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Chester Myers' Nutrition Series Information relating to HIV & Nutrition: HIV & Nutrients revisited The information in these pages is about some of the health problems that are caused by deficiencies of some of the micronutrients. Many of the symptoms of HIV are the same as these from nutritional deficiencies - make sure you are not deficient in these nutrients. Good nutrition is extremely important if you are HIV+. The information here deals only with certain aspects of good nutrition. NOTE: References for this document are included in References for HIV & Nutrition, part of this series INFORMation relating to HIV & Nutrition, or in a database owned by the author. HIV infection is often characterized by deficiencies of vitamins and minerals. The following page gives some symptoms that arise with nutrient deficiencies. Most information here is from "Advanced Nutrition and Human Metabolism", by S. M. Hunt, J. L. Groff (West Publishing Co., 1990). Some other references are Carmel (1988), Harriman et al (1989) and Reynolds (1976). Symptoms commonly found with HIV disease are in boldface. Also provided are statements regarding supplementation from some of the experts in the area. HIV disease is characterized by nutritional deficiencies as very early symptoms. Since 1993 we have had reports that significant slowing of disease progression is associated with vitamin/mineral supplementation. Furthermore, these same studies indicate that food alone is not enough, and is not associated with slowing of disease progression. There are many complexities regarding nutrition. For example, if you are HIV+ you may be taking high levels of vitamin C, even to 10 grams per day or more. Moreover, zinc is one of the minerals now known to be likely deficient; therefore zinc supplementation up to about 75 mg/day, has been recommended. Both high levels of vitamin C and zinc supplementation can cause decreases in your copper levels. So you see, extra copper would also be important. The absorption of zinc and copper into your body varies greatly; this is regulated partly by a protein called metallothionein. One third of this important protein is made from the amino acid cysteine. Since cysteine is low with HIV, metallothionein will also be low; therefore regulation of your zinc/copper absorption is impaired {see another in this series, called "HIV and Cysteine" to learn some more things about your diet and supplements that can help}. Nutrition and dietary supplementation can be quite different, for HIV-infected people, from those who do not have HIV. The other articles in this series INFORMation relating to HIV & Nutrition are intended to help you be more informed in making decisions about how you look after yourself. Articles by Lark Lands, Ph.D. are an excellent place to start learning about how much of each supplement you should take. In Toronto, you can obtain copies of her articles either at the ACT Resource Centre, or at the Community AIDS Treatment Information Exchange (CATIE). Nutrient & Some Possible Deficiency Symptoms Biotin - anorexia, nausea, dry scaly dermatitis Chromium - glucose intolerance, abnormal lipid metabolism, neuropathy, encephalopathy Cobalt - glossitis, anaemia Copper - neutropenia, leukopenia, failure of erythropoiesis, (high serum cholesterol if caused by high zinc intake), immune suppression Folic acid - megaloblastic anemia, diarrhoea, fatigue, confusion, forgetfulness, depression, dementia, apathy, insomnia, irritability, immune suppression Iodine - increase in blood lipids, thyroid enlargement Iron - decreased hematocrit, anaemia, immune suppression Magnesium - muscle weakness, muscle cramps, constipation, oxidative stress, immune suppression, growth retardation Manganese - impaired central nervous system, defects in lipid and carbohydrate metabolism, immune suppression Nickel - anaemia Pantothenate - epigastric distress, anorexia, numbness/tingling in hands/feet Potassium - weight loss, growth retardation Selenium - cardiac myopathy, pancreas degeneration, red blood cell fragility, oxidative stress, immune suppression Vitamin B1 - mental confusion, weakness, anorexia Vitamin B2 - edema of pharyngeal and oral mucous membranes Vitamin B3 - diarrhoea, mental confusion, glossitis Vitamin B6 - dermatitis, glossitis, immune suppression Vitamin B12 - megaloblastic anaemia, peripheral nerve degeneration, mental dysfunction, anorexia, glossitis, elevated mean corpuscular volume (MCV), neutropenia, low folate utilization, skin sensitivity, immune suppression Vitamin C - appetite loss, fatigue, bleeding gums, capillary rupture, immune suppression Vitamin E - neuropathy, myopathy, oxidative stress, immune suppression Vitamin K - defective blood clotting Zinc - immune suppression, oxidative stress, poor growth, poor wound healing, anorexia, abnormal taste and smell, anaemia, skin inflammation, low plasma zinc levels Re: use of a multivitamin in HIV/AIDS "Multivitamin supplements ... may be helpful" for "debilitated ARC or AIDS patients who suffer from malabsorption" (Dwyer et al, 1988, Tufts University) "Supplementation of vitamins and trace minerals in amounts one or two times the RDA may offset possible deficits..." (RJ Raiten, Life Sciences Research Office of the Federation of American Societies for Experimental Biology, 1990) "vitamin E supplementation should always be done in the presence of an adequate Se [selenium] level. .. an adequate level of Se is indispensable for potentiating vitamin E" (Tengerdy, 1990, Colorado State University). "supplements of vitamins and minerals, especially vitamins A (as ß-carotene), E, C, riboflavin, B6, and B12, and the minerals zinc and selenium, should be part of any oral regimen" (Gorbach et al, 1993, Tufts University) "..daily use of a multivitamin supplement was associated with a 40% reduction in the risk of a low CD4 T-lymphocyte count ...those whose supplement consumption was within the highest tertile of intake were about half as likely to develop AIDS compared to those in the middle or lowest tertiles". .. "intake of vitamin E and iron from supplements alone was also significantly associated with a reduced risk of AIDS". ... there was "no statistically significant association between AIDS and intake from food alone of micronutrients or the macronutrients fat and protein" (Abrams et al, 1993, University of California, Berkeley) "the highest levels of intake (from food and supplements) of vitamins C and B1 and niacin were associated with a significantly decreased progression rate to AIDS", and "the progression rate to AIDS was also decreased in subjects in the highest quartile of intake for vitamins B1, B2, B6, and C" (Tang et al, 1993, Johns Hopkins University) "the apparent protective effects observed from the B-group vitamins were primarily due to the intake of vitamins from supplements rather than food" ...."quartiles of food intake showed no association with survival" (Tang/Graham, 1995, Johns Hopkins University) "we have recommended multivitamin supplementation for all HIV-infected patients" (Coodley et al, 1993, 1994, 1996, Oregon Health Sciences University). "we agree that a single multivitamin a day may not be sufficient.." (Coodley et al, 1994) "across the spectrum of this disease many patients have micronutrient deficiencies but it was also shown that enhanced supplementation of these micronutrients was associated with longevity", (P Cimoch, 1994, Center for Special Immunology, California) "because of the urgency", and based on "preliminary data from an ongoing nutrition supplementation trial" we recommend "6-10 times the RDA for zinc, more than 25 times the RDA for vitamin B12, 6-10 times the RDA for vitamin A, 2-5 tiems the RDA for vitamin E, and more than 10 times the RDA for vitamin B6..".(MK Baum et al, 1992, 1994, 1995, University of Miami School of Medicine) "subjects in the highest [quarter] of serum vitamin E levels had a 33% decrease in risk of progression to AIDS compared to those in the lower three [quarters]" (Tang et al, 1996, Johns Hopkins University). Re: use of N-acetyl cysteine (NAC) in HIV/AIDS "Oral N-acetylcysteine transiently increases the concentrations of cysteine and glutathione in mononuclear cells of patients with HIV infection. A sustained increase in intracellular cysteine may be necessary to normalize intracellular glutathione. This may be accomplished by repeat administration of [NAC]" (de Quay et al, 1992, University of Bern, Switzerland) - 30 mg NAC/kg body weight, results monitored 2-4 hrs later "The apparent 'over-protection' of patients' [peripheral blood lymphocytes] by NAC treatment could be reason enough to apply early therapy with this molecule." (René et al, 1992, Institut Pasteur, France & Stanford University, USA) - study with HIV+ patients, using "600 to 1200 mg of NAC per day" "Preliminary findings indicate that in patients who self-administer the GSH prodrug N-acetylcysteine (NAC), GSH levels can be restored to normal." (Staal et al, 1992, Stanford University) ".. we have proposed already in 1988 to consider N-acetyl-cysteine (NAC) or other cysteine derivatives such as thiazolidine compounds for the treatment of [HIV-infected persons].." (Droge et al, 1993, German Cancer Research Centre) "Many reports [1988 onwards] indicate that HIV infected individuals including asymptomatic patients, were found to express decreased plasma cysteine and intracellular [glutathione] levels. .. N-acetyl-Cysteine administration to HIV seropositive patients seems to prevent early cell death and to induce an 'overprotection' status in patients' PBLs" (Olivier et al, 1993, France) - 600-1800 mg/day used in combination with AZT & ddC in a 1 yr study, higher CD4+ counts and fewer AIDS events with AZT+ddC+NAC, than with either AZT or AZT+ddC (Feregrino-Goyos et al, 1994, General Hospital of Mexico) - 1500 mg NAC/day "After the onset of the NAC treatment this expected decline [of CD4 cells] was inhibited while it continued in the placebo group." (Jarstrand et al, 1994, Huddinge University Hospital, Sweden) - "They were given 800 mg of NAC/day .." "When we treat patients for less than six months with NAC, we don't see much change. However, when the NAC treatment is longer than six months, NAC will restore apoptosis back to normal levels. This is a preliminary result ... I am convinced that oxidative stress is indeed involved in the progression from HIV infection to the AIDS stage." (Montagnier, 1995, Pasteur Institute, France) "The decrease in mean [body cell mass]/body fat ratios was prevented by N-acetyl-cysteine, .." (Kinscherf et al, 1996, University of Heidelberg and the German Cancer Research Centre) - non-HIV study with 400 mg NAC per day To get started with supplementation, a good multivitamin containing minerals could be considered. A minimum of 25 mg of vitamin B6, 50 mcg each of selenium and chromium, and no more than 10,000 i.u. of vitamin A could be a rule of thumb in choosing this multivitamin with minerals. In addition, another 50-75 mg of zinc, 400-800 i.u. of vitamin E from a natural source, vitamin B12 by a non-stomach route, and 800-1500 mg of N-acetyl cysteine (NAC) may be useful. In this series:
The material in this publication is for information purposes only. It does not endorse any particular treatment program nor strategy; neither is it intended as medical advice nor as a replacement for medical advice. ©This document is copyrighted by Chester Myers. All materials may be reprinted and/or distributed without prior permission. However, reprints may not be edited. |
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February 1997 | |
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Decisions about particular medical treatments should always be made in consultation with a qualified medical practitioner who is knowledgeable about HIV-related illness and the treatments in question. MORE | |