New York Buyers’ Club - The Blog

Two recent reports in the journal, Science, looked at two very different conditions. In both cases, they found that the effects that they were seeing were offset when they added one of my favorite antioxidant amino acids, N-acetylcysteine (NAC).

In one case, a study reported on the effects of asbestos and other particulates on the lungs. The article noted that chemotherapy doesn’t really help the lesions that arise from such particulate damage (Dostert et al., Science, 2 May 2008(320)674-677). What they realized was that part of the problem with particulates was that they caused certain inflammatory cytokines, such as interleukin-1beta (IL-1B) to be expressed. At one point in the experiments, they used NAC in cell cultures to evaluate whether reactive oxygen species played a role along with the IL-1B, and indeed, the NAC minimized this response. Would it help as a therapeutic? For people living with HIV and/or hepatitis C, IL-1B has been observed to be elevated (see, e.g., Antivir Chem Chemother. 2001 May;12(3):133-150 and J Viral Hepat. 2008 Mar 6. [Epub ahead of print].)

The second study looked at how a cancer tumor can move to other sites and tissues in the body (metastasis) (Ishikawa, et al., Science, 2 May 2008(320)661-664). Mitochondria, the little powerhouses of cells that produce the energy molecule, ATP, have long thought to be involved in cancer. While damaged mitochondria (or mutations in the DNA mitochondria carry), do not seem to necessarily be the start of cancer, they have been invoked in this study as a source of its metastasis. After determining that their model could indeed cause cancer to spread in mice, they tried NAC to see if they could thwart it. In fact, the reduction of reactive oxygen species (ROS) that NAC achieved did indeed result in reducing the metastatic potential in two mouse models. Address oxidative stress through routine use of antioxidants like NAC MIGHT help to prevent cancer from metastasizing.

This becomes more than just an interesting theory for people with HIV. A recent report underscored a higher risk of certain non-AIDS related cancers in HIV+ individuals. Can agents like NAC help to reduce this risk? No studies have been done in humans to support this idea–but given all the other potential and its safety, many of us are already using it. The report noted:

Anal cancer by 2003 had become 59 times more common among HIV-infected people than the general population, according to the study in the Annals of Internal Medicine.

Hodgkin’s disease was 18 times more common in this population, the study also found. In addition, liver cancer was seven times more common, lung cancer 3.6 times more common, the skin cancer melanoma and throat cancer both three times more common, and colorectal cancer 2.4 times more common.

(See http://www.aegis.org/news/re/2008/RE080516.html )

We’d like to recommend this article, by long-time AIDS treatment activist Nelson Vergel, which appears in the July-Dec. 2007 issue of GMHC’s Treatment News

It’s available online at

http://www.gmhc.org/health/treatment/ti/ti21_3_4.html#3

Lipodystrophy has been one of the most discussed side effects of HIV medications in the past ten years, and, as this article points out, its potentially devastating psychological effects have added urgency to the search for scientific understanding about the condition, and treatment options to address it.

This excellent summary divides the discussion into three parts:

–lipoatrophy (fat loss in the face, buttocks, arms and legs)

–lipohypertrophy (fat accumulation in specific areas of the body such as the neck, belly, upper torso, and breasts)

–lipid abnormalities (high LDL ["bad"] cholesterol and triglycerides, low HDL ["good"] cholesterol)

Nelson outlines how Zerit and AZT were especially implicated in lipoatrophy; he also sorts through the ongoing uncertainties about the origins of lipohypertrophy and lipid abnormalities in people with HIV on HAART.

This article is also very useful in reviewing the treatment options for these three conditions, including facial wasting reconstruction therapies like Sculptra (formerly Newfill) for lipoatrophy; prescription drugs for lipohypertrophy (testosterone or Metformin*); nutritional supplements like fish oil and Niacin for lipid abnormalities (these are often most successful when used along with diet and exercise programs, and can enhance the effectiveness of prescription statins).

Nelson Vergel continues to do a great service in making this kind of treatment information available to PWHIV. For more info, you can also visit the website www.facialwasting.org, or subscribe to the pozhealth internet HIV health discussion group by sending a blank email to pozhealth-subscribe@yahoogroups.com.

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*See the recent post on this Blog for a recommendation about supplementing with B vitamins when taking Metformin.

Here is an excerpt from Dr. Hyla Cass’s recommendations for use of alpha lipoic acid for diabetes (as found in her excellent guide, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition, pp 54-55):

“Diabetics require strong antioxidant protection, and alpha-lipoic acid fits this bill. This ’super antioxidant’ has been found to have healing effects on neuropathy in diabetics, as well as to control insulin resistance. [...] ALA has been found to help insulin work better, and to promote production of glutathione, a powerful antioxidant made in the liver. Its use even in medication-dependent diabetics has been shown to reduce complications.“

Caution: Diabetics should inform their doctor if taking alpha lipoic acid, because it can reduce blood sugar levels and can consequently lower need for insulin or other diabetes medications.

Suggested dosage: 200-600mg/day

See also the NYBC entry on Alpha Lipoic Acid.

We often get questions about recommended dosages of Florastor, the form of the probiotic Saccharomyces boulardii that NYBC has carried for a number of years. It was recently pointed out to us that the Wikipedia entry on this supplement includes a “Dosage Ruler” for a number of indications (conditions). See entry at:

http://en.wikipedia.org/wiki/Saccharomyces_boulardii

As Dr. Hyla Cass points out in her excellent book Supplement Your Prescription: What Your Doctor Doesn’t Know about Nutrition, NSAIDs (including older ones such as aspirin, as well as newer ones like Celebrex), which are very widely used for arthritis pain, have the unfortunate side effect of inhibiting the enzymes needed to create cartilage. “Essentially,” she writes, “this means that the drugs used to relieve arthritis-related discomfort accelerate the progression of the disease.” (p. 86)

Indeed, as Dr. Cass goes on to note, there’s a study showing that people taking NSAIDs on a regular basis to relieve knee arthritis pain actually have a greater risk of worsening the disease over time than people who take a dummy pill! Moreover, another study showed that people taking NSAIDs for knee arthritis were at higher risk for developing arthritis in the hip or in the other knee, compared to people who did not take these drugs.

Just another reason to consider use of the supplement glucosamine chondroitin to support joint health. See additional information, including dosage recommendations, at NYBC’s Glucosamine Chondroitin entry.

Here’s an excerpt from the NYBC info sheet on Beta Glucans, an extract of yeast cell walls which has been used in immune-compromised patients.

Function: Cholesterol regulation, immune support. May also modestly improve blood pressure.

Beta glucans enhance the power of the immune system by activating a certain type of white blood cell known as macrophages. These cells patrol the body and fend off foreign invaders such as bacteria and fungi by engulfing them.

Beta glucans are also well known to be effective in lowering blood lipid levels and are the key factor for why oat bran is so beneficial in this regard. Like other soluble fiber components, beta glucans work by binding cholesterol, facilitating its elimination from the body. Because beta glucans lower the bad LDL and increase the good HDL blood cholesterol levels, they are useful in preventing coronary heart disease.

See also the NYBC entry on Beta Glucans (Jarrow)</a>.

Here’s a story on the probiotic Saccharomyces boulardii from John James of AIDS Treatment News, posting at AIDS Treatment News Daily Alerts - www.aidsnews.org/now.

2008-04-30

Report raises C. diff concerns; yeast-based probiotic shown to help significantly reduce recurrence

Antibiotic-resistant Clostridium difficile (C. difficile) infection is becoming an increasingly serious problem. In principle at least, the use of a probiotic along with antibiotic treatment could make sense.

“A recent meta-analysis of 31 studies compiled and published in the American Journal of Gastroenterology concluded that S. boulardii is the only probiotic that is effective in fighting recurrent C. diff-associated disease.[reference] Additionally, an article in the March 2006 issue of Gastroenterology and Hepatology showed that use of S. boulardii provided an almost 50 percent decrease in subsequent recurrence among patients who suffered recurrent CDAD symptoms.[reference] ‘Because Florastor (S. boulardii) is a yeast and not a bacteria, it is not killed by the strong antibiotics that are being used to kill the C. diff bacteria, so it survives in the digestive tract,’ says Dr. Raymond. ‘When the ‘baby’ C. diff emerge from their spores, they are greeted by a well-colonized gut, rather than an empty playground.’”

Note: references and more detailed reporting at

http://www.eurekalert.org/pub_releases/2008-04/bi-rrc042908.php

For additional information, see the NYBC entry on Florastor or other entries on Saccharomyces boulardii on this blog.