Im concerned and confused about supplements.

In <Healing HIV>, Dr. Jon Kaisers nutritional supplement recommendations include a high-potency multiple vitamin/mineral; 2000 mg vitamin C; 400 iu vitamin E; 100 mg vitamin B6, 30 mg Coenzyme Q-10, 500 mg NAC; and Acidophilus all to be taken 2 times a day with breakfast and dinner.

In <Nutrition and HIV>, Dr. Mary Romeyns recipe for a safe, supportive nutritional regimen specifies a twice-a-day dosing of a multivitamin without extra iron, a B stress complex, 250 mg Magnesium, and 50 mcg Selemium; and once-a-day dosing of a trace element supplement, 3000 mg vitamin C, 1200 units vitamin E, 15 mg beta-carotene.

In <Built to Survive>, Michael Mooney and Nelson Vergels daily supplementation plan calls for a complete multivitamin with 50 mg of the B complex; a complete multimineral containing 1000 mg Calcium, 600 mg Magnesium, 200 mcg Selenium, 200 mcg Chromium, and 30 mg Zinc in three divided doses; 2000 mg vitamin C and 400 iu vitamin E; 500 mg NAC; Acidophilus; 1 tsp to 1 tbsp Glutamine; 2 EPA fish oil capsules; and 100 mg Alpha Lipoic Acid all to be taken 3 times a day with each meal. Thats a lot of supplements!

In your book, <A Clinicians Guide to Nutrition in HIV and AIDS>, you mention a few studies yielding mixed results and state, Although these studies do not provide clear evidence of supplementation of nutrients, they open the question for further exploration. You also state, Whether exogenous sources of antioxidants and their precursors have the ability to enhance the endogenous supply remains to be elucidated. Your position seems to be in dramatic contrast to other nutrition experts who recommend extensive nutrition supplementation. However, none of the authors I cited are registered dietitians. Im concerned because you mentioned a study (Tang et al) in which greater intakes of certain nutrients delayed progression to a diagnosis of AIDS, but the highest intakes of vitamin A and zinc may be related somehow to a more rapid progression to an AIDS-defining complication. Would you say these nutritional experts are really not so expert and may be offering detrimental advice? Who should I listen to?

Welcome to the club! Everyone is pretty confused about supplements. One reason why there are not sweeping recommendations in the "Clinician's Guide" is that there is very little to support them at this time. We are all making what we hope is an educated guess about what might work and what might not do harm. Most of the information that is used to support general recommendations comes from other disease states and theory about the function of nutrients in the generally healthy person. Unfortunately, we do not know what will match the circumstances we see in HIV disease. We assume that a chronic inflammatory disease, such as HIV or inflammatory bowel disease or others, means that a person will use up more nutrients. However, we have little to go on to determine what levels of supplemented nutrients can be toxic, less well tolerated than in a healthy population, and cause harm. When we know that a medication's toxicity is blunted by supplementation, we research supplementation and recommend it. What happens with an individual is much less straightforward.

General recommendations can be extremely frustrating when they are not geared to work for the individual. Even epidemiologic evidence, such as you have mentioned in Alice Tang's study, simply opens the door for a question, but certainly does not provide the answer. In HIV disease we don't generally wait for extremely definitive evidence before trying something if it looks like there might be some benefit and it is less likely that will be harm. But those recommendations need to be tailored to you, personally. For instance, which medications are you taking? What other issues do you have, such as high blood fats, insulin resistance or diabetes, liver or kidney compromise, active opportunistic infection or cancer, high viral load? And many more questions. The recommendations should be tailored to your circumstances. Then they need to be monitored by more than your report of "feeling better." You can feel great while bad things are happening inside. There is a general "upper limit" recommendation based on reports of toxicity. For the most part, we respect that level and try to stay below it. Another important thing to remember is that when you "load" on one thing, you will affect others.

So, going with what we know means making a leap of faith about what is appropriate to recommend in general or in individuals at this point. My recommendation is to have a good and cooperative contact with your dietitian or other nutrition advisor. Making the decision is ultimately your responsibility and it is a tough one when the people who issue general recommendations don't know you and would still be making a guess based on their own experiences in taking those leaps of faith.

As you can guess, if you are feeling confused then it is likely that you are thinking! I don't mean to sound so down on the topic, but most of us are confused for good reason. We don't have clear information on which to base decisions that can affect the life and well being of others.