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

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

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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.

hla b27 positive diet
Starchy foods can make some autoimmune disease symptoms worse. A low-starch diet can help. istock.com/enot-poloskun

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.

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  1. 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.

  2. 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!

  3. I have joint pain… my fingers, wrist and angles.. Received my blood test HLA-B27. PLEASE HELP

    • Hi Mariuz,
      I made a short video to share how I manage AS pain free. I hope it helps you 🙂

      • 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.

  4. 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

  5. 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 ?

      Thanks,
      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.

  6. 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.

  7. 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.

  8. 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!

  9. 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–
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845688/

    • 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

  10. 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
      Daniela

  11. 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.

  12. 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.

  13. 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.

  14. 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!

  15. 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!

  16. 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.

  17. 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.