Starch-Free Elimination Diet for Ankylosing Spondylitis – Part 2

This post is the promised ‘part 2’ to a starch-free elimination diet for ankylosing spondylitis – part 1. My intent with this post is to offer more tangible encouragement and support by providing a starch-free elimination diet food list and meal ideas. I remember being in so much pain that I could hardly think straight, let alone plan a menu for a diet so new to me. I hope this post will help others who find themselves in that place of feeling painfully ‘stuck’.

I am not a medical professional and the information I share is strictly from personal experience and spending many hours researching well-established elimination diets. I am a Starch-Free Success Story and I have walked my talk, but I am not qualified to give advice. As such, my sharing of this post is strictly an effort to offer hope and help to those eager to explore alternative treatment options for Ankylosing Spondylitis.

Please work with your healthcare practitioner to use this information in the best way possible to promote your unique health situation.

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The Goal

Elimination diets, in general, are a great tool for identifying food intolerances. The starch-free elimination diet has helped me reduce/eliminate general inflammation and also pain associated with ankylosing spondylitis (AS). This diet is meant to be nutrient dense (high in healthy fats and proteins), nourishing, and healing.

There is no ‘one-size-fits-all’ fix. We all have different eating patterns and we are each unique in terms of our genetics and disease presentations. Elimination diets seek to determine each individual’s optimal diet. Eliminating the most offending food(s) and substances all at one time is the most reliable way to find out which foods may be contributing to symptoms.

The Diet

If I were to do an elimination diet again I would eat more than only broccoli and chicken for months on end (that’s my story). As such, I have included a greater variety of starch-free foods that may be appropriate during a period of elimination on the list provided below. 

In addition to avoiding all starch, this elimination diet excludes foods that commonly cause inflammation in people who suffer from autoimmune diseases. I refer to these foods as ‘fringe foods’. These include (but are not limited to) dairy, eggs, nightshades, nuts and seeds, sugar, etc. Even ‘healthy’ foods contain many different naturally occurring chemicals that can be a problem for some people and should be avoided during the time of elimination.

While this is not a weight loss diet many people go through a period of losing weight. Typically, weight loss will plateau and, in my experience, the body returns to its preferred weight. During this time the body is often simply recalibrating. 

Feelings of hunger aren’t uncommon when first starting the elimination diet. This hunger tends to subside after the initial weeks on the elimination diet. Eat as much food as you desire but stick to the list of foods you have chosen for your period of elimination.

My Top 3 Tips for a Starch-Free Elimination Diet.

Planning ahead will be the key to success. 

Non-Linear Healing 

The rate of improvement in each individual varies greatly. Success is not guaranteed and often isn’t instant and a degree of self-experimentation is required. It can take several months of strict adherence to this diet (and its reintroductions) to see significant improvement.

In my experience, the road to improvement was two steps forward and 1 step back. Eventually, the good days outnumbered the bad. My personal suggestion would be to strictly adhere to the starch-free diet for six months before deciding whether it is helpful for you or not (however, this should be discussed with a medical professional as everyone has unique health situations).

Often diet is only a piece of the puzzle. Other huge factors that have affected my healing journey have been stress (both external and internal), weather, hydration, exercise, hormones, etc.

Continued Gut Healing 

While a starch-free diet may help significantly reduce or entirely eliminate symptoms of AS, it is common for pain to return with dietary slip-ups (I learned that cheats were not worth the pain!). I recommend looking into additional gut healing strategies as those may provide more long-term healing and success. 

Still, I have LOVED the starch-free diet because:

1. It has offered me a reprieve from the pain 
2. It has eliminated inflammation
3. According to my rheumatologist’s interpretation of labs and imaging, it has halted the progression of AS
4. It has allowed me to focus on further healing without brain fog and pain distracting my efforts

Elimination Dieting Isn’t Fun. 

I felt worse before I felt better.

Withdrawal symptoms are real. I felt hungry, tired, crabby, and depressed. These feelings lasted about 2 weeks for me. 

I continued to eat foods that nourished and sustained my body because I desired to heal, not because I loved the monotonous diet.  

Progress was sometimes subtle but enough to keep me going. Eventually, when my pain reduced significantly, I started reintroducing foods.

The Bottom Line

 There is no one-diet-fits-all version of the starch-free elimination diet. Still, here are two key things to note:

1. Starch consumption appears to be a common cause of symptoms for those with AS. Eliminate it and do not attempt to reintroduce it until solidly in remission.
2. Individuals may react to fringe foods. Eliminate these foods and slowly reintroduce them after initial symptoms have significantly reduced. 

The starch-free elimination diet aims to exclude both starchy foods and fringe foods for a limited time.

Starch-Free Elimination Food Options

Below is a list of foods appropriate for a starch-free elimination period. These foods adhere to the two main objectives of the diet (listed above). It is still a good idea to test foods for starch with iodine. If a food sample tests starchy do not consume it (and always discard the sample tested with iodine!).

Many people will choose a limited number of foods from the list below in an effort to control variables during their time on the diet. Still, aim to consume as many varied nutrients as possible.

• Meat stock – 4-5 cups/day

• Beef
• Turkey
• Chicken
• Lamb
• Fish (cod, salmon, halibut, etc.)

• Broccoli (frozen broccoli has tested starchy for me at times)
• Leafy greens (bok choy, kale, spinach, lettuce, arugula, etc.)
• Nappa cabbage (red and green cabbage often test starch-free, also)
• Cucumber (seeds can test starchy)
• Fennel
• Mushrooms (can test starchy)
• Avocado (can test starchy)
• Celery
• Parsley
• Radishes
• Cilantro
• Dill
• Mint leaves
• Basil

• Blueberries*
• Grapes*
• Raspberries*
• Blackberries*
• Avocado (can test starchy)
• Lemon (use caution as citrus can affect some people)

• Sea salt/Himalayan salt (use it liberally as electrolytes -sodium, potassium, magnesium- are crucial on a low-carb diet)
• Avocado oil
• Extra virgin olive oil (EVOO)
  
  * Consider consuming these in extremely limited quantities as even fruits high in natural sugars can trigger symptoms.

Optional Extras (to be used with caution)

• Raw honey (extremely limited quantities to limit sugar, especially during the initial healing stages)
• ACV (apple cider vinegar with ‘the mother’) – like Braggs
• l-glutamine for gut healing (find a starch-free version)
• collagen/gelatin for gut healing (find a starch-free version)

Tips for Elimination

• Eat as much as you want and go for the best quality you can afford (grass-fed, organic, wild, free-range, etc.). Eat for nourishment.
• Some people react to foods listed above (such as spinach – high in oxalates, grapes – high in natural sugar, beef – red meat, lemon – citrus, etc.). You may choose to experiment with these ingredients or, if you’re not seeing improvement, consider eliminating them for a time. Some people do best on a plant-heavy diet, while others thrive on mostly meat.  
• One of the challenges I faced on this diet was boredom with eating the same foods continuously. I found variety in different cooking styles to be helpful.
• Be creative and open to new customs. For example, breakfast won’t look the same if you’re used to only cereal or toast.
• Eating in restaurants during elimination is difficult. You cannot be 100% sure what is in the food served. Consider using the money you save by not eating out to spend it on higher quality compliant ingredients instead.

Ankylosing Spondylitis is your enemy. A starch-free diet is your friend. Embrace the diet. Your mindset and the stress caused by discontent and frustration will affect your pain levels in a negative manner.

Commonly Overlooked Starchy Foods

I found little relief until I had eliminated all starch from my diet.

These are some items that are often overlooked in initial purging of starch from ones diet:

1. Supplements (I either eliminated starchy supplements or had them compounded in a starch-free alternative such as olive oil). In my experience, the benefits of most starchy supplements did not outweigh the detrimental effects on my symptoms.
2. Spices (many have starchy fillers – use iodine to test). 
3. Pre-packaged meats (including rotisserie chickens from the deli) almost always test starchy.
4. Not all vegetables and fruits are starch-free. Check them with iodine.
5. Black pepper, bananas, most squashes, yams, corn, peas, legumes, etc. are all starchy.

Starch-Free Reintroductions

Reintroducing non-starchy foods after a period of elimination should be done as systematically as possible (one food at a time!) and only when disease symptoms have subsided. I followed the four stages of reintroduction from the AUTOIMMUNE WELLNESS website.

If a newly reintroduced food causes a symptom, remove it immediately. Using a food diary during the reintroduction phase may help shed light on which foods cause reactions. Just because you fail a food challenge at one point doesn’t mean your body will forever negatively react to it. More healing may be necessary before trying to reintroduce that particular food again. Try reintroducing something else once the reaction has subsided.

Possible early reintroductions:

• eggs (yolk first)
• coconut
• garlic and onion (high in inulin, so this may not be successful immediately, but it will add so much flavor to food!)
• sauerkraut (raw, not fermented in vinegar or wine, only salt). Start slow because introducing probiotics to the gut can cause reactions.
• no/low starch nuts and seeds, ghee, etc.

Starch-Free Elimination ‘Mix and Match Meal Ideas’

Simplicity is key!

Be creative but KEEP IT SIMPLE!

In terms of meal planning – this stage is easy. Your limited ingredients will ensure your grocery list is simple and allow your imagination to go wild when it comes to putting them together in creative ways 🙂

Here are some ideas to get you started but please don’t be limited or intimidated by this list! Many times I just threw some nourishing food in a pan, cooked it, and called it a day.

Proteins

• Meat Stock
• Instant Pot Shredded chicken
• Instant Pot Chicken legs/quarters* (omit black pepper, broil for crispy skin after cooking in Instant Pot)
• Instant Pot Chicken Breasts
• Roasted Chicken (and broth) – test dried herbs for starch or use fresh
• Kick AS Green Soup
• Lemon-Dill Poached Salmon
• Oven-Baked Salmon* (omit black pepper)
• Multi-Purpose Shredded Beef
• Ground Meat Patties: Combine ground chicken/turkey/beef, add salt and fresh herbs, shape into patties, and pan-fry.
• One Pan Meal: Cook protein in a frying pan. Once the protein is almost cooked through, add veggie of choice (I like broccoli, spinach, or kale and mushrooms), salt, and a dash of EVOO/avocado oil. Cook until the veggie is cooked to your liking. Remove from heat and add an optional squeeze of lemon juice before enjoying.

Veggies

• Simple Sauteed Red Cabbage
• Radish ‘Breakfast Potatoes’*
• Oven Roasted Broccoli
• Kale Chips
• Sauteed Cabbage (omit black pepper)
• Sauteed Spinach*
• Sauteed Kale and Mushrooms
• Fennel Salad (omit pepper)
• Roasted Fennel (omit balsamic vinegar or replace with ACV)
• Steamed Broccoli
• Air Fryer Broccoli* (omit pepper)
• Salad (greens, herbs, cucumber, and a simple dressing of oil, ACV/lemon juice, salt, etc.)
• Andrea’s Fav Green Juice (omit apple)
• Grilled Broccoli* (omit black pepper)
• Roasted veggies
• Steamed Veggies
• Cucumber salad

* Note: Some recipes may have ingredients that may not align with the elimination ingredients you have chosen (For example, black pepper should be avoided because it is starchy, and garlic may be avoided because it’s high in inulin, etc.). Adjust accordingly.

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Personal note: 
Going through a time of elimination can be challenging and intimidating. While I am no expert, I walked the journey and I am happy to walk alongside others who are intrigued or in need of commiseration or encouragement. 
Please contact me and I will try to respond at my earliest convenience!

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Disclaimer: Starch-Free Feasting may discuss topics related to diet and nutrition. The information provided on this website is for informational purposes only. Consult a physician or medical professional before making changes to your diet and medication. You assume the risk of any potential injury that may result.