(HIVPlus) Standard of Care : Complemenatary Care

SEPTEMBER 1998

NUMBER ONE

STANDARD OF CARE

Give Yourself a Complement
Vitamins, nutrition, and exercise aren't just for Richard Simmons.

Eating right is a critical part of HIV care. HIV, HIV-related infections, and HIV drugs commonly cause nutritional deficiencies, weight and muscle loss, nausea, loss of appetite, diarrhea, and gastrointestinal distress; other problems can worsen these. Even if you feel healthy and look good, you may not be getting enough nutrients or vitamins because HIV-and the body's response to it-diminishes them from the body. Zinc and selenium are common deficiencies. Getting enough calories by eating nutritious meals and exercising regularly are important. It's called complementary care.

HIV drugs are potent but toxic, depleting the body while stressing different organs-particularly the liver, pancreas, and kidneys-as well as the nerves and gut. Listed below are extra supplements that can help detoxify the body and counteract the negative effects of HIV drugs. The easiest way to get these needed micronutrients is through food-that's also cheaper than buying a lot of supplements. A good nutritionist can help you come up with a diet designed to overcome HIV and drug-related nutritional deficiencies. Some HIV nutritionists think a good multivitamin is the important key for fighting deficiencies. New proof? A recent South African study of 2,100 people with AIDS showed that adding a daily multivitamin B complex greatly increased their survival time.

The Basics

Consult an HIV-knowledgeable nutritionist; pregnant women and infants have special requirements.
Eat a moderate-protein, complex-carbohydrate diet including fruits, vegetables, and "good" fat: mostly mono-unsaturated fats like olive, sesame, canola oils.
Weight training builds muscle; aerobics boost immune function.
Helpful: Sulphur-rich foods with amino acids methionine and cysteine (eggs, whey proteins, apricots).
Supplementary daily multivitamin, like Silver Centrum (but high potency) with A, C, D, E, strong B complex (B6, B12), chromium, calcium, and magnesium. The last two should be taken hours apart to help absorption; take one at breakfast, the other at dinner.
B 12 shots/nasal spray counter B 12 deficiency caused by HIV (see below).
Helpful: Zinc, magnesium, selenium, beta carotene.
Monitor your nutritional status; see a dietitian if possible.
Check to see what foods contain which vitamins and minerals.

Supplements	Dose	Effect
To help protect your gut and colon:
Soluble fiber (oat bran, fruit, white rice)	Daily	Counters diarrhea
L-glutamine	10-15 grams/day to 30-40 grams/day	Used to treat drug-associated diarrhea; heals intestinal tissues; maintains absorption
Lactobacillus acidophilus; Bifidobacterium bifidus	Daily	Replaces intestinal and vaginal flora destroyed by antibiotics and prevents yeast infections; may counter Cryptosporidium, Mycobacterium avium
Garlic extract	Coated capsule	Counters candida
Supplements	Dose	Effect
To help protect your kidneys:
Drink lots of water	8 glasses a day, ideally
Warning: Avoid magnesium if you have kidney or heart problems. Consult your doctor.
Supplements	Dose	Effect
To help protect your liver, lower glucose, cholesterol, lipid levels, which also protects your heart:
Sulphur-rich diet	daily	Lowers cholesterol, liver supportive (cysteine, methionine)
Myo-Inositol	50 mg	Prevents fatty liver)
Chromium Polynicotinat	1000 mcg/day	Improves lipid profiles)
Carnitor (L-carnitine)	3 grams/day	Lowers triglycerides)
Milk thistle herb	300-600 mg/day	Restores glutathione, lowers liver enzyme)
NAC (n-acetyl cysteine)	2,000-4,000 mg/day	Restores glutathione)
Thioctic acid/ALA alpha-lipoic acid	100-200 mg three times a day. High dose: 1200 mg daily	Restores glutathione; improves energy production; lowers liver enzymes; may lower high blood glucose)
Niacin	50-100 mg/day with doctor's supervision	Reduces cholesterol; common side effect: flushed skin, tingling)
Dandelion Root		Liver supportive)
Essential Fatty Acids (EFAs): Omega-6 fatty acids (GLA in primrose, grapeseed, borage oils)	Daily	Decreases triglycerides)
Omega-3 Fatty Acids (EPA/DHA in flaxseed oil, linseed oil, fish oils (Max -EPA)* Fish oils have bad aftertaste: try eating fish (salmon, mackerel, sardines, tuna). Warning for diabetics and hemophiliacs: fish oil reduces blood-clotting capabilities; can decrease insulin secretion.	Daily	Decreases triglycerides, controls blood pressure)
Glutathione (GSF-cysteine, glycine, glutamic acid) *Best approach to maintaining glutathione is combined use of vitamin C, E, NAC, ALA, glutamine.		Restores glutathione levels lowered by HIV*, drug detoxifier)
Warning: Iron		Extra iron can hurt liver; check B12 deficiency and source of anemia)
Supplements	Dose	Effect
To help protect your spleen/pancreas/blood:
PABA (paraamino benzoic acid)	30 mg/day
Vitamin B12	Daily; consider B12 injections if B12 deficient (signs:-fatigue, memory problems, neuropathy). 100 mcg daily for a week, then 1000 mcg twice a week	Alcohol or drugs lower B12 serum levels; standard B12 tests are often inaccurate in HIV patients.
Vitamin E and Selenium	400 IU/day 400 mcg/day (600 mcg is high dose)	May offset drug-associated anemia. Warning: Extra vitamin E is risk for hemophiliacs; over 1000 mcg of selenium may be toxic.
Alternative approaches: Anecdotal studies suggest Chinese herbs (dong quai, bai shao, chuan xiong) are blood builders that may help counter drug-associated anemia (red-blood-cell drop) and neutropenia (white-blood-cell drop).
Supplements	Dose	Effect
To protect nerves/treat neuropathy:
B vitamins see above
Biotin	5-20 mg/day	protects nerves
Myo-Inositol	1000-3000 mg/three times a day	protects nerves
Choline citrate	400-800 mg/day	protects nerves
Essential Fatty Acid (see above)
GLA	240 mg. two to three times a day	reverses nerve damage
ALA	see above	reduces pain, numbness
Folic acid	160 mcg three times a day	protects nerves
Carnitine	240 mg three times a day (see above)	protects nerves
Thiamine	50-100 mg/day	useful in diabetic neuropathy
Magnesium	200-400 mcg/day	take with a meal
* Sources: FDA, DAAIR, Immunet, Critical Path AIDS Project, "Power Nutrients" article in Poz, July, 1998, by Lark Lands, PhD. (See "Vital Resources"). The above recommendations are based on anecdotal reports and some small-scale clinical studies. Most compounds have not been studied in well-controlled clinical trials but are viewed as helpful and will do no harm at above doses. Consult a HIV nutritionist first.