Klebsiella Causes Rheumatoid Arthritis, Ankylosing Spondylitis, and What to Do to Hopefully Recover

Bacteria are ubiquitous, and some are more helpful in improving our health than others. Some bacteria are mutualists; for example, we feed them nutrients through eating food, they produce vitamin K which we absorb and utilize for our health. Other bacteria can be more opportunistic, in that they are likely to cause infections and chronic health issues, but may help us from time to time. Klebsiella is one such genus of bacteria where it can be considered then lean towards being opportunistic, with occasional mutualist benefits. Some Klebsiella strains, for example, produce the short chain fatty acid, butyrate, when we feed it, and it is kept in check by our immune system and microbiome.

However, if given a chance the bacteria will stab us in the back, cause pneumonia, or leave our joints in an inflammatory hell.

All About Klebsiella

Having a multitude of different strains of the bacteria are normal flora in our body. Klebsiella is ubiquitous and is found almost everywhere. As long as this Gram-negative, rod-shaped bacteria are kept in check by our immune system, it lives as a commensal with us. Klebsiella colonizes portions of the human body, from our nasal passages, mouth, lungs, urinary tract, and our digestive tract. The bacteria’s colonization occasionally benefits us; it breaks down and ferments lactose in the intestinal tract. Klebsiella can easily break down using its enzymes, resistant starch type two and three (corn starch, potato starch, rice starch, for examples). When the bacteria is probiotic flora, it can help to break down the occasional ingestion of resistant starch feeding itself, us, and other bacteria within our microbiome. Finally, can ferment protein, producing ammonia causing health issues and utilize supplemental amino acids as well for survival.^{1 2 3 4 5 6}

The bacteria serve niche purposes in strengthening our overall digestive health when it is commensal by helping us assimilate carbohydrates.

Klebsiella subspecies list:^{7 8}

• K. granulomatis
• K. michiganensis
• K. oxytoca – a known human colonizer.
• K. pneumoniae – a known human colonizer.
• K. quasipneumoniae – a known human colonizer.
• K. variicola

What Medical Conditions Does Opportunistic Klebsiella Cause?

I guess we should not blame Klebsiella for its breaking bad ways, most microorganisms if given a chance become opportunistic. What are known infection areas of the bacteria?

Conventional acute infection areas:^{9 10 11 12}

• Blood – a cause of septicemia, can inhabit intravenous equipment.
• Bone – a cause of osteomyelitis
• Brain – a cause of meningitis.
• Colon – a cause of dysbiosis.
• Lungs – a cause of pneumonia, can inhabit ventilator equipment.
• Nose – a cause of upper respiratory tract infections.
• Oral cavity – a cause of dental caries and cavitations.
• Small intestine – a cause of both SIBO-D (small intestinal bacterial overgrowth) and upper gut duodenal, liver, pancreas, and gallbladder health issues.
• Skin – wound infections
• Throat – a cause of upper respiratory tract infections.
• Urinary tract – a cause of infections, can inhabit urinary catheters.

There are many different strains of multiple antibiotic resistant Klebsiella, making it a serious emerging health care threat. For example, most Klebsiella strains have the ability to produce extended-spectrum beta-lactamases and are resistant to mostly all of the known beta-lactam antibiotics, except carbapenems. Recently even some strains are developing resistance to carapenems as well. Through the improper of antibiotics we are running out of antibiotics to fight Klebsiella. Finally, in late 2016, a resident of Washoe County Nevada was hospitalized in Reno, Nevada due to a chronic Klebsiella pneumoniae infection she developed from a chronically infected broken femur two years prior from being hospitalized in India. She developed septic shock and tragically died in September of that year. Testing of the microbe done by the Centers for Disease Control was found to be resistant to all known antibiotics within the United States.

Opportunistic Klebsiella infects different parts of the body and causes many medical conditions. So what about the bacteria colonizing and causing chronic inflammation in the joints or spine? Is it possible that Klebsiella produced endotoxins leak out of the gut and trigger specific immune responses that cause issues with collagen production and increased inflammation in the joints or spine? Why is it so hard for mainstream medicine to believe that chronic infections or immune reactions stemming from dysbiosis and leaky gut of the bacteria can cause two different “autoimmune conditions.”¹³

What is Ankylosing Spondylitis and How Is It Caused by Klebsiella?

Ankylosing spondylitis (AS) is a chronic Klebsiella infection or inflammation from endotoxins of the axial skeleton and occasionally the joints. Ankylosing spondylitis usually develops from chronic Klebsiella dysbiosis when one is a young adult, and the symptoms of the disease slowly worsen. Early symptoms of AS include lower back pain, increased curvature of the lower spine, joint pain, stiffness in the lower back, weight loss, fever, and fatigue. Later progression of the disease can cause loss of spinal manipulation, issues with breathing and chest expansion, arthritis in the hips and shoulders, severe pain, and swelling.^{14 15}

AS is diagnosed from radiological imaging to determine function, sclerosis, and erosion of the spine and joints. Inflammatory markers like C-reactive protein, TNF-a, and interferon gamma may increase during acute phases of severe dysbiosis or active infection of Klebsiella and the HLA-B27, HLA-DR4 genes may be tested. Human leukocyte antigen genes are essential in the regulation of our immune system in reaction to the world around us, including pathogens. Mutations in HLA-B27 and HLA-DR4 have been discovered to be linked to increased Klebsiella sensitivity from leaky gut and the development of AS.^{16 17 18 19}

What Is Rheumatoid Arthritis and How Is It Also Caused by Klebsiella?

Rheumatoid arthritis (RA) is a chronic Klebsiella infection or inflammation of endotoxins of the joints. Rheumatoid arthritis usually develops from the chronic dysbiosis of Klebsiella, and the symptoms of the disease slowly worsen. Symptoms of RA include joint pain, joint stiffness (loss of range of motion), increased joint curvature, cervical spine pain, liver and kidney issues, swelling of joints, rheumatoid nodules on the skin, and dryness of the eyes and mouth. Later progression of the disease can cause a severe reduction in joint manipulation, lung fibrosis, crippling pain and swelling in the joints, and heart disease.^{20 21}

RA is diagnosed with radiological imaging to determine function, inflammation, and erosion of joints. Inflammatory markers like C-reactive protein, TNF-a, IL-1, IL-6, and interferon gamma may increase during acute phases of dysbiosis or active infection of bacteria and testing of the genes HLA-B27, HLA-DR4 usually occurs. It is fascinating how mostly the same markers are tested for in people with AS and RA to determine if they are suffering from different chronic conditions. There are, however, other tests that are run to determine if one has RA. Rheumatoid factor (IgM) is tested in the blood which is linked to being an antibody reaction to Gram-negative (Klebsiella is Gram-negative) bacterial endotoxins. ACPA (anti-citrullinated antibodies) is also tested to determine if you are suffering from RA, but the antibodies can be elevated from Gram-negative bacterial endotoxins as well. Even though, both of these tests are rarely run for people to help diagnose AS, from the evidence we have it appears that people with AS would most likely test positive for these antibodies as well.^{22 23 24 25 26 27 28}

Klebsiella Dysbiosis the Cause of Ankylosing Spondylitis and Rheumatoid Arthrits

I mentioned a few clues above that link the bacteria as being the cause of AS and RA. Is it not weird for an “autoimmune” condition to cause a fever during the acute, painful stage? Here is another coincidence: the same inflammatory markers tested for AS and RA are elevated in Th1 dominant immune conditions what are caused by the Gram-negative bacterial genus, Klebsiella. Mutations in HLA-B27 and HLA-DR4 distort a proper immune response to Klebsiella dysbiosis. The distortion of immune function can allow for easier Klebsiella dysbiosis or can cause abnormal immune reactions to LPS endotoxins triggering Th1 dominance and chronic inflammation in the spine and joints for issues with proper collagen production. Reducing starch in the diet has been demonstrated in studies to reduce Klebsiella populations in the gut and reduce symptoms of AS and RA. Finally, multiple studies have found dysbiosis of Klebsiella and increased antibodies to Klebsiella endotoxins in people with AS and RA.^{29 30 31 32 33}

So why do some people with Klebsiella dysbiosis develop mostly digestive issues and some develop the conditions AS or RA? Many people have Klebsiella in their body as natural flora. Are mutations or epigenetic changes in the genes HLA-DR4 and HLA-B27 and possibly other genes the difference in why someone who takes antibiotics long-term or eats a lot of resistant starch eventually develops AS or RA? It is possible. I will go one step further and say that it is even possible for these genes to mutate epigenetically (mutations that occur from the environment). Could severe dysbiosis of Klebsiella itself change one’s genetics making the body more susceptible to it? Klebsiella endotoxins modify the expression of HLA-B27 and HLA-DR4. Klebsiella itself might be able to change the expression of HLA-B27 or HLA-DR4 so that the immune system fails to recognize and control the pathogen leading to excessive inflammation and Th1 dominance. Now you might also be asking yourself, why do some people develop RA, instead of AS or vice-versa if Klebsiella causes both conditions? It could depend on many different factors, including, an individual’s gene expression, what period of their life they developed the dysbiosis, their immune system, or the individual strain of Klebsiella that can cause different manifestations of the chronic diseases. Finally, I find it interesting that many people with AS have joint inflammation and pain, whereas most people with RA also have joint curvature and cervical spine pain, almost if both diseases had a similar pathology?^{34 35 36}

The most damning evidence that Klebsiella causes AS and RA is that most people with those conditions tragically die from cardiovascular or pulmonary symptoms. The cardiovascular and pulmonary systems are under constant assault from increased inflammation occurring from Th1 dominance in response to endotoxins produced from Klebsiella, which inflame the arteries, heart, and veins over time. Chronic inflammation from endotoxins produces cardiovascular disease which may eventually lead to heart failure and death. Lung fibrosis is a commonly recognized consequence of having both RA and AS and can lead to cardiopulmonary failure. Klebsiella is known to colonize the lungs and is a cause of bacterial pneumonia.^{37 38 39}

Medication that is used in treating AS and RA tackles the symptoms only but does not relieve the Klebsiella dysbisos and fix the health of your microbiome and immune system. Opioids help to control the pain that is caused by inflammation and scar tissue caused by the dysbiosis. NSAIDS and most biologics hinder the immune system and reduce Th1 dominance which for a time qualms inflammation and improves symptoms. However, the bacterial dysbiosis worsens from being uncontrolled and most people relapse and inflammation increases which override the medications, causing a vicious cycle of inflammation, scar tissue formation, and pain.^{40 41}

What to Do if Klebsiella is Causing SIBO (Small Intestine Bacterial Overgrowth) or Colonic Dysbiosis

Klebsiella typically inhabits our colon in our digestive tract. The bacteria’s colonization occasionally benefits us; it breaks down and ferments lactose in the intestinal tract. Klebsiella can break down quickly using its enzymes, resistant starch type two and three (corn starch, potato starch, rice starch). When Klebsiella is probiotic flora, it can help to break down occasional ingestion of resistant starch for better digestion by helping to feed our microbiome. Klebsiella is also able to break down and ferment the prebiotic FOS (inulin), fructose, and mannose. Klebsiella breaks down different types of carbohydrates and protein for itself, us, and other microorganisms for utilization.^{42 43 44 45 46}

But when an overgrowth of Klebsiella develops, SIBO or colonic dysbiosis may occur causing issues. Many people with digestive issues test positive for Klebsiella strains in stool tests. Depending on the strain of Klebsiella, you may develop either Th1 immune dominance from the endotoxins it produces or Th2/Th17 immune dominance if the specific strain of Klebsiella you are dealing with produces histamine. With Th1 immune dominance, you will have more inflammatory reactions with Th2/Th17 you will have more histamine intolerance symptoms. Depending on your immune reaction to Klebsiella you might need to follow a different protocol to help relieve dysbiosis and calm your immune system.

There are a few things you can do to help improve your health if you are suffering from Klebsiella dysbiosis no matter what form of immune dominance it is causing.

First of all, immediately reduce the quantity of resistant starch in your diet; Klebsiella can easily break down resistant starch and use it to increase virulence. I would recommend most people follow the Perfect Health Diet (unless you are suffering from Th2/Th17 Dominance, if you are then follow a low histamine and low starch diet instead) and consume all starchy foods fresh and hot, do not refrigerate them and consume them later. When rice, sweet potatoes, oats, corn, beans, and potatoes are cooked and then cooled, resistant starch begins to form. Reheating the starchy food does not lower its resistant starch content. For example, consuming jasmine rice after it is first cooked would have little resistant starch, if any at all. Letting it cool in the refrigerator and cooking it later in some vegetable egg fried rice, would cause the rice to have a good amount of resistant starch. In addition, starchy fruits like plantains and bananas should be consumed ripe; they contain a lot of resistant starch when they are unripe. Any type of previously prepared starchy food including potato chips, potato starch, corn chips, corn starch, rice chips, rice crackers, rice starch, cereals, or tapioca starch also contain differing amounts of resistant starch. Wheat bread and gluten-free bread also contain differing amounts of resistant starch. Whole grains would be a greater source of starch as well. Most flours also contain differing amounts of resistant starch sadly. Finally, I would avoid beans which are rich in resistant starch and large quantities of the prebiotic inulin, which feeds Klebsiella as well. There is a good list of resistant starch foods on Selfhacked that you may want to try to avoid under the starch and legumes lists.⁴⁷

For some people that are in a severe state of inflammation a more restrictive diet like an autoimmune paleo diet with resistant starch restriction might be needed.

Proper exposure to the sun is also essential as well to help reduce inflammation and calm an overactive immune system. Midday sunlight exposure increases endogenous vitamin D production and reduces overactive immune responses, calming the immune system and reducing pathogen load. Finally, proper sleep hygiene is vital for inflammation reduction.

Klebsiella Dysbiosis With Th1 Dominance Relief Protocol

Antibacterial Agents to Reduce Klebsiella

• Ceylon cinnamon oil – take one drop in one tsp. of extra virgin coconut oil or extra virgin olive oil, twice daily. Use with caution if you have hypoglycemia.
• Allicin-C – two to eight capsules daily in divided doses with food.
• Olive leaf extract – one – two capsules, twice daily with food.
• Black cumin seed oil – one tsp. with breakfast and one with dinner.

Supplements to Reduce Th1 Induced Inflammation

• Proper Omega 3 intake.
• Thorne Curcumin – one capsule with breakfast and one with dinner.
• Boswellia – one capsule with breakfast and one with dinner.

What You Can do to Support Your Microbiome

• Ingest fermented vegetables like organic sauerkraut and kimchi, daily.
• Holigos – one packet daily mixed well with filtered water at breakfast.
• Consume kombucha on occasion.

General Advice for Improving Klebsiella Dysbiosis With Th1 Dominance

• Follow these recommendations if you are dealing with diarrhea or constipation.
• Acupuncture and CBD oil may help relieve Th1 inflammation.
• Supplement with magnesium or B12 if you are deficient.
• Correct hypothyroidism if you are suffering from it.

Cinnamon, allicin, olive leaf extract, and black cumin seed oil have been shown to be effective against Klebsiella in studies. Omega 3 supplementation, curcumin, CBD oil, acupuncture, and boswellia will help to reduce inflammation caused by Klebsiella endotoxins. Galactomune, and fermented vegetables will help to regrow and repopulate your probiotic microbiome. Many people with Th1 overactivity and gut dysbiosis suffer from hypothyroidism and supporting your thyroid will improve your recovery.^{48 49 50 51 52 53 54 55 56 57}

Klebsiella Dysbiosis With Th2/Th17 Dominance Relief Protocol

Antibacterial Agents to Reduce Klebsiella

Clove oil – take one drop in one tsp. of extra virgin olive oil (if you have issues with salicylates, mix it in ghee), twice daily.

Allicin-C – two to eight capsules daily in divided doses with food.

Black cumin seed oil – one tsp. with breakfast and one with dinner.

If needed add Zane Hellas Oil of Oregano (take two drops in one tsp. of extra virgin olive oil [if you have issues with salicylates, mix it in ghee]), twice daily, but I would not use it in a first run protocol because it is both systemic and broad spectrum, it will reduce your probiotic microbiome throughout your entire body.

What You Can Do to Relieve Your Histamine Intolerance

• Sodium ascorbate – take 3,000 mg, two to three times daily in divided doses.
• Quercetin (use with caution if you have a COMT mutation) – one capsule on an empty stomach, twice daily.
• Ingest freshly grated ginger or consume ginger tea once daily.
• If needed ask your doctor for a prescription of the mast cell stabilizer, cromoglicic acid.
• DGL licorice may also help to relieve histamine issues.

What You Can do to Support Your Microbiome

• Liposomal Colostrum – one tbsp. mixed in filtered water, consumed at breakfast.
• GutPro Capsules – one – two capsules before bed. Use filtered or bottled water when ingesting.

Choose either arabinogalactan or 2-FL to help rebuild your microbiome:

• Arabinogalactan – one scoop mixed in filtered water, consumed at breakfast with the colostrum.
• Holigos – one packet daily mixed well with filtered water at breakfast.

General Advice for Improving Klebsiella Dysbiosis With Th2/Th17 Dominance

• Supplement with glutathione to see if it helps your histamine issues as long as you do not have any mercury amalgams or have tested positive for elevated mercury deposits recently.
• Follow a low starch/low histamine diet as referenced above.
• Supplement with magnesium or B12 if you are deficient.
• Avoid a diet heavy in medium chain triglycerides (coconut oil, mct oil, or Brain Octane oil). If you are suffering from Th2/Th17, these oils may sensitize your gut to histamine, causing further intolerance issues and poor digestion.

Clove, allicin, oil of oregano, and black cumin seed oil have been shown to be effective against Klebisella in studies and not effect histamine. Vitamin C is a natural anti-histamine. Quercetin is a natural mast cell stabilizer. Ginger and licorice reduce Th2 immune reactions. Liposomial colostrum, arabinogalactan’s, and 2-FL will help to regrow and repopulate your probiotic microbiome.^{58 59 60 61 62 63 64 65 66 67 68}

Conclusion

Klebsiella dysbiosis can be a challenege to relieve but it can be done. Klebsiella is normal flora in the gut, you cannot rid yourself of it, but you can relieve your dysbiosis and work on improving the health of your immune system so that it can keep it in check and not cause debilitating conditions like RA and AS. No one should have to suffer from the crippling inflammation or histamine issues that Klebsiella causes. The protocols that are listed in this blog are basic templates; if you want more refined individual recommendations to help tackle Klebsiella dysbiosis, contact me for coaching.