Mayo Clinic recommendations: cholesterol-lowering supplements

The Mayo Clinic has a post, updated in 2012, on the topic of “Cholesterol-lowering supplements: Lower your numbers without prescription medication.” As always, we advise you to check with your healthcare provider before starting to use any of these for cholesterol management.

Most of these suggestions have been in the New York Buyers’ Club repertory for quite a while, but we are happy to repeat them here:

Fish oil (omega-3 fatty acids): can lower triglycerides

Green tea: some research on its cholesterol-lowering capacity; epidemiologic evidence suggests that green tea may lower stroke and cardiovascular disease risk. There are several choices for green tea supplements: see Green Tea; Green Tea Decaffeinated; and Green Tea Organic.

Plant sterols: see Cardio Edge for a supplement featuring plant sterols in a formula designed to support healthy cholesterol levels

Garlic extracts: contact NYBC for information on allicin, a garlic extract that has been studied for cardiovascular health

The Mayo Clinic guide also mentions grains, including oat bran and flaxseed, which can lower cholesterol.

Last, the guide discusses red yeast rice, a supplement that can lower LDL cholesterol. Note the caution that some forms of red yeast rice may contain a naturally occurring form of the prescription medication lovastatin. Lovastatin in the supplement may present some dangers to the user, because there is no way to know the quantity or quality of this prescription medication equivalent. For that reason, it is especially important to consult with your healthcare provider and monitor your usage of this supplement.

See the Mayo Clinic guide at

Mayo Clinic: Cholesterol-lowering supplements: Lower your numbers without prescription medication

Changing diet reduces risk of dyslipidemia (abnormal blood fats) in people with HIV starting antiretroviral treatment

Switching to a diet that concentrates on fruits, vegetables, nuts and whole grains was found in a recent study to very significantly reduce the risk of people with HIV developing dyslipidemia when they started antiretroviral treatment. Dyslipidemia is an abnormal amount of fats (such as cholesterol) in the blood. It is generally associated with an increase in risk of cardiovascular disease. Dyslipidemia is one of the side effects frequently found with HIV drugs (protease-inhibitors and nonnucleoside-reverse-transcriptase inhibitors).

The study followed two groups of HIV+ people who were beginning antiretroviral therapy: one group switched to the high-fiber, low-fat diet, and the other group did not. After one year, 68% of the group that did not change its diet had developed dyslipidemia, while only 21% of the group that changed its diet had.

The study was reported in the Journal of the American College of Cardiology, and was accompanied by an editorial that commented:

“it is likely that patients living with HIV infection who do not eat too much (ie, calorie restriction) and who eat fruits, vegetables, nuts, and whole grains (ie, high-fiber, low-cholesterol, and low-fat foods that keep the ‘bowels soft’) will benefit by avoiding illness and improving quality of life […]For patients living with HIV infection, avoiding dyslipidemia also avoids, or at least delays, use of lipid-lowering medications [such as statins], which are expensive and are complicated to use in patients on HAART.”

Quite a lot of advantages!

References:

1. Lazzarretti RK, Kuhmmer R, Sprinz E, et al. Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected individuals. J Am Coll Cardiol 2012; 59:979-988.
2. Stein JH. Nutritional intervention to prevent dyslipidemia in patients starting antiretroviral therapy for human immunodeficiency virus. J Am Coll Cardiol 2012; 59:989-990.

Acetylcarnitine



NYBC has issued a new info sheet on ACETYLCARNITINE, a key item in our catalog.

Below is some background on this supplement, as well as some of the important evidence supporting its use.

Or–click on the image above for the full-sized INFO SHEET.

Acetylcarnitine is a form of carnitine, an amino acid found in nearly all cells of the body. Carnitine plays an essential role in the mitochondria, the energy factories within cells. The acetyl component of acetylcarnitine provides for the formation of the neurotransmitter acetylcholine, key to memory function in the brain. Acetylcarnitine is often regarded as the preferred form for carnitine supplementation because it is better absorbed from the small intestine than L-carnitine and more efficiently crosses the blood-brain barrier.

Significant research on acetylcarnitine:

• Acetylcarnitine may have a triglyceride-lowering effect for some people, as well as helping to elevate HDL (“good”) cholesterol levels. It may have cardioprotective activity in addition to beneficially affecting cardiac function. It may also have antioxidant and neuroprotective properties.
• There has been a great deal of attention to carnitine because it may help counter the mitochondrial toxicity experienced in HIV infection and all the successive problems which that may cause, including neuropathy, myopathy, bone marrow suppression (and resulting decreases in red and white blood cells and platelets), pancreatitis, fatty liver, lactic acidosis, and fat loss (lipoatrophy).
• Acetylcarnitine has also been studied for its capacity to enhance memory and other cognitive function.


Please visit the NYBC product entries for more information:


Acetylcarnitine – Biosint


Acetylcarnitine – Montiff

Healthy cholesterol levels the botanical way

We’ve long known about certain supplements like niacin, pantethine, omega-3 fatty acids that can have an effect on cholesterol levels. In recent years, research attention has also focused on “plant sterols” and other botanical substances that can provide help in supporting healthy cholesterol levels.

Responding to this emerging science, supplement suppliers have devised some combination supplements. Among them is Douglas Lab’s Cardio-Edge, which includes: plant sterols (phytosterols) from soy; Sytrinol (a proprietary extract obtained from citrus and palm fruits); and pomegranate extract.

Here’s a little more detail on the product:

Cardio-Edge is designed to help maintain cardiovascular health and support healthy cholesterol levels. Sytrinol is intended to have the following effects, some of which you can monitor with routine bloodwork to assess its effect for you. These include:
1) Decrease apoprotein B, needed for LDL synthesis
2) Decrease action of an enzyme in the liver that makes triglycerides
3) Inhibit HMG-CoA reductase in the liver

Patented combination of citrus PMFs and alpha, delta and gamma tocotrienols derived from palm fruit (U.S. patents #6,251,400, and #6,239,114). Palm tocotrienols have been shown to inhibit HMG CoA reductase, the enzyme responsible for regulating cholesterol synthesis in the liver. Clinical studies in both animals and humans support Sytrinol’s role in reducing total and LDL-cholesterol as well as triglycerides.

Plant Sterols
Blood cholesterol is derived from the diet and synthesized in the liver. Sterols work by reducing the absorption of both forms of cholesterol – Sterols compete with cholesterol for absorption. Sterols and sterol esters can now be found in many foods including orange juice, rice drink, and margarine.

Pomegranate
Recent science has been focusing on the cardioprotective aspects of pomegranate. These brightly colored fruits contains numerous cornpounds known for their antioxidant capabilities, induding anthocyanidins, catechins, tannis, and gallic and ellagic acids. Research has shown that supplementation with pomegranate juice can decrease macrophage lipid accumulation, and cellular cholesterol accumulation in mice. Recently, research in humans has confirmed a beneficial effect of consuming pomegranate juice on parameters such as LDL oxidation, blood pressure, and blood vessel health.

In human clinical studies involving hypercholesterolemic subjects, no side effects were observed and four weeks of supplementing with a daily dose of 300 mg of Sytrinol.

See further information on recommended dosing on the NYBC website:

http://nybcsecure.org/product_info.php?products_id=284

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.]

Nutrition important…

…for so many things, of course. Lately, the news is that sugary drinks can be bad for you (obesity being not the least of the concerns!) But they also can raise blood pressure. All those crap sodas from companies that have a let them eat crap philosophy: ditch ’em!

Researcher finds surprising link between sugar in drinks and blood pressure

Add to that, more recent data on cholesterol and the link with inflammation…
Cholesterol crystals incite inflammation in coronary arteries

Contact: Jason Cody, University Relations, Office: (517) 432-0924, Cell: (734) 755-0210, Jason.Cody@ur.msu.edu; George Abela, Department of Medicine, Office: (517) 353-4830, abela@msu.edu

Published: May 18, 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.

Short-term effects of extended-release niacin on endothelial function in HIV-infected patients on stable antiretroviral therapy

“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)