Sunday, 18 June 2017

...

My heart with the families of the more than 100 victims of one of the most horrifying tragedies in Portugal. This is unacceptable and must urge our politicians towards a solution; the same that has been postponed for years in a row, so to feed the corrupted leech that this 'business' has become for all of them over time. 


Friday, 16 June 2017

Practolol

When it comes to the root of events that triggered the emergence of pharmacovigilance, regulatory affairs, adverse event recognition and keeping records of bad medical experiences by 'good' patients, everyone considers thalidomide [1] as the starting point. I guess I wrote very briefly about it here. But in fact thalidomide and its nasty teratogenic effects recognised in the 1960s cannot be considered the sole potentiator of utter vigilance and attentive pharmacological screening. There was yet another product that also contributed to this wind of change, but because of a lesser visual impact turned out to be the poor relative of a family of historical drugs that would change our relationship with medicines forever.

(in progress, stay tuned)...

[1] Grootheest, K. (2003). "The Dawn of Pharmacovigilance". International journal of Pharmaceutical Medicine, 17(5), pp. 195-200.

Thursday, 15 June 2017

What Portugal needs is a € Vision not the EuroVision

For such a small country like Portugal is, winning the European Champions football title and right after the Eurovision Song Contest is proof that we know how to do things, we mean business. When given the adequate tools, we deliver. However, this is a tale to be told to the outsiders who visit our country, be it as tourists or mere web-surfers wanting to know more about the rectangular piece of terrain in the Iberian Peninsula some imbeciles still believe belongs to Spain. Portugal - A country so famous for the cheap sense of happiness, peacefulness, freedom, sun, beaches, and Summer festivals.

It's good to see the country recognised for its merits, it's even better to see big rich countries astonished by the incredible potential the Portuguese are showing on the different areas of our modern society. We are resourceful, very capable, flexible, versatile, intelligent and adaptable people. 

And even though I consider that we played terrible bad football when we won the recent European title, or that winning the EuroVision Song Contest should be a matter of shame for any participating country, rather than this poetic flood of star-status travesty nothingness intensely breathed by all involved... Being a pain in the ass of other bigger nations (embedded with an egocentric self-awareness) in a very positive and peaceful manner, is a victory on its own. 

Winning such 'tough' battles when the country is going through levels of austerity since even before austerity was a fancy proposal as response to the world economic crisis... it's a statement of quality, a statement of intention, an incredible stamp of warranty that with the Portuguese employee and implemented humane employment warranties, all is going to be OK.



Now think about this:

ONE in each FOUR Portuguese citizens survives with an average of €322 a month [1] - a fourth of the country's population. And for those preparing the guns of supposed common sense that shoot bullets of "yeah but it's a cheap country", I defy any of said claimers to go and live in Portugal for the same money. Pay rent, pay health bills, pay scholar bills, eat, drink and invest in your kids' education and safety. If you do it you are definitely a resilient son-of-a-gun.

If you think that the rest of the crew has got some good money and this 'paraphrased' fraction of our society are the unprivileged ones, here's another amazing piece of stats: the average money a Portuguese citizen manages monthly is €731!!!

Add to that a real unemployment rate of 15.8% in 2013 [2] (twice as much as in the UK for the same time period) and you have a nice picture that no one really debates publicly outside of Portugal these days. Why should they, though?

So when my friends complain that I do not celebrate our victories, that does not correspond to the truth. I celebrate every single one of these as if they were mine, personally. But I am positive that what Portugal needs is a €Vision and not so much the EuroVision.


[1] Survey on Living Conditions and Income, Instituto Nacional de Estatistica, 2016,  [https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=281091354&DESTAQUESmodo=2], last visited on the 15th of June 2017, last updated on the 16th of May 2017.

[2] Eurostat: Real unemployment double than the official rate, The European Sting, [https://europeansting.com/2014/01/21/eurostat-real-unemployment-double-than-the-official-rate/], last visited on the 15th of June 2017, last updated on the 21st of January 2014.

1st Post image from Global News.

2nd Post image from D+C Development and Cooperation.


Sunday, 11 June 2017

Best weaponry for fighting Sjogren's Syndrome - Division Human Shield - Part 3 of 3

Times have been so incredibly busy for me that I looked on the computer clock and said to myself "How on Earth will I find energy to post anything this month"? But I had to find that energy somewhere because the blog must go on, the information is important, the need for information must be satiated and it's all for a greater good. So what do you do on those times when all your energy phased away but you love something so much you need to find the diesel to get yourself going? Having a blog you love is almost like having a child, with the respective emotional integrity but the honesty in the feeling behind loving your blog is vital to maintain it afloat. 

So I just 'scrubbed' my eyes, not rubbed... and decided to play some motivational music that would give the energy but not in a rage type modus operandi. I didn't go for the typical fury-driven songs, I played Jack Johnson and John Legend, dreamt of sharks playing guitars, sea starts dancing on the background and sexy velvety R&B dancers. Crazy stuff? Definitely, but at least I managed to start typing some initial paragraphs towards what is really important, i.e., sharing with you my experiences, my acquired information.

This is the final chapter to the Best Weaponry for Fighting Sjogren's Syndrome - Division Human Shield. The other two parts can be found here and also here. With this third and final part to my personal advice towards a better management of your problem, there is no disregarding of a visit to a specialist. I do it every year by visiting my rheumatologist. And we actually have great conversations. She appreciates my efforts in getting to know this problem better and looking for solutions to remedy it. And I don't say this of medical doctors very often, mostly because some, if not the biggest part of them, are actually arrogant presumptuous people who can't see past their incredibly tough to gain titles. The fact that their jobs exist on the grounds of people being sick and needing treatment says very little to a lot of them. However, I can see a wind of change and some are starting to understand that the very privileged professional group they compose, orbits around the horizon threshold of the black hole that sickness is, especially for something so 'unknown' as Sjogren's Syndrome. Some are starting to understand that humility is the first step towards knowledge, and for one to improve knowledge one needs to admit that there is so much more to learn and a lifetime is not at all enough to know it all.

And because there is no such thing as knowing it all, I decided to share MY learned information, so we can exchange ideas and get much better some day. The recipe is simple, read with interest, judge with impartiality, share with love:

Coconut oil and olive oil instead of hydrogenated fats


(image from bbcgoodfood.com)

Hydrogenated fats/Trans-fats are triggers to inflammation. As simple as it gets. The highest our intake on these type of fats the worse it gets in terms of inflammatory proneness and endothelial function. In addition, a more vegetarian diet, say a much more reduced in saturated and trans-fats and low in protein, is known to result in a profile of higher antioxidant levels, reduced levels of C-reactive protein (an inflammation marker) and lower risk of coronary heart disease [1, 2]. And in all honesty our body does not know very well how to use these hydrogenated/trans-fats anyways, so why poison it any further? If you don't believe me read Kinsella et al (1981) [3]. The good alternative I've been using is coconut oil, the virgin version whenever possible. The anti-inflammatory potential of this natural oil, alongside its anti-pyretic properties has been vastly confirmed with acute inflammatory models [4].

Rice milk instead of cow's milk


(image from superhumancoach.com)

I could come again with coconut milk or some vanilla-flavoured version of soy milk, but let's be creative, original, different. Rice milk tastes awesome, in opposition to almond milk that often makes me wanna puke! Rice milk works in a neutral way on my taste buds and helps me avoid as much as possible dairy. Actually, dairy products are a big NO NO for inflammatory diseases... and also for those who want to have ripe cut bodies for the Summer! The fact that the allergenic/immunogenic potential of dairy can trigger/increase immune/allergic responses is enough information for me. And I tell you of milk as I tell you of honey and peanuts that I also very much reduced to extremely limited consumption. Only when I have stupid cravings I resort to these, but even then I try to have the bare minimum. In addition, I also replaced the typical butter and yogurts for soy butter/yogurts, and/or olive oil butter (it's only 15% olive oil fat in a plant fat emulsion though - but with a really nice taste). 

And this is my final list of tips in regards to dieting. Believe me, after three years these guidelines made a whole lot of difference in my life. Just give it a try yourselves after consulting with a doctor and you might as well enjoy the same benefits I am enjoying these days. Now, in terms of products that help with my eye and mouth dryness, and those that just caused me loads of secondary effects, I have to tell you of the following. I AM NO FAN OF HYDROXYCHLOROQUINE and I definitely do not understand this new wave of applause that looks into this product as if it were the panacea for the immunologic imbalance. Pure stupidity in my humble opinion. A product that takes around 6-month to start producing proper results [5] and in the meanwhile can cause irreparable retinal toxicity with likelihood for irreparable damage [6], can only be a joke. I don't care if they say that the incidence of retinopathy (damage to the retina of the eyes) in users of hydroxychloroquine is low to very low. Vision, and the loss of it, is no joke for one to roulette it.  

Two comfort shields I have been using on a daily basis whenever I am dealing with terrible discomfort caused by Sjogren's on my eyes and mouth are: Hycosan Extra and Boots Expert Dental dry mouth spray. I should be charging these companies for publicity, but believe me these have helped me tremendously along the way. When things get more serious in terms of dry eyes and Hycosan is not enough anymore (which is rare though) I have to resort to a less fluidly and more oily option. This is typical of when I am stuck in closed environments with very active air-conditioning pumps working all day!


     (image from butterflies-eyecare.co.uk)                                                             (image from Amazon UK)


Finally, Naproxen helps when I can't control the inflammation by the rules of diet, but to be fair that happens once every year... which proves my point that this metabolic response can be optimised to reduce our afflictions. 

Remember, no artificial sugars, no 'artificial' fats, no immunogenic foods, no carbonated drinks that will pore your teeth even further. 

Be safe, be well.

[1] Szeto, Y. T., Kwok, T. C., Benxie, I. F. (2004). "Effects of long-term vegetarian dieton biomarkers of antioxidant status and cardiovascular disease risk". Nutrition, 20, pp. 836-866.

[2] Ridker, P. M., Rifai, N. R., Stamper, M. J., Hennekens, C. H. (2000). "Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men". Circulation, 101, pp. 1767-1772. 

[3] Kinsell, J. E., Bruckner, G., Mai, J., Shimp, J. (1981). "Metabolism of trans fatty acids with emphasis on the effects of trans, trans-octadecadienoate on lipid composition, essential fatty acid, and prostaglandins: an overview". American Journal of Clinical Nutrition, 34(10), pp. 2307-2318.

[4] Intahphuak, S., Khonsung, P., Panthong, A. (2010). "Anti-inflammatory , analgesic, and antipyretic activities of virgin coconut oil". Pharmaceutical Biology, 48(2), pp. 151-157.

[5] Hydroxychloroquine, RheumatoidArthritis.net, [https://rheumatoidarthritis.net/treatment/hydroxychloroquine/], last visited on the 11th of June 2017, last update unknown.

[6] Hydroxychloroquin and  Ocular Toxicity - Recommendations on Screening, The Royal Collge of Ophtalmologists - The British Society for Rheumatology, [http://www.bad.org.uk/shared/get-file.ashx?id=774&itemtype=document], last visited on the 11th of June 2017, last updated on October 2009.

Friday, 26 May 2017

Best weaponry for fighting Sjogren's Syndrome - Division Human Shield - Part 2 of 3

Apologies for the time it took me to post the second part of a three-part article on the best weaponry for fighting Sjogren's Syndrome - Division Human Shield. For the first post on the matter please check here.

It has been hectic for me with loads to do at work, the second serious game that I am designing (this time the main topic is forensic science - check here for more info) and also the numerous books that have been piling up on my bed table... because when I manage to go to sleep I'm already a zombie-like creature and very little allows me to remain awaken.

Well, last post on my findings concerning the best natural substances for fighting Sjogren's symtpoms covered the essentials of Turmeric (curcumin), Green Tea (Camellia sinensis L. leaves) and walnuts. Three everyday fundamentals for counteracting inflammation. Today we are going to cover a few more shields with proven sound scientific background information.


Almonds

These nuts are low in saturated fatty acids and rich in saturated fatty acids! At the same time they are rich in dietary phytosterol antioxidants that in animals reduce total serum/plasma cholesterol and low density lipoprotein cholesterol [1] (LDL - commonly known as bad cholesterol because in high levels it is harmful). But the one precious element that almonds contain, and that is primordial for Sjogren's syndrome patients, is vitamin E. That because as you might all know at this point, the dryness peculiar to this syndrome, and that affects among other body parts, especially eyes and mucosal glands, will require vitamin E as a reducer of potential macular degeneration. Because  inflammatory autoimmune diseases have the potential to cause severe and recurrent ocular surface disease, however, the vitamin E present in almonds will require also good levels of vitamin C, beta-carotene and zinc. In addition, vitamin E is also associated to reduced LDL due to its alpha-Tocopherol (1 of 8 isoforms of vitamin E) (also known as the most potent fat-soluble antioxidant in nature) [2]. The fact that vitamin E has been proven (in tested rodents) to protect them against enlargement of lymph nodes and to reduced levels of serum inflammatory factors (e.g., TNF-alpha, IL-6, -10, -12) [3] is also very good news. Remember, Sjogren's patients have ~5% more chances of having a lymphoma.



Blueberries (antioxidants)


(image obtained from organic facts.net)

One great example of the 'quintessential' life style that I have these days is portrayed perfectly by the daily intake of a large bowl of blueberries. I savour it like a wild beast and could live of it for weeks because they have an awesome flavour. Again, another great weapon against macular degeneration and inhibition of inflammation; among figuratively a trillion other benefits (e.g. protecting against cancer, diabetes, memory loss and so on and so forth). The polyphenols present in blueberries, for example the 3-glucoside/arabinoside/galactoside-based polymers, amidst others, once again suppress the pro-inflammatory cytokines IL-1-beta, IL-6 and IL-12 [4]. The benefits are so vast that the only issue I have recognised as negative is glutony, and a mild intestinal disarray because of my inconsolable gluttony. But nothing common sense, that I totally lack when it comes to fruit cravings, can't fix it for you. And to be fair, as a immune system modulator, between taking hydroxychloroquine and eating blueberries everyday, I will always go with the berries, especially because of the severe side effects (strong headaches, extreme sensitivity to light, and above all nausea) felt with the pharmaceutical. How can a product that when taken over long periods can potentially cause irreversible retinal damage be a good option for the public? Mad!


Stevia (instead of sucrose)

(image obtained from www.fitday.com)

People love sugar, and in nowadays's society sugar loves people because it haunts us and daunts us in every little corner shop of this world. But if you have Sjogren's syndrome one of the immediate worries is the progressive, almost galloping tooth decay. Lack of saliva promotes a more acidic environment in one's mouth where enamel will perish and bacteria will thrive, if sugar is readily available. And matter of fact sugar is always readily available in our modern diets, so the idea is to reduce it to the minimum possible. If you want to protect your enamel and assure that you have the least dentin exposed, cut immediately on pretty much all that contains artificial sugars and replace sucrose by this plant-based one. The immediate advantages to using Stevia rather than sucrose are the fact that Stevia is a zero calories product, it's a sugar that isn't metabolised by bacteria that populate the buccal moiety, it won't imbalance the energy levels in our organism, does not contribute to high blood pressure (and I have around 30 to 40% African ancestry so I'm at higher risk), and also extremely important, it won't feed one of the toughest organisms that insist in colonising Sjogren's syndrome's patients - Miss Candida albicans, a God damn persistent organism and tough as hell to get rid of. But believe me, from personal experience, Stevia and dietary discipline really weaken its presence to a minimum and you feel the difference. As reviewed by Thomas and Glade (2010), Stevia is associated to antihyperglycemic, insulinotropic, glucagonostatic, hypotensive, anticariogenic, antiviral, antimicrobial, antiinflammatory, immunostimulatory and chemopreventative effects [5].

I will try my very best to keep responding to all the questions I get, but in the meantime if you do not hear from me, please just browse through the previous posts. Most of the times your enquiry has already been covered in a previous post.

[1] Ling, W. H., Jones, P. J. H. (1995). "A Review of Metabolism, Benefits and Side Effects". Life Sci, 57, pp. 195-206.

[2] Szodoray, P., Horvath, I. F., Papp, G., Barath, S., Gyimesi, E., Csathy, L., Kappelmayer, J., Sipka, S., Duttaroy, A. K., Nakken, B., Zeher, M. (2010). "The immunoregulatory role of vitamins A, D and E in patients with primary Sjogren's syndrome". Reumatology, 49, pp. 211-217.

[3] Venkatraman, J. T., Chu, W. C. (1999). "Effects of dietary omega-3 and omega-6 lipids and vitamin E on serum cytokines, lipid mediators and anti-DNA antibodies in a mouse model for rheumatoid arthritis". J Am Coll Nut, 18, pp. 602-613.

[4] Cheng, A., Yan, H., Han, C., Wang, W., Tian, Y., Chen, X. (2014). "Polyphenols from blueberries modulate inflammation cytokines in LPS-induced RAW264.7 macrophages". International Journal of Biological Macromolecules, 69, pp. 382-387.

[5] Thomas, J. E. and Glade, M. J. (2010). "Stevia: It's not just about calories". The Open Obesity Journal, 2, pp. 101-109.


Friday, 28 April 2017

A database for those looking for hope

You might have noticed that in the databases links column there is a brand new link that will take you to the Clinical Trials (dot) Gov Home Page. This is a very useful database that works as "a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world". A place where one can "learn more about clinical studies,..., including relevant history, policies and laws".

All you have to do is pay the website a visit entirely free of charge and enter details of your health issue. If anything is happening you will get that information straight. Currently, as the picture above so well informs the visitor, there are over 40 thousand studies taking place worldwide.

I just tried t look for any studies world wide on Sjogren's Syndrome and there are actually 43 registered in the database. If you narrow it to the United Kingdom, there is five that are actually currently recruiting:



(click to enlarge, image from ClinicalTrials.Gov)



Thursday, 27 April 2017

Best weaponry for fighting Sjogren's Syndrome - Division Human Shield - Part 1 of 3

Sjogren's syndrome is, in simple terms, an autoimmune disease where the person's immune system attacks glands that secrete fluid, be it saliva, tears, etc. Known by many as the sicca syndrome or dry syndrome (since dry eye and mouth are the simplest of the symptoms one can associate to Sjogren's) this syndrome can reveal itself a complicated 'disease' to bear due to its arthritic profile. On the other hand, this syndrome increases in 5% the chances of a person to develop Non-Hodgkin's lymphoma (cancer of the lymphatic system that does not involve the Reed-Sternberg cells).

Among a vast list of complications that can go from glandular manifestations (parotitis, mouth dryness [xerostomia] and eye dryness [xerophtalmya], cornea abrasion, infection or inflammation [keratoconjunctivitis sicca], gum disease, difficulty swallowing, accelerated tooth decay, etc) to extraglandular manifestations (fatigue, tiredness, joint pain, arthritis [joint inflammation], lung inflammation, heartburn, gastroesophageal reflux disease, etc etc etc). The list is extensive even in regards to other associated complications, such as Lupus (also an autoimmune disease where the body attacks different tissue parts of the same) or the Hashimoto's thyroiditis (in which the immune system attacks specifically the thyroid resulting in low levels of thyroid hormones [hypothyroidism]). 

This is a syndrome - some even challenge the definition and actually call it a disease - that usually affects women in between their 40s to 60s. Well, I'm a man, last time I checked, that at the age of 36 was diagnosed with it, but I honestly believe that I've been dealing with it from my early 20s, however the most severe signs started back in 2008.

I 'postulated' (not so arrogantly as the word implies) in this blog several ideas of what I believe is behind the 'uprising' of Sjogren's, to a certain extent, obviously. One of many valid ideas that start emerging since doctor's don't know a lot about the etiology of this syndrome, or even how to cure it, let alone tackle it efficiently (regardless of what they might say this is an irrefutable fact as we speak). Based on an extensive literature review I was able to generate changes in my lifestyle that increased tremendously my quality of life and assured me to counteract efficiently the chronic progression of a health issue that I very much want to erase from my life. Bear in mind that when I looked for help with specialists from the UK and Germany no one offered me a proper diagnosis or even a mild solution. I was the one that in 2015 researched intensively and told the doctor with an open heart and 'humility' in my voice "Doctor, I believe I have Sjogren's". After a sialographic analysis (a radiographic examination of my parotid gland) the typical lesions were confirmed. However, no one told me what to do, what to take, what to think, or even where to go. They just did the best possible to assure that it wasn't progressing to something more serious. This does not intend to say doctors are dumb. This just attests of their limitations as any other human being confronted with the novel, with the unknown.

Like any other autoimmune disease, Sjogren's comes with a panoply of metabolic disorders. Some so immediate and severe that changed my whole life style, and I was already a vegetarian when I was diagnosed. I am taking no pharmaceuticals if not very occasionally when nothing else (not even prevention) works. And this weaponry I am sharing with you today is what in my personal case made the whole difference. It might work for you but not for your neighbor, so don't make it a gospel. However, it is based on scientific facts that I want to share with you.

Welcome to the Dos and Don'ts of my human shield against Sjogren's Syndrome and the reason why this is working 'so well' thus far. Bear in mind that I still think my case is mild as there are people with a lot worse signs and symptoms. Having said that, do not avoid a visit to your doctor before anything else. What might be good for one could very easily trigger something bad in another person:

Turmeric (curcumin)


[Image from Authority Nutrition]

What? The powder of grind Turmeric (Curcuma longa), an anti-inflammatory botanical spice part of the ginger family. 
Why? It addresses the underlying cause of inflammation so much better than them non-steroidal anti-inflammatory drugs that simply counteract the symptom. Contrarily to drugs, curcumin (the active ingredient) have minimal side effects and proven results against leukemia, colon, melanoma and breast cancer cell lines [1]. It triggers mechanisms that produce a decreased expression of pro-inflammatory cell signals (NF-kappaB, prostaglandins, etc) [2].
How? A teaspoon.
When? Every single morning and evening mixed in with my smokin' green tea.


Green Tea 
(Camellia sinensis L. leaves)


[Image from Nutrition-Group]

What? The leaves of the smoke-scented Camellia sinensis L. shrub available at any supermarket these days under the commercial name of 'Green Tea'. 
Why? Its flavonoids content is reportedly associated to antioxidant properties [3], but above all also correlated to anti-inflammatory processes, showing antimicrobial effects (read my posts on the link between H. pylori and Sjogren's to better understand why it's so important), and preventive of tooth decay [4] (anti-xerostomia? Sign me in!!!!). So many ticks in the Sjogren's symptom's list that we should grow the tree ourselves.
How? 3 large warm cups every day.
When? Morning to night.


Walnuts


[Image from Insight Himachal]


What? Walnuts, what else to say. They just taste great!
Why? Because I'm a vegetarian I'm not the richest of the guys in what concerns the fatty acid omega-3 that fishes give you. I have to resort to nuts but don't fool yourself, it is scarce the presence of omega-3 in traditional nuts like almonds, cashews, hazels, pistachios, therefore walnuts gain an enormous relevance. Omega-3 fatty acids need to be consumed within a reasonable ratio to become effective in terms of its anti-inflammatory role and aid against symptoms of dry eye and dry mouth. The omega-3 fatty acids help prevent arthritis and indirectly act in the lacrimal gland to prevent the death of secretory epithelial cells [5]. In addition, the immunomodulatory activity of this polyunsaturated fatty acid is incredibly important for tackling rheumatoid arthritis [6]. 
How? At least 30 g every single day.
When? Any time of the day.

And there is a lot more to tell you, so stay tuned because next posts will bring a lot more DOs and also a lot of NO NOs. As usual, if you'd like to contribute with your personal experience, by all means, just let me know by commenting on this post.


[1] Ramsewak, R. S., DeWitt, D. L., Nair, M. G. (2000). "Citotoxicity, antioxidant and anti-inflammatory activities of Curcumins I-III from Curcuma longa". Phytomedicine, 7(4), pp.303-308.

[2] Daniel, J. W. (2005). "The Sjogren's Book". Oxford University Press. The Sjogren's Syndrome Foundation. 4th Edition.

[3] Sharangi, A. B. (2009). "Medicinal and Therapeutic Potentialities of tea (Camellia sinensis L.) - A review". Food Research International, 42 (5-6), pp. 529-535.

[4] Chattopadhyay, P., Besra, S. E., Gomes, A., Das, M., Sur, P., Mitra, S., Vedasiromoni, J. R. (2004). "Anti-nflammatory activity of tea (Camellia sinensis) root extract". Life Sciences, 74(15), pp. 1839-1849.

[5] Roncone, M., Bartlett, H., Eperjesi, F. (2010). "Essential fatty acids for dry eye: A review". Contact lens and anterior eye, 33(2), pp. 49-54.

[6] Simopoulos, P. A. (2002). "Omega-3 fatty acids in inflammation  and autoimmune diseases". Journal of the American College of Nutrition, 21(6), pp. 495-505.