12.01.09
Posted in Acetylcarnitine, B vitamins, Carnitine, Chromium, Coenzyme Q10, DHEA, Florastor, GABA, Glutamine, K-Pax alternative, Multivitamins, NAC (N-acetylcysteine), Niacin, Omega-3, PharmaNAC, Probiotics, SAMe, Saccharomyces boulardii, THE SUPPLEMENT - Newsletter of NYBC, ThiolNAC, Traditional Chinese Medicine, Tryptophan, Vitamin B12, Vitamin C, Vitamin D, acidophilus, alpha lipoic acid, anxiety, bone health, calcium, cardiovascular health, cholesterol, depression, diabetes, diarrhea, digestive enzymes, fatigue, fish oil, gastrointestinal health, hepatitis, hiv, immune support, insulin resistance, lecithin, lipodystrophy, liver disease, mental health, milk thistle, nausea, neuropathy, pantethine, sexual function, silymarin, sleep aids, sterols, theanine, triglycerides tagged diabetes, diarrhea, high cholesterol, hiv, HIV/AIDS, insulin resistance, lipodystrophy and HIV, nausea, neuropathy, side effects at 12:18 pm by jarebe
To mark its fifth anniversary, the New York Buyers’ Club has prepared a special edition of SUPPLEMENT. In it you will find a concise Guide to managing and preventing HIV medication side effects with supplements and other complementary and alternative therapies.
This is an invaluable introduction to how nutritional supplements can be used to counter those side effects that can make life miserable–or even disrupt treatment adherence–in people taking antiretroviral medications for HIV.
Read about approaches to dealing with diarrhea, nausea, heart health issues, diabetes, insomnia, fatigue, liver stress, lipodystrophy, anxiety and depression.
This FREE Guide is available online at:
http://newyorkbuyersclub.org/
On the NYBC website you can also SUBSCRIBE to the nonprofit co-op’s quarterly FREE newsletter, THE SUPPLEMENT, which continues to offer a unique perspective on current evidence-based use of supplements for chronic conditions including cardiovascular disease, diabetes/insulin resistance, hepatitis and other liver conditions, anxiety/depression, osteoarthritis, cognitive and neurorological issues, and gastrointestinal dysfunction.
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11.23.09
Posted in Antioxidants, alpha lipoic acid, diabetes, evening primrose oil, neuropathy tagged alpha lipoic acid, diabetes, evening primrose oil, peripheral neuropathy, Vitamin C at 1:26 pm by jarebe
We were interested to read about an antioxidant therapy for Diabetic Peripheral Neuropathy (DPN). It includes alpha lipoic acid, which has been studied quite extensively for diabetes, as well as evening primrose oil (gamma linolenic acid being the active component) and Vitamin C:
…a recommendation for treatment of DPN by use of anti-oxidants, and is based on the research of Stan Angilley. It has been used successfully by many diabetics to reduce or even eliminate DPN. Before starting on this regimen, you should discuss it with your doctor, as you may have other medical issues which would contraindicate its use. It is likely that your doctor will have heard little or nothing about this approach, so we have provided citations to applicable literature below.
The DPN cocktail has three components: Alpha Lipoic Acid (ALA), Gamma Linolenic Acid (GLA) as contained in Evening Primrose Oil (EPO), and Vitamin C.
Read more at:
http://www.diabetes-support.org.uk/joomla/neuropathy-treatment
See www.newyorkbuyersclub.org for more on these supplements.
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09.14.09
Posted in alpha lipoic acid, diabetes, neuropathy tagged ALA, alpha lipoic acid, diabetic neuropathy, neuropathy at 12:32 pm by jarebe
We took a look recently at http://www.diabetesdaily.com/wiki/Neuropathy – Diabetes support network – an online community forum. Here is their info on supplements for diabetic neuropathy; there seems to be the most data and dosage information on alpha lipoic acid:
There are 2 dietary supplements that have clinical evidence showing them to be effective treatments of diabetic neuropathy; alpha lipoic acid and benfotiamine. In several studies using a variety of dosages and routes of administration, alpha lipoic acid was found to reduce the various symptoms of peripheral diabetic neuropathy. A recent review of the published data determined “ALA should be considered as a treatment option for patients with peripheral diabetic neuropathy.” Also a recent study using orally administered alpha lipoic acid found that 600 mg once a day caused a marked reduction in the symptoms of diabetic neuropathy including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. Benfotiamine is a lipid soluble form of thiamine that has several placebo controlled double blind trials proving efficacy in treating neuropathy and various other diabetic comorbidities. 400 mg a day was the most commonly studied dose.
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08.20.09
Posted in Carnitine, Coenzyme Q10, Nepal, THE SUPPLEMENT - Newsletter of NYBC, Traditional Chinese Medicine, alpha lipoic acid, cardiovascular health, diarrhea, fatigue, hiv, insulin resistance, lipodystrophy, neuropathy tagged alpha lipoic acid, CoQ10, hiv, HIV/AIDS, L-carnitine at 10:54 am by jarebe
We reprint below our report on this June 2009 forum, which brought together a range of views on managing HIV:
SUPPLEMENTS AND OTHER SMART STRATEGIES FOR LONGER LIVING was the title of a panel discussion on traditional, complementary and alternative therapies for HIV presented on June 25, 2009 by the New York Buyers’ Club in celebration of its fifth anniversary. The event brought together experts whose knowledge spans East and West, and whose experience ranges from community organizing and scientific writing, to clinical research and the practice of medicine, whether as an M.D. or as a licensed acupuncturist and specialist in Chinese herbalism.
NYBC was especially proud to host our Guest of Honor, Sunil Pant, the first openly gay Member of Parliament in Nepal, and Founder/Director of the HIV-support organization the Blue Diamond Society, which was recognized by the International Gay and Lesbian Human Rights Commission in 2007 as “one of the most effective human rights groups in the world.” At the start of the panel discussion, our Guest of Honor gave a moving account of the work he and his organization have done over the last decade in securing rights for sexual minorities in Nepal, and in fighting for decent treatment of Nepalis with HIV/AIDS. Sunil also took a moment to recall the many years he has known and worked with our own George Carter, who has directed NYBC efforts to provide supplements and other aid to BDS.
We also felt privileged to hear from our other panelists: Dr. Paul Bellman, a NYC physician who has been treating people with HIV/AIDS since the start of the epidemic; Tim Horn, President and Editor of AIDSmeds.com; Alex Brameier, a licensed acupuncturist and herbalist; and George Carter, Director of the Foundation for Integrative AIDS Research. It’s true that the first two of these panelists are in the mainstream of AIDS treatment practice, by which we only mean to say that their main area of expertise is antiretroviral pharmaceuticals. Yet Dr. Bellman also spoke of the usefulness of several supplements that NYBC and its predecessor DAAIR have long recommended: alpha lipoic acid, carnitine, and CoQ10. Tim Horn, whose website focuses largely on pharmaceutical treatments, nevertheless also acknowledged that the “holistic” approach to long-term health for people with HIV makes a lot of sense. And he went on to say that he recognizes that a whole range of “therapies” (including even diet and exercise) may be needed to address worrisome trends in heart and lung disease among people with HIV who are taking ARVs.
Alex Brameier, the Lic. Ac. on our panel, engaged our audience with an impromptu survey on how people view their acupuncture treatments. She then discussed some of the conditions that lend themselves to acupuncture, based on clinical experience: pain relief, stress reduction, neurological and musculoskeletal disorders, to name a few. Very useful as well was the contrast she drew between acupuncture as practiced in China and Japan (where treatment may be daily or every other day), and the West, where time and financial constraints often dictate otherwise. Her tips on how to get the best out of acupuncture and how acupuncture and herbs can work together were also very valuable.
Last but not least among our contributors was George Carter, who’s had two decades of experience with supplements, from clinical research to acting as NYBC Treatment Director. George, as all who know him can attest, is nothing if not thorough, and for this event he prepared a “Short Primer on Side Effects,” a compact but comprehensive review of HIV medication side effects, ranging from malabsorption/diarrhea//nausea, to lipid abnormalities (of concern for cardiovascular health), to fatigue and insomnia, to insulin resistance/diabetes, to liver damage, to bone issues, to peripheral neuropathy. We hope to produce this super-useful handout as a handy pocket guide in the near future, so stay tuned.
An inspirational, lively, and (if we do say so ourselves) immensely informative event. If you were there, thanks for coming! And if not–we certainly hope to see you at the next one.
Reprinted from the SUMMER 2009 SUPPLEMENT: Newsletter of the New York Buyers’ Club, which can be read in its entirety at
http://newyorkbuyersclub.org/supplement/index.html
In addition to the piece above, this issue contains a report on how research on diet and nutrition has led to new knowledge about supplements (“Are You Ready to Join the Food Revolution?”), and a short review on HIV and cognitive impairment.
Note: Email subscriptions to THE SUPPLEMENT are free to NYBC members.
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03.31.09
Posted in Chromium, Multivitamins, Omega-3, alpha lipoic acid, biotin, diabetes, fish oil at 11:24 am by jarebe
We were at a health fair in Brooklyn recently, and, because there is a high rate of diabetes in this area of NYC, we decided that we should produce a short list of the most important supplements that have been studied for diabetes:
Multivitamin/multimineral
Regular use of a multivitamin/multimineral supplement helps people with diabetes maintain good health (for example, by reducing the number of infections they experience).
Reference: Barringer, et al. Effect of a Multivitamin and Mineral Supplement on Infection and Quality of Life. Annals of Internal Medicine. 3/4/2003.
Omega-3 fatty acids (Fish Oil)
Many people with diabetes have high blood pressure and elevated cholesterol, which can increase the risk of heart disease and stroke. (Two out of three people with diabetes die of heart disease or stroke.) Omega-3 fatty acids have shown benefit for cardiovascular health in recent randomized controlled clinical trials. The FDA has also approved a health claim for fish oil: “supporting but not conclusive evidence shows that the consumption of EPA and DHA omega-3 fatty acids from fish oil may reduce the risk of coronary heart disease.”
Alpha-Lipoic Acid
Alpha-Lipoic Acid (ALA) has the ability to assist with glucose metabolism, and also promotes healthy nerve function. A recent study concluded that ALA (600mg) could be useful in helping to treat the symptoms of diabetes-related neuropathy (= generally, pain, tingling, numbness in feet and hands).
Reference: Ametov et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care. 2003, 26 (3)
Chromium
See entries under Chromium on this blog for additional information about this mineral and its potential benefit for people with diabetes.
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10.29.08
Posted in alpha lipoic acid, hiv, liver disease tagged hiv, liver disease, NAC, K-pax, K-Pax alternative, NAC (N-acetylcysteine) at 11:09 am by jarebe
The Canadian AIDS Treatment Information Exchange (CATIE) has reported on a small but significant study suggesting that exposure to the anti-HIV drug ddI (didanosine, Videx or Videx EC) may be the cause of otherwise unexplained liver damage in a small percentage of people taking it.
Researchers analysed health information, collected from three clinics, of HIV positive patients with unexplained and unexpected liver disease. All patients underwent extensive medical tests to try to find the cause of their problem(s). In total, the teams found 13 patients (2 females and 11 males) who had the following features in common:
- all had higher-than-normal levels of liver enzymes
- there were no obvious causes of liver problems
- no hepatitis-causing viruses were detected
- none of the participants were alcoholics
- swollen blood vessels in the throat and abdomen
- bleeding in the throat or abdomen
- water retention in the abdomen
- unintentional weight loss
- black stools
- exposure to ddI for at least two years
Researchers decided that all 13 patients should discontinue ddI and replace it with another suitable anti-HIV drug. Once this was done, liver enzyme levels fell and symptoms began to resolve.
Quite interesting was the researcher’s speculation about the cause of this liver damage:
[...] ddI may have decreased levels of a protective compound called GSH (glutathione) in cells. GSH is used to make enzymes that help detoxify harmful chemicals. Low levels of GSH may result in liver cells being susceptible to ddI-related toxicity.
The CATIE report goes on to discuss GSH deficiency in people with HIV, and the possibility that this deficiency may be in some cases intensified by ddI. As further noted in the report, the supplement NAC has been used to raise GSH levels. Perhaps NAC has a role to play in preventing the kind of liver damage discussed here? The CATIE reporter leaves the question open-ended:
Experiments with HIV positive people suggest that supplements of the amino acid cysteine (which is converted into GSH inside cells) can raise GSH levels in the blood. A formulation of cysteine called NAC (N-acetyl-cysteine) is used to help detoxify the liver in cases of overdose with the pain medication acetaminophen (Tylenol). To our knowledge, no clinical trials of NAC have been done in ddI users to assess its impact on GSH and liver health.
For NYBC’s view on NAC supplementation, see these entries:
NAC
PharmaNAC (an effervescent form of NAC, easy to take; made available in North America after some early research on the benefits of NAC supplementation for people with HIV in the 1990s)
ThiolNAC (NAC + alpha lipoic acid–another supplement recommended for liver support)
Note that NAC is also a key component in NYBC’s low-cost alternative to the K-Pax multivitamin/antioxidant combination pack:
MacPack
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09.23.08
Posted in Omega-3, alpha lipoic acid, diabetes, insulin resistance tagged alpha lipoic acid, Omega-3 fatty acid at 11:55 am by jarebe
“Prevention of Diabetes with Nutritional Supplements” is the title of a research project funded in 2007 by the National Center for Complementary and Alternative Medicine (an NIH Center). The researchers at University of California – Davis are investigating alpha lipoic acid and a combination of alpha lipoic acid and the omega-3 fatty acid EPA as means to prevent or delay onset of Type 2 diabetes. The researchers are hypothesizing that the combination of ALA and the omega-3 fatty acid (also known as eicosapentaenoic acid, a component of fish oil supplements) may have effect against insulin resistance associated with adult-onset diabetes, and against impairment of pancreatic function.
See also the NYBC entries on the supplements mentioned in this research:
Arctic Omega fish oil (with EPA)
Alpha Lipoic Acid (sometimes called just “Lipoic Acid”)
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09.13.08
Posted in Antioxidants, Hepatoplex, SAMe, THE SUPPLEMENT - Newsletter of NYBC, ThiolNAC, Vitamin C, alpha lipoic acid, hepatitis, hiv, liver disease, silymarin tagged alpha lipoic acid, Health Concerns, hepatitis, Hepato-C, Hepato-Detox, Hepatoplex, hiv, liver, liver disease, Pacific Biologic, silymarin, ThiolNAC at 3:45 pm by jarebe
Many Ways to Love Your Liver
(reprinted from the NYBC SUPPLEMENT, Summer 2008)
Liver impairment is a frequent concern for people with HIV. There are many different causes, including co-infection with hepatitis, HIV meds that put added stress on the liver, excessive alcohol or recreational drug use, opportunistic infections, repeated resort to antibiotics, or just consuming big doses of the over-processed, nutrient-poor junk that too often passes for food these days! (By the way, we like the rule of thumb for choosing good stuff at the supermarket: if your grandmother wouldn’t recognize the item as “food”—then it’s probably not very good for you.)
The liver is crucial for processing and breaking down wastes, whether those produced by normal body functioning or those absorbed into the system in the form of drugs, alcohol, or toxins. So keeping it in good repair is essential for health. One specific strategy to support liver function is to maintain levels of the intracellular (= “found within cells”) antioxidant glutathione, which plays a key role in protecting the liver as it performs its detoxification duties. Here is a short list of nutritional supplements that are frequently recommended for this purpose: Vitamin C (2–6 grams per day, in divided doses); N-acetyl-cysteine, or NAC (500 mg, 3 times per day); alpha-lipoic acid (300-600 mg, twice daily). (Note that NAC and Lipoic can be taken in the combination form ThiolNAC, one of the key supplements stocked by NYBC.)
Another worthy option for countering stresses to the liver is an herb called Milk Thistle (Silybum marianum), which has a long tradition of use as a botanical remedy. Modern research has isolated compounds referred to as silymarin within this plant, and many studies have pointed to silymarin’s effectiveness in protecting liver cells from toxic chemicals, and even in stimulating the repair and regeneration of liver cells. In 2007, a federally funded investigation identified one component of milk thistle as a potent anti-cancer agent, and suggested that it held much promise in protecting against or treating liver cancer. Be advised that if you consult sources such as the Canadian AIDS Treatment Information Exchange (CATIE) website, you may encounter concerns about whether silymarin interferes with HIV meds. But here’s what one National Institutes of Health study concluded: “Milk thistle in commonly administered dosages should not interfere with indinavir therapy in patients infected with the human immunodeficiency virus.” This and other research, we believe, suggests that milk thistle-HIV med interference is not actually a very signficant issue.
Now here’s a rather unusual dietary supplement that has been investigated for liver health: S-adenosylmethionine (SAM-e). First isolated by Italian researchers in the 1950s, SAMe is synthesized by living cells from the amino acid methionine and can’t be supplemented from food sources. In several European studies of people living with hepatitis B or C, it has been shown to help reduce jaundice, fatigue, and other symptoms. And it’s also been applied to treating alcohol-related damage to the liver. The unusual aspect of SAMe is that there’s also a great deal of published research on its value as an antidepressant and as a treatment for arthritis—so it’s quite a versatile molecule! (See the NYBC Blog at www.nybc.wordpress.com for more details.)
Last, we note that the New York Buyers’ Club, like its predecessor DAAIR, has carefully followed the modern, US-based study and dissemination of traditional Chinese herbal remedies for liver disease. For example, NYBC stocks Pacific Biologic’s Hepato-C and Hepato-Detox, and, more recently, has added Health Concern’s Hepatoplex One and Hepatoplex Two to its product list. Both of these California-based companies have a very good reputation for quality, and both have devised blends based on Traditional Chinese Medicine as well as current clinical experience by licensed practitioners. (Please consult the NYBC website for more information about the specific herbs in these formulas, as well as recommendations for their use.) Of course we’re always interested in hearing about the experience of our members in using these products, and so we welcome your comments and questions—just email us at contact@newyorkbuyersclub.org.
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05.19.08
Posted in alpha lipoic acid, diabetes tagged alpha lipoic acid, diabetes at 11:22 am by jarebe
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.
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04.21.08
Posted in B vitamins, Vitamin B12, alpha lipoic acid, diabetes, folic acid tagged CoQ 10, folic acid, insulin resistance, metabolic syndrome, metformin, side effects, Type 2 Diabetes, Vitamin B12 at 10:04 am by jarebe
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!
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04.04.08
Posted in Acetylcarnitine, NAC (N-acetylcysteine), Vitamin C, alpha lipoic acid, hiv tagged acetyl-l-carnitine, alpha lipoic acid, Carnitine, hepatitis, hiv, liver disease, NAC, ThiolNAC, Vitamin C at 4:14 pm by jarebe
CATIE provides an information sheet on liver toxicity as part of its “Practical Guide to Managing HIV Drug Side-Effects.” This info sheet suggests ways of coping with liver impairment, which is frequent in people with HIV, and may result from a variety of factors, including medication side-effects, hepatitis co-infection, repeated use of antibiotics, alcohol or drug use, or a nutrient-poor, chemically-rich diet.
Here’s an excerpt on some supplementation strategies to counteract liver impairment:
—
In addition to removing, as much as possible, anything that might be stressing the liver, it is very important to add the therapeutic agents that can help the liver to detoxify, repair and protect itself. There are a number of potentially useful agents, listed below:
Nutrients to Maintain Glutathione
Glutathione (GSH) is the most important intracellular antioxidant and is crucially important for protecting the liver against toxicity when it goes about its task of breaking down drugs and other toxins. Taking the following nutrients may help to maintain or increase levels of glutathione:
–vitamin C (2–6 grams per day, in divided doses)
–N-acetyl-cysteine, or NAC (500 mg, 3 times per day; always take with food because taking it on an empty stomach can cause gastrointestinal tract irritation)
–L-glutamine (5 grams per day, increased up to 30–40 grams in those who also have diarrhea or wasting). Note that anyone with seriously compromised liver or kidney function should not take glutamine without a doctor’s approval since it is an amino acid that must be processed by those organs.
–alpha-lipoic acid, or thioctic acid (300-500 mg, twice daily; take on an empty stomach with fluids). Alpha-lipoic acid is a naturally occurring fatty acid that acts as a cellular coenzyme. It is very important to the liver cell metabolic pathways and can be rapidly depleted when the liver is under stress. It appears to help boost repair when there has been either virally induced or drug-induced liver damage. Note that alpha-lipoic acid disappears from the bloodstream very rapidly, so products made in an extended-release form will last longer and work better.
For anyone with liver dysfunction or disease, the above nutrients may be very important as part of a total treatment approach.
For people with fatty livers, another important nutrient is the amino acid carnitine. Researchers say that it may help prevent mitochondrial toxicity, thus helping the body to handle fat better. Early studies of its use for non-HAART-related elevated triglycerides in PHAs did, indeed, show successful lowering of the blood fat levels. Research in animals has shown its successful use in reversal of fatty livers. The usual dosage is two capsules (500 mg each) twice daily. The alternative is Carnitor, the basic form of carnitine, available by prescription only. It is usually prescribed in doses of 3,000 mg daily (three 330-mg capsules, 3 times daily). Too-high doses can cause diarrhea, so watch for this. Doses of plain carnitine need to be higher because the acetyl-L-carnitine releases four times as much free carnitine into the bloodstream, using equivalent doses.
Note that in addition to the individual supplements mentioned above, NYBC also stocks its combination of N-acetyl-cysteine and alpha-lipoic acid, ThiolNAC.
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03.25.08
Posted in B vitamins, Carnitine, NAC (N-acetylcysteine), Niacin, Omega-3, alpha lipoic acid, hiv, lipodystrophy tagged alpha lipoic acid, B vitamins, Carnitine, hiv, lipodystrophy, NAC, Niacin, omeg-3 fatty acids at 10:06 am by jarebe
The people at the AIDS Treatment Data Network (ATDN) have developed a series of “Simple Fact Sheets” about treatment and management of HIV. Their fact sheet on “Nutritional Management of Lipodystrophy,” written by an HIV nutritionist at Cabrini Medical Center in New York, covers diet (the right mix of carbohydrates, protein, fruits and vegetables, the right kinds of fats), exercise, and supplements, beginning with a good multivitamin, preferably one that includes a good set of antioxidants. There’s also a description of some supplements that may be useful in reducing lipodystrophy: L-carnitine, NAC, chromium, alpha lipoic acid, B-complex vitamins (niacin may be key among the B vitamins, but the recommendation is to always supplement using a B-complex, since the different B vitamins support one another’s action), and omega-3 fatty acids (fish oil and/or flaxseed).
To read the entire fact sheet, go to
http://www.atdn.org/simple/nutrlip.html
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