May 24, 2010

May 24, 2010
Supplements for People With HIV and AIDS

Welcome to another day in my life. Today is Monday and I hope your week is off to a safe and great start. I had a great but very busy weekend. This week is also going to be very busy.

Most people need supplements (and vitamins) to have a healthy life. This is even more true for people with HIV and AIDS. It is tough to determine which supplements, if any, are the best for HIV positive people to take. One major reason is that individuals can have different deficiencies in certain vitamins, minerals and other nutrients.

The ideal scenario is to have your doctor run blood tests to measure your levels of each of the nutrients listed below. If any deficiencies are found, talk with your doctor or nutritionist about what they mean and whether supplementing is the best way to get your levels back up into a healthy range.

Another reason it is hard to identify the best dietary supplements to take is that there is limited research and no guidelines when it comes to supplementation among people with HIV. The recommended daily allowance (RDA) of dietary nutrients in the US was established many years ago and it was based on a population of HIV negative men in relatively good health. If anything, as an HIV positive person, you arguably need more than the RDA of some nutrients, since your immune system tends to be under more stress.

One of the most frequently asked questions that people living with HIV have is, "Will a supplement on top of my HIV meds give me an improved immune recovery or immune function?" The bottom line is that health care professionals do not know for sure. But what is known is that some supplements are a very good idea for your health overall.

Nelson Vergel regularly answers questions in our "Ask the Experts" forum on nutrition and exercise, and he recently conducted a survey on complementary therapy use by HIV positive people that included a breakdown of the most popular supplements and the reasons people took them. With his help, we have put together an alphabetical list of some of the nutrients that are especially worth watching and the supplements that may be most worth taking if you are a person living with HIV. As we mentioned earlier, this is not meant to be a comprehensive list of all the nutrients and supplements you should know about if you are HIV positive. Think of it as the beginning of a conversation that you should continue with your doctor or nutritionist, as well as additional research on and elsewhere. Please offer your own thoughts and experiences in the comments section at the bottom of this article!

(One quick note on forms of supplements: Most supplements are available not only as pills (i.e., tablets or capsules that you swallow), but also in liquid or gel formulations that can be injected or applied via nasal spray. Injections and nasal sprays tend to be much more potent than pills, so they might be used in cases of a severe nutrient deficiency. Generally speaking, supplements in pill form are readily available without a prescription, but injections and nasal sprays require prescriptions or must be administered under the supervision of a health care professional.)

Alpha-Lipoic Acid

* What It Does: Alpha-lipoic acid is a strong antioxidant that improves the way insulin captures glucose for later use. As such, it's being researched for its potential to improve insulin sensitivity in people who have diabetes. There has also been some indication that it may help treat peripheral neuropathy (particularly when taken as an injection) and could have some neurological benefits as well.

* What Alpha-Lipoic Acid Deficiency Can Cause: Little is known about the risks of not getting enough alpha-lipoic acid. What we know about alpha-lipoic acid tends to be more related to what we believe is good about having it rather than what is bad about not having it. Alpha-lipoic acid's antioxidant powers center around its ability to increase the body's production of a liver cleansing chemical called glutathione. We have seen data showing that people with HIV have low levels of glutathione compared to HIV negative people, which suggests alpha-lipoic acid can help, but we don't know much about what might happen to HIV positive people as a direct result of lower glutathione levels.

* People at Higher Risk for Alpha-Lipoic Acid Deficiency: Experts are not yet sure.

* Types of Alpha-Lipoic Acid Supplements: In addition to pill form, alpha-lipoic acid is available as an injection, though it needs to be given under the supervision of a health care provider.

* How Much Is Needed: There is no U.S. RDA.

* Foods in Which It is Most Commonly Found: green, leafy vegetables; red meat; organ meats

Calcium and Vitamin D

* What They Do: These may be the two most prominent nutrients being researched in HIV today. Bone disease seems to be a problematic trend among people with HIV, even at relatively younger ages than those normally associated with the start of bone problems. Calcium is important for proper heart, muscle and nerve function. It also plays a major role in preventing osteoporosis, by growing and maintaining healthy bones. Vitamin D is good for immune function and boosts the body's ability to absorb calcium.

* What Calcium or Vitamin D Deficiency Can Cause: Bone disorders. Researchers are also exploring whether there is a link between low calcium/vitamin D levels and some cancers.

* People at Higher Risk for Calcium or Vitamin D Deficiency: lactose-intolerant people, obese people, older people, people with dark skin, people with kidney problems, people with metabolic disorders, postmenopausal women, vegetarians

* Types of Calcium or Vitamin D Supplements: Although we get some vitamin D from our food and can naturally form it by absorbing sunlight through the skin, it may not be enough for people living with HIV. Some of the foods we buy are artificially fortified with vitamin D (milk, for instance), but you can also buy vitamin D2 and D3 supplements, both of which can increase your vitamin D levels (although D3 is believed to do so more effectively). Calcium supplements exist in a variety of forms, including pills and tablets that you can chew or dissolve in a drink (such as Rolaids and Tums).

* How Much Is Needed: US RDA for calcium varies a bit by age; adults between the ages of 19 and 50 have an RDA of 1,000 mg, with the RDA increasing to 1,200 for people over 50. Vitamin D is measured in IU (international units), with an RDA of 200 IU for people between 19 and 50, doubling to 400 IU for people 51 to 70, and tripling to 600 IU for people over 70.

* Foods in Which It is Most Commonly Found: Calcium is commonly found in dairy products and green, leafy vegetables. Vitamin D is most often found in fatty fish (such as salmon and tuna), and milk is often artificially fortified with vitamin D. Our skin also makes vitamin D naturally when it's exposed to sunlight.


* What It Does: Carnitine (also called acetyl-L-carnitine or L-carnitine) shuttles fat droplets into the mitochondria, which are the energy factories within your cells. Mitochondria use sugar and fats to produce energy; carnitine improves the ability to use that fat for energy. Research suggests that carnitine decreases cholesterol and triglycerides in people with diabetes, and people generally report better mood and energy levels after beginning to take it. (Vergel is a true believer himself: He's taken carnitine regularly for over 20 years. Sometimes he runs out of it and that, he says, is when he realizes how well it improves his energy and ability to focus.)

* What Carnitine Deficiency Can Cause: a range of problems related to heart, muscle and liver function, including fatigue and male sexual dysfunction

* People at Higher Risk for Carnitine Deficiency: older people, people with HIV, people on cancer treatment, people with severe liver problems

* Types of Carnitine Supplements: Carnitine supplements are available as pills, powders (which can be mixed into drinks), liquid solutions and even wafers without a prescription. (It may appear on the bottle's label as acetyl-L-carnitine, L-carnitine or propionyl-L-carnitine.) It's also available by prescription, and can be administered intravenously by a health care professional.

* How Much Is Needed: There is no US RDA, and experts recommend a different dose of carnitine depending on the reason a person is taking it (e.g., for fatigue, erectile dysfunction, heart disease, etc.). Experts tend to recommend a dose somewhere between 1 g and 3 g (grams) per day, but talk to your doctor or nutritionist to determine what is right for you.

* Foods in Which It is Most Commonly Found: red meat, fish, poultry, milk

For more information and recommendations, see my blog tomorrow. Until then here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab