Low Vitamin B12 Linked to Cognitive Decline

We’ve seen much information in recent years about the relationship between the B vitamins, especially B12, and cognitive function. But a new study fills in details about the mechanisms connecting low B12 levels and declining cognitive health. And one of the study’s authors has suggested that, while there is already a general recommendation for older adults to supplement with B12, there may be cause to advise middle age adults to do the same.

The mechanisms of cognitive decline associated with low levels of B12 include brain atrophy and cerebral infarcts (=blood flow blockage leading to tissue death). Other recent research has suggested that supplementing with B12 may slow brain atrophy as we age, so the current study linking low B12 levels to greater degrees of brain atrophy is not a big surprise.

The Institute of Medicine, an organization that establishes recommended daily allowances for vitamins, currently advises older adults to supplement with Vitamin B12, since seniors frequently are deficient in the vitamin due to declining ability to absorb nutrients. But according to one of the current study’s authors, it may make sense to screen adults for B12 deficiency even before they reach senior status, and address early signs of deficiency with supplementation.

NYBC stocks Vitamin B12 as in a highly absorbable form:

Methylcobabalmin

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

For more information about the B12 research on cognitive decline, see: http://www.medpagetoday.com/Neurology/GeneralNeurology/28740

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Follow-up on folate and cancer risk

We’ve had a recent comment on our own post regarding the importance of B12 and folate supplementation for people with HIV. The comment expressed concern about some reports that folate may be associated with increased cancer risk. Here’s a reply to that comment:

We recommend this web page for a recent study of folate and REDUCED colorectal cancer risk:

http://www.michaelmooney.net/FolateReducesCancerWillet.html

The 2011 article cited, by a well-known nutrition scientist, finds folate from diet and folate from supplements both associated with reduced colorectal cancer incidence–when taken over a long period (we’re talking about 15-20-30 years). This fits with what is generally understood about the value of vegetables in reducing cancer risk. Not surprising to us is the other finding of the study: that short-term folate intake, around the time of the development of pre-cancers, is not going to help reduce cancer incidence! Indeed, many supplements do not necessarily produce pronounced short-term effects, but rather show health benefits over the long term.

Using B vitamin supplements for neuropathy: recommendation from Lark Lands

Peripheral neuropathy, or tingling/flushing/burning in the extremities (hands and feet), is a side effect found with diabetes, and can also be a side effect of some HIV medications. Here’s an approach to dealing with this condition described by Lark Lands, a treatment educator who has served as an advisor to the Canadian AIDS Treatment Information Exchange, from whose online Fact Sheets the following excerpt is drawn:

To treat peripheral neuropathy

Although vitamin B12 is most commonly associated with the treatment of peripheral neuropathy, supplements of other B vitamins may also improve this condition. In her book Positively Well, Lark Lands reports that biotin and thiamine supplements have helped improve symptoms of neuropathy. Other “unofficial” B vitamins such as choline and inositol, which are often included in B vitamin supplements, may also help to treat neuropathy. According to Lark Lands, these vitamins have improved symptoms of neuropathy in many of her HIV-positive patients. She recommends supplementation with all of the B vitamins, as taking only only one of this group can lead to deficiencies in others.

For more information, see the NYBC entry for B-Right (Jarrow), a B vitamin supplement that the purchasing co-op has chosen to stock because it meets many of the recommendations for supplementation with this vitamin (25mg dosage for B1, B2, B3, B6; includes choline and inositol).

Note that for effective B12 supplementation, NYBC recommends the B12 – Methylcobalamin format.

Taking Vitamins and Minerals When You’re HIV+ Some Advice from the Canadians

If you’re HIV+ and looking for a good introduction to the vitamins, minerals, and supplements that can help you stay healthy, we often recommend an online guide produced by the Canadian AIDS Treatment Information Exchange (CATIE), A Practical Guide to Nutrition for People Living with HIV.  CATIE is a national not-for-profit that’s been providing excellent information services to Canadians living with HIV/AIDS for many years. The Practical Guide is reviewed by a panel of healthcare professionals, and also includes information on such dietary supplements as alpha lipoic acid, NAC, Glutamine, CoQ10, probiotics, and carnitine/acetylcarnitine.  This version of the guide was released in October, 2007.

Here’s the excerpt on Multivitamins, Vitamins and Minerals:


Consider taking a multivitamin-mineral each day.


Several studies have shown that vitamin and mineral supplements can have many benefits in people living with HIV. Taking a multivitamin every day is an important part of a nutritional health plan. Check out Appendix E for a list of studies looking at the effect of micronutrient supplements in people with HIV/AIDS.
B vitamins may help slow disease progression in people with HIV. They are also important for healthy mitochondria, the power-producing structures in cells, and may help decrease the impact of mitochondrial toxicity. B vitamins are depleted quickly in times of stress, fever or infection, as well as with high consumption of alcohol. Keep in mind that the RDA is very low and taking a total of 50 mg of B1, B2 and B3 will more than cover B-vitamin needs. Check the multivitamin you take; if it has 30 to 50 mg of these vitamins, you don’t have to take a B-complex supplement in addition to the multivitamin.

Levels of vitamin B12 in the blood may be low in people with HIV. It can also be low in people over the age of 50 years. B12 deficiency is associated with an increased risk of peripheral neuropathy, decreased ability to think clearly, and a form of anemia. People with low B12 levels usually feel extremely tired and have low energy. This deficiency is also linked with HIV disease progression and death. Ask your doctor to check your blood levels. If they’re low, ask about B12 injections to get them back into the ideal range.

If you get B12 shots and your vision is getting worse, mention it to your doctor, especially if you are a smoker. Some forms of injectable B12 can damage your eyes if you have a rare genetic condition called Lerber’s hereditary optic atrophy.

Vitamin C is one of the most important antioxidants. It is very effective at cleaning up molecules that damage cells and tissues (see “Antioxidants and HIV,” this chapter). Vitamin C has been studied for cancer prevention and for effects on immunity, heart disease, cataracts and a range of other conditions. Although vitamin C cannot cure the common cold, supplements of 1,000 mg per day have been found to decrease the duration and severity of symptoms.

In people with HIV, there is some evidence that vitamin C can inhibit replication of the virus in test-tube experiments, but it is unclear what this means in the human body. The most important benefit for people with HIV is the widespread antioxidant action of vitamin C. The daily experimental high dose is between 500 mg and 2,000 mg, the upper tolerable limit.

Calcium – see under “Bone health,” below.

Vitamin D is emerging as a very important nutrient, with more diverse functions than just its traditional role in calcium metabolism. Mounting evidence suggests that 1,000 IU per day should be the recommended daily intake.

Vitamin D is found in some foods, but these sources generally do not provide enough vitamin D on a daily basis. Also, people who live in northern climates (like Canada) probably do not get enough sun exposure to make adequate vitamin D. And the use of sunscreen, which is highly recommended to prevent skin cancer, blocks the skin’s ability to make vitamin D.

For people with HIV, vitamin D supplements are a sure way to get the recommended daily allowance. Vitamin D is found in multivitamins and calcium supplements as well as individual vitamin D pills. Look for vitamin D3; it is the active form of the vitamin. Be sure to add up all the vitamin D from different supplements to be sure you are not getting too much.

Vitamin E has been used as an antioxidant, typically at doses of 400 IU per day. However, studies have found that people who take more than 200 IU per day may be at higher risk of developing heart disease. Until this is fully studied, it may be a good idea to reduce vitamin E supplements to 200 IU unless your doctor suggests you take more.

Vitamin E deficiency is associated with faster HIV disease progression. People with poor fat absorption or malnutrition are more at risk of being deficient in vitamin E. Use supplements from natural sources and those with “mixed tocopherols” for better effect.

Iron supplements to treat iron-deficiency anemia (low levels of red blood cells) should only be taken if prescribed by your doctor. Iron-deficiency anemia is diagnosed by having a low hemoglobin level in the blood. This can be confusing in someone on HAART because some anti-HIV drugs, especially AZT, can cause low hemoglobin levels. There are other blood tests that can help determine whether there really is an iron deficiency. The important point is to not take high doses of iron unless they are prescribed. Iron is a pro-oxidant (the opposite of an antioxidant), which means it can damage different tissues in the body.

Zinc is a critical mineral for the immune system; a deficiency can cause severe immune suppression. People with chronic diarrhea, new immigrants from refugee camps and malnourished people with HIV, especially children, are at high risk of having a deficiency. Be aware that high doses of zinc supplements in people who are not deficient can decrease immune function.

Selenium helps regenerate glutathione, the major antioxidant in cells. Studies have shown that low selenium levels in the blood are associated with an increased risk of disease progression and death. Deficiency is associated with low CD4+ cells. One small study found that a daily supplement of 200 micrograms might have a positive effect in some people with HIV. Studies of the general population suggest that selenium supplementation may provide some protection from cancer.

Fatigue, sleep disturbances, low energy, depression: dietary supplements may help address special health concerns for people with HIV

As we were mulling over the recent New York Times piece on the billions of dollars Americans spend each year on sleep aids that are only mildly effective (see today’s other post under “Melatonin”), we thought we’d reprint this article from the NYBC newsletter THE SUPPLEMENT, which appeared earlier this year.  It deals with the constellation of health concerns, from fatigue to depression, that often affect people with HIV, and gives an overview of some of the dietary supplements that have been used to address these issues.

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Sleeping poorly? Energy low? Feeling down?

Dietary supplements may have something to offer

Sleep disturbances are the third most common complaint among people with HIV seeking medical attention. Everybody knows what it’s like to sleep poorly, then feel cranky and fatigued the next day. But persistent insomnia, followed by chronic fatigue, can become major medical issues for people with HIV (we’re talking about lower CD4 counts and poor medication adherence), so it’s worth reviewing options for dealing with these problems.

A 2005 research presentation suggested that melatonin supplements can improve sleep patterns in people with HIV. Melatonin, a hormone secreted by the pineal gland, has long been studied as a sleep regulator—levels increase in response to darkness, then fall during daytime. It’s also been investigated as an anti-cancer agent, where it has shown the capacity to combat solid tumors. (But melatonin should not be taken by people with cancers affecting immune cells, such as lymphoma or leukemia.)

Good news: a recent trial indicates that low-dose melatonin (0.5 to 1.0 mg) may be perfectly effective as a sleep promoter, making it a very inexpensive option for this purpose.

Fatigue can stem from other causes besides sleep disturbances. Anemia, a shortage of red blood cells, is another leading cause of fatigue among people with HIV, and is especially common among women. (A recent large study found that about 30% of people on HAART had moderate anemia. Women had an 80% greater risk of being anemic than men, and African-Americans had a risk of anemia 2.6 times higher than whites.) It’s important to learn the source of anemia in people with HIV (taking Retrovir, AZT, is a drug-related factor). Treatment options include increasing intake of iron, vitamin B12 and folic acid. Note that NYBC stocks multivitamins with iron for those concerned about their intake of this mineral. You’ll also find folic acid and B12 in our multis, and may want to consider adding a separate vitamin B supplement as well.

While for some people with HIV treating anemia can be a key to helping them overcome fatigue and its frequent companion depression, there are other cases where low energy is not connected to low red blood cell levels, and where the treatment options are therefore different. Particularly in HIV+ men, steroid hormones (testosterone and DHEA) have proven to be useful in combating the fatigue-depression combination. Recent federally-funded research on DHEA showed it to be an effective anti-depressant, with the added interesting feature that it can enhance sex drive (rather than undermining it, as do certain common prescription anti-depressants).  And a Columbia University study of DHEA for fatigue and depression in people with HIV has found it to be a successful treatment for some, with the added bonus that, unlike some prescription energy boosters, it doesn’t carry the risk of addiction.