Taking Vitamins and Minerals When You’re HIV+ Some Advice from the Canadians

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.

Levels of vitamin B12 in the blood may be low in people with HIV. It can also be low in people over the age of 50 years. B12 deficiency is associated with an increased risk of peripheral neuropathy, decreased ability to think clearly, and a form of anemia. People with low B12 levels usually feel extremely tired and have low energy. This deficiency is also linked with HIV disease progression and death. Ask your doctor to check your blood levels. If they’re low, ask about B12 injections to get them back into the ideal range.

If you get B12 shots and your vision is getting worse, mention it to your doctor, especially if you are a smoker. Some forms of injectable B12 can damage your eyes if you have a rare genetic condition called Lerber’s hereditary optic atrophy.

Vitamin C is one of the most important antioxidants. It is very effective at cleaning up molecules that damage cells and tissues (see “Antioxidants and HIV,” this chapter). Vitamin C has been studied for cancer prevention and for effects on immunity, heart disease, cataracts and a range of other conditions. Although vitamin C cannot cure the common cold, supplements of 1,000 mg per day have been found to decrease the duration and severity of symptoms.

In people with HIV, there is some evidence that vitamin C can inhibit replication of the virus in test-tube experiments, but it is unclear what this means in the human body. The most important benefit for people with HIV is the widespread antioxidant action of vitamin C. The daily experimental high dose is between 500 mg and 2,000 mg, the upper tolerable limit.

Calcium – see under “Bone health,” below.

Vitamin D is emerging as a very important nutrient, with more diverse functions than just its traditional role in calcium metabolism. Mounting evidence suggests that 1,000 IU per day should be the recommended daily intake.

Vitamin D is found in some foods, but these sources generally do not provide enough vitamin D on a daily basis. Also, people who live in northern climates (like Canada) probably do not get enough sun exposure to make adequate vitamin D. And the use of sunscreen, which is highly recommended to prevent skin cancer, blocks the skin’s ability to make vitamin D.

For people with HIV, vitamin D supplements are a sure way to get the recommended daily allowance. Vitamin D is found in multivitamins and calcium supplements as well as individual vitamin D pills. Look for vitamin D3; it is the active form of the vitamin. Be sure to add up all the vitamin D from different supplements to be sure you are not getting too much.

Vitamin E has been used as an antioxidant, typically at doses of 400 IU per day. However, studies have found that people who take more than 200 IU per day may be at higher risk of developing heart disease. Until this is fully studied, it may be a good idea to reduce vitamin E supplements to 200 IU unless your doctor suggests you take more.

Vitamin E deficiency is associated with faster HIV disease progression. People with poor fat absorption or malnutrition are more at risk of being deficient in vitamin E. Use supplements from natural sources and those with “mixed tocopherols” for better effect.

Iron supplements to treat iron-deficiency anemia (low levels of red blood cells) should only be taken if prescribed by your doctor. Iron-deficiency anemia is diagnosed by having a low hemoglobin level in the blood. This can be confusing in someone on HAART because some anti-HIV drugs, especially AZT, can cause low hemoglobin levels. There are other blood tests that can help determine whether there really is an iron deficiency. The important point is to not take high doses of iron unless they are prescribed. Iron is a pro-oxidant (the opposite of an antioxidant), which means it can damage different tissues in the body.

Zinc is a critical mineral for the immune system; a deficiency can cause severe immune suppression. People with chronic diarrhea, new immigrants from refugee camps and malnourished people with HIV, especially children, are at high risk of having a deficiency. Be aware that high doses of zinc supplements in people who are not deficient can decrease immune function.

Selenium helps regenerate glutathione, the major antioxidant in cells. Studies have shown that low selenium levels in the blood are associated with an increased risk of disease progression and death. Deficiency is associated with low CD4+ cells. One small study found that a daily supplement of 200 micrograms might have a positive effect in some people with HIV. Studies of the general population suggest that selenium supplementation may provide some protection from cancer.

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