We be JAMA! Report: Multivitamin + selenium slows progression of early-stage HIV

We’re tempted to file this story under the heading of “news that we already knew,” but it’s still good to get a stamp of approval in the form of publication in Journal of the American Medical Association (JAMA), one of the top medical journals in the U.S., if not the world.

At NYBC and at our predecessor DAAIR we have long recognized the development of vitamin and mineral deficiencies in HIV, and have long recommended multivitamin/mineral supplements to counter those health-threatening deficiencies. We have also followed for years the work of Marianna Baum, lead author of the JAMA study, who has focused attention on the mineral selenium, which may have an important role in preventing replication of HIV. So, while this story doesn’t come as a complete surprise, it’s great to have further support for some long-held practices.

The combination of a daily multivitamin
plus the mineral selenium

proved to be an effective regimen,
cutting by about half

the risk of reaching the point
where ARV therapy would be recommended

Baum’s study was conducted in Botswana, where nearly one in four adults is infected with HIV. The trial followed about 900 newly infected adults who were not yet taking any HIV medications. These participants were divided into groups that randomly received different combinations of vitamins, the mineral selenium, or a placebo. Over the study’s two-year period, the combination of a daily multivitamin plus the mineral selenium proved to be the effective regimen, cuting by about half the risk of reaching the point where ARV therapy would be recommended in Botswana (CD4 count of 200-250).

Baum’s findings are especially relevant for early-stage HIV infection, where the multivitamin + selenium combination proved its value in cutting risk of progression, and actually decreased the likelihood that participants would reach the point where antiretroviral meds would be recommended. Other research, such as Dr. Jon Kaiser’s study of a multivitamin + antioxidants, has been directed at those who are using antiretroviral meds, and may have developed some symptoms or side effects such as peripheral neuropathy. Kaiser’s finding that the multivitamin + antioxidants combination could increase CD4 counts led to the development of K-PAX, and also motivated NYBC to offer its MAC Pack, a close equivalent of K-PAX, assembled from hand-picked products from NYBC’s catalog.

Taken together, the Baum and Kaiser studies suggest to us the value of long-term supplementation strategies that can slow progression of HIV, oppose the known, damaging deficiencies that are likely to develop with HIV, and help stabilize and even improve health for people with HIV, whether they are taking antiretroviral meds or not.

 

If you’d like to get started with NYBC’s MAC-Pack, or if you’d like to find a multivitamin + selenium combination,
please visit our website. You can also call our toll-free number at (800) 650-4983
for further information and advice about supplement strategies for HIV.

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:

Baum, M. et al. Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana: : A Randomized Clinical Trial. JAMA. 2013;310(20):2154-2163. doi:10.1001/jama.2013.280923. 

Kaiser, J. Micronutrient Supplementation Increases CD4 Count in HIV-infected Individuals on Highly Active Antiretroviral Therapy: A Prospective, Double-Blinded, Placebo-Controlled Trial. Kaiser JK, et al. JAIDS 2006;42[5]: 523-528.

 

Advertisements

NYBC Fundraising Campaign Almost There – Please Donate Today to Take Us Over the Top!


The New York Buyers’ Club, your community-minded nutritional supplements co-op, provides access to low-cost, high-quality supplements especially selected for people with HIV, Hepatitis C and other chronic conditions. NYBC also reports on the best and most useful scientific information on using supplements to stay healthy–see, for example, our previous post on a ground-breaking November 2013 study in the Journal of the American Medical Association, which points to an important role for multivitamins and selenium as a means to slow progression of HIV.


Please help us continue our important work—donate today:


DONATE TO NEW YORK BUYERS’ CLUB


(NYBC is a 501c3 nonprofit organization recognized by the IRS, so your contributions are tax-deductible!)


You can also visit the NYBC website and online catalog at

http://www.newyorkbuyersclub.org/

New study in Journal of the American Medical Association shows that a multivitamin + selenium slows progression of HIV

The Journal of the American Medical Association has published a new study showing that a multivitamin and selenium combination supplement significantly reduced immune decline and morbidity in people with HIV who were treatment naïve (=not on antiretroviral/ARV therapy). This was a two year study with individuals who had CD4 counts above the recommended threshold for beginning ARV treatment. Over the two-year period, the combination of a daily multivitamin plus the mineral selenium cut by about half the risk of reaching the point where ARV therapy would be recommended (CD4 count of 200-250).

This study shows the importance of daily multivitamin + selenium supplementation for HIV+ people who are recently infected and/or have relatively high CD4 counts. It also provides further confirmation of the value of multivitamin, multimineral supplement strategies like the one included in the NYBC MAC-Pack.

Glutamine and other supplements for gastrointestinal health (and to maintain lean muscle mass): Looking at Westerly Market’s online information about managing HIV/AIDS

Before there was Whole Foods, a friend likes to remind us, there was the Westerly Natural Market on Manhattan’s West Side. One of the nice things about Westerly, we’ve just been informed by the same person, is that they offer a very user-friendly website for those interested in getting more information about supplements, herbs, and how these substances or other “complementary and alternative” therapies are used for various conditions.

So, we took a look at the Westerly website’s Reference Library entry on HIV and AIDS, and found a concise account with several good points. One of these, we thought, was the discussion about maintaining muscle mass and preventing diarrhea, which over time deprives the body of needed protein. Here’s an excerpt:

Using certain supplements may help in maintaining body weight. A well-designed study compared the use of a daily supplement regimen that included enormous amounts of the amino acid 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-acetyl cysteine (2,400 mg) to placebo. People who took the supplements gained significantly more weight after 12 weeks than those who took the placebo.

Glutamine is a key supplement here, and has long been recommended by NYBC and its predecessor DAAIR for gastrointestinal support. See the NYBC entry

Glutamine Powder

or

Glutamine Capsules

Note that N-acetyl cysteine, Vitamin C and Vitamin E, beta carotene (as Carotenall), and selenium are also available through NYBC’s purchasing co-op–follow the links to see specific recommendations in each category.

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.

Can supplements reduce cancer risk?

Here’s an excerpt from the upcoming issue of the New York Buyers’ Club newsletter, THE SUPPLEMENT.

While it covers some of the same territory on supplements and cancer that we’ve posted earlier on this Blog, it’s valuable as an overview of the question, and balances the news of some notable advances in 2007 with notes and cautions at the end.

—–

Can Supplements Reduce Cancer Risk?

The short answer is: Yes—but please read on for important details!

Last year Memorial Sloan-Kettering Cancer Center (not the least informed organization when it comes to cancer) posted on its website the striking news from a study published in 2007: Vitamin D and calcium supplementation reduces cancer risk. This federally-funded investigation had followed more than a thousand post-menopausal women, some of whom were given calcium + vitamin D3 supplements, some just calcium, and some placebo. When researchers looked at the data, they reached this conclusion: “Improving calcium and vitamin D nutritional status substantially reduces all-cancer risk in postmenopausal women.”

A lot of researchers have been studying Vitamin D3 (the form recommended as most active in the human body) in the last few years, and it’s good to see the scientific findings percolating down to the general public. We were impressed by the lead article on Vitamin D in the February 2008 issue of the University of California, Berkeley’s Wellness Letter (a “newsletter of nutrition, fitness, and self-care”). The Wellness Letter is usually quite conservative on the subject of nutritional supplements, but in this case it found the recent research on Vitamin D persuasive enough to recommend that people “consider taking 800 to 1000 IU of supplemental D a day.” (That’s a higher dose than generally suggested in the past.) As the newsletter reports, there’s a new focus on Vitamin D’s multiple benefits, including its potential to “reduce risk of some common cancers.”

And speaking of getting word out to the general public. Tuning into the Martha Stewart Show not long ago, we saw nutrition and integrative medicine guru Dr. Andrew Weill answering a question from a female audience member by making a strong pitch for regular calcium and Vitamin D3 supplementation, even for younger women. Dr. Weill stressed not only the well-known value against osteoporosis, but also the many new findings on Vitamin D3, such as its role in reducing cancer rates.

But Vitamin D is not the only supplement receiving attention for its anti-cancer properties. A 2007 review of several large prostate cancer prevention studies concluded that several interventions, including dietary supplements such as lycopene, alpha-tocopherol and selenium, have now shown convincing evidence of being able to reduce the risk of this cancer in some circumstances. And the author of this article in the Journal of Urology urged doctors caring for men entering the range of age of prostate cancer risk to inform themselves and their patients about these “preventive opportunities.”

Also in 2007, researchers at the University of California, Irvine, published a study showing that a biologically active component of milk thistle (silymarin) has significant effect against liver cancer cells. Of course milk thistle/silymarin has a long tradition of use as a remedy for liver diseases, and is known to protect the liver from drug or alcohol-related injury. The lead author of this article, who has published extensively on viral hepatitis B and C, cirrhosis, and liver cancer, suggests that the particular component of milk thistle studied (silibinin) could potentially be used to prevent development of liver cancer, one of the most common cancers worldwide.

Notes & cautions: Although research on using supplements to decrease risk of cancer moves forward and has already produced some valuable results, note that there are also many concerns about use of vitamins and other supplements during and following cancer treatment. One problem: supplements may interfere with conventional medications and thus disrupt treatment. Furthermore, it’s important to look at dosage, since some studies have found that “megadoses” of vitamins may be harmful to people with certain cancers. In short, while we are encouraged by studies showing the anti-cancer activity of specific supplements—we’ve highlighted D3, silibinin, selenium, lycopene, and alpha tocopherol—no one should take these findings as a blanket endorsement of any level of supplement use under any circumstance whatsoever!

If you have a question about the usefulness of a supplement as an anti-cancer agent, we recommend the Memorial Sloan-Kettering Integrative Medicine website. This web resource came into being because health professionals recognized the widespread use of supplements by people concerned about their cancer risk or already diagnosed with cancer, and wanted to provide them with evidence-based information to guide their choices. This is also the approach of New York Buyers’ Club: we want to bring up-to-date, scientifically-based information to our members so that they can make good choices about supplement use.

Prostate cancer prevention studies: lycopene, alpha-tocopherol, selenium play a prominent role

This review, published in late 2007, concludes that studies of prostate cancer prevention are now maturing to the point where recommendations may soon be in order for reducing cancer risk by supplementing with such promising dietary supplement agents as lycopene, alpha-tocopherol, or selenium. Decreased dietary fat, nonsteroidal anti-inflammatory drugs and selective estrogen receptor modulators are also interventions under review.


Chemoprevention of prostate cancer: agents and study designs


PURPOSE: With the completion of the Prostate Cancer Prevention Trial and the ongoing performance of several additional large-scale prostate cancer prevention trials interest in this intervention has increased. We review promising agents for prostate cancer prevention, clinical trial designs and how these agents may be used clinically. MATERIALS AND METHODS: We reviewed current and completed randomized chemoprevention trials for prostate cancer as well as the most promising agents for which evidence suggests that a decreased prostate cancer risk may result from their use. RESULTS: Evidence suggests that lycopene, decreased dietary fat, antioxidants such as alpha-tocopherol and selenium, nonsteroidal anti-inflammatory drugs and selective estrogen receptor modulators such as toremifene and 5alpha-reductase inhibitors may prove useful for decreasing the risk of prostate cancer in a man. Ongoing studies are examining these agents in the 3 general scenarios of 1) general population studies (finasteride, alpha-tocopherol and selenium), 2) increased prostate specific antigen with negative biopsy (dutasteride) and 3) prostatic intraepithelial neoplasia (toremifene and selenium). CONCLUSIONS: There are many agents that may decrease the risk of prostate cancer. It requires careful study of the agents in specific populations to determine whether risk is reduced, the magnitude of the risk reduction and the spectrum of side effects associated with the agent. Physicians caring for men entering the range of age of prostate cancer risk must be aware of these preventive opportunities.


Citation: Chemoprevention of prostate cancer: agents and study designs.
Thompson IM. J Urol. 2007 Sep;178(3 Pt 2):S9-S13. Epub 2007 Jul 20.