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).

Carotenoid compounds derived from vegetable sources have been the subject of much research for their power as antioxidants with potential health benefits. For example, a 2006 study in Canada among people with HIV showed an improved survival among those using a high dose of beta carotene in the form of a mixed carotenoid complex compared to those using a multivitamin alone (Eur J Clin Nutr, 2006;60:1266-1276).

NYBC currently stocks Jarrow’s CarotenALL, which includes a wide range of carotenoid compounds including alpha and beta carotene, lutein, lycopene, etc., derived from natural vegetable sources including broccoli, spinach, tomato, etc.

The sources of carotenoids in this supplement include three distinct forms of sea algae, palm oil, tomatoes, marigolds, among others. Many of the carotenoid forms are patented. The amounts of both lutein and lycopene are identical to amounts used successfully in research studies. Astaxanthin is considered by some to be the most potent carotenoid currently researched. It is supplied in its correct natural form derived from Hawaiian sea microalgae at a 2 mg dose. There are also substantial amounts of other patented natural mixed carotenoids. Finally, we have included 5 mg of sulforaphane, not a carotenoid, but an extremely potent stimulator of the Phase II detoxification system as well as an initiator of several other antioxidant enzymes, making it one of the most potent free-radical neutralizers yet studied. New varieties of carotenoids are constantly being discovered, so this should NOT replace a diet rich in colorful foods, but to supplement your diet. Eat your fruits and vegetables–and lots of them!

Specifically, each softgel contains:

Vitamin A as CaroCare beta carotene . . . . . . . .2,583 IU
(beta carotene - 1.43 mg and alpha carotene - 0.7 mg)
Lutein (marigold extract) . . . . . . . . . . . . . . . . . .10 mg
Zeaxanthin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 mg
Lycopene (from GMO-free tomatoes) . . . . . . . . . . .10 mg
Phytoene (from GMO-free tomatoes) . . . . . . . . . . …1 mg
Phytofluene (from GMO-free tomatoes) . . . . . . . . . . 1 mg
Astaxanthin (Haematococcus pluvialis) . . . . . . . . .500 mcg
Gamma tocopherol. . . . . . . . . . . . . . . . . . . . . . . . .10 mg

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.

See the NYBC entry on Nutrivir No Sugar Added for information on this combination of whey protein powder, antioxidants, vitamins and minerals that’s formulated by upstate New York biotech company BioNexus. NYBC has chosen to stock the No Sugar Added version because that option responds to the concerns of many who are cutting down on refined sugar in their diets. (Of course, you can always add your favorite sweetener if you wish.)
Overall, NYBC members have found this product to be very useful for maintaining optimal weight and also just for its convenience in supplying antioxidant and multivitamin/mineral supplements in a single product that’s easy to incorporate into drinks, yogurt etc. Note some of the additional components of Nutrivir: digestive enzymes, vitamins A, C, E, beta carotene, lycopene, lutein, selenium, N-acetyl cysteine, alpha-lipoic acid, taurine and L-carnitine.

A recent letter to the editor of the NYT from a nutritionist expresses some of the same concerns about cholesterol control and cardiovascular health that we’ve been raising recently.

See also today’s NYT editorial on the FDA, which has lately been beset, bothered and besieged by questions about its ability to manage the drug approval process.

—
To the Editor:

Yet again, we miss the point about cholesterol. To read Gary Taubes’s article, one might think that cholesterol is a toxic substance.

In truth, cholesterol is a naturally occurring lipid produced by the liver. It is the biochemical precursor to vitamin D and to the sex hormones. It is an integral part of every cell membrane. So this war against cholesterol is a war against ourselves.

Perhaps a better question to ask would be, Under what conditions does cholesterol become part of the plaque that contributes to heart disease? And guess what? We’ve had some of the answers for years.

When free radicals attack or oxidize the LDLs, cholesterol may enter the plaque. This problem can be addressed by including more antioxidants in the diet or with vitamin supplementation.

Another factor is uncontrolled high blood glucose, which can damage blood vessels, increasing the potential for plaques to form. Here also, diet, exercise and antidiabetic drugs can help.

Moreover, there is a huge and valuable literature connecting heart disease to stress and emotional wounds. All the statin drugs in the world won’t scratch that itch.

Bottom line: When the questions we ask about health are defined by the pharmaceutical companies, the answers we get will be better for Big Pharma’s profits than for our health and healing.

Rona S. Weiss
Teaneck, N.J., Jan. 28, 2008

The writer is a nutritionist and health consultant.

This review, published in late 2007, concludes that studies of prostate cancer prevention are now maturing to the point where recommendations may soon be in order for reducing cancer risk by supplementing with such promising dietary supplement agents as lycopene, alpha-tocopherol, or selenium. Decreased dietary fat, nonsteroidal anti-inflammatory drugs and selective estrogen receptor modulators are also interventions under review.

Chemoprevention of prostate cancer: agents and study designs

PURPOSE: With the completion of the Prostate Cancer Prevention Trial and the ongoing performance of several additional large-scale prostate cancer prevention trials interest in this intervention has increased. We review promising agents for prostate cancer prevention, clinical trial designs and how these agents may be used clinically. MATERIALS AND METHODS: We reviewed current and completed randomized chemoprevention trials for prostate cancer as well as the most promising agents for which evidence suggests that a decreased prostate cancer risk may result from their use. RESULTS: Evidence suggests that lycopene, decreased dietary fat, antioxidants such as alpha-tocopherol and selenium, nonsteroidal anti-inflammatory drugs and selective estrogen receptor modulators such as toremifene and 5alpha-reductase inhibitors may prove useful for decreasing the risk of prostate cancer in a man. Ongoing studies are examining these agents in the 3 general scenarios of 1) general population studies (finasteride, alpha-tocopherol and selenium), 2) increased prostate specific antigen with negative biopsy (dutasteride) and 3) prostatic intraepithelial neoplasia (toremifene and selenium). CONCLUSIONS: There are many agents that may decrease the risk of prostate cancer. It requires careful study of the agents in specific populations to determine whether risk is reduced, the magnitude of the risk reduction and the spectrum of side effects associated with the agent. Physicians caring for men entering the range of age of prostate cancer risk must be aware of these preventive opportunities.

Citation: Chemoprevention of prostate cancer: agents and study designs.
Thompson IM. J Urol. 2007 Sep;178(3 Pt 2):S9-S13. Epub 2007 Jul 20.

Not all multivitamins are created equal–strengths and formulas vary astonishingly, as you’ll find out when reading the SUPPLEMENT FACTS label. Here are some selections that the New York Buyers’ Club membership has chosen consistently. Of course price is also a concern if you are intending to supplement on a regular basis over the years. These are generally one-month supplies, and because of its nonprofit status, NYBC stocks them at low cost: Jarrow Multi-1-3 is $14.25, the Douglas Added protection is $14.50, its Ultra Preventive Beta $17.00, and the Super Nutrition Opti-pack, which is strong on antioxidants, is $26.50.

Note that iron-free formulas are usually recommended if you have elevated liver enzymes or liver disease. The Douglas Ultra Preventive Beta is notable for reducing the Vitamin A in palmitate form, which also can be a concern for people with a liver condition.

Added Protection No-Iron

Jarrow’s Multi 1-3 iron-free

Super Nutrition’s Optipack - iron-free

Added Protection with Iron

Ultra Preventive Beta

We took a look at the recent issue of the Healthy Years newsletter (Volume 4G) from the UCLA David Geffen Medical School’s Division of Geriatrics, and were pleasantly surprised to find a good balance of advice ranging from exercise, diet, medication regimens when called for…and a number of on-target recommendations for promoting long-term health with the aid of dietary supplements.

The UCLA newsletter, which is directed especially to people 60 and older, offers several general supplement recommendations to promote healthy aging: a multivitamin/mineral supplement (because diet and digestive capability tend to change as you age); Vitamin D plus calcium for bone health; fish oil supplements to keep triglyceride levels down; glucosamine and chondroitin for moderate to severe arthritis knee pain; and CoQ 10 to help keep blood cholesterol down when taking a statin drug.  

A couple of other recommendations emerge for specific conditions: non-smokers with early-stage macular degeneration may want to consider an NIH panel’s advice to supplement with zinc and the antioxidant vitamins C, E, and beta carotene. And niacin and/or a fibrate drug could be beneficial in raising HDL (the so-called “good cholesterol”) levels in a person taking a statin.

Thanks, UCLA Division of Geriatrics! It’s nice to see a general-audience publication from a mainstream medical source include balanced information about supplements, and not just fixate on prescription drugs as the only possible choice for every condition.

This post runs a little long, but we think it’s worthwhile to put up the FAQ about nutritional supplements recently posted by the New York Buyers’ Club. It answers a lot of (sometimes anxious) queries about supplements, and also gives a quick rundown on some of the top uses of supplements among the NYBC membership.

What are supplements?
A nutritional or dietary supplement (or just plain supplement), as defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994, is “a product (other than tobacco) that is intended to supplement the diet and that contains one or more of the following: vitamins, minerals, herbs or other botanicals, amino acids, or any combination of the above ingredients,” and can be taken in tablet, capsule, powder, or liquid form.
NYBC specializes in supplements for those with HIV, hepatitis C, and other chronic conditions. Our Supplement Fact Sheets contain information on more than 100 supplements commonly used by our Members. Our nonprofit purchasing co-op stocks these supplements on a regular basis, and can also special-order many other supplements on request.
Why take supplements?
There is a great deal of research showing that supplements can help people manage serious chronic conditions such as HIV and hepatitis. Supplements can also be useful in addressing many common health issues, such as high cholesterol, diabetes, depression, arthritis pain, gastrointestinal disorders, etc. (see our short list of specifics below). Some supplements are derived from ancient traditions of use (for example, the botanicals of India’s Ayurvedic tradition), while other items (such as vitamins or amino acids) have been isolated and used as supplements much more recently. The scientific study of supplements has blossomed in recent decades, so we now have better evidence about many of them—even traditional botanicals—than we ever did in the past.
Are supplements considered “medicine”?
While supplements may have medicinal properties, they are not regulated in the same way that prescription drugs are, and are therefore accompanied by the disclaimer: “These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
The fact that supplements are not regulated in the same way that prescription drugs are naturally gives rise to concerns about purity, efficacy, and safety – so it’s good to have a knowledgeable ally like NYBC on your side! Collectively, we have many years of experience in using supplements, in researching information on them, and in evaluating suppliers to obtain the best quality product.
Are supplements “safe”?
Under current US regulations, supplements are assumed to be safe on the basis of their history of use, or because they are found in the food supply (like the microorganisms in yogurt or the vitamins and minerals in foods). The US Food and Drug Administration is responsible for removing supplements from the market if it finds evidence that they are unsafe, but it’s worth noting that this happens quite rarely. (The removal from the market of ephedra [aka the Chinese herb Ma huang], used at high dosage as a diet pill, is practically the only significant example since 1994). However, while supplements may be “assumed to be safe,” everyone who takes them needs to pay attention to the recommended dosage and any cautions or warnings. If you exceed the recommended dosage of certain supplements, there may be side effects, sometimes serious. Furthermore, a supplement may have negative interactions with other medications you are taking, or a particular supplement may not be a wise choice for you due to other health concerns. That’s why it’s always important to discuss your supplement use with your doctor.

Here are just a few examples of potentially dangerous supplement-medication interactions (from the National Center for Complementary and Alternative Medicine’s website) - further proof that consulting your physician about supplement use is crucial:

• St. John’s Wort can increase the effects of prescription drugs used to treat depression. It also dangerously interferes with drugs used for HIV, cancer, birth control, and rejection of organ transplants

• Ginseng can increase the stimulant effects of caffeine (as in coffee, tea, and cola). It can also lower blood sugar levels, creating the possibility of problems when used with diabetes drugs

• Ginkgo, taken with anticoagulant or antiplatelet drugs, may increase the risk of bleeding. Ginkgo may also interact with certain psychiatric drugs and with certain drugs that affect blood sugar levels

Of course, doing your own “homework” is also encouraged. Be sure to bring any notes or printouts from your research to share with your healthcare provider. That way, you’ll both be literally on the same page.
Identity, Purity and Potency
Safety is also a matter of product quality. Is the product what it claims to be on the label (that is, is it really fish oil)? This is the product Identity. Does the product contain any unwanted contaminants like heavy metals, insect parts, rodent droppings? All foods and medicinal products face these issues of Purity. And finally, does it have as much of the claimed amount of a substance? For example, if it says 100 mg of niacin, does it have that amount? This is the product’s Potency. These issues are of ongoing concern. NYBC has done everything possible to assure that products meet these standards. Websites such as www.consumerlab.com can help. Also indications of quality such as USP or other labels further add assurance. The good news is that the vast majority of products tested by consumerlab, for example, pass their tests. Still, NYBC believes an appropriately funded agency of the FDA could do more rigorous, routine and comprehensive testing.
What is CAM?
CAM is an acronym for complementary and alternative medicine. The use of supplements is considered CAM. Some prefer the term integrative medicine.
The National Center for Complementary and Alternative Medicine (NCCAM), a division of the US National Institutes of Health, defines CAM as “a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine.” NCCAM, like the US Office of Dietary Supplements, came into being after passage of DSHEA, and marks the federal government’s decision to commit funding to research and education about CAM. Over a billion dollars in your tax dollars have been spent by these agencies since their start.

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Using Supplements
What supplements can I use to improve my immune system?
Agents such as a potent multivitamin, NAC (N-acetyl cysteine), alpha lipoic acid and whey can all help offset oxidative stress and nutrient losses caused by HIV as well as the free radical generation and inflammation-related damage that some antiretroviral drugs cause.
For those with HIV, supplementation can be a valuable assist in restoring the body’s immune system, as evidenced by many studies, such as Dr. Jon Kaiser’s HIV Micronutrient Study, which showed a significant increase (26%) in the CD4 counts of the subjects who maintained a supplement regimen in addition to their regular medications. FYI: NYBC offers a “MAC Pack” (Micronutrient - Antioxidant Combination Pack), a product very similar to the one used in the study.
What supplements can be used to improve gut function?
Acidophilus or bifidus, glutamine, whey proteins, Saccharomyces boulardii (Florastor) and a good multi can all be important to offset gastrointestinal problems, whether HIV-related or of other origin.
What supplements can I use to manage my blood fats (cholesterol and triglyceride levels)?
“Bad cholesterol” (LDL) and triglycerides can be reduced with agents such as carnitine, pantethine, and fish oils. Niacin may be an excellent option which can also help increase HDL (“good cholesterol”). For heart health in general, aside from diet and exercise, CoEnzyme Q10 may also be of help (may also be useful in countering statin-related side effects).
What supplements are used to improve mental function and/or mood?
Acetylcarnitine, 5-HTP, tyrosine, ginkgo biloba, fish oils, SAM-e, DHEA, theanine, or St. John’s Wort may help mental function and alleviate depression, though each of these must be taken with some care (and not all together!)
See also: a full dossier on Memory Loss and Other Brain Problems from our Health+HIV section of Recommended Reading on the website www.newyorkbuyersclub.org; also recommended is the NYBC info sheet on Depression and supplements on this blog, under “Depression.”
What supplements can I use to combat fatigue?
Various conditions can cause fatigue, but in general, B12 (methylcobalamin) and Eleuthero (used to be “Siberian ginseng” - don’t use with high blood pressure!) may all help to improve energy. A good start may also be as simple as a good multivitamin!
For more information about the causes and treatments for fatigue, see our Fatigue Fact Sheet on the NYBC website.
What supplements can I use to stabilize my weight?
For those experiencing weight loss, whey proteins, carnitine and creatine plus CLA may all help - but of course especially in conjunction with a good diet and routine exercise! And we agree with Dr. Jon Kaiser and many others: resistance exercise remains an important component of a successful HIV management plan.
What supplements are used to treat nausea?
NYBC recommends ginger; marijuana, while effective, is not carried by the NYBC, as it is not yet approved for medical use in New York. For detailed information about the causes and treatments for nausea, see Health+HIV section of Recommended Reading on the NYBC website.
What supplements are used to improve liver function?

Liver function can be impaired due to several reasons, including disease, alcohol abuse, and the effects of some cholesterol-lowering drugs (statins).
While making sure there aren’t any interactions with your meds, supplements like milk thistle (Silymarin), NAC, alpha lipoic acid, Hepato-C or Hepato-Detox, Hepatoplex I or II, Ecliptex, SAM-e and Clear Heat are options to consider (again, not all at once!)
What supplements can be used to treat diarrhea?
NYBC suggests supplementing your diet with glutamine and calcium. For more information about the causes and other possible treatments, see our Fact Sheet about diarrhea in Recommended Reading, at www.newyorkbuyersclub.org.
What supplements can combat neuropathy?
Much scientific evidence now points to acetylcarnitine as an effective approach to countering neuropathy (numbness, tingling, or pain, usually in the extremities, which can be caused by HIV, diabetes or by some medications).

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

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.

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

 K-PAX, a multi-supplement pack, was developed following Dr. Jon Kaiser’s study that found an increase in CD4 count among HIV+ individuals using this mix of a potent multivitamin and antioxidants. (Dr. Kaiser was hardly new to the field of nutritional supplementation for people with HIV/AIDS—see his book Healing HIV: How To Rebuild Your Immune System, which was based on many years of clinical experience with hundreds of patients and still, in our judgment, has many valuable insights about everything from assessing and managing gastrointestinal problems, to exercise and diet for people with HIV.)  

At this point, the Medicaid or ADAP formularies of many states include the K-PAX formula. Unfortunately, some people may not have access to these programs and for them, cost can become an issue. For example, the price for the double strength K-PAX formula is about $140 per month, not an insignificant amount for anyone on a budget and dealing with the usual extra healthcare-related costs. That’s why NYBC has designed an alternative to the double-strength K-PAX formula, based on products and prices currently available through our nonprofit purchasing coop. Here’s our suggestion, which is not a precise, 100% match of the K-PAX, but does, we feel, provide a close equivalent–and at a much lower cost:

Acetylcarnitine – 3/day – one month supply = $15.50 (one bottle; 500mg/90)
Lipoic  - one/day – one month supply = $7.50 half a bottle; 300mg/60)
NAC – 3/day – one month supply = $11.25 (one bottle; 500mg/90)
Vit B6 (pyridoxal-5’-phosphate/P5P) – 3/day – one month supply = $7.85 (one bottle; 50mg/100)
Vit B12 (methylcobalamin) – 2/day – one month supply = $3.75 (actually, les than half a bottle; 1000mg/100)
Added Protection (or Ultra Preventive Beta) – 6/day – one month supply = $14.00 ($17.00 for UPB) (one bottle; 180)

Total monthly cost of the NYBC multivitamin-antioxidant package is $59.85. (The intial cost, since you use only half a bottle to make a monthly supply of some items, is $71.10.) This is HALF THE PRICE of the double-strength K-PAX.  Notes: 1) The NYBC package actually has MORE acetylcarnitine than the double-strength K-PAX—not a bad idea, especially if you believe, as we do, that acetylcarnitine is probably one of the key elements in the multivitamin-antioxidant combination. (Two a day is probably sufficient if you’re just interested in matching the K-PAX formula, but three or more can help if you’re dealing with neuropathy.)
 2) The multivitamins available through NYBC have somewhat different formulas than the K-PAX (see product labels available on the NYBC website for details). Taking an extra vitamin C tab along with the regular multi would make up for one significant difference. And some might wish to take a bit more calcium and vitamin D3 than Added Protection offers, as bone loss remains a concern among people with HIV.
 3) K-PAX only comes with iron; for those with liver trouble, this might NOT be a good idea. With the multivitamin Added Protection, you can choose whether to take iron or not. And Ultra Preventive Beta, another Douglas Labs multi, offers in addition to a standard multivitamin formula a variety of food-based nutrients, for an additional $3 per month. If you’d like more information on NYBC’s low-cost alternative to K-PAX, or if you’d like help in ordering the alternative package, please email us at contact@newyorkbuyersclub.org and we’d be glad to assist.