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).

The Linus Pauling Institute at Oregon State University provides a good review of research on fish oil (omega-3 fatty acids) and Type 2 diabetes (see excerpt below). Although there was some concern that fish oil supplements might interfere with glycemic control (= control of blood sugar levels) in diabetics, that does not seem to be the case. Moreover, fish oil supplementation can significantly lower triglycerides in people with diabetes, and there is good epidemiological evidence that over the long term higher omega-3 fatty acid intakes may also decrease the risk of cardiovascular disease in diabetics.
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Cardiovascular diseases are the leading causes of death in individuals with diabetes mellitus (DM). Hypertriglyceridemia [...] is a common lipid abnormality in individuals with type 2 DM, and a number of randomized controlled trials have found that fish oil supplementation significantly lowers serum triglyceride levels in diabetic individuals. Although early uncontrolled studies raised concerns that fish oil supplementation adversely affected blood glucose (glycemic) control, randomized controlled trials have not generally found adverse effects of fish oil supplementation on long-term glycemic control. A systematic review that pooled the results of 18 randomized controlled trials including more than 800 diabetic patients found that fish oil supplementation significantly lowered serum triglycerides, especially in those with hypertriglyceridemia. A more recent meta-analysis that combined the results of 18 randomized controlled trials in individuals with type 2 DM or metabolic syndrome found that fish oil supplementation decreased serum triglycerides by 31 mg/dl compared to placebo, but had no effect on serum cholesterol, fasting glucose or hemoglobin A1c concentrations. Although few controlled trials have examined the effect of fish oil supplementation on cardiovascular disease outcomes in diabetics, a prospective study that followed 5103 women diagnosed with type 2 DM, but free of cardiovascular disease or cancer at the start of the study, found that higher fish intakes were associated with significantly decreased risks of CHD over a 16-year follow up period. Thus, increasing EPA and DHA intakes may be beneficial to diabetic individuals, especially those with elevated serum triglycerides. Moreover, there is little evidence that daily EPA + DHA intakes of less than 3 g/day adversely affect long-term glycemic control in diabetics. The American Diabetes Association recommends that diabetic individuals increase omega-3 fatty acid consumption by consuming two to three 3-oz servings of fish weekly.

See also the NYBC entry on DHA Max, a DHA/EPA supplement from Jarrow.

We’ve heard a lot about the health benefits of deep-water fish, attributable especially to their omega-3 and omega-6 fatty acids. But what are the differences in fatty acid content among the various common types of canned fish, such as albacore or chunk light tuna, salmon, and mackerel? (After all, because of cost, most people in the US eat canned fish much more frequently than fresh fish, so this is a rather important question for the health-conscious.)

The Center for Botanical Lipids at Wake Forest University reports on a recent analysis of the fatty acid content of popular kinds of canned fish, and also reviews findings about mercury contamination, a cause for concern with some kinds of fish.

(Yes, we’re aware that these are not really botanical lipids–but we’re glad that someone has undertaken such a useful study and wants to get the findings out to the public!)

Highlights of the study:

–from a fatty acid prospective, canned salmon is more beneficial than any tuna product
–none of the canned fish in the study exceeded the Food and Drug Administration’s Action level of 1,000 parts per billion; but higher mercury levels were felt by the researchers to be of concern in some tuna, depending on type (albacore or chunk light) and whether canned in vegetable oil, soy oil, or water.

To read the full report, see

What About Canned Fish?

on the website of the Botanical Lipids Center.

And, our own closing note: for people seeking a health benefit, using distilled fish oil supplements can provide a defined quantity of fatty acids, and also eliminate concerns about mercury contamination. That’s not to say we’d ever give up the pleasure of eating salmon, whether fresh or canned!

We recently took a look at The Wake Forest University Center for Botanical Lipids website. This Center is one of five such dietary supplement research centers funded through the federal government’s National Institutes of Health–so this website represents our tax dollars at work!

The main goal of this new research center is to “determine the role of fatty acid based dietary supplements in the prevention and treatment of chronic human diseases associated with inflammation.” The center’s website also makes the point that “nearly 20% of Americans use dietary supplements, many of them botanicals, but scientific evidence for their safe and effective use in the prevention or treatment of human diseases has lagged behind the use of the products.”

Actually, we think the 20% estimate may be on the low side, especially if you include use of basic multivitamins; and certainly among groups with chronic conditions (such as osteoarthritis) the rate of supplement use is often higher than 20%. But we certainly agree that we need more scientific evidence about the effectiveness and safety of supplements, and we’re glad to know that the NIH has continued to fund such research, especially through its National Center for Complementary and Alternative Medicine (NCCAM) and its Office of Dietary Supplements (ODS).

OK, enough of the federal governmental acronyms, and back to the Wake Forest website. We’re pleased to see that it includes a user-friendly section with some publications easily understood by the general public (”Articles for Everyday People”). Here’s a sample from the piece entitled “The Use of Dietary Flaxseed for the Prevention of Human Disease”:
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Flaxseed (also called linseed) has been a part of the human and animal diet for thousands of years. It is the richest known plant source of omega-3 fatty acids - 58% of the total fat in flax is composed of alpha-linolenic acid (LNA); however, this fatty acid is a short chain omega-3 as opposed to the long chain omega 3s found in fish oil. A number of studies have shown that flaxseed does not replace fish oil in the diet because the conversion of LNA to the omega-3 fatty acids found in fish oil is very inefficient.

While most studies show a benefit of flaxseed oil, there have been studies which have not been positive. In 5 out of 6 epidemiological studies on prostate cancer, flaxseed was shown to increase cancer risk, and LNA is a strong growth stimulus in isolated prostate cancer cells (4). Neither of these effects has been seen with fish oil. In addition, recent studies suggest that flaxseed may increase the risk of macular degeneration or speed up the progression of the disease.

In a nutshell: flaxseed looks to be very interesting for breast cancer and cardiovascular disease, but not recommended when prostate cancer or prostate cancer risk is present.

Some information about Women’s Blend from Super Nutrition, which also produces the Super Blend and Opti-Pack multivitamins.

Here are some excerpts from the Super Nutrition description of this multi:

This is a food-based multivitamin, enriched with organic green foods and herbs.

–Includes a robust B-Complex formula to increase energy throughout the day
–Immune supporting, anti-aging antioxidants
–Bone support - 1,000 mg Calcium, 600 mg Magnesium, 1,000 IU Vitamin D, 3 mg Boron and 1,000 mg Vitamin C
–Heart Healthy - 1,000 mcg Folic Acid, 200 mg Vitamin B6, 200 mcg Vitamin B12 plus 400 IU Vitamin E
–Enriched with 600 mcg Biotin & 100 mg GLA
–Special female herbal blend with Pau d’Arco, Peony, organic Nettles and Rosemary
100 mg 5:1 Vitex extract*
–Special flower petal blend, featuring Red Rosebuds
–200 mg Vitamin B6 to help reduce PMS*
–6 tablets per day

*Here’s some additional information, supplied by Michael Mooney at Super Nutrition in response to our request:

> Vitex for PMS.  A placebo-controlled study showed that 20 mg of Vitex extract reduced PMS 28> percent better than placebo. Women’s Blend has 100 mg of 5:1 extract.

The NYBC co-op has recently added this item in the category of cholesterol management. For a while now we have been interested in the potential of plant sterols for maintaining healthy cholesterol levels, and we noted that our well-regarded supplier Douglas had formulated a supplement that incorporates both plant sterols and two other plant-based components that show a potential benefit in cholesterol management.

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Cardio-Edge (Douglas Labs). Cardio-Edge is designed to help maintain cardiovascular health and support healthy cholesterol levels. Its significant components are:

Plant sterols (phytosterols) from soy - 200 mg
Sytrinol - 75 mg
Standardized pomegranate extract (fruit; standardized to 40% ellagic acid) - 25 mg

Plant Sterols
Blood cholesterol is derived from the diet and synthesized in the liver. Sterols work by reducing the absorption of both forms of cholesterol–sterols compete with cholesterol for absorption. Sterols and sterol esters can now be found in many foods including orange juice, rice drink, and margarine.

Sytrinol
This is a proprietary extract of polymethoxylated flavones and tocotrienols from citrus and palm fruits. Sytrinol is intended to have the following effects, some of which you can monitor with routine bloodwork to assess its effect for you. These include:

1) Decrease apoprotein B, needed for LDL synthesis
2) Decrease action of an enzyme in the liver that makes triglycerides
3) Inhibit HMG-CoA reductase in the liver

Sytrinol includes a patented combination of citrus PMFs and alpha, delta and gamma tocotrienols derived from palm fruit. Palm tocotrienols have been shown to inhibit HMG CoA reductase, the enzyme responsible for regulating cholesterol synthesis in the liver. Clinical studies in both animals and humans support Sytrinol’s role in reducing total and LDL-cholesterol as well as triglycerides.

In human clinical studies involving hypercholesterolemic subjects, no side effects were observed with four weeks of supplementing with a daily dose of 300 mg of Sytrinol.

Pomegranate
Recent science has been focusing on the cardioprotective aspects of pomegranate. This brightly colored fruit contains numerous cornpounds known for their antioxidant capabilities, including anthocyanidins, catechins, tannins, and gallic and ellagic acids. Research has shown that supplementation with pomegranate juice can decrease macrophage lipid accumulation and cellular cholesterol accumulation in mice. Recently, research in humans has confirmed a beneficial effect of consuming pomegranate juice on parameters such as LDL oxidation, blood pressure, and blood vessel health.

Please let us know if you have questions or comments about this new item on the NYBC list–emails are welcomed at contact@newyorkbuyersclub.org.

The University of Maryland Medical Center’s Complementary Medicine website provides this guidance on dosage for CoQ 10 (Coenzyme Q 10, sometimes known as ubiquinone):

Note: these recommendations apply to Adults; also remember that CoQ10 is fat-soluble and generally best absorbed if taken when eating the fattiest meal of the day.

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The general recommended dose for CoQ10 supplementation is 30 to 60 mg daily. Higher doses have been used in studies and may be recommended for the following conditions:

The following summaries from the UMMC website may also be useful in deciding whether CoQ 10 supplementation should be considered. Please remember that the conditions described are both serious and complex, and it is thus very important that any supplement use be discussed with your doctor.

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Heart Disease

Studies of women with breast cancer suggest that CoQ10 supplements (in addition to conventional treatment and a nutritional regimen including other antioxidants and essential fatty acids) may shrink tumors, reduce pain associated with the condition, and cause partial remission in some individuals. It is important to recognize that the beneficial effects these women experienced cannot be attributed to CoQ10 alone. Additional antioxidants used in these studies include vitamins C, E, and selenium

See also NYBC’s discussions of CoQ 10 - 100mg and CoQ 10 - 30mg.

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.

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.

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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.

Thought we’d draw attention to a great online resource for getting the basics on a supplement, and for checking on potential interactions among supplements, drugs, food, alcohol:  Physicians’ Desk Reference (PDR) Health.
Below is an excerpt from the entry for EPA (fish oil), which includes the usual warning about interaction with blood-thinnning medications like Coumadin.

See also the entry on fish oil on the NYBC website.

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EPA

What is it?
EPA is an oil that comes from fish. It is used to treat asthma, cancer, arthritis, Lupus, blood clotting, gingivitis (gum disease), high cholesterol, hypertension (high blood pressure), colitis (inflammatory bowel disease), Crohn’s disease, and psoriasis. EPA is also used as an antiinflammatory (help with pain and swelling), to stimulate the immune system, and for cardiovascular health, to help prevent heart disease and stroke. It may also be used to prevent Alzheimer’s disease.

Other names for EPA include: Eicosapentaenoic Acid, Fish Oil, Omega-3 Fatty Acid, Essential Fatty Acid. 
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Drug and Food Interactions:
Do not take omega-3 fish oils such as EPA without talking to your doctor first if you are taking:

Blood thinning medicines (examples: warfarin (Coumadin(R); dicumarol (Dicumarol(R))

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).

After the spectacular failure of the cholesterol-lowering drug Zetia, widely reported in the media yesterday, we thought it might be a good moment to refer people to this article on statin + Niacin/Fibrates combination therapy. It’s by Dr. B Greg Brown, who is leading a large set of NIH-funded studies on this therapeutic combination.

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Maximizing coronary disease risk reduction using nicotinic acid combined with LDL-lowering therapy

B. Greg Brown–Division of Cardiology, University of Washington, A-506 Health Sciences Center, Seattle, WA 98195-6422, USA

Treatment with statins markedly reduces levels of LDL-cholesterol, and large, well-designed evaluations of these agents have demonstrated reductions in cardiovascular event rates of 20–40%. Additional therapeutic strategies will be required to make further inroads into the substantial residual burden of cardiovascular disease in statin-treated patients. Epidemiological studies over several decades and outcome studies with agents that raise levels of this lipoprotein (nicotinic acid or fibrates) have established low HDL-cholesterol as an important therapeutic target. Combining agents which decrease LDL-cholesterol and increase HDL-cholesterol within a single regimen might provide a means of improving cardiovascular prognosis beyond that possible with statins alone. Six randomized clinical trials involving treatment with nicotinic acid in combination with a statins or bile acid sequestrant have demonstrated regression, or markedly slowed progression, of atherosclerosis in patients at high risk of a cardiovascular event. Three of these trials, the HDL-Atherosclerosis Treatment Study, the Familial Atherosclerosis Treatment Study, and the Armed Forces Regression Study, have associated these benefits with significant improvements in clinical outcomes. Correcting low HDL-cholesterol in statin-treated patients may provide a means to achieve the next leap forward in the management of cardiovascular disease.

Citation: European Heart Journal Supplements Volume 7, Suppl F Pp. F34-F40