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Immune Disorders

In a clinical trial on athletes at the University of Pretoria 35 drops of Cellfood® increased the oxygen uptake by 5%, and normalized all haematological (blood) values, amongst others.

Our products, in addition to and in conjunction with other medical treatments, can be of great benefit to one's health.

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Acquired Immune Deficiency Syndrome (AIDS)

Where one's viral load requires that ARV's be taken or are prescribed by a doctor, one must be sure to take that route.

Introduction

Human immunodeficiency virus (HIV), the virus that causes AIDS, is transmitted through sexual intercourse, exposure to infected blood products, and perinatally from mother to neonate.

  • An infected person might not develop the symptoms of AIDS immediately; some people may stay healthy for a long period of time (from two to ten years), while others become ill sooner. A small percentage may never get sick.
  • On average it takes about eight years for an HIV-infected person to develop AIDS.

AIDS is an immune system disorder.

  • When the human immunodeficiency virus invades immune cells like T lymphocytes and multiplies, it causes a breakdown in the body’s immune system, eventually leading to overwhelming infection and/or cancer.
  • Most deaths among people with AIDS are not caused by AIDS itself, but by one of the many infections or cancers to which the syndrome makes the body vulnerable.

Prevention and treatment

The amount of virus in the blood is known as the viral load.

  • In the first few months after infection, a large number of viral particles circulate in the blood (the infection is now very contagious).
  • Later the viral load drops to a lower level that remains constant for some time. This level is an important indicator of how contagious the person’s infection is and how fast the disease is likely to progress.
  • The viral load is measured during treatment since a decreasing or very low level indicates that treatment is working.
  • The goal of treatment is to lower the viral load to the point where it is undetectable (suppressed) in the blood, although some virus is probably still present.
  • Prevention and treatment of HIV/AIDS should incorporate a strategy that includes key elements like education, dietary support and nutritional supplementation, the use of complementary and alternative medicine, and the appropriate use of drugs like anti-retrovirals (ARVs).

    • A malnourished body has a compromised immunity - with a poor immune function there is an increased progression rate of the disease.
    • Certain nutrients in food play a particularly helpful role in enhancing the immune system including vitamin C and E, carotenoids and other immune boosting ingredients.

    Nutritional supplements comprise a wide array of substances including amino acids, essential fatty acids, vitamins and minerals, enzymes and anti-oxidants.

    • Supporting science has established that many of these nutrients/substances have a positive influence on the disease markers that relate to HIV.
    • Significant among these substances are vitamin A, selenium, glutamine, co-enzyme Q10, beta-sitosterols and arginine.

    Complementary and alternative medicines employ a wide range of substances.

    • Many of these substances include herbs that have been used for centuries for the treatment of immune-compromised conditions.

    ARVs form part of the programme for the care of the HIV/AIDS patient.

  • ARVs have to be prescribed and administered by registered professionals after a careful assessment of the status of the patient.
  • It is necessary to introduce ARVs during the more developed phase of the disease.

Conclusion

It is essential that people with HIV/AIDS maintain proper immune function and prevent malnutrition to avoid opportunistic infections.

  • Emphasis must be placed on nutritious food, an aggressive supplementation programme, regular exercise, fresh air, positive thinking, and stress reduction.
  • There must also be an avoidance of any substance, activity, or behaviour that suppresses the immune system and prevents it from acting ay full capacity.

Fibromyalgia

What is fibromyalgia?

Fibromyalgia (FM) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. ‘Tender points’ refer to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips.

  • FM primarily occurs in women of childbearing age, but the elderly, men and children can also be affected.
  • Many children diagnosed with fibromyalgia, often start with flu-like symptoms and then become chronic, with sleep disturbance a major feature. Some children also display Attention Deficit Disorder (ADD) symptoms, fatigue, school and behavior problems and commonly a tendency to allergies. Some experts also find that such children frequently have very loose (hypermobile) joints.

What causes fibromyalgia?

Although the cause of fibromyalgia is unknown, researchers have several theories about causes or triggers of the disorder.

  • Some believe that the syndrome may be caused by an injury or trauma/shock (physical or emotional). This injury may affect the central nervous system.
  • Fibromyalgia may also be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength.
  • Others believe the syndrome may be triggered by an infectious agent such as a virus in susceptible people, but no such agent has been identified.
  • The myriad of symptoms certainly favors a central origin. No peripheral inflammatory or metabolic disorder has ever been defined as causal, but many patients do have arthritic or neuritic illnesses, which augment their centrally impaired pain-processing abilities.
  • Twenty to 40% of patients with connective tissue disorders, especially Lupus and Sjögren's syndrome, have concomitant fibromyalgia.

How is fibromyalgia diagnosed?

Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other disorders.

  • The physician reviews the patient's medical history and makes a diagnosis of fibromyalgia based on a history of chronic widespread pain that persists for more than 3 months.
  • The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the disorder. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of 18 specific tender point sites.
  • Pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist and pain below the waist. In addition there should be pain in the spine or the neck or front of the chest, or thoracic spine or lower back.

How is fibromyalgia treated?

Treatment of fibromyalgia requires a comprehensive approach. The physician, physical therapist, and patient may all play an active role in the management of fibromyalgia.

  • Studies have shown that aerobic exercise, such as swimming and walking, improve muscle fitness and reduce muscle pain and tenderness. Heat and massage may also give short-term relief.
  •  Antidepressant medications may help elevate mood, improve quality of sleep, and relax muscles. Sleep is a key feature of this condition and restoration of normal sleep is vital in recovery.
  • Patients with fibromyalgia may benefit from a combination of exercise, medication, physical therapy, and relaxation.
  • Many patients also have success using nutritional supplements.
Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.

 

Tuberculosis: A disease of many organs

Dr Jacques Rossouw (DSc Biochemistry; Hons Pharmacology; MBA).

Tuberculosis (TB) is a contagious disease caused by a bacterium known as Mycobacterium tuberculosis. Although primarily a disease of the lungs, it can affect any organ including the bones, spine, intestines, kidneys, lymph nodes, bladder, joints, liver, heart, and spleen. There are two strains, one human and one bovine (cow), which are spread by inhalation of infected sputum in the case of the former and by drinking infected milk in the case of the latter.

TB is generally overcome by an intact immune system but anyone with a lowered resistance from conditions such as malnutrition, stress, steroid therapy, diabetes and drug use (including alcohol, smoking or those taking drugs for immuno-suppression, as in HIV and AIDS) are more likely to succumb if this disease is contracted. Anybody with lung infection or disease is also more prone.

The incidents of tuberculosis remain high in overcrowded and Third World countries, but until recently TB was on the wane in the Western world. Unfortunately, injudicious use of antibacterial agents has led to resistant strains developing, which are now defeating even the strongest of antibiotics.

Left alone, the great majority of those who contract TB will simply defeat the bacteria and leave a characteristic calcified area noted on X-rays. This is formed by the body's attempt to wall in the infection. The bacteria may continue to live within this cavity and escape at times when the individual is run down, causing a reactivation of the symptoms.

Investigations include chest X-rays with lesions that usually appear in the upper part of the lungs. Some blood changes may be found but a definitive diagnosis is generally made by culturing sputum or urine samples, depending upon where the infection is, and growing them in special culture mediums. In a severely ill person, treatment with antibiotics may need to be started before a firm diagnosis is made and before it is known whether the antibiotics being used are in fact going to affect this type of bacteria. Complementary medical treatment may be of benefit in less seriously ill people whilst they await the sensitivity reports so that accurate antibiotic treatment may be given.

Some treatment recommendations that may be of value:

  • If tuberculosis is diagnosed, do not rush into drug treatment unless symptoms are causing marked problems. Instead consult a complementary medical practitioner with experience in this field. Self-treatment may not necessarily be the best.
  • To be successful against tuberculosis, antibiotic treatment must usually be taken every day for between nine months and one year after initial diagnosis. Researchers have, however, documented numerous cases in which people discontinue treatment after the symptoms are gone but before the infection itself is under control. To prevent drug resistance stick to and complete the treatment regime.
  • Ensure that a change in lifestyle is made to eliminate all factors that may be reducing immunity, especially bad habits such as smoking and excess alcohol. Any drug abuse will reduce the body's immune response.
  • Prevention is generally the best form of treatment so ensure that your health is at an optimum level before visiting areas where tuberculosis is endemic.

Miliary tuberculosis spreads through the blood and can thus infect any tissue or organ. Widespread symptoms may occur and the above treatment recommendations should be considered bearing in mind that this condition is far more aggressive and likely to have a poorer prognosis.

 

Chronic Fatigue

Chronic fatigue syndrome and fibromyalgia – just all in the mind?
Dr Jacques Rossouw

Introduction

According to a medical dictionary fatigue is a state of increased discomfort and decreased efficiency resulting from prolonged or excessive exertion; loss of power or capacity to respond to stimulation (Dorland’s Illustrated Medical Dictionary, 1994 p612). Depending on their activity and stress levels, most people experience fatigue daily. The feeling of fatigue usually subsides after a good night’s rest or two.

Some people, however, experience fatigue for extended periods of time. Chronic fatigue immune dysfunction syndrome (CFIDS) is an illness with many names: chronic fatigue syndrome (CFS), ‘yuppie flu’ or myalgic encephalomyelitis (ME). CFS is defined as severe fatigue of unknown aetiology lasting more than six months. Fibromyalgia (FM) is also a chronic condition accompanied by many symptoms, including widespread pain and fatigue.

CFS and FM - the same illness, but different names?

CFS and FM are distinguished by great uncertainty regarding aetiology, diagnostics, treatment and prognosis. Both illnesses are criteria diagnoses, FM since 1981 and CFS since 1988. There is a partly overlapping symptomatology where the diagnosis CFS is connected with symptoms like fatigue and exhaustibility, muscle pain, sore throat, headache, impaired memory, concentration difficulties and sleep disorder and FM with symptoms such as aches, pain, stiffness and feebleness in the muscles, fatigue, headache, swelling, bowel problems, and sleeping difficulties.

Fibromyalgia

FM is characterized by long-lasting widespread pain, aching, fatigue and stiffness, and is often accompanied by non-restorative sleep, mood disturbance, irritable bowel syndrome, headache and paraesthesias. While the aetiology of FM is poorly understood, most researchers agree that aberrant central pain processing mechanisms and a complex interaction of multiple factors are responsible for the symptoms of FM.

The prevalence of FM has been estimated to be 1-3%, often co-existing with CFS. FM affects women more often than men and exacts a high toll with regard to morbidity. The psychological profile of FM sufferers is heterogeneous and includes individuals who appear to manage their symptoms by adapting to their limitations or developing strategies to cope with everyday problems and those who perceive themselves to be helpless and unable to cope with their symptoms (Mannerkorpi and Iverson, 2003).
Compared with their healthy counterparts, patients with FM display reduced upper and lower extremity physical performance capacity, and many everyday activities such as walking, working with arms, and prolonged sitting and standing are difficult to perform. They also demonstrate reduced aerobic capacity compared with published standards of healthy individuals, but not in studies comparing patients with sedentary healthy women.

The symptoms and associated disability of FM are often aggravated by physical activities, stress, anxiety, fatigue and poor sleep, thus affecting many dimensions of life. The severity and consequences of FM have been associated with pain, fatigue, helplessness, psychological distress, work status, coping, level of education and an escalation of work-related disability and healthcare costs.

FM sufferers tend to present as stressed, tense, depressed and anxious. It may be induced or intensified by physical or mental stress, chronic overwork, poor sleep or sleep disorders, physical or emotional trauma, depression, exposure to dampness or cold, and occasionally by a systemic, usually rheumatic disorder (Crane, 2005).

In milder cases FM may spontaneously go into remission when stress levels are decreased, but most patients have chronic symptoms that are constant or recur at frequent intervals. With treatment, however, many do eventually resume increased activities (Crane, 2005).

Conventional treatment usually includes bed rest and a recommendation to decrease stress levels. Doctors may also recommend stretching exercises, local applications of heat and gentle massage for the pain. Nutritional supplements are also used with great success.

Chronic fatigue syndrome

A number of theories exist regarding the causes of CFS and includes a dysfunctional immune system, ongoing depression, a traumatic or stressful event, or a viral/bacterial infection. Some scientists postulate that muscle deficits are the cause of fatigue following activity while others implicate deconditioning (Mannerkorpi and Iverson, 2003).

A multi-disciplinary approach is an effective way to provide relief: a medical intervention addresses the symptoms, offering medication for pain, sleep disturbances, depression and anxiety, and flu-like symptoms, where supportive therapies involve the know how of a dietician, psychologist, and a physiotherapist/chiropractor.

Whenever the possibility exists that the immune system is involved, it is important to ensure that adequate amounts of nutrients are consumed, thus strengthening the immune system.

What supplements can be used?

The following supplements have proven to be of benefit for both CFS and FM sufferers (Crane, 2005; Holford, 2004):

  • Beneficial intestinal flora
  • Magnesium malate (600mg)
  • Vitamin B1: to address thiamin deficiency symptoms
  • Vitamin B12 IM
  • Vitamin C (2 x 1g)
  • Zinc 15mg
  • L-tryptophan and / or 5HTP for serotonin and dopamine rebalancing
  • Vitamin B6  - 50mg
  • Selenium 200 - 300mg
  • DHEA 5 - 25mg
  • Multivitamin and mineral
  • Omega 3 and 6
  • Tokuhon medical plasters for the pain

References
Crane, A. 2005. Dis-Chem benefits magazine; issue 10, 96-97.
Holford, P. 2004. New optimum nutrition bible. Piatkus Books Ltd; 455.
Mannerkorpi, K. and Iverson, M.D. 2003. Physical exercise in fibromyalgia and related syndromes. Best practise and research clinical rheumatology, vol 17 (4), 629-647.

 

Chronic fatigue: what should you know?

What is chronic fatigue?

Fatigue is a state of increased discomfort and decreased efficiency resulting from prolonged or excessive exertion; loss of power or capacity to respond to stimulation. Depending on their activity and stress levels, most people experience fatigue daily. The feeling of fatigue usually subsides after a good night’s rest or two.

Some people, however, experience fatigue for extended periods of time. Chronic fatigue immune dysfunction syndrome (CFIDS) is an illness with many names: chronic fatigue syndrome (CFS), ‘yuppie flu’ or myalgic encephalomyelitis (ME). CFS is defined as severe fatigue of unknown aetiology lasting more than six months.

How is chronic fatigue treated?

A number of theories exist regarding the causes of CFS and includes a dysfunctional immune system, ongoing depression, a traumatic or stressful event, or a viral/bacterial infection.

A multi-disciplinary approach is an effective way to provide relief: a medical intervention addresses the symptoms, offering medication for pain, sleep disturbances, depression and anxiety, and flu-like symptoms, where supportive therapies involve the know how of a dietician, psychologist, and a physiotherapist/chiropractor.

Whenever the possibility exists that the immune system is involved, it is important to ensure that adequate amounts of nutrients are consumed, thus strengthening the immune system.

Are nutritional supplements of value?

The following supplements have proven to be of benefit for CFS sufferers: a multivitamin/mineral, a probiotic, vitamins B1, B6, B12, and C, the minerals magnesium, zinc and selenium, omega 3 and 6, DHEA, L-tryptophan and/or 5HTP.

1.         Cellfood® and chronic fatigue

2.         Cellfood® Longevity and chronic fatigue

Conclusion

People with CFS need to manage their symptoms and support their immune system by taking an oxygen mineral supplement such as Cellfood®. Cellfood® Longevity reduces homocysteine levels, helps with tissue repair and provides energy.

 

Sickle cell anemia

"Sickle cell anemia is a hereditary, genetically determined hemolytic anemia, one of the hemoglobinopathies, occurring almost exclusively in Blacks..." Dorland’s Illustrated Medical Dictionary.

1.  Introduction

Sickle cell disease (SCD) is an inherited blood disorder caused by a genetic mutation that leads to the generation of a mutant form of the beta-globin chain of hemoglobin (Hb). Red blood cells containing Hb with this mutant beta-globin chain change shape upon deoxygenation, get stuck in blood vessels, deprive the surrounding tissues of oxygen, and thus lead to organ damage.

SCD is inherited from both parents, usually presents in childhood and occurs more commonly in people (or their descendants) from parts of tropical and sub-tropical regions where malaia is or was common. One-third of all indigenous inhabitants of Sub-Saharan Africa carry the gene, because in areas where malaria is common, there is a survival value in carrying only a single sickle cell gene (sickle cell trait). Those with only one of the two alleles of the sickle-cell disease are more resistant to malaria, since the infestation of the malaria plasmodium is halted by the sickling of the cells which it infests (Marieb, 1998).

Someone who inherits the hemoglobin S gene from one parent and normal hemoglobin from the other parent will have sickle cell trait. People with sickle cell trait do not have the symptoms of true sickle cell anemia.

The prevalence of the disease in the United States is approximately 1 in 5 000 and about 1 in 500 black births have sickle cell anemia.

 

2. Causes

In sickle cell anemia (also known as sicklemia), the havoc caused by the abnormal hemoglobin S (HbS), results from a change in just one of the 287 amino acids in a beta chain of the globin molecule (a valine residue is substituted with a glutamine residue at position 6). This alteration causes the beta chains to link together to form stiff rods, and as a result hemoglobin S becomes spiky and sharp when not fully loaded with oxygen. This, in turn, causes the reb blood cells to become crescent-shaped when they unload oxygen molecules or when the oxygen content of the blood is lower than normal, as during rigorous exercise and other activities that increases the metabolic rate. The stiffened and deformed erythrocytes rupture easily and tend to dam up in small blood vessels. These events interfere with oxygen delivery, leaving the victims gasping for air and exterme pain. The standard traetment for an acute sickle cell crisis is a blood transfusion (Marieb, 1998).

3. Symptoms

Patient symptoms usually don't occur until after the age of four months. Almost all patients with sickle cell anemia have painful episodes (crises), which can last from hours to days. These crises can affect the bones of the back, the long bones, and the chest. Some patients have one episode every few years while others have many episodes per year. The crises can be severe enough to require a hospital stay.

Common symptoms include: abdominal, chest and bone pain, delayed growth and puberty, yellowing of the eyes and skin (jaundice), breathlessness, fever, fatigue, rapid heart rate, excessive thirst, frequent urination, painful and prolonged erection (priapism occurs in 10-40% of men with the disease), poor eyesight/blindness, strokes and skin ulcers (due to poor blood flow) (Hebbel, 2008).

4. Examinations and tests

Tests commonly performed to diagnose and monitor patients with sickle cell anemia include:

  • Complete blood count (CBC)
  • Hemoglobin electrophoresis<
  • Sickle cell test

5. Treatment

Patients with sickle cell disease need ongoing treatment, even when they are not having a painful crisis (Geller and O'Connor, 2008). The purpose of treatment is to manage and control symptoms, and to limit the frequency of crises. Painful episodes are treated with pain medication and by drinking plenty of fluids. Non-narcotic medications may be effective, but some patients will need large doses of narcotics.

Patients with SCD are advised to take folic acid and B12 (essential for producing red blood cells) because red blood cells are turned over so quickly.

Hydroxyurea is a drug some patients use to reduce the number of pain episodes (including chest pain and difficulty breathing) (Brawley et al., 2008). It may benefit some adults with moderate and severe SCD by increasing fetal Hb (HbF) expression. However, it does not work for all individuals. Moutouh-de Parseval and colleagues have however found that immunomodulatory anticancer drugs lenalidomide and pomalidomide are more effective than hydroxyurea at inducing HbF expression by erythrocytes derived in vitro from CD34+ cells from healthy individuals.

Antibiotics and vaccines are given to prevent bacterial infections, which are common in children with sickle cell disease. Blood transfusions are used to treat a sickle cell crisis. They may also be used on a regular basis to help prevent strokes.

5.1 The value of nutritional supplements

Although supplements won’t cure the disease, they do have value in alleviating some of the symptoms. An oxygen mineral supplement like Cellfood® could help in supplying oxygen to the oxygen-deprived cells. In a clinical trial on athletes at the University of Pretoria (Nolte, 2001), 35 drops of Cellfood® increased the oxygen uptake by 5%, and the ferritin levels by 31%, amongst others.

  • These findings can also be of benefit to the SCD patient. Cellfood® is rapidly absorbed by the body, assists with oxygenation and increases the oxygen saturation in the blood.
  • Oxygen is one of the important elements for aerobic life as we know it and is essential for energizing and cleansing the body.
  • The increased ferritin levels can assist with the production of more red blood cells that are needed to transport oxygen to the different organs and cells.

5.2 Other treatments for complications may include:

  • Dialysis or kidney transplant (kidney disease)
  • Drug rehabilitation and counseling for psychological complications
  • Gallbladder removal (gallstone disease)
  • Hip replacementfor avascular necrosis of the hip
  • Irrigation or surgery for persistent, painful erections (priapism)
  • Surgery for eye problems
  • Wound care, zinc oxide, or surgery for leg ulcers

 

Bone marrow or stem cell transplants can cure sickle cell anemia. However, transplants have many risks, including infection, and rejection, and are currently thus not an option for most patients. Also, sickle cell anemia patients are often unable to find well-matched donors.

6. Prognosis

In the past, sickle cell patients often died from organ failure/infection between the ages of 20 and 40. Thanks to a better understanding and management of the disease, patients can today live into their 50’s or beyond. Some people with the disease experience minor, brief, infrequent episodes. Others experience severe, long-term, frequent episodes with many complications.

7. Prevention

Sickle cell anemia can only occur when two people who carry the sickle cell trait have a child together. About 1 in 12 African Americans has the sickle cell trait. Genetic counseling is recommended for all carriers of the sickle cell trait. It is also possible to diagnose sickle cell anemia during pregnancy.

7.1 The sickling of red blood cells can be lessened by:

  • Getting enough fluids
  • Getting enough oxygen (use CellfoodÒ for example)
  • Quickly treating infections

 

Patients are advised to have physical examinationss every 3 - 6 months to ensure that their diets are still sufficient, and that they are receiving the proper vaccinations. Regular eye examinationss are also recommended.

7.2 Preventing infections and a crises:

  • People with sickle cell anemia need to keep their immunizations up to date, including Haemophilus influenza, pneumococcal, meningococcal, hepatitis B, and influenza;
  • Some patients may receive antibiotics to prevent infections, and
  • Parents should encourage children with sickle cell anemia to lead normal lives.

7.3 To reduce a sickle cell crises, the following precautions need to be taken:

  • To prevent oxygen loss, avoid:
    • Demanding physical activity (especially if the spleen is enlarged)
    • Emotional stress
    • Environments with low oxygen (high altitudes, nonpressurized airplane flights)
    • Smoking
    • Known sources of infection
  • Ensure sufficient fluid intake:
    • Avoid too much exposure to the sun;
    • Have fluids on hand, both at home and away, and
    • Recognize signs of dehydration.
  • To avoid infection:
    • Consider having the child wear a Medic Alert bracelet;
    • Have the child vaccinated as recommended by the health care provider, and
    • Share the above information with teachers and other caretakers, when necessary.

Be aware of the effects that chronic, life-threatening illnesses can have on siblings, marriages, parents, and the child.

8. References

Brawley OW, Cornelius LJ, Edwards LR, Gamble VN, Green BL, and Inturrisi C. 2008. National Institutes of Health consensus development conference statement: hydroxyurea treatment for sickle cell disease. Ann Intern Med. 148: 932-938.

Dorland’s Illustrated Medical Dictionary. 1988. 28th ed. WB Saunders Company, p74.

Geller AK, and O'Connor MK. 2008. The sickle cell crisis: a dilemma in pain relief. Mayo Clin Proc. 8; 83: 320-323.

Hebbel RP. 2008. Pathobiology of sickle cell disease. In: Hoffman R, Benz EJ, and Shattil SS, eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; chapter 42.

Lee MT, Piomelli S, and Granger Sl. 2006. Stroke prevention trial in sickle cell anemia (STOP): extended follow-up and final results. Blood. 108: 847-852.

Marieb EN. 1998. Human anatomy and physiololgy. Fourth ed. The Benjamin/Cummings Publishing Company, Inc. 635-636.

Nolte H. 2001. The effect of CellfoodÒ on exercise performance. MA dissertation, University of Pretoria.

Saunthararajah Y, Vichinsky EP, and Embury SH. 2008. Sickle cell disease. Clinical features and management. In: Hoffman R, Benz Jr. EJ, Shattil SS, eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Churchill Livingston; chapter 43.

U.S. Preventive Services Task Force. 2007. Screening for Sickle Cell Disease in Newborns: U.S. Preventive Services Task Force Recommendation Statement. Agency for Healthcare Research and Quality, Rockville, MD. Sep 2007: AHRQ Publication No. 07-05104-EF-2.


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