I would appreciate anyfeedback. Thanks!

    • I would be suspicious that you are being sold expensive drugs to treat symptoms… when diet and supplements may help you more. Look for a functional doctor, even if you have to travel and pay out of pocket, they will look for root cause.

    • Hi there, my son takes Humira and gets stellar results. He’s only 21. Your Rhumo doc can tell you all about it. Get on humira plan thru their company and the meds are only $5.00.

    • I would also recommend seeing a Functional Med Doctor. You may need to detox and your gut may take longer to heal, depending on the severity of damage. That’s awesome that the IBS symptoms are gone. Focusing on healing the gut is so important. I have Crohns AND Ankylosing Spondylitis. My gut symptoms improved dramatically by cutting out starches, dairy, and refined sugars. I found hidden sources of starch in my supplements and meds. Once I cut those out, my symptoms improved even more. So important to test EVERYTHING with iodine that goes into your mouth. I also took Ancient Nutrition Bone Broth Protein Powder and made smoothies with coconut milk and frozen blueberries. I used Green Tea Extract drops (half a dropper mixed in a glass of water) every day and I took Ginger Root capsules for inflammation and probiotics (I had to experiment to find one that helped) and fish oil. Over time, as my gut healed, my AS symptoms got better and better with fewer relapses in between. A Functional Med Dr will help you sort all this out. I would try all that FIRST before resorting to the meds. Conventional Docs wanted to put me on biologics years ago and just thought I was insane for managing my symptoms with diet and supplements. But when it came down to it, they couldn’t argue the results. I may still have a flare now and then, due to hormones, stress or the weather, but maybe only a couple times a year. I asked that Doc if I were on the Biologics, would I be free from all flares, and he said No, most patients still have flare ups, but the drug is considered to be working if the flares are reduced to only 3 or 4 per year. I looked at him and said that I have less flare ups than that now with my own approach, so why would I want to mess that up and make myself worse? He had no answer.

  43. Thank you for this article! I was diagnosed with AS back in 2012 and am HLA-B27 positive. I have struggled with severe SI joint pain since 2010 (starting when I got pregnant with my first child) – typically with a constant low grade pain, but on three occasions with a flare so severe that I couldn’t walk for almost a month because it felt like my hip would collapse if I put any weight on it (this happened at 6 weeks postpartum with each of my kids, and then randomly one year ago). I discovered the low starch diet a year ago and immediately stopped eating all grains/potatoes/etc. A month later I stopped eating dairy and refined sugar. This brought my pain down significantly but I still had random flares here or there, especially as I tried to add back in certain starchy vegetables. I took the LEAP MRT (a blood test that tests for delayed sensitivities to 150 foods) and discovered that I was severely sensitive to two foods I was eating regularly (beef and pork), and moderately sensitive to several other foods (including many of the veggies I noted caused me problems earlier). I stopped eating all of those foods in December 2015 and have been pain free since then (unless I cheat, which happens occasionally).

    Around the same time I started eating fermented foods with the hope of diversifying my gut bacteria and healing my gut (kimchee, kombucha, water kefir, milk kefir, natto). I think of it as having 20 people in a room (i.e. a diverse microbiome) – if one of them starts getting unruly, the other 19 have a very good chance of stopping the unruliness. If there are only 2 people in the room, there is very little chance of stopping the unruliness.

    I agree with Chris that a diet that is low starch or too low carb is ultimately bad for your gut bacteria (good or bad) – and I am always trying to diversify my diet – so about three months ago I decided to try a few french fries at dinner. I found that I was able to eat them without any issue, and have since added in breads made from sourdough starter – I think that the fermentation process in sourdough helps my body break down the bread quickly. I should say that I started with potatoes because the LEAP MRT test I took showed I didn’t have a sensitivity to them. I have not had the same luck with rice, sadly. Either way, I stick mainly to a low starch diet and eat some potato and sourdough here and there. The diet has really been a life saver and I *almost* feel normal again (minus some thoracic back pain I can’t seem to get rid of). Thanks for posting such a great article about the connection between HLA-B27 and starch!

  44. I am in my 50’s and have had issues throughout my life mostly with various sleep issues and fatigue. Severe PMS (later told PCOS), early environmental allergies with high antibiotic usage and possible mercury exposures etc.
    Told as a teen I had mold allergies, dust mite, dander causing my chronic rhinitis. Also, later on some severe antibiotic and pain medication allergies.
    About 10 years ago started getting more then normal aches and pains. Prior to these I had a hysterectomy, and then told I had insulin resistance a couple of years following that.
    High family history of cancers and autoimmune disease, but so far just keep getting told I have non definitive, elevated inflammatory markers and test negative for….
    I have been struggling trying to figure out how to get passed the fatigue and think how to fix the pain, but keep getting lost.
    I think I am on the right track with some things though eg. (Looking back, high stress from various life situations prior to unplanned move to an area with high humidity, home that had leaks months before we bought it and several medications that I now believe contributed). I actually had just requested an HLA-B27 test 2 months ago (told it was also negative) and recently started questioning mold with heavy rains this year, while struggling with what to eat and steadily falling farther behind on life and feeling overwhelmed about how much I am missing out on.
    Anyway, I have questioned getting so much worse when I had cut out more meats and added in more beans and grains years ago after being told to do that because of family colon cancers and (just prior to insulin resistance showing it’s head) and despite being told no that could not have been the issue I have been gravitating back to a more paleo diet. However, just had doctor tell me the other day I need to add more grains, veggies and fiber to my diet (without even asking me what I was eating).
    I am so lost… It is so hard to think my way out of this.
    Is there not something I can easily just print out and follow along to start to feel better?

    • Hi Beth – my heart goes out to you with all your health issues. I too am in my fifties and have had a lifetime of health problems. All my tests came back negative and I’ve been made to feel that I was making it all up. After no resolution from two rheumatologists (and many other doctors along the way) I’ve been muddling along on my own.This year my pain reached crisis point and i decided to try one more rheumatologist – a really expensive one with a good reputation. He has finally diagnosed me with spondyloarthropathy, main components of ankylosing spondylitis, plus Sjögrens and fibromyalgia. I gave up his medication after two months of horrible side effects and switched to the no starch diet. It has been fantastic, though not yet perfect. I’m finding that there are other foods I need to watch out for like nuts and seeds – they also give me pain. I’m dairy free except for butter. How about going strictly starch and dairy free for a few days to see if it helps? If it does, you could slowly reintroduce other foods to see what’s what. You might find more help on the Kickas website. Good luck!

  45. Thank you for this article. I went to my doctor with “arthritic-like” symptoms, stiff, noisy joints, extremely painful back, fatigue. He tested me for Klebsiella and HLA-B27 (unsure of the subtype). I was positive for both.
    He suggested a no starch, no sugar diet (essentially Paleo with a few modifications for the no starch & no sugar). I can attest that almost immediately my pain went away and I had so much energy back. I can also add that for me this isn’t a “sort of Paleo diet” or “80% paleo”. It’s all or nothing for me personally. If I eat any starch or sugar (including fruit) the pain comes back almost immediately.
    I’ve been on this diet for over 2 years, the healing process is slow but so worth it. I would also add my mother that has has “arthritis” for most of her life has gone on the diet as well and has had tremendous pain relief and success.
    Best to all.

  46. We have this conversation often in our Spondylitis group. Based on Dr. Ebringer and the London AS Diet. Many follow it with success, some being a little more Paleo & adding intermittent fasting.

  47. I will ask my dr to test. I do have high igA, at the top end of normal range. Can celiac disease cause that? ( I have it ) and / or can candida cause high igA too?

  48. Thank you Chris, again, for all the research you’re doing and informing us.
    Although I don’t have a “starch problem” having reduced “simple starches” does seem to add to better health for me!

    I think what you’re discussing is just the tip of the iceberg…and soon many more “genetic connection’ will be linked to other diseases.

  49. I had been diagnosed of HLA-B27 positive about 6 years ago after undergoing a severe episode of Iritis and major back and lower hip pain. Ever since, I have had done a lot of reasearch on my own and through a support group called Kickass.org, I started experimenting the low start diet. I highly recommend a book called “IBS Low Starch Diet” by Carol Sinclair. It has a lot of interesting and useful information in it. Although I would still get flare ups in my eye every year or two, my other symptoms in the joints have reduced tremendously ever since I cut out my starch and processed sugar. My next goal is to have put my Iritis in remission as well.

    • I am HLA-B27 positive and went gluten free and now low starch. I can tell a big difference in joint pain. Wanted to let you know, I discovered my iritis is triggered by hair dye. I am able to use Henna, but everything else seems to trigger a response – even the hypoallergenic dyes result in a bout of iritis approximately 2 – 4 weeks after use.

      • Hi Sharon, thank you for youre insight, I have gone Gluten-free for the past couple of weeks and wheat free, my low back pain has subsided a bit, someone at work told me to take Magnesium and thats also helping for over all body aches. I am a young 54 and try to stay active. finding it hard to choose some meals like breakfast as I loved my toast and peanut butter and now I cant have that, but I guess its a small comprimise if its going to make me feel better!! Thanks again.

  50. Thanks for the article helping me understand what HLA B27 typing actually means.

    Erythema nodusum is another auto-immune disease associated with HLA B27 typing. I understand some families with A.S. will sometimes have other members with Crohn’s Disease.

  51. hi chris I was Dx with AS 33yrs ago and I am HLAB27 positive. the lower starch diet and following the AIP and now going Paleo has helped me significantly. Thanks for a informative post.
    Keep up the great work as I’m a big fan and follower.

  52. Hi Chris,
    I have AI condition since child.
    My history: birth by cesarean, i don’t have mother’s milk, psoriasis, many alergic crisis, and high doses of cortisone
    My gut “was broken” when I have 16 years (ten years ago), and for many years I used laxative pills diary. Sad.
    Today i’m diagnosed with celiac disease also
    Many doctors said (during all my life): it’s emotional, you need therapy
    So, I had therapy and pay lots of money for nothing

    I started Paleo in 2013, when (like you) I had a general colapse in my health
    Since when I cut off starch of my life. And slow down all carbs.
    I tried resistent starch some times, but it’s horrible for me also.
    Many fibres are horrible X 100.

    I’m using cycles of Elixa (www.elixa-probiotic.com/) like a probiotics since last november, and is very well.
    Today I’m Keto, and supplement with oil fisl, d3, multivitamin, gaba – and sometimes with 1,5 mg of ldn.
    I have acupuncture and autohemotherapy (10ml) once time at week

    I’m brazilian and Scientist of Human Ecology. My job give me knowledge and freedom.

    I learned so much with you in the last years
    Thanks for all

  53. Actually, I have been on a very restricted minimal carbohydrate diet for a number of years, still with chronic pain from osteoarthritis. I have also had constipation issues. I have recently begun to add limited carbohydrates to my diet in the hopes that this will help with my constipation issues. Thanks to this article, I will be very cognizant to observe any changes in my osteoarthritis symptoms. Thank you

    • BL- In this short article Chris cited 28 studies to support the hypothesis presented and suggested using the principle of n=1 (self-experimintation) to determine effectiveness on an individual basis. What further “proof” is needed to give the ideas presented merit in your mind?

    • Like you, I want proof too!

      Luckily for both of us, Chris includes references to the scientific literature for each of his claims. See those numbers in the brackets eg “(28”) at the end of each paragraph? Click on those and then read the articles.

    • The proof is in trying it yourself, won’t hurt you, won’t cost you much, simple but takes some effort, its going to be positive benefit or not.

    • I am proof. A low-starch diet reduced my AS symptoms about 80-90% (I started the diet in January 2012). It’s not even that hard to try out and see, as the symptoms will resolve quickly. The downside (obviously) is that avoiding starch is a sizable dietary adjustment. For me, I learned low-carb wasn’t very good for me either and I was inadvertently starving myself, so now I actually consume a fair of amount of simple sugars (honey, maple syrup, sucanat, fruits that are ripe, even some natural soda sometimes, like Reed’s Ginger Beer, coconut water).

      I also discovered lactose sets off some mild symptoms. So, I tend to avoid that too.

    • I’ve been on the no/low starch diet for 3.5 years and I can say that I’ve seen an immense difference. I am HLA B27+ (haven’t checked deeper than that) with numerous AI issues (Axial spondylitis, psoriatic arthritis, PBC, colitis, psoriasis…) It took 3 months of strict no starch to see results, but that first morning of waking up without pain cinched the deal. If anecdotal evidence means anything (and I believe it does), I encourage you to check out kickas.com or The Low/No Starch Diet for Ankylosing Spondilitis page on Facebook. There you will find a community of people who have conducted/continue to conduct this experiment on themselves, and who tweak the approach on a personal and daily basis.

    • Yes, I have a autoimmune disease called Mixed Connective Disease.
      The effects of carbs and sugar sounds like a case of Candida, if you ask me. Been dealing with since many antibiotic back in 2005. They are now saying autoimmune disease is caused by an infection. There you go, good old Western Medicine!

    • I also, like thousands others, am living proof. I have AS and Crohns. I started in 2012 with a 3 day fast, and then the low starch diet. I went from a pain level of 10 down to a 5 within about 4 days. So I was encouraged to stick with the diet. After 2 weeks my pain was down to a two and I have maintained this success since then. I was taking no other medications at the time so nothing else could have had this affect but the diet. If I deviate from the diet by eating even just one spoonful of starch, my AS pain shoots up to a 10 again within 2 hours. What other proof do I need. That’s more powerful to me than a piece of paper with writing on it. However, there is a substantial amount of written scientific proof as well. Do yourself a favor and experiment with the diet. It can do no harm. But to be a fair test, you must follow it strictly and not cheat. I suggest starting off with a mini fast first, to clear your body. For more information, keep your eyes open for a new website that will be coming Online in a couple months: http://www.AnkylosingSpondylitisCenter.org.

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