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Article written by
Kimberly Mugler, R.D.N., L.D.N.
There is very little available research on the connection between spondylitis and diet. Spondylitis is an inflammatory form of arthritis that causes joint pain — most commonly in the lower back. Axial spondyloarthritis, the most common subtype of spondylitis, is categorized by whether the damage it causes can be seen in X-rays. Ankylosing spondylitis is a form of axial spondyloarthritis diagnosed when inflammation and damage are visible in imaging scans. Nonradiographic axial spondyloarthritis is diagnosed when the damage is not yet visible in X-rays.
There is no conclusive research that a specific diet can prevent, cure, or improve the symptoms of spondylitis at any stage. However, eating an anti-inflammatory diet or avoiding certain foods associated with inflammation may help.
Inflammation is an immune system response that occurs when white blood cells and chemical messengers are activated by the presence of injury or infection. The hallmarks of inflammation are pain, warmth, swelling, and redness. Inflammation occurs in acute and chronic forms. When we get sick, our body responds with short-term (or acute) inflammation to fight off the infection or protect the injury from further damage. This is a normal and healthy response. Long-term, chronic inflammation is linked with several inflammatory conditions including spondylitis, rheumatoid arthritis, diabetes, heart disease, and more.
There are several causes of chronic inflammation. Common culprits include stress, inconsistent sleep, poor diet quality, and autoimmune diseases. Spondylitis is an autoimmune disease that creates inflammation and attacks the joints. In individuals with spondylitis, inflammation can lead to joint pain, eye pain, fatigue, and problems with mobility.
An anti-inflammatory diet is technically any diet that reduces inflammation in the body. It is important to understand that the scientific evidence on an anti-inflammatory diet for spondylitis is scarce. Nonetheless, the benefits of an anti-inflammatory diet are known to reduce inflammation in the body, which may help with symptoms of spondylitis. The most popular types of anti-inflammatory diets are the Mediterannean diet, a high-fiber diet, and a vegan diet.
A Mediterannean diet is rich in oleic acid, omega-3 fatty acids, whole grains, and phytochemicals. The diet contains high amounts of olive oil, fish, legumes, fruits, vegetables, nuts, and seeds. It limits red meat and refined grains, and it includes moderate consumption of red wine. The Mediterannean diet is linked with reduced rates of vascular inflammation, oxidative stress, and several chronic diseases, such as diabetes, high blood pressure, metabolic disease, and heart disease.
Diets rich in high-fiber foods may help lower body weight, nourish beneficial bacteria in the intestines, and lower levels of C-reactive protein (CRP) — a marker of inflammation — in the blood. Foods with abundant fiber include most fresh fruit and vegetables, whole grains, beans, and many nuts.
Those following a completely vegan diet avoid all foods that come from animals, including dairy, meat, fish, eggs, and honey. Some studies indicate that a vegan or even vegetarian (incorporating dairy and eggs, but no meat) diet may help reduce inflammation, but more research is needed. Avoiding meat is associated with a healthy body weight, lower blood pressure, and lower cholesterol.
Many MySpondylitisTeam members have reported following an anti-inflammatory diet as they seek to manage their condition. “I was able to stop four meds when I changed my eating habits,” shared one.
Foods and nutrients that have proven anti-inflammatory effects on the body include omega-3 fatty acids, spices like turmeric, antioxidants, whole grains, and more. These nutrients are present in the Mediterannean diet, which is the diet most correlated with an anti-inflammatory eating style. The Mediterannean diet is a healthy diet option for most people, especially those suffering with autoimmune diseases.
There are key nutrients in the Mediterannean diet that may specifically improve spondylitis symptoms.
Studies have suggested that olive oil can reduce the risk or progression of rheumatoid arthritis. Extra virgin olive oil has been linked to reduced levels of cartilage damage and joint damage. Olive oil is a monounsaturated fatty acid proven to decrease the risk of heart disease and to lower LDL cholesterol (the “bad kind” of cholesterol).
Dietary fiber remains one of the most influential foods for the prevention and management of inflammation. Fiber is also beneficial for healthy weight, blood sugar control, cholesterol management, and a healthy gut microbiome. Some studies have found relationships between dietary fiber intake and the inflammatory biomarkers, but other studies have found contradictory reports. Despite no conclusive evidence supporting a relationship between fiber intake and arthritis symptoms, the U.S. Food and Drug Administration still approves claims of fiber being beneficial for health.
Fiber is considered a prebiotic, which promotes the growth of healthy bacteria in the gut microbiome. A healthy gut microbiome is related to decreased risk of chronic disease and inflammation.
It’s hard to think of an anti-inflammatory diet without antioxidants. Antioxidants are substances that prevent or delay cell damage. Antioxidants tend to be associated with phytochemicals and flavonoids, which are two other components of an anti-inflammatory diet. Phytochemicals and flavonoids are compounds found in plant-based foods that fight free radical damage and decrease inflammation. Eating a variety of fresh fruits and vegetables and whole grains is an easy way to ensure you are getting enough antioxidants, phytochemicals, and flavonoids. Try to eat five servings of vegetables per day and two or three servings of fruit per day.
Turmeric, ginger, and black pepper have antioxidant properties that may decrease inflammation. These are spices that can be used while cooking vegetables, soups, stews, smoothies, and more. Green tea contains polyphenols and antioxidants called catechins. Some research suggests that catechins may disrupt the process that causes inflammation and arthritis. Substituting green tea for coffee may provide beneficial effects.
MySpondylitisTeam members often share creative ways to incorporate these ingredients. “I have turmeric powder in my coffee and my orange juice. I also make smoothies with it,” said one member. “I like to make a tonic with pineapple, a tablespoon or so of coconut oil, turmeric, and sometimes I add tart cherries when I have them,” shared another. “I'm changing my diet to reduce inflammation,” announced another. “Switching to green tea and adding turmeric wherever I can, along with gingerroot.”
Omega-3 fatty acids are an important component of an anti-inflammatory diet. They come in three different forms: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA cannot be made by the body, so it is crucial to obtain it from the diet. It is found in chia seeds, flaxseed, soybeans, and canola oil.
Studies have found that people with rheumatoid arthritis, another type of inflammatory arthritis, who take omega-3 supplements may require less pain relief medication. Remember to always consult your physician before starting a new supplement to ensure it does not interact with any other medications. Getting omega-3 fatty acids in your diet can be made easier by adding chia seeds and flaxseed meal to oatmeal and smoothies. It is recommended to consume two servings of fatty fish (such as sardines, mackerel, or tuna) per week, as well.
Several foods can contribute to inflammation. Refined grains, starch, and added sugar are often thought to encourage inflammation. They spike blood sugar levels, leading to increased production of insulin. Sodium should also be avoided, as studies have linked high intake of salt with arthritis. Use herbs and spices, which have healthy components, instead of salt to flavor dishes.
“When I eat too much sugar, I am ripped from sleep because of intense muscle cramping in my leg,” said one MySpondylitisTeam member. “I personally found ALL grains cause me problems, except white rice,” wrote another member. “Legumes appear problematic, as well, and I found dairy caused symptoms resembling seasonal allergies.”
“I’m going to try the low-starch diet for a few months and see if there is a change,” said another.
Saturated fat and trans fats are two culprits of inflammation. Saturated fat is found in red meat and processed meat, as well as full-fat dairy products. Trans fats are found in baked goods, fried foods, and some shelf stable or frozen products. It is important to always read nutrition labels, and steer clear of products with hydrogenated oils or high fructose corn syrup listed as ingredients. Fried foods should be eliminated or avoided. Dairy should be limited to no more than three servings per day.
Some MySpondylitisTeam members report that drinking alcohol worsens their symptoms. “I’ve recently learned that having alcohol the night before seriously aggravates my [ankylosing spondylitis]!” wrote one member. “My rheumatologist had mentioned this to me, so I gave it a little test, and man was he right!😮” Another member shared, “I had to remove alcoholic beverages from my downtime also. So not worth the pain the next day.”
Keeping a food diary can be an easy way to identify foods that trigger your spondylitis symptoms to flare. Either on paper or using an app, track what you eat each day and how you feel. Watch for patterns of worsening pain in the hours or days after eating certain foods. If you suspect a food is associated with a spondylitis flare, try eliminating it and track results in your journal.
You can also take a systematic approach to evaluating your diet for inflammation triggers by doing an elimination diet. This strategy helps you eliminate all common inflammatory foods, then slowly add them back in while monitoring how your symptoms change.
While some foods are more common triggers for inflammation, there is no way to know what yours are without paying close attention to the association between what you eat and how you feel.
A MySpondylitisTeam member shared how an elimination diet helped her: “The first thing I did was cut out all processed (fast) foods. Then I went on to eliminate other foods that caused me to flare — beef, pork, and artificial sweeteners. It took a long time, but was well worth it. I suggest taking it step by step and talking with your doctor. Every person is going to be different.”
Rather than trying to completely cut out favorite foods that might be problematic, focus on limiting your consumption to rare occasions. “I still allow myself to eat some of those favorite items every once in a blue moon,” shared one MySpondylitisTeam member. “I allow myself one small indulgence a week,” said another. “Carrot cake is my favorite.”
The most important goal is to gain a better understanding of which foods affect you.
“I still eat what I want for special occasions or vacations,” wrote one member. “But now I can do so with the knowledge of how it will affect my body.”
Before starting an anti-inflammatory diet, it might be a good idea to do a pantry sweep. Discard anything that lists trans fats or saturated fat in the ingredients on the nutrition label. This includes the phrase “hydrogenated oil.” Avoid all products that contain high fructose corn syrup. Common culprits are snacks like crackers, dressings, marinades, and other packaged goods.
After a pantry sweep, it’s time to fill your kitchen with healthy, anti-inflammatory foods. Grocery shopping can be a challenge with spondylitis pain and fatigue. “Going to get groceries is so hard. Tires me out!” wrote one MySpondylitisTeam member. Ordering grocery delivery is an increasingly popular way to stock up on food. Depending on where you live, you may be able to set up a monthly or biweekly produce delivery box from a local farm.
Here are some staples to include on your grocery list to follow an anti-inflammatory diet:
Be sure to include plenty of fresh or frozen vegetables on your shopping list. You really can’t go wrong in this department. When choosing frozen vegetables, steer clear of items that include sauces, salt, and other additives.
Fruit is another healthy source of fiber and antioxidants, but it should be eaten in moderation like most foods. Most Americans only need two or three servings of fruit per day, due to its high carbohydrate content. Look for the smallest fruits you can buy when it comes to options like apples, peaches, pears, and oranges. Berries, like blueberries or strawberries, tend to yield a larger serving size for a smaller calorie and carbohydrate content. They are also higher in fiber than most fruits.
Cooking, like shopping, can be difficult for those living with spondylitis. Taking breaks and involving other members of the household can help. “I cook and every five minutes I sit for a few minutes due to back pain. That’s how I cook,” shared one MySpondylitisTeam member. “I tested out a new recipe with my granddaughter. I did what I could, and she did the actual cooking,” wrote another.
An important component of healthy eating is to make a plan each week. Use a notepad or journal to organize meals, and focus on one meal per week to get started. This can help prevent feeling overwhelmed.
Here are a few anti-inflammatory recipes to try over the first few weeks. Rather than overhaul your entire diet overnight, consider just starting with breakfast.
Try egg white muffins for breakfast and stick with your normal lunch and dinner recipes. This recipe helps you get a serving of vegetables in with breakfast to boost fiber and antioxidant intake.
Incorporate a new fish recipe for dinner — such as this salmon.
From there, try getting into the habit of preparing salads for lunches that are full of vegetables to reap the anti-inflammatory benefits. This recipe is a unique way to enjoy a Mediterannean salad without too much work.
It can be a learning curve as you try new recipes and methods of cooking to adapt your diet. However, there are delicious and satisfying replacements for most ingredients, and they are easier to find than ever. “You can make decent gluten-free cornbread, corn tortillas, and socca without wheat,” explained one MySpondylitisTeam member. “I cook with almond meal, sweet rice flour, and garbanzo bean meal. I add turmeric when I can to foods like rice for anti-inflammatory benefits. You do have to learn to cook if you don't already.”
Be patient with yourself as you learn. There are cooking videos online that demonstrate how to make thousands of different recipes. Find a website or a YouTube channel with recipes you like and easy-to-follow videos.
Members of MySpondylitisTeam are often excited to share healthy new meals they create. “Non-inflammatory lunch!” wrote one member proudly. “Kale slaw, sprouts, mushrooms, pumpkin seeds, green onions, with homemade dressing. Fresh squeezed orange, EVOO [extra virgin olive oil], and agave nectar.”
Changing eating habits can be hard. When you join MySpondylitisTeam, you gain a social support network of more than 53,000 people living with spondylitis. Members cheer each other on through challenges relating to diet, offer tips and recipes, and help each other stay on track.
“I know I should do the anti-inflammatory diet, but food is my comfort,” lamented one member. “I have to choose — pain or diet. Anyone else face this dilemma?” Another member responded with compassion and encouragement: “There are times I struggle with that too. But I have decided feeling good is better!” A different MySpondylitisTeam member shared a mantra that works for him: “Nothing tastes as good as feeling good feels.”
Here are some recent conversations on MySpondylitisTeam about following an anti-inflammatory diet:
Here are a few question-and-answer threads about anti-inflammatory diets for spondylitis:
Have you tried an anti-inflammatory diet? Are there any foods you’ve used or avoided to help with your spondylitis symptoms and overall health? Comment below or start a conversation on MySpondylitisTeam.
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