The latest on Vitamin K2: a new therapeutic agent for rheumatoid arthritis and for prostate cancer?

Vitamin K2, which is best known for its role in supporting bone health and its potential for countering osteoporosis, has also been investigated recently for other health benefits. A 2013 study reported that Vitamin K2 significantly decreased disease activity in patients with rheumatoid arthritis. And other research, also published in 2013, found evidence that Vitamin K2 is active in suppressing various types of prostate cancer cells. The authors of this study conclude that Vitamin K2 “may be a potential therapeutic agent in the treatment of prostate cancer.”

For further information about Vitamin K2, see the NYBC catalog entries for the Bone Up, Bone Up Ultra, and Vitamin K supplements (all from Jarrow):

Bone and Joint Supplements

References:

Ebina, K, et al. Vitamin K2 administration is associated with decreased disease activity in patients with rheumatoid arthritis. Mod Rheumatol. 2013 Sep;23(5):1001-7. doi: 10.1007/s10165-012-0789-4.

Samykutty, A, et al. Vitamin k2, a naturally occurring menaquinone, exerts therapeutic effects on both hormone-dependent and hormone-independent prostate cancer cells. Evid Based Complement Alternat Med. 2013;2013:287358. doi: 10.1155/2013/287358.

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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.

Maca Root Powder

NYBC recently decided to stock this form of the traditional botanical, which has a long history of use and some newer research as well to support its use. Below is our take on MACA (excerpted from our catalog description).

Read more, and purchase from the buyers’ co-op, at

MACA ROOT POWDER

Royal Maca (Whole World Botanicals) Each bottle, 180 maca root gelatinized capsules. Each capsule, 500 mg Royal Maca Root Extract along with 2.49 mcg of selenium. This is certified organic by BIO LATINA in Lima, Peru, which so far as we have reviewed here at NYBC appears to be a legitimate certification institution for organic products from this region.

Whole World Botanicals obtains its root from a farm in the high Central Sierra of Peru. Maca, from the root of Lepidium peruvianum / meyenii, has a nutty, malty flavor and is used in traditional medicine to address hormonal imbalances in both women and men. Consider it for managing PMS or menopausal symptoms, for low energy related to hypothyroidism (low function) and may help improve bone strength. Men also use it for libido, erectile function, mood, mental clarity, focus and energy (especially over age 40).

This product is a fair trade product, according to the manufacturer, however it is not labeled as such (yet).

Suggested use varies. For men, 2-6 capsules every day or every other day. For women, if young and peri-menopausal, 2 caps daily. If needed, increase to 3 caps per day in the second month. For women who are not menstruating, 2-3 caps per day for hot flashes is suggested. Evaluate after 5 days and increase by 1-2 caps per day every five days until symptoms are 80% better. Do NOT take with estrogen or estrogenic herbs (may increase hot flash symptoms!). Also do not take with estrogen or if you have any hormone-related cancer.

Bone Up & BioSil

NYBC stocks Jarrow Formulas’ Bone Up, which is a comprehensive formula to support bone health. Its essential components are calcium in a form readily usable for bone building in the body, Vitamin D and Vitamin K. By the way, here’s the Health Claim regarding bone health which the FDA allows for Calcium and Vitamin D:

Adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis later in life.

Jarrow also recommends using Bone Up together with its product BioSil, a bioavailable silicon solution that is helpful in maintaining nails, bones, joints, hair and skin. (Silicon is important for tissue strength and elasticity.)

See the NYBC entries for more information on Bone Up:

http://nybcsecure.org/product_info.php?cPath=53&products_id=241
Jarrow

and BioSil:

http://nybcsecure.org/product_info.php?cPath=50&products_id=234

Nelson Vergel: “Survivor Wisdom”

A Talk by Nelson Vergel: “Survivor Wisdom: Advances in Managing Side Effects, Living Well, and Aging with HIV” – New York City, November 9, 2010

How could you not be impressed by the schedule HIV treatment activist Nelson Vergel keeps? A few days before he arrived in New York to share his “Survivor Wisdom” with New York Buyers’ Club members and guests, he was an invited participant at the 12th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV in London. The founder and moderator of the “pozhealth” group on Yahoo—the largest online discussion group for HIV issues–Nelson also finds time to answer questions on a forum hosted by thebody.com. In addition, he serves as a community member of the federal government’s Department of Health and Human Services HIV treatment guidelines advisory board. And did we mention that he’s the author of a new book, “Testosterone: A Man’s Guide,” especially useful for people with HIV who are considering testosterone therapy to address fatigue and other problems?

As you might expect, Nelson also covered a lot of territory in his NYBC talk, which was co-hosted by the City University of New York’s Graduate Center. He briefly updated the audience on new treatments and guidelines, then reviewed the exceptional case of the HIV+ “Berlin patient,” whose apparent cure following a bone marrow transplant has opened up, at least tentatively, some new lines of research about curing HIV.

Most of Nelson’s talk, however, dealt with familiar issues in managing HIV symptoms and medication side effects: cardiovascular health challenges, lipoatrophy (facial wasting especially) and body fat accumulation (lipohypertrophy), aging with strong bones, fighting off fatigue, minimizing the risk of anal cancer.

Amid this discussion of symptoms and side effects, Nelson spent time on the topic of supplements. His first point, which NYBC would certainly agree with, is that a lot of good evidence has accumulated about the benefit of multivitamin supplementation, and a multivitamin plus antioxidant combination, for people with HIV. These “micronutrients,” as they’re called in the scientific literature, can enhance survival, delay progression of disease in people not yet on HIV meds, and increase CD4 counts in people taking the meds. We have to admit we were pleased when Nelson also took a moment to praise NYBC (and especially our Treatment Director George Carter) for making available an inexpensive, “close equivalent” of the multivitamin/ antioxidant combination that was the subject of Dr. Jon Kaiser’s well-known research and that led to the development and marketing of K-PAX. New York State residents, as Nelson pointed out, have access to many such supplements through formularies. But for residents of other states, this half-price version of the multivitamin/antioxidant combination (MAC-Pack or Opti-MAC-Pack) can provide welcome relief in the budgetary department.

Our speaker then ran through a list of about a dozen supplements that have reasonably good evidence to support their use by people with HIV. He chose to focus more closely, however, on just a few:

Niacin. Despite “flushing” that makes it difficult for some to use, niacin can be very effective in bringing up levels of HDL (“good”) cholesterol in people with HIV. Since cholesterol control is a major long-term health issue for many people on HIV meds, and since recent research suggests that raising HDL cholesterol levels may be an extremely important factor in reducing cardiovascular risk, niacin may be a top choice for many. (Fish oils/omega-3 fatty acids, plant sterols, pantethine, carnitine, and CoQ10 are other supplements that NYBC and many others put in the category of “supports cardiovascular health.”)

Vitamin D. Seems that, even at the London conference Nelson had just attended, the “sunshine vitamin” was a hot topic. Partly that’s because people with HIV have recently been found to have a high prevalence of Vitamin D deficiency, and then because Vitamin D, calcium and other mineral supplementation is a logical approach to addressing long-term challenges to bone health in people taking HIV meds. (Look on the NYBC blog for a whole host of other recent studies about Vitamin D’s potential benefits, from reducing cardiovascular risk to cancer prevention—even as a way of warding off colds and flu.)

Carnitine. This is a supplement, Nelson told the audience, that he’s taken for many years. Reported/perceived benefits: to improve fatigue, lipids, brain function and neuropathy. (NYBC Treatment Director George Carter put in that “acetyl-carnitine”—a form of the supplement that crosses the blood/brain barrier–has shown the most promise for dealing with neuropathy.)

Probiotics. The vulnerability of the gut in HIV infection, and the well-documented problems people with HIV experience in absorbing nutrients, make probiotics a very helpful class of supplements for long-term health maintenance. (Probiotics, good or “friendly” bacteria residing in the gut, are available in a variety of products, from yogurt to supplements. There’s quite a bit of research about the effectiveness of different varieties, and note as well that there are some newer formats that don’t require refrigeration.)

Above and beyond the treatment issues involving supplements, meds, and other strategies, Nelson referred several times to areas where there’s a need for advocacy. He mentioned the cure project, for one, but also a national watch list to help people follow and respond to the devastation created by recent funding cuts and the resultant waiting lists in the ADAP programs of many states, such as Florida.

All in all, NYBC members and guests would doubtless agree: a very thought-provoking presentation, with much helpful information to take away. For more on these and other issues, be sure to check out the NYBC website at:

http://www.newyorkbuyersclub.org/

[A version of this article also appears in NYBC’s free e-newsletter, THE SUPPLEMENT, along with additional reporting on a new Mayo Clinic guide to supplements, and a look at the current state of regulation and research on supplements in the US.]

High Frequency of Vitamin D Deficiency in People with HIV

A number of reports in recent years have suggested an increased prevalence of osteopenia and osteoporosis (moderate and severe bone loss) in HIV-infected patients. In 2008, moreover, a study in the Journal of Clinical Endocrinology & Metabolism reported a higher rate of fractures in HIV-infected individuals compared with uninfected individuals. So there is reason for concern that osteoporosis and osteoporotic fractures will become major health problems for people with HIV as they age.

Here, we’re reporting on another study, released at the start of 2009, which fills in more pieces of information about bone health in people with HIV–and also provides guidance on supplementation strategies that could counteract bone loss and increased bone fracture rates associated with HIV. This research looked at fairly healthy (“ambulatory”) people with HIV visiting a Boston clinic in mid-winter and early spring months, and found a high frequency of vitamin D deficiency. Further tests linked this deficiency to a diminished ability to absorb and use calcium, the central ingredient in bone mass.

Based on their study, the investigators suggested that many people with HIV could benefit from daily vitamin D intake of at least 700-800 IU taken with 1200-1500mg of calcium, especially during the winter months, when the body does not have the opportunity to produce Vitamin D from exposure to sunlight.

Our conclusion: studies are now filling in the details that allow us to conclude that osteoporosis and osteoporosis-related fractures may become an increasingly important health concern for people with HIV as they age. However, there is also growing evidence that supplementing with Vitamin D and calcium can reduce this risk to bone health. It’s therefore important for people with HIV to check their multivitamin to see if they are getting appropriate levels of these two nutrients, or add a specific Vitamin D – Calcium supplement to their diet.

NOTE: NYBC stocks Vitamin D3 (the form most readily used by the body) and Calcium Blend (a food-based vegetarian supplement which includes Vitamin D3). Also available: Bone Up (Jarrow), a supplement containing calcium, Vitamin D and other components specifically for bone health.

Reference: M. Rodriguez, B. Daniels, S. Gunawardene, and G.K. Robbins. High Frequency of Vitamin D Deficiency in Ambulatory HIV-Positive Patients. AIDS RESEARCH AND HUMAN RETROVIRUSES, Vol 25, 1, 2009.

Maintaining bone health – recommendations for Calcium and Vitamin D3 supplementation

Calcium and Vitamin D are both important for keeping bones healthy. Calcium is needed by the body every day, and if not enough is taken in, then calcium is lost from the bones. Meanwhile, in order to absorb calcium effectively, the body needs Vitamin D3. So these two nutrients are both necessary, on a very regular basis, for the long-term maintenance of bone health and the prevention of such conditions as osteopenia and osteoporosis.

Recently, there has also been a lot of research and discussion about the optimum intake of Vitamin D3 to maintain bone health. Many investigators now believe that a minimum of 700 to 800 IU of vitamin D3 per day is needed by adults. This is approximately double the daily intake of 400mg that was commonly recommended in the past.

Other lines of recent research have pointed to supplementation with calcium and Vitamin D3 as having benefits in reducing risk of cancer in some populations; and there is also much study now being devoted to Vitamin D3’s role in the health of the immune system. So the old “sunshine vitamin” is definitely one to watch!

References:

Vieth R, Bischoff-Ferrari H, Boucher BJ, et al. The urgent need to recommend an intake of vitamin D that is effective. American Journal of Clinical Nutrition 2007 Mar;85:649-50.

Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. AmericanJournal of Clinical Nutrition 2007 Jun;85(6):1586-91.

For special concerns regarding HIV and bone loss, see the CATIE treatment update “Complications and Side Effects – Calcium and Vitamin D”.

For some recommendations on supplementation from NYBC, see the section “Better Bones”.