11.27.07
Who owns Glycobiology?
A recent article in Science (2 Nov 07(318):734-737) discussed the wealthy Mannatech company that produces aloe-based products such as Acemannan. It has long been used as one of the many alternative approaches to managing HIV infection. Sugars (carbohydrates) are often found in the body attached to fats (lipids) or proteins where they are known as glycolipids or glycoproteins. As a field of scientific discovery, this is a relatively new area of understanding biological systems and functioning.
Some scientists in the field have taken umbrage against Mannatech for commercializing products that are little understood and applying a patina of science to their own sales efforts. While the science is definitely critical, company-sponsored research is always questionable. With agents like dietary supplements, we suffer the double whammy of little financial interest in paying for these studies due to lower profits as well as lack of interest on the part of mainstream medicine.
However, Mannatech is a well-heeled company, charges a great deal (with a workforce of 500,000 independent sales people according to the article) and some $400 million in sales, they are hardly poor, if not as stinking rich as even relatively small pharmaceutical companies. At issue is a scientific conference that Mannatech has provided some funding for. This conference on glycobiology to take place in Ireland has some scientists up in arms.
Essentially, paid for conferences of this type ARE problematic. The pharmaceutical industry has virtually completely replaced continuing physician education with dog and pony shows designed solely to sell product, while downplaying side effects. (An article from the November 25, 2007 New York Times on the topic is illustrative.)
Unfortunately, there is only one significant study of Acemanna in the context of HIV (J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Jun 1;12(2):153-157) which found no benefit in terms of CD4 count nor in the older p24 antigen assay (prior to viral loads and not very useful as a marker). The abstract is below.
But this leaves us in a bind. How do we get good data on these types of interventions? How can we figure out what works, what helps? And how can we establish the cost/benefit of such interventions? Perhaps a new administration will reinvigorate the NIH so that more independent studies can be undertaken of the most important questions.
Sadly, the for-profit, privatized approach to discovery, let alone access, has left us with fewer reliable data, misinformed physicians and reduced access to best practices and care.
George M. Carter
Montaner JS, Gill J, Singer J, Raboud J, Arseneau R, McLean BD, Schechter MT, Ruedy J.
Canadian HIV Trials Network, St. Paul’s Hospital/University of British Columbia, Vancouver, Canada.
SUMMARY: We assessed the safety and surrogate markers’ effect of acemannan as an adjunctive to antiretroviral therapy among patients with advanced HIV disease receiving zidovudine (ZDV) or didanosine (ddI) in a randomized, double-blind, placebo-controlled trial of acemannan (400 mg orally four times daily). Eligible patients of either sex had CD4 counts of 50-300/microl twice within 1 month of study entry and had received 26 months of antiretroviral treatment (ZDV or ddI) at a stable dose for the month before entry. CD4 counts were made every 4 weeks for 48 weeks. P24 antigen was measured at entry and every 12 weeks thereafter. Sequential quantitative lymphocyte cultures for HIV and ZDV pharmacokinetics were performed in a subset of patients. Sixty-three patients were randomized. All were males (mean age 39 years). The mean baseline CD4 counts were 165 and 147/microl in the placebo and acemannan groups, respectively; 90 percent of the patients were receiving ZDV at entry. Six patients in the acemannan group and five in the placebo group developed AIDS-defining illnesses. There was no statistically significant difference between the groups at 48 weeks with regard to the absolute change or rate of decline at CD4 count. Among ZDV-treated patients, the median rates of CD4 change (ACD4) in the initial 16 weeks were – 121 and – 120 cells per year in the placebo and acemannan groups, respectively ( p = 0.45), ACD4 from week 16 to 48 was 0 and – 61 cells per year in the acemannan and placebo groups (p = .11), respectively. There was no statistical difference between groups with regard to adverse events, p24 antigen, quantitative virology, or pharmacokinetics. Twenty-four patients, 11 receiving placebo and 13 receiving acemannan, discontinued study therapy prematurely, none due to serious adverse reactions. Our results demonstrate that acemannan at an oral daily dose of 1600 mg does not prevent the decline in CD4 count characteristic of progressive HIV disease. Acemannan showed no significant effect on p24 antigen and quantitative virology. Acemannan was well tolerated and showed no significant pharmacokinetic interaction with ZDV.
Acetylcarnitine from Montiff
NYBC has been working with this company for some time. The NYBC product that we had was from them, via the contract manufacturing of “mass quantities” through DAAIR. We had that material tested at an independent lab and it came through fine.
This link provides some additional information on the product, which is included as part of the Mac Pack. Don’t forget that if you are suffering from neuropathy, the data from Youle’s study suggest a higher dose may be necessary.
http://www.aminoacidbotanicalandsupplementsource.net/N-Acetyl-L-Carnitine%20HCL_info.htm
11.18.07
Chromium and glucose tolerance factor
Since there are a number of federally funded research studies dealing with chromium supplementation and blood glucose levels (see other posts under “Chromium” on this blog), we’d be very interested in hearing about the experience of our members in using this product.
Jarrow Chromium GTF
Here’s an extract of the manufacturer’s product description:
Chromium GTF (Jarrow) Each bottle, 100 caps. Each capsule, 200 mcg of chromium (in a food matrix of 100 mg of Saccharomyces cerevisiae nutritional yeast).
Chromium has been shown to be deficient in populations that consume high carbohydrate diets and especially high in simple sugars. Chromium is an important component in eliciting the glucose tolerance factor (GTF) action upon serum glucose and more importantly enhancing the effectiveness of insulin in glucose disposal into the cell. This makes sense. The more carbs you eat, the more your body will need the chromium to manage them. This could help offset the losses of chromium used up in that effort to take care of the carbs. Of course, this points to another logical step: reduce carb intake!! Check out the glycemic index of the foods you eat and focus on those with lower numbers. This index tells you how rapidly a particular carbohydrate turns into sugar. Check out the URL below for more information on the glycemic index:
http://www.hsph.harvard.edu/nutritionsource/carbohydrates.html
11.17.07
The Virtues of Whey Protein
We thought we’d reproduce a little piece on the virtues of whey protein powders that appeared in an early edition of NYBC’s newsletter THE SUPPLEMENT. This overview gives a good capsule history of the research that led to this supplement’s popularity far beyond the muscle-building crowd.
At NYBC, we’ve tried various whey protein powders over the years. Although the manufacturing processes have evolved and improved, not all wheys are created equal. For example, some manufacturers include too much sugar along with the whey protein powder, which is why we abandoned some brands a while back. Flavor is also important, actually not a minor consideration at all for something that you might want to use on a regular basis, so we have made some decisions based on that criterion as well.
NYBC’s currently stocks:
–Ultimate Balance
–Jarrow’s Whey Protein in Vanilla or Caribbean Chocolate
–Nutrivir, a fortified whey protein (NYBC staff and volunteers contributed suggestions to the formulators of this low-sugar protein powder blend, which also includes other nutrients.)
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WHEY PROTEIN POWDERS PRODUCE MANY HEALTH BENEFITS BY SUSTAINING THE BODY’S LEAN MUSCLE MASS AND BY MODULATING GLUTATHIONE LEVELS
Remember Little Miss Muffet of nursery rhyme fame, eating her “curds and whey”? It turns out that modern versions of her preferred snack have recently won attention from researchers interested in the health benefits of whey, a component of milk. (Yes, we know that body-builders were early adopters and enthusiasts of whey protein powders, and hope they won’t take offense at this reminder that Little Miss Muffet was one of their forerunners!)
In the 1980s and 1990s, several investigations of whey focused on its value as an easily absorbed protein source, especially helpful for building and sustaining the body’s lean muscle mass. In studies of HIV patients, both children and adults, whey protein proved to be a useful supplement to counter wasting and thereby improve overall health.
But research on whey also branched out to encompass other areas of health benefit besides muscle-building. Studies of the impact of whey protein on cancerous tumors, on atherosclerosis (accumulation of plaque in the arteries), and on compromised immune function have all yielded impressive results. Many of these investigations have suggested that whey protein’s ability to modulate levels of the antioxidant glutathione may help account for its wide-ranging beneficial effects. Interestingly, whey protein seems to decrease glutathione levels in tumor cells, thus weakening them or inhibiting their growth. But it also has the capacity to increase glutathione levels in cells depleted of this key antioxidant. In infections like HIV, where severe glutathione depletion is common, whey protein thus protects against oxidative damage to cells and organs and helps to improve immune function.
Special filtering techniques have been developed in recent decades to produce whey protein powders. These techniques ensure that unwanted elements like lactose and fat are left out, while proteins in their natural state (“undenatured proteins”) and crucial components linked to health benefits (such as lactoferrin) are kept in. The good news is that these techniques are now widely available, and that holds down costs!
11.16.07
DHEA and depression
Here are citations for two well-designed recent studies on DHEA and depression. The first was undertaken by the NIH/National Institute of Mental Health and used DHEA as the sole therapy with a group of men and women aged 45 to 65 who were experiencing major or minor midlife-onset depression. The researchers concluded that DHEA was an effective treatment for this group. Note: a further item of interest is that DHEA therapy was also found to be associated with improvement in sexual function. (Contrast with certain prescription anti-depressants, which shall remain nameless!)
The second study, by Judith Rabkin et al. at Columbia Univ., focused on people with HIV and examined DHEA as a therapy for non-major depression, especially among a group that was not in the best physical health. The finding: DHEA was an effective and useful therapy under these conditions.
For more information on DHEA, including recommendations for use, see the NYBC
description of
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Source: Arch Gen Psychiatry. 2005 Feb;62(2):154-62.
Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression.
Authors: Schmidt PJ, Daly RC, Bloch M, Smith MJ, Danaceau MA, St Clair LS, Murphy JH, Haq N, Rubinow DR. Behavioral Endocrinology Branch, National Institute of Mental Health, Rockville, MD CONTEXT: Alternative and over-the-counter medicines have become increasingly popular choices for many patients who prefer not to take traditional antidepressants. The adrenal androgen and neurosteroid dehydroepiandrosterone (DHEA) is available as over-the-counter hormonal therapy and previously has been reported to have antidepressant-like effects. OBJECTIVE: To evaluate the efficacy of DHEA as a monotherapy treatment for midlife-onset depression. DESIGN: A double-blind, randomized, placebo-controlled, crossover treatment study was performed from January 4, 1996, through August 31, 2002.S ettings The National Institute of Mental Health Midlife Outpatient Clinic in the National Institutes of Health Clinical Center, Bethesda, Md.Patients Men (n = 23) and women (n = 23) aged 45 to 65 years with midlife-onset major or minor depression participated in this study. None of the subjects received concurrent antidepressant medications.Intervention Six weeks of DHEA therapy, 90 mg/d for 3 weeks and 450 mg/d for 3 weeks, and 6 weeks of placebo. MAIN OUTCOME MEASURES: The 17-Item Hamilton Depression Rating Scale and Center for Epidemiologic Studies Depression Scale. Additional measures included the Derogatis Interview for Sexual Functioning. Results were analyzed by means of repeated-measures analysis of variance and post hoc Bonferroni t tests. RESULTS: Six weeks of DHEA administration was associated with a significant improvement in the 17-Item Hamilton Depression Rating Scale and the Center for Epidemiologic Studies Depression Scale ratings compared with both baseline (P<.01) and 6 weeks of placebo treatment (P<.01). A 50% or greater reduction in baseline Hamilton Depression Rating Scale scores was observed in 23 subjects after DHEA and in 13 subjects after placebo treatments. Six weeks of DHEA treatment also was associated with significant improvements in Derogatis Interview for Sexual Functioning scores relative to baseline and placebo conditions.CONCLUSION: We find DHEA to be an effective treatment for midlife-onset major and minor depression.
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Source: American Journal of Psychiatry. 2006 Jan;163(1):59-66.
Placebo-controlled trial of dehydroepiandrosterone (DHEA) for treatment of nonmajor depression in patients with HIV/AIDS
Authors: Rabkin JG, McElhiney MC, Rabkin R, McGrath PJ, Ferrando SJ.
New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York
OBJECTIVE: Subsyndromal major depressive disorder is common among HIV-positive adults. This study was designed to assess the efficacy of dehydroepiandrosterone (DHEA) as a potential treatment. METHOD: One hundred forty-five patients with subsyndromal depression or dysthymia were randomly assigned to receive either DHEA or placebo; 90% (69 of 77) of the DHEA patients and 94% (64 of 68) of the placebo patients completed the 8-week trial. The primary measure of efficacy was a Clinical Global Impression improvement rating of 1 or 2 (much or very much improved) plus a final Hamilton Depression Rating Scale score <or=8. Outcome was assessed by using intent-to-treat analysis, followed by completer analysis. Safety was assessed by queries about side effects at every study visit plus measures of CD4 cell count and HIV RNA viral load at baseline and week 8. DHEA dosing was flexible (100-400 mg/day). RESULTS: On the basis of clinicians’ ratings, DHEA was superior in the intent-to-treat analysis, where the response rate was 56% (43 of 77) for the DHEA group versus 31% (21 of 68) for the placebo group. In the completer analysis, the response rate was 62% (43 of 69) for the DHEA group, compared to 33% (21 of 64) for the placebo patients. The number needed to treat was 4 on the basis of intent-to-treat data and 3.4 on the basis of completer data. Few adverse events were reported in either treatment group, and no significant changes in CD4 cell count or HIV RNA viral load were observed in either group.
CONCLUSIONS: Nonmajor but persistent depression is common in patients with HIV/AIDS, and DHEA appears to be a useful treatment that is superior to placebo in reducing depressive symptoms. The low attrition rate in this group of physically ill patients, together with requests for extended open-label treatment, reflect high acceptance of this readily available intervention.
11.12.07
Practical Guide to Nutrition for People Living With HIV – a new publication from the Canadian AIDS Treatment Information Exchange (CATIE)
Our friends at the Canadian AIDS Treatment Information Exchange (CATIE) have released a noteworthy new publication, freely available online:
A Practical Guide to Nutrition for People Living With HIV
CATIE has a long-standing interest in nutritional supplements and HIV, and maintains on its website a collection of info sheets on a variety of relevant topics, from individual supplements to managing and preventing side effects of HAART with supplements.
This newly-issued guide brings together a wealth of accumulated knowledge in a very readable format, so overall we recommend it highly.
In the section on Vitamins, Minerals and Supplements, the new guide gives an overview of the following topics:
–micronutrient deficiencies and HIV
–antioxidants and HIV
–key vitamins and minerals for people with HIV (B vitamins, vitamins C, D, E, Calcium, Iron, Zinc, Selenium)
–other supplements used by people with HIV (alpha lipoic acid, carnitine and acetyl-l-carnitine, NAC, glutamine, probiotics, and CoQ10)
Very useful is the chart summarizing recommendations and dosing for these supplements, especially in light of more recent findings, which, for example, lead to the recommendation of a higher daily dose for Vitamin D (1000 IU), and more caution in the use of some items (such as Vitamin E and Zinc).
In addition to these pages on nutritional supplements for HIV, we also recommend the guide’s sections on “Managing the Effects of HIV and Meds on the Body,” “Managing Symptoms and Side Effects,” and “Hepatitis C Co-infection.”
Oh, and by the way: “Appendix D: Web Resources” gives a listing for the NYBC website:
New York Buyers Club (for information on nutrition, herbal and homeopathic supplements) www.newyorkbuyersclub.org/index.html
Whatever happened to policosanols?
Several years ago, there was growing interest in policosanols, a newly identified supplement, as a cholesterol-lowering agent. Major international scientific journals published promising studies of this substance derived from sugar cane wax, and it was already being marketed in a number of countries by the Cuban manufacturer, which had also conducted all the major studies (hmmm…). As of 2005, the accumulation of evidence was so impressive that even the NIH decided to fund an investigation of policosanols to lower lipid levels in people with HIV on HAART.
So what happened to this once-promising supplement? The tale is told in a piece of investigative reporting that NYBC published in early 2007. Author: Sean-Michael Fleming, with additional contributions from George Carter and Jared Becker.
—- Studies of sugarcane-derived policosanols first emerged from Cuba in the mid-1990s. Interest grew as human trials confirmed the supplement’s effectiveness in treating dyslipidemia. (Dyslipidemia refers to abnormal blood fat levels: elevated “bad” cholesterol and triglycerides, and low HDL or “good” cholesterol; it is frequently the precursor of cardiovascular disease.)
While updating the NYBC website [in 2006], I encountered disturbing reports of new, damning studies of policosanols, once the cholesterol-lowering darling of the supplement world. After some investigation, I realized I had started down a trail of…international intrigue.
Policosanols (chemically speaking, a mix of different kinds of long-chain fatty acids) became the golden child of supplements in recent years, with dazzling promise of being able to lower LDL (“bad”) cholesterol up to 30% with negligible side effects – and at far less cost than prescription statins. They seemed a godsend for those on HAART (highly active antiretroviral therapy), who often struggle with cholesterol control. Described in many respected scientific journals worldwide, they had been tested successfully on thousands of people!
The Cuban studies received a major seal of approval from German scientists reviewing them in the American Heart Journal in 2002. Surveying over 20 published studies, the scientists declared the supplement to be “a fascinating new agent for the prevention and treatment of atherosclerotic disease.” Meanwhile the sale of Cuban sugarcane policosanols – now patented – expanded to more than 40 countries, mainly in South America and the Caribbean. The Cuban version couldn’t be sold in the US due to the trade embargo, but a multitude of policosanol products appeared here as well. At NYBC we were enthusiastic about policosanol’s potential, and added it to our catalog in 2005.But doubts were surfacing. Studies of policosanols extracted from wheat germ and from rice failed to find an effect, though some claimed these forms did not contain the right balance of aliphatic alcohols (=policosanols).
In 2006 the German scientists who had given the Cuban studies high marks returned with results of their own rigorous trial of Cuban sugarcane policosanols, which found them no more effective than a dummy pill. Later in the year, Canadian researcher Dr. Peter Jones also reported a study using Cuban sugarcane policosanols that showed the supplement had no value in lowering cholesterol. (However, he used a 10 mg dose that may have been too low; others suggest the study was too short, being only 28 days long.)
Perhaps there was cause for skepticism from the start. Almost all the Cuban studies came from Dalmer Labs, which was connected to the nation’s Center for Scientific Research and then became the marketer of Cuba’s patented policosanols. No independent scientific verification took place outside of Cuba for years. And was it coincidence that the policosanol studies came out just when Cuba’s sugar industry was staggering under the loss of Soviet subsidies and a string ofbad harvests? Boosting sales of sugarcane derivatives became an acknowledged national goal, and would certainly be a good way to restore profitability to the island’s major cash crop.
We don’t yet know the full back-story to this “policontroversy.” At NYBC we are considering discontinuing policosanols, and would like to hear reactions from any member who has used them. In the meantime, we urge anyone interested in using them to do so at the beginning of bloodwork on a stable regimen. Then see if they work for you—or not. And please share your experiences with us.
With the promise of policosanols tarnished, what lipid-lowering alternatives to prescription drugs do people have? Fish oils continue to gain respect in scientific/medical communities in Europe and the US (see info about them on our new Supplement Fact Sheets – see “Resource Relaunch Revealed” in this issue). Dr. Jones sees a potentially bright future for plant sterols, which may significantly improve lipid profiles—we look forward to more study of these substances. Then there’s niacin, which despite the problem of “flushing/itching,” works very well for some people as a cholesterol-lowering agent (see detailed suggestions on our website).
Of course, nutritionists have long known about the moderate cholesterol-lowering effect of high-fiber foods like oatmeal. If you are trying to control your cholesterol, you should also understand that sugar intake, not just fat intake, influences your cholesterol level. And when monitoring cholesterol and cardiovascular risk, remember that the more recent focus has been not just on lowering “bad” cholesterol, but raising “good” cholesterol (which niacin does very well). And of course, making dietary changes and getting routine exercise are the first basis with which to start.
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Thoughts? Comments? Any further information to offer us as we prepare to close the books on this once-promising supplement?
11.11.07
Fish oil (omega-3 fatty acids) used after heart attacks in Europe–why not in the US?
Here’s an excerpt from a 2006 New York Times article, which points out some of the resistance to supplements that is a feature of US medicine–in this case, rather clearly to the detriment of American cardiac patients.
Note: the American Heart Association’s recently updated guidelines on fish oil / omega-3’s are posted on this blog under “Omega-3″ – Oct. 23, 2007.
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In Europe It’s Fish Oil After Heart Attacks, but Not in U.S.
by ELISABETH ROSENTHAL
ROME — Every patient in the cardiac care unit at the San Filippo Neri Hospital who survives a heart attack goes home with a prescription for purified fish oil, or omega-3 fatty acids.
“It is clearly recommended in international guidelines,” said Dr. Massimo Santini, the hospital’s chief of cardiology, who added that it would be considered tantamount to malpractice in Italy to omit the drug.
In a large number of studies, prescription fish oil has been shown to improve survival after heart attacks and to reduce fatal heart rhythms. The American College of Cardiology recently strengthened its position on the medical benefit of fish oil, although some critics say that studies have not defined the magnitude of the effect.
But in the United States, heart attack victims are not generally given omega-3 fatty acids, even as they are routinely offered more expensive and invasive treatments, like pills to lower cholesterol or implantable defibrillators. [...]
“Most cardiologists here are not giving omega-3’s even though the data supports it — there’s a real disconnect,” said Dr. Terry Jacobson, a preventive cardiologist at Emory University in Atlanta. “They have been very slow to incorporate the therapy.”
[...]
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Note: Full article appeared in NYT Oct. 3, 2006 and was accessed from the online edition by us on Nov. 11, 2007.
11.10.07
Antioxidant supplementation and HIV
The NYBC website offers info sheets on many individual dietary supplements. One of the most comprehensive information sheets is “Antioxidants and HIV,” from which we give the main conclusions (below).
See also our post on “K-Pax” for more on the practical considerations involved in using antioxidant supplementation.
…the use of antioxidant nutrients along with nucleoside analog drugs [for HIV] may well help to prevent the damage the nukes might otherwise cause. The same antioxidants could also help to counter the oxidative stress of HIV disease, in general, in ways that could protect immune cells and slow disease progression.
Diagnosis of either oxidative stress or mitochondrial problems is mostly done only in studies since the laboratory assessments that can show these phenomena are difficult to do and are not commonly available to individuals. However, the research evidence that these problems exist in people with HIV is compelling enough for us to believe that everyone living with this disease should be doing whatever is possible to counter them.
Among the most important nutrients for countering these problems are antioxidant vitamins and minerals, amino acids, and fatty acids. Of particular importance are the nutrients that work together to maintain a healthy level of glutathione and the important enzymes for which it is a cofactor (glutathione peroxidase and glutathione transferase). These include N-acetyl-cysteine, alpha-lipoic acid, glutamine, selenium, and vitamins C and E. These and the other important antioxidants (including the carotenoids and coenzyme Q-10) are needed to counter the oxidative stress and help reduce the body wide inflammation that HIV infection causes.
You can find the full information sheet here:
NYBC Info Sheets
11.09.07
Gingko biloba and omega-3 fatty acids for cognitive health
In its annual bibliography of significant advances in dietary supplement research for 2006, the National Institutes of Health focused on two studies in the category of “cognitive health.” One, involving gingko biloba, found that a component of this botanical may have therapeutic potential for the prevention and treatment of Alzheimer’s disease. This research on gingko provides further background information for of two large randomized controlled investigations that are now underway: the Gingko Evaluation of Memory study, and the GuidAge study.
A second study in the “cognitive health” category was a clinical trial that followed patients with mild to moderate Alzheimer’s disease who took omega-3 fatty acid supplements, as compared to those taking placebo. A significant reduction in cognitive decline was found in those with very moderate dysfunction who took the omega-3.
This investigation also was undertaken in support of a wider investigation on Alzheimer’s and omega-3s, which is being funded by the National Institutes of Health.
11.07.07
Fatigue, sleep disturbances, low energy, depression: dietary supplements may help address special health concerns for people with HIV
As we were mulling over the recent New York Times piece on the billions of dollars Americans spend each year on sleep aids that are only mildly effective (see today’s other post under “Melatonin”), we thought we’d reprint this article from the NYBC newsletter THE SUPPLEMENT, which appeared earlier this year. It deals with the constellation of health concerns, from fatigue to depression, that often affect people with HIV, and gives an overview of some of the dietary supplements that have been used to address these issues.
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Sleeping poorly? Energy low? Feeling down?
Dietary supplements may have something to offer
Sleep disturbances are the third most common complaint among people with HIV seeking medical attention. Everybody knows what it’s like to sleep poorly, then feel cranky and fatigued the next day. But persistent insomnia, followed by chronic fatigue, can become major medical issues for people with HIV (we’re talking about lower CD4 counts and poor medication adherence), so it’s worth reviewing options for dealing with these problems.
A 2005 research presentation suggested that melatonin supplements can improve sleep patterns in people with HIV. Melatonin, a hormone secreted by the pineal gland, has long been studied as a sleep regulator—levels increase in response to darkness, then fall during daytime. It’s also been investigated as an anti-cancer agent, where it has shown the capacity to combat solid tumors. (But melatonin should not be taken by people with cancers affecting immune cells, such as lymphoma or leukemia.)
Good news: a recent trial indicates that low-dose melatonin (0.5 to 1.0 mg) may be perfectly effective as a sleep promoter, making it a very inexpensive option for this purpose.
Fatigue can stem from other causes besides sleep disturbances. Anemia, a shortage of red blood cells, is another leading cause of fatigue among people with HIV, and is especially common among women. (A recent large study found that about 30% of people on HAART had moderate anemia. Women had an 80% greater risk of being anemic than men, and African-Americans had a risk of anemia 2.6 times higher than whites.) It’s important to learn the source of anemia in people with HIV (taking Retrovir, AZT, is a drug-related factor). Treatment options include increasing intake of iron, vitamin B12 and folic acid. Note that NYBC stocks multivitamins with iron for those concerned about their intake of this mineral. You’ll also find folic acid and B12 in our multis, and may want to consider adding a separate vitamin B supplement as well.
While for some people with HIV treating anemia can be a key to helping them overcome fatigue and its frequent companion depression, there are other cases where low energy is not connected to low red blood cell levels, and where the treatment options are therefore different. Particularly in HIV+ men, steroid hormones (testosterone and DHEA) have proven to be useful in combating the fatigue-depression combination. Recent federally-funded research on DHEA showed it to be an effective anti-depressant, with the added interesting feature that it can enhance sex drive (rather than undermining it, as do certain common prescription anti-depressants). And a Columbia University study of DHEA for fatigue and depression in people with HIV has found it to be a successful treatment for some, with the added bonus that, unlike some prescription energy boosters, it doesn’t carry the risk of addiction.
Sleep drugs wildly popular, and expensive, but not terribly effective–what about melatonin as an alternative?
We were amused to see the recent New York Times article about how many billions of dollars Americans spend on popular sleep drugs like Ambien, yet how little effect these medications actually seem to have:
Sleep Drugs Found Only Mildly Effective, but Wildly Popular NYT Oct. 23, 2007
Meanwhile, there have been a number of studies over the years pointing to the dietary supplement melatonin as a useful sleep aid, providing comparable effects to the prescription meds.
For example:
Psychopharmacology (Berl). 1996 Jul;126(2):179-81.
Low dose melatonin improves sleep in healthy middle-aged subjects.
University Department of Psychiatry, Littlemore Hospital, Oxford, UK.
We studied the effects of single evening doses of melatonin (0.3 mg and 1.0 mg orally) on polysomnographically measured sleep in 15 healthy middle-aged volunteers, using a placebo-controlled, double-blind, cross-over design. Compared to placebo, the 1.0 mg dose of melatonin significantly increased Actual Sleep Time, Sleep Efficiency, non-REM Sleep and REM Sleep Latency. These data are consistent with the hypothesis that low dose melatonin has hypnotic effects in humans. It is possible that administered melatonin may have a role to play in the treatment of sleep disorders.
There are also current studies funded by NIH on melatonin for sleep disturbances in the elderly, and in people with Alzheimer’s.
But getting back to the New York Times piece: while the article reported prices of prescription sleep aids in the $2-4 range per dose, the typical melatonin dose can cost just a few cents. See, for example, the Douglas Labs Melatonin stocked by NYBC.
