Les antibiotiques sont produits sous des formes pharmaceutiques telles que des pilules acheter du amoxil
elles permettent d'injecter la quantité de préparation strictement nécessaire.
British Journal of Rheumatology
UNCOOKED, LACTOBACILLI-RICH, VEGAN FOOD AND RHEUMATOID
M. T. NENONEN, T. A. HELVE,* A.-L. RAUMA and O. O. HA
Department of Physiology, University of Kuopio and *Kivela¨ Hospital, Helsinki, Finland
We tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and controlgroups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to anomnivorous diet aggravated symptoms. Half of the patients experienced adverse effects (nausea, diarrhoea) during the diet andstopped the experiment prematurely. Indicators of rheumatic disease activity did not differ statistically between groups. Thepositive subjective effect experienced by the patients was not discernible in the more objective measures of disease activity( Health Assessment Questionnaire, duration of morning stiffness, pain at rest and pain on movement). However, a compositeindex showed a higher number of patients with 3–5 improved disease activity measures in the intervention group. Stepwiseregression analysis associated a decrease in the disease activity (measured as change in the Disease Activity Score, DAS ) withlactobacilli-rich and chlorophyll-rich drinks, increase in fibre intake, and no need for gold, methotrexate or steroid medication(R
2 = 0.48, P
= 0.02). The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms ofrheumatoid arthritis. Large amounts of living lactobacilli consumed daily may also have positive effects on objective measuresof rheumatoid arthritis.
K : Rheumatoid arthritis, Vegan food, Activity index, Vitamin B12, Sodium excretion, Lactobacilli.
P with rheumatoid arthritis (RA) often claim
26 mg, n
= 13), zinc (9 mg to 18 mg, n
= 13) and
that their symptoms are alleviated by a special diet or
niacin (11 mg to 19 mg, n
= 13) increased during the
by simple elimination of certain constituents from
intervention. There was also an increase in the intakes
their free-choice diet. Foods most often linked with
of vitamins C and E .
worsened symptoms are red meat, spices, flour prod-
Kjeldsen-Kragh et al.
 have reported positive
ucts, citrus fruits, chocolate and alcohol . Improving
effects of fasting and 1 yr of a vegetarian diet in RA.
symptoms have been reported with vegetables, oils and
Their patients were mainly in functional group II and
fish . True food allergy seems uncommon in patients
had only mild medication. In their study, there was a
with RA . Fasting is an effective treatment of the
high drop-out rate (35%), most (22%) due to flare-up
symptoms of RA, but most patients relapse on reintro-
of arthritis symptoms. Kjeldsen-Kragh  summar-
duction of food [3, 4].
izes the studies of the group, stating that the beneficial
Haugen et al.
 have collected data from patients
effect of the dietary treatment was perhaps not related
suggesting that extreme vegan diets have alleviated
to the diet per se
, but was caused by alterations in the
their rheumatic symptoms. ‘Living food' teachers and
microflora secondary to changes in the diet.
consumers have also reported beneficial effects of the
Alterations of intestinal bacterial flora may play a
diet [6–8]. ‘Living food' is an uncooked vegan diet,
role in RA. The composition of the intestinal flora of
rich in lactobacilli, which contains no animal products,
patients with RA seems to differ from that of healthy
raffinated substances or added salt. A detailed descrip-
subjects . Uncooked vegan food increases the
tion of the diet is presented by Ha¨nninen et al.
counts of faecal lactobacilli in the healthy population
The majority of food items are soaked and sprouted
 and in rheumatoid patients . Peltonen et al.
(seeds and grains), and many are fermented. Some
 have shown that a change in the faecal microflora
items are blended and dehydrated (bread ). Fermented
was connected with decreasing activity of RA in the
products contain high amounts of various lactobacilli
above-mentioned 1 yr intervention with vegan and
. Fermentation and mechanical processing distin-
vegetarian diets .
guish this diet from other vegan diets.
Our previous studies [7, 8] have shown anecdotal
Finnish RA patients often consume a deficient diet.
evidence of positive effects of the extreme, uncooked,
Rauma et al.
 have found that their calculated
vegan diet (‘living food') in RA. The aim of the
intakes for energy, iron, zinc and niacin were lower
present study was to investigate subjective and
than those in healthy persons. Shifting to a ‘living
objective effects of this diet on chronic RA, and to
food' diet in the present study significantly increased
select possible therapeutic components of the diet for
the daily intakes of energy (6.6 MJ to 8.9 MJ, n
13). The calculated daily intakes of iron (13 mg to
SUBJECTS AND METHODS
Submitted 23 October 1996; revised version accepted 2 July 1997.
Forty-three consecutive adults with diagnosed (ARA
Correspondence to: M. Nenonen, National Research and
Development Centre for Welfare and Health, PO Box 220,
criteria; [16 ]), chronic and active RA (Steinbrocker's
FIN-00531 Helsinki, Finland.
functional class II–III; ) visiting the Rheumatic
1998 British Society for Rheumatology
NENONEN ET AL
.: VEGAN FOOD IN RHEUMATOID ARTHRITIS
Outpatient Clinic at the Kivela¨ Hospital, Helsinki,
daily urinary sodium excretion. Accurate use of the
Finland, were selected for the study. There were no
intervention diet  causes a decrease in urinary
refusals. All selected patients had active joint symptoms
sodium excretion to less than one-third part.
(more than three swollen or five tender joints) andelevated inflammatory parameters [erythrocyte sedi-
mentation rate (ESR) >20 mm/h, or C-reactive pro-
One rheumatologist ( TAH ) carried out the clinical
tein (CRP) >10 mg/l ]. Patients were randomized into
evaluation blindly. The patients filled in questionnaires
two groups. The intervention group started the experi-
recording their subjective experiences and gastrointest-
mental diet and the control group continued their
inal functions on the 0–10 scale at the beginning, in
previous omnivorous diet. Three intervention patients
the middle, and at the end of the dietary intervention.
could not eat all of their diet, and two of them refusedto continue in the study after a few weeks; one stopped
This questionnaire has been modified from the ques-
tionnaires used in our previous studies . It is a
ffered abdominal pains and distension.
One patient from the control group stopped the study
modification of a visual analogue scale ( VAS ) with a
for personal reasons, and one died of a heart attack
numbered scale. Patients were interviewed after the
just after the 3 month follow-up period had ended.
study, and their experiences were collected by a struc-
Their data are used where adequate, no extrapolations
tured discussion. Three months after the study period,
their impressions about the effects were recorded again
One intervention subject with high sodium excretion
with the 0–10 scale.
(diet non-compliance) and one patient from the controlgroup (because of medication-induced hepatic toxicity)
were excluded from analyses of interfering variables.
Fasting blood, daily urine and faecal samples were
None were hospitalized and all patients continued their
collected according to normal laboratory practice.
previous medication at the beginning. The medication
Samples for the intervention period were collected: (1)
was modified when necessary on clinical grounds (by
before the dietary intervention (weeks −1 and 0); (2)
rheumatologist TAH ). Caffeine-containing drinks,
after the first month (weeks 4–5); (3) at the end of the
chocolate, alcohol and tobacco smoking were prohib-
intervention period (weeks 8–9 or 12–13); and (4) 3
ited in both groups.
months after the intervention period. Most of the
The duration of the intervention was planned to be
analyses were carried out immediately. The samples
3 months, but eight patients had to stop their inter-
analysed later were stored at −20°C. The analyses
vention diet after 2 months because of nausea,
were carried out with normal laboratory methods used
= 3) or difficulties with the taste of some
in the hospital.
food items. The controls stopping the follow-up after2 months were selected to match these interventionsubjects by age, sex, disease activity and body mass
index. There were no differences between the 2 and 3
The normality of interval variables was checked by
month intervention groups, and the duration of the
calculating the Shapiro–Wilk statistic W
, and data
intervention had no effects on the clinical outcome.
were scrutinized for outliers. The data for C-reactive
The basic data of the subjects are presented in Table I.
protein (S-CRP) and the duration of morning stiffnessdeviated intolerably from the normal distribution, andnormal scores calculated from the ranks  were used
in statistical analysis. Analyses were performed with
The 7 day dietary records were collected by a
MANOVA for repeated measurements  using
qualified dietitian three times: the first before theintervention, the second in the middle, and the third
different combinations of independent variables and
at the end of the intervention. Subjects in the dietary
change in weight as a percentage as covariate.
intervention group received all the components of their
The overall changes in the disease activity were
daily diet from a specialized ‘living food' kitchen in
analysed with a composite index described by Paulus
packed form. The kitchen weighed the components,
. The index was calculated from the changes
and the subjects recorded items they did not consume
in the following six variables: ESR, number of swollen
and the amount of extra food. Subjects were super-
joints, number of tender joints, rheumatic pains on a
vised and tutored daily by the teacher of the ‘living
VAS, HAQ and global patient estimate. A decrease or
food' diet. The patients in the control group prepared
increase of 20% or more was estimated as significant
their omnivorous meals at their homes without
and the number of significantly changed variables was
calculated for each patient. Changes in ESR within
The nutrient contents of the diets were calculated
normal values and <5 mm/h were judged as non-
with UNIDAP ( Unilever Dietary Analysis Program,
significant. Zero values as divisor were replaced by
Paasivaara Ltd, Finland ), and the results have been
0.01, and the clinical relevance and significance of the
published separately . The dietary compliance
change in percentage was checked individually in these
of the intervention group was followed by daily
events. Separate indices were calculated for improved
interviews, dietary records and by analysing their
and deteriorated variables. The percentage of each
BRITISH JOURNAL OF RHEUMATOLOGY VOL. 37 NO. 3
Test statistics (A), anthropometric data (B), history (C ) and medication (D) of rheumatic disease and compliance with the diet of theintervention and control groups (E ) in the 2 to 3 month intervention study with an extreme vegan diet, ‘living food'. Interval data are given
as means and ..
A. Test statisticsRandomized for study
Started the study
Completed the study
Follow-up after study
Duration of test (2/3 months)
B. Anthropometric dataSex: male/female
Body mass index (kg/m2)
C. History of rheumatic diseaseRheumatic disease (yr)
D. MedicationGold (i.m. or p.o.)
Non-steroidal anti-inflammatory drugs
E. Dietary complianceStrict dietary compliance
Use of fermented wheat drink
(only 5 patients usedthe fermented wheatdrink daily and hada strict compliancewith other fooditems)
*Fisher's exact test.
number of variables within the intervention and control
groups was compared with Fisher's exact test.
The Disease Activity Score (DAS ) was calculated
The randomization divided subjects into intervention
and control groups with no difference in height, weight,
Rheumatism ( EULAR; ). The stepwise regression
body mass index, duration of rheumatic disease, sero-
analysis was used to build models explaining the
positivity and medication. Yet the intervention group
changes in disease activity described by DAS.
was younger (49 vs
56 yr, P
= 0.02) (Table I ). The
2 improvement, minimum R
dietary compliance in the intervention group was good,
ment, stepwise and backward elimination methods
as shown by the urinary excretion of sodium. Only
were used. Medication, diet, disease history and
one patient lacked a clear decrease. However, only six
anthropometric data served as independent variables.
of the 19 subjects used all their fermented wheat
The power of significance of the tests was calculated
drink (Rejuvelac) daily (recommended amount 500–
from the nomogram presented by Altman . For a
1000 ml ). According to the daily records, nine patients
30% change in most variables, the statistical power
had minor deviations from the diet. The diet of the
was >0.5 at a significance level of 0.05. On pains at
control group remained stable during the intervention
rest, HAQ, morning stiffness, Ritchie indices, ESR,
period. However, some started to use minor amounts
alanine (ALAT ) and c-glutamyl (c-GT ) transferases,
of ‘living food' items. The patients could keep the
this power was achieved for 50% changes. The vari-
secret and the clinical observer ( TAH ) remained
ation in CRP was so high that the power to detect a
blinded during the follow-up. All were on stable
50% change was only 0.25. The subjective estimates of
medication and continued with least possible changes
patients were analysed by Mann–Whitney U
(decrease of medication for six patients in the interven-
NENONEN ET AL
.: VEGAN FOOD IN RHEUMATOID ARTHRITIS
tion and for three patients in the control group,
had a rising tendency at 3–6 months after intervention
increase of medication for one control patient).
= 0.15) (Fig. 1). ESR increased during the inter-
The intervention group lost weight, 9%, during
vention period in both groups. This rise was seen
the intervention, while the controls gained 1% of
in methotrexate users (40%, P
= 0.03), and it was
weight. The difference in the weight changes between
independent of the intervention diet.
the groups was significant (P
= 0.0001) and was notexplained by medication when tested separately for
methotrexate, gold and steroids ( Fig. 1).
The composite index, after Paulus , for changes
in disease activity showed in the intervention group
an improvement of 20% or more in 2.9 variables (
Serum alkaline phosphatase (P
= 0.01) and alanine
1.7). In the control group, only 2.0 variables improved
aminotransferase (0.002) decreased in the interventiongroup. The change in weight as covariate abolished
(.. 1.3, F
= 3.79, P
= 0.059, ANOVA). There were
the significance of these changes. Serum protein values
no differences in the mean amounts of deteriorated
in the intervention group were significantly lower at
variables (1.4 vs
1.6). The percentage of patients with
the end of the intervention than before it (P
= 0.025), four (P
= 0.076) and five (P
The decrease in protein levels was seen in patients on
0.05) improved variables was greater in the interven-
methotrexate treatment (P
= 0.05) independently of
tion group ( Fig. 2). This difference was nearly signi-
the diet. Albumin levels decreased in both groups with
= 0.056–0.1) even when the data were
no effect of diet (P
analysed according to the intention to treat principle.
Serum vitamin B12 levels decreased in the interven-
The percentage of patients with one or two deterior-
tion group (P
= 0.0006). Values already differed after
ated variables was not higher in the intervention
4–5 weeks (P
= 0.02). This decrease was strongest in
the most compliant diet subgroup (used the diet with
A decrease in disease activity, as measured as a
no aberrations and consumed all the fermented wheat
change in the DAS , during the intervention was
drink daily). Their values decreased from 308 to
associated in a stepwise regression model (R
2 = 0.48,
179 pmol/l (P
for combined effect of accuracy of diet
= 0.02) with increasing daily amounts of wheat grass
and use of drink = 0.05). Serum calcium (corrected
drink and fermented wheat drink, increased intake of
for serum protein) decreased in both groups (P
dietary fibre, and decreased intake of iron during the
0.0001). Serum sodium (P
= 0.0001) levels decreased
intervention, and no need for gold, methotrexate or
in both groups in the first half of the intervention.
steroid medication at entry ( Table III ). In the interven-
Daily excretion of sodium decreased (P
= 0.0001) to
tion group as a whole, the changes in DAS were not
one-fourth of the pre-test level in the dietary interven-
statistically significant (given as mean/95% confidence
tion group, whereas excretion of potassium increased
interval at the beginning, in the middle, at the end
and 3 months after: 3.26/2.88–3.63, 3.12/2.73–3.50,3.01/2.54–3.48 and 3.13/2.70–3.57 in the interven-
Most patients in the dietary intervention group
3.46/3.02–3.90 and −3.56/3.18–3.94 in the control
experienced positive subjective changes during the
group, respectively; P
= 0.7, MANOVA for repeated
intervention diet in rheumatic pains, rheumatic joint
swelling, morning stiffness and general impression( Table II ). Most of the control group experienced no
change. The difference was statistically significant
This study showed that an uncooked vegan diet rich
< 0.03). When the interven-
in lactobacilli, ‘living food', caused subjective improve-
tion was over, the majority of intervention patients
ment in the symptoms of RA. The objective measures
reported either no change or a negative change in the
of disease activity did not change when analysed
above-mentioned parameters (P
< 0.01), except the
separately. Two indices describing the activity of RA
ability to move. Correlation analysis showed thatthe subjective estimates of disease activity were mainly
were used to analyse the results (composite index by
dependent on the number of tender joints (Pearson
Paulus, DAS by van der Heijde). Both indices showed
fficients 0.41–0.6, P
ffect of the dietary intervention with
‘living food' or an effect of some of its components on
Activity measures of rheumatoid arthritis
the symptoms of RA.
CRP, ESR, B-haemoglobin, B-thrombocyte count,
The following group of dietary factors was partially
Ritchie index, HAQ, morning stiffness, VAS for pains
(48%) responsible for the observed decrease in the
at rest and on movement did not behave statistically
disease activity index: fermented wheat drink, wheat
differently in the intervention and control groups. The
grass drink, dietary fibre and iron. These factors are
steroid users in both groups had an 18% lower number
indicators of compliance with the ‘living food' diet.
of tender joints (P
= 0.02) with a decrease at the end
Fermented wheat drink (Rejuvelac, [6 ]), the water
of the study and 40% lower swollen joint numbers
phase of germinated wheat seeds and water (1:3)
= 0.002). The CRP values of the intervention group
mixture (fermented for 48 h with freshly cut wheat
BRITISH JOURNAL OF RHEUMATOLOGY VOL. 37 NO. 3
F. 1.—The results of the clinical and laboratory follow-up of the intervention and control groups in the 2 to 3 month intervention study inrheumatoid arthritis patients (N
= 39) randomized to either intervention group starting an extreme vegan diet, ‘living food', for 2–3 monthsand omnivorous controls. Data were collected during and 3 months after the dietary intervention. Periods used in the figures are: Start, at thebeginning of the intervention; Middle, in the middle of the intervention; End, at the end of intervention (2 to 3 months); After, 3 months afterthe intervention. Data are given as means and 95% confidence interval (95% CI ). Intervention group, /; control group, --$--; regular useof fermented wheat drink, ···%···; no regular use of fermented drink, ···#···. Statistical significance (MANOVA for repeated measurements)is given as P
values for the effects of time alone/effects of division to intervention vs
control groups/effects of consuming fermented wheat drink.
grass), gives large amounts (2.4–4.5×1010/day) of
effects on other bacteria in the gut and regulate their
viable Lactobacillus plantarum
number [23–25]. The role of lactobacilli is further
, and it modifies the intestinal microflora. The
supported by the findings of Peltonen et al.
counts of faecal lactobacilli were higher in the interven-
Eerola et al
. [26 ]. They found that in both the study
tion group  and their faecal b-glucuronidase activity
of Kjeldsen-Kragh  and in this intervention, the
decreased during the study (P
= 0.04, MANOVA for
positive clinical effect was associated with a change in
repeated measurements). Lactobacilli have many
the colonic microflora.
NENONEN ET AL
.: VEGAN FOOD IN RHEUMATOID ARTHRITIS
The subjective estimates of the rheumatoid patients about their disease symptoms during and after dietary intervention (uncooked, lactobacilli-rich, vegan food in the test group). Data were collected immediately and 3 months after completion of the study on 0–10 scales (5 = no
change). Significant difference between groups was tested with the Mann–Whitney U
-test (from the original 0–10 scale material )
Swelling of joints
Swelling of joints
= 0.07 n.s.
*Two patients stopped the diet after a few weeks, one later; some patients left some qustions unanswered.
†One patient stopped the study for personal reasons and one died just after the intervention period. Some patients left some questions
Stepwise regression analysis of the disease activity score (DAS ) forthe change in the rheumatic disease activity during the 2 to 3 monthintervention period (maximum R
2 improvement method, d.f. = 8)in a group (N
= 39) of rheumatoid arthritis patients randomized to
either an uncooked vegan or omnivorous diet
2 for the model
Prob > F
Prob > F
Gold (p.o. or i.m.)
Fermented wheat drink
Wheat grass juice (ml/day)
Change of fibre intake (%)
Change of iron intake (%)
Daily urinary sodium
excretion at the start(mmol/24 h)
The other drink, wheat grass drink, is consumed at
50–150 ml/day. It is pressed from fresh wheat grass
F. 2.—The 2 to 3 month intervention study in rheumatoid arthritis
and presumably contains high amounts of chlorophyll
= 39) randomized to either intervention group starting
and coumarin . Its effects are unknown. The daily
an extreme vegan diet, ‘living food', for 2–3 months and omnivorous
intake of dietary fibre increased 2- to 4-fold when
controls. Percentage of patients in the intervention and control
shifting to the intervention diet . This may have
groups with at least 20% improvement or worsening in 0–6 of the
contributed to the changes in colonic microflora 
following variables: ESR, number of swollen and tender joints,
by shortening the intestinal transit time . In this
rheumatic pains ( VAS), HAQ and global patient estimate. Statistical
study, shifting to uncooked vegan food increased the
significance is calculated with Fisher's exact test and the results aregiven as P
values for all randomized patients (intention to treat
calculated daily intake of iron by 98% . The
analysis of 42 patients) and for the patients completing the 2 to 3
haemoglobin levels remained unchanged, however. The
month intervention (N
absorption of iron was probably impaired. There is
BRITISH JOURNAL OF RHEUMATOLOGY VOL. 37 NO. 3
evidence about alterations in iron metabolism in RA
subjective experiences mainly with the number of
, and Haugen et al.
 have shown a negative
tender joints. Thus, their estimates may have been
correlation between serum iron and ESR.
influenced by even small variation in their status and
The calculated energy intake of this experimental
strengthened by the great expectations caused by the
diet was not hypocaloric, but it caused a decrease in
strange and ‘mystic' diet.
body weight of 9%. This may be due to the low
When the results of this study are compared with
biological availability of the energy-yielding nutrients
those of the minocycline intervention studies [33, 34],
that was caused by the insufficient food processing and
the most striking difference is the almost total lack of
the high fibre content of the diet (42 g/day; ). It
subjective improvement in the subjective variables
could also result from the difficulties experienced with
during the antibiotic treatment. However, both types
the diet (nausea, etc.). The loss of weight could have
of interventions probably caused changes in the intest-
influenced the immune response and explained part of
inal microflora. One explanation for this discrepancy
the results. On the other hand, the multivariate analysis
could be either less placebo effect in the double-blind
of variance does not support this. The calculated
antibiotic intervention or differences in the gastrointest-
content of the experimental diet covered most of the
inal effects of these studies (selection of bacteria?).
recommended daily requirements . The calculated
Many recorded parameters behaved differently in
daily protein intakes in the intervention group
patients with different medications (methotrexate, ster-
increased from 58 to 80 g/day; in the control group,
oids, etc.). Many of these effects probably have no real
the intake was stable (57–59 g/day; ). These values
significance because of the small number of patients in
are near to those measured in long-term users of this
each group. The effect of dietary manipulation might
diet (48 g/day; ). The lowered serum albumin
be better studied without drugs, but this was considered
values were found in both groups and were not solely
unethical. The association of decreasing disease activity
associated with the intervention diet. Achieving this
with no need for arthritis-specific drugs may denote a
kind of daily intake demands that all food items are
better effect of the diet in less active disease.
consumed in recommended amounts. This is not always
This study showed that subjective relief of the symp-
possible because of the unfamiliar taste and the strenu-
toms of the RA could be achieved with a radical
ous and time-consuming processing of some items. It
dietary manipulation (uncooked extreme, lactobacilli-
must also be remembered that the intervention diet
rich vegan diet, ‘living food'). There were, however,
corrected many deficiencies in the diet of the RA
no significant effects on the separate objective disease
patients studied by Rauma et al.
. This alone may
markers (CRP, ESR, joint counts, etc.). The activity
have had positive effects on the patients in the interven-
index calculated from four disease activity indicators
tion group. The results of regression analyses did not,
did, however, find a statistically significant connection
however, support this hypothesis. The stepwise regres-
between compliance with the tested diet and the
sion analyses did not include changes in the problem-
decrease in disease activity.
atic nutrients in the models explaining positiveresponses.
Half of the patients experienced adverse effects
The authors thank all their brave and patient
(nausea, diarrhoea) during the diet and stopped the
patients, Dr E. Leskinen ( Kivela¨ Hospital ), J. Laakso
experiment prematurely, three during the first days or
and I. Ruokonen (MILA Ltd ) for laboratory analyses,
weeks and eight after 2 months. There were no severe
Mrs M. Svennevig (Green-Way restaurant) for provid-
side-effects caused by the diet, but the high premature
ing the diet and tutoring the intervention group, Mrs
cessation rate shows that extreme diets are not good
L. Pajanne ( Kivela¨ Hospital ) for the practical arrange-
for every patient. Caution and sound rationing is
ments in the rheumatology out-patient clinic, Mrs A.
needed both from the patient and the doctor.
Rokka for her help in the dietary analyses, and Dr H.
The indicators of disease activity behaved as
Lenzner ( University of Tarto) for analysis of the faecal
expected. The changes were not statistically significant
bacteria. This study was supported by the Juho Vainio
as in the Kjeldsen-Kragh et al.
 study. Exclusion
of the unfavourable patients in their study may havecaused this difference. The patients in the present study
also had a more severe disease history and used more
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 was used in both studies, the proportions of
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Gazi University Journal of Science GU J Sci 25(2):377-383 (2012) ORIGINAL ARTICLE A Validated HPLC Method for Separation and Determination of Mefloquine Enantiomers in Pharmaceutical Formulations Ola A. SALEH,1 Aida A. EL-AZZOUNI1♠, Amr M. BADAWEY2, Hassan Y. ABOUL-ENEIN2,♠ 1Medicinal and Pharmaceutical Chemistry Department, Pharmaceutical and Drug Industries Research
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