New York Buyers’ Club - The Blog

From http://eatg.org/news/newsitem.php?id=14774

Note also that the study reported a reduction in neuropathy in multi recipients. When will a potent multi simply be considered a STANDARD OF CARE for HIV+. Inexpensive and can be provided immediately upon diagnosis (even at high CD4 counts, of course). And helps when Antiretroviral therapy is needed.

Daily micronutrients of some benefit for HIV-positive patients receiving TB treatment Tuesday, April 22, 2008
	A simple micronutrient tablet reduced the rate of tuberculosis relapse in HIV-positive patients. By Michael Carter A simple micronutrient tablet reduced the rate of tuberculosis relapse in HIV-positive patients, according to a study published in Tanzania and published in the June 1st edition of the Journal of Infectious Diseases (now online). Use of the micronutrient also reduced the risk of peripheral neuropathy, a condition that can be caused by both HIV infection and key medication used to treat tuberculosis. None of the patients was taking antiretroviral therapy, and the use of micronutrients did not reduce the risk of death, nor was it associated with an improvement in CD4 cell count or a fall in viral load. However, the investigators did find that micronutrients reduced the risk of both extrapulmonary tuberculosis and genital ulcers in HIV-negative patients. An editorial accompanying the study called its results “promising” and suggested that micronutrients could be “an important adjuvant therapy for patients with TB.” Latest figures from the World Health Organization suggest that there were 1.7 million deaths from tuberculosis, and the infection is an important cause of death in patients with HIV in resource-limited countries, despite the availability of effective anti-tuberculosis therapy. Patients with tuberculosis often have significant nutrient deficiencies, particularly low levels of vitamins A, B complex, C, as well as selenium. These nutrients are key to the health of the immune system and its ability to respond to serious infections like tuberculosis. But there is contradictory evidence regarding the value of micronutrient therapy for patients receiving tuberculosis treatment. Therefore investigators designed a randomised, placebo controlled study involving 471 HIV-positive and 416 HIV-negative adults in Dar es Salaam, Tanzania, with sputum-positive pulmonary tuberculosis. The study ran between 2000 and 2005. Patients were randomised to receive either a daily micronutrient tablet containing vitamin B complex, vitamin C, vitamin E, folic acid and selenium at doses of six to eight times the recommended daily allowance, or a placebo. All the patients received tuberculosis therapy consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol by directly observed therapy for two months, and then self-administered isoniazid and ethambutol daily for a further six months. The study outcomes included treatment failures after one month (defined as a failure to achieve smear-negative tuberculosis), relapse from smear-negative to smear-positive tuberculosis during the rest of treatment, death during two years after the completion of treatment, changes in immune system measures, including CD4 cell count, weight gain, and for, patients with HIV, alterations in viral load. Over two-thirds (67%) of the patients were male, and the average age for patients with HIV was 34 years, and 30 years for HIV-negative individuals. Tuberculosis therapy was less likely to fail after one month in HIV-positive patients who received the micronutrient tablet than those who were given the placebo (13% vs.17%; for all patients 15% vs. 21%), but these differences were not statistically significant. However, amongst HIV-positive patients who responded to tuberculosis therapy, those who received the micronutrients were significantly less likely to experience a relapse and the reemergence of smear-positive tuberculosis during the next seven months of treatment than those who received the placebo (5% vs. 13%, p = 0.02). Overall there were 155 deaths during the total follow-up period. Most of these deaths (140) were in patients infected with HIV. There was no difference in mortality between patients who received the micronutrient supplement and those treated with the placebo (74 deaths vs. 66 deaths). Nor was there any difference in the risk of progression to another AIDS-defining illness between the micronutrient arm and the placebo arm. Amongst HIV-positive patients, CD3, CD4, and CD8 cell count and HIV viral load were comparable between those who received the micronutrient and those given the placebo during the eight months of tuberculosis therapy and during the extended follow-up period. But micronutrients were associated with CD8 cell counts (p = 0.02) and CD3 cell counts (p = 0.02) during tuberculosis treatment for HIV-negative patients. This group of patients also had a non-significant increase in CD4 cell count (p = 0.07), during longer follow-up. Micronutrient supplementation was associated with a 57% reduction in the risk of peripheral neuropathy (41% vs. 69%, p < 0.001), irrespective of a patient’s HIV status. For HIV-negative patients, micronutrients reduced the risk of extrapulmonary tuberculosis (p = 0.01). There was also some evidence that micronutrients might help reduce the risk of infection with HIV for HIV-negative patients, as patients who received them were significantly less likely to be diagnosed with genital ulcers (p = 0.03). There was no evidence that taking the micronutrient improved body weight or body composition in either HIV-positive or HIV-negative patients. In their discussion, the investigators highlight their finding that “micronutrient supplements appeared to decrease the risk of early tuberculosis recurrences among HIV-positive patients”, as well as the “significantly decreased… incidence of peripheral neuropathy, regardless of HIV status.” They note, however, that none of the patients in their study were taking antiretroviral therapy and conclude “the impact of micronutrient supplementation on TB-related outcomes needs to be ascertained among HIV-infected patients receiving antiretroviral therapy.” Reference 1. Villamor E et al. A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis. J Infect Dis 197: (online edition), 2008. 2. Benn CS et al. Should micronutrient supplementation be integrated into the case management of tuberculosis? J Infect Dis 197: (online edition), 2008.

NYBC has been, where and as it can, helping our friends at the Centre in Harare, Zimbabwe as well friends at the Blue Diamond Society in Kathmandu, Nepal.

Recently, Super Nutrition sent us a donation of vitamins that we immediately turned around and sent off to these two organizations. We are grateful that such high quality products are getting some play around the world: healthcare is a RIGHT. And we know a multi is a significant part of managing HIV disease. The clinical data unequivocally support the use of a multi, whether using antiretrovirals or not. (And yes, NYBC disagrees with the notion proposed by some that either ARV or a multi are the only things one needs; neither position is very intelligent!)

In other news, Blue Diamond Society has been working to find housing for people with HIV who have been removed from their clinic by a homophobic and AIDSphobic landlord. An all-too-familiar story around the world.

If you can help NYBC with donations either of vitamins/supplements or cash to help our friends, it would be greatly appreciated! NYBC’s sister organization, FIAR, is accepting any funds earmarked to help out the Nepali situation. More information below:

HIV & AIDS Hospice
Concept note for the purchase of a building
Kathmandu, March 21 (IANS) Twelve men diagnosed with AIDS, four of whom are terminally ill and unable to walk, were thrown out and the AIDS hospice and care centre run for them shut down in Nepal due to the prevailing anti-gay bias, without any human rights group intervening on their behalf. Just as Nepal’s sexual minorities were celebrating the community’s first participation in a national election as contestants, the AIDS hospice run in Kathmandu for homosexuals by Nepal’s pioneer gay rights organisation was closed down Thursday night by the landlord after pressure from the neighbours.

Introduction
Despite significant progress in recent years on policy and awareness, society’s stigma and discrimination towards males who have sex with males and transgender people (MSM/TG) in Nepal remains. This prejudice is compounded when MSM/TG are infected with HIV and Blue Diamond Society’s (BDS) Care & Support programme has been severely challenged in finding accommodation for its HIV & AIDS Hospice. To remove the obstacle of landlord’s prejudice, BDS believes it is necessary to purchase its own premises for Hospice/Care & Support activities.

Background
Government estimates put the number of MSM/TG in Nepal at 130,000 although BDS’ and regional/international experience suggests it is closer to 500,000. Official studies show an HIV prevalence rate of 3-4% indicating an MSM/TG population living with HIV & AIDS in excess of 4,000. Many of these have been rejected by their families and society and it became clear to BDS that they needed care and support from their own community who understood their sexuality/gender, could provide compassionate care and give them access to health services without discrimination. With the support of the Elton John AIDS Foundation (UK) and Sidaction (France), BDS in 2005 opened a hospice centre in Kathmandu. MSM/TG from all over Nepal have made use of this facility and, in two and half years, over 700 MSM/TG living with HIV & AIDS have been supported by staff, many of whom are themselves HIV positive, and been given counselling, care and medical treatment. During the 6 months ended 30 September 2007, despite only having 7 proper beds, a total of 94 MSM/TG were accommodated (on mattresses on the floor when all beds were full) at the Hospice for periods ranging from 1 day to several months. However this work has been severely hampered by being forced to move premises 4 times in 2½ years as landlords, often pressured by neighbours offended by the presence of MSM/TG and HIV+ staff and clients, refuse to extend short-term leases leading to eviction. It has become more difficult to find suitable premises and following the last eviction on 20 March 2008, staff and 12 patients have been forced to find a temporary home in a meeting room at BDS’ office.

Proposed Project
To overcome discrimination by landlords and the disruption of frequent moves, BDS believes it is necessary to purchase its own building for Hospice/Care & Support activities. This building would provide a stable and secure base from which to continue the following existing activities of BDS Care & Support:
Clinical care
Hospice facility (15 beds minimum)
Medical check up and monitoring
HIV testing and counseling
Opportunistic Infection treatment
Co infection treatment
Anti Retroviral Therapy facilitation
Social support
Ambulance service to access hospital services
Training (for self-care and treatment etc) and stress reduction workshops
Palliative care
Food and logistical support

Running costs would continue to be funded by existing donors and/or new ones.

Estimated Budget (US dollars)
Buying the building (depends on the location) 100,000 – 150,000
Furnishing and equipment 50,000
Setting up cost 5,000

Total US$ 155,000 - 205,000

We would be more than happy to submit full proposal in necessary once we have a positive indication from you.

Sunil Babu Pant
Director
Blue Diamond Society

Blue Diamond Society is Nepal’s leading community based organisation representing sexual and gender minorities. It seeks to convince Nepali society to respect the human rights of its community members and to empower them to advocate for these rights and deliver HIV & AIDS programmes for themselves.
www.bds.org.np
bluediamondsociety@yahoo.com

Some information about Women’s Blend from Super Nutrition, which also produces the Super Blend and Opti-Pack multivitamins.

Here are some excerpts from the Super Nutrition description of this multi:

This is a food-based multivitamin, enriched with organic green foods and herbs.

–Includes a robust B-Complex formula to increase energy throughout the day
–Immune supporting, anti-aging antioxidants
–Bone support - 1,000 mg Calcium, 600 mg Magnesium, 1,000 IU Vitamin D, 3 mg Boron and 1,000 mg Vitamin C
–Heart Healthy - 1,000 mcg Folic Acid, 200 mg Vitamin B6, 200 mcg Vitamin B12 plus 400 IU Vitamin E
–Enriched with 600 mcg Biotin & 100 mg GLA
–Special female herbal blend with Pau d’Arco, Peony, organic Nettles and Rosemary
100 mg 5:1 Vitex extract*
–Special flower petal blend, featuring Red Rosebuds
–200 mg Vitamin B6 to help reduce PMS*
–6 tablets per day

*Here’s some additional information, supplied by Michael Mooney at Super Nutrition in response to our request:

> Vitex for PMS.  A placebo-controlled study showed that 20 mg of Vitex extract reduced PMS 28> percent better than placebo. Women’s Blend has 100 mg of 5:1 extract.

Super Blend is a comprehensive multivitamin enriched with organic green foods and herbs. NYBC members choose this multivitamin for its very wide spectrum of high-potency anti-aging nutrients, vitamins, minerals, antioxidants and phyto-antioxidants–a combination that can simplify supplement-taking by fulfilling multiple needs in one formula.

Some highlights of Super Blend:

100 mg alpha-Lipoic acid; 30 mg CoQ10; 75 mg N-Acetyl Cysteine; 100 mg Quercetin;18 phyto-antioxidants, including Grape Seed & Skin extracts, Lutein, Lycopene, Ginkgo Biloba, Green Tea extract; the prime antioxidants Vitamin C, Vitamin E and Beta-Carotene; a potent B-complex formula; bone health support - 1,000 mg Calcium, 600 mg Magnesium, 1,000 IU Vitamin D and 1,500 mg Vitamin C; for cardio support - 1,000 mcg Folic Acid, 1,000 mcg Vitamin B12, 200 mg Vitamin B6 and 800 IU Vitamin E. Suggested use is 8 tablets per day.

Note: NYBC stocks Super Blend - No Iron. In keeping with its non-profit mission, the NYBC co-op price is the lowest we’ve seen for this formula–$43.

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:
—

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.

A recent letter to the editor of the NYT from a nutritionist expresses some of the same concerns about cholesterol control and cardiovascular health that we’ve been raising recently.

See also today’s NYT editorial on the FDA, which has lately been beset, bothered and besieged by questions about its ability to manage the drug approval process.

—
To the Editor:

Yet again, we miss the point about cholesterol. To read Gary Taubes’s article, one might think that cholesterol is a toxic substance.

In truth, cholesterol is a naturally occurring lipid produced by the liver. It is the biochemical precursor to vitamin D and to the sex hormones. It is an integral part of every cell membrane. So this war against cholesterol is a war against ourselves.

Perhaps a better question to ask would be, Under what conditions does cholesterol become part of the plaque that contributes to heart disease? And guess what? We’ve had some of the answers for years.

When free radicals attack or oxidize the LDLs, cholesterol may enter the plaque. This problem can be addressed by including more antioxidants in the diet or with vitamin supplementation.

Another factor is uncontrolled high blood glucose, which can damage blood vessels, increasing the potential for plaques to form. Here also, diet, exercise and antidiabetic drugs can help.

Moreover, there is a huge and valuable literature connecting heart disease to stress and emotional wounds. All the statin drugs in the world won’t scratch that itch.

Bottom line: When the questions we ask about health are defined by the pharmaceutical companies, the answers we get will be better for Big Pharma’s profits than for our health and healing.

Rona S. Weiss
Teaneck, N.J., Jan. 28, 2008

The writer is a nutritionist and health consultant.

Not all multivitamins are created equal–strengths and formulas vary astonishingly, as you’ll find out when reading the SUPPLEMENT FACTS label. Here are some selections that the New York Buyers’ Club membership has chosen consistently. Of course price is also a concern if you are intending to supplement on a regular basis over the years. These are generally one-month supplies, and because of its nonprofit status, NYBC stocks them at low cost: Jarrow Multi-1-3 is $14.25, the Douglas Added protection is $14.50, its Ultra Preventive Beta $17.00, and the Super Nutrition Opti-pack, which is strong on antioxidants, is $26.50.

Note that iron-free formulas are usually recommended if you have elevated liver enzymes or liver disease. The Douglas Ultra Preventive Beta is notable for reducing the Vitamin A in palmitate form, which also can be a concern for people with a liver condition.

Added Protection No-Iron

Jarrow’s Multi 1-3 iron-free

Super Nutrition’s Optipack - iron-free

Added Protection with Iron

Ultra Preventive Beta

We took a look at the recent issue of the Healthy Years newsletter (Volume 4G) from the UCLA David Geffen Medical School’s Division of Geriatrics, and were pleasantly surprised to find a good balance of advice ranging from exercise, diet, medication regimens when called for…and a number of on-target recommendations for promoting long-term health with the aid of dietary supplements.

The UCLA newsletter, which is directed especially to people 60 and older, offers several general supplement recommendations to promote healthy aging: a multivitamin/mineral supplement (because diet and digestive capability tend to change as you age); Vitamin D plus calcium for bone health; fish oil supplements to keep triglyceride levels down; glucosamine and chondroitin for moderate to severe arthritis knee pain; and CoQ 10 to help keep blood cholesterol down when taking a statin drug.  

A couple of other recommendations emerge for specific conditions: non-smokers with early-stage macular degeneration may want to consider an NIH panel’s advice to supplement with zinc and the antioxidant vitamins C, E, and beta carotene. And niacin and/or a fibrate drug could be beneficial in raising HDL (the so-called “good cholesterol”) levels in a person taking a statin.

Thanks, UCLA Division of Geriatrics! It’s nice to see a general-audience publication from a mainstream medical source include balanced information about supplements, and not just fixate on prescription drugs as the only possible choice for every condition.

This post runs a little long, but we think it’s worthwhile to put up the FAQ about nutritional supplements recently posted by the New York Buyers’ Club. It answers a lot of (sometimes anxious) queries about supplements, and also gives a quick rundown on some of the top uses of supplements among the NYBC membership.

What are supplements?
A nutritional or dietary supplement (or just plain supplement), as defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994, is “a product (other than tobacco) that is intended to supplement the diet and that contains one or more of the following: vitamins, minerals, herbs or other botanicals, amino acids, or any combination of the above ingredients,” and can be taken in tablet, capsule, powder, or liquid form.
NYBC specializes in supplements for those with HIV, hepatitis C, and other chronic conditions. Our Supplement Fact Sheets contain information on more than 100 supplements commonly used by our Members. Our nonprofit purchasing co-op stocks these supplements on a regular basis, and can also special-order many other supplements on request.
Why take supplements?
There is a great deal of research showing that supplements can help people manage serious chronic conditions such as HIV and hepatitis. Supplements can also be useful in addressing many common health issues, such as high cholesterol, diabetes, depression, arthritis pain, gastrointestinal disorders, etc. (see our short list of specifics below). Some supplements are derived from ancient traditions of use (for example, the botanicals of India’s Ayurvedic tradition), while other items (such as vitamins or amino acids) have been isolated and used as supplements much more recently. The scientific study of supplements has blossomed in recent decades, so we now have better evidence about many of them—even traditional botanicals—than we ever did in the past.
Are supplements considered “medicine”?
While supplements may have medicinal properties, they are not regulated in the same way that prescription drugs are, and are therefore accompanied by the disclaimer: “These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
The fact that supplements are not regulated in the same way that prescription drugs are naturally gives rise to concerns about purity, efficacy, and safety – so it’s good to have a knowledgeable ally like NYBC on your side! Collectively, we have many years of experience in using supplements, in researching information on them, and in evaluating suppliers to obtain the best quality product.
Are supplements “safe”?
Under current US regulations, supplements are assumed to be safe on the basis of their history of use, or because they are found in the food supply (like the microorganisms in yogurt or the vitamins and minerals in foods). The US Food and Drug Administration is responsible for removing supplements from the market if it finds evidence that they are unsafe, but it’s worth noting that this happens quite rarely. (The removal from the market of ephedra [aka the Chinese herb Ma huang], used at high dosage as a diet pill, is practically the only significant example since 1994). However, while supplements may be “assumed to be safe,” everyone who takes them needs to pay attention to the recommended dosage and any cautions or warnings. If you exceed the recommended dosage of certain supplements, there may be side effects, sometimes serious. Furthermore, a supplement may have negative interactions with other medications you are taking, or a particular supplement may not be a wise choice for you due to other health concerns. That’s why it’s always important to discuss your supplement use with your doctor.

Here are just a few examples of potentially dangerous supplement-medication interactions (from the National Center for Complementary and Alternative Medicine’s website) - further proof that consulting your physician about supplement use is crucial:

• St. John’s Wort can increase the effects of prescription drugs used to treat depression. It also dangerously interferes with drugs used for HIV, cancer, birth control, and rejection of organ transplants

• Ginseng can increase the stimulant effects of caffeine (as in coffee, tea, and cola). It can also lower blood sugar levels, creating the possibility of problems when used with diabetes drugs

• Ginkgo, taken with anticoagulant or antiplatelet drugs, may increase the risk of bleeding. Ginkgo may also interact with certain psychiatric drugs and with certain drugs that affect blood sugar levels

Of course, doing your own “homework” is also encouraged. Be sure to bring any notes or printouts from your research to share with your healthcare provider. That way, you’ll both be literally on the same page.
Identity, Purity and Potency
Safety is also a matter of product quality. Is the product what it claims to be on the label (that is, is it really fish oil)? This is the product Identity. Does the product contain any unwanted contaminants like heavy metals, insect parts, rodent droppings? All foods and medicinal products face these issues of Purity. And finally, does it have as much of the claimed amount of a substance? For example, if it says 100 mg of niacin, does it have that amount? This is the product’s Potency. These issues are of ongoing concern. NYBC has done everything possible to assure that products meet these standards. Websites such as www.consumerlab.com can help. Also indications of quality such as USP or other labels further add assurance. The good news is that the vast majority of products tested by consumerlab, for example, pass their tests. Still, NYBC believes an appropriately funded agency of the FDA could do more rigorous, routine and comprehensive testing.
What is CAM?
CAM is an acronym for complementary and alternative medicine. The use of supplements is considered CAM. Some prefer the term integrative medicine.
The National Center for Complementary and Alternative Medicine (NCCAM), a division of the US National Institutes of Health, defines CAM as “a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine.” NCCAM, like the US Office of Dietary Supplements, came into being after passage of DSHEA, and marks the federal government’s decision to commit funding to research and education about CAM. Over a billion dollars in your tax dollars have been spent by these agencies since their start.

——————————————————-
Using Supplements
What supplements can I use to improve my immune system?
Agents such as a potent multivitamin, NAC (N-acetyl cysteine), alpha lipoic acid and whey can all help offset oxidative stress and nutrient losses caused by HIV as well as the free radical generation and inflammation-related damage that some antiretroviral drugs cause.
For those with HIV, supplementation can be a valuable assist in restoring the body’s immune system, as evidenced by many studies, such as Dr. Jon Kaiser’s HIV Micronutrient Study, which showed a significant increase (26%) in the CD4 counts of the subjects who maintained a supplement regimen in addition to their regular medications. FYI: NYBC offers a “MAC Pack” (Micronutrient - Antioxidant Combination Pack), a product very similar to the one used in the study.
What supplements can be used to improve gut function?
Acidophilus or bifidus, glutamine, whey proteins, Saccharomyces boulardii (Florastor) and a good multi can all be important to offset gastrointestinal problems, whether HIV-related or of other origin.
What supplements can I use to manage my blood fats (cholesterol and triglyceride levels)?
“Bad cholesterol” (LDL) and triglycerides can be reduced with agents such as carnitine, pantethine, and fish oils. Niacin may be an excellent option which can also help increase HDL (“good cholesterol”). For heart health in general, aside from diet and exercise, CoEnzyme Q10 may also be of help (may also be useful in countering statin-related side effects).
What supplements are used to improve mental function and/or mood?
Acetylcarnitine, 5-HTP, tyrosine, ginkgo biloba, fish oils, SAM-e, DHEA, theanine, or St. John’s Wort may help mental function and alleviate depression, though each of these must be taken with some care (and not all together!)
See also: a full dossier on Memory Loss and Other Brain Problems from our Health+HIV section of Recommended Reading on the website www.newyorkbuyersclub.org; also recommended is the NYBC info sheet on Depression and supplements on this blog, under “Depression.”
What supplements can I use to combat fatigue?
Various conditions can cause fatigue, but in general, B12 (methylcobalamin) and Eleuthero (used to be “Siberian ginseng” - don’t use with high blood pressure!) may all help to improve energy. A good start may also be as simple as a good multivitamin!
For more information about the causes and treatments for fatigue, see our Fatigue Fact Sheet on the NYBC website.
What supplements can I use to stabilize my weight?
For those experiencing weight loss, whey proteins, carnitine and creatine plus CLA may all help - but of course especially in conjunction with a good diet and routine exercise! And we agree with Dr. Jon Kaiser and many others: resistance exercise remains an important component of a successful HIV management plan.
What supplements are used to treat nausea?
NYBC recommends ginger; marijuana, while effective, is not carried by the NYBC, as it is not yet approved for medical use in New York. For detailed information about the causes and treatments for nausea, see Health+HIV section of Recommended Reading on the NYBC website.
What supplements are used to improve liver function?

Liver function can be impaired due to several reasons, including disease, alcohol abuse, and the effects of some cholesterol-lowering drugs (statins).
While making sure there aren’t any interactions with your meds, supplements like milk thistle (Silymarin), NAC, alpha lipoic acid, Hepato-C or Hepato-Detox, Hepatoplex I or II, Ecliptex, SAM-e and Clear Heat are options to consider (again, not all at once!)
What supplements can be used to treat diarrhea?
NYBC suggests supplementing your diet with glutamine and calcium. For more information about the causes and other possible treatments, see our Fact Sheet about diarrhea in Recommended Reading, at www.newyorkbuyersclub.org.
What supplements can combat neuropathy?
Much scientific evidence now points to acetylcarnitine as an effective approach to countering neuropathy (numbness, tingling, or pain, usually in the extremities, which can be caused by HIV, diabetes or by some medications).

Our friends at the Canadian AIDS Treatment Information Exchange (CATIE) have released a noteworthy new publication, freely available online:

A Practical Guide to Nutrition for People Living With HIV

CATIE has a long-standing interest in nutritional supplements and HIV, and maintains on its website a collection of info sheets on a variety of relevant topics, from individual supplements to managing and preventing side effects of HAART with supplements.

This newly-issued guide brings together a wealth of accumulated knowledge in a very readable format, so overall we recommend it highly.

In the section on Vitamins, Minerals and Supplements, the new guide gives an overview of the following topics:

–micronutrient deficiencies and HIV

–antioxidants and HIV

–key vitamins and minerals for people with HIV (B vitamins, vitamins C, D, E, Calcium, Iron, Zinc, Selenium)

–other supplements used by people with HIV (alpha lipoic acid, carnitine and acetyl-l-carnitine, NAC, glutamine, probiotics, and CoQ10)

Very useful is the chart summarizing recommendations and dosing for these supplements, especially in light of more recent findings, which, for example, lead to the recommendation of a higher daily dose for Vitamin D (1000 IU), and more caution in the use of some items (such as Vitamin E and Zinc).

In addition to these pages on nutritional supplements for HIV, we also recommend the guide’s sections on “Managing the Effects of HIV and Meds on the Body,” “Managing Symptoms and Side Effects,” and “Hepatitis C Co-infection.”

Oh, and by the way: “Appendix D: Web Resources” gives a listing for the NYBC website:

New York Buyers Club (for information on nutrition, herbal and homeopathic supplements)  www.newyorkbuyersclub.org/index.html

 K-PAX, a multi-supplement pack, was developed following Dr. Jon Kaiser’s study that found an increase in CD4 count among HIV+ individuals using this mix of a potent multivitamin and antioxidants. (Dr. Kaiser was hardly new to the field of nutritional supplementation for people with HIV/AIDS—see his book Healing HIV: How To Rebuild Your Immune System, which was based on many years of clinical experience with hundreds of patients and still, in our judgment, has many valuable insights about everything from assessing and managing gastrointestinal problems, to exercise and diet for people with HIV.)  

At this point, the Medicaid or ADAP formularies of many states include the K-PAX formula. Unfortunately, some people may not have access to these programs and for them, cost can become an issue. For example, the price for the double strength K-PAX formula is about $140 per month, not an insignificant amount for anyone on a budget and dealing with the usual extra healthcare-related costs. That’s why NYBC has designed an alternative to the double-strength K-PAX formula, based on products and prices currently available through our nonprofit purchasing coop. Here’s our suggestion, which is not a precise, 100% match of the K-PAX, but does, we feel, provide a close equivalent–and at a much lower cost:

Acetylcarnitine – 3/day – one month supply = $15.50 (one bottle; 500mg/90)
Lipoic  - one/day – one month supply = $7.50 half a bottle; 300mg/60)
NAC – 3/day – one month supply = $11.25 (one bottle; 500mg/90)
Vit B6 (pyridoxal-5’-phosphate/P5P) – 3/day – one month supply = $7.85 (one bottle; 50mg/100)
Vit B12 (methylcobalamin) – 2/day – one month supply = $3.75 (actually, les than half a bottle; 1000mg/100)
Added Protection (or Ultra Preventive Beta) – 6/day – one month supply = $14.00 ($17.00 for UPB) (one bottle; 180)

Total monthly cost of the NYBC multivitamin-antioxidant package is $59.85. (The intial cost, since you use only half a bottle to make a monthly supply of some items, is $71.10.) This is HALF THE PRICE of the double-strength K-PAX.  Notes: 1) The NYBC package actually has MORE acetylcarnitine than the double-strength K-PAX—not a bad idea, especially if you believe, as we do, that acetylcarnitine is probably one of the key elements in the multivitamin-antioxidant combination. (Two a day is probably sufficient if you’re just interested in matching the K-PAX formula, but three or more can help if you’re dealing with neuropathy.)
 2) The multivitamins available through NYBC have somewhat different formulas than the K-PAX (see product labels available on the NYBC website for details). Taking an extra vitamin C tab along with the regular multi would make up for one significant difference. And some might wish to take a bit more calcium and vitamin D3 than Added Protection offers, as bone loss remains a concern among people with HIV.
 3) K-PAX only comes with iron; for those with liver trouble, this might NOT be a good idea. With the multivitamin Added Protection, you can choose whether to take iron or not. And Ultra Preventive Beta, another Douglas Labs multi, offers in addition to a standard multivitamin formula a variety of food-based nutrients, for an additional $3 per month. If you’d like more information on NYBC’s low-cost alternative to K-PAX, or if you’d like help in ordering the alternative package, please email us at contact@newyorkbuyersclub.org and we’d be glad to assist.