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).

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 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

Acetyl-l-carnitine, which is available through the NYBC purchasing co-op at the lowest price we’ve seen, is one of the key components of the NYBC MAC Pack, and may be especially useful in counteracting peripheral neuropathy.

Furthermore, it’s also one of the most studied dietary supplements to counter the effects of aging; taking 1,500 mg a day (a commonly suggested dose) of this supplement may improve cognitive function and mood. As we’ve written elsewhere on this blog, the B vitamins and the botanical gingko biloba also have good evidence to support their use to address the effects of aging. Finally, don’t forget that recent research has pointed to daily physical exercise–such as walking–as one of the most important things you can do to counter age-related cognitive decline.

Here’s more on the role of the B Vitamins in depression, together with some common supplementation strategies.

Source: University of Maryland Medical Center’s Complementary Medicine web resource

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DepressionStudies suggest that vitamin B9 (folate) may be associated with depression more than any other nutrient. Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed. Many healthcare providers start by recommending a multivitamin (MVI) that contains folate, and then monitoring the homocysteine levels in the blood to ensure the adequacy of therapy. Elevated homocysteine levels indicate a deficiency of folate even if the levels of folate in the blood are normal. If the MVI alone is not enough to lower homocysteine and improve folate function, the provider may suggest additional folate along with vitamins B6 and B12 to try to bring the homocysteine levels down, thereby eliminating the functional folate deficiency and, hopefully, helping to improve feelings of depression.

Note: NYBC stocks Douglas Lab’s Added Protection Without Iron, a highly bioavailable multivitamin that includes a comprehensive B complex. The no-iron formula is recommended especially if you have elevated liver enzymes or hepatitis.

You can also consider Added Protection With Iron if you want to include iron in your supplements.

Another choice for focusing on the B Vitamins is Jarrow’s B-right, which is especially formulated to provide optimal amounts of folate/folic acid (B-9), B-6 and B-12 for lowering homocysteine levels.

If you’re HIV+ and looking for a good introduction to the vitamins, minerals, and supplements that can help you stay healthy, we often recommend an online guide produced by the Canadian AIDS Treatment Information Exchange (CATIE), A Practical Guide to Nutrition for People Living with HIV.  CATIE is a national not-for-profit that’s been providing excellent information services to Canadians living with HIV/AIDS for many years. The Practical Guide is reviewed by a panel of healthcare professionals, and also includes information on such dietary supplements as alpha lipoic acid, NAC, Glutamine, CoQ10, probiotics, and carnitine/acetylcarnitine.  This version of the guide was released in October, 2007.

Here’s the excerpt on Multivitamins, Vitamins and Minerals:
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Consider taking a multivitamin-mineral each day.

Several studies have shown that vitamin and mineral supplements can have many benefits in people living with HIV. Taking a multivitamin every day is an important part of a nutritional health plan. Check out Appendix E for a list of studies looking at the effect of micronutrient supplements in people with HIV/AIDS. B vitamins may help slow disease progression in people with HIV. They are also important for healthy mitochondria, the power-producing structures in cells, and may help decrease the impact of mitochondrial toxicity. B vitamins are depleted quickly in times of stress, fever or infection, as well as with high consumption of alcohol. Keep in mind that the RDA is very low and taking a total of 50 mg of B1, B2 and B3 will more than cover B-vitamin needs. Check the multivitamin you take; if it has 30 to 50 mg of these vitamins, you don’t have to take a B-complex supplement in addition to the multivitamin.

This excerpt from the Office of Dietary Supplements - National Institutes of Health Fact Sheet on Vitamin B12 discusses why older adults (people over 50) may need to take supplements or use fortified foods to prevent Vitamin B12 deficiency:

Hydrochloric acid helps release vitamin B12 from the protein in food. This must occur before vitamin B12 binds with intrinsic factor and is absorbed in your intestines. Atrophic gastritis, which is an inflammation of the stomach, decreases the secretion of gastric juices, including hydrochloric acid. Less hydrochloric acid decreases the amount of vitamin B12 separated from proteins in foods and can result in poor absorption of vitamin B12. Decreased hydrochloric acid secretion also results in growth of normal bacteria in the small intestines. The bacteria may take up vitamin B12 for their own use, further contributing to a vitamin B12 deficiency. Up to 30 percent of adults aged 50 years and older may have atrophic gastritis, an increased growth of intestinal bacteria, and be unable to normally absorb vitamin B12 in food. They are, however, able to absorb the synthetic vitamin B12 added to fortified foods and dietary supplements. Vitamin supplements and fortified foods may be the best sources of vitamin B12 for adults older than age 50 years.
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Caution: Folic Acid and vitamin B12 deficiency
Folic acid can correct the anemia that is caused by vitamin B12 deficiency. Unfortunately, folic acid will not correct the nerve damage also caused by vitamin B12 deficiency [1,36]. Permanent nerve damage can occur if vitamin B12 deficiency is not treated. Folic acid intake from food and supplements should not exceed 1,000 μg daily in healthy individuals because large amounts of folic acid can trigger the damaging effects of vitamin B12 deficiency [7]. Adults older than 50 years who take a folic acid supplement should ask their physician or qualified health care provider about their need for additional vitamin B12.

A further excerpt from the ODS Vitamin B12 Info Sheet discusses the relationship between vitamin B12, homocysteine, and cardiovascular disease. As noted, “clinical intervention trials are underway to determine whether folic acid, vitamin B12, and vitamin B6 supplements can lower risk of coronary heart disease.”

Cardiovascular disease involves any disorder of the heart and blood vessels that make up the cardiovascular system. Coronary heart disease occurs when blood vessels which supply the heart become clogged or blocked, increasing the risk of a heart attack. Vascular damage can also occur to blood vessels supplying the brain, and can result in a stroke.

Evidence supports a role for folic acid and vitamin B12 supplements for lowering homocysteine levels, however this does not mean that these supplements will decrease the risk of cardiovascular disease. Clinical intervention trials are underway to determine whether folic acid, vitamin B12, and vitamin B6 supplements can lower risk of coronary heart disease. It is premature to recommend vitamin B12 supplements for the prevention of heart disease until results of ongoing randomized clinical trials positively link increased vitamin B12 intake from supplements with decreased homocysteine levels AND decreased risk of cardiovascular disease.

Although we’ve given a lot of attention to supplements that have been studied specifically for depression, such as SAM-e, DHEA, St. John’s Wort, Tryptophan, and 5-HTP, this note from the University of Maryland Medical Center’s Complementary Medicine website reminded us of the importance of looking at general nutritional status in assessing and responding to complex health conditions like depression. In this case, it’s a suggestion that supplementing with B Vitamins can have an impact on depressive symptoms.

See additional information in NYBC’s entry on its B Vitamin supplement.
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Depression
Studies suggest that vitamin B9 (folate) may be associated with depression more than any other nutrient. Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed. Low folate levels tend to lead to elevated homocysteine levels. Many healthcare providers recommend a B complex multivitamin that contains folate as well as vitamins B6 and B12 to improve symptoms. If the multivitamin with these B vitamins is not enough to bring elevated homocysteine levels down, the physician may then recommend higher amounts of folate along with vitamins B6 and B12. Again, these three nutrients work closely together to bring down high homocysteine levels, which may be related to the development of depression.

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).

Folate, a B vitamin, frequently appears in news about dietary supplement research. (Note: folic acid is the form found in supplements or fortified foods.)

For example, an article earlier this year offered this announcement: “Higher Folate Levels Linked To Reduced Risk For Alzheimer’s Disease. ” (JAMA and Archives Journals: 2007, January 9)

And you wouldn’t have to look too far to discover current research on folate deficiency associated with the potential for cardiovascular problems, or folate deficiency linked to higher rates of breast, pancreatic, or colon cancer.  

Of course, when folate was first identified and studied 70 years ago, the chief draw for researchers was its role in combating anemia and supporting the health of women during pregnancy. But since then, as understanding of the vitamin has grown, it’s come under scrutiny for many other reasons.

Indeed in 1996, the US federal government decided that the health benefits of folic acid were very clear–and yet too many Americans were not getting enough from their diets. The response? The Food and Drug Administration (FDA) published regulations requiring the addition of folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products–where you’ll find it today (check nutritional labels).

For more information on whether you’re getting enough folate in your diet, and who should consider supplementing, see the Office of Dietary Supplement fact sheet on FOLATE:

http://www.ods.od.nih.gov/factsheets/folate.asp

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

As we were mulling over the recent New York Times piece on the billions of dollars Americans spend each year on sleep aids that are only mildly effective (see today’s other post under “Melatonin”), we thought we’d reprint this article from the NYBC newsletter THE SUPPLEMENT, which appeared earlier this year.  It deals with the constellation of health concerns, from fatigue to depression, that often affect people with HIV, and gives an overview of some of the dietary supplements that have been used to address these issues.

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Sleeping poorly? Energy low? Feeling down?

Dietary supplements may have something to offer

Sleep disturbances are the third most common complaint among people with HIV seeking medical attention. Everybody knows what it’s like to sleep poorly, then feel cranky and fatigued the next day. But persistent insomnia, followed by chronic fatigue, can become major medical issues for people with HIV (we’re talking about lower CD4 counts and poor medication adherence), so it’s worth reviewing options for dealing with these problems.

A 2005 research presentation suggested that melatonin supplements can improve sleep patterns in people with HIV. Melatonin, a hormone secreted by the pineal gland, has long been studied as a sleep regulator—levels increase in response to darkness, then fall during daytime. It’s also been investigated as an anti-cancer agent, where it has shown the capacity to combat solid tumors. (But melatonin should not be taken by people with cancers affecting immune cells, such as lymphoma or leukemia.)

Good news: a recent trial indicates that low-dose melatonin (0.5 to 1.0 mg) may be perfectly effective as a sleep promoter, making it a very inexpensive option for this purpose.

Fatigue can stem from other causes besides sleep disturbances. Anemia, a shortage of red blood cells, is another leading cause of fatigue among people with HIV, and is especially common among women. (A recent large study found that about 30% of people on HAART had moderate anemia. Women had an 80% greater risk of being anemic than men, and African-Americans had a risk of anemia 2.6 times higher than whites.) It’s important to learn the source of anemia in people with HIV (taking Retrovir, AZT, is a drug-related factor). Treatment options include increasing intake of iron, vitamin B12 and folic acid. Note that NYBC stocks multivitamins with iron for those concerned about their intake of this mineral. You’ll also find folic acid and B12 in our multis, and may want to consider adding a separate vitamin B supplement as well.

While for some people with HIV treating anemia can be a key to helping them overcome fatigue and its frequent companion depression, there are other cases where low energy is not connected to low red blood cell levels, and where the treatment options are therefore different. Particularly in HIV+ men, steroid hormones (testosterone and DHEA) have proven to be useful in combating the fatigue-depression combination. Recent federally-funded research on DHEA showed it to be an effective anti-depressant, with the added interesting feature that it can enhance sex drive (rather than undermining it, as do certain common prescription anti-depressants).  And a Columbia University study of DHEA for fatigue and depression in people with HIV has found it to be a successful treatment for some, with the added bonus that, unlike some prescription energy boosters, it doesn’t carry the risk of addiction.