New @ NYBC – February 2015

supplement-header-2014These New Products and More
Available Through NYBC’s Newly-Redesigned Website & Co-Op Store

mega-pc-35-lecithin-1200mgMega PC-35 Lecithin – (Jarrow Formulas, 120 x 1200 mg; $9.75) Each softgel contains 1200 mg lecithin with choline 57 mg (from 35% PC lecithin) and 420 mg of phosphatidylcholine derived from soy. Phosphatidylcholine is a compound containing different types of fatty acids, glycerin, phosphorus and choline (a nitrogen-containing base). This may be an excellent product for people with hepatitis B or C, according to one well-designed study using 3 grams per day. Other benefits may be for mood enhancement for those with neurological disorders, to enhance cardiovascular health (in the context of a better diet), and possibly preventing or treating gallstones.

betaine-plus-pepsin-100-capsFor digestive health, NYBC is now carrying Twinlab’Betaine HCL Caps (100 caps $9.50). Each capsule contains betaine (as betaine hydrochloride) – 648 mg plus pepsin, 130 mg.

The addition of pepsin is thought to significantly improve the ability of the betaine to help the stomach lower the pH, that is, make the stomach more acid. That first amount of hydrochloric acid that your food hits arriving in the stomach is a crucial part of digestion. Betaine is typically used for people with a condition of low stomach acidity known as hypochlorhydria. This may actually be the problem even though one has reflux. It is a fairly common finding, for example, among people living with HIV, among a range of other conditions. Supplementing with betaine can help to improve digestion IF this is the case. Getting properly diagnosed before trying this is critically important. A 2013 study among healthy adults who had chemically-induced reduction in gastric acid (e.g., through proton-pump inhibitors) saw a reduction in stomach pH when given betaine supplements.

Uridine-5-monophosphate, 60 capsules for $22.20 from Jarrow. Each capsule contains 250 mg Uridine-5’-monophosphate disodium salt. Uridine is one of the nucleotides that is used by the RNA molecule. It is found in abundance incorporated in the phospholipid membranes of neural (especially brain) tissue. Data are limited but suggestive of benefits for memory and liver function. This is not dissimilar to an intervention utilized to help minimize mitochondrial toxicity associated with some antiretroviral drugs. One study suggested this could reduce damage to AZT or d4t (stavudine or Zerit)-related mitochondria, however, markers of inflammation were worsened. So this one should probably be used in the context of an anti-inflammatory protocol such as including carnitine, NAC, alpha lipoic, curcumin, omega-3 fatty acids and the like, which are a good idea anyway to keep TNF, IL-6 and hsCRP in check.

Astaxanthinastaxanthin-12-mg-30 12 mg – 30 softgels $16.25 from Jarrow Formulas. Astaxanthin is one of the many varieties of carotenoids (beta-carotene being one of the longest known and best characterized). Studies are somewhat mixed on the benefits of this agent to offset oxidative stress induced by exercise, with some benefit seen among soccer players and none for cyclists. One study using a mix of carotenoids showed an enhancement of visual acuity. Other small studies suggest benefits for increasing HDL, skin tone, and reflux frequency.


Garlic & Allicin  Sadly, NYBC no longer carries Dr. Zhang’s popular Allicin supplement,garlicell and arlipure however we have found these two excellent substitutes that indicate the amount of allicin and other components on the label. GarliPure from Natrol (120 “odor controlled” caps for $17). Each capsule contains 750 mcg of allicin along with 7.5 mg gamma glutamyl-cysteine, 5 mg allicin, 4 mg sulfur and 800 mcg of thiosulfinates, and GarliCell.
Source Naturals’ GarliCell features “no after-odor.” Each $14 bottle has 90 tablets; each tablet contains 6 mg (6000 mcg) of allicin along with 4.2 mg sulfur and 6 mg of thiosulfinates. Allicin is thought to possess the greatest activity of garlic’s various components. Early studies showed some pretty robust effects on cryptosporidiosis. Aside from anti-infective activity, there may be some benefit for maintaining a healthy blood lipid profile.


New Strengths + Sizes…

NYBC is now carrying a few new strengths and sizes of customer favorites. Our ever-popular “house brand” of CoQ10, Jarrow’s CoQ10 Q-Absorb, now is available in a very economical 120 x 100 mg softgel size for only $29. For those seeking a higher dose, we now also have CoQ10 400 mg (60 softgels) from Protocol for Life at $44.50.

curcumin-phytosome-jarrow-500-mg-60cNYBC has also picked up Jarrow Formulas‘ new Curcumin Phytosome (each cap 500 mg curcumin phytosome-phosphatidylcholine complex with 18-22% curcuminoids), a formulation that may further improve the absorption of curcumin. In the Ayurvedic tradition, recipes often include honey or black pepper, today known to enhance the body’s ability to absorb this increasingly important and well-researched anti-inflammatory agent.

Also new at NYBC…

calcium-blend-iron-free-easy-swallow-180A very moderately priced B100 (B Complex) from Twinlab for $11.75 that contains  100 mg of eachof the B-vitamins (and 100 mcg of B12). Each bottle, 100 capsules… Borage (Jarrow Formulas; 120 sg for $16.25) Provides one gram of polyunsaturated fatty acids from the Borago officinalis plant, including 240 mg of gamma linolenic acid (GLA/omega-3) and other fatty acids. This is a good source of GLA, especially in combination with flaxseed oil … New variation on SuperNutrition‘s Calcium Blend, an iron-free, easy-swallow formulation, same price ($14.25) and strength – just smaller (and more!) tablets.

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New research on depression, and a new look at supplements for mood and sleep disorders

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.

 

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:

CDC statistics on antidepressant use in the US, 2005-2008: http://www.cdc.gov/nchs/data/databriefs/db76.htm

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.

National Center for Complementary and Alternative Medicine at NIH. S-Adenosyl-L-Methionine (SAMe): An Introduction Accessed at http://nccam.nih.gov/health/supplements/SAMe

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

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

Why Vitamins B12 and D3 Are Especially Important to People with HIV

Our friends at the Canadian AIDS Treatment Information Exchange (CATIE), a Canadian government-supported education and prevention organization, recently published an excellent guide to managing HIV medication side effects. This online guide covers the territory from body shape changes, to gastrointestinal disorders, to neurological effects, to emotional wellness, to fatigue, to sexual difficulties.

The Appendix to this guide focuses on two vitamins, both of which have been highlighted as especially important for people with HIV: B12 and D3. Deficiency of these two vitamins appears to be common among people with HIV, and supplementing to correct the deficiency can bring about major improvements in health. So it’s definitely worthwhile to check your B12 and D3 status, and, if you’re deficient, find a good supplementation strategy. Note that NYBC stocks both of these inexpensive vitamins: the methylcobalamin form of Vitamin B12 recommended below; and several strengths of Vitamin D3, including the commonly recommended D3 – 2500IU format.

Below are the CATIE recommendations:

Vitamin B12

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. Vitamin B12 deficiency can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as foggy thinking, memory loss, confusion, disorientation, depression, irrational anger and paranoia. Deficiency can also cause anemia. (See the section on Fatigue for more discussion of anemia.) It has also been linked to lower production of the hormone melatonin, which can affect the wake-sleep cycle.

If you have developed any of the emotional or mental symptoms mentioned above, especially combined with chronic fatigue, vitamin B12 deficiency could be contributing. This is especially true if you also have other symptoms that this deficiency can cause, including neuropathy, weakness and difficulty with balance or walking. On the other hand, these symptoms can also be associated with HIV itself, with hypothyroidism or advanced cases of syphilis called neurosyphilis. A thorough workup for all potential diagnoses is key to determining the cause.

Research at Yale University has shown that the standard blood test for vitamin B12 deficiency is not always reliable. Some people who appear to have “normal” blood levels are actually deficient, and could potentially benefit from supplementation.

The dose of vitamin B12 required varies from individual to individual and working with a doctor or naturopathic doctor to determine the correct dose is recommended. Vitamin B12 can be taken orally, by nasal gel or by injection. The best way to take it depends on the underlying cause of the deficiency, so it’s important to be properly assessed before starting supplements. For oral therapy, a typical recommendation is 1,000 to 2,000 mcg daily.

One way to know if supplementation can help you is to do a trial run of vitamin B12 supplementation for at least six to eight weeks. If you are using pills or sublingual lozenges, the most useful form of vitamin B12 is methylcobalamin. Talk to your doctor before starting any new supplement to make sure it is safe for you.

Some people will see improvements after a few days of taking vitamin B12 and may do well taking it in a tablet or lozenge that goes under the tongue. Others will need several months to see results and may need nasal gel or injections for the best improvements. For many people, supplementation has been a very important part of an approach to resolving mental and emotional problems.

Vitamin D

Some studies show that vitamin D deficiency, and often quite severe deficiency, is a common problem in people with HIV. Vitamin D is intimately linked with calcium levels, and deficiency has been linked to a number of health problems, including bone problems, depression, sleep problems, peripheral neuropathy, joint and muscle pain and muscle weakness. It is worth noting that in many of these cases there is a link between vitamin D and the health condition, but it is not certain that a lack of vitamin D causes the health problem.

A blood test can determine whether or not you are deficient in vitamin D. If you are taking vitamin D, the test will show whether you are taking a proper dose for health, while avoiding any risk of taking an amount that could be toxic (although research has shown that toxicity is highly unlikely, even in doses up to 10,000 IU daily when done under medical supervision). The cost of the test may not be covered by all provincial or territorial healthcare plans or may be covered only in certain situations. Check with your doctor for availability in your region.

The best test for vitamin D is the 25-hydroxyvitamin D blood test. There is some debate about the best levels of vitamin D, but most experts believe that the minimum value for health is between 50 and 75 nmol/l. Many people use supplements to boost their levels to more than 100 nmol/l.

While sunlight and fortified foods are two possible sources of vitamin D, the surest way to get adequate levels of this vitamin is by taking a supplement. The best dose to take depends on the person. A daily dose of 1,000 to 2,000 IU is common, but your doctor may recommend a lower or higher dose for you, depending on the level of vitamin D in your blood and any health conditions you might have. People should not take more than 4,000 IU per day without letting their doctor know. Look for the D3 form of the vitamin rather than the D2 form. Vitamin D3 is the active form of the vitamin and there is some evidence that people with HIV have difficulty converting vitamin D2 to vitamin D3. Historically, vitamin D3 supplements are less commonly associated with reports of toxicity than the D2 form.

It is best to do a baseline test so you know your initial level of vitamin D. Then, have regular follow-up tests to see if supplementation has gotten you to an optimal level and that you are not taking too much. Regular testing is the only way to be sure you attain — and then maintain — the optimal level for health.

With proper supplementation, problems caused by vitamin D deficiency can usually be efficiently reversed.

Vitamin B-12 for vegetarians and vegans

We seem to run across more and more people these days who are vegetarians or vegans. Some have adopted these diets for health reasons. And there’s a growing number who believe that vegetarianism is a logical part of wise stewardship of Earth’s resources. So here’s one bit of supplement advice to help vegetarians and vegans:

Vitamin B-12 is of special interest to vegetarians since it is not found in any significant amounts in plant foods. Many vegetable or bean foods that were once thought to supply B-12 (including fermented tempeh, miso, and various seaweeds) have been shown not to contain the form of the vitamin needed and, thus, strict vegans (those who eat no animal products at all) will definitely need B-12 supplementation.

NYBC stocks Vitamin B12 as in a highly absorbable form:

Methylcobabalmin

Also available is the B-complex:
B-right (Jarrow)

MS Sufferer Improves Dramatically

Here is a terrific YouTube post by Dr. Terry Wahls. She is a person living with secondary, progressive multiple sclerosis (MS). By 2008, she could not walk more than a short way with two canes. At this point, she began a journey into understanding how her disease progresses and ways in which diet and supplements can have an impact on that disease. Check out the video and see her remarkable results–one of the always remarkable and inspiring TED talks series!

How often to check vitamin levels?

MedPage Today, an online medical information service that addresses current health care findings, recently conducted a readers’ poll on the question of how often vitamin levels should be checked. Most of those responding to the poll agreed that factors such as processed foods, mineral-depleted soil, overcooked vegetables and daily stress have combined to create widespread deficiencies in some vitamins and minerals. The majority also agreed that vitamin levels should be checked yearly. Here are some of the comments:

We asked readers if and when patients should be assessed for vitamin deficiencies. Of the more than 2,200 votes, 69% said that patients’ vitamin levels should be assessed at least annually.

“I cannot remember how many patients have been rescued from dementia and psychosis by B12, especially when I have a geriatric focus,” said one doctor, who also touted vitamin D, calcium, fish oil, and thyroid testing. “Everybody deserves a look about once a year.”
[…]
“I have just been rescued from severely low vitamin D levels, and my daughter has been found to have low vitamin levels as well. I wish my doctors had been checking levels all along,” noted another MedPage Today reader.

And another expressed similar exasperation. “It was not until I was diagnosed with osteoporosis that I had a vitamin D 25-OH test, and found out that despite being outside every day, my level was insufficient. By then it was too late. I am very disappointed that my physician did not order this inexpensive test years ago. Now, I have asked for a B12 test as well.”

See details at http://www.medpagetoday.com/