The movie Dallas Buyers Club scored a couple of splashy wins at the Oscars on March 2: Best Actor for Matthew McConaughey (playing Ron Woodroof, the cantankerous founder of the early AIDS buyers’ club); and Best Supporting Actor for Jared Leto (playing Rayon, a transgender HIV+ woman who becomes Woodroof’s sidekick). Bravura performances indeed, and controversial, too (just read the blogs!).
Meanwhile for us at the New York Buyers’ Club… real life goes on. We think Dallas Buyers Club does an important job in casting its bright Hollywood lights on the work of buyers’ clubs in the fight against HIV/AIDS, beginning in the early days of the pandemic. But here at NYBC –the last HIV/AIDS buyers’ club standing- we would like to present our own award: to YOU! For being an NYBC member, and thereby participating in a long-running community effort to distribute the best available information about managing symptoms and side effects of HIV and HIV meds, while also helping to make beneficial supplements widely accessible through a nonprofit co-op. And a special thanks to the many contributors out there who lent their financial support to NYBC’s recent successful fundraising campaign—you’re our equivalent of the Hollywood producer, without whom the magic can’t happen!
Of course much has changed, and a great deal has changed for the better, since the days depicted in Dallas Buyers Club. Some may even ask why we need a buyers’ club, given that HIV meds have advanced so much in the past 20 years. Unlike Ron Woodroof’s Dallas Buyers Club, NYBC is not importing unapproved drugs or trying novel therapies—that desperate search for any sort of treatment has abated (at least in the wealthier countries). We can look back at the time when New York was home to the PWA Health Group and DAAIR (from which NYBC arose), and there were buyers’ clubs for people with HIV/AIDS in Boston, Houston, San Francisco, Chicago, Atlanta, and Phoenix, among other places. But what need does the New York Buyers’ Club fill today?
Some ask why we need a buyers’ club,
given that HIV medshave advanced so much
in the past 20 years?What need does
the New York Buyers’ Club fill today?
Well, recent research brings into sharper focus what we have understood for quite a while: living long term with HIV is a huge challenge. Antiretroviral (ARV) therapy works to reduce the risk of an AIDS-defining illness to nearly zero, while offering the prospect of a normal life span. But problems abound. First, several non-AIDS-defining conditions become more common. These include several cancers, some stemming from infections like HPV. Then there are the longer term effects of ARV, which can threaten quality of life and increase mortality risk, including challenges to the cardiovascular system, nerves, cognitive function, liver, kidneys, and bones.
These side effects are being understood today by some old mechanisms that are getting new attention. At NYBC’s community event on HIV and Aging, held last March, our speaker Steve Karpiak, Ph.D. emphasized the inflammatory processes that continue throughout HIV infection and the cascade of damage that persistent inflammation causes, even as ARV therapy holds the virus in check. And just last October, we were interested to read a comprehensive review on the health effects of chronic inflammation during HIV infection. According to this overview, many markers of inflammation remain high during HIV infection, and those inflammatory problems are linked to elevated risk of cardiovascular, liver, kidney, bone, and neurologic diseases. But none of this is really news to us: addressing the chronic inflammation that accompanies HIV has been central to our work at NYBC—and between those of us at NYBC and those who go back to DAAIR days, we’ve been addressing this model of the disease for over 20 years!
Probiotics may help in countering
the damaging inflammatory processes that are found in HIV infection,
even when the virus is held in check by meds.
The recent review of inflammation effects during HIV did suggest that probiotics, for example, may hold promise for countering inflammatory processes that are concentrated in the gut. Indeed, probiotics have been a staple in the NYBC catalog from the start, even when we were simply recommending them to support gastrointestinal health and improve absorption of nutrients. Now we’re looking forward to new research on supplements, which in this case may help us understand the additional benefits of probiotics as anti-inflammatories. Meanwhile, NYBC continues to search out the latest news about a wide array of topics, from hepatitis C coinfection, to alternative treatments for sleep and mood disorders, to the value of a daily multivitamin + selenium for people with HIV.
In conclusion (music coming up now, so we must hurry), see Dallas Buyers Club, both for the Oscar-winning performances, and for its slice of history about HIV/AIDS buyers’ clubs. But please remember to think of the New York Buyers’ Club as well, and what it’s doing for you today!
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:
Enid Vazquez. “Houston Buyers Club: Desperate Days Beyond Dallas.” Positively Aware, Jan-Feb 2014.
An excellent review of Dallas Buyers Club, with much background on the HIV/AIDS buyers’ club movement
Deeks, Steven G et al. “Systemic Effects of Inflammation on Health during Chronic HIV Infection.” Immunity, October 17, 2013
At the end of 2013, there was much buzz about new studies showing that curing insomnia in people with depression might double the chance of a complete recovery from depression. The studies, financed by the National Institute of Mental Health, were welcomed as the most significant advance in treating depression since the introduction of the “selective serotonin re-uptake inhibitor” (SSRI), Prozac, twenty-five years ago. In effect, the new research findings turn conventional wisdom on its head, since they suggest that insomnia can be a main cause of depression, rather than just a symptom or a side effect, as previously assumed. If you can successfully treat a depressed person’s insomnia, according to the new view, you eliminate one of the main factors causing the depressed state.
New research findings turn conventional wisdom on its head suggesting that insomnia can be a main cause of depression rather than just a symptom or a side effect as previously assumed
As we followed reports on this breakthrough research on insomnia and depression, we were especially encouraged to read comments like the one from Washington DC psychiatrist James Gordon, who has advocated an integrative approach to treating depression. Here’s his letter to The New York Times:
I welcome a new report’s finding that cognitive behavioral therapy is improving the outcome for depressed people with significant insomnia (“Sleep Therapy Seen as an Aid for Depression,” front page, Nov. 19).
It reminds us that changes in attitude and perspective, and a therapeutic relationship, can right biological imbalances — like disordered sleep — and significantly enhance the lives of troubled people. The study also puts the therapeutic role of antidepressant medication in perspective: the depressed participants who received behavioral therapy did equally well whether or not they were taking the drugs.
I hope that these results will encourage the National Institute of Mental Health, researchers, clinicians and all of us to expand our horizons.
There are a number of other nonpharmacological therapies, including meditation, physical exercise, dietary change and nutritional supplementation, acupuncture and group support, that show promise for improving clinical depression and enhancing brain function.
At NYBC we have long believed that non-prescription therapies, such as supplements, are valuable alternatives for treating mood disorders and sleep disorders When the Centers for Disease Control surveyed use of antidepressant drugs in 2008, it found that one in 10 Americans was taking an antidepressant, and many had taken these drugs for years. Over a period of ten years, antidepressant use in the U.S. had shot up by 400%! So the question arises: how much of this spectacular increase represented real gains in treatment, and how much was over-prescribing? As Dr. Gordon mentions in his letter above, in some cases behavioral therapy for depression has worked just as well whether people were taking antidepressants or not—hardly a strong argument for the value of the prescription drugs.
A well-publicized 2008 report in the New England Journal of Medicine found that pharmaceutical companies had consistently reported only the most favorable trial outcomes for their popular antidepressants
A well-publicized 2008 report in the New England Journal of Medicine found that pharmaceutical companies had consistently reported only the most favorable trial outcomes for their popular antidepressants, passing over evidence that suggested a more limited effectiveness. Furthermore, as with many drugs, especially those used over a long period, antidepressants have side effects. Higher bone fracture risk and multiple cardiovascular risks have been identified; sexual side effects are common with antidepressants in both men and women; and withdrawal symptoms for those tapering off antidepressants include a long list of problems, such as panic attacks, insomnia, poor concentration and impaired memory.
Turning to the alternatives, we describe below supplements that NYBC has highlighted over the years for sleep and mood disorders. Note cautions about their use, but also note that some of these products may actually carry added benefits, rather than unwanted side effects.
1. Melatonin is a hormone occurring naturally in the body, but some people who have trouble sleeping have low melatonin levels. Melatonin has been used for jet lag, for adjusting sleep-wake cycles for people doing shift work on varying schedules, and for insomnia, including insomnia due to high blood pressure medications called beta-blockers. It is also used as a sleep aid when discontinuing benzodiazepines (Klonopin, Xanax, etc.) and to reduce side effects when quitting smoking.
2. Fish Oil. Epidemiologists have noted that populations that eat fish regularly have low rates of depression. And research has found that omega-3 fatty acids in fish oil supplements can be of benefit in treating depression and bipolar disorder. Fish oil can also be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: fish oil can help manage cholesterol, and supports cardiovascular health.
3. Deficiencies in the B Vitamins, especially B12 and folate, can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as memory loss, confusion, disorientation, depression, irrational anger and paranoia. A number of studies have shown that vitamin B12 is deficient in a large percentage of people with HIV, and the deficiency can begin early in the disease. Supplementing with a B complex protects against deficiency and supports cognitive health and mental function.
4. Vitamin D deficiency has also been linked to depressed states. Lack of the “sunshine vitamin” may be especially associated with Seasonal Affective Disorder (SAD), the “winter blues.” Vitamin D also supports bone health, and may protect against colds and flus.
5. Theanine, an amino acid found in green tea, acts as a relaxing agent by increasing levels of certain neurotransmitters (=brain chemicals that shape your mood), including serotonin, dopamine, and GABA (gamma amino butyric acid). Human studies have been limited to date, but one small study showed that theanine decreases stress responses such as elevated heart rate. Another investigation compared theanine’s calming effect to that of a standard anti-anxiety prescription drug, and found that theanine performed somewhat better. Note that NYBC stocks Theanine Serene (Source Naturals), a combination supplement that includes theanine and GABA.
6. Probiotics. Very recent research has looked into the communication between the digestive system and the brain, with a goal of understanding how gut health may influence chronic conditions, including mood disorders like depression and anxiety. For example, it has been shown that certain probiotics promote production of the calming, anti-stress neurotransmitter GABA in the body, pointing to a direct influence of probiotics on mood. Other potential links between the gastrointestinal system’s microorganisms and brain function are currently being explored.
7. L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan). These closely related supplements are converted in the body to serotonin and to melatonin. (Take L-tryptophan with carbohydrates to make it effective.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, take the supplement an hour before bedtime.) Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them, so it may be worthwhile to try the other if the first doesn’t produce an effect An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.
8. In research funded by the National Institute of Mental Health, DHEA (dehydroepiandrosterone) was found to be an effective therapy for mild-to-moderate or severe midlife depression, on par with some prescription drugs. Moreover, the research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate conditions or cancer.
9. SAMe (S-adenosyl-l-methionine) is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and dopamine. Several studies show SAMe having an antidepressant effect comparable to that of some prescription drugs. SAMe should be avoided in people with bipolar disorder, and should be used cautiously with other antidepressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build-up of homocysteine, which has been linked to heart disease SAMe may also support joint health and liver function. Caution: the National Center for Complementary and Alternative Medicine has posted a warning that SAMe may increase likelihood of pneumocystis infection in immune-compromised people. Note: see also Trimethylglycine (TMG), which includes the raw materials that the body uses to manufacture SAMe. TMG is much less expensive than SAMe.
10. St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it may affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections.
11. Finally, we’ll mention another combination supplement that NYBC has stocked: GABA Soothe (Jarrow). The GABA in this supplement is the neurotransmitter that promotes calmness coupled with mental focus. Also included is theanine (see above for a description of its anti-anxiety effects) and an extract of ashwagandha, an herb which has long been used in the Ayurvedic tradition of India to reduce fatigue and tension associated with stress.
This article from the Spring 2014 edition of SUPPLEMENT: Newsletter of the New York Buyers’ Club, available for download at http://www.NewYorkBuyersClub.org
Turner, E et al. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. New England Journal of Medicine, 2008; 358:252-260 January 17, 2008 doi: 10.1056/NEJMsa065779
Logan, A.. Omega-3 fatty acids and major depression: A primer for the mental health professional. Lipids Health Dis. 2004; 3: 25; doi: 10.1186/1476-511X-3-25
Sudden cardiac death secondary to antidepressant and antipsychotic drugs, Expert Opinion on Drug Safety, March 2008; 7(2):1081-194
Alramadhan E et al. Dietary and botanical anxiolytics Med Sci Monit. 2012 Apr;18(4):RA40-8.
Rogers PJ, Smith JE, Heatherley SV, Pleydell-Pearce CW. Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together. Psychopharmacology (Berl) 2008;195(4):569–77.
Kimura, K et al. L-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan;74(1):39-45.
Carpenter, D J. St. John’s wort and S-adenosyl methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit? Altern Med Rev. 2011 Mar;16(1):17-39.
Foster, J A et al. Gut-brain axis: how the microbiome influences anxiety and depression Trends in Neuroscience. 2013 May;36(5):305-12. doi: 10.1016/j.tins.2013.01.005.
Rao, A V & Bested, A. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009; 1: 6 doi: 10.1186/1757-4749-1-6
As the days get shorter and we approach the end of October, here in the Northern Hemisphere many worry about the Cold and Flu Season. Colds and flus aren’t fun for anyone, and people with compromised immune systems may be especially vulnerable. Here are some recommendations from NYBC, both in the prevention department and in the symptom alleviation department. Using these supplements, we believe, can make the Cold and Flu Season a lot less scary!
Vitamin D. According to some recent thinking, the “cold and flu season” may actually be the “Vitamin D deficiency season.” As the days grow shorter, people get less sunshine, leading to a decline in the body’s levels of this vitamin, which is essential to good health in many more ways than we used to think. Taking Vitamin D during the winter may therefore be one of the most effective ways to prevent colds and flu. Many researchers who’ve studied Vitamin D now recommend at least 2000 IU/day, but those with a known deficiency may be advised to supplement at even higher levels. There’s a simple test available to check for Vitamin D deficiency – ask your doctor.
Cold Away. This blend of Chinese herbs from Health Concerns is designed to “clear external heat and alleviate symptoms of the common cold.” A key component of this formula is the herb andrographis, which in several recent US studies was found to significantly decrease cold symptoms and the duration of a cold; it may also be useful for prevention. (NYBC stocks over 20 varieties of Traditional Chinese Medicine formulas, by the way.)
Vitamin C. Many good studies have shown a decrease in cold symptom duration, but no benefit for prevention. According to a guide to natural products published by the American Pharmacists’ Association in 2006, taking between one and three grams of Vitamin C per day may decrease cold symptoms (sore throat, fatigue, runny nose) by one to 1½ days.*
N-acetylcysteine (NAC) supports respiratory and immune system function. It has been studied extensively for chronic bronchitis. NAC is also the antidote for acetaminophen poisoning, now the leading cause of liver disease in the US. (Acetaminophen’s best-known tradename is Tylenol®, but it’s also found in many other drugs, so it’s become all too easy to overdose–especially when you’re fighting cold or flu symptoms.)
One popular way to take NAC is to use PharmaNAC, notable for its careful quality control, pleasant “wildberry” flavor, and effervescent fizz!
Botanicals. In Traditional Chinese Medicine, astragalus is used for chronic respiratory infections, for colds and flu (both prevention and treatment) and for stress and fatigue. It contains complex sugar molecules called polysaccharides, which some studies show stimulate virus-fighting cells in the immune system. Researchers at the University of Texas and M.D. Anderson Cancer Center have turned up evidence that astragalus boosts immune responses in lab animals, and in human cells in lab dishes.
Probiotics. They say the best defense is a good offense, so consider upping your intake of the beneficial bacteria found naturally in such things as kefir (the lightly fermented milk beverage) and yogurt: they boost the flora in your intestinal tract, which is where an estimated 80% your immune system resides. Also note that NYBC stocks several varieties of probiotic supplements, including Jarrow’s Ultra Jarro-Dophilus, which has helped many maintain healthy digestive function, always a key to getting proper nutrition into your system and thus supporting immune strength.
And this just in: See posts on this blog for Beta Glucan, which, according to very recent research reports, may be of substantial benefit for fighting colds.
*Natural Products: A Case-Based Approach for Health Care Professionals, ed. Karen Shapiro. Washington, DC: American Pharmacists’ Assoc. (2006), “Cold and Flu,” pp. 173-192.
A recent article, technical as usual, looked at the kinds of bacteria found in the intestines of people living with HIV vs those uninfected (and included one long-term non-progressor who has lived 21 years without treatment and no progression). What they found was described beautifully in this post with embedded video.
The idea presented was that perhaps we can help reduce bodywide inflammation by establishing a more healthy bacterial profile in the gut. An idea we have been talking about for decades!! And indeed, this is why we have proposed the use of agents like glutamine (which help the cells lining the gut called villi to turnover), along with probiotics and prebiotics (fiber and/or beta glucans). These are rather blunt tools but do seem to help improve gut function. We do have some data on the use of probiotics in the management of HIV-related diarrhea and for bacterial vaginosis (and our sister organization, FIAR, is working on a meta-analysis on those data). While these kinds of interventions have some benefit, ultimately, understanding what one’s ideal “microbiome fingerprint” is — what is the balance of different types of bacteria that colonize your gut under uninfected conditions — and figuring out how to replace that may provide a substantial improvement in clinical condition, dramatically reducing bodywide inflammation that may persist even under conditions of antiviral suppression.
See the NYBC website for more information on PROBIOTICS
Below is a report on a recent conference on one of our favorite categories of supplement–PROBIOTICS.
We aren’t surprised that prestigious scientific organizations like the New York Academy of Sciences devote their resources to spreading the word about Probiotics. Over the last 100 years, these “friendly bacteria” have been the subject of an enormous amount of scientific study, confirming their crucial role in maintaining the human body’s immune system. And we also know that many NYBC members over the years have benefited from use of Probiotics such as the Jarrodophilus line from Jarrow, or Florastor (Saccharomyces boulardii). For a full list of these Probiotics, with indications for their use and dosing recommendations, see the NYBC catalog at PROBIOTICS AT NYBC
Report on Probiotics, Prebiotics, and the Host Microbiome: The Science of Translation
Wednesday, June 12, 2013 | 7:45 AM – 6:00 PM /The New York Academy of Sciences
George M. Carter
This was a day-long series of discussions, with nearly 70 posters that brought together a variety of researchers, clinicians and, of course, pharma reps sniffing around for profits. And all about the horrors of–BACTERIA! Of course, some bacteria cause disease…but most of them not only don’t, but we need them to live. And there are indeed a lot of them!
These good ones, when they are found in the diet or as a supplement, are known as probiotics, such as acidophilus or bifidobacteria. They are found, for example, in yogurt or other fermented foods. Prebiotics, on the other hand, are substances that help to facilitate the growth of those good bacteria, but are otherwise non-digestible. They include fiber (soluble or insoluble) and agents such as beta glucans, inulin and oligosaccharides.
There seemed to be a general feeling of anticipation as our knowledge grows about the microbes we share—and depend upon for our survival. Various populations of microbes live in distinct communities on and in our bodies. Each bacterium has its own set of DNA, just like each of our human cells (except cells like platelets and red blood cells). All of our human cell DNA contributes about 25,000 genes. By contrast, if you add up all the “bugs” in and on our bodies, that figure runs into the MILLIONS of genes, recent estimates placing the number at about 8 million. And if you removed all the microbes from your body, aside from killing you, that entire amount of bacteria would weigh up to 3 pounds!
That collection of microbes and their genes and gene-products are known as the microbiome. This is a complex system of various species of bacteria that interact with the host (us) and other bacteria. They tend to form ecologies at various sites so that the crew found in your nostrils may not be the same as that found in the gut, the vagina, or on the skin, for example. And the patterns of bugs that colonize us are different from person to person to some degree—and even change over the course of a lifetime.
These various types of bacteria are categorized by their taxonomy. Taxa refers to the genus, species and strain of the bacteria; for example, you may have heard of Lactobacillus acidophilus, often found in enriched yogurts. “Lactobacillus” is the genus name and “acidophilus” is the species. These also may be divided into further subtypes known as strains, so one strain is L. acidophilus L1, used to feed cattle to reduce the amount of bad bacteria such as E. coli O157:H7.
And these bacteria are necessary for our survival. They perform a huge number of functions, including producing some vitamins, training our immune systems, blocking bad bacteria from growing, and even altering our moods. They communicate within and between species of bacteria, as well as with our body. Some of them may cause trouble, including Helicobacter pylori (ulcers) and Clostridia difficile (colitis). How best to treat a dysbiosis (=microbial imbalance on or inside the body) is evolving as we increase our understanding of the relationships and ecologies of these bacterial communities.
The alterations in the nature of these communities arise from the time we are born. If one is born by a Caesarean, one tends to get more of the microbes of the mother’s skin as opposed to the vaginal microbial system that the infant collects during a vaginal birth. Whether this has any longer term clinical impact remains unclear, though some evidence suggests that those born by Caesarean may be at higher risk of allergies or asthma. The microbiota tend to establish themselves as a more adult phenotype by the tender age of 2 or 3. Some researchers are developing models that look at similarities in the patterns of the microbes such that people are divided into 2 or 3 enterotypes.Although this attempt at classification is still evolving, it may help us see how an individual’s response to or problems with host bacteria can be understood and managed.
Indeed, some of the sessions focused on new discoveries of particular bacteria that appear to be associated with protection from certain diseases, or may be implicated in causing disease. One group discussed their findings of a putative association of Akkermansia muciniphilia with the development of diabetes, while others focused on patterns of the microbiome that might underscore a potential for obesity. Many of the sessions were devoted to research in mice, which was moderately interesting from an academic perspective. Others looked at the inter-relationship between probiotics and brain function as well as “gut feelings” (the gut containing what some have dubbed a second brain’s worth of neuronal innervation).
This raised some issues abouthow to study these agents in the context of a Food and Drug Administration that is at the least bureaucratically hostile to the study of dietary supplements and currently forbids them to be marketed as preventing, curing or mitigating diseases. Discussion was devoted to these challenges, but I think it failed to get to the heart of the matter, namely, that we need—VERY carefully[1]—to address how to create rulemaking with regard to Investigational New Drug requirements that does not require an absurd level of documentation of safety for products ALREADY on the market and in widespread use!
Other studies in humans can avoid the onerous process of acquiring an IND by using a primary endpoint (what the study seeks to establish) that is more in line with either the supplement’s use as a “medical food” (a very narrow definition), or that seeks to improve outcomes to structure or function of the body (the currently allowed dietary supplement claim).
The frightening prospect, to me, was the pharma reps sniffing around, no doubt seeing how they can “capitalize” on and/or patent products to extract huge profits. The notion of “public-private” partnerships in this arena gives me the horrors as it usually means taking away access except for the wealthy. We’re talking about products found in yogurt that have been used for millennia!
Still, the day also had a couple of remarkable and straightforward studies. The most exciting was the work of a group who helped women in various nations in Africa to produce their own probiotics and yogurt. This had the added advantage of creating an economic opportunity for the women, increasing respect from male householders as they brought in income while also improving health outcomes. This was augmented even more by the addition of a powder of the dried leaves of Moringa, a plant that grows like a weed from South America, throughout Africa, South and Southeast Asia, and which has a good array of micronutrient vitamins and minerals. Not in huge amounts, but fairly comprehensive.
A speaker from Scotland, Mr. Burns, also discussed the kind of “grassroots” organizing that they undertook in Scottish hospitals to translate research into the public health sphere. The point of this exhilarating talk was how to get from the bench to the bedside—in short, he was promoting a very comprehensive strategy for creating awareness among physicians and others, working with district leaders and hospital administrators. Their efforts got them, for example, to adhere more closely to checklists for surgeries and pneumonia management. By requiring and getting more attention to these matters, they were able to successfully, and dramatically, drop death rates. Some of these programs have run now for over 10 years, and involve getting physicians and others to prescribe probiotics or prebiotics and actually use them in preventing C. diff. or better management of bacterial vaginosis,or management of HIV-related diarrhea!
It was a day packed with information and interesting people. I attended with Dr. Henry Sacks of Mount Sinai School of Medicine, with whom I have been working on a grant from the National Institutes of Health to undertake meta-analyses of various questions relating to the use of Complementary and Alternative Medicine (CAM) approaches to managing HIV disease and ARV side effects. We are finishing up work on our first two questions, the use of a multivitamin/mineral among HIV+ people, and the management of peripheral neuropathy with Cannabis sativa. Our next question, which we are now beginning to work on, is the use of probiotics!
Footnote:
[1] Any changes in IND rulemaking should be careful to avoid opening the floodgates to drug companies using such changes to weaken safety or oversight of new drugs, of course. Accelerated approval has been abused by the companies to push more drugs more rapidly onto the market that are NOT medically superior or addressing a desperate need as antiretroviral drugs were in the mid-90s.
A recent review article that pooled findings from more than 11,000 patients concluded that probiotics were effective for preventing and treating antibiotic-associated diarrhea. About 30% of people treated with a course of antibiotics develop diarrhea, so this is a significant medical issue. Types of probiotics reviewed include Lactobacillus and Saccharomyces boulardii; both were found effective. See NYBC’s entries under Probiotics for details on how to use.
Reference: Hempel S, et al “Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis” Journal of the American Medical Association 2012; 307: 1959-1969
As we pass through the short days of winter, which also brings the cold and flu season to those of us in the northern hemisphere, our thoughts may turn to fortifying ourselves with a good diet, making it as healthy as possible till that day when the arugula sprouts in the garden or the new crop of berries arrives (ok, getting a little poetical here!)
Anyway, here are NYBC suggestions for green foods and green/red foods combinations, which many use to boost the nutritional content of their diet when that boost is most needed:
Organic DAILY 5 (Jarrow). A mix of greens and reds (fruits). Used as directed, it is a 30-day supply, at $23.40/month. It is a blend of high quality, organic (USDA seal) fruits and vegetables, rich in antioxidants such as proanthocyanidins.
Each single (6 g) scoop provides 3,240 mg of a blend of organic fruits and vegetables, including apple, carrot, raspberry, strawberry, cranberry, blueberry, beet powder acerola powder, broccoli and spinach. In addition, each scoop includes 1,720 mg of organic flax seed powder as well as 110 mg of a blend of organic barley grass, wheat grass and oat bran powders.
Green Vibrance is a more complex mix of probiotics, greens, and immune supportive nutrients. The list of ingredients is long, so please follow the link to see how this green food supplement is structured. A month’s supply is $38.50, and a 60-day Green Vibrance is also available for the savings-conscious. (The large size will save you about 20% off the one-month version, if our calculations are correct.)
As this story notes, the bacteria in our guts are important for a variety of health issues, including production of vitamins as well as protecting the immune system. They note a study indicating that the use of probiotics (like acidophilus, bifidus and the like) can help reduce the insulin resistance seen with type II diabetes.
The article is a short review of a presentation given by Professor Willem M. de Vos at the fourth Environmental Microbiology Lecture: “Microbes Inside” on October 10, 2011.
NYBC’s Low-Cost Alternative to the Pricey “Ultramind Solution”
The UltraMind Solution by Dr. Mark Hyman is one of many recent books that attempt to translate the piles of research from the last few decades about nutrition and brain function into useful guidelines for improving and maintaining good mental functioning and psychological well-being.
The Ultramind Solution contends that changing your diet–your “nutritional intake”–can often make a huge difference with conditions like depression, memory impairment, or “brain fog.” Dr. Hyman’s recommendations focus both on weeding out elements that harm the system (too much sugar, poorly chosen carbs, alcohol, cigarettes), and sticking to a menu of what’s good, especially what’s good for brain function: 1) omega fatty acids (found in salmon, sardines, flaxseed); 2) amino acid sources (nuts, lean meats); 3) high-quality carbs (for example, beans, peas, and lentils); 4) phyto-nutrients (plant foods containing antioxidants and other helpful substances, like blueberries, cilantro, etc.).
Finally, Dr. Hyman observes that, since more than 90% of Americans don’t get adequate nutrients from food (a finding from an often-cited US government survey), many people realistically will need to supplement in several key categories: 1) a multivitamin; 2) fish oil (omega fatty acids); 3) Calcium/Magnesium; 3) Vitamin D; 4) B complex vitamins; 5) probiotics (for good absorption of nutrients).
And yes, you can even go to the ”Ultramind” online store, where you can purchase a kit containing these supplements. The problem is that, at $121.50 for a month’s supply, this package is way overpriced. But never fear—NYBC, as a nonprofit supplements co-op, can offer an alternative that’s a close equivalent (or slightly better), but at only $90 for a month’s supply ($80 if you sign up for a $5 minimum annual membership in the co-op).
Multivitamin: Added Protection without Iron (Douglas)
Fish oil: Max DHA (Jarrow)
Calcium/magnesium/Vitamin D: Ultra Bone Up (Jarrow)
B: Methyl B-12 (other B vitamins included in the multi)
Probiotic: Ultra Jarrodophilus
By the way, you can purchase any of these items individually at NYBC if you like. Again–at lower prices than in the “Ultramind” store.
Here’s the NYBC summary of recent research on Saccharomyces boulardii, which is available under the tradename Florastor:
Saccharomyces boulardii, sometimes abbreviated Sac. boulardii or S. boulardii, is a very well-researched probiotic, with several hundred peer-reviewed studies to its credit, many from the past two decades. It’s now the first choice among probiotics for antibiotic-associated diarrhea, C. difficile colitis, and “traveler’s diarrhea.” It can also help with irritable bowel syndrome, ulcerative colitis and Crohn’s disease. Here are some recent research highlights:
-Harvard Medical School researchers have identified specific pathways by which Saccharomyces boulardii decreases intestinal inflammatory responses; their 2006 report helps explain the broad range of protective effects that this probiotic exerts in a variety of gastrointestinal disorders. (Sougioultzis S, et al. Saccharomyces boulardii produces a soluble anti-inflammatory factor that inhibits NF-kappaB-mediated IL-8 gene expression. Biochem Biophys Res Commun. 2006 Apr 28;343(1):69-76.)
-A 2006 meta-analysis (combined analysis of multiple individual studies) found that Saccharomyces boulardii was the only probiotic studied that was effective against Clostridium difficile disease, a common form of antibiotic-associated diarrhea. (McFarland L V. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006 Apr;101(4):812-22.)
-A 2008 study found that Crohn’s patients receiving Saccharomyces boulardii treatment showed significant improvements in intestinal function compared with those given a placebo. (Garcia Vilela E, et al. Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn’s disease in remission. Scand J Gastroenterol. 2008;43(7):842-8.)
-An investigation published in 2009 found that, of a variety of probiotics, Saccharomyces boulardii was uniquely able to stimulate production of secretory IgA, the main immunoglobin found in mucus, saliva, and secretions from the intestine and the lining of the lungs, and a main component of the body’s protective mechanism against pathogens. Thus Saccharomyces boulardii may now be credited with an ability to enhance immune function in general. (Flaviano S. et al. Comparative study of Bifidobacterium animalis, Escherichia coli, Lactobacillus casei and Saccharomyces boulardii probiotic properties. Archives of Microbiology, Volume 191, Number 8 / August, 2009.)
Jarrow Formulas advertises this product as the number one selling probiotic supplement on the US market, and, at least in this case, we tend to think that’s a sign that it is a worthwhile supplement, helpful for people dealing with malabsorption or various gastrointestinal disturbances that prevent adequate digestion.
Here’s the product review from the NYBC website:
Jarro-Dophilus EPS (Jarrow) Each bottle, 60 capsules. Each capsule contains 4.4 billion probiotic organisms, including various species of Lactobacillus, Bifidus, Pediooccus acidilactici and Lactococcus diacetylactis. These capsules are enterically-coated to preserve them without refrigeration, which makes this an ideal product for use while travelling. However, if at home, refrigerate anyway, just to preserve them as well. Blister packed. Suggested use is 1-2 capsules per day, if possible, without food. Dairy-free and vegetarian formulation. Also contains potato starch, magensium stearate and ascorbic acid.
Note: A 2006 consumerlab.com report evaluated several brands of acidophilus-containing products. This Jarrow product passed all of their tests!
Further information on this and other probiotic supplements can be found on the NYBC website:
We’re reprinting below the NYBC recommendations
for supplements that address the common gastrointestinal
problems of people with HIV:
Diarrhea. This is one of
the most common side effects of
antiretroviral drugs–especially protease
inhibitors. When it occurs, make
sure to drink plenty of (healthy) fluids
to replace electrolytes (potassium,
sodium, and magnesium ions) and
prevent dehydration. Avoid sugary
and/or caffeinated beverages.
One of the simplest remedies: bananas!
Adding a yogurt with active
cultures to your regular diet can also
improve diarrhea. In addition to adding
beneficial flora to your gastrointestinal
tract, yogurt is nutritionally
rich in protein, calcium, riboflavin,
vitamin B6 and vitamin B12.
However, for some, dietary changes may
not be enough to control the diarrhea
Supplements to consider in treating
diarrhea associated with protease
inhibitors include calcium, and glutamine
(up to 20-40 grams daily for
diarrhea while it persists). There are
some clinical data to support these
interventions. A note of caution: calcium
carbonate works fine but should
be avoided if you are using atazanavir
[Reyataz].
If diarrhea is associated with the use
of antibiotics, go probiotic! Use acidophilus,
bifidus or Saccharomyces
boulardii (Florastor) to control C.
difficile (a problem frequently encountered
with antibiotic use) and to improve gut function.
Use of digestive enzymes may also help to improve
digestion (e.g., lipase, protease, amylase, and
lactase).
Malabsorption is the difficulty in digesting or
absorbing nutrients from food. It’s a widespread
problem among HIVers, and a serious
one at that. HIV disease damages the
guts, where it is estimated that 80%
of the disease “lives,” hindering the
digestive tract’s ability to absorb nutrients
(or meds). Additionally, many
HIVers actually have too little acid
in their stomachs – a little-discussed
condition. This can cause the sphincter
at the opening of the stomach to
fail to close properly, resulting in
GERD: gastro-esophageal reflux disorder.
In general, gut function can be
improved with probiotics such as
acidophilus and bifidus, as well as
2-5 grams of glutamine, taken daily.
Further, digestive enzymes that help
break down fats, carbs and proteins
may be useful in promoting better
absorption. Again, a good diet and
a potent multi are important starting
points!
See the NYBC entries for more detailed
recommendations regarding these supplements:
Meanwhile for us at the New York Buyers’ Club… real life goes on. We think Dallas Buyers Club does an important job in casting its bright Hollywood lights on the work of buyers’ clubs in the fight against HIV/AIDS, beginning in the early days of the pandemic. But here at NYBC –the last HIV/AIDS buyers’ club standing- we would like to present our own award: to YOU! For being an NYBC member, and thereby participating in a long-running community effort to distribute the best available information about managing symptoms and side effects of HIV and HIV meds, while also helping to make beneficial supplements widely accessible through a nonprofit co-op. And a special thanks to the many contributors out there who lent their financial support to NYBC’s recent successful fundraising campaign—you’re our equivalent of the Hollywood producer, without whom the magic can’t happen!
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