The Danger of Protein During Pregnancy

Posted by on July 12, 2010 64 comments

At PerfectHealthDiet.com we’re advocates of protein restriction. We recommend:

  • Avoiding all protein-containing plants, as plant proteins tend to be toxic;
  • Striving to eat fatty, not lean, meats and fish, in order to keep protein intake down and fat intake up.

Protein restriction helps protect against viral and bacterial infections by promoting autophagy, the process of intracellular protein scavenging, digestion, and recycling.  During autophagy, bacteria and viruses, as well as junk human proteins and damaged organelles, are digested.  Autophagy has been strongly linked to longevity [1] and is protective against many diseases.

Our advocacy of low protein intake separates us from many other Paleo bloggers.  Loren Cordain, the dean of the Paleo movement, has long advocated consumption of lean meats.  Although he has moderated his stance somewhat, the front page of his site still places lean meats first among his favored foods:

Learn how a diet based on lean meats …

The Paleo Diet is a way of eating in the modern age that best mimics diets of our hunter-gatherer ancestors – combinations of lean meats …

(The other major difference we have with Dr. Cordain is his exclusion of starchy foods from a “Paleo” diet, even though starchy tubers have been part of the ancestral human diet for 4 million years. But that is a story for another day.)

Those who have read the pre-publication draft of our book know that we place high store on human breast milk as an indicator of the optimal composition of the human diet.  Human breast milk provides only 7% of calories in the form of protein. (Carbs are about 38% and fats about 55%.) One can debate whether 7% is the right level of protein for adults; but, if the principle of natural selection is sound, it must be that infants need a low-protein diet.

Science bears this out.  As our book notes, diets containing 20% of calories as protein are highly toxic to infants. Pre-term infants fed 20% protein diets had more fever, lethargy, and poor feeding than infants fed 10% protein diets, and lower IQs at ages 3 and 6 years. [2] Even a slight increase in the protein content of formula, from 7% to 9%, significantly increased the likelihood that babies would be overweight by age 2. [3]

Given our skepticism toward high-protein diets, especially for babies, we were pleased to see Dr. Cordain in his most recent newsletter [The Paleo Diet Update v6, #20 – Protein Intake for Pregnant Women] acknowledge the dangers of high protein intake by pregnant mothers. Dr. Cordain advises a pregnant mother:

[Y]ou probably should increase your fat and carbohydrate consumption, and limit protein to about 20-25% of energy, as higher protein intakes than this may prove to be deleterious to mother and fetus for a variety of physiological reasons….

“Protein intakes above this [25% of total calories] threshold may affect pregnancy outcome through decreased mass at birth and increased perinatal morbidity and mortality.” [4]

The physiological basis for this aversion stems from a reduced rate of urea synthesis during pregnancy that is evident in early gestation [5] as well as increases in the stress hormone cortisol [6]. Hence, pregnant women should include more carbohydrate and fat (i.e. fattier meats) in their diets and limit dietary protein to no more than 20-25% of their total caloric intake.

What are the long-term effects of a high-protein diet during pregnancy on the offspring?  In long-term follow-up studies of the adult children of mothers who ate high protein diets while pregnant between 1948 and 1954, it was found that by age 40 offspring commonly had high levels of the stress hormone cortisol [6] and high blood pressure [7,8].  The effects of faulty maternal diets can be long-lasting.

At PerfectHealthDiet.com, we think 20% is still likely to be a bit more protein than is desirable. We would advise pregnant mothers to restrict protein to about 15% of calories and to strive to obtain 30% of calories as carbohydrates.  As long as adequate carbs are obtained, there is only a modest need for protein and as little as 10% of calories as protein may be sufficient.

Note that this advice is very close to the ratios of 30% carb, 15% protein, and 55% fat that we recommend to adults and children generally.  Pregnant women may benefit from slightly more starch and slightly less protein than others; but on the Perfect Health Diet, pregnancy should not require a significant change in eating habits.

[1] Jia K, Levine B. Autophagy is required for dietary restriction-mediated life span extension in C. elegans. Autophagy. 2007 Nov-Dec;3(6):597-9. http://pmid.us/17912023.

[2] Goldman HI et al. Clinical effects of two different levels of protein intake on low-birth-weight infants. J Pediatr. 1969 Jun;74(6):881-9. http://pmid.us/5781798. Goldman HI et al. Effects of early dietary protein intake on low-birth-weight infants: evaluation at 3 years of age. J Pediatr. 1971 Jan;78(1):126-9. http://pmid.us/5539071. Goldman HI et al. Late effects of early dietary protein intake on low-birth-weight infants. J Pediatr. 1974 Dec;85(6):764-9. http://pmid.us/4472449.

[3] Koletzko B et al; European Childhood Obesity Trial Study Group. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr. 2009 Jun;89(6):1836-45. http://pmid.us/19386747.

[4] Speth JD. Protein selection and avoidance strategies of contemporary and ancestral foragers: unresolved issues. Philos Trans R Soc Lond B Biol Sci. 1991 Nov 29;334(1270):265-9; discussion 269-70. http://pmid.us/1685584.

[5] Kalhan SC. Protein metabolism in pregnancy. Am J Clin Nutr. 2000 May;71(5 Suppl):1249S-55S. http://pmid.us/10799398.

[6] Herrick K et al. Maternal consumption of a high-meat, low-carbohydrate diet in late pregnancy: relation to adult cortisol concentrations in the offspring. J Clin Endocrinol Metab. 2003 Aug;88(8):3554-60. http://pmid.us/12915635.

[7] Campbell DM et al. Diet in pregnancy and the offspring’s blood pressure 40 years later. Br J Obstet Gynaecol. 1996 Mar;103(3):273-80. http://pmid.us/8630314.

[8] Shiell AW et al. High-meat, low-carbohydrate diet in pregnancy: relation to adult blood pressure in the offspring. Hypertension. 2001 Dec 1;38(6):1282-8. http://pmid.us/11751704.

A Good Diet is the Most Effective Therapy

Posted by on July 11, 2010 1 comment

There is a widespread (and correct) recognition that a well-nourishing diet is the best way to prevent disease, but it is usually qualified with the (often incorrect) belief that medicine is the best treatment for disease.

Here, quoted by Asclepius at Natural Messiah, is T. Colin Campbell, the misguided advocate of vegan dieting:

I think the institution of science, which has basically served a very reductionist way of thinking, that is producing little pills and magic bottles to do this that and everything else, that’s what medical science has largely been, been fostering, been concerned with, and interested in.

And of course it … serves our sense of how to control disease through cure, but, it doesn’t serve the public. Prevention is really the way to go, and at the centre of the plate for prevention is nutrition, how we decide to eat and how we decide to behave otherwise, and that’s a very comprehensive sort of lifestyle dietary change. That’s where we get good health – that’s what the public needs to know, and science is not delivering it. [1]

This is true as far as it goes:  Medicine is overly preoccupied with drugs, which rarely cure and often do nearly as much harm as good. Nourishing diets really do prevent disease and deliver good health.

However, stopping there risks leaving sick people with the impression that, having missed their chance at prevention, they must now “control disease through cure” – in other words, that they have to look to doctors and drugs, not to a nourishing diet, for healing.  This is, I think, usually a mistake.

We believe that most diseases are the cumulative effect of food toxins, malnutrition, and infection. Food toxins and malnutrition sabotage immune defenses and enable infections to proliferate and damage the body. A well-nourishing diet enables the immune system to control infections and maintain good health.

When a cure is needed, repairing the diet must still be among the highest priorities.  A poor diet will continue to disable the immune system and prevent recovery.  Repairing the diet will rejuvenate the immune system and give the patient a fighting chance. 

Medicine is not a cure-all.  Drugs are not cure-alls.  They can aid the immune system, but it is the immune system which must ultimately defeat pathogens and heal injured tissues.  The source of a cure is within.

Nutrition has been largely disjoined from therapy. Medicine today fails to utilize diet as an adjunct to therapy. As long as that continues, medicine will continue to be ineffective against chronic disease.

[1] T. Colin Campbell, interviewed by One-Off Productions, 1997, http://www.mcspotlight.org/people/interviews/campbell.html.

The China Study: Evidence for the Perfect Health Diet

Posted by on July 9, 2010 54 comments

T. Colin Campbell became famous for his book The China Study, which claims that a Chinese epidemiology study supports a vegetarian diet.  Chris Masterjohn pointed out some time ago that Campbell’s conclusions had little basis in the study data. [1] Now, Denise Minger has delved into the raw data and shows clearly that Campbell has presented “a strongly misleading interpretation of the original China Study data.” [2] She concludes:

Campbell’s “China Study” book is a spectacular example of how you can cherry-pick data to create a trend that isn’t there. [3]

Campbell’s recommended diet is very different from the Perfect Health Diet. Although hardly carnivores, we at PerfectHealthDiet.com are not idolators of plant foods. Plants have much higher toxin levels than animal foods, and are more difficult to digest. Fiber is often adduced as a reason to eat plant foods, but fiber’s influence on gut bacteria is complex; not all plant fiber improves the composition of gut flora.

We recommend eating daily some safe starches (sweet potato and taro are our favorites; white rice is quick and easy), fruits and berries, seaweed, and assorted vegetables.  We eat vegetables mostly to improve the flavor of our meals. What would a beef stir fry, chicken soup, omelette, or bibimbap be without vegetables?

But, though plant foods constitute 50-70% of the mass of food eaten on our diet, we recommend that carbs provide only 20% of calories.

So, now that Ms. Minger has summarized a lot of the data from the China Study, I thought it would be interesting to see whether the China Study data is supportive of the Perfect Health Diet. The China Study data, as summarized by Ms. Minger, is relevant to four of our claims.

1. Animal Proteins Are Preferable To Plant Proteins

The Perfect Health Diet deprecates plant proteins (which are often toxic) and recommends that protein be obtained from meat, fish, and eggs.  However, we also recommend lower levels of protein consumption than other Paleo diets. We personally obtain about 10% of calories from protein.

So, did the China Study prefer plant or animal sources of protein?  And what is its result for total protein intake?

Ms. Minger reports how protein intake is associated with cancer deaths:

[W]hen we look solely at the variable “death from all cancers,” the association with plant protein is +12. With animal protein, it’s only +3. [2]

The positive numbers mean that more protein is associated with more cancer deaths, suggesting that Chinese should eat less protein.  Since the plant protein association is higher than the animal protein, it’s better to eat animal protein than plant protein.  Just as we would expect!

What about heart disease?

Correlation between animal protein and myocardial infarction and coronary heart disease: +1

Correlation between fish protein and myocardial infarction and coronary heart disease: -11

Correlation between plant protein and myocardial infarction and coronary heart disease (from the China Study’s “diet survey”): +25

Correlation between plant protein and myocardial infarction and coronary heart disease (from the China Study’s “food composite analysis”): +21

Looking at myocardial infarction and coronary heart disease, fish protein was apparently protective (perhaps because it comes with omega-3 fats), animal protein was neutral (as we would expect from healthy protein, which is fairly innocuous health-wise), and plant protein was harmful (as we would expect from toxins).

2. Dairy Fats Good, Dairy Proteins Problematic

The Perfect Health Diet strongly approves of dairy fats (such as butter and heavy cream – clarified butter or ghee for those with dairy sensitivity) and approves of fermented dairy products (yogurt, cheese), but recommends avoiding most dairy protein – especially products containing pasteurized cow casein that has not been pre-digested by bacteria.

In the China Study, dairy proteins seem to have a strong relation to high blood pressure. Ms. Minger notes the following correlations with hypertension:

Milk and dairy products intake: +30

Egg intake: -28

Meat intake: -4

Fish intake: -14

Meat, fish, and eggs are all healthy.  Milk and dairy products – higher blood pressure.  Presumably this is because of the casein.

Cow casein, especially the pasteurized form which is difficult to digest, has various well-documented problems. Ms. Minger cites several studies showing that cow casein increases cancer growth, while milk whey and other protein sources are benign. [2]

3. Grains Are Bad; But Rice Is OK

The Perfect Health Diet strongly recommends eliminating all grains except rice.  Wheat, which has an exceptionally high toxin load, is strongly deprecated.  Rice, on the other hand, is accounted along with taro, sweet potatoes, and other underground starch storage organs among our “safe starches.”

Ms. Minger notes the extraordinary correlations of wheat consumption with disease rates:

Why does Campbell indict animal foods in cardiovascular disease (correlation of +1 for animal protein and -11 for fish protein), yet fail to mention that wheat flour has a correlation of +67 with heart attacks and coronary heart disease, and plant protein correlates at +25 with these conditions?

Speaking of wheat, why doesn’t Campbell also note the astronomical correlations wheat flour has with various diseases: +46 with cervix cancer, +54 with hypertensive heart disease, +47 with stroke, +41 with diseases of the blood and blood-forming organs, and the aforementioned +67 with myocardial infarction and coronary heart disease? (None of these correlations appear to be tangled with any risk-heightening variables, either.) [2]

Wheat was, indeed, by far the most toxic food found in The China Study.  It consistently produced the highest correlations with disease. Ms. Minger concludes:

[W]heat may be one of the most toxic things you could ever put in your mouth. [3]

Note that almost everyone in China eats substantial amounts of either rise or wheat; the people who eat little wheat eat a lot of rice.  Wheat has a high correlation with disease only because rice is anti-correlated with disease. If rice were not safe, wheat would not appear so dangerous.

In fact, the correlation coefficient of rice with heart disease deaths is -58%, almost the opposite of the +67% for wheat. Other grains had a correlation coefficient of +39%. [4] So: rice good, other grains bad, wheat worst of all.

4. Calories Should Come Predominantly From Fat

The Perfect Health Diet recommends obtaining most calories from fat:  the ideal macronutrient ratio is around 20% carbs, 10% protein, and 70% fat by calories.  These fat calories should consist of saturated and monounsaturated fats; polyunsaturated fats should be less than 5% of calories.

No region in China eats at these macronutrient ratios, but one comes substantially closer than others:  the county of Tuoli. [5] Located in the far northwest of China, Tuoli is occupied by a herding people who traditionally eat a great deal of dairy and meat but very few vegetables.

While the average macronutrient intake of all counties in the China Study was 74% carbs, 10% protein, 16% fat, the macronutrient intake in Tuoli was 35% carbs, 19% protein, and 46% fat.

Helping the comparison with the Perfect Health Diet, the Tuoli obtain their fats predominantly from dairy and meat; these contain few polyunsaturated fats. Plant oils, legumes, nuts, eggs, and fish are all non-existent in their diet; so we can be sure they aren’t eating soybean oil, canola oil, or corn oil.

So how do the people of Tuoli stack up in health compared to the rest of China?  Pretty well.

Death from all causes for people under the age of 65 was lower in Tuoli county than in 11 of the 13 counties that ate the least animal protein.

This excellent result was achieved even though the people of Tuoli are among the highest consumers of wheat in China:  they average 0.82 pounds per day of wheat flour.  Without their high consumption of this most toxic of foods, Tuoli county might have the best health in China. Add another point in favor of fat-rich diets.

But What About Seaweed?

In reading Ms. Minger’s discussion, I was able to find only a few correlations that went the wrong way. The only significant one was the correlation of sea vegetables with colorectal cancer (+76%). We highly recommend seaweed consumption, in part for its high content of iodine and other micronutrients.

However, as Ms. Minger notes, the association of seaweed with colorectal cancer is the result of a confounding factor. The areas of China that eat a lot of seaweed have very high rates of schistosomiasis infection, which is an extremely strong promoter of colorectal cancer.  

Conclusion

At least in the data provided by Ms. Minger, there appears to be no data from the China Study that contradicts a recommendation of the Perfect Health Diet, and plenty of data that support our recommendations.

It seems that the China Study is much more supportive of the Perfect Health Diet than of T. Colin Campbell’s diet! 

This doesn’t surprise us:  the Perfect Health Diet is the result of a rigorous five year search through the literature, and every recommendation has, we believe, the weight of scholarly evidence behind it.  But it’s nice to examine new data and find that it agrees with our findings. I’m tempted to look into the raw data of the study, now available from Oxford University’s web site [6], to see if the rest of the study is also supportive of our recommendations.

Thanks much, Denise, for your work. Bravo!  A fine analysis of a large data set.

References

[1] Chris Masterjohn, http://www.cholesterol-and-health.com/China-Study.html.

[2] Denise Minger, http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/. Hat tip Stephan Guyenet, for the link.

[3] Denise Minger, http://rawfoodsos.com/2010/05/25/exciting-update/.

[4] Brad Marshall, http://bradmarshall.blogspot.com/2005/12/is-wheat-killing-us-introduction-maybe.html

[5] Denise Minger, http://rawfoodsos.com/2010/06/23/tuoli-chinas-mysterious-milk-drinkers/.

[6] “Diet, Lifestyle and Mortality in China,” http://www.ctsu.ox.ac.uk/~china/monograph/chdata.htm.

Multiple Sclerosis: A Curable Infectious Disease?

Posted by on July 7, 2010 46 comments

For more than a century many strands of evidence have pointed toward an infectious cause for MS.

Pierre Marie, lecturing in 1892, said that “the causative agent in multiple sclerosis is manifestly of an infective nature.  What is its precise nature?  No one so far has been able to isolate it but one day this goal will be achieved.” [1]

For a long time, little progress was made. In the 1950s, however, Paul Le Gac noticed similarities between multiple sclerosis and symptoms developed in the aftermath of diseases like Rocky Mountain spotted fever and typhus caused by Rickettsia bacteria. [2]  Rickettsia are obligate intracellular parasites that cannot survive outside a host. By 1966, Le Gac recognized that the Chlamydiae, another order of intracellular parasitic bacteria, might be responsible for MS. [3]

Le Gac tried treating multiple sclerosis with tetracyclines and other broad spectrum antibiotics, and reported a number of cures. Here is one of his case studies:

Mr. Maurice Q., a Belgian citizen, 46 years of age. Multiple sclerosis was manifested in 1955 by transient retrobulbar neuritis. In 1956 he became bedridden. As of November 1961, [he had been] totally quadriplegic for three years….

Antibiotic treatment and alginated baths were followed, within a few months, by a spectacular improvement.

In May 1962, Mr. Q. was walking normally. He was able to discard all assistive devices, and soon afterward went back to work as a freight–truck driver. [3]

However, Le Gac’s work was criticized on the ground that MS patients generally lacked antibodies to Rickettsia, not all MS patients responded to Le Gac’s treatment, and no controlled clinical trials had been conducted. [4]

Meanwhile, epidemiological evidence was accruing in support of the idea of an infectious origin.  For instance, MS was virtually unknown in the Faeroe Islands until British troops were stationed there in 1940, after which an epidemic of MS occurred.  Nearly all the MS cases diagnosed between 1943 and 1960 were in people who had resided as children in the towns where the British were stationed. [5] In general, MS risk is increased in populations with low vitamin D and poor hygiene; both associations are suggestive of an infectious origin, since vitamin D is so crucial for intracellular immunity. [6]

Technological advances in molecular biology in the 1980s and 1990s finally made possible a robust investigation into microbial causes. A key invention was real-time PCR, which was honored by the Nobel Prize for Chemistry in 1993. This technique permitted sensitive detection of bacterial DNA from tissue or fluid samples, and enabled for the first time reliable detection (and species identification) of intracellular bacteria. PCR entered research use in the 1990s.

Some scientists at Vanderbilt, who had previously been studying the role of Chlamydia pneumoniae in chronic fatigue, discovered its presence in the cerebrospinal fluid of MS patients. [7] PCR showed that DNA from C. pneumoniae was present in the cerebrospinal fluid of up to 97% of MS patients. [8] In 2002, the Vanderbilt scientists patented a combination-antibiotic therapy for C. pneumoniae [9]. They established a clinic at Vanderbilt specializing in antibiotic treatment of chronic fatigue syndrome and MS.

In medicine, some of the most important progress has been made by doctors and scientists trying to cure their own conditions. The combination of high motivation, intimate familiarity with the disease, and technical expertise is hard to beat. For this reason, I think the story of Dr. David Wheldon, a clinical microbiologist from Britain, and his wife Sarah is significant in the history of MS.  I will abridge their story from various accounts they have published. [10, 11, 12, 13]

In 1999, the Wheldons contracted a respiratory infection which produced a mild pneumonia. In its aftermath, Sarah developed asthma and David developed a myalgia which prevented him from turning his head. By 2003, Sarah had developed full-blown multiple sclerosis: she could not walk unaided, her speech was slurred, she was numb from the waist down, and an MRI revealed numerous white-matter brain lesions. 

Dr. Wheldon searched the literature and found the Vanderbilt work.  He gave his wife doxycycline and roxithromycin, both effective anti-chlamydial agents.  He writes:

What followed was dramatic. For a few days, Sarah had a Herxheimer-like reaction, with a fever and night-sweats. After this, her mental fog and cognitive deficits speedily began to vanish. Slowly, the disease was rolled back … [12]

Sarah improved from a grade of 7 on the Kurtzke Expanded Disability Status Scale (EDSS) to a grade of 2, and remains at that grade seven years later. The same antibiotics cured David’s myalgia.

Dr. Wheldon and Dr. Stratton of the Vanderbilt group have since collaborated on papers summarizing the evidence for C. pneumoniae as the causal agent of MS.  [14] Dr. Wheldon now treats MS patients, and he and his wife also helped popularize a site, cpnhelp.org, set up by a chronic fatigue and fibromyalgia patient, Jim Kepner, to help chronic disease suffers defeat C. pneumoniae infections. This site has a rich lode of MS patients recounting their experiences with antibiotics.

On the clinical research side, pilot trials of antibiotic therapies for MS have been undertaken by several groups, with promising results. [15, 16, 17] It seems only a matter of time, patient pressure, and perhaps a few funerals before large-scale trials are funded.

The experience of MS patients shows that combination antibiotic treatments targeted at C. pneumoniae often halt MS progression and sometimes, as in the case of Sarah Wheldon, bring about substantial recovery.

In an upcoming post, I’ll talk about dietary reasons why antibiotics may fail, or succeed only after a protracted struggle with exceptionally difficult side effects.

[1] Marie, P., Leçons sur les Meladies de la Moelle, Paris, Masson, 1892. Cited in: “Cures” for multiple sclerosis. Br Med J. 1970 Jan 10;1(5688):59-60. http://pmid.us/5411441.

[2] “Cures” for multiple sclerosis. Br Med J. 1970 Jan 10;1(5688):59-60. http://pmid.us/5411441.

[3] Le Gac P et al. The psittacosis virus in the etiology of multiple sclerosis. C R Acad Sci Hebd Seances Acad Sci D. 1966 Nov 28;263(22):1793-5. http://pmid.us/4963916. A translation of the full text is available here:  http://www.davidwheldon.co.uk/Le%20Gac%204.pdf. More case studies may be found here: http://www.davidwheldon.co.uk/Le%20Gac%206.pdf.

[4] Field EJ, Chambers M. Rickettsial antibodies in multiple sclerosis. Br Med J. 1970 Jan 3;1(5687):30-2. http://pmid.us/4983591.

[5] Kurtzke JF, Hyllested K. Multiple sclerosis in the Faroe Islands: I. Clinical and epidemiological features. Ann Neurol. 1979 Jan;5(1):6-21. http://pmid.us/371519. Kurtzke JF, Heltberg A. Multiple sclerosis in the Faroe Islands: an epitome. J Clin Epidemiol. 2001 Jan;54(1):1-22. http://pmid.us/11165464.

[6] Cantorna MT. Vitamin D and multiple sclerosis: an update. Nutr Rev. 2008 Oct;66(10 Suppl 2):S135-8. http://pmid.us/18844840.

[7] Sriram S et al. Multiple sclerosis associated with Chlamydia pneumoniae infection of the CNS. Neurology. 1998 Feb;50(2):571-2. http://pmid.us/9484408. Stratton CW et al. Does Chlamydia pneumoniae play a role in the pathogenesis of multiple sclerosis? J Med Microbiol. 2000 Jan;49(1):1-3. http://pmid.us/10628821.

[8] Sriram S et al. Chlamydia pneumoniae infection of the central nervous system in multiple sclerosis. Ann Neurol. 1999 Jul;46(1):6-14. http://pmid.us/10401775.

[9] Mitchell, William M. & Stratton, Charles W. “Diagnosis and management of infection caused by Chlamydia,” U.S. Patent Number 6,884,784, http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=6884784.PN.&OS=PN/6884784&RS=PN/6884784.

[10] David’s story told by himself: http://www.cpnhelp.org/?q=david_wheldons_story_cpn_treatment_of_cardiac_myalgic_symptoms

[11] Sarah’s story told by herself:  http://www.cpnhelp.org/?q=node/4

[12] Sarah’s story told by David: http://avenues-of-sight.com/Ignoring-the-Evidence.html

[13] http://www.davidwheldon.co.uk/ms-treatment.html

[14] Stratton CW, Wheldon DB. Multiple sclerosis: an infectious syndrome involving Chlamydophila pneumoniae. Trends Microbiol. 2006 Nov;14(11):474-9. http://pmid.us/16996738.  Stratton CW, Wheldon DB. Antimicrobial treatment of multiple sclerosis. Infection. 2007 Oct;35(5):383-5; author reply 386. http://pmid.us/17882356.

[15] Sriram S et al. Pilot study to examine the effect of antibiotic therapy on MRI outcomes in RRMS. J Neurol Sci. 2005 Jul 15;234(1-2):87-91. http://pmid.us/15935383.

[16] Minagar A et al. Combination therapy with interferon beta-1a and doxycycline in multiple sclerosis: an open-label trial. Arch Neurol. 2008 Feb;65(2):199-204. http://pmid.us/18071030.

[17] Metz LM et al. Glatiramer acetate in combination with minocycline in patients with relapsing–remitting multiple sclerosis: results of a Canadian, multicenter, double-blind, placebo-controlled trial. Mult Scler. 2009 Oct;15(10):1183-94. http://pmid.us/19776092.