The Link between Ankylosing Spondylitis, Crohn’s Disease, Klebsiella, and Starch Consumption Original paper

What was studied?

This article explores the link between ankylosing spondylitis (AS), Crohn’s disease (CD), Klebsiella pneumoniae, and starch consumption. The study investigates how these elements interact and contribute to the development of AS and CD. Both AS and CD are chronic diseases associated with inflammation, and their onset is thought to be influenced by genetic and environmental factors. The study discusses the hypothesis that Klebsiella pneumoniae, a gut microbe, plays a key role in the initiation and progression of these diseases, especially in individuals genetically predisposed, such as those carrying the HLA-B27 allelotypes. The article emphasizes the role of diet, particularly the consumption of starch, in triggering the growth of Klebsiella in the gut, which may activate immune responses leading to inflammation in both the joints (AS) and the gut (CD).

Who was studied?

This review does not focus on a specific cohort of patients but synthesizes data from various studies involving patients diagnosed with AS and CD. The focus is on individuals with genetic susceptibility, specifically those carrying the HLA-B27 allele, which is strongly associated with AS and has been implicated in IBD. The studies referenced in this review discuss patients from different geographical regions, particularly those in Europe, North America, and parts of Asia. The research explores the role of gut microbes, specifically Klebsiella, in patients with AS and CD. Additionally, the review includes studies on the impact of dietary factors, particularly starch consumption, on the gut microbiota and disease progression in these conditions.

Most important findings

This study highlights several significant findings that help explain the link between AS, CD, Klebsiella pneumoniae, and starch consumption. One of the key points is the role of Klebsiella pneumoniae as a potential microbial trigger for both AS and CD. The bacteria are more likely to proliferate in the gut of individuals who consume high levels of starch, which is thought to provide a favorable environment for Klebsiella growth. The research shows that high starch consumption, notably resistant starch, increases the bacterial load of Klebsiella in the gut, which can exacerbate both AS and CD. This finding suggests a dietary intervention as a potential therapeutic approach to manage these diseases. Additionally, the study underscores the molecular mimicry hypothesis, where immune responses to Klebsiella antigens cross-react with self-antigens, particularly HLA-B27, leading to autoimmune inflammation in the joints (AS) and gut (CD).

Another critical finding is the potential of a low-starch diet to reduce disease activity in AS and CD patients. Evidence from clinical trials and observational studies indicates that reducing starch intake can help decrease inflammation, as it limits the growth of Klebsiella and potentially other pathogenic microbes. This is especially significant when combined with conventional treatments such as biologics and anti-inflammatory drugs.

Key implications

The findings of this review have several important clinical implications. First, they highlight the need for a more integrated approach to managing AS and CD, where dietary modification could be considered alongside pharmacological treatments. Specifically, a low starch diet may help reduce disease activity and improve patient outcomes, particularly in those with AS and CD linked to Klebsiella infections. Furthermore, the research underscores the importance of understanding the gut-liver and gut-joint interactions in autoimmune diseases. Clinicians should consider dietary factors when managing patients with these conditions, particularly in patients who exhibit elevated levels of anti-Klebsiella antibodies or show signs of microbiome dysbiosis.