Being Alive Newsletter, Being Alive/Los Angeles - August 1993
Jennifer Jensen, RD

WHAT ABOUT ANTIOXIDANTS, AND WHY TAKE THEM?

In case you haven't heard, antioxidants are making the news these days in both the public and scientific press. Recently, researchers stated that extra vitamin C had demonstrated a beneficial effect in preventing heart attacks the group studied was taking 300 mg per day. Then, some months later, the New England Journal of Medicine reported two studies showing the benefits of vitamin E, at a level of 100 I.U. per day for reducing heart attack risk by about 40%. (Though these studies reported on heart disease, the benefits seen were from the antioxidant properties of the vitamins, explained in more detail below.)

Somewhat ahead of my time, I have been an antioxidant champion for at least ten years. Before going further, I want to take a science break to describe what antioxidants are and what they do. They can seem confusing, even mysterious, but it's really rather simple, as are all great truths: Antioxidants prevent oxidation. That's simple, but the name probably told you that.

What it didn't tell you is how very important it is to prevent oxidation. To truly take science into the kitchen (do try this at home), peel a banana, an avocado or an apple. Leave home for the rest of the day, noting the appearance of your specimen. Upon returning, observe the results of your experiment: brown, seemingly rotten, fruit. This result is visible evidence of oxidative damage, the kind of oxidation that antioxidants prevent.

These same types of chemical reactions occur within our bodies all the time unseen and unfelt. Oxidative processes are constantly trying to rot all of us from the inside out (and for sunbathers, also from the outside in). The chemicals that cause oxidative reactions are known scientifically as "free radicals" I'm not making that up.

Free radicals attack the by-products of metabolic reactions such as processing foods and medicines. Free radicals are also activated by smog, smoke and fumes. In fact, they result from the chemical reactions going on in our bodies 24 hours a day. So, "mission possible" is to defuse free radicals. The scientific term for this is "quenching" I'm not making that up either.

Some reasoning may achieve a strategy. When we are stressed, injured or infected, biochemical reactions occur more rapidly, more free radicals are activated, and more damage is done. If, during high-risk times, our antioxidant supply is strong enough to quench the free radicals, tissue damage won't happen. I suggest that in HIV/AIDS, well-advised supplementation with antioxidants is likely to allow for a better, and probably longer life, while maximizing health potential.

The prime "player" in the world of antioxidants is an enzyme called glutathione, abbreviated "GSH." The enzyme itself is a carefully designed molecule of protein that can quench free radicals but it needs both vitamin E, the mineral selenium, and other factors in order to do its work. (See safe and adequate dose suggestions, in last month's article; don't self-prescribe.)

In making GSH, our bodies may need supplements as support. One promising way to do this is a relatively new supplement called NAC (N-acetyl-L-cysteine). This sulfur-containing amino acid is, apparently, the "rate-limiting" step in our bodies' capacity to make GSH. Supplemental NAC appears to be non-toxic and a daily NAC supplement may be beneficial.

Vitamin C is a hallmark antioxidant. During the kitchen experiment suggested earlier, if you had soaked those fruits in liquid vitamin C, the appearance of the fruit would have been preserved. Again, this can be done at home and I suggest it; seeing is believing. Once you compare the unprotected banana to the vitamin C banana, you'll never want your insides to resemble the untreated banana ever again!

The use of vitamin C is highly controversial in HIV/AIDS. We have the very low RDA level of 60 mg, the Linus Pauling level of 20 grams, and we also have vitamin C infusions at 200 grams (1,000 mg = 1 gram). You decide; I'm not on record with any recommendation.

Beta carotene may be the most famous antioxidant of all. In March 1992, the Journal of Nutrition published a study testing beta carotene's effects on certain HIV laboratory monitors, specifically natural killer cells, immunoglobulins, and activated lymphocytes. Increases in all three markers were seen at three months, but no increases of CD4 or CD8 were seen. Optimistically, then, one could presume at least some benefit of taking beta carotene no toxicities were seen, though the dose was high at 60 mg (100,000 I.U.) per day.

A year later the March 1993 Journal of Acquired Immune Deficiency Syndrome reported one of those classics the randomized, placebo-controlled, double-blind, crossover, clinical trials, which found that beta carotene at 180 mg (300,000 I.U.) per day increased white blood count, increased CD4 levels, and improved CD4/CD8 ratios. Importantly here, no toxicity was observed and the authors conclude that beta carotene has an immunostimulatory effect.

Beta carotene is usually sold in 25,000 I.U. doses, and to reach the 300,000 I.U. per day of the second trial, you'd have to take 12 supplement pills each day. While I do not recommend doses that high, it does appear to be non-toxic (although it wouldn't surprise me to see some yellow skin!). Considering, however, all the pills one must take for "normal" management of HIV/AIDS to either treat OIs or prevent them at least this one could have a positive result; increases in immune capacity have been seen.

To take a food break for just a moment, look again at beta carotene. It's a pigment a bright yellow/orange color and it has over 400 relatives, "carotenoids," each of which, too, is a pigment. So, we have only 1/400th of the available carotenoids available in pill form. Eating the highly-colored fruits and vegetables, you can be sure, adds a vastly broader range and it's likely that the other carotenoids could have similar or additive effects to the more common beta carotene.

NOTES ON MINERALS

The classic mineral in HIV/AIDS is zinc. Its RDA is only 13 mg, but internationally renowned nutrition/immunology expert Dr. R.K. Chandra suggests a 75-100 mg daily intake of zinc for HIV/AIDS. Not only is zinc closely associated with the T-cell making thymus gland, it is also necessary for virtually every chemical reaction involving enzymes, making it, too, a necessary co-factor for glutathione. Food sources of zinc include meats and legumes. Too much zinc is risky as it may depress immune function and create other mineral deficiencies (e.g., copper).

And, as mentioned earlier, the mineral selenium is functionally necessary for GSH, and was only given an RDA in 1989 of 55 mcg/day. Formerly, selenium held a designated ESA (Estimated Safe and Adequate) range of 50-200 mcg. Food sources of selenium include brazil nuts, starches and pasta. Use a great deal of caution on selenium toxic at high doses, it could do more harm than good. The range of the former ESA is a good guideline.

Other minerals which you should obtain from your supplement include copper, iodine, molybdenum, chromium, manganese, calcium and magnesium, and even boron. Iron at RDA levels is safe, but because of its strange metabolism in HIV/AIDS, I always recommend that it be handled by your physician. Also, I'm frequently asked about potassium; any over-the-counter gator-type drink is just fine to replace the electrolytes in fluid losses (sweats, vomiting, diarrhea).

(Jennifer Jensen maintains a private nutrition practice in Santa Monica. She welcomes your call at 310.450.5581.)
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