Arthritis is a condition normally associated with old age. But Sean Codling was just 20 years old when he started suffering from stiff and painful joints—symptoms he later discovered were caused by a form of arthritis called ankylosing spondylitis (AS).
"It started in my lower back, then progressed to my knees, feet, hands, hip and neck," said Sean, now a 50-year-old father of three from Kent, UK. "By the time I was 21, the arthritis was affecting all of my joints."
Sean remembers having frequent "flare-ups"—periods of time when his symptoms were particularly bad—which would always follow a bout of flu-like symptoms. "I'd suddenly feel absolutely dreadful and washed out, then 24 to 48 hours later it was like my joints were exploding. Sometimes it was my back that was worst, sometimes it was my hip and sometimes it was my feet. The inflammation seemed to move around my body."
Sean also suffered from "extremely painful" uveitis, inflammation of the middle layer of the eye that's linked to AS and other forms of arthritis. The condition can cause eye redness, blurred vision and sensitivity to light, and, for Sean, the pain was often worse than his joint pain.
Sean's agonizing symptoms meant he was unable to do any of the activities he used to enjoy, like cycling or playing squash and football. Even getting out of bed was a struggle. "My back would be so stiff in the morning that I'd have to roll out of bed," he said.
Sean managed to go to work—he was working in London as a commercial artist at the time—but had to wear slippers because his feet were so tender and needed to take taxis to and from train stations to commute.
Searching for answers
Sean saw numerous doctors and rheumatologists over the years about his symptoms, but none could agree on a diagnosis. "I was diagnosed with gout, fibromyalgia, psoriatic arthritis . . . each doctor said something different."
What they did agree on, though, was the treatment—powerful anti-inflammatory drugs—and the prognosis: there was no cure, and his condition was only going to get worse. One doctor even told Sean he'd be in a wheelchair by the time he was 30. But Sean refused to accept that these were the only answers.
After looking into the side-effects of the drugs, which include gastrointestinal bleeding, kidney disease and even death, Sean said "thanks but no thanks" to his doctors' prescriptions. Instead, he became committed to finding the root cause of his health problems—and ensuring a wheelchair wouldn't be his fate. "I didn't believe I was just unlucky. There had to be a reason why I was ill, and I was determined to find it and fight it every step of the way."
An alternative approach
Having always had an interest in alternative medicine, Sean started researching drug-free ways to tackle his symptoms and ended up trying a laundry list of holistic therapies, from reflexology and reiki to Chinese herbs and acupuncture. "Some helped to give me short-term relief," said Sean. "Reflexology, for example, was wonderful. The practitioner would manipulate my feet, and it really helped me sleep at night. But nothing provided me with a permanent solution."
But then Sean came across Dr John Mansfield, an allergy specialist and founding member of the British Society for Allergy and Environmental Medicine, who had written a book about the connection between allergy and arthritis called Arthritis: Allergy, Nutrition and the Environment (Thorsons, 1995). Dr Mansfield, who treated thousands of arthritis patients before his death in 2016, believed that most forms of arthritis are environmentally induced—most commonly by foods but also by house dust, mites and molds, tobacco smoke and other environmental chemicals.
Sean read his book and "related to a lot of things in it," so decided to visit Dr Mansfield at his clinic. "I saw him throughout my 20s," said Sean. "I followed his elimination diet and anti-fungal treatments. I found out I had a lot of underlying issues."
But although Sean experienced a great improvement in several of his long-term symptoms—his extreme fatigue, abdominal bloating and dry skin all resolved—his joint pain and uveitis remained. "It got to a stage where we had gone as far as we could in terms of the allergy approach," said Sean.
Luckily for Sean, while Dr Mansfield was unable to help him further, he knew a man who could. "He told me to get in touch with a Professor Alan Ebringer, who was a professor at King's College London at the time. I tracked him down and made an appointment to see him at his London clinic."
The turning point
Fast forward a few weeks, and Sean found himself sitting in Professor Ebringer's office, amazed to finally have a definitive diagnosis for his condition. "He'd asked me lots of questions about my symptoms and had me take lots of tests, including testing for the HLA-B27 gene, which came back positive, and told me I have AS. It was such a relief to get a cast-iron diagnosis after nearly 12 years."
Even better was what Ebringer told Sean next: his theory on the cause of the condition, which he backed up with scientific evidence, and his solution, which was "ridiculously simple."
"He said that 96 percent of patients with AS were carriers of the HLA-B27 gene, while only about 8 percent of the general population had the gene. If you have this gene, an overgrowth of the common gut bacteria Klebsiella can trigger an autoimmune response—when the immune system attacks the body's own tissues. It's this reaction that causes the symptoms of AS."
Professor Ebringer then went on to tell Sean what he could do about it: deny the bacteria its food source. "Klebsiella thrive on starch. Remove starch from your diet, and the bacteria will reduce and so will your symptoms. I couldn't believe how simple it was," said Sean.
The low-starch switch
Everything Dr Ebringer said made perfect sense to Sean—and the professor had years of research to support it (see box, page 70)—so he immediately switched to a low-starch diet. Out went the bread, potatoes, white rice, pasta and cakes, and in came plenty of green vegetables, meat, fish and sources of good fats like avocados, nuts and coconut oil. Sean also made sure he ate fresh, organic produce whenever possible and avoided processed foods.
Sean stuck to the diet rigidly, and after three or four months, he noticed significant improvements in his symptoms. "I started to get my life back," said Sean. Then after nine months on the diet, all of Sean's symptoms—his joint pain, stiffness, difficulty getting out of bed, uveitis—all completely disappeared. "It was an incredible feeling," he said.
Sean saw Professor Ebringer for regular follow-ups at his clinic, and vividly remembers seeing the same people in the waiting room each time, visibly ravaged by AS—struggling to walk or in wheelchairs, with "agony on their faces." "I asked Professor Ebringer once why his other patients weren't getting any better, when I was bouncing into his office pain-free. He said, 'Some people can't do without their toast in the morning, baked potato for lunch and pasta for dinner. Not everyone is as strong-willed as you!'"
A new way of life
Sean has followed a low-starch diet ever since and is proud to report he's been symptom-free for over 18 years now.
"People always ask me how I stick to the diet, but it's actually really easy—even when I eat out. I know what to look for on menus. If I have a roast dinner, I just skip the potatoes and get extra vegetables instead. And I'll have the occasional treat, but I'll have dark chocolate—70 to 80 percent cacao—rather than cakes or cookies. It's not that restrictive."
Sean's medical records say that he is "in remission from AS," but Sean is not afraid to classify himself as "cured." He has none of the symptoms he suffered with for over a decade, does not take any medication and has not required any surgery. He's even fitter and more flexible than most of his friends—he plays squash and racquetball, goes skiing and cycling and practices yoga and Wing Chun kung fu. "People can't believe where I'm at now," says Sean.
Sean does experience a slight stiffness in his back on the rare occasions that he slips from the diet, but it serves as a reminder of what he is trying to achieve. "I can't afford for the bacteria to build up again," he says.
In addition to following a low-starch diet, Sean also takes probiotics and has regular colonics as his "insurance policy" to keep the bad gut bacteria in check.
Sean is now trying to spread the word about Professor Ebringer's work and the diet that changed his life. He's already helped several family members who shared some of his symptoms, like his brother, who no longer suffers from uveitis after switching to a low-starch diet. And he's made sure his two sons, who have recently tested positive for the HLA-B27 gene, are aware of what can happen if they eat a high-starch diet.
"It's so important to get this information out there," says Sean. "I owe my life to Professor Ebringer. I don't know where I'd be without him. Probably in a wheelchair."
AS fact file
• Ankylosing spondylitis (AS) is a chronic condition in which the spine and other parts of the body become inflamed.
• Some 2.7 million Americans are estimated to suffer from AS to some degere.1
• Symptoms include back pain and stiffness, pain and swelling around the joints, fatigue, inflammation of the eye and bowel problems.
• The condition is more common in men than in women.
• It tends to first develop in late adolescence but is usually diagnosed in young adulthood.2
Before and after: Sean's typical daily diet
As with many of Professor Ebringer's AS patients, Sean's symptoms resolved after switching to a low-starch diet—one that cut out bread, cereals, pasta, rice and all other grains, along with potatoes and sugary foods like cakes and biscuits, and instead emphasized protein and healthy fats. Meat, fish, beans, fruit and vegetables (although preferably more of the non-starchy varieties like berries and leafy greens), nuts and full-fat milk and cheese are all on the menu for Sean. Here's what his typical daily diet looked like before and after the switch.
Breakfast: 2 slices of white toast with peanut butter
Lunch: Bacon and avocado on a roll with salad and a bag of chips
Dinner: Baked potato with ham, lettuce, tomato, corn, cucumber, mayonnaise
Snacks/treats: Chocolate, cookies, cake
Drinks: Tea, coffee, fruit juice
Breakfast: Cheese, onion and bacon omelette with avocado
Lunch: Chicken salad with cheese and an apple
Dinner: Gluten-free sausages, mashed sweet potato, broccoli, carrots and fried onions
Snacks/treats: Kefir, Nakd bars (gluten- and refined sugar-free natural fruit and nut bar), fruit, walnuts, dark chocolate
Drinks: Coffee, green tea, water
The bacteria behind AS
Klebsiella is a ubiquitous bacteria normally found in the digestive tract, but as pioneering immunologist Professor Alan Ebringer and other researchers have discovered, the bacteria is much more common in the stool samples of patients with AS compared to controls, and AS patients have higher levels of antibodies against Klebsiella compared to healthy individuals.1
Other studies have revealed that the vast majority of AS patients possess a version of the HLA gene called HLA-B27, although it's fairly rare in the general population. Each version of the HLA gene produces a slightly different end-product, a type of protein called a surface recognition antigen, but they all have the same function: to serve as a sort of molecular passport that helps the immune system differentiate the body's own cells from foreign invaders.
Intriguingly, the Klebsiella microbe has molecular sequences resembling that of HLA-B27.2 Professor Ebringer hypothesized that the presence of Klebsiella in HLA-B27-positive individuals can cause the immune system to become confused and produce antibodies to its own tissues in a process called 'molecular mimicry'—and it's this reaction that causes the symptoms of AS.
As Klebsiella depends on dietary starch to survive, Professor Ebringer proposed that a low-starch diet—avoiding the "four major poisons" of bread, potatoes, cakes and pasta—may be beneficial for patients with AS, and he used this diet at his clinic with great success until his retirement.
In a controlled study, a low-starch diet led to reduced antibody levels in the blood as well as symptoms and measures of inflammation in AS patients.2
Useful contacts and resources
Sean Codling's website for AS sufferers (including interviews with Professor Ebringer and low-starch recipes): www.stopas.co.uk
AS support site and forum: www.kickas.org