July 28, 2011
News about Niacin
You may have read worried news reports earlier this year about a study of niacin + a statin drug used to lower cholesterol (lipids). The study was stopped prematurely because researchers detected a small increase in strokes among participants taking the niacin +simvastatin (Zocor) combination. This was quite a surprise to scientists, because niacin (a B-vitamin) has a 50-year history of safe and effective use for normalizing lipid levels, and the suggestion that a statin drug/niacin combination might carry even a slight extra cardiovascular risk was disturbing.
We were therefore glad to see the Canadian AIDS Treatment Information Exchange (CATIE) review and clarify the results of this study, while at the same time reporting on an important new piece of research about niacin, lipid control, and HIV. (You can find the full CATIE reporting about niacin at www.catie.ca.) CATIE’s view, in line with other cautionary voices, stresses that the niacin/statin study data do not show any clear connection between niacin and increased strokes. And it’s also true that, through 50 years of research on niacin and lipids, there’s never been any evidence of such a connection. In short: expect more examination of the issue, but don’t jump to any conclusions—there’s just not the evidence to support dropping niacin for lipid control.
Coincidentally, as the niacin/statin study was being suspended, results of another trial involving niacin for lipid control were being published. This research, conducted at Baylor College of Medicine in Texas, looked at a combination of niacin, fenofibrate (a prescription drug used to lower cholesterol), diet and exercise for lipid management among people with HIV. Called the Heart Positive study, this investigation found that a combination of high-dose niacin, together with fenofibrate, diet and exercise was clearly the best strategy for managing lipids in a group of more than 100 people with HIV. And, significantly–there were no signs in this research that niacin was unsafe.
We certainly urge all our members who use or are thinking of using niacin as part of a strategy to control lipids to talk to their doctors about the recent research. (You may even want to share the CATIE info with your physician.) As we’ve said above, we don’t see clear evidence that niacin poses extra, unexpected risks. Meanwhile, its benefits continue to be documented in research like the Heart Positive study. As always, we need to keep up with research news—and also maintain a bit of skepticism in judging how that news gets reported.
For more information on Niacin, see the NYBC entries:
or the lower, starter dose:
January 2, 2011
Care for your Heart
CATIE has an excellent review of heart health, abstract below. It reviews the risk factors, methods for assessing heart health and means to help reduce risk of heart attack and stroke. There is a special emphasis on issues affecting people living with HIV.
Fact Sheets
HIV and cardiovascular disease: keeping your heart and blood vessels healthy
SummaryCardiovascular disease affects the health of your heart and blood vessels and can lead to heart attacks or stroke. You may think that these are problems that affect only older people. However, emerging research suggests that HIV infection increases the risk for cardiovascular disease, including heart attacks and stroke, even in relatively young people. So, regular monitoring by your doctor of your overall and cardiovascular health should be part of your plan for living longer and living well. Getting on treatment for HIV is one of the best things you can do to stay healthy. This Fact Sheet has many additional steps you can take to reduce your risk for heart attacks, stroke and other complications.
This CATIE fact sheet addresses the potential of certain supplements to support cardiovascular health: Omega-3 fatty acids (fish oil); niacin; carnitine; CoQ10; and chromium (subject of an interesting small study in Canada).
Read more about supplements for cardiovascular health at NYBC’s pages on “Cholesterol/Triglycerides” at
http://nybcsecure.org/index.php?cPath=35 and on “CoQ10″ at http://nybcsecure.org/index.php?cPath=47 (includes practical suggestions for optimizing your use of CoQ10).
November 17, 2010
Nelson Vergel: “Survivor Wisdom”
A Talk by Nelson Vergel: “Survivor Wisdom: Advances in Managing Side Effects, Living Well, and Aging with HIV” – New York City, November 9, 2010
How could you not be impressed by the schedule HIV treatment activist Nelson Vergel keeps? A few days before he arrived in New York to share his “Survivor Wisdom” with New York Buyers’ Club members and guests, he was an invited participant at the 12th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV in London. The founder and moderator of the “pozhealth” group on Yahoo—the largest online discussion group for HIV issues–Nelson also finds time to answer questions on a forum hosted by thebody.com. In addition, he serves as a community member of the federal government’s Department of Health and Human Services HIV treatment guidelines advisory board. And did we mention that he’s the author of a new book, “Testosterone: A Man’s Guide,” especially useful for people with HIV who are considering testosterone therapy to address fatigue and other problems?
As you might expect, Nelson also covered a lot of territory in his NYBC talk, which was co-hosted by the City University of New York’s Graduate Center. He briefly updated the audience on new treatments and guidelines, then reviewed the exceptional case of the HIV+ “Berlin patient,” whose apparent cure following a bone marrow transplant has opened up, at least tentatively, some new lines of research about curing HIV.
Most of Nelson’s talk, however, dealt with familiar issues in managing HIV symptoms and medication side effects: cardiovascular health challenges, lipoatrophy (facial wasting especially) and body fat accumulation (lipohypertrophy), aging with strong bones, fighting off fatigue, minimizing the risk of anal cancer.
Amid this discussion of symptoms and side effects, Nelson spent time on the topic of supplements. His first point, which NYBC would certainly agree with, is that a lot of good evidence has accumulated about the benefit of multivitamin supplementation, and a multivitamin plus antioxidant combination, for people with HIV. These “micronutrients,” as they’re called in the scientific literature, can enhance survival, delay progression of disease in people not yet on HIV meds, and increase CD4 counts in people taking the meds. We have to admit we were pleased when Nelson also took a moment to praise NYBC (and especially our Treatment Director George Carter) for making available an inexpensive, “close equivalent” of the multivitamin/ antioxidant combination that was the subject of Dr. Jon Kaiser’s well-known research and that led to the development and marketing of K-PAX. New York State residents, as Nelson pointed out, have access to many such supplements through formularies. But for residents of other states, this half-price version of the multivitamin/antioxidant combination (MAC-Pack or Opti-MAC-Pack) can provide welcome relief in the budgetary department.
Our speaker then ran through a list of about a dozen supplements that have reasonably good evidence to support their use by people with HIV. He chose to focus more closely, however, on just a few:
Niacin. Despite “flushing” that makes it difficult for some to use, niacin can be very effective in bringing up levels of HDL (“good”) cholesterol in people with HIV. Since cholesterol control is a major long-term health issue for many people on HIV meds, and since recent research suggests that raising HDL cholesterol levels may be an extremely important factor in reducing cardiovascular risk, niacin may be a top choice for many. (Fish oils/omega-3 fatty acids, plant sterols, pantethine, carnitine, and CoQ10 are other supplements that NYBC and many others put in the category of “supports cardiovascular health.”)
Vitamin D. Seems that, even at the London conference Nelson had just attended, the “sunshine vitamin” was a hot topic. Partly that’s because people with HIV have recently been found to have a high prevalence of Vitamin D deficiency, and then because Vitamin D, calcium and other mineral supplementation is a logical approach to addressing long-term challenges to bone health in people taking HIV meds. (Look on the NYBC blog for a whole host of other recent studies about Vitamin D’s potential benefits, from reducing cardiovascular risk to cancer prevention—even as a way of warding off colds and flu.)
Carnitine. This is a supplement, Nelson told the audience, that he’s taken for many years. Reported/perceived benefits: to improve fatigue, lipids, brain function and neuropathy. (NYBC Treatment Director George Carter put in that “acetyl-carnitine”—a form of the supplement that crosses the blood/brain barrier–has shown the most promise for dealing with neuropathy.)
Probiotics. The vulnerability of the gut in HIV infection, and the well-documented problems people with HIV experience in absorbing nutrients, make probiotics a very helpful class of supplements for long-term health maintenance. (Probiotics, good or “friendly” bacteria residing in the gut, are available in a variety of products, from yogurt to supplements. There’s quite a bit of research about the effectiveness of different varieties, and note as well that there are some newer formats that don’t require refrigeration.)
Above and beyond the treatment issues involving supplements, meds, and other strategies, Nelson referred several times to areas where there’s a need for advocacy. He mentioned the cure project, for one, but also a national watch list to help people follow and respond to the devastation created by recent funding cuts and the resultant waiting lists in the ADAP programs of many states, such as Florida.
All in all, NYBC members and guests would doubtless agree: a very thought-provoking presentation, with much helpful information to take away. For more on these and other issues, be sure to check out the NYBC website at:
http://www.newyorkbuyersclub.org/
[A version of this article also appears in NYBC's free e-newsletter, THE SUPPLEMENT, along with additional reporting on a new Mayo Clinic guide to supplements, and a look at the current state of regulation and research on supplements in the US.]
October 14, 2010
Mayo Clinic’s Guide to Alternative Medicine 2011
This is an easy-to-read, magazine-style guide created by the Mayo Clinic, the world-famous healthcare facility which also happens to have a long-standing receptiveness to alternative and complementary therapies for wellness and prevention. (That’s one of the reasons why it has recently been cited as an example of best practices in American healthcare–the kind of practices that need to be more widely imitated.)
The section on dietary supplements provides capsule reviews of the scientific evidence for the safety and effectiveness of several dozen popular products, from botanicals like ginseng, echinacea and St. John’s Wort, to vitamins C, D, E, B-3 (niacin), and B-9 (folate or folic acid), as well as minerals like selenium, calcium and zinc. Also discussed are fairly well-known categories of supplements, including probiotics and omega-3 fatty acids (these often obtained with fish oil supplements).
The guide rates these supplements with a green, yellow or red light symbol, depending on the strength of the evidence for their use and their safety profile. We weren’t too surprised by most of the ratings. For example, green for niacin, folic acid, Vitamin C and Vitamin D, but a yellow caution light for Vitamin E, which has shown no effectiveness in several good studies dealing with cardiovascular health and cancer, leading some researchers to wonder if the standard “alpha-tocopherol” form of the vitamin is a good format for supplementation. Also, a yellow light for St. John’s Wort, not because it isn’t effective for mild/moderate depression, but because it can interact with a lot of other medications.
Other supplements getting the green light from the Mayo Clinic editors: SAMe (for depression); saw palmetto (for enlarged prostate); green tea (for cardiovascular health, possibly for cancer prevention, and apparently–according to a large epidemiological study–for longevity); gamma linolenic acid (for peripheral neuropathy); CoQ10 (for cardiovascular health, for which it’s used by millions in Japan); glucosamine chondroitin (for osteoarthritis).
Also getting the green light, a supplement most have probably never heard of, but which is featured in the Health Concerns formula Cold Away, available from NYBC: the botanical Andrographis (a cold remedy, showing promise where many other products have disappointed).
See the NYBC entries for more details on how best to take supplements:
http://www.newyorkbuyersclub.org/
May 8, 2010
Niacin to increase HDL
Helping reduce cardiovascular risk is crucial. This may be a safer and smarter way than use of the limited statins that can by used along with antiretrovirals (ARV). However, some people have significant flushing and itching reactions; this can be offset by the use of lower doses, gradually escalating over time.
“In summary, this pilot study demonstrated that short-term niacin therapy could improve endothelial function in HIV-infected individuals on stable ART who have low HDL-c.”
AIDS: 24 April 2010
Chow, Dominic C; Stein, James H; Seto, Todd B; Mitchell, Carol; Sriratanaviriyakul, Narin; Grandinetti, Andrew; Gerschenson, Mariana; Shiramizu, Bruce; Souza, Scott; Shikuma, Cecilia aHawaii Center for AIDS, University of Hawaii John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA bDivision of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA cPublic Health Sciences, University of Hawaii, Honolulu, Hawaii, USA.
Abstract
Objective: To assess the short-term effects of extended-release niacin (ERN) on endothelial function in HIV-infected patients with low high-density lipoprotein-cholesterol (HDL-c) levels.
Methods: Randomized controlled study to determine the short-term effects of ERN on endothelial function, measured by flow-mediated vasodilation (FMD) of the brachial artery, in HIV-infected adults with low HDL-c. Participants on stable HAART with fasting HDL-c less than 40 mg/dl and low-density lipoprotein-cholesterol less than 130 mg/dl were randomized to ERN or control arms. ERN treatment started at 500 mg/night and titrated to 1500 mg/night for 12 weeks. Controls received the same follow-up but were not given ERN (no placebo). Participants were excluded if they had a history of cardiac disease, uncontrolled hypertension, diabetes mellitus, or were on lipid-lowering medications such as statins and fibrates. Change in FMD was compared between arms with respect to baseline HDL-c.
Results: Nineteen participants were enrolled: 89% men, median age 50 years, 53% white/non-Hispanic, median CD4 cell count 493 cells/µl, and 95% of them had HIV RNA below 50 copies/ml. Participants receiving ERN had a median HDL-c (interquartile range) increase of 3.0 mg/dl (0.75 to 5.0) compared with -1.0 mg/dl in controls (-6.0 to 2.5), a P value is equal to 0.04. The median change in FMD was 0.91% (-2.95 to 2.21) for ERN and -0.48% (-2.65 to 0.98) for controls (P = 0.67). However, end of study FMD for ERN was significantly different from controls after adjusting for baseline differences in FMD and HDL-c, 6.36% (95% confidence interval 4.85-7.87) and 2.73% (95% confidence interval 0.95-4.51) respectively, a P value is equal to 0.048.
Conclusion: This pilot study demonstrated that short-term niacin therapy could improve endothelial function in HIV-infected patients with low HDL-c.
Introduction
The incidence of myocardial infarction (MI) in HIV-infected individuals has been increasing. Although much of the coronary artery disease (CAD) risk in the HIV population has been attributed to elevated levels of low-density lipoprotein-cholesterol (LDL-c) and hypertriglyceridemia, low levels of high-density lipoprotein-cholesterol (HDL-c) also contribute to CAD risk. In the general population, low serum levels of HDL-c are associated with increased risk for MI, restenosis after angioplasty, sudden cardiac death, and stroke [1-3]. The primary mechanism by which HDL-c exerts its atheroprotective effect is believed to be reverse cholesterol transport; however, HDL-c also has antioxidant effects [4]. Additionally, HDL-c has direct arterial effects that help preserve endothelial function. Endothelial dysfunction is an early phenomenon in atherosclerosis that precedes structural changes of the arterial wall and clinical manifestations of CAD [5]. This protective effect of HDL-c on endothelium-dependent vasoreactivity may depend on the binding of HDL-c to scavenger receptor class B type I and subsequent stimulation of nitric oxide formation [6]. HDL-c activates both extracellular signal-regulated kinase 1/2 and Akt, resulting in enhanced stability of endothelial nitric oxide synthase [7].
In dyslipidemic HIV-infected patients on stable antiretroviral therapy (ART), low levels of HDL-c have been associated with endothelial dysfunction [8]. Moreover, use of statins in HIV-infected patients on ART improves endothelial function [9]. We hypothesized that increases in HDL-c associated with the use of niacin also would improve endothelial function in HIV-infected individuals. Therefore, we conducted a pilot study to assess the effects of niacin on endothelial function in HIV-infected patients with low HDL-c levels.
(click above for the complete article on NATAP)
April 23, 2010
Niacin for heart health in diabetics
A news item in the journal Diabetes Forecast reported that taking the B vitamin Niacin in addition to statin drugs was a good way to increase the amount of HDL cholesterol (the so-called “good” cholesterol, as opposed to the “bad” or LDL cholesterol) for diabetics who were being treated for high cardiovascular risk.
Higher levels of HDL cholesterol have been linked in a number of studies to lower risk for heart attack, so Niacin appears to be a good way for diabetics to reduce one of the main health challenges of their condition.
Reference: “Vitamin B for your heart,” in Diabetes Forecast, April 2010.
NYBC stocks Niacin in two strengths:
and
Please read the NYBC entries on these two products for recommendations on how to gradually increase Niacin dosage in order to minimize “flushing” (redness, itchiness) that can be associated with taking Niacin.
December 22, 2008
Nutritional supplements to reduce cardiovascular risk
Here’s an excerpt from the Fall 2008 issue of the New York Buyers’ Club SUPPLEMENT . (You can read the full issue online at http://www.newyorkbuyersclub.org/supplement/, where you’ll also find an archive of past numbers.)
It’s all about managing risk.
People try to control risk all the time, whether it’s kids learning to cross the street on green, people buckling their seat belts when getting into the car, or a smoker looking at the statistics relating tobacco use to cancer and heart disease and deciding that now is the time to quit.
Earlier this year, a group of experts on HIV and heart disease recommended that people with HIV pay special attention to monitoring and controlling cardiovascular risk factors like high cholesterol and diabetes. Overall, according to currently available evidence, the risk of heart attack is approximately 70% to 80% higher for HIV-positive people than for HIV-negative people. This increased level of risk is likely due in part to HIV itself, and in part to HIV medications. Some typical cardiovascular warning signs for people with HIV include reduced levels of HDL (“good cholesterol”) and high triglycerides, or a tendency toward pre-diabetes. The panel of experts, which was convened by the American Heart Association and the American Academy of HIV Medicine, found indications that even HIV+ children on meds have early development of these kinds of cardiovascular risk factors.
You may also have heard recent news stories about the HIV medication abacavir and elevated risk of heart attack. A commonly used HIV med in the family of drugs called nucleoside analogs (“nukes”), abacavir is part of the combination drugs Ziagen and Trizivir. Two studies based on large databases have detected an association between abacavir and increased risk of heart attack. Although there isn’t an exact understanding of how abacavir (or another nuke, ddI) could cause higher risk of heart attack, the research does suggest that people with other cardiovascular risk factors, such as smoking or high cholesterol, are at the greatest risk.
Which brings us back to our original point: it’s all about managing risk—knowing the risk factors, then lowering them as much as you can. And that’s where nutritional supplements can be helpful.
At the top of the list of supplements to support cardiovascular health is fish oil, with its key component being the omega-3 fatty acids. Since 2005, the American Heart Association, following a hefty accumulation of scientific evidence, has recommended daily intake of fish oil for people with cardiovascular disease. And there has been research specifically looking at fish oil for people with HIV who have elevated cardiovascular risk. For example, a 2007 study of HIV+ people who had high triglyceride levels found that fish oil supplementation reduced these levels by 25% or more. Also of note: fish oil supplementation for people with HIV is being studied in federally funded research that examines how this supplement might counter the effects of lipodystrophy, a syndrome that includes blood lipid abnormalities.
People with HIV are often prescribed statin drugs like Lipitor to lower cholesterol and reduce cardiovascular risk, and while these drugs can be effective, they may also produce side effects, including joint and muscle pain and changes in mood and thinking ability. Many integrative health specialists endorse the idea of taking the supplement CoQ10 along with statins, since depletion of this nutrient by statins may be linked to some of the drug’s major side effects. Moreover, research suggests that, due to its antioxidant and blood-thinning properties, CoQ10 when combined with a statin decreases heart disease risk more than just the statin alone. Similarly, there is important research indicating that statins together with niacin can be more effective at reducing cardiovascular risk over the long term than just the statins. Though niacin dosage may have to be slowly increased in order to avoid “flushing” (redness, itchiness), strong scientific evidence for this supplement’s effectiveness and safety dates back to the 1970s, and indicates that it may be especially helpful in bringing up levels of HDL (“good cholesterol”), which is now regarded as a very significant marker for assessing cardiovascular risk.
A few months ago we were impressed by a talk given by Dr Jon Kaiser, an HIV physician with extensive experience in integrating nutrition and nutritional supplementation into his health care practice. While Dr. Kaiser ranged over several topics, including his well-known interest in the benefits of general micronutrient support for people with HIV, he also had much to say about controlling cholesterol levels with nutritional supplements. His approach consists of low-dose niacin (low dose to minimize flushing), fish oil, plant sterols and pantethine. As he’s started to follow case histories over the past few years, he’s become quite encouraged by the results, and believes that many people with HIV could achieve good results (comparable to those offered by statins, but without the side effects) by adopting this kind of combination therapy.
In the past year, NYBC has begun stocking a Douglas Labs product called CardioEdge, which, like Dr Kaiser’s approach, involves a combination of supplements (including plant sterols) to manage cholesterol. We’ve also recently added a Jarrow product, Pressure Optimizer, which combines several supplements (including theanine from green tea) that are useful in maintaining normal blood pressure. (High blood pressure is a major risk factor for cardiovascular disease, and it’s one of the first issues anyone should address in bringing down heart attack risk.)
We find that physicians who are knowledgeable about nutrition and nutritional supplements have a lot of useful advice to offer when it comes to controlling cardiovascular risk. For example, Dr Hyla Cass, author of the book Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (recently reviewed on the NYBC blog), calls attention to the fact that metformin, the most frequently prescribed diabetes drug in the US, depletes the B vitamins and thus can cause a spike in the body’s levels of homocysteine, a substance linked in recent research to high cardiovascular risk. To counter this danger, she emphasizes the need to supplement with B vitamins when taking metformin.
In line with much current scientific thinking, Dr Cass also believes that cholesterol level by itself is not an adequate measure for assessing cardiovascular risk. In addition, it’s necessary to look at underlying inflammatory processes in order to comprehend the threats to heart and circulatory system health. That’s why Dr. Cass recommends that people who want to reduce their risk of cardiovascular disease should develop a diet plan centering on anti-inflammatory nutrients. She suggests a diet high in antioxidant-rich foods—colorful fruits and vegetables, curry, rosemary, ginger, green tea, dark chocolate, and low-toxin fish like salmon or sardines. (Actually could make for quite a tasty menu, don’t you think?)
To conclude: yes, it’s sobering when researchers warn about increased cardiovascular risk for people with HIV. But there’s also general agreement that cardiovascular risk is very susceptible to management by choices in diet and nutrition. (Exercise and quitting smoking are also important!) So, while you can’t control everything in life, remember that there are many choices you can make to significantly reduce your cardiovascular risk.
Nutritional supplements discussed in this article: fish oil, CoQ10, niacin, plant sterols, pantethine, B vitamins; and the proprietary formulas CardioEdge and Pressure Optimizer.
September 26, 2008
Lipodystrophy: some comments from Nelson Vergel
Nelson Vergel, long-time AIDS treatment activist and community expert on lipodystrophy, recently posted a good set of guides to understanding this topic:
–D4T and AZT linked to lipoatrophy; some protease inhibitors linked to insulin resistance, which can be related to higher triglycerides and fat cell size in some patients
–exercise helpful for maintaining lean body mass; anabolic steroids for help in regaining normal weight
–supplements like omega-3/fish oil and niacin to help statins and fibrates to lower bad cholesterol (LDL), triglycerides and increasing good cholesterol (HDL)
Also included in the post are reviews of some regimen-switching strategies to counter lipodystrophy.
“Unfortunately,” Nelson concludes, more research is still needed on “lower glycemic index diets, good comparison data of what happens to visceral fat when different protease inhibitors or non-nucleosides are used with Truvada in naives with low and higher CD4 at baseline, diet/exercise combinations, and other supplements like carnitine and others.”
Read the full entry at thebody.com.
May 23, 2008
“HIV Lipodystrophy: Where are we after ten years?” – Nelson Vergel, in GMHC Treatment News, July-Dec. 2007
We’d like to recommend this article, by long-time AIDS treatment activist Nelson Vergel, which appears in the July-Dec. 2007 issue of GMHC’s Treatment News
It’s available online at
http://www.gmhc.org/health/treatment/ti/ti21_3_4.html#3
Lipodystrophy has been one of the most discussed side effects of HIV medications in the past ten years, and, as this article points out, its potentially devastating psychological effects have added urgency to the search for scientific understanding about the condition, and treatment options to address it.
This excellent summary divides the discussion into three parts:
–lipoatrophy (fat loss in the face, buttocks, arms and legs)
–lipohypertrophy (fat accumulation in specific areas of the body such as the neck, belly, upper torso, and breasts)
–lipid abnormalities (high LDL ["bad"] cholesterol and triglycerides, low HDL ["good"] cholesterol)
Nelson outlines how Zerit and AZT were especially implicated in lipoatrophy; he also sorts through the ongoing uncertainties about the origins of lipohypertrophy and lipid abnormalities in people with HIV on HAART.
This article is also very useful in reviewing the treatment options for these three conditions, including facial wasting reconstruction therapies like Sculptra (formerly Newfill) for lipoatrophy; prescription drugs for lipohypertrophy (testosterone or Metformin*); nutritional supplements like fish oil and Niacin for lipid abnormalities (these are often most successful when used along with diet and exercise programs, and can enhance the effectiveness of prescription statins).
Nelson Vergel continues to do a great service in making this kind of treatment information available to PWHIV. For more info, you can also visit the website www.facialwasting.org, or subscribe to the pozhealth internet HIV health discussion group by sending a blank email to pozhealth-subscribe@yahoogroups.com.
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*See the recent post on this Blog for a recommendation about supplementing with B vitamins when taking Metformin.
April 30, 2008
Recommendations for Cardiovascular Health: from “Supplement Your Prescription,” by Hyla Cass, M.D.
We return to this excellent guide published in 2007 by Hyla Cass, a practicing physician and expert on integrative medicine.
In Chapter 4 of the book, Dr. Cass reviews recent findings that call into question the idea that dietary cholesterol causes cardiovascular disease. In line with the current scientific thinking on this subject, she suggests looking at underlying inflammation as essential to any understanding of risks to heart and circulatory system health. As a consequence, she says, people who want to reduce risk of cardiovascular disease should consider dietary changes that are anti-inflammatory (that is, a diet high in antioxidants, anti-inflammatory herbs, and antioxidant-rich foods–that’s colorful fruits and vegetables, curry, turmeric, rosemary, ginger, green tea, dark chocolate, low-toxin fish like salmon or sardines).
Statin drugs, though they come with some side effects, have proven of benefit to certain groups of people with cardiovascular complications, including diabetics, those who have had a heart attack, and those diagnosed with cardiovascular disease. Like many others, Dr. Cass recommends supplementing with CoQ 10 if you’re taking statins. She also supports use of omega-3 fatty acids (from fish oil), niacin (though not recommended for diabetics), plant sterols, tocotrienols (a form of the antioxidant vitamin E), and D-ribose for controlling cholesterol and otherwise countering cardiovascular disease. In addition, the B vitamins are recommended to help lower homocysteine, high levels of which are associated with artery damage and increased risk of heart disease.
Citation: Hyla Cass, M.D., Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (Basic Health Publications, 2007).
March 25, 2008
Nutritional Management of Lipodystrophy: A Simple Fact Sheet from ATDN
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
