I have been pushing very low carbohydrate diets for 15 years and in the last 5 years strict ketogenic diets in patients. Seronegaitve spondyloarthritis responds particularly well to this approach with a significant percentage of patints with B27 going into remission off of meds. All patients from RA, to PSA to OA require substantially less medication to control disease. This is not a minor effect. Compliance is challenging but there are a growing number of compliance resources available as well as ketometers and glucometers to aid with compliance and guide dietary decisions.