Nutrition and Vitamins in HIV Infection	Maker	Access	Description
Nutrition in General	n.a.	n.a.	Part of fighting AIDS is clearly understanding your choices in diet and understanding the effects on your body of the foods you eat. Equally important is your awareness of the high rate of nutrient deficiencies and the resulting high need for nutrient supplementation. Malnutrition occurs early in HIV infection [see J Physicians Assoc AIDS Care, (1995) 2(1):12-5; J Am Diet Assoc, 94(9):1018-22]. There is a requirement for an increased intake of both nutrients and calories. Higher protein/complex carbohydrate/fiber diets are encouraged, keeping fat to no more than 25% of the diet. If an appropriate diet is not followed and nutrients are not supplied at adequate levels, the result can be diarrhea, weight loss, and wasting. THIS CAN KILL! There is also no relation to T-cell count, antiviral medication, or even presence of an OI [see INDEX 2, CLINICAL/IATROGENIC, entry: weight loss/wasting]. The following list provides general dietary supplementation information. While whole foods are an important base, even a good diet will not provide the levels of nutrients needed for an optimal approach to HIV infection. Starting early with a nutrient supplementation program (preferably immediately upon diagnosis) is highly advisable. Several studies suggest such intervention can significantly delay progression. Nutrition is NOT "alternative" medicine; it is a fundamental component of medical care [see Being Alive, 5/95]. In addition to deficiencies in many vitamins/micronutrients, the "resting energy expenditure" of people with HIV is elevated (i.e., more energy is being burned even while one is just resting [see J Assn of Nurses in AIDS Care, (11/94 & 12/94) 5(6):30]. This underscores the fact that people with HIV need to take in a LOT more calories, preferably from complex carbohydrates and definitely not from fat! While additional research is desperately needed, there is already significiant evidence for deficiencies in people with HIV (PWHIV) as well as very significant evidence that intervening with diet changes and supplementation can have beneficial effects. Even in asymptomatics with higher CD4 counts, progressive deficiencies have been found in vitamins A, B6, C, E, B12, folic acid, selenium, zinc, and beta-carotene, both in adults and children. In people with lower CD4 counts and one or more OI's, "nearly every specific nutrient is deficient[!]" [see Beach, RS & Lefkowitz, M. Nutritional aspects of HIV infection; PAACNOTES 1(6):221-223 (Nov/Dec, 1989)]. In Jan 1994, several AIDS newsletters reported on nutritional and complementary (or so-called "alternative") approaches to AIDS, including these publications: Provincetown Positive, Issue #16; GMHC's Treatment Issues Vol. 7, nos. 11/12; and the AIDS Treatment Data Network's Treatment Review, Issue #9; [see ARIC's extensive AIDS Contacts Index for listings of available AIDS Newsletters]. A repeating theme in these articles was the lack of interest in this area of research on the part of the medical establishment and the resulting lack of data, underscoring the need for trials (preferably well-designed ones) that ask the right questions!! [See "Experts Emphasize Need for Nutrition Therapy in AIDS," AIDS Weekly, Nov 22 & 29, 1993; see also: Feldman, C, "Vitamin Megadoses May Slow Onset of AIDS, Researchers Find" from Nation's Health (1/94) 24(1):27; also: Cohan, G, "Malnutrition and HIV Disease" in Being Alive Feb 1994. For a good report on vitamins, see Rick Whitaker's "Vitamins, Minerals and HIV Infection" (available through ACT UP/St. Louis).
antioxidants	Amni, Perque, Biotics, Bronson, Cardiovascular Research, Jarrow, others	O	These include vitamins A, C and E; beta carotene, selenium, coenzyme Q10, quercitin, bioflavonoids, N-acetyl cysteine (NAC, as precursor to glutathione), and other nutrients that work either directly as antioxidants or form part of other antioxidant substances [see below for specific information on each; for more information: see Carter report on NIH conference on Oxidative Stress in AIDS, Nov 8-10, 1993 (published by ACT UP/NY, copy available through ARIC)]. Tests: Serum vitamin levels are notoriously bad for assessing true deficiencies; often, surrogate markers may provide a clearer picture and tissue levels are an even better marker (e.g, EGOT levels for B6 deficiency). See Lark Lands' book Positively Well for a lengthier discussion. Other markers like malondialdehyde and clastogenic plasma factor (DNA damaging material) may also indicate the degree of oxidative stress. Thiobarbituric acid-reactive substances test (TBARS) is another good test; sudden increases in this value were correlated with the development of OIs, particularly toxoplasmosis; however, this test needs more research confirmation and may not be readily available through your physician.
acidophilus	Natren, Jarrow, Perque, others	O	Necessary and beneficial bacteria that are naturally present in the intestines and aid in digestion. Acidophilus bacteria in live or freeze-dried form can be used to counteract the intestinal upset which may following prolonged antibiotic therapy (antibiotics destroy the natural balance of intestinal flora/fauna that help keep digestion running smoothly), in cases of candidiasis (additional beneficial bacteria compete to to prevent Candida growth) or in some types of diarrhea. These "good" bacteria produce many types of micronutrients, including: thiamine, riboflavin, niacin, pantothenic acid, vitamin B6, vitamin B12, folic acid, choline, biotin, and vitamin K. Prolonged deficiency of beneficial bacteria can cause nutrient deficiencies, absorption problems, and can be one cause of chronic diarrhea. Recent research suggests that they may also help to prevent infections like MAC or cryptosporidiosis or CMV from taking hold in the intestines, both by competing for space with the pathogens in a way that keeps these pathogens from colonizing the intestinal lining and also by producing natural substances with antibiotic and antiparasitic properties [see Harp J, Chen W, and Harmsen A. Resistance of severe combined immunodeficient mice to infection with Cryptosporidium parvum: the importance of intestinal microflora. Infection and Immunity 60(9):3509-3512, 1992]. Good sources of information: Natren's "Patient Guide" to what they call "probiotic" products (i.e., acidophilus and other beneficial microorganisms); to order: 800-992-3323 or 805-371-4737. Also, see discussion in Lands' Positively Well guide.
beta-carotene	various	O	Dosage: 25,000-150,000 IU's/day. Water-soluble precursor of Vitamin A; the molecule cleaves in half to form two molecules of Vitamin A when the body needs it. Clear anti-cancer properties. One artificial form, Accutane, improves CD4+ counts and NK cell activity; unfortunately, benefits appear to wain after 3 months (at 60mg/day). There are many types of carotenes found in various foods: carrots, sweet potatoes, pumpkin, and winter squash contain alpha- & beta-carotenes; green leafy vegetables contain lutein (and beta carotene); tomatoes and watermelon contain lycopene (and gamma-carotene for tomatoes); citrus fruits contain beta cryptoxanthin; corn and peaches contain zeaxanthin; salmon and certain seafood contain astaxanthin. In general, go for dark green, orange, yellow, and red fruits and vegetables. Note: IU (International Units) is the term usually used for vitamin A amounts; for beta carotene, 15 mg is roughly equivalent to 25,000 IU of raw Vitamin A. Note: Vitamin A can be toxic in large doses; take beta-carotene instead for safety! Information resources: J. of Nutrition, March 1992; 122(3):728-732. Several articles in Proceedings of the Nutrition Society, (1991) 50. Coodley, GO, et al., Alpha-carotene in HIV Infection, Journal of AIDS, (1993) 6:272-276. Hoffmann La Roche: Nutritional Aspects of Ambulatory Care - Vitamins & Immune Response, Document: RCD 5265].
biotin	Amni, Nature’s Way, Solgar, others	O	10-15 mg/day. Normally produced by intestinal bacteria which are destroyed in anyone on antibiotics. Not much in food so supplementation necessary. Helps prevent candida problems. Helps metabolize fatty acids, and thus is critical for fat digestion; also necessary for amino acid metabolism. Biotin deficiency can cause dementia; shown in kidney dialysis patients on biotin-free restricted diets; such neurological problems reversed with a couple of months of biotin supps. May also help reverse neuropathy, both peripheral (cause of numbness and pain in feet, legs, hands, arms) and autonomic (contributor or cause of impotency and digestive problems). For neuropathy, works best when used in doses of 15-20 mg/day (15,000-20,000 mcg) and in combination with choline, inositol, B6, B12, and thiamine. See Lark Lands' Positively Well, Treatments for Neuropathy. (Comment: biotin is good for cats with flea bite-induced allergies and skin problems; sprinkle 1000 mcg in their food daily; scratching themselves stops; scabs disappear; cats are happy.)
calcium	Biotics, Perque	O	Dosage: 1000 mg/day, take at suppertime. Balance with magnesium (see below) taken at breakfast, since they compete for absorption.
carnitine	Cardiovascular Research; Carnitor	O, P	[Note: Also sold as L-carnitine] A critical amino acid necessary for fat metabolism; levels decline as HIV disease progresses; lack can cause internal decline and wasting. Use 250-1500 mg/3-4 times per day on an empty stomach. It provides energy by transporting long chain fatty acids to mitochondria to act as fuel. One study showed reductions in high levels of TNF-alpha, triglycerides and ß2M (6 g/day for 2 weeks). Reduces AZT-myopathy by limiting damage to microtubules (see Lab Invest 1994 Jul;71(1):102 12; see also Immunopharmacology and Immunotoxicology 15(1):1-12, 1993; De Simone C, et al. L-carnitine deficiency in AIDS [AIDS 6(2):203-205, 1992]. See also CLINICAL/IATROGENIC Index, entry: myopathy. See also discussion in Lark Lands' Positively Well, Chapter Two, The Core Approach; very important! Note: Expensive in the higher doses often needed; Rx form Carnitor available; depending on your insurance coverage, might save you money (although it's MUCH more expensive if you're paying out of pocket.)
choline	various	O	Dosage: 1000 mg/2x/day choline citrate. Improves nerve and immune function. May help reverse neuropathy, both peripheral and autonomic; higher doses may be needed, up to 1000-3000 mg of phosphatidylcholine, 3 times per day; see discussion under biotin; Cardiovascular Research has good inositol/choline mixture in their "Supercholine."
co-enzyme Q-10	Biotics, Jarrow, NutraMax	O	[Note: Also known as ubiquinone] Dosage: 30-300 mg/day with meals. Improves basal cell energy, oxygenation of cells; good for PWAs prone to cardiomyopathy (loss of heart muscle) or periodontal disease; may help prevent or reverse congestive heart failure; reverses cardiotoxic effect of adriamycin. Effective against fatigue and adenopathy (swollen lymph nodes). May help prevent progression of disease. At least one study suggests that people with HIV become more CoQ-10 deficient as HIV disease progresses [see Folkers, et al., Biochem Biophys Res Commun 1988 153(2):888-96]. Unfortunately, CoQ-10 ain't cheap! Receptagen filed a patent on use of CoQ10 to inhibit apoptosis [contact Clive Woodhouse, Ph.D., Director of Research and Product Development of Receptagen Corp: (206) 778-5260].
copper	Allergy Research Group, Cardiovascular Research	O	Dosage: 2-4 mg/day. Zinc in morning, copper in evening (they balance each other). Deficiency prevents normal response of the scavenger cells to infection; supplementation may interfere with zinc uptake if taken at same meal [see Proc. Nat'l. Acad. Sci., (1992) 89:6794-6797]. Possible faster progression seen in one trial in people with higher zinc intake may be either (a) a statistical anomaly or (b) due to lack of copper balance. If you also take an iron supplement, take it with the copper.
dimethylglycine (DMG)	DaVinci, Biotics	O	Dosage depends on AZT; usually 100-200mg/day with each meal. Oxygenates cells and increases energy.
folic acid, folate, folinic acid	Biotics, others	O	Folic acid is a water-soluble vitamin [chemically: pteoric acid linked to L-glutamic acid]. Folic acid and folate are natural nutrients and are essential to health; folinic acid is a synthetic version of folic acid. Folinic acid is now more widely known as leucovorin or citrovorum factor, and is used to raise folic acid levels in patients with natural or drug-induced deficiencies. [Note: folacin is an older name for folic acid]. Taken with Vitamin B12, 1000 mcg/day dosage; folic acid deficiency can result in megaloblastic anemia (badly formed red blood cells). Folic acid is necessary for proper hematopoeisis (development of stem cells). Folic acid deficiency may increase the susceptibility to anal or cervical dysplasia or cancer. In HIV-neg women, study has shown reversal of cervical dysplasia with doses of 5 mg (5000 mcg) per day; anal tissue is similar so may also help there. [See discussion in Lands' Positively Well].
glutamine	Ross, others	P	Very important addition to Total Parenteral Nutrition (TPN) [example: Alitraq brand TPN with glutamine/Ross]; helps repair the gut and soothe intestines when diarrhea has caused damage; can be added to TPN preparation up to dosage of 8g/day (slowly raised to this level). It has helped reduce constant diarrhea to an intermittent level in some patients; used for those undergoing cancer radiation therapies.
inositol	various	O	Dosage: 500 mg/2x/day. Improves nerve function; taken with choline and biotin, some have found improvements in HIV-induced neuropathy at doses of 1000-4000 mg/day; Cardiovascular Research has good inositol/choline mixture in their "Supercholine" product. See also: biotin.
iodine	various	O	Deficiency may result in thyroid problems. A healthy diet or a standard multivitamin should provide sufficient quantities of iodine.
iron	Perque, Cardiovascular Research, Smith Kline	O	Use separate form (not in multi-vitamin as it rapidly oxidizes other minerals). Deficiency produces impaired bacterial killing ability, possible T-cell decrease; over-use (>100mg/day) can actually increase bacterial virulence. Should be taken w/copper supplements for better absorption. According to the PDR, the SmithKline product is manufactured with an ozone-depleting chemical called methylchloroform, which may cause increased risk of skin cancer and global warming; since they're so mean, use someone else's product! Taking doxycycline with iron supplements results in decreased drug absorption; use with cimetidine (Tagamet) may result in decreased absorption/lowered effect; decreased iron effect also in kids with vitamin E.
lauric acid (monolaurin)	Cardiovascular Research	O	Lauric acid is an Essential Fatty Acid (EFA) shown to kill lipid-enveloped viruses (like herpes and maybe HIV) and many protozoan bugs. It is found in concentrated amounts in coconut fat. Coconut cream, available in Southeast Asian markets, is a good CHEAP source; 2 tablespoons, 3X/day, would provide amounts of lauric acid proposed by lipid expert Mary Enig, Ph.D., as probably working both against protozoal infections and HIV. Interesting salvage therapy trial of monolaurin (?) for cryptosporidiosis done by Donald Kotler, M.D., at Columbia; as general non-toxic antiviral, monolaurin (6-12 caps/day on an empty stomach; take 6 at a time with big glass of water). However, coconut cream is much cheaper and a far more concentrated source of lauric acid, plus it tastes good, and can be used in cooking, soups, supplemental drink mixtures, as spread, etc. Enjoy!
lipoic acid (thioctic acid)	Jarrow, Cardiovascular Research	O, E	An antioxidant and liver protector. Lots of meds used by PWAs can damage the liver as can other infections [see INDEX 2, VIRUSES; entry: hepatitis]. 1-2 with each meal may help protect liver from drug toxicity. Helps to lower liver enzymes (AST or SGOT, ALT or SGPT). "AST is generally a more sensitive indicator of chronic and infiltrative lesions while ALT is the more sensitive test in acute and obstructive liver disease" [source: Yanick P and Jaffe, R: Clinical Chemistry & Nutrition Guidebook. See also: Hepatitis. May also have anti-HIV properties (?).There was a combo therapy trial with AZT which showed strong anti-HIV effects in vitro [see Klin Wochenschr., (1991) 69:722-24] and anti-tat activity [see Biochem Biophys Res Commun 1994 205(1):967 75]; other sources: Int'l Conf on AIDS 1991 [see abstract MA.1075]; 1994 Yokohama [#401A, PA0336]. Improvements in glutathione levels, plasma ascorbate and thiol groups and reductions in oxidative stress markers malondialdehyde and 4-hydroxynonenal seen in small (n=10), open label study [Arzneimittelforschung 1993 43(12):1359 62]. Interesting! Any more info out there?
lysine (an amino acid)	various	O	Dosage: 1-3 g/day is dosage used by some HIV+ patients to suppress herpesvirus outbreaks; however, note that the anti-herpes effect comes because lysine blocks the uptake of arginine, another amino acid that is necessary for production of human growth hormone; long-term blocking of arginine is, thus, not a good idea; HGH may be very important for long-term prevention of wasting; see Lands' Positively Well for info on approach to increasing HGH via a combo therapy with lysine and arginine.
magnesium (magnesium glutamate)	Amni, Allergy Research Group, Biotics	O	Deficiency can cause constipation, cramping, worsening of PMS symptoms, neuropathy and thymic hyperplasia. For constipation, 750-1000 mg/day. Used up in AZT breakdown. Take in morning (calcium at supper since they compete for absorption). Magnesium used with aminoglycosides results in increased neuromuscular blockade (a problem).
methionine (an amino acid)	Livron, others	O	[Note: Also sold as L-methionine] Required for building the body's antioxidant defense molecules; may be very beneficial for myelopathy which is a crippling nerve disorder. Study under way at Mt. Sinai, NYC [see INDEX 2: NEUROLOGICAL].
molybdenum	various	O	Dosage: 50-150 grams/day. A must for ddI users since it's used up when the drug is metabolized (broken down); the resulting deficiency could allow sulfite sensitivity and a subsequent severe (possibly even life-threatening) allergic reaction to some drugs.
multiple vitamins	Perque, others	O	From Lark Lands' Positively Well: "A supplement program should always have as its base a hypoallergenic, very bioavailable multiple vitamin and mineral that will supply a basic level of all the nutrients most important to human function in a form likely to be taken up by those suffering from the absorption problems of HIV infection. A good, high-potency multiple makes up for overall dietary deficiencies and helps maintain nutritional balance when you are taking other nutrients separately. This type of supplement will provide a balanced supply of nutrients in appropriate ratios for normal function. However, please remember that you are not dealing here with normal function. With all the factors that result in the advanced deficiencies that have been found in most of those living with this disease, it is almost always necessary to add to the multiple a number of additional supplements both to increase dosage levels and to include those things often not found in multiples. . . For the best absorption and metabolism, the multiple should contain very absorbable forms of minerals that are pure, easily absorbed and transported, and biologically active, including citrates, fumarates, malates, aspartates, ascorbates, picolinates, and those from vegetable culture sources, rather than in the form of gluconates (the most common, cheapest, and least absorbable forms); examples include zinc picolinate and calcium citrate. In addition, the multiple vitamin should include advanced forms of the B vitamins, such as B 6 in the form of pyridoxal-5'-phosphate rather than pyridoxine alone, vitamin B2 in the form of riboflavin-5'-phosphate instead of just riboflavin, and so on. Most formulas would require taking 2-4 capsules or tablets per day with meals for an optimal dose (check specifics for the one you're taking). Because of the water-soluble nature of some nutrients that results in quick loss from the body, the best formulas will be designed such that you take one or two with each meal or at least one with breakfast and with dinner." Make sure the brands you buy are the highest possible quality!
octacosanol	Solgar,Twinlab, Biotics	O	2-3 caps/day improves energy and muscular endurance.
omega-3 and omega-6 fatty acids	Biotics	O	Very important for skin and immune system health. May reduce the inflammatory response, IL-1 alpha, IL-1 beta, TNF-alpha and neutrophil chemotaxis response [see NEJM, (3/2/89) 320(5):265-271]. Omega-3 found in marine lipid concentrate formulations [MaxEPA/DHA (EicosaPentAenoic and DocosaHexAenoic Acids) 300-600 mg/day]. Omega-6 includes gamma-linolenic acid [found in evening primrose oil, borage oil, grape seed oil, others; 240mg-720 mg/day] [See NEJM (1989) 320:265-271; see also: good discussion on fatty acids in Lark Lands' Positively Well]. EFAs can really help eliminate dry, itchy skin that drives HIV+ people nuts!
PABA (a B vitamin)	various	O	PABA stands for Para-AminoBenzoic Acid. Protects against damage to lungs done by ozone. (Less ozone high in the atmosphere causes bad sunburn; too much at street level is bad for the lungs); also provides some protection against radiation damage from sun or radiation therapy. PABA with pyrimethamine (Daraprim) may decrease pyrimethamine effect against toxoplasmosis.
pantothenic acid	various	O	See Vitamin B5
quercitin	various	O	Bioflavonoid from blue-green algae; antioxidant, antihistamine, anti-inflammatory. Synergistic with Vitamin C. 500-2000 mg/day. May be helpful with allergies. May help reduce body-wide inflammation that stimulates viral replication. Also helps reduce capillary fragility; may improve abnormal bruising.
rutin	various	O	A bioflavonoid (particularly found in buckwheat). Helpful with capillary fragility, abnormal bruising (Aside: good for cats with flea-bite induced allergies.)
selenium	Biotics, Nutramax	O	Dosage: Minimum 150-200 micrograms/day; maximum 800-1000 mcg/day (600-800 is probably optimal because of high oxidative stress of HIV disease). Better w/Vit. E. Inorganic (selenate or selenite) forms are probably best. Will Taylor suggests selenium deficiency may be important in pathogenesis; he derives the ideas from comparisons of genetic requirements of viruses (see J Med Chem 1994, 37:2637 2654). Suppose it's possible that if HIV needs selenium this may in fact be "feeding the virus" but Taylor thinks this keeps virus happy so it doesn't feel need to go elsewhere in search of selenium, replicating along the way; selenium deficiency may result in more lethal viral variants (I know I get testy and nasty when I'm hungry...so maybe keeping the HIV "fat and happy" will prevent nastier variants from arising; certainly, it is apparent that people who become infected with AZT-resistant virus acquire a meaner pathogen that results in faster progression)–see Newsday article by Laurie Garrett 5/1/95 "Study: Diet Can Start Virus' Lethal Mutation." However, the study she discusses looked only at Coxsackie virus, not HIV.
thioctic acid (lipoic acid)	Cardiovascular Research	O	See lipoic acid
vegetable juice	Vitamix, others	O	Juicers are a good idea but PWA/HIVs must be very careful to VERY thoroughly clean vegetables before juicing. If CD4s <150, they should be peeled or (preferably) dipped in boiling water for 5-10 seconds (to eliminate MAC and other germs in soil, etc.). Best choice is juicer like VitaMix that retains the pulp because that's where a large percentage of the nutrients are. You can use any and all colored vegetables (red, orange, yellow, dark green). However, be careful with beet juice; recommended in many herb books but, boy, does it shock the liver; small amount (no more than 1/4 cup in large glass of juice) good for liver function (although don't be alarmed after you drink it if your stool is red/purple; you're not bleeding to death; it's just the beet juice!)
vitamin A	various	O	Dosage: 10,000-15,000 IU/day. Fat soluble vitamin. Helps maintain integrity of respiratory tract; high concentrations may suppress HIV replication in macrophages; regression of hairy leukoplakia seen with A; stored in fat, so high doses (usually >50,000 IU/day but everyone has individually determined tolerance) can be toxic. Important in first-line, nonspecific antimicrobial defenses. Take with your zinc supplement. Vitamin A deficiency has been correlated with HIV disease mortality; also with vertical transmission (from mother to infant) which supplementation reduces dramatically when given early on to mothers who are deficient. Vitamin A use may increase anticoagulant effect of warfarin (Coumadin).
vitamin B1 (thiamine)	various	O	Dosage: 100 mg/day; thiamine is important in carbohydrate metabolism, essential for normal digestion, appetite and normal functioning of nervous tissue. Lack can cause neuropathy, confusion, dementia, colitis, diarrhea, loss of appetite and serious loss can cause nervous disorders, beriberi and paralysis. Sources: whole grain cereals, peas, beans, peanuts, oranges.
vitamin B2 (riboflavin)	various	O	Dosage: 100 mg/day; riboflavin deficiency generally depresses primary antibody response to immunization (same with Pantothenic Acid) as well as lassitude, weakness, skin atrophy, anemia, photophobia, reddening/cracking of lips (cheilosis) and cataracts. Found eggs, liver, green veggies, lean meat, milk and wheat germ. The RDA is around 1.3-1.4 mg.
vitamin B3 (niacin, niacinamide, nicotinamide, anti-pellagra vitamin)	various	O	Dosage: 100 mg/day; to avoid the "flushing" associated with niacin, stick with niacinamide. The body needs it for tissue respiration, fat synthesis and glycolysis (sugar breakdown). GI and mental disturbances can arise from deficiency, as well as pellagra (a disease that can cause inflamed tongue (glossitis), red, scaly patches on the skin, diarrhea, anemia, ulcers and cyst development, nerve weakness, etc. RDA around 16 mg. Niacin (not other forms) may lower cholesterol/triglyceride levels.
vitamin B5 (pantothenic acid)	various	O	Dosage: 300-1000 mg/day of calcium pantothenate. Pantothenic acid is necessary for the production of adrenal hormones and the production of energy in the body. It has been shown to increase endurance in athletes, both decreasing their oxygen use and their lactic acid buildup. It has also been shown to speed wound healing. Pantethine is the part of the pantothenic acid molecule which is a powerful free radical scavenger; 600-1200 mg/day lowers triglyceride levels in HIV-negative.
vitamin B6 (pyridoxine)	various	O	Best form is pyridoxyl phosphate, 50-100 milligrams/3x/day. Other form (pyridoxine) at 50-100mg/day. Deficiency can: suppress humoral and cell-mediated immunity, delayed skin hypersensitivity, may cause lymph tissue atrophy, lowered lymphocyte counts and inflammatory response; also splenic hypoplasia and neutrophil impairment. B6 can increase IL-2 production. Important supplement as many people are deficient. Early anxiety associated with B6 deficiency in HIV+. Take WITH other B-vitamins. More if on AZT or Isoniazid (INH). Dosage: 2000-4000 mg/day; Warning: too much may be toxic. May be useful to protect uninfected cells from HIV [see Auslander, J "AIDS Vitamin," Associated Press (1/14/94)].
vitamin B12	Merit, others	O, P	Injection: hydroxocobalamin; intranasal and oral: standard issue. Dose: 1000-2000 mcg, 2-3 times per week or daily for those with severe deficiencies. Deficiency can cause cognitive dysfunction, memory loss, dementia, fatigue, tinnitus (ringing in ears), canker sores. Many people w/HIV are B12 deficient. Take with folic acid. Severe deficiency can result in pernicious anemia (and may cause permanent nerve damage). Univ. of Miami study showed reversal of cognitive dysfunction with B12 injections. Get holo-transcobalamin II level for tissue, not just serum B12. Best form is nasal gel (1 every other day; Oral forms don't get absorbed well; best is to use Ener-B B-12 nasal gel (Nature's Bounty) or do injection of hydroxocobalamin, 2000 mcg, 2-3x/wk; injection usually Rx'd as intramuscular (can also be done subcutaneously, which may be less painful, easier for some). [See also INDEX 2: CLINICAL/IATROGENIC, entries: neuropathy, fatigue]
vitamin C	SDV, Bronson, Perque	O	T-cell activator; concentrations become high in phagocytes. Anti-inflammatory. With NAC, 9X increase in antiviral effect in vitro! Antiviral against herpes, poliomyelitis, hepatitis. With acute viral infections (flus, colds) can reduce symptom severity, shorten illness time, if and only if done at tissue saturation level. To reach this, gradually increase dose from 3-6 g/day up to the amount that causes diarrhea; then reduce to an amount 10-20% below this level; this will be your tissue saturation level; even conservative vitamin researcher Richard Beach, M.D., now recommends that everyone with HIV do tissue saturation level long-term; because of biochemical individuality and presence of other infections (bacterial, protozoal, viral, fungal) which greatly affect the level you may need, some people may need up to 100-200 grams/day! Hi-dose not recommended for pregnant women. For in-depth discussion of all aspects, see Lark Lands' Positively Well, Chapter Six, Ascorbic Acid. Hi dose vitamin C should be accompanied by other antioxidants. CPCRA has been struggling for YEARS with a beta-carotene/Vitamin C efficacy trial: now it's been stripped down to no beta-carotene and can vitamin C cause diarrhea? Answer before trial is conducted: of course it does if you take too much too fast. Certainly, this underscore the amount of crap flowing from NIH. Now that I've given them the answer, could they give me the money? May decrease anticoagulant effect of warfarin (coumadin).
vitamin D	various	O	Fat soluble. Not only will too much result in build-up that can be toxic to liver, it appears to increase HIV replication in monocytes (see AIDSWeekly, 8/26/91). Widely found in dairy products. Created in skin with any sun exposure. Supplementation probably not needed. One test tube study, however, showed improvements of maturation defects seen in macrophages (POA24-0544); seen also in some, but not all, PWAs who had low serum D3 levels and high neopterin.
vitamin E (tocopherols)	Metagenics, Solgar, Vitaline, others; the source of all Vit E is Eastman Kodak (!)	O	Antioxidant. Deficiency depresses immune response to antigens, lymphocyte proliferative response and general resistance to infection. E concentrates more in white than red blood cells. However, really large doses may inhibit immune function or bactericidal ability. 400-800 IU/day suggested of d-alpha tocopherol; dl-alpha is synthetic form that is not as useful. Other variants are the beta, gamma, and delta. CAUTION FOR PEOPLE WITH HEMOPHILIA: CAN DECREASE STICKINESS OF PLATELETS; FOR THOSE WITH COAGULATION FACTOR DEFICIENCY, COULD BE A PROBLEM. Don’t take with anticoagulant drugs (e.g., warfarin). Good for itchy skin but if taking more than 800 IU/day, take under physician’s care. Decreased iron response in kids taking vitamin E; take iron and vitamin E separately. Good with vitamin C and selenium (which some products provide both).
vitamin K	Solgar; others	O	Fat soluble vitamin associated with improved blood clotting; deficiencies marked by hemorrhage. Deficiency most often occurs in neonates, absorption disorders (ring a bell?) or during antibiotic therapy since that kills the good bacteria that normally produce it in adults. Helpful for liver function. 2 natural types, K1 and K2 (phytonadione and menaquinone, respectively). A synthetic form, K3 (menadione) also. Sources include green leafy veggies, liver, cheese, butter, egg yolk. Yum!
water	Unimportant as long as it is either FILTERED(!) to less than one micron, BOILED or DISTILLED (see below).	O	Very important! 6-8 large glasses/day. Important to kidney health. Dehydration (from drugs, etc.) makes good conditions for viral growth. However, you MUST have purified water. In light of recent outbreaks of cryptosporidiosis caused by water supplies in the Midwest, NYC, even in HIV-negative persons, this applies regardless of CD4 level. Recent detection of Mycobacteria and Legionella in urban water systems is also frightening. BEST BET: GET A GOOD FILTER OR BRING WATER TO A FULL BOIL FOR TEN MINUTES. The expense for filters may definitely be worth it in the long run for the sake of convenience, and for ensuring complete removal of the problematic organisms, including those found in shower water. Water purifiers/filters MUST SAY that they are certified for "NSF Standard 53 Cyst Removal"; for a list of certified filters, call 800/NSF-MARK. [Note: A list of "safe" brands appears in INDEX 2: PROTOZOA, entry: cryptosporidiosis.] To filter out mycobacteria, you need an even finer filter. Water filtration systems can be very expensive! If purchasing, you must consider both purchase price and the cost of long-term maintenance and replacement filters, how often they need to be replaced, etc. Sierra Environmental Systems has a product called the Sierra Pure (#SE-700-L) that seems to give the most for the least expense, especially when you consider the costs over time of filter cartridge replacement. This filter is .4 micron in size and will remove both Cryptosporidia and Mycobacteria. Nice extra: they automatically remind you when it's time to replace the cartridge; good for 3 years of "normal" use (whatever that is) or 3000 gallons.
wheatgrass juice	made by the goddess	O	Available at a lot of healthfood stores, this is practically pure chlorophyll (similar structure to hemoglobin but Mg instead of Fe); it is an excellent detoxifier and a regimen of three weeks will help cleanse the body. However, note that there's no way to purify the grass so best avoided if CD4s < 150 (to avoid MAC); Suppository, too. Can do 3-day liquid fast first (see physician first!) As your body detoxifies, the first feeling is a flu-like illness (the "blahs"), but this goes away soon.
zinc	Biotics, Solgar, others	O	Zinc is extremely important to the immune system and is required for the creation of thousands of enzymes in the body, including those required for the production of DNA and RNA; it's essential for preservation of cell-mediated immunity (T cells); deficiencies can cause susceptibility to infections and white blood cell defects. It is absolutely fundamental to immune function because you can't produce immune cells, particularly CD4 cells, without it. Zinc stimulates T-cell differentiation and maturation, stabilizes cell membranes, and increases the number of circulating T cells. Deficiency causes reduced antibody responses, thymic wasting, growth retardation, poor appetite, underfunctioning sex glands, impotency, delayed wound healing, skin problems, mental lethargy, and abnormalities of taste, smell, hearing, and vision including night blindness and tinnitus (chronic ringing in the ears. Overdosing with very high amounts of 300 mg/day in non-HIV men for 6 weeks resulted in reduced lymphocyte responsiveness, although this reversed when the zinc was discontinued. If supplementing (and balancing with copper), 25-50 mg/day of zinc citrate or zinc picolinate. Zinc sulfate at 120 mg/2x/day or 60 mg elemental zinc/day resulted in increased testosterone (these were not HIV+ pts)–Netter A et al. Arch. Androl. (1981) 7:69. For best absorption, take with B6 (25 mg of pyridoxal phosphate) and beta-carotene or vitamin A; may also improve absorption if taken with Vit D3 and/or pancreatic enzyme tab. One study appeared to show increased progression w/zinc supplementation although many experts doubt the validity; may have been a statistical anomaly, or lack of copper balancing or? Conflicts with several other large studies that have shown decreased disease progression in those with higher zinc (and other micronutrient) intake. Recent study presented at an international conference on Nutrition and AIDS in Cannes, France (April 28-29, 1995) showed very significantly reduced numbers of OIs in a group given 200 mg of zinc sulphate per day for 30 days; those given the zinc had increased CD4 cells, increased plasma levels of zinc-bound thymulin (critical thymic hormone); frequency of OI's in the 24 months following the zinc treatment was greatly reduced in both stage 3 (1 infection in zinc-treated vs 13 infections in controls) and stage 4 (10 infections in zinc-treated vs 24 infections in controls) groups. More research is needed but, for now, the weight of evidence is in favor of zinc supplementation, so long as it is balanced with copper supplements (see above).