Neuropathy pain and HIV: supplement recommendations

You may have read reports in late February 2012 about the FDA’s skeptic ism about a patch called Qutenza, which had been tested for relief of neuropathy pain in people with HIV. Following a meeting to review the evidence, an FDA panel concluded that Qutenza, whose active ingredient is a synthetic form of capsaicin (the compound that makes chili peppers hot) was not effective for HIV-related neuropathy pain.

The FDA’s finding on Qutenza reminds us again that neuropathy (generally, pain or tingling in the extremities) continues to be one of the most troublesome effects of HIV/AIDS and/or its treatment—and one of the most difficult to manage. According to a survey report in 2010, for example, more than one third of those on combination antiretroviral therapy for HIV do experience neuropathy, leading to lower quality of life and often disability. So, it may be worthwhile to repeat some of NYBC’s recommendations on this topic:

Peripheral neuropathy: “nukes” (nucleoside reverse transcriptase inhibitors) such mas ddI (Videx), and d4T (stavudine/ Zerit) – and Indinavir, T20, and even 3TC (Epivir)may all cause this feeling of pins and needles or numbness to toes and fingers. It can travel up the legs and become debilitating. HIV, diabetes, alcohol abuse, and vitamin deficiencies can all be causes of peripheral neuropathy. Supplements that are “good for your nerves” and that have the most robust data include acetylcarnitine (1-3 grams/ day, quite well studied for peripheral neuropathy) and alpha lipoic acid (200-600 mg/day). Other agents that can help are Vitamin B12, biotin, lecithin, magnesium, borage oil, evening primrose oil, choline and inositol.

See the NYBC website for more details about these supplements:
http://nybcsecure.org/

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Info sheet on “Supplements studied for diabetes/insulin resistance”

NYBC has prepared an updated version of its info sheet on the topic of supplements that have been studied for diabetes or insulin resistance. Here’s the text below:

SUPPLEMENTS STUDIED FOR DIABETES/INSULIN RESISTANCE

Multivitamin/multimineral: Regular use of a multivitamin/multimineral supplement helps people with diabetes maintain good health and reduce infections. Clinical evidence indicates that diabetics have unique nutritional needs, and should take a daily multivitamin to supplement their normal diet.

Note: NYBC stocks Jarrow’s Multi 1-to-3; Douglas Lab’s Added Protection, and SuperNutrition’s family of multivitamins (such as the Opti-Pack).

Reference: Barringer, et al. Effect of a Multivitamin and Mineral Supplement on Infection and Quality of Life. Annals of Internal Medicine. 3/4/2003.

Omega-3 fatty acids (Fish Oil): Many people with diabetes have high blood pressure and elevated cholesterol, which can increase the risk of heart disease and stroke. Omega-3 fatty acids have shown benefit for cardiovascular health in recent randomized controlled clinical trials. The FDA has also approved a health claim for fish oil: “supporting but not conclusive evidence shows that the consumption of EPA and DHA omega-3 fatty acids from fish oil may reduce the risk of coronary heart disease.”

Note: NYBC stocks Max DHA –Omega-3 Fish Oil Purified by Molecular Distillation (Jarrow); and ProOmega –Nordic Naturals (60 softgels or 180 softgels).

Alpha-Lipoic Acid: Alpha-Lipoic Acid (ALA) has the ability to assist with glucose metabolism, and also promotes healthy nerve function. A recent study concluded that ALA (600mg) could be useful in helping to treat the symptoms of diabetes-related neuropathy (= generally, pain, tingling, numbness in feet and hands).

Note: NYBC stocks ALA (Montiff) 300mg/60.

Reference: Ametov et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: The SYDNEY Trial. Diabetes Care. 2003, 26 (3)

Other supplements studied for diabetes: Chromium and biotin (these two supplements, taken together, are believed to play an active role in balancing insulin production with glucose uptake). Also: evening primrose oil, resveratrol, bitter melon.

Talk to your doctor before you use these or other supplements. Do not discontinue medications you are taking for diabetes/glucose control without first discussing with your healthcare provider any complementary treatments you are considering!

Antioxidants for Diabetic Peripheral Neuropathy

We were interested to read about an antioxidant therapy for Diabetic Peripheral Neuropathy (DPN). It includes alpha lipoic acid, which has been studied quite extensively for diabetes, as well as evening primrose oil (gamma linolenic acid being the active component) and Vitamin C:

…a recommendation for treatment of DPN by use of anti-oxidants, and is based on the research of Stan Angilley. It has been used successfully by many diabetics to reduce or even eliminate DPN. Before starting on this regimen, you should discuss it with your doctor, as you may have other medical issues which would contraindicate its use. It is likely that your doctor will have heard little or nothing about this approach, so we have provided citations to applicable literature below.

The DPN cocktail has three components: Alpha Lipoic Acid (ALA), Gamma Linolenic Acid (GLA) as contained in Evening Primrose Oil (EPO), and Vitamin C.

Read more at:

http://www.diabetes-support.org.uk/joomla/neuropathy-treatment

See www.newyorkbuyersclub.org for more on these supplements.

Evening Primrose Oil: How It’s Used by People with HIV

Evening primrose oil is derived from a plant native to North America. It’s rich in gamma-linolenic acid (GLA), which is normally produced in the body through the breakdown of omega-6 fatty acids, a process that may be disrupted in people with HIV. Thus supplementing with evening primrose oil can add available GLA to the body, which can help maintain many important functions.

Our friends at the Canadian AIDS Information Exchange (CATIE) have prepared a good information sheet detailing the purposes for which people with HIV use evening primrose oil:

Evening Primrose Oil

This CATIE Supplement Sheet includes information on using evening primrose oil to:

–help heal nerve damage (peripheral neuropathy)

–treat skin conditions associated with anti-HIV drugs

–cope with premenstrual syndrome

–reduce cholesterol levels

For more information on this supplement, see also the NYBC entries:

Evening Primrose Oil – Super

Evening Primrose Oil + Gamma Tocopherol