Category Archives: Ankylosing spondylitis

Update: Attacking Ankylosing Spondylitis with PHD

Posted by on November 18, 2014 52 comments

UPDATE: Steven has created his own website with more information, www.recoveryfromas.com. Check it out!

In January I wrote about Steven Morgan’s recovery from Ankylosing Spondylitis on a modified version of PHD. Steve generously shared his email address and has been trading ideas with other Ankylosing Spondylitis (AS) sufferers.

Steve had a flare of his AS recently after drinking some dirty water on a camping trip, so he has had to re-recover from AS. He recounts his recent experiences here:

Commentary

AS sufferers often see symptoms flare when consuming starch. This may be, as Alan Ebringer has argued for the last 20 years, because the disease is caused by a Klebsiella infection in and around the gut. Infiltration of Klebsiella into lymph nodes around the gut can lead to formation of antibodies that cross-react between Klebsiella lipopolysaccharides and our native HLA-B27 and collagen. These autoantibodies can generate autoimmune attacks on collagen, a characteristic of all the spondyloarthropathic diseases. [1] [2] [3] [4] [5] [6] [7]

Klebsiella is a carbohydrate-metabolizing bacterium; in cell cultures, any carbohydrate – glucose, fructose, galactose, and compound sugars such as sucrose, lactose, and starch – will facilitate Klebsiella growth. This has led Ebringer to advocate a diet low in carbohydrate for AS patients. Since resistant starch is the largest source of carbohydrate fiber in modern diets, that means a low-starch, low-carb, high-protein diet.

The general tendency of PHD is the opposite: we recommend getting about 30% of calories as carbs, and 5/6 of all carb calories from glucose. On a natural whole foods diet, this means that starches are a significant part of the diet.

PHD is generally a gut-friendly, fiber-rich diet. A diverse gut flora is associated with good health, and achieving a diverse gut flora requires a diet rich in carbohydrate fiber including resistant starch from cooked-then-cooled starchy foods.

This raises a tension in many gut diseases:

  • Symptoms flare whenever starches and other foods rich in carbohydrate fiber, such as the FODMAP bearing fruits and vegetables, are eaten.
  • However, there cannot be a full recovery until a complete gut flora has been restored, which requires feeding probiotic bacteria with starches, fruits, and vegetables.

Ebringer’s recommendation of a low-carbohydrate diet is palliative but not necessarily curative. It reduces symptoms, but it doesn’t by itself roll back the infection or bring about growth of a beneficial gut microbiome.

As a temporary therapeutic measure to facilitate a full recovery, I often suggest using dextrose in place of starches as a source of carbs, along with steps to support immunity and development of a probiotic gut flora.

Dextrose is pure glucose. It is rapidly absorbed in the small intestine and therefore is unavailable to gut bacteria. Dextrose can therefore provide enough carbs to support immune function, mucus production, collagen repair, and general good health, without providing any fiber to gut bacteria.

Steps like consumption of liver, sun exposure, intermittent fasting, and circadian rhythm entrainment will further support immune function and aid suppression of the infection that caused the disease.

During this period of low-fiber dieting, eating fermented vegetable juice and other sources of probiotic bacteria can help displace bad bacteria from the gut. As probiotic microbes become more dominant in the gut, normal whole foods can gradually be restored, allowing a probiotic bacterial population to grow in place of the pathogenic bacteria.

Steven has largely followed this plan of attack, with success. It should work for all the spondyloarthropathic diseases including rheumatoid arthritis. I’d love to hear from others who try it.

References

[1] Fielder M et al. Molecular mimicry and ankylosing spondylitis: possible role of a novel sequence in pullulanase of Klebsiella pneumoniae. FEBS Lett. 1995 Aug 7;369(2-3):243-8. http://pmid.us/7649265.

[2] Ebringer A et al. Molecular mimicry: the geographical distribution of immune responses to Klebsiella in ankylosing spondylitis and its relevance to therapy. Clin Rheumatol. 1996 Jan;15 Suppl 1:57-61. http://pmid.us/8835505.

[3] Tani Y et al. Antibodies to Klebsiella, Proteus, and HLA-B27 peptides in Japanese patients with ankylosing spondylitis and rheumatoid arthritis. J Rheumatol. 1997 Jan;24(1):109-14. http://pmid.us/9002020.

[4] Rashid T et al. The potential use of antibacterial peptide antibody indices in the diagnosis of rheumatoid arthritis and ankylosing spondylitis. J Clin Rheumatol. 2006 Feb;12(1):11-6. http://pmid.us/16484874.

[5] Ebringer A et al. A possible link between Crohn’s disease and ankylosing spondylitis via Klebsiella infections. Clin Rheumatol. 2007 Mar;26(3):289-97. http://pmid.us/16941202.

[6] Rashid T, Ebringer A. Ankylosing spondylitis is linked to Klebsiella–the evidence. Clin Rheumatol. 2007 Jun;26(6):858-64. http://pmid.us/17186116.

[7] Rashid T et al. The link between ankylosing spondylitis, Crohn’s disease, Klebsiella, and starch consumption. Clin Dev Immunol. 2013; 2013:872632. http://pmid.us/23781254.

Curing Ankylosing Spondylitis

Posted by on January 4, 2014 112 comments

UPDATE: Steven has a new video update, to which I have added an updated commentary: Update: Attacking Ankylosing Spondylitis with PHD, November 18, 2014. FURTHER UPDATE, September 2015: Steven has created his own website with more information, www.recoveryfromas.com. Check it out!

Ankylosing spondylitis is a fearsome disease. The Mayo Clinic states:

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture. A severe case of ankylosing spondylitis can make it impossible for you to lift your head high enough to see forward….

Inflammation also can occur in other parts of your body — such as your eyes and bowels.

There is no cure for ankylosing spondylitis, but treatments can decrease your pain and lessen your symptoms.

But the “no cure” part is probably mistaken. Yesterday I received an email from Steven Morgan:

Hey Paul,

Your website and book saved my ass and gave me a chance to recover from Ankylosing Spondylitis, no small feat.  I made a video about it here:  http://www.youtube.com/watch?v=qvgjJTLrM3M

There was a thread on your site about high cholesterol and possible causes when going Paleo.  That thread was HUGE in my recovery….  My cholesterol fell over 200 points in two months!

Anyhow, you’re the best.  Thank you!

Cheers,

Steven

Here’s Steven’s story:

In a follow-up email, Steven elaborated:

My health is fantastic lately!  I’m still able to push the edges of what I can tolerate, and am enjoying eating butter, some white-rice based gluten-free breads, some vegetables, and occasionally cheddar cheese.  Sure beats just the 5 foods I took on my trip!  Well, to be honest, after several months of just eating coconut, cacao, pemmican, fish, and white rice, I grew quite fond of it all.  It’s amazing how your palate can change.

I gave Steven a few suggestions that I think would help anyone with AS:

  • Nutrition:
    • Vitamin A (1/4 to 1/3 lb liver per week plus spinach, sweet potatoes, yams, carrots, persimmons)
    • Vitamin D from sun and supplements.
    • Vitamin C
    • Collagen from soups and stews with joints, bones, tendons, and tripe.
    • Zinc and iodine.
  • Circadian rhythm entrainment
  • Intermittent fasting

Steven wants to share experiences with other ankylosing spondylitis sufferers; he asked me to “let folks know I’d be happy to connect; I’m especially interested in connecting with other people who have AS!” You can reach Steven by email at stevenmorganjr@gmail.com.

Conclusion

The Mayo Clinic is correct that medicine offers no cure for ankylosing spondylitis; but diet and lifestyle may do better. AS is probably an infectious condition caused by a pathogenic gut flora. Improved immune function and remodeling of the gut microbiome ought to be able to work a cure.

Steven experimented with a no-starch diet, but had better results on something more PHD like. As we’ve discussed, eating carbs is important for formation of the intestinal mucosal barrier and for proper immune function. A very low-carb diet often delivers short-term relief by starving pathogens, but it doesn’t support a probiotic gut flora and can bring long-term problems from suppressed immunity and impaired gut barrier integrity. That often leads to food sensitivities like those Steven suffered from. It’s better to obtain sufficient dietary carbohydrates to support a healthy gut. White rice is often one of the easier carbs to start with.

Thanks for writing, Steven! Your experiences and video should give hope to AS sufferers everywhere!