New York Buyers’ Club - The Blog

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!

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:
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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:

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.

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

A study by Jariwalla, et al., published in the Journal of Alternative and Complementary Medicine (2008 Nov 2;14(2):139-146) reported on the effects of using 300 mg alpha lipoic acid, three times a day (900 mg) among 33 HIV+ men and women. These individuals had viral loads greater than 10,000 copies, despite being on antiretroviral therapy (ARV). The patients were randomized to receive either alpha lipoic acid or placebo over 6 months.

The main results included not only an increase in glutathione levels over baseline that was statistically significant, and a considerably enchanced ability of white blood cells (lymphocytes) to respond to antigens. In addition, as glutathione levels were increased, the ability of cells bearing CD3 molecules to respond to antigens was also enhanced.

While the intervention did not impact CD4 counts or viral load, these improvements in overall immunity in this very vulnerable population were encouraging. Improving the functional reactivity of lymphocytes to T-cell mitogens helps to strengthen immune responses to other potentially lethal pathogens. While a small study, this is encouraging news and further studies are needed in this and in populations of HIV+ individuals at other stages of infection and responsiveness to ARV therapy.

For background information on alpha lipoic acid, see the NYBC entry:

Alpha Lipoic Acid

The Oregon State University/Linus Pauling Institute website is highlighting a number of recent studies, especially from 2005-2006, which have examined the potential of acetyl-l-carnitine or L-carnitine, together with alpha lipoic acid, to counter the effects of aging in laboratory rats. Like the Linus Pauling Institute reviewer, we are looking forward to human clinical trials in the next few years to further define useful dosages and health benefits.

NOTE: a great deal of previous research on acetylcarnitine, L-carnitine, and alpha lipoic acid is reviewed on the NYBC website.

…two studies found that supplementing aged rats with either ALCAR [acetyl-l-carnitine] or alpha-lipoic acid, a mitochondrial cofactor and antioxidant, improved mitochondrial energy metabolism, decreased oxidative stress, and improved memory. Interestingly, co-supplementation of ALCAR and alpha-lipoic acid resulted in even greater improvements than either compound administered alone. Likewise, several studies have reported that supplementing rats with both L-carnitine and alpha-lipoic acid blunts the age-related increases in reactive oxygen species (ROS), lipid peroxidation, protein carbonylation, and DNA strand breaks in a variety of tissues (heart, skeletal muscle, brain). Improvements in mitochondrial enzyme and respiratory chain activities were also observed. While these findings are very exciting, it is important to realize that these studies used relatively high doses (100 to 300 mg/kg body weight/day) of the compounds and only for a short time (one month). It is not yet known whether taking relatively high doses of these two naturally occurring substances will benefit rats in the long-term or will have similar effects in humans. Clinical trials in humans are planned, but it will be several years before the results are available.

ThiolNAC, a combination of the two antioxidants NAC (N-Acetyl-Cysteine) and Alpha Lipoic Acid, is again available as a combination supplement from the New York Buyers’ Club. The manufacturer of this supplement is Montiff, which also produced NYBC’s previous version of ThiolNAC.

ThiolNAC (NYBC): NAC 500mg, Lipoic 200mg [90 tablets/bottle].

NAC (N-acetyl-cysteine) is recommended for its antioxidant properties and because studies have suggested it may improve immune function. Often used in Europe to treat chronic bronchitis and chronic sinusitis. Also recommended if you are taking acetaminophen (Tylenol). Alpha Lipoic Acid is widely recognized as a potent antioxidant and liver protective agent. Research suggests it has the capacity to protect many organs and tissues from damaging inflammation due its antioxidant power. Long used to treat neuropathy in diabetics.

Note: ThiolNAC can be used to replace the separate NAC and Lipoic components of NYBC’s MAC (Multivitamin Antioxidant Combo) Pack, the purchasing co-op’s low-cost alternative to K-Pax.

This is a brief overview on alpha lipoic acid, a much-studied antioxidant that holds special interest to those with chronic liver disease and/or HIV. If you’re one of those people who like their information in capsule summary form (with further details and references attached), this may be just the ticket to get you started. The full entry can be found on the University of Maryland Medical Center’s website –another in a growing set of mainstream medical information resources that host serious information on “integrative medicine,” including dietary supplements.
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