John:

I've been thinking about how to reply to this post for sometime now. I can't imagine any reason why Canadian physicians would fear the wrath of their American counterparts if they felt the information was evidence-based. Regardless, that's a small point. Speaking from personal experience, while the physicians I have spoken are aware of Ebringer's diet, none of them recommend it to their patients. I'm sure you'll find variability in those that are willing to discuss it's validity. Some will discredit it outright. Others will likely support patient endeavours as long as it is not detrimental to their health.

I have to admit that I'm a little concerned about your idea that physicians would knowingly withhold a dietary treatment from patients because it is easier to write a Rx. There are many examples where physicians suggest dietary changes to their patients - type II (or late age onset) diabetes is a prime example of a condition where physicians try to get results by modifying diet and lifestyle before they prescribe meds. Other conditions associated with heart disease like dyslipidemia and hypercholesteremia follow similarly. Furthermore, looking at the statistics on obesity and other lifestyle measurements in North America, I would propose that some patients are reluctant to follow doctor's orders on diet and lifestyle, but would rather get the Rx that you suggested was easier for the doc to write. (Not to mention other reasons other than solely motivation - like those in remote communities or of low socio-ecomonic status who cannot employ the suggested changes, but thats a discussion for another time I think).

Getting back to my initial point - physician suggested dietary management of illness... Perhaps the most striking example of a physician approved dietary management of illness is the gluten free diet for Celiac disease.

http://www.mayoclinic.com/invoke.cfm?id=DS00319#Treatment

This comes from the Mayo Clinic and states
"Celiac disease has no cure, but you can effectively manage
the disease through changing your diet.Once gluten is
removed from the diet, inflammation in your small intestine
will begin to subside, usually within several weeks. At first
you may need to take vitamin and mineral supplements
recommended by your doctor or a dietitian to help correct
nutritional deficiencies. Significant healing and regrowth of
the villi may take several months in younger people and as
long as 2 to 3 years in older individuals.

Improvements from eating a gluten-free diet may be
especially dramatic in children. Not only do their physical
symptoms improve, but also their behavior often improves
and their growth starts to pick up."

I guess I'm curious about where the difference lies between Celiac and AS. If both the gluten free and no starch diets are equally evidence based, why is one supported by physicians but not the other?

Personally speaking, I dont believe that any physician should omit diet moderation in the medical management of AS patients. At the very least, suggesting that patients attempt as healthy a weight as possible is probably solid advice, so that there is less additional stress on already sore joints. And, even ancedotal evidence should be included in conversations with patients that ask specifically about symptom management with diet, if for no other reason than in the context of patient autonomy. But it would be negligent to propose only dietary management to patients when peer reviewed evidence doesnt support it.

Look forward to your reply.
Jeanna



'I would have cried and laughed less while watching
TV and more while watching life - EB'