A lot of functional medicine practitioners believe that leaky gut is necessary for autoimmune disease to occur (see Alessio Fasano's work). I came across this study of ankylosing spondylitis patients and it is fascinating. The study says that leaky gut does in fact precede AS. "Our study confirms that alternation of the gut wall occurs before the clinical manifestation of AS".

They split up their study into 3 groups. People with AS, healthy 1st degree relatives of people with AS, and a group of normal healthy individuals as the control. They found that both the patients with AS and their healthy relatives had statistically significant higher leaky gut than the normal control. 60-70% had leaky gut was 20% in the control.

This makes the Klebsiella argument more plausible since it seems you would need intestinal permeability so that the bacteria can enter the blood stream and trigger an autoimmune response.

This is empowering because a NSD diet helps in both repairing the leaky gut and diminishing the number of Klebsiella bacteria. However, it may not be enough for some people and they may need to take other supplements or necessary changes to eliminate leaky gut.

The study is called "Intestinal permeability in patients with ankylosing spondylitis and their healthy relatives"

Pre-As (sacriolitis) dx 2013
Chronic iritis in right eye
HLA-B27 Negative
3g fish oil, vitamin D, multivitamin, bacillus coagulans, digestive enzymes, curcumin, l-glutamine, butyrate (Alex Shikhman gut-based protocol)
Ibuprofen as needed a few times a month