It is fairly uncontroversial that type II diabetes has diet as one of the root causes. There have been diet studies done to demonstrate that, at least in early stages, it can be reversed by diet alone.
At Cedar Sinai hospital, the AS rheumetologist happens to share an office area with a nutrition department supporting diabetes patients, who can really use the help from professionals. They also need support from their close family members, or else it is almost impossible. As a result, very few people who actually have type II diabetes have managed to cure themselves by diet -- they are frequently on prescription drugs to control it!
So, suppose for the moment that diet were a significant contributing factor to AS.
In one sense we are in the same boat as the diabetes patients, in that it is very challenging to design a successful diet treatment without the support of experts. Many people will fail, and a few very determined, with very supportive families and/or friends, or perhaps less far-advanced in disease will succeed. So the case-study results will be mixed, which is what I've observed.
Side note: people who succeed at diet while others fail do not have the right to be arrogant about how they have "so much more determination and will-power". Their whole life situation contributed to success as well... for instance they either have a super-dedicated loved one preparing starch-free dairy-free whatever-free meals for them, or they still have sufficient health to be able to shop and cook things from scratch. Also the availability or lack of availability of starch-free produce in local markets could have a big impact on whether you succeed or not. In addition there is the question of how long it takes to respond to diet; those who see even small results in a few weeks have a
huge advantage over someone who wouldn't be able to discern any improvement without strict compliance for a whole year.
So, what about the research studies on diet: if diet is a valid approach to treating AS, why isn't anybody publishing papers on it?
Even if diet works, it would still be hard to get the large-scale medical studies going to provide evidence. There are millions of people with diabetes, and governments have pegged it as a high-priority public health issue -- how many people have even
heard of AS in comparison?
On the other hand, rheumetologists
have heard of AS, and could be doing small-scale studies of diet similar to those old London studies that certain people are getting tired of. Why aren't they?? Doctors are people too, and are influenced by current medical culture and what they were taught in school. Diet treatments were NOT taught much in medical school; they are the realm of nutritionists, not hot-shot arthritis researchers. Biotech is very hot and glamorous, and the lead researcher for the AS study in which I participate is just as turned on by new biologics as I am by elegant software design. At the moment he doesn't want to spend his time designing nutritional studies instead, and figuring out how to recruit enough patients who will actually be compliant day in and day out for months and years at a time. What exactly is his motivation to switch?
Another side note: I have doctors in my family, and a cousin currently in med school. Note that I
didn't say they are all in the pockets of the drug manufacturers. Sure drug companies have an influence on mainstream medical knowledge by making it easy to get funding for certain types of studies, but they haven't perfected mind-control or anything.
I do know one doctor who studied at UCLA (very traditional, well-respected medical school) but has sort of a maverick personality and keeps a close watch on "alternative" medicine areas to learn what the mainstream medical practices might be missing. He found that diet is one of those areas, and has incorporated it into his practice. He has had good success in treating many "ADD" (Attention Deficit Disorder) children with diet instead of drugging them like just about every other doctor in our county. He also happens to be my doctor, and his professional opinion on auto-immune arthritis (as a GP, not a specialist) is that:
* the immune system is flared up over some type or types of germs chronically present in the body
* starch-free diet cuts down on a known reservoir of potentially problem-causing germs, especially important if the gut is "leaky"
* finding the right drug to kill the problem germs could also work well, but some bacteria are
very tricky about hiding inside cells and are nearly impossible to eradicate (see
http://cpnhelp.org/ for example of a tricky bug implicated in some cases of auto-immune diseases such as MS and non-AS arthritis)
So, I've got one "mainstream" doctor who likes to organize big research projects and focuses on high-tech treatment of symptoms rather than exploring causes, and one "maverick" doctor who is interested in exploring diet and antibiotics but only on a patient-by-patient basis -- no interest in organizing research projects, doesn't have time left after his practice and raising his kids. No prospect in sight for getting into a rigorous study on diet, and that is where we all stand right now...
). In fact, my own GP likes to read case studies for ideas on what to try.