How a Healthy Lifestyle Helps With Ankylosing Spondylitis

dr michael

How a Healthy Lifestyle Helps With Ankylosing Spondylitis

Food and exercise are medicine, and they changed the trajectory of my life with ankylosing spondylitis.

For years, even though I exercised regularly, ate healthy, and many considered me a health nut, I didn’t fully realize the power that nutrition and exercise could have over my AS symptoms. My life is vastly different today because I embraced the power of lifestyle medicine.

I wrote a book on my journey with AS called Ankylosing Spondylitis Pyramid: The Lifestyle That Lets You Take Back Control. My primary purpose was to help those of us living with AS understand the importance of lifestyle treatment. One of the most critical parts to that is living an active, thriving lifestyle.

I’ve learned firsthand that with an inflammatory type of arthritis, like AS, movement is one of the most powerful remedies I have. But it takes work. Even if I’m a bit stiff in the morning when I wake up, I know that moving will simply make my day better. Staying still makes me stiffer. After even a few days without exercise, I feel it. Moving loosens everything up, makes me stronger, and just makes me feel better, inside and out.

I recently returned from a 2-week vacation through Fiji and Tonga. During my trip, I was largely off my exercise routine and made less-than-healthy nutrition choices. I had the worst flare I’d had in more than 5 years. It was tough to get up in the morning. It was hard to get my body to do what I wanted it to do.

Part of me wanted to just rest. But I knew my body was up for more than that. So I powered through, got my butt to the gym, and started moving. I took it a bit easier than I normally would have, but I did it. Each day, the exercise got easier and within a week or two, my muscles and joints were very thankful I had pushed through it.

I know that the thought of exercise when you’re already stiff, inflamed, and in pain is less than appealing. I’ve been through it. But I found that on the other side of that struggle was a life with far less pain, much more energy, and a much more positive outlook on life.


Because I love wellness and wanted to know all I could to help me with my own health journey, I became a certified personal trainer. I use that knowledge to keep my exercise routine safe and effective for me.

I make sure to constantly change up my routine for two reasons. First, your body gets used to doing the same thing over and over and I want to continue to push myself. Second, I've noticed that when I do the same exercise too often, my body doesn't like it. I tend to get tendinitis or other types of inflammation from too much stress if I focus on a given body part or particular exercise too often. 

I enjoy lifting weights, something I do 5 to 6 times a week, focusing on a different body part each day. In addition to extended warm-ups, I lift the weights slowly, especially when lowering the weights. This feels better on my joints and tendons and also puts more focus on the muscle without having to lift really heavy weights.

I don’t enjoy cardio, but I push myself to include it because having an inflammatory condition like AS raises my chances of heart disease more than the average person. So I grin and jump on the treadmill. But I have to be careful. As is often typical with AS, I can get inflammation and pain in joints other than my back.

I make sure to warm up at least for 5 to 10 minutes and then increase the intensity very slowly. I've found that long warm-up period is gentler on my joints and they're much happier the next day.

Stretching is something I really enjoy because I can feel my whole body loosening up. My body’s genetics are working against me, trying to stiffen everything up. It feels powerful to know that I can counter that with a good stretch routine after getting my muscles and joints warmed up.

While I hit on all body parts, I definitely focus on my lower back and chest because those are the areas where I tend to get stiff. Not stretching could lead to permanent stiffness, so I stretch often. The chest is important so I don't get fusion in the joints around my chest bone, which could affect my lungs.


I had been thinking about making some changes to my diet for quite some time. So about 5 years ago, I took a chance and tested out a theory.

It rocked my world.

Just like with exercise, the research around some of the changes I heard about is very limited -- practically nonexistent. There’s a lot of discussion around one particular strategy: low starch. I’m not talking about just cutting back how often you eat potatoes each week. I’m talking about practically eliminating starch from your diet.

There’s very little scientific evidence to support the starch theory, but I dug into what was out there. Through my research, I learned a gut infection with a bacteria called Klebsiella pneumoniae may trigger the inflammation in AS. These bacteria thrive on starch. When cut off from starches, the theory is that these bacteria can’t spark that inflammatory process that leads to the pain and stiffness of AS.

I decided to give it a shot. For me, it was life changing. My most troubling symptoms of my AS were the pain and inflammation in my sacroiliac joints in my lower back (sacroiliitis) and in the joints that connect my chest bone to my ribs (costochondritis). I really hated the random fatigue that would strike unexpectedly, leaving me feeling sluggish as if I had a mild case of the flu. These symptoms would come and go, seemingly without any particular reason.

I made a decision to practically eliminate starchy trigger foods -- no bread (or bread products like biscuits, muffins, etc.), rice, or potatoes. While not typically part of a low-starch diet, I also limit other foods with starch, like beans. In their place, I load up on lean protein, including a decent amount of plant-based protein, plenty of seafood, eggs, and lots of vegetables. I do have some fruit, but choose to get my healthy carbs primarily from veggies.

Now, more than 5 years later, I’m still in awe of the changes my new diet led to. I very rarely have sacroiliitis or costochondritis. That random, very irritating fatigue is gone. Just the other day, I realized that the pain in my heels and soles of my feet from plantar fasciitis, something I lived with for a long time, had been gone for years. I completely forgot about it!


The only time my symptoms rear their ugly head is when I stray from my diet. A high-starch meal is OK every now and then, but when I consistently choose foods that are typically on my no-no list, like when I’m on vacation, boy, can I feel it! After that recent 2-week trip, it took me at least a week or two of being back on my low-starch plan before I started to feel normal again.

You can’t "-ish" a low-starch diet. I know this firsthand.

It took a while to find the lifestyle therapy that worked for me, and sticking to it can be a challenge. But it’s well worth it.

WebMD Feature Reviewed by Michael W. Smith, MD on October 14, 2020
© 2020 WebMD, LLC. All rights reserved.



Visuals of an Invisible Illness

Several years and 35 specialists later, Sal Marx finally found a name for the pain in her spine -- ankylosing spondylitis. See how she channels her experience into her paintings.


How Healthy Habits Help

The chief medical director of WebMD describes how changes in his diet and exercise regime drastically improved his AS symptoms.