November 17, 2010
Nelson Vergel: “Survivor Wisdom”
A Talk by Nelson Vergel: “Survivor Wisdom: Advances in Managing Side Effects, Living Well, and Aging with HIV” – New York City, November 9, 2010
How could you not be impressed by the schedule HIV treatment activist Nelson Vergel keeps? A few days before he arrived in New York to share his “Survivor Wisdom” with New York Buyers’ Club members and guests, he was an invited participant at the 12th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV in London. The founder and moderator of the “pozhealth” group on Yahoo—the largest online discussion group for HIV issues–Nelson also finds time to answer questions on a forum hosted by thebody.com. In addition, he serves as a community member of the federal government’s Department of Health and Human Services HIV treatment guidelines advisory board. And did we mention that he’s the author of a new book, “Testosterone: A Man’s Guide,” especially useful for people with HIV who are considering testosterone therapy to address fatigue and other problems?
As you might expect, Nelson also covered a lot of territory in his NYBC talk, which was co-hosted by the City University of New York’s Graduate Center. He briefly updated the audience on new treatments and guidelines, then reviewed the exceptional case of the HIV+ “Berlin patient,” whose apparent cure following a bone marrow transplant has opened up, at least tentatively, some new lines of research about curing HIV.
Most of Nelson’s talk, however, dealt with familiar issues in managing HIV symptoms and medication side effects: cardiovascular health challenges, lipoatrophy (facial wasting especially) and body fat accumulation (lipohypertrophy), aging with strong bones, fighting off fatigue, minimizing the risk of anal cancer.
Amid this discussion of symptoms and side effects, Nelson spent time on the topic of supplements. His first point, which NYBC would certainly agree with, is that a lot of good evidence has accumulated about the benefit of multivitamin supplementation, and a multivitamin plus antioxidant combination, for people with HIV. These “micronutrients,” as they’re called in the scientific literature, can enhance survival, delay progression of disease in people not yet on HIV meds, and increase CD4 counts in people taking the meds. We have to admit we were pleased when Nelson also took a moment to praise NYBC (and especially our Treatment Director George Carter) for making available an inexpensive, “close equivalent” of the multivitamin/ antioxidant combination that was the subject of Dr. Jon Kaiser’s well-known research and that led to the development and marketing of K-PAX. New York State residents, as Nelson pointed out, have access to many such supplements through formularies. But for residents of other states, this half-price version of the multivitamin/antioxidant combination (MAC-Pack or Opti-MAC-Pack) can provide welcome relief in the budgetary department.
Our speaker then ran through a list of about a dozen supplements that have reasonably good evidence to support their use by people with HIV. He chose to focus more closely, however, on just a few:
Niacin. Despite “flushing” that makes it difficult for some to use, niacin can be very effective in bringing up levels of HDL (“good”) cholesterol in people with HIV. Since cholesterol control is a major long-term health issue for many people on HIV meds, and since recent research suggests that raising HDL cholesterol levels may be an extremely important factor in reducing cardiovascular risk, niacin may be a top choice for many. (Fish oils/omega-3 fatty acids, plant sterols, pantethine, carnitine, and CoQ10 are other supplements that NYBC and many others put in the category of “supports cardiovascular health.”)
Vitamin D. Seems that, even at the London conference Nelson had just attended, the “sunshine vitamin” was a hot topic. Partly that’s because people with HIV have recently been found to have a high prevalence of Vitamin D deficiency, and then because Vitamin D, calcium and other mineral supplementation is a logical approach to addressing long-term challenges to bone health in people taking HIV meds. (Look on the NYBC blog for a whole host of other recent studies about Vitamin D’s potential benefits, from reducing cardiovascular risk to cancer prevention—even as a way of warding off colds and flu.)
Carnitine. This is a supplement, Nelson told the audience, that he’s taken for many years. Reported/perceived benefits: to improve fatigue, lipids, brain function and neuropathy. (NYBC Treatment Director George Carter put in that “acetyl-carnitine”—a form of the supplement that crosses the blood/brain barrier–has shown the most promise for dealing with neuropathy.)
Probiotics. The vulnerability of the gut in HIV infection, and the well-documented problems people with HIV experience in absorbing nutrients, make probiotics a very helpful class of supplements for long-term health maintenance. (Probiotics, good or “friendly” bacteria residing in the gut, are available in a variety of products, from yogurt to supplements. There’s quite a bit of research about the effectiveness of different varieties, and note as well that there are some newer formats that don’t require refrigeration.)
Above and beyond the treatment issues involving supplements, meds, and other strategies, Nelson referred several times to areas where there’s a need for advocacy. He mentioned the cure project, for one, but also a national watch list to help people follow and respond to the devastation created by recent funding cuts and the resultant waiting lists in the ADAP programs of many states, such as Florida.
All in all, NYBC members and guests would doubtless agree: a very thought-provoking presentation, with much helpful information to take away. For more on these and other issues, be sure to check out the NYBC website at:
http://www.newyorkbuyersclub.org/
[A version of this article also appears in NYBC's free e-newsletter, THE SUPPLEMENT, along with additional reporting on a new Mayo Clinic guide to supplements, and a look at the current state of regulation and research on supplements in the US.]
June 25, 2010
Symptoms common, often ignored by docs
A recent report underscored the myriad symptoms and problems facing significant numbers of people living with HIV. The study involved 751 patients enrolled in the Veterans Aging Cohort Study, undertaken between 1999 and 2000. Commonly reported symptoms included fatigue (71%), difficulty sleeping, depression, muscle aches and diarrhea (each reported by 60% of the respondents). Over 50% of patients reported headache, difficulty remembering, tingling hands or feet (neuropathy), weight loss and body shape changes.
The worry is that some may be associated with meds and this may reduce adherence to drug schedules. This can lead to resistance, etc. Which is why we at NYBC take very seriously the methods and means that may be available to manage some of these side effects. Diarrhea has been managed in studies that investigated agents like calcium and glutamine. Acetylcarnitine has some benefit for nuke-related neuropathy. You can review our literature on what we know (and need to learn more) about such interventions along with the different symptoms and side effects people experience and how they can be managed.
The study included about 54% African American. The study noted that healthcare providers often don’t recognize these as important symptoms. Perhaps this is why there is a strong racist element within American health care, one that arises out of blindness and ignorance as much as any overt hostility.
The second aspect of such care is that many people, of every ethnicity, are economically impoverished. So how can many people access sometimes costly, nearly always out-of-pocket agents like acetylcarnitine? NYBC is working on ways to make this possible, though we will need additional help to assure such access. State-run programs like ADAP and Medicaid can help in some states–but many of these programs are facing cuts due to tight budgets. Tight budgets induced by banks getting a socialized bailout for their malfeasance while Americans suffer?
So political activism will remain a key component in any comprehensive effort to provide care and treatment that includes the types of agents NYBC investigates and makes available. Ongoing research into dietary supplements and the ways in which they may improve health outcomes, enhance adherence to medications, reduce side effects and lower the burden of public costs by reducing morbidity and mortality are keenly needed.
April 2, 2009
Organic hemp protein powder from Jarrow
Studies of hemp protein in mice conducted in China showed improvements in energy, less fatigue and some immune system modulation. This included increases in CD4 numbers in the spleen (though of course whether this would have any relevance to people living with HIV is unknown; see Wei Sheng Yan Jiu. 2008 Mar;37(2):175-178). Lactic acid levels were also seen to decrease. A rat study showed a significant decrease in LDL (the so-called bad cholesterol) and an increase in the good cholesterol, HDL, over a 20-day period. Again, whether this is relevant to humans or what dosage daily would be needed to achieve this is unclear.
In any event, this products offers another alternative for a good protein source with a favorable amino acid profile. It has an innocuous flavor and is great in juice! If you are able to assess your energy level or start this around the time you get blood work, get a fasting lipid panel–and let us know what happens (improvement, no change or any problems).
Each 2 scoops contains: Total protein – 15 g
Total fat – 4 g
Sat fat – 0.4 g
trans fat – 0 g
Omega 3 – 0.7 g
Omega 6 – 2 g
Cholesterol – 0 mg
Sodium – 1 mg
Total Carbohydrates – 7 g
Dietary fiber – 6 g
Sugars – 1 g
Calcium – 39 mg
Iron – 6 mg
Vitamin A – 49 IU
Suggested use: Add 2 level scoops to water, fresh juice or other beverages, or your favorite smoothie recipe. May also be used as a topping for salads, cereals, and soups. For a low-carb, high-protein baking alternative, substitute hemp protein for flour (up to 25%) in your favorite recipe.
Contains no wheat, no gluten, no soybean, no dairy, no egg, no fish/shellfish, no peanuts/tree nuts. Suitable for vegetarians/vegans. Certified Organic by QAI.
See the NYBC entry for further details:
October 30, 2008
Rhodiola rosea
For a review of the botanical Rhodiola rosea, we recommend “Rhodiola rosea: A Phytomedicinal Overview,” published in HerbalGram 2002;56:40-52 (American Botanical Council).
Known as a medicinal botanical for at least 2000 years, Rhodiola rosea derives from a plant typically found at high elevations in Asia and Europe. Traditionally, the botanical has been used to increase physical endurance, longevity, resistance to altitude sickness, and to treat fatigue, depression, anemia, impotence, and nervous system disorders.
Since the 1960s, Rhodiola rosea has found a place in medical and pharmacological texts, especially in Russia and Scandinavia. It’s described as a stimulant to combat fatigue, a remedy for psychiatric and neurological conditions, and a means to relieve fatigue and to increase attention span, memory, and work capacity in healthy individuals.
The authors of the 2002 Herbalgram review include two practicing M.D.s (Richard P. Brown, Assoc. Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons, and Patricia L. Gerbarg, Assistant Clinical Professor in Psychiatry at New York Medical Center) who have used Rhodiola rosea in treating more than 150 patients with conditions including “depressive syndromes, mental and physical fatigue (secondary to psychiatric and medical conditions), memory loss and cognitive dysfunction from a variety of causes, sexual dysfunction, and menopausal-related disorders.” The authors also advocate additional research to confirm and define the benefits of this botanical for treating depression, disorders of memory and cognition, attention deficit disorder, Parkinson’s disease, endocrine disorders (infertility, premenstrual disorder, menopause), sexual dysfunction, and disorders of the stress response system (fibromyalgia, chronic fatigue syndrome, and post traumatic stress disorder). They also note continuing interest in studying the herb’s application to sports performance and aviation and space medicine (enhancing physical and mental performance while reducing stress reactions).
Read the full review at:
http://content.herbalgram.org/abc/herbalgram/articleview.asp?a=2333
See also NYBC’s entry for Rhodiola rosea at
March 3, 2008
Why Vitamin B12 and Folic Acid (Folate) are important to people with HIV
We’ve adapted this piece from the NYBC Info Sheet on Vitamin B12.
NYBC members often supplement with B-right B complex or with Methylcobalamin, a form of B12 that is better absorbed by the body than other forms of B12.
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B-12 may play a very critical role in preventing HIV disease progression: a large Johns Hopkins University study found that people with HIV who are deficient in B-12 have a two-fold increased risk of progression to AIDS. In this study, those who were B-12 deficient progressed to AIDS four years faster than those who were not. The exact mechanism by which adequate B-12 in the body may slow progression is not known, but the finding is not surprising, given all the roles B-12 is known to play in healthy human function.
B12 and another B vitamin, folic acid, are critical to prevent or eliminate the often-overwhelming fatigue that so often accompanies HIV disease, as well as to help prevent some forms of neuropathy and brain and spinal cord changes. Maintaining adequate B12 levels also supports the bone marrow’s production of blood cells (crucial to prevent white and red blood cell decreases), and helps protect the heart.
There are countless anecdotal reports from people with HIV that using B-12 supplementation has dramatically improved their lives by its ability to reverse fatigue, often restoring normal energy to people who had previously been so exhausted that their daily functioning had been greatly affected. Many people have also reported significant improvements in memory and mental functioning, improvements that have made a huge difference in daily life. The possibility that B-12 supplementation might also help prevent or reverse the spinal cord changes that can have such devastating effects on some people is also very encouraging.
B-12 and folic acid should always be given together. Doses of B-12 (1000 mcg given daily via pills, or one to several times weekly via prescribable nasal gel or injections) and folic acid (800 mcg daily via pills) may be useful for restoring energy, treating neuropathy, protecting the heart, increasing overall feelings of well being, and boosting mental function (especially when combined with thiamin, niacin, and folic acid, since all four of these B vitamins are needed for normal neurological function) even when tests don’t indicate obvious deficiencies.
Deficiencies of B-12 can result in deterioration of mental function and neurologic damage that will yield such symptoms as memory loss, decreased reflexes, weakness, fatigue, disorientation, impaired pain perception, tinnitus (chronic ringing in the ears), neuropathy, burning tongue, and various psychiatric disorders. B-12 deficiency can also cause canker sores in the mouth, impaired bone marrow function, loss of appetite, and loss of weight, as well as impaired antibody responses to vaccines.
Folic acid deficiency can also cause fatigue and weakness, along with irritability, cramps, anemia, nausea, loss of appetite, diarrhea, hair loss, mouth and tongue pain, and neurological problems. In addition, folic acid deficiency is believed to play a role in the development of numerous and varied types of human cancers.
A combination of B-12 and folic acid deficiency can allow increases in blood levels of homocysteine, a chemical that can damage artery walls and contribute to heart disease.
One of the known causes of B12 deficiency is chronic viral illness with resulting poor gastrointestinal absorption. AZT use may contribute to deficiencies of both B-12 and folic acid. Many other drugs may worsen folate status in the body including TMP/SMX (Bactrim, Septra), pyrimethamine, and methotrexate (all three of which are folate antagonists), as well as phenytoin (Dilantin), various barbiturates, and alcohol (all of which block folate absorption). B-12 deficiency can also worsen folate levels in the body because B-12 is required to change folate into its active form.
January 23, 2008
FAQ on nutritional supplements
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).
December 18, 2007
Folate, the feds, and you
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:
November 7, 2007
Fatigue, sleep disturbances, low energy, depression: dietary supplements may help address special health concerns for people with HIV
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.
