Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Diet, disease activity, and GI Symptoms in AS

Recent study on diet and disease activity in Ankylosing Spondylitis:

http://www.springerlink.com/content/hj61r46078v45756/

dated August 12, 2010

"The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered postal questionnaire regarding demographic data, diet, medication, and gastrointestinal symptoms in addition to two established disease assessment questionnaires, i.e., the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). "

"Despite these connections between the gut and AS, surprisingly few studies have investigated the effect(s) of diet on AS disease activity and associated clinical gastrointestinal symptoms. The primary aim of this study was to investigate the relationship between diet and disease activity, using a cross-sectional design, among patients with AS without a diagnosis of IBD. Secondly, the study aimed to investigate the presence of gastrointestinal symptoms and their relationship to diet among such patients."

"No significant correlation between diet and disease activity was found. Overall, 27% of the patients reported aggravating gastrointestinal problems when consuming certain foodstuff(s). The 30% of patients who reported suffering from gastrointestinal pain had significantly greater disease activity and poorer functional status according to their BASDAI and BASFI scores (p&#8201;<&#8201;0.01 and p&#8201;=&#8201;0.01, respectively). Patients who reported gastrointestinal pain had a significantly higher consumption of vegetables (p&#8201;<&#8201;0.01) and lower consumption of milk and soured milk (p&#8201;=&#8201;0.04). No significant correlation was found between the use of non-steroidal anti-inflammatory drugs (NSAID) and gastrointestinal symptoms. In multiple regression models, BASDAI and the consumption of vegetables were independent and statistically significant predictors of gastrointestinal pain."

"No correlation between dietary intake and disease activity, as measured by BASDAI, was found when considering the patient group as a whole."

"To conclude, we found no obvious correlation between diet and disease activity in AS. There were, however, correlations between diet and gastrointestinal pain. These gastrointestinal symptoms seem to be independent of NSAID usage. Since the gastrointestinal problems may contribute to the suffering and disability of patients with AS, we propose that further research of the gastric complaints, their relationship to disease activity, gut flora metabolism, and diet is needed."

I done the nsd and lsd and it helps me and my wifes IBS/IBD problems but it does nothing for my AS.

does NOT surprise me in the least

But they are looking at day-to-day consumption on an 'average' Western diet.

They have not investigated the effects of *eliminating* particular foodstuffs for an extended period. NO diet is going to change things (like a systemic illness) overnight...

Hi,

That sounds like me.
But I had nothing to do with the study lol.
"Diet" in this sense must mean food consumption of any kind.

Soured Milk???

Take care,
James

...an odd term for yogurt, cottage cheese, sour cream, etc. - anything made from fermented milk.

My kids stopped eating my homemade yogurt when they heard it referred to this way. Oddly, they still eat store-bought yogurt...

You are correct in that they did not ask AS patients to modify their dietary habits. They did ask very specific questions about the AS patient's dietary habits. Some of those participating reported aggravated AS symptoms associated with food/diet. Assumably if they believe that there is a dietary connection to their symptoms, they were are already on some form of modified diet. We don't actually know how many patients ate a traditional "Western" diet and how many were NSD/LSD/other dietary restrictions. What was apparent from this particular study was that there was no apparent connection between objective measures of AS symptoms (BASDI) and diet consumed.

" Dietary habits were assessed by a validated 84-question semiquantitative food frequency questionnaire (FFQ) [8], which had been used in the MONICA studies. This questionnaire contained pictorial examples of portion sizes on four different plates regarding vegetables, meat, or fish and a staple foodstuff such as rice, pasta, or potatoes. The frequency was reported on a nine-level scale ranging from never to four times or more, per day. These frequencies were converted to a monthly basis and pooled into groups to describe food patterns."

"Seven patients reported that they experienced aggravated arthralgia or AS symptoms associated with a particular foodstuff, most commonly vegetables/fruits (n&#8201;=&#8201;2) or food rich in flour (n&#8201;=&#8201;2). No correlation between dietary intake and disease activity, as measured by BASDAI, was found when considering the patient group as a whole. With regard to gender differences, females had a significantly lower intake of fats and a higher consumption of fruit, vegetables, fiber, and fish compared with males (Table 1)."

So far, the only thing I have noticed about changing my diet is that vegetables make my UC much worse.I tried the NSD/LSD although I couldn't stick with it more then a week at a time without getting UC problems. I couldn't fast more then 24 hours. My UC flares when my AS flares.

It is well known that one of the major genetic factors associated with AS is the IL-23 receptor (IL23R) so it's worth understanding just how IL-23 interacts with AS pathogenesis.

Accumulating evidence indicates that IL-23 is a likely master regulator of mucosal immunity during GI infection and inflammation.

A recent study of 13000 IBD patients found a significant increase in diseaes incidence (IBD) in individuals who were exposed to Salmonella/Campylobacter gastroenteritis in the previous year. That is, IL-23 may not only play a role in Salmonella/Campylobacter-mediated host immunity, but it may prove pivital in modulating susceptibility to IBD post-Salmonella/Campmplyobacter gastroenteritis.

Thus IL-23 mediated IBD may set the stage for AS in those individuals 'lucky' enough to be also HLA-B27 (and possibly also with the relevant ERAP1 allele).

The other question is what is it about a high vegetable intake that would worsen AS symptoms. Well, possibly bacteria that benefit from high sugar / starch, for example, the Gram negatives such as Klebsiella are the chronic target of an innate immune-mediated IBD attack and hence drive the AS.
There are other potential Gram Negative bacteria that could also be implicated such as anearobic Gram negatives such as Bacteroides / Prevotella species.

If this is truly a study about diet and AS (which seems like a stretch in my opinion), why are NSAIDS part of the picture? It doesn't make sense to me.