Full text of DOI:10.1089/10762800152709688

Natural Interventions for
Treating Autoimmune Diseases
Current Knowledge and New Possibilities
Shari Lieberman, Ph.D., C.N.S.,
F.A.C.N.
a RR of 1.2, and past users had a RR of
.8. A proportional increase in risk was
DHEA
More recent studies have shown that,
1
observed with the duration of use of
for some types of autoimmune disorders,
exogenous DHEA replacement may actu-
ally be therapeutic for treating rheuma-
6
postmenopausal hormones.
1
2
13
onventional medical interven-
tion for a variety of autoimmune
Estrogen Dominance May Be a Factor
toid arthritis (RA) and SLE.
Many American women have “hyper-
estrogenism” or estrogen dominance
because they consume meat, chicken,
veal, and dairy products that still retain
estrogens that have been added to live-
stock as well as xenoestrogens from
pesticides and other environmental tox-
In a double-blind, placebo-controlled
study, 21 patients with severe S LE
received either 200 mg per day of DHEA
or placebo in addition to conventional
treatment (corticosteroids, immunosup-
pressives) for 6 months. The mean
improvement of a SLE activity index was
greater in the DHEA-treated group and 7
of 9 patients who took DHEA versus 4 of
10 who took the placebo were responders.
DHEA also demonstrated a protective
effect with respect to corticosteroid-
C
diseases has been disappointing
at best. Therapy is generally initiated
to control some of the symptoms and
slow the progression of disease. Howev-
er, conventional treatment does not
offer a “cure” and long-term prognoses
for remissions still remain poor. Many
of the drugs used to treat these disor-
ders have serious side-effects, such as
bone loss, ulcers, joint and organ dam-
age , and addi tio nal w o rseni ng of
immune function and symptoms over
7
ins.
In addition, only 32 percent of Ameri-
cans eat the recommended 5 servings of
8
fruit and vegetables and consumption
among these women of whole grain
9
13
food is very low. Fruits, vegetables,
induced osteopenia. Adjuvant DHEA
1
,2
time.
Autoimmune disease is more
and whole grains are important sources
of phytohormones, which can modulate
estrogen levels in the body by enhanc-
ing the metabolism o f estradiol to
estrone and produce estriol as a final
byproduct.
therapy given at similar levels in addition
to conventional treatment has been shown
3
prevalent in women compared to men
and studies suggest that increased
serum estrogens play a role in autoim-
12
to reduce symptoms associated with RA.
It has been suggested that DHEA
increases androgen levels rather than
estrogen levels in these patients, thus
3
mune disease.
12,13
High levels of estradiol have repeatedly
reducing the symptoms of disease.
What Research Shows
1
0
been implicated in breast cancer.
Research into autoimmune diseases
and their treatment provide some useful
leads regarding their causation and treat-
ment.
Japanese women, who eat a more plant-
based diet that is also rich in soy, appear
to have a lower risk of developing breast
cancer and have decreased serum estradi-
o l l e v e l s c o m p a r e d t o A m e r i c a n
women. It would be interesting to see if
there is a connection between phytohor-
mone ingestion (e.g., vegetables, soy) and
prevention of autoimmune disease.
Melatonin’s Potential Benefit
In a case report of a patient with multi-
ple sclerosis (MS), 3 mg of melatonin
taken at 2 PM each day, when the patient
experienced severe blurring of vision,
resulted in dramatic improvement in
visual acuity within 15 minutes of ingest-
ing the supplement. It has been suggested
that melatonin may be of benefit to
patients with MS because melatonin mod-
ulates the thermogenic regulatory mecha-
1
1
Negative Effects of Estrogen Replacement
Studies have shown that estrogen
replacement therapy in menopausal
women significantly raises the risk of
developing systemic lupus erythemato-
sus (SLE) and/or developing discoid
Potentially Helpful Supplements
4
14
lupus (DL) and that the use of oral con-
nisms of the pineal gland.
5
traceptives also raises these risks. In the
Current research indicates that two
supplements, dehydroepiandrosterone
(DHEA) and melatonin, may confer bene-
fits on patients with some types of
autoimmune disorders.
Nurses Health Study, more than 69,000
postmenopau sal users of estro gen
replacement had a relative risk (RR) of
The Mercury Debate
The potent neurotoxin mercury has
been shown to induce systemic autoim-
mune conditions in genetically suscepti-
2
.1 for developing SLE, current users had
341

3
42
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
Vegan and gluten-free diets have been shown
to be of benefit to patients with autoimmune diseases.
cance of results, further research into
nutritional intervention for autoimmune
disease has been quite slow in com-
Female:Male Ratios in Autoimmune Diseases
1
1,15,18–47
ing.
Autoimmune condition
Female:male incidence ratio
Hashimoto’s disease/hypothyroiditis
Systemic lupus erythematosus
Sjøgren’s syndrome
50:1
9:1
9:1
9:1
9:1
8:1
8:1
7:1
4:1
3:1
2:1
2:1
2:1
Dietary Interventions
Low fat diets have been reported to be
beneficial in both human and animal
studies with respect to autoimmune dis-
Antiphospholipidsyndrome
Primary biliary cirrhosis
Mixed connective tissue disease
Chronic active hepatitis
Graves’ disease/hyperthyroiditis
Rheumatoid arthritis
1
8
19,20
eases such as SLE and MS.
For example, very–long-term studies
following patients with MS for 34 and
3
6 years have shown that patients who
followed very–low-fat diets (<20 g fat
per day) experienced significantly less
deterioration and much lower death
rates than patients who consumed high-
Scleroderma
Myasthenia gravis
1
9,20
er amounts of dietary fat.
Approxi-
Multiple sclerosis
mately 95 percent of patients who were
followed during these 34- and 36-year
studies survived for the duration of the
Chronic idiopathic thrombocytopenic purpura
Notes: Many autoimmune diseases have a disproportionatelyhigh incidence among women.
s t u d ie s a nd r e m ai ne d p h y si c a ll y
Reproduced with permission from an online document entitled Autoimmune Diesases in Women–The Facts, posted on
the Web site of the American Autoimmune-Related Diseases Association, Inc. (AARDA) Online document at
www.aaarda.org/women.html Copyright 1998. Adapted for use with permission from the AARDA.
19,20
active.
An even lower-fat diet
(
10–15 g of fat per day) resulted in bet-
ter improvement in energy and reduced
1
6,17
fatigue levels.
In patients who con-
sumed >20 g of fat per day, the death
rate approached 80 percent by the end
of the 34- and 36-year studies.
1
5
Natural Approaches
ble mice. These animals also have a
narrow safety margin compared to
non–genetically susceptible mice. One
study revealed that death rates from MS
were linearly related to the numbers of
decayed, missing, and filled teeth in
patients from 6 Australian states, 48
American states, and 45 Asian and Euro-
19,20
Scientific studies have shown that spe-
cific dietary supplements, dietary modifi-
cations, and life style changes may be of
benefit to patients with autoimmune dis-
ease as demonstrated by extended clinical
remissions, reductions in symptoms,
and/or reductions in dosages of steroids
and other drugs used to control the dis-
Low-fat diets could potentially modu-
l a t e p r o s t a g l a n d i n m e t a b o l i s m ,
specifically arachidonic acid and inflam-
matory prostaglandins. High-meat diets
are rich in arachidonic acid and high-fat
diets are generally quite high in linoleic
acid—both of which may result in an
imbalance of prostaglandin metabolism
by enco uraging the p ro duc tio n of
1
6
pean countries. Another study demon-
strated a 21-percent increase in MS in
relation to dental carries compared to
controls in England. This compelling
evidence has prompted many practition-
ers to advise patients to have mercury
amalgams removed. Anecdotal evidence
of patient improvement has been report-
ed by numerous practitioners.
1
1,15,18–47
eases.
Although a more natural
intervention is best utilized at the very
onset of disease, this type of treatment can
also be combined with conventional thera-
py to help provide symptom relief and
lessen the side-effects of pharmaceutical
agents that are used to treat patients in
later stages of disease. Despite the signifi-
1
7
21
inflammatory prostaglandins. In addi-
tion, lower-fat diets would result in
lower levels of oxidative stress.
Vegan diets and gluten-free diets have
been shown to be of benefit to patients
22
23
24
with RA, psoriasis, eczema, dermati-

ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
343
Food and chemical sensitivities are more
common in patients with autoimmune diseases.
2
5
26
tis herpetiformis, type 1 diabetes, or
Omega-3 and Omega-6 Fatty Acids
sion of SLE without any negative side-
effects. Fish-oil supplementation has
2
7
30
Crohn’s disease. Milk consumption has
been shown to increase the incidence of
Numerous animal models of SLE
have demonstrated marked protection
from kidney disease, increased life
spans, and autoimmune suppression.
Human clinical studies have shown
that fish oil can induce clinical remis-
also been shown to benefit patients
with MS, in particular, newly diag-
nosed patients, by significantly reduc-
ing neurologic scores and exacerbation
2
8
MS. Food and chemical sensitivities are
more common in patients with autoim-
mune diseases, in particular, those with
3
0
2
9
31
SLE.
rates. There are many studies show-
Mainstream Medicine on Autoimmune Disease
National Institutes of Health
Bethesda, MD 20892-3560
Phone Diabetes, Digestive, and Kidney Diseases Information:
(301) 654-3810
NIDDK Information Office (Thyroid Diseases)
Building 31/Room 9A04
31 Center Drive
Bethesda, MD 20892-3560
Phone: (301) 496-3583
Web site: www.niddk.nih.gov
Despite exellent data on alternative treatments for autoimmune
diseases, mainstream organizations are unaware of this research.
However, these organizations can offer other kinds of support. Because
autoimmune diseases affect so many different structures and functions of
the body, numerous institutes at the National Institutes of Health (NIH)
conduct research into treatments for autoimmune diseases. Many of
these diseases fall under the aegis of the National Institute of Allergy and
Infectious Diseases (NIAID), which maintains a Web site that provides
extensive links to other relevant institutes and to nongovernmental
organizations that provide disease-specific information to patients with
specific autoimmune disease diagnoses. The institutes and private
organizations also coordinate and may fund research into the specific
diseases. Institutes of the NIH that oversee medical research and
provide information about specific autoimmune diseases include:
National Institute of Neurological Disorders and Stroke
Office of Scientific and Health Reports
P.O. Box 5801
Bethesda, MD 20824
Phone: (301) 496-5751
Web site: www.ninds.nih.gov
National Institute of Allergy and Infectious Diseases
Office of Communications
Building 31/Room 7A50
Office of Rare Diseases
Building 31/Room 1B03
3
1 Center Drive
3
1 Center Drive, MSC 2520
Bethesda, MD 20892
Phone: (301) 402-4336
Web site: www.rarediseases.info.nih.gov
Bethesda, MD 20892-2520
Phone: (301) 496-5717
Web site: www.niaid.nih.gov
National Institute of Arthritis and Musculoskeletal and Skin
Private organization
Diseases
Information Clearinghouse/NIH
American Autoimmune-Related Diseases Association
(AARDA)
1
AMS Circle
Bethesda, MD 20892-3675
Phone Fast Facts: (301) 881-2731 (to receive information by fax)
22100 Gratiot Avenue
East Detroit, MI 48021
Clearinghouse: (301) 495-4484
Web site: www.niams.nih.gov
Phone (800) 598-4668 or (586) 776 3318
Web site: www.aarda.org
The AARDA is the principal private organization that distributes
information about autoimmune diseases. This organization initiates and
fosters research and sends packets of information on autoimmunity
and autoimmune diseases.
National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK)
Information Clearinghouse
1
Information Way

3
44
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
Supplementation with just one
antioxidant can potentially induce oxidative stress.
3
7
ing a beneficial effect of fish oil supple-
Patients with scleroderma who took 1g
per day of EPO had clinical benefits,
including pain relief, improved skin tex-
ture, and ulcers healing. The authors of
this study suggest that 6 g per day may
offer greater benefit in patients with
800–1600 international units (IU). The
vitamin may also reduce symptoms asso-
ciated with scleroderma and Raynaud’s
3
2
mentation for patients with RA. These
benefits include reduced use of nons-
teroidal anti-inflammatory drugs and
reductions in such symptoms as joint
3
7–39
syndrome.
Case reports on vitamin
E use have described clearing of sclero-
derma lesions and reductions of RA
symptoms. Similar doses of the vitamin
3
2
tenderness and swelling.
4
5
Clinical benefit of fish-oil supplementa-
tion (in particular, enteric-coated supple-
ments) has also been observed in patients
with such disorders as Crohn’s disease by
lowering the relapse rates and maintain-
scleroderma.
3
8,39
Borage (Borago officinalis) oil capsules
supply 240 mg of GLA per capsule there-
by reducing the number of capsules a
patient needs to take to gain therapeutic
benefit. GLA sup plementation for
patients with RA has produced reduced
inflammation of joints, with better results
produced these results.
High-dose vitamin A (more 100,000 IU
per day) or etritinate may significantly
reduce psoriasis symptoms. However
patients must be monitored for potential
s id e- e f f e c t s an d t o x i c it y , su c h as
headaches and elevated results in liver-
3
3
ing remissions. Patients who have
received long-term administration of fish
oil had clinical improvement in psoriasis
3
4
35
40
lesions.
at higher intakes (1.4 g versus 2.4 g).
function tests.
In general, studies have used high-
dose fish oil supplementation of at least
Similar intakes of GLA for patients
with MS have produced improvements in
It is possible that conducting studies
with multiple antioxidants along with
other nutrients may yield better results.
For example, as mentioned earlier, vita-
min C can regenerate vitamin E and pro-
tect it from oxidation. In addition,
antioxidants such as vitamin E help to
protect polyunsaturated fatty acids from
fish oil, EPO, or borage oil from being
oxidized.
3
6
3
.6 g per day. This amount is at least 9
hand-grip strength. Theoretically, one
may be able to obtain similar results by
lowering the fat content of the diet and
using lower doses of GLA. Some practi-
tioners recommend using both fish oil
and GLA supplementation.
fish oil capsules per day, depending
upon the g of fish oil provided by each
capsule. The eicosapentaenoic acid con-
tent of 1.5 g of fish oil is 450 mg and the
docosahexaenoic acid content is general-
ly 300 mg.
Fish oil appears to work as well as, if
not better than, conventional drug treat-
Antioxidants
Patients who are chronically ill with
autoimmune disease have consistently
higher levels of oxidative stress and lower
levels of antioxidants. However, studies
have generally examined the effects of
one antioxidant at a time on disease pro-
gression. The problem that arises with
this type of research is that, unfortunate-
ly, supplementation with just one antioxi-
dant can potentially induce oxidative
stress.
For example, because vitamin E is a
polyunsaturated fat, if given alone, it
could potentially oxidize. When given
concomitantly with vitamin C to a
patient, the ascorbic acid will prevent
vitamin E oxidation and regenerate vita-
min E in the body. Studies have shown
that vitamin E may be beneficial for
patients with SLE and DL, producing
complete clearing of lesions and/or clini-
cal remission at very high doses of
What is surprising is that, while excel-
lent results were achieved using vitamin
E supplementation to treat patients with
SLE, DL, and scleroderma, there is a sur-
prising lack of studies that have used
vitamin E to treat patients who have MS,
except for just a few studies that com-
bined selenium, vitamin C, and vitamin
3
0–34
ment, produces no side-effects
and
can be combined with conventional thera-
3
0–34
py.
However, coadministration of a
very-low-fat diet may reduce the quantity
of fish oil required to improve a patient’s
condition and/or induce remission of
symptoms of autoimmune disease.
4
1
E.
Gamma Linolenic Acid
With regard to using each antioxidant
The results of studies using evening
primrose (Oenothera biennis) oil (EPO)
for treating autoimmune disease have
been mixed, perhaps because of differ-
ent doses used in these studies. EPO is a
significant source of g-linolenic acid
individually, it is equally surprising that,
when great results were obtained for a par-
ticular autoimmune disease, they were not
necessarily repeated for another disease.
It would be prudent to administer all
major antioxidants to patients who have
autoimmune disease because of the syn-
ergistic effects of these supplements,
their role in modulating essential fatty
acid (EFA) metabolism to favor the pro-
d u c t i o n o f a n t i - i n f l a m m a t o r y
prostaglandins (which is why they work
(
GLA) with each capsule providing 45
mg per capsule of GLA. However, in
order to produce a therapeutic benefit,
6
–12 capsules of EPO (4–8 g) have been
needed in studies (both human and ani-
mal) for treating autoimmune disorders.

ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
345
As is the case with antioxidants, B vitamins do
not operate in a vacuum but rather are synergistic.
1
5,4 7
well with EFA supplements), and their
ability to quench free radicals and pre-
vent organ and cellular damage.
rarely reported.
In light of these
blood, salivary, or urinary levels of these
hormones is imperative during hormonal
therapy.
results, patients who are given high-
dose PABA should be monitored for
these side-effects.
In a follow up study, of patients who
were maintained on Potaba therapy, 81.4
percent survived 5 years from diagnosis
and 69.4 percent survived 10 years from
None of these interventions require
that a patient stop conventional therapy,
making them ideal. Many of the study
outcomes are as good as—or better
than—many conventional therapies for
autoimmune disease. What appears to
make them superior, is their apparent
lac k o f se rio us side- ef f ec ts . Mo re
research is needed to determine which
combination therapies are the most
effective for specific types of autoim-
mune diseases. In the meantime, many
practitioners can combine interventions
with the hope of achieving maximum
B Vitamins
A number of B-vitamins have been
the f oc u s o f rese arc h on dif ferent
autoimmune diseases. In general, this
research has shown that some B-vita-
min deficiencies have been associated
with autoimmune disorders and that
therapy with certain B vitamins appears
to reduce the symptoms of autoimmune
4
7
diagnosis. While these results are out-
standing, and side-effects are still mini-
mal compared to other standard forms
of therapy, it remains a mystery as to
why this therapy is not utilized by
physicians.
The B-vitamin research has also fol-
lowed the “magic bullet” protocol of
generally researching only one particu-
lar B-vitamin at a time. But, as is the
case with antioxidants, B vitamins do
not operate in a vacuum but rather are
synergistic. The synergy in these vita-
mins is the result of their being coen-
zymes that modulate EFA metabolism
and neurotransmitter metabolism. The
B vitamins also participate in the Kreb’s
cycle to produce adenosine triphos-
phate.
4
1
disease.
For example, one study suggests that a
vitamin B deficiency may predispose a
6
4
2
person to develop MS. In another study,
2
g of pantothenic acid significantly
results.
n
decreased stiffness and degree of disabili-
4
3
ty and pain in patients with RA. In yet
another study, 67 patients with SLE and
DL received 10–15 g per day of a pan-
tothenic-acid supplement along with
References
1. Anonymous. Fractures in adults on systemic
steroid therapy. Prescrire Int 8(43):153–156,
1
999.
1
000–1200 mg of vitamin E for 7–19
2
. Anonymous. Pain medicine—the dangers of
months. All of the subjects showed
marked reductions of symptoms and
relapse rates for the duration of the study.
Only transient gastric distress was report-
acetominophen. Harvard Health Lett 26(9):6,
2
001.
3
. Greenstein, B.D. Lupus: Why women? J
W o m e n ’ s H e a l t h G e n d e r B a s e d M e d
4
4
ed as a side-effect.
1
0(3):233–239. 2001.
Conclusion
There have been several human stud-
ies that demonstrated the effectiveness
of high-dose para-aminobenzoic acid
4
. Meier, C.R., Sturkenboom, M.C., Cohen,
According to what is currently known,
dietary interventions, omega-3 and
omega-6 fatty acids, antioxidants, and B-
vitamins can be helpful for treating
patients with autoimmune disorders.
These interventions can slow the progres-
sion of disease and extend clinical remis-
sion in some cases. In others, these
treatments can relieve symptoms, thus,
reducing the need for (or doses of) of
pharmaceutical agents.
In addition, being that mercury is a
known neurotoxin, removal of such amal-
gams may be beneficial to patients with
autoimmune disorders. DHEA and mela-
tonin may also be help ful for suc h
patients; however, closer monitoring of
A.S., et al. Postmenopausal estrogen replace-
ment therapy and the risk of developing sys-
temic lupus erythematosus or discoid lupus. J
Rheumatol 25(8):1515–1519, 1998.
(
PABA) supplementation (Potaba). The
researchers administered 12 g per day to
patients with scleroderma. In a retro-
spective study, analyses were made of
the records of 390 patients, 224 of whom
were taking Potaba for extended periods
o f t i m e— as l o n g a s 10 y e ar s . T h e
researchers found that 90 percent of the
5
. Petri, M. Exogenous estrogen in systemic
lupus erythematosus: Oral contraceptives and
ho r m o ne r e p la c em e nt t he r a p y. L up us
1
0(3):222–226, 2001.
6
. Sanchez-Guerro, J., Liang, M.H., Karlson,
E.W., et al. Postmenopausal estrogen therapy
and the risk for developing systemic lupus ery-
thematosus. Ann Int Med 122(6):430–433, 1995.
7. Rao, T., Richardson, B. Environmentally
induced autoimmune diseases: Potential mech-
a n i s m s . E n v i r o n H e a l t h P e r s p e c t
Suppl.5:737–742, 1999.
2
24 patients treated with Potaba experi-
enced mild, moderate, or marked skin
softening with a significant difference
noted between the patients who did not
4
7
take Potaba. Some patients reported
side-effects such as skin rashes, anorex-
ia, nausea, and fever; liver toxicity was
8
. Krebs-Smith, S.M., Cook, A., Subar, A.F., et
al. U.S. adults fruit and vegetable intakes,

3
46
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
1
989–1991: A revised baseline for the Healthy
with rheumatoid arthritis: A systematic review.
Scand J Rheumatol 30(1):1–10, 2001.
37. Ayres, S., Mihan, R. Is vitamin E involved
in t he a u to i mmu ne me cha ni s m? C ut is
21:321–325, 1978.
38. Darlington, L.G., Stone, T.W. Antioxidants
and fatty acids in the amelioration of rheuma-
toid arthritis and related disorders. Br J Nutr
85(3):251–269, 2001.
39. Ayres S. Raynaud’s phenomenon, sclero-
derma and calinosis cutis: Response to vitamin
E. Cutis 11:54–62, 1973.
40. Kaplan, R.P. Etretinate therapy for psoria-
sis: Clinical responses, remission time, epider-
mal DNA and polyamine response. J Am Acad
Dermatol 8(1):95–102, 1983.
People 2000 objective. Am J Public Health
8
9
tion of grain and whole-grain foods by Ameri-
can population during the years 1990–1992. J
Am Diet Assn 95(6):703–704, 1995.
5(12):1623–1629, 1995.
. Albertson, A.M., Tobelmann, R.C. Consump-
23. Lithell, H., Bruce, A., Gustafsson, I.B., et al.
A fasting and vegetarian diet treatment trial on
chronic inflammatory disorders. Acta Derm
Venereol 65(5):397–403, 1983.
24. Finn, R.A. Serum IgG antibodies to gliadin
and other dietary antigens in adults with atopic
eczema. Clin Exp Dermatol 10(3):222–228, 1985.
25. Leonard, J., Haffenden, G., Tucker, W., et al.
Gluten challenge in dermatitis herpetiformis. N
Engl J Med 308(14):816–819, 1983.
26. Jaeger, C., Hatziagelaki, E., Petzoldt, R. et
al. Comparative analysis of organ specific
autoantibodies and celiac disease–associated
antibodies in type 1 diabetic patients, their
first-degree relatives and healthy control sub-
jects. Diabetes Care 24(1):27–32, 2001.
1
0. Chang, Y.C., Riby, J. et al. Cytostatic and
anti es tr oge nic ef fe ct s of 2-( indo lyl- 3-
methyl)3’,3’-diindolylmethane, a major in vivo
product of dietary indole-3-carbinol. Biochem
Pharmacol 58(5):825–834, 1999.
1
1. Nagata, C., Kabuto, M., Durisu, Y., et al.
Decreased serum estradiol concentration asso-
ciated with high dietary intakes of soy prod-
ucts in premenopausal Japanese women. Nutr
Cancer 29(3):228–233, 1997.
41. Klenner, F.R. Response of peripheral and
central nerve pathology to mega-doses of the
vitamin B-complex and other metabolites. J
Appl Nutr 25:16–40, 1973.
1
2. Cutolo, M. Sex hormone adjuvant therapy
in rheumatoid arthritis. Rheum Dis Clin North
Am 26(4):881–895, 2000.
27. Curtis, W.B., Schuman, B.M., Griffin, J.W.
Association of gluten-sensitive enteropathy
and Cr ohn’s colitis. A m J G astroente rol
87(11):1634–1637, 1992.
28. Agranoff, B., Goldberg, D. Diet and the geo-
graphical distribution of multiple sclerosis.
Lancet ii:1061–1066, 1974
29. Carr, R.I., Wold, R.T., Farr, R.S. Antibodies
to bovine gamma globulin (BCG) and the
occurrence of a BCG-like substance in systemic
lupus erythematosus sera. J Allergy Clin
Immunol 50(1):18–30, 1972.
42. Mitchell, D.A., Schandl, E.K. Carbon
monoxide, vitamin B and multiple sclerosis—
6
1
3. Van Vollenhoven, R.F., Park, J.L., Gen-
a theory of interrelationship. Am J Clin Nutr
26(8):890–896. 1973.
ovese, M.C., et al. A double-blind, placebo-
controlled, clinical trial of dehydroepiandros-
terone in severe systemic lupus erythematosus.
Lupus 8(3):181–187, 1999.
43. Anonymous. Calcium pantothenate in
arthritic conditions: A report from the General
Practitioner Research Group. Practitioner
224:208–211, 1980.
44. Welsh, A.L. Lupus erythematosus: Treat-
ment by combined use of massive amounts of
pantothenic acid and vitamin E. Arch Dermatol
Syphilol 70:181–198, 1954.
1
4. Sandyk, R. Diurnal variation in vision and
relations to circadian melatonin secretion in
multiple sclerosis. Int J Neurosci 83(1–2):1–6,
1
995.
1
5. Bagenstose, L.M., Salgame, P., Monestier,
M. Murine mercury-induced autoimmunity: A
model of chemically related autoimmunity in
humans. Immunol Res 20(1):67–78, 1999.
30. Clark, W.F., Parbtani, A. Omega-3 fatty acid
supplementation in clinical and experimental
lupus. Am J Kidney Dis 23(5):644–647, 1994.
31. Nordvik, I., Myhr, K.M., Nyland, H. et al.
Effect of dietary advice and n-3 supplementa-
tion in newly diagnosed multiple sclerosis
patients. Acta Neurol Scand 102(3):143–149,
2000.
32. Kremer, J.M. N-3 fatty acid supplements in
r h e u m a t o i d a r t h r i t i s . A m J C l i n N u t r
71(suppl.1):349–351, 2000.
33. Belluzi, A., Brignola, C., Campieri, M., et al.
Effect of an enteric-coated fish oil preparation
on relapses in Crohn’s disease. N Engl J Med
334(24):1557–1560, 1996.
45. Strong, A.M., Campbell, A., Thompson, J. The
effect of oral linoleic acid and gamma-linolenic
acid (Efamol). Br J Clin Pract 39(11–12):444–445,
1985.
46. Zarafonetis, C.J., Dabich, L., Skowronski,
J.J., et al. Retrospective studies in scleroderma:
Skin response to potassium para-aminoben-
zoate therapy. Clin Exp Rheumatol 6(3):261–268,
1988.
47. Zarafonetis, C.J., Dabich, L., Negri, D., et al.
Retrospective studies in scleroderma: Effect of
potassium para-aminobenzoate on survival. J
Clin Epidemiol 41(2):193–205, 1988.
1
6. Craelium, W. Comparative epidemiology of
multiple sclerosis and dental carries. J Epidemi-
ol Comm Health 32:155–165, 1972.
1
7. McGrother, C.W., Dugmore, C., Phillips,
M.J., et al. Multiple sclerosis, dental carries and
fillings: A case control study. Br Dent J
1
87(5):261–264, 1999.
1
8. Corman, L.C. The role of diet in animal
models of systemic lupus erythematosus: Pos-
sible implications for human lupus. Semin
Arthritis Rheum 15(1):61–69, 1985.
1
9. Swank, R.L., Dugan, B.B. Effect of low satu-
rated fat diet in early and late cases of multiple
sclerosis. Lancet 336:37–39, 1990.
34. Kojima, T., Terano, T., Tanabe, E. et al.
Long-term administration of highly purified
eicosapentaenoic acid provides improvement
of psoriasis. Dermatologica 182(4):225–230, 1991.
35. Belch, J.J., Hill, A. Evening primrose oil and
borage oil in rheumatologic conditions. Am J
Clin Nutr 71(suppl.1): 352–356, 2000.
36. Simpson, L.O. Dietary supplementation
with Efamol and multiple sclerosis. NZ Med J
98(792):1053–1054, 1985.
Shari Lieberman, Ph.D., C.N.S., F.A.C.N., is a
research scientist and industry consultant in
New York City.
2
0. Swank, R.L., Grimsgaard, A. Multiple scle-
rosis: The lipid relationship. Am J Clin Nutr
4
8:1387–1393, 1988.
2
1. Lucas, C., Power, L. Dietary fat aggravates
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