Ankylosing spondylitis (AS) is a chronic, inflammatory condition primarily affecting the spine. While there is no cure for AS, early diagnosis and appropriate management techniques can help individuals cope with symptoms and reduce the risk of complications. Emerging research suggests that diet can play a significant role in managing AS symptoms and overall well-being. This article explores dietary recommendations for individuals who are HLA-B27 positive, focusing on foods that can help fight inflammation, support bone health, and manage weight, while also highlighting foods to limit or avoid.
Understanding HLA-B27 and Its Connection to Diet
HLA-B27 is a gene that is strongly associated with spondyloarthritis (SpA), a group of inflammatory diseases that includes ankylosing spondylitis. While the exact mechanisms are still unknown, recent data suggests that HLA-B27 may predispose individuals to AS by altering the intestinal microbiome.
Research indicates that diet impacts the composition of gut microbiota, representing a substrate for the synthesis of metabolites affecting the mucosal immune system. Certain pro-inflammatory mediators, such as emulsifiers and microparticles, induce a more profound cytokine response, promoting inflammation. This knowledge has allowed progress in pharmacological therapy. The role of diet in the pathogenesis and treatment of diseases pertaining to the HLA-B27 spectrum is of great significance, considering possible future applications in individualized medicine.
Key Dietary Recommendations for HLA-B27 Positive Individuals
1. Embrace an Anti-Inflammatory Diet
Adopting an anti-inflammatory diet, similar to the Mediterranean diet, may help reduce inflammation in the body. This approach emphasizes whole, unprocessed foods and limits those known to trigger inflammation.
- Leafy Greens: Incorporate leafy greens such as spinach, collard greens, kale, and Swiss chard into your diet. These are rich in magnesium, which is known to decrease inflammatory markers. Cooking them with garlic and olive oil can maximize their benefits.
- Broccoli: This cruciferous vegetable contains sulforaphane, an antioxidant that may help reduce levels of inflammatory compounds.
- Onions: Onions, garlic, shallots, and leeks are part of the allium family and are rich in sulfuric compounds, which have anti-inflammatory properties. Onions are also packed with quercetin, a flavonoid that helps inhibit inflammation-causing agents in fats.
- Berries: Strawberries, raspberries, blueberries, and blackberries are rich in antioxidants, which help decrease inflammation and fight the effects of free radicals. Much of their inflammation-fighting power comes from anthocyanin, the antioxidant flavonoid that gives them their distinctive color.
- Wild Salmon: Fatty fish is the superstar protein when it comes to an anti-inflammatory diet due to the omega-3 content. Omega-3s may help reduce chemicals that create inflammation in your body. Other fish with anti-inflammatory benefits include rainbow trout, mackerel, sardines, and Atlantic cod.
2. Focus on Omega-3 Fatty Acids
A diet high in omega-3 fatty acids has a consistent but modest positive effect on joint inflammation associated with rheumatoid arthritis (RA), a condition similar to AS. Good sources include:
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- Chia seeds
- Fatty fish, such as salmon, sardines, and tuna
- Flaxseed and flaxseed oil
- Walnuts
3. Prioritize Whole Grains
Whole grains are high in fiber and nutrients. Examples include brown rice, corn, quinoa, buckwheat, and oatmeal. According to a 2018 meta-analysis, whole grains may also help reduce inflammation across the body. However, grains containing gluten - such as barley, wheat, and rye - may trigger people with celiac disease or a gluten sensitivity. As AS is a similar inflammatory condition, grains may also be a trigger for people with this condition.
4. Incorporate Anti-Inflammatory Herbs and Spices
Certain herbs and spices may also be anti-inflammatory, including:
- Garlic: Some compounds in garlic exhibit anti-inflammatory properties.
- Ginger: Gingerols, a major compound in ginger, can help reduce arthritis and pain.
- Turmeric: Curcumin, a main component of turmeric, may help reduce inflammation.
5. Consume Plenty of Fruits and Vegetables
Eating a variety of fruits and vegetables each day ensures a high intake of many of the vitamins and minerals necessary for overall health. These foods also tend to be low in calories and high in fiber. Focus on colorful fruits and vegetables, as they are typically high in antioxidants. Antioxidants may help with AS symptoms because they protect cells from substances called free radicals, which may contribute to inflammation.
6. Ensure Adequate Calcium and Vitamin D Intake
AS weakens the bones, which is why calcium-rich foods are so important. Calcium is essential for improving bone strength. Food sources high in calcium include:
- Fortified plant milks and cereals
- Dairy products, such as milk, yogurt, and cheese
- Dark leafy greens, such as watercress and kale
- Broccoli
- Almonds
- Canned sardines with bones
- Chinese cabbage
- Fortified tofu
Vitamin D allows the body to absorb calcium and is another vital nutrient for healthy bones. Higher levels of vitamin D are associated with a lower risk of developing AS. The body gets vitamin D from sun exposure and foods such as:
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- Fish and seafood
- Egg yolk
- Cod liver oil
- Fortified products, such as juices, cereals, dairy, plant-based milk, and tofu
- UV-treated mushrooms
7. Maintain a Healthy Weight
Maintaining a moderate weight is important for people with AS, as excess weight places stress on the bones and joints of the body, which can worsen symptoms. Carrying excess body weight can lead to greater inflammation, more severe symptoms, and a higher risk for structural damage in people with AS.
8. Stay Hydrated
Drinking 8 to 10 glasses of water every day is important for everyone, including people with AS.
Foods to Limit or Avoid
While there is limited evidence to support a direct link between specific foods and AS symptoms, some foods are known to trigger inflammation and may worsen symptoms.
1. Sugar and High-Fructose Corn Syrup
Added sugar and refined foods can lead to inflammation in the body. Reduce the amount of sugary foods and beverages you consume, including desserts, candy, pastries, and sodas.
2. Salt and High Sodium Foods
High salt intake has been linked to the production of an inflammatory cell that has links to autoimmune conditions. Reducing salt intake may be a good idea to help manage the condition.
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3. Red and Processed Meats
Red meat contains certain compounds that can aggravate inflammation, including saturated fat. Processed foods are typically low in fiber and high in sodium, and they often contain inflammation-promoting refined grains and sugars.
4. High-Fat Foods
Foods that contain saturated fats include pizza, red meat, cheese and full-fat dairy products, and processed foods. Excess consumption of omega-6 fatty acids may trigger the production of pro-inflammatory chemicals.
5. Alcohol
People with AS should try to limit their alcohol intake or completely avoid it. Heavy alcohol use can affect bone mineral density and increase the risk of osteoporosis. Alcohol may also interact with AS medications and reduce nutrient absorption.
6. Gluten
Gluten-containing grains - such as wheat, rye, and barley - may contribute to inflammation in some people.
Specific Diets to Consider
1. Mediterranean Diet
Healthcare providers usually recommend the Mediterranean diet as the most heart-healthy diet. In one study of 7,000 people, those that ate a Mediterranean diet were 30% less likely to have a heart attack or stroke than people who ate a low-fat diet. People who swapped their usual foods for more foods in line with the Mediterranean diet saw positive improvement in their AS symptoms.
2. Low-Starch Diet
The low-starch diet cuts back or eliminates starchy foods, a type of carbohydrate. One study found that the diet reduced AS symptoms and inflammation. However, this study only included a small number of people and the specifics of the low-starch diet in the study were not well defined. Foods you should avoid on the low-starch diet include bread, grains, pasta, popcorn, rice, and starchy fruits and vegetables.
3. Gluten-Free Diet
For people with celiac disease, gluten causes severe inflammation and damage to their small intestines. But it may also trigger an immune response in people without the disease. Since both celiac disease and AS are immune disorders and people with AS often have gastrointestinal problems too, eliminating gluten may help.
4. Keto Diet
The keto diet, where calories come primarily from fat, has rapidly gained a loyal following since its reboot. Research indicates that the keto diet shows promise in reducing inflammation by stabilizing blood sugar and helping you lose weight.
The Importance of Personalized Nutrition
Foods that trigger pain and other symptoms of AS vary from person to person. Keeping a food diary for a month can help a person pinpoint any foods that seem to make their symptoms worse. When testing different dietary changes for AS, keep a food journal. Note your symptoms to see if the diet reduces any of the following: fatigue, pain, swelling, and stiffness.
Additional Considerations
1. Supplements
A person with ankylosing spondylitis should consider supplementing their diet with calcium and vitamin D. Certain supplements may also be recommended to compensate for drug side effects. Talk to your doctor about which supplements are right for you.
2. Probiotics
Consuming probiotics may be helpful for people with AS. A disease-causing bacteria called Klebsiella may play a role in the development of the condition and is present in the bowel flora of those with AS. Probiotics may alter the gut microflora to help reduce a person’s susceptibility to AS. However, more research on humans is required to confirm the benefits of probiotics on AS.
3. Medications
It is important to find out from your doctor whether any medications that you take affect how your body uses what you eat. Avoid alcohol or foods that can interact with your medication.
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