What’s in Your Medicine Cabinet for Cold & Flu Season?

Here are some recommended supplements great for cold and flu season that have been the subject of recent, good research.

Vitamin D.  According to some recent thinking, the “cold and flu season” may actually be the “Vitamin D deficiency season.” As the days grow shorter, people get less sunshine, leading to a decline in the body’s levels of this vitamin, which is essential to good health in many more ways than we used to think. Taking Vitamin D during the winter may therefore be one of the most effective ways to prevent colds and flu. Many researchers who’ve studied Vitamin D now recommend at least 1000 IU/day, but those with a known deficiency may be advised to supplement at even higher levels. There’s a simple test available to check for Vitamin D deficiency – ask your doctor.

Cold Away. This blend of Chinese herbs from Health Concerns is designed to “clear external heat and alleviate symptoms of the common cold.” A key component of this formula is the herb andrographis, which in several recent US studies was found to significantly decrease cold symptoms and the duration of a cold; it may also be useful for prevention. (NYBC stocks  over 20 varieties of Traditional Chinese Medicine formulas, by the way.)

Vitamin C.  Many good studies have shown a decrease in cold symptom duration, but no benefit for prevention.  According to a guide to natural products published by the American Pharmacists’ Association in 2006, taking  between  one  and  three grams of Vitamin C per day may decrease cold symptoms (sore throat, fatigue, runny nose) by one to 1½ days.*

N-acetylcysteine (NAC) supports respiratory and immune system function. It has been studied extensively for chronic bronchitis. NAC is also the antidote for acetaminophen poisoning, now the leading cause of liver disease in the US. (Acetaminophen’s best-known tradename is Tylenol®, but it’s also found in many other drugs, so it’s become all too easy to overdose.)

One popular way to take NAC is to use PharmaNAC, notable for its careful quality control, pleasant “wildberry” flavor, and effervescent fizz!

Botanicals.  In Traditional Chinese Medicine, astragalus is used for chronic respiratory infections, for colds and flu (both prevention and treatment) and for stress and fatigue. It contains complex sugar molecules called polysaccharides, which some studies show stimulate virus-fighting cells in the immune system. Researchers at the University of Texas and M.D. Anderson Cancer Center have turned up convincing evidence that astragalus boosts immune responses in lab animals, and in human cells in lab dishes.

Elderberry extract (as found in Jarrow Formulas’ Wellness Optimizer) and American ginseng (found in two Health Concerns formulas) are two other botanicals that have been studied for cold and flu symptoms in recent North American research, with some promising results. Also, a study conducted by Israeli scientists showed that elderberry extract suppressed the growth of influenza viruses in lab dishes. The same research team reported that patients given the extract recovered from the flu faster. The perennially popular echinacea, however, has generally disappointed in cold prevention studies, but is still touted by some as beneficial at the onset of a cold.

Probiotics. They say the best defense is a good offense, so consider upping your intake of the beneficial bacteria found naturally in such things as kefir (the lightly fermented milk beverage) and yogurt: they boost the flora in your intestinal tract, which is where an estimated 80% your immune system resides.

NYBC stocks eight varieties of probiotic supplements, ranging from Florastor capsules, a favorite of international travelers, to the 40 billion beneficial baceteria-per-capsule Ultra Jarro-Dophilus, to Green Vibrance, a powder added to fruit juice or another beverage of choice (complimentary shaker cup included!).

*Natural Products: A Case-Based Approach for Health Care Professionals, ed. Karen Shapiro. Washington, DC: American Pharmacists’ Assoc. (2006), “Cold and Flu,” pp. 173-192.

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Instead of Overly Restrictive Rules, Can We Please Have More Useful Research and Education on Supplements from our Federal Agencies?

The New York Buyers’ Club Co-Op’s Treatment Director advocates for more useful research on supplements from the federal government, and shares his long expertise and personal experience in managing liver health with supplements:

Instead of Overly Restrictive Rules, Can We Please Have More Useful Research and Education on Supplements from our Federal Agencies?

The Food and Drug Administration (FDA) recently released a proposed new rule, which many believe could unnecessarily restrict consumer access to supplements introduced after 1994. (Access to supplements on the market before 1994 is generally protected by the Dietary Supplements Health and Education Act, passed that year.)

Perhaps the greatest concern is the form of vitamin B6 known as pyridoxal- 5′-phosphate or P5P. (Used for example, in the MAC-Pack, NYBC’s low-cost alternative to the K-PAX multivitamin/antioxidant combination for people with HIV.) There has been a concerted effort by pharmaceutical companies over the years to turn this vitamin into a drug, thus restricting access to it, and likely raising the price.

Overall, it is unclear what benefit the proposed new FDA rule would have for supplement users—if any. Certainly we believe there is much the FDA can do for consumers, including a robust program to test supplements for identity, potency and purity and broadcast the results quickly and widely. And, turning to the major health research agency of the federal government, we would welcome the National Institutes of Health (NIH) conducting more clinical trials to assess benefits and limitations of supplements. This type of research can answer important clinical questions and truly help consumers.

I am living with hepatitis C and without health insurance, and have relied on diet, lifestyle changes and supplements—identified through years of personal research–to normalize my liver enzymes, slow disease progression and keep my viral load fairly low while I try to enroll in a clinical trial. * Why can’t our federal agencies promote more research on supplement combinations like the ones I have used and circulate useful knowledge about the results, rather than wasting resources on restricting access to widely used supplements like the form of vitamin B6 mentioned above?

George Carter

*You can find a pocket guide to my recommendations for using supplements for liver health in NYBC’s Summer 2010 Supplement Special Issue, 50+ Ways to Love Your Liver.

You can also find a library of other useful guides to using supplements to maintainn and improve your health at NYBC’s SUPPLEMENT Archive Page:

http://newyorkbuyersclub.org/supplement/index.html

Supplements for the Brain (and Nerves)

“For Your Peace of Mind…”

Recent research on supplements for memory, cognition and other neurological functions
You may remember (we hope you remember!) the Scarecrow’s petition to the Wizard of Oz for a brain. Be advised–we at NYBC do not stock new brains, so don’t come to us with that request.

However, we do follow the sometimes startling new research on supplements, brain function and related neurological issues. In this department, there’s special cause for concern for people with HIV. According to a Canadian study released in 2010, in a group of 1615 people receiving treatment for HIV during the decade 1998-2008, one fourth had neurological problems, including memory loss, cognitive impairment and peripheral neuropathy. Of course being worried about brain function–and neurological function in general–is not unique to people with HIV. As people age, they are more likely to experience memory loss or forms of dementia such as Alzheimer’s. And the nerve condition called peripheral neuropathy (pain, tingling in the feet and hands) is found not just in people with HIV, but also among the growing population with Type 2 diabetes.

Now, on to what we see as some of the most valuable recent findings about supplements and brain or neurological function:

B vitamins can be considered a foundation because they are needed in so many processes essential to the brain’s operation, from energy supply and healthy blood flow, to the formation of neurotransmitters (=chemical messengers of neurologic information from one cell to another). Furthermore, there is evidence that several groups of people, including those over 60 and those with HIV, have a greater risk for Vitamin B deficiencies. So supplementing with a B complex vitamin is a sensible start to cognitive health. More specifically, there is good research linking deficiency of vitamins B12 and B6 to mood disorders like depression—and depression earlier in life is associated with higher risk of dementia in later life. Last, there is also some evidence that B vitamins may reduce stroke risk in older people.

Omega-3 fatty acids (fish oil) support cognitive health in a variety of ways. In 2008, UCLA researchers reported on a lab study showing that the omega-3 fatty acid DHA, together with exercise, improved cognitive function. This caught our attention, because there is wide agreement that regular exercise strongly supports brain function as we age, and here the suggestion is that omega-3 fatty acids multiply that known benefit. A diet rich in omega-3 fatty acids/fish oil has also been linked to lower risk of depression—another plus. And still more: recent research found that omega-3 fatty acids block the development of retinopathy, a chief cause of blindness as we age. (The retina of the eye is actually part of the brain–it is full of nerve cells essential for vision.) All in all, the neurological benefits of omega-3 fatty acids seem both wide-ranging and quite convincing, so it’s high on our recommended list.

The amino acid acetylcarnitine has shown benefit for brain function in a number of studies with humans. In the last decade, acetylcarnitine has also been investigated for peripheral neuropathy in people with HIV. (Some recommend using it with evening primrose oil and Vitamin C.) A 2008 study found that acetylcarnitine influences a chemical process in the brain that triggers Alzheimer’s, so researchers are continuing to puzzle out how this supplement produces its neurological benefits.

Antioxidants. There’s much suggestive research about how antioxidants counter destructive oxidative processes in the brain, thus blocking memory loss and cognitive decline. For example, a 2003 report found that the antioxidant combination alpha lipoic acid and NAC reversed memory loss in aged laboratory mice. And there’s also been a lot of attention to the combination acetylcarnitine and alpha lipoic acid for memory impairment. Furthermore, other antioxidants such as curcumin are under study for their potential to fight the processes that lead to declining brain function.

Acetylcholine. The first neurotransmitter to be identified, acetylcholine is closely associated with memory, with lower levels linked to memory loss. NYBC currently stocks two combination supplements that support acetylcholine levels in the brain, while also providing other nutrients for neurological function: Neuro Optimizer (Jarrow), which includes acetylcholine enhancers, acetylcarnitine, and alpha lipoic acid; and Think Clearly (SuperNutrition), which includes B vitamins, as well as acetylcholine enhancers and a botanical traditionally used for cognitive support, ginkgo biloba.

Resveratrol. In the past decade, there has been intense scientific interest in this compound, most famously found in red wine. While some research ventures have hoped to find in resveratrol a life-extending supplement (a capacity demonstrated in animal studies), others have focused on its therapeutic value for conditions like diabetes or cognitive decline. For example, Cornell researchers reported in 2009 that resveratrol reduced the kind of plaque formation in animal brains that causes Alzheimer’s. And a year later another lab investigation, this one at Johns Hopkins, found that a moderate dose of the compound protected animal brains from stroke damage.

Ginkgo biloba, a botanical derived from Earth’s most ancient tree species, has been widely used for cognitive function. In the late 1990s, two reviews of dozens of ginkgo studies concluded that it could improve symptoms of dementia. However, a long-term trial of ginkgo published in the Journal of the American Medical Association in 2008 found that the supplement did not prevent development of dementia in a group of more than 3000 older people who had normal cognitive function at the start of the research. One possible conclusion: ginkgo may help symptoms of cognitive decline, but doesn’t address underlying causes.

NYBC’s RECOMMENDATIONS: A B complex supplement (like Jarrow’s B-right) and fish oil (like Jarrow’s Max DHA) are foundations for maintaining cognitive health, especially important for people with HIV or people over 60. There is some evidence for acetylcarnitine, alpha lipoic and acetylcholine supplementation for memory impairment and possibly for cognitive decline. Acetylcarnitine and other supplements can be used to address peripheral neuropathy. And stay tuned for emerging research on preserving brain function with compounds like resveratrol, NAC and curcumin.

Supplements for Liver Health

NYBC has published an online guide to Liver Health, which you can access at

SUPPLEMENT No. 17 Summer 2010

Liver Health

And, yes! You’ll find liver healthy supplements like silymarin, alpha lipoic acid and Chinese herbal formulas, all described in detail with usage recommendations in a special section of the NYBC catalog pages:

http://nybcsecure.org/index.php?cPath=57

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.]

Mayo Clinic’s Guide to Alternative Medicine 2011

This is an easy-to-read, magazine-style guide created by the Mayo Clinic, the world-famous healthcare facility which also happens to have a long-standing receptiveness to alternative and complementary therapies for wellness and prevention. (That’s one of the reasons why it has recently been cited as an example of best practices in American healthcare–the kind of practices that need to be more widely imitated.)

The section on dietary supplements provides capsule reviews of the scientific evidence for the safety and effectiveness of several dozen popular products, from botanicals like ginseng, echinacea and St. John’s Wort, to vitamins C, D, E, B-3 (niacin), and B-9 (folate or folic acid), as well as minerals like selenium, calcium and zinc. Also discussed are fairly well-known categories of supplements, including probiotics and omega-3 fatty acids (these often obtained with fish oil supplements).

The guide rates these supplements with a green, yellow or red light symbol, depending on the strength of the evidence for their use and their safety profile. We weren’t too surprised by most of the ratings. For example, green for niacin, folic acid, Vitamin C and Vitamin D, but a yellow caution light for Vitamin E, which has shown no effectiveness in several good studies dealing with cardiovascular health and cancer, leading some researchers to wonder if the standard “alpha-tocopherol” form of the vitamin is a good format for supplementation. Also, a yellow light for St. John’s Wort, not because it isn’t effective for mild/moderate depression, but because it can interact with a lot of other medications.

Other supplements getting the green light from the Mayo Clinic editors: SAMe (for depression); saw palmetto (for enlarged prostate); green tea (for cardiovascular health, possibly for cancer prevention, and apparently–according to a large epidemiological study–for longevity); gamma linolenic acid (for peripheral neuropathy); CoQ10 (for cardiovascular health, for which it’s used by millions in Japan); glucosamine chondroitin (for osteoarthritis).

Also getting the green light, a supplement most have probably never heard of, but which is featured in the Health Concerns formula Cold Away, available from NYBC: the botanical Andrographis (a cold remedy, showing promise where many other products have disappointed).

See the NYBC entries for more details on how best to take supplements:


http://www.newyorkbuyersclub.org/

“Supplements and Diabetes” and “Diabetes Facts & Figures”

NYBC INFO SHEET ON SUPPLEMENTS STUDIED FOR DIABETES

Below we describe some of the best recent research on supplements as used for the management of diabetes. More extensive information on these supplements, including recommended dosages, can be found on the NYBC website.

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.

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/day) could be useful in helping to treat the symptoms of diabetes-related neuropathy (= pain, tingling, numbness in feet and hands). A protocol for diabetic neuropathy using ALA, evening primrose oil and Vitamin C has also been proposed.

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)

Chromium and Biotin: These two supplements have been proposed as a useful adjunct therapy for poorly controlled diabetes. Chromium is also under investigation for insulin resistance in people with HIV.

Note: NYBC stocks these two supplements from Jarrow.

Reference: Singer, G M, & J Geohas. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus. Diabetes Technol Ther. Dec. 2006.

Bitter Melon: A popular vegetable in Southeast Asia, Bitter Melon (sometimes called Bitter gourd) contains an insulin-like substance that can lower blood sugar in people with Type 2 diabetes. Warning: Bitter Melon may result in hypoglycemia (low blood sugar) if combined with other blood glucose-lowering drugs or supplements.

NYBC stocks Bitter Melon (Zhang).

Reference: “Bitter gourd (Momordica Charantia): A dietary approach to hyperglycemia.” Nutrition Rev. July 2006.

B Vitamins: These are recommended for those taking Metformin, the most widely prescribed oral diabetic drug in the US. Metformin depletes B12, B6 and folic acid, which in turn leads to a build-up of homocysteine, linked to cardiovascular disease.
NYBC stocks B-right (Jarrow).

Reference: Zhao-Wei Ting, R et al. “Risk factors of vitamin B12 deficiency in patients receiving metformin.” Archives of Internal Medicine, Oct. 9, 2006.

IMPORTANT: 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! As noted above regarding Bitter Melon, there is a risk of dangerous hypoglycemia if multiple blood sugar-lowering agents are used at the same time.

Diabetes Facts and Figures

–Poor diet (processed foods, fast foods, sweetened drinks) and lack of exercise are major factors in recent large increases in Type 2 Diabetes in the US. (The rate of Type 1 Diabetes, which is largely inborn, remains stable.)

–In 2009, 24 million Americans had diabetes. With no changes in diet and exercise rates, the number of US diabetics is projected to double over the next 25 years and the annual costs of treating the disease will rise from $113 billion to $336 billion.

–Minorities are disproportionately affected by diabetes: African-Americans, Hispanics and Native Americans are almost twice as likely as Whites to have diabetes. A main contributing factor for this disparity is limited healthy food choices and an abundance of bad food choices available in minority communities.

–Childhood obesity, closely linked to the development of diabetes, is now considered epidemic in the US, with 40% of US children overweight and 13% obese. The current generation of US children consequently risk having higher rates of cardiovascular disease and other diabetes-related health problems than their parents’ generation.

–The proportion of people with HIV who also have Type 2 Diabetes is increasing. The effects of combination therapies for HIV appear to increase the risk of Type 2 Diabetes; it is estimated that as many as 80% of people with HIV treated with protease inhibitors may develop insulin resistance, a precursor to diabetes (see John G. Ryan, “Increased Risk of Type 2 Diabetes Mellitus with HIV-1 Infection,” in Insulin, Jan. 2010).

–A class of drugs approved by the FDA as second-line treatment of diabetes has shown a dubious safety record. One of them, Avandia, may have caused hundreds of heart attacks per month and as of early 2010 the FDA was considering whether to ask for its withdrawal from the market.