New York Buyers’ Club - The Blog

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.
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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. 

A study by Jariwalla, et al., published in the Journal of Alternative and Complementary Medicine (2008 Nov 2;14(2):139-146) reported on the effects of using 300 mg alpha lipoic acid, three times a day (900 mg) among 33 HIV+ men and women. These individuals had viral loads greater than 10,000 copies, despite being on antiretroviral therapy (ARV). The patients were randomized to receive either alpha lipoic acid or placebo over 6 months.

The main results included not only an increase in glutathione levels over baseline that was statistically significant, and a considerably enchanced ability of white blood cells (lymphocytes) to respond to antigens. In addition, as glutathione levels were increased, the ability of cells bearing CD3 molecules to respond to antigens was also enhanced.

While the intervention did not impact CD4 counts or viral load, these improvements in overall immunity in this very vulnerable population were encouraging. Improving the functional reactivity of lymphocytes to T-cell mitogens helps to strengthen immune responses to other potentially lethal pathogens. While a small study, this is encouraging news and further studies are needed in this and in populations of HIV+ individuals at other stages of infection and responsiveness to ARV therapy.

For background information on alpha lipoic acid, see the NYBC entry:

Alpha Lipoic Acid

Curcumin is an extract of the kitchen spice turmeric, the main ingredient in curry. It’s also among those traditional botanicals that in very recent times have been the subject of new scientific interest. (Several National Institutes of Health studies of curcumin have been conducted or are currently underway.)

Here’s a capsule history from the NYBC entry on Curcumin:

“…Curcumin’s use dates back to the time of Egyptian pharaohs and Indian rajas more than 6,000 years ago. A tall, stemless, perennial plant cultivated throughout the tropics, especially in India, China and Indonesia, turmeric is what gives curry its unique flavor and color; but in addition to its kitchen uses, curcumin has been used by traditional medicine for liver disease (particularly jaundice), indigestion, urinary tract diseases, blood purification, inflamed joints (rheumatoid arthritis), insect bites, dermatological disorders and as an atherosclerosis preventative. Although the chemical structure of curcumin was determined in 1910, it was only during the mid 1970s and 1980s that the potential uses of curcuminoids in medicine began to be extensively studied.”

There’s more about the anti-inflammatory properties of curcumin in the NYBC web entry, where you also find information on dosing recommendations. Note that curcumin has also been studied in recent decades for its anti-cancer properties, as well as for its usefulness to people with HIV.

These and other stories can be found in the latest issue of the New York Buyers’ Club newsletter, THE SUPPLEMENT, now available online at

http://www.newyorkbuyersclub.org/supplement/index.html

On this page, you can also browse through SUPPLEMENT issues from the past three years, which contain stories on topics ranging from the latest thinking on supplements and cholesterol control, to US practitioners of Traditional Chinese Medicine and their formulas for liver health.

You can also visit www.newyorkbuyersclub.org for NYBC’s full set of information resources.

If you’re HIV+ and looking for a good introduction to the vitamins, minerals, and supplements that can help you stay healthy, we often recommend an online guide produced by the Canadian AIDS Treatment Information Exchange (CATIE), A Practical Guide to Nutrition for People Living with HIV.  CATIE is a national not-for-profit that’s been providing excellent information services to Canadians living with HIV/AIDS for many years. The Practical Guide is reviewed by a panel of healthcare professionals, and also includes information on such dietary supplements as alpha lipoic acid, NAC, Glutamine, CoQ10, probiotics, and carnitine/acetylcarnitine.  This version of the guide was released in October, 2007.

Here’s the excerpt on Multivitamins, Vitamins and Minerals:
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Consider taking a multivitamin-mineral each day.

Several studies have shown that vitamin and mineral supplements can have many benefits in people living with HIV. Taking a multivitamin every day is an important part of a nutritional health plan. Check out Appendix E for a list of studies looking at the effect of micronutrient supplements in people with HIV/AIDS. B vitamins may help slow disease progression in people with HIV. They are also important for healthy mitochondria, the power-producing structures in cells, and may help decrease the impact of mitochondrial toxicity. B vitamins are depleted quickly in times of stress, fever or infection, as well as with high consumption of alcohol. Keep in mind that the RDA is very low and taking a total of 50 mg of B1, B2 and B3 will more than cover B-vitamin needs. Check the multivitamin you take; if it has 30 to 50 mg of these vitamins, you don’t have to take a B-complex supplement in addition to the multivitamin.

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.

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.

A few words about PharmaNAC, an effervescent NAC (n-acetylcysteine) that the New York Buyers’ Club has been supplying in the past year. This form of NAC has proven especially useful to people with respiratory conditions like chronic bronchitis. And we were interested to read recently of a person with cystic fibrosis reporting on her use of PharmaNAC.

NAC in various forms has been researched and used more widely in Europe than in the US, although some influential work on this supplement for people with HIV was conducted at Stanford back in the 1990s, and helped lead, for example, to the inclusion of NAC in K-Pax, a multivitamin antioxidant combination that showed significant enough benefit to be added to state government-financed formularies for people with HIV.

NYBC originally imported a German effervescent NAC called ACC Akut (Hexal), but we were delighted when a North American supplier began to offer the very similar PharmaNAC, which we have stocked for the past year. (PharmaNAC is actually a higher dose of NAC per tab–900mg–than ACC Akut’s 600mg, though we have been able to keep the price about the same due to lower shipping costs.)

NYBC’s mission as a nonprofit buyers’ co-op also motivated us to devise a low-cost alternative to K-Pax for those who don’t have access to subsidized versions of this product. The NYBC MAC-Pack provides a close equivalent to K-Pax, but the cost has been brought down to less than half that of K-Pax.

Note: it’s also possible to order non-effervescent NAC and ThiolNAC separately:

NAC 500mg/90 tabs

ThiolNAC (500mg NAC and 200mg alpha lipoic acid/90 tabs)

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

Glutamine capsules 500mg/100.

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!
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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.

Following the lead of its predecessor DAAIR, NYBC stocks a proprietary extract of garlic bulb from New York area-based supplier Tai He: Allicin.

Allicin is thought to possess the greatest activity of garlic’s various components, and the Tai He preparation has been used in some studies, including the Search Alliance study of cryptosporidiosis in people with HIV (see abstract below). Other reported uses of allicin range from bacterial infections to fungal infections.

See additional reports on allicin and its antibiotic properties at

http://pubs.acs.org/subscribe/journals/mdd/v05/i04/html/04news4.html
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The use of a high-dose garlic preparation for the treatment of Cryptosporidium parvum diarrhea. Fareed G, Scolaro M, Jordan W, Sanders N, Chesson C, Slattery M, Long D, Castro C.

The New York Buyers’ Club stocks PharmaNAC, an effervescent form of N-acetylcysteine (NAC) produced in North America by BioAdvantex, which is also the supplier of our high-quality whey protein powder, Ultimate Balance.

PharmaNAC is a high-quality preparation of NAC, a supplement that has been studied extensively for immune system support, and for support of respiratory tract function. Currently forms of NAC (including effervescent forms) are more widely used in Europe than in North America, but this may change as its benefits are more generally recognized and studies continue.

A bit of anecdotal evidence: we have noticed some positive reviews of PharmaNAC in online forums dealing with cystic fibrosis.

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:

Glutamine

Arginine

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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.