We be JAMA! Report: Multivitamin + selenium slows progression of early-stage HIV

We’re tempted to file this story under the heading of “news that we already knew,” but it’s still good to get a stamp of approval in the form of publication in Journal of the American Medical Association (JAMA), one of the top medical journals in the U.S., if not the world.

At NYBC and at our predecessor DAAIR we have long recognized the development of vitamin and mineral deficiencies in HIV, and have long recommended multivitamin/mineral supplements to counter those health-threatening deficiencies. We have also followed for years the work of Marianna Baum, lead author of the JAMA study, who has focused attention on the mineral selenium, which may have an important role in preventing replication of HIV. So, while this story doesn’t come as a complete surprise, it’s great to have further support for some long-held practices.

The combination of a daily multivitamin
plus the mineral selenium

proved to be an effective regimen,
cutting by about half

the risk of reaching the point
where ARV therapy would be recommended

Baum’s study was conducted in Botswana, where nearly one in four adults is infected with HIV. The trial followed about 900 newly infected adults who were not yet taking any HIV medications. These participants were divided into groups that randomly received different combinations of vitamins, the mineral selenium, or a placebo. Over the study’s two-year period, the combination of a daily multivitamin plus the mineral selenium proved to be the effective regimen, cuting by about half the risk of reaching the point where ARV therapy would be recommended in Botswana (CD4 count of 200-250).

Baum’s findings are especially relevant for early-stage HIV infection, where the multivitamin + selenium combination proved its value in cutting risk of progression, and actually decreased the likelihood that participants would reach the point where antiretroviral meds would be recommended. Other research, such as Dr. Jon Kaiser’s study of a multivitamin + antioxidants, has been directed at those who are using antiretroviral meds, and may have developed some symptoms or side effects such as peripheral neuropathy. Kaiser’s finding that the multivitamin + antioxidants combination could increase CD4 counts led to the development of K-PAX, and also motivated NYBC to offer its MAC Pack, a close equivalent of K-PAX, assembled from hand-picked products from NYBC’s catalog.

Taken together, the Baum and Kaiser studies suggest to us the value of long-term supplementation strategies that can slow progression of HIV, oppose the known, damaging deficiencies that are likely to develop with HIV, and help stabilize and even improve health for people with HIV, whether they are taking antiretroviral meds or not.

 

If you’d like to get started with NYBC’s MAC-Pack, or if you’d like to find a multivitamin + selenium combination,
please visit our website. You can also call our toll-free number at (800) 650-4983
for further information and advice about supplement strategies for HIV.

supplement-header-2014
This article from the Spring 2014 edition of SUPPLEMENT: Newsletter of the New York Buyers’ Club, available for download at http://www.NewYorkBuyersClub.org

 

References:

Baum, M. et al. Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana: : A Randomized Clinical Trial. JAMA. 2013;310(20):2154-2163. doi:10.1001/jama.2013.280923. 

Kaiser, J. Micronutrient Supplementation Increases CD4 Count in HIV-infected Individuals on Highly Active Antiretroviral Therapy: A Prospective, Double-Blinded, Placebo-Controlled Trial. Kaiser JK, et al. JAIDS 2006;42[5]: 523-528.

 

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Super Immune Multivitamin (was SuperBlend) daily multivitamin/multimineral formula with herbs. These are easy-to-digest, vegetarian tablets in a food-based formula. Since the formula is so comprehensive, you may be able to eliminate any additional single vitamins you might be taking, such as vitamin C, E, selenium, zinc.

For a complete list of SuperNutrition products at NYBC, including Calcium, Vitamin C, and a cognitive support supplement, Think Clearly, see this page:
SuperNutrition at NYBC

Response to Annals Hysteria

Aside from the recent Times article that once again spread a message of fear and misinformation, three articles were published in the Annals of Internal Medicine that were accompanied by an editorial verging on hysteria that proclaimed in stentorious tones: DON’T TAKE THEM!

Is that a justifiable conclusion? Well, when you look at the studies undertaken, I don’t believe the answer is that clearcut.  However, there also may be evidence here that clarifies who may and may not benefit from a simple micronutrient supplement.  At the end of the article are links to other analyses that rebut the claims made.

Let’s take a little closer look at each of these three negative studies. First, one relatively large study, using a low dose combination of often synthetic vitamin constituents (Centrum Silver) among older individuals (1). Using these modest doses, the upshot of the study, which was otherwise well-controlled and randomized, found no benefit of the use of the supplement in offsetting or mitigating cognitive decline over about 10-14 years. This was part of the large physician’s study and the study was limited by the potential that the doses may have been too low for an otherwise well-nourished population. Is this generalizable to older individuals who are well-nourished?

Perhaps so and taking a Centrum is therefore quite probably a waste of money if maintaining cognitive function is the goal. However, this is the same study that had previously reported that even this simple intervention modestly reduced the risk of cancer. Is that a useful endpoint? And indeed, the authors note that the study may need to be up to 20 years or longer to adequately detect any significant differences.

The third study was a meta-analysis or review of the literature that has pre-specified criteria for the selection of studies to be reviewed and then applies stastical analytic techniques to combine the results into a conclusion (3). They sought to assess the use of multivitamins in the primary prevention of cancer or cardiovascular disease. (Drug studies indeed more commonly look at the use of a drug in preventing a second heart attack, for example: secondary prevention.) Having done these, I know there is a certain degree of judgment in what gets selected and the method used for analysis. In this case, the authors note that the primary limitations are as they note is 1) they only assessed four RCTs and one cohort study that used radically different multivitamin/mineral formulas; one of these was a study that used a multi with only 5 ingredients another only 3 vitamins; 2) these were ONLY among otherwise healthy adults (not secondary prevention studies). The PHS-II study, discussed above, and another the SU.VI.MAX study were the two largest studies. So what can we conclude from this? That the extant data do not robustly support the use of a multi for these indications? Possibly, though they also note that the large PHS-II study that found a benefit for reducing cancer risk also detected a benefit for fatal myocardial infarction (adjusted hazard ratio, 0.61 [95% CI, 0.38 to 0.995]; P < 0.048). It may again be that these interventions are not up to the rather daunting task of achieving the endpoint of primary prevention—such studies probably need to be larger and a lot longer to come up with definitive conclusions.

They also reviewed single and paired studies. They noted that calcium alone is ineffective overall and possibly dangerous as a single supplement, but you throw in vitamin D, and gosh–lower mortality, though just barely (unadjusted RR 0.94, 95%? CI 0.87,1.01). It begins to beggar the imagination however to think these extremely disparate trials can be combined in any meaningful way when the populations, interventions and even primary outcomes were so significantly different.

The third study, however, did assess the effects of chelation therapy, with or without a multivitamin/mineral combination as secondary prevention for a heart attack (myocardial infarction) (3). It was a relatively short study with a median follow-up of 31 months in the vitamin group. The article notes that there was a huge dropout rate. Of the 853 in the vitamin arm and the 855 in the placebo arm, 584 and 547 were lost to follow up, respectively but the analysis was done “intent-to-treat” and all were included in the final analysis. Further, the study was not powered to see a difference with the few that were finally enrolled and completed the study—i.e., the initial proposal was to enroll 2,372 patients. And there was a small difference: while the primary and secondary outcomes did not achieve statistical significance, one can see in the Kaplan-Meier curves that there is a lower rate of events in the multi arm compared to the control by about 11% and that appears to improve as the study progresses: had it lasted longer or been better powered, might this trend have improved over time? We don’t know. The effect is relatively modest but the study wasn’t powered to detect this difference.

It seems to me that the latter study reflects reality and should calm the anxieties about people using supplements expressed by the editors (4). The upshot: Most people don’t want to take vitamins as suggested by the Lamas study. If THAT conclusion is generalizable, they have little to fear—but is that wise public policy?

The other important fact to note was that all the studies showed no evidence of adverse events. For the most part, side effects of the use of supplements are exceedingly rare and generally arise with the use of single agents (e.g., vitamin E or beta-carotene alone). Probably not the wisest way to use interventions designed to work in a biological way or in a system that is severely oxidatively stressed.

I would suggest several caveats. First, this is irrelevant to people living with HIV. Even a fairly simple formula can have a significant impact in slowing disease progression and reducing mortality (modestly) with the use of a multivitamin/mineral. The results of our meta-analysis will, we hope, be published soon. (This of course does NOT mean they are a replacement for antiretroviral therapy! Absolutely not.)

Second, these are SUPPLEMENTS – diet and access to clean water need to be the first consideration and far too many people have limited access to these basics while millions of others are forced to consume what is available on the market, which is often poor quality, processed, loaded with chemicals, preservatives, antibiotics, hormones and potentially dangerously genetically modified.

And finally, supplements are NOT drugs in key ways. They are supporting the body’s ability to fight disease while retaining an optimal level of health, especially when we are discussing the use of vitamins and minerals (as opposed to botanicals). Whether the optimal dosages have been determined, whether the findings are generalizable to everyone, whether there are groups, like people with HIV, for whom they are demonstrably beneficial—these are questions hardly answered to the point of declaring no one should ever use them as these editors have done.

Links:

Harvard rebuts the Annals of Internal Drugs.

http://www.hsph.harvard.edu/nutritionsource/multivitamin/

Linus Pauling Institute of Oregon State University.

http://lpi.oregonstate.edu/news/enoughisenough-response.html

Michael Mooney’s overview:

http://www.michaelmooney.net/Erroneous_Annals_Of_Internal_Medicine_Study_Says_Vitamins_Don%27t_Work.html

Industry’s Council for Responsible Nutrition:

http://www.nutraceuticalsworld.com/contents/view_blog/2013-12-18/enough-is-enough/?email_uid=dee72d271a/list_id=396c189146/

Michael Murray, ND:

http://doctormurray.com/?utm_source=WOW+-+Editorial+in+Medical+Journal+Promotes+Propaganda+Against+Multiple+Vitamin+&utm_campaign=CCmailing6-12-13&utm_medium=email

References:

1. Grodstein F, O’Brien J, Kang JH, et al. Long-Term Multivitamin Supplementation and Cognitive Function in Men: The Physicians’ Health Study II. Annals of Internal Medicine. 2013;159(12) :806-814-814. doi: 10.7326/0003-4819-159-12-201312170-00006.

2. Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. Nov 12 2013;159(12):824-834-834. doi: 10.7326/0003-4819-159-12-201312170-00729.

3. Lamas GA, Boineau R, Goertz C, et al. Oral High-Dose Multivitamins and Minerals After Myocardial Infarction. Annals of Internal Medicine. 2013;159(12):797-805-805. doi: 10.7326/0003-4819-159-12-201312170-00004.

4. Guallar E, et al. Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Ann Intern Med. 2013;159(12): 850. Retrieved 19 Dec 2013 from http://annals.org/article.aspx?articleid=1789253

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.

NYBC Fundraising Campaign Almost There – Please Donate Today to Take Us Over the Top!


The New York Buyers’ Club, your community-minded nutritional supplements co-op, provides access to low-cost, high-quality supplements especially selected for people with HIV, Hepatitis C and other chronic conditions. NYBC also reports on the best and most useful scientific information on using supplements to stay healthy–see, for example, our previous post on a ground-breaking November 2013 study in the Journal of the American Medical Association, which points to an important role for multivitamins and selenium as a means to slow progression of HIV.


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New study in Journal of the American Medical Association shows that a multivitamin + selenium slows progression of HIV

The Journal of the American Medical Association has published a new study showing that a multivitamin and selenium combination supplement significantly reduced immune decline and morbidity in people with HIV who were treatment naïve (=not on antiretroviral/ARV therapy). This was a two year study with individuals who had CD4 counts above the recommended threshold for beginning ARV treatment. Over the two-year period, the combination of a daily multivitamin plus the mineral selenium cut by about half the risk of reaching the point where ARV therapy would be recommended (CD4 count of 200-250).

This study shows the importance of daily multivitamin + selenium supplementation for HIV+ people who are recently infected and/or have relatively high CD4 counts. It also provides further confirmation of the value of multivitamin, multimineral supplement strategies like the one included in the NYBC MAC-Pack.

Movie preview: Dallas Buyers Club

Dallas Buyers Club
Image Credit: Anne Marie Fox/Focus Features
———————————————————————-

Last night we had the chance to preview the astonishing and inspiring new movie, Dallas Buyers Club, starring Matthew McConaughey and Jared Leto. It’s the story of Ron Woodroof, a Texas rodeo rider and electrician who tested positive in 1986, and went on to fight the medical establishment and pharmaceutical companies, searching for alternative treatments throughout the world and setting up a buyers’ club to make these alternatives available to others with HIV/AIDS.

We were astonished by the movie because, having labored for a decade (or two decades, for some of us at NYBC) in the field of buyers’ clubs for people with HIV, we weren’t prepared to think of our work as material for a Hollywood production. If you looked at the NYBC probiotics that have helped people keep their digestive systems functioning thru years of taking HIV meds, or the MAC-Pack that has helped HIV+ people keep up CD4 counts, or supplements that have helped support liver function–it didn’t all add up, in our minds, to a Hollywood movie starring Matthew McConaughey!

We do want to give credit to the movie’s creators for doing an excellent job in depicting that moment, in the late 1980s and early 1990s, when people with HIV decided to fight a slow-moving, closed-minded FDA that was blocking access to alternative treatments and even to some of the early HIV meds that were becoming available elsewhere in the world.

We particularly liked the early scene in Dallas Buyers Club, when the Ron Woodroof/Matthew McConaughey character, who’s been told by a Dallas hospital doctor that he has 30 days to live, drives down to Mexico, and finds an off-the-grid AIDS clinic run by a American doctor who’s had his license revoked. At that point, Ron Woodroof looks in pretty bad shape, and the clinic doctor tells him that first of all he needs to start taking a “multivitamin with zinc, plus some essential fatty acids.” That’s the starting point for Ron’s new treatment quest, which discards the side effect-ridden AZT being pushed by Pharma and mainstream doctors, and scans the world for alternatives. (The Mexican clinic is also importing DDC, an early line HIV med from France, not approved at the time in the USA.)

There’s a lot going on in Dallas Buyers Club: the homophobic Ron Woodroof undergoes a big change of heart as he sets up the buyers’ club with help from the drag queen played by Jared Leto. At one point you’ll catch a glimpse of a TV news story about ACT-UP storming the FDA to protest the glacial pace of HIV med trials. You’ll also see a fight in a supermarket over whether to buy the typical American junk foods, or some real nutrition. And there’s quite a bit of money changing hands as the buyers’ club takes off (the Dallas Buyers Club was NOT a nonprofit, unlike NYBC!). And we should advise that some of the drugs that Ron Woodroof imported for his buyers’ club were promising starts, while others today we’d have to dismiss. In the end, though, we’ll take Dallas Buyers Club for what it’s meant to be: an inspiring tale about how buyers’ clubs brought treatment alternatives to people with HIV/AIDS, even when that quest ran against most of the conventional medical wisdom. And we’d add that while the treatments have certainly changed over the years, we at NYBC still identify with the need for treatment alternatives, and still don’t want to settle for just the conventional medical wisdom.

So—come on down and visit us at http://www.newyorkbuyersclub.org/. We do recommend that you see the movie, too, when it opens on November 1. And if you support any or all of our convictions about the importance of buyers’ clubs for people with HIV, why not make a donation to NYBC at

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