There is little available research that is conclusive about the connection between ankylosing spondylitis and diet.1 Ankylosing spondylitis is an inflammatory form of arthritis that causes joint pain — most commonly in the lower back.2
Axial spondyloarthritis, the most common subtype of spondyloarthritis, is categorized by whether the damage it causes can be seen in X-rays. It can be radiographic, called radiographic axial spondyloarthritis or ankylosing spondylitis, when inflammation and damage are visible on X-rays. Nonradiographic axial spondyloarthritis is diagnosed when the damage is not yet visible on X-rays.3
There is no conclusive research that a specific diet can prevent, cure, or improve the symptoms of spondylitis at any stage.1 However, eating an anti-inflammatory diet or avoiding certain foods associated with inflammation may help.4
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 around the affected area. Inflammation occurs in acute and chronic forms.5
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.5 This is a normal and healthy response. Long-term or chronic inflammation happens when inflammation is activated for an extended period of time.5 Chronic inflammation is linked with several inflammatory conditions, including spondyloarthritis, rheumatoid arthritis, diabetes, and heart disease.5 Inflammation in spondyloarthritis can affect more than just the back. It may also cause eye, skin, and gut issues, as well as peripheral symptoms, or symptoms in the arms and legs.3
An anti-inflammatory diet is a way of eating that aims to help reduce inflammation in the body. Eating anti-inflammatory foods or following an anti-inflammatory diet may help reduce symptoms of chronic pain from inflammatory arthritis like spondyloarthritis.4 Popular types of anti-inflammatory diets include the Mediterranean diet, a high-fiber diet, and a vegan diet.4,6,7
A Mediterranean diet is rich in omega-3 fatty acids, unsaturated fats, and phytochemicals.8 The diet contains high amounts of olive oil, fish, legumes, fruits, vegetables, nuts, and seeds. It limits red meat and refined grains, and may include moderate consumption of red wine.8
The Mediterranean diet has been linked with lower rates of vascular inflammation, oxidative stress, and several chronic diseases, such as diabetes, high blood pressure, metabolic disease, and heart disease.8
Diets rich in high-fiber foods may help lower body weight, nourish beneficial bacteria in the intestines, and reduce levels of C-reactive protein — a marker of inflammation — in the blood.6 Foods with abundant fiber include most fresh fruits and vegetables, whole grains, beans, and many nuts.6
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 diet that is vegan or even vegetarian (incorporating dairy and eggs but no meat) may help reduce inflammation, but more research is needed. Avoiding meat is associated with a healthy body weight, lower blood pressure, and lower cholesterol.7
Foods and nutrients that have proven anti-inflammatory effects on the body include omega-3 fatty acids, spices like turmeric, antioxidants, and whole grains.4,9,10 These nutrients are present in the Mediterranean diet, which is correlated with an anti-inflammatory eating style.4
Eating in alignment with an anti-inflammatory diet could be a healthy option for people with inflammatory diseases.4 However, it’s always best to discuss any potential dietary changes with your primary health care or rheumatology provider to ensure you’re making adjustments that are healthy and safe for you.3
Some key nutrients of an anti-inflammatory diet may help improve spondyloarthritis symptoms.
Olive oil and flaxseed oil are considered key components of an anti-inflammatory diet.4 One study conducted on mice found an association between extra-virgin olive oil and reduced levels of cartilage damage and joint damage.11 Olive oil is high in monounsaturated fatty acids, which have been shown to help decrease the risk of cardiovascular disease when consumed as part of a Mediterranean diet.8
Dietary fiber may be helpful for the prevention and management of inflammation. Fiber is also beneficial for healthy weight, cholesterol management, and a healthy gut microbiome.6
Some studies have found relationships between dietary fiber intake and inflammatory biomarkers like CRP.6 Reduced levels of CRP and inflammation may not necessarily translate to reduced spondyloarthritis symptoms, but decreasing CRP levels may help improve overall health.6
Fiber is considered a prebiotic, which promotes the growth of healthy bacteria in the gut microbiome.12 Some experts believe the health of the gut microbiome is a factor in arthritic disease.12
It’s hard to think of an anti-inflammatory diet without antioxidants. Antioxidants are substances that may prevent or delay cell damage. Antioxidants tend to be associated with phytochemicals and flavonoids, which can be two other components of an anti-inflammatory diet. Phytochemicals and flavonoids are compounds found in plant-based foods that fight inflammation.13
Eating a variety of fresh vegetables and fruits is an easy way to ensure you are getting enough antioxidants.14 US food and nutrition policy encourages people to eat more fruits and vegetables.14
Turmeric and ginger are recommended as part of an anti-inflammatory diet and may help decrease inflammation.4 These spices can be used when preparing vegetables, soups, stews, smoothies, and more. Green tea and water are also considered key components of an anti-inflammatory diet.4
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 ginger root.”
Omega-3 fatty acids are an important component of an anti-inflammatory diet. They come in three 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 your diet.15
Omega-3 fatty acids can be taken through supplements but they are also present in a variety of foods, like flaxseed oil, soybean oil, chia seeds, walnuts, fish, and some other seafoods.15 Studies have found that people with rheumatoid arthritis, another type of inflammatory arthritis, have experienced reduced symptoms with a diet rich in omega-3 fatty acids.4
Getting omega-3 fatty acids in your diet can be made easier by adding flaxseed to oatmeal and smoothies.4 Fish, such as salmon, tuna, and sardines, are high in omega-3 fatty acids as well.15
Several foods can contribute to inflammation and potentially symptoms of arthritis. Processed foods and sugars are often thought to encourage inflammation.12
“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.
A variety of foods common in the Western diet may contribute to inflammation, including processed and sugary foods.12 Foods that contain soy, eggs, gluten, dairy, alcohol, and certain meats may be inflammatory in some people but not in others.12 You might also have sensitivities to some of these foods.4 It is important to always read nutrition labels so you can know the ingredients in the foods you’re eating.
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 spondyloarthritis 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 spondyloarthritis flare, try eliminating it and track the results in a journal.4
You can also take a systematic approach to evaluating your diet for inflammation triggers by doing an elimination diet.12 This strategy helps you eliminate all common inflammatory foods, then slowly add them back in one by one while monitoring how your symptoms change.12
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.12
A MySpondylitisTeam member shared how an elimination diet helped them: “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 for your spondyloarthritis, 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 and your spondyloarthritis symptoms. “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.”
Changing eating habits can be hard. When you join MySpondylitisTeam, you gain a social support network of more than 89,000 people living with spondyloarthritis. Members offer support through challenges relating to diet and offer their own tips and recipes.
Have you tried an anti-inflammatory diet? Are there any foods you’ve used or avoided to help with your spondyloarthritis symptoms and overall health? Comment below, or start a conversation on MySpondylitisTeam.
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GL-DA-2300220. Date of preparation: September 2023
© UCB Biopharma SRL, 2023. All rights reserved.
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