March 16, 2012
As a confirmed supplement taker, it struck me some time ago that I should really make more effort to understand what I'm taking and why and whether I'm doing it in such a way that my body gains maximum benefit. I always suspected that swallowing a handful of vitamins and minerals with the orange juice every morning was possibly swallowing a whole lot of advertising propaganda at the same time. Yet still I did it (and forgot the orange juice too) because as someone with both HIV and neuropathy, I felt that my immune system was continually under attack and therefore needed boosting with supplements to enable it to fight off the unknown and unexpected.
I suspect most people supplement their vitamins because they feel they should and not because of specific medical advice. Furthermore, when you read an article about the latest supplement claiming to help your particular problem, you're tempted to add it to your list. It was almost a cliché in the early eighties that desperate people trying to survive with HIV were taking twenty to thirty supplements a day and that seemed shocking then. However, that feeling that you're somehow letting your system down unless you use supplements, hasn't gone away and is actively fed by the supplement industry, the media and by the internet. Perhaps more worryingly, it is stronger than the underlying and unsettling feeling that you may actually be overdoing it! Hmm! Hints of addictive behaviour maybe! In my case I've just always felt that I needed someone to tell me how to supplement sensibly instead of leaving me to my own devices. Am I the only one? I somehow don't think so.
The problem is, despite that nagging feeling that I should really be more responsible both with my wallet and with what I throw down my throat, I still do it every day! I have a few medical problems for which there are no cures and I suspect it's a slightly panicked response to that. Eventually, my conscience pricked me enough to do some research to try to find out what really is necessary and what the best means of taking vitamins actually is. What I discovered was a maze of differing opinions concerning which vitamins are useful for what; when they should be taken and most importantly, what dosage strengths are recommended. The industry behind supplements has mushroomed and that has led to conflicting opinions as to what is truth and what is plainly hot air.
What follows is a summary of what most experts have found. You will always discover doctors and nutritionists who disagree with various points. However, the only way an ordinary person, without a nutritional science degree but with HIV-related problems, can plot his or her way through the vitamin obstacle course, is to take the consensus opinion and trust that it's not going to do you any harm. Before you take any action however, you do need to talk to as many medical experts as possible and do your own research. Your HIV-specialist should probably be the primary advice giver -- you don't want to be taking anything that will compromise your HIV-medication (we all know about St. John's Wort and grapefruit for instance!)
The Harvard nutritionist Victor Herbert's famous Time magazine quote in 1992, that vitamins just give you "expensive urine", has stuck in many people's minds. However, sales figures since then would beg to differ, as would the American Food and Drug Administration, which began requiring Folic acid (a form of vitamin B) to be added to grain products only four years later. That single smart move quickly prevented a worrying rise in cases of spina bifida in babies, caused by mothers not receiving enough folate in their diet and undoubtedly saved lives. Cases like this convinced more and more people that boosting their vitamin levels was a good idea.
According to the American Journal of Preventative Medicine, more than half of all Americans use vitamins or supplements and according to the Hartman Group, (a natural products marketing firm) they spend more than five billion dollars each year in the process! Whilst these astounding statistics are probably reasonably accurate for most developed countries, the rest of the world may regard the idea with some cynicism -- the cost and availability alone will make it prohibitive for many populations. I wonder if the statistics are even higher for people living with HIV; though again, it may depend on their demographic. Whether it's somewhat of a western luxury or not, the fact is that vitamin supplementation is here to stay and shows no sign of slowing down. So what's the truth behind the hype?
One of today's buzz words is 'micronutrients'. These are basically vitamins, minerals and anti-oxidants and although we don't require large amounts, they are essential for good health. As the body goes through its normal daily functions, the necessary chemical reactions in cells are 'fed' by micronutrients. However, many people living with HIV need more, or supplemented, micronutrients to support cells damaged by the virus and to bolster the immune system.
More Information: New Year's Resolutions for Neuropathy and HIV
Another problem for people with HIV is getting the correct amount of nutrients via their diet. The virus itself and certainly the medication, can affect your metabolism which in turn, prevents proper absorption of micronutrients. Apart from this; lack of appetite, diarrhoea and sickness, plus possible liver, kidney and intestinal problems can block essential intake of vitamins, anti-oxidants and minerals. It's not surprising then that the immune system is even further compromised.
The most common deficiencies in HIV+ people include vitamins A, E, and B-complex (B1, B2, riboflavin, niacin, B3, B6, B12, B9 and folic acid), leading to various immune system related conditions and of course for readers of this blog, neuropathy. Some studies have concluded that micronutrient deficiencies can even lead to lower CD4 counts but this is not universally accepted.
More Information: HIV and Nutrition
There are basically two sorts of vitamins and they are categorised according to how they're transported through the body. The body cannot manufacture vitamins itself (with the exceptions of vitamin D, which is manufactured by the body on exposure to sunlight; and vitamin K, which is created by bacteria in the intestine) and cannot survive without them.
They're mainly the B-vitamins: folic acid, biotin, pantothenic acid, thiamine (B1), niacin (B3), pyridoxine (B6) and cyanocobalamin (B12) and vitamin C.
Water-soluble vitamins (B, C, folic acid), are found in meat, fish, fruit, vegetables and whole grains and you should eat foods containing these every day. Over-cooking also destroys them, so it's always better to grill or steam rather than boiling. As I've already mentioned, many people with HIV have trouble eating normally and that's where supplementation comes in.
Fat-soluble vitamins (A, D, E, and K), are generally found in meat and meat products, animal fat and vegetable oils, dairy products and fish.
n.b.: This article is not going into the subject of minerals but it is important to remember that vitamins and minerals are two completely different things. In general, minerals help vitamins to work properly. Just for reference, the most important minerals are: calcium, iron, magnesium, iodine, copper, phosphorus, manganese, chromium, selenium and zinc. The last two are frequently recommended for people with HIV but they are not vitamins.
Vitamins are essential for good health and people whose immune systems are compromised do need to maintain a normal level of vitamins daily in their system.
Vitamin A is the body tissue vitamin; helping to maintain and develop skin and bone. It also helps with vision, the functioning of the nervous system, reproduction and growth.
The B vitamins increase fat production along with proteins and carbohydrates and assist with metabolism, building red blood cells and maintaining the protective sheathes of the nerves (especially relevant for neuropathy patients).
Vitamin C is definitely an aid for immune system performance, helping to heal wounds as well as forming tissues, cells, bones and teeth.
Vitamin E protects the membranes on the outside of cells and therefore assists the immune system in fighting off illness.
Vitamin K is necessary for blood clotting at wound sites.
The following two sections, coming up in Part Two of this blog entry, are probably the ones of most interest to most people and for that I apologise for the amount of information you had to wade through to get to this point. Although we want to know when to take these supplements and which daily dose is the right one; I always want to know what it is I take and what it's supposed to do. This is not so easy when researching HIV medications but is much easier with vitamins.
This and other posts are based on my opinions and impressions of living with both neuropathy and HIV. Although I do my best to ensure that facts are accurate and evidence-based, that is no substitute for discussing your own treatment with your HIV specialist or neurologist. All comments are welcome.