More supplement hysteria

Here we go again. Sanity seems once again to have fled the playing field. Some “scientists” have declared supplements are all worthless at best or dangerous at worst. This is as ridiculous as those who would say all “drugs” are worthless or dangerous.

First, we have an article published on 12/22/13 in the New York Times. (Note: link embedding seems to be broken on WordPress: http://www.nytimes.com/2013/12/22/us/spike-in-harm-to-liver-is-tied-to-dietary-aids.html?emc=eta1 ).  Once again, an article that purports to be informative distorts knowledge in pernicious ways. Let’s unpack it a bit.

The article notes that some people have reported liver damage due to supplements. Here they conflate the effects of supplements themselves with the notion that some supplement manufacturers are crooks who spike their products with drugs. And then they trot out the usual lie that the FDA is helpless because of the Dietary Supplement Health Education Act (DSHEA). Eventually, they note that the FDA DOES indeed have the power to go after companies that have a corrupt product; it’s just they only recently started to actually do this work, in a very limited way. Why? Because they don’t have the budget (thank you, horrible Congress) to do their job of assuring that dietary supplements AND drugs AND food are pure and contain what the label says.

More critically, they go on to the topic of the potential of some supplements to harm the liver. Here, there IS truth–though a bit of context may help. The specific example they go after is the potential for the catechins found in green tea to be hepatotoxic (liver damaging). Indeed, this can happen but is extremely rare; some cases of presumptive damage by green tea was again due to a contaminant by the herb, germander. (Other cases of young people using it to get “cut” in bodybuilding one may expect liver toxic steroid use or supplements again so adulterated.) However, some few cases have been reported and consumers using Green Tea supplements should be on the alert for liver trouble. We have amended our entry on Green Tea to reflect this. But overall, the benefits of green tea supplements or drinking green tea outweigh this potential risk.

The case of the young man facing a liver transplant is indeed horrible. What remains unclear is whether this was directly due to the supplement or whether there was a contaminant in the supplement. Such an anecdote of harm, however, is no more valid than an anecdote of benefit.

We need a robustly funded FDA to assure that products are what they say they are.

Coming up–a review of the Annals of Internal Medicine–bits of truth lost in more hysteria.

HIV and Aging: Living Long and Living Well

By 2015, more than 50% of the United States HIV population will be over 50. There are approximately 120,750 people now living with HIV/AIDS in NYC; 43% are over age 50, 75% are over age 40. Over 30% are co-infected with hepatitis.

What does the future hold for people with HIV and HIV/HCV as they get older?

These statistics and this question furnished the starting point for the New York Buyers’ Club March 28 event HIV and Aging: Living Long and Living Well, presented by Stephen Karpiak, PhD, of the AIDS Community Research Initiative of America (ACRIA).

Dr. Karpiak’s background uniquely positions him to paint the full picture behind the bare statistics, and to provide expert guidance through the complex healthcare challenges faced by the growing population of older people with HIV. After two decades as a researcher at Columbia University’s Medical School, Dr. Karpiak moved to Arizona, where he directed AIDS service organizations through the 1990s, including AIDS Project Arizona (which offered a supplements buyers’ club similar to NYBC’s). In 2002, back in NYC, he joined ACRIA as Assistant Director of Research, and was the lead investigator for the agency’s landmark 2006 study, Research on Older Adults with HIV. This report, the first in-depth look at the subject, surveyed 1,000 older HIV-positive New Yorkers on a host of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.

Why are there more and more older people with HIV? The first and principal answer is very good news: HIV meds (HAART), introduced more than 20 years ago, have increased survival dramatically. Secondly, a smaller but still significant reason: older people are becoming infected with HIV, including through sexual transmission. (Older people do have sex, though sometimes healthcare providers don’t seem to acknowledge this reality.)

As Dr. Karpiak noted, HAART prevents the collapse of the immune system, and so it serves its main purpose, to preserve and extend life. And yet, as he reminded the audience, HIV infection initiates damaging inflammatory responses in the body that continue even when viral load is greatly suppressed. These inflammatory responses, together with side effects of the HIV meds, give rise to many health challenges as the years pass. In people with HIV on HAART, research over longer time periods has found higher than expected rates of cardiovascular disease, liver disease, kidney disease, bone loss (osteoporosis), some cancers, and neurological conditions like neuropathy.

That brings us to “multi-morbidity management”—a term we weren’t enthused about at first, since it sounded more like medical-speak than the plain talk our NYBC event had promised. But Dr. Karpiak gave us a simple definition: dealing with three or more chronic conditions at the same time (and HIV counts as one). He then made the case that this is a critical concept to grasp if older people with HIV are going to get optimal care. Multi-morbidity management, he explained, is a well-accepted healthcare concept in geriatric medicine, which recognizes that older people may have several conditions and will benefit from a holistic approach in order to best manage their health. Treating one condition at a time, without reference to other co-existing conditions, often doesn’t work, and sometimes leads to disastrously conflicting treatments.

And here’s where Dr. Karpiak warned about “polypharmacy”–another medical term worth knowing. “Polypharmacy” can be defined as using more than five drugs at a time. Frequently, it comes about when healthcare provider(s) add more and more pills to treat a number of conditions. But this approach can backfire, because, as a rule of thumb, for every medication added to a regimen, there’s a 10% increase in adverse reactions. That’s why adding more and more drugs to treat evolving conditions may be a poor approach to actually staying well.

In closing, Dr. Karpiak focused especially on a finding from ACRIA’s 2006 study: the most prevalent condition for older people with HIV, aside from HIV itself, was depression. Over two-thirds of those surveyed had moderate to severe depression. Yet while depression can have serious conse-quences–such as threatening adherence to HIV meds–it has remained greatly under-treated. It may seem an obvious truth, but as Dr. Karpiak underlined, psychosocial needs and how they’re met will play a big role in the health of people with HIV as they age. What social and community supports are available becomes a big medical question, and how healthcare providers and service organizations respond to it can make for longer, healthier lives for people with HIV.

And now we come back to NYBC’s contribution to the discussion on HIV and Aging. While NYBC doesn’t keep track of such information in a formal way, we do recognize that quite a few of our members have been using supplements since the days of our predecessor organization DAAIR–going back 20 years now. That’s a lot of accumulated knowledge about managing symptoms and side effects among people with HIV! To accompany the March 28 presentation, our Treatment Director George Carter drew up a pocket guide to complementary and alternative approaches: HIV and Aging – Managing and Navigating. Partly derived from his long experience, and partly drawn from a 2012 Canadian report, the guide ranges over those kinds of “co-morbidities” that Dr. Karpiak spoke of, including cardiovascular, liver, kidney, bone, and mental health conditions. Interventions or management strategies include supplements, but also diet and exercise recommendations, as well as psychosocial supports (counseling, support groups, meditation, and activism).

NYBC has also updated several info sheets from its website and blog, offering these as a way to address some of the most common healthcare issues facing people with HIV as they get older: cardiovascular topics; :digestive health; NYBC’s MAC-Pack (a close equivalent to K-PAX®); key antioxidants NAC and ALA and their potential to counter inflammatory responses; and supplement alternatives to anti-anxiety prescription drugs. These info sheets, together with the HIV and Aging – Managing and Navigating pocket guide, are available on the NYBC website and blog.

We hope that our HIV and Aging: Living Long and Living Well event has been useful to all. Special thanks to our audience on March 28, many of whom brought excellent questions to the session. Now let’s continue the conversation…

To your health,

New York Buyers’ Club

NYBC_March282013

Curcumin: An Old Spice Performs New Tricks

Curcumin is one of the main components of the Indian spice turmeric, and gives the spice its characteristic yellow color. Aside from its use in cooking, curcumin/turmeric also holds a position of esteem in the ancient Indian medical tradition called Ayurveda, where it is most frequently recommended to treat gastrointestinal disorders.

In recent decades, this old spice has drawn the attention of a large crop of US-based scientific researchers, who have focused on its powers to address illnesses including cancers, liver disease, and Alzheimer’s. A 2007 review of research concluded that curcumin could protect against skin, oral, intestinal and colon cancers by inhibiting the proliferation of cancer cells, by restricting blood supply to tumors, and by other mechanisms as well. As a researcher at the M. C. Anderson Cancer Center in Texas has put it: “The reason curcumin is so effective against cancer is that it hits not just a single target or cell signalling pathway but dozens of targets implicated in cancer.”

Due to its anti-inflammatory properties, curcumin has also been adopted as a potential therapeutic agent by scientists investigating difficult-to-treat liver disease. Preliminary research published in 2010 found that curcumin blocks several types of inflammation that can lead to cirrhosis (=scarring of tissue and destruction of liver function). The study authors suggest that the botanical, as a natural substance with few side effects, may ultimately prove a better treatment than currently available medications for some liver disease.

Frequently, supplement research looks for refinements and synergies in investigating the medicinal powers of traditional botanicals like curcumin. That’s been the case with a recent study involving Vitamin D3 and derivatives of curcumin known as curcuminoids. This combination of supplements, remarkably enough, proved helpful in clearing the kind of plaque in the brain that is associated with Alzheimer’s Disease. Of course the University of California researchers who conducted this study are now looking for further confirmation of D3/curcuminoids as a preventive and as a therapy for Alzheimer’s.

NYBC stocks Curcumin (Jarrow) in two formats:

Curcumin 500mg/60

Curcumin 500mg/120

As new studies of Curcumin have emerged, NYBC also began stocking additional forms from Vibrant Health, which add bioperine (black pepper extract) for enhanced absorption:

Curcuminoids 1000 mg/30c w/bioperine

Curcuminoids 1000 mg/60c w/bioperine


References:

Surh YJ, Chun KS. Cancer chemopreventive effects of curcumin. Adv Exp Med Biol. 2007.
Champeau, R. Vitamin D, curcumin may help clear amyloid plaques found in Alzheimer’s. Press release, UCLA, July 15, 2009.
Baghdasaryan, A et al. Curcumin improves sclerosing cholangitis in Mdr2-/- mice by inhibition of cholangiocyte inflammatory response and portal myofibroblast proliferation. Gut, 2010.

Antioxidant Optimizer: broad spectrum antioxidant formula

NYBC now stocks Antioxidant Optimizer from Jarrow Formulas, a broad spectrum antioxidant supplement that provides a blend of water and fat soluble antioxidants ( meaning they are widely absorbed in the body), including:

Lutein and lycopene, which protect the eyes, cardiovascular system, breast, cervical, and other tissues and organs;

and

Green tea extract, olive fruit extract, grape seed extract, and milk thistle, which support liver health and cardiovascular system health.

For more details, see the NYBC entry:

Antioxidant Optimizer

Yes, you’ll also notice that NYBC’s nonprofit co-op price for this product is very reasonable!

Instead of Overly Restrictive Rules, Can We Please Have More Useful Research and Education on Supplements from our Federal Agencies?

The New York Buyers’ Club Co-Op’s Treatment Director advocates for more useful research on supplements from the federal government, and shares his long expertise and personal experience in managing liver health with supplements:

Instead of Overly Restrictive Rules, Can We Please Have More Useful Research and Education on Supplements from our Federal Agencies?

The Food and Drug Administration (FDA) recently released a proposed new rule, which many believe could unnecessarily restrict consumer access to supplements introduced after 1994. (Access to supplements on the market before 1994 is generally protected by the Dietary Supplements Health and Education Act, passed that year.)

Perhaps the greatest concern is the form of vitamin B6 known as pyridoxal- 5′-phosphate or P5P. (Used for example, in the MAC-Pack, NYBC’s low-cost alternative to the K-PAX multivitamin/antioxidant combination for people with HIV.) There has been a concerted effort by pharmaceutical companies over the years to turn this vitamin into a drug, thus restricting access to it, and likely raising the price.

Overall, it is unclear what benefit the proposed new FDA rule would have for supplement users—if any. Certainly we believe there is much the FDA can do for consumers, including a robust program to test supplements for identity, potency and purity and broadcast the results quickly and widely. And, turning to the major health research agency of the federal government, we would welcome the National Institutes of Health (NIH) conducting more clinical trials to assess benefits and limitations of supplements. This type of research can answer important clinical questions and truly help consumers.

I am living with hepatitis C and without health insurance, and have relied on diet, lifestyle changes and supplements—identified through years of personal research–to normalize my liver enzymes, slow disease progression and keep my viral load fairly low while I try to enroll in a clinical trial. * Why can’t our federal agencies promote more research on supplement combinations like the ones I have used and circulate useful knowledge about the results, rather than wasting resources on restricting access to widely used supplements like the form of vitamin B6 mentioned above?

George Carter

*You can find a pocket guide to my recommendations for using supplements for liver health in NYBC’s Summer 2010 Supplement Special Issue, 50+ Ways to Love Your Liver.

You can also find a library of other useful guides to using supplements to maintainn and improve your health at NYBC’s SUPPLEMENT Archive Page:

http://newyorkbuyersclub.org/supplement/index.html

Chlorella: a green food with benefits

Chlorella, a green food supplement derived from algae, has grown in popularity in recent years due to some striking new research on its potential benefits, especially for people susceptible to insulin resistance/diabetes or hypertension (high blood pressure). It’s also been studied recently for its potential use in eliminating toxins such as mercury from the body, and for its potential as a chemopreventive agent against liver cancer.

See the NYBC entry for more details:

Chlorella

A 2011 lab study found that chlorella had the ability to significantly improve insulin sensitivity, improving the digestion of sugars. The study authors suggest that chlorella may therefore be useful as an additional therapy for people with insulin resistance or pre-diabetes.

In a 2009 report on a study involving 80 patients, researchers found that “Chlorella significantly decreased high-normal blood pressure and borderline hypertension, and is a beneficial dietary supplement for prevention of the development of hypertension.”

References:
Y. J. Chiu, et al. Improvement of Insulin Resistance by Chlorella in Fructose-rich Chow-fed Rats. Phytother Res. 2011 Feb 10. doi: 10.1002/ptr.3379.

M. Shimada et al. Anti-hypertensive effect of gamma-aminobutyric acid (GABA)-rich Chlorella on high-normal blood pressure and borderline hypertension in placebo-controlled double blind study. Clin Exp Hypertens. 2009 Jun;31(4):342-54.

See also Journal of Toxicological Sciences 2010; 35(1): 101-105 (for chlorella’s ability to eliminate mercury from the body; and J Zhejiang Univ Sci B. 2009 Jan;10(1):14-21 (for chlorella’s chemopreventive effect against liver cancer cells).

Supplements for Liver Health

NYBC has published an online guide to Liver Health, which you can access at

SUPPLEMENT No. 17 Summer 2010

Liver Health

And, yes! You’ll find liver healthy supplements like silymarin, alpha lipoic acid and Chinese herbal formulas, all described in detail with usage recommendations in a special section of the NYBC catalog pages:

http://nybcsecure.org/index.php?cPath=57