What diet is recommended for managing ankylosing spondylitis?

Diet Recommendations for Ankylosing Spondylitis

There is no specific diet that has been conclusively proven to treat ankylosing spondylitis, but an anti-inflammatory diet rich in omega-3 fatty acids and fiber while limiting ultra-processed foods may help reduce disease activity and improve symptoms.

Current Evidence on Diet in Ankylosing Spondylitis

The ASAS/EULAR management recommendations for ankylosing spondylitis do not specifically mention dietary interventions as part of the core treatment approach 1. Instead, they emphasize that optimal management requires a combination of non-pharmacological and pharmacological treatments, with NSAIDs as first-line drug therapy and physical therapy as a cornerstone of non-pharmacological management.

However, emerging research suggests that nutrition may play a supportive role in managing symptoms and inflammation:

Potentially Beneficial Dietary Approaches

1. Mediterranean Diet

   • May have beneficial effects on inflammation and symptoms 2
   • Rich in fruits, vegetables, whole grains, fish, and olive oil
   • Emphasizes anti-inflammatory foods

2. Omega-3 Fatty Acid Intake

   • Higher doses of omega-3 supplements (4.55g/day) have been associated with decreased disease activity according to BASDAI scores 3
   • Low intake of omega-3 PUFAs is associated with higher disease activity as measured by ASDAS 4
   • Sources include fatty fish, flaxseeds, and walnuts

3. Fiber-Rich Diet

   • Low fiber intake is associated with higher disease activity 4
   • Emphasize whole grains, legumes, fruits, and vegetables

4. Weight Management

   • Higher BMI and waist circumference are associated with higher disease activity 4
   • Hypocaloric diets and weight loss may benefit overweight/obese patients with SpA by reducing systemic inflammation 2

Dietary Factors to Limit

1. Ultra-Processed Foods

   • High intake is associated with increased disease activity as measured by BASDAI 4
   • Limit convenience foods, sugary beverages, and highly processed snacks

2. Potential Food Sensitivities

   • Some patients may have sensitivities to certain foods containing gluten, which can trigger or worsen symptoms, especially when associated with intestinal inflammation 2
   • Individual food sensitivities may vary and could require personalized dietary adjustments 5

Practical Dietary Recommendations

Based on the available evidence, the following dietary approach may be beneficial:

1. Increase consumption of:

   • Fatty fish (salmon, mackerel, sardines) 2-3 times per week
   • Olive oil as the primary cooking oil
   • Fresh fruits and vegetables (aim for 5+ servings daily)
   • Whole grains and legumes for fiber
   • Nuts and seeds (particularly those high in omega-3s like walnuts and flaxseeds)

2. Decrease consumption of:

   • Ultra-processed foods and snacks
   • Refined carbohydrates and added sugars
   • Excessive red meat
   • Foods that may trigger individual symptoms

3. Consider supplementation:

   • Omega-3 fatty acids (higher doses around 4-5g daily may be more effective) 3

Monitoring Dietary Impact

Patients should consider keeping a food diary to track potential associations between specific foods and symptom flares. This can help identify individual triggers that may not apply to all patients with ankylosing spondylitis.

Important Caveats

1. Diet should be considered an adjunctive approach to standard medical therapy, not a replacement for conventional treatments 5.

2. The genetic factors and immunopathogenesis of ankylosing spondylitis cannot be changed by diet alone, and effective pharmacological therapy is always required 5.

3. Individual responses to dietary interventions may vary significantly, as nutrient-receptor interactions occur differently in each patient 5.

4. Current evidence on dietary interventions in ankylosing spondylitis is limited, and more robust research is needed before making definitive recommendations 2.

Remember that while diet may help manage symptoms, it should be part of a comprehensive treatment approach that includes appropriate medication, regular exercise, and physical therapy as recommended by the ASAS/EULAR guidelines 1, 6.