Can an Anti-Inflammatory Diet Help With Axial Spondyloarthritis?
Medically reviewed by Jonathan Purtell, MS, RD, CDN
While studies supporting the relationship between diet and axial spondyloarthritis (axSpA) are extremely limited, following a Mediterranean diet rich in anti-inflammatory foods may be helpful.
Axial spondyloarthritis is a type of inflammatory arthritis that causes pain and stiffness in the joints that connect the bottom of the spine to the pelvis (sacroiliac joints) and the spine. There is no cure for axSpA, but receiving an early diagnosis and proper treatment can help prevent joint damage and other long-term complications.
This article discusses the benefits of an anti-inflammatory diet for axSpA, foods to eat, and foods to avoid for better management.
Inflammation and Axial Spondyloarthritis
In the early stages of axial spondyloarthritis, inflammation is the main cause of pain in the lower back, buttocks, and hips.
Over time, chronic inflammation in the spine and sacroiliac joints can lead to structural damage and new bone formation. Eventually, the joints and bones of the spine may grow together (fuse), causing the back to become stiff and difficult to move.
Reducing inflammation in your body is essential to slow disease progression and ease symptoms.
Inflammation associated with axSpA is often treated with medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), which are considered to be effective at alleviating pain and stiffness. Corticosteroids and biologic drugs may also be used.
In addition to using medications, certain foods have anti-inflammatory properties that can help reduce body-wide inflammation.
Can Switching to an Anti-Inflammatory Diet Help?
While no specific diet can cure or prevent axSpA, following a healthy, anti-inflammatory eating plan may help reduce inflammation throughout the body and improve symptoms of axSpA.
One 2021 study looked at the impact of the Mediterranean diet on disease activity in individuals with axSpA over six months. At the end of the study, individuals who adhered to the Mediterranean diet experienced improved markers of inflammation and disease activity.
The Mediterranean diet is an anti-inflammatory eating plan that emphasizes vegetables, fruits, nuts, olive oil, and legumes (beans, peas, and lentils) while limiting ultra-processed foods and red meat.
Following a Mediterranean diet can also help you achieve and maintain a moderate weight, which can decrease stress on your joints.
Popular Anti-Inflammatory Eating Plans
Anti-inflammatory eating plans include:
What to Eat to Lower Inflammation
An anti-inflammatory diet, like the Mediterranean diet, is rich in omega-3 fatty acids, antioxidants, fiber, and healthy fats. These nutrients may benefit axSpA by reducing inflammation and easing symptoms like stiffness and pain.
Omega-3s
Omega-3 fatty acids are compounds found in oily fish, including salmon, tuna, and sardines, and some plant foods, such as walnuts, soybeans, chia seeds, and ground flaxseed. They may be beneficial at reducing joint pain and inflammation in individuals with arthritis.
Omega-3s interact with immune cells called leukocytes and enzymes called cytokines, which play an essential role in the body’s inflammatory response.
Regularly eating foods rich in omega-3 fatty acids can also reduce your risk of heart disease and stroke. Eating 3 to 6 ounces of oily fish at least twice per week is recommended to reduce inflammation and support heart health.
If you find it difficult to consume the recommended amount of omega-3s from food alone, ask a healthcare provider if a fish oil supplement may be beneficial.
Antioxidants
Antioxidants are chemicals that react with and neutralize unstable molecules called free radicals that promote inflammation and cause cell damage.
The best way to enrich your diet with antioxidant-rich foods is to eat a variety of colorful fruits and vegetables, such as berries, cherries, spinach, kale, and broccoli.
In particular, berries are considered one of the best fruits for arthritis because they're loaded with anti-inflammatory antioxidants, such as vitamin C, carotenoids, and flavonoids.
Fiber
Fiber is a plant-based carbohydrate nutrient that your body cannot digest. A high-fiber diet rich in beans, whole grains, fruits, and vegetables can help lower markers of inflammation, normalize bowel movements, and support healthy digestion. Eating more fiber can also keep you fuller longer and help you take in fewer calories each day.
One 2022 study found that an increase in total fiber intake of 5 grams per day was associated with significantly lower concentrations of C-reactive protein (CRP) and other markers of inflammation. Eating more fiber is also associated with a lower incidence of cardiovascular disease (CVD).
Of note, only cereal fiber was consistently associated with lower inflammation and CVD incidence in this study. This suggests that cereal fiber may be more beneficial than fiber from fruits and vegetables in reducing whole-body inflammation.
Dietary fiber also feeds the "good" bacteria in the gut, which then produce short-chain fatty acids (SCFAs) that can decrease inflammation in the gut and, when combined with a high-fiber diet, improve inflammatory arthritis.
The 2020–2025 Dietary Guidelines for Americans recommends that adults should consume between 22 and 34 grams of fiber daily. The specific amount you need will depend on your age and sex.
Healthy Oils
Olive oil, the primary source of added fat in the Mediterranean diet, is high in antioxidants and other anti-inflammatory compounds. It may also help reduce the risk of heart disease.
Virgin olive oil contains the phenolic compound oleocanthal, which, similar to Advil (ibuprofen), inhibits the production of pro-inflammatory COX-1 and COX-2 enzymes.
Furthermore, clinical evidence suggests that oleic acid, the main fatty acid in olive oil, can significantly reduce CRP.
Incorporate more extra-virgin olive oil into your diet by using it in salad dressings and marinades. You can also use it in place of butter in most dishes.
Which Foods Should You Avoid?
Certain foods tend to contribute to inflammation. Limiting these pro-inflammatory foods may reduce symptom severity in people with axial spondyloarthritis and other types of inflammatory arthritis:
Sugar
Trans fats (found in fried foods and vegetable shortening)
Saturated fats (found in red meat, whole-fat dairy, butter, lard, mayonnaise)
Omega-6 fatty acids (found in vegetable oils)
Refined carbohydrates (white rice, white flour, white potatoes)
Monosodium glutamate (MSG) (a flavor enhancer found in many processed foods)
Alcohol
Will a Gluten-Free Diet Help?
People with autoimmune forms of arthritis, such as axSpA, are at higher risk for celiac disease. Individuals with both conditions may find relief by avoiding foods that contain gluten. However, there is currently insufficient evidence to routinely recommend a gluten-free diet to treat symptoms of inflammatory arthritis.
Summary
While there are no specific dietary guidelines for axial spondyloarthritis, following a Mediterranean style diet rich in omega-3s, antioxidants, fiber, and olive oil but low in processed foods and saturated fat can help reduce body wide inflammation and improve joint pain and other symptoms.
Eating a nutrient-dense diet that consists of antioxidant-rich fruits and vegetables, fiber-rich whole grains, olive oil, and fatty fish may help reduce inflammation and symptom severity. A balanced diet can also help you achieve and maintain a moderate weight, which can reduce stress and strain on your joints.
Consider talking with your healthcare provider or registered dietitian to develop an eating plan that fits your needs.
Frequently Asked Questions
Can switching to a low-starch diet help with axial spondyloarthritis?
While research on a low-starch diet for axSpA is limited, one nine-month study in people with ankylosing spondylitis (a subgroup of axSpA) observed an improvement in inflammatory markers and a reduction in the use of anti-inflammatory medication in the majority of people who decreased their intake of dietary starch.
Which foods trigger axSpA flare-ups?
Inflammatory foods, such as sugar, alcohol, refined carbohydrates, ultra-processed foods, and saturated fat may increase inflammation throughout the body and worsen symptom severity.
Why is it important to maintain a healthy weight when you have axial spondyloarthritis?
Carrying extra weight can put extra strain on inflamed weight-bearing joints and increase pain.
