Re: NATAP: Vitamins May Have Down Side for HIV Patients

[Guest guest]

This study is interesting to me since I take SuperNutrition Super Blend vitamins, which are excellent, along with an extensive list of other antioxidants, additional individual vitamins, and supplements. I have taken these for years. During this time, I have seen my t cells increase, my viral load go to undetectable, my liver and kidney function normalize, my cholesterol and triglycerides are normal, and the rest of my lab work is within the normal range. I admit the drug combination I am on has something to do with this, but its the vitamins and supplements that have kept me alive in the past when my drugs werent working, and during this time, I should have had major complications, which I did not. Contrary to this study, my blood sugar levels have also been normal. This leads me to believe, in my opinion, the guys that do these studies are not always trying to see if vitamins are beneficial, rather, they are trying to find the negative to scare people away from them. It would be interesting to know who actually provided the funding to do this study, it wouldn't surprise me if it was one of the pharmaceutical companies. Glenn

[Guest guest]

Or perhaps you are trying to credit vitamins for your own body

efforts in fighting HIV, in my experience vitamins do help to a degree, but they

do have

side effects and Truth to be told vitamins and supplements are only help full

when our

body has a specific deficiency.

And that is the problem, it is impossible to monitor our blood for everything,

and so we take supplements without really knowing if they are needed or if they

can even

be counter indicated based on our current physical condition or medications.

Quick examples:

L-arginine can stimulate herpes in HIV infected individuals

Garlic supplements irritate hemorrhoids

Vitamin C and Garlic can painfully irritate the prostate in individuals with a

chronically

prostatitus

Vitamin B can increase acne and according to some increases hair loss

DHEA increase estrogen levels and is not indicated in people suffering from

Gynecomastia

Vanadyl sulfate and other sulfa base supplements causes allergic reaction in

people

allergic to sulfates.

How many more counter indications and side effects are we not aware of?

In my experience the best way to acquire vitamins is from a good diet with

plenty of fruits

and vegetables, and to limit supplement to a multivitamins or specific such as

niacin or

carnitine when recommended by a doctor.

> This study is interesting to me since I take SuperNutrition Super Blend

> vitamins, which are excellent, along with an extensive list of other

> antioxidants, additional individual vitamins, and supplements. I have taken

these for

> years. During this time, I have seen my t cells increase, my viral load go

to

> undetectable, my liver and kidney function normalize, my cholesterol and

> triglycerides are normal, and the rest of my lab work is within the normal

> range. I admit the drug combination I am on has something to do with this,

but

> its the vitamins and supplements that have kept me alive in the past when my

> drugs werent working, and during this time, I should have had major

> complications, which I did not. Contrary to this study, my blood sugar

levels have

> also been normal. This leads me to believe, in my opinion, the guys that do

> these studies are not always trying to see if vitamins are beneficial,

rather,

> they are trying to find the negative to scare people away from them. It

> would be interesting to know who actually provided the funding to do this

study,

> it wouldn't surprise me if it was one of the pharmaceutical companies.

> Glenn

[Guest guest]

Or perhaps you are trying to credit vitamins for your own body

efforts in fighting HIV, in my experience vitamins do help to a degree, but they

do have

side effects and Truth to be told vitamins and supplements are only help full

when our

body has a specific deficiency.

And that is the problem, it is impossible to monitor our blood for everything,

and so we take supplements without really knowing if they are needed or if they

can even

be counter indicated based on our current physical condition or medications.

Quick examples:

L-arginine can stimulate herpes in HIV infected individuals

Garlic supplements irritate hemorrhoids

Vitamin C and Garlic can painfully irritate the prostate in individuals with a

chronically

prostatitus

Vitamin B can increase acne and according to some increases hair loss

DHEA increase estrogen levels and is not indicated in people suffering from

Gynecomastia

Vanadyl sulfate and other sulfa base supplements causes allergic reaction in

people

allergic to sulfates.

How many more counter indications and side effects are we not aware of?

In my experience the best way to acquire vitamins is from a good diet with

plenty of fruits

and vegetables, and to limit supplement to a multivitamins or specific such as

niacin or

carnitine when recommended by a doctor.

> This study is interesting to me since I take SuperNutrition Super Blend

> vitamins, which are excellent, along with an extensive list of other

> antioxidants, additional individual vitamins, and supplements. I have taken

these for

> years. During this time, I have seen my t cells increase, my viral load go

to

> undetectable, my liver and kidney function normalize, my cholesterol and

> triglycerides are normal, and the rest of my lab work is within the normal

> range. I admit the drug combination I am on has something to do with this,

but

> its the vitamins and supplements that have kept me alive in the past when my

> drugs werent working, and during this time, I should have had major

> complications, which I did not. Contrary to this study, my blood sugar

levels have

> also been normal. This leads me to believe, in my opinion, the guys that do

> these studies are not always trying to see if vitamins are beneficial,

rather,

> they are trying to find the negative to scare people away from them. It

> would be interesting to know who actually provided the funding to do this

study,

> it wouldn't surprise me if it was one of the pharmaceutical companies.

> Glenn

[Guest guest]

Or perhaps you are trying to credit vitamins for your own body

efforts in fighting HIV, in my experience vitamins do help to a degree, but they

do have

side effects and Truth to be told vitamins and supplements are only help full

when our

body has a specific deficiency.

And that is the problem, it is impossible to monitor our blood for everything,

and so we take supplements without really knowing if they are needed or if they

can even

be counter indicated based on our current physical condition or medications.

Quick examples:

L-arginine can stimulate herpes in HIV infected individuals

Garlic supplements irritate hemorrhoids

Vitamin C and Garlic can painfully irritate the prostate in individuals with a

chronically

prostatitus

Vitamin B can increase acne and according to some increases hair loss

DHEA increase estrogen levels and is not indicated in people suffering from

Gynecomastia

Vanadyl sulfate and other sulfa base supplements causes allergic reaction in

people

allergic to sulfates.

How many more counter indications and side effects are we not aware of?

In my experience the best way to acquire vitamins is from a good diet with

plenty of fruits

and vegetables, and to limit supplement to a multivitamins or specific such as

niacin or

carnitine when recommended by a doctor.

> This study is interesting to me since I take SuperNutrition Super Blend

> vitamins, which are excellent, along with an extensive list of other

> antioxidants, additional individual vitamins, and supplements. I have taken

these for

> years. During this time, I have seen my t cells increase, my viral load go

to

> undetectable, my liver and kidney function normalize, my cholesterol and

> triglycerides are normal, and the rest of my lab work is within the normal

> range. I admit the drug combination I am on has something to do with this,

but

> its the vitamins and supplements that have kept me alive in the past when my

> drugs werent working, and during this time, I should have had major

> complications, which I did not. Contrary to this study, my blood sugar

levels have

> also been normal. This leads me to believe, in my opinion, the guys that do

> these studies are not always trying to see if vitamins are beneficial,

rather,

> they are trying to find the negative to scare people away from them. It

> would be interesting to know who actually provided the funding to do this

study,

> it wouldn't surprise me if it was one of the pharmaceutical companies.

> Glenn

[Guest guest]

Hmmm? Why should researchers be trying to find benefit

for vitamins? Or anything else for that matter? Just

because some research contradicts your experience or

beliefs doesn't mean it is faulty research. paul

--- gea121@... wrote:

> This study is interesting to me since I take

> SuperNutrition Super Blend

> vitamins, which are excellent, along with an

> extensive list of other

> antioxidants, additional individual vitamins, and

> supplements. I have taken these for

> years. During this time, I have seen my t cells

> increase, my viral load go to

> undetectable, my liver and kidney function

> normalize, my cholesterol and

> triglycerides are normal, and the rest of my lab

> work is within the normal

> range. I admit the drug combination I am on has

> something to do with this, but

> its the vitamins and supplements that have kept me

> alive in the past when my

> drugs werent working, and during this time, I

> should have had major

> complications, which I did not. Contrary to this

> study, my blood sugar levels have

> also been normal. This leads me to believe, in my

> opinion, the guys that do

> these studies are not always trying to see if

> vitamins are beneficial, rather,

> they are trying to find the negative to scare

> people away from them. It

> would be interesting to know who actually provided

> the funding to do this study,

> it wouldn't surprise me if it was one of the

> pharmaceutical companies.

> Glenn

>

__________________________________________________

[Guest guest]

Hmmm? Why should researchers be trying to find benefit

for vitamins? Or anything else for that matter? Just

because some research contradicts your experience or

beliefs doesn't mean it is faulty research. paul

--- gea121@... wrote:

> This study is interesting to me since I take

> SuperNutrition Super Blend

> vitamins, which are excellent, along with an

> extensive list of other

> antioxidants, additional individual vitamins, and

> supplements. I have taken these for

> years. During this time, I have seen my t cells

> increase, my viral load go to

> undetectable, my liver and kidney function

> normalize, my cholesterol and

> triglycerides are normal, and the rest of my lab

> work is within the normal

> range. I admit the drug combination I am on has

> something to do with this, but

> its the vitamins and supplements that have kept me

> alive in the past when my

> drugs werent working, and during this time, I

> should have had major

> complications, which I did not. Contrary to this

> study, my blood sugar levels have

> also been normal. This leads me to believe, in my

> opinion, the guys that do

> these studies are not always trying to see if

> vitamins are beneficial, rather,

> they are trying to find the negative to scare

> people away from them. It

> would be interesting to know who actually provided

> the funding to do this study,

> it wouldn't surprise me if it was one of the

> pharmaceutical companies.

> Glenn

>

__________________________________________________

[Guest guest]

Hmmm? Why should researchers be trying to find benefit

for vitamins? Or anything else for that matter? Just

because some research contradicts your experience or

beliefs doesn't mean it is faulty research. paul

--- gea121@... wrote:

> This study is interesting to me since I take

> SuperNutrition Super Blend

> vitamins, which are excellent, along with an

> extensive list of other

> antioxidants, additional individual vitamins, and

> supplements. I have taken these for

> years. During this time, I have seen my t cells

> increase, my viral load go to

> undetectable, my liver and kidney function

> normalize, my cholesterol and

> triglycerides are normal, and the rest of my lab

> work is within the normal

> range. I admit the drug combination I am on has

> something to do with this, but

> its the vitamins and supplements that have kept me

> alive in the past when my

> drugs werent working, and during this time, I

> should have had major

> complications, which I did not. Contrary to this

> study, my blood sugar levels have

> also been normal. This leads me to believe, in my

> opinion, the guys that do

> these studies are not always trying to see if

> vitamins are beneficial, rather,

> they are trying to find the negative to scare

> people away from them. It

> would be interesting to know who actually provided

> the funding to do this study,

> it wouldn't surprise me if it was one of the

> pharmaceutical companies.

> Glenn

>

__________________________________________________

[Guest guest]

Like many, I have normalized my lipids, triglycerides, glucose, and blood

pressure without the use of pharmaceuticals using vitamins, antioxidants,

minerals, herbs, excercise, and other " nutriceuticals " . It costs a lot of money

as these products are not covered by insurance and it didn't happen overnight

and I continually research and refine my supplement protocol, but it can be

done.

Everyone is an individual so results with supplements will probably vary from

one person to the next, but for anyone to categorically say that supplements

do not benefit individuals living with HIV is ignorant, at best.

Mike in Los Angeles

[Guest guest]

Leave it to JAIDS to publish an article with a suspicious title, given its content. I really do wonder about the peer reviewers on this article.

There are many pieces of this paper to critique.

There is no control group which would give information on what the natural progression of these subjects would be if given no treatment.

People here were on HAART for 76 (plus or minus 34 weeks), essentially a 1-2 year span of therapy, about the time that mitochondrial toxicity would usually start to evidence itself.

Note that 6 of 10 subjects are on a “D†drug regimen, the meds most associated with lipodystrophy or lipoatrophy. One person is on the very intense combo of D4T/DDi, not used now.

There are two mechanisms to mitochondrial toxicity, the first disturbance is slowing of ATP production, due to cytochrome disturbance in the inner-membrane of the mitochondria. A slower but equally important mechanism is the inhibition of mDNA in the outter membrane, which retards fatty acid transport across the membrane wall. Free fatty acids accumulate in the cell space. ( et al. Nature Medicine, 1995 1(5):417.

Free fatty acids directly provoke insulin resistance. The Roden paper on this topic (J Clin Invest 1996 97:2859) is seminal reading for anyone wanting to understand lipodystrophy and insulin resistance in HAART. Steve Grinspoon always used to mention it in his early lectures on lipodystrophy, and wrote about it in Meinenger et al. Elevated concentrations of free fatty acids and Insulin .... Metabolism 2002 51(2):260.

Free fatty acids in the cell space also trigger more TNFa production. TNFa inhibits insulin activation, but for a good reason. It is an acute phase responder. A body does not want to be clearing glucose under certain stressful conditions, sugar is supposed to remain in circulation, e.g. to perhaps feed an immune cell response.

Note, you see TNFa levels drop in people with high triglycerides who go on L-carnitine treatment. (De Simone et al. High dose L-carnitine improves immunologic and metabolic parameters in AIDS patients. Immunopharmacol Immunotoxicol. 1993 Jan;15(1):1-12).

A seldom appreciated event in “D†drug therapy is that these agents, more than AZT, affect sympathetic nervous system signals. (Fliers E et al. HIV-associated adipose redistribution syndrome as a selective autonomic neuropathy. The Lancet 362: 1758 – 1760, 2003). More noradrenaline activity has it’s own effect on increasing insulin resistance. (Landsberg Ann N Y Acad Sci 1999 892:84.)

To think that vit C, vit E or N-acetylcysteine (NAC) would cause insulin resistance would not make sense in the biochemical literature.

In general, decades of bench science investigations of NAC and glucose metabolism and insulin-resistance report that NAC improves glucose tolerance and sugar clearance.

An example pertinent to this discussion: is this paper. See the title: Haber CA, Lam TK et al. N-acetylcysteine and taurine prevent hyperglycemia-induced insulin resistance in vivo: possible role of oxidative stress. Am J Physiol Endocrinol Metab. 2003;285(4):E744-53. Another paper: out of Albert Einstein describes how antioxidants, including NAC, reverse insulin problems in irritated mitochondria. (Lin, Berg, et al. The hyperglycemia-induced inflammatory response in adipocytes: the role of reactive oxygen species. J Biol Chem. 2005 Feb 11;280(6):4617-26.)

The Droge group in Heidelberg, who have a number of HIV-related metabolism papers to their credit, do report how NAC does raise HOMA-R in some types of (HIV-neg) subjects, and lower it in others, but at the same time NAC promotes body fat loss (something seen in this paper: a tiny drop in waist-hip ratio).

The simple rationale: both vit C and E are glutathione-sparing, and NAC is GSH-boosting. As glutathione improves insulin binding to cells, as part of glucose tolerance factor, we could expect that these substances would help the situation.

The “rationale†the authors report, is that oxidative stress is some mechanism of lipoatrophy, and treating it with antioxidants could be useful. There is a modest case for this in the literature, so the trial has merit. The de la Asuncion paper in the authors references do mention vit C and vit E as protective of mitochondria, and they use the doses applied in that paper. An important difference here though, is that the Spanish subjects were on AZT mono-therpay, not HAART.

It seems that the operative mechanism in lipoatrophy is excessive TNFa expression: (Mynarcik DC, et al. Association of severe insulin resistance with both loss of limb fat and elevated serum tumor necrosis factor receptor levels in HIV lipodystrophy. J Acquir Immune Defic Syndr. 2000;25(4):312-21).

While TNFa can come from excess production of ROS (random oxygen species), the more likely culprit here for the Cleveland subjects is the free fatty acid accumulation in the cell space caused by mitochondrial toxicity of nucleosides.

A modest proof of this concept comes in a disgustingly titled article, also in JAIDS, lead author Gelato: Improved insulin sensitivity and body fat distribution in HIV-infected patients treated with rosiglitazone: a pilot study. J Acquir Immune Defic Syndr. 2002; 31:163-70.

In this disguised infomercial for Glaxo, there is a miniscule improvement in insulin-sensitivity as assessed by HOMA-R, but triglycerides doubled in many of the treated patients, including a jump from 600 to 1200 in one!. This data suggest that insulin resistance is a useful state in a distressed cell, and that messing with it is not healthy. (PS, A better title for this Gelato paper might have been “Glitazone induces profound dyslipidemia in HIV patients on HAART. Perhaps this side of the Merk Vioxx trial, side effects will be more honestly reported.)

In the Cleveland paper at hand, lactate levels did not rise, an event I think which the antioxidant vitamin supplements can be credited with, via their role on keeping TNFa levels lower than they might have climbed. Higher lactate levels generate insulin resistance, as a cell tries to limit sugar metabolism. If insulin pushes more sugar into glycolysis, but there is less Krebs cycle activity to follow it with (due to mitochondrial toxicity) too much lactate would be generated and the cell (and person) would die. A rise in insulin-resistance in the setting of this paper, (people on D drugs) is a smart move by the body. It would have been great to have a control group to show that the same HOMA-R scores were happening, or worse! in a parallel group, receiving no supplements.

If McComsey et al. had added high dose B-complex 25 vitamins, with 1 gram of L-carnitine, to their intervention I suspect you would have seen a far different outcome. Glucose tolerance would have improved, and the LDL-C lowered even more. The idea is that another source of the insulin-resistance would have been treated: mitochondrial distress.

Most people in this study were on PI’s, which slow GLUT-4 activity by approx. 23%, thus contributing to hyperinsulinemia and transient hyperglycemia. Elevated sugar levels also can provoke TNFa expression.

All in all, N=10 or N=8 is not a strong case for anything. That it got published as open-label “proof of concept†seems tough since some key metabolic data, like cytokine levels or mDNA.

I could suggest a better title: Antioxidant support fails to counteract hypertiglyceridemia and lipoatrophy of HAART. To mention insulin resistance data and link it to the intervention is stretching the concept of causality, without a placebo arm.

Charlie Smigelski RD

Fenway Community Health, Boston

www.eatupbooks.com