New York Buyers’ Club - The Blog

Below is an excerpt from the Canadian AIDS Treatment Information Exchange (CATIE) information sheet on the use of CoQ 10 by people with HIV/AIDS. This excerpt focuses particularly on changes in lipid profiles that may accompany HIV medications, and the strategy for addressing these potentially damaging changes:

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One common side effect of highly active antiretroviral therapy (HAART) is increased levels of fatty substances or lipids in the blood. Examples of the lipid changes that can occur in HAART users include the following:increased levels of triglycerides
increased levels of cholesterol
increased levels of LDL (bad cholesterol)
decreased levels of HDL (high-density lipoprotein – good cholesterol)

See also NYBC’s entries on Coq10 100mg and CoQ10 30mg . The NYBC information includes reference to a 2007 study in the American Journal of Cardiology on COQ 10 and the relief of myopathic symptoms in patients treated with statins. Please also note cautions on using CoQ 10 with the blood-thinning agent coumadin.

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.

CoQ10 has been studied extensively for its potential in addressing cardiovascular health concerns, but recent research has suggested its usefulness as an anti-cancer agent as well. In a striking set of studies, University of Miami Medical Center investigators identified a mechanism whereby CoQ10 induces the death of cancer cells while causing no significant collateral damage. Here’s a news article about this work on CoQ10, which was presented at a meeting of the American Association for Cancer Research:

http://www.med.miami.edu/news/view.asp?id=519

We expect to hear more about CoQ10 and its anti-cancer potential in the future, so stay tuned.  

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

This story was from an article we caught in the Reuters Health service back in June, 2007. It reported on an article from the American Journal of Cardiology.

Here’s a quote pulled from the original AJC article:

“Coenzyme Q10 supplementation (100 mg/day for 30 days) decreased muscle pain by 40% and improved the interference of pain with daily life activities by 38%,” the authors conclude. “These findings suggest that coenzyme Q10 may be beneficial for patients using statins by ameliorating myopathic symptoms and improving subjects’ well-being and functioning in daily activities.”

Am J Cardiol 2007;99:1409-1412. 

Here’s a report from 2004 on CoQ10 and how it may benefit people taking statins:

NEW YORK (Reuters Health) - Findings from a small study suggest that statin therapy can impair left ventricular diastolic function, but that coenzyme Q10 supplementation can reverse this dysfunction. “For more than a decade, there has been a suggestion of impairment of diastolic function after the administration of statins, and our findings suggest that this may be a common event and potentially a precursor to symptoms associated with ventricular dysfunction,” lead author Dr. Marc Silver, from Advocate Christ Medical Center in Oak Lawn, Illinois, and colleagues note. As such, routine coenzyme Q10 use may be beneficial, they add.The findings, which appear in the American Journal of Cardiology for November 15th, are based on a study of 14 asymptomatic patients who were treated with atorvastatin at a dose of 20 mg/day for 3 to 6 months.Doppler echocardiography was used to assess left ventricular diastolic function before and after atorvastatin therapy. Patients who showed worsening of diastolic function were offered treatment with coenzyme Q10 while continuing atorvastatin therapy.

For additional CoQ 10 information, see the NYBC Supplement Fact Sheets.

NYBC Product Info Sheets:

CoQ 10 - 100mg strength

CoQ 10 - 30mg strength

From the NYBC SUPPLEMENT, May-June 2006:

Coenzyme Q 10, or CoQ10 for short, is widely found in body tissues, where it acts as a key player in the production of energy for cell growth and maintenance. It also works as a powerful antioxidant, that is, it can “mop up” potentially harmful byproducts of normal metabolism and restrain damaging processes like inflammation.

When CoQ10 was first identified and studied in the late 1950s and early 1960s, there was much interest in it because lower than normal levels of this molecule were found to be associated with various cancers. As understanding deepened, CoQ10 was seen as stimulating the immune system and increasing resistance to disease, and theorized as an adjuvant therapy (treatment given after primary treatment) for cancer. Later, it was also shown to have the specific ability to protect the heart from damage caused by a chemotherapy drug (see SUPPLEMENT online for further reading).

In the 1970s, research turned to CoQ10’s potential for addressing cardiovascular conditions. Its effect on hypertension (high blood pressure), myopathy (weakening of the heart muscle), and congestive heart failure was examined, with at least some benefit detected in many (but not all) studies. Today, heart health concerns are probably the leading reason that people take CoQ10. In Japan, it’s been an approved treatment for heart failure since 1974.

Quite recently, a clinical trial found Co Q10 effective in slowing progression of early-stage Parkinson’s disease. This kind of finding suggests that we haven’t heard the last word on CoQ10, and that, furthermore, it could prove interesting even outside the area of cardiovascular concerns. As with many dietary supplements—we wish we knew more!
For people with HIV/AIDS, nutritional supplements expert Lark Lands has recommended use of CoQ10 in the context of broad-spectrum antioxidant therapy that includes carotenoids, selenium, vitamin E, vitamin C, lipoic acid, and NAC. But we should note that Dr. Jon Kaiser, who has conducted studies of vitamin/antioxidant supplementation and people with HIV, concluded a couple years back that CoQ10 gave little added value compared to other antioxidants. So, the stronger recommendation for use of this supplement may be limited to those concerned about cardiovascular issues.

NYBC stocks several other supplements of interest to people dealing with cardiovascular conditions, including pantethine and fatty acids (Evening Primrose and DHA Max). Check out descriptions in the Catalog and Treatment Guide.

CoQ10 Advisories and warnings: CoQ10 is fat soluble, and so is better absorbed if taken with olive oil or the like. Take with vitamin E, since the two work together. It also may affect levels of diabetes drugs, statins, and other prescription meds—another reason to be sure to tell your doctor if you are using this supplement. Recommended dosage varies a great deal, depending on what CoQ 10 is being used for.