March 3, 2011
Glutamine for the Gut
We’re reprinting information on the use of Glutamine for Inflammatory Bowel Disease (ulcerative colitis and Crohn’s disease) and for HIV/AIDS. These excerpts are from the University of Maryland Medical Center’s Complementary Medicine web resource, which provides an extensive and generally up-to-date database on nutritional supplements and their applications.
NYBC stocks two forms of Glutamine. And, by the way, we’ve just noticed that our bulk Glutamine powder (1 kilogram) is about HALF THE PRICE of a “discounted” Glutamine powder offered by a chain of vitamin/supplement stores! (GNC…sssshhh)
Read these entries for dosage recommendations:
Glutamine as a bulk powder (1 kilogram)
and
Glutamine is the most abundant amino acid (building block of protein) in the bloodstream. It is considered a “conditionally essential amino acid” because it can be manufactured in the body, but under extreme physical stress the demand for glutamine exceeds the body’s ability to synthesize it.
…
Inflammatory Bowel Disease (IBD)
Glutamine helps to protect the lining of the gastrointestinal tract known as the mucosa. Because of this, some experts speculate that glutamine deficiency may play a role in the development of IBD, namely ulcerative colitis and Crohn’s disease. These conditions are characterized by damage to the mucosal lining of the small and/or large intestines, which leads to inflammation, infection, and ulcerations (holes). In fact, some preliminary research suggests that glutamine may be a valuable supplement during treatment of IBD because it promotes healing of the cells in the intestines and improves diarrhea associated with IBD.HIV/AIDS
Individuals with advanced stages of human immunodeficiency virus (HIV) often experience severe weight loss (particularly loss of muscle mass). Some studies of individuals with HIV have demonstrated that glutamine supplementation, along with other important nutrients including vitamins C and E, beta-carotene, selenium, and N-acetylcysteine, may reduce the severe weight loss associated with this condition.
—
December 2, 2010
Supplements for Diarrhea and Malabsorption
We’re reprinting below the NYBC recommendations
for supplements that address the common gastrointestinal
problems of people with HIV:
Diarrhea. This is one of
the most common side effects of
antiretroviral drugs–especially protease
inhibitors. When it occurs, make
sure to drink plenty of (healthy) fluids
to replace electrolytes (potassium,
sodium, and magnesium ions) and
prevent dehydration. Avoid sugary
and/or caffeinated beverages.
One of the simplest remedies: bananas!
Adding a yogurt with active
cultures to your regular diet can also
improve diarrhea. In addition to adding
beneficial flora to your gastrointestinal
tract, yogurt is nutritionally
rich in protein, calcium, riboflavin,
vitamin B6 and vitamin B12.However, for some, dietary changes may
not be enough to control the diarrhea
Supplements to consider in treating
diarrhea associated with protease
inhibitors include calcium, and glutamine
(up to 20-40 grams daily for
diarrhea while it persists). There are
some clinical data to support these
interventions. A note of caution: calcium
carbonate works fine but should
be avoided if you are using atazanavir
[Reyataz].If diarrhea is associated with the use
of antibiotics, go probiotic! Use acidophilus,
bifidus or Saccharomyces
boulardii (Florastor) to control C.
difficile (a problem frequently encountered
with antibiotic use) and to improve gut function.
Use of digestive enzymes may also help to improve
digestion (e.g., lipase, protease, amylase, and
lactase).Malabsorption is the difficulty in digesting or
absorbing nutrients from food. It’s a widespread
problem among HIVers, and a serious
one at that. HIV disease damages the
guts, where it is estimated that 80%
of the disease “lives,” hindering the
digestive tract’s ability to absorb nutrients
(or meds). Additionally, many
HIVers actually have too little acid
in their stomachs – a little-discussed
condition. This can cause the sphincter
at the opening of the stomach to
fail to close properly, resulting in
GERD: gastro-esophageal reflux disorder.
In general, gut function can be
improved with probiotics such as
acidophilus and bifidus, as well as
2-5 grams of glutamine, taken daily.
Further, digestive enzymes that help
break down fats, carbs and proteins
may be useful in promoting better
absorption. Again, a good diet and
a potent multi are important starting
points!
See the NYBC entries for more detailed
recommendations regarding these supplements:
Glutamine Powder:
http://nybcsecure.org/product_info.php?cPath=49&products_id=128
or Glutamine Caps:
http://nybcsecure.org/product_info.php?cPath=49&products_id=127
Douglas Vegetarian Enzymes:
http://nybcsecure.org/product_info.php?cPath=49&products_id=264
Jarro-Zymes Vegetarian Enzymes:
http://nybcsecure.org/product_info.php?cPath=49&products_id=335
Ultra Jarro-Dophilus (probiotic):
http://nybcsecure.org/product_info.php?cPath=27&products_id=354
Jarrodophilus EPS (No refrigeration needed):
http://nybcsecure.org/product_info.php?cPath=27&products_id=199
Saccharomyces boulardii (Florastor):
http://nybcsecure.org/product_info.php?products_id=217
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.
March 31, 2010
Top search terms bringing visitors to this blog
Dear NYBC Blog Reader,
Thought you might be interested to see some of the most popular search terms that brought people to the New York Buyers’ Club Blog in the past year:
1. “Saccharomyces boulardii C difficile”
2. “glutamine ulcerative colitis”
3. “cholesterol lowering supplements”
4. “B vitamins depression”
5. “HIV Vitamin D”
6. “vitamins for neuropathy”
7. “Tylenol antidote”
And here, in very brief form, is the information these searchers found on the NYBC Blog:
Saccharomyces boulardii, which NYBC stocks in the form of Florastor, appears in a recent study to be the best probiotic for the stubborn gastrointestinal infection C. difficile.
Glutamine has shown effectiveness in reducing symptoms of ulcerative colitis and other gastrointestinal conditions in a number of research studies.
Plant sterols, fish oil, niacin, pantethine have been studied for cholesterol control.
B vitamins strongly affect mood and memory, and addressing a B vitamin deficiency can improve depressive symptoms.
Vitamin D deficiency is widely prevalent among people with HIV, and supplementing with 1000IU/day of D3 plus 1000mg/day of calcium may be a good way to support bone health for people taking HIV meds. Other research has noted the link between Vitamin D deficiency and cardiovascular disease, certain cancers, and susceptibility to cold and flus.
Acetylcarnitine, alpha lipoic acid and evening primrose oil are among the supplements studied for diabetic or HIV-related neuropathy (pain, tingling in feet, hands).
NAC (N-acetylcysteine) is used as the antidote to acetaminophen overdose. Acetaminophen is the active ingredient in Tylenol and is added to many other over-the-counter drugs, so overdose leading to liver damage or liver failure has become common in the US.
March 5, 2009
NYBC’s Quick Guide to Gastrointestinal Health
The latest issue of the NYBC newsletter, THE SUPPLEMENT, includes a “Quick Guide to Gastrointestinal Health.” Here’s the introduction:
Gastrointestinal or gut health is basic to overall health, whether you’re talking about how well you feel on a daily basis (nausea, cramps, diarrhea, etc. being among our least favorite experiences), or the importance of properly absorbing food that you eat and thereby supplying your body with the nutrients it needs to stay healthy over the long term.
Gastrointestinal health can also be a complicated issue, since gut disturbances may stem from many different causes, whether it’s a bug picked up from poor food handling practices, a side effect of medications, or one of the symptoms of an underlying disease or infection (such as HIV) that requires treatment in itself. Identifying the root cause or causes of gastrointestinal problems can be a major challenge, and of course we urge you to work with your healthcare provider to sort that question out, especially if your condition lingers, becomes acute, or has an impact on your ability to go about your daily life.
And here are the major topics covered by the guide:
Probiotics: only some types of probiotics, such as lactobacillus and bifidus, have been studied for gastrointestinal health (to prevent diarrhea, for example); Saccharomyces boulardii, available in the US as Florastor, is one of the most researched of the probiotics, and has been shown to be useful for antibiotic-related diarrhea and traveler’s diarrhea
Glutamine and other supplements to maintain body weight: glutamine, calcium carbonate, and other supplements have been investigated for their application to gastrointestinal health, and particularly for minimizing diarrhea and improving absorption in people with HIV, which in turn helps maintain body weight
Traditional botanicals/remedies for GI health: Chinese or Tibetan herbal formulas from Health Concerns and Pacific BioLogic; and Mastic Gum, a traditional remedy for heartburn from the Eastern Mediterranean, now recently studied for additional health benefits
Read the complete “Quick Guide to Gastrointestinal Health” online:
February 27, 2008
Glutamine for Inflammatory Bowel Disease (ulcerative colitis and Crohn’s disease) and HIV/AIDS
Here is information on the use of Glutamine for Inflammatory Bowel Disease (ulcerative colitis and Crohn’s disease) and for HIV/AIDS. These excerpts are from the University of Maryland Medical Center’s Complementary Medicine web resource, which provides an extensive and generally up-to-date database on nutritional supplements and their applications.
NYBC stocks:
Glutamine as a bulk powder (1 kilogram)
and
Note: Glutamine is one of the main components of Juven, a patented blend that also includes L-arginine and HMB. Unfortunately “patented” = much more expensive. It’s a lot cheaper to purchase Glutamine in bulk than to buy it in the form of Juven!
—
Glutamine is the most abundant amino acid (building block of protein) in the bloodstream. It is considered a “conditionally essential amino acid” because it can be manufactured in the body, but under extreme physical stress the demand for glutamine exceeds the body’s ability to synthesize it.
…
Inflammatory Bowel Disease (IBD)
Glutamine helps to protect the lining of the gastrointestinal tract known as the mucosa. Because of this, some experts speculate that glutamine deficiency may play a role in the development of IBD, namely ulcerative colitis and Crohn’s disease. These conditions are characterized by damage to the mucosal lining of the small and/or large intestines, which leads to inflammation, infection, and ulcerations (holes). In fact, some preliminary research suggests that glutamine may be a valuable supplement during treatment of IBD because it promotes healing of the cells in the intestines and improves diarrhea associated with IBD. Not all studies have found this positive benefit, however. For this reason, more research is needed before conclusions can be drawn. In the meantime, follow the advice of your healthcare provider when deciding whether to use glutamine for IBD.
HIV/AIDS
Individuals with advanced stages of human immunodeficiency virus (HIV) often experience severe weight loss (particularly loss of muscle mass). A few studies of individuals with HIV have demonstrated that glutamine supplementation, along with other important nutrients including vitamins C and E, beta-carotene, selenium, and N-acetylcysteine, may reduce the severe weight loss associated with this condition.
February 14, 2008
Maintaining optimum weight: recommendations for people with HIV from University of Maryland Medical Center
Here’s a good overview of some issues related to maintenance of optimum weight for people with HIV. This is an excerpt from the University Of Maryland Medical Center’s Complementary/Alternative Medicine website.
Some of the key supplements mentioned below are:
—-
Weight loss can be a serious problem for people with HIV. This symptom may begin early in the course of the disease and can increase the risk for developing opportunistic infections. Weight loss is exacerbated by other common symptoms of HIV and AIDS, including lesions in the mouth and esophagus, diarrhea, and poor appetite. Over the last several years, weight loss has become less of a problem due to the new protease inhibitors used for treating HIV. Reduction of muscle mass, though, remains a significant concern. Working with a registered dietitian to develop a meal plan to prevent weight loss and muscle breakdown is extremely helpful. Resistance training (lifting weights) can also protect against muscle breakdown and increase lean body mass.
Preventing diarrhea and ensuring that the body absorbs enough protein to maintain muscle strength has become a major goal of HIV/AIDS preventative care. One program for combating diarrhea includes using soluble fiber (not insoluble fiber, such as Metamucil and psyllium husks). For some people, soluble fiber can help food stay in the digestive tract for longer periods of time, increasing the amount of nutrients that are absorbed, and lessening bowel frequency. Good sources of soluble fiber include apple pectin, oat bran, and flax seed. Because diarrhea can be a potentially life-threatening situation, soluble fiber therapy should be used under the strict supervision of a trained professional.
Using certain supplements may help in maintaining body weight. A well-designed study compared the use of a daily supplement regimen that included enormous amounts of the amino acid glutamine (40 g per day), along with vitamin C (800 mg), vitamin E (500 IU), beta-carotene (27,000 IU), selenium (280 mcg), and N-acetyl cysteine (2,400 mg) to placebo. People who took the supplements gained significantly more weight after 12 weeks than those who took the placebo.
Another study found that a combination of glutamine (7 g per day), arginine (7 g), and an amino acid derivative called hydroxymethylbutyrate or HMB (1.5 g) helped people gain lean body weight during 8 weeks of treatment compared to placebo. High doses of arginine however, may be linked to an increase in herpes viral outbreaks. To find the right dose that offers benefits without dangerous side effects, consult with a trained nutritionally oriented physician.
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).
November 12, 2007
Practical Guide to Nutrition for People Living With HIV – a new publication from the Canadian AIDS Treatment Information Exchange (CATIE)
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
October 29, 2007
Probiotics, soluble fiber, and L-glutamine (LGN) reduce nelfinavir (NFV)- or lopinavir / ritonavir (LPV / r)-related diarrhea
Here’s an article from 2004.
Note the combination of probiotics, soluble fiber, and glutamine used:
—–
Carla R. Heiser, MS, RD, LD Center for Functional Nutrition, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA ; Judith A. Ernst, DMSc, RD Indiana University, Indianapolis, Indiana, USA; James Tom Barrett, MD Howard Brown Health Center, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA; Neel French, MD and Malte Schutz, MD Howard Brown Health Center, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA; Michael P. Dube, MD Indiana University, Indianapolis, Indiana, USA
Purpose: Highly active antiretroviral therapy (HAART) can be associated with diarrhea and other gastrointestinal (GI) side effects. Reducing these side effects may improve treatment durability and quality of life (QOL). This study assessed the impact of nutritional co-therapies known to reduce diarrhea in HIV-positive men treated with nelfinavir (NFV)- or lopinavir/ritonavir (LPV/r)-containing regimens. Methods: Thirty-five HIV-positive men treated with NFV (n = twenty-seven) or LPV/r (n = eight) with diarrhea (± two liquid stools/day [d]) participated in a 12-week prospective study. Twenty-eight subjects were randomly assigned supplements (S), seven received standard of care (C). Group S received probiotics (1.2g/d) and soluble fiber (11g/d). If diarrhea persisted at week 4, 30g/d L-Glutamine (GLN) was added. Diarrhea incidence, as well as supplement and antidiarrheal use, was assessed monthly. Results: Weight, CD4 count, and HIV RNA were unchanged in both groups. Diarrhea completely resolved in 10 of 28 (36 percent) S subjects. The mean (± SD) number of stools/d declined [3.40 ± 1.25 to 2.54 ± 1.34 (p < 0.01)]. Diarrhea (loose, watery stools/d) lessened in S from 2.84 ± 1.42 to 0.74 ± 1.03 (p < 0.0001). Fifteen S subjects did not obtain full relief with probiotics and fiber, but stools/d decreased from 4.08 ± 1.35 to 3.06 ± 1.68 (p < 0.05) after starting GLN. In C, stools/d, 4.14 ± 4.86 to 3.44 ± 1.68(p = 0.678) and incidence of diarrhea/d, 3.00 ± 4.82 to 1.36 ± 1.29 (p= 0.361) was unchanged. In S, loperamide use decreased from 1.69 ± 2.34 to 0.31 ± 0.69 mg/d (p < 0.01); 18 versus eight subjects used loperamide at 0 and 12 weeks, respectively. Conclusion: Probiotics, soluble fiber, and GLN significantly reduced diarrhea for subjects receiving NFV or LPV/r. Nutritional co-therapies show clinical benefit in HIV-positive men with diarrhea.
Citation: J Int Assoc Physicians AIDS Care (Chic Ill) 3: 121-129
