Skip to main content

The Use of a Low Starch Diet in the Treatment of Patients Suffering from Ankylosing Spondylitis

Clinical Rheumatology volume 15, pages 62–66 (1996)Cite this article

Summary

The majority of ankylosing spondylitis AS) patients not only possess HLA-B27, but during active phases of the disease have elevated levels of total serum IgA, suggesting that a microbe from the bowel flora is acting across the gut mucosa.

Biochemical studies have revealed that Klebsiella bacteria, not only possess 2 molecules carrying sequences resembling HLA- B27 but increased quantities of such microbes are found in fecal samples obtained from AS patients and such patients have Crohn’s like lesions in the ileo- caecal regions of the gut. Furthermore AS patients from 10 different countries have been found to have elevated levels of specific antibodies against Klebsiella bacteria. It has been suggested that these Klebsiella microbes, found in the bowel flora, might be the trigger factors in this disease and therefore reduction in the size of the bowel flora could be of benefit in the treatment of AS patients.

Microbes from the bowel flora depend on dietary starch for their growth and therefore a reduction in starch intake might be beneficial in AS patients. A “low starch diet” involving a reduced intake of “bread, potatoes, cakes and pasta” has been devised and tested in healthy control subjects and AS patients. The “low starch diet” leads to a reduction of total serum IgA in both healthy controls as well as patients, and furthermore to a decrease in inflammation and symptoms in the AS patients.

The role of a “low starch diet” in the management of AS requires further evaluation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Reference

  1. Ebringer, A. Theoretical models to explain the association of HLA-B27 with ankylosing spondylitis. Scand J Rheumatol 1990, sup 87, 151–163.

    Google Scholar 

  2. Schwimmbeck, P.L., Yu, D.T.Y., Oldstone, M.B.A. Autoantibodies to HLA-B27 in the sera of HLA-B27 patients with ankylosing spondylitis and Reiter’s syndrome: molecular mimicry with Klebsiella pneumoniae as potential mechanism of autoimmune disease. J Exp Med 1987, 166,173–181.

    CAS  PubMed  Article  Google Scholar 

  3. Fielder, M., Pirt, S.J., Tarpey, I., Wilson, C, Cunningham, P., Ettelaie, C, Binder, A., Bansal, S., Ebringer, A. Molecular mimicry and AS: possible role of a novel sequence in pullulanase of Klebsiella. FEBS Letters 1995, 369, 243–248.

    CAS  PubMed  Article  Google Scholar 

  4. Ebringer, A., Ahmadi, K., Fielder, M., Rashid, T., Tiwana, H., Wilson, C, Collado, A., Tani, Y. Molecular mimicry: the geographical distribution of immune responses to Klebsiella in ankylosing spondylitis and its relevance to therapy. Clin Rheumatol 1995,15(Suppl.l), 57–61.

    Google Scholar 

  5. Ebringer, A. Ankylosing spondylitis is caused by Klebsiella: Evidence from immunogenetic, microbiologic and serologic studies. Rheum Dis Clin N Amer 1992,18,105–121.

    CAS  Google Scholar 

  6. Veys, E.M., Van Laere, M. Serum IgG, IgM and IgA levels in ankylosing spondylitis. Ann Rheum Dis 1977, 32, 493–496.

    Article  Google Scholar 

  7. Cowling, P., Ebringer, R., Ebringer, A. Association of inflammation with raised serum IgA in ankylosing spondylitis. Ann Rheum Dis 1980, 39, 545–549.

    CAS  PubMed  Article  Google Scholar 

  8. Cowling, P., Ebringer, R., Cawdell, D., Ishii, M., Ebringer, A. C-reactive protein, ESR and klebsiella in ankylosing spondylitis. Ann Rheum Dis 1980, 39, 45–49.

    CAS  PubMed  Article  Google Scholar 

  9. Mielants, H., Veys, E.M., Cuvelier, C, De Vos, M. Ileocolono-scopic findings in seronegative spondyloarthropathies. Brit J Rheum 1988, 27(Sup. 2), 95–105.

    Article  Google Scholar 

  10. Finegold, S.M., Sutter, V.L., Sugihara, P.T., Elder, H.A., Lehmann, S.M., Philips, R.L. Fecal microbial flora in Seventh Day Adventist populations and control subjects. Amer J Clin Nut 1977, 30, 1781–1792.

    CAS  Google Scholar 

  11. Deschamps, A.M., Richard, C, Lebeault, J.M. Bacteriology and nutrition of environmental strains in Klebsiella pneumoniae involved in wood and bark decay. Ann Microbiol (Inst Past) 1983, 134A, 189–196.

    CAS  Article  Google Scholar 

  12. Ebringer, A., Baines, M., Childerstone, M., Ghuloom, M., Ptaszynska, T. Etiopathogenesis of ankylosing spondylitis and the crosstolerance hypothesis. Adv Inflam Res 1985, 9,101–128.

    Google Scholar 

  13. McNeil, N.I., Bingham, S., Cole, T.J., Grant, A.M., Cummings, J.H. Diet and health of people with an ileostomy. 2. Ileostomy function and nutritional state. Brit J Nut 1982, 47, 407–415.

    CAS  Article  Google Scholar 

  14. Anderson, I.H., Levine, A.S., Levitt, M.D. Incomplete absorption of carbohydrate in all-purpose wheat flour. New Engl J Med 1981, 304, 891–892.

    CAS  PubMed  Article  Google Scholar 

  15. Nissila, M., Lahesmaa, R., Leirisalo, M., Lehtinen, K., Toivanen, P., Granfors, K. Antibodies to Klebsiella, E.coli and Proteus in ankylosing spondylitis: Effect of sulfasalazine treatment. J Rheumatol 1994, 21, 2082–2087.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Immunology Section Division of Life Sciences, King’s College, Campden Hill Road, Kensington, London W8 7AH, UK

    A. Ebringer & C. Wilson

  2. Department of Rheumatology, UCL School of Medicine, Middle sex Hospital, London, England

    A. Ebringer

Authors
  1. A. Ebringer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ebringer, A., Wilson, C. The Use of a Low Starch Diet in the Treatment of Patients Suffering from Ankylosing Spondylitis. Clin Rheumatol 15, 62–66 (1996). https://doi.org/10.1007/BF03342649

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03342649

Keywords

  • Ankylosing spondylitis
  • Low Starch Diet
  • Treatment of AS