Dietary Supplements For HIV Wellness
by Michael Mooney (Excerpted from Built To Survive, updated January, 2001)

When it comes to improving your chances of optimum health, nutrients can be as valuable as drugs in some respects, with a thousand times less potential for toxicity or side effects. (See toxicity data below.) Dr. Jon Kaiser, of San Francisco, believes that good nutritional support may improve your body's response so that lower doses of antiviral drugs work better, which means less overall toxicity. He also asserts that you are less likely to develop resistance to the antiviral drugs, so you don't have to switch drugs or drug combinations as often. Nutrients also are necessary for healthy immune response, and can prime your metabolism for best muscle growth. These are compelling reasons to optimize your nutritional supplement program. How do you do this? Fundamentals first.

While there a number of exotic dietary supplements and special foods and herbs that may be very helpful, the most important thing to include in your regimen are high-potency, complete daily multivitamins and minerals. These should include all the essential vitamins and minerals, along with the common antioxidants, as they all have roles in supporting optimal immune health. You definitely need a lot more than the RDA, though, as a number of studies over the last several years have shown the benefits that supplementing with higher doses of specific nutrients can provide.

For instance, studies on micronutrient megadoses in HIV disease conducted by Dr. Mariana Baum of the University of Miami School of Medicine found that nutrient abnormalities of vitamins B2, B6, B12, A, C, E, and zinc were prevalent in HIV-1 infected men despite dietary nutrient intake at or above the RDA. She also found that HIV(+) people needed 6 to 25 times the RDA levels of essential nutrients to get healthy cellular levels of these nutrients, some of which are associated with improved immune function. In her study Dr. Baum found that it took about 6 times the RDA of vitamin B2, 10 times the RDA of vitamin B5, 25 times the RDA of vitamin B12, 10 times the RDA of vitamin A, 6 times the RDA of vitamin C, 6 times the RDA of vitamin E, and 6 times the RDA of zinc to get adequate blood levels of these essential nutrients. And, very important, no evidence of toxicity was observed at these doses. ^{1 2}

You Can Not Get All Your Nutrients From Food
While many doctors in the HIV medical community have done great work in learning to control viral replication and increase T cells during the last few years, some doctors are still behind when it comes to the importance of nutrients. At an AIDS conference in New York recently one of the world's most well-known HIV doctors was heard saying that "Unless you have under 500 T cells you don't need to take multivitamins." Research shows us that this is simply wrong. It has been clearly demonstrated that taking multivitamins improves useful immune response.^{3 4} And this is important whether your T cells are 5 or 500.

One study of 296 HIV(+) men completed at the University of California at Berkeley concluded that the subjects who took a daily multivitamin were 31 percent less likely to progress to a full-blown AIDS diagnosis over six years.⁵ A placebo-controlled study in 1998 showed that HIV(+) people who took 800 IU of vitamin E and 1000 mg of vitamin C per day over three months experienced a trend towards lower viral load.⁶ The researchers said, "This is worthy of larger clinical trials, especially in HIV(+) people who cannot afford new combination therapies." This statement points out that inexpensive vitamins might be important healthsavers for HIV(+) people in third world countries who cannot afford expensive antiretroviral medicines.

And a recent study of 2,000 HIV(+) people from Johannesburg General Hospital in South Africa showed that people who did not take vitamin supplements developed AIDS in an average of 32 weeks, while it took 72 weeks for people who took vitamin supplements to develop AIDS.They also found that those who did not take B-vitamins survived for a median 145 weeks, while those who took a B-vitamin supplement lived for a median 265 weeks.¹³ Doesn't this make it seem like everyone in the world, HIV(+) of HIV(-), should at least take a good multivitamin?

However, it becomes confusing when we hear old-school conservative dietitians say that HIV(+) people shouldn't take dietary supplements that amount to more than a one-a-day vitamin or that HIV(+) people should try to get all their nutrients from food. Dr. Baum's data, as stated above, shows that this is simply impossible.

If we consider that it takes about five servings of fruits and vegetables just to get the RDA of the essential nutrients, then it would take somewhere between 30 and 125 servings of fruits and vegetables per day to get what Dr. Baum's data tells us HIV(+) people need.

Taking higher potency nutritional supplements should also be considered because there is an increased need for nutrients when the immune system is taxed during infection in HIV, and gastrointestinal problems like diarrhea can cause poor absorption of nutrients. Fortunately, numerous dietitians who work with HIV(+) people go beyond the outdated conservative approach to nutritional supplements and recommend a progressive approach to supplementing the diet with vitamins and other supplements that generally will add up to considerably more than one tablet per day.

I especially recommend reading anything that Harvard dietitian Charlie Smigelski has written about nutrients, as he has tremendously progressive insight. Use your "search" function to search for Charlie's work.

Vitamins, Minerals, and Antioxidants with Muscle
Numerous studies show that optimal intake of specific vitamins or nutrients correlate with your best overall health. Do not settle for low-dosage, Centrum-type vitamins or nutrient levels. A one tablet-per-day multivitamin formula does not provide enough physical space to even contain the RDA of all the essential vitamins and minerals; it takes about three fairly large tablets just to have enough space to contain the RDA for 1000 mg of calcium carbonate, and 400 mg of magnesium oxide. (The carbonate carrier for calcium and the oxide carrier for magnesium require about 3,500 mg, which is about 60% of the weight of the tablets.)

It takes even more space to give you the RDA for the other essential minerals and vitamins, and the RDA is barely adequate for healthy people who have no health problems, as the RDA supplies only part of what is required for optimal health.

Consider that the average American gets approximately 12 IU of vitamin E from their diet per day, but the RDA for vitamin E is 60 IU. However, even if we manage to somehow get the 60 IU RDA dose on a daily basis, the preponderance of scientific data show that it takes a minimum of about 400 IU per day of vitamin E to begin to optimally reduce the oxidation of cholesterol that is associated with reducing the risk of cardiovascular disease and death from a heart attack.⁷

And new studies indicate that 1200 IU works better than 400 IU or 800 IU to protect your cardiovascular system.⁸ Get multivitamins with some muscle - they will help you stay alive and healthy. A little addition shows us that this can mean taking four or more tablets per day, not one-a-day.

Complete Daily Vitamins
For years I have recommended my father's very high-potency daily vitamin formula called the SuperNutrition Opti-Pack (complete daily vitamins, minerals, and antioxidants in six tablets) as the most powerful and most cost effective foundation for a daily nutrient program. However, the newest SuperNutrition formula called The Super Blend contains even more antioxidants than the Opti-Pack. (The full potency Super Blend totals eight tablets per day, but it contains 87 nutrients and replaces dozens of bottles.)

I attest that these two formulas are the best multivitamin values in the world, per penny per milligram. This is not just hype; it is verifiable by adding up what nutrients they contain, what they cost, and comparing them to other formulas. (Call 1-510-446-7980 or 1-800-262-2116 to get the Opti-Pack and Super Blend comparison charts that compare them to other popular vitamin formulas.) On a milligram per penny cost basis these two formulas give you almost double what a typical multi-vitamin from other manufacturers gives you.

SuperNutrition Super Blend and Opti-Pack

Both formulas have superior levels of many of the nutrients I suggest (see below), along with generous amounts of antioxidants. There are a number of other great vitamin formulas on the market that can serve the HIV(+) person well; the Jarrow Pack and the AMNI Added Protection lll are two of the best. But no other formula gives you as much for your money as the Opti-Pack or the Super Blend; this is because my father maintains the lowest profit margin in the world. POZ magazine mentioned the Super Blend as the vitamin formula that people with HIV should take in the April, 2000 issue.

It is important to emphasize that some of the multivitamin products that are marketed to the HIV community give you relatively small doses of very important nutrients, yet cost a lot more per milligram than the Opti-Pack, the Super Blend, the Jarrow Pack, or the AMNI Added Protection lll. The Opti-Pack and the Super Blend are available in stores around the U.S. or call SuperNutrition at 1-800-262-2116 or 1-510-446-7980 for more information or to find an outlet near you.

Vitamin Safety
While spokespeople from seemingly credible public service or government organizations, including the United States Food and Drug Administration, have made erroneous statements that vitamins can be "as dangerous as drugs," research proves that this is not true. For instance, the first eight annual reports of the American Association of Poison Control Centers, which collected statistics from issues of the American Journal of Emergency Medicine, show that during the first 10-year reporting period of the 72 poison control stations in the United States there was no documentation of a death being caused by a vitamin, but there were 2,556 deaths attributed to over-the-counter medicines like aspirin, and more than 1,000,000 deaths caused by prescription drugs. Vitamins are at least thousands and maybe millions of times safer than drugs.

Nutrient Tests
For optimal effects on improving your health while reducing any potential for negative effects caused by having too much of a given nutrient, ask your doctor to test the nutrient levels in your body. These tests include tests like the FIA Vitamin Analysis Blood Test from Spectracell Labs (800-227-5227). Taking nutrient analysis tests can help you know what vitamins and minerals you need to take in higher amounts, while helping you determine what is safe for you. Even though it might seem like a good idea to take high levels of all the nutrients because they are generally very safe, you might have an unusual problem with a specific nutrient.

For instance, one HIV(+) man who has suffered from neuropathy found that his body was storing very high levels of vitamin B6. While HIV specialist Dr. Jon Kaiser details how he uses vitamin B6 supplementation to treat neuropathy in his book Healing HIV, having too much B6 can promote neuropathy. Supplementing with the nutrients that will help to correct deficiencies can decrease your chances of suffering from infections caused by a weakened immune system, but it can be important to spend the extra time to determine if there are any nutrients that you shouldn't take.

Basic Daily Vitamin and Nutrient Plan
This is a quick-look plan for a simple, effective dietary supplement program that is generally appropriate for most people who are on a budget but want to cover a very broad range of the most important nutrients. These nutrients should be taken three times per day, if possible. (All costs listed below are best prices as found in local health food stores or HIV buyer's clubs.)

Essential Nutrients
1. Complete multi-vitamin - 25 to 50 mg B-complex, including vitamin B6, with each meal. Most people report that a total of about 200 mg of B6 per day is best. I also suggest that total daily doses of folic acid should be 1000 mcg, and vitamin B12 should be 1000 mcg to reduce homocysteine for the health of the cardiovascular system.
2. Complete multi-mineral - the daily total equals 1000 mg calcium, 600 mg magnesium, 200 mcg selenium, 200 mcg chromium, 30 mg zinc, with all the other minerals.
3. Antioxidants - 1,000 to 2,000 mg of vitamin C with 400 IU of vitamin E per meal.
The Opti-Pack or the Super Blend can supply almost all of the nutrients listed above to save money. Adding extra vitamin C and E helps you arrive at these total amounts; the Opti-Pack contains 1200 mg of vitamin C and 800 IU of vitamin E, and the Super Blend contains 1500 mg of vitamin C and 800 IU of vitamin E per daily dose.

Special Supplements
1. N-acetyl cysteine - 500 mg per meal. (Cost = $7 to $8 per month.)
2. Acidophilus as a powder, as the label indicates. ($10 per month.)
3. Glutamine powder - Glutamine works best when taken in 3 to 5 divided doses per day. 12 grams per day for maintainence ($18 per month), or 36 grams per day when there is diarrhea or when losing weight or ill. (One heaping teaspoon is 4 grams. One heaping tablespoon is 12 grams.) Buy raw powder, capsules are too expensive.
4. EPA fish oil capsules - 1 to 2 capsules per meal. ($10 to $20 per month.)
5. Alpha lipoic acid - 100 mg per meal. ($12 per month.)
6. Carnitine - 200 mg per meal ($13 per month).

More Than Once A Day
Notice that this plan says "with each meal." Even if you can not be disciplined enough to take your daily nutrients three times per day, try to divide the total amount and take them twice per day. It is important to spread your nutrients out throughout the day rather than take them all at one meal because most nutrients only stay in the blood for a few hours. Taking them in divided doses helps keep blood levels relatively constant for optimal protection and immune support all day long.

Take Vitamins With Meals
Taking most nutrients after you eat some food improves absorption for two reason; first, smelling food, and chewing food stimulate the secretion of gastric juices and enzymes that improve digestion and absorption. Second, having some food mass in your gastro-intestinal system slows the movement of the nutrients down so that they do not pass through your digestive system too rapidly without being broken down.

A More Optimal Plan
You can go further with a daily nutrient program that I consider to be more optimal if your budget allows. Here are the optimal total daily doses of vitamins, minerals, and other supplements I recommend for people with HIV. The doses may be high relative to the recommendations of people who are more conservative than I, but the published medical literature shows that the doses I suggest are not generally considered to be toxic, and may be much more beneficial than lower doses for HIV(+) people. Many of these nutrients are contained in sufficient levels in the SuperNutrition Opti-Pack and the Super Blend complete daily vitamins, but for optimal health it is wise to use one of these formulas as a daily nutrient foundation and add booster levels of some of the most important nutrients, depending on what you can afford. Again, the nutrients are best taken in divided doses several times per day.

All the essential nutrients I listed above as a foundation, plus added amounts of nutrients to equal this list:
1. N-acetyl-cysteine - 500 to 1000 mg per meal
2. Alpha lipoic acid - 100 to 300 mg per meal
3. Beta carotene - 2,000 to 4,000 per meal
4. Vitamin C - 1,000 to 3,000 mg per meal
5. Vitamin E - 200 to 400 IU per meal
6. Selenium - 100 to 200 mcg per meal
7. Omega-3 fatty acids - 2 to 3 capsules per meal
8. Coenzyme Q-10 - 30 to 100 mg per meal
9. Carnitine or acetyl-L-carnitine - 500 to 1000 mg per meal. Acetyl-L-carnitine appears to have superior absorption, but it is more expensive. (Note: For some people high doses of carnitine promote diarrhea.)
10. Glutamine - Glutamine works best to stop diarrhea when taken in 3 to 5 divided doses per day. 12 grams per day for maintainence, or 36 grams per day when there is diarrhea or when losing weight or ill. (1 heaping teaspoon is 4 grams. 1 heaping tablespoon is 12 grams.) Buy raw powder, capsules are too expensive.
11. EPA fish oil capsules - 2 to 3 per meal
12. Acidophilus - as a powder or capsules, as the label indicates.
13. DHEA - dosing should be calculated by working with your doctor and having blood or saliva tests. Read about DHEA's importance to the immune system and HIV wellness in the section on DHEA in Dr. Jon Kaiser's book Healing HIV. Also read the article called DHEA and HIV Illness by Dr. Judith Rabkin that was published in The AIDS Reader 7(1):28-36, 1997.

Many HIV(+) people also include prescription vitamin B12 injections in their supplement regimens because of the potential for low absorption of B12 in the gut. This is usually done as a 1,000 mcg injection one or even up to seven time per week for those who are having serious health challenges. Some people who are very healthy only administer it once per month because the body stores vitamin B12, so more frequent dosings may not be necessary. However, administration several times per month provides good insurance for most HIV(+) people, and optimal cellular B12 has been shown to be associated with improved survival in HIV,⁹ not to mention the potential B12 has to reduce dementia and neuropathy.^10-12 Ask your doctor about prescription injectable vitamin B12.

For comprehensive information about how each of the nutrients affects your metabolism, including recommendations by Dr. Lark Lands, visit the "HIV Treatment Info Pages" at the DAAIR web site. See also the "Managing Side Effects/Nutritional Therapies" information on the HBC web site.

I'd like to give credit to Joan Priestley, MD; the core of the Optimal Supplement Plan mimics the recommendations for nutrients for HIV that she created several years ago based on her experiences with her several hundred healthy patients. Dr. Priestley was one of the pioneers of nutritional medicine for HIV.

References:
1. Baum, M, et al. Inadequate dietary intake and altered nutrition status in early HIV-1 infection. Nutrition (1994) 10(1):16-20. 54. Baum, MK, et al. Micronutrients and HIV-1 disease progression. AIDS (1995) 9(9):1051-1056.
2. Baum, MK, et al. Micronutrients and HIV-1 disease progression. AIDS (1995) 9(9):1051-1056.
3. Bogden, JD, et al. Daily micronutrient supplements enhance delayed-hypersensitivity skin test responses in older people. Am J Clin Nutr (1994) 60(3):437-447.
4. Chandra, RK, et al. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet (1992) 340 (8828):1124-1127.
5. Abrams, B, et al. A prospective study of dietary intake and AIDS in HIV-positive homosexual men. J AIDS (1993) 6:949-958.
6. Allard, AIDS (1998) 12:1653 - 1659.Effects of vitamin E and C supplementation on oxidative stress and viral load in HIV-infected subjects. Author Allard JP; Aghdassi E; Chau J; Tam C; Kovacs CM; Salit IE; Walmsley SL Address Department of Medicine, University of Toronto, Ontario, Canada. Source AIDS, 12(13):1653-9 1998 Sep 10
7. Devaraj S, et al. Dose-response comparison of RRR-alpha-tocopherol and all-racemic alpha-tocopherol on LDL oxidation. Arterioscler Thromb Vasc Biol, 17(10):2273-2279 1997 Oct.
8. Fuller CJ, et al. Effects of increasing doses of alpha-tocopherol in providing protection of low-density lipoprotein from oxidation. Am J Cardiol, 81(2):231-233 1998 Jan 15.
9. Tang, AM, et al. Low serum vitamin B-12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1) disease progression. J Nutr, 127(2):345-351 1997.
10. Herzlich BC, et al., Reversal of apparent AIDS dementia complex following treatment with vitamin B12. J Intern Med, 233(6):495-497. 1993 Jun.
11. Tan SV, et al., Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS. J Neurol Neurosurg Psychiatry, 65(1):23-8 1998 Jul.
12. Gilmer WS. Neurologic problems of the lower extremity associated with HIV and AIDS. Clin Podiatr Med Surg, 15(2):281-303 1998 Apr.
13. Kanter AS, Spencer DC, Steinberg MH, et al. Supplemental vitamin B and progression to AIDS and death in black South African patients infected with HIV. Journal of Acquired Immunodeficiency Syndromes 1999;21:252-257.

Disclaimer: This article is provided for educational purposes only, and is in no way a substitute for the advice of a qualified medical doctor or a recommendation to do other than your doctor determines is best for you. You should present this information to your doctor for their analysis because appropriate medical therapy should be tailored by a knowledgeable doctor for the individual as no two individuals are alike. I do not recommend self-medicating with any pharmaceutical drug or compound as you should consult with a qualified medical doctor who can determine your individual situation. If you use the information I present without the approval of your doctor, you do so strictly at your own risk and no responsibility is implied or intended on my part.