Book Review: “Supplement Your Prescription — What Your Doctor Doesn’t Know About Nutrition,” by Hyla Cass, M.D.

This is an excellent guide to managing the side effects of prescription drugs through better nutrition and nutritional supplements. Published in 2007 by Basic Health Publications, it synthesizes much recent research on how the most frequently prescribed drugs for Type 2 diabetes, cardiovascular disease, osteoarthritis, and depression often cause nutrient deficiencies that can lead to additional health problems. Dr. Cass, who is a practicing physician and a specialist in integrative medicine, provides clear analyses of these damaging side effects and offers recommendations on how to address them.

The first condition discussed by the book is Type 2 Diabetes/insulin resistance/metabolic syndrome. For those who are taking the most commonly prescribed drug for Type 2 Diabetes, metformin, Dr. Cass stresses the importance of supplementing with Vitamin B12 (200-1000mg/day) folic acid (400-800mg/day) and CoQ 10 (30-200mg/day) to make up for the nutrient-depleting effects of the medication. Vitamin B12 and folic acid, together with Vitamin B6, are crucial for keeping levels of an amino acid called homocysteine in check in the body. Since elevated levels of homocysteine are associated with heart disease, stroke, hypertension, neuropathy, and Alzheimer’s, it’s a top priority to keep the body supplied with the B vitamins that can control it.

Dr. Cass also provides a “Diabetes Supplement Program” especially directed to pre-diabetics who may be able to address their condition with diet, exercise, and supplements (the B vitamins and CoQ 10 mentioned above, plus alpha lipoic acid, antioxidants, and the trace minerals chromium and vanadium, which are needed in blood sugar processing).

Much more to discuss in this very useful book, so we will come back to it again!

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Depression and B vitamins – University of Maryland Medical Center’s Complementary Medicine Website

Here’s more on the role of the B Vitamins in depression, together with some common supplementation strategies.

Source: University of Maryland Medical Center’s Complementary Medicine web resource

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Depression
Studies suggest that vitamin B9 (folate) may be associated with depression more than any other nutrient. Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed. Many healthcare providers start by recommending a multivitamin (MVI) that contains folate, and then monitoring the homocysteine levels in the blood to ensure the adequacy of therapy. Elevated homocysteine levels indicate a deficiency of folate even if the levels of folate in the blood are normal. If the MVI alone is not enough to lower homocysteine and improve folate function, the provider may suggest additional folate along with vitamins B6 and B12 to try to bring the homocysteine levels down, thereby eliminating the functional folate deficiency and, hopefully, helping to improve feelings of depression.

Note: NYBC stocks Douglas Lab’s Added Protection Without Iron, a highly bioavailable multivitamin that includes a comprehensive B complex. The no-iron formula is recommended especially if you have elevated liver enzymes or hepatitis.

You can also consider Added Protection With Iron if you want to include iron in your supplements.

Another choice for focusing on the B Vitamins is Jarrow’s B-right, which is especially formulated to provide optimal amounts of folate/folic acid (B-9), B-6 and B-12 for lowering homocysteine levels.

Why Vitamin B12 and Folic Acid (Folate) are important to people with HIV

We’ve adapted this piece from the NYBC Info Sheet on Vitamin B12.

NYBC members often supplement with B-right B complex or with Methylcobalamin, a form of B12 that is better absorbed by the body than other forms of B12.


B-12 may play a very critical role in preventing HIV disease progression: a large Johns Hopkins University study found that people with HIV who are deficient in B-12 have a two-fold increased risk of progression to AIDS. In this study, those who were B-12 deficient progressed to AIDS four years faster than those who were not. The exact mechanism by which adequate B-12 in the body may slow progression is not known, but the finding is not surprising, given all the roles B-12 is known to play in healthy human function.

B12 and another B vitamin, folic acid, are critical to prevent or eliminate the often-overwhelming fatigue that so often accompanies HIV disease, as well as to help prevent some forms of neuropathy and brain and spinal cord changes. Maintaining adequate B12 levels also supports the bone marrow’s production of blood cells (crucial to prevent white and red blood cell decreases), and helps protect the heart.

There are countless anecdotal reports from people with HIV that using B-12 supplementation has dramatically improved their lives by its ability to reverse fatigue, often restoring normal energy to people who had previously been so exhausted that their daily functioning had been greatly affected. Many people have also reported significant improvements in memory and mental functioning, improvements that have made a huge difference in daily life. The possibility that B-12 supplementation might also help prevent or reverse the spinal cord changes that can have such devastating effects on some people is also very encouraging.

B-12 and folic acid should always be given together. Doses of B-12 (1000 mcg given daily via pills, or one to several times weekly via prescribable nasal gel or injections) and folic acid (800 mcg daily via pills) may be useful for restoring energy, treating neuropathy, protecting the heart, increasing overall feelings of well being, and boosting mental function (especially when combined with thiamin, niacin, and folic acid, since all four of these B vitamins are needed for normal neurological function) even when tests don’t indicate obvious deficiencies.

Deficiencies of B-12 can result in deterioration of mental function and neurologic damage that will yield such symptoms as memory loss, decreased reflexes, weakness, fatigue, disorientation, impaired pain perception, tinnitus (chronic ringing in the ears), neuropathy, burning tongue, and various psychiatric disorders. B-12 deficiency can also cause canker sores in the mouth, impaired bone marrow function, loss of appetite, and loss of weight, as well as impaired antibody responses to vaccines.

Folic acid deficiency can also cause fatigue and weakness, along with irritability, cramps, anemia, nausea, loss of appetite, diarrhea, hair loss, mouth and tongue pain, and neurological problems. In addition, folic acid deficiency is believed to play a role in the development of numerous and varied types of human cancers.

A combination of B-12 and folic acid deficiency can allow increases in blood levels of homocysteine, a chemical that can damage artery walls and contribute to heart disease.

One of the known causes of B12 deficiency is chronic viral illness with resulting poor gastrointestinal absorption. AZT use may contribute to deficiencies of both B-12 and folic acid. Many other drugs may worsen folate status in the body including TMP/SMX (Bactrim, Septra), pyrimethamine, and methotrexate (all three of which are folate antagonists), as well as phenytoin (Dilantin), various barbiturates, and alcohol (all of which block folate absorption). B-12 deficiency can also worsen folate levels in the body because B-12 is required to change folate into its active form.

Folic acid/folate (Vitamin B9) to protect against development of cancer

The University of Maryland Medical Center’s website on Complementary Medicine (a clearly written, up-to-date resource, by the way) provides this review of folic acid (also known as folate or Vitamin B9) as a supplement protecting against the development of cancers. The strongest evidence appears to be for folic acid’s ability to protect against colorectal and breast cancers. In our excerpt below, we have highlighted two significant passages.

For recommendations on how to take this supplement (you may be getting it in a multivitamin or a B-complex supplement), see the NYBC entry on Folic Acid.



Cancer
Folic acid appears to protect against the development of some forms of cancer, particularly cancer of the colon, as well as breast, esophagus, and stomach, although the information regarding stomach cancer is more mixed. It is not clear exactly how folate might help prevent cancer. Some researchers speculate that folic acid keeps DNA (the genetic material in cells) healthy and prevents mutations that can lead to cancer.

Population-based studies have found that colorectal cancer is less common among individuals with very high dietary intakes of folic acid. The reverse appears to be true as well: low folic acid intake increases risk of colorectal tumors. To have a significant effect on reducing the risk of colorectal cancer, it appears that at least 400 mcg of folic acid per day over the course of at least 15 years is required. Similarly, many clinicians recommend folic acid supplementation to people who are at high risk for colon cancer (for example, people with a strong family history of colon cancer).

Similarly, one population-based study also found that cancers of the stomach and esophagus are less common among individuals with high intakes of folic acid. Researchers interviewed 1095 patients with cancer of the esophagus or stomach as well as 687 individuals who were free of cancer in three health centers across the United States. They found that patients who consumed high amounts of fiber, beta-carotene, folic acid, and vitamin C (all found primarily in plant-based foods) were significantly less likely to develop cancer of the esophagus or stomach than those who consumed low amounts of these nutrients. Another important, good-sized study, however, did not find any connection between folic acid intake and stomach cancer. The possibility of some protection from folate against stomach cancer in particular needs clarification and, therefore, more research is warranted.

Low dietary intake of folate may increase the risk of developing breast cancer, particularly for women who drink alcohol. Regular use of alcohol (more than 1 ½ to 2 glasses per day) is associated with increased risk of breast cancer. One extremely large study, involving over 50,000 women who were followed over time, suggests that adequate intake of folate may lessen the risk of breast cancer associated with alcohol.

Folate, the feds, and you

Folate, a B vitamin, frequently appears in news about dietary supplement research. (Note: folic acid is the form found in supplements or fortified foods.)

For example, an article earlier this year offered this announcement: “Higher Folate Levels Linked To Reduced Risk For Alzheimer’s Disease. ” (JAMA and Archives Journals: 2007, January 9)

And you wouldn’t have to look too far to discover current research on folate deficiency associated with the potential for cardiovascular problems, or folate deficiency linked to higher rates of breast, pancreatic, or colon cancer.  

Of course, when folate was first identified and studied 70 years ago, the chief draw for researchers was its role in combating anemia and supporting the health of women during pregnancy. But since then, as understanding of the vitamin has grown, it’s come under scrutiny for many other reasons.

Indeed in 1996, the US federal government decided that the health benefits of folic acid were very clear–and yet too many Americans were not getting enough from their diets. The response? The Food and Drug Administration (FDA) published regulations requiring the addition of folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products–where you’ll find it today (check nutritional labels).

For more information on whether you’re getting enough folate in your diet, and who should consider supplementing, see the Office of Dietary Supplement fact sheet on FOLATE:

http://www.ods.od.nih.gov/factsheets/folate.asp