08.12.09
B vitamins and brain function: the latest studies
The evidence continues to pile up that levels of the B vitamins, in particular B6 (pyridoxine), B9 (folate), and B12 (cyanocobalamin), are closely related to maintaining cognitive function and warding off brain-related disorders like Alzheimer’s as we age. Well-designed studies, including the Veterans Affairs (VA) Normative Aging Study, have pointed particularly to Vitamin B deficits being associated with buildup of homocysteine, which in turn may be responsible for impairment to cognitive function.
B Vitamins are central to the preservation of mental capacities as we age. At the same time, the aging digestive system may not absorb nutrients as effectively as it once did; so an obvious strategy is to consider B complex supplementation as well as good dietary habits as we get older.
Read more on the B vitamins on the NYBC site:
B-right (Jarrow) We selected this as a good comprehensive B vitamin supplement.
B-12 Methylcobalamin (Jarrow) Studies have suggested that this is a very effective way to supplement with B12, which may not always be well-absorbed by the body when taken in other formats.
Some References:
Kim JM, Stewart R, Kim SW Changes in folate, vitamin B12 and homocysteine associated with incident dementia. J Neurol. Neurosurg. Psychiatry 2008;79;864-868.
Tucker KL, Qiao N, Scott T, et al. High homocysteine and low B vitamins predict cognitive decline in aging men: the Veterans Affairs Normative Aging Study. Am J Clin Nutr. 2005 Sep;82(3):627-35.
Wang HX, Wahlin A, Basun H, et al. Vitamin B12 and folate in relation to the development of Alzheimer’s disease. Neurology 2001;56:1188-94.
07.01.09
B vitamins for eye health
A heart disease study sponsored by the NIH has also yielded some interesting information about the relationship between B vitamins and eye health. The research study, from Brigham and Women’s Hospital in Boston, found that taking a mixture of B vitamins, including B-6, folic acid and B-12, lowered the chance of middle-aged women developing macular degeneration (a common form of vision loss in older adults) by one-third. The study, which tracked more than 5000 women age 40 and older, was published in the Archives of Internal Medicine, Feb. 23, 2009.
Note that NYBC stocks this B vitamin supplement:
B-right includes folic acid, B-6 and B-12; one of the rationales for its formulation is to prevent buildup of the chemical homocysteine, which in studies has been associated with heart attacks.
02.11.09
Sublingual Vitamin B12 for better absorption
For those with serious Vitamin B12 deficiency, injections or sublingual tablets (tablets that dissolve under the tongue) are often recommended.
This recommendation may be especially pertinent for people with HIV who experience peripheral neuropathy. But B12 is crucial for many systems in the body, and the use of sublingual tablets may be advised in a number of cases.
Here’s a Canadian AIDS Treatment Information Exchange Info Sheet on Vitamin B deficiency in people with HIV; it presents some of the rationales for use, and also underlines the importance of getting an effective dose through injection or sublingual tabs: CATIE INFO SHEET ON HIV and VITAMIN B12
NYBC, like its predecesor DAAIR, stocks B-12 as Methylcobalamin (Jarrow). These are chewable tablets; or may be dissolved under the tongue. The methylcobalamin form is generally acknowledged to be well-absorbed (=”bioavailable”).
02.03.09
Review article: “Nutritional therapies for mental disorders” (2008)
Shaheen E Lakhan and Karen F Vieira. Nutritional therapies for mental disorders. Nutrition Journal 2008, 7:2doi:10.1186/1475-2891-7-2
This well-documented article provides a state-of-the-art review of nutritional therapies or nutritional supplementation for some of the most prevalent disabling mental disorders. Here’s an excerpt from the introduction of the article, which gives an idea of its scope and the significance of its topic:
Currently, approximately 1 in 4 adult Americans have been diagnosed with a mental disorder, which translates into about 58 million affected people. Though the incidence of mental disorders is higher in America than in other countries, a World Health Organization study of 14 countries reported a worldwide prevalence of mental disorders between 4.3 percent and 26.4 percent. In addition, mental disorders are among the leading causes for disability in the US as well as other countries. [...] [T]he four most common mental disorders that cause disabilities are major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD).
Typically, most of these disorders are treated with prescription drugs, but many of these prescribed drugs cause unwanted side effects. For example, lithium is usually prescribed for bipolar disorder, but the high doses of lithium that are normally prescribed cause side effects that include: a dulled personality, reduced emotions, memory loss, tremors, or weight gain. These side effects can be so severe and unpleasant that many patients become noncompliant and, in cases of severe drug toxicity, the situation can become life threatening.
Researchers have observed that the prevalence of mental health disorders has increased in developed countries in correlation with the deterioration of the Western diet. Previous research has shown nutritional deficiencies that correlate with some mental disorders. The most common nutritional deficiencies seen in mental disorder patients are of omega-3 fatty acids, B vitamins, minerals, and amino acids that are precursors to neurotransmitters. Compelling population studies link high fish consumption to a low incidence of mental disorders; this lower incidence rate has proven to be a direct result of omega-3 fatty acid intake. One to two grams of omega-3 fatty acids taken daily is the generally accepted dose for healthy individuals, but for patients with mental disorders, up to 9.6 g has been shown to be safe and efficacious. Western diets are usually also lacking in fruits and vegetables, which further contributes to vitamin and mineral deficiencies.
It’s refreshing to see a respected publisher of scientific journals such as Springer giving a place to this kind of review. By pulling together the best of recent research on nutritional therapies for mental health (there are 107 references for this article, almost all from the last two decades), the authors provide support to a very useful approach that has been unfortunately overshadowed by over-reliance on prescription medications. We hope this publication, together with others like it, will help educate both healthcare providers and healthcare consumers!
You can read the complete article at
01.13.09
Supplement recommendations in “The Ultramind Solution” by Dr. Mark Hyman
The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First
Mark Hyman, M.D.
This is one of many books published in recent years that seek to translate the enormous body of research findings from the last few decades about nutrition and brain function into simple, useful guidelines for improving and maintaining good mental functioning and psychological well-being. While it’s a popularizing text (Dr. Hyman has even been on Martha Stewart–see link below!), this book does, we feel, accurately register many important trends in our knowledge of nutrition and nutritional supplements and how these factors relate to mental health.
Here’s the statistic that sets off Dr. Hyman’s project: one in three Americans suffer from some kind of “brain dysfunction” (one term in use: “brain fog”), including symptoms such as depression, anxiety, memory loss, attention deficit disorder, autism, and dementia.
“The Ultramind Solution” contends that revising your diet–changing your nutritional intake–can often make a huge difference in these symptoms. Dr. Hyman’s recommendations focus both on weeding out elements that adversely affect the system (too much sugar, poorly chosen carbs, alcohol, cigarettes), and sticking to a menu of what’s good, especially what’s good for brain function: 1) omega fatty acids (found in salmon, sardines, flaxseed); 2) amino acid sources (nuts, lean meats); 3) high-quality carbs (for example, beans, peas, and lentils); 4) phyto-nutrients (plant foods containing antioxidants and other helpful substances, like blueberries, cilantro, etc.).
Finally, Dr. Hyman observes that, since more than 90% of Americans don’t get adequate nutrients from food (a finding of an often-cited US government survey), people realistically will need to supplement at least periodically in several key categories: 1) a multivitamin; 2) fish oil (omega fatty acids); 3) Calcium/Magnesium; 3) Vitamin D; 4) B complex vitamins; 5) probiotics (for good digestion/absorption of nutrients); and 6) occasionally a sleep aid like melatonin to insure a good amount of rest.
Here are some NYBC suggestions for supplementing in the categories recommended by Dr. Hyman:
Multivitamins: Added protection with Iron (Douglas) ; Added Protection without Iron (Douglas) – recommended for those with liver conditions; Opti-Pack – iron-free (SuperNutrition); Super Immune Multivitamin – iron-free (SuperNutrition)
Fish oil: Max DHA (Jarrow); ProOmega (Nordic Naturals) 60 caps; ProOmega (Nordic Naturals) 180 caps;
For Calcium, Magnesium, Vitamin D, NYBC recommends Bone-Up (Jarrow), which provides all three nutrients in the most useful dosages.
B complex vitamins: B-right (Jarrow)
Probiotics: NYBC recommends Jarrodophilus EPS (Jarrow) because it doesn’t require refrigeration. But other probiotics may be useful as well–see the Probiotics entry on the NYBC website.
NYBC also stocks Melatonin in several formats.
See Dr. Hyman on Martha Stewart:
http://www.marthastewart.com/portal/site/mslo/menuitem.3a0656639de62ad593598e10d373a0a0/?vgnextoid=0f545e9ea969e110VgnVCM1000003d370a0aRCRD&vgnextfmt=default
01.07.09
Using B vitamin supplements for neuropathy: recommendation from Lark Lands
Peripheral neuropathy, or tingling/flushing/burning in the extremities (hands and feet), is a side effect found with diabetes, and can also be a side effect of some HIV medications. Here’s an approach to dealing with this condition described by Lark Lands, a treatment educator who has served as an advisor to the Canadian AIDS Treatment Information Exchange, from whose online Fact Sheets the following excerpt is drawn:
To treat peripheral neuropathy
Although vitamin B12 is most commonly associated with the treatment of peripheral neuropathy, supplements of other B vitamins may also improve this condition. In her book Positively Well, Lark Lands reports that biotin and thiamine supplements have helped improve symptoms of neuropathy. Other “unofficial” B vitamins such as choline and inositol, which are often included in B vitamin supplements, may also help to treat neuropathy. According to Lark Lands, these vitamins have improved symptoms of neuropathy in many of her HIV-positive patients. She recommends supplementation with all of the B vitamins, as taking only only one of this group can lead to deficiencies in others.
For more information, see the NYBC entry for B-Right (Jarrow), a B vitamin supplement that the purchasing co-op has chosen to stock because it meets many of the recommendations for supplementation with this vitamin (25mg dosage for B1, B2, B3, B6; includes choline and inositol).
Note that for effective B12 supplementation, NYBC recommends the B12 – Methylcobalamin format.
12.22.08
Nutritional supplements to reduce cardiovascular risk
Here’s an excerpt from the Fall 2008 issue of the New York Buyers’ Club SUPPLEMENT . (You can read the full issue online at http://www.newyorkbuyersclub.org/supplement/, where you’ll also find an archive of past numbers.)
It’s all about managing risk.
People try to control risk all the time, whether it’s kids learning to cross the street on green, people buckling their seat belts when getting into the car, or a smoker looking at the statistics relating tobacco use to cancer and heart disease and deciding that now is the time to quit.
Earlier this year, a group of experts on HIV and heart disease recommended that people with HIV pay special attention to monitoring and controlling cardiovascular risk factors like high cholesterol and diabetes. Overall, according to currently available evidence, the risk of heart attack is approximately 70% to 80% higher for HIV-positive people than for HIV-negative people. This increased level of risk is likely due in part to HIV itself, and in part to HIV medications. Some typical cardiovascular warning signs for people with HIV include reduced levels of HDL (“good cholesterol”) and high triglycerides, or a tendency toward pre-diabetes. The panel of experts, which was convened by the American Heart Association and the American Academy of HIV Medicine, found indications that even HIV+ children on meds have early development of these kinds of cardiovascular risk factors.
You may also have heard recent news stories about the HIV medication abacavir and elevated risk of heart attack. A commonly used HIV med in the family of drugs called nucleoside analogs (“nukes”), abacavir is part of the combination drugs Ziagen and Trizivir. Two studies based on large databases have detected an association between abacavir and increased risk of heart attack. Although there isn’t an exact understanding of how abacavir (or another nuke, ddI) could cause higher risk of heart attack, the research does suggest that people with other cardiovascular risk factors, such as smoking or high cholesterol, are at the greatest risk.
Which brings us back to our original point: it’s all about managing risk—knowing the risk factors, then lowering them as much as you can. And that’s where nutritional supplements can be helpful.
At the top of the list of supplements to support cardiovascular health is fish oil, with its key component being the omega-3 fatty acids. Since 2005, the American Heart Association, following a hefty accumulation of scientific evidence, has recommended daily intake of fish oil for people with cardiovascular disease. And there has been research specifically looking at fish oil for people with HIV who have elevated cardiovascular risk. For example, a 2007 study of HIV+ people who had high triglyceride levels found that fish oil supplementation reduced these levels by 25% or more. Also of note: fish oil supplementation for people with HIV is being studied in federally funded research that examines how this supplement might counter the effects of lipodystrophy, a syndrome that includes blood lipid abnormalities.
People with HIV are often prescribed statin drugs like Lipitor to lower cholesterol and reduce cardiovascular risk, and while these drugs can be effective, they may also produce side effects, including joint and muscle pain and changes in mood and thinking ability. Many integrative health specialists endorse the idea of taking the supplement CoQ10 along with statins, since depletion of this nutrient by statins may be linked to some of the drug’s major side effects. Moreover, research suggests that, due to its antioxidant and blood-thinning properties, CoQ10 when combined with a statin decreases heart disease risk more than just the statin alone. Similarly, there is important research indicating that statins together with niacin can be more effective at reducing cardiovascular risk over the long term than just the statins. Though niacin dosage may have to be slowly increased in order to avoid “flushing” (redness, itchiness), strong scientific evidence for this supplement’s effectiveness and safety dates back to the 1970s, and indicates that it may be especially helpful in bringing up levels of HDL (“good cholesterol”), which is now regarded as a very significant marker for assessing cardiovascular risk.
A few months ago we were impressed by a talk given by Dr Jon Kaiser, an HIV physician with extensive experience in integrating nutrition and nutritional supplementation into his health care practice. While Dr. Kaiser ranged over several topics, including his well-known interest in the benefits of general micronutrient support for people with HIV, he also had much to say about controlling cholesterol levels with nutritional supplements. His approach consists of low-dose niacin (low dose to minimize flushing), fish oil, plant sterols and pantethine. As he’s started to follow case histories over the past few years, he’s become quite encouraged by the results, and believes that many people with HIV could achieve good results (comparable to those offered by statins, but without the side effects) by adopting this kind of combination therapy.
In the past year, NYBC has begun stocking a Douglas Labs product called CardioEdge, which, like Dr Kaiser’s approach, involves a combination of supplements (including plant sterols) to manage cholesterol. We’ve also recently added a Jarrow product, Pressure Optimizer, which combines several supplements (including theanine from green tea) that are useful in maintaining normal blood pressure. (High blood pressure is a major risk factor for cardiovascular disease, and it’s one of the first issues anyone should address in bringing down heart attack risk.)
We find that physicians who are knowledgeable about nutrition and nutritional supplements have a lot of useful advice to offer when it comes to controlling cardiovascular risk. For example, Dr Hyla Cass, author of the book Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (recently reviewed on the NYBC blog), calls attention to the fact that metformin, the most frequently prescribed diabetes drug in the US, depletes the B vitamins and thus can cause a spike in the body’s levels of homocysteine, a substance linked in recent research to high cardiovascular risk. To counter this danger, she emphasizes the need to supplement with B vitamins when taking metformin.
In line with much current scientific thinking, Dr Cass also believes that cholesterol level by itself is not an adequate measure for assessing cardiovascular risk. In addition, it’s necessary to look at underlying inflammatory processes in order to comprehend the threats to heart and circulatory system health. That’s why Dr. Cass recommends that people who want to reduce their risk of cardiovascular disease should develop a diet plan centering on anti-inflammatory nutrients. She suggests a diet high in antioxidant-rich foods—colorful fruits and vegetables, curry, rosemary, ginger, green tea, dark chocolate, and low-toxin fish like salmon or sardines. (Actually could make for quite a tasty menu, don’t you think?)
To conclude: yes, it’s sobering when researchers warn about increased cardiovascular risk for people with HIV. But there’s also general agreement that cardiovascular risk is very susceptible to management by choices in diet and nutrition. (Exercise and quitting smoking are also important!) So, while you can’t control everything in life, remember that there are many choices you can make to significantly reduce your cardiovascular risk.
Nutritional supplements discussed in this article: fish oil, CoQ10, niacin, plant sterols, pantethine, B vitamins; and the proprietary formulas CardioEdge and Pressure Optimizer.
12.12.08
Multivitamin Antioxidant Combination (MAC-Pack): a K-Pax alternative available in no-iron formula for those with liver impairment
In 2007, NYBC began offering an alternative to the K-Pax multivitamin-antioxidant supplement, which was added to some ADAP and Medicaid formularies following publication in 2006 of Dr. Jon Kaiser’s study that found CD4 increases in people with HIV taking a micronutrient combination supplement. A first reason for the NYBC alternative, called the MAC-Pack, was price: for those without access to ADAP or Medicaid programs, the double strength K-Pax cost of about $140/month was rather high, and NYBC as a nonprofit co-op was able to present a close equivalent for only $62/month.
But another rationale for introducing the MAC-Pack was its flexibility. In fact, because MAC-Pack uses the AMNI/Douglas multivitamins Added Protection as its core, it can be configured as a formula with or without iron. Having the option of an iron-free MAC-Pack is important especially to people with elevated liver enzymes, liver impairment, or hepatitis co-infection. Taking iron supplements is generally not recommended for this group, since processing the iron puts an extra strain on liver function.
Also note that the MAC-Pack provides somewhat more acetylcarnitine than the K-Pax, which may not be a bad idea, especially if you believe, as we do, that acetylcarnitine is probably a key element in the multivitamin-antioxidant combination. (Two tabs/day is sufficient if you’re just interested in matching the K-Pax formula, but three/day may be better especially for those dealing with neuropathy.)
For more information, see the NYBC entry:
10.31.08
Folate (Folic acid) supplementation: a recommendation for acute, continuation and maintenance treatment of depression
Here is a dosage recommendation for supplementation with Folate/Folic acid during the treatment of depression. It’s the conclusion offered by Simon N. Young, Dept. of Psychiatry, McGill University in a 2004 review article:
What about the recommendation that 2 mg of folate be given during the acute, continuation and maintenance treatment of depression? The actual dosage may be debatable; 1 mg may suffice, particularly in countries where there is voluntary or compulsory fortification of food with folate, and the addition of a vitamin B12 supplement may be prudent, but the general principle is reasonable. With our current knowledge, the potential benefits seem to far outweigh any disadvantages.
Reference: Simon N. Young, “Folate and depression—a neglected problem” in J Psychiatry Neurosci. 2007 March; 32(2): 80–82.
For further discussion, see the NYBC entries:
10.08.08
Nutritional supplements for depression: recommendations from an expert on integrative/holistic health
NYBC has been following recent developments in the use of dietary supplements for depression for quite some time now, and we’d like to recommend a recent guide to this topic by Hyla Cass, which appears in her book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition.
Dr. Cass, a practicing physician and an expert on integrative (“holistic”) health, devotes a chapter of her 2007 book to depression. The core elements of her recommendations are the B vitamins, Folate, Omega-3 fatty acids, Calcium, and Vitamin D (especially in winter). She also discusses SAMe, a natural mood enhancer essential for the manufacture of neurotransmitters (like serotonin), and two botanicals that have a history of use as anti-depressants, St. Johns Wort and Rhodiola.
Dr. Cass’ account is particularly good at reviewing the role of neurotransmitters in depression, and explaining how supplements and nutrition have an impact on them. For example, tryptophan, eaten together with carbohydrates, will raise levels of serotonin, the neurotransmitter that makes you feel happy and calm and helps you sleep well. The amino acid 5-HTP, meanwhile, can also help the brain produce more serotonin, though unlike tryptophan it does not need the carbs for it to enter the brain.
Anti-depressant prescriptions, as Dr. Cass notes, are among the top sellers among US pharmaceuticals, with 60 million prescriptions written per year at a cost of $10 billion. And while “antidepressants may be enormously helpful, even life-saving for some people,” she continues, “they are often overprescribed, at too high a dose, over too long a time, and often before a good medical evaluation has been done.” (p. 117) Hence her timely guide to using supplements to help maintain the “nutritional balance necessary for good mental health,” or to create “neurotransmitter balance in depression.”
Reference: Hyla Cass, M.D. “Prescriptions for Psychological Health,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. (Basic Health Publications, 2007)
See also the NYBC entries on supplements mentioned above:
04.30.08
Recommendations for Cardiovascular Health: from “Supplement Your Prescription,” by Hyla Cass, M.D.
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).
