Until recently it was usually the term used for a condition called Reiter’s Syndrome, which was characterised by (1) inflamed joints, (2) inflammation of the eyes (conjunctivitis) and (3) inflammation of the genital, urinary or gastrointestinal system.  Reactive Arthritis is now the preferred name for this condition, since the history of Dr. Hans Reiter’s dubious past of enthusiastically embracing Nazo politics and medical abominations, has come to light.

Reactive Arthritis was a term first used by the Finns in 1973-4 for arthritic symptoms which had been caused by food poisoning with dysentary from either the Shigella, Salmonella or Yersinia bacteria.  But Professor Alan Ebringer recognised that all these are close relatives of Klebsiella, although Klebsiella does not cause the symptoms of food poisoning because it is a normal bowel microbe found in most people.

However, in recent years, rheumatologists are beginning to accept that Klebsiella is commonly implicated in Ankylosing Spondylits, and the term HLA-B27 Reactive Arthritis is beginning to be used.

Anyone who has had numerous diagnoses from various rheumatologists will probably be aware that a number of different names are often given to forms of arthritis with similar symptoms.  Gradually the rheumatology world is beginning to see the wood for the trees.  Here is a statement from one authoritive source:

Reactive arthritis is considered a systemic rheumatic disease.  This means it can affect other organs than the joints, causing inflammation in tissues such as the eyes, mouth, skin, kidneys, heart and lungs.  Reactive arthritis shares many features with several other arthritic conditions, such as psoriatic arthritis, ankylosing spondylitis, and arthritis associated with Crohn’s disease and ulcerative colitis.  Each of these arthritis conditions can cause similar disease and inflammation in the spine and other joints, eyes, skin, mouth and various organs.  In view of their similarities and tendency to inflame the spine, these conditions are collectively referred to as “spondyloarthropathies”.

Your first question was how many hours after eating the wrong food will your AS pains kick in?  I think this is different  for every individual, but I hear from some of my correspondents that the pain will definitely return the day after.  With IBS pain and bloating, the pain begins to make itself felt much more quickly – about 30 minutes to an hour after eating starchy food.  If you also have IBS, you can rely on those pains to tell you you’re in for an AS flare up.  From my experience, when the IBS symptoms show, I know the AS symptoms will follow by the next day.

I’m afraid I don’t know whether hemp is starch-free or not, as I never tested it.  My advice, as always, is to get yourself some iodine and test it yourself.  Also test the protein powder, which of course should not show any signs of starch – but we can’t always rely on manufacturers to be completely upfront about these things.  Just as gluten-free foods are not usually entirely gluten-free – because the process of separating the gluten from the wheat is not perfect and depends on the efficiency of the manufacturer – so we can’t really be sure about other processed foods until we’ve tested them.  This doesn’t apply to raw foods, of course.

Now, I’m very perturbed about your fasting period when you give up meat, eggs and dairy foods.  Is this for religious reasons?  If so, you must obey your beliefs, but try to make it as short a fasting period as possible, because these are the foods you need most of all.  If you are having to give up meat, I can’t really see that protein powder is very different.  However, that is your decision.  Your food options during a fast of this sort would be very limited.  I can only think of salads including avocado, and cooked vegetables which are safe, such as spinach, asparagus, tomatoes, sweet peppers (not green) mushrooms, fennel and mild onions.  You could make some great vegetarian dishes from these, but some cheese would make a tasty addition.  Tell me what you eat in your fasting periods.  I will be very interested to hear.

Lemons are not recommended in great quantity.  The pith (white inner lining) is full of starch.  The juice is OK, but better diluted with water and of course, sugar added.  If you are experiencing a flare-up and you can trace it to any particular food, you should eliminate it, or use it sparingly.  I have never recommended raw or toasted pumpkin seeds.  I remember testing them years ago and finding them too starchy.  But once again I recommend you test them yourself.  There’s always the possibility that the samples I tested were not exactly normal: had been picked unripened, stored in cold store etc. etc.

Get yourself that bottle of iodine (original, rusty-brown in colour) and you’ll never have any worries about whether foods contains starch or not.

Feel free to write again if you wish.

Regards,

Carol

Dear Linda,

I wish I could give you another dietary plan for your flare ups, but all I can advise is to re-double your efforts with the Low-Starch Diet. I would eliminate every bit of starch from your diet for a limited time – say two weeks – or until your symptoms begin to subside. I am sure that they will, as you have already experienced when you began the diet. It is just that it’s such a shock to discover how quickly they return, that you want them to disappear equally quickly. You must have patience and the assurance that they will disappear again.

If you don’t already test for starch in your food with iodine, you must begin to do this. It reveals all the hidden starches in our processed foods. My book tells you how to do this, but you need original iodine, which is a rusty-brown colour – not colourless iodine, sometimes called povidine – which does not reveal the presence of starch. If you have trouble getting this, let me know.

Your range of problems are very serious. To have all three major diseases, AS, Crohn’s and microscopic colitis, is a terrible struggle. I really feel for you.

I am going to send your letter to Professor Alan Ebringer, who wrote the foreword in my book, because he is presently involved in research on Crohn’s. He’ll be interested to read of your case because he’s found that the Low-Starch Diet works when no other treatment does. Patients are referred to him by doctors when they are desperate because they can no longer tolerate the medication. On the Low-Starch Diet they are able to return to normal life.

I’m so sorry I can’t offer you a quick fix. But I’m sure that you will overcome your symptoms on the Low-Starch Diet – and I know of no other way.

Please feel free to write to me again if you wish.
Very best wishes,
Carol

When you try all those products that are advertised to overcome IBS, and they don’t work, do you think it’s your fault? ‘Obviously it works for everyone else, otherwise the manufacturers wouldn’t keep on advertising them and people wouldn’t keep on buying them!’

Let me tell you, it’s not in your mind – it’s not your fault, and you’re never going to get rid of IBS by eating more whole-grain foods, or pro-biotic yoghurts, or going on a low-fat diet, or giving up coffee and red meat – or any of the tired old recommendations.

OK – maybe for a few weeks you’ll notice a slight relief of symptoms – or a change in symptoms – but it won’t last. I know, because I tried them all for years, and they all failed.

The only thing that was successful – and still is successful after 25 years – is the low-starch diet. You see, your gut is full of bacteria, some good and some bad. The bad bacteria, klebsiella in particular, live on undigested starch in your gut. When you cut down or eliminate starch, the bacteria has nothing to live on and starves to death. And your gut pain and bloating disappears. The bacteria has been causing fermentation in your gut – and you know what happens when fermentation occurs? Gas! And gas produces pain and bloating.

There are plenty of low-starch foods to eat and cook – over 200 recipes and ideas for snacks. It’s all in my book, The IBS Low-Starch Diet by Carol Sinclair. The Low-Starch Diet works!