The Best and Worst Foods for Ankylosing Spondylitis

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What you eat can impact inflammation within the body. More research is needed on the link between ankylosing spondylitis (AS) and diet. But a healthy diet, in addition to conventional treatment, may help reduce symptoms and prevent flare-ups in this type of inflammatory arthritis.

This article describes how diet impacts ankylosing spondylitis, including foods to include and foods to avoid if you have AS.

A person takes a forkful of vegetables from a plate of traditional vegan Lebanese cuisine

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How Diet Impacts AS

It's well known that what you eat and put in your body daily can affect your health. When it comes to AS, this seems to be no exception. There is some research suggesting that choosing foods that are considered low-inflammatory may help with managing symptoms of ankylosing spondylitis

Bacteria in the gut (together called the gut microbiome) are directly affected by the types of foods you eat. When the gut microbiome is out of balance, autoimmune conditions, such as AS, may be triggered. In autoimmune conditions, the immune system mistakenly attacks a person's own tissues.

Because AS is an inflammatory condition, following an anti-inflammatory diet may help support a more balanced gut microbiome, thus helping to ease the symptoms of AS.

An anti-inflammatory diet emphasizes whole, plant-based foods rich in antioxidants, healthy fats, and phytonutrients (beneficial nutrients found in plants). This includes plenty of vegetables, fruits, nuts, seeds, healthy oils, whole grains, and fish.

Link Between AS and Gastrointestinal Issues

People with AS are more likely to develop gastrointestinal (GI) issues, such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). Additionally, people with IBD are at increased risk of developing AS, with an estimated 5% to 10% of people with AS also being diagnosed with IBD.

It is thought that the relationship between AS and GI issues has to do with the imbalance of the gut microbiome and the subsequent inflammatory reaction.

Foods to Avoid

In an effort to reduce the amount of inflammation in your body, removing substances that promote inflammation is a good place to start. Some foods are known to increase inflammation in people with AS, especially if consumed in excess. Below are foods to limit or avoid on an anti-inflammatory diet.

Sugar

Several studies have reported that high added sugar intake, specifically from sugar-sweetened beverages, may be a contributing factor to inflammation, as measured by an inflammatory marker called C-reactive protein (CRP).

The Dietary Guidelines for Americans recommend that everyone 2 years of age and older should limit their intake of added sugars to no more than 10% of their total daily calories. For a 2,000-calorie diet, this is about 12 teaspoons.

Natural sugars in fruit and dairy do not count towards this. Added sugars are found in foods such as sugar-sweetened beverages, desserts, and sweet snacks.

High-Sodium Foods

Sodium is a nutrient known for causing fluid buildup in the body when consumed in excess, leading to high blood pressure. In addition, corticosteroids that are sometimes prescribed to people with AS can cause the body to hold on to more sodium.  Some research also suggests that a high sodium intake may contribute to increased inflammation.

Foods high in sodium often include frozen prepared meals and foods, canned foods, cold cuts and cured meats, breads, cheese, and savory snack items, such as potato chips and pretzels. Instead of seasoning your food with salt, try flavoring your meals with herbs, spices, onion, garlic, citrus, or vinegar.

High-Fat Foods

Several studies have reported that a high fat consumption contributes to inflammation. In particular, saturated fats made up of long-chain fatty acids (such as in palm oil) have pro-inflammatory effects, as seen in many studies.

Other foods high in saturated fats include fatty meat, lard, butter, cheese, cream, some baked goods, and deep-fried foods. The Dietary Guidelines for Americans recommends that no more than 10% of the total calories you eat and drink daily should come from saturated fats.

The American Heart Association recommends further restriction to 5% to 6% of calories coming from saturated fat. For a 2,000-calorie diet, that’s about 13 grams of saturated fat per day.

Trans fats, made from partially hydrogenated oils (PHOs), should be avoided altogether. Among fats, PHOs seem to have the most harmful health effects. The Food and Drug Administration (FDA) has determined that PHOs are not generally recognized as safe (GRAS) and ruled they cannot be added to foods as of 2020.

Alcohol

Alcohol, when consumed in large amounts, can overwhelm the gastrointestinal tract and other organs, such as the liver. This also promotes intestinal inflammation and alters the gut microbiome along the way. A small Chinese study reported that alcohol consumption worsened the overall physical functioning of people with AS.

In addition, alcohol may interact with some prescription or over-the-counter medications. If you have AS, it might be best to avoid alcohol altogether. However, If you want to enjoy the occasional alcoholic drink, talk with your healthcare provider beforehand. 

Gluten

In some people, eating gluten (a protein found in some grains) can cause inflammation in the gut, as is seen in people with celiac disease. Consequently, some researchers wonder whether gluten may also cause inflammation in people with other autoimmune diseases. These include AS. 

Gluten is found in certain grains, such as wheat, barley, and rye. If you feel you are sensitive to gluten and it is affecting your AS, talk with your healthcare provider to decide if trialing a gluten-free diet is right for you.

If you go on a gluten-free diet, be sure to meet with a registered dietitian to assure you are meeting your nutrient needs.

Beneficial Foods for AS

In addition to avoiding foods that may contribute to inflammation, consuming foods that have anti-inflammatory effects may help manage symptoms in people with AS. Below are beneficial foods to include in your anti-inflammatory diet if you have AS.

Whole Grains

A 2018 meta-analysis suggested that whole grains may help reduce inflammation throughout the body. Whole grains are a good source of dietary fiber as well as vitamins, minerals, and antioxidants, such as iron, magnesium, zinc, B vitamins, and selenium.

Whole grains aren’t only found in whole wheat. Whole grains with gluten include spelt, kamut, farro, bulgar, barley, and rye. Gluten-free whole grains include oats, brown rice, quinoa, millet, cornmeal, and teff. Oats are gluten-free in nature but are often contaminated with wheat (and therefore gluten) unless labeled "gluten-free."

Omega-3 Fatty Acids

Some foods are rich in inflammation-fighting omega-3 fatty acids, which reduce certain inflammatory proteins in your body, such as C-reactive protein.

Salmon, tuna, sardines, anchovies, and other cold-water fish are all great sources of omega-3 fatty acids. Walnuts, flaxseed, chia seeds, and soy foods are additional sources of omega-3 fatty acids.

Fruits and Vegetables

Fruits and vegetables are packed with antioxidants and phytonutrients that support the immune system and may help fight inflammation. Help build your body’s natural defense system by enjoying a variety of colorful fruits and vegetables, such as berries, cherries, apples, kiwi, spinach, bell peppers, kale, beets, artichoke, and broccoli.

Calcium- and Vitamin D-Rich Foods

Osteoporosis (low bone mineral density) is common in people with AS. Calcium is essential for bone health. In addition, vitamin D plays an important role in bone health by helping the body absorb calcium.

One 2015 review found that people with ankylosing spondylitis who had higher vitamin D levels had fewer symptoms related to the condition. Another 2020 study also found vitamin D to be protective in people with AS.

Good sources of calcium include dairy products, canned fish with bones, fortified orange juice, broccoli, dark leafy green vegetables, Chinese cabbage, fortified cereals, and fortified tofu. 

Your body can make vitamin D from sun exposure, or you can get it through diet from food sources such as egg yolks, fortified beverages (milk and orange juice), fatty fish, and cod liver oil. If your vitamin D levels are low, your healthcare provider may advise taking vitamin D supplements.

Anti-Inflammatory Herbs

Some herbs and spices have been shown to have anti-inflammatory properties. This includes turmeric, ginger, garlic, pepper, clove, and coriander. Using these spices and herbs in your cooking is a great way to flavor your foods and help decrease inflammation.

Be sure to talk with your healthcare provider before taking any dietary supplements, as they could interact with your medications.

Summary

Diet can impact health, including inflammation in the body. People with ankylosing spondylitis might be more sensitive to some foods and may benefit from an anti-inflammatory diet.

Foods and nutrients to include in your diet if you have ankylosing spondylitis are whole grains, fruits and vegetables, omega-3 fatty acids, calcium- and vitamin D-rich foods, and anti-inflammatory herbs and spices.

Foods to avoid if you have ankylosing spondylitis include added sugars, high-fat foods, high-sodium foods, alcohol, and possibly gluten.

A Word From Verywell 

Changing your diet can be difficult. However, the hope of better symptom management can be good motivation in people with ankylosing spondylitis. Talk with your healthcare provider or a registered dietitian about your diet and how you can best work towards following a healthy diet for ankylosing spondylitis.

Frequently Asked Questions

  • What foods are best for reducing inflammation and preventing AS flares?

    Anti-inflammatory foods can help reduce inflammation, and thus may help improve AS symptoms. Foods known for their anti-inflammatory properties include whole grains, fruits and vegetables, nuts, seeds, beans, legumes (beans, peas, and lentils), and certain herbs and spices such as garlic, ginger, and turmeric.

    Consistently following an anti-inflammatory diet, such as the Mediterranean diet, may help manage symptoms and prevent AS flares.

  • What causes ankylosing spondylitis flare-ups?

    Experts do not know exactly what causes AS flare-ups. Some possible causes for flare-ups include stress, illness, infection, eating certain foods or beverages, not taking medications as prescribed, and overactivity. Pay attention to what may have triggered your AS flare-ups so you can take action to help prevent future flare-ups.

  • Is there a cure for ankylosing spondylitis?

    Currently, there is no cure for ankylosing spondylitis. Your healthcare provider may recommend different treatments to help manage symptoms and slow the progression of the disease. This may include medications, physical activity, and following a healthy eating pattern.

    With proper treatment, the majority of people with ankylosing spondylitis can have a good quality of life.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Brittany Poulson, MDA, RDN, CD, CDCES
Brittany Poulson, MDA, RDN, CDCES, is a registered dietitian and certified diabetes care and education specialist.