February 27, 2012
Neuropathy pain and HIV: supplement recommendations
You may have read reports in late February 2012 about the FDA’s skeptic ism about a patch called Qutenza, which had been tested for relief of neuropathy pain in people with HIV. Following a meeting to review the evidence, an FDA panel concluded that Qutenza, whose active ingredient is a synthetic form of capsaicin (the compound that makes chili peppers hot) was not effective for HIV-related neuropathy pain.
The FDA’s finding on Qutenza reminds us again that neuropathy (generally, pain or tingling in the extremities) continues to be one of the most troublesome effects of HIV/AIDS and/or its treatment—and one of the most difficult to manage. According to a survey report in 2010, for example, more than one third of those on combination antiretroviral therapy for HIV do experience neuropathy, leading to lower quality of life and often disability. So, it may be worthwhile to repeat some of NYBC’s recommendations on this topic:
Peripheral neuropathy: “nukes” (nucleoside reverse transcriptase inhibitors) such mas ddI (Videx), and d4T (stavudine/ Zerit) – and Indinavir, T20, and even 3TC (Epivir)may all cause this feeling of pins and needles or numbness to toes and fingers. It can travel up the legs and become debilitating. HIV, diabetes, alcohol abuse, and vitamin deficiencies can all be causes of peripheral neuropathy. Supplements that are “good for your nerves” and that have the most robust data include acetylcarnitine (1-3 grams/ day, quite well studied for peripheral neuropathy) and alpha lipoic acid (200-600 mg/day). Other agents that can help are Vitamin B12, biotin, lecithin, magnesium, borage oil, evening primrose oil, choline and inositol.
See the NYBC website for more details about these supplements:
http://nybcsecure.org/
February 6, 2012
The Versatile Vitamin C
Most people associate Vitamin C with help in reducing cold symptoms. Indeed studies have shown that taking high-dose Vitamin C (500- 1000mg every hour) at the first sign of a cold can shorten its duration by one-third, helping to relieve symptoms faster. Vitamin C revs up the immune system by increasing the body’s production of antibodies, white blood cells, and interferon (a natural antiviral), and so it may be effective against many infections.
But that’s not the only way Vitamin C can keep you healthy. Here’s another major benefit of this versatile vitamin:
Joint health. Vitamin C’s anti-inflammatory properties help the body maintain cartilage, the all-important connective tissue that keeps your joints working smoothly. It’s also important to note that NSAIDS (nonsteroidal anti-inflammatory drugs), a whole group of drugs commonly used for arthritis pain, regularly deplete Vitamin C, so anyone taking these medications (which range from aspirin to prescription items like Celebrex) absolutely needs to replace the lost Vitamin C. In short, supplementing with 1000-3000mg of Vitamin C per day is essential if you’re also taking NSAIDS.
For some Vitamin C supplement choices, see NYBC’s descriptions of:
C1000- Ascorbic Acid Plus Olea
January 10, 2012
What’s in Your Medicine Cabinet for Cold & Flu Season?
Here are some recommended supplements great for cold and flu season that have been the subject of recent, good research.
Vitamin D. According to some recent thinking, the “cold and flu season” may actually be the “Vitamin D deficiency season.” As the days grow shorter, people get less sunshine, leading to a decline in the body’s levels of this vitamin, which is essential to good health in many more ways than we used to think. Taking Vitamin D during the winter may therefore be one of the most effective ways to prevent colds and flu. Many researchers who’ve studied Vitamin D now recommend at least 1000 IU/day, but those with a known deficiency may be advised to supplement at even higher levels. There’s a simple test available to check for Vitamin D deficiency – ask your doctor.
Cold Away. This blend of Chinese herbs from Health Concerns is designed to “clear external heat and alleviate symptoms of the common cold.” A key component of this formula is the herb andrographis, which in several recent US studies was found to significantly decrease cold symptoms and the duration of a cold; it may also be useful for prevention. (NYBC stocks over 20 varieties of Traditional Chinese Medicine formulas, by the way.)
Vitamin C. Many good studies have shown a decrease in cold symptom duration, but no benefit for prevention. According to a guide to natural products published by the American Pharmacists’ Association in 2006, taking between one and three grams of Vitamin C per day may decrease cold symptoms (sore throat, fatigue, runny nose) by one to 1½ days.*
N-acetylcysteine (NAC) supports respiratory and immune system function. It has been studied extensively for chronic bronchitis. NAC is also the antidote for acetaminophen poisoning, now the leading cause of liver disease in the US. (Acetaminophen’s best-known tradename is Tylenol®, but it’s also found in many other drugs, so it’s become all too easy to overdose.)
One popular way to take NAC is to use PharmaNAC, notable for its careful quality control, pleasant “wildberry” flavor, and effervescent fizz!
Botanicals. In Traditional Chinese Medicine, astragalus is used for chronic respiratory infections, for colds and flu (both prevention and treatment) and for stress and fatigue. It contains complex sugar molecules called polysaccharides, which some studies show stimulate virus-fighting cells in the immune system. Researchers at the University of Texas and M.D. Anderson Cancer Center have turned up convincing evidence that astragalus boosts immune responses in lab animals, and in human cells in lab dishes.
Elderberry extract (as found in Jarrow Formulas’ Wellness Optimizer) and American ginseng (found in two Health Concerns formulas) are two other botanicals that have been studied for cold and flu symptoms in recent North American research, with some promising results. Also, a study conducted by Israeli scientists showed that elderberry extract suppressed the growth of influenza viruses in lab dishes. The same research team reported that patients given the extract recovered from the flu faster. The perennially popular echinacea, however, has generally disappointed in cold prevention studies, but is still touted by some as beneficial at the onset of a cold.
Probiotics. They say the best defense is a good offense, so consider upping your intake of the beneficial bacteria found naturally in such things as kefir (the lightly fermented milk beverage) and yogurt: they boost the flora in your intestinal tract, which is where an estimated 80% your immune system resides.
NYBC stocks eight varieties of probiotic supplements, ranging from Florastor capsules, a favorite of international travelers, to the 40 billion beneficial baceteria-per-capsule Ultra Jarro-Dophilus, to Green Vibrance, a powder added to fruit juice or another beverage of choice (complimentary shaker cup included!).
*Natural Products: A Case-Based Approach for Health Care Professionals, ed. Karen Shapiro. Washington, DC: American Pharmacists’ Assoc. (2006), “Cold and Flu,” pp. 173-192.
January 20, 2011
Vitamins C and D for osteoarthritis
There’s a lot of scientific evidence that simply supplementing with key vitamins C, D, E and B complex can improve joint health and reduce symptoms of osteoarthritis.
Osteoarthritis is the most common form of joint disease and a leading cause of disability in older people. The usual recommendations for managing the disease concentrate on relief of symptoms, using agents such as non-steroidal anti-inflammatory drugs (NSAIDs – “pain relievers”). These drugs, however, do have significant side effects and don’t slow the progression of osteoarthritis.
Perhaps the most important of all the vitamins for osteoarthritis is vitamin C, which slows inflammatory response in the body (and moreover has many other health benefits, such as reduction of cardiovascular risk). Here are two important studies on vitamin C and osteoarthritis:
•The Framingham Osteoarthritis Cohort Study found that moderate intake of vitamin C (120-200 mg/day) yielded a three-fold lower risk of osteoarthritis progression. The association was strong and highly significant, and was consistent between sexes and across different severities of the disease. The higher vitamin C intake also reduced the likelihood of development of knee pain.
•A smaller 2003 study from Denmark carefully tested 1 gram/day of calcium ascorbate (containing 898mg Vitamin C) versus placebo for people with verified osteoarthritis of the hip and/or knee. The main finding was that vitamin C reduced pain significantly compared to placebo.
As for Vitamin D: bone and cartilage metabolism depend on the presence of vitamin D. Several studies of vitamin D suggest adequate intake of vitamin D may slow the progression and possibly help prevent the development of osteoarthritis. See, for example, the older study, “Vitamin D and bone health in the elderly,” in the American Journal of Clinical Nutrition in 1982; and again, in the Framingham study mentioned above, risk of osteoarthritis progression was seen to increase three-fold in participants with the lowest levels of vitamin D intake and serum levels of vitamin D.
For recommendations on how best to take these vitamins see NYBC entries at
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/
June 17, 2010
Get the Lead Out!
This article, Why Lead Poisoning May Be Causing Your Health Problems, suggests that many of us may have lead in our tissues, any amount actually being “excessive” (if not necessarily obviously toxic). He suggests, among other things, extra vitamins C and D3, which makes sense. We’re curious if NAC might not also be part of such a program as it can help chelate some heavy metals.
February 20, 2009
Time to throw out the supplements? Comments on The New York Times article: “Vitamin Pills: A False Hope?”
Several people have asked us to comment on recent news stories about research showing that taking vitamin pills has little if any health benefit, and in fact may be harmful in certain instances (such as for people with a cancer diagnosis). A representative article in this vein is the New York Times piece “Vitamin Pills: A False Hope?” by Tara Parker-Pope, published Feb. 16, 2009, and accessed by us online at http://www.nytimes.com/2009/02/17/health/17well.html.
Here’s our commentary, which takes its start from a key passage in the article:
NYT: In any event, most major vitamin studies in recent years have focused not on deficiencies but on whether high doses of vitamins can prevent or treat a host of chronic illnesses. While people who eat lots of nutrient-rich fruits and vegetables have long been known to have lower rates of heart disease and cancer, it hasn’t been clear whether ingesting high doses of those same nutrients in pill form results in a similar benefit.
NYBC BLOG: 1. In fact, most of the studies making news are surveys of people with no known vitamin deficiency and no evident health problem. The studies cited generally found that there was no improvement in rates of disease development over time (heart disease and cancers, primarily) for people taking the vitamins, as opposed to those who didn’t. On the other hand, NYBC’s interest has focused on the detection of vitamin deficiencies in people with chronic illnesses such as HIV, and then targeted supplementation and its results. For example, supplementation with Vitamin D (plus calcium) in people that are deficient has been found to have benefit, both for bone health and for reduction of cardiovascular disease risk (and, according to more recent research, for cancer risk as well). The same goes for supplementation with people deficient in minerals; in a well-known study, University of Miami researchers identified selenium deficiency in people with HIV, and also found that supplementing with this mineral improved health in this group. More generally, many vitamin and other nutrient deficiencies have been detected in people with HIV, and there have been many studies showing health benefits from supplementing to counteract these deficiencies. So, in conclusion, we are not terribly surprised if people with no known vitamin deficiencies and no known health problems are found not to gain much, if any, health benefit from taking vitamins–but that’s really a different question from those (many) studies showing that specific deficiencies and their related disease states can often be successfully addressed by supplementation.
2. Regarding vitamins and cancer: we certainly recommend caution here, and have frequently referred people to the Memorial-Sloan Kettering Cancer Center website on complementary medicine for guidance. Studies have indicated that vitamin supplementation (with C, for example) can accelerate certain cancers. However, as the MSKCC website shows, there is wide interest in, and much evidence for, use of certain dietary supplements as adjuncts in cancer therapy. The world of dietary supplements is much bigger than just the short list of vitamins; and research on supplements and cancer is a major topic among projects funded by such sources as the federal government’s National Center for Complementary and Alternative Medicine. Indeed cancer research has focused quite often on the therapeutic potential of botanical sources. The cancer drug paclitaxel, to give just one example, derives from the yew tree; and many traditional botanicals continue to be studied for their anti-cancer properties: turmeric/curcumin, green tea (with its polyphenols), silymarin, astragalus, to name just a few.
3. While the vitamin studies reported in the NYT article are negative, no one disputes the fact that nutrition has an enormous impact on health. In fact, the New York Times also recently ran articles reiterating the substantial health benefits of the “Mediterranean diet” (good fats like olive oil rather than bad fats; fish rather than meat; carbs from beans, peas, lentils; more veggies than meats), which has been associated with lower risk of heart disease and–in a newer area for research–a lower risk of depression and other mental health disorders. So, can the clear health benefits of a particular diet be translated in any useful way to the field of supplements? One obvious “yes” comes in the increased study and use of fish oil/omega-3 fatty acid supplements over the last few decades. Here’s a case in which an individual nutrient within a healthful diet has been isolated and can be usefully delivered as a supplement that bestows health benefits. (Fish oil supplements have a particular advantage over food sources, too: they can be refined to eliminate mercury contamination, a growing concern these days, whether you are eating fresh or canned fish.) We certainly know that it is possible to extract a component from food and use its particular properties to confer a health benefit, while leaving behind some other parts of the food that we don’t want or need. (This is the case with whey protein powders, which leave behind milk fat, but keep the whey protein with its interesting nutritional benefits.)There may also be increasing recognition that effective supplementation can require a wide-spectrum approach. Instead of emphasis on single vitamins, we’ve known for a while that the B vitamins work together and are usually best taken as a complex; or that a complex of carotenoids from vegetable sources is probably better than just a few select samples of these compounds. Of course, we would like to have more research about the particular value conferred by “food-based” supplements such as the popular “green foods.” In short: do choose a good diet to stay healthy, but don’t throw out the supplements, which can also make their contribution to your health and well-being!
January 27, 2009
“Good Fats/Bad Fats”: new dietary recommendations for supporting heart health and reducing cardiovascular risk
We were interested to read the Personal Health column by Jane Brody in the New York Times earlier this month. The article was entitled New Thinking About How to Protect the Heart, but you might also give this advice column on cardiovascular health the title of “Good Fats/Bad Fats.”
The main reason for revisiting diet recommendations for people trying to reduce their risk of heart attack is a new focus on the importance of inflammation in assessing cardiovascular risk. It’s been found, for example, that even people with normal cholesterol levels have a heightened risk of heart attack if they have a high reading of C-reactive protein (CRP), a marker of inflammation that correlates with clots that block blood flow to the heart.
So, if it’s not just cholesterol levels that people should be watching in order to minimize cardiovascular risk, what kind of diet should they be following to support a healthy heart? The short answer is not entirely new: it’s the Mediterranean diet, which actually turns out to be quite high in fats–think olive oil, oily fish, nuts, seeds and certain vegetables. It’s just that these are sources of “good fats”–not the heart-unfriendly saturated fats (=solid at room temperature) derived from red meats and cheese. And guess what? These “good fats” are found not only to lower cholesterol ratios, but also to decrease inflammation levels.
Recent studies, from the last 10 years or so, are pretty clear in showing the value of the Mediterranean diet, which is not only tasty and easy to follow for most people, but also appears to reduce the rates of heart disease recurrence and cardiac death by 50 to 70%.
As cardiovascular research sorted out the role of inflammation markers and the good fat/bad fat distinction, there also emerged a better understanding of the potential of supplements to maintain heart health. Fish oil, with its heart-healthy omega-3 fatty acids, is now widely recognized as a useful supplement for reducing cardiovascular risk. Other supplements, which incorporate elements of the Mediterranenan diet (such as olives), have also become available.
Here are a few entries from the NYBC catalog that are of special interest for this discussion:
Fatty Acids (see especially MaxDHA, and the ProOmega fish oil supplements)
C-1000 Ascorbic Acid plus Olea Fruit Extract This Vitamin C supplement from Jarrow has been enriched with an olive extract in a combination designed to support cardiovascular health.
January 22, 2009
Glutamine and other supplements for gastrointestinal health (and to maintain lean muscle mass): Looking at Westerly Market’s online information about managing HIV/AIDS
Before there was Whole Foods, a friend likes to remind us, there was the Westerly Natural Market on Manhattan’s West Side. One of the nice things about Westerly, we’ve just been informed by the same person, is that they offer a very user-friendly website for those interested in getting more information about supplements, herbs, and how these substances or other “complementary and alternative” therapies are used for various conditions.
So, we took a look at the Westerly website’s Reference Library entry on HIV and AIDS, and found a concise account with several good points. One of these, we thought, was the discussion about maintaining muscle mass and preventing diarrhea, which over time deprives the body of needed protein. Here’s an excerpt:
Using certain supplements may help in maintaining body weight. A well-designed study compared the use of a daily supplement regimen that included enormous amounts of the amino acid glutamine (40 g per day), along with vitamin C (800 mg), vitamin E (500 IU), beta-carotene (27,000 IU), selenium (280 mcg), and N-acetyl cysteine (2,400 mg) to placebo. People who took the supplements gained significantly more weight after 12 weeks than those who took the placebo.
Glutamine is a key supplement here, and has long been recommended by NYBC and its predecessor DAAIR for gastrointestinal support. See the NYBC entry
or
Note that N-acetyl cysteine, Vitamin C and Vitamin E, beta carotene (as Carotenall), and selenium are also available through NYBC’s purchasing co-op–follow the links to see specific recommendations in each category.
January 9, 2009
Vitamin C: what to take, how to take, and why take
The NYBC purchasing co-op stocks several different choices for those who wish to supplement with Vitamin C. We are in the cold season in North America, after all, and, yes, there is evidence that Vitamin C has some effect in shortening the duration and decreasing the intensity of colds. But there are other reasons as well to supplement with this critical antioxidant Vitamin–see some details below.
1. Super C Powder (SuperNutrition).</ Each bottle, 82 grams of sugar-free powder. Each one half teaspoon contains:
Vitamin C (Ascorbic Acid/Ascorbate) – MG – 1,690
Sodium (as sodium bicarbonate) – MCG – 57.5
Potassium (As Chloride & Succinate) – MG – 50
Other Ingredients
Bicarbonate (from sodium & potassium bicarbonate) – MG – 175
Natural Lemon flavoring (from lemons) – Trace
Suggested use is to sip, over 10-15 minutes, a quarter teaspoon in at least one half cup of water (for 845 mg of vitamin C). Or 1/2 tsp in one half cup of water for 1690 mg of C, or a full tsp in a full cup of water for 3,380 mg of vitamin C. Remember that taking too high a dose of C all at once can cause diarrhea!
2. Esterol (Allergy Research Group). Each bottle, 200 tablets. Each tablet contains 675 mg of ester C polyascorbate, 75 mg of calcium polyascorbate, 50 mg of rutin, 25 mg of quercetin, and 2.5 mg of grape seed proanthocyanidins (antioxidant compounds which are also found in high concentrations in blueberries).
This ARG product contains ascorbic acid and calcium in a formulation designed to enhance absorption and retention of vitamin C. (One of the problems in supplementing with Vitamin C is rapid removal from the system.) The ester formulation is non-acidic and should be minimally irritating to the intestines.
ARG Info Sheet on Esterol:
http://www.allergyresearchgroup.com/proddesc/discuss/EsterolPDFProductSheet011106.pdf
3. C powder, Calcium Ascorbate (Source Naturals) Each bottle, 8 ounces of vitamin C as calcium ascorbate. A serving of 1/2 a rounded teaspoon (about 2.7 grams) provides 2,150 mg of vitamin C as calcium ascorbate and 245 mg of calcium. This is a non-acidic form of vitamin C and thus will not harm the teeth (as a powdered ascorbic acid might). It also provides a bit of extra calcium.
4. C1000 – Ascorbic Acid plus Olea Fruit Extract (Jarrow) Vitamin C Overview: Vitamin C is another critical nutrient, an antioxidant and highly efficient free radical scavenger, antiviral, antibacterial and antifungal which should be in any HIV protocol. Vitamin C is responsible for the reactivation of key antioxidants, particularly vitamin E, beta-carotene, and glutathione, after they have been oxidized by donating electrons to neutralize a free radical (known as the redox process). Vitamin C and certain sulfur amino acids are the only water-soluble nutrients which can be taken in sufficiently large, yet safe, quantities to effectively conduct this redox process. Vitamin C is available in both quick and slow release tablets, powders, as well as esterified form (vitamin C chemically bonded with one or more minerals in a compound containing aldonolactones; (see U.S. patent #4,822,816) and effervescent forms. However, note that the Vitamin C Foundation flat out states that ascorbic acid is the only worthwhile vitamin C and everything else is just marketing nonsense. They claim there is no convincing evidence to support superior bioavailability of these other forms that supports their excessive cost. (Of course, take any powdered form of ascorbic acid with care to avoid damaging tooth enamel.)
September 24, 2008
Vitamin C
Vitamin C in a sustained release form (to maintain useful levels over time) is highly recommended for daily use by NYBC. Here’s an excerpt from the website description:
Vitamin C Overview: Vitamin C is another critical nutrient, an antioxidant and highly efficient free radical scavenger, antiviral, antibacterial and antifungal which should be in any HIV protocol. Vitamin C is responsible for the reactivation of key antioxidants, particularly vitamin E, beta-carotene, and glutathione, after they have been oxidized by donating electrons to neutralize a free radical (known as the redox process). Vitamin C and certain sulfur amino acids are the only water-soluble nutrients which can be taken in sufficiently large, yet safe, quantities to effectively conduct this redox process.
For more details, see the complete NYBC entry:
