New York Buyers’ Club - The Blog

We return to this excellent guide published in 2007 by Hyla Cass, a practicing physician and expert on integrative medicine.

In Chapter 4 of the book, Dr. Cass reviews recent findings that call into question the idea that dietary cholesterol causes cardiovascular disease. In line with the current scientific thinking on this subject, she suggests looking at underlying inflammation as essential to any understanding of risks to heart and circulatory system health. As a consequence, she says, people who want to reduce risk of cardiovascular disease should consider dietary changes that are anti-inflammatory (that is, a diet high in antioxidants, anti-inflammatory herbs, and antioxidant-rich foods–that’s colorful fruits and vegetables, curry, turmeric, rosemary, ginger, green tea, dark chocolate, low-toxin fish like salmon or sardines).

Statin drugs, though they come with some side effects, have proven of benefit to certain groups of people with cardiovascular complications, including diabetics, those who have had a heart attack, and those diagnosed with cardiovascular disease. Like many others, Dr. Cass recommends supplementing with CoQ 10 if you’re taking statins. She also supports use of omega-3 fatty acids (from fish oil), niacin (though not recommended for diabetics), plant sterols, tocotrienols (a form of the antioxidant vitamin E), and D-ribose for controlling cholesterol and otherwise countering cardiovascular disease. In addition, the B vitamins are recommended to help lower homocysteine, high levels of which are associated with artery damage and increased risk of heart disease.

Citation: Hyla Cass, M.D., Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (Basic Health Publications, 2007).

Below we give the abstract of a recent (2005) assessment of acetyl-l-carnitine’s effectiveness in the management of neuropathy (tingling, pain due to nerve damage) in people with diabetes.

For additional information on the use of this nutrient for neuropathy and other conditions, see the NYBC entry on Acetylcarnitine.

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Acetyl-L-Carnitine Improves Pain, Nerve Regeneration, and Vibratory Perception in Patients With Chronic Diabetic Neuropathy: An analysis of two randomized placebo-controlled trials

Anders A.F. Sima, MD, PHD, Menotti Calvani, MD, Munish Mehra, PHD and Antonino Amato, MD

OBJECTIVE—We evaluated frozen databases from two 52-week randomized placebo-controlled clinical diabetic neuropathy trials testing two doses of acetyl-L-carnitine (ALC): 500 and 1,000 mg/day t.i.d. [tid = 3 times per day]

RESEARCH DESIGN AND METHODS—Intention-to-treat patients amounted to 1,257 or 93% of enrolled patients. Efficacy end points were sural nerve morphometry, nerve conduction velocities, vibration perception thresholds, clinical symptom scores, and a visual analogue scale for most bothersome symptom, most notably pain. The two studies were evaluated separately and combined.

RESULTS—Data showed significant improvements in sural nerve fiber numbers and regenerating nerve fiber clusters. Nerve conduction velocities and amplitudes did not improve, whereas vibration perception improved in both studies. Pain as the most bothersome symptom showed significant improvement in one study and in the combined cohort taking 1,000 mg ALC.

CONCLUSIONS—These studies demonstrate that ALC treatment is efficacious in alleviating symptoms, particularly pain, and improves nerve fiber regeneration and vibration perception in patients with established diabetic neuropathy.

Citation: Diabetes Care 28:89-94, 2005

This is an excellent and easy-to-read booklet that can be read online, or ordered from thebody.com at

http://www.thebody.com/content/art13137.html

Gastrointestinal or gut problems–diarrhea, nausea, indigestion, gas, loss of appetite–are very common for people with HIV, with consequences ranging from temporary to very serious. This booklet takes you through the common causes: HIV meds, other meds or supplements, the effects of HIV itself, your diet, psychological triggers, or other health problems (such as parasites). It then sorts through some of the most used treatments, including over-the-counter drugs, supplements, prescription meds, changing your diet.

Some of the many good points about this booklet: the “When to Call Your Doctor” sections, the personal stories, the “Doctor’s Notes,” and the dietary tips and supplement recommendations.

The National Library of Medicine, which is a service of the National Institutes of Health, publishes ratings on a number of dietary supplements in order to help consumers judge their effectiveness. Below is the NLM rating for Saw Palmetto for Enlarged Prostate/benign prostatic hypertrophy (BPH).(

The NLM Grade for this use of Saw Palmetto is “A” or “strong scientific evidence for this use.”
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Enlarged prostate (benign prostatic hypertrophy/BPH)

Numerous human trials report that saw palmetto improves symptoms of benign prostatic hypertrophy (BPH) such as nighttime urination, urinary flow, and overall quality of life, although it may not greatly reduce the size of the prostate. The effectiveness may be similar to the medication finasteride (Proscar®) with fewer side effects. Although the quality of these studies has been variable, overall they suggest effectiveness.
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For further commentary and dosing recommendations, see the NYBC entry on Saw Palmetto (Jarrow). In addition, NYBC stocks Saw Palmetto with Pygeum (Jarrow)</a>; Pygeum is another botanical that has been studied for enlarged prostate. Note additional recommendation for supplementing with omega-3 fatty acids to support prostate health.

From http://eatg.org/news/newsitem.php?id=14774

Note also that the study reported a reduction in neuropathy in multi recipients. When will a potent multi simply be considered a STANDARD OF CARE for HIV+. Inexpensive and can be provided immediately upon diagnosis (even at high CD4 counts, of course). And helps when Antiretroviral therapy is needed.

Daily micronutrients of some benefit for HIV-positive patients receiving TB treatment Tuesday, April 22, 2008
	A simple micronutrient tablet reduced the rate of tuberculosis relapse in HIV-positive patients. By Michael Carter A simple micronutrient tablet reduced the rate of tuberculosis relapse in HIV-positive patients, according to a study published in Tanzania and published in the June 1st edition of the Journal of Infectious Diseases (now online). Use of the micronutrient also reduced the risk of peripheral neuropathy, a condition that can be caused by both HIV infection and key medication used to treat tuberculosis. None of the patients was taking antiretroviral therapy, and the use of micronutrients did not reduce the risk of death, nor was it associated with an improvement in CD4 cell count or a fall in viral load. However, the investigators did find that micronutrients reduced the risk of both extrapulmonary tuberculosis and genital ulcers in HIV-negative patients. An editorial accompanying the study called its results “promising” and suggested that micronutrients could be “an important adjuvant therapy for patients with TB.” Latest figures from the World Health Organization suggest that there were 1.7 million deaths from tuberculosis, and the infection is an important cause of death in patients with HIV in resource-limited countries, despite the availability of effective anti-tuberculosis therapy. Patients with tuberculosis often have significant nutrient deficiencies, particularly low levels of vitamins A, B complex, C, as well as selenium. These nutrients are key to the health of the immune system and its ability to respond to serious infections like tuberculosis. But there is contradictory evidence regarding the value of micronutrient therapy for patients receiving tuberculosis treatment. Therefore investigators designed a randomised, placebo controlled study involving 471 HIV-positive and 416 HIV-negative adults in Dar es Salaam, Tanzania, with sputum-positive pulmonary tuberculosis. The study ran between 2000 and 2005. Patients were randomised to receive either a daily micronutrient tablet containing vitamin B complex, vitamin C, vitamin E, folic acid and selenium at doses of six to eight times the recommended daily allowance, or a placebo. All the patients received tuberculosis therapy consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol by directly observed therapy for two months, and then self-administered isoniazid and ethambutol daily for a further six months. The study outcomes included treatment failures after one month (defined as a failure to achieve smear-negative tuberculosis), relapse from smear-negative to smear-positive tuberculosis during the rest of treatment, death during two years after the completion of treatment, changes in immune system measures, including CD4 cell count, weight gain, and for, patients with HIV, alterations in viral load. Over two-thirds (67%) of the patients were male, and the average age for patients with HIV was 34 years, and 30 years for HIV-negative individuals. Tuberculosis therapy was less likely to fail after one month in HIV-positive patients who received the micronutrient tablet than those who were given the placebo (13% vs.17%; for all patients 15% vs. 21%), but these differences were not statistically significant. However, amongst HIV-positive patients who responded to tuberculosis therapy, those who received the micronutrients were significantly less likely to experience a relapse and the reemergence of smear-positive tuberculosis during the next seven months of treatment than those who received the placebo (5% vs. 13%, p = 0.02). Overall there were 155 deaths during the total follow-up period. Most of these deaths (140) were in patients infected with HIV. There was no difference in mortality between patients who received the micronutrient supplement and those treated with the placebo (74 deaths vs. 66 deaths). Nor was there any difference in the risk of progression to another AIDS-defining illness between the micronutrient arm and the placebo arm. Amongst HIV-positive patients, CD3, CD4, and CD8 cell count and HIV viral load were comparable between those who received the micronutrient and those given the placebo during the eight months of tuberculosis therapy and during the extended follow-up period. But micronutrients were associated with CD8 cell counts (p = 0.02) and CD3 cell counts (p = 0.02) during tuberculosis treatment for HIV-negative patients. This group of patients also had a non-significant increase in CD4 cell count (p = 0.07), during longer follow-up. Micronutrient supplementation was associated with a 57% reduction in the risk of peripheral neuropathy (41% vs. 69%, p < 0.001), irrespective of a patient’s HIV status. For HIV-negative patients, micronutrients reduced the risk of extrapulmonary tuberculosis (p = 0.01). There was also some evidence that micronutrients might help reduce the risk of infection with HIV for HIV-negative patients, as patients who received them were significantly less likely to be diagnosed with genital ulcers (p = 0.03). There was no evidence that taking the micronutrient improved body weight or body composition in either HIV-positive or HIV-negative patients. In their discussion, the investigators highlight their finding that “micronutrient supplements appeared to decrease the risk of early tuberculosis recurrences among HIV-positive patients”, as well as the “significantly decreased… incidence of peripheral neuropathy, regardless of HIV status.” They note, however, that none of the patients in their study were taking antiretroviral therapy and conclude “the impact of micronutrient supplementation on TB-related outcomes needs to be ascertained among HIV-infected patients receiving antiretroviral therapy.” Reference 1. Villamor E et al. A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis. J Infect Dis 197: (online edition), 2008. 2. Benn CS et al. Should micronutrient supplementation be integrated into the case management of tuberculosis? J Infect Dis 197: (online edition), 2008.

The Linus Pauling Institute at Oregon State University provides a good review of research on fish oil (omega-3 fatty acids) and Type 2 diabetes (see excerpt below). Although there was some concern that fish oil supplements might interfere with glycemic control (= control of blood sugar levels) in diabetics, that does not seem to be the case. Moreover, fish oil supplementation can significantly lower triglycerides in people with diabetes, and there is good epidemiological evidence that over the long term higher omega-3 fatty acid intakes may also decrease the risk of cardiovascular disease in diabetics.
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Cardiovascular diseases are the leading causes of death in individuals with diabetes mellitus (DM). Hypertriglyceridemia [...] is a common lipid abnormality in individuals with type 2 DM, and a number of randomized controlled trials have found that fish oil supplementation significantly lowers serum triglyceride levels in diabetic individuals. Although early uncontrolled studies raised concerns that fish oil supplementation adversely affected blood glucose (glycemic) control, randomized controlled trials have not generally found adverse effects of fish oil supplementation on long-term glycemic control. A systematic review that pooled the results of 18 randomized controlled trials including more than 800 diabetic patients found that fish oil supplementation significantly lowered serum triglycerides, especially in those with hypertriglyceridemia. A more recent meta-analysis that combined the results of 18 randomized controlled trials in individuals with type 2 DM or metabolic syndrome found that fish oil supplementation decreased serum triglycerides by 31 mg/dl compared to placebo, but had no effect on serum cholesterol, fasting glucose or hemoglobin A1c concentrations. Although few controlled trials have examined the effect of fish oil supplementation on cardiovascular disease outcomes in diabetics, a prospective study that followed 5103 women diagnosed with type 2 DM, but free of cardiovascular disease or cancer at the start of the study, found that higher fish intakes were associated with significantly decreased risks of CHD over a 16-year follow up period. Thus, increasing EPA and DHA intakes may be beneficial to diabetic individuals, especially those with elevated serum triglycerides. Moreover, there is little evidence that daily EPA + DHA intakes of less than 3 g/day adversely affect long-term glycemic control in diabetics. The American Diabetes Association recommends that diabetic individuals increase omega-3 fatty acid consumption by consuming two to three 3-oz servings of fish weekly.

See also the NYBC entry on DHA Max, a DHA/EPA supplement from Jarrow.

This is an excellent guide to managing the side effects of prescription drugs through better nutrition and nutritional supplements. Published in 2007 by Basic Health Publications, it synthesizes much recent research on how the most frequently prescribed drugs for Type 2 diabetes, cardiovascular disease, osteoarthritis, and depression often cause nutrient deficiencies that can lead to additional health problems. Dr. Cass, who is a practicing physician and a specialist in integrative medicine, provides clear analyses of these damaging side effects and offers recommendations on how to address them.

The first condition discussed by the book is Type 2 Diabetes/insulin resistance/metabolic syndrome. For those who are taking the most commonly prescribed drug for Type 2 Diabetes, metformin, Dr. Cass stresses the importance of supplementing with Vitamin B12 (200-1000mg/day) folic acid (400-800mg/day) and CoQ 10 (30-200mg/day) to make up for the nutrient-depleting effects of the medication. Vitamin B12 and folic acid, together with Vitamin B6, are crucial for keeping levels of an amino acid called homocysteine in check in the body. Since elevated levels of homocysteine are associated with heart disease, stroke, hypertension, neuropathy, and Alzheimer’s, it’s a top priority to keep the body supplied with the B vitamins that can control it.

Dr. Cass also provides a “Diabetes Supplement Program” especially directed to pre-diabetics who may be able to address their condition with diet, exercise, and supplements (the B vitamins and CoQ 10 mentioned above, plus alpha lipoic acid, antioxidants, and the trace minerals chromium and vanadium, which are needed in blood sugar processing).

Much more to discuss in this very useful book, so we will come back to it again!

The Pacific College of Oriental Medicine website hosts an overview of research on green tea and HIV. Here’s an excerpt:

[...]Dr. Kuzushige Kawai at the University of Tokyo is one of a handful of scientists who have taken an interest in the implications of Green Tea for treatment of HIV. Most specifically it is the Epigallocatechin Gallate (EGCG) scientists are interested in. This is the same chemical compound that has been linked with lower rates of heart disease, stroke, lowered cholesterol, managing diabetes, and better liver health.

What Dr. Kawai found in lab tests was that the EGCG found in Green Tea prevented the virus from bonding to CD4 molecules in healthy T-cells, by bonding with them before the virus.

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Read the rest of the article at

http://www.pacificcollege.edu/publications/articles/2006/december/12-03-2006_green_tea.htm

NYBC has stocked a Jarrow green tea extract: http://nybcsecure.org/product_info.php?products_id=260

We’d be glad to hear any reports on use of this product, or any additional information our members may have on green tea.

Lactobacillus acidophilus, L. acidophilus–acidophilus for short–is the most widely used probiotic, a beneficial microorganism that helps support gastrointestinal health in a variety of ways. For example, the byproducts of acidophilus (lactic acid, hydrogen peroxide) make for an environment that is hostile to undesirable organisms in the gut. And acidophilus also produces lactase, the enzyme that breaks down and allows digestion of milk sugar (lactose).

The University of Maryland Medical Center’s Complementary Medicine website provides a review of therapeutic uses of acidophilus and other probiotics. Here are some highlights:

–Treating overgrowth of “bad” organisms in the gastrointestinal tract (a condition that tends to cause diarrhea and may occur from use of antibiotics).
–Alleviating symptoms of irritable bowel syndrome and, possibly, inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis).
–Preventing and/or reducing the recurrence of vaginal yeast infections, urinary tract infections, and cystitis (bladder inflammation). The best scientific evidence exists for vaginal infections.
–Improving lactose absorption digestion in people who are lactose intolerant
–Enhancing the immune response. Studies have suggested that consumption of yogurt or milk that contains specific strains of Lactobacillus or supplements with Lactobacillus or Bifidobacterium may improve the natural immune response. Further research is needed to confirm these early findings and to best understand how the improved immune function may or may not help in warding off infections.

NYBC carries Jarro-Dophilus, a combination of acidophilus and other probiotic species together with a prebiotic (basically, the foodstuff that probiotic species thrive on). Note that this item needs to be refrigerated to maintain its effectiveness.

NYBC also carries Jarro-Dophilus EPS. This is a probiotic that does not require refrigeration. As reported on the NYBC website, a recent consumerlabs.com test of this product gave it very good marks!

We’ve heard a lot about the health benefits of deep-water fish, attributable especially to their omega-3 and omega-6 fatty acids. But what are the differences in fatty acid content among the various common types of canned fish, such as albacore or chunk light tuna, salmon, and mackerel? (After all, because of cost, most people in the US eat canned fish much more frequently than fresh fish, so this is a rather important question for the health-conscious.)

The Center for Botanical Lipids at Wake Forest University reports on a recent analysis of the fatty acid content of popular kinds of canned fish, and also reviews findings about mercury contamination, a cause for concern with some kinds of fish.

(Yes, we’re aware that these are not really botanical lipids–but we’re glad that someone has undertaken such a useful study and wants to get the findings out to the public!)

Highlights of the study:

–from a fatty acid prospective, canned salmon is more beneficial than any tuna product
–none of the canned fish in the study exceeded the Food and Drug Administration’s Action level of 1,000 parts per billion; but higher mercury levels were felt by the researchers to be of concern in some tuna, depending on type (albacore or chunk light) and whether canned in vegetable oil, soy oil, or water.

To read the full report, see

What About Canned Fish?

on the website of the Botanical Lipids Center.

And, our own closing note: for people seeking a health benefit, using distilled fish oil supplements can provide a defined quantity of fatty acids, and also eliminate concerns about mercury contamination. That’s not to say we’d ever give up the pleasure of eating salmon, whether fresh or canned!

We recently took a look at The Wake Forest University Center for Botanical Lipids website. This Center is one of five such dietary supplement research centers funded through the federal government’s National Institutes of Health–so this website represents our tax dollars at work!

The main goal of this new research center is to “determine the role of fatty acid based dietary supplements in the prevention and treatment of chronic human diseases associated with inflammation.” The center’s website also makes the point that “nearly 20% of Americans use dietary supplements, many of them botanicals, but scientific evidence for their safe and effective use in the prevention or treatment of human diseases has lagged behind the use of the products.”

Actually, we think the 20% estimate may be on the low side, especially if you include use of basic multivitamins; and certainly among groups with chronic conditions (such as osteoarthritis) the rate of supplement use is often higher than 20%. But we certainly agree that we need more scientific evidence about the effectiveness and safety of supplements, and we’re glad to know that the NIH has continued to fund such research, especially through its National Center for Complementary and Alternative Medicine (NCCAM) and its Office of Dietary Supplements (ODS).

OK, enough of the federal governmental acronyms, and back to the Wake Forest website. We’re pleased to see that it includes a user-friendly section with some publications easily understood by the general public (”Articles for Everyday People”). Here’s a sample from the piece entitled “The Use of Dietary Flaxseed for the Prevention of Human Disease”:
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Flaxseed (also called linseed) has been a part of the human and animal diet for thousands of years. It is the richest known plant source of omega-3 fatty acids - 58% of the total fat in flax is composed of alpha-linolenic acid (LNA); however, this fatty acid is a short chain omega-3 as opposed to the long chain omega 3s found in fish oil. A number of studies have shown that flaxseed does not replace fish oil in the diet because the conversion of LNA to the omega-3 fatty acids found in fish oil is very inefficient.

While most studies show a benefit of flaxseed oil, there have been studies which have not been positive. In 5 out of 6 epidemiological studies on prostate cancer, flaxseed was shown to increase cancer risk, and LNA is a strong growth stimulus in isolated prostate cancer cells (4). Neither of these effects has been seen with fish oil. In addition, recent studies suggest that flaxseed may increase the risk of macular degeneration or speed up the progression of the disease.

In a nutshell: flaxseed looks to be very interesting for breast cancer and cardiovascular disease, but not recommended when prostate cancer or prostate cancer risk is present.

The University of Maryland Medical Center’s Complementary Medicine website provides an assessment of some recent studies on melatonin as an adjunct treatment for breast cancer. Of course melatonin is best known and has been most researched for its effects on sleep and its potential to address sleep disorders. Most of these investigations have focused on people whose circadian rhythms are disrupted by factors such as jet lag or work schedules, but there have also been studies looking at melatonin as a sleep aid for the elderly or for those with HIV (see other “Melatonin” entries on this Blog).

This excerpt from the UMMC article on Melatonin indicates, however, that this supplement may be eliciting additional interest as an auxiliary to certain cancer treatment regimens. We have highlighted the last sentence in this passage, which repeats one of the crucial guides in using supplements: be sure to consult your health care professional.

“Several studies indicate that melatonin levels may be linked with breast cancer risk. For example, women with breast cancer tend to have lower levels of melatonin than those without the disease. In addition, laboratory experiments have found that low levels of melatonin stimulate the growth of certain types of breast cancer cells, while adding melatonin to these cells inhibits their growth. Preliminary laboratory and clinical evidence also suggests that melatonin may enhance the effects of some chemotherapy drugs used to treat breast cancer. In a study that included a small number of women with breast cancer, melatonin (administered 7 days before beginning chemotherapy) prevented the lowering of platelets in the blood. This is a common complication of chemotherapy, known as thrombocytopenia that can lead to bleeding.

In another study of a small group of women whose breast cancer was not improving with tamoxifen (a commonly used chemotherapy medication), adding melatonin caused tumors to modestly shrink in over 28% of the women. People with breast cancer who are considering taking melatonin supplements should consult their doctors before beginning supplementation.“