New York Buyers’ Club - The Blog

Here’s a story on the probiotic Saccharomyces boulardii from John James of AIDS Treatment News, posting at AIDS Treatment News Daily Alerts - www.aidsnews.org/now.

2008-04-30

Report raises C. diff concerns; yeast-based probiotic shown to help significantly reduce recurrence

Antibiotic-resistant Clostridium difficile (C. difficile) infection is becoming an increasingly serious problem. In principle at least, the use of a probiotic along with antibiotic treatment could make sense.

“A recent meta-analysis of 31 studies compiled and published in the American Journal of Gastroenterology concluded that S. boulardii is the only probiotic that is effective in fighting recurrent C. diff-associated disease.[reference] Additionally, an article in the March 2006 issue of Gastroenterology and Hepatology showed that use of S. boulardii provided an almost 50 percent decrease in subsequent recurrence among patients who suffered recurrent CDAD symptoms.[reference] ‘Because Florastor (S. boulardii) is a yeast and not a bacteria, it is not killed by the strong antibiotics that are being used to kill the C. diff bacteria, so it survives in the digestive tract,’ says Dr. Raymond. ‘When the ‘baby’ C. diff emerge from their spores, they are greeted by a well-colonized gut, rather than an empty playground.’”

Note: references and more detailed reporting at

http://www.eurekalert.org/pub_releases/2008-04/bi-rrc042908.php

For additional information, see the NYBC entry on Florastor or other entries on Saccharomyces boulardii on this blog.

This is an excellent and easy-to-read booklet that can be read online, or ordered from thebody.com at

http://www.thebody.com/content/art13137.html

Gastrointestinal or gut problems–diarrhea, nausea, indigestion, gas, loss of appetite–are very common for people with HIV, with consequences ranging from temporary to very serious. This booklet takes you through the common causes: HIV meds, other meds or supplements, the effects of HIV itself, your diet, psychological triggers, or other health problems (such as parasites). It then sorts through some of the most used treatments, including over-the-counter drugs, supplements, prescription meds, changing your diet.

Some of the many good points about this booklet: the “When to Call Your Doctor” sections, the personal stories, the “Doctor’s Notes,” and the dietary tips and supplement recommendations.

The Pacific College of Oriental Medicine website hosts an overview of research on green tea and HIV. Here’s an excerpt:

[...]Dr. Kuzushige Kawai at the University of Tokyo is one of a handful of scientists who have taken an interest in the implications of Green Tea for treatment of HIV. Most specifically it is the Epigallocatechin Gallate (EGCG) scientists are interested in. This is the same chemical compound that has been linked with lower rates of heart disease, stroke, lowered cholesterol, managing diabetes, and better liver health.

What Dr. Kawai found in lab tests was that the EGCG found in Green Tea prevented the virus from bonding to CD4 molecules in healthy T-cells, by bonding with them before the virus.

—

Read the rest of the article at

http://www.pacificcollege.edu/publications/articles/2006/december/12-03-2006_green_tea.htm

NYBC has stocked a Jarrow green tea extract: http://nybcsecure.org/product_info.php?products_id=260

We’d be glad to hear any reports on use of this product, or any additional information our members may have on green tea.

Lactobacillus acidophilus, L. acidophilus–acidophilus for short–is the most widely used probiotic, a beneficial microorganism that helps support gastrointestinal health in a variety of ways. For example, the byproducts of acidophilus (lactic acid, hydrogen peroxide) make for an environment that is hostile to undesirable organisms in the gut. And acidophilus also produces lactase, the enzyme that breaks down and allows digestion of milk sugar (lactose).

The University of Maryland Medical Center’s Complementary Medicine website provides a review of therapeutic uses of acidophilus and other probiotics. Here are some highlights:

–Treating overgrowth of “bad” organisms in the gastrointestinal tract (a condition that tends to cause diarrhea and may occur from use of antibiotics).
–Alleviating symptoms of irritable bowel syndrome and, possibly, inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis).
–Preventing and/or reducing the recurrence of vaginal yeast infections, urinary tract infections, and cystitis (bladder inflammation). The best scientific evidence exists for vaginal infections.
–Improving lactose absorption digestion in people who are lactose intolerant
–Enhancing the immune response. Studies have suggested that consumption of yogurt or milk that contains specific strains of Lactobacillus or supplements with Lactobacillus or Bifidobacterium may improve the natural immune response. Further research is needed to confirm these early findings and to best understand how the improved immune function may or may not help in warding off infections.

NYBC carries Jarro-Dophilus, a combination of acidophilus and other probiotic species together with a prebiotic (basically, the foodstuff that probiotic species thrive on). Note that this item needs to be refrigerated to maintain its effectiveness.

NYBC also carries Jarro-Dophilus EPS. This is a probiotic that does not require refrigeration. As reported on the NYBC website, a recent consumerlabs.com test of this product gave it very good marks!

Carotenoid compounds derived from vegetable sources have been the subject of much research for their power as antioxidants with potential health benefits. For example, a 2006 study in Canada among people with HIV showed an improved survival among those using a high dose of beta carotene in the form of a mixed carotenoid complex compared to those using a multivitamin alone (Eur J Clin Nutr, 2006;60:1266-1276).

NYBC currently stocks Jarrow’s CarotenALL, which includes a wide range of carotenoid compounds including alpha and beta carotene, lutein, lycopene, etc., derived from natural vegetable sources including broccoli, spinach, tomato, etc.

The sources of carotenoids in this supplement include three distinct forms of sea algae, palm oil, tomatoes, marigolds, among others. Many of the carotenoid forms are patented. The amounts of both lutein and lycopene are identical to amounts used successfully in research studies. Astaxanthin is considered by some to be the most potent carotenoid currently researched. It is supplied in its correct natural form derived from Hawaiian sea microalgae at a 2 mg dose. There are also substantial amounts of other patented natural mixed carotenoids. Finally, we have included 5 mg of sulforaphane, not a carotenoid, but an extremely potent stimulator of the Phase II detoxification system as well as an initiator of several other antioxidant enzymes, making it one of the most potent free-radical neutralizers yet studied. New varieties of carotenoids are constantly being discovered, so this should NOT replace a diet rich in colorful foods, but to supplement your diet. Eat your fruits and vegetables–and lots of them!

Specifically, each softgel contains:

Vitamin A as CaroCare beta carotene . . . . . . . .2,583 IU
(beta carotene - 1.43 mg and alpha carotene - 0.7 mg)
Lutein (marigold extract) . . . . . . . . . . . . . . . . . .10 mg
Zeaxanthin . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 mg
Lycopene (from GMO-free tomatoes) . . . . . . . . . . .10 mg
Phytoene (from GMO-free tomatoes) . . . . . . . . . . …1 mg
Phytofluene (from GMO-free tomatoes) . . . . . . . . . . 1 mg
Astaxanthin (Haematococcus pluvialis) . . . . . . . . .500 mcg
Gamma tocopherol. . . . . . . . . . . . . . . . . . . . . . . . .10 mg

CATIE provides an information sheet on liver toxicity as part of its “Practical Guide to Managing HIV Drug Side-Effects.” This info sheet suggests ways of coping with liver impairment, which is frequent in people with HIV, and may result from a variety of factors, including medication side-effects, hepatitis co-infection, repeated use of antibiotics, alcohol or drug use, or a nutrient-poor, chemically-rich diet.

Here’s an excerpt on some supplementation strategies to counteract liver impairment:
—

In addition to removing, as much as possible, anything that might be stressing the liver, it is very important to add the therapeutic agents that can help the liver to detoxify, repair and protect itself. There are a number of potentially useful agents, listed below:

For people with fatty livers, another important nutrient is the amino acid carnitine. Researchers say that it may help prevent mitochondrial toxicity, thus helping the body to handle fat better. Early studies of its use for non-HAART-related elevated triglycerides in PHAs did, indeed, show successful lowering of the blood fat levels. Research in animals has shown its successful use in reversal of fatty livers. The usual dosage is two capsules (500 mg each) twice daily. The alternative is Carnitor, the basic form of carnitine, available by prescription only. It is usually prescribed in doses of 3,000 mg daily (three 330-mg capsules, 3 times daily). Too-high doses can cause diarrhea, so watch for this. Doses of plain carnitine need to be higher because the acetyl-L-carnitine releases four times as much free carnitine into the bloodstream, using equivalent doses.

Note that in addition to the individual supplements mentioned above, NYBC also stocks its combination of N-acetyl-cysteine and alpha-lipoic acid, ThiolNAC.

We’re re-printing below an excerpt from a piece Lark Lands wrote several years ago, because it still has much solid advice for people with HIV/AIDS. A medical journalist and longtime AIDS treatment educator and advocate, Lark was a pioneer in focusing attention on an integrated, “holistic” approach to HIV disease. She served as science editor for POZ magazine, and has also been a contributor to Canadian AIDS Treatment Information Exchange (CATIE) publications.

The title of this piece is “The 7 Deadly Sins for those wishing to live long and well with HIV.” This excerpt has to do with nutrient needs (but see also the other sections, including those on gastrointestinal health and maintaining muscle mass.)
—

Sin #2: Ignoring the nutrient needs that both the disease and the medicines create.

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:

—

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 people at the AIDS Treatment Data Network (ATDN) have developed a series of “Simple Fact Sheets” about treatment and management of HIV. Their fact sheet on “Nutritional Management of Lipodystrophy,” written by an HIV nutritionist at Cabrini Medical Center in New York, covers diet (the right mix of carbohydrates, protein, fruits and vegetables, the right kinds of fats), exercise, and supplements, beginning with a good multivitamin, preferably one that includes a good set of antioxidants. There’s also a description of some supplements that may be useful in reducing lipodystrophy: L-carnitine, NAC, chromium, alpha lipoic acid, B-complex vitamins (niacin may be key among the B vitamins, but the recommendation is to always supplement using a B-complex, since the different B vitamins support one another’s action), and omega-3 fatty acids (fish oil and/or flaxseed).

 To read the entire fact sheet, go to

http://www.atdn.org/simple/nutrlip.html

We’ve spoken recently about the study of HIV and aging produced by ACRIA, a non-profit, community-based AIDS medical research and treatment education organization.

A main finding of the 2006 study is the prevalence of depression among older adults with HIV. In its survey of about 1000 older HIV+ adults, ACRIA researchers found that they experienced depression at a rate almost 13 times as higher than the general population. And for people with HIV, the consequences of depression are associated with many physical issues, far beyond just “feeling down”:

“By suppressing the immune system, depression may render people more vulnerable to infectious diseases. Stress and depression have harmful effects on cellular immunity, including those aspects of the immune system affected by HIV. Body cell mass depletion is associated with significant increases in fatigue, global distress and depressive symptomatology, and reduced life satisfaction. Elevated symptoms of depression are associated with a faster progression to AIDS and a higher risk of mortality. Depressive symptoms, especially in the presence of severe stress, are related to decreases in CD4 cell count and declines in several lymphocytes.”

These study findings and other related research motivated NYBC to assemble up-to-date information on dietary supplements and depression. See, for an overview, this information sheet:

Printable version of the info sheet, including a chart for quick comparison of these supplements as used to address depression

More information on the individual supplements is also available on the NYBC website, at  www.newyorkbuyersclub.org, as well as on this Blog, under “Depression.”

Acetyl-l-carnitine (often shortened to acetylcarnitine) and L-Carnitine (aka carnitine) are among the most heavily investigated of dietary supplements for their applications to HIV/AIDS. In particular, acetylcarnitine has been studied for more than a decade for HIV-associated neuropathy, especially by Michael Youle in the UK (see other entries under “acetylcarnitine, this Blog). Acetylcarnitine is also a key component in the K-Pax (and NYBC’s low-cost K-pax equivalent, the MAC Pack). Meanwhile, carnitine is also much used by people with HIV, and the prescription form, Carnitor, is made available through some state-funded formularies.

For a very good overview on acetycarnitine and carnitine research and application to HIV/AIDS, see

Acetyl-l-carnitine and L-carnitine: Canadian AIDS Treatment Information Exchange Fact Sheet

A brief excerpt:

Why do PHAs use this supplement?
Carnitine has many potential uses, including the following:

1. helping to heal damaged nerves—peripheral neuropathy (PN)
2. helping to decrease levels of lactic acid in the blood
3. reducing higher-than-normal levels of cholesterol and/or triglycerides
4. helping to maintain muscle growth

1. To manage peripheral neuropathy (nerve damage causing tingling, numbness or burning in the hands, feet and legs)
Levels of carnitine in the blood are sometimes lower in PHAs with peripheral neuropathy, particularly under the following conditions:

• damage from viral infections such as HIV and CMV (cytomegalovirus)
• the use of “d” drugs such as d4T, ddI and ddC
• the use of some anti-cancer drugs and antibiotics
• alcohol abuse
• diabetes

What the medications in the above list have in common is that they can damage the energy-producing parts of nerve cells—the mitochondria. Injured mitochondria cannot supply sufficient energy and nerves begin to malfunction and can die. Nerves in the feet, legs and hands, particularly in the skin covering those body parts, appear to be especially susceptible to PN. Some researchers have noticed that PHAs with PN can develop abnormal sweating, suggesting that nerves in sweat glands can also be affected.

One formulation of carnitine, acetyl-L-carnitine (ALCAR), may play a role in the management of PN. This compound helps mitochondria function and also appears to enhance the effect of a chemical that helps nerves grow—nerve growth factor.

Researchers in England conducted an extensive study of ALCAR in PHAs with peripheral neuropathy. Their findings revealed that most PHAs showed some degree of recovery from nerve damage after taking ALCAR 1.5 grams twice daily for up to 2¾ years.
—

See also the NYBC entry on acetylcarnitine. Like its predecessor DAAIR, NYBC has this key supplement manufactured by pharmaceutical-grade producer Montiff; this allows for considerable cost savings for co-op buyers compared to commercially available products.

NYBC stocks the probiotic Florastor, which is Saccharomyces boulardi lyo (lyo = freeze dried, the best means discovered for preserving the effectiveness of this agent). Saccharomyces boulardii, a yeast first investigated by French microbiologist Henri Boulard in Indochina in the 1920s, has been widely researched and distributed over the last fifty years, though it has a longer history of use in Europe than in the US.

We’re glad that Florastor has become available in the United States in the last five years, since before that we were obliged to import this pharmaceutical grade probiotic from Europe; the US versions of Saccharomyces boulardii often seemed quite a bit less effective, perhaps because the European production techniques were more advanced.

Here are the main indications/conditions for which Saccharomyces boulardii has been investigated:

Acute Diarrhea
A controlled study found a significant reduction in symptoms of diarrhea in adults taking 250mg of S. boulardii twice a day for five days or until symptoms were relieved.

Irritable Bowel Syndrome
A placebo-controlled study found that patients with diarrhea due mainly to irritable bowel syndrome (IBS) had a significant reduction in number and consistency of bowel movements.
Suggested dosage is 250mg twice daily.

Inflammatory Bowel Disease
Additional benefits to inflammatory bowel disease (IBD) patients may be found in 1) prevention of relapse in Crohn’s disease patients currently in remission and 2) benefits to ulcerative colitis patients with moderate symptoms. Suggested dosage is three 250mg capsules a day.

Antibiotic-Associated Diarrhea
Some evidence for its use in the prophylaxis (prevention) of antibiotic-associated diarrhea (AAD) in adults. Suggested dosage: 250mg twice a day with the standard antibiotic course.

HIV/AIDS-Associated Diarrhea
Saccharomyces boulardii was shown to significantly increase the recovery rate of stage IV AIDS patients suffering from diarrhea versus placebo. On average, patients receiving S. boulardii gained weight while the placebo group lost weight over the 18 month study. There were no reported adverse reaction observed in these immunocompromised patients.

Recurrent Clostridium difficile Infection
Two 500mg doses per day of Saccharomyces boulardii when taken with one of two antibiotics (vancomycin or metronidazole) were found to significantly reduce the rate of recurrent Clostridium difficile (pseudomembranous colitis) infection. However, note that significant benefit was not found for prevention of an initial episode of Clostridium difficile-associated disease.

Some citations (there are many more, since Saccharomyces boulardii is among the most-studied probiotics):

–Höcher W, Chase D, Hagenhoff G (1990). “Saccharomyces boulardii in acute adult diarrhoea. Efficacy and tolerance of treatment”. Münch Med Wochenschr 132: 188–92. 
–McFarland L, Surawicz C, Greenberg R (1994). “A randomised placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease”. J Am Med Assoc 271: 1913–8. 
–Maupas J, Champemont P, Delforge M (1983). “Treatment of irritable bowel syndrome with Saccharomyces boulardii: a double blind, placebo controlled study”. Medicine Chirurgie Digestives 12(1): 77–9. 
–Guslandi M, Mezzi G, Sorghi M, Testoni PA (2000). “Saccharomyces boulardii in maintenance treatment of Crohn’s disease”. Dig. Dis. Sci. 45 (7): 1462–4. PMID 10961730. 
–Guslandi M, Giollo P, Testoni PA (2003). “A pilot trial of Saccharomyces boulardii in ulcerative colitis”. Eur J Gastroenterol Hepatol 15 (6): 697–8. doi:10.1097/01.meg.0000059138.68845.06. PMID 12840682. 
–Saint-Marc T, Blehaut H, Musial C, Touraine J (1995). “AIDS related diarrhea: a double-blind trial of Saccharomyces boulardii”. Sem Hôsp Paris 71: 735–41.