AIDS TREATMENT NEWS No. 250 - July 5, 1996
Lark Lands

Dr. Lands also has had lifelong diabetes, and is an expert on diabetic neuropathy, which has been much better researched than neuropathy caused by HIV. She believes that some (not all) kinds of HIV-related neuropathy may be similar to the diabetic condition, and may respond to some of the same treatments. AIDS TREATMENT NEWS asked Dr. Lands if we could interview her on what has been learned about treating diabetic neuropathy, and how that might apply to HIV. It turned out to be more practical to publish a section of Dr. Lands' new book than to conduct a separate interview.

Readers should know that Dr. Lands emphasizes an integrated program of HIV disease management -- including antivirals and other mainstream medical treatments, nutritional approaches, and other kinds of therapy -- rather than using nutrition to treat only a specific symptom. Also, her book includes a detailed section on different kinds of HIV neuropathies. Other sections focus in detail on specific nutrients and other therapies, providing much information not included here. Unfortunately the book is not yet available. But readers should know about potential therapies which, although not conclusively proven and not officially approved, are supported by research, and have appeared to be helpful for many people.

Patients should talk with their physician before using any therapy, including nutritional treatments. Even if the physician is not familiar with or does not approve of the treatment, he or she may know about specific cautions or contraindications, due to a patient's medical condition.

The following is a small example of the useful information Dr. Lands has compiled. Her book will be an important advance in providing practical treatment information for persons with HIV disease.

[Note: POSITIVELY WELL can be ordered by calling 800/542-8102 within the U.S. and Canada (from elsewhere, call 905/672- 7470), 9:00 a.m. to 5:00 p.m. Eastern time. The price is $24.95 plus shipping and handling. People can leave their name, address, phone number, and VISA or MasterCard number, which will not be charged until the book is ready to be shipped. (Remember that POSITIVELY WELL is not yet available, with estimated publication date of late summer. JSJ]

From POSITIVELY WELL: LIVING WITH HIV AS A CHRONIC, MANAGEABLE SURVIVAL DISEASE:

Although there has been virtually no research on the use of nutrient therapies for HIV-related neuropathies, there has been a fair amount of research (mostly in other countries) on their use for diabetic neuropathies. Since it appears likely that at least some of the mechanisms for the nerve damage may be similar in the two diseases (inflammation and oxidative damage to the nerves combined with B vitamin deficiencies), there is reason to believe that therapies which have proven useful for diabetics may also work for at least some people living with HIV who develop neuropathy. Many people living with HIV have reported to me that they have successfully eliminated neuropathy with some combination of the nutrient therapies discussed here. Thus, in addition to the other treatments mentioned, I would stress the importance of therapy with the B vitamins and other nutrients, especially acetyl-L-carnitine, gamma-linolenic acid, alpha-lipoic acid, magnesium, and chromium. I would definitely consider including the nutrients that have been shown to help rebuild the myelin sheath around nerves and/or improve nerve functioning such as choline, inositol, gamma linolenic acid, B6, B12, niacin, thiamine, biotin, folic acid, and magnesium.

Biotin, choline, inositol, and thiamine are B vitamins that have all been found useful in treating the peripheral and autonomic neuropathies found in diabetes and may also help with HIV-related neuropathies. In a study at the University of Athens, it was shown that regular, long-term use of biotin in diabetics was very effective both for improvement in nerve conduction and relief of pain.(1) Improvement in nerve conduction occurred after only 4-8 weeks of therapy. In this study, biotin was given via daily intramuscular injection (10 mg/day) for 6 weeks; then 3 times per week (10 mg), intramuscularly, for 6 weeks; then 5 mg/day taken orally for up to two years. The researchers hypothesize that deficiency, inactivity, or unavailability of biotin in diabetics may result in disordered activity of the biotin-dependent enzyme, pyruvate carboxylase, leading to an accumulation of pyruvate and/or a depletion of aspartate, either of which could adversely affect nervous system metabolism. There are a number of reasons why HIV-positive persons may be deficient in biotin and, thus, potentially at risk for a similar problem. It has been suggested that those with neuropathy symptoms might try 10-15 mg/day orally, taken in conjunction with the other B vitamins found useful for improving nerve function.

B12 deficiency is a known cause of neuropathy so this vitamin, along with its coworker folic acid, should certainly be included in any program aimed at eliminating this symptom. Typical symptoms of peripheral neuropathy related to B12 deficiency include the type of leg and foot pains experienced by many. B6 deficiencies are also known to cause both carpal tunnel syndrome (with symptoms of numbness, tingling, and pain in the hands and wrists) and degeneration of peripheral nerves and may be responsible for some peripheral neuropathy problems.

Choline and inositol also seem to be very important parts of the combination of vitamins needed for neuropathy resolution. Diabetic neuropathy is known to be associated with a reduction in myo-inositol levels in nerves and tissues. The decreased level of myo-inositol is believed to cause a decrease in the activity of the sodium-potassium pump and, thus, to change the sodium permeability of nerves. Both diets high in inositol and inositol supplementation have been shown to improve diabetic neuropathy. Researchers at the University of Alabama found a statistically significant improvement in nerve function in diabetics placed on a diet high in inositol. Included in the diet were high-inositol foods such as cantaloupe, peanuts, grapefruit, and whole grains. Other researchers have reported that supplementation with inositol in doses of 2-6 grams per day has resulted in improvements in neuropathy. Robert Atkins, M.D., has reported his successful use of 2-6 grams per day for reversing diabetic neuropathy, and notes that physicians at St. James Hospital in Leeds, England, have reported good results with even smaller dosages.(2)

In addition to the use of inositol itself, treatment with acetyl-L-carnitine can help raise nerve myo-inositol content. Florida researchers have found that peripheral nerve function in diabetes is linked to nerve myo-inositol content and that acetyl-l-carnitine can raise the levels of myo-inositol in the nerves of animals with experimentally induced diabetes.(3) It also apparently protects the nerve membranes from free-radical damage, as evidenced by reduced malondialdehyde levels in the animals treated with acetyl-l- carnitine.

Thiamine has also been seen to be useful in treating diabetic neuropathy. Stanley Mirski, M.D., has reported that a large percentage of his diabetic patients who suffer from neuropathy have achieved improvements with daily thiamine supplementation in doses of 50-100 mg. Using a fat-soluble form of thiamine such as thiamine tetrahydro-furfuryl disulfide may be preferable because of the relatively poor absorption of water-soluble forms of this vitamin. This type is contained in Cardiovascular Research's Allithiamine. A large number of HIV-positive people have reported to me their successful elimination of neuropathy with the combined use of the B vitamins discussed here. The information on acetyl-l- carnitine is too recent for much in the way of anecdotal reports to have surfaced, but it might be an important addition to improve the chances for successful elimination of neuropathy. Research has made it clear that people living with HIV are often deficient in carnitine.

Alpha-lipoic acid has long been used in Europe for the treatment of peripheral neuropathy in diabetics. A number of controlled clinical trials have shown its usefulness for reducing both the pain and numbness suffered by those with diabetic neuropathy, and its use for this condition is approved in Germany.(4) Its antioxidant properties may help protect the nerves from the inflammation and oxidative damage that HIV induces, as has been shown to be true with diabetic neuropathy.(5) Because of its liver protective and antioxidant benefits, it has been included as a component of the programs of many of my clients for several years now. It may have contributed to the success of the neuropathy elimination programs some of them have used.

Gamma linolenic acid is an essential fatty acid found in borage oil, grape seed oil, black currant oil, and evening primrose oil that has been shown to be successful in reversing nerve damage in diabetics suffering from peripheral neuropathy. In a double-blind, placebo-controlled study using 480 mg of GLA daily, all the diabetics given the fatty acid experienced gradual reversal of nerve damage and improvement in the symptoms related to the peripheral neuropathy, while those on placebo gradually worsened.(6) It is thought that GLA may help to rebuild the myelin sheath around the nerves, thus restoring proper nerve conduction.

Magnesium is also known to be necessary for nerve conduction; deficiency is known to cause peripheral neuropathy symptoms. Thus, including optimal amounts of magnesium might contribute to elimination of neuropathy. There have also been reports of chromium deficiency causing peripheral neuropathy. I learned this too recently for chromium to have been included in most of the neuropathy therapy programs used by my clients in the past and, thus, I'm not sure what it might contribute. However, chronic infection is known to deplete body stores of chromium, so adding a dose of perhaps 200-400 mcg/day to a complete nutrient protocol might be reasonable.

In addition to all the nutrient supplements, an analysis of data coming out of the Immune Enhancement Program in Portland, Oregon, appears to show that their program, which includes Chinese herbs along with acupuncture and various other therapeutic approaches, results in improvement in neuropathy for some.

For additional information on the nutrients which might be helpful for eliminating neuropathy, including appropriate dosage ranges, see the individual nutrient entries in Chapter Six of POSITIVELY WELL, "Therapeutic Basics." If you are considering supplementation with any of the B vitamins discussed above, never forget that although B vitamins are by and large non-toxic, any individual B vitamin should always be taken along with the full B complex to prevent imbalance in the body. Long-term use of very high doses of individual B vitamins taken alone, without the rest of the B complex, can induce imbalances or deficiencies in other B vitamins.

References

1. Koutsikos D, Agroyannis B, and Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. BIOMED. PHARMACOTHER. Volume 44, number 10, pages 511-514.

2. Atkins R. DR. ATKIN'S NUTRITION BREAKTHROUGH New York: William Morrow, 1981, page 194.

3. Lowitt S, Malone JI, Salem AF, and others. METABOLISM. 1995; volume 44, pages 677-680.

4. Packer L, Wiott EH, and Tritschler HJ. Alpha-lipoic acid as a biological antioxidant. FREE RADICAL BIOLOGY & MEDICINE 1995; volume 19, number 2, pages 227-250.

5. Kehler W, Kuklinski B, Ruhlman C, and Plotz C. Diabetes mellitus -- a free radical-associated disease: Effects of adjuvant supplementation of antioxidants. In: Gries FA and Wessel K (editors), THE ROLE OF ANTIOXIDANTS IN DIABETES MELLITUS: OXYGEN RADICALS AND ANTI-OXIDANTS IN DIABETES Frankfurt am Main: pmi Verl-Gruppe, 1993:33-53.

6. The Gamma Linolenic Acid Multicentre Trial Group. Treatment of diabetic neuropathy with gamma-linolenic acid. DIABETES CARE 1993; volume 16, number 1, page 8.

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