Dr. Amy Nett: What Chris talked about is that Klebsiella is of particular concern in patients who have this HLA-B27. Likely for reasons due to molecular mimicry, there are more joint issues, in particular, with these patients, so when we recommend a low- or no-amylose diet, it’s in patients who specifically have that HLA-B27 type and they have Klebsiella and either joint pain or a diagnosis of ankylosing spondylitis. If someone’s not officially diagnosed with ankylosing spondylitis but still has joint pain, we probably will recommend a no- or low-amylose diet during treatment, and similarly, if they have a diagnosis of ankylosing spondylitis, even if they don’t have active inflammation, it might be something to consider when Klebsiella is present.
Hopefully this is just a short-term treatment. We generally are recommending it as part of the treatment approach, and our preference is always to minimize the duration that people are doing a no- or low- amylose diet, hopefully short term. But then going back to Tom’s question—are there supplements that you can do to help negate some of these issues that can be associated with low-carbohydrate diets?—there are a few non-starch sources of carbohydrate, so you can think about things like glucose. You can even do a glucose powder, also known as dextrose, and you can also think about fructose or fruit. These are absorbed and dealt with a little bit differently, so these might be considered acceptable on a no-amylose diet.
Other things you can think about doing to support people when they’re on a no-amylose diet in this setting would be prebiotics. You could use some prebiotic supplements as well. That would be ways to support people when they’re on the no-amylose diet.