Ankylosing Spondylitis updates in diet, the gut microbi… — Transcript

Inflammatory back pain. This is different than the usual back pain that we think about when our back hurts. Ankylosing spondylitis, also known as bamboo spine disease, is an inflammatory arthritis of the spine. The vertebras of the spine fuse together and kind of look like the stick of a bamboo. Ankylosing spondylitis affects millions of people worldwide, about 0.5% of the world population. It is seen more often in men and more often in young people, usually between the ages of 17 and 45. It has to be taken care of early so we can minimize problems later on. Why is it so important to talk about this condition? One word: misdiagnosis. Amongst autoimmune diseases, there is a lot of misdiagnosis. Ankylosing spondylitis really is up there. Usually, when we look at medical textbooks and who could get ankylosing spondylitis, we think of a young Caucasian male, possibly with a genetic test positive called HLA B27. What happens if you're a young Chinese woman or an older Black woman or none of these? Could you still have this condition? Absolutely, but the pickup is much more difficult if you don't hit all the check marks, which is why it's so important to talk about because there are people right now today that are going to the wrong specialists and clinicians because they don't realize what they actually have is inflammatory back pain and not the regular wear and tear back pain that we think about, like when I hurt my back. It could be from degenerative changes like a herniated disc, and sometimes you don't even know why you got it. But inflammatory back pain is from an autoimmune condition in which you are going to have problems with flexibility and stiffness and a whole host of other things if it's not taken care of. And even though it's a disease of the back, it can affect tendons and ligaments, other areas of the body including your eyes. There's so much that's a part of it that's not just the back. And what it usually is, is when you're waking up in the morning, you're feeling really stiff and it takes a while to kind of get moved. Exercise tends to help it, and so do medications like anti-inflammatories, what we call NSAIDs. And we're going to get to that in a few seconds because there's some things that you must know about this condition. Number one, ankylosing spondylitis is associated with some other factors: smoking, having a higher BMI, body mass index, or being overweight. More associated with high cholesterol, high blood pressure, osteoporosis, vertebral fractures. Yes, low bone density, because again, it's an inflammatory disease. It's not just a regular "I have back pain." This is inflammation working away at your bones, so yes, there's a higher chance of osteoporosis. Something else that's really come to attention in the last few years though for ankylosing spondylitis is that there's a higher risk of hip fractures. See, we all think about back pain and we think about back stiffness and how it affects the back. It affects the tendons, the ligaments, the vertebrae of the back, but also what is connected to the back? It's the hips, right? So you can also have poor hip flexibility, and on top of that, I just told you osteoporosis or low bone density. The inflammation is working away on that, so there's a higher chance of hip fractures at a younger age. Hip fractures are a major cause of dying. You know, as our population gets older, this is more common as it is. And on top of that, if you have this condition, it is certainly more possible to get something else that's really come to attention recently. What does weight have to do with ankylosing spondylitis? A higher BMI or body mass index is associated with more inflammatory activity, and we don't know if it's really the disease itself or the fact that we consider fat to be inflammatory. And so, is that what's causing the inflammation? Either way, we want the medications to work. If you're going to take the medications, it's good to keep a healthy BMI so that they actually work for you. Exercise. Okay, this is a big one for ankylosing spondylitis and all rheumatic diseases. We suggest exercise; however, in this one, it's particularly important. Important because it is actually something that modifies the disease process. People do better with exercise. This is a long-term disease. You want to maintain as much flexibility as you can, not only in the back but also in the neck and your other areas, right? There are people that can no longer look from side to side or down or up when they have ankylosing spondylitis if they haven't been getting treatment or it hasn't worked adequately. And also, what type of exercise do we want? There actually have been studies on this, and in a recent one, there were 30 volunteers in the study. In one group, it was spinal flexibility exercise, and the other group was spinal flexibility exercise plus aerobic exercise. Guess which one did better? Okay, the second group, the one that did both spinal flexibility and aerobic exercise, they definitely did better in outcomes with ankylosing spondylitis. So yes, you need to also get that heart rate up and do aerobic activity. Now, what about yoga versus aerobic activity? Which one did better? Actually, trick question: they both did fairly decently, so you could choose either one, but you just need to do it. Now, there was a Chinese study in 2020 that actually was really interesting. It was a wearable study where they were given a device to wear to see if that would help with movement and flexibility and exercise because, as they put it, not everybody can make it to big medical centers and do weeks and weeks of physical therapy. They have lives, so why not do it at home with a wearable device? What happened? It worked. People did better when they were using these wearable devices and doing their own exercise. But what was preventing them from doing all the exercise was a lack of time, a lack of energy, and a lack of willpower. Well, that kind of affects us in so many different ways, in so many different processes, so it's not just ankylosing spondylitis, but yes, movement did help. Now, is there any type of movement to avoid? Well, actually, there is. What's important in ankylosing spondylitis is to avoid kind of jerking activity or too much loaded pressure, for example, on the neck. Like, you may not want to work for a moving company and carry heavy boxes because that could perhaps affect your neck flexors and your spine more, so not the best job for ankylosing spondylitis. Another one was, I remember when I worked in New York City, and I would have all these cab drivers as patients, and I would just think the stop-start, stop-start kind of movement, especially in a place like New York City, is not really good for somebody who has ankylosing spondylitis because imagine how much it affects the neck. Or if you're doing a high-impact exercise, a high-impact sport like, for example, tennis or basketball, it's not that you can't do them; it's that it's a little more risky when you have ankylosing spondylitis because the inflammation can be at the tendons and ligaments. If you're in full remission and you want to give it a try, that might be better than somebody who is really not having good control of the disease and then they want to go out and try all these sports. Probably not the best thing. Lower impact like yoga, tai chi, badminton, those might be a little bit better. But if somebody is a high-intense sport athlete and they are well controlled on these drugs, it's a risk balance, you know? And I have people like that, and they try to do everything else in their life to control these factors like lifestyle, diet, exercise along with the medication to see if their ankylosing spondylitis does better, and they often do just fine. What about the diet? Right, food is so impactful. How about in this condition? Well, I would say we have much more diet studies in other rheumatic illnesses than we do in AS. The gut microbiome is an area for study in so many diseases because there have been thoughts that there's a connection between what you eat, how your gut is processing it, recognizing it, and what diseases may manifest because of issues between your gut and your body. Now wha—

Stick of a bamboo anking spondilitis which affects millions of people worldwide about 05% of the world population seen more often in men seen more often in young people usually between the ages of 17 and 45 it has to

be taken care of early so we can minimize problems later on why is it so important to talk about this condition one word Mis diagnosis amongst autoimmune diseases there is a lot of misdiagnosis anen spondilitis really is up there usually when we look at Medical

textbooks and who could get anoing spondilitis we think of a young Caucasian male possibly with a genetic test positive called HLA B27 what happens if you're a young Chinese woman or an older black woman or none of these

could you still have this condition absolutely but the pickup is much more difficult if you don't hit all the check marks which is why it's so important to talk about because there are people right now today that are going to the

wrong Specialists and clinicians because they don't realize what they actually have is inflammatory back pain and not the regular wear and tear back pain that we think about like when I hurt my back uh it could be from degenerative changes

like a herniated disc and sometimes you don't even know why you got it but inflammatory back pain is from an autoimmune condition in which you're are going to have problems with flexibility and stiffness and a whole host of other

things if it's not taken care of and even though it's a disease of the back it can affect tendons and ligaments other areas of the body including your eyes there's so much that's a part of it that's not just the back and what it

usually is is when you're waking up in the morning you're feeling really stiff and it takes a while to kind of get moved exercise tends to help it and so do medications like anti-inflammatories what we call enets and we're going to

get to that in a few seconds because there's some things that you must know about this condition number one anking spondilitis is associated with some other factors smoking have a higher BMI body mass index or being overweight more

associated with high cholesterol high blood pressure osteoporosis vertebral fractures yes low bone density because again it's an inflamm disease it's not just a regular I have back pain this is inflammation working away at your bones so yes there's a higher chance of

osteoporosis something else that's really come to attention in the last few years though for anking spondilitis is that there's a higher risk of hip fractures see we all think about back pain and we think about back stiffness and how it affects the back it affects

the tendons the ligaments the vertebra of the back but also what is connected to the back it's the hips right so you can also have poor hip flexibility and on top of that I just told you osteoporosis or low bone density the

inflammation is working away on that so there's a higher chance of hip fractures in a younger age hip fractures are a major cause of dying you know as our population gets older this is more common as it is and on top of that if

you have this condition it is certainly more possible to get something else that's really come to attention recently is what does weight have to do with closing spondilitis a higher BMI or body mass index is associated with more

inflammatory activity and we don't know if it's really the disease itself or the fact that we consider fat to be inflammatory and so is that what's causing the inflammation either way we want the medications to work if you're

going to take the medications it's good to keep a healthy BMI so that they actually work for you exercise okay this is a big one for anking spondilitis all romatic diseases we suggest exercise however in this one it's particularly

important important because it is actually something that modifies the disease process people do better with exercise this is a long-term disease you want to maintain as much flexibility as you can not only in the back also in the

neck and your other areas right there are people that can no longer look from side to side or down or up when they have anoing spondilitis if they haven't been getting treatment or it hasn't worked adequately and also what type of

exercise do we want there actually has been studies on this and in a recent one there was uh 30 Volunteers in the study and in one group it was Final flexibility exercise and the other group was Final flexibility exercise plus

aerobic exercise guess which one did better okay the second group the one that did both spinal flexibility and aerobic exercise they definitely did better in outcomes with anging spondilitis so yes you need to also get that heart rate up and do aerobic

activity now what about yoga versus aerobic activity which one did better actually trick question they both did fairly decent so you could choose either one but you just need to do it now there was a Chinese study in 2020 that

actually was really interesting it was a wearable study where they were given a device to wear to see if that would help with movement and flexibility and exercise because as they put it not everybody can make it to Big medical

centers and do weeks and weeks of physical therapy they have lives so why not do it at home with a wearable device what happened it worked people did better when they were using these wearable devices and doing their own

exercise but but what was preventing them from doing all the exercise was a lack of time a lack of energy and a lack of willpower well that kind of affects us in so many different ways in so many

different processes so it's not just anoing spondilitis but yes movement did help now is there any type of movement to avoid well actually there is what's important in anking spondilitis is to to avoid kind of jerking activity or too

much loaded pressure for example on the neck like you may not want to work for a moving company and carry heavy boxes because that could perhaps affect your neck flexors and your spine more so not the best job for ankling spondilitis

another one was I remember when I worked in New York City and I would have all these cab drivers as patients and I would just think the stop start stop start kind of movement especially in a place like New York City is not really

good for somebody who has ankle SE spondilitis cuz imagine how much it affects the neck or if you're doing a high impact exercise a high impact sport like for example tennis or basketball it's not that you can't do them it's

that it's a little more risky when you have ankle loosing spondilitis because the inflammation can be at the tendons and ligaments if you're in full remission and you want to give it a try that might be better than somebody who

is really not having good control of the disease and then they want to go out and try all these Sports probably not the best thing lower impact like yoga taichi badminton those might be a little bit better but if somebody is a high intense

sport athlete and they are well controlled on these drugs it's a risk balance you know and I have people like that and they try to do everything else in their life to control these factors like lifestyle diet exercise along with

the medication to see if their angling spondilitis does better and they often do just fine what about the diet right food is so impactful how about in this condition well I would say we have much more diet studies in other Rheumatic

illnesses than we do in as the gut microbiome it is an area for study in so many diseases because there has been thoughts that there's a connection between what you eat how your gut is processing it recognizing it and what

diseases May manifest because of issues between your gut and your body now what do they see in as there was a study it was average size about 200 patients and they took 100 anging spondilitis patients and 100 healthy controls and

they collected stool stampless for all of them and they kept them Frozen they took them immediately froze them transferred them to a lab facility froze them again until they were evaluated and they found that bacteroides was the most represented

class in these samples but it was also the most represented class of bacteria in normal samples so they definitely have some of the same but there were differences seen But microbiome in ankal losing spondilitis is different than those of healthy controls now is it the

disease that has made it different or was it different to begin with and therefore you got the disease there are still a lot of questions to be answered 2024 a Turkish abstract has been published where they use the dietary

inflammatory index on 21 people ages 19 to 64 they believe according to their evaluation that a diet containing omega-3 fatty acids and mono unsat saturated fatty acids which presumably have anti-inflammatory effects can help improve disease activity in anking

spondilitis is this going to pan out in a larger trial randomized control trial well I hope so but we don't know that data yet another study reported on fiber and anking spondilitis and they found that an increase in fiber consumption

decreased the inflammation in as dietary studies are hard to do though because there is often recall bias along with other biases for example if you were asked what did you eat yesterday or last week you will try your best to remember

especially if it's for a study but you may not remember everything accurately or it could be that you may not prefer to tell everything accurately either way there is bias so it's really hard to do diet studies so we need to see them

replicated at a larger scale there is a spot of good news now with anoing spondilitis we have so many treatments out there and yet one of the main stay of treatments and in fact the first line of treatment is something called nids or

anti-inflammatories you might have heard of ibuprofen Advil a but in ankley spondilitis we use it kind of more as a daily medication and sometimes at very high doses of it and that can control disease activity like in our other

conditions we'll say okay take it when you have pain don't necessarily take it all the time but in this particular condition we do say that sometimes especially in very mild or early disease that may be all somebody needs but we

worry about the the risk of heart heart attacks and strokes and and the risk to your gut and your kidneys so we worry about so many things when we say take Nets there was a study from 2020 that

said actually even though people took a lot of nids in anking spondilitis there wasn't necessarily more heart events or cardiovascular events so that was at least a little bit reassuring for us since we prescribed so much of it but

again you still have to be careful because we don't know how it will affect each individual person there is a lot to take in with ankling spondilitis the medications are getting better and better but also so important to try to

improve all of the lifestyle interventions that you can that you have to improve all around you so whether it's diet exercise mental health because it's definitely associated with depression and poor quality of life right when you can't move and you're not

flexible and you can't do all the things you want to do so you have to kind of try to modify all these things in your life it's not easy to do but it's something that has to be a part of this

process with ankling spondilitis I'm Dr basali and if you want to see more videos on autoimmune disease and how it affects our health you can check this one next