Media Distortions, as usual…

The news says: Elderly ladies, stop the Ca+D. The title here, for example:
USPSTF Says No to Vitamin D, Calcium for Older Women

The panel said something a bit different–don’t waste your time if the DOSE IS TOO LOW. Will have to get the original article. But it seems to be a tiresome misrepresentation of the data. At least, for those who read the article, they do note first —

“400 IU of vitamin D3 combined with 1,000 mg of calcium carbonate has no effect” BUT then —

“daily intake of 600 IU for vitamin D and 1,200 mg of calcium for women ages 51 to 70 had a clearer net benefit in fracture prevention.

Last month, the USPSTF finding that vitamin D supplements reduce the risk of falls in community-dwelling older people who may be prone to falling.”

Acquiring enough calcium from a healthy diet, getting enough sun and resistance exercise are all the BASIC elements of sustaining good bone health. Supplements have their place for many people. But the media distortions do not help people to make the best decision, especially when they outright distort the recommendation. And indeed many, many people are very low in Vitamin D–as we have discussed frequently here!



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:

and BioSil:

Higher Vitamin D Recommendations

You may have heard reports about a scientific advisory panel that recently called for increasing the recommended dietary allowance (RDA) of Vitamin D and calcium. The same panel also revised upward the “tolerable upper limit,” or highest advisable daily dose, for D and for calcium.

The new guidelines, issued by the Institute of Medicine, are summarized as follows:

Vitamin D; Ages 1-70: 600 international units (IUs) per day. Older than 71:800 IUs. The IOM previously said 200 IUs was adequate for people aged 50 and younger, 400 IU for people aged 51-70, and 600 IUs for people older than 70.

The tolerable upper limit (UL) is 4000 IUs for ages 9 and above (up from 2000 IU in the IOM’s previous guidance).

Calcium: based on age, ranges from 700 to 1300 milligrams (mg) daily with a tolerable upper limit range of 1000-3000 mg.

Note that the recommended daily allowances are basically for the sake of maintaining health. When deficiencies are identified in individuals or groups (such as people with HIV), then higher dosages may be recommended.

See NYBC’s entry on Vitamins and Minerals for further details about multivitamins, Vitamin D, calcium, and other vitamins and minerals:

NYBC’s Quick Guide to Gastrointestinal Health

A number of NYBC members and visitors to our website and blog have asked us to reprint the NYBC “Quick Guide to Gastrointestinal Health,” which first appeared in the Winter 2009 issue of our free newsletter THE SUPPLEMENT:

NYBC’s Quick Guide to Gastrointestinal Health

Gastrointestinal or gut health is basic to overall health, whether you’re talking about how well you feel on a daily basis (nausea, cramps, diarrhea, etc. being among our least favorite experiences), or the importance of properly absorbing food that you eat and thereby supplying your body with the nutrients it needs to stay healthy over the long term.

Gastrointestinal health can also be a complicated issue, since gut disturbances may stem from many different causes, whether it’s a bug picked up from poor food handling practices, a side effect of medications, or one of the symptoms of an underlying disease or infection (such as HIV) that requires treatment in itself. Identifying the root cause or causes of gastrointestinal problems can be a major challenge, and of course we urge you to work with your healthcare provider to sort that question out, especially if your condition lingers, becomes acute, or has an impact on your ability to go about your daily life.

Below we present various tips, tricks, news and research notes, all designed to help you maintain good gastrointestinal health, or find help when things are not going so well in your digestive tract.

Probiotics. These are “friendly” microorganisms that can re-balance the ecology of your gut. Probiotics are well-known for their benefit to digestive health, and especially for their ability to resolve some types of diarrhea. Here are the major types stocked by NYBC: bifidus (as Bifidus Balance/Jarrow); lactobacillus/bifidus (as Jarrodophilus/Jarrow—needs refrigeration); lactobacillus/bifidus (as Jarrodophilus EPS–needs no refrigeration); and Saccharomyces boulardii (as Florastor from Biocodex—needs no refrigeration).
Some NYBC members find that using Jarrodophilus every other day keeps diarrhea away. (And it’s actually cheaper than getting the probiotics from yogurt—though admittedly not quite so tasty or nutritious.) Another approach: try the green foods supplement Pro Greens (Nutricology), which has a rich variety of nutrients, but also includes a substantial lactobacillus/bifidus component. The BioCodex product Florastor, meanwhile, is most often used for antibiotic-associated diarrhea or to avoid “traveler’s diarrhea” (when started in advance of the trip).

Research note, as reported last year by John James in the online AIDS Treatment News Daily Alerts. The note deals with C. difficile, a diarrhea-producing infection that’s on the rise, and is often a lingering byproduct of antibiotic treatment: “A recent meta-analysis of 31 studies compiled and published in the American Journal of Gastroenterology concluded that S. boulardii is the only probiotic that is effective in fighting recurrent C. diff-associated disease. […] ‘Because Florastor (S. boulardii) is a yeast and not a bacteria, it is not killed by the strong antibiotics that are being used to kill the C. diff bacteria, so it survives in the digestive tract,’ says [researcher] Dr. Raymond. ‘When the ‘baby’ C. diff emerge from their spores, they are greeted by a well-colonized gut, rather than an empty playground.’”

Glutamine and other supplements to prevent diarrhea and maintain body weight. In the era of antiretroviral therapy, weight loss has become less of a problem for people with HIV. Yet maintaining muscle mass over time remains a big concern, and one key to that is controlling diarrhea, which deprives the body of needed protein and other essential nutrients.

One frequently used remedy for diarrhea is the amino acid glutamine. It has been studied for leaky gut syndrome, which results when intestinal tissues are damaged, and also has a long history of application to maldigestion in people with HIV. Anecdotally, people with protease-inhibitor diarrhea find relief using 30-40 grams per day. Start with about 15 grams per day and increase the dose until the diarrhea is controlled. A daily maintenance dose is about five grams a day. Note that glutamine is best taken in three daily doses.

Research note: A well-designed study published in the journal Nutrition found that a glutamine-antioxidant regimen was effective at helping HIV+ people with weight loss to regain body weight. The regimen included glutamine (40 g per day), along with vitamin C (800 mg), vitamin E (500 IU), beta-carotene (27,000 IU), selenium (280 mcg), and N-acetylcysteine (2,400 mg). People who took the supplements showed significant weight gain in 12 weeks, while participants taking a placebo did not.

Other supplements have also been used to counteract malabsorption and diarrhea associated with HIV and/or HIV medications:

Calcium: two Canadian studies from 2004 and 2005 re-affirm the thinking that calcium carbonate can be useful in controlling protease inhibitor-related diarrhea. Calcium supplements have long been used for this purpose by buyers’ club members; see the recommendations under “Digestive Maintenance” on the NYBC website for details.

Soluble fiber such as apple pectin, oat bran, and flax seed. For some people, soluble fiber can help food stay in the digestive tract for longer periods of time, increasing the amount of nutrients that are absorbed, and lessening bowel frequency.

Traditional botanicals/remedies for gastrointestinal health. NYBC stocks two formulas produced by the well-regarded California-based developers of herbals, Health Concerns and Pacific BioLogic. Both formulas are derived from traditional schools of herbal medicine (Chinese or Tibetan), but are also informed by modern clinical practice. Here are the indications for use supplied by the manufacturers:

Quiet Digestion (Health Concerns). Used to reduce gastric distress including pain, cramping, nausea, vomiting, diarrhea, regurgitation, poor appetite; addresses viral or bacterial gastroenteritis as well as motion sickness, hangover and jet lag effects.

GI Tract: Gastro Regulator (formerly Digest Ease) from Pacific BioLogic. Derived from a Tibetan medicine formula, it is designed to help the function of the gastrointestinal tract, helping to optimize the course of digestion and colonic function, particularly problems arising from bad dietary habits. There may be a brief period of diarrhea or constipation at the beginning of using this product.

Recently an NYBC member called our attention to Mastic Gum, a resin traditionally used in the Eastern Mediterranean as a remedy for heartburn, and generally to protect the stomach and duodenum. Now there’s intriguing new research supporting use of mastic for gastrointestinal health and perhaps additional purposes as well:

1. A study published in 2007 found evidence that mastic could help prevent or manage prostate cancer. This prostate-protective effect may be achieved via an inhibition of nF-KB–interestingly, that’s a cellular protein that HIV also hijacks to help produce more of itself.

2. Another recent study looked at use of 2.22 grams of mastic/day among patients with Crohn’s disease (a chronic, debilitating bowel disorder). Not only did this dosage help in this small pilot study, but two markers of inflammation were significantly reduced: interleukin-6 and C-reactive protein. Again, it’s of interest that both markers are also often elevated in HIV disease. booklet: “The HIVer’s Guide to Coping with Diarrhea & Other Gut Side Effects.” NYBC recommends this thorough and easy-to-read booklet, which has been reviewed by HIV specialist physicians, and also includes case studies of people with HIV who have worked through some typical gastrointestinal problems. It can be read online, or ordered from at
Here’s a capsule summary of the 29-page booklet:

Gastrointestinal or gut problems–diarrhea, nausea, indigestion, gas, loss of appetite–are very common for people with HIV, with consequences ranging from temporary to very serious. This booklet takes you through the common causes: HIV meds, other meds or supplements, the effects of HIV itself, your diet, psychological triggers, or other health problems (such as parasites). It then sorts through some of the most used remedies, including over-the-counter drugs, supplements, prescription meds, or changing your diet or your HIV drug regimen.

For further information, please also see individual product entries in the “Digestive Maintenance” section of the NYBC catalog. In addition to the items mentioned above in our “Quick Guide,” you’ll also find here our recommendations in the category of digestive enzymes:


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.

Calcium carbonate for protease inhibitor-related diarrhea

Calcium is best-known as a supplement to support bone health, but it also has a long history of use to control diarrhea, especially protease inhibitor-related diarrhea, in people with HIV.

Below are a couple of recent Canadian studies that tend to re-affirm the effectiveness of this widely used strategy. See also the NYBC entry on Digestive Maintenance, which includes two types of Calcium supplement.

Turner MJ, Angel JB, Woodend K, Giguère P. The efficacy of calcium carbonate in the treatment of protease inhibitor-induced persistent diarrhea in HIV-infected patients. HIV Clin Trials. 2004 Jan-Feb;5(1):19-24. Pharmacy Department, The Ottawa Hospital, Ontario, Canada.

BACKGROUND: Although some evidence exists to support the practice of using calcium carbonate to treat nelfinavir-induced diarrhea, there is a lack of data supporting the role of calcium in diarrhea induced by other protease inhibitors (PIs). PURPOSE: The objective of this prospective open-label study is to evaluate the efficacy of calcium carbonate in the treatment of PI-induced persistent diarrhea in HIV-infected patients. METHOD: Along with dietary advice, patients were asked to take oral calcium carbonate 500 mg twice daily for 2 weeks. Visual Analog Scale (VAS) and the National Cancer Institute of Canada (NCIC) scale were used to assess the severity of diarrhea. Data were analyzed using paired t tests to test for differences in VAS and NCIC scores between baseline and 14 days. Pearson correlation was used to explore the relationships between change in diarrhea and patient baseline factors. RESULTS: At day 0, the mean VAS +/- standard deviation was 6.6 +/- 2.1 and decreased to 5.3 +/- 1.9 (p=.01) after 14 days. At day 0, the mean NCIC score was 1.9 +/- 0.8 and decreased to 1.2 +/- 0.9 (p=.005) after 14 days. No baseline patient factors predicted change in NCIC or VAS grade. CONCLUSION: Calcium carbonate is associated with a reduction of diarrhea in individuals with diarrhea induced by PI.

Rachlis A, Gill J, Baril JG, LeBlanc RP, Trottier B, MacLeod J, Walmsley S, Van der Vliet W, Belsky G, Burgoyne R. Effectiveness of step-wise intervention plan for managing nelfinavir-associated diarrhea: a pilot study. HIV Clin Trials. 2005 Jul-Aug;6(4):203-12. Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Ontario, Canada.

PURPOSE: Pilot study to evaluate the effectiveness of a step-wise diarrhea management strategy for nelfinavir-associated diarrhea. METHOD: HIV-infected adults (CD4 count > 100 cells/mm3, and no evidence of enteric pathogens) developing symptoms of diarrhea after initiation of nelfinavir for a duration of > or = 1 month were enrolled into this 9-week prospective pilot study. Step-wise interventions, reviewed and adjusted additively at 2-week intervals, included nutritional counseling (+/- lactase and/or psyllium), calcium carbonate, and loperamide. Outcome measure included stool-form consistency, bowel movement frequency, and incidents of associated morbidity (urgency, incontinence) daily. Patient quality of life was also assessed. RESULTS: Eighteen patients completed the study. Mean daily bowel movement frequency decreased by 32%, from 2.98 to 2.03 (p = .005). Mean daily stool form shifted from a rating of 4.24 to 2.37 (p = .0001), representing a shift to firmer stools. Period prevalence of incontinence (28%) and urgency (33%) decreased to 6% each, respectively. Quality of life ratings relating to gastrointestinal disturbance and overall physical/psychosocial function were improved. CONCLUSION: The results of this pilot study demonstrated that a step-wise intensified approach may be successful in managing nelfinavir-associated diarrhea and will need to be validated in a larger scale, randomized controlled trial.

Supplement recommendations in “The Ultramind Solution” by Dr. Mark Hyman


One-third less than the over-priced “Ultramind Solution” supplements!

The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First
Mark Hyman, M.D.

This is one of many books published in recent years that seek to translate the enormous body of research findings from the last few decades about nutrition and brain function into simple, useful guidelines for improving and maintaining good mental functioning and psychological well-being. While it’s a popularizing text (Dr. Hyman has even been on Martha Stewart–see link below!), this book does, we feel, accurately register many important trends in our knowledge of nutrition and nutritional supplements and how these factors relate to mental health.

Here’s the statistic that sets off Dr. Hyman’s project: one in three Americans suffer from some kind of “brain dysfunction” (one term in use: “brain fog”), including symptoms such as depression, anxiety, memory loss, attention deficit disorder, autism, and dementia.

“The Ultramind Solution” contends that revising your diet–changing your nutritional intake–can often make a huge difference in these symptoms. Dr. Hyman’s recommendations focus both on weeding out elements that adversely affect 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 of an often-cited US government survey), people realistically will need to supplement at least periodically 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 digestion/absorption of nutrients); and 6) occasionally a sleep aid like melatonin to insure a good amount of rest.

Here are some NYBC suggestions for supplementing in the categories recommended by Dr. Hyman:

Multivitamins: Added protection with Iron (Douglas) ; Added Protection without Iron (Douglas) – recommended for those with liver conditions; Opti-Pack – iron-free (SuperNutrition); Super Immune Multivitamin – iron-free (SuperNutrition)

Fish oil: Max DHA (Jarrow); ProOmega (Nordic Naturals) 60 caps; ProOmega (Nordic Naturals) 180 caps;

For Calcium, Magnesium, Vitamin D, NYBC recommends Bone-Up (Jarrow), which provides all three nutrients in the most useful dosages.

B complex vitamins: B-right (Jarrow)

Probiotics: NYBC recommends Jarrodophilus EPS (Jarrow) because it doesn’t require refrigeration. But other probiotics may be useful as well–see the Probiotics entry on the NYBC website.

NYBC also stocks Melatonin in several formats.

See Dr. Hyman on Martha Stewart: