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 because they are likely to cause infections and chronic health issues but may help us occasionally. Klebsiella is one such genus of bacteria that can be considered then lean towards opportunism, 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 Klebsiella will stab us in the back, cause pneumonia, or leave our joints on fire.

All About Klebsiella

Many different strains of Klebsiella are normal flora within our bodies. 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 our body, from our nasal passages, mouth, lungs, urinary tract, and digestive tract. The bacteria’s colonization occasionally benefits us; it breaks down and ferments lactose within our intestinal tract. Klebsiella can easily break down using its enzymes, resistant starch types two and three (corn starch, potato starch, rice starch, for example). When the bacteria are probiotic flora, they can help to break down the occasional ingestion of resistant starch, feeding itself, us, and other bacteria within our microbiome. Finally, it can ferment protein, producing ammonia, causing health issues, and utilize supplemental amino acids 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. aerogenes – a known human colonizer.
• 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?

We should not blame Klebsiella for its breaking bad ways, most microorganisms if given a chance become opportunistic. What are the 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.
• Joints – a cause of arthritis.
• 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 either SIBO-D (small intestinal bacterial overgrowth, diarrhea) or H2S (hydrogen sulfide) SIBO.
• Skin – a cause of wound infections.
• Spinal column – a cause of spinal bone/disc degradation and inflammation.
• Throat – a cause of upper respiratory tract infections.
• Upper gut dysbiosis – a cause of esophageal dysbiosis/inflammation, dysbiosis/laryngeal inflammation, gastritis, stomach and duodenal ulcerations, liver, gallbladder, and pancreas infections and dysbiosis.
• 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 healthcare threat. For example, most Klebsiella strains can produce extended-spectrum beta-lactamases and are resistant to mostly all known beta-lactam antibiotics, except carbapenems. Recently, even some strains are developing resistance to carbapenems as well. Through the improper use of antibiotics, we are running out of antibiotics to fight Klebsiella dysbiosis and infections. 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 to being hospitalized in India. She developed septic shock and tragically died in September of that year. Testing of the bacteria done by the United States Centers for Disease Control was found to be resistant to all known antibiotics within the United States.

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

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

Ankylosing spondylitis (AS) is inflammation caused by chronic Klebsiella dysbiosis, infection, or endotoxin exposure of your axial skeleton and occasionally your joints. Ankylosing spondylitis usually develops from chronic Klebsiella dysbiosis when one is a young adult, and the disease symptoms 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 the function, sclerosis, inflammation, and erosion of your spine and joints. Inflammatory markers, including C-reactive protein, TNF-a, and interferon-gamma, may increase during acute phases of severe dysbiosis or active infection of Klebsiella and should be tested to monitor inflammation. Your HLA-B27 and HLA-DR4 genes may also be tested to confirm if a genetical Klebsiella weakness causes your AS. Human leukocyte antigen genes are essential in the regulation of our immune system in its reaction to our world around and in us, including microorganisms. Mutations in HLA-B27 and HLA-DR4 have been discovered to be linked to reduced immune reactivity to Klebsiella, increased reactivity to Klebsiella endotoxins, and the increased likelihood of developing AS if you suffer from Klebsiella dysbiosis or infection.^{16 17 18 19}

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

Rheumatoid arthritis (RA) is inflammation caused by chronic Klebsiella dysbiosis, infection, or endotoxin exposure of your joints. Rheumatoid arthritis usually develops from Klebsiella’s chronic dysbiosis, and the disease symptoms 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 your skin, and dryness of your eyes and mouth. Later progression of the disease can cause a severe reduction in joint manipulation, lung fibrosis, crippling pain and swelling in your 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 suffer from different chronic conditions. There are, however, other tests that are run to determine if one has RA. Rheumatoid factor (IgM) can be tested in your 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 also be elevated from other Gram-negative bacterial endotoxins. Even though both tests are rarely run for people to help diagnose AS, from our evidence, people with AS would most likely test positive for both antibodies.^{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, which can be 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 cause abnormal immune reactions to LPS endotoxins triggering Th1 dominance and chronic inflammation within our spine and joints hindering proper collagen health and production. Reducing starch within the diet has been demonstrated in studies to reduce Klebsiella populations within our digestive system 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}

Why do some people with Klebsiella dysbiosis develop mainly digestive issues, and some create the conditions AS or RA? Many people have Klebsiella within or on their bodies 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 their 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 your immune system fails to recognize and control the pathogen leading to excessive inflammation and Th1 dominance. Now you might also be asking yourself why some people develop RA, instead of AS or vice-versa if Klebsiella causes both conditions. It could depend on many factors, including an individual’s gene expression, what period of their life they developed the dysbiosis, their immune system, or the 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. In contrast, most people with RA also have joint curvature and cervical spine pain, almost like both diseases have a similar pathology.^{34 35 36}

The most conclusive evidence that Klebsiella causes AS and RA is that most people with those conditions tragically perish from cardiovascular or pulmonary symptoms. Their cardiovascular and pulmonary systems were under constant assault from increased inflammation from Th1 dominance in response to the endotoxins produced by Klebsiella, which inflamed their arteries, heart, and veins over time. Chronic inflammation from endotoxins cause 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 our lungs and is a cause of bacterial pneumonia.^{37 38 39}

Medication used in treating AS and RA tackles the symptoms only but does not relieve Klebsiella dysbiosis or optimize your microbiome and immune system. Opioids help control the pain caused by inflammation and scar tissue caused by dysbiosis. NSAIDS and most biologics hinder the immune system and reduce Th1 dominance which for a time qualms inflammation and improves symptoms. However, bacterial dysbiosis worsens from your immune system being hindered—most relapse and inflammation rages, overriding the medication’s ability to inhibit inflammation. Medication dosages are increased or switched out, ultimately causing a vicious continuing cycle of increased inflammation, dysbiosis, 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 within our intestines. Klebsiella can break down quickly using its enzymes, resistant starch types two and three (corn starch, potato starch, rice starch). When Klebsiella is probiotic flora, it can help to break down the occasional ingestion of resistant starch for better digestion by helping to feed our microbiome. Klebsiella can also 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 colonic, SIBO, or upper gut dysbiosis may occur when Klebsiella dysbiosis develops, causing numerous symptoms. 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 or hydrogen sulfide 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 inflammatory symptoms. With Th2/Th17 you will have histamine intolerance symptoms. Depending on your immune reaction to Klebsiella you should follow a different protocol to help relieve dysbiosis and restore your immune system.

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

First, 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 hydrogen sulfide Klebsiella dysbiosis, then follow a low sulfur diet combined with eating very low amounts of resistant starch, and if you are suffering from histamine-producing Klebsiella dysbiosis, I recommend following a low histamine diet combined with eating very low amounts of resistant starch) 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 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 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 contains differing amounts of resistant starch. Wheat bread and gluten-free bread also have varying 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 and legumes which are rich in resistant starch and large quantities of the prebiotic inulin, which also feeds Klebsiella. The following 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 (unless you are suffering from hydrogen sulfide Klebsiella dysbiosis, then follow a low sulfur diet combined with eating very low amounts of resistant starch, and if you are suffering from histamine-producing Klebsiella dysbiosis, I recommend following a low histamine diet combined with eating very low amounts of resistant starch).

Proper exposure to the sun is also essential 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 and proper immune system regulation.

Klebsiella Dysbiosis With Th1 Dominance Relief Protocol

Antibacterial Agents to Reduce Klebsiella

• Ceylon cinnamon oil – consume one to three drops of the ceylon cinnamon oil in one teaspoon of extra virgin coconut oil or extra virgin olive oil, twice daily. Use with caution if you have hypoglycemia or are suffering from histamine intolerance.
• Allicin-C – take two to eight capsules daily in divided doses with food. Use with caution if you are suffering from Klebsiella producing hydrogen sulfide dysbiosis.
• Olive leaf extract – take one to two capsules, twice daily with food.
• Black cumin seed oil – take one teaspoon with breakfast and one with dinner.
• Consume one to two cups of organic green tea daily. Use with caution if you are suffering from histamine intolerance or are sensitive to caffeine.

Supplements to Reduce Th1 Induced Inflammation and Leaky Gut

• Proper Omega 3 intake is important.
• Thorne curcumin – take one capsule with breakfast and one with dinner. Use with caution if you are suffering from Klebsiella producing hydrogen sulfide dysbiosis.
• Boswellia – take one capsule with breakfast and one with dinner.
• Red light LED therapy and CBD oil supplementation may help relieve Th1 inflammation.
• Zinc carnosine – take two capsules with breakfast and two with dinner.

What You Can do to Support Your Microbiome

• Ingest fermented vegetables like organic sauerkraut and kimchi, daily. Ingest with caution if you are suffering from Klebsiella producing hydrogen sulfide dysbiosis.
• Holigos – take one packet daily mixed well with filtered water at breakfast.
• Take a recommended probiotic an hour before bed with filtered or bottled water like Smidge.

General Advice for Improving Klebsiella Dysbiosis With Th1 Dominance

• Follow these recommendations if you are dealing with diarrhea or constipation.
• 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 are 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 to three drops of clove oil in one teaspoon of extra virgin olive oil (if you have issues with salicylates, mix it in ghee), twice daily.
• Allicin-C – take two to eight capsules daily in divided doses with food. Use with caution if you are suffering from Klebsiella producing hydrogen sulfide dysbiosis.
• Black cumin seed oil – take one teaspoon with breakfast and one with dinner.

If needed, add Zane Hellas Oil of Oregano (take two to three drops in one teaspoon 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 three thousand milligrams, two to three times daily in divided doses.
• Quercetin (use with caution if you have a COMT mutation) – take one capsule on an empty stomach twice daily. Use with caution if you are suffering from hypothyroidism.
• 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 supplementation may also help to relieve histamine issues and relieve reflux or leaky gut.

What You Can Do to Support Your Microbiome

• • Liposomal colostrum – consume one teaspoon mixed in with filtered or bottled water at breakfast.
  • Take a recommended probiotic an hour before bed with filtered or bottled water like Smidge.

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

• Arabinogalactan – take one scoop mixed in filtered water, consumed at breakfast with the colostrum.
• Holigos – take 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. Also, use with caution if you are suffering from Klebsiella producing hydrogen sulfide dysbiosis.
• 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 are effective against Klebisella in studies and not affect histamine intolerance. Vitamin C is a natural antihistamine. Quercetin is a natural mast cell stabilizer. Ginger and licorice reduce Th2 immune reactions. Liposomial colostrum, arabinogalactans, 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 challenge 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 improve 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 suffer from the crippling inflammation or histamine issues Klebsiella causes. The protocols in this blog are basic templates; if you want more refined individual recommendations to help tackle Klebsiella dysbiosis, contact me for coaching.